Issue 5

WHY COMPLAINTS MATTER

By Jim Martin, Scottish Public Services Ombudsman

A salutary reminder

Anyone working in complaints in the public sector must have looked at the findings of the Francis Report into the Mid Staffordshire NHS Foundation Trust with a real sense of despair and frustration. However, the emotion I suspect was missing was surprise.

I am sure we all recognise the culture issues arising from the Mid Staffs Inquiry in the public sector in Scotland. I am not one of those who believe that a Mid Staffs could not happen here. Less likely perhaps, but not impossible to imagine. And not just in the health sector - all our public services aim to support vulnerable people in many ways, as well as members of the community who may not be vulnerable but who expect and often depend on a high level of service provision.

The critical elements of failure in Mid Staffs were about culture, governance and management, in a climate where financial and performance driven reporting and public image replaced service as the key significant performance indicator for the Trust. The experience and the concerns of the service user, in this case patients and their families, were not given sufficient weight - in fact they were looked upon as an inconvenience and certainly not worthy of finding their way on to the agenda of the senior managers and board members.

In her evidence, the chair of the board demonstrated an ignorance of the value of complaints. Francis comments on her approach saying:

‘However, it is far from certain that a more penetrating look at complaints would have shaken her confidence in the management of the Trust because her instinctive reaction to complaints appears to have been a combination of scepticism about their substance and a tolerance, borne of a belief that such complaints were not uncommon in the NHS.’  (Volume 1 p 250-251)

All too frequently I hear senior people saying that most people were treated well so that’s fine. I fundamentally disagree – I think that all organisations, my own included, are only as good as their weakest point. The challenge of Francis for all of us is to truly value complaints as a learning tool and to ensure that we have the right culture, management and governance processes in place to ensure we are doing so.

One step towards this is to improve the status and professionalism of those responsible for managing complaints and to give them a role in informing decision-making at a senior level.


Improving complaints standards

Raising the status of complaints handlers is just one aspect of changing the culture, governance and management of complaints.  The model complaints handling procedures (CHPs) that we were asked to develop for the public sector emphasise time and again the significance of culture as well as process.

All too frequently I hear senior people saying that most people were treated well so that’s fine. I fundamentally disagree – I think that all organisations, my own included, are only as good as their weakest point.

Over the last two years our Complaints Standards Authority has been working closely with sector representatives from public bodies across Scotland to deliver the decision of Parliament that there should be standardised CHPs across the public sector in Scotland that:

•    are simple and streamlined
•    are accessible to the public
•    deal with complaints as quickly and effectively, and as close to the point of service delivery as possible; and
•    share the learning from complaints to drive up the standards of service delivery.

There are now standardised CHPs for the local government, housing and further and higher education sectors.  Next year, the Scottish Government and its agencies and NDPBs come on stream.  We are also working with the NHS in Scotland to support the changes brought about by the Patients Rights Act. This will mean that, across public services, it will be simpler for people to navigate complaints procedures and gain speedier resolution, and that the services themselves will improve.


Recording and benchmarking

Significantly, the model CHPs require bodies to record all complaints to inform service improvements.  For the first time, standardised performance monitoring is will be an integral part of complaints handling.  This will enable organisations to assess complaints handling performance to provide assurance in relation to their performance, to facilitate continuous improvement and to assist in benchmarking performance.  It is driven by self-assessment, with compliance overseen by bodies such as Audit Scotland and the Scottish Housing Regulator, so that the regulatory burden is light but effective.

We will soon be in a position where bodies will be able to provide rich complaints data that can be used across the various public service areas in Scotland.  This will help them benchmark and identify and respond to emerging trends.


Engaging with service providers

Over the last year we have worked individually and collectively with public bodies to help us understand the context in which public services are being delivered and to help bodies understand our organisation and the challenges we face.

We will soon be in a position where bodies will be able to provide rich complaints data that can be used across the various public service areas in Scotland. This will help them benchmark and identify and respond to emerging trends.

We recently held our first sounding board forum for the NHS in Scotland with representatives of chairs, chief executives and medical and nursing directors. I am currently travelling around the country meeting chief executives and senior teams in local authorities and health boards, and I hope to do the same in future with some housing associations and further and higher education bodies.

My message to all is the same. We are seeing more complaints and, like all other bodies, we have real resource pressures (we have a total of around 50 staff looking after almost all of the public sector in Scotland).


Resource pressures

Since 2009/10 we have seen around a 23% increase in complaints and at the same time had a 15% reduction in resource. Last year we had a 12% increase in complaints and a 12% increase in productivity.

The trend seems to be continuing, as we move further towards a one stop shop model for public sector complaints. Scottish Government policy changes, such as the integration of health and social care services and changes to the social work complaints procedures, will impact on demand for our service. Other expansions in the pipeline will result from changes by the Westminster government, such as the abolition of the body for reviewing Social Fund payments.  And of course any constitutional change would have far-reaching implications for us.

We welcome the simplification of the complaints landscape for members of the public, making it easier to access complaints processes. However, it has a knock on effect on volumes of complaints to this office.  Put bluntly, if the pressures continue, we will have to decide between timescales for delivering what we do and the quality of what we do. And, as I have said in a number of forums recently, if we need to choose, we will not sacrifice quality of decision making.

 

For further information about the SPSO visit www.spso.org.uk and for the Complaints Standards Authority visit www.valuingcomplaints.org.uk

By Jim Martin, Scottish Public Services Ombudsman

Issue 5

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