spso annual report 2012 13

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SCOTTISH PUBLIC SERVICES OMBUDSMAN ANNUAL REPORT 2012–2013 1 Providing a high quality user-focused independent service 4 Simplifying complaints handling systems 5 Being an accountable and best value organisation 2 Supporting public service improvement in Scotland 3 Improving complaints handling

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SPSO Annual Report 2011-12

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Page 1: SPSO annual report 2012 13

SCOTTISH PUBLIC SERVICES OMBUDSMANANNUAL REPORT 2012–2013

1Providing ahigh qualityuser-focusedindependentservice

4Simplifyingcomplaintshandlingsystems

5Being anaccountableand best valueorganisation

2Supportingpublic serviceimprovementin Scotland

3Improvingcomplaintshandling

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Laid before the Scottish Parliament by the Scottish Public ServicesOmbudsman in pursuance of section 17(1) of the Scottish PublicServices OmbudsmanAct 2002.

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CONTENTS

Ombudsman’s Introduction 5

Casework PerformanceStrategic Objective 1 11

Making aDifferenceStrategic Objective 2 19

Case Studies 24

Complaints Standards AuthorityStrategic Objectives 3& 4 31

Corporate PerformanceStrategic Objective 5 39

Equality andDiversity 45

Governance andAccountabilityAudit & Advisory Committee 51Service Delivery Complaints 52

Statistics 54

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Myultimate commitment is toensure justice for the people ofScotland. Iwant this office tocontribute to improving people’slives throughbetter publicservices.

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SPSO ANNUAL REPORT 2012>2013 PAGE 5

Annual reports are a good opportunityto reflect on what has changed andwhat has stayed the same, and tolook ahead to future challenges.This annual report is the first to chartprogress against our 2012/16 StrategicPlan. I am pleased to report that, despiteincreasing numbers of complaints andsignificant cuts in our resourcing, weare well on course to deliver the keyobjectives of that plan.

Maintaining qualityin times of changeWhat stayed the same in 2012/13was that the number of complaintswe received increased, as did ourproductivity, and there were furtherexpansions of our remit. This has beenthe pattern since 2009/10 – in thattime we have seen a 23% increase incomplaints, and a 15% reduction inresource, excluding funding for newareas of responsibility.

In line with our predictions, complaintsreceived rose by 5% in 2012/13. Ourproductivity also rose, and we dealt with9% more complaints than in the previousyear. This increase in productivity is aremarkable achievement, given ourbudget constraints, and the fact thatthere are fewer than 50 of us to lookafter almost all of the public sector inScotland. I commend my staff for theircontinuing hard work and dedication.

Overhauling complaintsprocedures andbuilding futureimprovementIt is disappointing that in 2012/13,I upheld 46% of the complaints thatwere valid for us to look at, comparedwith 39% in the previous year. These arecomplaints where the public serviceprovider has already had the opportunityto look into the complaint and provideresolution. The increase in upheldcomplaints demonstrates thecontinuing importance of our workto improve public service providers’complaints handling.

The most radical change we broughtabout in 2012/13 was led by ourComplaints Standards Authority (CSA).This small SPSO team is on track todeliver the decision of Parliamentthat there should be standardisedcomplaints handling procedures acrossthe public sector that are simple,streamlined and accessible, and thatdeal with complaints as quickly andeffectively as possible.

Over the past two years the CSA hasworked collaboratively with publicbodies to develop common complaintsprocedures for the local government,registered social landlord, furtherand higher education and ScottishGovernment sectors. Hundreds oforganisations across Scotland are nowcommitted to a two stage procedure –frontline resolution and investigation –with complainants having the right toan external review by SPSO or a similarbody if they remain dissatisfied.

As well as developing complaintsprocedures that will benefitcomplainants and organisations,the CSA has provided the groundworkfor future continuous improvement.New recording and reporting systemshave been set up. Performancemeasures have been agreed with thesectors and with the regulators thatwill ensure compliance with thosemeasures. This means that in Scotlandwe will soon be in the unique positionof having rich complaints data withinorganisations and across the varioussectors in the public service. This willhelp us all to benchmark and identifyemerging trends. The CSA has carriedout our statutory role to promote goodpractice in complaints handling in anumber of innovative ways, includingestablishing sectoral networks anda cross-sectoral online communityforum. Its informative website carriesguidance on good complaints handlingand hosts our online training centre.

OMBUDSMAN’S INTRODUCTION

TheOmbudsmanservice is evenmorenecessaryin times ofeconomic hardshipwhen the alreadyvulnerable aredisproportionatelydisadvantaged.

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It is an enormous personal pleasure to evidence the fulfilment of the visionand ambitions ofmyReview for the reformof theComplaintsHandlingSystem forPublic Bodies in Scotland. I strongly believe theSPSOhas put inplace a leadingworld class systemwhich helps ensure that public servicedelivery is to the highest level. TheOmbudsman andhis teamshould becongratulated for a jobwell done. PROFESSOR LORNE CRERAR

The approach by theFit for PurposeComplaints SystemActionGroup canbe summarised in oneword: simplification. That objective has nowbeenachieved.Wenowhave standardised, simplified complaints handlingprocesses for each public service sector. TheSPSOhas built this strongand enduring foundation onwhich our public services need to continue toembedan ethoswhich sees genuine complaints as opportunities forlearning andwhich empowers complaints handlers to resolve asmany complaints as possible at thefirst level. DOUGLAS SINCLAIR

The architects of the new complaints landscape – Professor Lorne Crerar and Douglas Sinclair– have given positive verdicts on our work to bring about this groundbreaking new approach tocomplaints handling.

(L –R: JimMartin, LorneCrerar,DouglasSinclair)

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SPSO ANNUAL REPORT 2012>2013 PAGE 7

Highlighting injustice and improvingpublic servicesOur traditional role as an ombudsman serviceis in handling the complaints brought to us bymembers of the public who claim suffering orhardship as a result of something going wrongin a public service. Our job continues to be torestore public confidence and add value byputting things right where we can.

We have included a selection of case studiesin this report to illustrate the range of our work.Some studies are examples of where we havemade recommendations to put things right andensure failings are not repeated. Others showsome of the positive actions that organisationshave taken in response to complaints. Still othersare included as examples of where organisationshave delivered a service and investigated thecomplaint properly.

Thematic reportsThis year, for the first time, we are publishingseparate, more in-depth analyses of our findingsin each of the main areas under our remit. Thesewill be published over the summer and earlyautumn and will help us provide more detail abouteach area, to be used as a tool for sharing andlearning.

We received a record number of complaints in2012/13, and through our new reporting mechanismwe put more decisions into the public domain thanever before. These contain a mine of informationabout what can go wrong, and what organisationsand ultimately my office can do to try to put thingsright.

A range of viewsUsers and observers of our office express a rangeof views about our service, both positive andnegative. To demonstrate this I have givenexamples of some user comments.

Firstly, people tell us they are satisfied that throughus they have got the answers they were looking for.

Although the SPSO is the end of the complaints linefor people who are unhappy with a public service, wedo not always have the legislative power to look into amatter or to bring about the outcome or change thatpeople want. Nowhere is this more apparent than incomplaints about the planning system (which is thesecond highest category of complaint about localgovernment services after housing).

Inevitably, given our role as the final decision-maker,we will never satisfy everyone who brings acomplaint to our office. Our job can entail managingthe difficult behaviour of people who have becomedisillusioned with a public service and with SPSO.Some people speak and write to me and my staff interms that are not always easy to deal with, and wecarry out staff training, including courses run byorganisations like the Samaritans, in dealing with this.

OMBUDSMAN’S INTRODUCTION

Itwaskindof you to listen tome, and tounderstandhow it allmademe feel, becauseattheheart of all this… ishowawful it allmademefeel. I feel like I canput it all behindmenow.

Although I amdisappointed that youwereunable to uphold any ofmy complaints againstthe council, I justwanted to say thank you for allyour timeandwork. I still think that there areseriousflaws in the planning systembutaccept your findings inmy complaint.

Despite the fact that I have absolutely noconfidence in your organisation andquite franklyconsider it to be a useless, toothless quango,I will be pleased to have a response. I havethough copied this letter tomyMSPwiththe suggestion that your offices shouldbe closed down immediately.

Thank you for taking the time to telephonemeto informmeof yourdecision. I justwanted tothank you for looking into this forme– I canseehow thorough it has all been. Even if theoutcomehadnot been in ‘my favour’, I stillwouldwant to say ‘thank you’, because youmusthaveput anawful lot ofwork into all of this.

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SPSO ANNUAL REPORT 2012>2013 PAGE 8

Making a differenceIn resolving complaints, the goal is not onlyindividual redress, important though that is.We are also committed to ensuring thatorganisations put in place changes that meanthat the same things should not happen tosomeone else. This is why our decisions oftencarry recommendations for improvementand this is a key way in which our servicemakes a difference. In 2012/13 we issuedover a thousand recommendations. Someof the case studies that appear later in thisreport contain examples of these.

Governance and complaintsOver the past year, I have visited senior teamsin many of Scotland’s councils and healthboards and I plan similar visits in future withhousing associations and further and highereducation organisations. I know from thesediscussions that there is a strong leadershipcommitment to improvement. These aredifficult times of reducing budgets, a risingdemand on services and changes in howthose services are delivered. In this context,I urge organisations to do two things. The firstis to see our decisions as tools for prioritisationand improvement, and the second is to use theexpertise and support provided by our CSA teamto ensure that complaints procedures are openand accountable and used effectively as sourcesof feedback and learning.

The Francis Report into the failings atMid-Staffordshire NHS Foundation Trust hasconcentrated minds as never before on theimportance of complaints as a lever forprevention and learning. In the wake of Francis,it is simply untenable for organisations not tohave governance arrangements in place thatrecognise the value of complaints and usethem actively to improve services.

In light of Francis and other reviews of the NHSin England, it is important that the distinct rolesof the SPSO and regulators are clearlyunderstood. Our role is to seek redress forpeople at an individual level. However, if aninvestigation points to the possibility of asystemic issue, we can and do make broaderrecommendations as well as publicly alert theappropriate regulator to look into the matter.

Administrative justiceAdministrative justice is the sphere of justice thatseeks to ensure that the rights of individuals areprotected when powerful public bodies makedecisions. For this to work effectively, individualsneed to know how to participate in, question andchallenge decisions that affect them and theircommunities.

This is an important principle and weincreasingly use the language of justice andrights in our policy work. I am encouraging policymakers to ensure that when they are consideringnew rights, duties or responsibilities they alsoconsider the right to question and challenge.I accept that this is a complicated area becausethis right is not absolute, and the rights ofindividuals need to be balanced against therights of the broader community. There areof course times when finality is needed indecision-making and policy makers may view itas impractical or undesirable for there to be anunrestricted right to challenge. Nevertheless,the right to do so should be embedded in policychanges and it is essential that this is done at theformulation stage rather than, as has sometimesbeen the case in the past, left to the end of theprocess. When this has happened, the SPSO canbecome the target for disaffection by peoplewho feel that this right has been denied to them.Their anger and frustration is often aimed atSPSO and I understand why, but we cannot bearresponsibility for systems that we did not set up.

Consideration also needs to be given to howuser-friendly the system is. Complex systemswith numerous routes for complaints andappeals can be baffling and discouraging.The SPSO was formed in 2002 as a one-stopshop to reduce this complexity and ourexperience is that simplicity is of great benefit tousers. This was emphasised in the Crerar andSinclair reviews and the more recent ChristieCommission report. I repeatedly highlightin consultation responses, meetingsand other engagement the need for theadministrative justice system to be lookedat holistically, for there to be a meaningfulright of challenge, and for the perspectiveof the service user to be paramount.

OMBUDSMAN’S INTRODUCTION

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Looking aheadI believe we have now maximised the benefitsof the process changes I introduced to improvethe quality and timeliness of our decisions.SPSO is good value for money and I seerecognition of this in Parliament’s decisionto expand our role to include improvingcomplaints standards and the Government’sdecisions to widen our remit in new areas.We are, however, a demand-led service.To increase demand without allocating theresources required to maintain our service levelsputs the quality of what we do and the servicewe offer at real risk.

My ultimate commitment is to ensure justicefor the people of Scotland. I want this office tocontribute to improving people’s lives throughbetter public services. To do this I must have theright processes and sufficient resources in place

to run the high quality complaints handlingservice the public deserves. The Ombudsmanservice is even more necessary in times ofeconomic hardship when the already vulnerableare disproportionately disadvantaged.

I will, therefore, continue to have discussionsthat may make some people uncomfortable.I want there to be a mature debate about thepowers of the SPSO. For example, why shouldthese be greater in health complaints than inthose about local authorities or prisons? In whatways could we strengthen our human rightsapproach in our work? I also want to exploredifferent funding models. I will continue to seekclarity about enhancing our accountabilityand will always insist on protecting ourindependence.

I think that this is no less than the public wouldexpect from Scotland’s Ombudsman.

JimMartinOmbudsman

OMBUDSMAN’S INTRODUCTION

I urge organisations to see our decisions astools for prioritisation and improvement,and to use our expertise and support toensure that complaints procedures are openand accountable andused effectively assources of feedback and learning.

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1Providing ahigh qualityuser-focusedindependentservice

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CASEWORK PERFORMANCESTRATEGIC OBJECTIVE 1

This section reports on our 2012/13 annualbusiness plan key priority for this strategicobjective, which is to deliver an efficient andeffective complaints handling service, workingto stretching but achievable targets,continuously building quality and accessibility.

As a free, accessible alternative to the courts,we provided over 4,000 people in Scotland withaccess to independent advice and final stagereviews on decisions made by public bodies.In 2012/13 we dealt with 9% more complaintsthan last year, a total of 4,077. We achieved thiswith the same level of investigation resourcethrough a continued focus on performancemanagement and further streamlining ourcomplaints process.

Case volumes and efficiencyIn 2012/13 we received 531 enquiries and 4,120complaints compared to 625 and 3,918 in theprevious year.

Given that since 2009/10 case volumes haverisen year on year, and based on the increaseswe saw in some sectors this year, we anticipate afurther increase of up to 10% in 2013/14. Thiswill include an expected rise in prison healthcarecomplaints. These came under our jurisdiction inNovember 2011 as a result of changes broughtabout by the Scottish Government, but theresulting complaints only began to reach us innumbers in 2012/13. This coming year, we willalso receive complaints about the new ScottishWelfare Fund – a consequence of anotherScottish Government policy decision which tookeffect from 1 April 2013.

Our Complaints Standards Authority’s work insimplifying complaints procedures across thepublic sector is likely to lead to complaintsreaching us more quickly than when some ofthose processes had more stages and no setstandards on timescales. This is a positive stepfor public service users as it means certaintyaround response times, less delay and speedierresolution, but it could potentially lead to ahigher volume of complaints finding theirway to SPSO. This is something that we willmonitor closely.

Like all casework-driven public services withfixed or reducing resources, the challenge forSPSO is to respond proactively and efficientlyto an increasing volume of complaints, whilemaintaining the quality and impartiality of ourdecisions and delivering an open, accessible andempathetic service. In 2012/13 we reviewedour business process to consider how we couldstreamline it further. As part of this initiative, in2013/14 we are carrying out targeted work witha group of public service providers to helpthem have greater impact on the volumes ofcomplaints that they resolve and to preventescalation to the SPSO.

Sector Complaint

Local government 1,505

Health 1,237

Scottish Governmentand devolved administration 525

Water 353

Housing associations 328

Further & higher education 127

Other 45

Total 4,120

Complaintsreceived bysector in2012/13

30%

36.5%

13%

8.5%

8%

3%1%

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TimescalesDespite the increase in case volumes, wecontinue to work hard to meet our owntimescales for handling enquiries andcomplaints. The time taken can vary significantlyfrom case to case, depending on the level ofadvice, resolution work or investigation required.We have, however, set average timescales forstaff to work towards in these different areas andwe publish them on our website.

In 2012/13, it was clear that increasingcomplaints numbers had impacted ontimescales. We dealt with 97% of advice caseswithin our target of ten days (our target was 95%).We made a decision on or progressed for furtherinvestigation 69% of cases within our target of 50working days (our target was 95%), and weissued 55% of decisions within our target of sixmonths (our target was 85%). Our final measurewas the number of public investigation reportswe laid before the Parliament within 12 monthsof receiving the complaint, and our performancewas 96% (our target was 95%).

We achieved this in spite of the level of complexityand gravity of the subjects, the volume of evidencethat must be gathered and the need for detailedexpert advice on many of the more complicatedcases. It was achieved against a background ofreducing resources and rising complaintsnumbers. Much of the increase was in complaintsabout the NHS which rose most sharply – andsuch complaints are often among the mostcomplex and time-consuming that we handle.Our most recent research of complainants’ views,published in August 2012, tells us that people areless concerned about timescales than they areabout thoroughness of investigation. We havebeen clear and consistent in our messageinternally and externally that, put bluntly, if wehave to decide between timescales for deliveringwhat we do and the quality of what we do, we willnot sacrifice the quality of our decision-making.

Each year we review and refresh ourperformance measures to ensure they are

focusing on and driving performance in a waythat is best for service users. The refreshedperformance measures for this strategicobjective and other areas of the business for2013/14 are set out in the business plan, whichis published on our website. To achieve thesemeasures requires efficiency on our part and onthe part of our advisers, the right resourcinglevels, and the ongoing cooperation of publicbodies in working to the deadlines we set them.

Quality of decisions and serviceThe SPSO offers the right to an independent,impartial, evidence based final review ofdecisions made by public bodies. In 2012/13 wecontinued to show how we delivered this throughfunding and governance arrangements thatcomply with the Ombudsman Associationindependence criteria, and by ensuring that wefollow the principles of natural justice in makingevidence based decisions.

Our aim is to allow individuals to tell their storiesin a user-friendly way, not bound by courtroomformalities and prohibitive costs, in a manner thatis meaningful to them. We also want to ensurethat we understand what the person is hoping toachieve by complaining to us and that wherepossible we make recommendations that arein line with the action they are seeking. We,therefore, carefully explore with complainantsthe outcome they want, and explain early on inour dialogue with them what we can and cannotachieve.

We do this both in writing and, increasingly, overthe phone ensuring that we understand andagree what the complaints are, whether thematter is one we can look at and whether theorganisation has had a full opportunity to resolvethe matter. We then gather and analyse therelevant evidence. During the investigationprocess, our decisions are guided by the SPSOAct, which sets out what we can and cannot lookat; by the policies and legislation relevant to thecomplaint, and by technical advice provided byindependent specialist advisers.

CASEWORK PERFORMANCE

Our aim is to allow individuals to tell their stories in auser-friendlyway, not bound by courtroom formalities andprohibitive costs, in amanner that ismeaningful to them.

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People who bring us their complaints invariablyfeel strongly about the issues they are raising.We take our responsibility as the final stagedecision-maker in the complaints process veryseriously. Where we are not able to uphold acomplaint, having assessed the evidence, our jobis to ensure that we clearly explain how and whywe have reached our decisions. Our aim is alwaysto do so with empathy and understanding for theindividual's circumstances. This is not alwayseasy but our staff work hard to achieve thisdifficult balance and we know from complainants’feedback that we can and do get it right forthe majority of people.

We understand that the nature of what we domeans that some individuals will never acceptthe decision we reach on their case. This canoccasionally lead to persistent expressions offrustration and criticisms of this office and it canalso lead to people exploring other avenues fortheir complaints issues to be heard, such asthrough the media or by political lobbying.We know that this is part and parcel of being thefinal stage in the complaints process. We acceptand welcome constructive and balanced criticismand seek to engage and learn from it, whereverit comes from.

The fact that we see multiple cases aboutsimilar issues helps to ensure balancein reaching our decisions and makingrecommendations. While no two cases are everidentical, the volume of casework intelligencebrings consistency to our decision-making.

It also gives us the ability to draw on priorknowledge, and to build proportionality intojudgements and recommendations. Thisperhaps in part explains why there were nojudicial review challenges to our decisionsor recommendations in 2012/13 by eithercomplainants or public organisations, and whythese organisations have continued to recogniseand respond to the expectation that they willcarry out our recommendations, even whenthey do not agree with them.

We also pay close attention to multiple casesto see if there are patterns that may indicatesystemic failure. We set out later in this reportthe work we do to publicly share our decisionswith others so that these are as visible aspossible. This allows us to also reflect the qualityof service that people are receiving both from usand from other organisations.

We have a process that allows both partiesto ask for decisions to be reviewed if theyconsider there is new evidence or there arefactual inaccuracies. This includes decisions notto look at a complaint, as well as the decisionswe issue following investigation in a decisionletter. In 2012/13, we received requests forreview on 5.5% of all such decisions and werevised our decision in ten cases (0.2% ofthe total cases). We publish statistics aboutrequests for review on our website. We deal withcomments on drafts of the detailed investigationreports we publish in full through a separateprocess.

CASEWORK PERFORMANCE

While no two cases are ever identical,the volumeof casework intelligence bringsconsistency in our decision-making. It alsogives us the ability to drawonpriorknowledge, and to build proportionalityinto judgements and recommendations.

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Driving improvementAnother way that we test the quality of our work,including that of our decisions, is through ourquality assurance (QA) process. Under our newQA process, in 2012/13 we randomly selected10% of the complaints at different stages in ourprocess. No decisions were changed as a resultof this and all findings, including examples ofbest practice, were fed back at an individual,team and organisational level to ensurecontinuous improvement. In 2013/14 we willcontinue to look for ways to strengthen our QAprocess, and seek out examples of good practicein other organisations.

Where individuals are unhappy with our service,rather than with our decision, we respondthrough our service delivery complaints process.This is a non-statutory scheme that we have putin place because we recognise how important itis for us to demonstrate best practice in ourown complaints handling. To help us do this,we appoint an external Independent ServiceDelivery Reviewer. His findings are in a latersection of this report.

To ensure that we are learning and improvingfrom all the information we receive about ourservice, we have an internal forum. This meetsquarterly to consider all the intelligence that wereceive about our service – for example fromrequests for review, quality assurance andservice delivery complaints – and recommendsand implements improvement initiatives.

As a result of this feedback, and of complainantfocus group research that we published inAugust 2012, we asked the Samaritans to runcourses for our complaints reviewers abouteffective communication with people who areseverely distressed or angry. We recognise thatthe softer skills of understanding and listening

can be just as important as expertise in technicalmatters, and that we have a duty to support staffand complainants in dealing with the sometimesharrowing experiences that we investigate.

On very rare occasions, however, we may takethe view that an individual’s engagement with usis inappropriate or disproportionate. It may bedamaging for staff or diverting resources fromfrontline services. If this happens, we apply ourunacceptable actions policy. This helps usmanage contact with that individual in a waythat minimises the impact of their behaviour.The policy has been widely referenced by otherpublic bodies, perhaps indicating a widerchallenge and a general need for trainingand support of staff in public services. In2013/14, we will further develop our toolsand guidance in this difficult area.

CASEWORK PERFORMANCE

We test the quality of ourwork,including that of our decisions,through our quality assuranceprocess.Wewill continue tolook forways to strengthen thisprocess, and seek out examplesof good practice in otherorganisations.

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CASEWORK PERFORMANCE

Case outcomes and impactAs the Ombudsman explains in his introduction,this year we are publishing separate, morein-depth analyses of our findings in each of themain areas under our remit. In this report,therefore, we provide a brief overview of thevolume of complaints in each area, showing thechange from previous years. Most notably therehas been a 28% increase in the number ofhealth complaints we dealt with, 4% of whichrelates to the new area of prison healthcarecomplaints. In our themed health report, weexamine this rise in complaints about the NHSin more detail. We received 23.5% morecomplaints about the NHS this year comparedto last. We attribute the increase to greaterpublic concern and awareness of what cango wrong, as well as to changes in the waycomplaints are recorded and handled as a resultof new duties placed on health boards under thePatient Rights (Scotland) Act 2011.

In 2012/13 we handled 531 enquiries and 4,077complaints. All enquiries are dealt with at ouradvice stage. We also handled 2,476 complaints atthis stage (3% more than the previous year) and ofthese 40% were premature (i.e. they reached usbefore they had completed the organisation’s owncomplaints process). We explain what happens atthis stage below.

Complaints dealt with by sector2011–12 and 2012–13

Sector 2011–12 2012–13 %difference

Further 115 138 +20%and highereducation

Health 937 1,197 +28%

Housing 278 316 +14%associations

Local 1,497 1,507 +1%authority

Scottish 852 874 +3%Government incl water incl waterand devolvedadmin

Other 69 45 -35%

In 2011/12, we reported water complaints as partof the Scottish Government sector; this year weare publishing separate themed reports aboutwater and Scottish Government and devolvedadministration bodies.

AdviceAt the end of this annual report, there is adetailed table with all the outcomes of thecomplaints we dealt with. Here, we identify someof the key points. All complaints and enquiriescome first to our advice team. Their role is toprovide information, signposting and support.They can also make a decision on a complaint ifthey consider that it is premature or if it is clearlya matter we are not legally able to consider.Where they can they will signpost people to otheragencies who may be able to help if we havebeen unable to. In volume terms, complaintshandled at the advice stage are a large proportionof the overall complaints received (around 60%of the total) and much of the work of this teamis conducted by telephone.

Our advice team spend much of their timedealing with complaints that reach usprematurely. There are two main reasons

for people contacting us too early. The first isthat the complainant has not been told enoughabout the organisation’s complaints processand does not understand how to escalatetheir complaint.

The second is that, despite the complainanthaving the correct information, their complainthas got stuck in the system. In the firstscenario, our advice team explains theorganisation’s complaints process and whereappropriate supports the complainant toprogress their complaint. In the second, as wellas providing advice and support, the team maycontact the organisation concerned to ask themto get in touch with the complainant to explainthe reason for the delay. It is good news forcomplainants that the rate of prematurecomplaints continues to fall – three years agoit was 51%, two years ago 45%, last year 43%and this year 40%.

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Assessing and investigating complaintsLast year, 1,601 cases were passed on from theadvice stage for further, detailed review. At thisstage, we try wherever possible to talk to thecomplainant to make sure we understand theircomplaint and what outcome they want. We aimto see if there is a resolution that would beagreeable and acceptable to all parties, and lastyear we resolved 47 complaints at this stage.We also have to assess whether there arereasons we should not take the complaintfurther. We can only investigate where we havebeen given the legal power to do so. We know itis frustrating for complainants if we can't resolvea complaint or take it further and so we try tomake this decision as quickly as we can. Lastyear, we made a decision at this stage that wecould not take 615 cases further. This wasbecause they were premature, out of jurisdiction,or we were unable to take the matter furtherbecause the complainant did not provide us withenough information, withdrew the complaint, orwanted an outcome we could not achieve forthem. We provide a breakdown of the decisionswe made at this stage at the end of the annualreport.

At the investigation stage, we issued decisions byletter in 895 cases (an increase of 27% on lastyear). Each month, we publish summary reportsof as many of these cases as we can and laythem before Parliament. These reports detailthe complaint, our decision and whetherrecommendations were made. We alsopublished 44 detailed investigation reports in full.

We talk in more detail about the impact of ourcasework in the next chapter. However, wewould like to highlight those 44 reports. These

cases represent a small proportion both of ourcaseload and of our published reports but arethe most resource intensive. We hope all of ourpublished reports help to raise wider publicawareness and to support learning. We feelthese detailed investigation reports haveparticular potential to do this and take care tohighlight them in our e-newsletter when wepublish all the reports each month. Therewere 21% fewer detailed reports this year. Thenumber of cases that need dealt with in this wayis not high and the figure fluctuates each year.It is important to stress that we make a specificdecision on every case investigated to seewhether it should be dealt with in this way.Like many of our decision letters, these reportscontain recommendations, which we make inorder to provide individual redress and widerservice improvement. We discuss the impact ofrecommendations further in the next chapter.

Of all the complaints that were ‘fit for SPSO’(i.e. ready for us to look at and about a subjectthat we could look at), we upheld or partly upheld46%, up 7% from 2011/12. Much of this increasewas due to a rise in upheld complaints aboutlocal authorities (from 32% last year to 47% thisyear). We report on this in more detail in theseparate thematic report about this sector.These are complaints where the organisation hasalready had the opportunity to investigate, and yetwe are still finding that there has been a failing.While the position for each sector varies, thissignals that across public services there is a needfor a continued focus on supporting good qualitycomplaints handling practice, both at thefrontline and at the second tier stage of theprocess when senior personnel become involvedin the decision-making.

CASEWORK PERFORMANCE

Casework performance information for 2012/13 is availableon our website atwww.spso.org.uk/statistics

Weupheld or partly upheld 46%of valid complaints, up 7%from2011/12. These are complaintswhere the organisationhas already had the opportunity to investigate, and yetweare still finding that there has been a failing.

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CASEWORK PERFORMANCE

> Since 2009/10,wehave seen a23% increase in complaints and

a15%reduction in our resource*

> Thenumber of complaints received this year rose by5%on last year

> Wehandled4,077complaints,9%more than last year

> Thenumber of premature complaints fell to40%of our caseload(3% less than last year)

> Peoplewho received advice, support and signposting:3,007

> Number of cases decided following detailed consideration

pre-investigation:662

> Complaints fully investigated:939 (23%more than last year)

with850** publicly reported to parliament

> Wemade1,003recommendations for redress and improvementsto public services (62%more than last year)

> The overall rate of upheld complaintswas46%(up from39% last year)

* Excluding funding for newareas of responsibility.** In a small number of caseswedonot put information in the public domain, usually to prevent

the possibility of someonebeing identified.

Key figures 2012/13

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2supportingpublic serviceimprovementin Scotland

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MAKING A DIFFERENCESTRATEGIC OBJECTIVE 2

In this section we report on our 2012/13 annualbusiness plan key priorities for this strategicobjective. These are to:

> share strategic lessons from our caseworkwith service providers and appropriatescrutiny bodies;

> ensure service providers implement SPSOrecommendations; and

> use communications tools effectively topromote understanding of the SPSO.

Sharing strategic lessonsOur main instruments for change are ourinvestigations and recommendations. When weexamine a complaint, we shine a light on thetreatment someone has received from a publicservice provider. If we find that something hasgone wrong – and we did in 46% of cases that wecould investigate in 2012/13 – we want to putthings right for the individual and to ensure, asfar as possible, that the same things do nothappen to anyone else. We do this through ourrecommendations, and by sharing lessons withothers through our stakeholder engagementplan and communications channels.

Public reportsWe published 850 public reports last year.We highlighted earlier the 44 cases that weconsider are the most significant. When weassess what cases should be reported in thisway, rather than in summary, we use publicinterest criteria.

Informing service providers andappropriate scrutiny bodiesThe primary recipients of these reports are thecomplainant and the organisation concerned.We also send the public interest reports to thechairs of the relevant governing body, such asthe council leader or the chair of the healthboard. Where appropriate, we may raiseconcerns about the possibility of a systemic issuewith a regulator or other relevant organisation.All our reports, detailed public interest and shortdecision ones, are publicly available to raisewider awareness and to support learning acrosssectors. We publicise all our reports through theOmbudsman’s monthly e-newsletter, whichhighlights themes and issues from the reports.It is sent to 1,800 recipients including MSPs,scrutiny bodies, service providers, advocacyagencies and the media.

We send a number of organisations annualletters with some analysis of the complaints wehave received about them or with informationabout organisations they regulate. In 2012/13 weexpanded the number of organisations to whichwe send these letters. In addition to everycouncil and health board for which we receivedcomplaints, we sent letters and statistics to theScottish Housing Regulator, Scottish Water,Business Stream, the Scottish Prison Service,Scotland’s Colleges and Universities Scotland.All of the letters, along with comprehensiveannual statistics, are published on our website.

During his 2012/13 visits to councils and healthboards, the Ombudsman reinforced importantmessages from the complaints we saw abouttheir organisation, discussed general sectoralissues, and listened to feedback to help improveour performance and service. As the majority ofour published public interest reports are aboutthe health sector, a ‘sounding board’ ofrepresentatives from different professionalgroups was set up for sharing developmentsabout health matters. It met for the first timein March 2012.

These can include:

> significant personal injustice

> systemic failure

> significant failures in the localcomplaints procedure

> precedent and test cases

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Policy engagementThe Ombudsman gave oral and writtenevidence to two Holyrood committees in 2012/13.He appeared before the Local Government andRegeneration Committee, to speak about ourannual report, and before the Health and SportCommittee, as part of their inquiry into theregulation of the care of older people in acutesettings.

We responded to a further nine inquiries, workplans or consultations where the subject matterhad a direct impact on or relevance to our work.We responded in particular where their scoperelated to changes that would affect users ofpublic services or were about how organisationscan learn from mistakes. This includedHealthcare Improvement Scotland’s consultationon 'Building a national approach to learningfrom adverse events through reporting andreview'. We were later invited to participate intheir working group on learning from adverseevents, which met for the first time in May 2013.

Drawing on our experience of what people wantwhen things go wrong with public services,particularly in the NHS, we responded toconsultations on no-fault compensation forinjuries resulting from clinical treatment andon a proposed Apologies Bill. Our experience ofwater complaints informed our response

to Consumer Focus Scotland’s consultation onproposals for a Regulated Industries Unit.We also gave advice when it was proposed thatthe Children’s Commissioner should be able tocarry out investigations on behalf of individualchildren and young people.

Our Complaints Standards Authority (CSA), withits focus on streamlining complaints processes,was responsible for much of our policyengagement in 2012/13. It will continue to playa key role in this area in the coming year. Itprovided responses or input to:

> the consultation on the integration of adulthealth and social care in Scotland;

> the Scottish Housing Regulator'sconsultation on Scottish Social HousingCharter indicators; and

> the consultation on the Charter of PatientRights and Responsibilities (introduced bythe Patient Rights (Scotland) Act 2011).

The CSA was also invited to participate in a shortlife working group to consider and decide uponthe most appropriate options for social workcomplaints (and appeals guidance), following theGovernment’s consultation on the review ofsocial work complaints. We expand on the CSA’sinput in the next section of this report.

MAKING A DIFFERENCE

All our evidence sessions and consultation responses are posted on ourwebsite atwww.spso.org.uk/media-centre/inquiries-and-consultations

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ScottishWelfare FundA key change that we prepared for in2012/13 and which came into effectfrom 1 April 2013 was the Government’sintroduction of the Scottish Welfare Fund.The fund is administered by localauthorities so the SPSO, by default, becamethe final point for complaints. In preparationfor this change, we gathered knowledgeon the subject, and briefed our staff on thetype of complaints that will come to SPSOand our powers in this area. We also producednew leaflets for advisers and complainants,with background information and case studies.

The Ombudsman and other senior SPSO staffdiscussed these, and other policy areas, withkey stakeholders, including MSPs, ScottishGovernment officials, consumer and advocacygroups, regulators and inspectorates.

Administrative justice frameworkWe also had strategic input into theadministrative justice arena. As theOmbudsman highlights in his introduction,we have in particular used our policy workand consultation responses to emphasise,when policy changes are being formulated,the importance of building in consideration ofpeople’s right to challenge decisions. We havealso emphasised that the starting point for policychanges should be the perspective of the userrather than that of organisations, and thatchange should be looked at holistically. Withthis in mind, we welcomed the Government’sinvitation for us to discuss their intention todevelop a Strategy for Administrative Justicein Scotland. We were pleased to provide auser-focused emphasis, and to be involvedin discussions and workshops held by theScottish Committee of the AdministrativeJustice and Tribunals Council about the roleand remit of the body that will replace it.We also supported the Scottish Human RightsCommission’s development of a national actionplan for human rights for Scotland, through theOmbudsman’s membership of the advisorypanel and through other engagement.

Ensuring our recommendationsare implementedThe case studies in this report provide examplesof the kinds of recommendations we make.There are hundreds more available in the casespublished on our website. We may recommend,for example, that a health board should reviewor change a nursing practice or a consent policy,or carry out training or awareness raising. Veryoften, we recommend that they make a full ormeaningful apology to the person who broughtthe complaint.

Across all areas of jurisdiction in 2012/13, wemade 1,003 recommendations on cases weclosed (up from 619 last year). We track everyrecommendation to ensure that the organisationimplements it within a specified timescale andprovides suitable evidence to show that ithas done so effectively. In 2012/13, of 918recommendations due for implementation, 78%were carried out within the agreed timescaleand 99% within three months of the target date.

It is difficult to quantify the impact of ourrecommendations, but we know fromdiscussions with public bodies, the ScottishGovernment and others that organisationsrefer to our published case summaries toensure that their own practices and proceduresare in line with recommendations. In the healthsector, we know that the Scottish Governmenttrack our recommendations across all healthboards. We see this as an excellent way ofensuring learning across a whole sector andwould welcome it being adopted in other areas.

MAKING A DIFFERENCE

We track every recommendationto ensure that the organisationimplements itwithin a specifiedtimescale and provides suitableevidence to show that it hasdone so effectively.

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Using communicationstools effectively2012/13 was the first full year of publishingsummaries of our investigation decisions andrecommendations. We published 806 decisions,in addition to the 44 public investigation reports.

These are all searchable on our website bysector, organisation, date and outcome, andprovide a wealth of material for complainantsand organisations. As mentioned earlier in thissection, we promote the learning from thesereports through the Ombudsman’s monthlye-newsletter. In 2012/13, we redesigned andrelaunched the e-newsletter and a healthyaverage of 35% of subscribers open it.

The media is of course a useful tool foramplifying the reach of our complaintswork. Each year we analyse media coverageof SPSO, and 2012 showed a continuingtrend of increased reach.

We regularly review and, where appropriate,update our information leaflets for the public.We have around 20 leaflets on complaintsubjects as diverse as antisocial behaviour,GP practices and council tax benefit. Theseare all available online and as hard copies. In2012/13 we published a number of new leaflets,including about the Scottish Welfare Fund,

prison and prison healthcare complaints,student complaints, and information rights.After the April 2012 local elections we alsopublished a Guide to the SPSO for councillors.Like our Guide for MSPs/MPs and ParliamentaryStaff, this explains our role and remit andprovides advice and support on matters such asgetting consent from the person affected by thecomplaint and on making complaints.

The digital revolution is shaping society andculture, and transforming public services.We recognise that, increasingly, individualsare using technology to access private andpublic services.

To ensure that we meet the changing needsand demands of our service users, wecontinually measure and monitor the impactand value of our on- and off-line services.

Last year, we carried out an expert evaluationand accessibility audit of our main digitalplatform, the SPSO website. This work includedseveral tests designed to gauge how well itmeets the needs of users, including thoseof disabled users. The results of the accessibilityreview resulted in changes to our website andmobile platform, which will be fully implementedby summer 2013. There is more about our workto ensure accessibility in the equalities sectionof this annual report.

STRATEGIC OBJECTIVE 2

Thedigital revolution is shaping society and culture,and transforming public services.We recognise that,increasingly, individuals are using technologyto access private and public services.

Complaints informationwww.spso.org.uk@SPSO_Ombudsman

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We also dipped our toe into the world of socialmedia, setting up Twitter accounts for our SPSOand CSA websites in October 2012. Theseadditional communication channels are aminor but significant part of our stakeholderengagement strategy. We see Twitter as anextension of our corporate voice, supportingthe strategic objectives of making our serviceaccessible to all users, raising informedawareness of our role and promoting goodcomplaints handling through networks,sharing good practice and training.

At the end of March 2013, we had posted40 tweets and had around 150 followers. Manyof our followers are key stakeholders.

Of course, we recognise that there are manypeople who do not have internet access and wecontinually seek ways to provide an inclusiveservice. During a prison visit in 2012, we setup a discussion forum amongst young offendersto gather real-time, face-to-face feedback onour communications materials and perceptionsof our service. As a result, we changed thewording of our prisoner leaflets to clarify ourrole and independence, and worked with youngoffenders to produce audio-visual information.

As, however, the telephone remains our mainmeans of contact with our customers, we haveundertaken training to ensure that we do this ina meaningful and effective way.

We are continuing to develop ways of raisingawareness among hard-to-reach or typicallyexcluded users and potential users of ourservice, particularly through advocacy andadvice centres. As we do each year, we had astand at the Gathering organised by the ScottishCouncil for Voluntary Organisations. We find thisan excellent opportunity for networking with thethird sector, advocacy and consumer groups,and particularly Citizens Advice Bureauxworkers. One of our objectives for 2013/14 isto build on our relationships with these groups.We want to ensure that the routes to our serviceare open to all, especially given our new rolewith the Scottish Welfare Fund. Looking furtherahead, we want to find new ways to meet thepublic in the communities they live in, hear fromthem about their concerns and continue to raiseawareness and understanding of our service.

We are developing several projects under our2013/14 business plan to fulfil these aims.

STRATEGIC OBJECTIVE 2

Looking further ahead,wewant to findnewwaystomeet the public in the communities they live in,hear from themabout their concerns and raiseawareness andunderstanding of our service.

Complaints Standards Authoritywww.valuingcomplaints.org.uk@valuecomplaints

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CASE STUDIES

This complaint was about the length of time that an emergency ambulancetook to arrive, when a man died after becoming extremely unwell at home.The ambulance service said the delay was because of failures in the systemand by the call taker. We found that, although the outcome might have been thesame even had the ambulance arrived more quickly, the delay made a verytraumatic experience even worse for the man’s wife. Although the service hadaddressed some of the failings, their complaints handling was poor. They hadtried to explain the system difficulties in their response, but the information wastoo technical and the response letter was not sent until about a year after theevent. We said that they should have investigated the complaint as a priority toensure that any failures in the emergency callout service were fixed immediately.They also did not apologise for what went wrong, or for the significant distresscaused, which we found unacceptable and insensitive.

RecommendationsThe ambulance service review the systems issue; report to us on additionalsupport for less experienced call handling staff; review their complaints handlingand apologise in full to the man’s wife.

Health: delay in sending ambulance; poor complaints handlingCase 201103310

IntroductionThis is a selection of case studies from investigations we published in 2012/13. Some illustratethe double injustice that can happen when a poorly delivered service is compounded by poorcomplaints handling. Other case studies are included to show some of the positive actions thatorganisations take in response to complaints. To share this good practice, in the report on ourwebsite we normally highlight where an organisation has taken such action. Still other casestudies summarised here are included as examples of where organisations have delivered aservice and investigated the complaint properly.

To read our decisions visitwww.spso.org.uk/our-findings

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CASE STUDIES

After a joint investigation with the Department for Work and Pensions (DWP), itwas decided that a claimant was not entitled to all the benefits she was receiving.Although she tried to appeal, the council began recovering overpaid housing andcouncil tax benefit. While appealing against the withdrawal of DWP incapacitybenefit, the claimant asked the council for a discretionary payment to write offthe council-related benefit overpayments, but they said they could not do this.She asked again, as she was suffering hardship, but the council did not respond.They later said they were awaiting the outcome of a DWP appeal before makinga decision. That appeal was determined in the claimant’s favour, and the DWPwrote off all her overpayment. Although the council did not accept that decision,they then agreed not to recover the rest of the overpaid benefits. We found thatthey had not dealt properly with the claimant’s request for the council’s owndecision to be sent to appeal. They should also have considered suspendingdeductions from her benefits, as their policy was to stop these when an appealwas outstanding. As well as this, they had delayed in dealing with her secondapplication for a discretionary payment, and had not communicated appropriately.

RecommendationsThe council credit the claimant’s rent and council tax accounts with theamount already taken, and apologise for all the failures we identified; reviewtheir practices to reflect housing and council tax benefit guidance; remind staffthat they should handle applications promptly and communicate effectivelywith applicants.

Local government: housing benefit; council tax benefit appealsCase 201003747

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CASE STUDIES

The State Hospital introduced a new clinical model, setting up new hub and cluster units.Each of the four hubs supports a cluster of three wards, with various social activitiestaking place in the hub. There is also a central unit for more formal therapies andeducational activities.

A patient in the hospital complained that when this was introduced he was unreasonablypressurised to attend activities in the hub although he did not like it there. The boardacknowledged that there were initial problems with the new regime. This sometimesmeant that wards were closed, or patients relocated to other wards, to allow staff to besuitably deployed while ensuring patient and staff safety.

Our investigation found that since the man’s original complaint to the board – which theyupheld – matters had improved. They had addressed staff recruitment and training andreviewed policies to allow more flexible use of resources. This had allowed them to keepmore wards open while still staffing the hub, and in the last few months the man's wardhad not been relocated. He said that he thought this only happened because he hadcomplained. However, we explained that the complaints system is meant to be used sothat issues can be raised and solutions found.

We took independent advice on this case from a mental health adviser, and did not upholdthe complaint as we found no evidence that the man was unreasonably pressurised toattend the hub. Our adviser said that good and positive progress had been made on thenew model. He said that staff would be failing in their duty of care if they did not try toencourage patients to engage with treatment programmes.

Health: facilities and activities Case 201104822Positive action takenby organisation

A man, who is a prisoner, complained that he was not allowed to have two electrical itemsalthough he had purchased them in a previous prison and was allowed to use them there.

We obtained a copy of his current prison’s policy which confirmed that the items wereprohibited. Our investigation found that his previous prison did permit him to have them, asprison governors have discretion about which items they allow. However, his current prisonhad already acknowledged the discrepancy and offered to reimburse him the cost of theitems. We considered this reasonable and did not uphold the complaint.

We accepted that lack of consistency across prisons could be a source of frustration forprisoners. However, as the Scottish Prison Service confirmed that they were currentlytaking steps to source a national supplier for such goods and developing a uniform policyabout their use, we made no recommendations about this.

Prisons: personal property Case 201104125Positive action takenby organisation

SPSO ANNUAL REPORT 2012>2013 PAGE 26

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CASE STUDIES

SPSO ANNUAL REPORT 2012>2013 PAGE 27

A tenant complained that the association knew of dampness in his house before letting theproperty to him, and that they delayed in carrying out repairs. The association had indeedbeen aware of what they thought was minor dampness, which they had addressed beforeit was let. It turned out later that the problem was more severe. It affected homes in thewhole building and so other owners, as well as the association, were jointly responsiblefor repairs. We accepted that the association did not know this before letting it, and thatwhen they found out, they tried to get the other owners to agree to resolve this. We were,however, concerned at the length of time the tenant had lived with the problem, althoughthe association had already offered him a payment to make up for this. We were alsoconcerned that there was no written record of the accompanied viewing with the tenantbefore the let, which would have noted any issues brought to his attention.

RecommendationsThe association consider the tenant’s request for housing points, if his property shows moresigns of internal dampness; and in future retain a note of the accompanied viewing of property.

Housing association: dampness in let propertyCase 201100230

An elderly man who had acute kidney failure was transferred to a community hospital forrehabilitation, where he remained for almost two months, although his condition worsenedduring his time there. He was eventually transferred to another hospital, but died the nextday. Our investigation found failings in the care at the community hospital. It providedmainly nursing care, and used external GP services to assess and treat patients whobecame unwell. We found that two out-of-hours GPs failed to recognise how poor theman’s condition was, and did not arrange to transfer him to another hospital soon enough.We also found that decision-making, care and communication about palliative care bynursing staff was inappropriate.

RecommendationsThe health board carry out a critical incident review of these events; consider routinediscussions about care escalation for patients admitted to such establishments, and howto ensure that severe illness is promptly recognised, by using suitable scoring systems;consider a strategy to determine the appropriate limits of care as soon as a patientbecomes acutely unwell, where there has been no advance discussion.

Health: treatment and care of an elderly personCase 201102756

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A man complained when a health board decided to relocate a hospital pain managementclinic. He said that the previous location was more accessible for him and he now faced ajourney time of over eight hours for a 15 minute appointment. The board suggestedalternative means by which he could attend the clinic but he did not feel they wereappropriate. He felt the board had not taken his health needs into account when deciding torelocate the clinic and complained to us.

We explained that health boards have the authority to decide where to site services in theirarea. The board had provided information about public transport links and the availability ofpatient transport services. They had also offered to pay a taxi fare for his next appointmentand said that the matter would be kept under review. They also suggested that to avoid theneed for travelling, he could have a telephone consultation. We concluded that the board hadtaken appropriate action.

Health: siting of facilities Case 201103887Positive action takenby organisation

This complaint arose after an elderly man was diagnosed with dementia. His family knewthat he would eventually need residential care, and that at that point the council wouldassess his finances to decide what he should pay towards care costs. The family decided totemporarily transfer some money to his wife, so that she could benefit from the interestuntil then. She, however, unexpectedly moved into residential care herself. Before she wasfinancially assessed, the family moved the money back into the man’s account. On thefinancial assessment forms, they explained what they had done, and why. When the socialwork department looked at this, they decided that the money in fact belonged to the man’swife, and she should be considered as still having it. This meant that she had to pay themajority of her care costs. A social work complaints review committee (CRC) looked at this,but said they could not comment on the social work department’s decision, which was amatter of professional judgement. We took the view, however, that the CRC should havelooked at it, and that in not doing so they had denied the family the opportunity to challengethe original decision.

RecommendationsThe council apologise to the family and arrange for the financial assessment to beindependently reviewed; ensure they tell those having their case reviewed by a CRC of theextent of the CRC's remit and powers; and ensure that CRC members have appropriatetraining and access to expert advice to deal with all matters presented to them.

Local government: complaints review committee– failure to reviewCase 201101997

CASE STUDIES

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A woman complained that after heavy rainfall flooding prevented her from getting out. She saidthis had happened several times. It had ruined her garden, and the authority had refused tocompensate her for the damage.

Our investigation found that the water authority agreed that there was a problem in the areaand had been trying to resolve it. They had been unable to find a solution but now planned toappoint engineers to look at this. They had kept in contact about the complaint, usually byphone, and, after a few months, had written in detail to update residents on what washappening. They also told the woman that as they had not been negligent they would not paycompensation.

We explained to her that flooding could be a very difficult problem to resolve. There may bemore than one cause, and other organisations may share responsibility. Flooding is not alwaysthe fault of the water authority and they could not always get funding to resolve major floodingproblems. We explained that funding was part of a complex process. The authority could notsimply decide to spend more or increase water charges to get extra money. We also explainedthat it was not their responsibility to deal with all rainwater, and that some responsibility laywith the local authority, who had separate sewers of their own.

We considered that the water authority had actively tried, and were continuing to try, to resolvethe problem. We found no evidence that their handling of it was unacceptable. In respect of thecompensation claim, our role is, broadly speaking, limited to considering whether the authorityfollowed their procedures in reaching their decision about it. The question of if, or how much,compensation is due is a matter for the courts. We found no evidence that the authority didanything wrong when coming to their decision.

Water: sewer flooding Case 201103863Positive action takenby organisation

A council tenant complained about changes to the lighting in the close that he shares with hisneighbour. He said that, historically, lighting was provided from dusk to dawn, but that thisservice was withdrawn.

Our investigation found that the council were not obliged to provide lighting in the close. Theoriginal light was connected to the neighbour's electricity supply and, although there was anunderstanding that the light would be left on overnight, this was ultimately at her discretion.When a new tenant moved into that property she decided not to use the light. Although thecouncil were not required to light the close, we found that they had provided the man with asecond light, over which he had sole control.

We were satisfied that this was an appropriate gesture and that they had suggested other stepsthat he could take to increase the level of lighting available.

Local government: stair lighting Case 201200538Positive action takenby organisation

CASE STUDIES

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3improvingcomplaintshandling

4simplifyingcomplaintshandlingsystems

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COMPLAINTS STANDARDS AUTHORITYSTRATEGIC OBJECTIVES 3 AND 4

In this section we report on our 2012/13 annualbusiness plan key priorities for these strategicobjectives. These are:

> to facilitate the improvement of complaintshandling by public service providers

> to simplify and standardise the designand operation of complaints handlingprocedures (CHPs) across the publicsector, in line with the vision set outin the Crerar and Sinclair reports.

Strategic objective 3: to improvecomplaints handling by publicservice providersThis objective focuses on improvement throughmonitoring, promoting and facilitating thesharing of best practice in complaints handlingand supporting service providers in improvingtheir complaints handling. We aim to achievethis through developing and coordinatingnetworks of complaints handlers, promotinggood complaints handling by providers throughthe sharing of best practice and by developingand delivering high quality training.

Networks of complaints handlersIn 2012/13 we successfully established the localgovernment and registered social landlord (RSL)complaints handlers networks, which met forthe first time in September and October 2012.

The networks are led by individuals from eachsector. They have begun a programme ofdiscussion focused on supporting complaintshandling practitioners, sharing best practice andlearning, developing standardised reportingframeworks and providing a forum forbenchmarking performance against SPSOindicators. The networks also provide a voicefor the sectors on specific issues affectingcomplaints handling.

The networks were established from the workinggroups set up to help develop the model CHPsfor each sector and have provided a usefulsupport mechanism. We plan to use a similarapproach to developing networks in other areasto help create a cross-sector network ofcomplaints handlers.

ValuingComplaintswebsiteand online forumIn 2012/13 we facilitated the sharing ofknowledge and best practice in complaintshandling through the launch of our dedicatedCSA website. The website, launched in May2012, provides:> information on the CSA and progress on

roll-out across the sectors, including accessto model CHPs and the requirement toimplement these;

> good practice guidance on complaintshandling and links to relevant sources ofinformation and best practice in complaintshandling;

> an online community forum for discussionand sharing best practice in the professionalcomplaints handling community, both withinand between sectors;

> an SPSO training centre providing access toour e-learning resources and informationabout directly provided courses offered byour training unit.

Our aim has been to develop the website andforum and increase its usage as a centralinformation point for complaints handlers.The online forum aims to facilitate the effectiveprofessional networking of complaints handlersand support the sharing of experiences andlearning.

Douglas Sinclair set out in therecommendations of his 2008 reportfrom the Fit for Purpose ComplaintsSystem Action Group that:

> Anetwork for complaints handlersshould…be established. Scrutinybodies and service providers shouldwork together to deviseways to bringcomplaints handling employeestogether to share experiences andsupport each other.

> The SPSO should establish across-sectoral network of complaintshandlers and awebsite to allowcomplaints handlers to share bestpractice in complaints handling.

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Training unitTraining coursesOur training unit continued its good workthroughout 2012/13, meeting a steep increasein demand for direct delivery courses resultingfrom the introduction of the model CHPs and CSAengagement with the RSL and local governmentsectors. We expect this trend to continue into2013/14 as we roll out the CHPs for the remainingsectors.

In 2012/13 we directly delivered 71 courses,including 43 in the RSL sector and 21 in localgovernment. This represents a 97% increase onthe number of courses requested and delivered in2010/11 (36) and a 73% increase on 2011/12 (41).

The training unit courses continue to get very highratings from participants and are accessed by awide range of organisations across sectors. Therollout of e-learning training provides significantscope and value, particularly for frontline publicsector staff. However, classroom based trainingfor complaints investigators and others involved incomplaints handling remains crucial to improvingthe way that organisations deal with complaints,particularly in reaching the right decisions firsttime. Along with the new streamlined approachto complaints handling, we expect this to be asignificant factor in how we help manage thenumbers of complaints coming to the SPSO.

E-learning coursesA significant development in 2012/13 wasthe development and launch of our e-learningmodules on frontline complaints handling.We developed these in response to concernsexpressed by some service providers in ourconsultation on the rollout of the model CHPs.They told us that, given the strong focus onfrontline resolution and the empowerment offrontline staff, they would find training andawareness for these staff challenging.

Our e-learning platform provides modules thatare free and accessible to all public sector staff.They aim to increase awareness of theimportance of good complaints handling andthe role of frontline staff in complaints, and helpimprove the skills required for successfulfrontline resolution. The first course, specific tothe local government sector, was launched inMay 2012, with a similar course for RSLsfollowing in August 2012. The courses are provingpopular, with around 2,000 users signed updirectly through our training centre. In addition,a number of organisations have integrated thecourses into their internal e-learning systemsand have rolled these out to the majority oftheir staff.

Over the final quarter of 2012/13 we alsodeveloped e-learning modules with NHSEducation Scotland (NES) to support the roll-outof training on the Patient Rights (Scotland) Act2011 and its requirements on feedback andtraining. In 2013/14 we plan to develop packagesfor further and higher education and ScottishGovernment frontline staff, to support theimplementation of model CHPs in those sectors.

COMPLAINTS STANDARDS AUTHORITY

For more about our training activities, visitwww.spsotraining.org.uk

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Strategic objective 4: to simplifythe design and operation of thecomplaints handling system inScottish public services

Simplified complaints handling procedures2012/13 was a significant year in moving towardsour vision of a streamlined complaints handlingsystem across the public sector. Having publishedmodel CHPs for local government and RSLs inMarch and April 2012, we developed model CHPsfor further and higher education and the ScottishGovernment, Scottish Parliament and associatedpublic authorities. These were published inDecember 2012 and March 2013.

The model CHP for further and higher educationwas developed in partnership with Scotland’sColleges (now College Development Network)and Universities Scotland and in consultationwith working groups of college and universityrepresentatives. This engagement wasvaluable in providing sector-specific input andidentifying areas where there was a need for asector-specific approach. In particular it tookaccount of challenges currently faced by thesectors in terms of funding, restructuring and anincreasingly competitive environment. For theScottish Government, Scottish Parliament andassociated public authorities we engaged with theScottish Government Public Bodies Unit, ScottishParliament and Audit Scotland on appropriatearrangements.

In line with our targets, the model CHP is nowoperating in over 160 registered social landlordsand across all council services in Scotland’s 32local authorities. The NHS are also operating astandardised process under the revisedCan IHelp You? guidance, published by the ScottishGovernment in March 2012.

Scotland’s 37 colleges and 19 universities are oncourse to implement by September 2013. Withover 70 Scottish Government and associatedpublic authorities required to implement by April2014, we are well on course to achieve a fullystandardised complaints system across thepublic sector in 2013/14.

CSAengagement and supportWorking in partnership with service providers,regulators and other stakeholders has been keyto our success in facilitating the development andimplementation of the model CHPs. Throughoutthe year we have supported organisations andother stakeholders in a range of ways to help withthe adoption of the model CHP, improvingcomplaints handling standards or by providingadvice, guidance and support in relation tocomplaints handling procedures.

Enquiries and requests for supportIn terms of direct support and engagementfor service providers, between April 2012 andMarch 2013 we responded to over 1,000stakeholder enquiries.

The majority of our activities related to RSLsand local government, reflecting the earlypublication of the CHPs in these sectors, withRSLs accounting for 51% and local government35% of contacts. This involved support on a rangeof issues related mainly to implementation,including specific guidance on CHP requirementsand good practice, compliance checks, supportfor staff training/systems changes and generalcomplaints handling guidance. Many werestraightforward requests, but others requireddetailed advice, guidance and follow-up contact.

COMPLAINTS STANDARDS AUTHORITY

Wearewell on course toachieve a fully standardisedcomplaints systemacross thepublic sector in 2013/14.

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The publication of model CHPs for the furtherand higher education sectors in December2012 and our plans for publishing a modelCHP for the Scottish Government, ScottishParliament and other public authorities inScotland in March 2013, saw a rise in ouractivities with these sectors towards theend of the year. This accounted for a further10% of our support activities. The chart belowillustrates the range and extent of these contactsacross the public sector in Scotland.

Meetings, events and conferencesWe provided speakers at a total of 64 conferences,meetings and events across sectors, deliveringpresentations to staff, management teams,regulators and representative bodies.

There is a sectoral breakdown in the chartbelow. Our outreach activities were crucial inensuring senior level commitment to improvingcomplaints handling and the quality of the

arrangements that organisations were putting inplace. We used them to explain the requirementsof the model CHPs, provide feedback ondeveloping CHPs and organisational plans forimplementation, and provide tailored advice onimproving complaints handling processes andculture. We also provided support through theRSL and local government complaints handlersnetworks and through the NHS ComplaintsPersonnel Scotland (NCPAS) organisationwhich has provided a similar network for NHScomplaints professionals for many years.

COMPLAINTS STANDARDS AUTHORITY

RSL 51%

Local government 35%

Higher education 3%

Further education 4%

Scottish Government& associated bodies 3%

Other 4%

CSAcontacts2012/13Total1,039

RSL 47%

Local government 19%

Scottish Government& associated bodies 11%

Higher education 8%

Health 6%

Water 3%

Further education 3%

Other 3%

Outreachactivity/supportTotal64

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CHPComplianceWe want to be as light-touch as possible inmonitoring implementation of the model CHPs,whilst ensuring that organisations have adoptedthe CHP and its requirements in full. TheSPSO Act 2002 now contains powers for theOmbudsman to monitor and report onnon-compliance. Our aim, however, was to workwith regulatory and sponsor bodies to develop aconsistent method for monitoring compliancewith the model CHPs within existing regulatorystructures including, wherever possible, throughself-assessment. In 2012/13 we achieved this by:> developing arrangements with Audit Scotland

to assess compliance through the SharedRisk Assessment (SRA) and annual auditprocesses, providing Audit Scotland with anassessment of compliance for all localauthorities.

> embedding the model CHP and itsrequirements in the Scottish Social HousingCharter. This will be monitored in 2013/14 bythe Scottish Housing Regulator (SHR) as partof their wider monitoring of the Charter.All RSLs are required to confirm theircompliance with the CHP to the SHR.

> incorporating compliance arrangementsfor further and higher education into theScottish Funding Council’s financialmemorandum for further and highereducation institutions.

> agreeing with the Scottish Governmentand Audit Scotland to pursue the possibilityof stipulating compliance with the CHPas an expectation on all central governmentbodies as part of future changes to theexisting sponsorship framework.

Complaints handling performanceOne of the aims of the CHPs is to improve theinformation available about complaints to helpdevelop a performance culture in complaintshandling across the public sector in Scotland.As well as requiring service providers to analyseand report complaints information internally on aregular basis, CHPs require them to publishannual information on complaints performancestatistics.

With each of the model CHPs we publishedindicative performance indicators, designedto be broadly consistent across the sectors. Weworked with the Chartered Institute of Housing,HouseMark and the Scottish Housing Best ValueNetwork to develop detailed guidance onperformance indicators. This was published inDecember 2012, to assist RSLs in assessing theircomplaints handling in line with the SHR’srequirement to report on the Charter. Using thoseindicators as a basis we have developed moredetailed indicators for local government, with thatsector’s complaints handlers network. These willalso form the basis of development with othersectors.

The indicators will help us move towards agreater consistency of reporting on complaintsacross the sectors and provide an excellent basisfor developing benchmarking arrangements forcomparing performance. For the first timemembers of the public will have access to clear,transparent and consistent information on thevolume of complaints received by serviceproviders and how they have handled these.

COMPLAINTS STANDARDS AUTHORITY

For thefirst timemembers of the publicwill have access to clear, transparent andconsistent information on the volumeofcomplaints received by service providersandhow they have handled these.

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Socialwork and social careWe have raised concerns about the lack of clarityin how complaints are handled in this area ofmultiple overlapping procedures/legislativeroutes for complainants. This is particularlyimportant because social work and social caredecisions impact hugely on individuals andfamilies. The social work complaints procedure,in particular, is an area where moststakeholders agree that reform is needed.This was subject to review by the ScottishGovernment throughout 2012/13 in line withthe recommendations of the 2008 Sinclairreport.

The Scottish Government’s report of theirconsultation on the review of social workcomplaints was published in August 2012.This indicated that their recommended optionswere those that would see local authoritiesadopt the model CHP for social work complaints(but with some flexibility around timescales) andthe SPSO taking on the role of complaint reviewcommittees. This was felt to be the most likely tocreate a fit-for-purpose complaints system forthe future. It is one that we support, given thatit aligns with the aims of simplifying thecomplaints landscape.

The strength of these options is that there wouldbe a streamlined internal model for handlingcomplaints, and the individual could have anobjective, external view of decisions that have apotentially profound impact on them. It is also amodel that would be adaptable enough to copewith the changes being brought about by themove towards integrating health and social care.We highlighted the implications of this forservice user complaints through variousengagements with key stakeholders during2012/13.

In February 2013 a social work complaintsworking group set up by the ScottishGovernment reached broad agreement onthese future options, subject to furtherdiscussion on detail.

The working group included SPSO, the CareInspectorate, the Convention of Scottish LocalAuthorities (COSLA), the Association of Directorsof Social Work and a number of third sectororganisations, including Capability Scotlandand Children First. We have since held furtherdiscussions with the Association of Directors ofSocial Work and Capability Scotland on thedetails of the potential options ahead of a finalproposal being agreed in 2013/14.

COMPLAINTS STANDARDS AUTHORITY

Clarity in howcomplaints arehandled in this area...is particularlyimportant becausesocialwork and socialcare decisions impacthugely on individualsand families.

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5being anaccountableand best valueorganisation

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CORPORATE PERFORMANCESTRATEGIC OBJECTIVE 5

In this section we report on our 2012/13 annualbusiness plan key priority for this strategicobjective. This is to deliver operational efficiency,effectiveness and accountability through clearlydefined priorities, performance measures andresources that meet business needs, whilesupporting development of new areas ofbusiness.

Managing resources effectively

The SPSO makes an annual budget applicationto the Scottish Parliamentary Corporate Body(SPCB). This is considered by the Parliament’sFinance Committee and the ScottishGovernment. Over the three year period between2010/11 and 2013/14 the SPSO committed toachieving as a minimum a 15% real termsdecrease in its 2010/11 baseline budget.The 2011/12 budget represented a saving of6.5%, which was largely achieved throughrestructuring the organisation. The approvedbudget for 2012/13, in cash terms, was £3.29million, a 6% decrease on the refreshed2011/12 baseline budget.

We also achieved this reduction and ensuredvalue for money through, for example, regularlyreviewing all contracts and procurementarrangements as well as through sharedservices initiatives. In 2012/13, we continued toshare office space with, and provide corporateservices to, other SPCB sponsored office holdersand to liaise with the SPCB on other potentialareas for saving.

The actual expenditure for 2012/13 was £3.23million, below the approved budget. Thisadditional saving was achieved largely through

the higher than anticipated revenue generatedby our training unit. The approved budget for2013/14 is £3.207 million, a further 2.7%decrease on 2012/13. The summary of our2012/13 expenditure can be seen in the tablelater in this section. The Public Services Reform(Scotland) Act also requires us to provideinformation on specific expenditure areas. Wepublish this regularly on our website, and willpublish our full audited accounts there, oncethese have been signed off in October 2013.

The challenge for SPSO as a demand-ledorganisation is to continue to seek efficienciesin an environment of increasing demand andrising caseloads, in a way that minimises theimpact on the service user and maintains theindependence and credibility of our office.

In 2012/13 we successfully achieved aproductivity increase of 9%, with an end yearcaseload of 546 against a target of 500, in spiteof a 5% increase in complaints.

We undertook a review of our core complaintsprocess to ensure it was as efficient andstreamlined as possible. As a result, we haveintroduced a number of initiatives to help uscontinue to build on our strong record ofimproving productivity as well as service qualityas we progress in 2013/14.

To ensure that SPSO is managing its resourcesto best effect, there are a number of checks andbalances in place. These are set out in moredetail by John Vine, chair of the SPSO Auditand Advisory Committee, in the governanceand accountability section.

The challenge for SPSOas a demand-led organisationis to continue to seek efficiencies in an environment ofincreasing demand and rising caseloads, in away thatminimises the impact on the service user andmaintainsthe independence and credibility of the office.

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Improving operational efficiencyThe corporate planning process plays a keyrole in ensuring operational efficiency andeffectiveness. The 2012/16 Strategic Plan isavailable in full on our website. It sets outour five strategic objectives and equalitiescommitments, and provides the framework fordeveloping our annual business plans andaccompanying annual performance measures.

In 2012/13, progress against these plans andmeasures was reviewed regularly by operationalmanagement, the senior management teamand the Audit and Advisory Committee. Detailsof this progress are documented against eachstrategic objective in the relevant sectionsof this annual report. Our business plansfor 2012/13 and 2013/14 and performancemeasures for each year were shared with SPCBofficials. These plans and measures, along withminutes of meetings to record and monitorprogress, are on our website.

Information from external and internal auditingprocesses is also used to drive efficiency andeffectively manage risk. There were nosignificant findings arising from the 2011/12external audit completed in November 2012.This found that we have effective corporategovernance structures and a risk assessmentapproach that is fully embedded into thecorporate and performance management,business planning and financial reportingprocesses of the organisation. This year, as partof the three year internal audit programme for2012/15, the internal auditors looked at theareas of accounting and budgeting, businesscontinuity, payroll and facilities management.In each area we achieved either a satisfactoryor good rating.

We had a strong record of ICT systems reliabilityin 2012/13. We also continued to explore waysto seek efficiency gains through technology.We are working towards upgrading the existingcase management system to allow for smootherprocessing of online applications. This work isdue to be completed in 2013/14.

Our peopleAs an Investors In People employer, we workhard to ensure we provide managers and staffwith the knowledge, skills, tools and supportto manage and deliver strong performance,sometimes in very challenging circumstances,to engage effectively with our goals and meetour service commitments.

We monitor staff absence closely to maintaina position well within public sector norms.In 2012/13 we worked with our teams to developand deliver a learning and developmentprogramme that met individual, team, andorganisational objectives. We provided updatetraining to staff on the legal and investigativeaspects of our work. In partnership withorganisations like the Samaritans, we continuedto build skills in dealing with people when theyare at their most vulnerable. We take the safetyof staff and service users seriously, enhancing itthrough audit and training activities.

CORPORATE PERFORMANCE

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Meeting our obligationsand statutory dutiesWe have a number of other specific statutoryduties that we report on in full on our website.One of these is sustainability, on which we arerequired to report under the Public ServicesReform (Scotland) Act 2010. In 2012 wepublished our first sustainability report on ourwebsite, monitoring carbon emissions andwaste management activities, and met thetargets set.

A second area is access to information. We havea responsibility to protect the sensitive personaldata gathered through our casework and toprovide as much access to information about usas possible. We also have to meet the obligations

of the SPSO Act to conduct all investigationsin private. We take this very seriously.

We receive a number of requests for case-related and organisation-related data each year.In 2012/13, we received 123 requests underFreedom of Information and Data Protectionlegislation, compared to 142 in the previous year.Our policy is to process these requests in theway that gives the member of the public thegreatest access to information whereverpossible. There were only two appeals againstour decision about the information to provide.

Reports on the above areas and other materialabout our corporate performance are availableon our website.

CORPORATE PERFORMANCE

Summaryanalysis of expenditure 2013 2012 2011£000s £000s £000s

Staffing costs 2,559 2,660 2,385

Other operating costs

Property* 293 292 301

Professional** 138 166 94

Office running costs***† 358 324 310

Total operating expenditure 3,348 3,442 3,090

Capital 62 128 48

Other income (180) (93) (90)

Net expenditure 3,230 3,477 3,048

Staff FTE 47 45 46

* Including rent, rates, utilities, cleaning andmaintenance** Including professional adviser fees*** Including ICT, annual report and publications† Office costs for earlier years adjusted to exclude notional cost of capital which is no longer charged.

Full audited accounts are available on the SPSOwebsitewww.spso.org.uk

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CORPORATE PERFORMANCE

SPSO ANNUAL REPORT 2012>2013 PAGE 42

ForwardBusiness PlanningOur key point of reference for the four year period beginning 2012 is our Corporate Strategic Plan.We published our 2012/2016 plan at the end of March 2012, after inviting stakeholders – the public,the Parliament, public service providers, regulators and others – to comment on a draft plan. Theirresponses were highly supportive of the five strategic objectives and equalities commitments thatwe set out. We commissioned independent analysis of the responses and, where appropriate, wechanged the draft plan. The consultation, responses, independent analysis and our reasoning forthe changes were all published on our website, along with the final plan.

The five strategic objectives constitute our high-level strategic plan and under it will sit businessplans for each year. Our equalities commitments remain the same for the duration of the plan.Inevitably, business plans sit within an environment that is continually changing and which candirectly impact on our work. This annual report charts progress against the first year of our StrategicPlan, which is available in full, along with our 2013/14 business plan, on our website. Both theseplans contain targets and goals against which our progress can be measured, and which are sharedwith officials of the Scottish Parliamentary Corporate Body.

Our five corporate strategic objectives are:

Toprovideahighquality, user-focused independent complaintshandling serviceBy developing our capacity as complaints handlers to be able to deliver individual benefitto our customers; by being accessible and dealing with all enquiries and complaintsimpartially, consistently, effectively, proportionately and in a timely manner; and byproducing clear, accurate and influential decisions about complaints.

Tosupport public service improvement inScotlandBy continuing to raise informed awareness of the role of the SPSO and to feed back andcapitalise on the learning from our consideration of individual enquiries and complaints,for example, through thematic reports, and by working in partnership with public servicedeliverers, policy makers, scrutiny bodies and regulators to promote good administrativepractice.

To improve complaintshandlingbypublic serviceprovidersBy using our expertise and resources to monitor, promote and facilitate the sharing ofbest practice and support service providers in improving their complaints handling.

Tosimplify thedesignandoperationof the complaintshandling system inScottishpublic servicesBy working in partnership with service providers, regulators and other key stakeholdersto facilitate the development of and compliance with simplified, standardised anduser-focused complaints handling procedures across the public sector as an integralpart of the wider administrative justice system in Scotland.

Tobeanaccountable, best valueorganisationBy making best use of our resources and demonstrating continuous improvement inour operational efficiency and supporting the professional development of our staff.

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Equalityanddiversity

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EQUALITY AND DIVERSITY

Our strategic plan has five equalitiescommitments. This section explains how wehave acted to fulfil them. With input from ourequality and diversity specialist, we have workedto highlight equality elements in complaintsand to ensure that our policies and practicescomply with equality legislation. Our specialistalso helped our Complaints StandardsAuthority (CSA) team in their work on producingmodel complaints handling procedures andguidance to help organisations understandhow to meet their equality obligations whenhandling complaints.

MonitoringWe want to know who uses our service,and when people bring us a complaint,we ask them to complete a monitoring form.We handle the information they give usseparately from their complaint, and makesure that data about our service usersremains anonymous.

Last year, only 577 people completed theforms, compared to 808 in the previous year.As a percentage of those who brought uscomplaints, this represented 14%, comparedwith 21% the previous year. This drop is likelyto be because we moved from a combinedcomplaints and monitoring form to one wherethe two documents were separate. Completingthe form is voluntary, but we do want to gatheras much information as we can about who usesour service, helping us in the equally importanttask of knowing who does not. So, in light ofthe reduction in responses, we moved back toa combined form in June 2013, and anticipatethat return rates will rise.

Many of the statistics we received were verysimilar to last year. Of those who responded,we found that:

> 42.5% were female, and 54% male, with3.5% not telling us their gender

> 64% fell into the age groups 35 – 49 (27%)and 50 – 64 (37%)

> 5% of respondents said that they wereunder 24

> 95% considered themselves to be from awhite ethnic group

> Around 27% considered themselves to havea disability, of which the majority (66%)related to physical mobility problems.

In the newsFrom time to time, our decisions attractmedia attention. Below are some newspaperheadlines from last year, highlightingdecisions about equality and human rights-related issues.

Themothersfighting back againstbirth interventionThe Observer, 16 December 2012

University told to domorefor disabled studentsThe Herald, 7 June 2013

Lack of BSL interpreters puttingdeaf people at riskThe Guardian, 8 May 2013

Deaf patient given silent treatmentDaily Record, 29 March 2013

Deaf patient’s plea for help is ignoredScottish Daily Mail, 29 March 2013

Deaf patient denied interpreterbyDundeeHospitalScotsman.com, 8 March 2013

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Living up to our equalitiescommitments

to take proactive steps to identify andreduce potential barriers to ensurethat our service is accessible to all.Our office is physically accessible and

we have induction loop facilities for those withhearing difficulties. We also want to make surethat we provide a range of contact methods forpeople who get in touch with us, so we ask onour complaint form if the person has anyparticular needs in terms of how we keep intouch with them. As far as we can, we then makereasonable adjustments to ensure that ourcommunication is as helpful as possible forthem. Last year, most of the adjustments wemade were for people with learning difficulties– mainly dyslexia – and sight or hearingimpairments. For example, when a person foundwritten communication difficult because ofdyslexia, we made sure that we always phonedto tell them what was happening. In anothercase we used the Typetalk text service providedby Action on Hearing Loss to discuss thecomplaint with a person whose hearing wasimpaired. We corresponded in large font or easyread format with several people and took extratime to communicate with a complainant whoneeded longer than usual to correspond with usbecause of a disability. We provided translationfacilities so that we could write to and discusscomplaints with people who do not have Englishas their first language. And we translated copiesof our leaflets and posters into other languages,such as Polish and Vietnamese.

Our website is an essential channel forcommunicating with the public and ourstakeholders. Last year our IT support serviceprovider carried out an accessibility audit. Thisidentified potential issues for users of assistivetechnologies and users with disabilities. In thecoming year, on the basis of the findings, we willimprove the overall online user experience.

to identify common equality issues(explicit and implicit) withincomplaints brought to our office andfeed back learning fromsuchcomplaints to all stakeholders.

We do this by sharing the learning from thecomplaints we receive. We include case studiesin our annual report and share the learning fromour work every month through our website andthe Ombudsman’s e-newsletter. For example, inMarch 2013 we drew attention to one of the casestudies that follow, where interpretation was notprovided for a hospital patient. We highlightedthat organisations to whom the Equality Act 2010applies should examine their policies to ensurethat in similar circumstances they would beready to provide suitable support, in line withtheir legal duty to do so.

We do not, of course, determine equalities andhuman rights issues (which is the job of thecourts) but we have a role in ensuring thatorganisations reflect in their policies andpractices the obligations placed upon themby the Equality Act.

Another example that follows is of an issuethat we have highlighted in previous annualreports – a failure to understand or to meetthe requirements of the Adults with Incapacity(Scotland) Act 2000. We are concernedthat we still receive complaints about this,having brought the legislation and itsrequirements to public attention over thepast two years.

EQUALITY AND DIVERSITY

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EQUALITY AND DIVERSITY

to ensure thatwe informpeoplewho are taking forward a complaintof their rights and of any availablesupport, and thatwe encouragepublic authorities to do the same.

We cannot deal with all the issues that membersof the public bring us, and we know howimportant it is that we signpost them to placesthat can. This is why our leaflets provideinformation about other avenues through whichthey may be able to pursue their concerns, orwhere they may be able to find out more abouttheir rights. Through our CSA work we haveencouraged organisations to share goodpractice, policies and procedures in complaintshandling in the light of any work they haveundertaken as a result of the Equality Act.

to ensure thatwe play our part inensuring that service providersunderstand their duties to promoteequality within their complaintshandling procedures.

Our CSA website gives organisations informationand support about good complaints handling.In December 2012, we published an article andguidance from our equalities adviser there.The guidance aims to mainstream equality incomplaints handling. It explains some of themany implications of the Equality Act for all ofus in the public sector, particularly in terms ofcomplaints processes, and in ensuring that

these have fair and equal treatment built infrom the start. It also includes examples of bestpractice. In addition, our model complaintshandling procedures require organisations tobe mindful of their equalities obligations,in particular the need to make reasonableadjustments where necessary.

tomonitor the diversity of ourworkforce and supply chain andtake positive stepswhereunder-representation exists.

We are a small employer with a low staffturnover. However, we are committed toensuring diversity of our staff. We regularlymonitor the diversity of our workforce andthrough rigorous recruitment, selection anddevelopment processes, we ensure thatindividuals are selected, developed andpromoted on the basis of their abilities alone.We positively value the different perspectivesand skills of all staff and make full use of thesein our work. We ensure that our procurementprocesses are open and transparent, and werequire any potential suppliers or providers todemonstrate the same level of rigour as SPSOin their approach to diversity.

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It was clear from the records that thatMsA felt isolated dueto being deaf andnot being able to communicate.MsA’s notesstated that that an interpreterwas to be contacted at thefamily’s request… I consider that it was unacceptable for theboard not to obtainBritish Sign Language interpretation forMsAduring her 12-day in-patient admission to the hospital,and upheld the complaint.JIM MARTIN, OMBUDSMAN’S COMMENTARY, MARCH 2013

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We received a complaint on behalf of a student with Asperger's (a form of autism, in whichpeople may find difficulty in social relationships and in communicating). His father complainedto us that university staff were not made sufficiently aware of his son’s needs as a disabledstudent. He said that this was because his son’s disability was ‘hidden’ – i.e. his condition wasnot obvious to those who met him. We agreed that there were some shortcomings in relationto the individual learning plan (ILP) which was not regularly updated or reviewed in the way itshould have been. Although we did not uphold all the complaints raised with us, we found thatthe student was invited to a meeting, the purpose of which was not made clear in advance,and without inviting him to bring along a supporter or advocate. We agreed that he shouldhave been invited to bring somebody with him, particularly as his ILP identified that in difficultsituations he was prone to anxiety which could overwhelm him. We also found that the outcomesof meetings between him and the university were not adequately recorded. This was particularlyimportant as he had an identified need to record and confirm verbal discussions.

RecommendationsThe university arrange for a programme of staff training to raise awareness of hiddendisabilities and their impacts; review the procedures related to the review and updating of ILPs;make greater use of notes to record discussions, issues, changes, decisions and update ILPs,and copy these for any student with any additional support needs; ensure that staff pay greaterattention to the detail of the ILP when dealing with students with additional support needs;and use email to confirm arrangements for students with additional support needs arisingfrom hidden disabilities.

CASE STUDIES

Higher education: a studentwith additional support needs Case 201201566

A woman, who is hearing-impaired and communicates using British Sign Language (BSL),was admitted to hospital for surgery. During her 12-day stay in hospital, although hospital stafftried to communicate with her, they did not provide a BSL interpreter. This was despite thewoman repeatedly pointing to a poster for interpreter services and twice handing staff a BSLinterpreter’s card. It was clear from the hospital records that she felt isolated because of thelack of communication. During our investigation, we took independent advice from our equalityand diversity adviser. She said that staff had not taken appropriate steps to obtain a BSLinterpreter for the woman, which they had a legal duty to do under the Equality Act. As soon asthey knew that she needed an interpreter, they should have drawn up a clear plan tocoordinate the availability of medical staff with that of a BSL interpreter who was sufficientlytrained to be able to communicate complex medical issues.

We found that, in failing to obtain a BSL interpreter, the board did not follow their informedconsent policy. Although we recognise that there is a shortage of such professionals, wetook the view that hospital staff did not try hard enough to find an interpreter, which wasunacceptable.

Health: interpretation services Case 201104213

The information in these case studies focuses on the equality-related issue rather than allthe issues raised in the complaint.

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CASE STUDIES

An 85-year old man lived alone and had a number of health difficulties. When he fell at homeand broke his hip, he was admitted to hospital for a hip replacement. He was discharged fromhospital after two weeks, but two days later he fell again. He was readmitted to hospital,where his condition gradually deteriorated and he died. His son complained about a numberof issues relating to the care and treatment that his father received in hospital. One of hisconcerns was that staff had failed to consider and assess his father’s cognitive function. Theson also complained that they had not communicated directly with him about the plans fordischarge, resulting in his father being inappropriately discharged from hospital.

This case raised some particularly difficult issues. Our medical adviser said that it was notpossible to decide from the records whether the elderly man’s care and treatment wasreasonable. This was mainly because there was no evidence that staff had formally assessedhis cognitive function, despite some evidence that he might have been suffering short-termmemory loss. It was not clear whether this would have resulted in different care, but anassessment was needed to establish whether he had the capacity to make decisions about hisown welfare (as required by the Adults with Incapacity legislation). We noted that, if staffbelieved that he had the capacity to make his own decisions, they had acted appropriately.However, our main concern was that no assessment of that capacity took place, even thoughthere were a number of factors that could have alerted staff to the need for this. Our medicaladviser said that on balance it would have been preferable if the son had been involved directlyin communication, given the doubts about his father’s capacity. All the problems that occurredstemmed from the lack of assessment.

RecommendationsThe board provide us with evidence that they have implemented a policy to assess the cognitivefunction of elderly patients, including whether a patient has capacity to participate indecision-making, taking new government policy on this issue into account.

Health: assessment for capacity Case 201101255

RecommendationsThe board consider amending their interpretation and translation policy to highlight their legalobligations, and to make clear that BSL is a registered language; produce further guidance forstaff on what to do when a patient says they need a BSL interpreter; consider providingtraining to staff on deaf culture, language and legal rights; consider seeking input from deafpeople to review the effectiveness of the implementation of the interpretation and translationpolicy; offer to meet with the woman and a BSL interpreter to answer any questions she hasabout her treatment and to apologise, explain and feed back how her complaint has helpedthem to develop their service.

Health: interpretation services continued

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Governanceandaccountability

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GOVERNANCE AND ACCOUNTABILITY

Report fromJohnVine, Chairof the SPSOAudit andAdvisoryCommitteeThe Ombudsman, as accountable officerfor the SPSO, is responsible for ensuring thathis resources are used economically, efficientlyand effectively. The SPSO is subject to externalaudit (currently provided by Audit Scotland),and internal audit (under a shared servicesarrangement with the Scottish Legal AidBoard). The Ombudsman gives evidenceannually to the Parliament’s Local Governmentand Regeneration Committee following thepublication of his annual report. He alsoholds regular discussions with the ScottishParliamentary Corporate Body about theSPSO annual budget submission and othergovernance issues that may arise.

Our remit is to work with the Ombudsmanat his invitation as a non-executive group,advising on the discharge of the functionsof the accountable officer and ensuring highstandards of governance and accountability,in accordance with Best Value principles.I am the Independent Chief Inspector ofBorders and Immigration and was chair of thecommittee in 2012/13. I was very pleased to bejoined on the committee by Tom Frawley, theNorthern Ireland Ombudsman and Anne Seex,one of the Local Government Ombudsmen forEngland. I am grateful to them for their energy,commitment and wisdom.

The committee’s purpose and duties are set outin the SPSO scheme of control. We support theOmbudsman and the senior management teamby monitoring the adequacy of the SPSO’sgovernance and control systems and offeringobjective advice on issues concerning the risk,control and governance of the SPSO. Thecommittee also provide a source of advice andfeedback on SPSO strategic objectives andannual business plans and comment on therecommendations of internal and external audit.

The committee met three times in 2012/13.Representatives from the SPSO’s externaland internal auditors attend our meetings.They can advise us in private when required,before we discuss with the Ombudsman thekey operational priorities and risks. In the pastyear, the committee carefully examined theoperational and financial management of theSPSO with a focus on service delivery and valuefor money to the public. In 2012/13 wespecifically looked at the SPSO’s proposals forand findings of their new quality assurancemechanism, the external review of theirbusiness process, the auditors’ findingsand issues raised by the Ombudsman in theParliament, including that of special reports.

We also discussed matters relating to theOmbudsman’s work in standardising andstreamlining complaints procedures. In all theseareas, we were impressed by the clarity andbreadth of the evidence provided and thepartnership and problem-solving approachshown by the Ombudsman and his seniormanagement team. There is a genuine andimpressive commitment from all theseindividuals to delivering the highest qualityservice possible within the legislative andfinancial constraints within which theorganisation operates.

In all these areas,wewereimpressed by the clarity andbreadth of the evidenceprovided and the partnershipand problem-solvingapproach shownby theOmbudsmanandhis seniormanagement team.

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SPSO ANNUAL REPORT 2012>2013 PAGE 52

We have benefited from the constructiveengagement of the external auditors and the inputand contribution from the internal audit service.In his role as Ombudsman, Jim Martin has beenopen and constructive with all our requests andhas provided considerable energy to and soundleadership of the SPSO.

The significant programme of change beingpursued by the Scottish Parliament andGovernment will bring increased demands on theSPSO in the coming year. I am confident that theorganisation is well placed to meet thosechallenges. While my three-year tenure as chairhas now ended, I am reassured from all that I haveseen that my colleagues and their successors onthe committee will continue to build on the solidfoundation we have created to provide theindependent scrutiny necessary to ensurecontinuing public confidence in the SPSO.

Service Delivery ComplaintsIn 2012/13, we received 45 formal service deliverycomplaints out of the total 4,651 cases received.Of these, 24 were not upheld, 18 were fully orpartly upheld, two had no decision reached andone was withdrawn. Eleven of these complaintswere decided by the Independent Service DeliveryReviewer. Complaints are considered by theIndependent Reviewer solely at the requestof the complainant. We publish statistics aboutservice delivery complaints on our website.

Report fromDavid Thomas,Independent Service DeliveryReviewerIt is uncommon for public sector ombudsmanschemes to have arrangements for servicedelivery complaints to be reviewed externally.It is to SPSO’s credit that they voluntarily createdsuch arrangements in April 2007.

During the year ended 31 March 2013, 11 peoplereferred service delivery complaints to me. Two ofthem complained about two cases. So I looked at13 case files in total – less than 0.3% of the caseshandled by SPSO. Though I focused on theconcerns that had been raised with me, I alsocarefully reviewed the whole of each case file, tosee whether there were any wider lessons to bedrawn.

All of the people who brought service complaintsto me were disappointed in some way with theoutcome of their case against the public authority.Some of them found it difficult to distinguishbetween their view of the merits of their complaint(which is not a matter for me) and their view of theway in which the case was handled (which can befor me).

In seven of the cases that I looked at, I consideredthat the service delivery complaints were entirelyunfounded. SPSO had dealt with the casesimpartially, efficiently and with considerablepatience.

Some people had unrealistic expectations.Some wrongly expected to be able to direct SPSO’sindependent investigation of the case. And oneperson complained that, when he phoned andasked to speak to a senior manager, one was notavailable immediately – even though, as he waspromised at the time, a senior manager calledhim back promptly.

At the beginning of a case, SPSO summarise thescope of what they will be investigating – which islegally a matter for SPSO. A few complainantsthought that they should have the last word onscope. I am glad to note that, during the year,SPSO amended their explanatory leaflet to makeit clear that SPSO have the last word on this.

GOVERNANCE AND ACCOUNTABILITY

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SPSO ANNUAL REPORT 2012>2013 PAGE 53

In five of the cases that I looked at, I consideredthat there had been a handling error in either thecase itself or the service delivery complaint: a lackof clarity, a minor delay or a minor proceduralerror. These handling errors did not have anysignificant impact on the five cases, butindicated areas in which SPSO might considerimprovements to their process.

In one case, there was confusion aboutwhether SPSO could or would award financialcompensation. It would have been helpful if SPSOhad explained this more clearly. In another case,where the complainant had not cooperated withthe investigation, it would have been helpful ifSPSO had sent a final warning before closingthe case.

In a further case, I considered that there hadbeen a lack of clarity which did have a materiallyadverse effect on the complainant. SPSO had notmade sufficiently clear at the outset that theywould not be investigating a financial issuereferred to in the complaint form sent to SPSO.The law says a complaint must first be made tothe public body concerned, which has to issue afinal response before SPSO can look at it. Thisraises problems where, as in this case, thecomplainant adds an issue between receivingthe public body’s response and referring thecomplaint to SPSO. It was obvious to SPSO thatthey could not look at the extra issue, but it wasnot obvious to the complainant. SPSO did notmake it sufficiently clear at the outset, or as theywent along, that they could not look at the extrafinancial issue – and it was not unreasonablefor the complainant to believe that SPSO weredealing with it. As the original case took asignificant time to resolve, it was months beforethe complainant received SPSO’s decision anddiscovered that it would be necessary to start overagain from scratch on the extra financial issue.The financial worry resulting from the delaycaused her distress.

In all the cases that I looked at, the Ombudsmanand his staff provided me with all of theinformation that I required. Where I upheld aservice complaint, SPSO reacted positively to myreport, accepting my conclusions and apologisingto the complainant concerned.

GOVERNANCE AND ACCOUNTABILITY

It is uncommon forpublic sector ombudsmanschemes to havearrangements for servicedelivery complaints to bereviewedexternally.It is to SPSO’s credit thatthey voluntarily created sucharrangements inApril 2007.

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SPSO ANNUAL REPORT 2012>2013 PAGE 54

STATISTICSAllcasesde

term

ined

2012/2013

Casetype

Stage

Outco

meGroup

Furthe

rHealth

Hou

sing

Local

Sco

ttish

Water

Other

Total

&Highe

rAssoc

iatio

nsGovernm

ent

Governm

ent

Edu

catio

nan

dDevolved

Adm

inistration

Enquiry

Advice&signpo

sting

Enquiry

321

621

74

1577

Outofjurisdiction

00

00

00

454

454

Totalenq

uiries

321

621

74

469

531

Com

plaints

Advice

Premature

41293

172

704

131

124

101,475

Outofjurisdiction(non-discretionary)*

812

1140

214

25121

Outofjurisdiction(discretionary)

118

219

35

048

Outcomenotachievable

24

113

32

126

Notdulymadeor

withdraw

n**

26298

58237

104

737

803

Resolved**

00

02

01

03

Total

78625

244

1,015

262

209

432,476

EarlyResolution1

Premature

363

346

259

1150

Outofjurisdiction(non-discretionary)*

820

2099

477

1202

Outofjurisdiction(discretionary)

534

340

106

098

Outcomenotachievable

234

426

96

081

Notdulymadeor

withdraw

n**

729

123

204

084

Resolved**

07

315

148

047

Total

25187

34249

125

402

662

EarlyResolution2

Fully

upheld

215

310

154

049

Partly

upheld

410

319

1411

061

Notupheld

757

1748

7725

0231

Outcomenotachievable

01

00

00

01

Notdulymadeor

withdraw

n**

00

03

11

05

Resolved**

01

11

14

08

Total

1384

2481

108

450

355

Investigation1

Fully

upheld

560

216

615

0104

Partly

upheld

581

763

814

0178

Notupheld

10118

475

1222

0241

Notdulymadeor

withdraw

n**

18

12

32

017

Total

21267

14156

2953

0540

Investigation2

Fully

upheld

025

03

30

031

Partly

upheld

19

03

00

013

Total

134

06

30

044

Totalcom

plaints

138

1,197

316

1,507

527

347

454,077

Totalcon

tacts

141

1,218

322

1,528

534

351

514

4,608

*includes

organisations

outofjurisdiction

**previouslyincluded

in‘nodecision

reached’category

Page 55: SPSO annual report 2012 13
Page 56: SPSO annual report 2012 13

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