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Under agenda item 6 we will take evidence from the Scottish Public Services Ombudsman as part of our annual inquiry. I welcome Jim Martin, the Scottish Public Services Ombudsman, and his officials: Niki Maclean, director; Paul McFadden, head of complaints standards; and Emma Gray, head of policy and communications. Would Mr Martin like to make an opening statement?
No, convener. You have a busy enough agenda without me going on as well. I will be perfectly happy to expand on any of the materials that we have sent to you and to take any questions that the committee may have.
Thank you very much. I had the pleasure of speaking to Mr McFadden and Ms Maclean at yesterday’s meeting of the Welfare Reform Committee.
First of all, Mr Martin, can you give us an indication of how the added responsibilities that you are about to undertake in relation to the appeals process for the Scottish welfare fund that starts on 1 April will affect the service that you provide?
I am happy to, convener. The Scottish welfare fund provision is being funded by the Scottish Government, and I am happy with the funding and resourcing. I ask Paul McFadden to tell the committee a bit about the practicalities of implementation from 1 April.
As the committee is aware, the new responsibilities bring a slightly different role for the ombudsman, in that we will have a role in directing local authorities about decisions that are made on the welfare fund. Therefore, many of our preparations have related to how we will adapt our process to take account of that different role.
The preparations have also related to timescales. Clearly, the circumstances in which people who apply for the fund find themselves mean that quick and robust decisions are crucial. Therefore, we have to design a process to cater for that and ensure that we get responses out quickly—within one day or, in the case of community care grants, 21 days.
From the early stages of the proposal that we should take on those responsibilities, uncertainty about what the review numbers would be has been a concern for us and a hindrance to our planning. In the first years of the current welfare fund scheme, the review numbers were particularly low compared with those under the previous scheme: the independent review service for the social fund had up to 6,000 cases for Scotland. However, we are looking at a significant increase in tier 2 reviews at local authority level over the past few years—we estimate that there will be in the region of 1,000 or maybe 1,200 such reviews, but it is a big unknown and we have to plan on that basis. We have recruited a team who will start shortly and we are preparing a detailed training programme for them.
Most important throughout the process has been our engagement with third sector advocacy and support agencies and with local authorities. We have set up two sounding boards for those groups, which have been a great help and support as we have prepared ourselves for taking on the role from 1 April.
I take it that you have done everything possible to simplify the design and operation of the complaints-handling system. Obviously, the cases will have to be dealt with quickly because folk are in crisis.
Absolutely. Simplicity of access and the speed of our decisions are at the forefront of everything that we are doing. Clearly, people who are applying in crisis situations will always be prioritised over anyone else who comes into our office. On crisis grants, we will look to request information from local authorities within 24 hours and, once we have received all information, make our decision within one day.
Good morning. Last year, you gave evidence about the integration of complaints handling in health and social care. How much progress has been made towards that? It is a key issue about which you expressed some reservations last year.
There has been significant progress on that. I am very grateful to the committee for putting its shoulder behind the arrangements because I felt like a voice crying in the wilderness for a very long time and, once the committee began to get involved and take a serious interest in the matter, things started to move quickly.
We are now on course to have an integrated approach between social care and health. We are currently bringing the national health service complaints process on to the same footing—the same complaints-handling procedures—as we have for other parts of the public sector. That will enable complaints to be dealt with through the same simple process. Paul McFadden has been leading on that work through the complaints standards authority.
Paul, do you want to add anything to that?
I put on record our thanks to the committee, which considered the matter in some detail. There was progress quite quickly after that.
There is clearly quite a bit to go to put in place the path for the legislative changes relating to a simple, standard process across all areas within integrated health and social care services. The NHS, social care and the integration joint boards will be operating from the same process by April 2017, so a lot of work is taking place with the boards and the other bodies that are involved in the process to ensure that it is well prepared for.
Thank you for your comments about the committee. We will probably put something about that in our legacy paper.
With such complaints, particularly the health ones, speed is of the essence. Are you satisfied that the process is being handled reasonably speedily, Mr Martin?
I think that we are getting there. I am very impressed by the progress that has been made, particularly in the national health service, in moving towards a single complaints-handling process, given the existing processes. At the moment, I am reasonably content with that.
In what specific ways do you consider that you have demonstrated that you have provided value for money and added value in the work that you have carried out over the period?
It depends what the period is.
Let us deal with a year.
Okay. Let us deal with this year. I will set aside the fact that, in implementing the Sinclair recommendation for a single complaints body in Scotland and absorbing prisons complaints and water complaints within the SPSO, we are saving the public purse £1.5 million year on year.
Over the year, the progress that has been made in bringing together improved complaints-handling procedures across the public service in Scotland is, frankly, worth its weight in gold. You will see from our strategic plan and the update that we gave on progress in the first nine months of the year that for the first time we are able to compare year-on-year numbers for complaints in local government. It is now possible to say that, at the first stage of local authority complaints, there has been an increase in the number of complaints upheld from 50 per cent to 70 per cent. That should enable local authorities in Scotland, and the committee, to ask whether that is because we getting better at dealing with the complaints that people bring or whether there is a problem with the services that are being provided. In that way, we add some value.
In the past year, we have made more than 1,000 recommendations for improvements in public services—health, local government, prisons and water. Each of those recommendations has either brought comfort to people who have had things go wrong, such as by getting an apology for poor treatment in the national health service, or has been accepted as a way of improving processes and the way that people are dealt with in the public sector.
I am pretty confident that, for the £3 million that is spent on the SPSO, far more value comes back every year.
How do we ensure that those 1,000 recommendations are acted on? How do we make certain that they are known by other public bodies, which might also need to improve?
I know that the committee took the time to look at some of our recommendations in detail. I welcome that and I am happy to discuss that process with you.
We never sign off a recommendation as having been completed until we have looked carefully at the evidence brought to us by the public body to which we made the recommendation. We do not give anybody carte blanche.
In our strategic plan, you will see that we are intent on creating a learning and improvement unit, part of the role of which will be to follow through on recommendations. I will ask Niki Maclean to talk a bit more about that in a second.
I have about a year to go as ombudsman, so I am starting to put down markers. The committee has quite rightly asked about impact. One of the most frustrating things for me is not being able to follow through when I see a number of individual complaints about the same issue. The Scottish Public Services Ombudsman Act 2002, which set up the SPSO and which was revised in 2010 after a review, tells me that I can look only at individual complaints that are brought to me. That is a waste of a public resource. Where there are systemic issues, the ombudsman should be encouraged to raise and investigate them.
I know that this is a long answer, convener, but let me give you just one example. Over a relatively short period of time, we received five different complaints about cancer diagnoses being missed in the radiography department of a particular hospital. Technically speaking, I could look at those complaints only in isolation and come to a decision on the merits of each. However, once you see four or five of these things, you begin to think that there is a systemic issue.
There are two ways of dealing with that: you can raise the matter with the appropriate bodies informally through back channels, which is what we do, or you can use one of the complaints to make a recommendation that highlights the systemic issue. Scotland would be better served if the ombudsman were able to flag up that a number of issues relating to the same area had been spotted and that we intended to conduct a systemic investigation of the issues.
I might say more about that next year at my last appearance before the committee, but perhaps Niki Maclean can say something about the learning and improvement unit, which the committee might be interested in hearing about.
11:15
Thank you for that, Mr Martin, but I have to say that there is absolutely nothing to prevent you from raising systemic issues with this or other parliamentary committees. Indeed, in your previous answer, you pointed out that the committee had been helpful to you in dealing with the complaints system for integrated health and social care. Do you sometimes feel reticent about coming to Parliament to raise some of these issues? If you raised them, we might be able to undertake an investigation or inquiry into any real difficulties that might have arisen in a particular area of public service.
There is no reticence, convener, but I am always conscious of the legislation under which I have to operate, which sets out quite clearly what I may and may not do. Bringing issues to the committees of the Parliament is a good and valuable way of getting things done; we need only look at this committee’s involvement in the health and social care complaints system to see how that can work.
What I am thinking of is the ability to move quickly and directly on issues such as the one that emerged in the radiography department of a certain hospital and enabling the very good people who work with me to bring their expertise to bear on looking at whether there are any systemic issues. I do not see the two things as being in competition—I think that they can run in parallel.
Sticking with the example that you have given, who at the health board would your recommendations about the separate cases go to? Who would be in receipt of your findings?
That is one of the improvements that we have made in the past couple of years, particularly in health. In the Robert Francis inquiry into what happened at Mid Staffordshire down south, it became perfectly clear that some of the deaths that happened could have been prevented had the trust, and in particular its chief executive and chair, taken the complaints process seriously. The NHS in Scotland’s governance arrangements for dealing with complaints have, over the past couple of years, become a lot better than they were three or four years ago, and the process is now being taken very seriously indeed. To that extent, I am happy that there is visibility of the individual cases that are being brought to boards.
However, things that happen in an individual board or between different boards are sometimes missed because they are seen only when they are presented. From where we sit, though, we can see and identify these things in a far simpler way. In some cases, if we say to a board or a local authority, “We think you’ve got a systemic issue”, they will grasp the matter with both hands; in other cases, people will point out to me the limits of my legislation and what I am permitted and not permitted to do.
So basically they will tell you, “You’re limited in what you can do here. Dinna you interfere.” Is that what you are saying?
I am not going to name names, but that has been said to me—and not often as politely as you have put it. Basically, they will say, “Your powers are limited to this, this and this, and you are straying beyond them.” If Scotland is still to be at the forefront of developing the ombudsman service—which, having been created by the Parliament, is internationally recognised—you are going to have to free up the next ombudsman to be able to look at these issues.
It would be very interesting for the committee to have sight of documentation in relation to where people think that you have overstepped your powers. It could then look at the situations that those people found themselves in before they reached the point of saying that to you.
I do not think that we should drift away from the issue of systemic failure. If I was an individual member of a health board, and the same kind of complaint was cropping up again and again, surely it would be my duty to delve further into that. Surely I should be grateful to the ombudsman for pointing such things out. Do folk not feel that way?
This year, one of the things that we introduced—which I think will help individual boards to join up the dots—is a learning and improvement statement in our annual letters to all the health boards. We have asked all bodies under our jurisdiction in the largest sectors to sign up and say that they have carried out that analysis, so that they do not look at individual cases on a piecemeal basis, but try to identify systemic issues, which they will confirm with us. That is part of the process that we introduced this year.
Mr Martin, you look like you wanted to come back in.
No. I think that Niki summed it up very well.
I will continue this wee discussion about systemic issues. I used to be a member of the Public Audit Committee and, in a previous life, I spent some time as a quality manager. I am interested in the kind of holy grail of performance improvement. Audit Scotland regularly identifies systemic issues, too—it points to them and makes recommendations and so forth. Audit Scotland points to certain patterns in the public sector, but that is where it ends.
I want to get your thoughts on this. When you produce your reports and make recommendations—I would even invite you to make recommendations for systemic improvement—how on earth do we get the systemic improvement into the system? It has come across that you get something like 5,000 complaints a year and that 76 per cent of those complaints are dealt with in the agreed period and everybody is happy with that. Do the same complaints keep happening year on year? Will the 5,000 complaints that are received next year be about the same stuff? How do we get improvement into the system so that we really bring down the complaints tally and see improvement across the public sector?
You are absolutely right—that is one of the great frustrations that we see. In a minute, Niki Maclean will talk about our learning and improvement unit.
Remember that I see only complaints about things that go wrong. We try hard, with the limited information that we receive, to enable each part of the public service to work out how it can tackle the issues. I have said to the committee before that it is the only committee in Europe that can see the local government complaints numbers for the whole country and base decisions on that information. In the whole of Europe, nobody else has that information—only you.
We are encouraging the Improvement Service and others to get beyond the top-level numbers and look at the areas in which complaints are generated. Is that in housing or social work? Are there common factors across the areas? The committee is doing excellent work to push benchmarking, and this is an area where benchmarking could work.
We are a small organisation. For us to help the whole public service in Scotland, we have a proposition that is going through the Scottish Parliamentary Corporate Body. That proposition is to staff a learning and improvement unit of two or three people in our office. Niki Maclean will explain that more.
To give a bit more context, I think that there are two issues to consider. Jim Martin has talked about the first issue, which is how we get benchmarking information from each sector. Paul McFadden and other colleagues have done an amazing job in working with local authorities, and we now know that there were 66,000 complaints across local authorities last year. As Jim Martin said, because you have that data, you can start to drill down and understand the problems.
A very small percentage of those cases flow through to our office. Despite the low volumes, there are still opportunities to identify potentially systemic issues, although that is hard to do because of the low volumes.
The proposition is that we establish some form of learning and improvement unit. As the committee will have seen from the four cases that it has looked into further, we make a range of recommendations of different types and in different subject areas. The recommendations can be split into two parts. The first part addresses the personal injustice and hardship that have happened to the individual. It is important to remember that that is fundamentally what an ombudsman’s service is for.
The second part is about improvement and learning. The quality of the recommendations that we make on that is important. Through the learning and improvement unit, we want to make sure that, as far as possible, we are consistent and challenging in our recommendations to drive improvement in the organisations that we are working with.
We get the gist of that. You talk about a new learning and improvement unit, and the Improvement Service has been mentioned. Are we talking about duplication? Is the unit required, or should information just be passed to the Improvement Service to deal with? I will play devil’s advocate: do we need an improvement service if you are going to carry out such functions?
We have the two separate areas of work that I referred to. We are obliged to make recommendations that arise from our casework, and we alone have the statutory powers to do that. We have to make sure that those recommendations are smart, challenging and consistent and that we follow through with organisations.
We do that at the moment, but we would like to have a distinct part of the organisation that takes on the responsibility. We now make 140 per cent more recommendations than in 2010, so the figure is significantly up. Significant work is involved in following those up and we could do it in a smarter way.
The Improvement Service operates only in local government. The whole public service in Scotland does not have an improvement service as local government does.
I will not fall into that can of worms. I could say something about that, but we will go back to Mr Coffey.
I hope to get a little closer to an answer to systemic issues. When you come back next year, I guarantee, on the basis of the figures that you produce year on year, that another 5,000 complaints will have been made. Will the new improvement service really look at some of the systemic issues and share best or good practice in the public sector to get that figure down?
The answer is yes. We share all our findings and recommendations already. We hope that we can continue to drill down and to support organisations to learn from the information that they gather from complaints.
It is quite hard to prove that something did not happen as a result of a particular recommendation, but the volume of complaints would begin to drop, and the SPSO would hope to attribute that to some of its interventions.
Can I ask another question, convener?
Is it on the same topic?
It is about the complaints process.
Could we stick to improvement first? I will bring you back in. I do not want to move away from the improvement scenario.
Mr Martin, you talk about possibly requiring more powers. We are talking about a learning and improvement unit. How do you drive improvements at the moment with the powers and resources that you have at your disposal?
11:30
I am glad that you referred to powers and resources. We must not lose sight of the fact that, in my organisation, I have just under 50 people, around 30 of whom are working directly on individual complaints that have been made. Our current complaints standards authority involves two people. My training unit involves 0.6 of a person, yet we are producing front-end training materials—for e-learning and face-to-face training—that are being used in the whole national health service in Scotland and across all local authorities. I understand that they are even being used in universities in Ireland and local authorities in New Zealand.
Which universities in Ireland and which local authorities in New Zealand?
Just as I was when you said that you did not want me to go into improvement, I am glad that you asked that question. For about three years, I have been banging on about the fact that we are producing training materials that are not licensed and are free to be used by anyone else in other parts of the United Kingdom and abroad. That is a missed opportunity by the Parliament to generate income that could subsidise my office’s activities. I have made that point on numerous occasions in numerous places —
Not here.
I am glad that you have given me the opportunity to raise it here as well, convener. Thank you.
We may look into that. Will you expand on how you are driving improvement with the current powers that you have?
I am charged with doing three things: first, looking at complaints that have been brought in by individuals seeking remedy, who feel that they have suffered an injustice; secondly, through that work, doing what I can to raise issues that will help to improve the provision of public services; and thirdly, under the Public Services Reform (Scotland) Act 2010, monitoring the handling of complaints and setting forth a standardised process for complaints handling across the public service. The second of those activities is very dependent on the other two activities, as the improvements that we suggest come out of complaints that are brought to us. That takes us back to the systemic issue.
As far as we can, we push for people to take our recommendations seriously. We were the first ombudsman’s office in the public sector in the United Kingdom to publish our decisions. Every month, we publish between 60 and 70 decisions, and we lay reports on more serious matters—perhaps three or four individual reports—directly before Parliament. We make them accessible, and we know that they are accessed by bodies across the public service.
I do not want us to become the improvement unit for the public service in Scotland, but I want to use the experiences of the people who come to us when things have gone wrong to help public bodies to think about the provisions that they are making. With the limited resources that we have, we do our best to do that.
We may come back to that.
I will pick up on your point about the NHS complaints process being brought more into line with those for the rest of the public sector. Are the complaints processes that people have to deal with still, by and large, pretty different? For example, do local authorities, the NHS, the police, the fire service and everything else have different systems for people to interact with? Are we trying to get a consistent, consolidated experience for the public, so that they have to complain in the same way no matter whom they want to complain about?
The 2010 act, which we work under, charged me with putting in place a standardised complaints process across all the bodies for which I am responsible as the ombudsman, and we are, by and large, there. The last part of that work involves the NHS and I will ask Paul McFadden to describe where we are going with that. I am an ex-Police Complaints Commissioner for Scotland, but the police service does not fall within my responsibilities, and nor should it. I am happy to discuss that any time.
By and large, the aim is to get as many public service organisations as possible operating a simple standardised process to ensure that the ordinary person in the street knows how to access things and that they are resolved as quickly as possible. I am glad that the NHS, too, has decided to go down that route; we are making substantial progress there.
In the NHS, a lot of good work was undertaken on complaints on the back of the Patient Rights (Scotland) Act 2011 and the supporting legislation and work around that. I see some differences between the handling of complaints in that sector and the process in other sectors; one of the crucial differences is that the emphasis on early local resolution close to the front line and at the point of service delivery has not really worked in the NHS. That is one of the key things that we are working with the NHS to implement.
For example, more than 80 per cent of complaints in local authorities are resolved at or close to the front line on a tight timescale of five or 10 days, and we want to get the NHS to the same point. The work that we are continuing with NHS stakeholders—and which we are progressing well with them on—is all about bringing the NHS into line with the standard process that is used in our other sectors, with regard to not just timescales and stages but the governance mechanisms, what is reported, how it is reported and so on.
Do you routinely consider material from Audit Scotland to get the big or global picture of the issues? You have said that you are restricted in your ability to investigate systemic matters, but surely you can consider messages in, for example, various Audit Scotland reports. Do you do that as part of your work?
We often speak to Audit Scotland, the Accounts Commission, Healthcare Improvement Scotland and the chief inspector of prisons. Across various sectors, we speak to people, including the water regulator, about what we and they are finding and we feed that information in. For example, when Healthcare Improvement Scotland investigated Aberdeen royal infirmary, we worked with it on a tool that allowed it to work out how efficiently NHS Grampian and the infirmary were handling complaints. That helped to inform Healthcare Improvement Scotland’s decisions as a result of its investigation and inquiry. We work with other agencies as much as we can.
What consideration, if any, is given to determining from the outset what wider public benefit might arise from an investigation?
You have to remember that a complaint will come to us from an individual who, in their view, has had a poor experience with a public body. In that investigation, many things might arise. It might be a simple matter of someone saying that their council tax has been miscalculated, which we can resolve quickly, but sometimes the issue can be more complex.
It rarely happens, but some matters might have broader implications, and that would be flagged up to me as the investigation was going on. As a workaday example, I am immediately informed of every case that comes into the SPSO’s office that involves a death or a vulnerable person, and that enables us to say, “Having looked at the circumstances of the case, we want it looked at in a bit more depth,” or, “We want this to be fast tracked.” I saw a case yesterday that pertains to the treatment of a child in an infirmary, and we want it to be fast tracked.
On general public policy improvement, the judgment as to whether an issue goes broader than the individual complaint or has wider implications is for me to make after we have been through the investigation. However, I am restricted to looking at the individual complaint; I am not supposed to look at the other complaints that come through, but the way of the world is that that is what is done.
Okay. What do you consider to be the added value of investigating cases solely to recognise the validity of the person’s complaint? What consideration is given to the implications for the people who are being investigated?
When we consider a case, we consider the proportionality of its investigation. For example, we consider whether we can achieve a practical outcome for someone over and above what they have already had. If we felt that a body had already carried out a thorough investigation, made comprehensive recommendations and implemented them and that it was not possible or practical for us to go beyond that, we would not progress the case any further. We are mindful of the impact that our investigations have on the bodies that we investigate.
So, if you felt that the body had done everything possible, you would not take the case any further.
No.
Would you communicate with the complainer as soon as possible to give the reasons why you were not taking it any further?
Yes.
Mr McFadden, you look like you want to come in.
No.
I am misreading body language today.
On many occasions when you have been in front of the committee, we have talked about your communication with complainers. Are you better at communicating with them about your reasoning for not pursuing complaints and the recommendations that you make, which they might not think are the right ones?
We do a lot of work with our staff to support good communication skills. We have clear service standards to which we operate. As far as we can, we give decisions over the telephone. We try to give people assurance that the body did everything that it could and should have done but, ultimately, people often feel that the case should have been investigated. In those circumstances, all that we can do is give a clear explanation and assurance as far as we possibly can.
There is a flipside to the matter, convener. Perhaps this is to reform your question but, often, public bodies tell me that they have already upheld a complaint and ask me why we are investigating it. There are a number of reasons why we might do that. One is that the complainant is not happy with the outcome, which is common. Others are that what was upheld is not the entirety of what the person complained about, or that we are just not convinced that a full investigation has taken place.
I will give you an example. I am sorry that I am using health cases, because this is the Local Government and Regeneration Committee—
Feel free to use whatever cases you think are best, Mr Martin.
I will use a health case. We had a case in which someone made a complaint about the death of someone during an operation. They complained to the health board about how the operation was conducted. The board investigated it and said that it was satisfied that the surgeon involved had acted appropriately. I think that the procurator fiscal also considered the case.
The complainant wanted to know not whether the surgeon had performed his duties appropriately but whether the operation had been carried out appropriately. When we investigated that, we found errors by an anaesthetist and that the relationship in the operating theatre at the time that the operation was conducted could be described as dysfunctional at best. Neither the board nor the fiscal had considered those issues, so although the board had said that one or two things might have gone wrong and upheld part of the complaint, we felt that we should consider the rest of what happened. We examined it, found learning points for the board, found learning points for the anaesthetist and were able to give the complainant some comfort.
We do not automatically assume that we should not investigate a complaint because a public body says to us that it has upheld it. We have a good look at what the complainant says to us and determine whether there is still something to be investigated.
11:45
We have had a look at four complaints about the efficiency and effectiveness of your organisation. One, from the University of Glasgow, comments on the potential effects that the time taken to investigate could have had on the complainer. How can you improve your efficiency in dealing with complaints timeously?
We have submitted evidence to the committee previously, and again this year, about the increasing efficiency in our case closure rate. We have a history of improving our efficiency within the resources that we have available. The gains that we can now make are in supporting and encouraging the bodies that we work with to improve their own efficiency in the handling of cases so that, when complainants come to us, we receive clear, well-documented complaints investigations that make it easier for us to reach decisions more quickly.
If I were unhappy at the length of time that you were taking to investigate my case, what would be my redress?
You would approach me, convener, and I would look into it. I am not happy about the time that we take to look into some of our cases; no one would be. In our defence—if we need to defend ourselves—we are probably the most efficient public services ombudsman body operating in the UK. For example, we measure the amount of time for which we have cases in our building from the minute that they arrive, whereas, to my knowledge, all our comparable offices start the clock only once they have received all the paperwork and information that they need to begin an investigation. We take the view that the time that is important is the time that the individual spends with us, not the time that we take to deal with the case.
Every year that I come here, I have said to the committee that the increasing complexity of the cases, particularly in health, is putting a real strain on our organisation. This year, for the first time since 2002, we have had a reasonably significant drop in the number of complaints coming through our door in the first nine months of the year—the figure is down 4.5 per cent or something. However, even allowing for that, we have had a 41 per cent increase on 2009-10 in the number of cases coming to our office, yet our staffing is virtually the same.
We try to use the resources that we have as efficiently as we can. When matters require a great deal of investigation, we are sometimes in the hands of the public body and we sometimes need to get advice from people, but at all times we try to ensure that we put the interests of the person who has brought the complaint to us first. Inevitably, given the volume of complaints that we receive and the number of staff that we have, some complaints take a long time to investigate.
Are there many areas in which you receive not repeated complaints from individuals but repeat complaints on the same subject?
There are a number.
Which areas are those, Mr Martin?
I will come to that in a second. One of the reasons why we want the learning and improvement unit to be in operation is so that we can flag up those areas and have the bodies concerned deal with them. Similar cases will arise in planning, and waits for repairs will be an issue in housing associations. In some housing associations, the quality of repairs will be an issue. When I first took up my office, the thing that struck me most was the number of cases in health boards that involved bed sores and pressure ulcers. In each of the sectors, you will find areas that are complained about repeatedly. In prisons, the issues tend to be about progression or training courses. We try to engage with the public bodies and say, “This is what we are seeing. These complaints are coming to us. You need to try to get hold of these issues.”
The fact that these things are occurring in the same areas does not show that you are being effective in getting across the message that public bodies need to improve in those areas, does it?
That is why we are looking at the learning and improvement unit and at engaging with bodies in all sectors, up and down the country.
I can sense the frustration behind your question, convener, and it is nothing compared to mine. It is absolutely nothing compared to mine.
Earlier, in the course of the budgetary examination, I talked about the decisive shift to prevention, which the Government has been looking for in almost every area. When I say “prevention”, I do not mean it just in terms of health.
From what you described, not very many lessons seem to have been learned, in certain areas, from your previous findings. If those lessons were learned, that would lead to the decisive shift to prevention and fewer complaints coming into your office.
You must remember that we are looking at the tip of the complaints iceberg. We are flagging things up and engaging. We are trying to find ways of working in partnership with organisations.
I will give you an example. We reckoned that something like 40 to 45 per cent of all the cases coming to our office were coming from around only 10 or 12 different organisations out of the whole of the public sector. We began to engage with those organisations individually. We said to them that there were a number of things that put them into that group: that the number of premature complaints—that is, people coming to the ombudsman when they should be going to the organisation itself—was too high; that the number of upholds was too high, compared with the rest of their sector; and that the volumes were not what we expected to see. We engaged with those organisations. For example, we sat down with people from Lothian Health Board and told them that their volumes were too high, their upholds were too high, their prematures were too high, and that we were not convinced that they were investigating complaints properly. That allowed them to revise how they do things.
You have to remember that we sit here as an ombudsman office. The very fact that we are an ombudsman office means that we flag things up and that we can try to push things. However, we do not have a big stick to make people do things.
Can I stop you there? I am a bit of an anorak when it comes to your reports. I cannot say that I read them all—that is not the case—but I read a fair bit of them. You are talking about a number of organisations that seem perpetually to present you with difficulties. Within the annual report, where is that information available to me and members of the public? If that is available in the annual report, why is it so difficult to find?
That is not something that we put into the annual report, but all the figures about—
Why not?
It relates to something that we spoke about previously at this committee, which is that we do not wish to name and shame organisations.
I am sorry, but I will stop you there. Earlier, we talked about the interventions that this committee has taken to try and resolve difficulties. It would be impossible for any one of us to track all the cases that are sent to us. Therefore, it would be very useful for us if you highlighted the organisations that are causing difficulties. I would say that the annual report is the place to do that. Either this committee or other committees of the Parliament could then make interventions.
We have already touched upon effectiveness and the decisive shift to prevention. We need to have information about those organisations simplified and in one place, so that we can move forward and try to create better services for the general public. Can we have that in the annual report? As for your not wanting to name and shame, we will never improve things unless we know which organisations are causing you the most difficulty.
Perhaps I can provide a little context. As I think the committee knows—indeed, we put it into our briefing—we provide on an annual basis statistics about every organisation about which we have received complaints, the subject of the complaint, whether we upheld it and so on. In addition, we provide, again on an annual basis, a letter containing detailed statistics on premature and upheld rates, the subjects involved and so on for each organisation and comparisons between those statistics and statistics for other organisations. It is therefore possible for anyone to look at all the information that is in the public domain and to carry out an analysis to ascertain what they wish to find out.
Ms Gray, it is very difficult to find the time to deal with every aspect of this life, and I do not think that anyone around this table will have the time to complete the analysis that you are talking about.
Beyond that, the numbers in the tables in the annual report and other material that you produce tell me and other members very little about what the complaints are; they could be the most simple things under the sun or the most severe issues. The statistics could show a smattering of complaints about an organisation that might be one-off cases with no connection whatever or which could be complaints about the same thing. We just cannot analyse that. What we require is something that helps us get to the point where we can say, “Ah—here we go. An intervention is required here to improve the situation for the public.” As it stands, we are unable to do that with the information that we are getting.
Can I take that away and think about it, convener?
If you could, Mr Martin.
The reason why I am asking to take your suggestion away and not saying, “Yes, we’ll do that” or “No, we’ll not do that” comes back to everything that you have just said and which I was about to say. There is a difference between raw data and raw league tables and qualitative matters. Of the 10, 11 or whatever it is—12, perhaps—organisations involved, there are one or two that you would expect to be there. For example, you would expect NHS Greater Glasgow and Clyde to be there, because of the huge volumes that it deals with. I am more worried about the outliers. If, for example, a smaller health board finds itself in our top 10, I have to ask myself why that is the case.
It might be more useful if I take your comments away and think about the qualitative information that the committee might find useful instead of bombarding you with raw statistics. I am happy to liaise with the clerk on what you think might be useful.
That would be extremely useful. I really think that there must be a simple way of dealing with the issue in the annual report to allow not only this committee but other interested parties to pick up on it.
As members have no more questions, I thank the witnesses for their evidence. I think that the clerks will be in touch, and we hope to hear from you on some of the matters that we have raised.
We now move into private session.
11:58 Meeting continued in private until 12:18.Previous
Subordinate Legislation