 происходит and welcome representing the opportunity. If you want to use tablet devices or tablets during the meeting, just please switch them to flight mode as they may otherwise affect the broadcasting system. Some committee members may prefer tablet services for the meeting because we provide papers in digital format. Agenda item 1 is to decide whether to take agenda item 3 on consideration of the oral evidence that we have received today in private. Are we all agreed? Agenda item 2 is our main item of business today, which is an oral evidence session on the complaints process for joint health and social care services. This is the latest in a series of sessions that we have undertaken over the last four years to establish how fully public authorities are responding to the public sector reform agenda. Members will recall that concern over the complaints process for joint health and social care were brought to our attention by the Scottish Public Services ombudsman Jim Martin back in January of this year. The aim of this evidence session today is to ascertain what progress, if any, is being made in relation to the establishment of an effective single public complaint handling process following the integration of health and social care services. We are also seeking clarification on the role of the SPSO in handling subsequent complaints made to him, which arise from the integration of health and social care. We have one panel of witnesses this morning, so I would like to welcome Paul McFadden, the head of complaint standards at the office of the Scottish Public Services ombudsman, Iona Colvin, chief officer for health and social care partnership in North Ayrshire, Alison Taylor, head of integration implementation at the directorate for health and social care integration of the Scottish Government, and Rami O'Casha, acting director of strategic development at the care inspectorate. Before we move on to questions, would any of you like to make an opening statement? Mr McFadden, would you like to go first? I am happy to open, given that we had raised those issues to the committee in January. As we said to the committee at that point in January, as we have said over a number of years through various forums and consultations, some of the concern around this area dates back to the single report that was published in 2008. The single looked at complaints system across Scottish Public Services as a whole and, as the committee knows, made a number of recommendations about trying to simplify it and make those systems less complex. There was a particular focus in that report around the area of social care complaints and within that social work complaints. I recognise that this was a particularly complex and confusing area for vulnerable users and, particularly in relation to social work, I recognise that that system was outdated and not particularly effective. A number of recommendations, including one that would simplify the social work complaints system and give the complaints review committee that currently sits within local authorities to the Ombudsman's office and a number of other recommendations and observations around the wider care complaints. At the heart of the issue is the fact that there are separate legislative processes for the various different areas around social care and also separate standards within each of those processes. For social work you have the statutory social work complaints process with very clear and specific timescales and stages and standards throughout that process internally. Signposting to a complaints review committee before you can come to the Ombudsman and our remit in relation to social work because of the complaints review committee's role around professional judgement is quite limited. Secondly, you have the health arrangements under the Patients Rights Scotland, which is a streamlined process. It is slightly at the moment with the wider complaints processes that we have put in place and social work. You have the care complaints, which are made directly to the care inspectorate. Our view, shared by a number of others, which we referred to in a briefing to the committee, is that there is a risk, a particular risk, to vulnerable users in this overlap and confusion. This is something that is raised with us by local authorities and health boards involved in the complaints arrangements. It is something that we see coming through in cases to our office. Integration has come along since that process. We have been very supportive of the integration agenda, which we think will be positive for users, but we have raised concerns that it is possibly a missed opportunity at least and could possibly even increase the confusion around complaints here unless there is quite specific guidance and detail around the arrangements that the integrated areas should be put in place in terms of complaints. We have seen bits and pieces of progress, and we have always had constructive discussions with all the various branches of government on this. Social work, we know that we are moving towards it, but we need some firm timescales on when the changes to social work are going to come in place, both to ourselves and to local authorities. We have constructive discussions around health. I think that there is something about integration and providing a bit more clear guidance to ensure that the arrangements that are currently being developed—it is consistent—all of those areas are currently developing processes in isolation. As the committee knows, we have worked very hard over the last few years to standardise and bring a clarity and consistency to complaint surrounding across the rest of the public sector. I think that there is an opportunity to work with the government to publish something that helps us to develop that level of consistency in relation to that area, too. I welcome the fact that you are looking at this. We need to move forward in terms of simplification of the process and co-ordination of the different bodies that are involved. I completely agree with everything that Paul has said. I look forward to the discussion. From the point of view of a chief officer, I am sure that members are aware, but the three-year partnerships have been established now as integration joint boards were established on 2 April. At the moment, we are the only ones that are established so far. From our point of view, what we are trying to do at the moment is to simplify the process from the point of view of the people who use the services. We will also simplify the process at the end of that so that there is important performance information going before the IGIB as well as to the NHS and the councils in order that they can see very clearly about both the level of complaints about services and the outcome of complaints about services. For me, those are the important points at the moment. We navigate the rest of the complex process. I am sure that that is probably what you want to look at today. I might be helpful if I just say a little bit about what the Care Inspectorate does in our role in relation to complaints, convener. We regulate 14,000 care services in Scotland in both children's services and services for adults and older people. We do that in order to support improvement where that is required, where services are not operating at a sufficient quality level. Some of those services will come under the purview of the integrated joint boards under the integrated arrangements, but other services that we regulate might not, for example childminders or school care accommodation and so on. We will work across a number of different landscapes in that sense. We investigate complaints about the quality of care in those care services and last year we received 4,400 complaints, which was a significant increase from that from two years ago. What we try to do with our complaints process is not simply resolve problems for individuals who are currently experiencing them or dissatisfied with what they have experienced, but try to use the information and intelligence that we obtain from complaints when planning our inspections and our scrutiny to make sure that what we are doing in the different parts of Scotland is justified by the evidence that we see. At the same time, leaving aside what we do within individual care services, we provide scrutiny of social work services in Scotland and are currently undertaken through a joint arrangement with Healthcare Improvement Scotland and with other regulators, where we have joint inspections of the community planning partnership, where we look at how well services are working together, both for children and for adults in those areas. With integration coming on stream, we will undertake additional responsibilities around strategic commissioning and looking at the impact of new arrangements on the outcomes for people who are living in the areas, so we have a particular interest in making sure and would expect that chief officers in each of those integration boards have a robust system in place for dealing with complaints at the lowest possible level where they can be solved. Ms Taylor, please. Thank you for the opportunity to talk to the committee about complaints. My job has been to lead the policy and the legislative work around integration for the last few years and now to oversee aspects of its implementation. As a starting statement for this, but I would particularly want to reflect on, is that right at the heart of integration, the only reason for doing it is to improve the user's experience of health and care and to improve people's families and carers' experience of health and care as well. This is very much a person-centred approach and that must also, obviously, apply in the territory of complaints. I think more broadly than that, also in the territory of listening to people generally, in involving people and communities in the integrated strategic planning of services so that people's voices are built in from the start of planning, if you like, and of course that the experience of complaining is smooth and integrated, does not present in itself further hurdles and is clearly understood. I think that we have done some very useful work in recent time with colleagues both in the SPSO and the Care Inspectorate and more broadly in the inspection agencies and elsewhere. Three things in particular came to my attention from the papers for this session, reflection naturally on the progression for the NHS complaint system to the SPSO model process, which the Government has committed to seeing in place in the next 12 to 18 months, which I think will help to provide some consistency with other aspects of public sector complaint processes. As you will know, the Cabinet Secretary for Health, Well-being and Sport convened a short-life working group on social work complaints recently. The recommendation of which was to remove the complaints review committee stage of that process and, likewise, to move the social work complaints process to the SPSO model process. I think that that is also good news. It again confers some consistency in terms of the application of process. We have more work to do with colleagues regarding the timescale for that. The third aspect of this, clearly from our point of view, is how these new bodies, the integration joint boards that the legislation has created, feed into complaints processes. Clearly I can answer more questions on that as members would find useful. There are two particular aspects to it that we have dealt with from the start. The joint boards are colloquially referred to as partnerships. Each partnership has a scheme of establishment and that scheme of establishment must explain how complaints processes will be integrated from the perspective of people living in the area. That is one safeguard that we have put in place. We will also move each of those joint boards, also known as partnerships, to the jurisdiction of the SPSO in the coming months, but we cannot do that until they are each established because they must each be consulted on being added to the SPSO's jurisdiction. Finally, guidance. Yes, indeed, over the next year or so there will be some requirement on us, I think, with our colleagues to develop appropriate guidance to ensure the processes are clear to people. Thank you very much. Thank you very much. At our stage 1 look at the Public Bodies Bill, a submission from Carers Scotland was quite typical. They said, we believe that one complaint procedure should be introduced for integrated partnerships to avoid confusion for people who use services and carers. What we are describing here today is somewhat confusing, even to us around the table, so God only knows what that is like to folks out there. Even as it stands at the moment, sometimes I have to think before I give folks advice about where they need to go to follow up their complaint. Mr McFadden said at the outset there that bits and pieces of progress have been made. Quite frankly, we do not want to see bits and pieces of progress. We want to see a system that is robust from the outset, which people can have faith in. Mr Taylor said that all of that will come under the SPSO jurisdiction soon after the boards have been consulted. There will be the issue of guidance after that. Have we put the cart before the horse here? I would have expected for all of that to be dealt with before the introduction of the service delivery. We have ensured that the horse is in front of the cart in part through the provisions that we have made about what must be in each partnership scheme of establishment. The local experience of complaining and ensuring that that is a satisfactory and integrated experience for the person who is making the complaint is a responsibility that sits with the partnership. That is why we have said that in order for the Cabinet Secretary for Health, Well-being and Sport to sign off each of those schemes, there must first be a sufficient statement indicating that making a complaint locally will be a simple and straightforward process for the person who is making the complaint. The system processes that go around that, particularly in terms of moving the IJBs, the partnerships to the jurisdiction of the SPSO, are driven by the legislative requirements of how they can be added to the jurisdiction, if you like. The first and most important step is that local bottom-up step, about how the partnerships will deal with complaints as they arise. The chief officers will obviously have a very important role to play in that. Ms Colvin, what do the chief officers think of all of this? I welcome some of the changes that are being proposed, particularly around the Social Work Complaints Review Committee and moving the NHS system under the SPSO as well, because that will make life easier. What we are working on just now is a front-end to the complaint system, so that it does not matter where you are in the partnership services, be it the NHS or council, there is one direct route in to make a complaint. Thereafter, we will navigate the processes that are required to be navigated either through the NHS process or through the council process. Sometimes, often, because people do not live in the wee boxes that we put them in, involves complaints about both services. I am obviously responsible for the operational side of all of health and social care within North Ayrshire, including mental health services for the whole of Ayrshire and Arran. I have just appointed a joint management team, so they are all jointly responsible. Everybody in my management team is responsible for social work and health services. My head of community care, for example, is responsible for NHS continuing care beds and for the care homes, for example. We have just now appointed managers underneath them, all of whom will have a joint responsibility. We are taking it seriously in terms of joint ownership and joint responsibility. When members of the public complain, we need to deal with their complaint, and we need to sort it out behind the scenes and give them one response, regardless of whether it contains an element around NHS and council. The complications obviously come quite often, particularly some of the most complicated complaints that we get relate to child protection in Ayrshire and Arran childcare services are part of our partnership. That can involve a number of agencies. Quite often people will go to SPSO, who will then refer them back, because they have not been through the complaints review committee process. They will also contact SPSC, who have not been mentioned so far, but who also have a responsibility in regulating practice of the practitioners involved here. Quite often they all write to every MP, MSP and councillor. It does become quite complicated often in terms of dealing with it, but our basic aim is to make sure that we simplify that from the point of view of the person who uses the service. Simulification would be good, because what this committee has found on numerous occasions when we are dealing with complaints is that people feel that there is a lack of communication. They are not signposted where they need to go to. We are well aware of situations in which they have reached stages that they should never have if the communication had been right at the very beginning. One of the things for individuals is that if they are very clear from the outset about how their complaint is going to be handled and all of the stages that they can go through, then there tends to be a level of satisfaction compared with those folks who are not signposted, who are not communicated well to, who at the end of the day may reach the level of the SPSO or the care inspector, whoever it may be. All levels of reasonableness have gone by that point, and no matter what you guys say, they are still going to be absolutely dissatisfied. The key thing for us here is to ensure that that signposting, that communication takes place, instead of this pillar to post, because, quite frankly, folks should not have to go to their MSP, their MP or their councillor to deal with this. Clare, you wanted to come in on that point. It was just a supplementary on that discussion. You mentioned that the Cabinet Secretary has to sign off on every joint board's procedures in terms of the initial one, but I'd just like to get a feeling of how variable those procedures may be, and could we be in a situation where one local authority, one joint partnership, is working significantly different from another one and how the ombudsman would actually view that situation in terms of monishing performances across Scotland? We'll take Ms Taylor first and then Ms Colvin. The requirement for the schemes that the Cabinet Secretary signs off is that they must describe how the experience of complaining will be streamlined and integrated from the perspective of the person making the complaint or their family. Which is, I think, quite a narrow requirement in the schemes themselves. The description tends to be fairly consistent because what it describes is the kind of arrangement that Iona has referred to, that teams will work together from an integrated perspective. In particular, there will be no question of someone making a complaint being told to go and give it to somebody else. That's fundamentally one of the most important things. There is a single point of entry and that any mechanism for working out what needs to be done with the complaint is a process shouldered by the organisation, by the partnership, not by the service user or their family member or whomever. Ms Colvin. That's absolutely the case. In Ayrshire, we've worked as three. There are three local authorities, as you probably know, on one health board. We've worked as three to achieve consistency. In this, we will work as three as well. Obviously, that's a requirement from the health board. You can't have a health board with different arrangements. To be honest, some of it is, to me, it's common sense. I was previously a CEP director in Glasgow City and it's something that we did in Glasgow City in terms of joining up the front end and joining up the back end as well so that we make sure that we've got clear performance reports that indicate what people are complaining about and the outcomes of those complaints. I think that it's relatively straightforward in terms of the front part and the back part. It's a bit in the middle at the moment where we have to navigate the different parts of the process and to come back to your point here at the moment because it's very complex, but it's incumbent on us to be able to guide people through that and be clear with people what that process is and how we will deal with it. We are aiming to deal with people, most people, at the lowest level possible so that we can resolve their issues and not have complaints that end up in front of the SPSO. That is absolutely our aim. For the vast majority of people, we do manage that. There are some complaints that are very complex and there are very few people who are always going to use every mechanism to complain. Sometimes they are very complex issues and they have to do with deprivation of liberty of removing people's children from their care. They have to do with very serious issues which have very serious implications. As we move forward and try to join up the system, particularly for me, the people who get passed from pillar to post most are the elderly and the carers of elderly as they have tried to negotiate our systems. The whole point of care, integration of health and social care is to join that system up as well. That is what we are currently doing as we are in the process of joining the system up and therefore we need to join up the system whereby people can complain so that they can make one complain and we can deal with it. That is what we are endeavouring to do. Our aim is to have that front end in April next year. In the meantime, we will endeavour to deal with everybody's complaints as we can. We are also actively involved in... Because you are talking about the front end and the back end. You hope to be endeavour to have all of this in place by April next year. You said and I am paraphrasing here that confusion is in the middle. Hearing that does not give me much hope in terms of what is going on here and how you are going to be able to do this properly. This scenario of confusion about the middle you are painting a picture whereby you hope to have everything dealt with at the very beginning of the complaints process. That is what we would all like to see. We live in a world where that does not happen all of the time. If there is confusion in the middle that will lead to a huge amount of consternation amongst those folks who feel that their complaint is not being dealt with properly. Am I right? I think that colleagues have explained the steps that they are putting in place to deal with the confusion in the middle. Part of it is about the role of the complaints review committee for social work complaints and the role of the care inspectorate and how the role of the care inspectorate relates across. In actual fact you can end up with a number of agencies involved in looking at complaints but I suppose what I am saying is that we now have joint managers and their job is to make sure that we deal with that on behalf of people so that we explain how complaints will be dealt with and as we navigate through the systems I think that colleagues are saying that the proposal is to change the systems in the middle. I am a punter. I have a complaint. I feel that my complaint has not been addressed at the very beginning. That is escalated and you bring in the manager but I as a punter have lost faith at that point. I have no idea what the set procedure is about and where the complaint is going to go. Am I not going to think that this is just an attempt to cover up and not deal with my complaint? If I do not know the processes if that is not laid out properly? No, we will lay out the process and we will lay out the entry point. So basically what we are seeing is that we will have one point of entry for complaints and then it will go into the NHS process and into the council process and that is how we will have to manage it until such time is joined up. That is what we need to do but we will make it clear to patients, service users, clients, whatever people want to be called that that is how we will deal with the process and we will take the responsibility of making sure that that is explained to people. If the complaint is not dealt with by the front line, it will be dealt with by the senior manager who has responsibility for the council services within their remit. Mr Acashaw, you have been dying to get in. It was really just in response to the point that Ms Adamson made about the information about different things that are happening in different parts of the country and it was to offer the committee some information about how we intend to work with other partners to provide some baseline information about what is going to be happening in different parts of the country. We are very cognisant that integration is something that is happening and that in that sense what we think is that a strong evidence base about what is actually happening and the experiences and processes around the country is important so we will be working with Healthcare Improvement Scotland and Audit Scotland to monitor and review the implementation of the integrated arrangements over the coming years not just in respect of complaints but right across the piece around integration so in year 1 this year we will be providing some baseline information on the basis of setting out what we know is happening around the country and how integration is beginning to work and in later years what we will start to do is apply some evaluative judgments about how well that is beginning to work and then move on to say and what impact is that having for people who are actually living in each of the areas. I think that some of the questions you answered about what is happening in different parts of the country will be provided by an evidence base from ourselves from Audit Scotland and from Healthcare Improvement Scotland over the coming years. Mr Mike Fadden. I think that there are a lot of positives in terms of commitments to things like a single point of contact, a single point of entry, a single coordinated response irrespective of where the responsibility lies at the back end and that is positive. I think that our experience of looking at the integration scheme and thinking of commitments there is very little detail of how that is actually going to happen. I think that there is a reason for that and I think that the reason for that is that the legislation and the legislative basis for these are conflicting and this is not just a confusion for the citizens it is a confusion for staff and managers that we speak to because I think you are trying to bring together and create these single point of entries and this clarity when you have a very complex system in the background and they are struggling to do that. The first step to that is legislative change to bring these together and I think that we have commitments to move towards that. The important thing is that that is not going to happen until probably until the end of next calendar year so after the point of integration we are going to have the ability to have a very clear legislative framework to create that very clear complaints process but I do think that that is the priority to get a clear timetable for that and communicate that to those that are developing these processes. I think that in the interim we can provide something which does the best job of trying to bring these together and make it clear to both staff managers and the citizen about how all these complaints should come through and where they should be routed to the Complaints Review Committee or the Health Service or the Care Inspectorate. It would not be ideal but I think that it is something that would help in the interim until we get the legislative background fixed. At the moment what we are seeing and what we are being told from people in the system is that all of the integrated areas are doing this in isolation so they are developing their own little solution to this very complex problem and what we have been saying is in other parts of the public sector that we have developed a very detailed and standard template for how this should be operating our Complaints system should be operating developing something similar would be of great benefit to the integrated joint boards and I think would ultimately be provide something which is as clear as it possibly in April for the citizen and thereafter we have to deal with that they can bring together the social work health and other legislative aspects. Thank you, convener. The integration schemes there are 31 of them in the public domain at the moment there are 31 partnerships but they haven't all been signed off yet so the Airshire 3 have been signed off and those three partnerships are fully functioning which is why it's very helpful that Iona can speak with us today and a further 14 have been signed off by the Cabinet Secretary but the remainder have not yet been signed off and it's as we go through the sign-off process that we ensure that everything is in order and that this particular commitment about ensuring an integrated experience of complaining is in there I've had a few questions from a whole range of sources asking why such and such a scheme has got away with X and the answer is well it hasn't because it hasn't been signed off yet so as we go through that sign-off process we will be making sure that these matters are in order although as you quite rightly say Paul the scheme is not the place for a huge amount of detail on any one particular aspect of local integration we have it in mind to issue guidance to IJBs the partnerships by the end of this summer and I think it would be particularly helpful if we were to work closely with our colleagues and other agencies particularly the SPSO because you're talking about guidance but Mr McFadden is talking about legislative change is the guidance enough to deal with this or are we going to have to go back and come up with primary legislation to make sure that this all works no we have to make a change to secondary legislation once each partnership is established to put them within the jurisdiction of the SPSO but recognising that that will take us at the end of the calendar year as Mr McFadden said we realise we can't leave a hiatus so what we're going to do is issue some guidance in the meantime to make transparent that that's our intention also to cover the cabinet secretary's intention to move social work complaints to the model three stage SPSO process as NHS complaints are now and to set out expectations in guidance for the kind of template that Mr McFadden refers to how complaints about integrated services ought to be managed and that's what we intend to do in the summer John Moffson, please Thank you, convener and just to follow on from the convener's earlier point one of the things that this committee is attempting to do is to try and make it not only clearer for ourselves to understand the complaints procedure but in particular the public because what I've heard seems to be a very cluttered landscape in terms of anybody at the present moment trying to make a complaint in reference to the 31 partnerships that are being currently worked on Could you give me an example of what you mean by a partnership? Yes, absolutely I'm pleased to do that A partnership is a health board and a local authority who together are required under the Public Bodies Joint Working Act to create what's described in the legislation as an integration authority Each health board and the local authority with which it is operating they're in the same geographical area obviously is required to create this partnership to which they delegate some of their functions and some of their money and that's what brings health and social care together in that area For example, NHS Lothian here where we are is in partnership with the City of Edinburgh Council so that's one partnership the Edinburgh partnership but it's also in partnership with East Lothian Council partnership Is that reasonable explanation? It's an explanation about and you said the geographical boundaries I'll give you an example a recent example that I picked up where a patient was taking into a neighbouring hospital, neighbouring to that boundary not within that partnership area was released from that hospital with a catheter was released without any care support went back into the local authority the living in those circumstances my understanding is there wouldn't have been a partnership between the local authority and the neighbouring health board what happens in those circumstances when the patient wants to make a complaint because who do they complain to do they complain to the NHS board that they were in hospital with or do they complain to the partnership in the area that they live in they can complain to their own local partnership because if it's an agreement with the neighbouring health board then their partnership will be part of the service level agreement with that health board so for example in North Ayrshire many patients from the north coast of North Ayrshire go to Inverclyd Royal hospital I liez with Inverclyd Royal hospital and in fact we have been having some on-going discussion about complaints that arose not so much from patients from GPs about the functioning of Inverclyd Royal hospital so it became my responsibility to then liez with the health board people who hold the service level agreement and to intervene in that discussion so that's quite clear although they were being treated by Peter Glasgow and Clyde they were patients from North Ayrshire and therefore we had a responsibility to sort that out sorry how do we get that message over to the general public because as I said the confusion that arose was who do they make the complaint to who do they deal with but at the present moment would that still apply given that in Ayrshire but as I understand it from what Miss Taylor said there's still a number of partnerships to be signed off by the Cabinet Secretary what would happen at the present time for a patient that found himself in that situation where there was that conflict between the health board that they were treated in and the integrated partnership that they actually resided in but there's no partnership agreement on that I imagine that technically there would be the health board from which they come from that would have the responsibility because that health board holds the service level agreement so I mean we are working towards a position and it's disappointing to hear of your constituents experience but we're working towards a position where people should not be discharged from hospital without a plan so my social workers and care at home workers go to Inverclyde Royal hospital and assess people in Inverclyde and organise discharge plans occasionally people are discharged without the discharge plan in place that shouldn't happen but I know that it does because your constituent has had that experience but that is the position we're working towards and where we would hope to be being discharged from hospital it's clear who is responsible for their care within the community and clearly that's a major issue for us as we take on more complex procedures within community and our nursing staff have to take those on and GPs take responsibility as well then it's absolutely critical that people are clear who is responsible for their care and that their care transfers back to the community so a lot of the work we're doing just now is really focused on how do we join up the community in hospital because that has been as much of a problem as has been the divide between health and social care at points is between hospital care and community care and that's part of what we will be measured against in terms of the national outcomes in relation to the partnerships and that ideally is what should happen but my gut instinct is that the NHS Ayrshire and Arran in our case have all the service level agreement with Glacier, Glasgow and Clyde and therefore have a responsibility to intervene on behalf of their patients Mr McFadden I think discharge is a good example where this most commonly crosses over and complaints that we see under the present system do cross over these different areas just to highlight the complexity for the person who's wanting to complain the elements that would relate to the health board would have to go through that health complaints process the elements that are very interrelated and joint but are about the social work assessment or that are going to the local authority they have to go through the statutory local authority complaints process and then come to SPA so we have quite a limited role to look at it we get complaints, we have and we do get complaints with these come to us and we are looking at the person being taken through these separate routes and they come to us and we are having to unpick and cross affair with different powers and different complaints and I think that's the issue that is going to remain until these statutes are aligned and removed so it is going to be a challenge for them to get the boards to do this but I think the kind of example you're talking about I think the kind of things that have to be put in place are very detailed and clear arrangements that are going to be talking about of what happens in this circumstance so that staff member knows We are there because we are talking about detailed arrangements and all of the rest of it again and we know that these detailed arrangements are missing something in the middle and now have kind of skirted around the issue that Mr Wilson was getting at who do they complain to initially in that case and you know this not being able to give an answer you really have not been able to give an answer and the very least I would have thought is that you would have said that you would be able to sign post that individual to who that initial complaint should be made to but even at this moment in time there seems to be a lack of understanding about where someone initially goes and that I have to say really really perturbs me I think it's clear that initial complaints are directed to the partnerships because that's why we've brought health and social care functions budgets planning and delivery together which partnership has a chief officer now I'm not about to suggest that every complaint should be directed individually and personally to the chief officer but it's incumbent on the partnership and the chief officer to ensure that there are integrated arrangements in place as articulated at a high level in the scheme to ensure that that process is straight forward I think in terms of the very concerning problems with discharge that we've discussed very briefly I think what this helps to illustrate is that it's up quite often with integration which is that such problems have existed for quite some time and are in fact in a sense what integration is designed to address what we need to do I think is ensure that we work together to ensure that there is clarity of understanding about this root in for complaints and for other ways of engaging with integrated partnerships Mr O'Kasha I think what's important to put your finger on it is that there needs to be a joined up front of house approach so if somebody approaches somebody be it in the care sector or the health sector and says well I'm unhappy I want to make a complaint that they're not told well I'm sorry I'm the wrong person to complain to that actually they're supported and assisted and that is the expectation that we would have of partnerships as they're developing and I think it's where our expectation is that chief officers will be able to put in place the appropriate systems to make that happen and what we can offer in future years is some evidence to justify to verify the extent to which that has happened and identify improvement support to be put in place if that isn't happening Thank you Mr O'Kasha some common sense comes into play Okay will I coffee please You've been around and you stole my question that I was intending to ask there the good questions I was keen to find out just what a person's experience is tomorrow if they make a complaint about any aspect of the service whether it's the local authority, social or care sector or even our NHS just what happens who do they go to and what's their experience even tomorrow or next April if there's a single point of contact and a single complaints experience what does it look like is it a complicated but single form what do they do would he envisage will be the experience or next April when those processes are fully integrated what will it look like he's going to go first Ms Taylor Mr O'Kasha has put it beautifully it will look like making a complaint to someone in the partnership an appropriate person there will be different circumstances I imagine some of these as I on and said some of the circumstances surrounding the provision of care under integrated arrangements are really really complex people in really vulnerable moments of their lives towards the end of their lives quite often there will be different circumstances in which the need to complain arises and the key for me is that in making a complaint the person doing so isn't pushed about or told to go away and go to someone else that the complaint is accepted by whomever it is made to and then the system carries the burden of excuse me working out what should happen and who needs to be involved he said that the person will complain to somebody in the partnership I mean how do you make that initial leap a person who's coming out of hospital or whatever circumstances they find themselves in wanting to complain how do they go about finding somebody in a partnership you know what do they do basically the if they're receiving services from the partnership then they'll have a front line worker who's working with them and we also will give information to everybody about how to make the complaint so that's partly what we're working on I'm sorry I'm trying to think if it's somebody in hospital for example who's coming out and there's a problem with their care package then they can complain via their social worker or via their district nurse probably whoever's in there delivering the service and that person will take the complaint regardless of whether it's about the social work component or the health component of the service and will deal with that complaint and that's what we're trying to do at the moment and we're training our staff in relation to that so we're moving we're trying to move away from our siloed systems and it's a bit difficult because we're kind of in transition so in some places we still have the siloed systems where the social workers come in nurses come in and perhaps the allied health professionals come in what we're creating now are joint teams so we've got integrated teams for example for people being discharged from hospital which have physiotherapists occupational therapists, social workers and district nurses and care at home staff in but one of those people will be allocated as the main worker for that person and they can complain directly to them and we will pick up the complaint and deal with it regardless of what the service is about if you don't mind question it's about that how do they know who to complain to if there's a multiplicity of people delivering service to their person all right across the board you don't want this multiple approach like the social worker or the career or the health worker or whatever what will it look like if you want to complain no matter who to or what about here is what to do will it be something like that is that in place tomorrow or is that something that will happen next to you Ms Culver so any of our staff who go in to somebody's house to deliver a service or meet with them in hospital should get a leaflet that says here's how you can make a complaint and here's who you would contact if you're not happy with the service so for example care at home are probably the biggest service we have they deal with 5,500 service users every week and basically everybody who receives care at home has a leaflet which tells them how to complain about the service and who to contact and what I'm trying to say is that if somebody wanted and they made that contact but they were actually complaining about the fact that their physiotherapist didn't turn up well we will not be saying you need to phone physiotherapy right thanks very much we'll look into it, we'll get back to you as soon as possible and try and resolve your issue so that it's about how we resolve the issues not expecting our clients our patients to go around all the houses basically and that's the approach that we are developing just now Asha your question Mr Cofi we received 4,500 complaints last year about care or at least from members of the public who were dissatisfied not all of those were things that we are empowered by statute to investigate so some of them might be related to the provision of NHS services so not something we could do but what we would never do is to say to those people well I'm sorry we can't help you what we would do is support them to be in touch with the appropriate person in the area where they need to be and make sure that link is there so I suppose in a sense some of what is being described as a local level the care inspectorate does it a national level so we have a telephone line that people can phone five days a week at staff by complaints inspectors who are specialised complaints inspectors who will offer advice or support and in some cases investigate the complaints that are being raised but very often the provision of some advice and support can help people without the necessity to undertake a complaint investigation I was just going to come to you Mr Acasha four in a four thousand four hundred complaints meaning as part of any complaints process there's an expectation that there'll be some learning experience as a result of that and that will inform future planning and improved service design it's all part of the customer improvement the continuous improvement agenda that exists right across all sectors really how do we know, how does the public know that amongst those four thousand four hundred complaints that you get that there are no repeats in there all over the place about the same issues over longer periods of time how do we know that and if any of those complaints result in recommendations for action for example with child protection issues somebody mentioned how do we know that they're being addressed and fed back into the process so that certain issues can't happen again that's a crucial element of the complaints management process and continuous improvement so how does the public get the assurance that that's what happens absolutely so with respect to care services that we regulate then we try and cut that information in two ways so we try and cut that information by service so that if someone is saying well I'm thinking of using this particular care service we publish on our website details of all the complaints that have been upheld about that service by us and we will say well here's the detail of the complaint we will redact personal information about individuals but we'll put a summary which says we received a complaint in April 2013 about the quality of nutrition in that particular care service to take an example and we upheld this complaint and we made the following requirement that this must change what we would then do is when we then follow up and go in to inspect that service we will use the information from that complaint to determine whether or not that complaint that we've made has actually been introduced and a change has happened if that hasn't happened then it's open to us to go further down our enforcement route to actually ensure that what happens what we expect to happen does happen and I think that provides public assurance to someone who is either using a service or thinking of potentially using that particular service because in social care there's often more of an element of choice than in NHS services but what we also then do is we can cut the data in terms of what's happening across the country so we can provide a picture of to say well these are the types of complaints potentially in a local authority area or in a health board area which we're getting lots of complaints about this particular issue in this area and that will allow us then to target our scrutiny a bit more strategically and say well the data suggests there's a problem here we need to start addressing that and we need to look at the audit reports as well it's probably aimed more at the professional than the public user but it's available That's a really good answer but it doesn't quite get there I was thinking more in terms of say it's some protection issues or whatever and you've picked up an issue that's hopefully resolved how do we know that other authorities perhaps that might be experiencing the same issue who are not quite made recommendations directly against pick up those lessons because we do hear of recurrences of things like child protection issues that happen across the country how do we know that the authorities are picking them up and taking action from recommendations made against that particular authority I think there's more work to be done in that area we do a limited amount to an extent by when we have received a complaint where there's a real learning point for that service or for other services we will publicise that through our various channels of communication in a case study format but I think you're right I think there is potentially more work that could be done around ensuring that the information from complaints is shared more consistently across different parts of the country when it comes to very serious matters of course there may well be a serious case review of some type whereby an awful lot of learning would be assimilated in one place and shared more consistently across an area really being in very serious cases where there was a very serious failing OK, thank you very much for that can we go on? OK, I'm going to go back to Ms Colvin because in answer to Mr Coffey you said that folk if they have a care package could talk to their social worker or their health worker what if they don't have a package in that forms part of the complaint some folk have got easy access to people on a day to day basis others do not and that is one of the difficulties in terms of that beyond that the complaint itself might be about the person who is dealing with their day to day care so how do we deal with that? so if the complaint is about the person who is dealing with their day to day care what we currently do is everybody has a leaflet with a phone number that they can phone to make a complaint to the person who is dealing with their care and the person at the end of the phone will make sure that we respond to that complaint appropriately as far as we can and I did say earlier we are moving from a siloed system into an integrated system so there are complications in relation to this we will also advertise widely in terms of how you can make a complaint in relation to the partnership services most people do not see those as partnership services they see them as NHS services and council services and actually the staff still work for the NHS and the council so we need to take that into account the other thing that we do in Ayrshire and Arran is we are part of patient opinion and we obviously get a lot of complaints or pre-complaints almost in terms of comments from people about their experience of using the NHS in Ayrshire and Arran and we get quite a lot in mental health services and in North Ayrshire we are piloting care opinion as well so that we are part of the pilot just now, the national pilot that is going on so that people can contact us online and describe their experience and we will respond as quickly as possible to people's experiences so that would be particularly quite often that is for people who don't necessarily have an allocated worker within the system and that's how we are dealing with it just now We know that change of service and change of organisational structures is one of the most challenging things that people can face in work and I mean this as no criticism of either social workers or NHS staff but just the history would show us that mentalities can remain and there can be difficulties so in a situation at the moment if somebody makes a complaint and it goes into that confused middle ground and social work services conduct their statutory duty and the complaint and NHS do the same and neither of them take responsibility who's the arbiter of what's going on in the service Ms Taylor I would entirely endorse the observation about cultural challenge and the difficulty of moving to new ways of working and particularly endorse the support of nature of the observation because it is very challenging and as a slight counterpoint to it I suppose there's our observation from the quite extensive evidence around integrating health and social care that oddly enough moving everybody to one organisation doesn't fix it which is part of the reason why this Parliament passed the legislation which doesn't take that approach and instead leaves it to us all who work across the system to try to lead for improvement and work together very explicitly In taking forward each of their statutory duties social work and the NHS as providers of care are fulfilling their responsibility and by aligning it so that each is following the same process I would expect a greater clarity about the steps that any given complaint moved through I would hope that it was almost irrelevant in fact totally irrelevant to the person making the complaint whether it was a social work or NHS complaint given that there will be a single point of entry and the same system of process in due course to go through to get to an outcome but in terms of who must pick up the responsibility for resolving the complaint with the integrated teams of the sort that Iona has described in her area Basically, as I described earlier we have just put in place a joint management arrangement so if you want to complain about community mental health services in Ayrshire and North Ayrshire there is one manager who is responsible for the social work service and the NHS service and their responsibility is to make sure that the response back to your complaint that we try to resolve your complaint be it about your NHS experience or your council experience or in fact about both and at the moment I have for the last few months been dealing with complaints of that nature where you get a complaint and actually it's about a number of issues in terms of both the NHS and the council response or indeed I think the moment that the systems are quite confused people find it difficult to get into certain parts of the service and it's not clear why you would be involved in the council mental health services opposed to the NHS mental health services so one of the things that we're doing as a first priority is joining those services up together so that they become one service with one overall manager who has responsibility for both components of that service and indeed it works with the third sector in terms of the delivery of their services as well and has responsibility to resolve complaints as fast and as effectively as we possibly can and we've just put that system into place in the last couple of weeks and I have at the moment the join tends to be me and the people who work for me the heads of service so the people who are in charge of community care and childcare or mental health and we have been making sure that so that we're not sending back responses that says that's about the NHS but you need to go through there that's about the social work but we are sending back responses that say we take on board what you're saying and we're trying to resolve the issues in relation to both the NHS and the council service or indeed sometimes it relates to third sector and independent sector services as well we will be leasing with the care and spectra around that very briefly an additional point rather at the other end of the spectrum it's very helpful description of what of course is the primary concern what happens to people who are making complaints on the ground it strikes me that it may be worth me just mentioning briefly that the legislation around integration has within it a series of principles and also a series of outcomes which are all to do with the wellbeing of individuals and the experience of care and the experience of the service users and the outcomes and principles at a legislative level apply not only to the partnership but also to the health board and the local authority so bound into that legislation is a duty for everybody to be on the same page in terms of pursuing the wellbeing of the individual and the family around them and so forth Claire I think that the points may have been slightly surpassed but in response to your question about where things go in people or signposts that have been outlined in terms of agency, ownership and responsibility from behind the scenes in terms of making sure that the user doesn't have to unpick things exactly the way we're trying to get to so that they enter the system get into the system is the first challenge and some people do struggle to identify where they go what happens afterwards at the moment that isn't always happening across the country I think people are going through the separate processes they're then signposted to either the Complaints Review Committee or the SPSO where we have different powers so that they don't follow all the processes they follow one process which narrows what they can ask a complaint about so they complain about the health element but they can't complain about the social care assessment element or vice versa but I think what Iona was talking about is where we're trying to get to and I think that's where we do need a bit of clarity for all of the integrity joint boards and how they're able to do that within the existing legislative framework and the future legislative framework I am concerned that a genuine disagreement between the health service and the social work service about where something has gone wrong and individual workers have been highlighted as feeling in their duty Obviously the council would have procedures for grievance and somebody could go through if they were unhappy about a complaint of a fellow worker in those circumstances but how does that work when it is two separate employers that are involved in the process Miss Coven It works through me and through the people that work for me because as the chief officer I'm responsible for the social work service and the council service all of that is delegated to me by the council and the health board so the IGIB has the strategic responsibility and a number of other responsibilities and I as the chief officer have both the strategic responsibility and the operational responsibility so my managers my heads of service and now my senior managers they all have that they will discharge that responsibility it's not acceptable that people get a response that says that it was the fault of the social worker or no it was the fault of the health worker we need to resolve that it's our responsibility to resolve that and to resolve that to the satisfaction of our patient client service user as far as we possibly can now that's not being acknowledged that's not been what's been happening up to now but that is our aim basically so my manager who's in charge of for example addiction services we quite often get complaints that relate both to the health component and to the social care component but it's his responsibility to make sure that we resolve that complaint and that we deal with any issues behind that if there is a dispute between health and care health and social care staff about what should be happening then management need to help to resolve that dispute and that's our responsibility not the responsibility of the people who are making the complaint clearly Alex Rowley please Hi, good morning things seem a bit complex and a bit confused and I'm not clear really where we're going if I think about just last week I had somebody come to me an 80-year-old lady or an 80-year-old lady had been released and the care package wasn't in place and I didn't see that as a complaint such as a sort of something that needed sorted and by going to the interim director of health and social care and it was cascaded for there and fixed so there's that that will be fixed for me the complaint would have come with that if it was clearly then to learn why that happened but the complaint would have come if somebody had come back to me and said we actually don't think that person deserves or should get care and that would be where the complaint would come in because you'd be challenging that decision and for any complaints procedure that's in place there's got to be confidence from the complaining there's got to be confidence that it'll be carried out it'll be examined properly and there's got to be a clear process set out so that the person understands how that complaint will be dealt with and the councils where the council does have that process right now if I put a complaint in tomorrow to 5 council and asked them what the procedure was they'd be able to send me that likewise NHS 5 would be able to send me that and the spokes where I'm trying to get to is where are we trying to get to with this are we saying that there is a streamline complaints system that's going to be put in place for the health, the joint integrated health and social care partnership and that there will be a complaints procedure there that's in place and clear to people that this is what happens when you complain this is the steps and if you're not happy you end up going to the ombudsman or you end up going wherever is that where we're aiming to get to and if we are should we as a committee could you set that out for us could perhaps not today but set it in writing where it is we're actually trying to get to go through this what the steps are in getting there and what was in some guidance going to be issued in the summer to use responsible for what I think that would be useful if we got that type of information we would then be able to see more clearly where this thing is going Ms Taylor We would be pleased to write back to you on that I think that would be helpful, thank you Just to suppose very very briefly in Fife the health board and the local authority have pointed a chief officer they have a shadow joint board in place they have a draft scheme with us under discussion at the moment and we expect that Fife partnership to put in place a front door for complaints which makes it easy for the person making the complaint as Iona has described from her area but then the other part of your observation question the process that flows that speaks to what I mentioned earlier about having the same three stage SPSO model process for health and social work and we can set that out for the committee absolutely, thank you Okay Can I ask about the complaints outcome side to the process when a determination is made about whether a complaint is upheld or dismissed what will the member of the public get will they get a letter will it be an invitation to meet with the single point of contact person what will the person's experience be when a decision is made and whatever the decision is what will the signposting then be for that person to take it further if they choose to do so Mr McFadden, are you signalling there I think I was just going to outline what we set out as best practice innovation to other areas under the kin model CHP and I think it very much depends on the individual circumstance of the complaint I think that's appropriate that it's tailored to the individual complaint whether or not they get a chance to meet with the staff or whether it's a letter that's maybe a relatively straightforward complaint we do encourage organisations to actually try and speak face to face to telephone as simply as they possibly can because I think we find our experiences that that allows staff at the front line to be empowered to resolve things for a staff which is definitely a positive and it allows the organisation to build empathy with the person where maybe something has gone wrong and it can help to rebuild that relationship with them and allows them to maybe apologise I think it does depend but I think staff in the appropriate guidance Is it clear what will happen for a person having a response what will happen tomorrow if I keep using that example if there's a decision made about a person today what will they receive tomorrow what will they see As far as possible we endeavour to speak to people face to face or on the phone and try and resolve their issue and so if somebody phones today and makes a complaint somebody should phone them back and speak to them about their complaint and see how we can resolve the issue if it gets to the second stage and at the moment before it would go to a complaints review committee then they would receive certainly receive a letter from us outlining how we're what the outcome of their complaint is and if the complaint is upheld they will receive an apology of course and they may depending on how serious the complaint is they may also be offered to meet as well not everybody wants to meet but they may well be offered a meeting either with myself or a head of service or another manager basically to talk through their complaint and the outcome of their complaint if the outcome of the complaint has significant implications for practice then that would also be dealt with through it would go through our clinical and care governance arrangements as well so that we're flagging up any practice issues and changes that need to be made to our practice or our arrangements within the services and ultimately that will also be scrutinised by the integrated joint board as well in terms of there will be a report presented to them about complaints that have been made about the service, about outcomes of complaints and where there are significant issues and particularly if it relates to children or to adult protection or indeed to public protection then that goes into the system in terms of adverse events so a significant case review for a child for example or for an adult or a MAPA instance would also become public in their own right in terms of a report ultimately being published Do we see, you could ask Mr Taylor is that the experience that everyone will receive when there's an outcome or a decision made about a person's complaint will they have that experience commonly in Scotland do you think? It certainly should be and I think this slightly goes back to something that I said earlier that it's the awareness that care itself and indeed complaints about care as part of that is not that well integrated everywhere which has led us to this programme of reform if you like. I think the evidence gathering that Mr Casha spoke about that the Cairns Spectra and others intend to roll forward as we see implementation taking place will be really important, we'll need to look at it and we are seeing that kind of integrated response quite consistently if you like or at least to a consistent degree of quality for people across the country and it's something we need to keep an eye on I think When a person gets a response from the system to say here's how we dealt with your complaint is it still the same single point of contact if they want to come back in and raise an issue about that or do they get signposted to the owners and go elsewhere after the two stages? Yeah If they're unhappy with it At the moment if it's a complaint about social work service then they would go to the complaint review committee of No no it's not at the moment but we would organise that so when we give them on the letter back if it's a social work complaint just now it's a complaint about social work service subject to the social work complaint review committee we'll see at the end of the letter now if you're not happy you need to tell us within 28 days and we will arrange a complaint review committee and that complaint review committee is independent of us obviously and that would report into the council and at the moment it's reporting into the council if it's the NHS then it's to the ombudsman We have to tailor at the moment we will tailor the letters dependent on the nature of the complaint Miss Taylor Of course it's why the cabinet secretary's commitment to transition to the three stage process for social work and the NHS will make it clearer in due course Okay Following on from that in terms of the new arrangements the care inspectorate wrote to the committee on the fourth of May signed off by the deputy chief executive then director of strategic development Karen Anderson and in that letter it says it's not at all clear what the leadership in coordinating arrangements are surrounding the development of a consistent pan-scotland approach to a complaint procedure following integration of health and social care arrangements I fear that unless this vacuum is filled progress will be very limited has the care inspectorate changed its mind since it wrote that letter in the fourth of May Mr Acacia? No, the position is very clear that we expect to see leadership in effective coordinating arrangements right across Scotland I think the commitment to moving to the complaints handling process set out by the ombudsman for both health and social care complaints is extremely welcome and I think that we would be extremely concerned if there were a vacuum and what we need to do is be able to provide an evidence base to determine whether things are working as they are intended and envisaged as we're hearing about today or whether in fact things haven't worked in which case that would be a very serious matter indeed So you still think there's a vacuum at this moment in time? We'd be highly concerned if there is a vacuum and what we want to do is ensure that there is an evidence base to allow us to ensure that that vacuum has been filled and that there is effective and coordinating leadership arrangements and I think what we've heard today convener from the committee is actually some very helpful examples from Ms Colvin about the commitment from her particular partnership to making sure that there is effective leadership at that local level that there is clarity for individuals who wish to make a complaint and that there is no passing from pillar to post What we will want to do is evidence that and we want to ensure that what we hear matches up with what we see Well, thank you convener Just to go back to Mr Dacasha Mr Dacasha, you made a comment earlier in response to one of the questions about the care inspectorate providing a helpline five days a week Yes What happens those other two days and I'm assuming those other two days of the weekends because the example I cited earlier was an example of somebody being discharged from a hospital at five o'clock on a Friday afternoon without a care package in place that person might have decided they wanted to phone the care inspectorate to raise issues with that Would you have got anybody at five o'clock on a Friday afternoon? We have on occasion been able to extend our helpline to be open at weekends and evenings where there's particular critical incidents happening in care services and we want to provide extended support to people I suppose what I wouldn't want to do is over claim what our helpline does and our helpline is not intended to be a national helpline for anyone with a concern about NHS services that's not within our statutory power to look at but what we can do is when people do come to us is signpost them in the right direction and support them many of the complaints that we deal with are when a care service itself has not been able to resolve an issue so in a sense our role is to investigate complaints about care services when the care service themselves has not been able to put in place the necessary changes or where people are frightened about going to it so we would never claim to be an emergency response line in that sense Can I ask the same question to Ms Colvin in terms of the similar scenario someone released discharged at five o'clock on a Friday afternoon without a care package what would be the integrated partnerships response mechanism and how would someone get in touch with the partnership to actually raise it that is an issue Ms Colvin, briefly please Basically we have an out of our service which is currently called social work standby service we're doing some work to look at how we integrate all of the out of our services including our nursing, our doctor's service and our social work service and within that service we have care at home managers on duty so we should resolve the issue straight away, hopefully right, thank you very much indeed Mr McFadden in the SPSO's communications with the committee you say that primary legislation is required to deal with this complaints procedure to make sure it's absolutely robust is that the case I think that's something we do need to clarify I think that the Government's commitment to lay out the key steps towards this is important the reason we felt that primary legislation may be necessary was because the social work changes would require the addition to a role of a remit of professional judgment over social work decisions which would bring this complaints review committee role to us we at the time felt that that may require primary legislation because it's fundamentally altering the SPSO Act 2002 I think there may have been discussion that there may be making powers or other such ways through alternative languages and it may be brought forward but I think that the position now we need a bit of clarity on that Ms Taylor, you said that only secondary legislation is required to deal with these things what's your reasoning why do you think that the SPSO is wrong in terms of saying that primary legislation may be necessary here our assessment at this point is that it's possible under the order making powers of the legislation but I think there's more here that we need to discuss we have yet to have the conversation with the parliamentary body about exactly how to take forward these changes so perhaps I should temper my input to say we believe it's a secondary legislation issue but we'll take that away and consider it more fully with our colleagues in the SPSO as well and make sure that we're clear on what's required well in terms of writing back to the committee as you've already agreed to do in a number of issues I'd be grateful if you could write back to us as soon as possible to let us know exactly what the legislative route that you're going to take is going to be whether that be primary or secondary legislation I don't want to preempt the committee in any way shape or form as we'll be discussing this evidence but I think it's likely that we may be seeing you folks again before the end of the year because I think that you may recognise that the committee is somewhat concerned at the way that this has been dealt with and I think that we will be keeping a very close eye in how progress is being made I thank you for your evidence today and for suspending me moving to private session