Supplementary questions on complaints.

The request was successful.

Dear Ms Hannan,

You have kindly responded recently with regard to my questions on PHSO process and your responses have raised more supplementary questions which I now need to try and get FOI answers to please.
Judging by the response you have kindly provided and if my maths is correct, this makes about 300 cases a year accepted for investigation by the PHSO - just about 1 per day.
Please advise: Is this correct?

My understanding from previous research is that the the Healthcare Commission used to get in the region of 20,000 complaint cases per year to investigate - so in my thinking, if 300 per annum is now the figure being quoted by the PHSO service, does this mean that it looks like the PHSO are investigating about 1.5% of complaints brought to them?

If this is the case then the logical conculsion can only be perhaps that around 98.5% of people making complaints will never be assessed according to the PHSO Principles for Remedy; so that they go to all the time and trouble of escalating a complaint to the PHSO for no good reason at all. Having been in the NHS Complaints system for over four years now I have total empathy.

Please advise: Am I understanding this data correctl? If I am, I feel that it doesn't seem very tenable to have a complaints service which is effectively using pubic money to deal with such small numbers of complaints....many of which may be showing significant system failure.

The PHSO recently published (in response to a FOI request on www.whatdotheyknow.com, Policy and Guidance on "Maladministration, Injustice and Worthwhile outcome" and once again have referred to the Principles of Remedy:
These are:

1. Getting it right

2. Being customer focused

3. Being open and accountable

4. Acting fairly and proportionately

5. Putting things right

6. Seeking continuous improvement

Please advise: How does this happen if only 1.5% of complaints are being investigated?

I am aware that the Healthcare Commision finished their remit without any public consultation and therefore feel my questions of the leading complaints service available to the public now must be:

1)How many cases have been referred to the PHSO altogether in the same period?
2)How many cases from those selected for investigation in the same period have been "upheld"?
3)What is the expected annual budget for the PHSO this year?
4)What is the total number of PHSO staff?

As I am also aware that the senior HC case manager from my complaint left to join the Care Quality Commission and the HC Investigation Team became the Care Quality Commission Investigation Team. Also the (ex)CEO of WLMHT and (ex) Nursing Director left their posts around the same time as publication of investigation reports into their Trust were published, and I did more research and was informed about Transfer of Undertakings for Protection of Employment(TUPE)which I now understand, effectively allows for the wholesale transfer of employees from one organisation to another.

Therefore:
5)How many of the PHSO staff were formally employed by the Healthcare Commission?
6)Were the former employees of the HC TUPE'd across to the PHSO or were they recruited directly by the PHSO?

Many thanks again for your previous answers and please feel free to contact me if any part of this is unclear, I will endeavour to explain it more fully.
Kind Regards.

Yours faithfully,

Dee Speers

foiofficer, Parliamentary and Health Service Ombudsman

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D. Speers left an annotation ()

There are some very worrying aspects to this in so much as the number of complaints seem to be just a tiny percentage of what the Healthcare Commission had to deal with. There must now be very real concerns about how effective the PHSO complaints service will ever be.
It appears that if there is a recommendation for escalating a complaint to the PHSO, only 1.5% of comp-laints will get accepted for investigation which begs the question....."whats the point?"

Dear Ms Hannan,

Following my earlier questions could I please add these questions, which have arisen after reading a FOI request to the LGO. As both Ombudsmen are now part of the Health and Social care system and I currently have my complaint being re-reviewed again after initial assessment declined an investigation. Therefore, I feel these may need to be answered too.

1) How many PHSO decisions are modified as a result of a Review or a re-review?
I appreciate that this might be difficult to quantify but I am happy to recieve a response to data held on:

2)How many 'non investigation' decisions by the PHSO's Assessment Panel since April 1st 2009 have been turned into 'investigation decisions' following a Review Team review or handling of a complaint against the PHSO?

3) How many review requests/complaints against the PHSO have been processed by the Review Team in total since April 1st 2009?

I am grateful for your time, thank you.

Yours faithfully,

Dee Speers

foiofficer, Parliamentary and Health Service Ombudsman

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Hannan Liz, Parliamentary and Health Service Ombudsman

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Dear Ms Speers
 
Please find attached my acknowledgement of the information requests you
made on 30 October 2009, in which I have listed the requests which I
identified.
 
Yours sincerely
 
Liz Hannan
Freedom of Information and Data Protection Manager
Parliamentary and Health Service Ombudsman
0300 061 4320
 
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Dear Hannan Liz,

Many thanks for your recent response and for your clarification, particularly on the first three bullet points, where I confirm I was indeed talking about Health Complaints to the Health Service Ombudsman.

However, this also applies to bullet point number four
and for ease of reference I repeat here "How many cases from those cases selected for investigation in the same period have been upheld?"
I confirm that by "upheld" I mean "a finding of maladministration or service failure with injustice" of course if the PHSO has other categories of 'upheld' then I would be grateful if you could provide a breakdown of these please.

I accept your comments on the non-factual evidence and thank you for pointing this out. I'm afraid my questionning becomes more focused depending on the time of year and with talk of family and Christmas, I'm afraid I am filling the void caused by the death of my son, but with perfectly reasonable questions I feel.

I do however get a little mixed up in factual, recorded and published information, for which I apologise and once again thank you for your time.

Yours sincerely,

Dee Speers

D. Speers left an annotation ()

The most worrying aspect of this now is that having sought confirmation of who regulates what....I have had this back from DH "I can assure you that this is not the case and the *Care* *Quality* *Commission* (CQC) is the regulator for all mental health services."
http://www.whatdotheyknow.com/request/20...

But if CQC has no role in complaints, they will not be alerted to anything wrong via the complaints route. It appears the CQC will rely entirely on statistics of deaths in hospital recorded by the Strategic Heath Authorities (SHA) but only if the SHA find out, record and notify them to the CQC.

a) If the CQC go looking say for i.e. a statistically unexpected high incidence of death, firstly as this is optional, we are assuming that CQC will be bothered to do something about it anyway, (especially given the public funding squeeze). It will take a very tenacious complainant to find a way through to resolution
....especially as the Parliamentary Health Service Ombudsman (PHSO) only investigates approx 300 cases per year: http://www.whatdotheyknow.com/request/18...
....approx 1.5% of complaints brought to the PHSO.

If this is correct then this effectively means, that no matter how much time and effort the complainant has to put in, 98.5% of complainants will not get any resolution to their complaint.

This is as compared to the Healthcare Commission who from the 140,000 NHS complaints they received per annum accepted 20,000 for ongoing review, sending the most serious concerns for full investigation.

History shows however, that the CQC (and Healthcare Commission before them) will reluctantly and occasionally make an example of a Trust e.g. Maidstone and Tonbridge, but only when it all hits the fan e.g. over MRSA and C-diff. In this particular case there were many other trusts that had a worse record and seemingly were not investigated.

And what has happened about all those failures at Mid-Staffordshire Foundation Trust?

The proposed system of regulation is, in my opinion, (which is based on four years of intensive exploration the NHS complaints system) FUNDAMENTALLY FLAWED.

Foundation Trusts are not affected as they have autonomany to interpret local needs (if local people are independentally involved in identifying these!)

The annual self-declaration process is being abolished in 2010 (as is National Suicide Prevention Policy) and Trusts will have a nominal, ongoing responsibility (as not enforceable, whether it is fulfilled remains to be seen!)to notify CQC of any situations of possible non-complaince with a core-standard arising as they occur. With no "locally aware" independent scrutiny of what is notified to CQC(or what is not notified to the CQC and should have been) it is unlikely that much will be notified by the trusts perhaps given pressure on targets and funding.

If Trusts really do use the systems at CQC and SHA as intended it may possibly affect the annual 'glowing ratings' from CQC. For a level playing field and in the best interests of PATIENT SAFETY, all trusts MUST take responsibuility and report as per guidance (which is also optional at present!) We either need full enforcement of policy and guiidance at management level or fully independent funding at local level.
Who is the best body with sufficient local knowledge to independently scrutinise the trust claims, I am not sure. But whoever is identified, they would also need some teeth and funding independent of the trust of course.

Hannan Liz, Parliamentary and Health Service Ombudsman

Dear Ms Speers
 
Thank you for your e-mail of yesterday, and for your further clarification
and explanation.   As I said, we aim to respond to your requests by 27
November 2009.
 
Yours sincerely
 
Liz Hannan
Freedom of Information and Data Protection Manager
Parliamentary and Health Service Ombudsman
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Dear Ms Speers
 
Please find attached my response to your information request, our
reference FDC-72062.
 
Yours sincerely
 
Liz Hannan
Freedom of Information and Data Protection Manager
Parliamentary and Health Service Ombudsman
 
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Dear Ms Hannan,

With grateful thanks for your comprehensive response, I appreciate your time.
I am aware that the Ombudsman service is also now involved in social care and my sincere apologies for this late request but just so that I can get as full picture as possible can you please advise: How many of the PHSO staff are involved in Health complaints"? What is the ratio of staff between social care and health complaints?

I hope this is clear, if not my apologies and please re-ask for clarification if needed.
Once again thank you.

Kind Regards
Dee Speers

Dear Ms Hannan,
So sorry, I'm likely to confuse the situation again!
On further reflection,I realized Health and Social care are now one and the same people. Sorry for any confusion.

Maybe if I just specify......here goes!:
1) How many staff deal with Parliamentary complaints?
2) How many staff deal with Health (which may involve some social care!)
3) How many general/admin staff are there?

I trust this makes more sense.
Kind Regards
Dee Speers

foiofficer, Parliamentary and Health Service Ombudsman

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Hannan Liz, Parliamentary and Health Service Ombudsman

Dear Ms Speers
 
Thank you for your e-mail of 25 November 2009.   You have asked how many
of the PHSO staff are involved in health complaints and what is the ratio
of staff between social care and health complaints.   We do not hold
information on the number of staff involved in health complaints.   I
should explain that many of the Ombudsman's staff work on both
parliamentary and health complaints and no information is kept on the
split of staff time between these activities.   Nor do we have any
information on staff time spent on complaints involving social care.   It
follows that I cannot provide you with the information you seek.
 
You may, however, find the following information helpful.   As at 1
December 2009 a total of 114 people (90.1 full time equivalent staff),
were employed in the Parliamentary and Health Investigative
Directorates.   Of these 87 people (64.29 full time equivalent) work
within the Health Investigations Directorate and 27 people (25.81 full
time equivalent) work within the Parliamentary Investigations
Directorate.   All these staff spend most, but not all, their time
investigating complaints, although they will also spend some time on
assessing whether complaints should be investigated.   Additionally at 30
September 2009 the Customer Service and Asssessment Directorate (CSA)
employed 156.23 full time equivalent staff.   CSA staff spend most of
their time working on both parliamentary and health enquiries, ie
complaints to the Ombudsman which have not been accepted for
investigation.   The figures I have provided do not include agency
staff.   They do include managers, support/administrative staff and, in
the Health Directorate, clinical advisers.   Outside of these three
Directorates there are a number of other staff who work on both
parliamentary and health complaints.   The Ombudsman also employs staff
which are not involved directly in working on complaints made to the
Ombudsman, for example finance and human resources staff.
 
I have now completed my response to your recent information request.
 
Yours sincerely
 
Liz Hannan
Freedom of Information and Data Protection Manager
Parliamentary and Health Service Ombudsman
 
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D. Speers left an annotation ()

One thing that seems to be coming across is that the 'medical advisers' are not independent as they are employed by the PHSO. So could there be a concern that advice of 'variable quality' shows up this lack of independence?

I also wonder if any medical advice is sought on a case before it goes to the Assessment Panel or whether advice is only sought on case after they have been accepted for investigation?

I suppose it all depends on how many medical advisers are employed? Also, do we know if all valid cases (aka ones that have been through Local Resolution at Trust level) are put to the PHSO Assessment Panel for a yes or no to investigation.....or is there another screening process before that?

Happy to receive knowledgeable comments.
Thanks:o)

“Dear Ms Hannan,

With much appreciation for your kind responses, I am grateful for your help in my understanding of the PHSO process.

As I have explained and I now more fully realize, the tragic loss of my son makes a big difference to my questioning at significant times of year. I suppose as Christmas is looming I am back in questioning mode and seek your patience with me.

In reading your recent response, one thing that seems to be coming across is that the 'medical advisers' are not independent as they are employed by the PHSO.
So could I politely inquire if there could possibly be a process concern that advice of possible 'variable quality' may show up this lack of independence?

I also wonder, at what part of the PHSO process is medical advice sought?

To be clear:

1) is any medical advice sought on a case before it goes to the Assessment Panel

2) or is medical advice only sought on a case after the Assessment Panel have accepted it for investigation?

Just thinking things through....I suppose it all depends on how many medical advisers are employed?

1) How many medical advisers does the PHSO employ?

2) Does the medical adviser commissioned by the PHSO have specific expert knowledege of the concerns in the complaint?

Also, I trust you are the expert to seek this advice from please?

1) How can I find out if all valid cases (aka ones that have been through Local Resolution at Trust level) are put to the PHSO Assessment Panel for a yes or no to investigation?

2) Is the Assessment Process the only screening process

or is there another screening process before that?

Thank you again for your patience and for your help in my understanding of gaining a better insight to the new PHSO 'complaints' process, I also appreciate your time.

Kind Regards

Dee Speers

Hannan Liz, Parliamentary and Health Service Ombudsman

Thank you for your e-mail. On Thursday 3 December I am at our Manchester Office. I work part time and my next working day at my desk is Tuesday 8 December. My e-mails are not being forwarded. Please e-mail [Parliamentary and Health Service Ombudsman request email] if you require a response before then.

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Dear Ms Hannan,

Whenever you can respond I would be most grateful.
Thank you

Yours sincerely,

Dee Speers

Hannan Liz, Parliamentary and Health Service Ombudsman

Dear Ms Speers
 
Thank you for your e-mail of 3 December 2009.   I write to acknowledge the
information request made in that e-mail.   You have requested the
following information:
 
1) is any medical advice sought on a case before it goes to the
Assessment Panel

2) or is medical advice only sought on a case after the Assessment

3) How many medical advisers does the PHSO employ?

4) Does the medical adviser commissioned by the PHSO have specific expert
knowledege of the concerns in the complaint?

5) How can I find out if all valid cases (aka ones that have been through
Local Resolution at Trust level) are put to the PHSO Assessment Panel for
a yes or no to investigation?

6) Is the Assessment Process the only screening process or is there
another screening process before that?

We aim to respond to your information request in January 2010.
 
Yours sincerely
 
Liz Hannan
Freedom of Information and Data Protection Manager
Parliamentary and Health Service Ombudsman
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Dear Ms Hannan,

Thank you for your kind response and I look forward to receiving this information in the New Year.
Can I take this opportunity to send you Seasons Greetings and thank you for your responses to date......they have been very helpful to me.

Yours sincerely,

Dee Speers

Hannan Liz, Parliamentary and Health Service Ombudsman

Thank you for your e-mail. I work part time and my next working day is Wednesday 16 December. My e-mails are not being forwarded. If you require an urgent response please e-mail [email address]

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Hannan Liz, Parliamentary and Health Service Ombudsman

2 Attachments

Dear Ms Speers
 
Please find attached my response to your recent information request,
together with the attachment referred to in my letter.
 
Yours sincerely
 
Liz Hannan
Freedom of Information and Data Protection Manager
Parliamentary and Health Service Ombudsman
 
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Dear Hannan Liz,

Just to thank you for your responses to my FOI requests. I greatly appreciate your help in this matter. I have the information I have requested and after adsorbing the replies, if I have further questions I shall link to this under a new FOI request if I may.

Thank you again and Happy New Year

Yours sincerely,

D. Speers

Hannan Liz, Parliamentary and Health Service Ombudsman

Thank you for your e-mail. I work part time and my next working day is Wednesday 13 January. My e-mails are not being forwarded. If you require an urgent response please e-mail [email address] though please be aware you may not receive an immediate response.

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