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The NHS is Unregulated and Patients Carry the Risks

The absence of appropriate checks and balances is the biggest problem with the NHS.

Britain’s National Health Service (NHS) is unregulated and patients carry the risks to all practical purposes. The avoidable death of Sam Morrish in December 2010 and his parents’ struggle for justice has resulted in a report, which admits a “catalogue of errors” by public authorities who misdiagnosed and mistreated his sepsis. This has become a familiar narrative for Britons since similar reports emerged in 2009: poor health care, frustrating investigations and belated admission of mistakes, without personal blame.

What makes this story more revealing is the moral weight of his parents’ criticisms of the Parliamentary Health Service Ombudsman. The body released its report with self-satisfaction that the system was working — supposedly showing that it investigated, found the truth and served justice. In actual fact, the Ombudsman had frustrated these poor parents with lethargy and incompetence. They (Susannah and Scott Morrish) have complained about the length of time the Ombudsman took to report, and the factual errors in the two prior drafts — piling unnecessary distress on top of injustices.

From all accounts, the Ombudsman’s reports are generally late and error-strewn, casting doubt on the motivations and skills of those employed there. The Ombudsman, as a body, is idle and irresponsible, taking advantage of a system with too many other authorities to blame. I have written about this chaotic, confusing and unaccountable system, which persists due to political and professional interests in avoiding accountability:

1) The NHS in its various ephemeral managerial forms, such as NHS England

2) Its various local “NHS trusts” that deliver services

3) The Care Quality Commission (CQC) that is supposed to inspect practitioners, but passed the Morecambe Bay Hospitals Trust as “outstanding” every year until an inquest in 2011 into elevated rates of mortality amongst mothers and babies

4)Nine ever-shifting health profession regulators that are recognized by the Professional Standards Authority

5) A Professional Standards Authority that is always satisfied with all the regulators, but does not investigate individual cases, except during random audits

The Ombudsman will not even admit a complaint, until a complainant proves that all other relevant authorities have failed to investigate properly. Each authority can avoid complaints by claiming that some other authority is primary. It can make the complaint process as frustrating as possible in the hope the complainant gives up. British health authorities have no standard for response times; typically, months pass between correspondence, at which point the complainant should fairly conclude they are being ignored. If a complainant escalates to the Ombudsman, the authority would avoid the body’s investigation by claiming the complainant has not completed its set process. Complainants face all the burden of proving that some authority has behaved unjustly and not investigated properly. Years go by in the process until most complainants run out steam.

Britain’s National Health Service (NHS) is unregulated and patients carry the risks to all practical purposes.

My reluctant but rational advice to anyone thinking of complaining is: don’t bother; you will almost certainly suffer years of more injustices without resolving any.

Stepping In: Dame Julie Mellor

In 2012, a new Health Ombudsman took over: Dame Julie Mellor. In July 2013, she promised a ten-fold rise in the number of cases the Ombudsman would tackle. But this would raise its investigation rate from just 1% to 10% of complaints, which she has not yet fulfilled. In any case, how did she calculate that 10% of complaints should be investigated rather than 5% or 15%? This is as arbitrary a proportion as any other. Are we to believe that 90% of complainants are so mistaken or corrupt that their complaints have no merit?

Complainants do not expect material gain. The Ombudsman almost never recommends compensation; the parents of Morrish have been offered just £20,000 for the loss of their child and three-and-a-half years of heartache. The average compensation for families of patients who died unnecessarily under the care of Stafford Hospital in 2007 was just £11,000.

Mellor has not given the impression that she is leading, but she often blames other authorities. In August 2013, Mellor gave an interview to The Daily Telegraph, in which she criticized the “toxic culture” in hospitals that frustrates complaints. Her solution? Hospitals should have 24-hour telephone lines and responsible staff. She did not suggest more accountability.

Even if the Ombudsman were to inspect, it refuses to investigate persons — only organizations. Consequently, the worst that 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.

That Susannah and Scott Morrish succeeded in getting the Ombudsman to investigate at all is a testament to their unusual skills of communication and tenacity, with dignified calm, and the clear malpractices they unveiled. Now, their complaints are about the Ombudsman. They ask: To whom is the Ombudsman accountable?

All health authorities are supposed to be accountable to the Ombudsman, but the body is accountable to practically no one. The Ombudsman is paid out of public money, but is not a civil servant or accountable to the public. Mellor has spent most of her career in commercial and quasi nongovernmental organizations — never as a health practitioner. One would naturally think the Ombudsman would be accountable to the Ministry of Health, but the government department happily indicates that the body is independent and, therefore, free of political bias.

Regulation or Collusion?

The highest regulatory authority on health in Britain is the Health Committee — formed from members of parliament. It does not investigate much or often, but released its latest report just one week before the Ombudsman revealed details of the Morrish case.

I was involved in the Health Committee’s latest investigation and can report personally on a waste of effort all around, which helps to explain the idleness and irresponsibility at every level from the Ombudsman down.

The committee’s latest investigation was an accountability hearing with the Health and Care Professions Council (HCPC), which is responsible for social workers. Social workers were once regulated by the laissez-faire General Social Care Council, which was abolished in 2012. So considerable uncertainty surrounds the regulation of social workers, who have been the most scandal-ridden over the last decade.

In 2013, I wrote to the Health Committee suggesting such a hearing, noting it was overdue. The committee had no plans at the time. I was surprised in January 2014, when the committee told me it had scheduled an accountability hearing into the HCPC. I was even more surprised when asked to submit a statement. Within days it had gathered all verbal and written evidence.Then nothing happened. I asked if I could expect any further investigation or report. The committee expected to report in the near future. However, I did not hear anything until June 17, when I received a copy of the report, just one day before its public release. I was never invited to comment. It made no reference to my submission.

Instead, the report quotes extensively from the verbal evidence by leaders of the HCPC but provides no criticisms. The report has practically no conclusions or recommendations, apart from some airy concern that perhaps things could be better. This is not regulation, it is collusion.

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

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