60.The PHSO define part of their role as “sharing the unique insight from our casework with Parliament… [and] more widely, with the organisations we investigate, regulators and policy makers to help them improve complaint handling and public service delivery.” The PHSO highlighted a number of cases where it judged that its recommendations had contributed to changes in policy, for instance changes in the regulation of midwifery, or raised awareness about certain risks, for example around recognition and treatment of sepsis within the NHS.
61.In its annual report, the PHSO state that for 99% of the complaints it completed the investigation for in 2016–17, the organisation involved agreed to implement the PHSO’s recommendations. However, the PHSO does not report how many of its recommendations were implemented, and it has been criticised for its failure to properly follow up its recommendations by the Patients Association and others. Mr Behrens explained that while the PHSO does ask organisations “whether or not they have implemented the [PHSO’s] report”, he intended to change how the question was asked and committed that “it would be different” in their next annual report.
62.We welcome the Ombudsman’s commitment to providing further information on whether his recommendations are implemented in the future. It will also be important for the PHSO be able to provide evidence on whether the implementation of its recommendations have the positive effect on services it expects; both for its own learning and in any assessment of the PHSO’s value for money.
63.We therefore recommend that the Ombudsman publishes in his annual report how many of his recommendations are implemented as well as how many are accepted. In the longer term, we also recommend the PHSO seeks to evaluate the impact of its recommendations.
64.With regard to improving complaint handling at a local level, especially in the NHS, the Ombudsman pointed towards the activity set out under objective three of the PHSO’s draft strategic plan, which includes the intention to develop “new tools and training approaches” to help improve the capacity of local complaint handlers. This is, in part, necessary because, as the Ombudsman explained, “it is entirely clear when you talk to people who have responsibility for complaints in hospitals that they do not believe that they are providing the optimum service or that they have the resources, the skills or the access to the clinicians to come up with the necessary answers.” The Ombudsman had made an offer to the local NHS Trusts to “provide an element of skills development, but we [the PHSO] cannot do it on our own.”
65.Both our predecessor Committee and the Health Committee in the previous Parliament highlighted serious failing in the NHS’s local complaint handling and investigations in recent years. In February 2016 the then Parliamentary Under-Secretary for Care Quality, Ben Gummer MP, told our predecessors that improving the handling of complaints was a “bit of unfinished business”, and that he hoped “that we will be able to come back to you with some really good policy in a few months’ time.”
66.The draft Health Services Safety Investigations Bill will provide the legislative underpinning for the new independent Health Service Safety Investigations Branch (HSSIB). As our predecessor Committees recommended, this includes a remit to support the improvement of local investigations into clinical safety incidents. However, HSSIB will only investigate a small number of incidents itself. The poor quality of local investigations into safety incidents is an issue in many complaints, but the problems go much wider both in-terms of complaints about non-clinical matters and the wider cultural resistance to learning from complaints.
67.We welcome the recent announcement of a joint committee of both House of Parliament to carry out pre-legislative scrutiny on the draft Health Service Safety Investigations (HSSI) Bill. However, the permanent establishment of an independent Health Services Safety Investigation Branch with a remit to improve local investigations is a necessary but not sufficient step to improve local complaints handling. We commend the focus in the PHSO’s draft strategic plan to using its own learning to help improve complaints handling in bodies in jurisdiction, especially within the NHS. However, improving complaints handling is the responsibility of the leadership of the NHS, and ultimately Ministers. This includes ensuring that local NHS leaders prioritise and properly resource complaints handling.
68.The Department of Health and Social Care should provide the Committee with an update on its progress on dealing with the “unfinished business” of local complaints handling the then Minister Ben Gummer MP identified in 2016, and the improvements that it has made. The Government should also ensure that once the Joint Committee scrutinising the HSSI Bill has reported that the revised Bill is introduced to Parliament as quickly as possible.
103 PHS 49 para 23.
104 Ibid paras 26 & 27
105 PHSO Annual Report p.11
106 Q77, The Patients Association, “”, December 2016.
107 Q74 & 77
108 PHS 49, Annex
111 See for example; Public Administration and Constitutional Affairs Select Committee, Seventh Report of Session 2016–17, “” HC 743, 31 January 2017; PACAC “Quality of NHS complaints investigations” 2016; and Health Committee “Complaints and Raising Concerns” 2015.
113 Department for Health, “Draft Health Service Safety Investigations Bill” , September 2017
114 The creation of a HSSIB like body was first recommended in Public Administration Select Committee, Sixth Report of Session 2014–15 “” HC 886, 27 March 2015
115 See PACAC, “PHSO Review: Quality of NHS complaints investigations” and “Will the NHS never learn?”
24 April 2018