The Parliamentary and Health Service Ombudsman Customer Journeys Research Debrief

1. The Parliamentary and Health Service OmbudsmanCustomer Journeys ResearchDebrief February– July 2011 Final Debrief Mark Speed Director Angus Tindle Senior Research Manager Rachel Whalley Research Executive IFF Research 020 7250 3035

2. Agenda Executive summary Conclusions and Recommendations Background, objectives, method Main findings: Enquirers Main findings: Complainants Main findings: Reviews

3. Executive Summary (1) Customers approaching PHSO with an enquiry tend to report that the supporting customer service is strong – e.g. operatives are polite, accessible by telephone, and correspondence is promptly acknowledged The key ‘moments of truth’ in determining customer satisfaction are the opportunity to liaise with the assessor and communication of the final decision Customers appear to be more accepting of the final decision (regardless of whether it is in their favour or not) if: There has been a telephone conversation with the assessor in which the assessor has displayed empathy and given the customer an opportunity to state verbally the key points of their case The final letter is personalised and explains both the nature of the evidence reviewed and how the decision was reached Enquirers

4. Executive Summary (2) The investigation process often begins with feelings of elation that the case is being taken on: However, variable expectations management regarding the timescales and scope of the investigation can sow the seeds for later dissatisfaction The process often incorporates good practice elements that are ‘key moments of truth’ for the customer: I.e. an opportunity for a substantial discussion of the case; and a final report/other final communication that explains the decision rationale However, there is still an opportunity to handle these more consistently Compensation awards in particular need advance discussion with the customer, and sensitive handling Without this, these can send unintended messages to customers or even prove offensive This appears to be an issue more in relation to relate to health cases (but not exclusively so) Complainants

5. Executive Summary (3) Customers requesting a review from PHSO tend to enter the review process feeling that PHSO has not grasped the key points of the case from their perspective The reliance on letter/email correspondence prevents dialogue and leaves many feeling ‘shut out’ of the review process The review decision letter often reiterates the content of the original decision letter This means the process tends to reinforce dissatisfaction Consistent with the enquiry stage, the key ‘moments of truth’ in determining customer satisfaction are the opportunity to discuss the case and communication of the review decision, i.e.: A telephone conversation in which the customer has been given an opportunity to state verbally the key points of their case The final letter is personalised and explains how the decision was reached; in doing so addressing the key points and/or pieces of evidence raised verbally by the customer Reviews

6. Conclusions and Recommendations

7. Enquirers:Conclusions and Recommendations (1) Recommendation Conclusion Telephone contact is key to encourage customer ‘buy-in’ to the decision • Consider encouraging ‘best practice’ approach of assessors always discussing complaint with the enquirer and, in doing so: • Demonstrating having reviewed written evidence prior to call • Displaying empathy for/recognising how customer feels • Giving the customer an opportunity to state verbally the key points of their complaint A tailored, transparent final letter reinforces positive contact with assessor • Consider encouraging ‘best practice’ approach to writing the final letter, encompassing: • Tailoring the letter to the individual enquirer • Recognising the point of their complaint (as determined in the phone call) • Communicating the evidence that was reviewed, who was spoken to etc. • Explaining the rationale for the decision Enquirers

8. Enquirers: Conclusions and Recommendations (2) Recommendation Conclusion Customer can doubt the authority of the assessor’s decision • Consider giving explanation of assessor credentials and role when they are introduced (e.g. in initial phone call, supported by letter?) • Consider use of counter-signatories on final letter to communicate it is not just one individual’s decision • Be more consistent in terminology used to refer to PHSO, to reduce wider confusion re: whether it is an individual or an organisation Customer can arrive at misconceptions about the purpose and remit of the enquiry stage • Consider addressing misconceptions by setting out in all initial communications with customer: • PHSO’s ‘referee’ role, i.e. encouraging the body the complaint is against to resolve matters with the customer • The extent of PHSO’s powers to compel bodies to provide evidence • That the enquiry stage is to decide whether to investigate or not, on the basis of evidence submitted by the customer and the body – i.e. it is not a full investigation Enquirers

9. Complainants:Conclusions and Recommendations (1) Recommendation Conclusion For complainants, the investigation experience often delivers a substantial discussion of the case, but this is not consistently done • Improve consistency in ensuring customers have a substantial telephone (or, if appropriate, face-to-face) discussion in which they can explain what they deem to be their case’s key points: • Give customer advance warning, and check this is sufficient time for them to prepare • Ensure this is positioned as a ‘chance to explain the case from their perspective’ (in case customer assumes it is repetition because of a poor handover to the investigator) • Ensure PHSO discusses which aspects of the case are to be investigated (and which are not) – including rationale • Empathy is key – recognise the feelings involved • Ensure verbal discussion is reinforced by a written summary Customer expectations of timescales and frequency of updates vary considerably • Consider whether it is possible for customers to be given a more realistic timescale expectation at the outset • Consider offering customers a ‘standard’ update frequency (e.g. every 4-6 weeks), and asking if they would prefer something more, or less frequent than this Complainants

10. Complainants:Conclusions and Recommendations (2) Recommendation Conclusion For complainants, the report stage often delivers an opportunity to comment and an explanation of the decision, but this is not consistently done • When seeking customer comments, explain rationale for two-week timescale; invite customer to ask for extra time if needed • Be transparent about timescales for comments by body complained about • Improve consistency in ensuring final report references case’s key points (mirroring substantial conversation with customer): • Explain how each element of evidence submitted by customer has been used (or, if not used, why not) • Detail how any report comments have been used (or, if not used, why not) Compensation can be misconstrued or offend customers • Suggest always having a verbal discussion of the possibility of compensation, and possible level of compensation, with the customer, prior to announcing this in the report draft: • Suggest only awarding compensation if it is wanted by the customer, and the customer is comfortable with the rationale for the level of compensation • Consider clarifying whether this affects their ability to seek further compensation in future (i.e. via the courts) Complainants

11. Reviews:Conclusions and Recommendations (1) Recommendation Conclusion A lack of dialogue at review stage leaves customer feeling ‘shut out’ and allows no opportunity for customer to explain their case • Consider ensuring that every review customer is given the opportunity for a substantial verbal discussion of the case: • Ensure they have an opportunity to explain the key points and key pieces of evidence from their point of view • Customer needs advance warning to prepare for conversation (and PHSO needs to check whether customer has had enough time to prepare) • Empathy is key – recognise the feelings involved • This is also an opportunity to explain who the key personnel involved in the review are (including credentials / degree of independence) • Ideally confirm points discussed in writing The review decision letter often repeats the content of the original decision letter • Consider ensuring that the decision letter references the key points of the case, the key areas of dissatisfaction, and / or the key pieces of evidence cited as important by the customer (in an earlier substantial verbal discussion): • Even if elements of the case and / or evidence are inadmissible, there is a need to explain why this is so Reviews

12. Reviews:Conclusions and Recommendations (2) Recommendation Conclusion Customers often assume the review will be a full (re)investigation of the case • Consider using both verbal and written communications to convey that this is a ‘sense check’ on PHSO’s own original decision making processes • Despite this, there remains a need to give the customer a rationale for how elements of the customer’s complaint / evidence have been used - or why elements of these are not within scope: • Consider building into initial review communications, a promise to review customers that PHSO will deliver this explanation? Reviews

13. Background, objectives, method

14. Background and Objectives Background PHSO commissioned IFF Research to gather further insight into the attitudes and views of PHSO’s customers by conducting customer journey mapping research • Objectives • The mapping research aims to: • Evaluate every step a customer takes through their journey with PHSO • Provide an overview in terms of the typical points of contact between PHSO and the customer • Identify how brand perceptions are affected (and are reinforced or changed) at each step and most importantly how actions taken by PHSO could improve perceptions throughout the journey

15. Method (1) • 48 in-depth interviews conducted between 25th February and 16th July 2011; 16 with each of: • Enquirers who have had more than one contact with PHSO • Complainants • Review customers • The sample was drawn from the PHSO quantitative customer satisfaction tracking survey, also conducted by IFF Research • The enquiry stage sample was structured by jurisdiction and the final decision on the enquiry:

16. Method (2) • The complainants stage sample was structured by jurisdiction and the decision: • The review stage sample was structured by jurisdiction and type of review:

17. Main findings: Enquirers

18. Early stages of the journey tend to be positive due to strong service and sustained unrealistic expectations Initial informal approach to PHSO by customer Initial response from PHSO Formal submission of case to PHSO ‘Receipt’ letter from customer services Assessor calls to introduce themselves Letter introducing assessor Excellent Excellent Rating Good Fair • Often come to PHSO with expectations of significant powers to ‘force’ bodies to surrender evidence and resolve complaints • Often expect full investigation (Often sustained until either substantial conversation with assessor or final letter) Expect • Often feel relieved – someone looking into it • Often reassured by capable customer service • Sometimes puzzled: lack of clarity of assessor role Feel = appears to consistently happen Enquirers = doesn’t consistently happen

19. Later stages are more variable and contain key ‘moments of truth’ Updates from assessor (phone, email) Customer calls chasing updates Customer cc-ed into correspond-ance with body Handover to different assessor Substantial verbal discussion of case with assessor Final decision letter Key ‘moments of truth’ Interchangeable sequence Excellent (where proactive) Excellent Excellent Rating Poor (where less proactive) Very poor Very poor • Often expect to feel involved in the case by having verbal discussion • Often expect to have opportunity to state what ‘the point’ of the complaint is in a verbal discussion • Expect assessor to have thorough knowledge of written submissions • Explanation of process; rationale for decision Expect • ‘Turning point’ – feel understood • Remain relieved/reassured (if proactive) • Can be angry/ ‘in the dark’ (if not proactive) • Concern (if not explained) • Elated • Disappointed but accepting Feel • Can feel angry/upset – not believed or understood = appears to consistently happen Enquirers = doesn’t consistently happen

20. The supporting customer service is perceived to be consistently strong “Customer service-wise; excellent. I never felt, ‘Ah, I cant get hold of him.’ The liaison was perfect all the way through. It was just the way it [the case] was handled.” The ‘core’ assessor relationship and communication of the decision is more variable, however “You get through within 3-4 minutes; if you email, they get back to you. I think the customer service was very good...They responded to every letter saying they’d received it.” Enquirers

21. There are some other, more specific, positives about customer service Can communicate by email (perceived to be more accessible than ‘laborious’ letter-only correspondence used by some other government departments) Appear to be honest about workloads – rather than not explaining why nothing is happening However, if communicating that workloads prevent any immediate progress, do give set timescales for responding (as can feel disheartening just to hear ‘we’re too busy to deal with it’ without knowing when it will progress) Enquirers

22. Substantial verbal discussion of case with assessor An empathetic conversation about the customer’s case helps them feel their grievance is recognised Empathy “He [the assessor] made me feel so… like someone was listening to me, he cared. He took time to listen, he asked me everything that happened. He was really good... you can’t talk to family.” “They [the assessor] was a bit detached, no tact really. Whether you believe my complaint or not, I think you should handle it with sensitivity and respect.” Enquirers

23. Substantial verbal discussion of case with assessor A conversation helps the customer feel confident that PHSO grasps the point of their case “I think, the turning point – very important – was a telephone conversation with the assessor at which stage, through a verbal basis, we had to go thought the whole complaint...I was able to talk through them [the key points] as the assessor looked through them [the documents] – it was in front of her. I think the penny dropped.” Clarification “The Ombudsman said your case is finished with now because they [the complainant body] have done [X]. So they classed that I was probably satisfied but they hadn’t dealt with the main problem... actually to speak to somebody...over the phone might have been a bit more reassuring but when you just rely on letters...I couldn’t understand what they were doing most of the time.” Enquirers

24. Substantial verbal discussion of case with assessor The level of preparedness of the assessor can reinforce – or shake – customer confidence in them Confidence “I said, ‘if you’ve read my reports, you’ll see that I complained about [X]. Have you read all of the evidence I sent you?’ and he went silent, so I was outraged, obviously, [that] in his final [letter] saying ‘we’re not investigating’, none of this was mentioned, but that’s something he questioned over the phone which shows me that...my evidence was not read through properly.” Enquirers

25. Substantial verbal discussion of case with assessor Thus, telephone contact from the assessor is key to encouraging customer ‘buy in’ to the decision Empathy Clarification Confidence Enquirers

26. Final decision letter A tailored, transparent final letter is an opportunity to reinforce positive telephone contact with assessor “I don’t think, in this situation, it should be made to feel like business...there’s ways you could let that person down a bit more gently.” “[The final letter] made me feel sick. I actually sat and cried...[but] the letter was caring – he put a lot of thought in to the way he wrote it. What happens now? Well, obviously nothing. I just left it.” “But then I got the final letter...There’s no explanation of what they did, or procedures – they just said ‘we’ve closed this investigation’ with no explanation whatsoever.” Enquirers

27. Patterns across individual customer journeys illustrate impact of telephone contact and final letter Decision in customer’s favour? Impact on customer Final decision letter Substantial verbal discussion of case with assessor Very satisfied Disappointed but more likely to accept decision Letter and outcome have ‘rescued’ situation Disappointed – letter needs to work extremely hard to win over customer Outcome has ‘rescued’ situation but customer may be underwhelmed Very dissatisfied Enquirers

28. There are some ‘grey areas’ regarding assessor authority Impact Possible action Issue Customer has negative experience with assessor Customer can imagine only one individual has looked at their case and feel that their decision does not carry the authority of PHSO, the organisation • Counter-signatories on final letter to communicate it is an organisation-wide decision Customer given no explanation of assessor role or credentials Customer left unsure of assessor credentials, or how they will review the complaint and make a decision – can doubt assessor authority as a result • State assessor credentials and how they will typically assess complaint, when introducing assessor (phone call reinforced by letter?) “It doesn’t feel like I complained to the Ombudsman, it feels like I complained to [assessor name], and [name] didn’t feel my case was worth investigating... Even if it [the final letter] was co-signed by one or two more people, you’d feel a bit more comfortable.” “The assessor – I didn’t know what they were qualified to do. Are they legal people, administrators? It did cause some concern...perhaps an introduction from the assessor as to what their role would be [would have helped].” Enquirers

29. Other ‘grey areas’ relate to PHSO’s authority and identity Impact Possible action Issue Customer assumes PHSO’s role is to resolve the complaint If PHSO refers the complaint back to the original body, customer can feel ‘let down’ or suspect PHSO of ‘covering up’ for the original body • Communicate that PHSO’s role is more akin to a referee, and that the complaint may still need resolving between the customer and the original body Customer hears varying terminology e.g. ‘we’, ‘PHSO’, ‘the Ombudsman’, ‘she’ Customer left unsure of whether dealing with a person or an organisation – makes PHSO feel more mysterious/obscure • Consistency of terminology across communications • Explanation that PHSO = an individual Ombudsman heading up an organisation “Who is this Ombudsman? Who is this entity? Is it a person? Is it an individual? Is the assessor acting on behalf of the Ombudsman’s office? Is there such a person? Who is the Ombudsman?” Enquirers

30. There are some misconceptions that need addressing at the enquiry stage What customer experiences Customer can conclude that... PHSO is all-powerful and will ‘force’ the body complained about to provide evidence or take corrective action Need MP referral to put case forward “For us, they were the ultimate authority. As the name suggests – ‘parliamentary’. If they can’t sort it, who can?” ‘Parliament’ mentioned in PHSO name PHSO is conducting a full investigation into their case PHSO are assessing their case This appears to take quite a long time PHSO is one government body investigating another – there’s no point, as they won’t be impartial PHSO is a public body Case passed from one assessor to another PHSO staff too busy to look at case properly; assessor ‘too junior’; assessor mishandled case and been fired! Enquirers

31. Other enquiry stage issues Is it desirable to communicate more proactively customers’ ability to challenge the initial PHSO decision? Many appear not to know or, if they do, claim that this wasn’t proactively volunteered by PHSO Some customers come to PHSO fearing they will be discriminated against: E.g. within this study, a customer from a Black and Minority Ethnic background and another who is transgender both feared they had received different treatment from PHSO as a result of their background (although there is no evidence of different treatment actually having occurred) Whilst it may not be possible (or desirable) for PHSO to treat these customers differently, it is worth noting that sensitive handling and empathy is all the more important to overcome these fears of discrimination Enquirers

32. Main findings: Complainants

33. Early expectations management re: timescales and scope is variable PHSO inform customer they will investigate complaint in part or fully. Contact made by the assessor by email, phone and confirmed in a letter. PHSO contact to inform customer of delays in being assigned an investigator Introductory contact from investigator by phone or email, confirmed by letter; discussion of scope of complaint and next steps PHSO begin process of assessing the case; requests for information or records from customer and/or body complained about Excellent Rating Excellent Excellent Fair Fair Poor Very poor • Most expect entire complaint to be investigated (If not, and if this is not discussed/explained, this can lead to disappointment and loss of trust) • Some expect PHSO will ‘demand’ swift responses from body complained about • Some expect to be ‘cc’ ed into correspondence with body Expect • Often elated / satisfied case is being investigated • For some, annoyance and frustration if case is delayed • For some, potential confusion and upset over the investigation’s scope • Most reassured case is progressing • A few feel left-out of the loop of communication between PHSO/body complained about Feel = appears to consistently happen Complainants = doesn’t consistently happen

34. Variable satisfaction at later stages is dependent on dialogue, decision and explanation of rationale Substantial discussion of case by telephone or F2F Customer receives draft report; given opportunity to comment Final report and recommendations Updates to customer / customer chases every 2-6 weeks Customer informed of change(s) of investigator = Key ‘moments of truth’ Excellent Excellent Excellent Excellent Good Rating Fair Fair Very poor Very poor Very poor • A substantial discussion of the case, at least by phone • To be kept informed, but expectation of frequency varies • New staff encountered will be ‘up to speed’ with case • To be given sufficient time to make comments • An explanation of how any comments were used • An explanation of how decision was reached, that references key points and elements of evidence from customer point of view Expect • Most delighted by dialogue; a few feel under-prepared • Most reassured, feel kept in loop; a few exasperated by ‘excessive’ contact or worried by poor handover • Many satisfied – feel justice has been done • Some disappointed but accepting (where expectations managed and explanation given) • A few very dissatisfied – feel let down by an investigation that has not addressed their key issues Feel = appears to consistently happen Complainants = doesn’t consistently happen

35. The process often incorporates good practice i.e. a substantial discussion and an explanation of the decision Element of customer service Substantial verbal discussions of case with investigator by phone or face-to-face Final report explains how decision reached (and covering letter addresses anything not in report itself) Impact on customer • Customer confident decision made on basis of ‘accurate grasp of case’ • Customer can better express their feelings and have them acknowledged Helps respondent to accept decision (even if not the outcome they hoped for) “It was a really positive interview – she [the PHSO investigator] was interested, engaged, intelligent enough to understand what I was saying, appeared to care about what I was telling her. It was the most positive experience I have had in this whole sorry story.” “The people at the PHSO listen: everyone I spoke to listened to what I had to say. Even if I hadn’t got the outcome I wanted I felt they did everything I wanted...It wasn’t completely upheld...It wasn’t a surprise really. ” “It is difficult to just write this; the telephone conversations gave me the opportunities to express my feelings.” Complainants

36. These key elements are often supported by other proactive communication by PHSO Thorough up-front explanation of how investigation process will work Proactive ongoing explanation from PHSO of what is happening at each stage Verbal discussions often supported by written confirmation from PHSO Element of customer service Feel reassured, helps to manage expectations Feel reassured, involved in process and ‘in control’ Feel reassured that own memory of points is correct and that PHSO has listened/ understood Impact on customer “The Ombudsman kept me informed...Every month someone phoned me to assure me I wasn’t forgotten.” “There was a set of notes issued so that I could go back over it, verify that it was right and that it matched with my memory of what things were.” “We knew exactly what was happening because there was a letter saying what would happen, so we knew what was happening at each stage.” Complainants

37. However, there are some suggested improvements to communication (1) Impact Possible action Issue Not always a dialogue about which aspects of case are being investigated This leaves some customers confused during the investigation process and disappointed by the final result • Improve consistency in ensuring opportunity for substantial discussion of case • Ensure written explanation given of what is in scope for investigation, and why Insufficient grasp of case when one staff member takes over from another Customer frustrated at having to repeat themselves, and starts to lose confidence that the key aspects of the case will be addressed • Ensure new staff member up to speed before contact • If this is an opportunity for customer to reiterate their key points, ensure it is clearly positioned as such “Disappointed – I didn’t feel that I’d had a say in the investigation although it went in my favour...[the PHSO investigator] didn’t at any stage say, ’I’ll investigate that, I won’t investigate this element.’ He just said he would investigate how the complaints department had treated me but because he didn’t qualify anything, I assumed he’d look at all the elements.” “I dealt with three people. It was caught between two people [investigators]...I had to re-explain things to each person I dealt with, so they could interpret the previous person’s notes...This gave me a little cause for concern, [that] it would fall between the gaps.” Complainants

38. However, there are some suggested improvements to communication (2) Impact Possible action Issue No advance warning of substantial phone calls to discuss case Customer feels ‘on the spot’ and unprepared for the call; feels at risk of omitting key points from their verbal explanation of their case • Ensure customer given advance warning, and check whether this has given them sufficient time to prepare for key verbal discussions Desired frequency of updates vary from customer to customer Some happy with updates every 4-6 weeks; others perceive this as wasting public money; others want more frequent contact for reassurance (e.g. fortnightly) • Agree a frequency of updates with the customer up-front, and tailor to this preference “It would have to be organised. Set a specific time to say, ’we’ll call, we need to talk for half an hour or so about the case’. If it’s just a call out of the blue… you need to be prepared.” “It was 12 or 13 communications I received...they bent over backwards to keep one in touch, but I’d rather they just got on with it...The 12 letters cost more than the £120 I was asking for...As a taxpayer, it made me a bit cross.” Complainants

39. Suggested improvements on handling of customer comments on draft report Impact Possible action Issue Can feel too little time to respond thoroughly; an unequal balance of power if body complained about has taken several months to respond to PHSO requests (and a few suspect body complained about is also given longer to comment on draft) Two-week deadline for customer to comment on draft report • Acknowledge time taken to date; explain PHSO is trying to bring investigation to a close; and invite customer to ask for extra time if needed • Be transparent about timescales for comments by body complained about No explanation of how used some / all of customer’s comments on the draft report Customer can assume that some/all of their comments have been ignored altogether – can feel their views have been dismissed • Ensure report, or supporting communication, explains how comments have been used (or, if not used, rationale for this) “Nothing came; [it was as if] ‘we’ve changed nothing; the report is the report and that’s it.’ I think I’d highlighted…some very good points [in the comments]. I just felt either you’re not looking, bothered, interested. You’ve just dismissed this.” “I was due to go on holiday about a week after I got the report. I felt, given this had taken such a long time. Suddenly I’ve got to reply in a very quick time.” Complainants

40. Compensation awards in particular need advance discussion and sensitive handling Impact Possible action Issue Customers receive unexpected compensation Customer can be perplexed or misconstrue e.g. as attempt to ‘buy them off’; Compensation level can be perceived as insulting in the context of e.g. bereavement • Ensure possibility and likely level of compensation has been discussed verbally prior to decision • Only award it when desired by customer “He recommended they award me £1,500 compensation which for the three and a half years I’ve been suffering – I was offended.” “They sent me £250 – I don’t know why as I didn’t want money...People say I’ve got an apology and now could sue; presumably the hospital gave me the £250 so they could say I had received compensation already.” • This appears to be an issue more in relation to relate to health cases (but not exclusively so) Complainants

41. Investigations are perceived as lengthy, and this can have either neutral or negative impacts Many are surprised by the length of time taken by the investigation “I wanted a thorough investigation, and I was prepared to wait for as long as that took.” “The snail-like pace made it 10 times harder for me in respect of the grieving process.” Ideally, customers would be given a more realistic timescale prediction at the outset “I didn’t care how long it took as my mum was already dead.” Complainants

42. Other issues at the investigation stage One customer was aware of media coverage of treatment of the elderly by the NHS: Added to her overall feeling of satisfaction with the investigation, that her own case is adding to the impetus for improvement Another customer queried his correspondence being shared with the body complained about, when he was not party to all of their correspondence with PHSO Perceived imbalance of power in this arrangement, with the situation being loaded in favour of the body complained about “Recently on the news in Parliament they’re bringing up the treatment of old people in hospital. So there must be a lot of complaints. So my complaint added to everyone else’s is having some effect.” “I would have liked to see [body’s] answers to PHSO questions for my own clarity…If [body complained about] can see everything I say, why can’t I see what they say? So there’s an unequal balance there.” Complainants

43. Main findings: Reviews

44. Minimal interpersonal communication appears to drive a poorly-rated customer experience Customer asks for a review – customer or e.g. ICAS complete the review form Reply by letter, usually from Business Support Officer, saying PHSO aims to reply within 16 weeks Customer chases PHSO OR PHSO update customer of delays by letter Decision letter from PHSO PHSO acknowledges further correspondence with a card but no further action taken Poor Rating Poor Poor Poor Poor Fair = Key ‘moment of truth’ • Often expect their case will be re-investigated rather than only the PHSO procedure • Some expect the review process will not take too long Expect • Disappointed with PHSO’s initial decision, so low expectations for review • Feelings compounded by PHSO reliance on correspondence. Most feel unable to express what matters about their case • Disappointment at final decision, which often did not address their concerns – frustration at time taken to arrive at ‘unsatisfactory’ outcome Feel = appears to consistently happen Reviews = doesn’t consistently happen

45. Many customers have entered the review feeling PHSO has not grasped the point of their case Impact Issue Often there has been no opportunity for dialogue at enquiry / investigation stage Customer has no opportunity to explain the key points of the case from the customer perspective “When I got the [enquiry] assessment back I didn’t even recognise my complaint! I tried to make the point [in writing, to the review team] that I actually wanted my original complaint assessed and not the case the assessor thought I was trying to bring.” • Customer unclear as to: • Why some aspects of the complaint have been addressed but not others • What evidence was used, and how • How the decision was reached “For me the part they did not address was more significant than the part they did deal in.” Often there has been a lack of detail in enquiry / investigation decision letter This applies to both reviews of service AND reviews of decision Reviews

46. There are some positives about the communications and support at the review stage For some, the tone of review staff was perceived to be neutral and professional I.e. avoids creating impression that they are defensive about / reluctant to review the case (however, for many, other factors do create an impression of reluctance) For some, when explanations were given, this was perceived to be done clearly, in layman’s terms Perceived to compare favourably with other customer service experiences (e.g. some utilities firms) Handover to review team is perceived to be ‘joined up’ One instance of PHSO referring the review customer to a source of advocacy support Reviews

47. A lack of dialogue and a reiteration of original decision letter content often merely reinforces dissatisfaction This cycle would ideally be broken by an opportunity for dialogue and a decision letter that addresses the customer’s concerns This cycle of dissatisfaction is currently ended simply because the customer cannot take any further action with PHSO, post-review STOP whereas Reviews

48. Customer comments illustrate the impact of this lack of dialogue and repetition of decision letter content “I’d say that this review is probably worse than the service I received from them beforehand...at least then I spoke to the assessor.” “[The review decision letter was] an echo of a parrot letter...It was exactly the same as the first assessment – just a rehashed version of the first response.” “I could not square the evidence I had submitted with the reply itself because there were many matters that I had not received an apology for... It would have been helpful if, in the final letter, it had been made explicitly clear that details that I had put forward as part of my complaint had been looked at – something that was not recorded explicitly in the final response.” Reviews

49. Speed of response and lack of communication makes review process feel arduous and dismissive What customer experiences Customer feels... The review process varies in length e.g. 3 weeks, 16 weeks, 30 weeks (but isn’t necessarily long in itself) They are facing a ‘wall of silence’ However, if the enquiry was rapid, it can seem relatively long It can be viewed as (even more) time ‘added onto’ the investigation ...and can conclude... Their case is not being taken seriously Communication appears to be almost entirely by letter = no opportunity for dialogue PHSO is trying to deter all but the most determined Majority of letters are standard updates, to say review will be completed in X weeks Reviews

50. Customer comments illustrate this feeling of being ‘shut out’ at the review stage Customer feels... They are facing a ‘wall of silence’ “They rarely answered my letters or questions... Each piece of correspondence we received was poor and the content never really said anything...It was much harder; the doors were firmly closed to us. In respect of the customer service this was even worse in the review.” ...and can conclude... “It is important for the member of public to feel that their complaint was being taken seriously; which means you want reasonably regular updates and a reasonable discussion...it was done entirely on paper and email – not once did I speak to anyone; she obviously never felt it was worth speaking to me...this could have been improved.” Their case is not being taken seriously PHSO is trying to deter all but the most determined “It was all done clinically by email or letter; it is a war of attrition – they [try to] wear you down...they hide behind...their processes...You can’t really get any proper answers..” “[You have to be] enormously determined...because of the delays...it feels like this is a process designed to weed out all but the most serious of complaints.” Reviews