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Y Pwyllgor Cydraddoldeb, Llywodraeth Leol a Chymunedau

Equality, Local Government and Communities Committee

03/10/2019

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Caroline Jones AM
Dawn Bowden AM
John Griffiths AM Cadeirydd y Pwyllgor
Committee Chair
Mark Isherwood AM

Y rhai eraill a oedd yn bresennol

Others in Attendance

Chris Vinestock Prif Swyddog Gweithredu a Chyfarwyddwr Gwella, Ombwdsmon Gwasanaethau Cyhoeddus Cymru
Chief Operating Officer and Director of Improvement, Public Services Ombudsman for Wales
Katrin Shaw Prif Gynghorydd Cyfreithiol a Chyfarwyddwr Ymchwiliadau, Ombwdsmon Gwasanaethau Cyhoeddus Cymru
Chief Legal Advisor and Director of Investigations, Public Services Ombudsman for Wales
Nick Bennett Ombwdsmon Gwasanaethau Cyhoeddus Cymru
Public Services Ombudsman for Wales

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Catherine Hunt Ail Glerc
Second Clerk
Naomi Stocks Clerc
Clerk
Osian Bowyer Ymchwilydd
Researcher

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Dechreuodd y cyfarfod am 09:05.

The meeting began at 09:05.

1. Cyflwyniad, Ymddiheuriadau, Dirprwyon a Datgan Buddiannau
1. Introductions, Apologies, Substitutions and Declarations of Interest

Welcome, everyone, to this meeting of the Equality, Local Government and Communities Committee. Item 1 on our agenda today is introductions, apologies, substitutions and declarations of interest. We've had apologies from Huw Irranca-Davies and Leanne Wood, and Dawn Bowden will join us later on. Okay. Are there any declarations of interest? No.  

2. Ombwdsmon Gwasanaethau Cyhoeddus Cymru: Adroddiad Blynyddol a Chyfrifon 2018/19
2. Scrutiny of the Public Services Ombudsman for Wales: Annual Report and Accounts 2018/19

We'll move on to item 2, which is scrutiny of the Public Services Ombudsman for Wales's annual report and accounts 2018-19. And I'm very pleased to welcome Nick Bennett, Public Services ombudsman for Wales; Chris Vinestock, chief operating officer and director of improvement; and Katrin Shaw, chief legal adviser and director of investigations. Welcome to you all. Croeso.

Perhaps I might begin with some questions on overall case load, unless you wanted to say anything by way of introductory remarks.

Only to say that I think this year is a good reflection on the office. We've never been as busy or done as much as we've done in the year in question. You'll see that we've increased productivity by 22 per cent, got rid of the backlog, and that's despite the fact that we've never had either as many complaints or as many health-related complaints, which are obviously the most complicated types of complaints that we receive. So, I'm very grateful to all the staff for the great work that they've done so that we can come here and report on those figures.

Okay, thanks for that, Nick. The initial questions we had on overall case load did deal with the general picture, really. I think perhaps I might start off by asking you whether that overall case load was what you anticipated and, as part of that, to what extent is the decrease in inquiries offset by the increase in complaints in terms of your overall workload?

I think in terms of anticipating trends, obviously we'd gone through a regulatory impact assessment exercise because of the new powers, so we had to look ahead in the short to medium term, and I think the projections there were between 5 and 12 per cent increases. So, I think an 11 per cent increase was towards the high end; I wish it had been lower, for obvious reasons, because we'd be able to reduce the case load even further. I am pleased to report on the fact that we've seen a reduction in inquiries. That is, to some extent, welcome, but it does not offset the increased demand put upon us with increasing numbers of investigations and of complaints themselves, particularly health complaints. We're five times more likely to investigate a health complaint than any other type of complaint, obviously given the very serious nature.

Yes, okay. We'll be coming on to some of the issues around the picture with the NHS. Before we do, though, your office achieved a 22 per cent increase in public body case closures. Could you expand on how that came about?

There were a number of measures that we took and, as I say, I'm very grateful to all staff, but the management team in particular, and both colleagues with me today. So, if I ask Chris perhaps to expand a bit on that.

Thank you. I think Nick has given some of the context in terms of the challenging case load, and you will recall that we also coincided with issues with maternity leave and adoption leave, which for a small organisation, when it reaches 10 per cent, becomes quite challenging. So, that was in the previous year, so we were starting from quite a difficult place, but we did bring in new staff. It takes a little while for them to be trained and know the ropes and be able to manage their case load fully, and that is where we got to during the course of the last year. We've dealt with the 557 cases that we brought forward from the previous year, and made good progress on the cases we received during the year. I think, as Nick has said, it's partly the development of the new staff so that they can be productive, and it's partly managers and staff performing well with the case load that they've got. So, I think there are a number of things, but very much a focus on trying to address the backlog and encourage and support staff to achieve high levels of progression with cases. 

09:10

Just in terms of the overall trend with increasing complaints, are you able to deduce the extent or the reasons for that in the context of whether, for example, it's an overall increase in maladministration or failure by public bodies, or breaches of code of conduct, or is it a greater awareness amongst the public of your function and the opportunity to register a complaint? Or is that public bodies' internal complaints processes are increasingly—or have seen a higher rate of failure to agree with the complainant, triggering greater reference to yourselves?

It could be a combination of all three. I think what's interesting is that not just have we never had such a volume come to us in any one year, but the fact that we found in favour of the complainant in about 67 per cent of cases. In two thirds of what's coming to us, there was a failing. Most of that was done through investigation, but early resolution has been a significant method for us to use, given the amount of volume that we're facing. So, it's been a record level for us in terms of number of complaints coming to the office, the amount of casework that we've dealt with, and then, probably, I would have thought, one of the highest levels of findings in favour of the complainant rather than the public body. 

And if two-thirds were upheld, and by definition, you would not normally accept a complaint unless the internal complaints process had been exhausted, except in exceptional circumstances, does that raise concerns about those internal complaints processes, and the way they are perhaps approaching complaints in a more risk-averse way?

Yes, and I think it tells you something about the variant, shall we say, from sector to sector. I was talking with some housing bodies yesterday. We have a relatively low-level number of complaints there, but our uphold rate from what we do receive is 13 per cent. Eighty-five to 90 per cent of what we've received there in recent years we've found in favour of the registered social landlord rather than the complainant, which I think tells you something about the robustness of their procedures and what we then receive. Whereas, perhaps, on health, it's the reverse of that—it's a 60 to 70 per cent uphold rate in favour of the complainant. So, I think what's positive in all of this is that we want to make greater shakes in terms of looking at those systems. We've been given these additional powers now in terms of looking at complaints standards. Good practice, which has made a difference in Scotland—if we can use that in Wales over the next few years, then it is about the culture of complaints, making sure that public bodies know what good looks like, and, hopefully, as a result of that, we won't just see more dissatisfied people coming to the office, but I would anticipate, if we've had that cultural impact, that the uphold rate would be lower. 

Okay. Perhaps I could—. Just sticking with case load and the different strands that make up the office's case load, in 2019-20, what would you anticipate in terms of overall case load in terms of potential increase, and, within that, are there any particular aspects of the overall case load that you would expect to significantly change?

Well, again, we've been through this regulatory impact assessment exercise, which demonstrated that we did anticipate an increase, but I think, touch wood, so far this year, things aren't looking too bad. I don't know if you'd like to expand on that, Chris. 

The complaint numbers are fairly stable this year. Enquiries are still increasing a little bit this year. I think it's always difficult to identify trends and patterns, and there do seem to be quite a lot of changes and fluctuations that don't have a clear explanation. There are a couple of things that are starting to appear in this year's case load. One is an increase in complaints about GPs, which have gone up—there are still relatively small numbers, but they've gone up about 25 per cent so far this year. And there's a steady increase in local authority complaints, but that is against a background, you may recall, of reductions in previous years. So, again, fluctuations. So, it's a little bit difficult to identify and make firm conclusions from patterns, but, broadly, the level of case load this year is fairly stable compared with last year.

09:15

Okay, Chris, thanks for that. We'll move on to Caroline Jones.

Good morning. Regarding public body complaints—NHS and local authorities; that's what I'm going to concentrate my questions on this morning—why do you think the number of complaints regarding the NHS has risen? Because there's a 10 per cent increase, isn't there, this year on complaints regarding public bodies and the NHS. So, I just wondered if you could explain to me why you think that this increase is here.

Well, it's difficult to pinpoint on one specific year, but if you look at the trend, over the past 40 years, there's been something like a 4,000 per cent increase in complaints emanating in England and Wales about health. We've probably seen a doubling, or certainly a significant increase, over the past five to 10 years. That's why we wanted the systemic powers, so that we can do more to make sure that the health boards are doing more. That's why we've designated some improvement officers to look at some of our best customers, if you like. So, this past year, we saw significant increases in Aneurin Bevan health board, in what is now Swansea Bay health board, dental complaints increased 86 per cent, complaints about GPs increased 22 per cent. We think that there is still this cultural issue when it comes to health board increases, because a significant number of health complaints are still about complaint handling. And I've said before that there are years where we see more health complaints about the way in which complaints have been handled and people have been treated by the corporate entity than there have been about surgery or waiting lists.

Do you think that the complaints regarding GPs have risen because they are under such pressure to see so many people? And, obviously, recruitment of GPs has been slow, not forthcoming. So do you think that has a lot to do with it?

I have no doubt—I'm sure demand pressures will have had an impact on the complaint levels. But some of this won't just be about the difficulty in getting a GP appointment, and I think we could perhaps analyse the data to see if there's more we could tell you there specifically about GPs or dentists.

Okay. Have you seen any cultural improvement across health boards by the way complaints are being handled? That's my next question.

We have seen, I think, a greater level of engagement. We've been out this year to have meetings in north and south Wales with all bodies and jurisdictions, to explain the changes that we anticipate. And you expect to have quite a negative response when you say, 'We're going to have some additional powers to enforce upon you', but I would say the response has been a positive one, in both north and south—much more positive than we anticipated. There's been a lot more engagement. We'd still like to see those numbers come down. But where we can work with—. I think there's a better relationship in terms of trying to make sure that we're resolving things quicker for the sake of the aggrieved patient. And I think that's promising. But the acid test for us would be a reduction—to actually see a year's reduction in the volume of health complaints coming to us would be great. This year might be the year, but we're only half way through, so I wouldn't like to make any cast-iron predictions.

There are concerns that the health board ABMU, within my region, has seen a year-on-year increase, and has indeed had the largest increase in 2018-19. Is there any reason for this?

We're still trying to explore those precise reasons. I will be seeing the chief executive and the chair of that health board within the next month or so. So, we certainly know the full picture in terms of the overall figures, and it's really about having that conversation with them about where those projections are going and what needs to be done to improve patient experience in that health board.

09:20

I'm concerned as well about the taking on and recruitment of improvement officers regarding the health boards. Are these temporary positions or are they permanent positions? How do we evaluate their work? How can we say that they've been successful? Do we just look if the number of complaints has gone down and so on? What exactly are we looking at here? Because complaints have gone up since their recruitment.

In some areas, yes.

So, if we're evaluating their role on just that aspect—KPIs and so on—then obviously it's not working. So, I just wonder if you can tell me more about the recruitment of these improvement officers and their longevity, really, and the KPIs to measure what they're doing.

I think, first of all, I'd like to reassure them that it's not an issue of their longevity. But, there are issues there, obviously, in terms of public value and input.

We designated a certain number of existing staff as improvement officers some years ago. They're amongst the most experienced senior investigators that we have in the office.

But when you've taken them from one area, does that mean that the area they've been taken from—have they been replaced or has that left a gap?

If I might explain a bit more, it's not so much longevity, but the reason why I said input—. Roughly, we expect them to spend one day a week on improvement activity. It hasn't been a statutory activity for us. Our capacity has been constrained, and I guess particularly this past year or so, when we're trying to get rid of that backlog, I think the emphasis has been more about, 'Do the traditional day job of making sure that you're investigating, getting those numbers down', rather than being able to concentrate on the broader cultural issues that I've talked about before. But, of course, this was a pathfinder for us, because it wasn't, at the time, a statutory function. I think as well they've done a great deal of work, for which we're very grateful, but I tried to reassure them from the beginning that you can't ask somebody—it's an unreasonable request, I think, to say, 'A £1 billion organisation, a massive health board, you're going to get one day a week this year—turn them around.' It's not a reasonable request of anyone.

So, we told them, 'You will be held to account not for the outcomes in terms of the trend or whatever, but your inputs. Can you demonstrate to us that you are working with the complaint teams in those respective health boards, that you're tailoring some of the messages to the specific issues that might be affecting them?' They've done that as far as they could this year, certainly for Betsi Cadwaladr, for Hywel Dda, ABMU and Aneurin Bevan as well. But I think we need to make sure now that if it is—which it is—a statutory function for us to be looking at complaint standards through the new 2019 Act, which you've kindly voted through for us, we look afresh as this activity. So, it's been of huge value to us, it's a new way of engaging. I think we can't just stand back like Canute and expect the sea to roll back; we've got to be proactive and try and do something that doesn't just actually benefit the pressures in our office, but benefits the NHS, benefits patients. So, I think the learning from the activities of those improvement officers over the last few years will be providing a big insight as we move forward to look at this as a statutory function.

And are experiences shared with these improvement officers—experiences of good practice, and the way to deal with things, and ideas pooled together—to have the best possible outcome for the reversal of the increase in complaints?

Yes. We've had seminar events, we've had networks with NHS bodies. So, we continue to try and press those key messages home. I certainly try and meet with our best customers, if you like, on an annual basis, at chief executive and chair level, but also to make sure that those improvement officers are with me, that we're talking truth to power, that if we feel that there's any gap perhaps between what's going on in the complaint teams and at board level, we're using real data and our front-line experience to inform their corporate knowledge.

09:25

Finally, may I ask you if we can explore the concerns that you have, really, regarding the increase of these complaints, and the organisational risks if these complaints continue to rise along NHS bodies and other public bodies, and so on—if they continue to rise, the impact it has overall, really, from one area onto another?

Well, certainly, it would be unsustainable if we were to see a year-on-year increase in health and local government complaints, because they are 80 per cent of the complaints that we receive. So, it would be a massive squeeze on us if both were to increase significantly at the same time. In previous years, we've seen this year-on-year increase in health but, fortunately, we did see an improvement in local government complaints coming to us—over two years, a 10 per cent decrease year on year. That's not quite true of last year, I think.

Again, what I can say is, in terms of—. I hope morale within the office, despite the fact that we've been through these challenges—. It's been a combination of challenge, where challenge is appropriate, and support as well. I hope that we have got the right culture. We're well equipped. Like a coiled spring, we are ready to take on future challenges and to make sure that the new powers that we get work as well. I really hope that they do.

I've spent four and a half years trying to advocate these changes. I'm now, you'll be pleased to hear, in the envious position—. Other ombudsmen in other parts of the UK are very jealous of the new powers that we have, but are also very interested, I think, to see what impact they will have. We tried to learn from other places. Will there be issues that arise now from Welsh experience that could inform better practice in England? So, I think we'll be under the spotlight. We hope that we can ensure that there's this reduction.

The rise in complaints and the knock-on effect in your department could be staff retention within your own organisation. So, I think that it's in everybody's interests really, isn't it, to get these complaints down.

Absolutely, but also, I think, as I said before, we have got to challenge ourselves. We've got to make sure that we are measuring and managing what counts in terms of people coming to us. They have been waiting a long time by the time they come to us. They will be losing a lot of patience. That then provides a challenge to staff, in terms of dealing with people who might be quite irate. We've got a duty of care to those staff. I think we're getting that balance right, in terms of making sure that work is being done but that people's broader well-being is being taken care of in the office as well.

We've put a lot of emphasis on that collectively; a lot of work. We had a well-being week to get over the January blues at the beginning of the year. We have put this emphasis on making sure that people aren't just under the cosh. We appreciate the pressures that they are under. I hope they see as well new blood coming into the office—new talent, a new capacity to deal with proactive, preventative measures, which is in the interests of existing staff. That can help them experience less pressure as well. So, everybody wins.  

In that context, when local authority complaints started falling a few years ago, it was after your office—admittedly, your predecessor—introduced an early intervention mediation approach to reduce demand and stop money being excessively spent on handling all of this. Would health boards benefit from similar direction? Certainly, from my own casework, it seems apparent that the increase is occurring where early green shoots—more of an early intervention, mediation, round-table approach—has now been replaced by what appears to be an entirely solicitor-led, standardised, 'don't shoot us' approach, 'and if you're not happy, refer to the ombudsman's office'. Finally, should we call a spade a spade and stop calling complaints 'concerns'? 

I'll start with the last one first. Whatever we call them, they're an expression of dissatisfaction. Obviously, we want to see standards improve. More importantly, though, they are feedback. If we're in a non-market-based system of public services—. As somebody said to me, 'If it's voice rather than choice, how are we measuring that?' So, there is some important data here that can inform the experience of the citizen. None of that should be—. Well, not all of it should be coming top down. I was having these discussions with the health board the other week. This isn't just about ministerial instruction  or civil service bureaucracy targets, which dictate what health boards have to pay attention to. I think there's a value in complaints data, because this is what the people are reporting back upwards. I think it's important that that has due prominence as well.

And back to this issue of culture, I'm very pleased that we're going to see some further legislation on health looking at the duty of candour and also the duty of quality, because I think what we're seeing is probably a reticence, shall we say—I think that's fair—which is certainly affecting the experience of complainants and the culture of health boards as well. So, if they adopt a lot of the bigger messages from that health legislation, it's about providing a big nudge in terms of culture and making sure that things are put right earlier. Katrin, would you like to add to that? 

09:30

Absolutely. I think culture is at the heart of that. By the time complainants reach us, they are really dissatisfied. They've been waiting a long time. If health bodies can look at complaints more openly and transparently—. I think where the public lose trust in the process is really when they've had a bit of misinformation from a body or there are long delays. We did a report a couple of years ago where the ombudsman highlighted these repeat issues that lead to dissatisfaction. So, absolutely, we want to change the culture of the way complaints are viewed. We can use the new powers that we have to enable us to do this to try and really shift the focus and make sure that bodies really learn from those issues and deal with them in that way. It's difficult when, sometimes, people are within the bodies where there's a culture of perhaps fear and blame maybe, and it very much needs to be led from the top we think.  

Could you issue, or could your office issue, guidance similar to that issued to local authorities some years ago, which may have been non-statutory but appeared to have a beneficial impact?

Well, what we want to do now, particularly in terms of health, is make sure that there's greater transparency. So, I think you and some of your colleagues have had to find out health board performance on 'Putting Things Right', for example, through Assembly questions. I think that data should be readily available. As I said earlier—what's the old adage?—what gets measured, gets managed. And we need to see a real step-up in terms of some of those PTR figures. We're going to be looking to do that with, perhaps, local government and housing associations as well. But I would hope that that broader picture in terms of performance transparency would be more beneficial in a health context than guidance. The NHS is not short of guidance. PTR's pretty detailed. There are pages of it, but that's of no use to somebody if they're still waiting, really losing patience, because there's a cultural issue or perhaps on a corporate level it's not getting the importance it should do, because what people are really getting measured against are deficits, cash management, waiting times. Let's have a bit more emphasis on measuring the patient experience, rather than the expectation of central Government, if that makes sense. 

Nick, when we were talking about improvement officers, you said that they were taken from within and had vast experience. Therefore, do you think that transparency could be compromised regarding complaints and regarding the way forward, really, by taking people from within, as opposed to recruiting from outside someone with a totally independent and fresh pair of eyes? 

Yes, absolutely, and I'm sure, as you can imagine, we are independent, we are impartial, so we have to put the relevant checks in place to make sure that those improvement officers were not compromised. So, they might only be doing one day a week, let's say working with Betsi Cadwaladr,  but that means, for the other four days a week, they must not be looking at complaints emanating from that particular health board, because that would be a compromise. 

I've got a very, very short one on this. This summer, I was approached by several senior clinicians, all of whom had tried to input into the system their suggestions for improvement, based on their own practical and clinical experience, and all of whom have now either resigned or have announced that they're resigning because they feel that they are being targeted, rather than welcomed, when they're making this advice. Who should they go to? 

09:35

Well, I take on complaints for service failure rather than corporate failure, but I think there’s a broader issue there, isn’t there, about the corporate health of any health board if that’s going on? I’ve heard counter to that. I do go out and talk to health boards. One chief executive was telling me—. He basically handed the corporate strategy over to the clinicians and said, ‘Come on, we’re here as a health board. Our role is to facilitate your productivity. What do you want? It’s your strategy, not mine. You own it.’ So, that’s a pretty counter approach to what you’ve experienced. But I think the truth will out on this. If that is the experience of some clinicians in some parts of Wales, then it’s going to lead to further shortages of skills. And I think, in some parts of Wales, that is an issue in terms of capacity, the ability to attract. And these are senior professionals, and sometimes there can be a cultural issue there where perhaps some of them have a problem responding to management. But I think, from a management perspective, you’re dealing with senior professionals who are not just there for the money; they’re there for satisfaction. For higher order skills, in terms of their day-to-day involvement—. Was it Maslow—the triangle of whatever it is in terms of human resources theory? It’s not just about the cash for them; it’s the way in which they’re valued, and the way in which they can have an input into broader outcomes, I think, is very, very important when you’re at that senior point in your career. So, as I say, those clinicians can’t come to me, but if they’re listening, or if any of their colleagues are, I think that is not the way in which you should be running a collaborative effort towards meeting an ever-increasing demand. With the backdrop of an ageing society and other issues as well, I wouldn’t advise it.

Okay. We're in danger of getting into wider health issues, I think, than is the province of either this committee or, indeed, the ombudsman's office, but there we are.

If we just move on to public body complaints outcome and performance. Are you concerned at all that complaint handling now accounts for around 10 per cent of public body complaints?

I am concerned, because I think it’s reflective of those cultural issues again, isn’t it? It’s tantamount to somebody shooting themselves in the foot. You can understand that, if somebody complains about waiting times and you’ve got capacity constraints, perhaps some of those complaints are inevitable. If someone complains about certain surgery, and inevitably nothing will go 100 per cent according to plan, there might well be certain circumstances where that can’t be prevented. But I would have thought, when it comes to the way in which somebody feels they’ve been treated and communicated with, that might be an easier win. So, it disappoints me and concerns me on the one hand, but, also, I think it’s a really important factor in trying to get these bodies on board. We’ve been consulting now on the complaints standards criteria and principles we’re going to be using. We’re going to have to lay regulations shortly with the Assembly. We don’t just want to be laying something that is command and control, ‘We’ve got power. We’re going to be coming around and enforcing this on you.’ You need a bit of buy-in from those bodies in jurisdiction to understand that it’s in their interests as well. If you’ve got that volume—10 per cent of complaints—which is really an easy win, I would hope that that’s a reputational incentive for bodies in jurisdiction to engage with us.

Okay. That's fine. Thanks very much. We’ve touched on early resolution already, haven’t we? Does the increase in early resolutions—? How would you account for that increase, and is there a danger sometimes, if early resolution is increasing, is a more proportionate approach and is favoured, that, nonetheless, it might be possible that the office is missing some of the thematic undercurrents that are involved?

Certainly, that’s been a risk that we’ve always been aware of. Without early resolution we wouldn’t have coped as well, certainly over the past 12 months. We’ve made a virtue out of necessity. Katrin, would you like to add to that?

As Nick's saying, given the year-on-year increase that we had over the last few years, we had to really try and adjust our process to try and deal with the increasing volume of complaints. And, obviously, first of all it's in the complainant's interest if we can get a resolution that they're happy with at an early stage; that's great, they don't have to wait for a more lengthy investigation. And I do hope that the examples in the annual report give a flavour of where that has been delivered within our nine-week target period for that. For example, there are cases where, maybe, a family member has cared for a niece or nephew and also where people have acted as special guardians. They have been entitled to funding; they've come to us because a year later they haven't received it, and the last thing they want is a lengthy investigation before they are delivered the remedy that they're looking for. So, obviously, it can be really beneficial for the people who come to us.

What we try and do, where we look at a case and resolve it at an early stage, we will ask a body to try and review to see if anybody else is affected in the same way. And also we are very mindful, as Nick said, that we don't lose on thematic issues, more wider systemic failings that, maybe, are better for our investigation team to look at. So, we record the reasons for resolving a complaint in our front-end complaints advice team. If they identify a pattern of conduct on behalf of a particular sector in a particular body, they will then refer the case through. So, we do very much try and look out for those underlying issues that, maybe, we need to focus and concentrate on more.

09:40

Can I assure you as well—? I think, sometimes, people think early resolution, or, in the past, some bodies in jurisdiction have felt early resolution is not as big as slap on the wrist—'Rather agree to this than have an upheld investigation against us.' We have to underline the fact that if any public body undertakes an early resolution, a voluntary settlement, and makes a promise to the service user, to the citizen, we will hold them to it. So, we had to issue one section 22 report; we laid it in front of the Assembly when one health board didn't honour an early resolution. And I think we did it again this year with Wrexham when it came to a language issue as well. So, it's a less bureaucratic way of dealing with things, but we've got to keep an eye on broader thematic systemic issues. We've got to make sure as well that it's not seen as a weaker form of administrative justice.

Okay, that's fine. Could I ask you about the compliance visit that you undertook, just to say a little bit more about that and whether you would anticipate such visits becoming more frequent in terms of the activity of the office?

Yes. Well, currently, we do undertake a number of compliance visits, but I thought it was only right that I should actually go out there and see specific public bodies, particularly if they've had a high volume of public interest reports or there are other issues of concern. So, the reason that I went up to see Betsi Cadwaladr was the fact that we'd had three public interest reports just for Ysbyty Glan Clwyd during the previous financial year.

I was very impressed by what I saw. We'd had huge concerns about urology services in Ysbyty Glan Clwyd. They were able to show me, so I was able to physically see the improvements there. So, that was very welcome. And they were able to demonstrate what they were doing to try and improve communications within the hospital. Critically, because one of these public interest reports was about a preventable death where junior doctors had not had a senior colleague to refer to over a weekend—somebody passing away with sepsis—we produced a thematic as well as a public interest report in the wake of that, and I'm delighted now to be able to go up there to hear from clinicians who now say that the policy is now in place: no junior doctors are left without recourse to a senior colleague on either weekends or bank holidays. So, that, in itself, that's the type of systemic improvement that we want rather than just seeing year-on-year preventable deaths coming into the office.

I think it's important for our commitment to our staff that they're not just seeing the same old, same old coming in. And, obviously, it's an issue of public safety and an issue of concern to the NHS, I'm sure. So, that was a trip that I did enjoy. I did go see the Daily Post afterwards and I spoke to the media about my findings there. I still expect to see—. I would like to see further improvements from Betsi Cadwaladr, but, I think, credit where it's due, they have made significant improvements, particularly in terms of urology and senior oversight.

More recently, I've been out to see Hywel Dda to discuss their capacity for dealing with complaints. We've got a plan in place with them now that we'll be working on to see an upheaval. It just so happened that I had a friend who was in Glangwili at the time and I was able to stop by and see him. It's great fun. They tease the staff, 'He's the ombudsman', you know, getting a bit of—. But the fantastic care that was obviously available there and it's good to just get out into those settings and real life, rather than just paper and complaints. So, I think it's the right thing to do and I do enjoy doing it as well. I hope to be able to do more of it, going forward, and I think that needs to be targeted though on those health boards that are still struggling the most with the level of complaints.

09:45

That's fine. Thanks very much. The decision and investigation time framework for public body complaints, there have been some issues in terms of indicators with regard to that aspect of performance. So, what would be your analysis of that?

Well, I think my overall analysis is that those figures are disappointing. Some of them are inevitable, given the fact that we did have this huge backlog—as we said earlier, 10 per cent of staff on maternity or adoption leave. We're turning that around. I said earlier as well, what gets measured gets managed; we are managing it and we are encouraged, I think, by some of the in-year progress that we've made. Katrin, would you like to expand on it?

Absolutely. As Nick was saying, we were in a position last year where the open cases that we carried over at the beginning of April were really high because of all the factors that we've outlined. So, the targets took a hit, really, because we had to queue cases to give staff a bit of relief. We were talking earlier about the pressures; it is really pressurised when individuals have high case loads. But that really gave them an opportunity to just focus on the cases on hand that they had. The downside of that was obviously the target figures for our decision times took a real hit there. It's improving this year so far. We're up to about 68 per cent on that and we expect to see some improvement for the remainder of the year, but the queue is really important because it allowed us to really close those additional cases last year and it gave everybody that opportunity to focus and have the support they needed to do that.

In terms of investigation timescales, yes, that was also disappointing, but actually, as Nick has alluded to, we needed to see that getting worse before we got better in terms of that overall figure, because when we measure cases closed—. Obviously, when you have open investigations and they're over 12 months, as soon as you close them, they're really going to knock that performance figure, so we've been expecting that. We have some cases over 12 months still ongoing, so we're still expecting a little bit of that negative impact there on that figure. But certainly, in terms of overall case load, we're down, now, to about 450 cases on hand, so it's much, much better. And this year, we're really seeing improvements in throughput.

Okay. In terms of the date sufficient information received part of the framework and the fall in performance there, is that part of that picture you've just outlined, or is there anything specific to that?

It is. It was really the direct effect of the queue. As I say, we had to queue cases to give staff a bit of relief, particularly when new starters had to be trained and mentored and they're not up to speed like established colleagues are. So, obviously, when we queued cases for the month at the front end of the process, we weren't going to achieve that. That was from May to September and that really knocked that figure down to 55 per cent last year.

The figures are improving and I think we're very conscious, you know, target-driven cultures, this can't just be about numbers, this has got to be about quality as well, so we've got a renewed emphasis on quality and continuous improvement to see that we're learning, and that we're holding a mirror up to ourselves as well. We can't be holier than thou, going out there and preaching certain messages for good complaint handling and good service user experience for public bodies if we're not trying to be true to those values ourselves. So, we are conscious of it, but again, it can't just be about numbers, there's got to be an eye to quality as well.

Okay, thanks very much for that. Over to Mark Isherwood again.

Thank you. Moving on to code of conduct complaints—take a deep breath. Several years ago when your office intervened, as I mentioned earlier, this had followed an upsurge in code of conduct complaints against a local authority in north-east Wales and a community council in central north Wales. I spoke to their clerk the other week and he told us how much it had improved in his community council since then, but notwithstanding that, your report indicates that the increase in code of conduct complaints has been driven by community council complaints. Why do you think that is?

09:50

I think you've alluded to the fact that, sometimes, you just get a cluster effect. Across Wales, there are some 760-odd community councils. A 90 per cent increase in complaints, is that across the country? No. It's probably three community councils where relationships have nosedived particularly dramatically. So, the more that we can make sure that that doesn't snowball and have a worsening effect, the better.

I'm pleased to say that we've seen a significant improvement in community council performance this year. I think One Voice Wales are doing a very good job. They seem to be signing up more and more members, doing more and more training, so we're grateful to them. Katrin and other colleagues have been out as well to train and remind people of the way in which this stuff should be dealt with.

I've got to say, overall, I am really pleased with the numbers on code, because if you look at what's been going on in terms of public life over the last five to 10 years with Brexit, social media, scope for all kind of—. Just this very week I think that there have been issues coming to the fore. Actually, we've seen a fall-off in those numbers, if you look over a five-year period. But we keep that emphasis on the public interest, rather than vexatious issues, and I think that's allowed us to really focus in on the areas that you'd expect us to focus on, so corruption, bullying, the use of public office for private gain—watch out, we've got to investigate and we would hold you to account. But with some of this broader stuff, which isn't really connected to the public interest, we're pleased at the way in which the numbers have emerged.

Thank you, Chair. My apologies for being late and apologies to you, as well, for being late, so if you've already covered this, forgive me. On the increase in the number of cases that you've had to deal with in all public bodies, you've touched on social media, you've touched on one or two other things. Have you been able to pin down any specific reason? Is it that we are seeing a poorer service in our public services, or is it that people have a greater awareness now of how to complain? What would be your assessment of that?

We have touched on some of this, and I think it's a combination of factors. I hope that people are more aware—. If we were receiving more complaints for that year in question, well we had more public interest reports—14 public interest reports. As you can imagine, every time there's a public interest report, there's media interest, it's reported on the media, so we get a lot more coverage. I think we can probably almost map certain things coming into the office.

But it's not just about us. I think there's a broader issue here, as I was alluding to earlier. There's been a 4,000—I hope these numbers are right—a 4,000 per cent increase in health complaints across England and Wales over the past 40 years. Seven hundred and eleven complaints across the UK in 1976, 30,000 now; I think that's 4,000 per cent.

So, the complaints are going up, but can I be clear about whether the number of cases that you uphold against those bodies are proportionately higher, or whether they're about the same, or they're proportionately lower?

Well, again, we've alluded to this, but I'm glad it's—. For the year in question, we've never had so many complaints come to the office, but also, in terms of upholding them, either through investigation or early resolution, I don't think we've ever had as high a figure: 67 per cent.

So, two thirds upheld, but that varies sector by sector. Health would be 60 per cent to 70 per cent; housing, perhaps, 13 per cent.

In fact, half of those code of conduct complaints related to the promotion of equality and respect. You've indicated that you considered most of the complaints that you received as vexatious, but nonetheless, equality and respect encapsulates many of the issues you've just referred to, and it's certainly what's grabbing the media interest and public awareness at the moment. So, do you think that's part of a trend or just a one-off?

I have no doubt it's part of a broader trend. Obviously, I've alluded to Brexit issues around language—it's prevalent everywhere now, isn't it? But I think more broadly, if you stand back, it's not just about the last three years. If you go back to cash for questions, broader disillusionment with public life, I think perhaps respect for authority never so low, expectations, scrutiny never so high—it can make for an explosive mix. And then I think the fact that you've got additional methods of expressing that, particularly through social media, particularly on Twitter, but Facebook and others—even I've had a Facebook issue—and there are other channels to choose from as well. It comes together, doesn't it, and means that, inevitably, there will be more of this? But as I say, you can still get vexatious complaints that allude to issues around equality and respect. If it's bullying, if it's misuse of public office, we would hold people to account.

09:55

As you say, in 83 per cent of code of conduct cases referred to you have been closed after initial investigation, so (a) what are the resource implications of that for you, but (b) why are you classing those as vexatious or closing them, where equality and respect per se is a statutory matter covered by equality Acts and other pieces of legislation applicable in Wales?

Because they don't meet the public interest test. We came up with a public interest test. We're very clear that you as elected Members, and more broadly as people we account to, and who expect value for money—if we receive a complaint about equality and disrespect, something along the lines of, 'The councillor in question was disrespecting me by clicking his biro in an aggressive manner', you would not expect me to spend public resource trying to judge the rhythmic qualities of his pen clicking, whereas if we are receiving complaints from Betsi about a preventable death, sepsis, other broader issues, that's where we put the resource. You'd expect us to do that. We wouldn't feel comfortable coming back here and accounting for that. It's a proper bar, and I'd like to reassure you of that as well, Mark—that maybe there's something to celebrate here in the fact that the number of referrals that we make to adjudication panels or to standards committees is relatively constant—has been constant. So, over these last few years where, I'm sure you know, it's been more challenging in terms of abuse of members—I get a bit of it, but I'm sure you get much, much worse—despite all that stuff, certainly from what we've seen in terms of local elected members' behaviour, it's been a constant small number, and if we've got 2,000 councillors in Wales or whatever, and if there are six referrals—there's something to celebrate there, in the fact that there hasn't been an explosion in those numbers. We keep a keen eye and we apply the bar, and it's not a quota—if there were twice as many offensive or bullying cases coming in, then there'd be twice as many referrals.

There are resource implications nonetheless, if you're having to process more than eight in 10 cases that shouldn't have come to you in the first place.

Yes, but I think again, on the positive side, through sending out those messages, and I hope through community councils, with One Voice Wales and others, we have seen a general reduction over the last five years. So, whilst having to sift through those 80 per cent, as resources—if it was 90 per cent, it would be worse. Is that right?

It's fairly limited, the work at that front end, informing somebody we're not going to look at a case. Yes, it does take some resource in our front-end team, but it's not unmanageable, at this stage anyway, and we deal with them as quickly as we possibly can. We can't stop people making complaints to us, so we have to deal with them in that way, really. But we do it as efficiently as we possibly can, really.

Okay. A final question in this section, then: the percentage of cases where complainants were informed within four weeks whether their case would be taken forward has fallen from 91 per cent to 75 per cent, and there's been a rise in the number of investigations taking longer than 12 months to complete. What is your analysis of the reasons for this?

Well, I think the analysis goes back to what we were saying earlier—10 per cent of the workforce are on maternity or adoption leave, and there's been a significant increase, particularly in health complaints, which take up the majority of our time. Those numbers are better now, though.

10:00

Yes, they certainly are, and we've developed a specialist group of investigators now who are doing those investigations, and it's just because they are relatively few that we deal with, they can be very difficult, with a number of witnesses that we need to contact and quite contentious, some issues. So, by focusing and getting a bit of expertise in that area, at this stage, we don't have any cases over 12 months. Obviously, that may change. But, certainly, we're managing the work in that way, once they reach the investigation stage.

Thank you, Chair. Your report notes that the performance of the four health boards that you've continued to designate as improvement bodies is disappointing, but your report in itself doesn't actually cover any information about the work and the progress of the improvement officers. Is there any particular reason why? You mentioned the concerns about those four health boards, but you don't actually have a section in the report about the work of those improvement officers.

No, that's true. We don't. You're quite right to point that out. We talked about the role of improvement officers earlier as well. It hasn't been a statutory function until now, so I think, from now on, we now have a fully-fledged improvement team, a lot of work's been done there. I think I gave a description of the type of work that we expected improvement officers to do, to really tailor their messaging to those four improvement bodies, given the specific challenges that they face. The improvement officers are the most senior and experienced investigators that we have, but it is only a small part of their role: one day in five, maybe—probably less over the last 12 months, because of the real pressures that we had in terms of additional casework coming into the office.

If I may, Chair, just to add, I think it will change with the new powers under the Complaints Standards Authority for Wales and much more emphasis on improvement. In the meantime, we do produce annual letters for each of the health boards that actually reflect some of the improvement activity and the areas for further work by the health boards or local authorities, and they're on our website.

Okay, I understand. So, we could see your annual report looking slightly different with the new powers, and that may be included—

It will be, yes. 

It will have to be. The Finance Committee have made it very clear that they want us to account separately for the additional money they've given us and the additional powers.

Okay, that's fine. That's good. So, just in terms of the new powers, then, perhaps you could just update the committee on the preparatory work that you're doing for that.

Yes. We've seen a huge amount of positive activity. Chris has got a—.

Yes, we're in a very good position now. We've recruited staff to all the new roles, which is great. We've trained existing staff on the implications for them of the new legislation. Obviously, it is a new Act, but there are actually changes in the way that we need to work as a result. We are now accepting oral complaints—a relatively small number at the moment, but we are accepting oral complaints, and I think that is already having some benefit in actually helping us to provide a service to people who would otherwise struggle to access the service.

A small part of the new powers relates to a limited role with private healthcare. So we've been in touch with all of the private healthcare providers in Wales. At the moment, and this was referred to earlier—. We've just finished, on 30 September, the formal consultation on the principles for own-initiative investigations and some of the preparatory work and principles for the complaints standards authority and model complaints-handling process. So, those are all—. We've got the responses back. We were dealing with those and we will be in a position to lay, as Nick said earlier on, the formal documents before the Assembly in the next few weeks.

Okay, that's fine. Thank you for that.

Just around the satisfaction survey: a significant drop in satisfaction this year. Was that expected? Does that tie in with the increased numbers of cases that you're dealing with, so you've got some delays? It was mainly around that, was it? Mainly around delays in responding.

It's more that we have actually changed the way that we seek feedback. It is always going to be difficult. I think we probably suffer from the TripAdvisor effect, and people are more likely to vent their frustration if they don't get the casework decision about a public body that they want. But what we've tried to do is get more meaningful feedback. A lot of the feedback, probably about 95 per cent of the feedback, that we got in previous years was on the very early stage of the process, so did we acknowledge the complaint well, and did we say we would investigate in a timely—. What we didn't get was much feedback in terms of the longer process, and we tended to get the feedback before they'd actually had a casework decision. What we're doing now is getting feedback when we're saying, 'We've not upheld your complaint—now how satisfied are you with the service?' And the difficulty for us is trying to separate out what is general genuine service dissatisfaction and people who are just unhappy with the decision.

What we're trying to do, or planning to do, rather than rely on questionnaires and surveys, which are good but limited, is actually trying to get maybe a focus group or something, so that we can have a more detailed discussion with people who've actually experienced an investigation and reached the end of the process, so they can actually give us a more nuanced feedback that isn't just, 'You didn't give me the outcome I wanted.'

10:05

Yes, and that's hugely important, isn't it? If somebody feels that their complaint is being taken seriously, that you've looked at everything—it's not dissimilar to how we have to deal with stuff. We can't always give a constituent the outcome that they're looking for, but if they're satisfied that we've given it everything—that's really the test that you're looking for now, is it?

Absolutely, and to try and make sure that we're demonstrating our commitment to that, we've got service standards that we obviously expect staff to work to, and we've published those on our website. We also are very keen to get the views of all service users, so that is complainants, but it's also health boards and local authorities and the public bodies that are within the ombudsman's jurisdiction, so that we get their feedback on the service so that we've got sounding boards for each of those, and are using the feedback from those as well to try and shape and improve our service.

Okay, that's helpful. Thank you. My final question, Chair, relates to the allocation of resources to your four strategic aims, and you know what I'm going to ask. You've got 80 per cent in aim 1 and only 3.5 per cent in aim 4. How do you arrive at that? Perhaps you could just explain a little bit about why that's been done and how that's been done.

I think it's important that we're able to reflect the statutory functions that we have. So, I think you would expect us—. Up to now, statute has dictated that we've been a reactive complaint handler, so we thought putting 80 per cent of our resource into reactive complaints handling is appropriate. The last few years, a greater emphasis on improvement, so only 15 per cent of our activity there. Sometimes that has had a significant impact; I alluded earlier to the thematic report that we did on out-of-hours services leading to a review across health boards, no junior doctors being left with no senior supervision during bank holidays and weekends as well. So, it's not just about numbers, it's about quality as well.

We have spent, we think, about 4 per cent of our time preparing for the new legislation, which obviously has to be done—it's going to be a significant culture change for us, being more proactive rather than simply reacting to events—but only 1 per cent on governance and accountability, which obviously involves coming here, but we do have some internal checks and balances, and other issues as well. So, I think it's a fair and accurate an explanation as we can make, I think. Chris—sorry.

Yes, as Nick says, it's based on how our staff time is used, and it does reflect the very high priority given to the core business of complaints handling. I think this is another one that will change in future years as the emphasis on the improvement agenda and the Complaints Standards Authority increases.

Sure, okay. All right, that's fine. Thank you. Thank you, Chair. 

Could I just ask a final question, really, and that's with regard to formal complaints that you've received about your work and your office? Would you say that any of those formal complaints have resulted in action and improvement during the year?

It's very, very early days. I think the new powers were enacted in July, so they've been live for what, three months? But we're glad to say they're there. Obviously, we have to and will continue to be expecting that most complaints are made in writing. So, it's not so much about ensuring a new form of improvement; there's a great level of access to our services.

This is the formal complaints about the work of the ombudsman's office, Nick.

Shall I pick that up? They are a relatively small number; it's about 30 out of 7,000 enquiries and complaints, and many more than that are actual contacts or interactions with the office. But I think the annual report sets out the outcomes of those. There are upholds. What I would say is that, in most cases, and I think the report gives a flavour of them, the upholds are things we haven't got quite right, but they're relatively low-level things, nonetheless important, but, generally, quite low-level things like typographical errors, which we shouldn't be making. There was one complaint where we didn't very well handle a challenge to a draft report, and we have put that right, but we've also learnt from that in the way that we deal with challenges to our draft decisions. We've got a much more formal process now, so that there's an independent review of any challenge to a draft decision. So, we do learn from them. There are other things, more administrative, about just the process for dealing with change of contact details and things, to make sure that they're handled appropriately, which we've also learnt from. But we do take it seriously. We obviously are telling others to take complaints seriously and learn from them; we're very keen to do that ourselves. I think they are relatively small numbers, but we do try and learn from them where we can. 

10:10

Okay. That's fine. Thank you very much. If there are no further questions, thank you all three of you for coming along to give evidence to the committee today. You will sent a transcript to check for factual accuracy. Diolch yn fawr. 

3. Papurau i'w Nodi
3. Papers to Note

Our next item is papers to note. We have one paper, which is correspondence from the Scottish Government, providing further information regarding our inquiry into benefits in Wales. Is committee content to note that paper? Okay. 

4. Cynnig o dan Reol Sefydlog 17.42(vi) i Benderfynu Gwahardd y Cyhoedd o Weddill y Cyfarfod ac o Eitemau 1 a 2 o'r Cyfarfod ar 17 Hydref 2019
4. Motion under Standing Order 17.42(vi) to Resolve to Exclude the Public from the remainder of this Meeting and Items 1 and 2 of the Meeting on 17 October 2019

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod, ac o eitemau 1 a 2 o'r cyfarfod ar 17 Hydref, yn unol â Rheol Sefydlog 17.42(vi).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting, and items 1 and 2 of the meeting on 17 October, in accordance with Standing Order 17.42(vi).

Cynigiwyd y cynnig.

Motion moved.

Item 4, then, is a motion under Standing Order 17.42 to resolve to exclude the public from the remainder of this meeting and items 1 and 2 of the meeting on 17 October. Is committee content so to do? Thank you very much. We will then move into private session. 

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:12.

Motion agreed.

The public part of the meeting ended at 10:12.

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