The wisdom of peers, OHO webinar. October 2021

SHARING EXPERIENCE

The PHSO’s chair, Rob Behrens opened the meeting by sharing PHSO’s own experience of Peer Review in 2018. In his opinion, the selection of the review panel team, particularly the Chair, is of great importance. In the case of the 2018 review, Behrens invited a team of three reviewers that included the Chair of the International Ombudsman Institute (IOI), an academic with Ombud experience and a Financial Ombudsman to form the review panel. This small team undertook a paper audit, based on documents concerning the PHSO’s financing and broader arrangements. This was followed by a two-day site visit in which the review team had the freedom to conduct private interviews with the staff. The scope and purpose of the Peer Review was to assess the value for money of the PHSO’s spending, with reference to current best practice in the ombudsman sector. The review team adopted an expanded view of value for money, where they considered all the operations of the office, rather than just the number of cases investigated. This included a range of policy proposals as well as a large number of preliminary assessments or investigations where the PHSO provided applicants with advice and guidance. The Peer Review panel then produced a report, which they defended in Parliament. The broad conclusion of the report was positive: “Under its current leadership, the organisation is moving out of ‘critical care’ and into ‘recovery’. Overall, from facing a set of severe challenges, the organisation is on its way to becoming an efficient and effective modern ombudsman service, which provides significant value for its stakeholders.” The report identified strengths and weaknesses of the organisation. Included in the latter were outmoded IT systems and the need to provide more training and independence to case handlers. The report had many positive outcomes, including greater public acceptance and credibility. Acting on the perceived weaknesses also strengthened the organisation.

Video: Assessing value for money

PRINCIPLES OF PEER REVIEW

James Hand, PHSO’s Assistant Director of Business Management, shared some pointers on processes and principles of Peer Reviews. The strength of a Peer Review is that it enables learning from the good practices of other offices, but because it is an external review it is seen as authoritative. The Peer Review process is also more cost-effective than a review conducted by paid consultants. One of the challenges of the Peer Review process is that there is a risk of professional insularity. In 2019, the PHSO and the IOI hosted a Peer Review conference in London, which resulted in formal guidance for recipients and participants. Critical to the success of a Peer Review is an approach that is both collegial and independent. The selection of reviewers is to be validated by the IOI and Terms of Reference of the review must be negotiated between reviewers and the recipient office. It is important, however, that reviewers have unrestricted access to ombudsman office staff. Reviewers should share initial findings with the recipient office but they must have editorial control of the final product. The Peer Review guidance documents are available on the IOI website.

Q&A

The South African OHO team had many questions for their UK colleagues. OHO Chair Makgoba wanted to know how a Peer Review would operate in South Africa where the societal context is different. “You are like a functioning oiled machine in a stable… democracy – we are in a democracy that is unstable – and with that come other imponderables.” UK’s Behrens confirmed that a Peer Review would work in South Africa, saying the main difference between the PHSO and the OHO is that the UK office is only politically accountable to the Queen and Parliament, whereas the SA office reports directly to the Minister of Health.

The meeting discussed many other issues relating to the size and composition of the review team, the cost of a review, the best time to conduct a Peer Review and whether a Peer Review is a credible tool for accountability. Participants also discussed the challenges of the COVID-19 pandemic and how it had affected their offices. OHO’s Monnatau Tlholoe commented that the pandemic gave them the opportunity to work through the case backlog, enabling them to close 173 out of 284 cases. In conclusion, the meeting discussed the desirability of conducting a Peer Review of the OHO. Prof Makhoba said that his main concern was whether the work they are doing is having an impact on strengthening the SA health service. A Peer Review could establish the public worth of the office and increase credibility and visibility of the organisation. Watch this space!

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The Better Health Programme, South Africa (BHPSA) is a health system strengthening programme funded by the UK government through the British High Commission in Pretoria and managed by Mott MacDonald.