PHSO Financial Redress / compensation

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Dear Parliamentary and Health Service Ombudsman,

Please can you provide the following under the Freedom Of Information Act 2000.

1. How does the PHSO grade complaints on receipt and at initial assessment level before full investigation (as PALS do)? With Guidelines set out by the Department of Health? If so, please include level of Seriousness and description examples.

2. Please provide the Financial Redress guidelines that the PHSO use for remedying instances of injustice relating to HEALTH complaints.

3. Please provide the guidelines for HOW the PHSO sets the figure for any Financial Redress that is due.

"No detailed research has ever been undertaken to compare settlements obtained through the ombudsman system with those awarded in the courts,44" http://www.ombudsman.org.uk/improving-pu...

I see on your website a "MRS F, suffers from multiple sclerosis and diabetes.." no action by the hospital was taken to prevent a second occurrence of a blood clot occurring which it did and doctors had to amputate her leg above the knee. Financial Redress was set by the PHSO at £75, 000.
http://www.ombudsman.org.uk/__data/asset...

In a similar case but using legal help and not the PHSO a "MR W, who suffers from diabetes" was admitted to Medway NHS Trust where they failed to control his diabetes and his leg had to be amputated below the knee. "The Trust agreed to pay him £250,000 shortly before the case went to court." http://www.thompsons.law.co.uk/ntext/com...

4. A total amount in £ for Financial Redress / special payment decisions awarded to complainants by the PHSO for HEALTH decisions ONLY for 2008, 2009, 2010, 2011, 2012

5. A list of each complaint that received compensation and the amount in £ (i.e one amputated leg £XXXXX or permanent brain damage caused by an NHS Trust £XXXXXX) for the following years FOR HEALTH decisions ONLY: 2008, 2009, 2010, 2011, 2012

6. Can you confirm that these ex gratia payments are awarded by the PHSO but that the Ombudsman has no power to enforce these recommendations - "however, bodies accepted her recommendations in 100 per cent of cases in 2009/10."

7. How did the PHSO arrive at this figure when "It is difficult to quantify the exact number of occasions when the PO has failed to secure redress." http://www.ombudsman.org.uk/improving-pu...

8. How many bodies accepted her recommendations for 2010/11 ? 2011/2012 ?

9. How many times has the PO found it "necessary to issue a section 10(3) report to Parliament notifying it of a failure of the government to provide suitable remedies.77" The PHSO website at the time of writing notes "on only 4 occasions. What is this figure now that it is 2013 ? The references cited are cases from 1977-78 and 1993-95 respectively..

10. How many PHSO clinical advice "experts" have been reported to the GMC following a failure to act within the GMC guidelines 'Acting as an expert witness' as "Serious or persistent failure to follow this guidance will put your registration at risk." (The same principle applies where a doctor acts in a role other than as a witness – for example, as an adviser in a case).

http://www.gmcuk.org/static/documents/co...

I look forward to hearing from you,

Yours faithfully,

Gina Terry

foiofficer, Parliamentary and Health Service Ombudsman

Thank you for your e-mail to the Parliamentary and Health Service
Ombudsman. This return e-mail shows that we have received your
correspondence.

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foiofficer, Parliamentary and Health Service Ombudsman

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RESTRICTED

Dear Ms Terry

 

Your information request

 

I write further to your email of 1 August 2013.  In your email you set out
a number of information requests.  I will address these in turn.

 

1) How does the PHSO grade complaints on receipt and at initial assessment
level before full investigation  (as PALS do)?  With Guidelines set out by
the Department of Health? If so, please include level of Seriousness and
description examples.

 

We do not grade complaints in the way that you describe.  We do not grade
or categorize complaints upon receipt.  We do carry out a risk assessment
on every case that we assess and investigate.  Details of how we carry out
risk assessments in our casework can be found in the attachment ‘Risk
assessment in our casework’.

 

2) Please provide the Financial Redress guidelines that the PHSO use for
remedying instances of injustice relating to HEALTH complaints.

 

When deciding on our recommendations, including those for financial
redress, we refer to the Ombudsman’s Principles for Remedy.  The
Principles can be found on our website:
[1]http://www.ombudsman.org.uk/improving-pu...

 

3) Please provide the guidelines for HOW the PHSO sets the figure for any
Financial Redress that is due.

 

We consider the recommendations we make on a case-by case basis.  However,
the internal guidance we provide to our staff is included in the
attachment ‘Making a decision and providing a remedy in our casework’.

 

4) A total amount in £ for Financial Redress / special payment decisions
awarded to complainants by the PHSO for HEALTH decisions ONLY for 2008,
2009, 2010, 2011, 2012

 

We do not award complainants financial redress or special payments. 
However, if following an investigation we find an individual has suffered
an injustice as a result of failings we can make recommendations for the
organisation to remedy that injustice. Details of the total amount of
financial redress secured following our recommendations to health
organisations can be found below:

 

Year Total amount of financial redress secured
2008 £92,950.00
2009 £112,650.00
2010 £226,979.53
2011 £591,924.69
2012 £739,885.82

 

Please note that these figures include recommendations for direct
financial loss. Recommendations for the reimbursement of direct financial
loss can be significantly high, such as in 2012 when one of our
recommendations led to almost £120,000 being paid by one organisation.

 

5) A list of each complaint that received compensation and the amount in £
(i.e one amputated leg £XXXXX or permanent brain damage caused by an NHS
Trust £XXXXXX) for the following years FOR HEALTH decisions ONLY: 2008,
2009, 2010, 2011, 2012

 

First, let me explain that we make recommendations for any injustices
caused by service failure in the round.  We do not put a monetary value on
injuries in the way you describe or that you may find in the guidance
relating to clinical negligence claims.  Instead, we consider the
injustices in the round and consider emotional injustice, material
injustice, physiological injustice and bereavement.  I have attached the
‘Typology of injustice’ which lists the injustices that we record in our
compliance data since 2010.  Please note that this list is used to record
the main injustices that we see.  The list is not exhaustive and there may
be other injustices suffered that are not recorded here.

 

Unfortunately, we have no easy way of determining precisely what each of
our recommendations for compensation was intended to remedy without
manually examining every individual investigation report.  To do this
would far exceed the time and cost limit set out in section 12 of the
Freedom of Information Act 2000.[2][1]  However, in an effort to assist
you in your request there is some information I can provide which answers
part of your request and additional information from our ‘Typology of
injustice’ which you may find useful. 

 

Therefore, attached to this email is an Excel spread sheet which lists
every financial recommendation we have made on every health case since
2008 (each tab corresponds to a different year).   As I explained above we
have recorded information from the ‘Typology of injustice’ in relation to
our recommendations and you will see from 2010-2012 I have provided you
with a list of which category from the typology have been recorded.  You
will need to use the ‘Typology of injustice’ as a key, using the code
there to read across to the Excel spread sheet.

 

I have provided this information in Excel as I thought this may be useful.
 However, if this format does not suit your requirements please let me
know.

 

6) Can you confirm that these ex gratia payments are awarded by the PHSO
but that the Ombudsman has no power to enforce these recommendations -
"however, bodies accepted her recommendations in 100 per cent of cases in
2009/10."

 

The recommendations we make to organisations are not enforceable. 
However, in practice almost all of our recommendations are complied with. 
If a body refuses to accept our recommendations or fails to comply we will
decide what to do on a case-by-case basis.  Section 14(3)(b) of Health
Service Commissioners Act 1993, and section 10(3) of the Parliamentary
Commissioner Act 1967, allows the Ombudsman to lay before each House of
Parliament a special report where it appears to her ‘that the injustice or
hardship has not been and will not be remedied’.  Guidance on securing
compliance can be found in the attachment ‘Compliance in our casework’.

 

7) How did the PHSO arrive at this figure when "It is difficult to
quantify the exact number of occasions when the PO has failed to secure
redress"? 

 

We began recording compliance information on the recommendations we made
on all upheld investigations, including whether or not they were
secured in 2008.  Furthermore, as I explained in question 5 we have
recorded information for the ‘Typology of injustice’ since 2010.

 

8) How many bodies accepted her recommendations for 2010/11? 2011/2012?

 

In the business year 2010/11 196 different bodies complied with our
recommendations and during 2011/12 229 different bodies complied with our
recommendations.  The table below shows how many recommendations were
complied with.  Please note that there can be several recommendations that
apply to one organisation.  Similarly we can investigate more than one
organisation under one investigation.

 

Recommendations Complied with 2010/12

Business Year Complied with Not complied with Total
2010/11 815 1 816
2011/12 1091 2 1093
Total 1906 3 1909

 

9) How many times has the PO found it "necessary to issue a section 10(3)
report to Parliament notifying it of a failure of the government to
provide suitable remedies.77" The PHSO website at the time of writing 
notes "on only 4 occasions. What is this figure now that it is 2013? The
references cited are cases from 1977-78 and 1993-95 respectively.

 

Since the establishment of the Office, there have been only six occasions
where the Ombudsman has felt it necessary to issue a special report to
Parliament under section 10(3).  These include:

 

1.    July 1978

Rochester Way, Bexley – Refusal to meet late claims for compensation,
Sixth Report, Session 1977-78, HC 598.

2. February 1995

The Channel Tunnel Rail Link and Blight: Investigation of complaints
against the Department of Transport, Fifth Report, Session 1994-95, HC
193.

 

3. July 2005

[3]A Debt of Honour’ The ex gratia scheme for British groups interned by
the Japanese during the Second World War, Fourth Report, Session
2005-2006,  HC 324.

 

([4]http://www.ombudsman.org.uk/__data/asset...)

 

4. March 2006

[5]Trusting in the pensions promise: government bodies and the security of
final salary occupational pensions. (HC 984)

 

([6]http://www.ombudsman.org.uk/__data/asset...)

 

5. May 2009

[7]Injustice unremedied: the Government’s response on Equitable Life (HC
435).

PHSO issues a special 10(3) report that says the Government’s response to
our report meant that no adequate remedy for the injustice suffered by
policyholders would be forthcoming.
Special 10(3) reports have only been issued on four other occasions since
the office was established in 1967.

 

([8]http://www.ombudsman.org.uk/improving-pu...)

 

6. December 2009

[9]Cold Comfort: the Administration of the 2005 Single Payment Scheme by
the Rural Payments Agency. (HC 81)

The report was issued as a section 10(3) report because Defra did not
accept the recommendations in full. This is only the sixth report issued
this way since the office was established.

 

([10]http://www.ombudsman.org.uk/improving-pu...)

The Ombudsman has issued two reports under the equivalent section of the
Health Services Commissioner Act 1993, Section 14(3).

 

1. June 2011
[11]Report by the Health Service Ombudsman for England of an investigation
of a complaint about a dentist in Staffordshire, Fifth Report, Session
2010-2012, HC 1079.

 

([12]http://www.ombudsman.org.uk/__data/asset...)

 

2. November 2011
[13]Report by the Health Service Ombudsman for England of an investigation
of a complaint about a GP in Dudley, HC1620.

 

([14]http://www.ombudsman.org.uk/__data/asset...)

 

10) How many PHSO clinical advice "experts" have been reported to the GMC
following a failure to act within the GMC guidelines 'Acting as an expert
witness' as "Serious or persistent failure to follow this guidance will
put your registration at risk." (The same principle applies where a doctor
acts in a role other than as a witness – for example, as an adviser in a
case).

 

We have one recorded instance of where a PHSO clinical adviser has been
reported to the GMC.  However, I should explain that advisers are
providing this advice to PHSO.  Their advice is only part of the
information we use to take a decision on a case.  They do not take
decision on cases themselves, these are corporate decisions usually taken
by the caseworker and signed off by their manager.  As such, it is not
appropriate for any member of the public to attempt to communicate
directly with an adviser who has provided advice on their case.  If
someone is unhappy with the content of the clinical advice or thinks
advice should be sought from a more suitable qualified adviser then they
should raise these issues with PHSO directly through our internal
complaints procedure by contacting the Review Team.  As the advisers are
contracted and employed by PHSO, it is PHSO who should be contacted if you
have any concerns.

 

I hope you have found the information I have provided to be helpful. 
However, if you are unhappy with my handling of your information request
you can request an internal review by writing to the Review Team at:
[15][email address]

 

If you remain dissatisfied it is open to you to approach the Information
Commissioner’s Office.  Details of how to contact them can be found on
their website at: [16]www.ico.org.uk

 

Yours sincerely

 

 

Claire Helm

Freedom of Information/Data Protection Officer

Parliamentary and Health Service Ombudsman

W: [17]www.ombudsman.org.uk

 

 

[1] The “appropriate limit” is specified in the Freedom of Information and
Data Protection (Appropriate Limit and Fees) Regulations 2004. In relation
to this Office, the appropriate cost limit is 18 hours or £450 at £25 per
hour.  If the appropriate cost limit is exceeded, information is exempt
from release under section 12 of the Freedom of Information Act.

 

 

show quoted sections

Thank you so much for your reply, it was very helpful

Yours sincerely,

Gina terry

foiofficer, Parliamentary and Health Service Ombudsman

Thank you for your e-mail to the Parliamentary and Health Service
Ombudsman. This return e-mail shows that we have received your
correspondence.

show quoted sections

All email communications with PHSO pass through the Government Secure
Intranet, and may be automatically logged, monitored and/or recorded for
legal purposes.
The MessageLabs Anti Virus Service is the first managed service to achieve
the CSIA Claims Tested Mark (CCTM Certificate Number 2006/04/0007), the UK
Government quality mark initiative for information security products and
services. For more information about this please visit www.cctmark.gov.uk

Gina terry left an annotation ()

The Link for Question 3 no longer works so I am adding the new one -

3. Please provide the guidelines for HOW the PHSO sets the figure
for any Financial Redress that is due.

"No detailed research has ever been undertaken to compare
settlements obtained through the ombudsman system with those
awarded in the courts,44"

http://www.ombudsman.org.uk/reports-and-...

D. Speers left an annotation ()

Thank you Gina!

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