About The Parliamentary and Health Service Ombudsman

The Parliamentary and Health Service Ombudsman (PHSO) makes final decisions on unresolved complaints about the NHS in England, UK government departments and other UK public organisations. We do this independently and impartially. We are not part of government or the NHS in England, nor are we a consumer champion.

We look into complaints where an individual believes there has been injustice or hardship because an organisation has not acted properly, or has given a poor service and not put things right.

We normally expect people to complain to the organisation in question first so that it has a chance to put things right. If, after an organisation has responded, an individual believes there is still a dispute about their complaint, they can ask us to look into it.

We share findings from our casework to help Parliament scrutinise public service providers and more widely to help public services improve. Examples of our reports and publications that have supported policy change and service improvements nationally include our Time to Act report on sepsis, our Midwifery Supervision and Regulation report, and more recently a report on how complaints are handled in Primary Care.

How the Ombudsman investigates complaints

There are a number of issues that we consider when deciding whether we are able to investigate a complaint. These include:

• whether there are signs that the organisation potentially got things wrong that have had a negative effect on the complainant and that haven't been put right;

• whether the complainant has the option of taking legal action instead and would prefer this;

• whether they complained to us within a year of knowing about the issue – there are some exceptions to this.

Once we have decided to investigate the case, it will be passed to a caseworker. If it is a health service complaint, they may seek clinical advice appropriate to the case. For example, if the complaint is about GP care they approach a GP Adviser such as myself and if it is a nursing issue the caseworker will go to the nursing advisers.

What is the role of clinical advisers?

The Ombudsman's clinical advisers all work in the NHS and provide advice for their area of expertise. We provide clear, impartial and timely advice, based on professional standards and clinical guidelines which applied at the time of the events complained about. We have a robust Quality Assurance programme in place which uses a peer-based approach to ensure the accuracy of the clinical advice we give to our caseworkers.

When assessing the standard of care, we do not use the Bolam/Bolitho principle which refers to the ‘reasonable body of clinical opinion’. This is because these are tests used in the courts in relation to medical negligence and we make determinations about maladministration and service failure. Where there is an absence of recognisable guidance or standards, the benchmark used is one of ‘established good clinical practice’.

Clinical advice is just one part of the evidence reviewed in the investigation of a case and the final decision about whether or not to uphold a complaint lies with the caseworker/investigator.

Good complaint handling in the NHS

The cornerstone of good complaint handling is to accept that there is always room for improvement. Encouraging patients to speak up when things have gone wrong could prevent problems from escalating, save money by avoiding formal complaints and identify areas in need of improvement quicker.

One Senior Clinician we know encourages his staff to actively seek out feedback from patients, carers and visitors on a daily basis and leads the way by very visibly doing this himself. His team meetings include a standing agenda item on ‘how are we doing’ to review the feedback they collect, discuss any action needed and review the implementation of changes made.

When they receive a formal complaint, a senior team member calls or meets with the complainant within a couple of days to demonstrate that they take the concerns seriously. This early conversation also helps in understanding the issues and what the complainant wants to achieve. It is also a good chance to explain how the matter will be investigated, how the complainant will be involved and kept updated, and how long it is likely to take.

The clinician also feels it is essential for staff to feel supported and involved in the process, by making it clear that it is a matter for the team and they were not alone. It is not about blame and ‘pointing the finger’ but rather learning and accountability.

Research around procedural justice shows that the more a person feels that the process has been fair, the more likely they are to accept a decision that goes against them. What people want in complaint decision-making includes:

• a real opportunity to be heard and have input into the process before a decision is made;

• to see how decisions are made via clear, understandable and transparent rules; and

• complaint handlers showing they are acting neutrally by basing decisions on objective information and appropriate criteria.

Top tips for handling patient complaints

• Making a complaint takes courage. Patients often fear that speaking up could affect their care, so be clear that complaints and feedback are welcome as a means of improving services.

• Show patients that complaining will make
a difference and promote any changes already made in response to complaints and feedback. People are more likely to speak up if they feel they will be listened to.

• Always look beyond the complaint in front of you to understand what may have led to it. This will help you identify wider concerns, issues or themes.

For more information go to www.ombudsman.org.uk

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