Chatting with Roy is a competitive business as Dame Julie Mellor DBE the Health Services Ombudsman found out on Wednesday – Mr Lilley has strong views on most things and making sure that his guest on the Lilley chatshow understands his (Lilley’s) take on stuff risks freezing out his guests. Roy thought the whole complaint handling process was broken. Unresponsive institutions, poor forensic skills on the part of complaint investigators, unsatisfied health service users and defensive and incompetent staff – was anything going right? The Patients’ Association don’t think so – see our last blog on the subject and the subsequent comments on what we wrote. Della Reynolds who identified herself as the Co-ordinator for the PHSO pressure group in the comment she wrote called the process ‘painful, deceitful and corrupt’. She at least was in favour of retaining the Ombudsman – the other commentator urged the scrapping of the PHSO which he saw as a mechanism set up to let the NHS off the hook, writing “saves the NHS the bother of dealing with members of the public it has upset.”
Adjudicator not Consumer Champion
Your correspondent took his place at the ringside in the expectation of some heavy punches being landed. After all the challenge to the Ombuds Office is a very serious one with the challenges coming from people who could in the past be counted on to be part of the Ombudsman supporters group – consumer and user organisations and Parliamentarians. We had to wait while Roy did his “This is Your Life” intro where we learned about Dame Julie’s RAF child upbringing. Her Oxford degree in the then fledging area of Experimental Pyschology lead her into Industrial and Employee Relations first for Shell and a mix of public and private sector employers including a stint at the National Consumer Council. Eventually we got to the present day. At last the Ombudsman said something about complaints and her Office. The recent difficulties and criticisms were acknowledged – at the heart of them perhaps is the misplaced view of the Ombudsman as a consumer champion. She is not – the Office acts as an adjudicator judging cases on the basis of evidence. If you can’t get the evidence together, you lose. Tough on the unassisted and distressed service user already wrung out and cynical after being given the NHS run-around treatment. Julie Mellor acknowledged the need for closer and better working with the Patients Association who were already members of the PHSO Consumer Panel. She reassured the meeting that while not legally obliged to do so, all the recommendations made by the PHSO had been accepted by all the organisations criticised bar one. The PHSO was not there to cover up the mistakes of the NHS or any other public bodies. But getting into the system is still difficult – ‘gruelling and distructive’ in the words of the Patients Association report.
Need for Early Intervention and Human Contact
Much more needs to be done before the complaint reaches the Ombudsman with a more effective local presence to assist the complainant. In the comments on the last blog, Partner Caroline Millar writing about her experience handling health complaints identified a need for more than local assistance – why not local mediation to stop complaints escalating? We also urged the Office to pay more attention to that first contact where an impersonal and long-delayed response leads to complainant despair. More interviews are now being done at this stage.
More Cases accepted for Investigation
But the principal internal change has been the lowering of the hurdles which had to be jumped before a case was accepted. Previous Ombudsman practice was to employ more people at the front end to decide whether to accept a case – now there were more case investigators and more cases were being taken on. The gate is not so strait.
Visions of the Future
I believe that the work the PHSO has been doing on defining a ‘user-led vision for raising concerns and complaints’ offers some hope for the future. The Ombudsman cannot solve the problems of the NHS but it can at least show the way how to make it better should anyone care to pay any attention. The 5 ‘I’ statements:-
- I felt confident to speak up
- I felt that making my complaint was simple
- I felt listened to and understood
- I felt that my complaint made a difference
- I would feel confident making a complaint in future
do offer a vision of progress. Pity of course that no one can add the clincher ‘ I am certain that the Ombudsman will agree that my complaint should be upheld and that all concerned be taken out and shot’ but then who said we live in a perfect world.
It just takes time. I wrote Consumers in Business in 1982 for the NCC which was the first description for UK audiences of a new and modern approach to complaint handling. Using US evidence, I showed why it was beneficial to organisations to have lots of complaints so long as they handled them well. It took about 20 years for that approach to become the norm in private sector companies – many of whom still get it wrong but at least have a grasp of the way things should be done to get it right first time all the time and have invested in the quality systems, staff training and complaint management software needed.
The public sector now knows the words on the songsheet with the Ombudsman providing much of the content of the best practice manual but when she sounds the Charge! the troops stubbornly stay in the trenches. What has really changed since Francis? Change takes for ever and nowhere is that truer than the NHS, an organisation over which the Ombudsman has no direct authority. In the Q&A session, the point was made that the NHS does not manage quality well and lacks the management skills or the simple tools like Human Factors Analysis to raise quality. Julie Mellor is continuing the work of Ann Abrahams in showing what a good complaint handling system looks and feels like to users. It is time for the NHS to show their people what a good system looks like from their side of the fence and it needs to start telling the story publishing evidence on complaints and their outcomes including complainant satisfaction data. A start has been made as this blog shows but more precise and illuminating information is needed. The analysis and the advice is there – Francis, Clwyd etc. However we have little clue as to implementation and improvement at the front line and in the meantime, the despair of users is focused on the organisation that tries to cope with the escalated and intractable consequences of front line service failure.