Three or four years ago, stretched out on the couch with a beer after a day’s graft, I found myself flicking through endless TV channels in search of something vaguely watchable.
A documentary popped up about an English neurosurgeon who regularly flew out to the Ukraine to perform brain operations on poor people in the region, using Bosch DIY drills and other primitive equipment.
Not only was the film highly watchable, its portrayal of Henry Marsh, the surgeon in question, was extraordinarily powerful. So when Marsh’s book Do No Harm came out a year or so ago, I bought and devoured it almost overnight.
The book is astonishing. Incredibly readable and almost lyrical, it examines, though not exclusively, Henry Marsh’s own surgical blunders through the prism of humility and an admission of personal human frailty.
Therefore I fully share Nick Bamford’s admiration for Do No Harm. Where he and I part company is over Nick’s use of Marsh to justify, in an article for Money Marketing last week, his attack on the Financial Ombudsman Service staff for not being as qualified as those they supposedly sit in judgement of.
Nick cites an incident where a case review is managed by NHS staff whose qualifications and technical knowledge are not to Marsh’s own standards. “Can it really be right the performance of an experienced, competent and qualified surgeon is judged by those without such attributes?”, Nick asks.
What Nick really means becomes apparent later on, when he explains how a friend of his wrote to the FOS to ask whether its adjudicators had the same level of qualifications as he did.
Nick’s friend wrote: “I must (and do) hold advanced level pension qualifications before being able to offer advice in this complex area. I would therefore, as a minimum, expect anyone adjudicating on complaints in this area to be similarly qualified. How many (and what percentage) of FOS staff involved in this area hold the CII AF3 or CII G60 pension qualifications (or equivalent)? And is AF3/G60 a minimum FOS qualification requirement for staff adjudicating in this complex area?”
In fairness to him, Nick quotes the FOS response to his friend’s request: as the service is not there to advise but to help settle disputes between clients and financial services businesses, the requirement for staff to have specific qualifications is not mandatory. Nor is the FOS able to provide him with percentages of staff with the qualifications his friend deems so important.
Nick somehow finds this reply to be “condescending”. I beg to differ: I found it polite and calm in the face of a bumptious failure to understand precisely how the FOS works.
As one who has complained to the FOS over a general insurance claim, let me enlighten him. The first stage involves an adjudicator gathering evidence and, where possible, settling a complaint informally.
There are some 2,000 adjudicators, all with different knowledge and expertise. In every case, the FOS aims to try to develop the skills of those adjudicators, encouraging them to pass exams relevant to their areas of work in the service.
If the adjudicator cannot resolve a complaint, the issue is passed on to an ombudsman. A glance at the descriptions of the 200-plus ombudsmen on the FOS site reveals a vast range of extremely high-level experience.
My guess is when a FOS investigation into a “complex defined benefit to defined contribution transfer complaint” takes place, if you do not think you have the technical expertise necessary or you do not believe any colleague with knowledge or skills in this area is there to help you, no one is going to ram that case down your throat.
Which may explain why of the many views expressed about FOS decisions – more than 200,000 a year – almost none involve complaints about a lack of technical skills.
Which brings me back to Henry Marsh. His book involves a lacerating self-examination in which he owns up to all manner of reasons for his errors, including a petty argument with a colleague after which he admits: “I was not in the right state of mind to carry out such dangerous and delicate surgery.” In this case, the operation left a patient with a half-paralysed face.
What makes the book so powerful is actually that Marsh self-chronicles not only his technical errors but his hubris and, yes, also his arrogance and dismissiveness about the input supposedly less skilled NHS colleagues can give to help prevent similar errors in future.
As it happens, a very good friend of mine is an investigator for an NHS trust, tasked with carrying out analyses into serious incidents such as these. He is not a surgeon but a clinical nurse of many years’ standing, able to call on other medical specialists for technical advice.
In Marsh’s exalted world, mistakes are made and lessons learned without recourse to support and guidance provided by less-qualified mortals. In the real world the issue is never about qualifications or their absence but about reaching considered assessments after careful analysis of all the facts – both within the NHS and at the ombudsman service.
Should Nick or his friend ever need to call on the services of a surgeon, they would do well to remember that.
Nic Cicutti can be contacted at firstname.lastname@example.org. Follow him on twitter @NicCicutti