Wednesday 19 November 2014

Welcome to SPSO News. In his overview, the Ombudsman highlights three matters:

• his 2013/14 complaints report about the NHS in Scotland;
• evidence provided in his submissions on the Scottish Welfare Funds (Scotland) Bill; and
• repeat issues identified within NHS complaints ranging from poor communication and failure to gain informed consent, to delayed diagnosis, and failure to care properly for vulnerable individuals.
   

This month we are laying seven reports before the Scottish Parliament – all about the NHS. We are also laying a report on 78 decisions about all of the sectors under our remit.  These can be read on our website at www.spso.org.uk/our-findings.

Case numbers
Last month (in October), we received 498 complaints. We determined 472 complaints and of these we:

• gave advice on 280 complaints
• considered 99 complaints at our early resolution stage
• decided 93 complaints at our investigation stage.

We made a total of 101 recommendations.

Overview

Health Report
At the end of October, we issued our annual health complaints report for 2013 – 14. During the year, complaints about the NHS in Scotland made up nearly a third of all the complaints we received, and covered a wide range of services, including GP and dental practices, pharmacists, nurses and hospital care. In the report I pointed to an 11.5% rise in health complaints, and an increased rate of upheld complaints. I also drew attention to my continuing concern about the time it is taking for coherent complaints procedures to be put in place for services delivered under the integrated health and social care models, and the barriers that some individuals have faced when trying to complain about NHS care in prison.

During the year, we made 684 recommendations for redress and improvement in the NHS – over half of the recommendations we made across all sectors during the year. The case studies in the report highlight how the learning from complaints can be used to make far-reaching changes in individual practices and across health boards. Those case studies, and the experiences of the people on whose complaints I report today, demonstrate the continuing need for vigilance and improvement in the NHS in Scotland. We will continue to work to ensure that the needs of people using the NHS are central to how they are cared for, and that they are able to express how they feel about the service and quality of care they receive.

The report, along with supporting information such as my annual letters to health boards with their individual statistics, is on our website.

Update on Welfare Funds (Scotland) Bill
I reported on this Bill in some detail in my July commentary. I have already provided the Welfare Reform Committee with written evidence on the proposals and, earlier this month, I attended the committee to give oral evidence. In the Bill, the Scottish Government propose that the SPSO take on a new role as the review body for Scottish Welfare Funds (SWF) decisions. As I have explained, if this goes ahead, it would mean an extension to our jurisdiction – the ability to review and, crucially, to change these decisions. It would mean adapting our current remit, processes and procedures to provide this service.

We have actively discussed with the Government and Scottish Parliamentary Corporate Body how we could manage and carry out this work. Throughout these discussions, the fact that people asking for review will need a quick decision and may be particularly vulnerable individuals has been a key focus for us.

Complaints about the NHS in Scotland
This month, I am again highlighting issues about communication, both with patients and their families and between health boards or health professionals, and the assessment of risk. Some of the patients involved were particularly vulnerable. In one case I have decided to draw the attention of the Scottish Government to my report and am sending them a copy to consider.

All the cases in this compendium involved distress and considerable extra concern for patients and their families at what were already difficult times for them. All NHS boards in Scotland should read these carefully and take steps to ensure that the failings outlined in the reports I lay before Parliament today are prevented from happening in their board area.

Read my Overview and summary of today's investigation reports in PDF (140KB) or via the links below.
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"it is unfortunate that Mr C has been left with on-going symptoms that affect his daily life.  While I am sure it was a relief for Mr C to have found out that he did not, in fact, have cancer, this must have been tempered by the overall outcome for him."
Diagnosis, clinical treatment
Lanarkshire NHS Board (201300451)
> Read full report (PDF, 78KB)
> Read summary (PDF, 33KB)

"It is of serious concern to me that it is highly likely that Miss C was unable to give her informed consent for the cremation of her daughter because of the persisting effects of the sedating medication she had received"
Consent, communication
Greater Glasgow & Clyde NHS Board (201302139)
> Read full report (PDF, 75KB)
> Read summary (PDF, 34KB)

"although the initial assessment of Mrs A was reasonable, as was the care plan developed from it, there were a number of failings in the care and treatment provided to Mrs A.  There is no evidence that Mrs A's risk of suicide was comprehensively assessed, before the level of risk assigned to her was substantially reduced"
Risk assessment, clinical treatment, communication
Forth Valley NHS Board (201302798)
> Read full report (PDF, 85KB)
> Read summary (PDF, 36KB)

"Mrs C's symptoms should have been treated as possible bowel cancer, until proved otherwise. The alarm symptoms … were not responded to in line with the relevant guidance. This failure led to a delay in the diagnosis of Mrs C's bowel cancer."
Delay in diagnosis, referral
A medical practice in the Tayside NHS Board (201302928)
> Read full report (PDF, 61KB)
> Read summary (PDF, 32KB)

"I am critical of the communication failings between [the hospitals] which led to the delay in Mrs A's treatment, and I am also critical of the Board for failing to clearly acknowledge to Mr C where responsibility lay for this issue.”
Clinical treatment, palliative care, record-keeping, communication
Greater Glasgow & Clyde NHS Board (201303786)
> Read full report (PDF, 64KB)
> Read summary (PDF, 35KB)

"Lack of action by various members of the Practice team left Mrs C and her family feeling unsupported when they were concerned about the seriousness of her condition. It had a traumatic impact on them when Mrs C was finally diagnosed, with serious questions about whether her prognosis could have been influenced by an earlier referral."
Delay in diagnosis, referral
A medical practice in the Grampian NHS Board area (201304325)
> Read full report (PDF, 70KB)
> Read summary (PDF, 30KB)

Complaints Standards Authority

Health
We continue to engage with the Scottish Government and other key partners on the Scottish Health Council’s (SHC) ‘Listening and Learning’ report on NHS complaints handling. In line with the SHC recommendations, we are discussing the potential to develop an NHS model complaints handling procedure (CHP) for the sector, increasing focus on encouraging early resolution of complaints as recommended in the SHC report. Further information for NHS stakeholders will be available soon.

Local government
The local authority complaints handlers network met on 31 October to progress arrangements for benchmarking complaints performance. Discussion focused on the pilot arrangements taken forward from the previous meeting, including discussion within the agreed ‘families’ of local authorities. The SPSO performance indicators for the local authority model complaints handling procedure were also covered, with discussion on specific requirements around reporting learning and outcomes. The information from councils’ reports on these indicators will be used to benchmark councils’ complaints handling performance. The network’s complaints surgery also considered commonly arising issues in dealing with complaints, for example political and elected member decisions, complaints about arm’s length external organisations (ALEOS) and complaints about schools.

Local authority – reporting performance
In October we issued our annual letters to local authority Chief Executives. These provided annual statistics for each local authority about complaints to SPSO. In his letter the Ombudsman outlined the fact that the statistics reflect the first full year of operation of the standardised model complaints handling procedure. As part of that he highlighted that each council is now required to report and publicise complaints information on a quarterly and annual basis, including annual reporting on how they perform against the agreed performance indicators, and that the statistics provided by SPSO in the annual letters are part of the detailed complaints picture that each authority is responsible for gathering and publishing, and using to benchmark through the local authority complaints handlers network.

We would remind local authorities that have not already done so to either send us (or send us a link to) their report of their annual complaints handling performance, in line with the SPSO performance indicators within the CHP implementation guide (PDF 90KB). On the basis of these, we will continue to discuss with the sector how they can ensure that they report consistent and comparable information, including demonstrating the learning from complaints, and ensuring this is shared both within and across local authorities.

Health and Social Care Integration
As previously highlighted, SPSO responded to the Scottish Government’s consultation on regulations to support the Public Bodies (Joint Working) (Scotland) Act (on health and social care integration). We highlighted the absence of consideration of complaints arrangements, which we have also noted as a key concern in our annual report and the local government report.We are keen to engage with the new integrated joint boards to discuss their plans for developing complaints arrangements in this area and met recently with the Care Inspectorate to discuss our arrangements in this area.

We are continuing to discuss the recommendations of the Scottish Government’s social work complaints working group with the Scottish Government’s team on Integration and Reshaping Care. The working group recommended the alignment of the internal social work complaints procedure with the local authority model CHP (subject to some flexibility in extension timescales) and SPSO taking on the role of the existing Complaints Review Committees. Timescales and legislative changes for implementing the group’s recommendations have still to be confirmed.

Audit Scotland - Developing excellence in administrative justice in Scotland
The Scottish Tribunals and Administrative Justice Advisory Committee (STAJAC), with Audit Scotland, SPSO and key local government partners, including SOLACE, SOLAR, COSLA and the Improvement Service, are developing a project to support more effective decision-making by local authorities in areas of administrative justice, and better understanding of the costs of administrative justice.

STAJAC and Audit Scotland are currently seeking to identify a selection of case studies to model the user journey for administrative justice, to help better understand the impact on users and on decision makers of not getting decisions right first time. The aim is to deliver a methodology/approach to help councils to assess the impact of administrative justice processes and provide best practice guidance to help councils ‘get it right first time’. This will include support for councillors and others involved in scrutinising administrative justice.

STAJAC and Audit Scotland are seeking views from local authorities on relevant work already undertaken by the sector in this area, suggestions for case study areas where work would be of most benefit and potential sources of data, particularly cost, process mapping and outcome data. Any councils or others who would like to contribute their views can contact the CSA in the first instance (CSA@spso.org.uk).

Housing
The Scottish Housing Regulator (SHR) have published information on all Registered Social Landlord (RSL) Annual Returns on the Scottish Social Housing Charter. This provides all of the data from each RSL on how they are performing against the outcomes of the Charter as outlined in the SHR’s indicators, including in relation to complaints volumes. RSLs should also report on their complaints handling performance in line with SPSO model CHP requirements and self-assessment complaints indicators for the housing sector, developed in association with the Chartered Institute of Housing, the Scottish Housing Best Value Network and HouseMark. We are engaging with the regulator to assess how we can further support the sector to benchmark complaints handling performance and welcome engagement with the sector to understand how existing approaches may be developed further to meet the reporting requirements of the model CHP.

Higher education
Earlier in October we attended a higher education complaints practitioners meeting at Heriot-Watt University, Edinburgh. This gave us the opportunity to update sector representatives on our work and to discuss and clarify a range of issues on operation of the model CHP and good complaints handling more widely. We were encouraged by the progress this group has made in sharing good practice on complaints handling, and reaffirmed our view that the sector would find benefit in the group benchmarking performance and seeking to share learning from complaints across the sector. We will attend further meetings of the group to further update members on the work of SPSO, and look forward to working more closely with the group to ensure best practice across the sector.

As with other sectors, we remind all universities of the requirement to report on their complaints handling performance annually in line with SPSO requirements, as documented in the CHP implementation guide (PDF, 101KB).

Further education
Working closely with the sector’s complaints handling advisory group, we are developing further guidance on the performance indicators that will form the basis of benchmarking complaints performance information. The indicators against which colleges are required to publish information for the last academic year are outlined in the implementation guide accompanying the model CHP (PDF, 99KB) and published in 2013.

The FE network have agreed to arrange a cross-sector benchmarking forum on annual complaints performance through the College Development Network, supported by the CSA. This will focus on annual performance reports and potential areas of improvement in complaints handling performance and the CHP.
Details will follow in due course from the College Development Network.

Prisons complaints
We had a helpful meeting with the Scottish Prison Service (SPS) complaints managers in October. In addition to a number of key complaints topics, we discussed the value that can be obtained from an increased focus on consistent recording and reporting of complaints, and the opportunity for the SPS to develop a complaints handlers network – like that for the local government sector – to identify, evaluate and benchmark good practice in complaints handling.

For this and previous updates and further information in relation to CHPs, visit our dedicated website www.valuingcomplaints.org.uk

The CSA can also be contacted directly at CSA@spso.org.uk

Jim Martin, Ombudsman | 19 November 2014