Mapping the Bodies involved in Health Redress in the United Kingdom

UKAJI has commissioned this research to explain the UK health systems and map the bodies involved in health redress in order to provide a resource for researchers who want to study aspects of the system, including regulators and ombuds. It is hoped that it may also contribute to the identification and discussion of pressure points and gaps relating to health redress.

By Carolyn Hirst

The aims of this research were to attempt to find the bodies currently involved in health redress in the UK, to identify their distribution, roles and responsibilities and so to assist in identifying the data sources which might be available to researchers working in this area. What has been found is a complex and moveable feast and there is much more to do on analysing both the gaps and the overlaps. Observations and comments relating to this are very welcome. The article has focused in the main on NHS-provided healthcare and it is acknowledged that there is much more to write on redress relating to the private health sector and on redress through the legal system.

I want to say at the outset that there are two reasons why I have a personal interest in doing this work. The first is that I have recently been involved, along with colleagues from the Scottish Public Services Ombudsman and from Queen Margaret, Glasgow and the West of Scotland universities, in research into How do complaints affect those complained about? An empirical investigation into the effects of complaints on public service employees. The second reason is that, as a Non-Executive Director and Board Complaint Champion of a Health Board in Scotland, I have a direct involvement in complaints about health. As both a researcher and a Board Member I have been struck by the number of bodies with a potential involvement in health complaints.

My focus in this article is not, in the main, on the ‘front-line’ health organisations who are complained about and have internal complaints procedures, or on the courts, which also provide redress for health-care disputes, but on the other organisations that inhabit this complex world. Also, the article focuses on NHS-provided care and does not cover social care except where it overlaps in redress mechanism and/or regulator remit. And this article can only be a snapshot in time of an organic system which is continually subject to change.

This mapping exercise highlights the confusion and uncertainty which must exist for those seeking health redress. Depending on the type of redress they want (such as monetary, service improvement, apology or professional sanction), complainants often need to make a choice at an early stage about which body to approach. There is an ongoing need to simplify this cluttered redress landscape. And now more than ever there is a need to make real the concept of the multi-door courthouse. Put forward by the late Professor Frank E. A. Sander as a system to direct disputants to the most appropriate route to resolution, this would assist complainants to make informed choices about the type of redress they are seeking.

There must also be complexity and confusion for those being complained about. In health-related complaints there is often a named professional whose alleged actions or omissions can be open to scrutiny and sanction by several different organisations. In addition to being challenging for the professional involved, this multi-agency approach can result in lengthy processes with the focus on an individual as opposed to systemic issues. Again, this speaks to the need to simplify the landscape. And also for redress to take Clinical Human Factors into account in order to enhance both learning and improvement – but that is a whole different article!

The full article is available below and to download here.

About the author:

Carolyn Hirst is an independent researcher and mediator.

She would like to thank the Scottish Public Services Ombudsman, the Public Services Ombudsman for Wales, the Northern Ireland Public Services Ombudsman and the Parliamentary and Health Ombudsman for their comments on the relevant sections of an early draft of this article. Any errors and omissions in the article are the responsibility of the author.