Committee
Health Committee, 30 Nov 2004
30 Nov 2004 · S2 · Health Committee
Item of business
Scottish Public Services Ombudsman
Professor Brown:
Watch on SPTV
It is worth stressing that, in relation to most cases that come to us, we spend a lot of time at the beginning giving people advice about what they need to do rather than examining papers in depth. In other cases, we need to examine the papers in depth before we are able to say that there is nothing else that we can do. A lot of work can be involved in that preliminary stage, even if all we do is provide an explanation for people and talk them through the paperwork that they have but which they do not understand. Our approach involves education—I do not mean that in a patronising sense. We seek to raise awareness among bodies that are under our jurisdiction and among the public about what we can and cannot do.The second aspect of our approach is prevention, which is very much in tune with the health debate. It is better to prevent problems from happening in the first place. Much of our work is at the beginning of processes. We work with the sectors that are under our jurisdiction and encourage them to get their processes right. Evidence shows that the first reaction when something goes wrong is most important. If a problem can be resolved early, matters should not grow out of proportion.The third aspect of our approach is to work on prevention in partnership with the bodies that are under our jurisdiction, and with other ombudsmen, regulators and so on. Last but not least, we seek to contribute to wider governance. We regard our role as being part of the process of delivering better public services for the people of Scotland so that the kind of services to which we all aspire are provided.One of the key aspects that arise from our work is learning of lessons. For the benefit of members of the public who are present, I will read out the information on slide 20, which they might not be able to see on the screen. This is the sad story of a man who presented at a clinic with earache, but who was given a vasectomy. Lest you fear, I hasten to add that the case did not happen in Scotland. The story is this:"A farmer who went to the doctor suffering from ear ache ended up having more radical treatment than he expected - he was given a vasectomy. Brazilian Valdemar Lupes de Moraes, 39, was suffering from muffled hearing and thought his name had been called out in the waiting room at a clinic in Montes Clacos."I will not go into the detail of the calling out of his name, but the name that was called out was Aldemar, rather than his first name of Valdemar. However, a vasectomy was carried out on the man. The story continues:"Asked why he had not complained Mr de Moraes told staff he thought his ear inflammation must have reached his testicles."—Laughter.Members may laugh, but people do not always understand what is going on when they are at the doctor. The story continues:"The father of two, who had the vasectomy last week, turned up at the same clinic again on Wednesday for the ear examination he failed to get the first time—but made no request for a reversal of the operation."There are obviously lessons to be learned from that example. First, there was a lack of clarity in calling out the patient's name. It must be clear that the patient who presents is the correct patient on whom a procedure is performed. Secondly, there was a lack of informed consent. The man had clearly not consented to a vasectomy. Thirdly, there was a lack of information concerning his understanding of his condition and the possible treatments.One of the ways in which our office can be a useful learning resource is through consideration of the most common complaints that we receive, a crucial one being about the attitude of health service staff to people when they first come through the door. Other common areas of complaint are the clinical care and treatment that people receive, delays in the process, handling of a patient's discharge from hospital and the relationship with other services at that point, removal from a general practitioner's patient list—we have seen a number of such cases—and complaint handling itself. Crucially, the common factor in all complaints is poor communication at all stages of the process. There is a lack of proper explanations about what has or has not happened.Clearly, we were set up as a one-stop shop for complaints and we deal with individual cases. However, there are other potential players in the field and we make links with that wider group. For example, if there are issues of serious service failure or fitness-to-practice issues, we work with other agencies, such as the General Medical Council, to talk about the issues more generally rather than about specific cases.There must be clarity in interaction between audit and regulatory bodies. We have created a one-stop shop for complaints, but there are many other such offices in Scotland, which causes confusion among the public. To reduce confusion and to make the system work more effectively, we are working on memoranda of agreement with other bodies—we have one such memorandum in place with the Mental Welfare Commission for Scotland. We are drafting another for the NHS quality improvement service and the Scottish Commission for the Regulation of Care. We are also in initial discussions with the GMC to try to clarify issues and the boundaries between our roles.We have produced a route map, which we will leave copies of, to direct members of the public through the right door, whether to the Auditor General for Scotland, to the Scottish information commissioner, to our office or to another office. We also raise a question with the committee: do we need something specific, such as the route map, for the NHS? It is difficult for people to know, with reorganisation and the other proposals that are under way, to whom they should go with specific issues. We would like to play a part with the committee and others in creating a mechanism to make the process simpler.
In the same item of business
The Convener:
SNP
Agenda item 3 is a briefing from the Scottish public services ombudsman. I welcome Professor Alice Brown to the committee. I also welcome Eric Drake, the dep...
Professor Alice Brown (Scottish Public Services Ombudsman):
Eric Drake and I welcome the opportunity to speak to the committee today. We offered to do so because I thought that it would be helpful if we were able to e...
Eric Drake (Scottish Public Services Ombudsman):
As Alice Brown said, there are a number of issues that we can consider and some that we cannot. The essential definition of our jurisdiction is that we look ...
Professor Brown:
It is worth stressing that, in relation to most cases that come to us, we spend a lot of time at the beginning giving people advice about what they need to d...
The Convener:
SNP
Thank you. We have about 10 minutes to deal with members' questions. I ask members to keep them as brief as possible. If the answers are brief, too, we will ...
Kate Maclean (Dundee West) (Lab):
Lab
I think that Eric Drake spoke about failure to provide a service as opposed to failure in the service that is provided. Can you please give an example of wha...
Eric Drake:
As I said, the legislation talks about the"failure of the authority to provide a service which it was a function of the authority to provide."The example tha...
Kate Maclean:
Lab
So, it would be up to an individual's interpretation of what is meant by a statutory service. You also said that you could not consider properly made decisio...
Eric Drake:
Yes. For example, some years ago, the English health ombudsman examined a case in which a chap who had serious brain injuries did not need hospital care any ...
Kate Maclean:
Lab
So, the matter is about the service that is provided, not about where or how it is provided.
Eric Drake:
Yes. It is about whether a service should be provided at all.
Mr Davidson:
Con
I agree that there is a need for a route map of the NHS for the public to use. We all probably have queries about what that would do. However, health boards ...
Professor Brown:
Yes—that was the purpose of the roadshow events. We have been round all 15 health board regions and have talked through many such matters. My impression is t...
Mr Davidson:
Con
Will you set a timescale in which people can expect the NHS to deal with the process?
Professor Brown:
Setting the timescale for the NHS is less clear cut; we tend instead to issue good practice guidance on the process. That said, it is perhaps more defined in...
Janis Hughes (Glasgow Rutherglen) (Lab):
Lab
People often come to MSPs after they have complained to a consultant and received a reply, after which the matter has not been taken further. What would you ...
Professor Brown:
Members of the public can get very confused about whether they have exhausted a body's complaints process. Before I answer the question, I point out that we ...
Janis Hughes:
Lab
You said that you cannot overturn a properly made decision. However, if such a decision has not been properly made and you are upholding a complaint, what po...
Professor Brown:
We can recommend that the body in question offer some form of redress. I point out that some areas are easier than others in that respect. Health is the most...
Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
I want to pursue an example of that. The 19th report in your submission centres on the removal of a patient from a GP list, and you say in your recommended r...
Eric Drake:
A special report might be made to Parliament but, in this case, the local health board has had further discussions with the GPs concerned, who have now apolo...
Mike Rumbles:
LD
So you have teeth.David Davidson asked about reasonable time for a health board to complete its investigations, including the independent review. I am not re...
Professor Brown:
The independent review stage is being removed. However, if we feel that there has been undue delay, we might intervene earlier.When someone has not exhausted...
Mike Rumbles:
LD
I will be in touch.
Professor Brown:
I am sure that you will.
Shona Robison (Dundee East) (SNP):
SNP
Having sat with a lady who had followed an exhausting complaints process in the health service, I think that it is good that the complaints procedure will be...
Professor Brown:
Eric Drake can supplement any points that I make. Informing the public is a big challenge for us, because we need to inform them about a lot. We will have in...
Eric Drake:
In examining the NHS internal complaints procedure, the Scottish Executive has sensibly obtained outside help to draft leaflets in plain English, so that the...
Dr Jean Turner (Strathkelvin and Bearsden) (Ind):
Ind
How can you help people who make a complaint while having treatment but who do not want to take it too far? Having highlighted their need or asserted themsel...
The Convener:
SNP
That probably comes under the heading "specific". You might not want to comment on that, in case that particular case comes up.