NHS ‘overcrowded with regulators’, says watchdog

Rob Behrens told HSJ he has requested a meeting with Baroness Julia Cumberlege to discuss the idea of a patient safety commissioner – which was a key recommendation of her report which highlighted “systemic” failings on safety.

Mr Behrens said he welcomed the Cumberlege report and agreed the health service is “disjointed, unresponsive and defensive”, but said he had not worked in a sector as “crowded with regulators and outside bodies” as health.

His role reports to the Commons public administration and constitutional affairs committee; while the proposed patient safety commissioner would report to the chair of the Commons health and social care committee, under the Cumberlege proposal. 

The ombudsman has this week presented a report to Parliament, which says the NHS complaints system is in urgent need of reform and investment. He has called for further statutory “powers of own initiative” so the PHSO service can address issues before it receives formal complaints – a change he said he has been requesting for three years.

Mr Behrens told HSJ: “There’s a lot we need to think about before we respond to these proposals [in the Cumberlege review]. What we don’t what to see is the constant creation of new institutions to address big cultural issues that have been on the agenda for a long time. The sector is overcrowded with regulators.

“What we have been arguing for three years is that the ombudsman should have the powers of own initiative so we can address issues that are not complained about.”

Mr Behrens added that complaints handling is not properly resourced across the health service and that “there a serious under investment for the qualities and skills staff need to handle complaints effectively”.

“In all the areas I have worked in before, the system has not been as crowded with regulators and outside bodies as the health service is,” he added. “It’s probably out of good intentions. When there’s a crisis particularly involving death one of the instincts of government is to rush to create an institutional response.”

The ombudsman’s report has found an “inconsistency in complaint handling across the NHS, leading to variable outcomes for people who complain,” with investigations carried out by staff “who have limited or no training, or who lack appropriate support”.

The report also said organisations “see complaints negatively” – which mirrors a key finding from the Cumberlege review.

The PHSO, having consulted with bodies such as the Care Quality Commission, Department for Health and Social Care, Healthwatch England and NHS England, is now proposing to create a “complaint standards framework”, modelled on the approach taken in devolved nations and Ireland, to “provide a consistency and support to frontline staff” and assist senior leaders to promote organisational change.

A public consultation is being held until 18 September ahead of the final version of the framework being launched later in 2020.

Mr Behrens added: “There’s a massive under investment in the professional skills of people who handle complaints. If we have a complaints standards framework that will do a great deal to professionalise the approach of trusts in the NHS.

“I understand that creating a complaints framework doesn’t change the culture of anything, but it does create an opportunity for leaders to change the culture by dealing what’s happening on an organisational basis.”

The Cumberlege review report said: “We do not need another re-organisation of the NHS to get this right; we do not need another regulatory body in an already crowded field. But we do need a new voice, with statutory powers, to talk and act from the perspective of the patient, to encourage the system to do what needs to be done and hold it to account.”

The Department of Health and Social Care, NHS England and the Cabinet Office have been approached for comment.