Outgoing Public Services Ombudsman for Wales Nick Bennett looks back at his time in the post and outlines the challenges facing his successor...
SINCE 2014, I have been the Public Services Ombudsman for Wales. The Ombudsman is appointed by the Welsh Parliament for one term of seven years. Although my term was extended due to the Covid-19 pandemic, I will be leaving the post at the end of March. Here, I reflect on the achievements of the office and highlight some serious challenges ahead.
Achievements
In my time in office, we have seen over 38,000 contacts from the public and over 18,000 complaints. We completed over 2,400 investigations, issued 50 public interest reports and four thematic reports.
I am immensely proud that, during my time at the helm, we have succeeded in securing legislative reform of the office.
We now have some of the most comprehensive ombudsman powers in Great Britain to proactively drive improvement in public services.
We can now launch an investigation even when we have not received a complaint. This is important because we do not always hear from people who need us the most.
Last year, we published our first own initiative investigation report, which considered how local authorities treated the homeless.
We can also now set model complaints procedures for bodies in our authority. We still get a lot of complaints about complaint handling. This is unnecessary, wasteful and frustrating for complainants.
We can now promote faster and better resolution for complainants – but also help the bodies in our authority free up resources to focus on less avoidable complaints.
The challenges ahead
At the start of the pandemic, we did not see a major increase in our caseload. We believe that reflected public sentiment and support for the NHS, with members of the public refraining from complaining about the service already under strain.
However, this grace period has ended.
We are hearing from members of the public who are increasingly impatient and distressed by services that, in their view, failed to meet their needs during the pandemic.
Since April 2021, our caseload has increased significantly. Compared to the same period last year, we have received 30% more complaints.
We are especially concerned by complaints about waiting times for treatment in the NHS (referral to treatment times or ‘RTT’).
We have previously received few complaints about RTT. However, we feel this is about to change.
According to recent Welsh Government data, in November 2021 there were just over 680,000 people on waiting lists – more than 22% of the entire population of Wales.
More than a third of those people have waited for their treatment for more than nine months.
These numbers represent nothing less than a major public health crisis in Wales.
This is not just a question of meeting the targets. Behind these statistics there are stories of frustration with delays and anxiety, distress and suffering of individual patients.
We consider each case involving RTT on its own merits and we have a high bar for investigating these complaints.
We understand this may be a source of frustration to people contacting us, particularly as we normally expect our complainants to raise their concerns with the relevant body before contacting us.
A rapid increase in such complaints reaching our office would represent a significant challenge for us.
We would have to reject many such complaints – or refer them back to the relevant body for consideration. This would do little to help individual complainants.
It would also compound the existing pressures on the health service, with even more resources needed to manage complaint handling processes.
However, we would also expect to see more cases where we would need to investigate – for example, because the excessive waiting time has caused unnecessary pain and suffering.
We know that waiting times are increasing for treatments of conditions which may deteriorate significantly if not addressed promptly (for example, glaucoma). Investigations of many such cases would put our resources, already stretched, under a huge strain.
What can be done?
Action is needed now. We can continue to work closely with the NHS bodies to improve their complaint handling processes and ensure better local resolution. We can also continue to make the public more aware of our approach to complaints about RTT.
However, the solution to this approaching crisis must lie within the NHS itself.
The pandemic has placed unprecedented pressures on the NHS, but it has also prompted new ways of thinking and working.
A report by several NHS bodies in March last year drew attention to examples of good and innovative practice, from digital mental health provision for Children and Young People at Aneurin Bevan University Health Board, to new ways of delivering cardiology diagnostics services for rural communities in Betsi Cadwaladr University Health Board’s area.
Another study highlighted innovative practices at Cardiff and Vale University Health Board, which prevented the widespread cancellation of elective surgery.
These examples show what can be achieved when NHS staff are empowered and trusted to work with more discretion, flexibility and with principles of prudent healthcare at the heart of service planning and delivery.
Embedding those ways of working is essential if the current waiting lists crisis is to be resolved.
Our office – and I am sure I speak for my successor, Michelle Morris, too – will always be open to working with the NHS bodies to support them in this endeavour. This is now more important than ever.
I wish Michelle every success as the new Public Services Ombudsman for Wales.
the moors of County Durham proved you need to keep sheep to supply faeces, the manure on which these insects hatch out in the spring and summer. In turn the bird life collects these hatching insects to feed to their chicks. So no sheep, no dung and no insects, a very plain fact.
Upland Wales has for centuries been grazed by sheep, since the times of the monks of Strata, Florida, Abbeycwmhir and Strata Marcella. Having shepherded sheep and being connected with managing a common for well over 70 years, riding a pony through your flock, you notice how interaction works. Optimum numbers of sheep to be grazed over a given area have been arrived at over centuries. If one overgrazes, the health of the sheep deteriorates and it cannot provide enough milk to sustain its young lamb. Upland shepherds know this and keep to their optimum number.
On our common, we have kept to the prescribed number. The Welsh Office directed us to reduce this number by more than half. The excess grass kept growing and in winter died. In seven years the surface became a matt of dead grass and when a dry spring occurred, it caught fire; the mature hares got away but not the young leverets, likewise the skylarks and other ground nesting birds flew away but what about the chicks? We interfere with accepted practice over centuries at our peril.
Lessons were learned at the commencement of the Second World War when British home grown food production was 30% of