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Notes from the field of public involvement

Wednesday, 02 August 2006

Making a Difference - Annual Report 2005-06 of the Parliamentary and Health Service Ombudsman

Big Bucks, Big Business, Big Difference

What big business Ombudsoffices are these days. Earlier this month, we had the Financial Services Ombudsman's Annual report showing income and expenditure of some £53million. No wonder Walter's editorial in the latest FSO Ombudsman News is all about his office's review of the way it is paid for. Ann Abraham's Parliamentary and Health Service Ombudsman office comes in at about half that figure with what they call a 'net cash requirement' of £23.6million. One big difference is that the FSO's unit case cost is around £433 and as far as I can make out using the same calculation - total costs divided by the number of closed cases, the PHSO rough equivalent is £6400 - £23million/ 3606 cases closed in a year. I did not see a figure in their report.

The last time we wrote about the costs of complaint handling in our study My Anger Propelled Me on complaints in the health service, we gave an estimate of over £20,000 per fully escalated case. 'Fully escalated' means a case that has been handled multiple times by the originating Trust, gone through the Healthcare Commission and then up to the Ombudsman. What is this money buying?

Customer Satisfaction Ratings

Well quite a lot of customer satisfaction in the case of the PHSO with some 68% of complainants satisfied with the service they received based on a monthly tracking surveys between October 2005 and March this year. This is very good for an escalated complaint handling service. By this stage, the complaint has often become a battle to the death where any idea or prospect of satisfaction has long since been replaced by a wish to see one's opponents chained to a rock and pecked to death.

 When I started talking to Ombudsmen about complainant research in the 90s, the initial reaction was it was hardly worthwhile - the ones who got a decision in their favour would be satisfied and the rest not. But subsequent experience showed that complainants can separate outcome from process. Ann's report quoted some customer views of the service - letters being "a pleasure to read, because you took the time to listen and this was conveyed over to me" or "I really appreciated your calm, thorough and measured approach". Another complainant appreciated being contacted "when or even before we expected it".

A Modern Service Process

The importance of these sorts of satisfaction surveys is that they position Ombudsmen services as a customer service organisation. Before when people like the National Consumer Council looked at Ombudsmen, they put values such as equity or fairness first. The values remain important of course but complainants prefer a quality service. Good intentions are not enough. The PHSO's Three Year Strategic Plan 2006-09 lists detailed outcomes and measures where each outcome is to be assessed by one or more measures. All this adds up to three core priorities - quality, efficiency and influence.

And the most important of these is 'influence'

The amount of money the public sector spends on putting things right after the event is not known to me or to anyone else perhaps. The Audit Commission might be able to make a guess. Using our experience of the Health Service, our guess is that it is far too high both in the first instance and then again in terms of the subsequent complaint handling costs and we will not speak of the costs of legal proceedings on top of that.

This is why I put influence as being the principal justification of the PHSO's work. If by behaving like an efficient and high quality customer service organisation itself, it helps other public service organisations to understand and to prioritise good service themselves, its cost per case can be put in perspective.

Don't Do as I Do - leading with bad examples

The question of example arises again when we look at the government's reaction to the Ombudsman's work. The Public Administration Select Committee (PACS) makes the point very strongly in its report HC 1081 The Ombudsman in Question (links to Adobe PDF)

Talking about the Ombudsman's report on pensions, PACS states "This is the second time in less than 12 months that the Ombudsman has reported to Parliament that she has found injustice that has not been, or will not be, remedied..The Government has been far too ready to dismiss the Ombudsman's findings of maladministration". The report concludes "The Parliamentary Commissioner is Parliament's Ombudsman: Government must respect her".

So the Government is keen for Ombudsmen whether public or private sector to investigate, decide and request redress except when it is the Government in the frame. Parliament itself can hardly claim to be whiter than white here if you remember the shambles of the Filkin affair in December 2001. (In case readers have forgotten, Elizabeth Filkin was the Parliamentary Commissioner for Standards who resigned after what Martin Bell described as a 'real and intense' whispering campaign from senior MPs whose noses had been put out of joint by her investigations.)

With this sort of example - lesser mortals have to stump up (think endowments) but governments are exempt - what hope for service improvement through example? However there are other important influences at work that are pushing service improvement. Tony B's speeches about public service reform may be too readily dismissed as being too late and too feeble but things may have changed more than his opponents are ready to admit.

Historic Shift in Service Culture of the Administrative Staff

I believe we are seeing a historic shift in the public service with continuing calls for service delivery reform replacing the traditional Civil Service emphasis. In the old days, the prestige and job satisfaction were associated with advising ministers. Running service delivery processes was left to the non-commissioned ranks working out of grim offices in the provinces where the chairs were bolted to the floor for fear of spontaneous gestures of disappointment with the service by an unimpressed public.

Now the priority is turning to running service delivery organisations. There is still a very long way to go as we can see with the Child Support Agency burning to the ground yet again but it seems a possibility especially if the advice giving is taken over by political special advisers.

So the power and influence of an Ombudsman who sees the job not just as one to determine complaints but also to improve the whole service culture of an administrative class, creates an Office which is an energetic, principled and increasingly effective agent of change. And since Walter Merricks at the FSO is having a look at how to make people pay for complaint resolution services, when will we see the PHSO start charging its costs back to Trusts, the Healthcare Commission and other public bodies?

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