CHILDREN AS COMPLAINANTS IN THE HEALTH AND PERSONAL SOCIAL SERVICES IN NORTHERN IRELAND

1 EXECUTIVE SUMMARY AND RECOMMENDATIONS

Health and Personal Social Services are required to respond positively and effectively to complaints from service users. In the case of children and young people, complaints about their treatment may arise within the post 1996 'Wilson Complaints procedures' or within the post 1995 Children Order procedure. This report investigates the operation of these two systems within Health and Social Services Trusts in Northern Ireland with regard to complaints made by or on behalf of children and young people. It also discusses the importance of such systems in upholding children's rights and in particular Article 12 of the U.N. Convention on the Rights of the Child which establishes the principle that children have a right to express their views on all matters of concern to them.

It was not possible within the confines of the resources made available for the study to also interview children, young people and/or their parents who had made complaints although this would have provided a very important perspective on the issues involved. However, the resources available for this study permitted a multi-method approach comprising four main elements. These four approaches and their resulting findings are noted below.

1) Analysis of administrative data held by the Department of Health Social Services and Public Safety. Departmental records for the half year January/June 2001 show that 2142 complaints were made. A total of 6.3% of these were in the Family and Child Care programme of care and 5.5% were in Maternal and Child Health, however complaints involving the care and treatment of children may occur in any of the other programmes of care with the exception of Elderly services.

2) A postal survey of HPSS Trust complaints staff in Northern Ireland seeking information on how complaints by or about children and young people are dealt with (the results are reported in Section 5 of this report). It was found that all of the 17 Trusts which responded to the survey provide information to the public on the Wilson complaints system although less information was available on the Children Order complaints process. Most Trusts did not produce material targeted at children with disabilities or children from linguistic minorities. Half of the Trusts reported difficulty in dealing with complaints involving children. All but one Trust reported receiving Wilson procedure complaints from an adult on behalf of a child for the year ending 31st March 2001. However only two Trusts reported receiving complaints under the Wilson procedure made by children themselves. Fifty four out of the 104 Children Order complaints for the year ending March 31st 2001 were made by children on their own behalf. Of these children 50 were in residential care. When an adult makes a complaint on behalf of a child, only half of the Trusts reported that they attempted to discover if the child's views were the same as the presenting adult's.

3) A postal survey of potential child advocacy organisations to establish availability of independent advocacy services for children and young people who may need them (results are reported in Section 8 of this report). Of the forty nine organisations which responded to the survey 19 reported that they currently provide advice and/or support in relation to complaints involving children's treatment within Health and Social Services.

4) Semi-structured telephone interviews with eighteen lay people involved in Health and Social Services complaints processes in Northern Ireland (these are reported in Section 7 of this report). Some concerns were raised about the role of lay persons within the Children Order complaints procedure and the importance placed on their views and role as independent people by Trusts. The majority of informants felt that a child's best interests could be adequately put forward by an adult acting on the child's behalf. Only three could give examples of when children's own views had been actively sought.

A number of improvements should be made to improve the rights and representation of children within Northern Ireland Health and Personal Social Services complaints systems and to uphold children's Article 12 rights to express an opinion on matters concerning them.

RECOMMENDATIONS

1) We recommend that research with actual complainants should be undertaken as soon as possible by The Department of Health, Personal Social Services and Public Safety or the regional NHS R & D Office. This would provide important baseline information for the new Children's Commissioner expected to be appointed in 2002.

2) We recommend that independent advocacy and support be easily accessible to all children and young people in residential care.

3) We recommend that Trusts should be required to implement the recommendations of those who carry out the Children Order complaints and representation procedure.

4) We recommend that all Trusts should be required to have readily accessible lists of those lay persons involved in their complaints procedures and should publish their identity in the Trust's Annual Report.

5) Trust switchboard operators should be more aware of the relevant office number to which to refer complaints related queries.

6) Complaints leaflets should include guidance on the kind of information which should be included in a complaint letter.

7) The use of proformas and pre-paid envelopes currently in some Children's Order leaflets for children should be extended to Wilson system leaflets and to adults as well as children.

8) We recommend that the Department/SSI should set a date by which all Trusts to whom the Children's Order is relevant should be required to have produced complaints material targeted at the most vulnerable groups of children and young people viz. children in residential care; children in foster care; children with disabilities whatever their care arrangements.

9) We recommend that the Department require Trusts to engage in six monthly pro active complaints publicity and consultation programmes with children in either of these forms of care and especially with children in foster care and/or looked after at home who are currently under-represented in complaints coming forward. In addition, the Department and the SSI/Board Children's Home Inspectors should require Trusts to produce six monthly reports documenting the actions they have taken and the changes to service they have made in response to children's complaints about residential and foster care. These new requirements should include the requirement that all such practice use disability sensitive methods and practices.

10) We recommend that Complaints Offices be made more visible and accessible to children using services.

11) We recommend that the Department should clarify the guidance about when to use the Wilson complaints system and when to use the Children Order complaints system.

12) We recommend that in all cases of complaints involving a child Trusts should seek to determine the views of the child involved as well as those of the presenting adult.

13) Complaints staff and lay persons need to be trained to recognise the importance of children's own views and their rights under Human Rights instruments and legislation to express them.

14) Panel working methods should be modified where appropriate to create an environment comfortable for children including the use of interviewers experienced in working with children.

15) The Department of Health, Social Services and Public Safety should immediately provide all lay persons involved in the HPSS complaints system whether Wilson or Children's Order, with appropriate indemnity on behalf of all HPSS Trusts and Boards.

16) The Department should also reissue guidance to Trusts stressing the importance of respecting the independence of lay persons.

17) Feedback on the outcome of complaints to lay persons in both Wilson and Children's Order complaints should be improved.

18) The Health and Social Services Councils should appoint/designate one of their officers to work specifically with children and young people in the HPSS, to liase with the non-statutory organisations involved in this area of work, and to liase with and advise The Children's Commissioner on HPSS complaints.

19) All organisations, statutory and non-statutory, providing support and advocacy for children and young people should seek to challenge the culture prevalent in Northern Irish society generally, and the public services in particular, which accepts that adults 'speak for' children and young people.

20) The department of Health, Social Services and Public Safety should provide guidance to all HPSS organisations of recognising and defining what constitutes a complaint.