The Ombudsman (PHSO)

What is the Parliamentary and Health Service Ombudsman?

The Parliamentary and Health Service Ombudsman, usually shortened to PHSO, independently investigates unresolved complaints about the NHS in England.

Its service is free.

PHSO describes itself as the final stage for complaints that have not been resolved by the NHS organisation involved.

When can I complain to PHSO?

PHSO will usually expect the NHS organisation to have had the opportunity to investigate and respond to the complaint first.

Once the local complaints process has ended and the organisation has issued its final response, a person who remains dissatisfied can ask PHSO to consider the complaint.

PHSO recommends using its complaint checker before making the complaint. This helps establish whether PHSO is the right organisation and whether the complaint is ready for it to consider.

What if the NHS has not answered my complaint?

A final response is the normal route into PHSO, but a person does not necessarily have to wait indefinitely where the NHS complaints process has stalled.

PHSO says people should contact it where the organisation does not reply within the time it said it would, or where the person is running out of time to bring the complaint to the Ombudsman.

Its NHS complaints guidance also says a person can complain to PHSO if their NHS complaint has not been dealt with after six months.

What NHS complaints can PHSO investigate?

PHSO can investigate complaints about NHS healthcare in England.

Its current guidance gives examples including:

• NHS hospitals;
• GPs;
• dentists;
• NHS-funded treatment delivered in a private hospital; and
• NHS continuing healthcare.

Whether PHSO can investigate also depends on the subject of the complaint and whether its statutory requirements are met.

How long do I have to complain to PHSO?

For a complaint about the NHS in England, PHSO says the complaint should be brought to it within one year of when the person became aware of the problem being complained about.

This is not always an absolute cutoff. PHSO can consider a complaint outside the ordinary period where it decides there is sufficient reason to do so.

Because the clock relates to awareness of the problem rather than simply the date of the final NHS response, someone who has spent a long time in the local complaints process should not assume that a fresh one-year period starts when the final response arrives.

What does PHSO look at?

PHSO considers whether the organisation got something wrong and whether that caused injustice or hardship that has not been properly put right.

An investigation can involve examining what happened, the information available to the organisation, its explanations and whether its actions or service were reasonable in the circumstances.

PHSO can obtain information needed for its investigation and reach an independent decision on the complaint.

Can PHSO uphold only part of a complaint?

Yes.

An Ombudsman investigation does not have to result in an all-or-nothing finding.

PHSO can fully uphold, partly uphold or not uphold the matters it considers, depending on what its investigation finds.

Where a complaint is upheld or partly upheld, PHSO can make recommendations designed to put the injustice right and improve services where appropriate.

What can PHSO recommend?

Where PHSO finds that an organisation got something wrong, its recommendations can include:

• an explanation;
• an apology;
• acknowledgement of mistakes;
• action to correct what happened;
• changes intended to improve a service or prevent recurrence;
• an action plan; and
• in appropriate cases, a financial payment.

PHSO’s financial-remedy guidance says payments can be recommended where a person has suffered financial loss or another injustice such as distress, inconvenience or unnecessary pain.

Can PHSO award clinical negligence compensation?

Not in the way a court does.

PHSO can recommend that an NHS organisation makes a financial payment as part of putting things right.

But the NHS complaints process is not a court process for deciding legal liability or awarding clinical-negligence damages. PHSO’s own complaint-handling guidance distinguishes financial remedies for complaints from compensation that might be awarded through a legal claim.

Are PHSO recommendations legally binding?

PHSO’s recommendations are not legally enforceable in the same way as a court judgment.

PHSO says that it follows up recommendations until they are acted upon and can escalate concerns where an organisation does not comply.

As a last resort, where an organisation fails or refuses to implement a recommendation and the injustice remains unresolved, PHSO can make a special report to Parliament.

What if I could take legal action instead?

This is particularly important for clinical-negligence complaints.

PHSO must consider whether the person has, or had, another legal route that could resolve the complaint, such as court proceedings.

Its current guidance says that where a possible legal route exists, PHSO considers the individual circumstances, including whether legal action would provide an answer to the complaint, its likely cost and how long it may take.

If legal action would fully answer the concerns or provide the outcomes being sought, PHSO may decide that legal action is the more appropriate route.

Can I make an Ombudsman complaint and a clinical negligence claim?

The two processes are different, but the possibility of legal action can affect whether PHSO decides it should investigate.

Someone considering both routes should therefore avoid assuming that they can simply run independently without affecting one another.

A clinical negligence claim addresses legal liability, causation and damages. PHSO addresses unresolved injustice through the public-service complaints system.

Does complaining to PHSO stop the clinical negligence limitation period?

No.

Submitting an Ombudsman complaint, waiting for PHSO to decide whether it can investigate, or waiting for an Ombudsman investigation to finish does not itself stop the limitation period for a clinical negligence claim.

The two time systems must be considered separately.

How do I complain to PHSO?

PHSO provides an online complaint checker to help determine whether the complaint is within its remit and ready to be made.

When making the complaint, it is useful to have:

• the NHS organisation’s final response, where one has been issued;
• a clear description of what remains unresolved;
• the important dates;
• an explanation of how the person has been affected; and
• what the person wants done to put things right.

PHSO says it will ask complainants to provide the organisation’s final response and explain the impact of what happened and the remedy being sought.

Do I need a solicitor to complain to PHSO?

No.

PHSO’s service is designed to be used directly by members of the public and is free.

Someone can still obtain help from another person or an advocate if they need support preparing the complaint.

PHSO itself can provide information about its process, although because it is the independent decision-maker it cannot act as the complainant’s advocate.