Background to the Research

• Health and Personal Social Services are required to respond positively and effectively to complaints from service users. In the case of children and young people, complaints about their treatment may arise within the post 1996 'Wilson Complaints procedures' or within the post 1995 Children Order procedure. This report investigates the operation of these two systems within Health and Social Services Trusts in NI, with regard to complaints made by or on behalf of children and young people. It also discusses the importance of such systems in upholding children's rights and in particular Article 12 of the United Nation's Convention on the Rights of the Child.
  

Research Approach

• A multi-method approach comprising four main elements was employed - administrative data held by the DHSSPS were analysed; a postal survey was sent to HPSS Trust complainants staff in NI, seeking information on how complaints by or about children and young people are dealt with; a postal survey was sent to potential child advocacy organisations to establish availability of independent advocacy services for children and young people; and semi-structured interviews were carried out with 18 lay people involved in Health and Social Services complaints in NI.
  

Main Findings

• The records from the DHSSPS, for the half year January/June 2001, showed that 2,142 complaints were made. 6.3% of these were in the Family and Child Care programme of care and 5.5% were in Maternal and Child Health.
• In relation to the postal survey of HPSS complaints staff, all of the 17 Trusts which responded to the survey provided information to the public on the Wilson complaints system, although less information was available on the Children Order complaints procedure. Most Trusts did not produce material targeted at children with disabilities or those from linguistic minorities. Half of the Trusts reported difficulty in dealing with complaints involving children. All but one Trust reported receiving Wilson procedure complaints from an adult on behalf of a child for the year ending 31st March 2001. Only two Trusts reported receiving such complaints by children. Fifty-four of the 104 Children Order complaints for the year ending March 31st 2001 were made by children on their own behalf, with 50 of these children being in residential care. When an adult made a complaint on behalf of a child, only half of the Trusts reported that they attempted to discover if the child's views were the same as the presenting adult's.
• Of the 49 organisations which responded to the postal survey, 19 reported that they currently provide advice/support in relation to complaints involving children's treatment within Health and Social Services.
• Some concerns were raised in the semi-structured telephone interviews about the role of lay persons within the Children Order complaints procedure and the importance placed on their views and role as independent people by Trusts. The majority of informants felt that a child's best interests could be adequately put forward by an adult acting on the child's behalf. Only three could give examples of when children's own views had been actively sought.

Conclusions/Recommendations

• A number of improvements should be made to improve the rights and representation of children within NI HPSS complaints systems and to uphold children's Article 12 rights to express an opinion on matters concerning them.
• Research with actual complainants should be carried out as soon as possible by the Department of Health, Personal Social Services and Public Safety or the regional National Health Service Research and Development Office.
• Independent advocacy and support should be easily accessible to all children and young people in residential care.
• Trusts should be required to implement the recommendations of those who carry out the Children Order complaints and representation procedure.
• Trusts should be required to have readily accessible lists of those lay persons involved in their complaints procedures and should publish their identity in their Annual Report.
• Trust switchboard operators should be more aware of the relevant office number to which to refer complaints-related queries.
• Complaints leaflets should include guidance on the kind of information which should be included in a complaint letter.
• The use of proformas and pre-paid envelopes should be extended to Wilson system leaflets and to adults as well as children.
• A date should be set by which all Trusts to whom the Children's Order is relevant should be required to have produced complaints material targeted at the most vulnerable groups of children.
• Trusts should be required to engage in six monthly pro active complaints publicity and consultation programmes with children in residential or foster care; and to produce six monthly reports documenting their actions taken in response to complaints.
• Complaints offices should be made more visible and accessible.
• Clarification should be made about when to use the Wilson or the Children Order complaints systems.
• Trusts should always seek to determine the views of the child involved.
• Training is required to ensure recognition of children's views and rights.
• All lay persons involved in the HPSS complaints system should be provided with appropriate indemnity.
• Guidance should be reissued to Trusts stressing the importance of respecting the independence of lay persons.
• Feedback on the outcome of complaints to lay persons should be improved.
• The Health and Social Services Council should appoint an officer to work specifically with children and young people in the HPSS.
• All organisations providing support and advocacy for children and young people should seek to challenge the culture prevalent in NI society and the public services, which accepts that adults 'speak for' children and young people.
• The DHSSPS should provide guidance to all HPSS organisations on recognising and defining what constitutes a complaint.