Research proposal from PHSOtheFacts
By Della Reynolds (PHSOtheFacts)
The following is a proposal for academic research drafted by Della Reynolds from the PHSO user organisation, PHSOtheFacts. Researchers interested in participating in the study, refining or developing the proposal, or who have suggestions for funding, are advised to contact Della on firstname.lastname@example.org.
PHSOtheFACTS is a service user group made up of members of the public who have all been let down by the Parliamentary and Health Service Ombudsman. We have found that there are no mechanisms for dissatisfied members of the public to hold the Ombudsman to account. Equally, there are no mechanisms for the public to improve the service and in the years we have been monitoring we have recorded no improvement based on our feedback. By sharing our experiences, we have identified common themes:
- a failure to deliver justice and remedy;
- a failure to improve public services;
- bias in favour of public bodies; and
- institutional arrogance when dealing with complaints about its own service.
Our findings are based on our first-hand experiences and the evidence of our own cases. Academic research is needed to independently determine whether our experiences are widespread and detrimentally affecting the Ombudsman from achieving its core objects. With proposals for reform of the Ombudsman as a backdrop, the findings of a research team could be instrumental in determining the nature of the legislation which will shape the new People’s Ombudsman Service.
- To what extent do lack of binding powers prevent the Health Service Ombudsman from achieving its core objectives?
Definition of core objectives:
- To provide remedy to the public where they have suffered injustice.
- To determine action plans to improve services.
The role of the Parliamentary and Health Service Ombudsman:
The Ombudsman’s role is to make final decisions on complaints that have not been resolved locally by the NHS in England. The Ombudsman looks at complaints where someone believes there has been injustice or hardship because an organisation has not acted properly or has given a poor service and not put things right. The Ombudsman can recommend that organisations provide explanations, apologies and financial remedies to service-users, as well as that they take action to improve services. Ombudsman.org – Feb 2019
Qualitative evidence regarding public satisfaction with the Ombudsman service records a consistent narrative of bias against the citizen stated by both individuals and advocacy services. As a consequence, further injustice rather than remedy is reported coupled with a failure to provide suitable action plans to improve services. Qualitative and quantitative evidence from the Patients Association indicates that the Ombudsman is failing to deliver its core objective of providing remedy to service-users.
A recent Clinical Advice Review conducted by Sir Liam Donaldson reported that there had been little progress in using complaints to improve NHS services since the 1960’s. It also confirmed that there is a lack of data indicating how complaints were impacting on identifying and rectifying recurring issues. This recent report confirms that the Ombudsman is failing to deliver its core objective of improving NHS services as quoted below.
“The nearest parallel to using complaints as a tool for learning and improvement of services is the way that patient safety incident reports have functioned (5). Here, the methods have not been effective. The sustained reductions in risk to patients revealed by incident reports have been few and far between, not only in this country but most others as well.
Just one example illustrates the ineffectiveness in system level learning and improvement. Recently, the government’s Health and Social Care Secretary commissioned a major academic study of the prevalence of medication error in the health service in England (6). This showed that an estimated 237 million errors occur at some point in the medication process each year. This is a shocking number, yet error rates in Britain are similar to those in other comparable health settings such as the United States of America and other countries in the European Union. The global cost of medication error is around $42 billion annually (7). A single litigation claim in a country’s health service can be huge. Damages in a single case of medication error in Britain amounted to £24 million (8). Yet, most categories of medication-related harm that happen today were delineated in a study in 1961 (9). No other major high-risk industry has such a poor record of safety improvement.
There were around 208,000 written complaints made to the NHS in England in 2017/18 (10). This equated to about 572 per day. There is no information available to show how these complaints align with each of the six sources of poor quality or unsafe care [as previously outlined in the report]. There is little information to show how complaints are used to systematically improve in these areas of quality and safety.”
The purpose of the research project:
- to examine both qualitative and quantitative data to establish to what extent lack of binding powers prevents the Ombudsman from delivering its core objectives.
- to investigate allegations of bias from citizens to determine whether there is evidence to support such claims and whether bias is a factor in preventing the Ombudsman from delivering its core objectives.
- to determine whether bias is linked to a lack of binding powers. The two key aspects of scoping the complaint in preparation for investigation and negotiation following the draft report should be a major focus for examination.
- to determine whether the lack of binding powers prevents adequate follow-up to investigation recommendations and action plans thereby hindering the Ombudsman in delivering improvements in service delivery.
- to determine whether the lack of binding powers prevents the Ombudsman from upholding key safety issues due to concerns regarding non-compliance.
- to examine the legal balance of power between the Ombudsman and the NHS bodies under investigation and whether the lack of binding powers leaves the Ombudsman vulnerable to the threat of legal action from these bodies introducing bias into the process.
Sources of evidence:
PHSO policies and procedures
PACAC reports and evidence submitted to PACAC by service users
Patients Association reports
Clinical Advice Review
Supporting data for clinical advice review such as evidence submitted by service users to the round table event – both oral and written
Evidence from service users contained in historic case files which can be sourced from PHSOtheFACTS.