• World
    • Africa
    • Asia Pacific
    • Central & South Asia
    • Europe
    • Latin America & Caribbean
    • Middle East & North Africa
    • North America
  • Coronavirus
  • Politics
    • US Election
    • US politics
    • Donald Trump
    • Brexit
    • European Union
    • India
    • Arab world
  • Economics
    • Finance
    • Eurozone
    • International Trade
  • Business
    • Entrepreneurship
    • Startups
    • Technology
  • Culture
    • Entertainment
    • Music
    • Film
    • Books
    • Travel
  • Environment
    • Climate change
    • Smart cities
    • Green Economy
  • Global Change
    • Education
    • Refugee Crisis
    • International Aid
    • Human Rights
  • International Security
    • ISIS
    • War on Terror
    • North Korea
    • Nuclear Weapons
  • Science
    • Health
  • 360 °
  • The Interview
  • In-Depth
  • Insight
  • Quick Read
  • Video
  • Podcasts
  • Interactive
  • My Voice
  • About
  • FO Store
Sections
  • World
  • Coronavirus
  • US Election
  • Politics
  • Economics
  • Business
  • Culture
  • Sign Up
  • Login
  • Publish

Make Sense of the world

Unique insight from 2,000+ contributors in 80+ Countries

Close

British Health Department Must Handle Complaints Over Health Care

By Bruce Newsome • Apr 06, 2015

© Shutterstock

Why does the Department of Health not accept public health complaints?

The British Parliament’s Public Administration Select Committee (PASC) has reported that the authorities for investigating health care failures in the United Kingdom are too numerous and unaccountable.

One committee has at least criticized the structure of British health care, but the PASC airily follows all previous inquiries by recommending a lot of cultural change, and a little structural change, outside of the Department of Health itself. Thus, probably nothing will improve before yet more scandals, more investigations, more findings of the obvious and more recommendations for change — perhaps for another decade, like the decade that has passed since around 1,200 avoidable deaths occurred at Mid-Staffordshire Hospital.

The British political elite’s refusal to improve the government’s own accountability defies the most basic solution to human-sourced risks (people must be accountable for the risks of which they are responsible) and undermines the most basic principle of democracy (government should be accountable to the electorate).

Why a New Report?

The good news is the PASC has focused on the ultimate authority for complaints against health care: The misleadingly titled Parliamentary and Health Service Ombudsman (PHSO), which is neither accountable to parliament or government, nor responsible for any of the health services — not even the National Health Service (NHS) in its most general sense.

The PASC is commendable because, by comparison with the Health Select Committee, the PASC suddenly looks engaged. The Health Select Committee failed to investigate the PHSO. It does not audit any organization to a set routine; its most recent “accountability hearing” was of the Health and Care Professions Council (HCPC) in early 2014. This was overdue, since the HCPC absorbed responsibilities for social workers from the General Social Care Council, which was abolished in 2012 without any accountability for years of incestuous self-regulation of the most scandal-ridden profession in Britain. The Health Committee accepted the HCPC’s largely self-serving and evidence-free testimony with no effective challenge, while ignoring critical testimony, before concluding that perhaps social work could be better regulated, without any recommendation as to how.

This author commends the PASC with reservations about its belated and incomplete engagement: The PASC’s report is not the product of proactive or routine regulation. On page five, it admits several unrelated inquiries into avoidable deaths dating back to 2005, of which none prompted its own inquiry. Instead, it was prompted by a single academic article published in 2014. Why this article in particular, rather than the numerous earlier informed comments on these issues? The PASC does not explain.

© Shutterstock

© Shutterstock

Similarly, the PASC does not mention years of independent private complaints about the PHSO. For instance, in November 2014, the charitable Patients Association declared that the  PHSO “is unaccountable and wholly ineffective”; correspondents had reported that the “PHSO is failing families, leaving them distressed and totally worn down”; the Patients Association called on the PASC “to address the failings” of the PHSO “and establish a truly independent, transparent and people’s Ombudsman.” One month later, the PASC announced its investigation into the complaints system.

The Myth of Cultural Change

The PASC unambitiously and unscientifically follows all previous inquiries in calling for a change of “culture.”

In February 2013, Robert Francis QC completed a public inquiry into the scandal at Mid-Staffordshire Hospital. He made 290 recommendations, the most profound of which was a legal duty of care, which surprised ordinary people who naturally had assumed that “carers” already had a legal duty of care.

In August 2013, a clinical professor completed an inquiry into safety within the wider NHS, which recommended a legal duty for all health care workers to admit their mistakes, a “zero harm” culture and “minimum staffing levels.”

In January 2014, Secretary of State for Health Jeremy Hunt promised an “open culture that learns from errors and corrects them,” following the example of the airline industry. (That promise came in response to Francis’ report of one year earlier, which itself took three years to produce, nine years after the first of the deaths at Mid-Staffordshire Hospital.)

So we come to March 2015, when the PASC “commend[s] the Secretary of State for Health’s determination to tackle the culture of blame and defensiveness.”

This wisdom after the fact is years overdue and yet still not profound. Politicians are unwilling to investigate a structure for which they are ultimately responsible; they appoint vested lawyers and health care insiders, who incestuously consult each other and conveniently blame “culture,” which — as an attribute of a collective — is nobody’s responsibility. Nobody consulted a scientifically-minded organizational designer or risk manager.

The Need for Structural Change

Cultural change is useless without structural change. As taught at the most introductory level of risk management, culture is just one of the three main dimensions of any collective. To change culture, one would need to change structure and process too, otherwise the dimensions would be incongruent. The culture needs to support the structure and processes of risk management, and vice versa. For instance, if members normatively think of the processes of risk management as too burdensome (a cultural problem), they are less likely to follow the processes (a procedural problem). To reiterate the process would be useless — the practitioners already know the process, they just don’t culturally value it.

A change of culture starts with structural change. Structure refers mainly to patterns of responsibilities and authorities. The authorities are those persons or organizations assigned to determine how risk should be managed. The responsible parties are supposed to manage risk as determined by the authorities.

Tangible structural recommendations would include stronger leadership of compliance, more frequent and deeper investigation of non-compliance, more rewards for compliance, more punishment for non-compliance and more frequent reviews and audits.

© Shutterstock

© Shutterstock

Under-Reporting of Risk

Compare the prescription above with current cultural impunity and structural unaccountability. In a rare editorial, followed by an interview, Health Ombudsman Julie Mellor criticized the NHS’ “toxic cocktail” of a “culture of defensiveness” and “a failure to listen to feedback.” Her most tangible recommendations were for 24-hour telephone lines and staff responsible for answering complaints. She did not suggest that the subjects of complaints should be more accountable. The PHSO refuses to investigate persons — only the organizations that have failed to satisfy complainants locally. In fact, the subjects of complaints are often anonymized in reports. Consequently, the worst an organization can expect is a ruling that “mistakes were made,” for which it should apologize and perhaps compensate, but no particular person is ever named as responsible.

Unaccountable systems are riskier systems. Unaccountable practitioners are not incentivized to control risks beyond the demands of their personal ethics, which can be overridden by natural, everyday contradictions as simple as laziness and distraction. When practitioners are not held to account, they develop cultures of impunity and are not forced to learn from mistakes.

In November 2013, the HCPC admitted finding that 20% of British adults had encountered behavior from a health or care professional that cast doubt on his or her fitness to practice, yet only 6% of British adults actually complained. In 2014, the HCPC’s testimony to the Health Select Committee claimed an “easier route” for complainants, but this supposedly “easier route” remains unclear.

If the complainant were dissatisfied with the HCPC’s handling of a complaint, his or her only recourse would be the PHSO. The PHSO traditionally has investigated only 1% of complaints, as if 99% of complainants had the time and motivation to complain unnecessarily. In January 2015, the Health Select Committee reported that “most” complainants (more than 50%) are motivated to protect others from failings, not for personal gain.

In July 2013, Mellor — after more than 18 months as Ombudsman — suddenly promised a ten-fold rise in the number of PHSO investigations, but the PHSO actually investigated only six times as many in fiscal year 2013-14 as in the previous year, or less than 8% of complaints received by the PHSO. The PHSO receives a tiny fraction of all the complaints handled by the 70-odd actors in the complaints system. The PHSO investigated merely 2,199 complaints in 2013-14; the NHS alone received 175,000 complaints that year.

Mellor hypocritically testified to the PASC that “local” authorities were to blame for “under-reporting of incidents and therefore an under-investigating of incidents, and therefore continuing risk to patient safety.” However, most of the written evidence that the PASC received about the PHSO was critical.

This is most obvious in the PHSO’s investigation into the avoidable death of Sam Morrish, a 3-year-old, from sepsis. In July 2014, the PHSO reported with self-satisfaction that it had found malpractice at local providers, without admitting that it had frustrated the child’s parents with inexplicable delays (lasting more than two years) and factual errors in earlier drafts. The PHSO’s own errors only came to light because the parents, Susannah and Scott Morrish, spoke to the media (there being no authority to which they could complain about the PHSO). Secretary of State Jeremy Hunt wrote to Mellor criticizing her failures personally, but she has not had the decency to resign or reform; although she has promised “streamlining,” among other platitudes.

If dissatisfied with the PHSO, the complainant has no official recourse than civil action, which is practically and financially infeasible, except perhaps for those in the metaphorical wealthiest 1%. The complainant has no right of appeal against the PHSO. No parliamentary committee or politician can overrule it. The PASC can only examine its reports.

The Need for Structural Change

For a decade now, British inquiries and politicians have fallen over each other in their eagerness to call for cultural change, without recommending the structural changes that would drive cultural change. They are self-serving — they do not want to be responsible for negative events, so they pass the buck to a bewildering array of quasi-non-governmental organizations (QUANGO), which pass the buck between each other, to avoid the responsibilities of oversight and investigation, lest they come to share the blame with the subjects of complaint.

The PASC’s most useful contribution is to draw attention to more than 70 organizations involved in health complaints or investigations, of which no “single person or organization is responsible and accountable for the quality of clinical investigations or for ensuring that lessons learned drive improvement in safety across the NHS.”

None is subject to the Department of Health, which happily informs hundreds of complainants per month that it has no role in complaints. In response to the PASC, Hunt explicitly ruled out a complaints department (on logistical grounds).

The PASC, in consultation with the secretary of state for health, recommends “a national independent patient safety investigation body.”

While this author agrees with the recommendation for an investigative authority that is singular, national and independent of the providers and deliverers, it should not be independent of the Department of Health — it should be the Department of Health itself. The Department of Health is the ultimate provider of public health; it is accountable to the political administration and thence the electorate; it must admit its own responsibility for everything that happens in British health care, rather than to refer complainants to some successor to the PHSO. The Department of Health will need to start by reviewing tens of thousands of complaints that the PHSO arbitrarily refused to investigate.

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

Photo Credit: BasPhoto / Brendan Howard / Franck Boston / Shutterstock.com


Donate image - CopyWe bring you perspectives from around the world. Help us to inform and educate. Your donation is tax-deductible. Join over 400 people to become a donor or you could choose to be a sponsor.

Share Story
CategoriesEurope, Opinion, Politics, Science TagsBritain, British, Health Care, NHS, United Kingdom
Join our network of more than 2,000 contributors to publish your perspective, share your story and shape the global conversation. Become a Fair Observer and help us make sense of the world.

Fair Observer Recommends

How Global Britain Confronts the Asian Century How Global Britain Confronts the Asian Century
By Will Marshall • Aug 21, 2020
Are the UK and US Suing for Divorce? Are the UK and US Suing for Divorce?
By Peter Isackson • Jan 15, 2020
Brexit Goes to the Proms Brexit Goes to the Proms
By Anu Shukla • Sep 23, 2019

3 Replies to “British Health Department Must Handle Complaints Over Health Care”

  1. Avatar Della Reynolds says:
    April 8, 2015 at 6:43 am

    What an excellent article which hits several nails firmly on the right head. Without responsibility to get impunity and that leaves us all at risk. Shame you did not mention phsothefacts the PHSO Pressure Group who have been campaigning for reform of the Ombudsman for the last 18 months and contributed to the PASC review with our factual evidence of the horrendous experience of using PHSO to resolve complaints. Many of us found the complaint process more traumatic than the original incident. This article deserves more attention and I plan to share it widely on phsothefacts and through twitter. At least the debate has begun, but we must continue to push for a People’s Ombudsman to serve and protect the citizens from the abuse of power. Thank you for your valuable contribution. Della Reynolds.

  2. Avatar brenda says:
    April 8, 2015 at 8:16 am

    PA are not the only one’s pushing for change, read and what about James Titcombe? Lets get the whole picture. BUT we do have a NHS and we are at liberty to criticise it. I haven’t met any British person who wants NHS privatised so that big, often US business, can take it over to make large profits out of the sick and disabled, for their share holders.

    US can learn a lot from our NHS.

  3. Avatar Simon says:
    April 9, 2015 at 1:49 am

    Brenda- you don’t seem to have read the article: the article wasn’t about privatisation or the US.

Leave a Reply Cancel reply

You must be logged in to post a comment.

Post navigation

Previous PostPrevious The Sexuality of a Celibate Life
Next PostNext Kenya Remains Unbowed and Unshaken
Subscribe
Register for $9.99 per month and become a member today.
Publish
Join our community of more than 2,500 contributors to publish your perspective, share your narrative and shape the global discourse.
Donate
We bring you perspectives from around the world. Help us to inform and educate. Your donation is tax-deductible.

Explore

  • About
  • Authors
  • FO Store
  • FAQs
  • Republish
  • Privacy Policy
  • Terms of Use
  • Contact

Regions

  • Africa
  • Asia Pacific
  • Central & South Asia
  • Europe
  • Latin America & Caribbean
  • Middle East & North Africa
  • North America

Topics

  • Politics
  • Economics
  • Business
  • Culture
  • Environment
  • Global Change
  • International Security
  • Science

Sections

  • 360°
  • The Interview
  • In-Depth
  • Insight
  • Quick Read
  • Video
  • Podcasts
  • Interactive
  • My Voice

Daily Dispatch


© Fair Observer All rights reserved
We Need Your Consent
We use cookies to give you the best possible experience. Learn more about how we use cookies or edit your cookie preferences. Privacy Policy. My Options I Accept
Privacy & Cookies Policy

Edit Cookie Preferences

The Fair Observer website uses digital cookies so it can collect statistics on how many visitors come to the site, what content is viewed and for how long, and the general location of the computer network of the visitor. These statistics are collected and processed using the Google Analytics service. Fair Observer uses these aggregate statistics from website visits to help improve the content of the website and to provide regular reports to our current and future donors and funding organizations. The type of digital cookie information collected during your visit and any derived data cannot be used or combined with other information to personally identify you. Fair Observer does not use personal data collected from its website for advertising purposes or to market to you.

As a convenience to you, Fair Observer provides buttons that link to popular social media sites, called social sharing buttons, to help you share Fair Observer content and your comments and opinions about it on these social media sites. These social sharing buttons are provided by and are part of these social media sites. They may collect and use personal data as described in their respective policies. Fair Observer does not receive personal data from your use of these social sharing buttons. It is not necessary that you use these buttons to read Fair Observer content or to share on social media.

 
Necessary
Always Enabled

These cookies essential for the website to function.

Analytics

These cookies track our website’s performance and also help us to continuously improve the experience we provide to you.

Performance
Uncategorized

This cookie consists of the word “yes” to enable us to remember your acceptance of the site cookie notification, and prevents it from displaying to you in future.

Preferences
Save & Accept