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

6 FINDINGS: THE POSTAL SURVEY OF TRUST COMPLAINTS STAFF

Of the 19 Northern Ireland HPSS Trusts all of the 17 who responded to this survey provide information to the public on the Wilson complaints system. All do so through leaflets, and about half use posters. A quarter use other methods. Only two Trusts provide separate publicity on the Wilson system specially designed for children and young people.

Despite the requirements of Equality legislation, no Trusts provide special complaints information for children with disabilities. This group of children is disproportionately likely to be in foster care, and also disproportionately likely to be physically or sexually abused by adults related and non-related (see Sneddon and Monteith 1999 and Monteith 1999). Targeting of complaints information and assistance towards them is an important part of protection, empowerment and equality strategies.

One Trust indicated that it had plans to produce such information in the future for children with disabilities and adults with sensory impairments.

No Trust has provided complaints information specifically designed for children and young people from non-English linguistic backgrounds although two Trusts have plans to do so in the future.

Nine of the fourteen relevant Trusts have however produced separate publicity about the Children Order complaints process for children although in only two cases is there specially targeted material for children with disabilities and in only one case for children from non-English linguistic backgrounds.

Most Trusts (14/17, 82.4%) reported use of a definition of a complaint which accords with that laid down in legislation and statutory guidance. That is, that a complaint is an expression of dissatisfaction which requires a response. It is of concern, however, that two Trusts stated their definition of a complaint 'varies' and that one could not provide a definition.

Only three of the fourteen relevant Trusts have material about Children Order complaints targeted at and designed for children and young people in residential care and three have this for children in foster care.

Complaints administration generally involves few staff in Trusts. In most cases it involves 5 staff or less (See Table 6.1).

Table 6.1. Number of Trust staff involved in complaints administration July 2001

In almost all Trusts, the Complaints Office is not located in areas accessible to service users, but instead are in administrative and/or Headquarter floors and buildings.

All seventeen Trusts reported that they provide training to staff in the operation of the Wilson Complaints System, and twelve of the fourteen relevant Trusts had done so in respect of the Children Order. Training is usually within the induction programme for new staff but may be included in other courses periodically on an ongoing basis for other staff. The only staff group for whom some trusts reported some difficulty in the provision of training was consultants.

Seven Trusts reported difficulty in dealing with complaints made by or on behalf of children and young people with four reporting difficulty in understanding and operating the distinction between Children Order and Wilson System complaints. Some cases originally dealt with under Wilson have been subsequently redirected for handling under the Children Order. Just under a third (5/17 or 29.4%) reported difficulties in dealing with children and young person's complaints due to differences between parents, clinicians and practitioners for example in cases where there is a suspicion of abuse or neglect.

Table 6.2 DIFFICULTY DEALING WITH COMPLAINTS

Trusts have responded differently to the introduction of the Children Order procedure to run alongside the Wilson system. At least one Trust automatically routes complaints involving or by children down the Children Order route. While most did not take this course of action many Trusts indicated that they would welcome guidance on how to decide which route was appropriate for complaints involving children. So long as this uncertainty remains, delays and inequities in the handling of complaints by or about children will remain. Delays resulting from administrative uncertainty may lead to children being put at risk.

Trusts found the Children Order system particularly difficult to operate. Problems reported included difficulty in recruiting appropriate persons, difficulty in recruiting lay members for panels, gaining the co-operation of staff about whom the complaint is made and the difficulty noted above of establishing whether complaints fall under the Children Order or the Wilson systems.

Just over a third (6/17, 35.3%) of Trusts said they provided special support to children and young persons in bringing forward their own 'Wilson' complaints and half (7/14, 50%) reported they do so in relation to Children Order Complaints. However only one Trust provided a lay advocacy service for children and young people, three offered the services of a social worker and three had a complaints administrator who specialised in children's complaints. Neither social workers nor Trust administrators are likely to be regarded by children and young people as independent advocates.

Table 6.3 SUPPORT PROVIDED TO CHILDREN

Just under half of Trusts (7/17 or 41.2% ) reported that external advocacy organisations usually of a private legal type have been involved in children's Wilson cases and the same applied in respect of Children's Order complaints cases. In four cases one of the four Health & Social Services Councils was named.

Over half of Trusts (10/17 or 58.8%) reported that when an adult makes a Wilson complaint about the treatment or care of a child or young person, complaints' administrators seek to determine the views of the child involved and whether these are the same as or different to those of the 'presenting adult'. Rather more (9/14 or 64.3%) did so in relation to Children Order complaints.

Table 6.4 EXTERNAL ADVOCACY/VIEWS OF CHILD SOUGHT

All but one Trust reported having received complaint/s from an adult on behalf of a child or young person under the Wilson procedure for the year ending 31 March 2001. Table 6.5 indicates the nature of the complaints received.

Only two Trusts reported having received complaints from a child or young person themselves under the Wilson system, although in one case the Trust could not provide any further details. Most Trusts do not record whether a complaint is by a child or an adult in the Wilson system.

Table 6.5 Nature of Wilson Complaints by/on behalf of children and young people, 2000/01, Northern Ireland.

Within the Wilson system most (62.6%) complaints made by or on behalf of children focused on issues of clinical practice and its adequacy or inadequacy. This is a higher proportion than when complaints are made by adults on their own behalf. Recategorisation of Table 4.1 in Section 4 using the same categories as for Table 6.5 here above shows just 40% of adult complaints being category 2. The higher category 2 proportion in complaints about children's treatment may reflect the difficulties many parents have in relinquishing their decision making and protective roles in relation to their children as they have to do when their children are under the medical or nursing care of others. Alternatively it may reflect greater inadequacies in clinical practice in relation to children and young people than in relation to adults. This is a subject with considerable equality significance under the Northern Ireland Act's Section 75 provisions which would benefit from more in depth research in the future.

Table 6.6 Children Order Complaints by/on behalf of children and young people, 2000/01, Northern Ireland.

Most complaints (50/54 or 92.6%) made by children themselves under the Children Order were made by children in residential care. Only 4 (7.4%) complaints were made by children in foster care or children being looked after at home. The most common types of complaints from children were about the rules and regulations of the accommodation, for example, rules about bedtimes and about not being permitted keys to lock one's own bedroom.

The second most common type of complaint concerned the behaviour of other residents and the third the behaviour or attitude of care staff. Almost the same number of complaints as were made by children themselves as was made by adults on their behalf under the Children Order. The most common type of complaint by adults on behalf of children concerned professional practice and judgement in the decision making process; the second most frequent type of complaint was to do with staff attitude and behaviour.

It is notable that the focus of children and adult's complaints overlap very little. With children being mainly concerned about the here and now, the shape and texture of their everyday lives, while adult complaints seek instead to query the process and final decision made about a child's care placement. This difference underlines the importance of encouraging children and young people in residential and foster care to speak up for themselves.