Official Report: Minutes of Evidence
Audit Committee, meeting on Wednesday, 16 October 2024
Members present for all or part of the proceedings:
Mr Alan Chambers (Chairperson)
Ms Diane Forsythe (Deputy Chairperson)
Mr John Blair
Mrs Ciara Ferguson
Witnesses:
Ms Margaret Kelly, Northern Ireland Public Services Ombudsman
Mr Sean Martin, Northern Ireland Public Services Ombudsman
Ms Kirsty McCool, Northern Ireland Public Services Ombudsman
Draft Budget 2025-26: Northern Ireland Public Services Ombudsman
The Chairperson (Mr Chambers): Good morning. I welcome Margaret Kelly, the Northern Ireland Public Services Ombudsman (NIPSO); Sean Martin, acting deputy ombudsman; and Kirsty McCool, head of governance. You are here this morning to present your draft budget for 2025-26.
The Deputy Chairperson and I met Margaret and Sean informally a couple of weeks ago to have a provisional look at the budget and challenges that they face in the incoming year. Margaret, the floor is yours.
Ms Margaret Kelly (Northern Ireland Public Services Ombudsman): Thank you for the opportunity to talk a bit about our work and our budget and to answer your questions. If members do not mind, I will take a few minutes to give an overview of the work and some of the key issues.
As the Committee will know, NIPSO's primary role is to make a difference to individual citizens in Northern Ireland by providing access to justice that is free, independent and impartial. NIPSO does that by independently investigating complaints from individual citizens and undertaking systemic investigations. We also aim to make a difference to public services and public bodies in Northern Ireland through promoting service improvement by learning from complaints.
I will not go through our whole range of functions because they are in the paper for the Committee to look at, and I know that members are familiar with them, but I want to talk a bit about what has been happening in our work.
Individual complaints in relation to maladministration and failures in care and treatment in health and social services make up the vast majority of our work. In order to be proportionate, we use a three-stage approach. Stage 1 is when we assess a complaint, decide whether we can accept it and whether it falls within jurisdiction. Stage 2 is an eight-to-10-week investigation, where we primarily seek to resolve a complaint. It costs a public body something like 40 times more to resolve a complaint at stage 3 than it does at stage 1, and the pressure on public finances means that we should all have a focus on trying to resolve complaints where we can. If that is not possible and there are very serious complaints, they will go through to a further stage of investigation. That is stage 3, which is usually around a 52-week investigation. The number of stage 3 investigations has gone up.
Overall, you will see that our complaints have increased really significantly, with just over 1,170 complaints last year, which has more than doubled since NIPSO was established in 2016 and represents an average 15% yearly increase. In the current year, that has continued apace. We are just at the seven-month mark in the year, and we estimate that, by the end of the year, we will have dealt with approximately 1,250 to 1,300 complaints. That does not include an additional 350 re-presented complaints. That is when someone comes to us and they have not finished the complaint of the public body, and we say to them, "Under the legislation, go back and try to finish that, and if you are still unhappy, come back to us". We are looking at 1,500 to 1,600 complaints this year.
We have seen complaints increase in almost all areas of public services. Health complaints in the past three years have gone up by 14% overall. They have gone from 38% of our total to 43%. Education complaints have gone up by 15% over the past three years and now make up a total of 13% of the complaints that come to NIPSO. Quite worryingly, over the past three years, housing complaints have risen by 28%, which is a cause for concern. I often say in the office that NIPSO is the tip of the tip of the iceberg. To get to us, you have to have gone through the public body's complaints process, which can often be difficult and require determination, and then you have to begin the process to come to us. So, when I see those kinds of increases, I know that there are usually many issues underneath that I will not have seen, because it does take real effort to get through to the office.
However, it is not only a matter of a sustained increase in complaints. I have also noted an increase in the complexity and seriousness of cases that I am seeing at stage 3. When we undertake a stage 3 report and do that investigation, we issue a draft to the public body and to the complainant to allow them to check for factual accuracy and to make sure that we have not missed anything. I see every single one of those when they come back. On average, they are running at, probably, 100 reports a year.
I have now been in the role for four years, so I have four years' worth of looking at that level of reports. In the past 12 months, the number of very serious cases that I have seen has really increased. What I am seeing, particularly in health and social care cases, is an increase in more serious harm and an increase in the number of cases where we would say that there had been preventable or untimely deaths. Just to give you a sense of that, I am going to reference a few of those cases that have come through the office in the past 12 months.
Someone with significant and severe pain was left for more than nine hours without pain relief. They developed sepsis, and failure to identify that in a timely manner led to the person's death. There was the intrauterine death of a baby at 34 weeks as a result of what I can only describe as acute failings in the care of the baby and that mother. It was a very high-risk pregnancy, and the risks were known. There was the failure to identify a cervical fracture, and a misdiagnosis of that as a cardiology problem, which led to compression of the spinal cord and death by pneumonia — again, a preventable death.
The Committee may be aware of the recent coverage for Mr Cull about his father's untimely death due to a bowel obstruction and the fact that his father's premature discharge meant that he died within seven hours of being discharged from hospital. Also, there was a serious kidney injury — actually, irreparable damage to the kidney of an adult with learning disability — due to the fact that a renal stent that should have been removed within three months, and certainly, according to the manufacturer's guidelines, by six months at the outside, was not removed until 18 months after it had been put in, which led to calcification of the stent and very serious kidney damage. It actually links to some of the issues around the ongoing urology inquiry, even though it is out of the time period of that inquiry.
Those are the kinds of serious cases that I have seen in the past 12 months that, in my first three years as ombudsman, I might have seen once or twice in a year. My team and I are definitely seeing an increase in the seriousness and complexity of cases. That has many implications. It is important for families that they have access to the ombudsman's office when they have those kinds of serious concerns. It is important for families that we investigate those fairly and appropriately and that the recommendations that we make give families some sense that we are working to prevent such incidents from happening again. The majority of complainants say to me, "I'm bringing this complaint so it won't happen to someone else". Therefore, in the case of the death of the baby, we recommended an independent review of the maternity and obstetric units and that the findings of the review should be reported to my office, because we have a concern that that should not have been missed.
There are other implications for the office. We use independent professional advisers when we investigate those cases. We have seen, because of the seriousness and number of cases, the cost of that rise significantly from £63,000 last year to almost £90,000 this year.
I just wanted to give the Committee a sense of that work. Obviously, we have work across a wide range of other functions, and, if the Committee will allow me, I will say more about that.
We have our own-initiative investigations, which look at systemic failings across public bodies. I hope that the Committee will be familiar with our personal independence payment (PIP) report, which looked at the changes to benefits in light of medical evidence. We also issued 'Forgotten', which reported on communications for those on health waiting lists. We had a finding of systemic maladministration, where we found that those were very much in disarray. We have been working with the Department of Health and health and social care trusts to implement the recommendations of that report, and we will report on that shortly. We are pleased, however, to see some improvements in that area and that many trusts have put a text system in place to properly alert patients when they are on a waiting list, to give them an idea of their clinical priority and to let them know how they can get in touch.
Sometimes, when we undertake systemic investigations in order to make best use of resources, we undertake an overview report rather than a full investigation. We also produced a report called 'Strengthening Our Roots', which was about tree preservation orders in the planning system. We focused on the lack of enforcement and the fact that there had been only one enforcement across 369 breaches of tree preservation orders.
We try to work in a systemic way to make broader improvements as well as individual ones. We have three reports due to come out shortly on access to healthcare. Those focus on charging for healthcare; patient removal from GP services, which is an increasing issue; and the use of translation services across GPs. We now have, in plan, a new own-initiative, which we will announce in the coming weeks.
We try to take the key themes and learning from our work and our investigations and share them with public bodies and the general public. We have produced two case digests to do that, one of which is on schools and the other on care homes. We have two more in the pipeline that are patient-safety focused, looking at sepsis and women's health.
The Committee will know that we have a complaints standards role, which is about trying to improve public bodies' complaints handling. We try to balance our work between being that focus on investigating individual complaints and helping public bodies to get it right first time at the point of service.
Local government in Northern Ireland has already moved to the new, simpler, more straightforward, two-stage complaints process, and we are working across the health family — trusts, GPs, care homes and family practitioners — to get that two-stage process in place. We will, shortly, publish a timetable, covering the next three years, to move all public bodies to that new process, so that they can see when that is happening.
If I may, I will briefly touch on my local government ethical standards role. Our overarching approach is to improve the understanding of the requirements of the local government code of conduct. We have engaged a lot with local councillors and council staff around the code of conduct. We did a number of really significant surveys, and we continued with that work this year. This year, we have engaged with over 38% of councillors, representing more than 160 councillors in all council areas. We have delivered 10 direct training sessions, and we are just about to launch a range of interactive training resources. The focus is on helping councillors to understand their responsibility so that they do not inadvertently take action that causes them to breach the code of conduct.
We have also worked very hard — we have written to the Committee about this — to ensure that those investigations are more timely. We always phone councillors directly when we get an allegation, and we encourage councillors to engage in the process. I am pleased to say that there is no case at investigation under the local government code of conduct that is any older than 12 months now, and the majority of cases are a lot less than that. The team has worked really hard to improve that.
Finally, the Committee will have seen our budget, and I know that you will have questions. We are happy to answer detailed questions on that. We have asked for an increase in our budget, and that is linked to the volume and complexity of the work that we are doing, which is putting our staff under significant pressure.
As you are aware, because you provided me with funding to undertake a pay and grading review, we have faced significant staff turnover. Our staff engagement score is over 80%, so staff are primarily leaving for reasons of pay. Staff can come to us and spend two years in the office, getting an excellent experience and skill set, but move on for significantly more pay. That is very difficult if you have someone who has a serious health complaint and their investigation officer moves on. We have looked at that pay and grading review. We have given the Committee information on it, and we have chosen option 2 on that because, for the sustainability and effectiveness of the office, it is important that we address that. We are happy to answer questions on that. We have also put in a number of additional investigation posts to try to deal with the volume, but we have frozen a number of posts to try to ensure that we make a balanced contribution to that.
We are happy to answer those detailed questions on budget or, indeed, any other questions that members have. Thank you for allowing me the time to do that.
The Chairperson (Mr Chambers): Thank you, Margaret. The Committee appreciates your sharing with us a flavour of some of the work that you do. It highlights the harrowing nature of some of the investigations that your staff have to undertake. I am sure that it must be difficult for them, at times, to deal with some of the cases. I appreciate your sharing that with us.
I have a couple of questions. I know, from previous conversations with you, that staff retention is a huge challenge for you. It is an increasing concern in your office. In addition to the pay and grading exercise, what steps have you taken to try to retain key skills in your office?
Ms Kelly: We have done a number of things. We have looked at pay and grading; we have an excellent staff engagement score, so we engage very heavily with our staff; we have a new learning and development plan, so we look at the opportunities for training — are there internal opportunities to step up and to take on some additional duties and gain additional experience? However, we are a small staff team with just over 60 people. At the end of the day, there are only so many opportunities for progression in such a small staff team.
Mr Sean Martin (Northern Ireland Public Services Ombudsman): One of the other things that we discussed with Committee previously was some sort of trainee programme. We have set up a team to start to develop that. Now that we have looked at it, we are going to broaden that out to develop, hopefully, some sort of professional qualification for our existing staff as well, while we are developing a trainee investigator programme, so that we are not always going to the market to recruit. We can bring in people, give them skills and, hopefully, retain them for longer. We are also looking at how we can have a programme that helps our staff to attain all their qualifications and experience so that they are much more involved in the office.
It is a difficult balance between the pressure at the front end and the amount of time that you devote to training and development. As Margaret mentioned, staff get really good experience with us, and when they leave us, they go on to very good roles in other organisations, primarily in the public sector. They will take the experience that they got with us and use it for good.
The size of the office means that holding people for as long as we can is imperative. We are aware that we will not keep them all the time. People will come in, contribute to the office and its development and the work that it does, and they will move on. In the time that I have been with the office, we have more earlier-career people now than we would have had in the past. I must say, they are very good, very capable, and they develop very well when they are with us. We have just recruited a new set of investigators. We have a fantastic induction programme to introduce them to the office and what we do and why we do it, and we help them with their skills development as they move through and the longer they are with us.
We are very mindful of that need. Salary is clearly an issue. It comes through in our staff exit interviews, but it is not just that. It is the whole package. As the senior leadership team, we meet our staff, as a whole team, every two months to give them the opportunity to ask us questions and to tell them about what we are doing. We tell them after each senior management team meeting what we have discussed and where we are taking the organisation. So we do our best in all of that, but, despite those efforts — you will see our staff turnover in an appendix to the paper — we do have an issue.
The Chairperson (Mr Chambers): I acknowledge that your staff do very challenging work, but I am sure that there must be a level of job satisfaction as well, when they conclude an investigation and get some closure for members of the public.
Before I open it up to the rest of the Committee, I have one more question. What impact would the proposed increased budget that you outlined have on the service that you can provide to the public?
Ms Kelly: It could have a number of impacts. We need more staff to deal with the volume of complaints. For the first time, our staff are starting to say that the volume of complaints is not manageable within our key performance indicators (KPI). We will have to create a queue. We will have to say to people, "Before we can even allocate your case, you will have to join a queue". One of the difficulties with that is that people will often have been in a complaints process for two or three years before they come to us. You are then saying to them, "Before we can even consider that, you will have to wait in a queue". That is difficult given the serious nature of the complaints.
Our staff are at capacity, so I definitely need more staff if I am going to continue to deliver that service. To deliver that service effectively, I really need to address pay and grading. As Sean said, people come to us, and they get an excellent experience. People tell us that as they leave. They often tell us that they do not want to go. However, people need to move because they have mortgages and families. I would hope that we will be able to retain those really good staff for longer.
Ms Forsythe: Thanks very much, Margaret and your team, for being here. The work that you do is so important. You talked about the volume and severity of cases. It speaks to the underfunding of our public services. Access to your service is so important for people when they face those issues. Margaret, you are to be commended for individually overseeing each of those reports to give people who feel so strongly a feeling of importance and satisfaction that the ombudsman is looking at their case.
You talked about the increase in the complexity of cases, in the severity of harm and, ultimately, in the number of preventable deaths. That is really serious and shocking stuff, and it is such important work. When your office is dealing with that, there is potential to do so much more. You deal with individual cases, but you could also look at the entire complaints procedures in health trusts and other public services. You talked about how, in respect of health trusts and housing, people have to exhaust those procedures before they come to you. Could you take forward work on that and make recommendations? You have so many significant cases coming through. If public service bodies' complaints processes were better, could that ultimately help as regards the volume of your work?
Ms Kelly: That could help as regards the volume of our work. A proportion will always come through to the ombudsman's office. If you look at the legislation, you will see that we are an alternative access to justice — we are an alternative to the court. There are cases that may otherwise have gone down the medical negligence route, but where people choose not to go down that route. That is a saving to the public purse. What people want is change. People come to us and say, "I know that I could go down that route, but I am not interested in that. What I want to see is change".
Through complaints standards, we have worked extensively with local government to put in place that new procedure. We are working with health. That is a big culture change, because there are big cultural issues about openness, candour and willingness to admit mistakes. In our experience, when public bodies put their hands up and say to people early on, "Actually, we've got this wrong", there is usually a degree of trust and openness. However, when that does not happen, and you get further into the complaints process and people lose trust in a public body, it is really difficult to get that back. We are working with trusts, care homes and GPs to try to improve their complaints handling. We will then do that with the other public bodies, but it is a mammoth task. We will do a certain amount on that, and we will put in place that two-stage procedure, but it also requires those other bodies to do it. That is a work in progress. It is a big system change, and that will take some time.
Ms Forsythe: Absolutely. You need the staff and expertise as well.
Things like the domestic homicide reviews and safeguarding panels are coming through. Will you work alongside those reviews, or will they happen completely separately?
Ms Kelly: They tend to happen separately, do they not?
Mr Martin: Our policy and engagement team keeps an eye on those things. If people come to us to raise concerns, and we have learnt something from looking at them, we share that to inform those reviews. Because of the independent nature of our role, we watch what is going on, share any information that we have that is useful to those reviews, and respond to consultations or input into them. We did work on restraint and seclusion in schools. We produced a digest and shared that with the Education Committee, which is taking forward work on that, and the Department of Education is working on new guidelines. That is kind of how we do it: we watch what is going on and then look at our information to see whether we have gleaned anything that would be useful to help better develop policy or to address concerns. We do not get large volumes of concerns about those areas, which is interesting because they are significant and serious.
Ms Forsythe: Absolutely. I want to talk about the pay and grading review that you have completed. Your work is specialised. You said that, when people move on from you, that is the common theme in the interview. Again, you are to be commended for taking the time to go through the exit interview process. That is what you are genuinely getting back: that people would love to stay, but they are moving on for opportunities to take on bigger investigations and more complex issues. It is a shame to lose people with that expertise in that way. As you say, your workload is increasing. You have the evidence base to show that it is increasing. I do not see any reason why we should expect it to suddenly drop. Do you think that that budget proposal would have a quick impact on staff turnover? Will we be able to see a difference within the first year or two?
Ms Kelly: I do not want to make myself a hostage to fortune. I know that we have lost people to some of the other regulators, especially in the cost-of-living crisis, because they have been able to go and get more money. I hope that it will mean that we will be able to keep some of those really good people, even though not all the posts' pay will go up. Civil Service pay grades have a very short scale, so you can be with us for two years and that is it; you are at the top of your scale and there is nowhere else to go. I hope that it will have a fairly immediate impact: that it will mean that we do not lose people purely because of that and keep them with us longer.
Mr Martin: We noticed the impact of that short scale particularly during the cost-of-living crisis. There was one year when nobody in the Civil Service got a pay rise. People who were at the top of their scale and got a 0% pay rise really felt it. People who would not necessarily have been looking for another role started to look. One thing that we propose in our pay and grading review is to move from the Civil Service scales to the National Joint Council (NJC) scales. The NJC scales are continuous, whereas there are big gaps between the Civil Service scales, which means that the impact of moving grades is significant. The impact of that on budget decisions is outlined in an appendix to the paper. When we look at the costs, we are trying to be pragmatic and to extend the scales to allow for progression so that people stay with us longer. Rationally, you would hope that, if we extend those scales, that would have the impact of people staying with us longer. If we do not have any internal promotion opportunities, at least they will stay with us while they progress along the scale.
Ms Forsythe: You have given a lot of thought to all those issues with regard to staff. Thanks very much.
Mr Blair: I think that my first question has been answered, so I will combine my two questions together. I think that the first one will be dealt with very quickly. I take it that there are no regulatory or formal barriers to departure from the Civil Service pay grades structure? Your explanations have kind of made that clear. That just came into my head during the presentation.
I want to add to the tributes that have been paid to the work that you do. I know the value that it brings to people, because, through our constituency services, we sometimes see where things end up, and we know that people get the outcome that they need and deserve. However, I also know that you will understand that, in the current economic and budgetary climate for Departments and public bodies, there may be perceptions, and there will most certainly be questions, about an annual increase far in excess of the rate of inflation. First, what, other than the pay increase, is contributing to that? The pay increase is clearly only a small proportion. Secondly, are other running costs and expenses, such as the cost of properties, bills and contracted services, examined regularly to secure as many savings as possible year-on-year?
Ms Kelly: I absolutely understand why you would ask me that. I understand the pressure on public services. Your question is fair. According to the legislation, we need to have due regard to Civil Service terms and conditions. That is a similar position to that of the Audit Office. Some years ago, the Audit Office moved away from Civil Service pay and grading, We looked at whether it would be workable for us to try to resolve this and stay on Civil Service pay and grading, but the cost of that would have been prohibitive — absolutely prohibitive. We are not going to do anything on that.
We do take a real look at costs. There are a number of things. First, there is a fair body of evidence that says that, when public services are under pressure, that is not the point at which to reduce scrutiny and that, in fact, it is the point at which to increase scrutiny. Secondly, I have to deal with what comes through my door. The only other way for me to deal with what comes through my door is to say to people, "I'm really sorry. I can't. You're just going to have to wait". It may be that that is the outcome, and, if so, I will come back to the Committee and explain how I intend to put that in place. Our staff capacity is stretched given what our staff are dealing with. I have excellent goodwill from my staff, but I know that I cannot stretch that any further. There is that issue for me.
I am going to hand over to Sean, and then to Kirsty. We have looked at where we can save. There are some general administrative expenditure (GAE) costs that are adding to the costs in the budget, but I will let them go into the detail.
Mr Martin: As you would expect, we, as a public-sector body, try to reduce our costs to direct to the front line as much of the money that we are given through the Vote as we can. Over two thirds of our staff are involved directly in managing complaints or in own-initiative investigations. The back house of the office is small. The corporate services team, which Kirsty runs, is a small team. We use HR Connect for our payroll, so we do not have payroll staff; we use IT Assist for the provision of all our computer systems; we use Construction and Procurement Delivery (CPD) for our procurement; and we use shared contracts for building maintenance. Where there is shared procurement in the Civil Service or broad public service system, we join those collaborative arrangements. Our cleaning is also provided through a collaborative arrangement. We try to reduce those costs, but one of the issues that we have faced in our GAE is that, as we increase our number of staff, we increase costs. Our IT costs go up due to software licences, hardware licences and so on. We have invested in a new finance system — it was introduced just last week. Part of the rationale and reason for upgrading that was to allow us to focus on cost and make sure that we can deliver value. We try to reduce our costs by sharing services.
One of the proposals that we have made is to freeze recruitment of non-front-line complaint-handling staff, for whom we have been given budget in the past. We have decided that it is better if we direct resources to managing the increased volume of complaints. For now, we can manage without those non-front-line staff. We have looked at all the roles in the office: at what they do and what they contribute. It is not that those roles are not valuable — they are — but, in the current climate, it is a case of meeting the increased volume of complaints, while being conscious of the pressure on resources generally.
Kirsty, do you want to add anything on those GAE costs?
Ms Kirsty McCool (Northern Ireland Public Services Ombudsman): The only other GAE cost that is increasing is for the independent professional advice (IPA) that we get, as Margaret mentioned earlier. IPA costs are up 20% to over £100K this year. Again, that is just because of the complex nature of the complaints coming through, and our need to assess those complaints fairly and accurately.
Ms Kelly: We get those independent professional advisers primarily from England. They come through our colleague ombudsman, the Parliamentary and Health Service Ombudsman. We get senior clinicians for rates of, for example, £50 per hour because they use it as a learning opportunity to look at casework. If we were to do that locally, we would pay hugely more. We are a small jurisdiction, and people tend to know each other, so we are also getting an independent and outside view from people who have a vast range of experience. It is just the increase in volume and seriousness that means —. Public bodies and individuals deserve for us to have bottomed out our findings and used the appropriate people to question the evidence and ensure that, when we make serious findings, they are right.
Mr Blair: OK. Thanks for that. You know the context of the question.
Ms Kelly: You are absolutely right to ask it.
Mr Blair: We all have to be cognisant of the budgetary pressures. I appreciate that.
Ms Ferguson: It is alarming to hear about the increase over the past three years in the range of complaints, particularly in relation to health, education and housing, and, likewise, about the complexity of those cases. There is also the issue of staff turnover: 10% is quite high when you have such a small team. You mentioned that the target for stage 3 cases is approximately 52 weeks. You said that people exhaust the complaints processes in Departments, and then they come to you. Is there a knock-on impact on targets that you set, particularly for stage 3 of a complaints process?
Ms Kelly: When I took up the post three years ago, we were struggling to do stage 3 on our KPI. We had a significant group of older cases. The team worked hard, and we cleared those and hit our stage 3. The senior management team monitors every month where we are on those KPIs. In the current year, stage 3 is under pressure. It could not be otherwise. We are working hard to get those out.
We are getting more cases in this year, and we have 52 weeks to complete those. The more cases that we get now, the more pressure there will be on our stage 3 next year. That is why we have come to do it. There was a point earlier in the year when we thought that we were not going to make our stage 3 in the current year. We hope that we have worked hard enough and done enough on it now, but that is the one that is under pressure. I think that we have four reports to issue every week between now and Christmas to make that KPI, so we are talking about significant pressure for the team.
We are working hard to keep that KPI at 70%, but that is what happened as an outcome of this. It is part of why I want to create a clear queue. Rather than just letting that build to where we were not meeting it, and people were thinking, "What's happening with the ombudsman's office?", I would prefer to create a clear queue to manage this, and say to people, "We haven't allocated your case yet, so you haven't even started that 52 weeks". There is real pressure, Ciara. My teams work hard and really care about the work that they do. They know that it is important work, but there is only so much that you can ask of people. Staff well-being and health also have to be considerations.
Ms Ferguson: Thank you for that. I very much welcome the work that you are doing, particularly around supporting the health sector in its two-stage complaints process. You noted in your report that you will look to assist all Departments, with a deadline of 2027. Have there been any key challenges — particularly in the health sector, given that you have the experience of doing that work — or barriers to progressing that work?
Mr Martin: One of the issues with Health and Social Care is that it is a huge and complicated system. There has been a lot of confusion in the past around the roles of various organisations in respect of complaints, serious adverse incidents (SAIs), safeguarding issues and regulatory issues, which are for the Regulation and Quality Improvement Authority (RQIA). When we did some work to help inform how we would take this forward, that was one of the key issues.
We have had a commitment from senior people in Health and Social Care. They understand that the complaints system is not delivering for them, and it is certainly not delivering for people who raise complaints. There is a willingness to try to address that. In order to do so, the big issue to address is culture. We can change the process to a two-stage process of five days and 20 days, but that requires organisations to be really open and honest when things have gone wrong. We can do more work to encourage culture change around openness, and how we deal with scenarios when organisations admit that things have gone wrong and caused harm. We need to have a mature conversation around that culture change, what it looks like and how we address things when they have gone wrong. Ideally, things do not go wrong, but the reality is that mistakes are made. When that happens in Health and Social Care, in particular, they have really serious consequences. A number of inquiries, as well as our investigations, have alluded to where that sits.
In order to support that change, our intention is to have a process, but we are also going to provide training resources, materials and best practice guides. Part of the approach that we have taken is to support the change to make sure that people at the front end of the health service are equipped to be able to empathise with people who have had a trauma and a really bad experience, and to work with them to give them clear and honest answers. As Margaret mentioned, our experience of the vast majority of people is that, if you are really open and honest with them when things have gone wrong and you build their trust, they accept that explanation. It is where they are faced with barriers and a lack of openness and do not get answers that they come to us.
That is a very costly process. Investigation is a costly thing. There are more than twice as many investigators in our staff team at stage 3 than there are at stage 2. That reflects the level of detail that is required. If public bodies were much more open with people, more of those complaints would be resolved by them. One of the key issues that we are pushing for under complaints standards is data. To be fair, Health and Social Care is probably better than a lot of sectors in that it gathers and publishes data. We want more transparency whereby all public services put forward their data on complaints, as well as their analysis of that data, what it tells them and what they are going to do to address recurring themes in complaints. We hope that that whole approach will drive improvement, but the culture change and culture of openness that we all desire — the Assembly desires it, and we desire it as the Public Services Ombudsman — is really important.
Ms Ferguson: Thank you very much. You are right: it is critical that resources are put in place across all Departments so that they have those mechanisms and proactive processes. Most people just want an open and honest opinion.
Are there enough resources across Departments — particularly Health, given that you have worked intensively there — so that they have qualified and experienced staff to deal with complaints processes?
Mr Martin: There are a number of issues around that, Ciara. In Health, the complaints handling staff tend not to be clinical. Those staff receive the complaints and make sure that they get to the right team. One of the issues that we face in many complaint investigations is a lack of independence. As you can imagine, it goes back to the team that originally provided the care. They need to be involved and answer to the issues that have been raised. We have found it useful, however, when some of our Health and Social Care bodies bring in someone from within the organisation, but who sits outside the team that delivered the care, to critically analyse the information. We find that that is more likely to bring about an early acknowledgement that things were not as they should have been and of where things may have gone wrong.
The people who deliver always need to be involved in the complaints process, because they know what happened. You need to speak to them and understand. However, there is a need for independence in that process and, sometimes, a need to take things outside your organisation for someone else to look at them, given the nature of the issues that have been raised. In those much more serious cases, the trust could do with resources — to be able to use royal college reviews or just have an independent voice — to help them to look at the issues that have been raised, particularly where they have caused harm, or at a more systemic issue that could affect other individuals as well.
To receive complaints, all those organisations need to have enough staff at the front end. My view is that it is about the training of those staff and their understanding, particularly in relation to empathising with people and the experiences that they have had and helping to support them through the complaints process. Our experience is that the complaints process is re-traumatising people. That is not helpful, so we need to look at it in the wider context of how we support them. The whole process takes much too long. Currently, to get through the complaints process with public bodies is an exhausting process, and then, as I say, if you do not get a resolution, you have another process with the Public Services Ombudsman. That is why, to your point, having properly resourced and trained staff in those organisations is crucial to delivering the improvement that we are looking for.
Ms Kelly: Ciara, that applies not just to Health. There are some public bodies where we see an increase in complaints and we know that part of what is driving that is really poor complaints-handling. This year, Sean and I met the chief executives of each of the trusts and reflected back to them our data on what we see in their complaints-handling. We also did a little bit of a comparison on how good they were. However, there are public-sector bodies where we are seeing a real increase in complaints because their complaints-handling is really poor. Our first response to that is to bring the issue to their attention. My team has gone and offered some support, but we then get to the point where we say, "Actually, this is not OK. Not dealing with your complaints properly is a governance issue. Not dealing with your complaints properly is a failure to understand where the public services that you are tasked with delivering are not working right. Your complaints service and your complaints data are a key part of informing you how well things are going, where your big areas of risk are and what your governance is like." That is work in progress.
I understand that there is loads of pressure on public services and that they might not always see complaints as a priority, but, particularly from the chief executives of the trusts, we have seen real engagement around an understanding that complaints are a key metric for them. If you look at our public inquiries in Northern Ireland, you will see that, in the vast majority, there were already serious and significant complaints in the system. There is a huge cost if you are not addressing those and you end up with a level of harm whereby you are in a public inquiry. There is a cost issue to it as well.
The Chairperson (Mr Chambers): On behalf of the Committee, thank you very much for your attendance this morning. We place on record our appreciation for the challenging and valuable work that you carry out on behalf of the public. We wish you well.