By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist 30 September 2016
The Parliamentary and Health Service Ombudsman (PHSO) is a troubled organisation that has been much criticised. It has protected other elements of the great NHS denial machine.
PHSO was criticised, including by Sir Brian Jarman [1], for carrying out too few investigations on complaints received about the NHS. The Ombudsman subsequently promised to increase PHSO’s rate of investigation. [2] PHSO dramatically increased the number of investigations but with dwindling resources, and questions arose about the quality of investigations. PHSO whistleblowers supported this impression earlier this year, when they complained of a “toxic environment” at PHSO, and they raised concerns that:
“…many PHSO complaint assessments were rebranded as investigations and varied in quality” [3]
PHSO has also experienced other scandal regarding questions of neutrality and probity, for example at Morecambe Bay, [4] in the handling of contracts, [5] and the appointment of Mick Martin, deputy Ombudsman – the latter despite two warnings by a harmed former employee and by Monitor. [6] Reports of unsatisfactory and slow PHSO investigations continue to arise. [7]
The PHSO is the last port of call for whistleblowers who have been unable to resolve their concerns through the health watchdog, the Care Quality Commission (CQC). Whistleblowers are often blocked and frustrated by CQC, which does its best to deal superficially with their disclosures. Whistleblowers often report that CQC prefers to accept assurance from employers, without too many questions asked and without examination of all the evidence. This was illustrated by an FOI enquiry about Sheffield Teaching Hospitals NHS Foundation Trust, which revealed that of 22 external whistleblowing episodes to CQC over three years, CQC relied on the trust’s investigation in 17 matters, and only one matter was externally reviewed. [8]
The situation is similar for complainants. The charity Action Against Medical Accidents (AvMA) has recently reviewed CQC inspection reports and has demonstrated disappointing failure in CQC’s regulation of the legal duty of candour, a fundamental care standard. AvMA noted:
“We noted that all of the inspections were heavily reliant on comments from the trusts regarding their own implementation of the duty of candour.” [9]
An FOI request to PHSO in 2015 showed that PHSO had received a total of 354 complaints about CQC since CQC’s inception, but none had yet been upheld. Only 17 (5%) of the 354 complaints had been investigated by PHSO. At the time of the FOI disclosure, PHSO had not upheld 11 of the 17 investigated complaints, and 6 of the complaints were still under investigation.
PHSO’s FOI disclosure of 21 September 2015 about its handling of complaints against the CQC is uploaded here: phso-foi-response-re-complaints-about-cqc-21-september-2015
Can we really believe that there have been no valid complaints about the equally criticised CQC?
The “circular assurance” described by Bill Kirkup in his investigation report on Morecambe Bay [3], in which NHS bodies pass flawed and superficial assurance amongst themselves whilst dismissing and minimising evidence from whistleblowers and complaints, still thrives.
“5.162 Assurance had become circular. The CQC was taking reassurance from the fact that the PHSO was not investigating; the PHSO was taking assurance that the CQC would investigate, the NW SHA was continuing to give assurances based in part on the CQC position. Monitor asked for assurance and received the perceived wisdom – that the issues were under control and minimal. At no time did Monitor question these circular arguments or the improbability of cultural concerns being resolved within six months.”
And they all lived happily ever after…. except the complainants and whistleblowers.
Items to cross-reference
See these notes on complaints about CQC (2644 complaints over six year), set in the context of CQC’s various pronouncements on best practice complaints handling:
https://minhalexander.com/2016/10/02/do-complaints-matter-to-cqc/
References
[1] Not many complaints are investigated. Prof Brian Jarman 14 May 2013
http://www.nhsmanagers.net/guest-editorials/not-many-complaints-are-investigated/
[2] Health Ombudsman to investigate more complaints, Simon Cox, BBC 19 July 2013 http://www.bbc.co.uk/news/health-23357866
[3] Whistleblowers expose ‘toxic environment’ at PHSO, Shaun Lintern, Health Service Journal, 22 March 2016
[4] The report of the Morecambe Bay investigation, Dr Bill Kirkup, March 2015
Click to access 47487_MBI_Accessible_v0.1.pdf
[5] Health Ombudsman was investigated over ‘contract’ failings. Shaun Lintern, Local Government Chronicle, 16 October 2014
[6] Report of investigation by Sir Alex Allan into PHSO’s appointment of Mick Martin, formerly of Derbyshire Healthcare NHS Foundation Trust
https://minhalexander.files.wordpress.com/2016/09/phso-mick-martin-sir-alex-phso-report.pdf
Helen Marks awarded £832, 711 by Employment Tribunal, BBC 16 February 2016
http://www.bbc.co.uk/news/uk-england-derbyshire-35581737
[7] https://twitter.com/AverilsDad/status/773109263707283456
https://twitter.com/AverilsDad/status/778599178683514881
[8] FOI diclosure by CQC about its handling of whistleblowers’ concerns about Sheffield Teaching Hospitals NHS Foundation Trust
cqc-data-disclosed-2-08-2016-by-foi-sheffield-teaching-hospitals-whistleblowing-contacts_ir7989-v2
[9] Regulating the duty of candour, AvMA August 2016
Alexander's Excavations 
Excellent summary of the system protecting the system and nobody else. Well done and keep on shining the light on institutional corruption.
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