The Parliamentary and Health Service Ombudsman (PHSO) has been in existence for over 50 years. There have been calls for change from various bodies, including the Patient Association. A new set of PHSO values has been formulated, new clinical standards published in August 2018 and a 2018/21 strategy defining the PHSO’s vision of being a model service. This is seen as one able to evolve and learn from best practice and improve organisational performance over ensuing years. While the PHSO Service Charter advises that the majority of people who go to the PHSO experience good service, there are instances where this is not the case and it recognises more needs to be done to address this. As an organisation, PHSO acknowledges achieving change will take time, but is aiming for demonstrable progress as soon as possible. Deborah Bellamy investigates.
Many reports have been published by the Patient Association regarding PHSO service, performance and other issues, the most pertinent being: PHSO — Labyrinth of Bureaucracy (updated 2016).
The Patient Association is clear; it will judge PHSO’s reform programme on the outcomes it achieves for patients. It will continue to raise concerns with PHSO as necessary and work with PHSO to help it become a patient-focused organisation that delivers a high-quality service.
For complaints about NHS clinical care and treatment in England, PHSO aims to establish what should have comprised good clinical care and treatment in the situation complained about and whether what was delivered fell short.
If GPs or practices are found to be at fault following a complaint, the Ombudsman may recommend that payments, apologies or other changes are made so lessons may be learned and quality improved.
The new PHSO clinical standard: the Ombudsman Clinical Standard (2018), was intended to provide greater “clarity and predictability”, as to how the appropriateness of treatment and care is considered.
Organisations and clinicians investigated will need to inform PHSO what professional guidance or standards they based their practice on. If they then deviated from such guidance, the rationale behind this.
The PHSO then deliberates the response of those complained about and assesses this alongside the stated relevant standards or guidance. By using this approach, it believes it offers clarity to those complained about at an earlier stage and opportunity to explain how they reached such decisions about care and treatment.
This method should also help PHSO’s approach be more transparent for people who use the Ombudsman service.
Court of Appeal query over standard
However, earlier this year a case was brought to the Court of Appeal by the medico-legal organisation, the Medical Defence Union (MDU) and another medical defence organisation where, as a result, the previous version of the Ombudsman’s Clinical Standard was referred to as “incoherent” and a “counsel of perfection”.
The Court of Appeal overturned a decision made by the PHSO where two GPs had been found to have provided unacceptable care to a patient. The Court judgment questioned the equality and range of the Ombudsman’s process of investigating clinical complaints.
The MDU also considered the 2018 Ombudsman’s Clinical Standard to be ambiguous. It suggests it could result in GPs having to make unnecessary apologies and payments. There is concern the PHSO approach does not tackle the Court of Appeal’s issue.
It contends GPs could be in jeopardy of unfair treatment due to lack of clarity from the PHSO about a clear opinion, test or standard against which clinical decisions can be benchmarked.
The General Practitioners Committee (GPC) also expressed reservations regarding the Ombudsman’s Clinical Standard, cautioning: “We are worried GPs will not be able to comply with the standards.”
Have these issues been resolved?
The MDU believes the concerns raised by the Court of Appeal have not been fully addressed and feel GPs need assurance that the future procedures will be fair and transparent.
One area that has caused issue from a GP’s perspective, is how the Ombudsman assesses its clinical judgments. The consensus is that GPs need to be informed in advance which specific standard they will be judged against and more detail as to how this standard will be used by experts provided.
With the breadth and extent of the role of the GPs, for much of their work there may not appropriate standard or guidance available. Where there is such information it may not be deemed relevant.
It is necessary to assess practice undertaken as a whole. The Ombudsman needs to define a consistent, replicable standard that can be utilised. To ensure parity, the clinical standard needs to be unambiguous and reflect the reality of general practice. GPs also need assurance that the procedures will be clear and equitable.
The Ombudsman has committed to continue to measure how it is performing through the Service Charter.
With regard to its values it outlines:
independence: PHSO is independent from organisations investigated, holding them to account for service failure
fairness: careful listening to complainants and the organisations investigated with impartial decisions based on relevant evidence
excellence: learning from engagement with complainants and organisations investigated to improve accessibility, efficiency and effectiveness and the quality of decisions
transparency: communication with service users and publication of information about findings, and performance, and how organisations investigated have responded.
PHSO goals for 2018/19
The PHSO goals for 2018/19 include the following.
Publishing of quarterly data about the health complaints received.
Development of an approach to enable more information about its findings to be published along with the level of compliance with recommendations.
Publishing a transparent set of principles and case studies about the use of financial remedy and work with national organisations to explore how it can better explain, who it is and what it does to organisations it investigates.
Building on training programmes to improve the quality of its investigation reports.