Annual Report 2006-07 Putting principles into practice

HC 838 The Parliamentary and Health Service Ombudsman (PHSO) exists to:

‘Provide a service to the Our vision is to: • We are an exemplar and provide expert advice in complaints • Make our service available to all public by undertaking handling who need it independent investigations • We share learning to achieve • Operate open, transparent, fair, into complaints that improvement customer-focused processes government departments, • Understand complaints and a range of other public investigate them thoroughly, Integrity quickly and impartially, and secure bodies in the UK, and the We are open, honest and appropriate outcomes NHS in England, have not straightforward in all our dealings and • Share learning to promote use time, money and resources acted properly or fairly improvement in public services effectively: or have provided a • We are consistent and transparent poor service.’ The values which underpin in our actions and decisions everything we do are: • We take responsibility for our actions and hold ourselves accountable for all that we do Excellence • We treat people fairly We pursue excellence in all that we do in order to provide the best possible service: Diversity • We seek feedback to achieve We value people and their diversity learning and continuous and strive to be inclusive: improvement • We respect others, regardless of • We operate thorough and rigorous personal differences processes to reach sound, • We listen to people to understand evidence-based judgments their needs and tailor our service • We are committed to enabling and accordingly developing our staff so that they • We promote equal access to our can provide an excellent service service for all members of the community Leadership These values will shape our behaviour, both as an organisation and as We lead by example and believe our individuals working in the work should have a positive impact: Ombudsman’s office. • We set high standards for ourselves and others Annual Report 2006-07

Session 2006-07

Presented to Parliament pursuant to Section 10(4) of the Parliamentary Commissioner Act 1967 and Section 14(4) of the Health Service Commissioners Act 1993

Ordered by The House of Commons to be printed on 18 July 2007

London: The Stationery Office

HC 838 £18.00

1 Contents Foreword: Foreword: putting things 2 right, sharing the putting things right, lessons – Principles of Good Administration sharing the lessons Government 6 departments, agencies and public bodies In March this year, my Office celebrated The National Health 26 the 40th anniversary of the establishment Service of the Parliamentary Ombudsman1. The Developing our 48 service Ombudsman post was created to put things Our workload and 56 right for people who have suffered from performance: facts and figures maladministration or poor service and to Managing our 62 assist Parliament in calling Government to resources account. Since 1967, the public sector has Annex A: Governance 68 changed almost beyond recognition and we Annex B: Strategic Plan 70 objectives 2007-10 have seen the introduction of legislation covering Freedom of Information, Data Protection and Human Rights. The role of Ombudsman itself has evolved with the times, but the principles behind its creation remain just as valid today.2

© Crown Copyright 2007 The text in this document (excluding any Royal Arms and departmental logos) may Everyone has the right to receive a The Principles are broad statements be reproduced free of charge in any good service from public bodies and of what I believe bodies within the format or medium providing that it is reproduced accurately and not used in a to have things put right if they go Ombudsman’s jurisdiction should do misleading context. The material must wrong. To mark the 40th anniversary to deliver good administration and be acknowledged as Crown copyright of my Office, I published the customer service. Based on the and the title of the document specified. Principles of Good Administration. considerable expertise and experience Any queries relating to the copyright in this document should be addressed to The Licensing Division, HMSO, 1 The Parliamentary Commissioner Act 1967 established the post of Parliamentary Commissioner for St Clements House, 2-16 Colegate, Administration. Norwich, NR3 1BQ. 2 A specially commissioned paper, The Parliamentary Ombudsman: Withstanding the test of time Fax: 01603 723000 or (HC 421), published in March 2007 to commemorate the anniversary, charts the development of e-mail: [email protected]. the Ombudsman role.

2 Celebrating 40 years in 2007

of my Office in handling large numbers of complaints over the past 40 years, the Principles show the sorts of behaviour we expect and the tests we apply when determining complaints. I am pleased that the Principles have been welcomed across Government and the NHS and hope that public bodies and policy makers will find them a useful contribution to improving public services.

“We think the principles represent common sense and good practice.” (Government response to Principles of Good Administration consultation)

“We note that many of the high profile cases which we Ann Abraham Parliamentary and Health Service Ombudsman have dealt with over the last year might have been and a lack of transparency – in short, a part of my Office’s work. However, avoided if [the Principles] lack of customer focus – are themes I public bodies often lack a consistent encounter all too often. The effects approach to providing a fair and had been applied.” on the people at the receiving end appropriate remedy for people who (Public Administration Select can be deeply distressing. have suffered injustice. To coincide Committee response to Principles of When things do go wrong it is best for with the 40th anniversary I issued a Good Administration consultation) complainants to have their complaint consultation paper on draft Principles resolved at a local level, as the for Remedy, setting out how I believe “The Principles are Principles suggest. Public bodies public bodies should approach should handle complaints well at putting things right. comprehensive and set source and put things right promptly. Complainants often express the wish out a useful framework A straightforward explanation of what that others will benefit from their went wrong can often prevent a of features that all users complaint and remedying a single complaint escalating beyond the point complaint can involve making wider of public services would of local resolution. But, as one changes to policies, procedures or complainant remarked about a wish to see.” systems. Public bodies should not department, “No one had the only address individual complaints, (Healthcare Commission) humanity to come out from behind the but also fix underlying problems and shield of bureaucratic doublespeak.” translate the learning into better Many complaints come to my Office Many complaints I receive could, and service for all. I believe the because of a failure to follow the should, have been resolved much Ombudsman has an important role earlier by the body concerned. Principles of Good Administration. as a catalyst in this regard and For example poor communication, Making recommendations for contributing to service improvement misleading or incomplete information remedying injustice is an important is a strategic objective for my Office.

3 Principles of Good Administration Good administration by a public body means:

1 Getting it right 2 Being customer 3 Being open and • Acting in accordance with the focused accountable law and with due regard for the • Ensuring people can access • Being open and clear about rights of those concerned services easily policies and procedures and ensuring that information, and • Acting in accordance with the • Informing customers what any advice provided, is clear, public body’s policy and they can expect and what the accurate and complete guidance (published or public body expects of them internal) • Stating its criteria for decision • Keeping to its commitments, making and giving reasons • Taking proper account of including any published for decisions established good practice service standards • Handling information properly • Providing effective services, • Dealing with people helpfully, and appropriately using appropriately trained promptly and sensitively, and competent staff bearing in mind their individual • Keeping proper and • Taking reasonable decisions, circumstances appropriate records based on all relevant • Responding to customers’ • Taking responsibility for considerations. needs flexibly, including, its actions. where appropriate, co- ordinating a response with other service providers.

4 Acting fairly and 5 Putting things right 6 Seeking continuous proportionately • Acknowledging mistakes and improvement • Treating people impartially, apologising where appropriate • Reviewing policies and with respect and courtesy • Putting mistakes right quickly procedures regularly to ensure they are effective • Treating people without and effectively unlawful discrimination or • Providing clear and timely • Asking for feedback and using prejudice, and ensuring no information on how and when it to improve services and conflict of interests to appeal or complain performance • Dealing with people and issues • Operating an effective • Ensuring that the public body objectively and consistently complaints procedure, which learns lessons from complaints and uses these to improve • Ensuring that decisions and includes offering a fair and services and performance. actions are proportionate, appropriate remedy when a appropriate and fair. complaint is upheld.

4 Celebrating 40 years in 2007

In the NHS, it is disappointing that there was little progress nationally this year towards improved complaints handling. However, I welcome the fact that complaint handling is now back on the agenda following the launch of the Department of Health’s consultation document on integrating the handling of health and social care complaints, Making Experiences Count: A new approach to responding to complaints (June 2007). This integration was one of my recommendations in 2005 and my Office has had considerable input to the development of the proposals. Nonetheless, if new arrangements are to be successful, the standard of complaints handling in the NHS must improve substantially. I share this conviction with the Healthcare Commission, whose role as regulator is a powerful lever for improvement. I recognise that NHS bodies juggle Work and Pensions that this appeal withstood the test of time by not many priorities, but there is no excuse raises, “important legal and losing sight of its founding principles for the poor service complainants constitutional issues, in particular on or the people we serve. sometimes receive. the relationship between the Where I have upheld a complaint, Ombudsman and the Government.” “It is reassuring to know the body concerned normally accepts It would be unreasonable to expect that the Ombudsman my findings and properly considers bodies in my jurisdiction to adopt the my recommendations for remedy. is there for children and Unusually, despite support from the Principles of Good Administration if families like ourselves Public Administration Select my Office did not also apply them to every aspect of our work. The with genuine concerns Committee for my report on Ombudsman is the last resort for occupational pensions, Trusting in the that can be addressed complainants: we have a duty to Pensions Promise (March 2006), the investigate thoroughly and promptly. and resolved.” Government largely rejected my We are committed to providing an (Mr A, complainant, HS-6311) findings and recommendations. excellent service and taking steps to Members of the Pensions Action improve it at every opportunity. Group subsequently initiated judicial Ann Abraham review proceedings against the We have made good progress this year Parliamentary and Health Service Department for Work and Pensions. towards achieving our strategic goals. I Ombudsman The High Court judgment in February would like to thank all my staff for 2007 is now the subject of an appeal making this possible and for their hard July 2007 by the Secretary of State and a cross- work at a time of continuing change. appeal by the claimants. I have Looking ahead, there are new notified the parties of my intention to challenges to tackle and aspects of be an active participant in the appeal. our work that we intend to improve I agree with the Secretary of State for upon, but I believe that my Office has

5 “Everyone has the right to receive a good service from public bodies and to have things put right if they go wrong.”

6 Celebrating 40 years in 2007

Government departments, agencies and public bodies

In 2006-07 we reported on 1,363 investigations relating to government departments, agencies and public bodies, of which 393 were about tax credits. A further 329 cases were accepted for investigation during the year but subsequently closed as an enquiry as a result of a change in our process for assessing requests to investigate (see the section ‘Our workload and performance’ for more details). Twenty-one cases were discontinued, mostly at the request of the complainant.

Figure 1 Parliamentary cases accepted and concluded in 2006-07

In hand at Accepted for Accepted Discontinued Reported on In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

Parliamentary – 314 120 15 1 393 25 tax credits

Parliamentary – 828 700 314 20 970 224 other

Parliamentary 1,142 820 329 21 1,363 249 total

† See 'Our workload and performance' for an explanation of the restatement of 1 April 2006 figures

Figure 1 summarises the method of We fully or partly upheld 58% of the number of contacts with the public. closure for parliamentary cases, parliamentary cases we investigated, Figure 2 shows the five departments showing tax credits cases separately excluding those about tax credits. For and agencies with the highest number from other cases. A large proportion tax credits, the uphold rate was higher of complaints reported on in 2006-07, with the uphold rate. These include of our work over the past two years (74% fully or partly upheld). the Department for Work and has involved complaints about tax As in previous years, a small number Pensions (DWP) (Figure 3 shows credits. For this reason we have of departments and agencies complaints against this Department separated the number of complaints generated a large proportion of the and its agencies), HM Revenue and received on this subject from the complaints we investigated. They are Customs (HMRC) and the former general parliamentary complaints. generally those that have the highest Immigration and Nationality

7 Directorate (IND, now the Border and the Ombudsman receives could, and Figure 4 on pages 9-12 lists the Immigration Agency) of the Home should, have been resolved more number of complaints against each Office. We have put considerable quickly and effectively at source. body. Some of these bodies are small effort into supporting these and not widely known and many of departments in improving their There is a wide range of public bodies complaints handling, since we falling within the Ombudsman’s them have little direct contact with consider that many of the complaints jurisdiction. the public.

Figure 2 Highest number of Parliamentary complaints by body 2006-07

In hand at Accepted for Accepted Discontinued Reported on % upheld In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

HM Revenue and Customs – 314 120 15 1 393 74% 25 tax credits

HM Revenue and Customs – 103 47 26 3 106 33% 16 other

Jobcentre Plus 149 126 48 3 174 62% 50

Child Support Agency 180 68 40 3 174 82% 31

Immigration and 51 106 10 2 112 76% 33 Nationality Directorate

The Pension Service 45 55 28 2 58 69% 12

† See 'Our workload and performance' for an explanation of the restatement of 1 April 2006 figures

Figure 3 Complaints against the Department for Work and Pensions and its agencies 2006-07

In hand at Accepted for Accepted Discontinued Reported on % upheld In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

Jobcentre Plus 149 126 48 3 174 62% 50

Child Support Agency 180 68 40 3 174 82% 31

The Pension Service 45 55 28 2 58 69% 12

Disability and Carers Service 38 36 19 0 48 52% 7

Debt Management Unit 14 13 3 2 15 60% 7

Department for Work 17 4 4 1 13 69% 3 and Pensions

Health and Safety Executive 3 3 1 0 3 33% 2

Rent Service 1 3 3 0 1 0% 0

† See 'Our workload and performance' for an explanation of the restatement of 1 April 2006 figures

8 Celebrating 40 years in 2007

Figure 4 Parliamentary complaints by body complained about

In hand at Accepted for Accepted Discontinued Reported on % upheld In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

Asylum and Immigration 0 3 0 0 3 33% 0 Tribunal

Cabinet Office 0 1 1 0 0 – 0

Charity Commission 4 1 2 0 2 100% 1

Charter Mark Unit 0 1 1 0 0 – 0

Child Benefit Office 0 2 0 0 0 – 2

Child Support Agency 180 68 40 3 174 82% 31

Children and Family Court 7 6 7 0 5 80% 1 Advisory and Support Service

Coal Authority 1 0 0 0 0 – 1

Commission for Patient and 0 1 0 0 1 100% 0 Public Involvement in Health

Commission for Social 14 2 1 0 14 50% 1 Care Inspection

Companies House 0 1 0 0 1 0% 0

Compensation Agency 1 1 1 0 1 0% 0

Construction Industry 1 0 0 0 1 0% 0 Training Board

Consumer Council for Water 0 1 1 0 0 – 0

Criminal Injuries 1 5 2 0 3 0% 1 Compensation Appeals Panel

Criminal Injuries 6 6 1 0 10 30% 1 Compensation Authority

Criminal Records Bureau 16 18 0 0 28 93% 6

Crown Estate Office 1 1 1 0 1 0% 0

Crown Prosecution Service* 0 2 2 0 0 – 0

Debt Management Unit 14 13 3 2 15 60% 7

Department for Communities 2 1 0 0 1 0% 2 and Local Government

Department for 6 1 2 0 4 25% 1 Constitutional Affairs

Department for Culture, 0 1 0 0 1 0% 0 Media and Sport

Department for Education 5 5 3 0 7 43% 0 and Skills

Department for Environment, 11 13 1 0 18 28% 5 Food and Rural Affairs

Department for Transport 1 0 0 0 1 0% 0

9 Figure 4 Parliamentary complaints by body complained about (continued)

In hand at Accepted for Accepted Discontinued Reported on % upheld In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

Department for Work and Pensions 17 4 4 1 13 69% 3

Department of Health 4 2 0 0 6 33% 0

Department of Trade 8 2 4 0 5 40% 1 and Industry

Disability and Carers Service 38 36 19 0 48 52% 7

Driver & Vehicle 5 16 9 0 12 33% 0 Licensing Agency

Driving Standards Agency 0 5 4 0 1 0% 0

Employment Appeal Tribunal 1 2 1 0 2 0% 0

Employment Tribunals 1 1 0 0 2 0% 0 Service

English Heritage 0 1 0 0 0 – 1

English Partnerships 0 1 1 0 0 – 0

English Sports Council 2 0 0 0 0 – 2

Environment Agency 5 2 0 0 4 50% 3

Food Standards Agency 2 0 0 0 2 50% 0

Foreign and Commonwealth 12 8 6 1 8 50% 5 Office

General Social Care Council 3 2 1 0 3 0% 1

Government Office for London 0 1 1 0 0 – 0

Government Office for the 1 0 0 0 1 100% 0 East of England

Health and Safety Executive 3 3 1 0 3 33% 2

Healthcare Commission 4 0 0 0 4 50% 0

Highways Agency 5 9 2 0 10 40% 2

Historic Royal Palaces 0 1 0 0 1 0% 0

HM Courts Service 25 25 5 1 28 43% 16

HM Prison Service 1 6 1 1 2 0% 3

HM Revenue and Customs 417 167 41 4 499 65% 40

HM Treasury 1 1 0 0 0 - 2

Home Office 6 0 3 0 2 50% 1

Housing Corporation 0 1 0 0 1 0% 0

Identity and Passport Service 2 7 2 0 6 50% 1

10 Celebrating 40 years in 2007

Figure 4 Parliamentary complaints by body complained about (continued)

In hand at Accepted for Accepted Discontinued Reported on % upheld In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

Immigration and Nationality 51 106 10 2 112 76% 33 Directorate

Independent Case Examiner 2 8 0 0 2 0% 8

Information Commissioner 4 3 0 0 6 17% 1

Insolvency Service 5 0 0 0 5 20% 0

Jobcentre Plus 149 126 48 3 174 62% 50

Land Registry 3 6 3 0 5 20% 1

Learning and Skills Council 1 1 1 0 1 100% 0 for England

Legal Services Commission 29 14 13 0 26 58% 4

Ministry of Defence 1 2 0 0 3 33% 0

National Endowment for 1 1 1 0 0 – 1 Science, Technology and the Arts

National Institute for 1 0 0 0 1 100% 0 Clinical Excellence

National Insurance 5 9 2 0 10 30% 2 Contributions Office

National Probation Service 0 1 0 0 0 – 1

Natural England 1 1 0 0 2 0% 0

Northern Ireland Court 1 0 0 0 1 100% 0 Service

Northern Ireland Office 0 1 1 0 0 – 0

Office for National Statistics 0 1 0 0 1 100% 0

Office for Standards in 3 2 4 0 1 100% 0 Education (OFSTED)

Office of Communications 0 1 1 0 0 – 0

Office of Fair Trading 0 1 0 0 1 0% 0

Office of Social Security and 0 1 1 0 0 – 0 Child Support Commissioners

Office of the Director 1 2 2 0 1 0% 0 General of Water Services (OFWAT)

Office of the Immigration 1 0 0 0 1 0% 0 Services Commissioner

Parole Board 1 0 1 0 0 – 0

Pensions Ombudsman 1 2 3 0 0 – 0

Planning Inspectorate 5 5 4 0 6 33% 0

11 Figure 4 Parliamentary complaints by body complained about (continued)

In hand at Accepted for Accepted Discontinued Reported on % upheld In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

Police* 0 3 2 1 0 – 0

Postal Services Commission 0 1 1 0 0 – 0

Postwatch 1 0 0 0 1 0% 0

Prisons and Probation 1 6 1 0 6 17% 0 Ombudsman

Public Guardianship Office 11 1 2 0 10 50% 0

Public Trust Office 1 0 0 0 1 0% 0

Regional Development 2 0 1 0 1 100% 0 Agencies

Rent Service 1 3 3 0 1 0% 0

Residential Property 1 1 1 1 0 – 0 Tribunal Service

Rural Payments Agency 8 16 8 1 10 80% 5

Security Industry Authority 0 5 0 0 3 67% 2

Special Educational Needs 1 1 2 0 0 – 0 & Disability Tribunal

Standards Board for England 5 4 7 0 0 – 2

The Pension Service 45 55 28 2 58 69% 12

Training Organisation for the 1 0 1 0 0 – 0 Personal Social Services

Tribunal Service 17 17 17 0 15 40% 2

UK Visas 6 7 4 1 6 100% 2

Valuation Office Agency 10 4 3 0 10 60% 1

Vehicle and Operator 1 0 0 0 1 0% 0 Service Agency

Veterans Agency 6 3 1 0 7 43% 1

Total 1,218 878 351 24 1,443 63% 278

* All Crown Prosecution Service (CPS) and Police complaints refer to complaints made under the Victims’ Code, see page 13 † See 'Our workload and performance' for an explanation of the restatement of 1 April 2006 figures

12 Celebrating 40 years in 2007

Victims’ Code This was the first year of the Victims’ Code (the Code). The Code sets minimum standards of service that criminal justice agencies should provide to victims of crime. The Ombudsman considers complaints which criminal justice agencies have not resolved locally. During this first year, we investigated only one of the eight enquiries referred to us. The other enquiries concerned matters that either pre-dated the Code, or which are not subject to it, for example a prosecution decision or a police investigation. The Code has been in operation for only a short time and we lack any firm evidence to suggest why the volume of complaints has not been as high as we • Being open and accountable A number of complaints have arisen anticipated. It might be that victims this year about failure to follow stated are choosing to delay making a • Acting fairly and policies and procedures or about the complaint until a prosecution has proportionately application of contradictory guidance. been concluded, which can be a • Putting things right A case involving the DWP showed lengthy process. It might also be that that guidance on investigating benefit complainants find the complaints • Seeking continuous fraud was confusing. process itself confusing. This is an area improvement DWP and HMRC regularly exchange we will continue to monitor from the Recurring themes from the information to assist them in complaints referred to us. complaints we have investigated this preventing and detecting benefit The section entitled ‘Our Workload year demonstrate the relevance of fraud. DWP check this information to and Performance’ provides further the Principles. Below we provide see whether people claiming income- details of our work on Parliamentary examples of how they apply to some based benefits appear to have more enquiries and investigations. of our complaints. savings than they have declared and, if so, whether that affects their benefit entitlement. If there is evidence of The relevance of the Getting it right this, Jobcentre Plus (on DWP’s behalf) Principles of Good Government departments and can interview a person under caution, agencies have millions of contacts if it appears that they might proceed Administration with the public every year. Inevitably, to prosecute him or her later on. In mistakes sometimes occur and some this case, we found that Jobcentre We issued the Principles of Good customers are dissatisfied with a Plus should have made informal Administration (the Principles) to help decision or the standard of service enquiries first before proceeding to public bodies get it right and deal they have received. In some cases, we conduct formal interviews (see the properly with their customers. The do not find any evidence of case of Miss Y overleaf). Principles are: maladministration. In others, we find • Getting it right the misapplication of policies or procedures, or a failure to provide an • Being customer focused effective service.

13 Case study Ref. PA-8232

Confusing guidance on investigating possible benefit fraud

Miss Y claimed contribution-based approximately £200 in income- under caution, which led to her Jobseeker’s Allowance in November based benefits. Jobcentre Plus taking her own life. 2003. In March 2004, she began decided to interview Miss Y under We partly upheld the complaint. part-time self-employment and caution about her savings and she We found that: declared her earnings to Jobcentre was invited to attend an interview Plus. In April she claimed income- on 24 September. Miss Y attended • Jobcentre Plus were based jobseeker’s allowance. She the interview, which was adjourned maladministrative in the way they told Jobcentre Plus that she had to allow her to collect information decided to interview Miss Y savings of £1,857. That summer about her savings to bring to an under caution; her business took off and on interview a week later. Miss Y took • Miss Y had insufficient time to 28 September, she told Jobcentre her own life on 29 September 2004. prepare for the interview; Plus of her intentions to end her Two DWP officers have indicated benefit claim. that sanction action would have • parts of the procedures for been unlikely in Miss Y’s case even if investigating undeclared savings Meanwhile, in August 2004, it had been found that she had were confusing and contradictory Jobcentre Plus received information wrongly received benefits. – guidance tells Jobcentre Plus from the Revenue that Miss Y had investigators to treat HMRC’s savings in 2001-02, which, if she still Miss Y’s mother complained about savings data with caution, but had them, would put her above the Jobcentre Plus’s actions, believing goes on to say that, where there limit for receipt of income-based they incorrectly used information are grounds to suspect an jobseeker’s allowance in May 2004. about her savings and offence on the basis of that data, At that time she had received inappropriately interviewed her claimants should be processed for an interview under caution. On the balance of probabilities, we did not uphold the complaint that the interview under caution directly caused Miss Y to take her life, although we recognised her parents were clearly very distressed and believed this to be the case. Jobcentre Plus agreed to our recommendation that they should review their procedures for dealing with HMRC’s savings data. They have strengthened the requirement to consider all available evidence and the likelihood of prosecution before proceeding to interview under caution.

14 Celebrating 40 years in 2007

Being customer focused

Delays in dealing with Case study correspondence, claims or Ref. PA-16220 applications are among the most common failings we encounter - a clear sign that a public body is not being customer focused. We reported Mishandling of an application for asylum on 112 complaints this year about the former IND of the Home Office (now Mr P complained in 2006 that his In August 2006, IND wrote to Mr P the Border and Immigration Agency). asylum application, made in removing his permission to work, Many of these related to delays in November 1998, remained but reinstated it promptly following handling applications combined with unresolved. a letter from Mr P’s MP and the administrative errors that prolonged Ombudsman’s intervention asking the delay (see the case of Mr P Mr P arrived in the UK on them to do so. opposite). The uphold rate of 76% for 9 November 1998 and applied for IND cases is higher than that for asylum. On 18 October 1999 he We found that IND’s handling of parliamentary cases overall (58%, was granted exceptional leave to Mr P’s application was exceptionally excluding tax credits complaints). remain in the UK for one year, poor and we upheld his complaint. We have had constructive discussions without consideration being given His file had been unnecessarily with IND about complaints handling to his asylum application in moved around the Directorate and during the year. More details are on accordance with IND’s then policy incorrectly placed in holding areas. page 18. on the former Federal Republic of IND failed to take a number of Yugoslavia. On 1 November 2000, Delay has also been the subject of a opportunities to rectify the Mr P’s solicitors wrote to IND number of complaints about the Rural situation, even though in the later asking about his application’s Payments Agency’s handling of stages they were aware of their progress. IND interviewed Mr P farmers’ claims under the 2005 Single failure to serve the refusal of on 25 January 2001. His asylum Payments Scheme. The scheme asylum decision on Mr P. They application was refused on the replaced the 11 subsidies paid to consistently failed to inform Mr P same day, but the letter setting farmers based on agricultural or his solicitors of the current out the full reasons for refusal and production with one payment for land status of his application. the appeal papers were never sent. management. Twenty-four of these IND have been unable to explain IND acknowledged that they had why this occurred, but have handled Mr P’s case poorly. To attributed it to a processing error. remedy matters they agreed to: Following this, Mr P’s file was • invite Mr P to an interview to moved around within IND and, give him the opportunity to put despite letters from Mr P’s MP and forward any additional solicitors, no action was taken on information before making a his application. Neither did his decision on his application; solicitors receive replies to their • apologise to Mr P, his solicitors letters. Finally, in late 2005, IND and his MP for their poor withdrew the decision of handling and the avoidable delay 25 January 2001 but took no in resolving his application; further action and failed to inform Mr P’s solicitors, although they • award Mr P a consolatory later confirmed the decision to payment of £250 in recognition Mr P’s MP and said that an asylum of the distress and team was dealing with his case. inconvenience he had suffered.

15 complaints fell into two broad categories and two representative cases are under investigation, which Case study we aim to complete in 2007-08. Ref. PA-7809 These involve: • complaints about the length of time it took the Rural Payments Agency to provide farmers and Provision of inadequate information landowners with accurate digitised maps of their fields. Complainants Mrs A complained that an officer told us that errors were reported at The Pension Service had given and corrected, only for fresh her inadequate information by mistakes to appear; failing to tell her that if she • complaints about notifying farmers remarried before her 60th and landowners of their scheme birthday, she would lose her right entitlement and delay in making to use her ex-husband’s National the payments. Complainants told Insurance contributions. Mrs A us that this had caused them remarried six weeks before financial loss, including increased reaching retirement age and interest payments and banking received a reduced rate retirement charges, inconvenience and stress. pension based only on her own contributions. She said that, if she had been given complete • that these failures contributed Being open and information about the directly to Mrs A’s loss of accountable consequences of her remarriage entitlement to her full for her pension, she would have retirement pension. One of the Principles stipulates that postponed her marriage until after The Pension Service agreed to pay public bodies should always be open she had reached age 60. Mrs A also Mrs A £7,264.91 for the pension she and accountable. That includes complained that The Pension should have received for the ensuring that information, and any Service failed to send her a period 27 January 2003 to 5 advice provided, is clear, accurate and pension forecast. Combined with November 2005. They also agreed complete. Some complainants have the inadequate information from to pay £526.04 in recognition of received poor advice or have been The Pension Service, this led to the loss of the use of the money influenced by misleading information the loss of almost half the weekly and an ongoing payment of £38.75 to make decisions that they would retirement pension she would per week in addition to the not otherwise have made. Through normal payment of her state otherwise have been entitled to. no fault of their own, they have pension. This put Mrs A back in experienced considerable distress We upheld Mrs A’s complaint on the position she would have been and sometimes financial loss. The the basis that: in, but for the maladministration. complaint of Mrs A against The • The Pension Service failed to Mrs A wrote to us and said, Pension Service of DWP illustrates this. provide the pension forecast “It is a tremendous relief Misleading information has also been and adequate information to have the matter the subject of a number of which resulted in Mrs A not complaints we have investigated this receiving the advice she needed settled in my favour. As year against the Criminal Records to make a reasonable decision you can imagine the last Bureau (the Bureau). We reported on about when she should get 28 complaints, of which all but two married and what the few years have been very were upheld. The majority were about consequences would be; difficult and worrying”. delays in processing Enhanced

16 Celebrating 40 years in 2007

Disclosures which are required for posts involving a high level of contact with children or vulnerable adults, for Case study example teachers or carers. This Ref. PA-11768 certifies that there is no evidence of a criminal record or other information that would bar them from doing such work. Delay in processing an application for The Bureau provides a one stop shop for applications for Enhanced Enhanced Disclosure Disclosures. In many cases, the delays were caused by staff shortages and Mr J, an Ofsted inspector, them after eight weeks if their other problems which delayed police complained that the Criminal checks on an application remain checking of applications, and were Records Bureau delayed in outstanding. We considered it therefore not directly within the processing his application for reasonable for Mr J to expect that Bureau’s control. However, the Bureau Enhanced Disclosure. As a result, he he would receive his Disclosure was fully aware of these problems had to withdraw from three Ofsted within the Bureau’s four week and did not warn applicants of the inspections, causing financial loss. published service standard. likelihood of delay. We therefore It took the Bureau just over eight We recommended the Bureau upheld the complaints because the weeks to process Mr J’s should compensate Mr J for loss Bureau’s escalation process misled application. During that time, the of earnings and make him a applicants about how long they Bureau failed to alert Mr J to the consolatory payment in recognition would have to wait for a Disclosure. likely delay when his application of the inconvenience caused. The Bureau agreed to compensate was with the police for checking. The Bureau agreed that they had complainants whose case was upheld The Bureau’s published service mismanaged Mr J’s expectations. for loss of earnings or inconvenience, standard for the processing of They consequently agreed to since they had failed to manage enhanced applications is 90% make him a payment of £4,000: complainants’ expectations of the within four weeks, but they have a £3,870 for loss of earnings and £130 service they would receive and the published agreement with the as a consolatory payment for the likely timescale for the issue of police to pursue matters with inconvenience caused. Disclosures. See the case of Mr J opposite.

17 Putting things right

Departments and agencies with a high Case study public profile and many customer Ref. PA-13448 contacts are bound to generate complaints about decisions and processes. This makes it even more important that they handle complaints well at source. Those Inadequate handling of an application bodies which do not operate an effective complaints procedure are Advisers complained on behalf of and Mrs X’s MP, IND finally issued failing to act up to the Principles. The Mrs X about the way in which the Mrs X’s correctly endorsed high uphold rates for complaints we Immigration and Nationality passport and status documents on investigate about some of these Directorate (IND) had handled her 11 April 2006. application for leave to remain in departments show that there is still We upheld the advisers’ the UK. room for improvement. An example complaint. It was clear that there of the need to put mistakes right, It took IND two years to was a series of errors and delays quickly, is the case of Mrs X (opposite). determine Mrs X’s application for by IND in their handling of the Senior staff from this Office have leave to remain in the UK as a case. The advisers wrote to IND’s held regular liaison meetings with the domestic worker in a private complaints unit on four occasions, Director General of IND (now the household, which she made on but IND acknowledged only some Chief Executive of its successor body, 23 May 2003. Although IND wrote of those letters and never the Border and Immigration Agency). to Mrs X in June 2003 indicating provided a substantive response We agreed to establish a direct route that they expected to determine to the complaints. into IND, for resolving some her application by March 2004, it complaints without carrying out a was not until June 2005 that this IND acknowledged that their full investigation, which had not occurred. IND then repeatedly handling of Mrs X’s application was previously existed. In this way, we gave Mrs X leave to remain in a unacceptable. They awarded her a have quickly resolved complaints on diplomatic household rather than consolatory payment of £100 for several occasions during the year. a private household and it took the inconvenience caused. They also them almost a year to correct that apologised to her advisers for the Assisting government departments error. Following the lengthy poor handling of their complaints. and agencies in making improvements intervention of Mrs X’s advisers to their complaints handling is a priority for us. During the year we had productive discussions with Ministers and staff at DWP. In October 2006 the Ombudsman and some of her investigation staff hosted a visit to the Office by the Rt Hon John Hutton MP, Secretary of State for Work and Pensions. This gave the Secretary of State the opportunity to learn about our day-to-day work, the types of issues that cases about DWP raise and the effect on complainants. The Ombudsman and senior staff also met DWP’s Executive Team in November 2006 to discuss opportunities to improve complaints handling across the department.

18 Celebrating 40 years in 2007

There have been a number of promising developments at DWP. The Department extended the remit of Case study the second-tier Independent Case Ref. PA-7361 Examiner to cover all of its businesses from 1 April 20073, a move we have advocated for some time. In addition, the Child Support Agency (the Persistent errors and poor Agency), whose complaints handling has left much to be desired in the complaint handling past (see Miss G’s case opposite), overhauled their internal complaints Miss G is a parent who is process with effect from April 2007. responsible for childcare. She There is now a two-stage process complained about the general within the Agency, staffed by a team handling of her case by the Child of dedicated complaints handlers. If a Support Agency (the Agency). complaint is not resolved through that Specifically, she said they failed to process, a complainant can approach set the correct effective date the Independent Case Examiner and (from which maintenance would then, if necessary, the Ombudsman be payable) on her case and that via his or her MP. All of these new she had not received child support arrangements are at an early stage, but maintenance as a result. we hope they will provide a speedier and more satisfactory route to Miss G completed a maintenance resolution for DWP complainants. application form in February 1999. Following receipt of that form, the Agency sent the non-resident “We will publish the fact parent a maintenance enquiry that we will adhere to form. However, the non-resident parent failed to return it and the these principles, so that Agency sent a duplicate form in people can judge our July 2000. The non-resident parent again failed to return the form, but service against them where the Agency failed to take investigation. Achieving a appropriate.” appropriate action to collect the successful resolution required relevant information. The Agency senior staff at the Agency to (Independent Case Examiner, DWP, follow matters up at our request. response to the Principles changed the effective date several consultation.) times but failed to deal with the We fully upheld Miss G’s complaint. issue of financial loss that Miss G We were very critical of the Agency had suffered. for their handling of Miss G’s case both before and after its referral When she complained to the to the Ombudsman. Ombudsman, Miss G believed that the Agency had set the effective Eventually, the Agency took date later than they should have positive action to make amends by done and failed to explain their making a payment of £4,792.29 actions. The Agency failed initially plus interest in respect of to respond to our enquiries. This maintenance that Miss G should 3 Jobcentre Plus, The Pension Service, the Child led to significant and unnecessary have received, and £85 in Support Agency, the Disability and Carers Service, Debt Management, The Rent Service delays in processing the consolatory payments to Miss G. and the Financial Assistance Scheme.

19 404). During the year we reported on 393 cases, some of which had been accepted in previous years. We referred 330 complaints back to the Tax Credit Office and the Adjudicator’s Office under the new arrangements. (See Figures 1 and 2 on pages 7 and 8 and the section on ‘Our Workload and Performance’). The proportion of tax credit cases fully or partly upheld has also been reduced from the previous year (74% compared with 90%). It would appear the reduction in complaints referred to us is a result of administrative improvements in the tax credit system. The complaints we receive about not getting through to their helpline, being given inappropriate advice or not receiving a response have declined in number. As a result, the majority of complaints are now about overpayments. Putting things right: that these changes should see a As a large number of complaints reduction in the backlog of tax credits about tax credits continue to be complaints at HMRC and referred to us, and constitute a complainants should receive a better Our special report, Tax credits: significant proportion of our and more prompt response from putting things right (HC 124, June parliamentary work, we plan to issue them. It was agreed with the Tax 2005), highlighted extensive problems a follow-up report on tax credits Credit Office and the Adjudicator’s with the delivery and operation of the in 2007-08. Office that the changes would be tax credits system following its implemented from 1 April 2006. We introduction in April 2003. The report now only investigate complaints raised concerns about the way in which have exhausted HMRC’s which HMRC handled the recovery of complaints procedures, raise new overpayments which were a result of issues which we feel need exploring, HMRC’s own mistakes. These mistakes or where there are other issues which caused financial hardship and distress make a referral to the Tax Credit to some families with children, and Office or the Adjudicator’s Office others on low incomes (see the case inappropriate. We refer all other cases of Mrs A overleaf). We received many back to those Offices for complaints about this, a large investigation and resolution. Both proportion of which could, and Offices have established a central should, have been resolved team to deal with these complaints satisfactorily by the Tax Credit Office. and to ensure that they are handled Following constructive discussions promptly and appropriately. with this Office, HMRC made changes As a result, we accepted fewer cases to the way they handle complaints for investigation in 2006-07 than in about tax credits. We were satisfied the previous year (120 compared with

20 Celebrating 40 years in 2007

The draft Principles for Remedy, which we issued for consultation in Case study March 2007, provide a framework for Ref. PA-17355 putting things right. Many of the departments and agencies we deal with already have internal guidelines for calculating financial redress Overpayment of tax credits payments (see the case of Mr D overleaf). However, a proper approach to remedy is about much more than Mrs A complained in January 2005 financial redress, which is only one of that her tax credits payments a range of possible responses. It is stopped without warning. This also about the way in which people occurred shortly after she had are treated and how the lessons are informed HMRC that she was used to improve customer service receiving less tax credits than she or administrative practice. Our was entitled to because they had investigations reveal the lack of not registered her daughter as a consistent approach to redress being in full-time education. She and remedy across departments was told there was a major system and agencies. error that could not be repaired and she eventually started to receive manual payments. After Seeking continuous informing HMRC that she had improvement received three renewal notices, all of which were incorrect, she The Principles of Good Administration received an award notice that took make clear the importance of addressing the underlying problems no account of her daughter being but HMRC never explained the that lead to complaints in order to in full-time education. Mrs A reason for this. immediately reported this, but avoid similar difficulties for others. HMRC then paid two payments Mrs A said that her health had For that reason, we may recommend totalling £2,579.14 into her bank suffered as a direct result of the the review and amendment of account. Mrs A suspected these stress and anxiety caused by guidelines or procedures, or additional were gross overpayments, but she dealing with HMRC. staff training, to address wider problems. The case of Mr A overleaf had no idea by that point what her We found that the system fault, shows how a complaint can help to real entitlement was. combined with a series of complex improve services. HMRC accepted that there had errors, meant that Mrs A could not been an overpayment, but told reasonably have been expected to Mrs A they would write to her work out whether the payments once they had worked out how she was receiving bore any relation much she owed them. However, to her actual entitlement. they failed to do so. Instead, they HMRC agreed to waive the started making deductions from overpayments which totalled her payments. Mrs A then received £3,676.01, paid Mrs A, a lump sum three further award notices, each of £492.56 (the sum they had of which referred to a different already recovered from her) and level of overpayment. made her a consolatory payment Furthermore, the amount she of £160 for the inconvenience and owed increased as time passed, distress their errors had caused.

21 Case study Ref. PA-6339

Backdating of a war disablement pension

Mr D complained that the Veterans In September 1993, having learned Agency (the Agency), having agreed that he might qualify, Mr D applied in 1995 to backdate the award of his for a war pension. His file could war pension to 1957, had refused to not be found and the Agency said pay interest on that payment. As a that it appeared to have been result, Mr D suffered financial loss. destroyed during a file weeding exercise in 1989. This should not The war pension scheme applies to have happened, since Mr D’s former members of the armed circumstances in 1989 had not met forces who have suffered the criteria for file destruction. disablement due to injury or disease attributable to their service. The Initially, the Agency awarded Mr D degree of disability compared with a gratuity. Having considered a healthy person is expressed in further medical evidence supplied percentage terms. A one-off by Mr D, they then awarded a war gratuity is paid for disability pension from the date of Mr D’s claim in September 1993. Mr D assessed at less than 20%; disability made further representations about assessed at 20% or more is paid as the start date and the Agency an ongoing war pension. If claims agreed in May 2005, to backdate it are made outside certain time to January 1957. They paid him a limits, the start date for the award is lump sum back-payment of the date of the claim. Until 7 April £23,806.14, covering the period from 1997, the Secretary of State for January 1957 to September 1993. payments in 1995 as an admission of Defence had discretion to depart Mr D and his solicitors subsequently error and we therefore concluded from this rule where it was sought interest on the backdated that since the Agency had decided considered reasonable to do so and payment. The Agency consistently that he was due a pension from 1957 substantial evidence could be refused these requests. They did they should pay interest. produced to support the decision. not accept there was evidence of The Agency agreed to pay Mr D the Mr D was discharged from his clear and unambiguous error and outstanding interest and interest on National Service on medical said that the decision to backdate that interest up to the end of grounds in January 1957. Although had been made in ‘good faith’ and August 2006. In accordance with the Ministry of Defence sent Mr D’s was not an admission of error. the Agency’s financial redress medical records to the Agency for We considered there had been scheme, the interest on the them to consider if a pension maladministration in 1957 and in backdated award came to £26,745.18 should be paid, the available 1989, when Mr D’s file was and the interest on that interest to records do not show what decision destroyed. The absence of the file £12,104.92, a total of £38,850.10. the Agency took. Mr D said the means it is not possible to know Agency had no contact with him what happened in 1957. However, we at that time. saw the decision to backdate the

22 Celebrating 40 years in 2007

Case study Ref. PA-5916

Change in guidance following a complaint

Mr A, a pensioner, remarried in Service leaflet, which told him he document, which was approved in 2002. He saw a Pension Service had to inform The Pension Service early 2002. This said that DWP staff leaflet, which said he must inform of a change of circumstances, which should ‘provide a proactive them of changes in circumstances. could affect his entitlement. Mr A service...such as explaining options, He contacted The Pension Service should therefore have expected identifying further action...and and was told to send in his marriage assistance when he contacted them giving assistance’. The Pensions certificate, but received no further in 2002. Service then agreed that the advice or assistance. They also procedures in place in 2002 failed to The Pension Service initially wrote to him telling him to send the uphold these standards, and were rejected this approach. They said it certificate in, but again did not give therefore maladministrative. was Mr A’s responsibility to ensure any further advice. Mr A did so, but he was getting all the benefit he As a result, Mr A received £4,204.40 heard nothing more. He assumed was entitled to. However, they (plus interest) in compensation for that his benefit would not be agreed to amend the Guide to lost adult dependency increase and affected by his remarriage, as The ensure that in the future people in a a £200 consolatory award. Pension Service had not raised this similar situation would get more with him. The Pension Service have agreed to assistance. But The Pension Service review and amend the Guide in line In 2004 Mr A spoke to The Pension said that at the time Mr A had with the recommendations in our Service about his wife’s pension. called, the guidance was adequate report, which include explaining They told him he could have and they had not provided a potential options and giving general applied for adult dependency substandard service. advice to people who had made a increase in 2002. Mr A made an We referred The Pension Service to proactive attempt to inform them immediate claim, and attempted to their Service Standards Framework of a change in circumstances. backdate it. The Pension Service backdated it for the maximum three months, and Mr A appealed to the Tribunal. The Tribunal dismissed his appeal, but highlighted the fact that The Pension Service had not provided any advice in 2002. Mr A made three requests for compensation, all of which were refused. He then complained to the Ombudsman. We found that The Pension Service had failed to provide advice and the Pensions Procedure Guide (the Guide) failed to provide adequate guidance to staff on this issue. Mr A had been acting on a Pension

23 Ex gratia compensation schemes

During the year we published a special report, Put together in haste: ‘Cod Wars’ trawlermen’s compensation scheme (HC 313, February 2007), which reported on our investigation into complaints about the Icelandic waters trawlermen’s compensation scheme. The Department of Trade and Industry (DTI) set up the ex gratia scheme in 2000 to compensate former UK-based Icelandic waters trawlermen who had lost their livelihoods as a result of the settling of the ‘Cod Wars’ with Iceland in the 1970s. We found that there were shortcomings in the way that the scheme was devised, announced and operated. DTI agreed to our recommendations There were such similar issues in of Honour. The MoD commissioned and undertook to: both cases that, in addition to the its own report into the administration • make a consolatory payment of four recommendations in the of the scheme and accepted that £1,000 to each of the five trawlermen report, we made a fifth errors had been made. On 14 March complainants; recommendation: that the 2007, the Veterans Minister • review the eligibility criteria and Government should develop central announced that he had placed a copy scheme rules to ensure that they guidance for public bodies on the of the MoD’s detailed response to the are consistent with the policy development and operation of ex report into how inconsistent criteria intention behind the scheme; gratia compensation schemes. came to be used in deciding payments to former civilian internees in the The Ombudsman said, “Such guidance • once the review is complete, House of Commons Library. The reconsider the cases of the five can, in my view, only be helpful to Minister said that the report’s complainants in line with the [public bodies] – and may well recommendations were all being outcome of the review; prevent a reoccurrence of the considered and that some of them • consider the case of anyone else problems I have identified in this were being taken into account as part who claims to have suffered a report.” The Government has of a wider review of the MoD’s similar injustice. accepted the need for such guidance. guidance on policy making. HM Treasury have indicated that this We had already made similar findings In reviewing the scheme the MoD work will be incorporated into the in A Debt of Honour: the ex gratia consulted the representative revision of its manual Government scheme for British groups interned by organisation for civilian internees, the Accounting, which is due for the Japanese during the Second World Association of British Civilian publication during this year. War (HC 324, July 2005), a report on Internees (Far East Region), and the our investigation into complaints We are also pleased that the Ombudsman to ensure that their about the Ministry of Defence (MoD) Government has now fully accepted views were taken into account. The compensation scheme. the recommendations made in A Debt extension of the scheme in June 2006,

24 Celebrating 40 years in 2007

to include those who were British significant sums of money. It should subjects when interned and who had work with others who share lived in the UK for 20 years, between responsibility to find a solution.5” 1945 and 2000, went some way The Secretary of State for Work and towards putting things right. The Pensions rejected the findings of fact further full reconsideration of the and all but one of the cases of those denied a payment recommendations in our report. under the earlier scheme criteria resulted in further awards to some Following the Secretary of State’s former internees. decision, four members of the Pensions Action Group (representing The Public Administration Select members of failed final salary Committee took evidence from the occupational pension schemes) Minister for Veterans on 25 January initiated a claim for a judicial review 2007. The Chairman concluded that against the DWP. the story was not yet over and urged the Minister to try to sort out the Mr Justice Bean handed down his remaining unfairness in the ex gratia judgment in the High Court of Justice compensation scheme. (the Court) on 21 February 2007. The most significant elements of the judgment were that: Occupational pensions • the Court quashed the decision of Our report Trusting in the pensions the Secretary of State to reject the The judgment is the subject of an promise: government bodies and the Ombudsman’s findings that official appeal by the Secretary of State for security of final salary occupational information on the security of Work and Pensions and a cross-appeal pensions (HC 984, March 2006) found pensions was misleading; by the claimants, which is listed to be that official information provided • the Court directed the Secretary of heard in July 2007. The Ombudsman over many years gave a misleading State to reconsider the has notified the parties that she will impression of the security of recommendation that the be an active participant in the appeal. occupational pensions schemes. This Government should consider caused injustice to a large number of making arrangements for pension Prudential regulation of people who complained that they had restoration in the light of the relied on government information finding that the misleading official the Equitable Life when making choices about their information constituted Assurance Society future pension provision. Many of maladministration; these people lost all or most of their • the Court ruled that, unless the Our investigation into the prudential pension when their occupational findings made in one of the regulation of Equitable Life during the pension schemes were wound up. Ombudsman’s reports are period prior to 1 December 2001 is A report by the Public Administration “objectively shown to be flawed ongoing. We continue to keep MPs Select Committee in July 20064 or irrational, or peripheral, or and complainants informed about supported our findings of there is genuine fresh evidence progress and we sent out our most maladministration and argued that: to be considered”, those findings recent update on 22 May 2007. As yet “the Government cannot simply are binding on the parties to we can give no commitment as to the abandon people who have lost complaints. timetable for publication.

4 The Ombudsman in Question: the Ombudsman’s report on pensions and its constitutional implications (Sixth Report of Session 2005-06, HC 1081, July 2006).

5 Public Administration Select Committee press notice, House of Commons to debate Occupational Pensions, 4 December 2006.

25 “Like all public bodies, the Health Service needs to be open and accountable at all times.”

26 Celebrating 40 years in 2007

The National Health Service

In 2006-07 we reported on 1,139 health investigations. The complaints we investigate are only a small proportion of the many thousands of complaints which the NHS deals with each year, but they are among the most serious. The vast majority of complaints are dealt with at local level by NHS bodies.

Prior to July 2004, if complainants Complaints about the NHS are remained dissatisfied after their received in this Office in a variety of complaint had been dealt with by an ways. A significant proportion of our NHS body, they could ask a convener complaints have been reviewed by the (generally a non-executive member of Commission with the complainant the organisation complained about) having remained dissatisfied and for an independent review by a panel having complained to this Office. We of lay people, which had access to start by investigating the handling of clinical advice. This was known as the the complaint by the Commission, to second or independent review stage of the NHS complaints procedure. This Office considered cases where the complainant was not satisfied with, or was not offered, an independent review. The NHS complaints procedure was revised in July 2004, at which point the Healthcare Commission (the Commission) became responsible for carrying out the independent review stage. Most cases we reported on in 2006-07 had been dealt with under the new procedure. However, we still received a substantial number of complaints which were dealt with by the NHS under the old procedure.

27 determine whether there were In exceptional cases complaints are Facts and figures shortcomings in the Commission’s referred to us direct by the process, decision or service. Commission, under a protocol for Figure 5 summarises the method of direct referral agreed between this closure for health cases, showing Where we uphold a complaint Office and the Commission. Such separately cases in which we received because we have found the referrals are agreed on a case-by-case complaints about decisions on Commission’s process to be flawed or basis, and could, for example, involve whether patients should receive full its decision unreasonable, we will not a complaint where the individual NHS funding for long-term care normally investigate the original concerned has a terminal or (continuing care). complaint ourselves, but will refer the significantly degenerative illness. complaint back to the Commission We fully or partly upheld 52% of for them to remedy the situation. In other instances, we exercise our complaints, excluding those about We would consider investigating the discretion to investigate, even though continuing care (85% fully or partly original complaint ourselves in cases the complainant has not invoked and upheld). Many of the complaints we where we may not be confident of exhausted the NHS complaints receive cover several issues and the Commission’s ability to conduct procedure, as is normally required. sometimes more than one health an adequate investigation, or to do An example of this may be where body. They are often complex, so in a reasonable timescale, or trust in the NHS complaints involving issues about clinical care where we consider that the procedure has completely broken and treatment. circumstances or experience of the down, to the extent that the complainant are such that it would complaint is unlikely to be resolved not be reasonable for them to be locally or by the Commission. referred back to the Commission.

Figure 5 Health cases accepted and concluded in 2006-07

In hand at Accepted for Accepted Discontinued Reported on In hand at 1.4.06 investigation but closed in the year in the year 1.4.07 (restated)† in year as an enquiry

Health – 199 239 7 9 352 70 continuing care

Health – other 521 623 37 22 787 298

Health – total 720 862 44 31 1,139 368

† See 'Our workload and performance' for an explanation of the restatement of 1 April 2006 figures

28 Celebrating 40 years in 2007

Figure 6a Health complaints by type of body 2006-07

Reported on % upheld In hand at 1.4.07

Ambulance Trust 6 83% 1

Foundation Trust 37 54% 10

General Dentist Practitioner 16 47% 3

GP 89 21% 12

Healthcare Commission 484 52% 252

Mental Health Act Commission 2 0% 0

Mental Health, Social Care and 60 75% 9 Learning Disability Trusts

NHS Hospital, Specialist and 170 66% 26 Teaching Trusts (Acute)

Primary Care Trust 289 72% 64 Figure 6a shows the uphold rates for different types of health body. Strategic Health Authority 199 88% 31 Other Health Service Provider** 4 0% 3 Figure 6b shows the proportion of complaints reported on by type of Total 1,356 62% 411 health body. **Other Health Service Provider includes NHS Direct, NHS Litigation Authority, Dental Practice Board and an optican This year complaints arising under the revised NHS complaints procedure comprised an increasing proportion Figure 6b of our caseload. The number of Health category type by investigations reported on complaints we reported on that came through the former NHS complaints procedure has decreased Healthcare Commission accordingly. Figure 7 shows the Primary Care Trust distribution of cases by Strategic Strategic Health Authority Health Authority area. NHS Hospital, Specialist and Teaching Trusts (Acute)

GP

Mental Health, Social Care and Learning Disability Trusts

Foundation Trust

Other

29 1.4.06 1.4.06 (restated)† in year investigation but closed as an enquiry in the year in the year 1.4.07 Bedfordshire and Hertfordshire Bedfordshire London North West South East London London South West Manchester Greater Peninsula South West South Midlands West Yorkshire West South Yorkshire Total 197 239 7 9 352 85% 70 East Midlands Strategic Strategic East Midlands AuthorityHealth Trent Strategic East of England AuthorityHealth and Cambridgeshire Norfolk, Suffolk and Rutland Northamptonshire Leicester, Essex 12 26 28 0 26 0 0 25 0 84% 13 47 94% 7 New SHANew SHAs Previous London Strategic AuthorityHealth London North Central North East London North East Strategic AuthorityHealth Strategic North West In hand at and Wear Tyne Northumberland, AuthorityHealth for Accepted Accepted Valley Cumbria and Lancashire Durham and Tees County Strategic South Central Discontinued AuthorityHealth on Reported and Merseyside Cheshire Thames Valley 20 % upheld Strategic South East Coast 7 and Sussex Surrey AuthorityHealth In hand at Strategic of Wight South West and Isle Hampshire AuthorityHealth 18 and Wiltshire 4 Gloucestershire and Medway Avon, Kent 38 Strategic Midlands West AuthorityHealth Country Birmingham and Black and Somerset Dorset 2 and The Humber Yorkshire 50 39 0 and North and East Yorkshire Authority Health Strategic and Staffordshire Shropshire 20 Northern Lincolnshire 10 1 18 41 2 0 22 30 7 8 2 33 3 11 0 0 14 73% 0 3 73% 63 0 1 1 2 0 81% 1 69 34 32 0 20 86% 21 91% 78% 6 17 90% 8 7 94% 4 3 Figure 7 Figure 2006-07 Authority area Health Strategic by cases health care Distribution of continuing of 1 April 2006 figures of the restatement an explanation for and performance’ workload † See ‘Our

30 Celebrating 40 years in 2007 1.4.06 1.4.06 (restated)† in year investigation but closed as an enquiry in the year in the year 1.4.07 Bedfordshire and Hertfordshire Bedfordshire London North West South East London London South West Manchester Greater Peninsula South West South Midlands West Yorkshire West South Yorkshire CommissionHealthcare organisations*Other national Total 189 3 574 1 21 506 1 623 7 0 37 484 3 53% 22 0% 251 787 0 58% 298 New SHANew Strategic East Midlands AuthorityHealth Trent Strategic East of England SHAs Previous AuthorityHealth and Cambridgeshire Norfolk, Suffolk and Rutland Northamptonshire Leicester, Essex 26 8 In hand at for Accepted Accepted 25 Discontinued 0 on Reported % upheld In hand at 4 3 4 26 1 69% 5 21 62% 3 London Strategic London Strategic AuthorityHealth London North Central North East London North East Strategic AuthorityHealth Strategic North West and Wear Tyne Northumberland, AuthorityHealth Valley Cumbria and Lancashire Durham and Tees County Strategic South Central AuthorityHealth and Merseyside Cheshire Thames Valley 85 Strategic South East Coast 13 and Sussex Surrey AuthorityHealth Strategic of Wight South West and Isle Hampshire AuthorityHealth 10 1 and Wiltshire Gloucestershire and Medway Avon, Kent 49 Strategic Midlands West AuthorityHealth Country Birmingham and Black and Somerset Dorset 7 and The Humber Yorkshire 26 9 and 1 North and East Yorkshire Authority Health Strategic and Staffordshire Shropshire 23 Northern Lincolnshire 12 6 31 5 2 0 4 4 24 1 72 0 2 10 0 2 1 63% 0 80% 1 46 0 10 0 0 3 74% 2 26 19 0 26 8 54% 29 58% 69% 25 4 55% 8 4 76% 1 1 Figure 7 Figure 2006-07 Authority area Health Strategic by cases health care Distribution of non-continuing Board and the Dental Practice Act Commission the Mental Health * This contains of 1 April 2006 figures of the restatement an explanation for and performance’ workload † See ‘Our

31 1.4.06 1.4.06 (restated)† in year investigation but closed as an enquiry in the year in the year 1.4.07 Bedfordshire and Hertfordshire Bedfordshire London North West South East London London South West Manchester Greater Peninsula South West South Midlands West Yorkshire West South Yorkshire CommissionHealthcare organisations*Other national Total 189 3 574 1 21 714 1 862 7 0 44 484 3 53% 31 0% 251 1,139 0 66% 368 East Midlands Strategic Strategic East Midlands AuthorityHealth Trent Strategic East of England AuthorityHealth and Cambridgeshire Norfolk, Suffolk and Rutland Northamptonshire Leicester, Essex 42 34 49 4 30 3 0 51 1 76% 18 68 84% 10 New SHANew SHAs Previous London Strategic AuthorityHealth London North Central North East London North East Strategic AuthorityHealth Strategic North West In hand at and Wear Tyne Northumberland, AuthorityHealth for Accepted Accepted Valley Cumbria and Lancashire Durham and Tees County Strategic South Central Discontinued AuthorityHealth on Reported and Merseyside Cheshire 105 Thames Valley % upheld Strategic South East Coast 20 and Sussex Surrey AuthorityHealth In hand at Strategic of Wight South West and Isle Hampshire AuthorityHealth 28 5 and Wiltshire Gloucestershire and Medway Avon, Kent 87 Strategic Midlands West AuthorityHealth Country Birmingham and Black and Somerset Dorset 9 and The Humber Yorkshire 59 1 65 and North and East Yorkshire Authority Health Strategic and Staffordshire Shropshire Northern Lincolnshire 43 37 7 48 46 4 0 26 34 32 105 9 2 5 21 0 1 16 66% 0 76% 4 109 12 0 1 1 3 78% 2 95 53 58 28 1 77% 50 79% 74% 10 42 70% 16 11 83% 5 4 Figure 7 Figure 2006-07 Authority area Health Strategic by cases Distribution of health Board and the Dental Practice Act Commission the Mental Health * This contains of 1 April 2006 figures of the restatement an explanation for and performance’ workload † See ‘Our

32 Celebrating 40 years in 2007

The section entitled ‘Our Workload and Performance’ provides further details of our work on health Case study enquiries and investigations. Ref. HS-2503

Failing to observe the Principles of Care and treatment of an older person

Good Administration Complaint against an We found that when Mrs Z was NHS Trust readmitted to hospital there was a Many of the cases on which we clear failure by the consultant reported during the year demonstrate Mrs Z, suffering from abdominal surgeons to consider a diagnosis of the relevance of these Principles pain, was admitted to the hospital recurrent gallstone ileus, until her managed by the Trust on 13 of Good Administration to the fifth and final admission, despite it September 2002. She was diagnosed health service: being known that large stones with periumbilical hernia and remained in Mrs Z’s gall bladder • Getting it right protrusion of a loop of the intestine after the first laparotomy. The through a weakened section of the Trust accepted this finding. • Being customer focused abdominal wall, with signs of obstruction of the small bowel. A There was a lack of clear • Being open and accountable consultant surgeon who reviewed responsibility for Mrs Z’s care her on 16 September concluded following her first admission and • Acting fairly and that she had an intestinal she received care of an extremely proportionately obstruction and an emergency poor standard as a result of a wide laparotomy to open the abdomen range of systemic failures. These • Putting things right was carried out the same day. This included inappropriate discharge • Seeking continuous revealed that the hernia was not the from hospital, non-reporting of cause of the obstruction but that X-ray films, poor record keeping, improvement Mrs Z had a gallstone ileus poor pain control, poor care (obstruction) due to two large planning, lack of nutritional gallstones. The stones were monitoring and inadequate Getting it right removed and the hernia was communication between clinicians. repaired, though it was noted that The Principle of ‘Getting it Right’ some stones remained in the gall In addition, the convener, when means, among other things, taking bladder. Mrs Z was discharged on considering Mrs Y’s complaint ‘proper account of established good 27 September. She was readmitted about her mother’s care, failed to practice’. Despite the existence of on four more occasions within a take independent clinical advice national standards and professional period of five weeks with symptoms when it was appropriate and guidance for care and treatment, our of pain and constipation. During her mandatory to do so. investigations reveal that patients fifth admission Mrs Z was diagnosed We upheld all aspects of Mrs Y’s sometimes receive a standard of care with a recurrent gallstone ileus. An complaint. We also made emergency laparotomy was below that which they should expect. recommendations to assist the performed. Mrs Z subsequently The case of Mrs Z opposite, who was Trust in addressing the very serious developed multiple organ failure in great pain but received very poor issues raised by this investigation, and died on 29 October 2002. the majority of which were care, illustrates many common systemic. The Trust agreed to features of complaints. It also Mrs Z’s daughter, Mrs Y, complained that: there was a failure to consider implement these recommendations revealed significant systemic problems a diagnosis of recurrent gallstone and indicated that it had already at the Trust concerned. This case ileus; Mrs Z received inadequate introduced new practices in came to us through the pre-2004 NHS care and treatment; and the response to the issues raised by complaints procedure. convener failed to take independent this complaint. The Trust also clinical and nursing advice. apologised to Mrs Y.

33 Being customer focused attentive care, which is sometimes to refer their complaint back to the tantamount to neglect; inadequate Commission for reinvestigation. Our investigations often highlight a assistance with feeding; and poor risk Common themes include: poor care lack of focus on the patient - the assessment, revealed by a number of planning and failure to follow the person for whom the service is complaints about falls and handling. national guidance on the Care provided. Failure to observe the Programme Approach; inadequate In the case mentioned previously Principle of ‘Being customer focused’ explanations of care and treatment; (page 33) Mrs Z was an older and is especially obvious in complaints and a tendency to disregard people’s vulnerable person, unlikely to complain. involving vulnerable people: older views and concerns. Trust staff have acknowledged that people, those with a mental illness she was more likely to suffer in silence People with special needs, whether and children or adults with special than to draw attention to herself. Her they have a learning or physical needs. These people are more likely pain was not adequately controlled disability, should routinely have those to have complex and enduring needs and it is apparent that there was a needs taken into account in their care and to suffer complications or a rapid failure to take Mrs Z’s family’s planning and treatment. Regrettably, deterioration of their condition. They concerns seriously and to respond to a number of cases we investigated are usually the least able to express them appropriately. this year show that NHS bodies their needs or to complain when sometimes fail to make adequate We have carried out a number of things go wrong. arrangements. This is illustrated by substantive investigations of the following case which was This is illustrated by a number of cases complaints involving people with a received through the pre-2004 NHS highlighting deficiencies in the care mental illness. We decided to complaints procedure. and treatment of older people. investigate the substance of their Recurrent problems include: poor complaint because these people had communication between professional experienced considerable distress in groups in hospital and in the transfer making a complaint in the first place, of care to the community; lack of and it would have been inappropriate

34 Celebrating 40 years in 2007

Case study Ref. HS-4160

Care and treatment of a person with learning disabilities

Complaint against an other patients. Following the and did not seek advice from an NHS Trust bumped needle incident they felt expert in learning disabilities from this had deteriorated. Ms A thought the outset of the complaint. We Ms A, who has learning disabilities, that the Senior Staff Nurse was therefore upheld the complaint was a regular attendee at the Trust aggressive towards her and thought about the Trust’s handling of for haemodialysis. On 24 September that she had heard the Senior Staff Mr B’s complaint. 2003, she was put on a dialysis Nurse make what she felt were machine. Shortly afterwards, her The Trust agreed to implement our unpleasant and derogatory recommendations to: arm began to swell up and was comments. painful. When Ms A told the Senior • review arrangements for Ms A’s Staff Nurse, Ms A said that the Mr B complained on 7 February dialysis appointments to see Senior Staff Nurse told her there 2004 on Ms A’s behalf that she was whether a solution could be was nothing wrong with her arm provided with an inadequate reached which would make Ms A and that it was like that when she standard of care and treatment on feel safe. This review should had arrived. Ms A said that the 24 September 2003, which had involve a discussion with Ms A Senior Staff Nurse repeatedly told affected her care since that date and a learning disabilities adviser; her that the needle had not and that the Trust’s handling of the • make sure that staff specifically bumped (when the dialysis needle complaint was unsatisfactory. address the needs of patients goes through the vein and into the We upheld Mr B’s complaint about with learning disabilities when surrounding tissue). However, Ms A’s care in that the Trust failed planning their care; another nurse noticed that the adequately to plan for her care, did needle had bumped, and removed not address or show an • provide training for staff on it. This incident frightened and understanding of her learning assessing the needs of patients upset Ms A. disabilities and delayed taking with learning disabilities; At Ms A’s next dialysis appointment, action to address the incident of • review its complaints policy so she told the Senior Staff Nurse that the bumped needle. However, we that: the investigation team seeks she did not want her to put her on were unable to determine what specialist advice where the dialysis machine any more. This happened at the appointment when necessary; information on local meant that at Ms A’s following the bumped needle incident advocacy services is included in dialysis appointments she had to occurred or whether the Senior replies to complaints; and wait for other nurses to be available Staff Nurse made any derogatory complainants receive a formal to care for her, so she was nearly comments. The Senior Staff Nurse written response to their always the last on the dialysis and Ms A’s accounts of events could complaint; and machine. While waiting to be put not be reconciled. • review the way it deals with on the dialysis machine she was not The evidence shows that the Trust complaints to ensure it complies offered anything to eat or drink. attempted to resolve the complaint with the Disability Equality Duty Ms A and Mr B, her main carer, had rapidly. However, their investigation under the Disability previously had a very good was muddled, they did not Discrimination Act. relationship with the nurses and interview all the staff concerned

35 Seeking continuous improvement Case study Ref. HS-8953 One of the Principles of Good Administration is ‘Seeking continuous improvement’. In line with this, many of the recommendations we make to NHS bodies involve changes to policy Communication between consultant and or practice where a complaint has revealed a more widespread problem. patient about diagnosis Complainants often say they complained in order to prevent others Complaint against an of her as a whole person with experiencing the same problems in NHS Trust emotional and psychological as the future. NHS bodies also tell us well as physical needs. Ms A had seen Dr B, a consultant that they find our recommendations We found that Ms A was not neurologist, between 1978 and helpful in improving their services. denied any treatment option as a 1996. She was diagnosed with result of not being told about the Multiple Sclerosis (MS) in 1979 and uncertainty of the MS diagnosis ‘I would like to thank you subsequently treated for that and her physical condition did not condition. Despite the evidence and the Professional suffer as a result. However, we from an MRI scan in 1994, Dr B had found that Ms A was justified in Adviser for your never told Ms A that the diagnosis believing that it was a serious of MS might be questionable or independent view of failing not to have alerted her to indicated that she might not have our processes... Your the possibility that she might not it, nor did he suggest that she seek have MS. We also agreed that the constructive suggestions a second opinion or undergo possibility should have been have helped us to directly further tests to be sure that she shared with her before she was did have it. improve our systems.’ discharged. This would have Ms A was very distressed to learn allowed her to reflect on the (NHS and Social Care Partnership in 2002 from Dr D, another implications for her life and health Trust, HS-390) consultant neurologist, that there as a whole. were grounds to doubt the We therefore upheld the Being open and diagnosis of MS. She could not complaint, recommending that the accountable believe that these doubts had not Trust make a consolatory payment been shared with her before. She of £1,000 to demonstrate the Like all public bodies, the Health received only a perfunctory sincerity of its apology, which it Service needs to be open and apology from the Trust. agreed to do. accountable at all times. But Furthermore, she did not receive a inadequate communication with full explanation of why Dr B patients, their relatives and carers is discharged her from the Trust’s often a factor in the complaints we Neurology Clinic in October 2006 investigate. The case of Ms A, sent to without telling her the MS us under the pre-2004 NHS diagnosis was questionable. Ms A complaints procedure, illustrates the complained that she had suffered impact on a patient of poor unnecessary distress as a result. communication by a consultant. She also felt that the Trust, in treating her as a person with a particular condition, had lost sight

36 Celebrating 40 years in 2007

Putting things right: the for the most complex, difficult and Common failings include excessive intractable complaints. If the NHS is delays in responding to complaints complaints system treating complaints seriously and or in notifying complainants of An effective complaints system is handling them properly, neither the decisions, failure to take clinical crucial if public bodies are to put Commission nor the Ombudsman advice when it is necessary and things right. So it is disappointing that should need to be a volume appropriate and failure to provide national developments on complaints complaints handler. information to complainants about how to request an independent handling did not progress as quickly Nonetheless, evidence indicates that review. It is also disturbing that there during the year as we had hoped. This there is still a long way to go before is sometimes a reluctance to take is in spite of the progress we noted in complaints handling is taken as people’s concerns seriously, as the last year’s annual report in response to seriously as it should be across the following case demonstrates. the recommendations of our report NHS. We recognise that NHS bodies Making things better? A report on have many pressing priorities, but the reform of the NHS complaints they vary greatly in their level of procedure (HC 413, March 2005). commitment to good complaints However, it is promising that handling. We would expect to see momentum appears to be picking up NHS bodies monitoring complaints as again. On 18 June 2007, the an integral part of clinical governance Department of Health issued a and risk management. However, not all consultation paper on proposed Boards do this regularly or thoroughly, integrated arrangements for health even though all NHS Trusts are and social care complaints handling, required to have a Board member following its commitment in the with responsibility for complaints. White Paper, Our health, our care, our say in January 2006. There is still much work to be done before the proposals become a reality, but we hope this will make it simpler for people to make a complaint that crosses service boundaries. Making things better? advocated a shared commitment to improvement in complaints handling at every level of the NHS. We urged leadership from the Department of Health in setting standards that all NHS complaints handlers should achieve. We highlighted the important role of the Healthcare Commission (the Commission) as regulator in ensuring that good complaints handling features strongly in the inspection and performance regime. At local level, we said that improvements in complaints handling should be underpinned by a corporate commitment to taking complaints seriously and learning the lessons arising from them. The Ombudsman should be the last resort

37 Case study Ref. 11132

Refusal to investigate a complaint about care and treatment

Complaint against an NHS Trust, directly referred to the Ombudsman by the Commission After a psychotic episode, Mr E was detained under the Mental Health Act from July to October 2003, when he was discharged. He was then seen as an out-patient up to January 2005. Mr E first formally raised his concerns about inadequate care and treatment during his admission with the Independent Complaints Advocacy Service (ICAS) in August 2004. He said he had been so traumatised by his experience that he had not been able to speak to anyone about it for a year. ICAS assured him that his complaint would not be judged out of time under the NHS (Complaints) Regulations 2004 since he was receiving ongoing care and Commission on the basis that We found that the Trust failed to treatment as an out-patient. Mr E the Trust had failed to use its adhere to the Regulations since it complained to the Trust in writing discretion flexibly and sensitively had not: provided a response by the on 21 January 2005. The Trust to investigate Mr E’s ‘out of time’ Chief Executive to a formal complaints manager informed him complaint. The Commission asked complaint and an explanation of the on 8 February that his complaint the Trust in November 2005 to next stage of review; exercised its would not be investigated because review its decision not to discretion to waive the time limits; of the time that had elapsed. and complied with the Commission’s investigate the complaint, since decision that the Trust should ICAS asked the Trust to reverse its they considered Mr E met the investigate the complaint. We decision, since Mr E became aware criteria for making a complaint therefore upheld Mr E’s complaint of his need to complain about his within the time limit. However, the on the basis of flawed process and 2003 admission only in August 2004. Trust continued to assert that it we were highly critical of the Trust. His formal complaint followed would not pursue the matter or However, we found that Mr E’s within the six-month timescale, in carry out a formal investigation. January 2005. However, the Trust clinical care and treatment were continued to refuse to investigate. In January 2006, the Commission of a reasonable standard and we ICAS therefore requested an directly referred Mr E’s complaint to did not uphold this element of Independent Review from the the Ombudsman. his complaint.

38 Celebrating 40 years in 2007

Complaints reviewed by the Healthcare Case study Commission Ref. HS-8891

The Commission reviews complaints which have not been resolved locally. The National Health Service The Healthcare Commission’s review of (Complaints) Regulations 2004 govern the way in which the Commission a complaint against a GP manage these complaints. If a complainant is dissatisfied with the Mrs N complained to the adviser an inaccurate summary of Commission’s decision or the way it Commission about the care and the case; and the panel system handled the complaint, he or she can treatment provided to her by Dr Z used to obtain clinical advice in complain to the Ombudsman. When when Mrs N found a lump in her this case was inadequate. We considering such complaints we first breast. The Commission’s review found that Dr Z had acted in assess the Commission’s handling of found that Dr Z had failed to accordance with the guidelines the case. follow the referral guidelines for and that the Commission’s During the year we accepted 575 such suspected breast cancer. They recommendation was complaints for investigation. We found that Dr Z had also failed to inappropriate. reported on 484 cases and of those, ensure that Mrs N fully The Commission accepted our we fully upheld 34% and partly upheld understood that a non-urgent recommendations, including that 18%. We also received increasing referral to the breast clinic was they should: numbers of enquiries relating to the being made and how long it might • apologise to Dr L and Dr Z for Commission. The most common take to get an appointment. the failings identified; reason for not accepting a complaint The Commission recommended for investigation is that people that the Primary Care Trust should • review how they obtain and use contacted us before approaching the consider whether Dr Z should be clinical advice. The Commission Commission or before the referred to the National Clinical told us that, since 2004, they Commission had completed its review. Assessment Service, the body have changed the way clinical We have liaised closely with the responsible for assessing a doctor’s advice is obtained and a performance if it gives cause for suitably qualified clinical adviser concern. Dr Z’s colleague, Dr L, is given the necessary disagreed with the outcome of documents and records before the Commission’s review and producing a report; complained to the Ombudsman • seek advice from a suitably on behalf of Dr Z about the qualified clinical adviser with conduct and decision of access to the relevant papers if the review. they intend to question the We upheld Dr L’s complaint. We competence of GPs; found that: the Commission did • consider whether it would not obtain all of the relevant be good practice to share clinical records; they appeared to draft reports. give more weight to Mrs N’s evidence than that of Dr Z; the Commission’s case manager misinterpreted the referral guidelines and gave the clinical

39 Commission this year to assist them in systematically against relevant improving their standards of guidance and standards and there is a complaints handling. more structured approach to seeking clinical advice. The cases we saw during the year demonstrate that the Commission has We also noted a number of areas that developed and improved its required improvement. These complaints handling. We upheld some included: the explanation of the complaints about unreasonable delay, Commission’s jurisdiction; its approach during which the Commission failed to redress; agreeing and clarifying the regularly to update the complainants nature of the initial complaint; the on progress. These complaints dated thoroughness of investigations and from the early stages of the evidence gathering; the seeking and Commission’s complaints handling use of clinical advice; and the role, when it received many more provision of a clear explanation in complaints than forecast. Since then, reports. Two case studies (on pages it has generally maintained regular 39 and 41) illustrate some of these contact with complainants, including issues. In the first, we investigated during the period when it had to the Commission’s handling of manage a backlog resulting from an the complaint. unexpectedly high volume of cases. A In the second case, we investigated number of cases show that the the Commission’s handling of the Commission reviewed complaints complaint and subsequently returned efficiently and proportionately. the complaint to the Commission for Complex reviews are carried out more further work.

40 Celebrating 40 years in 2007

Case study Ref. PA-12171

The Healthcare Commission’s review of a complaint about the care and treatment of an elderly patient

Mr H, aged 83, was admitted to failed to notice that he was hospital on referral by his GP on deteriorating. Arrangements were 24 October 2003 with increasing put in place to discharge Mr H shortness of breath. He was briefly despite his deterioration. Although cared for on C Ward (the admissions Mrs H asked to see a doctor to ward) and then moved to G Ward discuss her concerns, this was (a general medicine and respiratory not arranged. ward). On 27 October he was The Trust considered Mrs H’s considered well enough for complaint and assured her that: discharge. However, on 29 October Mr H’s transfer to J Ward was he became unwell with a high appropriate since he was assessed as temperature and was started stable and remained under the on intravenous antibiotics. By same consultant; that the plans for 30 October, his temperature had discharge complied with the Trust’s settled and medical staff discharge policy; and that the considered his condition had medical team would not have improved. He was transferred to discharged Mr H until they felt he • seek clinical advice on the J Ward (a general surgical ward that was well enough. Dissatisfied, Mrs H monitoring of Mr H’s condition accepts outlying patients from complained to the Commission, while he was on J Ward or specialist wards) that evening and which took clinical advice and consider the standard of record started on oral antibiotics on confirmed the Trust’s own findings. keeping and documentation; 4 November, with a planned discharge of 7 November. However, Mrs H considered that the • consider whether there was by 7 November he had developed a Commission did not address the evidence of formal raised temperature again and was issues satisfactorily and her documentation on discharge transferred back to G Ward. He complaint was referred to the arrangements and did not appear continued to be unwell and a clear Ombudsman. We upheld the to have reviewed the hospital’s deterioration in his condition was complaint against the Commission discharge policy; noted on 11 November. Mr H died since we found a number of flaws • address Mrs H’s complaint about the following day. in their investigation. We found the difficulty she experienced in evidence to suggest that Mr H was Mrs H complained that her husband arranging to see a doctor. already unwell before his transfer was placed on an inappropriate We returned the complaint to to J Ward. In addition, the ward (J Ward) where staffing levels the Commission, recommending Commission did not: were inadequate to meet the that they reinvestigate the dependency levels of the patients. • address the issue of the complaint and, in particular, obtain Mr H’s condition was inadequately adequacy of staffing levels on appropriate clinical advice to monitored there and medical staff J Ward; address these issues.

41 Putting things right: complainant having to go to court. However, the detailed regulations on remedy how and when this will be achieved When mistakes occur, ensuring that are still awaited. injustice is remedied is an important The following two cases illustrate our part of our work. In addition to approach to remedy. Both involve establishing the facts of a case and financial redress as well as determining whether a complaint is recommendations for changing justified, we make recommendations policies or procedures. The first case, for remedy where a complaint is which came to us through the upheld. The draft Principles for pre-2004 NHS complaint procedure, Remedy, on which we consulted this demonstrates that redress can come year, provide a framework for the through action from a combination approach to take when remedying of bodies. injustice or hardship. The second case was one in which the Recognition of the appropriateness in Ombudsman exercised her discretion some circumstances of financial to investigate, although it had not redress for mistakes is gaining ground gone through all the stages of the in the NHS. The NHS Redress Act NHS process. 2006, was a step towards this. It reforms the way lower value negligence cases will be handled so that a suitable remedy (including financial redress where appropriate) can be provided without the

42 Celebrating 40 years in 2007

Case study Ref. HS-2341

Remedy for a patient following a cataract operation

Complaint against an the cataract surgery as it did offer a hospital, so we did not uphold this NHS Trust realistic chance of improving his part of the complaint. central vision. However, the most The Trust agreed to our Mr A was diagnosed with glaucoma, likely cause of the deterioration in recommendation that it should which made him totally blind in his Mr A’s eyesight was a significant rise review its cataract policy to ensure left eye and partially sighted in his in the intraocular pressure (pressure that it distinguishes between right eye. In 1990, Mr A was within the eye) of his right eye categories of patient so that informed that his left eye was following the operation. The Trust beyond repair, but that the right should have been proactive in appropriate care and treatment are eye, though badly affected, would anticipating this in a patient with provided. Mr A demonstrated to us give him useful vision for the rest of advanced glaucoma who already that the deterioration in his his life. In 2003, Mr A underwent a had tunnel vision, but the surgical eyesight, owing to the poor post cataract operation on his right eye, team followed the Trust cataract operative care, had clearly had an which was described as uneventful. policy of not taking any additional adverse impact on his quality of life. After the operation, however, Mr A action because the post-operative We therefore also recommended experienced deterioration in the reading was not above a certain that he should be offered financial sight of his right eye. He also level. We therefore upheld the redress to compensate him and that suffered from post-operative aspect of Mr A’s complaint about the Trust should refer the case to inflammation, for which he was poor post-operative care. However, the NHS Litigation Authority for treated at A&E. it was appropriate for Mr A’s care to consideration. Mr A has now been Mr A complained that: he was not be transferred back to his local awarded £5,000 in compensation. informed before the operation of the risk of losing his existing level of sight; he should not have undergone the operation on his right eye because of his advanced glaucoma; he was provided with a poor standard of post-operative care; and he should not have been transferred back to the care of his local hospital so soon after the operation. We found that the risks of the operation were properly explained to Mr A, including the possibility of surgery damaging the vision in some circumstances and that having advanced glaucoma might affect the outcome. We also found it reasonable that Mr A was offered

43 Case study Ref. HS-6273 and HS-6311

Provision of occupational therapy and physiotherapy to a child with special care needs

In two related complaints, Mr A occupational therapy service had waiting for independent review by complained about the provision of not approached the Local Education the Commission. Given the occupational therapy and Authority about providing it. Mr A immediacy and seriousness of the physiotherapy by the Primary Care considered that G’s health and concerns about G’s welfare, the Trust to his son, G, who has special future development were affected. Ombudsman exercised her care needs. Mr A also complained about other, discretion to investigate, with the significant shortcomings in the agreement of all parties. We found Mr A’s first complaint raised serious occupational therapy service. He concerns about the absence of that there were serious failures of had attempted to have things put occupational therapy for G while organisation and management in the right, but there was no visible attending school. G’s Statement of occupational therapy service. This improvement to the service. Special Educational Needs was compounded by poor recommended one hour per week Mr A raised his concerns with the communication and decision- of occupational therapy, but the Ombudsman while his case was making at many levels of the Trust. The result was that G was not receiving the service he should have received. We therefore recommended that the Trust urgently address the provision of occupational therapy to out-of- borough children and carry out an urgent review to identify the scope and core functions of the service, how it should be delivered and appropriate staffing levels. The Trust agreed to all the recommendations and apologised to Mr A. Mr A’s second complaint concerned the provision of physiotherapy to G while attending a nursery and later at an infants school. Following Mr A’s dissatisfaction with the Trust’s original response, the Trust’s Independent Review Panel made recommendations to the Trust to put things right. But, despite attempts to get information from the Trust about their

44 Celebrating 40 years in 2007

implementation, Mr A did not the Chartered Society of receive a response. It took the Physiotherapy. They should also Trust a year to provide a formal review caseloads and the system response to Mr A and that was as a for prioritising children. We result of the Ombudsman’s recommended that the Trust intervention. Even then, the Trust consider making a consolatory did not explain the reasons for the payment to Mr A in recognition of delay and lack of communication the inconvenience, frustration and with Mr A. distress he and his family experienced. The Trust agreed to Our investigation found that the the recommendations and made a Retrospective continuing care funding physiotherapy service provided to consolatory payment of £750 to and redress (HC 386, March 2007). G fell below the standard he Mr A. should have received. We concluded that the Trust’s delay in G is now educated at home and responding to the Independent Mr A told us that he had received Continuing care: remedying Review Panel’s recommendations, a payment from the council for long standing problems the absence of an explanation for services that G had not received the delay and the failure to while he was at school. Mr A has The NHS provides funding for long- apologise were maladministrative. also agreed to take part in the term care for some people who have We also found that the Trust’s Trust’s Service User Forum. Mr A continuing care needs because of response to the recommendations said, accident, illness or disability. It covers did not adequately address services from the NHS, local problems with caseloads and “I was delighted with the authorities and private providers. resources, record keeping and the positive outcome of my Arrangements for deciding who should receive NHS fully funded care balance between paediatric complaint ...he is an physiotherapy and occupational have long been a matter for concern. 6 therapy services. The Trust had altogether different The Ombudsman’s special report in February 2003 showed that some been aware that there were not child and this has gone enough staff to cope with the high people were paying for their care demand for paediatric a long way to improving when the NHS should have paid for it, causing distress and financial hardship. physiotherapy services, but had his self-confidence and not been sufficiently proactive in One of her recommendations was taking action. social skills. It is reassuring that Strategic Health Authorities and to know that the Primary Care Trusts should take steps We therefore recommended that to remedy retrospectively any the Trust should produce Ombudsman is there for injustice to those people and to any guidelines on procedures for others in their area who had also reviewing children and on the children and families ... structure of clinical notes and with genuine concerns audit, following advice provided that can be addressed by the Association of Paediatric

Chartered Physiotherapists and and resolved”. 6 NHS funding for long-term care of elderly and disabled people (HC 399, February 2003).

45 wrongly been made to pay for their Further details can be found in Figure while funding their care. PCTs said care. Subsequently, the process of 5 on page 28, Figure 7 on pages 30-32 that they were following guidance carrying out retrospective reviews of and the section entitled ‘Our from the DH in calculating the local funding decisions was fraught Workload and Performance’. amounts payable. The Department’s with difficulties. We received many guidance advised paying the care As NHS bodies have carried out more complaints about delay, poor review costs the NHS should have paid, but retrospective reviews and reached processes and the application of took no account of other possible decisions, we have received overly restrictive eligibility criteria. financial losses nor did it highlight complaints about the amount of PCTs’ discretion to include an We have worked closely with both redress received. Since these revealed element of compensation for any the Department of Health (DH) and evidence of more widespread distress and inconvenience suffered. Strategic Health Authorities to assist problems, we published a report on them in resolving the large numbers Furthermore, the guidance advised the results of our investigation into of complaints about the retrospective calculating interest based on the these complaints, Retrospective reviews. NHS bodies and the DH have retail price index (RPI) rather than continuing care funding and redress made considerable efforts to put the higher County Court judgment (HC 386, March 2007). right the shortcomings we identified debt rate. The result was that there both in our 2003 special report, the Complainants alleged that the amount was inconsistency in the way PCTs follow-up report we produced in of recompense they had received calculated the redress due and the December 20047 and in our later from Primary Care Trusts (PCTs) did amount of compensation people investigation work. The number of not fully compensate them for all the received depended on where outstanding complaints about reviews financial losses they had incurred they lived. is now reducing and we are more confident that claimants will receive a robust, fair and transparent review of their eligibility. We also welcome the National Framework for NHS Continuing Care and NHS Funded Nursing Care in England, which the DH published on 26 June 2007 and which we first recommended in our 2004 report. The National Framework establishes national criteria for eligibility for continuing care funding and a framework for assessing who should receive it. It will come into operation on 1 October 2007, and will not be retrospective. Continuing care complaints have been a decreasing part of our workload this year. We reported on 352 cases, compared with 1,097 the previous year, and had 70 cases in hand on 1 April 2007. We fully or partly upheld 85% of complaints investigated, a much higher proportion than for other types of health complaint.

7 NHS funding for long term care: follow up report (HC 144, December 2004).

46 Celebrating 40 years in 2007

Where people had received social agreements to people not eligible Healthcare in prisons security benefits during the period for for NHS funding who might have to which they later received retrospective sell their homes to fund their care; A significant change to our jurisdiction this year involved the NHS funding, we concluded that they • provide advice on how to calculate transfer to the NHS of the would not usually have suffered any interest payments. unremedied injustice. This was responsibility for commissioning because the Department for Work The DH agreed to produce such healthcare for most prisoners in and Pensions had agreed not to guidance in response to our England and Wales from 1 April 2006. reclaim those benefits. The total sum recommendations and issued NHS Complaints by prisoners about the those people received (reimbursed Continuing Healthcare: Continuing healthcare they receive now go care fees plus interest at RPI and Care Redress on 14 March 2007, to through the NHS complaints retained benefits) would in most cases coincide with the publication of procedure, with the Ombudsman as have at least equalled the amount of our report. the third and final tier. So far we have received fewer complaints than we compensation received had the With these developments on redress, might have expected, given the prison benefits been reclaimed and interest the long-running saga of problems population. Until we have investigated been calculated using County Court with continuing care retrospective and reported on more complaints, judgment debt rate. However, we were funding should now be drawing to a there is insufficient evidence to clear that PCTs should compensate close. It illustrates the importance of suggest reasons for this. However, we any complainants who could provide the Principle of acting fairly and shall monitor themes arising from evidence of financial loss. proportionately in public services. such complaints, including However, we are concerned that there PCTs were acting on DH advice and accessibility and the consistency of are still too many applicants for we concluded that the Department local complaints handling. was maladministrative in deciding on retrospective funding who have not had their applications properly its formula for redress and in the way determined. Some Strategic Health it communicated its approach to the Authorities have found a way to NHS. We therefore recommended address the remaining applications. that the Department should develop We have asked the DH how they properly considered national guidance intend to bring this long standing on continuing care redress. This problem to a resolution for all those should: involved. Subject to successful • remind PCTs that compensation resolution of the remaining payments should aim to return applications, we intend to publish a individuals to the financial position final special report in 2007-08. New they would have been in if they (non-retrospective) complaints about had not been wrongly denied continuing care funding will come continuing care funding; through the NHS complaints procedure, as will complaints about • clarify that PCTs are empowered the amount of compensation to make payments in recognition received in retrospective review of the inconvenience and cases. We are liaising closely with distress caused; the Commission to ensure that a • remind PCTs that local authorities robust system is in place for can offer deferred payment determining those complaints.

47 “We aim to make our service more accessible and to deal with people correctly, consistently and as speedily as possible.”

48 Celebrating 40 years in 2007

Developing our service

In suggesting that public bodies adopt the Principles of Good Administration, it is important that we apply them to every part of our own business. Providing a high quality complaints handling service is one of our strategic aims and everything we do should contribute to achieving it.

Customer focus for the benefit of complainants the customer. A new Directorate of and to plan for future demand for Customer Services and Assessment This year, we have consolidated and our service. aims to make our service more refined the new approach to handling We are also restructuring our accessible and to deal with people complaints, which we introduced in organisation to focus more clearly on correctly, consistently and as speedily 2005. We have acted on what complainants, bodies within jurisdiction and others have told us about our approach through formal and informal feedback. Implementing improvements to the ‘front end’ of our complaints handling process is an organisational priority. During the second half of the year, we introduced a more systematic and consistent approach to assessing requests to investigate. Every complaint is considered by senior staff to decide whether the Ombudsman can and should investigate it or if there is a better route to achieving a suitable outcome. This enables us to decide the best way to handle individual investigations, to take a strategic overview of the complaints we receive and to identify recurring problems more quickly. It allows us to use our resources more effectively

49 as possible from the point of their first contact with us. Even if we are unable to help directly, we try to Customers’ comments on our service assist people to find the right place to direct their enquiry. We worked hard during the year to “I could not have met a “Although I am reduce the number of investigations more professional disappointed that I will in hand that had built up to a peak during 2005-06. As a result, we response than [your not receive any finished the year with 617 investigator] gave me. financial benefit, investigations in hand compared with 1,862 the previous year. In addition, we She always replied as nevertheless I feel that had only 73 investigations over a year she promised and gave my case was examined old in hand and only six cases that had her full attention to thoroughly and fairly. I been accepted for investigation but had not yet been allocated after six the sorry details.” can now accept the weeks. This is an encouraging (Mrs D, complainant) situation and move on.” foundation on which to improve our performance and to achieve our (Mrs Y, complainant) customer service standards. More details are provided in the following section, ‘Our Workload and “Thank you for your “I am very grateful for Performance’. comprehensive report the very thorough following my complaint investigation you have Customers’ views about the DWP. I felt it undertaken. I would Our customer satisfaction survey, run for us by Ipsos MORI between was very fair and also like to say how October 2005 and September 2006, focused on the points pleased I am to be measured how complainants felt we that were very given the chance to handled their complaints. Of the 1,258 complainants interviewed during that important to me.” comment on the period, 63% were satisfied or very (Mrs A, complainant) draft report.” satisfied with the way in which their complaint was handled. Large (Ms X, complainant) numbers of complainants described us as accessible, responsive, sympathetic and fair. Staff were also described as friendly and helpful. Areas for improvement, which we recognise and accept, included reducing the length of time taken for investigations and managing complainants’ expectations better in terms of what the Ombudsman can do and the possible outcomes. This year, with the help of Opinion Leader Research, we also carried out a

50 Celebrating 40 years in 2007

qualitative survey of our main stakeholders, including complainants, departmental and health service Stakeholder views of the Ombudsman complaints handlers, the Commission, MPs, and advisory and other bodies. We are grateful to everyone who took part. Complaints handlers noted that “I find it very helpful “I think you do a very our new approach to handling sometimes to share good job as far as we complaints is having a positive effect. things with are concerned in They particularly welcomed the more flexible approach to investigations, [Ombudsman staff] actually picking out sharing of best practice information and share their what the issue is and increased levels of dialogue. information and to because I think it is The majority of stakeholders believed we have excellent case management bounce ideas off them very complicated.” practices, although managing and it has been a very (Parliamentary complaint complainants’ expectations and handler) enforcing recommendations were fruitful partnership.” considered to be challenges for the (Senior stakeholder) Ombudsman. Finally, some complainants and other stakeholders thought we could investigate complaints more quickly, but no one “I would be more than happy to call on the wanted us to compromise the Ombudsman because they’ve always been thoroughness of investigations in incredibly approachable.” doing so. We take all the views expressed very (Health complaint handler) seriously and we will feed the messages emerging from both surveys into improvements in our service.

Complaints about us

We believe that we should live up to the standards we expect of others when we handle complaints. We also consider that complaints about our service give us important feedback to help us improve that service. We received 1,219 complaints about us during the year, covering 1,310 heads of complaint. Of these, 1,097 related to the decision we had reached, 147 were about our service and a further 66 related to Freedom of Information Act and Data Protection Act requests. We resolved 1,136 complaints about us during the year, of which we upheld 157.

51 Of these, in 34 cases (3% of the total), refused permission to proceed. The “I think you’ve got to we identified an error in the decision, Office was awarded costs in all but 69 (6%) needed a different or two of those cases. Eight applications make sure that the additional explanation and in 54 cases were subsequently renewed; three complainants know how to (5%) we found that our service had were again refused permission by the have access. Therefore not been of the standard a complainant court, with costs being awarded to was entitled to expect from us. the Office, one was given permission you’ve got to think about to proceed (no hearing date yet fixed), Lessons arising from complaints about how to get to them and and we are awaiting the results of the how we approach our work are fed that’s not necessarily by back to staff and translated into remaining four renewal applications. changes in our procedures. the normal methods of The Office receives relatively few legal Access to our services communication, because a challenges to its work, although Many respondents to our customer lot of these people are not numbers have increased over the past survey described us as accessible. few years, which matches the able to access them.” However, we know from research experience of other public bodies. carried out in previous years that (Senior stakeholder) Very few of the challenges to the awareness of the Ombudsman’s Ombudsman are successful, the vast services is low among certain people, Some stakeholders also felt that majority failing even to receive including ethnic minority groups and requiring people to make a complaint permission to proceed to hearing. younger people. Our stakeholder to the Ombudsman about a During the year the Office was the survey indicated that complainants’ government department or agency subject of 10 judicial review knowledge and understanding of the through their MP might prevent some applications, all of which were initially Ombudsman’s role could be improved. people from complaining. Moreover, the multitude of complaints systems in force across the public services can make it difficult for potential complainants to know where to turn. For these reasons, we consider it a priority to improve awareness of our service and make putting a complaint to the Ombudsman as simple and straightforward as possible. Since we cannot reach all the people who might want to use our service directly, we have developed close contacts with advocacy and advice bodies. These include Citizens’ Advice and the Independent Complaints Advocacy Service of the NHS. We intend to strengthen our contacts with these bodies, and are developing an outreach strategy to help us achieve this. During the year we continued to implement our equality and diversity strategy, which was based on research on external perceptions and staff views.

52 Celebrating 40 years in 2007

We have also continued to work with other Ombudsmen, particularly the English Local Government Ombudsmen, to make it easier for Responses to the Principles of people whose complaints cross service boundaries to achieve Good Administration consultation a resolution.

Contributing to public “We welcome the “I think that the (draft) service improvements development of these Principles that you Principles...They are propose should Our second strategic objective is to contribute to improvements in public written in a way which support improvements service delivery. In addition to handling staff will find relevant in public administration individual complaints, providing information and analysis from our and helpful to their and the way in which casework is a powerful lever for work.” complaints are change. Although we have done much (Cabinet Secretary, co-ordinated in recent years to fulfil this role, our handled.” response on behalf of stakeholder survey indicated that it is (Comptroller and Auditor government departments) less well known than our complaints General, National Audit Office) handling role. We therefore intend to do more in the coming years to share good practice and the learning arising from complaints. “A clear guide to the “We welcome the standards against which Principles and believe “I think what we don’t NHS organisations that the clarity they often pick up on is how should be held in their will provide both to much services have dealings with the complainants and bodies improved as a result of the public.” within jurisdiction will Ombudsman’s decisions.” (South West Strategic be invaluable.” Health Authority) (Advisory body) (National Archives)

The Principles of Good Administration, have been well received. A wide range of bodies responded positively and constructively to the consultation. They included a co-ordinated response by the Cabinet Secretary on behalf of government departments. We were pleased that government departments found the Principles themselves relevant and helpful. Many other bodies said that the Principles resonate with their own values and

53 the standards they aspire to in their Ireland and Ireland. These include the learning from complaints with people work. We followed this work up by British and Irish Ombudsman who are in a strong position to bring consulting on draft Principles for Association’s draft Guide to Principles about public service improvement. Remedy. We hope that both sets of Good Complaint Handling, the The Ombudsman has also given of Principles will provide public Department of Health consultation evidence to the Public Administration bodies with a helpful framework on the Future regulation of health Select Committee on a number of within which to plan and deliver and adult social care in England and occasions during the year, including to services and to put things right the General Medical Council their inquiry Public Services: Putting where they have gone wrong. consultation on Seeking Patients’ People First? Learning and improvement is a two- Consent: the Ethical Considerations. way process. Sharing information and During the year the Ombudsman and discussing issues of mutual interest senior staff were invited to speak at with other UK Ombudsmen helps us conferences and meetings of to improve our service and working professional groups. These included practices while contributing to the Constitution Unit of University developments in complaints handling. College London, the General The British and Irish Ombudsman Assembly of the International Association (BIOA) is a prominent Ombudsman Institute (European forum for this and we have played an Region), the Royal College of active role in it again this year. During Psychiatrists, Action on Elder Abuse the year, the Ombudsman responded and the Improving Care for Older to a number of important consultation People Conference. Such speaking exercises sometimes jointly with her engagements provide the opportunity public service Ombudsman colleagues to raise awareness of the in England, Scotland, Wales, Northern Ombudsman’s role and to share

54 Celebrating 40 years in 2007

Developing our capacity Dealing effectively with equality and diversity issues is highly important During the past two years we have to our business. We aim to be made extensive changes to our responsive to the differing needs and complaints handling approach in order circumstances of customers and staff. to improve our service to To reflect the importance we attach complainants and secure better to these issues, we developed and outcomes. The high level of skill and implemented an equality and diversity commitment of our staff have made strategy and action plan. During the successful implementation of 2006-07 we commenced an extensive these changes possible. To maintain programme of training for all staff to this level of performance and to ensure that equality and diversity increase staff satisfaction we have issues are fully integrated in our work. made a significant investment in Among other things, this enables our training and development. staff to identify complainants with specific needs and to tailor their With the assistance of consultants, responses accordingly. We have also Penna, we are working on a put in place arrangements to identify management development equality and diversity issues arising programme to enhance our from our casework and to ensure that management capacity and improve staff are aware of them. In addition, overall organisational performance. we have reviewed our employment We are also developing a strategy for policies to make sure that they are in talent management, recognising the line with our strategy. importance of ‘growing our own’ future caseworkers and managers.

55 “We dealt with over 14,000 enquiries during the year.”

56 Celebrating 40 years in 2007

Our workload and performance: facts and figures

Introduction Being accountable for our performance is important to us. In recent years, we have been working to improve our casework processes and to refine the way we record, monitor and report on the work we do. Our aim is to improve our service and to give greater consistency and clarity to our workload and performance information. We took some significant steps towards this aim during 2006-07.

Because different reporting Investigations methodologies were being used, the The figures in this Report show that figures for 2006-07 are not directly comparable with the figures reported we accepted considerably fewer cases for 2005-06. However, following the for investigation in 2006-07 than in development of our performance 2005-06. There are two main reasons reporting and the improvement in for this. data quality, we are now much closer First, we have introduced a more to establishing, and being accountable robust process for deciding whether for, a consistent baseline of workload we could and, if so, whether we and performance. should accept a case for investigation. Our aim has been to ensure that our Enquiries decisions to accept cases for investigation are correct in law, The number of contacts made with consistent, speedy and strategic – the Office has not changed in line with the Ombudsman’s role as significantly over the past year, but a complaint handler of last resort. the overall number that we record as ‘enquiries’ is lower. That is because Secondly, promoting better local repeated contacts about the same complaints handling and resolution is complaint are no longer recorded as one of our key objectives. Our separate enquiries. assessment process therefore ensures that the body complained about has had an opportunity to resolve the

57 complaint. Also, where appropriate, Overall, while the number of Of the requests to investigate: we ensure that the complainant has investigations has reduced, our overall • 17% were accepted for investigation made use of any appropriate second workload remains substantially tier complaint handler, such as the unchanged as more work is being • 28% were not properly made (for Adjudicator or the Healthcare done at the enquiry stage. The example, not referred by an MP) Commission. changes are more of presentation • 23% were premature than of substance. Before we accept a case for • 18% were out of remit investigation we want to be satisfied that: Restatement of workload in • 3% were withdrawn by the complaint • the complaint is properly within hand at 1 April 2006 • In a further 11% of cases we the Ombudsman’s remit and the The in hand figures for the number of decided not to investigate (for body complained about has not investigations and the number of example, because there was no been able to resolve it; complaints about bodies quoted at 1 evidence of maladministration) • there is evidence of April 2006 in the 2005-06 Annual maladministration leading to Report have been restated in some Figure 8 shows the number of un-remedied injustice; instances. This has arisen because of enquiries received and closed. Figure 9 data quality issues, which have since sets out the closure reasons. • there is a reasonable prospect of been addressed by improving system a worthwhile outcome to our controls, and partly because a small investigation. number of concluded investigations Caseload We have also established a much were reopened following a complaint We began 2006-07 with 1,862 cases in clearer distinction between cases about our decision. hand. During the year we accepted a where we intervene to secure a further 1,682 cases for investigation. positive outcome for a complainant Enquiries Our output of completed cases of without the need to launch an 2,927 in 2006/07 exceeded the investigation, and cases where we We dealt with over 14,000 enquiries number of cases accepted for investigate and report. Therefore, in during the year. Of these, around investigation during the year by 1,245 future we will be able to report more 4,400 (31%) were requests for and as a result the in hand figure accurately and comprehensively on information and just over 9,800 (69%) reduced by 67% to 617. A summary is those cases where our intervention were requests to investigate. given in Figure 10. This year we placed short of an investigation has secured the resolution of a complaint, which is an important aspect of our work. Such cases are now recorded as Figure 8 concluded enquiries. Number of enquiries received and closed in 2006-07 The figures in this Report show a substantial number of cases that were In hand at Received Closed including those In hand at initially accepted for investigation but 1.4.06 accepted for investigation 1.4.07 (restated)† subsequently closed as an enquiry. This is because we reassessed all cases Telephone 0 5,790 5,787 3 in hand when we adopted the Email 7 2,145 2,132 20 assessment process described above. Subsequently, 373 cases were closed as Written 333 6,575 6,264 644 enquiries rather than as investigations. Total 340 14,510 14,183 667

† See above for an explanation of the restatement of 1 April 2006 figures

58 Celebrating 40 years in 2007

particular emphasis on reducing the number of in hand investigations that were over a year old, which resulted in a 69% reduction in the number of these cases from 234 to 73.

Customer service standards

Investigations over a year old have a significant ‘drag factor’ which affects our ability to meet the customer service standards we aspire to. As shown in Figure 11, we failed to meet these standards during the year. However, concluding a large

Figure 9 Number of types of closed enquiries 2006-07

Infomation Not Out of Premature – Premature – Discretionary Withdrawn Accepted Total request properly remit Health Parliamentary decisions not made to investigate

Telephone 4,112 620 634 404 1 1 10 5 5,787

Email 148 993 579 389 1 5 2 15 2,132

Written 113 1,131 593 1,011 479 1,035 240 1,662 6,264

Total 4,373 2,744 1,806 1,804 481 1,041 252 1,682 14,183

Figure 10 Cases accepted for investigation and concluded in 2006-07

In hand at Accepted for Accepted but Discontinued Reported on In hand at 1.4.06 investigation closed as an enquiry in the year in the year 1.4.07 (restated)† in year

Parliamentary – tax credits 314 120 15 1 393 25

Parliamentary – other 828 700 314 20 970 224

Parliamentary – total 1,142 820 329 21 1,363 249

Health – continuing care 199 239 7 9 352 70

Health – other 521 623 37 22 787 298

Health – total 720 862 44 31 1,139 368

PHSO – total 1,862 1,682 373 52 2,502 617

† See page 58 for an explanation of the restatement of 1 April 2006 figures

59 Figure 11 proportion of our older cases in Performance against Customer Service Standards 2006-07 has resulted in a significant decrease in the average age of Completion time from Target Health Parliamentary Total investigations in hand at the year end acceptance for investigation (55% under 3 months old and 77% to report under 6 months old). This means we Within 3 months 30% 17% 13% 15% are in a strong position to improve on that performance in the year ahead. Within 6 months 60% 48% 38% 43%

Within 12 months 90% 80% 79% 79% Outcomes

Of the complaints we investigated in Figure 12 2006-07, 34% were upheld in full Outcome of complaints investigated 2006-07 (compared with 37% in 2005-06), 28% were upheld in part (30% in 2005-06) and 38% were not upheld (33% in Upheld in Upheld in Not Total full part upheld 2005-06). A summary is given in Figure 12. The increase in the not upheld rate Parliamentary – tax credits 30% 44% 26% 100% reflects the changing profile and Parliamentary – other 29% 29% 42% 100% nature of the complaints we reported Parliamentary – total 30% 33% 37% 100% on. For example, continuing care cases have high uphold rates. In 2005-06, Health – continuing care 72% 13% 15% 100% these made up 33% of complaints Health – other 25% 27% 48% 100% reported on (pushing up the overall Health – total 39% 23% 38% 100% uphold rate), but in 2006-07 the proportion of continuing care cases PHSO – total 34% 28% 38% 100% had reduced to just 15% of complaints reported on. Detailed complaint outcomes, by body complained against, are included in the ‘Government departments, agencies and public bodies’ and ‘The National Health Service’ sections of this report.

Compliance with recommendations

All the recommendations we made during the year have been accepted or are currently being considered by the body or practitioner complained about. The majority of recommendations in our health investigations focused on an apology or some action to prevent a recurrence (for example, a review of or changes to procedures, or staff training). Others included action to remedy the failure identified, or

60 Celebrating 40 years in 2007

reconsideration of the decision. The majority of recommendations in our Parliamentary investigations focused on financial compensation for inconvenience or distress. Others included an apology, financial compensation for loss or an action to remedy the failure identified.

Freedom of Information and Data Protection requests

During the year, we received over 250 requests for information under the Freedom of Information Act or the Data Protection Act. These were either from members of the public, requesting information about our procedures and statistics, or from complainants or their representatives seeking copies of information from their files. We did not always meet the statutory timescales for responding to requests. Responding to these requests presents difficulties for the Ombudsman. This is mainly because of the interaction between the Freedom of Information and Data Protection Acts and the Ombudsman’s powers as set out in the Parliamentary Commissioner for Administration Act 1967 and the Health Service Commissioners Act 1993. A project is underway to look at how best we can approach the Freedom of Information and Data Protection Acts and we have been discussing with the Information Commissioner’s Office how we can reconcile these issues. In the meantime, our current Publication Scheme is available on our website, www.ombudsman.org.uk, and contains a wide range of information about our work.

61 “Being accountable for our performance is important to us.”

62 Celebrating 40 years in 2007

Managing our resources

The Parliamentary and Health Service Ombudsman’s full Resource Accounts 2006-07 were laid before Parliament on 18 July 2007 and are available on our website at www.ombudsman.org.uk or from The Stationery Office.

Summary Financial The Comptroller and Auditor General, who has been appointed by the Statements for the year Parliamentary and Health Service ended 31 March 2007 Ombudsman as auditor, has given an unqualified audit opinion on the Statement of the PHSO’s Resource Accounts. Parliamentary and Health Service Ombudsman The following Financial Statements are a summary of information extracted Ann Abraham from PHSO’s full annual accounts for Parliamentary and Health Service 2006-07, which were signed by the Ombudsman Ombudsman on 26 June 2007. While the summary below does not contain sufficient detail to allow for a full understanding of the financial affairs of the PHSO, they are consistent with the full annual accounts and auditor’s report, which should be consulted for further information.

63 Statement of the Comptroller Financial Review Capital investment expenditure for the year was £4,958k, mainly utilised and Auditor General to the PHSO’s net operating cost for 2006-07 on our accommodation refurbishment House of Parliament was £22,853k, comprising expenditure project. This was a marginal of £23,222k spent in carrying out its I have examined the Summary underspend against the £4,994k activities offset by operating income Financial Statement of the funding approved by Parliament for of £369k. Excluding £5k income that Parliamentary and Health Service 2006-07. Ombudsman comprising a summary must be surrendered to the PHSO’s General Fund reserve has financial review, resource outturn, Exchequer, and £179k funding from the Consolidated Fund for the salary and increased by £4,393k, which mainly operating cost and cash flow on-costs of the Ombudsman, PHSO’s reflects the increased value of our statements for the year ended 31 net total resource requirement for the asset base as a result of the March 2007 and a summary balance year was £22,679k, which was an capitalisation of the costs of our sheet at that date. underspend of £962k (4.1%) of PHSO’s accommodation refurbishment The Ombudsman is responsible for 2006-07 funding as approved by project. preparing the Summary Financial Parliament. The reasons for this Statement. My responsibility is to underspend were: report to you my opinion on its • retention of an unutilised preparation and consistency with the contingency reserve of £150k; full Resource Accounts. • a reduction of £360k in our costs I have conducted my work in following the rationalisation of our accordance with Audit Bulletin accommodation requirements; 1999-06, “The auditors’ statement on the summary financial statement”, • lower than expected costs arising issued by the Auditing Practices from the annual revaluation of our Board. My certificate on the full fixed assets; and accounts of the Parliamentary and • reduced depreciation charges Health Service Ombudsman describes arising from the deferment of the the basis of my opinion on those accommodation project into accounts. I have also read the other 2006-07 from 2005-06. information contained in the Annual Report to the accounts and considered the implications for my opinion if I become aware of any apparent misstatements or material inconsistencies with the Summary Financial Statement. In my opinion the Summary Financial Statement is consistent with the full Resource Accounts of the Parliamentary and Health Service Ombudsman for the year ended 31 March 2007.

Sir John Bourn Comptroller and Auditor General

64 Celebrating 40 years in 2007

Summary of Resource Outturn 2006-07

2006-07 2005-06 Estimate Outturn

Gross A in A Net total Gross A in A Net total Net total Outturn expenditure expenditure outturn compared to estimate: saving/(excess) £000 £000 £000 £000 £000 £000 £000 £000

Request for 24,047 406 23,641 23,043 364 22,679 962 22,263 resources

Total 24,047 406 23,641 23,043 364 22,679 962 22,263 resources

Non operating – 5 (5) – – – (5) – cost A in A

PHSO’s net cash requirement for the year of £26,889k was within our cash financing limit of £27,650 as approved by Parliament.

Operating Cost Statement for the year ended 31 March 2007

2006-07 2005-06 £000 £000 Administration costs: Staff costs 13,458 12,907 Other admin costs 9,764 9,840 Gross administration costs 23,222 22,747 Operating income (369) (402) Net administration costs 22,853 22,345 Net operating cost 22,853 22,345

Net resource outturn 22,679 22,236

65 Balance Sheet as at 31 March 2007

31 March 2007 31 March 2006 £000 £000 £000 £000 Fixed Assets: Tangible assets 6,354 2,594 Intangible assets 638 821 6,992 3,415 Current assets: Debtors 968 1,237 Cash at bank and in hand 391 178 1,359 1,415 Creditors (amounts falling due within one year) (1,597) (1,929) Net current liabilities (238) (514) Total assets less current liabilities 6,754 2,901 Creditors (amounts falling due after more than one year) (825) (999) Provisions for liabilities and charges (844) (1,218) (1,669) (2,217) 5,085 684

Taxpayers’ equity General Fund 4,709 316 Revaluation Reserve 376 368 5,085 684

66 Celebrating 40 years in 2007

Cash flow statement for the year ended 31 March 2007

2006-07 2005-06 £000 £000 Net cash outflow from operating activities (22,110) (22,138) Capital expenditure and financial investment (4,958) (1,500) Payments of amounts due to the Consolidated Fund (68) (44) Financing 27,349 23,349

Increase/(decrease) in cash in the period 213 (333)

67 The Board as at March 2007

Ann Abraham Trish Longdon Bill Richardson Parliamentary and Health Service Deputy Ombudsman Deputy Chief Executive Ombudsman

Philip Aylett Linda Charlton Director of Strategy and Director of Equality and Diversity Communications (Policy Information (left on 30 March 2007) and Communications from 1 April 2007)

Andrew Puddephatt OBE Tony Redmond Cecilia Wells OBE Audit Committee Chair External Board Member External Board Member

68 Celebrating 40 years in 2007

Annex A: Governance

The post of Parliamentary and Health Service Ombudsman combines the two statutory roles of Parliamentary Commissioner for Administration and Health Service Commissioner for England.8 The Ombudsman is solely responsible and accountable for the conduct and administration of all work carried out by this Office and for the decisions made in each case.

The PHSO Advisory Board that date, members of the Executive The Executive Board Board normally attend Advisory Board The Ombudsman appointed a non- meetings, but are not members. The Executive Board is chaired by the statutory Advisory Board in 2004 to Ombudsman and included in 2006-07 The role of the Advisory Board is to reinforce the governance of this the Deputy Ombudsman, Deputy provide support and advice to the Office. During 2006-07, this comprised Chief Executive, the Director of Ombudsman in providing leadership the Ombudsman (as Chair and Chief Strategy and Communications and the and good governance, as set out in Executive in line with her statutory Director of Equality and Diversity. The the Office’s Governance Statement9. accountability), two non-executive Executive Board manages the Office’s Its external perspective assists in the members, who bring an external functions and activities and is development of policy and practice. perspective to our work, and four responsible for the delivery of our The Advisory Board provides specific executive officials: the Deputy strategic vision, policies and services advice and support on: Ombudsman, Deputy Chief Executive, to the public and other stakeholders. Director of Strategy and • Purpose, vision and values; The Director of Equality and Diversity Communications and Director of • Strategic direction and planning; left the Office on 30 March 2007. She Equality and Diversity. has been appointed a member of the • Accountability to stakeholders, Advisory Board from 1 April 2007. During 2006-07, the Ombudsman including stewardship of public decided to appoint two additional funds; and The Ombudsman carried out a external members to bring in-depth restructuring during 2006-07 to align • Internal control arrangements and knowledge of organisational the Office’s internal organisation risk management arrangements. development/change management more closely with the business and communications/marketing. The The Advisory Board has two formal process and to join up related new appointments were made sub-committees, an Audit Committee functions more effectively. through a process of fair and open and a Pay Committee, which have key competition and the appointees took roles in supporting the effective up their posts on 1 April 2007. From governance of this Office.

8 The Ombudsman’s powers are set out in the Parliamentary Commissioner Act 1967 and the Health Service Commissioners Act 1993. 9 The full Governance Statement is available at www.ombudsman.org.uk/about_us/governance/governance_statement.html.

69 Ombudsman Deputy Ombudsman Operations Ann Abraham Trish Longdon Investigation Directors Carole Auchterlonie Christine Corrigan Valerie Harrison Deputy Chief Jack Kellett Executive Hilary York Bill Richardson Clinical Advice Director Susan Lowson Director of Strategy Head of Gateway & Communications Damian Brady Philip Aylett

Director of Corporate Resources Diversity & Equality Finance Director Linda Charlton Graham Payne (left on 30 March 2007) Human Resources Director Jon Ward Service Delivery Director Mark Castle-Smith

Legal Adviser Anne Harding

70 Celebrating 40 years in 2007

Annex B: Strategic Plan objectives 2007-10

Our aims and Aim Objectives objectives for To deliver a high quality To deliver a high quality service based on understanding our customers’ 2007-10 are: complaints handling needs and making our service service to customers. accessible to all who need it. To maintain a high quality service by anticipating the impact of changes in customers’ needs and public service policy and developing our capacity to respond. To operate a high quality service by developing high performing staff and getting the best from our resources.

Aim Objectives To contribute to To establish a distinct and recognised role in the administrative justice improvements in public landscape and regulatory service delivery by being environment. an influential organisation, To be recognised and utilised by others as a source of expertise in sharing our knowledge and good administration and complaint expertise. handling. To be an authoritative voice on delivering systemic change, actively sought out by others.

Three core priorities drive our work:

• Continuously improving the quality of our service; • Increasing the efficiency of all aspects of our core activities; • Extending our influence with others to help improve public service delivery.

71 About the Parliamentary and Health Service Ombudsman

The Parliamentary To find out more, visit our website Ombudsman www.ombudsman.org.uk or carries out independent investigations contact our Helpline on into complaints that government 0845 015 4033 to ask for departments and a range of other information or to request a leaflet. public bodies in the UK have not You can also write to us at the acted properly or fairly or have address below or email us at provided a poor service. [email protected] The Health Service Parliamentary and Health Service Ombudsman for England Ombudsman undertakes independent Millbank Tower investigations into complaints made Millbank by, or on behalf of, people who have London suffered because of poor treatment SW1P 4QP or service provided through the NHS. The Parliamentary and Health Service Ombudsman is completely independent of the Government, the Civil Service and the National Health Service. The Ombudsman’s services are available to everyone and are free of charge.

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