The N'I' HPSS Complaints System

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The N.I. HPSS Complaints System

• Tom Frawley
• Assembly Ombudsman for NI and NI Commissioner for
  Complaints

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Wilson Review Findings (1994)

• Described features of effective procedure
• Maximum commonality across the service
• Separation between complaints and the
  disciplinary procedures
• Publicity and branding
• Use of informal responses
• Well trained staff
• Support for complainants and respondents
• Time limits

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Aims of the 1996 Procedure

• Ease of access
• A more rapid process with an emphasis on early
  resolution
• An approach which is open and thorough with the
  prime aim of resolving problems and satisfying
  concerns
• Making it easier to learn from complaints and to
  improve services as a result

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Background (Before 1996)

• At least nine different and complex HPSS
  Complaints Systems
• Complainants faced an uphill struggle in making
  their views known and in getting a response
• Using the system tended to increase rather than
  reduce the dissatisfaction of complainants

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Wilson Review Findings (1994)

• Called for a complainants procedure based on
• Responsiveness
• Quality enhancement
• Accessibility
• Impartiality
• Simplicity
• Speed
• Confidentiality
• Accountability

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Key Elements of the HPSS Complaints Procedure

• A three tier system which applies across all
  elements of the service, including FHS
• Local Resolution
• Independent Review at Board Level
• The Ombudsman
• Clear accountability on the part of CEs to
  investigate and resolve complaints and to apply
  lessons so that services can be improved

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The Process.(1) Local Resolution (LR)

• Providers must respond within 20 working days, or
  preferably resolve the complaint on the spot
• LR must not be seen simply as a run-up to
  Independent Review
• Staff must be empowered to deal with complaints
  if LR is to work effectively

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The Process(2) Independent Review (IR)

• Complaint can be referred to HSS Board Convenor
  within 4 weeks of LR response
• Convenor is non-exec of Board
• Convenor, with advice from independent
  chairperson, will
• Ascertain if all opportunities to satisfy
  complainant have been explored
• Decide if an IR Panel should be set up
• Establish the IR Panels Terms of Reference

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The Process(2) Independent Review (IR)

• The IR Panel comprises independent chair, a
  convenor and an independent lay member. The Panel
  has access to clinical/professional advice
• The Panel investigates the facts of the case, can
  interview all parties and must provide a written
  report with conclusions and suggestions within 60
  days of the appointment of the Panel members

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The Process(3) The Ombudsman

• Convenor must inform all who request IR of the
  right to go to the Ombudsman
• Ombudsman normally takes the view that the HPSS
  procedure should be fully exhausted before he
  investigates
• If he finds that a complaint is wholly or
  partially justified he can recommend that the
  body concerned should provide a remedy

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The National Evaluation (Reported in March 2001)

• Set up to provide and evaluation of how the
  complaints procedure is operating across all
  parts of the NHS
• The Report is now out for consultation in NI.
  Submissions to be made before end November
• It finds significant levels of dissatisfaction
  among complainants and males a number of
  Recommendations.

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Recommendations (1)

• The board of every NHS organisation should be
  held accountable for its complaint handling
  performance
• Each NHS board should receive quarterly reports
  on the causes of complaints and action taken or
  proposed
• Complaint handling should be part of the
  performance management of board chairs and CEs

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Recommendations (2)

• Regular training in complaint handling for front
  line staff
• Wider use of conciliation
• Role and empowerment of Complaints managers is a
  key issue
• There should be even greater independence in the
  IR process (e.g. Panels with only lay members and
  their own support arrs)

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In Summary

• A whole system
• Strong compliance to a uniform system
• Rooted in local resolution
• Independent 2nd level other than body
  complained of
• Ombudsman final rung

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In Summary

• Culture Shift for
• Health Service Professionals
• Managers
• The Public
• Therefore properly resourced

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In Summary

• Joined up Government
• Elderly/children about more than health
• About social care
• About housing
• About transport
• Therefore
• Single Ombudsman/ Commission is key

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In Conclusion

• Some issues are not soluble
• No conclusion possible
• Closure involves unattainable outcomes
• Genuinely best was done
• A solution would have required unrealistic
  expectations
• Ultimate Conundrum
• Infinite Need Finite Resource

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Final Thought!

• Simple courtesies can make a big difference and
  the word sorry can transform the circumstance