Submission by individual who does not wish to be named [CCF0092]

Disclaimer: I have no medical or legal training. I am just an ordinary patient applying logic to situations and reporting what I have been told to the best of my ability and in good faith. I might have misunderstood things.

I am a patient who has struggled with the NHS Complaints procedures. I am grateful for this opportunity to put some of my thoughts in the public domain in a constructive manner with the hope they may have some influence in changes being made for the benefit of other patients in the future.

Para 1

The General Medical Council (GMC) and specifically the key role of the doctor acting as an expert to an investigation.

I am including comments on the General Medical Council as part of my submission to this inquiry for the following reasons:

• The Parliamentary and Health Service Ombudsman (PHSO) and other complaints organisations and investigations place reliance on expert evidence from doctors before coming to conclusions;
• What the experts say is often key to the conclusion made;
• I assume only doctors who are registered with the GMC are used as experts;
• Doctors acting as experts and registered with the GMC are bound by ethical guidance from the GMC when acting as experts;
• It would be up to the GMC to assess a complaint where it was considered the doctor had not followed the ethical guidance;
• Misleading advice given by an expert could have serious consequences, if, as a result of such advice, no failings were identified and so no changes were made. The whole investigation would have been in vain;
• Approaching the GMC is an alternative option available to NHS patients whose concerns are about the conduct of individual doctors only.

Para 2

Overseeing of the General Medical Council (GMC) by the Professional Standards Authority (PSA) is meaningless.

• There does not appear to be anyone satisfactorily overseeing the crucial first stage of the GMC process where the GMC decide whether to open an investigation or not;
• The PSA are purporting to do this but if you actually look at what they are doing and calling an ‘audit’ it is meaningless;
• Please look into the way the PSA select their sample of cases for their ‘audit’ and what powers they have if errors are found or they disagree with the decision of the GMC not to look into a complaint;
• Anyone familiar with the audit processes involved in a company audit, would understand the significance of the method of selecting the sample, in relation to the amount of assurance that can be gained from the results.

Para 3

Expert Advisors to the Parliamentary and Health Service Ombudsman (PHSO) should make their General Medical Council (GMC) reference numbers available to the complainant as standard procedure in certain circumstances.

• Following on from my comments above (see para 1), I think the GMC reference numbers should be routinely included in any PHSO report which has relied on those experts to reach their conclusion;
• The expert role is key. The PHSO caseworkers have no medical knowledge;
• If the expert advisor cannot be identified, when in most cases they are passing comment on the actions of their fellow GMC members anyway, where is the independence and accountability?
• Assuming the GMC reference number was made available as routine, it would then be an option for the patient, if they had concerns, to take their concerns to the GMC and request that the GMC look into whether the expert advisor has acted according to GMC guidelines.  This would be progress;
• However to provide true assurance, in addition to making the GMC reference numbers available, the GMC early stages processes would have to be properly overseen, rather than the current inadequate Professional Standards Authority ‘audit’ (see para 2 above).

Para 4

The Professional Standards Authority (PSA) can’t investigate individual complaints.

• The Professional Standards Authority has informed me that “Although Section 28 of the NHS Reform and Health Care Professions Act 2002 was drafted to allow us to deal with complaints, it is not in force. We therefore do not have any legal power to investigate the complaints we receive.”

Para 5

The Information Commissioner’s Office (ICO) don’t have powers to force organisations to release records.

• I have been directed to the ICO by various people when I have been unable to obtain records that I am entitled to. However I think there exist misunderstandings in the actual powers the ICO hold to help an individual obtain their records;
• The ICO have told me that if concerns are raised with them they write to organisations if they think they have breached the Data Protection Act (DPA) and sometimes provide them with advice about how to comply in the future;
• The powers of the ICO do not extend to making sure that the organisation do actually provide you with copies of your personal data; 
• The ICO does not act on behalf of individuals and it is not their role to secure the information asked for; 
• The ICO say that in many cases the effect of the ICO writing to an organisation does have a positive outcome and sometimes results in the information being released;
• The ICO say the only realistic option if the organisation continues to withhold your personal data is to take your case to court. 
   

Para 6

My Parliamentary and Health Service Ombudsman (PHSO) Report looks hurried through. It would be better to produce no report than a substandard one; it is inhumane to a patient with genuine concerns naively expecting professionalism.

• I submitted a complaint to the PHSO a year or so ago regarding my NHS treatment over a period which included doctors and other NHS workers from a Mental Health Trust and a GP Practice. I received the PHSO final report of my case six months later;
• The report contained errors of fact, illogical statements, glaring misunderstandings and I was shocked by the lack of professionalism;
• I feel violated, oppressed and psychologically abused both by those who gave evidence to the PHSO about my case and the way the evidence was processed by the PHSO;
• In addition I feel I was mis-sold a service and have been duped by the PHSO;
• I have lost trust in the medical profession and all regulatory bodies;
• My view of society has changed.

Para 7

My Parliamentary and Health Service Ombudsman (PHSO) Review Request had to be submitted within 3 months of the final report.

• I submitted a review request within the 3 month period allowed but said I hadn’t had time to get all the information I needed to support my request;
• The PHSO have said:

“…..As you intend to provide further information, we do not think it would be appropriate to begin a review at this stage, as we will only carry out one review. We will consider your request once you have provided all the information that you would like us to consider…………..It would be helpful if you could attach to your request a short covering letter explaining that it has been made outside of our three month time limit as you have been waiting for our response to your information request.”

Para 8

The Parliamentary and Health Service Ombudsman (PHSO) Review Request form I have been asked to complete has 3 sections.

The form I have been asked to fill in requesting a review of the PHSO decision has 3 sections as follows:

“(1)We made our decision based on information that you can show contained facts that were not accurate………………………….Please provide, where possible, copies of information to support this which we have not already seen;

(2)You have new information that was not previously available and which you can show might change our decision;

(3)We overlooked or misunderstood parts of your complaint or did not take account of relevant information.”

• My report is 8 pages long. Where do I start? How do I possibly go about this?
• Just consider section (1) as an example. The PHSO have already made factual errors based on the information they have.  How many different pieces of information showing the same fact do they need to see before they get the fact right? Is that what they are asking for?
• As it is, I am a year or two on and still don’t have the full information I need to submit my review request. There is no point doing it unless I can get all the information;
• In any case I might put all the effort in and be refused a review;
• The PHSO did not understand my complaint the first time round. What is the guarantee they will understand when I point out where misunderstandings have occurred?
• It would be like putting myself back into a boxing ring with no more voice than I had before, just laying myself open to be hit again.

Para 9

My Parliamentary and Health Service Ombudsman (PHSO) Report contains a fundamental flaw. 

The PHSO say they cannot look into what happened in my mental health assessment.

The period of care I requested the PHSO look into included an assessment of my mental health. Present were my own General Practitioner (GP), a psychiatrist and a social worker who was the Approved Mental Health Practitioner (AMHP).

The report I received from the PHSO contained the following:

“We are unable to look at your concerns about what you were told during the Mental Health Assessment because none of the people carrying out the assessment were performing an action on behalf of the NHS at the time; the AMHP is not an NHS employee and the doctors present were carrying out the assessment using their powers under the Mental Health Act, not for the NHS.”

I think they are wrong because my concerns are with the doctors and not the AMHP and everyone I have approached consider the doctors were working for the NHS at the time. [Apparently the situation regarding the AMHP is more complicated]. There was no use of the Mental Health Act in my case.

However no-one is helping me sort this out.

There is no point me submitting a review request if the PHSO are not going to agree first that any review would include consideration of my mental health assessment, as the assessment was pivotal to the period of care I asked the PHSO to look into, but no one will give me that confirmation.

Para 10

The Parliamentary and Health Service Ombudsman are perpetuating disjointed care in the NHS.

I received a full report from the PHSO about my GP Practice and the Mental Health Trust. However the PHSO only sent the Trust the part of the report relating to them and the GP Practice, I assume got the parts relating to them. So neither organisation realised the true impact of my concerns as they did not get the full picture.

Para 11

NHS England complaints handling: A Customer Contact Centre Case Officer at NHS England suggested one complaint of mine was as minor issue, knowing nothing of my medical history and suggested another would not need to be investigated if I could be considered as a vexatious complainant.

I put two very serious concerns to NHS England and I have had very poor complaint handling. I have seen behind the scenes the words minor issue for one complaint and vexatious for another mentioned. The complaints were neither minor nor vexatious (do I seem like a vexatious patient putting in all this effort to help share my experiences and promote improvement for others?)

but I have no voice.

Para 12

The reality of ICAS (Independent Complaints Advocacy Service)

• Feeling oppressed and exhausted I contacted ICAS;
• An envelope arrived with yet more paperwork;
• There was an agreement that I wouldn’t be rude, offensive or insulting or behave in an inappropriate manner;
• They reserved the right to terminate my case without warning;
• The NHS complaints procedure allows patients to be given no voice but expects them to remain polite and unruffled at all times;
• I wasn’t prepared to sign, tell yet another stranger details of my medical history, only to lay myself open to them terminating my case due to their subjective view of my behaviour being unacceptable;
• At least I explored the option.

Para 13

And finally, General Practitioner (GP) Zero Tolerance and head in the clouds about the effectiveness of the NHS Complaints System.

• I was assured that the GP caring for me whilst my PHSO complaint was ongoing would appreciate the additional stress I was under as a result of the complaints system and make allowances;
• The GP has now withdrawn from my care;
• I have seen the GP has written the following in my medical records:

• No-one seems to consider the fact that my ‘current mental health issues’ might be caused by the ineffectiveness and frustrations of the complaints system and being given no voice;
• They haven’t a clue what I have been through or the real me.