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Published 4 June 2018
When it comes to the delicate and complex issue of complaints made to the NHS, diplomacy is vital, tempered with honest, plain talking.
Straight talking is clearly a strength of the Parliamentary and Health Service Ombudsman (PHSO), Rob Behrens, who despite being in the post for just over a year has already implemented several changes.
“It’s been a tough, character-building experience,” says Behrens. It’s an honest assessment about the challenge he faced when taking on leadership of the body that independently and impartially makes final decisions on complaints that have not been resolved by the NHS in England, UK government departments, and other UK public organisations.
Behrens’ predecessor, Dame Julie Mellor, had previously resigned and Behrens says: “I joined an organisation that had lost its two senior leaders, where staff morale was low, where the office had lost contact with colleagues in the Ombudsman world and other key stakeholders, where too many complainants were unhappy with their experience, and where we were confronted with a 24% budget cut over three years.”
In partnership with his Chief Executive Amanda Campbell, progress has been made. “We have devoted an enormous amount of time on engaging with staff on a daily basis, individually and collectively. We have invested hugely in staff training and development. We have clarified our core role as an independent Ombudsman service, with morale improving significantly.
“We are now more of an open-faced organisation. We have open meetings, launched Radio Ombudsman – a regular podcast featuring conversations on various topics – and have reconnected with the Ombudsman world.”
A new user-friendly, more effective case handling process for complainants has also been introduced. It puts them at the forefront of the process to ensure better communication.
Behrens came with considerable experience of investigating allegations of public service failure. Previous roles include Complaints Commissioner at the Bar Standards Board and Independent Adjudicator for Higher Education (Office of the Independent Adjudicator) in England and Wales. With the Ombudsman office currently in the middle of a three-year budget reduction of 24%, Behrens has faced some tough decisions.
Staff numbers have been cut by 13% as a cost saving measure, he says, adding: “We have moved our operations to Manchester saving a huge amount of money on releasing property in London. We have reduced our staffing by 60, which has been painful but necessary, and now we are in a strong position to deliver the required spending cuts.”
Asked what he has found most rewarding during his first year in office, Behrens says: “Closing cases that have been unresolved for too long and also meeting bereaved and distressed complainants and listening to their experience.”
He is also proud of publishing two insight reports – one on anorexia and one on general mental health provision.
“When I joined, it was an organisation in transition, which was not performing well. It wasn’t clear what its core role was anymore. My aim was to create an organisation that reflects the Ombudsman DNA – meaning being independent of bodies in jurisdictions, but also of complainants.”
Behrens’ plans for the future are encapsulated by a new strategy. “The strategy is necessary because there was a lack of clarity in the organisation about the relative status of complaint handling on the one hand, and doing insight work on the other. “The core role of the Ombudsman service is to resolve complaints as effectively as possible. Out of that come the insight reports building on the experience of handling complaints.
“The strategic plan addresses that. We want to introduce techniques that are used in other Ombudsman services like early resolution of cases, or mediation. “That will shorten the time it takes to resolve a complaint, but also we have to be more transparent in all that we do. Over a period of time, we will publish summaries of everything that we adjudicate on in the course of a year.”
Behrens is determined that more complaints should and could be dealt with locally before they reach his office. “We get around 120,000 calls a year from people asking for help and we get 30,000 complaints. Many of these should be resolved on the frontline in the health service and public administration.
“Complaint handlers, particularly in the health service but also more widely, are desperate for status, for support, for recognition and for help in developing more effective methods in dealing with complaints.
“We will work with bodies in jurisdiction to help them resolve complaints more effectively. It’s very difficult for them [complaint handlers] in a culture that gives primacy to professional clinicians. Challenging clinicians in a constructive way is a skill and they need support and advice about how to do that.”
The work of the Ombudsman office must maintain a balance between recognising the good work that the NHS does and ensuring that mistakes are dealt with appropriately, Behrens explains. “When you go out and visit nurses on wards and talk to clinicians and patients, you realise what a magnificent achievement the NHS is.
“But there is no doubt that this is a service under extreme pressure. We have an increasingly elderly population, an under-resourced sector as far as mental health is concerned (see page 8), and we have historic problems of resourcing professional posts in particular areas of the NHS.
“These are big issues and it means there are detriments to individuals and things that need to be done better. But we must do it in a way that doesn’t undermine the morale of the good people who are providing a public service.”
In 2016-17, the Ombudsman service handled 31,444 complaints and investigated 4,239 cases. During 2016, it completed 835 investigations into potential avoidable deaths in the NHS in England, of which 368 were fully or partly upheld.
The office’s workload appears to be growing and in September of last year, NHS Digital data showed that the number of written complaints about the NHS increased by 4.9% (208,400) on the previous year. Behrens believes this trend could continue.
“The demographics mean that it’s likely there will be a rise in complaints over a period of time. What worries me is that there are sectors of users in the health service who don’t complain as much as they might do, such as older people or people with mental health challenges.
“We found that too many people feel they will be victimised when they are elderly if they make a complaint.”
Work is also needed to improve the public’s knowledge and perception of the Ombudsman office. “Only around 22% of the public in surveys are aware of the existence of the National Ombudsman,” says Behrens.
“I have a responsibility to promote the role of the Ombudsman, explaining very carefully to people that we are not there to be their champions, but to impartially investigate their complaint with empathy. We have to work with those bodies [local NHS organisations] to make sure that they can resolve as many cases as they possibly can, but in terms of good practice, it is a national asset to have a last resort for complainants who can come to us if they have exhausted the frontline service and don’t get the remedy they think they deserve. There should always be that opportunity for people.”
The Government’s plans for a single Public Service Ombudsman (PSO) role, that would combine the current local government and social care Ombudsman office with his role, is welcomed by Behrens.
“Even before I came here, I argued in favour of it,” he says. “I am disappointed that the implementation of the legislation has been put on hold. It may be a number of years before we actually get it.
“We need it because it’s not sensible to separate health and social care in the way that it is currently. We have very close and cordial links with the local government Ombudsman, but we need a new, joined-up institution that can effectively deal with those cases holistically.
“We need new powers for the Ombudsman. Around the world, most Ombudsmen have the right in exceptional circumstances to look at cases or issues where there hasn’t been a specific complaint. We should have that power.”
Self-confidence at the Ombudsman office appears to be returning.
Anne Crofts, Alistair Robertson