Reviewing the Parliamentary and Health Services Ombudsman: From ‘Critical Care’ to ‘Recovery’

In recent years, the Parliamentary and Health Services Ombudsman (PHSO) – the organisation responsible for providing final determinations of complaints about UK central government bodies and the English NHS – has been organisation in crisis, as a result of leadership failures, high profile problems with its case handling, and a loss of confidence from key stakeholders. Following a recommendation by the House of Commons Public Administration and Constitutional Affairs Committee (PACAC), Chris Gill was appointed to an independent peer review panel (led by Peter Tyndall, President of the International Ombudsman Institute) tasked with reviewing the value for money provided by the PHSO. On 8 January 2019, the panel gave evidence at a PACAC scrutiny session and answered questions from Members of Parliament. This blog summarises the key findings of the independent review. 

Cost-per-case

 The panel considered that cost-per-case (dividing annual budgets by the number of cases handled annually) was a very limited measure of value that required significant contextualisation and sensitivity in terms of its interpretation. It was also a measure that excluded or underplayed a large amount of the added value that ombudsman offices delivered for their stakeholders. Nonetheless, the panel concluded – drawing on a comparative analysis with a leading UK public service ombudsman – that, on completion of its transformation programme, the PHSO’s cost-per-case would not be significantly out of step with other leading public services ombudsman offices.

Value for money in context

 While the panel appreciated the surface appeal of cost-per-case as a measure of value for money, it was strongly of the view that stakeholders should seek to adopt more qualitative and contextual approaches to understanding the value of ombudsman offices. In particular, cost-per-case approaches tended to under-value the importance of (1) advice, signposting, and support work delivered by ombudsman offices and (2) wider systemic work carried out with a view to improving public services. Consequently, the approach in the independent review focused on examining the PHSO’s current practices and plans for change and assessing whether these conform to established best practice.  

Leadership and change management  

The PHSO’s current senior leadership team is a significant strength of the organisation. The panel were impressed by the strong direction provided by senior leaders and the bold steps they had taken as part of their transformation programme. This included the development of a clear strategy and a holistic, cross-organisational approach to improving the structures and processes needed to deliver on that strategy. In the context of significant pressures and historical problems, the panel considered that the PHSO was now laying strong foundations for the future efficiency and effectiveness of the organisation. The panel was confident that, if current progress was maintained, the PHSO’s transformation programme would be successfully implemented.  

Casework process  

Despite remaining hampered by its legislation, the PHSO has put in place a set of reforms to its casework process that adopts widely used practices in the ombudsman sector. The panel agreed that the PHSO’s previous approach had been “stuck in time” and had failed to keep up to date with expectations from complainants and other stakeholders. Reforms included a greater focus on resolution, less double-handling of cases, and the use of generalist casework teams. While these steps were positive, the panel noted that further thought was required in relation to preserving caseworker expertise and developing a more efficient Casework Management IT System. The panel also noted that the PHSO faced particular challenges in relation to its casework – including the existence of the MP filter (requiring complaints to be made through a Member of Parliament), the lack of integrated jurisdiction, and the fact that around 80% of cases were about healthcare – which presented some limitations on achieving greater efficiencies.  

Thematic and systemic activities  

The value of the PHSO is not restricted to resolving disputes between individual citizens and public bodies. There is a broader systemic value to its work, where dealing with individual complaints provides information that allows for change in public services. The impact of this work is almost impossible to quantify, but the panel considered that the PHSO had made important contributions to public debate and practices in the public sector as a result of its systemic work, and that lives are likely to be saved and significant financial savings will also flow from this work. The panel’s main observation in this respect is that the PHSO’s underpinning legislation currently limits its ability to do more in terms of improving public services. The PHSO is now out of line with other UK public services ombudsman offices and wider international practice in this regard.  

Training and development  

The PHSO has created a new training programme for its caseworkers. The panel considered that this represented a model of good practice that was likely to be of interest to others in the ombudsman community. There was good evidence from staff evaluations that the training was effective and was a key part of helping develop better casework practice. The panel also welcomed the PHSO’s commitment to develop accreditation for caseworkers, which would be important in providing external assurance and improving public confidence in casework quality.  

Quality assurance and stakeholder engagement

 The PHSO has robust systems in place to manage quality. The panel noted that the PHSO had recently moved away from targets that had had unintended consequences on the quality of casework and that performance was now managed more holistically. The panel was particularly impressed by the use of customer feedback as a basis for assessing the delivery of Service Charter commitments. The panel also considered that the PHSO was very open to stakeholder feedback and had taken significant steps to restore public confidence in the service.

Conclusion and follow-up

 To use a medical metaphor familiar from the Ombudsman’s casework, the report concluded that, under its current leadership, the PHSO was moving out of ‘critical care’ and into ‘recovery’. Overall, from facing a set of severe challenges, the organisation is on its way to becoming an efficient and effective modern ombudsman service, which provides significant value for its stakeholders. The report’s conclusions were followed-up at an evidence session conducted by the House of Commons Public Administration and Constitutional Affairs Committee. This provided an opportunity for the key findings described above to be discussed in greater detail. The hearing can be watched on Parliament TV by clicking here and a transcript of the session is available here.