Artillery Row

Why is the government letting another quango mislead Parliament?

The PHSO misrepresents both inputs and outputs in pursuit of more funds and less litigation

The PHSO is supposed to be the final arbiter of complaints against public organizations, including health services (hence the unwieldy title: Parliamentary and Health Services Ombudsman). The PHSO investigated 30.6 percent fewer cases in 2019-2020 compared to the preceding year, even though enquiries fell by 7.4 percent. Yet, the PHSO misreported 13 percent more enquiries, as recently as August this year. 

I will unpack the data in a moment, but first let’s examine the two objectives for the PHSO’s false claim. 

The first motivation is to reverse cuts in the PHSO’s funding, each fiscal year, since 2016-2017. On 20 March 2020, the PHSO submitted its main budgetary request for 2020-2021: “PHSO has experienced a sustained 13% increase in demand. Additional resources to meet this demand were agreed as part of CSR19 (Comprehensive Spending Review 2019).” Two pages later, the request states:

We have seen a sustained increase in demand throughout 2019/20 of 13% and this is expected to continue into 2020/21. This is now impacting on previously good KPI (Key Performance Indicator) performance in a number of areas in particular the number of unallocated cases, which in turn is having an impact on the overall length of time that complaints are held within our system. This is resulting in a negative impact on Service Charter scores in relation to overall service provision.

Behrens is seeking more funds from the government and less litigation from the lawyers

On 18 May 2020, the Ombudsman (Rob Behrens) submitted written and oral testimony to Parliament’s Public Administration and Constitutional Affairs Committee (PACAC). One committee member asked why Behrens’ written statement included a demand for “necessary investment” before the PHSO could meet its “ambitions” in 2020-2021. Behrens’ answer was “that in the last period we took a hit of 24%. Since then, the volume of cases being submitted to us has risen, as with most ombudsman services, by 13%. That puts added pressure on what we are doing.” (In fact, PHSO had been allowed to spend more than budgeted, so the hit in spending was 20.8 percent since 2016-2017. Its annual report admits the extra spending, yet claims that “In 2019-20, we met this [CSR19] target.”) 

The second motivation for the false claim of increased demand is to garner sympathy from potential litigators. On 7 August 2020, seventeen days after the House of Commons officially printed the annual report, Behrens posted on a website providing news on litigation: 

Last year, we received over 100,000 enquiries and handled over 30,000 complaints. This was a 13% increase on the previous year. Like other ombudsman services, demand for our service is growing, which highlights the importance of having an independent, impartial redress body for members of the public.

His statements in these fora are not accidental – nor are the motivations: Behrens is seeking more funds from the government and less litigation from the lawyers. 

Where on earth does this 13 percent come from? The claim appears twice in the PHSO Board’s minutes of 1st October 2019:

10.6. Ram Gidoomal asked about the increase in demand (paragraph 2) and whether we had adjusted our assumptions for future years. Amanda Campbell advised that the volume of complaints received this year had risen by 12-13% over the same period in 2018/19. We had adjusted our assumptions… 

18.2. Alex Robertson said that the key operational issue was an increase in casework demand of 12% over the predicted level. We had revised our current year assumptions and would also build the increase into our forecasts for 2020/21.

(Confusingly, these minutes describe the increase as both a rise in actual complaints and a gap between actual and predicted. The PHSO confirmed to me that it had assumed that demand would remain constant from 2017-2018 to 2018-2019.) 

The claim next appears in the Board’s minutes of 12th December 2019:

18.1. Abi Howarth presented the paper to the Board. She highlighted that there has been a sustained 13% increase in demand throughout the year, but most KPIs were holding steady. The queue was expected to peak in March at around 700 and was then expected to fall to tolerance in October 2020.

The Board was clearly focused on the risks to itself. The Board was more explicit on 30th January 2020:

3.12. Ruth Sawtell asked why increased demand was not listed as a key risk. Amanda Amroliwala [formerly: Amanda Campbell] replied that we had experienced a single increase this year of 13%. If this was sustained year on year then that would be a significant additional risk. However, we were not seeing a continuous increase. We had taken action to mitigate the increase this year and had improved our forecasting.

Numbers do not convey the human stories of complainants failed and misrepresented

In the PHSO’s annual report for the year to April 2020, Amanda Amroliwara states that the 13% increase was “over the first half of the [fiscal] year” (i.e., to October 2019). The main body of the report is more confusing. It warns that the PHSO changed its metrics, as of November 2019, so annual comparisons aren’t reliable. Yet this doesn’t stop it claiming that, “prior to this, we saw an increase of 13% compared to 2018-2019.” The phrase “prior to this” means prior to November 2019, but the sentence ends in “2018-2019,” implying a whole-of-year comparison. The PHSO confirmed to me that the 13 percent increase was for the period April-November 2019 compared to April-November 2018, and does not apply after November. 

So, if the PHSO was clear that the increased demand ended in November 2019, why was the PHSO claiming a 13 percent increase as of March, May, and August 2020? 

And how did the PHSO lower demand from November 2019 to April 2020, despite an increase by 13 percent through October 2019? The PHSO claimed it couldn’t tell, given that it had changed its metrics in November 2019. Yet the annual report contains a count of enquiries for the year through April 2020. This shows that enquiries went down by 7.4 percent in those twelve months (compared to 2018-2019), which means the PHSO must have reduced demand by 27.8 percent in the final six months. 

The PHSO refused to quantify the reduction of demand in the final six months. The PHSO’s communications with me on these issues were confusing. Its first excuse was that the person responsible for that part of the report separated from the PHSO. Another excuse was that the National Audit Office hadn’t asked for clarification or correction of that part of the report. In the end, it went back to its claim that because its metrics changed in November 2019 it could not be expected to quantify the subsequent fall in demand . 

Certainly, demand fell from November 2019, even though the PHSO was telling Parliamentarians and litigators otherwise. This reduction cannot be explained by Covid-19, because the PHSO was still taking enquiries through the end of March. Rather, the PHSO took active measures to reduce demand. 

The annual report boasts that the PHSO increased the rate at which it closes enquiries before they could be carried forward for further assessment (from 92 percent to 96 percent within three years). Thence, the number of enquiries admitted as “new complaints” fell by 4.0 percent from 2019-2020 to 2018-2019. (Given unresolved complaints from previous years, and restarts due to complainant dissatisfaction, the number of “complaints handled” rose by 3.5 percent.) 

Admitting a new complaint entails up to seven days of consideration before admission for further assessment, which entails an average assessment burden of 140 days. You can see the PHSO’s incentive not to admit new complaints. Assessments went down commensurate with the decline in enquiries for the year (7.5 percent). Investigations went down four times faster (30.6 percent).

The PHSO’s separate reports on complaints against the NHS (which normally account for two-thirds of enquiries) also prove that the PHSO increased the rate at which it rebuffed enquiries. For the most recent quarter on which the PHSO reported (before the Covid-19 emergency interrupted public reports), the PHSO recorded 229 more enquiries against the NHS (April through June 2019) compared to the preceding quarter, of which only 41 were admitted for further assessment (even though the preceding quarter was the least investigative quarter of its fiscal year). 

There are other discrepancies between what the PHSO Board recorded in its minutes and what Behrens testified to Parliament. His budget request of March 2020 warned that increased demand “is now impacting on previously good KPI performance in a number of areas [and thence] the overall length of time that complaints are held within our system.” In fact, as the PHSO confirmed to me, demand fell from November 2019. Moreover, in the board minutes of 12 December 2019, Abi Howarth states that “most KPIs were holding steady.” 

Numbers do not adequately convey the human stories of complainants failed and misrepresented. The PHSO’s prior reports have repeatedly misled the public about the outcomes of its few investigations. When Behrens posted on that litigation website earlier in August 2020, he included a claim that “NHS Improvement established a review to identify any systemic issues” in the death by hanging of Matthew Leahy within a mental health facility in 2012. His claim wasn’t true, as he was reminded on the same day by the victim’s mother

If this government wants to blame its mishandling of Covid-19 and exam grades on quangos, why is it letting another quango mislead Parliament and the public?

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