The response to Covid has had countless pernicious effects. But one you are unlikely to have heard about in the news is the damage done to one of England’s most important public bodies.
Since Covid, you are far less likely to have your complaint about the NHS investigated by the Parliamentary and Health Service Ombudsman (PHSO). The vital service offered by the PHSO has been quietly – and unjustly – downsized to help it tackle a large backlog of complaints caused by lockdowns and other restrictions.
The decision by the PHSO to greatly limit the number of complaints it will now investigate was taken not by our elected representatives but by the Ombudsman himself and those closest to him in the organisation, which is independent from Government. There has been little public and media scrutiny of the decision and its consequences, in particular whether a different course of action could and should have been taken.
The most obvious harmful effect of the change is that many more members of the public are now being denied justice than they were before Covid. But there are other serious effects. Fewer health service providers and those in charge of them are being held to account. In the PHSO’s scramble to meet its self-imposed performance targets, many providers today face no penalties for their – often avoidable – failures. Consequently, they are no longer told by the PHSO to learn from their mistakes. Patients are now more likely to face risks which would have been addressed and greatly reduced before the Government’s self-serving reaction to Covid.
How, exactly, did we reach this point, and could it have been avoided? And when – if ever – will the public have access to the Ombudsman service it pays for and needs?
Many receive good care from the NHS. But when things go awry and if patients are unhappy with the way an NHS provider answers their complaint they can ask the PHSO to step in. Over 80% of its work concerns healthcare complaints. It handles tens of thousands of complaints each year. Although it investigates a far lower number than that, since it was set up in 1993 it has righted many wrongs and helped improve the NHS. It plays a crucial role in the health of the nation. But it has never been an easy job. Even before Covid its workload was high. Complaints can be complex and caseworkers daily face a series of difficult decisions about the many complaints they are handling.
The service is far from perfect, of course. Over the years it has received much criticism, much of it justified, but some selective and unfair.
For many of those who receive poor service from the NHS and who then complain to the PHSO, in April 2021 things suddenly got worse. A large swathe of complaints began to be summarily struck off the PHSO’s books. Back in March 2020, when Boris Johnson announced the first lockdown, NHS chiefs decided not to accept complaints from the public between April and June. And amid the sense of alarm intentionally generated by our Government, the NHS focused its attentions on Covid. The PHSO, in turn, suspended the processing of complaints in part because it was unable gather the information it needed from the now otherwise preoccupied NHS.
And, as with most companies and organisations across the country, the PHSO had to make the rapid shift to working from home. For the PHSO this was unlikely to have been easy. It required moving most of its operation into the homes of its staff, while fulfilling its obligation to protect the privacy of complainants’ data.
For three long months the processing of complaints by PHSO to decide which ones should be investigated and which ones reasonably rejected stopped. Those awaiting a decision on their complaint were held in limbo. While current cases were delayed, new complaints, needing assessment, began to stack up. On resuming its work in July 2020, the PHSO was further hampered. Covid restrictions meant the NHS responded more slowly to the PHSO’s queries than it had before the pandemic. If that wasn’t enough, paper-only files it needed from Government departments could not be accessed because everyone, everywhere was working from home.
The PHSO’s work in general was slower, further adding to the backlog. Its staff were less productive, with some having to balance working from home with educating children and supporting elderly relatives. To make matters worse there were technical issues. Cases were not correctly tracked and data monitoring was negatively impacted, hindering parliamentary oversight.
As a consequence of all this, the PHSO resolved far fewer complaints and the backlog of complainants waiting for an initial decision again grew. Rather than the usual three or four months, many had to wait up to a year. A sting in the tail was that – while the precise causes remain unclear – as Covid declined, the number of new complaints increased.