“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.
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.