PHSO Annual Scrutiny 2017/18: Towards a Modern and Effective Ombudsman Service Contents

2Independent Peer Review

7.In its report on the last annual scrutiny session, in response to the PHSO’s evidence that they were likely to seek extra resources in the forthcoming spending review, the Committee recommended:

Given its past problems an external audit mechanism is required that will provide robust assurance of the value for money of the PHSO’s operations to its Board, the Committee and the public. We recommend that the Ombudsman ask his non-executive directors to commission this and report back to us.11

8.In July 2018 the PHSO’s board appointed an “Independent Peer Review Panel” (the “panel”) comprising Peter Tyndall, Ombudsman for the Republic of Ireland and President of the International Ombudsman Institute; Caroline Mitchell, Lead Ombudsman, Financial Ombudsman Service; and Dr Chris Gill, Lecturer in Public Law at the University of Glasgow.12 The panel undertook a review of relevant literature and management data to establish a “quantitative and qualitative baseline for the study”, followed by a two day study visit in August 2018.13 The panel’s report was published on 12 November 2018.14

The Peer Review’s Conclusions

9.The panel’s overall conclusion was:

… under its current leadership, the [PHSO] is moving out of ‘critical care’ and into ‘recovery’. Overall, from facing a set of severe challenges, the organisation is on its way to becoming an efficient and effective modern ombudsman service, which provides significant value for its stakeholders.15

10.The “severe challenges” the panel identified included external factors such as:

11.However, many challenges arose from issues within the PHSO’s control including:

12.Although the PHSO “has a ways to go” according to Peter Tyndall,18 the panel concluded that it was on its “way to becoming an efficient and effective modern ombudsman service, which provides significant value for its stakeholders.”19 He and Dr Gill pointed to the significant improvement in staff morale, the data from the PHSO’s Customer Service Charter [See Chapter 3] and other sources, the new training and casework model that had been introduced, as well as their observations of staff and systems in operation as underpinning this conclusion.20

13.Mr Tyndall also expressed his confidence that this “recovery” would be maintained, “because the foundations have been attended to with such detail and because of the leadership team”.21 However, he cautioned that this was not guaranteed and that the PHSO’s leadership would need to adapt as the reforms they had introduced matured.22 Mr Behrens agreed that the report was “not a basis for complacency”.23

Value for Money

14.The panel concluded “that the PHSO’s recent reforms have significantly enhanced the efficiency of its operations and the value for money it is able to provide”, and that it provided good value for money compared to similar Ombudsmen.24 This was based on a “contextual and holistic approach” to judging value, which took into account the value of the “advisory and signposting service” it provides to those caught in England’s “complaint maze” and the qualitative value of PHSO’s work to improve public services through its thematic reports, research and best practice guidance.25 However, they accepted that there was limited systematic evidence on the impact of this work.26

15.The panel had completed a direct comparison between the PHSO’s costs versus the number of complaints it handled (“cost per case”) and the Scottish Public Service Ombudsman, regarded as one of the “lower cost” of UK ombudsmen.27 The panel produced three alternative “cost per case” metrics (see table 1 below) reflecting the PHSO and SPSO’s overall budgets divided by, respectively, every individual they had contact with (“cost per person helped”); every valid complaint they received whether it was investigated or not (“cost per complaint handled”); and for the number of completed investigations (“cost per investigation”).

Table 1: Comparison of PHSO and SPSO cost per case metrics

Metric

PHSO

SPSO

Cost per person helped

£227

£501

Cost per complaint handled

£801

£716

Cost per investigation

£10,680

£2,617

Source: Tyndall et al “Value for Money Study”

16.However, the panel cautioned against using “cost per case” as a measure of value for money owing to the lack of comparable data, the different caseloads between ombudsmen and its failure to capture the qualitative value of the PHSOs wider work. The panel highlighted the fact that the PHSO screens out substantially more of the complaints made to it at the pre-investigation phase than the SPSO, investigating only 8% of the complaints it receives compared to the SPSO’s 24%. This reflects, in the panel’s view, the comparatively large number of misdirected or premature complaints the PHSO receives.28 They also argued that the PHSO’s large proportion of health-related casework, 76% of complaints compared to 35% of the SPSOs, increased its costs owing to their added complexity and the cost of acquiring expert clinical advice.29

17.Notwithstanding these concerns, Peter Tyndall told us that the figures did “suggest that there was value for money” from the PHSO.30 He had, in fact, expected a “higher price differential” owing to the preponderance of health cases dealt with by the PHSO.31

18.Based on the evidence they presented we accept the Peer Review Panel’s conclusion that the PHSO is “moving out of critical care and into recovery”, and that it is “on its way to becoming an efficient and effective modern ombudsman service, which provides significant value for its stakeholders”.32 We note Peter Tyndall’s confidence in the leadership of the PHSO to continue this turn-around, but also his warning of the need to guard against complacency.

The peer review process

19.Peer review is a relatively new process in the ombudsman sector, and as Dr Gill explained several countries were considering how to evaluate ombudsmen’s offices effectively.33 A number of written submissions criticised the membership of the PHSO’s peer review panel as being insufficiently independent as it contained two ombudsmen and an academic expert on ombudsmen (Dr Gill) who was formerly employed by the Scottish Public Sector Ombudsman.34 The fact that the panel’s chair was chosen, and its terms of reference were set, by the PHSO’s board, (in-line with PACAC’s recommendation) were also raised.35

20.Mr Tyndall robustly defended his personal independence and that of his colleagues, noting their professional reputations relied on it.36 He confirmed that the panel had “largely determined its own process” and that there had been no restriction on their access to talk to staff at the PHSO.37 Mr Behrens pointed out that Mr Tyndall had selected his fellow panel members.38 On the question of whether it might have been advantageous to have a member of the panel from a different sector both Mr Tyndall and Rob Behrens argued that it required expert experience from the sector, and that the experience with “generic consultancy companies” reviewing ombudsmen had not been positive.39 However, Peter Tyndall did accept that it would be worth considering people with a wider range of experience in future reviews.40

21.In his evidence Mr Tyndall also suggested that, on reflection, if he were to repeat the review he might seek to engage directly with people who had used the PHSO’s services alongside using the PHSO’s own customer satisfaction data.41 The lack of direct contact with complainants, rather than relying on the PHSO’s data, was criticised by several people who made written submissions.42

22.Mr Tyndall also advised that it was necessary for such review processes to be repeated, potentially after three years, alongside the ongoing monitoring of performance and other data, to ensure that the expected changes had occurred.43 The Ombudsman agreed that a peer review “every three or three and a half years” would be “a good discipline” for the PHSO.44

23.The Committee has no doubt in the peer review panel’s personal independence and integrity. There is considerable value in the insight that leading practitioners and experts in a field, such as the panel that carried out this review, can bring. A single review, no matter how authoritative, is, however, only a snapshot. It will always have to be taken with the other available evidence, and that is how the Committee has approached it.

24.The Committee recommends that the PHSO repeat a peer review process every three to four years. For future reviews it also recommends that the PHSO considers how to reach outside the Ombudsman sector to obtain informed perspectives from professional peers with relevant experience in related sectors. This would potentially add further value to a review’s conclusions in the eyes of Parliament and the public. Engaging directly with people with direct experience of the PHSO’s service and other stakeholders would also add value and complement existing customer satisfaction data.


11 PACAC, Third Report of Session 2017–19, “PHSO Annual Scrutiny 2016–17” HC 492, 24 April 2018, para 20

12 Peter Tyndall, Caroline Mitchell, and Chris Gill “Value for Money Study: Report of the independent peer review of the Parliamentary and Health Service Ombudsman” 12 November 2018, para 1.2

13 Ibid para 1.5

14 Ibid

15 Ibid p2

16 Ibid paras 2.4–7

17 Ibid paras 2.1–3. See also PACAC “PHSO Annual Scrutiny 2016–17” Paras 7–9

18 Q7

19 Tyndall et al “Value for Money Study” p 2. For an explanation of the characteristics of a “modern ombudsman service” see Q1

21 Q9

22 Q9

24 Q32 & Tyndall et al. “Value for Money Study” para 10.7

25 Ibid paras 10.6–7

28 Tyndall et al. “Value for Money Study” para 4.5

29 Ibid para 4.6

32 Tyndall et al. “Value for Money Study” p2

34 A1 (PSC0001) A Kampalis (PSC0017) & Nicholas Wheatley (PSC0032)

35 A1 (PSC0001) A Kampalis (PSC0017) & Wendy Morris (PSC0018)

37 Q24 & Q51

42 Mr Richard Von Abendorff (PSC0015) A Kampalis (PSC0017) & Nicholas Wheatley (PSC0032)




Published: 25 March 2019