PHSO – Solution or part of Poisonous Problem?

poison cocktail image“Final and fatal mix of that toxic culture” – strong words from the Patients Association alleging that a ‘toxic culture’  – a phrase first used by the Parliamentary Health Services Ombudsman herself  about  NHS complaint handling – is now being applied to the PHSO itself. And this at the very time when the PHSO working with Healthwatch and the Local Government Ombudsman publishes its Vision for Complaint Handling. This vision of complaint management perfection is somewhat at odds with – no let us be blunt – completely contradicted by the allegations and failings listed in the Patients Association’s anecdotes. What is going on?

Process and Emotion

The seven anecdotes featured make painful and sad reading. Heartfelt stories of loss and pain made worse by what appeared to the complainants as indifference, delay, omission and error. Our characterisation of complaint handling as an emotion treated as a process with all that that implies of a lack of empathic understanding has never been so obviously true. The rawness of the emotions in these difficult cases inspiring the Patients Association verdict that the PHSO is now part of the toxic culture the Office condemned, makes those cases very difficult to manage and handle. This failure to meet complainants’ expectations are all the more obvious when these realities are confronted with the visionary ambitions of the Office and its partners to create the ideal process driven by what they call ‘I statements’ built on user expectations and experience. The intention appears to be wholly at odds with the reality. Managing these problems with a degree of professional detachment unrelieved by empathic connection is then perceived by the complainant as ‘dry and detached’.

The Experience of the One vs the Many

7 stories are told in the Patients Association paper and on the strength of those stories and the Association’s experience, 21 findings  are set out. This is not a big evidence base when the PHSO is getting about 16,000+ queries per year – boiled down in what must be an intensive triage process to about 400 actually investigated. The emotional charge behind the events people are complaining about is considerable and no wonder the complainants found the process  ‘gruelling and destructive”. Expensive too as families had to put together dossiers of evidence – lots of photocopying needed e.g. for 80 page case summaries and in some cases,(infuriatingly) apparently ignored – and then only to be offered ‘an insulting’ £250 in compensation (returned by the complainant). But there is other evidence to take into account.  The Ombuds Office’s own rolling complainant satisfaction survey showed a satisfaction rate of 92% with the way that investigated complaints were handled. True 37% of the  complaints about the Ombudsman’s own service were upheld and of 979 complaints about decisions, 103 were upheld partly or in full. Numbers enough to ignite the seam of frustration and anger especially in complaint handling where the experience of the few or indeed just the one can be so persuasive and worrying for the rest of us who might find ourselves in those circumstances one day. Where to go and which data to believe? is as ever the users’ problem.

Outcome

In an area like health services, the fully escalated case with its mix of clinical, emotional and bureaucratic process and practice calls for case handlers of a very high order of skills – emotional intelligence and case management skills combining to make a decision that will stand up to scrutiny and challenge. The only comparable area is the fully escalated complaint to the Legal Ombudsman which I remember from a survey I did, abound in allegations of corruption at the highest level, the wilful incompetence of judges, barrister and solicitors to say nothing of the motives and mistakes of juries. Green Ink Man still exists. If you add to the mix as many of these clinical cases do, death, serious harm, grieving families – these are elements that can overwhelm even the most evolved complaint management process especially when they are under the pressure of increased numbers of queries and cases from members of the public with higher and higher expectations. The thought comes to mind – not original but relevant perhaps – that front-end investment  focusing on feelings and taking a moment to have a discussion that calibrates and moderates expectation – almost a counselling session – is never wasted. It is not enough to file the case in a three month queue and send a postcard with the news that your case will be dealt with at an estimated – not promised – date in the future. This aspect of the process conveys its own strong message. This was a lesson we took away from working with a counselling organisation offering therapies to people in trouble where a delay between contact and first session – a silence – could create a negative mindset that cast a cloud over the subsequent relationship – if that indeed took place because many contactors for help did not proceed and take up the offer made to them.

The Alternative is Worse

But the Patients Association whose independence and energy on behalf of the users of health service play such an important role in holding the NHS and others to account, risks doing complainants a disservice if in the interests of improvement, it destroys confidence in the Health Services Ombudsman. What are the alternatives? The law – a suit for clinical negligence taking the route reported on by the NHS Litigation Authority? Well I suppose a few more cases won’t make too much of a difference to the Clinical Negligence Expenditure reported by the Authority for 2013/14 of £1,192,538,084. It puts the £40m funding the Ombudsman gets into perspective. You can join that group of supplicants in the  but the slightest acquaintance with the processes of the law will make the Ombudsman the preferred route. Make those Visions and Expectations a reality please Mrs Mellor.

Comments

  1. says

    As coordinator for the PHSO Pressure Group I can tell you that there are a lot more stories such as those in the Patients Association report. Some are already in the public domain such as the appalling treatment delivered to James Titcombe and many others are still fighting to get acknowledgement and remedy. How many does it take for PHSO to clean up its act? The alternative to the Ombudsman is not court action, but a better Ombudsman. One that works to protect the citizens and not those in power. We should all be uniting to demand a first class service in line with the best in Europe. Our present Ombudsman service can never be the preferred route. It is painful, deceitful and corrupt. Enough!

  2. David Hopkins says

    Probably the quickest way to improve complaints handling in the NHS would be to scrap the PHSO. Patients and their relatives need to realize that when the NHS fails to resolve a dispute their only options are giving up or going to court. The PHSO simply saves the NHS the bother of dealing with members of the public it has upset.

    My local hospital falsified my medical records in order to conceal its shortcomings I complained to the PSHO. The response I got from the PSHO demonstrated that they had not even read the evidence. I asked them to send me the evidence on which their decision was based. It turned out that they had not sought any evidence from the hospital, had lost two documents I had sent them, and substituted evidence about a different patient. The PHSO asked to have another go. This time they got some documents from the hospital and even found the documents that had been mislaid but they still came to the same decision. This despite the fact that amongst the many false statements made in my records what one doctor had written to cover up their mistake directly contradicted what a different doctor had written to cover up .a different mistake. The PHSO seems to think its OK for the NHS to falsify your medical record as long as it offers you the opportunity to state that you disagree with what has been written.

    Looking back on it these doctors knew that they could cover their tracks by falsifying my medical records even though others had witnessed what had really happened. They knew no one in the NHS would object. They knew the hospital would support them just as the hospital knew the PHSO would condone their actions. No wonder the first PHSO investigator did not bother to ask the hospital for evidence or even to read the evidence I had sent. These people know its all a charade.

    If you are a victim of NHS wrongdoing then it probably is worth pursuing it. Even wasting time going to the PHSO serves a purpose in that the complaint gets counted. You should bare in mind that those who run the NHS and PHSO are a very tight knit establishment elite. If there is any way they can help each other they will. so keep your expectations low and you will not be disappointed

  3. Caroline Millar says

    It seems to me that the PHSO faces a task which may be well nigh impossible. I adjudicate on complaints in the private health care sector and it takes between 2 and 4 days on average to carry out a proper investigation including reading the complaint correspondence and the medical notes, identifying who is who, working out the chronology and addressing apparently contradictory versions of events. Complaint files can run to many hundreds of pages.

    This is a paper-based process and does not usually involve any direct interaction with the complainant or the hospital/provider except to ensure that all the relevant paperwork is in place. with 400 escalated complaints a year, assuming a similar process is applied, 0ne has to question whether this really is the best use of public money.

    It would make much more sense to improve the quality of local complaint handling by providing independent local mediation with patients as soon the problems arise. By the time complaints reach ombudsman emotions are running high and cynicism has often set in on the part of the complainant. But if someone who knows that they are doing and has the trust of both sides could sit down and talk to the complainant, find out what they really want and liaise with the provider to find a mutually agreeable solution, there might be hope. I’d hazard a guess it would end up being a lot cheaper in the long run too!

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