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Introduction Title

 

A1 Introduction

A1.1 Introduction

This document outlines the temporary changes to current work practice that have been implemented in response to the Covid-19 pandemic. The content of this addendum should be read in conjunction with the Complaints Process Manual.

Temporary guidance on working at home is available. This guidance provides information on your workspace requirements, information security and telephones.

The PSOW business continuity telephone number is 01656 641157.

A1.2 My Portal

The My Portal system will be used to indicate whether you are working and available. Please amend your My Portal status to HOME when you are working and available, to BREAK when you are on a break, and to OUT OF OFFICE once you have finished for the day. Do not change your status to office.

Calls to your office telephone number will be transferred directly to a telephone number of your choice. Please consider which telephone number you wish to use (mobile or landline) and ensure that it is on My Portal as your home telephone number. When you are unavailable, please amend your My Portal status accordingly so that the call is transferred to the My Portal voicemail not your home voicemail. You can then access your message when you are available.

If a telephone call is re-directed to your home telephone number, it will be handled by your home telephone answer service. Any business-related messages should be deleted as soon as actioned.

When dialling out, prefix all business calls with 141 in order to withhold your personal number. Guidance on using My Portal is available.

A2 Case Management

A2.1 Making and receiving telephone calls

Telephone calls re-directed to home telephone numbers will not be recorded.

      1. Email

        Automatic use of Egress has been suspended for correspondence at the moment. While this in place, it is vital that you take extra care when sending emails. Ensure that you input the correct email address and check it before sending. Ensure that you have attached the correct documents. You can open the attached document to check the content before sending. Egress remains available and its use should be considered for particularly sensitive material.

        The out of office email message should state that you are unavailable and provide the date you intend to return to work. Avoid directing people elsewhere wherever possible.

        The out of office email message should be switched off when you are working.

      2. Post

        Casework Support are providing a daily incoming post service as normal.

        Casework Support are providing a daily outgoing post service as normal. However, Royal Mail are not collecting signatures for “signed for” post.

      3. Casework Support Service

        Casework Support are providing a normal casework support service, albeit with a limited resource due to imminent recruitment.

        A3 Enquiries

        A3.1 Telephone enquiries

        The main PSOW telephone number (150) has been switched off, with a recorded message suggesting the use of email if possible. There is an answerphone facility that is being monitored by CAT.

        A3.2 Other enquiries

        These should be recorded and dealt with as usual, but you should avoid asking a Relevant Body for information as far as possible.

        A4 Assessment

        A4.1 Premature complaints

        When a complaint is assessed and considered to be premature, inform the complainant and suggest that they raise the complaint with the Relevant Body directly. Do not forward the complaint to the Relevant Body.

        A4.2 Requesting information

        Whilst, wherever possible, a decision should be reached on new complaints without seeking further information from the Relevant Body, requests for information from the Relevant Body can be made. However, any reminders sent should be gentle and we should not pressure them for the information, especially if the RB indicates that its ability to provide a service has been affected by the pandemic. Consider whether it is possible to request the information from the complainant instead.

        A4.3 Delays in obtaining information

        Where a Relevant Body does not respond in a timely way to a request for information, or indicates it is not in a position to provide information due to the

        pandemic and that there will be a delay, a manual task should be created on the case that it is “On Hold – Coronavirus”. A Relevant Body can be gently reminded that we are waiting for information, but do not pressure them.

        Complainants may also encounter difficulties in providing us with the information because of the pandemic (for example, if they are unwell). Where that is the case, use the “On Hold – Coronavirus” task as before.

        “On Hold – Coronavirus” cases should be added to the “On Hold” list on the CAT area of the Hub and kept in the CO/IO’s caseload. Once you are able to progress the case you must complete the “On Hold – Coronavirus” task and update the “On Hold” list on the HUB.

        Take the lead from the Relevant Body when agreeing an Early Resolution, although we must also consider the needs of the complainant. Longer time frames may be needed for compliance with Early Resolutions.

        A4.4 Complaints that are not sufficiently serious

        New closure codes of “not sufficiently serious” have been created for assessment cases, where the matter does not merit further PSOW resources given the national crisis caused by the pandemic. The criteria for these cases is:

        • The issue does not significantly impact on the person’s wellbeing

        • There is no risk to the person, or it is so minor that it does not merit PSOW intervention

        • The complainant is not vulnerable (e.g. through ill health (including mental ill health), age, disability etc.)

        • The RB has offered some kind of response or an undertaking to respond

        • There is a time delay by the RB in responding but it seems reasonable in the circumstances, and we believe that the RB will respond when it is able.

A5 Investigation

A5.1 Starting an investigation

If a decision has been made to start an investigation, proceed to start the investigation in accordance with the usual process.

If the Relevant Body is unable to proceed, telephone the complainant, or if that is not possible, write to them, advising of the intention to start an

investigation. Take the opportunity to discuss and agree the proposed heads of complaint, outline the expected delays, and explain the investigation

process. Ensure that there is a note on the Workpro file to reflect this action.

Any extension requests should be considered on a case by case basis. There should be a note on the Workpro file reflecting the decision.

A5.2 Professional advice

Advice requests will be handled as normal, but with a question to potential advisers as to whether they have capacity to undertake the work. Ensure that there is a note on the Workpro file outlining any delays/difficulties experienced.

The IPA Workflow will be updated to show the availability of an Adviser to assist PSOW during this time.

A5.3 Interviews

Face to face interviews and visits should not be arranged, and any that have been arranged should be cancelled.

Where possible please use written questions or, if relatively simple, a telephone call followed up by a signed statement. Interviews can be carried out and arranged via Microsoft Teams (refer to guidance). If interviews are to be carried out over telephone, ensure that they are recorded.

A5.4 Updating the complainant

Please can you ensure that all complainants are updated.

A5.5 Issuing a draft report

Where appropriate, you can issue a draft report in accordance with the usual process.

Please consider any extension requests on a case by case basis. Ensure that there is a note on the Workpro file to reflect this action.

A5.6 Issuing the Final report

Where appropriate, you can issue a final report in accordance with the usual process. In those reports that have recommendations you may want to consider making prior contact with the Relevant Body to ensure that it has capacity and is able to deal with it. If prior contact is made, and once the Relevant Body has confirmed that it can deal with the report, then proceed to issue it.

A6 Compliance

Compliance is likely to be more difficult at the moment, so please liaise with Contact Officers and allow additional time for compliance with recommendations. Ensure that there is a note on the Workpro file to reflect this action.

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Complaints Process Manual

Contents Page

A1 Introduction

0

A1.1 Introduction

0

A1.2 My Portal

0

A2 Case Management

1

A2.1 Making and receiving telephone calls

1

A.2.2 Email

1

A.2.3 Post

1

A.2.4 Casework Support Service

1

A3 Enquiries

2

A3.1 Telephone enquiries

2

A3.2 Other enquiries

2

A4 Assessment

2

A4.1 Premature complaints

2

A4.2 Requesting information

2

A4.3 Delays in obtaining information

2

A4.4 Complaints that are not sufficiently serious

3

A5 Investigation

4

A5.1 Starting an investigation

4

A5.2 Professional advice

4

A5.3 Interviews

4

A5.4 Updating the complainant

5

A5.5 Issuing a draft report

5

A5.6 Issuing the Final report

5

A6 Compliance

5

1 Introduction, abbreviations and definitions

1

1.1 Introduction

1

1.2 Abbreviations

1

1.3 Definitions

1

2 Case Management

3

3 Enquiries

4

    1. The complaints assessment team (“CAT”) 4

    2. Telephone enquiries 4

    3. Incoming emails/web complaints/oral complaints 6

    4. Incoming Mail 7

    5. Authorisation 8

    6. Requesting information 8

    7. A duly made complaint 8

  1. Assessment 9

    1. Date sufficient information received 9

    2. Significant cases 9

    3. Matters outside the Ombudsman’s jurisdiction 10

    4. Premature complaints 10

    5. ALR 11

    6. Rejection 11

    7. Sift 12

    8. Professional Advice 12

    9. Refer to the Investigation Team for further consideration 12

    10. Provisional view 12

    11. Settlement of complaints 14

    12. Decision not to investigate 14

  2. Investigation 15

    1. The Investigation Team 15

    2. Significant cases 15

    3. Starting an investigation 15

    4. Settlement/Discontinuation 17

    5. Professional advice 17

    6. Interviews 18

    7. Updating the complainant /body 18

    8. Suspending an investigation 18

    9. Drafting the report 18

    10. Non-public interest report 19

    11. Public Interest report 20

    12. Recommendations 20

    13. Issuing a draft report 21

    14. Challenges to the draft report 21

    15. Final report 21

  3. Special Report 22

  4. Compliance 22

  5. Challenges to decisions 22

  6. Information Management 24

    1. Information security 24

    2. Requests for information 24

    3. Redaction 24

    4. Restricted Access to casefiles on Workpro 24

  7. Comments and complaints about us 24

  8. Appendix 1 Subject related guidance 25

    1. Subject related guidance – Factsheets 25

    2. Subject related guidance – Evidence 25

    3. Subject related guidance – Health 25

    4. Subject related guidance – Care Homes 25

    5. Subject related guidance – Planning 25

  9. Appendix 2 General Administration 26

    1. End of month closure checklist 26

    2. General Administration 26

    3. Out of office messages 26

    4. Signing correspondence 27

  1. Introduction, abbreviations and definitions

    1. Introduction

      The Ombudsman’s power to investigate complaints originates from the Public Services Ombudsman (Wales) Act 2019 (“the Act”).

    2. Abbreviations

      PSOW Public Services Ombudsman for Wales

      CAT Complaints Assessment Team

      COO/DoI Chief Operating Officer / Director ofImprovement CLA/DoI Chief Legal Adviser / Director of Investigations IM Investigation Manager

      AIM Assistant Investigation Manager

      IIO Investigation & Improvement Officer

      IO Investigation Officer

      CO Casework Officer

      CWS Casework Support Team

      RSQO Review & Service Quality Officer

      ALR Alternative legal resolution

      EHRAG Equalities and Human Rights Advice Group

    3. Definitions

      PSOW Where reference is made to PSOW, this is interchangeable with ‘the Ombudsman’.

      DoI Where reference is made to DoI in this process, this refers to the COO / DoI or the CLA / DoI throughout.

      IM Where reference is made to IM in this process, staff should read IM and/or AIM unless otherwise specified.

      IO Where reference is made to IO in this process, staff should read IO, IIO or AIM throughout.

      CAT PSOW’s front line complaints handling service. The CAT consists of COs, IOs and IIOs, managed by an IM and an AIM.

      Investigation Team Undertake investigations on behalf of the Ombudsman.

      The team consists of IOs and IIOs, managed by an IM and AIMs.

      Improvement Team Undertakes investigations and own initiative

      investigations on behalf of the Ombudsman. The Team consists of an IIO, IO, the Complaints Standards officers and the Policy and Communications Team.

      The team is managed by an IM.

      CWS Provide administrative support to the IO’s. The CWS consists of casework support officers and is managed by the Assistant Manager Casework Support.

      Complaint Means a written expression of concern about maladministration or service failure on the part of one of the relevant bodies.

      Complainant Means any person who submits a complaint about a

      relevant body.

  2. Case Management

    PSOW’s case management system Workpro organises complaints into distinct steps:

    • Enquiry

    • Assessment

    • Investigation

    The Workpro assist page on the Hub provides guidance on how to use Workpro and answers to FAQ’s.

    All actions taken and written documents prepared at all steps must be recorded and stored within the complaint record on Workpro. Each record should be appropriately titled and categorised to aid identification of key documents in accordance with PSOW’s naming convention guidance.

    Throughout this process “file” refers to the paper investigation file and “record” refers to the Workpro record.

    Standardised template documents are available on Workpro (‘Create a Document’ tab) and should be used at all steps of this process wherever possible. When using a template, effort and care must be taken to ensure that all text in the final document is appropriate to the circumstances of the case.

    All email communication (internal and external) containing confidential or sensitive personal information should be sent via the Workpro system and in accordance with the Egress Process unless otherwise agreed (see special circumstances Paragraphs 3.3, 3.4 and 3.5). Emails without confidential/personal information should be sent unencrypted. There is guidance available on encrypting emails and accessing egress packages.1

    There are occasions when access to a casefile should be restricted or locked. The Restricted Case Process provides guidance on when and how access to such cases should be restricted, and which officers will have access to the information.

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    1 GPS – Egress

    The provisions of PSOW’s Welsh Language Policy should be considered and complied with at all stages of this Process.

    To ensure a consistent approach in communication and drafting House Style guidance is available.

  3. Enquiries

    1. The complaints assessment team (“CAT”)

      The CAT provides the PSOW’s front line complaints handling service. All incoming complaints and enquiries for PSOW are considered and processed in the CAT. All CAT officers have the delegated authority of the Ombudsman to reach decisions on his/her behalf.

      CAT officers can advise and assist complainants in submitting complaints but do not provide an advocacy or support role, due to the need for PSOW to remain impartial in the consideration of complaints.

      The CAT must process enquires and undertake an assessment of complaints within set timescales.

      Enquiries may be made by telephone, in writing or by email/via the website.

    2. Telephone enquiries

      All incoming calls to the main PSOW line will be directed to the CAT via the My Agent software system. My Agent distributes the calls between the COs (and IOs as necessary) logged into the system.

      All incoming calls to the PSOW main line are recorded. Call recordings will remain on the system for one calendar month and will then be deleted. Requests from PSOW staff to access recordings of calls should be made to CWS via Workpro. Requests from callers should be forwarded to the Information Governance Manager (see chapter 9).

      Callers are greeted with an automated message offering a choice of language options (Welsh Language Policy).

      The caller now has a choice to speak in Welsh or English so the greeting should be in the appropriate language, and when appropriate the complainant record should be updated to include the ‘preferred language’.

      If a complainant wishes to communicate in a language other than English or Welsh or has additional communication needs, the Equality Services Process provides the procedure for requesting services to meet such requests. The complainant record should be updated to include the ‘preferred language’.

      CAT officers should try to provide as much assistance to complainants as possible. If appropriate, a complaint form can be sent to the caller, alternatively the caller can be directed to PSOW’s website (www.ombudsman-wales.org.uk), to complete an online complaint form. If it appears that a caller might need assistance or support in making a complaint, officers should direct them to an appropriate advocacy or support service. A caller can request to make a complaint to PSOW over the telephone and this should be dealt with in accordance with the guidance. Should a caller indicate they might fall within the remit of the Equality Act 2010 and need a reasonable adjustment, this must be considered, in consultation with an IM/AIM if necessary. Any reasonable adjustments should be recorded on the complainant record as ‘Special Circumstances AGREED’.

      Having received a new enquiry, a Workpro record will be created. Personal details are no longer required at the enquiry stage. Should personal details be provided, the enquiry should be linked to an existing or new named individual on the individual database. Where no name details are provided the telephone number or email address used for the incoming enquiry should be noted in the ‘Enquiry Details’ box.

      CAT officers should record the complainant’s preferred method of contact, at the earliest opportunity.

      The Managing Customer Contact Policy provides guidance on handling calls from aggressive, abusive, offensive, unreasonably frequent or demanding callers or correspondents.

    3. Incoming emails/web complaints/oral complaints

      CAT COs operate a weekly rota system to ensure the regular monitoring of emails received into the general ‘ask@ombudsman-wales.org.uk’ address and the ‘Pending’ area, where on-line complaints are received. The database will be searched to ascertain whether the complainant already exists within Workpro. Where the complainant already exists on the database, the existing complainant will be used on the new case. If a duplicate individual record has been created by Workpro it will be marked as retired once the new case has been assigned to the correct complainant on the individual database.

      Junk mail or ‘Spam’ emails should be deleted. Emails relating to ongoing/closed cases should be forwarded promptly to the relevant case officer.

      Complaints may also be made over the telephone. A process for taking oral complaints is available for health and maladministration cases.

      When a new enquiry is received, a new Workpro record is created and the documents uploaded to Workpro.

      The complainant has a choice to correspond in Welsh or English and the complainant record should be updated to include the ‘preferred language’ choice.

      Should a complainant indicate they might fall within the remit of the Equality Act 2010 and need a reasonable adjustment, this must be considered, in consultation with an AIM/IM if necessary. Any reasonable adjustments should be recorded on the complainant record as ‘Special Circumstances AGREED’.

      If a complainant wishes to communicate in a language other than English or Welsh or has additional communication needs, the Equality Services Process provides the procedure for requesting services to meet such requests. The complainant record should be updated to include the ‘preferred language’.

      The complainant’s ‘preferred means of contact’ should be noted on the complainant’s Workpro record at the earliest opportunity.

      All enquiries and complaints should be acknowledged within three working days.

    4. Incoming Mail

      Following the completion of any relevant scanning, incoming post is delivered to CAT each day.

      All incoming post and pending complaints to CAT are recorded with a screenshot and in the CAT post book. A daily tally of all incoming complaints is recorded for monitoring purposes.

      The CO will upload individual post to the Workpro record and send a task to the relevant officer.

      Correspondence is acknowledged. Documents will not be returned to the complainant unless they are requested or are clearly original documents.

      When a new enquiry is received, a new Workpro record is created and the documents uploaded to Workpro.

      The complainant has a choice to correspond in Welsh or English and the complainant record should be updated to include the ‘preferred language’ choice.

      If a complainant wishes to communicate in a language other than English or Welsh If a complainant wishes to communicate in a language other than English or Welsh or has additional communication needs, the Equality Services Process provides the procedure for requesting services to meet such requests. The complainant record should be updated to include the ‘preferred language’.

      Should a complainant indicate they might fall within the remit of the Equality Act 2010 and need a reasonable adjustment, this must be considered, in consultation with an AIM /IM if necessary. Any reasonable adjustments should be recorded on the complainant record as ‘Special Circumstances AGREED’.

      The complainant’s ‘preferred means of contact’ should be noted on the complainant’s ‘Workpro record’ at the earliest opportunity.

    5. Authorisation

      If a complaint is submitted by someone on behalf of another person, CAT officers must satisfy themselves that we have appropriate authorisation from the aggrieved person.

    6. Requesting information

      Additional information may be requested from the complainant in the first instance, or, if it is not appropriate to ask the complainant for the information, the relevant body. CAT staff have access to a network of Liaison Officers at the bodies within PSOW’s jurisdiction. Liaison Officers can often provide useful background to help us understand the circumstances that have led to the complaint. Complaints Departments will usually have access to the complaint file, so this is sometimes a quicker route to take when trying to obtain evidence of the body’s previous involvement and responses to the complaint.

      We normally give the complainant 10 working days to provide information. In the event that it is necessary to repeat the request, the complainant has a further five working days to respond. If the information is unavailable from either party, a decision will be made based on the information provided.

      There may be occasions when a complainant provides evidence in the form of a covert audio or video recording. Guidance on accepting and using covert recordings is available.

    7. A duly made complaint

      When a duly made complaint is received, the Workpro record is progressed to ‘Assessment’ stage.

      Consideration should be given to ensuring that any reasonable adjustment requests have been documented, considered and, where appropriate, implemented. This, along with the complainant’s ‘preferred language’ choice, should be recorded on the Complainant ‘Workpro record’.

      If a complainant wishes to communicate in a language other than English or Welsh, If a complainant wishes to communicate in a language other than English

      or Welsh or has additional communication needs, the Equality Services Process provides the procedure for requesting services to meet such requests. The complainant record should be updated to include the ‘preferred language’.

      The complainant’s ‘preferred means of contact’ should be noted on the complainant’s ‘Workpro record’ at the earliest opportunity.

  4. Assessment

    1. Date sufficient information received

      Once the CO has received sufficient information from the complainant to allow for a decision to be made, the Workpro record is updated to show the ‘date sufficient information is received’ (“DSIR”) date. Sometimes it will be appropriate to obtain information from relevant body where the information is needed to assess a case. However, the DSIR should only be modified to reflect the date the information is provided by the relevant body where the complainant has been unable to, or has significant difficulties, in providing this information themselves (for example, perhaps because they have literacy issues, or lack the technology to share it, or they are vulnerable in some way).

      Before proceeding with any further deliberation of the complaint, consideration should be given to ensuring that any reasonable adjustment requests have been documented, considered and, where appropriate, implemented. This, along with the complainant’s ‘preferred language’ choice, should be recorded on the Complainant ‘Workpro record’.

      If a complainant wishes to communicate in a language other than English or Welsh, then a request should be made to the Head of Communications & Public Affairs/Translator to arrange the translation service. The complainant record should be updated to include the ‘preferred language’.

      The complainant’s ‘preferred means of contact’ should be noted on the complainant’s ‘Workpro record’ at the earliest opportunity.

    2. Significant cases

      Significant cases are those that have been identified by the IM or above as

      having additional organisational risk inherent within them. Cases that have been identified as significant require additional management support. Guidance is available on identifying and processing significant cases.

    3. Matters outside the Ombudsman’s jurisdiction

      The initial consideration of an enquiry/complaint should identify whether the body complained about is within PSOW’s jurisdiction. If the body is out of

      jurisdiction the matter will be closed and the CAT officer should provide the complainant with a written explanation of the decision.

      Once the decision letter has been issued the Workpro record should be amended to include the ‘Assessment Outcome Date’ and the ‘Assessment Outcome’; there is a drop-down box with a list of outcome codes.

      The complainant should receive a decision within 3 weeks of the DSIR date.

    4. Premature complaints

      It is often evident from the information provided whether the complainant has already complained or received a response to their complaint from the relevant body. Whilst it is preferable for complainants to complete the body’s complaints procedure, and we will usually advise complainants to do so, PSOW has discretion to progress cases that have not.

      When a complaint is evidently ‘Premature’, and there is no reason to exercise discretion, the CAT officer dealing with the matter should advise the complainant to await the body’s response and explain that they can return to PSOW if they are not satisfied with the response they eventually receive. Complainants can be advised that complaints processes may take around twelve weeks to complete, but that this period may be extended in complex cases, such as health or social services matters. Complainants may be advised to contact us again if they do not receive a response from the body within a reasonable time.

      Sometimes, a response has been provided by the body, but the complainant has

      outstanding concerns or disputes the accuracy of the body’s response. Whilst the Ombudsman has the discretion to proceed with his consideration of the complaint, in some circumstances, it may be appropriate to allow the body a further attempt to respond to the complainant’s concerns. The complaint may then be referred back to the body for further consideration providing authorisation is in place. The case will then be closed as ‘Premature’.

      CAT officers need to ensure that information forwarded to the body is necessary for the proper consideration of the complaint and does not contain unnecessary third-party information.

      Once the decision letter has been issued the Workpro record should be amended to include the ‘Assessment Outcome Date’ and the ‘Assessment Outcome’; there is a drop-down box with a list of outcome codes.

      The complainant should receive a decision within 3 weeks of the DSIR date, or 6 weeks if it is necessary to obtain further information.

    5. ALR

      The Ombudsman has discretion to investigate a complaint, even if the aggrieved person has or had a right of appeal, a right to a reference or review before a tribunal, or a remedy by way of proceedings in a court of law. There is guidance on what factors should be considered in reaching a decision on whether an ALR is reasonably available.

    6. Rejection

      Where it is evident following assessment that the investigation of a complaint would not be merited, the complaint can be rejected.

      Rejection letters need to include clear reasoning and should be tailored to the circumstances of the complaint, without relying too heavily on standard phrases and paragraphs. A redacted and anonymised copy of the decision letter should be forwarded to the body.

      Once the decision letter has been issued the Workpro record should be amended to include the ‘Assessment Outcome Date’ and the ‘Assessment Outcome’; there is a drop-down box with a list of outcome codes.

      The complainant should receive a decision within 3 weeks of the DSIR, or 6 weeks if it is necessary to obtain further information.

    7. Sift

      When a CO is satisfied that enough information is available about a complaint, but it is not a matter on which they can reach a decision, a lilac file should be created and put in the sift. The file should contain the complaint made to PSOW. The file is then ‘sifted’ by the IM/AIM/IIO, who decides if it is a matter that needs further preparatory work by a CO, can be concluded by a CO with guidance, or if it needs to be passed to an IO for further consideration or passed directly to the Investigation Team.

    8. Professional Advice

      There are occasions when the CAT officer will take limited professional advice to help reach a decision about the best way to deal with a case (see paragraph 5.5).

    9. Refer to the Investigation Team for further consideration

      On assessing a file, the CAT IO may consider investigation may be merited. They should then write a brief note for the IM to recommend further consideration.

      On sifting a file, the IM may consider that, on the basis of the information available, the case should be referred directly to the Investigation Team for consideration.

      When further consideration by the investigation team is deemed necessary, the IM completes the ‘sift’ form. These files are then queued by the IM until they are allocated on a weekly basis to the IM of the Investigation Team.

    10. Provisional view

      Before allocation to the Investigation Team, the CAT officer will undertake an assessment of the complaint (unless the IM has decided to refer it directly to the Investigation Team). This is only an indication of the CAT view and the IO giving further consideration to the complaint must form his/her own view before proceeding. On receipt of the file, the IO tasked with further considering the complaint needs to establish one of thefollowing:

      • The complaint is about a body within the Ombudsman’s jurisdiction or, if not, how best we can help the complainant;

      • The complaint is about a body within jurisdiction and there is an absolute statutory bar which prevents the Ombudsman considering the complaint. If there is, the complainant will be informed by letter and/or via their preferred method of communication;

      • The complaint is about a body within jurisdiction, a statutory bar exists but the IO is satisfied that in the particular circumstances the Ombudsman’s discretion should be exercised to investigate the complaint;

      • The complaint is in jurisdiction and a statutory bar exists but the Ombudsman should not exercise discretion in the complainant’s favour;

      • Whether there is the potential to settle the complaint.

        Before arriving at any of the above conclusions it may be necessary to seek further information from the complainant or, if more appropriate, from the relevant body.

        There may be occasions when a complainant provides evidence in the form of a covert audio or video recording. Guidance on covert recordings is available.

        If the matter is one which the Ombudsman could investigate the IO will then need to consider whether it is one that should be investigated.

        Factors to be considered in arriving at a decision include (but are not limited to):

      • The public interest – the seriousness and consequences of the complaint. Is there evidence of systemic failures by the relevant body which could

        affect others and could action by the Ombudsman improve the delivery of the services provided by the body or public services in Wales in general?

      • Would an investigation be proportionate? Can a practical outcome be achieved? If there is any unremedied injustice, what outcome can be delivered for the complainant and is the remedy sought by the complainant achievable?

    11. Settlement of complaints

      Where there is prima facie evidence of maladministration or service failure, a settlement can be an appropriate and proportionate way of addressing the matter.

      The potential to settle a complaint should be considered at any stage during the assessment and investigation stages. Sometimes the offer will come from the body concerned, but a potential remedy may occur to us during our consideration of the complaint.

      Before proposing or accepting a suitable settlement, an AIM/IM may be consulted. Any proposed settlement by the IO must be in line with the procedure outlined in the Ombudsman’s redressguidance.

      An early settlement should never be considered where it would be in the wider public interest to publish a report because of, for example, evidence of systemic failures by the body, or because the subject of the complaint has wider ramifications for the delivery of public services in Wales as a whole.

      For any case that is settled, an anonymised case summary must be prepared using the standard template. The summary should briefly explain the nature of the complaint and theresolution.

      All compliance requirements should be recorded on Workpro and will be followed up. In the event that evidence is not provided to satisfy the grounds of the settlement, the case should be referred to the AIM/IM in accordance with the compliance procedure.

    12. Decision not to investigate

      IOs should use their delegated authority whenever appropriate. IOs should approach their AIM/IM for advice on more complex cases.

      Sometimes a provisional decision letter will be appropriate. This will give the complainant the opportunity to challenge the reasoning for a proposed decision and/or to submit new evidence before a final decision is made. This option should be the exception rather than the norm. If a response is received, then the complaint should be re- considered (after discussion with the complainant if appropriate).

      Once the decision letter has been issued the Workpro record should be amended to include the ‘Assessment Outcome Date’ and the

      ‘Assessment Outcome’; there is a drop-down box with a list of outcome codes.

  5. Investigation

    1. The Investigation Team

      The investigation team consists of IOs and IIOs, managed by an IM and AIMs. All IOs have the delegated authority of the Ombudsman to reach decisions on his/her behalf.

      The IOs are expected to progress cases in a timely manner and use the case milestones to guide them through the investigation process.

      Once allocated a file, the IO will consider the complaint and all of the information on the Workpro record and determine whether an investigation should be started or the complaint should be rejected.

    2. Significant cases

      Significant cases are those that have been identified by the IM or above as having additional organisational risk inherent within them. Cases that have been identified as significant require additional management support. Guidance is available on identifying and processing significant cases.

    3. Starting an investigation

      Before proceeding with any further deliberation of the complaint, consideration should be given to ensuring that any reasonable adjustments requests have been documented, considered and, where appropriate, implemented. This, along with the complainant’s ‘preferred language’ choice, should be recorded on the Complainant ‘Workpro record’.

      If a complainant wishes to communicate in a language other than English or Welsh, then a request should be made to the Head of Policy & Communications/Translator to arrange the translation service. The complainant record should be updated to include the ‘preferred language’.

      The complainant’s ‘preferred means of contact’ should be noted on the complainant’s ‘Workpro record’ at the earliest opportunity.

      When making a decision to investigate a complaint, the IO should use the guidance to determine whether there are any relevant equalities or human rights elements to the complaint. Consideration of these matters may be demonstrated by the completion of the toolkit (available on Workpro ‘Create a Document’ tab), or a note on the case file. If these issues are identified, the file should be referred to EHRAG. Referrals to EHRAG should be by email (the email address is found in the shared distribution list) and should include the relevant case reference number. Once EHRAG has considered the referral, any recommendations will be placed on the relevant Workpro record, and the IO notified with a task. EHRAG meets every other Tuesday. An IO should not wait for EHRAG to review the file before starting an investigation.

      When starting the investigation, the IO should prepare the statement of complaint. The letter should provide a full explanation of the decision. If not all parts of the complaint (as made) are to be investigated, the letter should explain the reason(s) why. In any event it is important that the complainant is aware of the scope of the investigation which should be proportionate. The complainant should also be told of the Ombudsman’s discretion to discontinue an investigation. Finally, the IO may request additional information from the complainant. There may be occasions when, in response to this request, the complainant provides evidence in the form of a covert audio or video recording. Guidance on accepting and using covert recordings is available.

      The relevant body should also be informed of the decision to investigate by letter. A copy of the original complaint will be attached. The letter will include a request for general comments on the complaint from the body as well as any other person who is alleged in the complaint to have taken or authorised the action complained of. The letter should also include a request to provide information specific to the complaint.

      Once the ‘investigation start letters’ have been issued, the Workpro record will be moved to ‘Investigation’.

      If, having received information the IO considers our Criteria for starting an OI investigation has been met, the OI Extended Guidance should be followed.

      The ‘Heads of Complaint’ tab on the Workpro record should be updated. The complainant should receive a decision within 6 weeks of the DSIR.

      When the relevant body has had a reasonable opportunity to provide all the information requested, the complaint will be re-considered. Should a relevant body fail to respond to the request for information, or requests an extension, the matter may be escalated accordingly.

      Once all the information has been received, the IO will decide whether further investigation is required. Care must be taken to ensure that the investigative steps taken are proportionate and that any action taken would not delay the completion of the investigation. Where appropriate, details of any further investigation required, or information requested, should be properly recorded on the Workpro record.

    4. Settlement/Discontinuation

      Voluntary settlements (section 3 PSOW Act) may be considered during the investigative stage, if appropriate. See paragraph 4.11.

      If the IO believes an investigation should be discontinued, a recommendation should be made to the AIM/IM outlining the reasons.

    5. Professional advice

      Health – During the course of an investigation, the IO may wish to seek professional advice2 from one of the Ombudsman’s Advisers. The advice request should be completed, and the request submitted to the Professional Advice Co-Ordinator via IPA workflow tab on the hub.

      Planning – The Planning Adviser attends the office on a regular basis. The Planning Adviser is available for ad hoc discussions about cases, or an appointment can be sought in advance via the planning adviser’s liaison officer. An advice request should be completed, and an electronic sub-file of relevant documents created. The Planning Adviser is also available via email.

    6. Interviews

      During the course of an investigation, the IO may wish to interview the complainant or witnesses. Interviews may be undertaken either at the PSOW office or at an alternative location.

    7. Updating the complainant /body

      It will be the responsibility of the IO who ‘owns’ the case to update the complainant (normally by the complainant’s preferred method) and body at appropriate intervals.

    8. Suspending an investigation

      There will be occasions when it is appropriate to submit a request to the IM/AIM to suspend an investigation. Requests should detail the reason for the request and a proposed review date, to be agreed. If an investigation is suspended, the Workpro record should be updated and the IO must notify the complainant and the body.

    9. Drafting the report

      When all the available relevant evidence has been gathered, the IO will need to

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      2 GPS on General guidance on records and obtaining advice

      evaluate and assess the quality of the evidence to decide how best to conclude the investigation by issuing a draft report.

      Reports should be logical and reasoned but do not require every detail to be included. Best practice is to draft the report as the investigation progresses. When drafting the report consideration should be given to the house style guidance.

      When drafting the findings, the IO should outline any failings identified for each head of complaint, and for the avoidance of any doubt, state explicitly whether they amount to maladministration or service failure. In order to uphold a complaint any maladministration or service failure must have caused injustice to the aggrieved person – so the IO must also explicitly say what injustice has been caused to the aggrieved person as a consequence of the failing identified and explain why any recommended redress would remedy that injustice.3

      Once the draft report is complete, consideration should be given to which section of the PSOW Act the report should be issued under. A file note should be completed briefly explaining the reason for choosing whether the report should be issued as a public interest report. If an IO is in any doubt or the decision is finely balanced the file should be referred to their IM/AIM.

    10. Non-public interest report

      A non-public interest report may be issued if PSOW is satisfied that the public interest does not require a public report to be issued AND either:

      • The complaint is not upheld because the person aggrieved has not sustained injustice or hardship as a consequence of the matter investigated; or

      • The complaint is upheld in full or in part because the person aggrieved has sustained injustice or hardship and the body has agreed to implement any recommendations made by the Ombudsman.

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        3 Email from Jenny Strinati dated 03/05/2017

        When drafting a non-public interest report, consideration should be given to whether a letter report would be the most appropriate format. Letter reports are generally not appropriate for upheld complaints or more complex cases. Letter reports should not generally exceed two pages.

    11. Public Interest report

      A public interest report may be issued if the complaint is upheld in full or in part and the body has not indicated that it will accept the recommendations and/or if, after taking account of the interests of the person aggrieved and any other person, the Ombudsman considers it to be in the public interest to publish the report.

      Public Interest factors include:

    12. Recommendations

      If the complaint has been upheld, the IO should consider what recommendations, if any, should be made. There are a range of remedies available, which includes financial redress. Guidance on the financial redress process and calculating financial redress is available.

    13. Issuing a draft report

      Once complete, in cases where the advice has been used in the report, the draft report should be shared with the Adviser (via the Casework Support Team) to ensure that the advice has been interpreted and used correctly. If the IO is satisfied that the advice has been correctly interpreted, the draft report may be issued to the complainant/advocate and the relevant body for comment at the same time as it is shared with the Adviser.

      Once, if appropriate, the adviser has seen and commented on the draft report, it is issued to the complainant/advocate and the relevant body for comment.

      In the event that a second draft report should be issued the process is available here.

    14. Challenges to the draft report

      The complainant and/or the relevant body may comment on the draft report. The complainant is asked to restrict comments to:

      • The accuracy of the facts

      • Concerns that the IO has failed to consider material information

      • New evidence.

        There will be occasions when either the complainant or the body challenges to the advice given. It is for the IO to determine the most appropriate action based on the nature of the challenge and by whom the challenge has been made.

        Significant challenges to draft reports should be referred to the IM/AIM.

        Investigation reports should be amended, where appropriate, to reflect the comments provided by the complainant and the body.

    15. Final report

      Once the comments have been received and the report has been amended the IO should draft a summary of the report.

      The final report and summary4 must be proof read by a colleague prior to it being issued.

      The IO should ensure that, where appropriate, the ‘Heads of Complaint’ field on Workpro is completed.

      The ‘final report type’, ‘publicity confirmed’, ‘case weighting’ and ‘case outcome’ fields should be completed on Workpro.

      The file is forwarded to CWS to issue the report and close.

  6. Special Report

    This step will be used when a body fails to satisfactorily implement the recommendations contained in an Ombudsman’s report, or when a body fails to comply with the terms of a settlement. If the Ombudsman agrees, he will detail the procedure to be followed.

  7. Compliance

    This relates to the actions taken by the body once it has agreed to a settlement or recommendations.

    The compliance procedure details how compliance is recorded and verified. It also outlines the escalation process should a body not comply.5

  8. Challenges to decisions

If a complainant challenges a decision, and it clearly includes sufficient information to render the original decision no longer valid, a new complaint can be opened on Workpro and the officer may assess the complaint accordingly (Do not reopen the original Workpro record).

In all other cases where the complainant challenges the decision, the IO should attempt to address the issues that have been raised and provide a fulsome

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4 Link to an example of a report summary

5 GPS on compliance

explanation of the decision (Do not reopen the original Workpro record).

There will however be occasions where, despite receiving full explanations, the complainant will request a review and details of the information used when making a decision. For a review request to be considered, the complainant will normally need to write to us within 20 working days of being notified of our decision. The complainant will also need to show either:

  • That there is new evidence for us to consider; or

  • That we have not properly taken information into account in making our decision.

    On receipt of such a challenge, the officer will ensure that the Workpro system is updated and a review record is created. The officer will also draft a note providing appropriate information on the review request. The case will then be referred to the RSQO who will consider the matter and respond personally to the complainant or decide how best to respond to the issues raised. Options may include:

  • Refusing a review if the grounds above are not met;

  • Commissioning a review by a colleague

  • Referring the matter to the DoI/Ombudsman with a recommendation on how to respond

  • Convening a caseconference

  • Referring the matter to a colleague (complaints about members of our staff).

  • Upholding the review and referring the matter back to the CAT or Investigation Team for assessment/consideration (Do not reopen the original Workpro record – create a new Workpro case record)

Appropriate consideration should also be given to any challenge submitted by the relevant body.

The RSQO’s decision is final.

  1. Information Management

    1. Information security

      The Information Governance Helpdesk provides guidance on information security, data protection and records management, including guidance on Consent, Authorisation, Declaration and Privacy Information for Complainants, and the disclosure of information to elected representatives.

    2. Requests for information

      Guidance on general requests for information, requests for material evidence and requesting telephone recordings is available.

    3. Redaction

      When issuing a document, consideration should be given to redacting third party information. Guidance on anonymisation and redaction is available.

    4. Restricted Access to casefiles on Workpro

      There are occasions when access to a case file should be restricted or locked. The Restricted Case Process provides guidance on when and how access to such cases should be restricted, and which officers will have access to the information.

  2. Comments and complaints about us

    In the event someone wishes to complain about the service received from PSOW, the member of staff should try to establish the reason for the concern, and where possible, try to resolve the matter informally.

    If this is not possible, the matter should be escalated to the relevant AIM/IM.

    Should the complainant wish to make a formal complaint about the service received from PSOW, then s/he may be referred to the website for the complaint form and guidance on how to make a complaint.

  3. Appendix 1 Subject related guidance

    1. Subject related guidance – Factsheets

      There are factsheets available for specific subjects.

    2. Subject related guidance – Evidence

      There is an guidance on evidence and audio and video recording.

    3. Subject related guidance – Health

      The Ombudsman’s standards in clinical care cases.

      Continuing health care – there is guidance on assessing retrospective continuing health care complaints and the questions for continuing health care advisers.

      There is also an online training session available – CHC – GPS.

      Family health service providers – There is guidance on current family health service providers as well as those who are retired / former employees.

      Referral to Treatment – there is guidance on investigating complaints about the failure to meet the NHS referral to treatment times.

      Medical records – There is guidance on understanding medical records and consent to treatment.

    4. Subject related guidance – Care Homes

      The guidance on dealing with complaints about care homes supports officers in identifying the funding/contracting arrangements in place for people in care homes.

    5. Subject related guidance – Planning

      There is an online training session available – Planning GPS.

  4. Appendix 2 General Administration

    1. End of month closure checklist

      At the end of each month the IO will check his/her closed case records for the month and confirm completion using the ‘case monthly check’ page (the link is found on the Investigation Team page). Nil returns should also be completed.

    2. General Administration

      The ‘Ways of working’ document provides clarification on administrative tasks and responsibilities of officers. It also includes guidance on document control, categories, closing cases and compliance.

    3. Out of office messages

      1. Out of office Voice Mail

        English

        I am now out of the office until XXX. Please leave a message and I will get back to you on my return.

        If your call is urgent please contact Casework Support on 01656 644219. If they are unable to assist, your message can be forwarded to a colleague who may be able to help.

        Cymraeg

        Rwyf bellach allan o’r swyddfa nes XXX. Gadewch neges, os gwelwch yn dda, a byddaf yn cysylltu â chi ar ôl i mi ddychwelyd.

        Os yw eich galwad yn un brys, cysylltwch â Chymorth Gwaith Achos ar 01656 644219. Os nad ydynt yn gallu cynorthwyo, gall eich neges gael ei anfon ymlaen at gydweithiwr a allai eich helpu.

      2. Out of office email

English

Thank you for your email. I am now out of the office until XXX. I will respond to your email on my return.

If you need to contact the office urgently in my absence you can email casework@ombudsman-wales.org.uk who can forward your email to a colleague who may be able to respond on my behalf.

Cymraeg

Diolch am eich e-bost. Rwyf bellach allan o’r swyddfa nes XXX. Byddaf yn ymateb i’ch e-bost ar ôl i mi ddychwelyd.

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Os oes angen i chi gysylltu â’r swyddfa ar frys yn ystod fy absenoldeb, gallwch anfon e-bost at gwaithachos@ombwdsmon-cymru.org.uk a fydd yn gallu anfon eich e-bost at gydweithiwr a allai ymateb ar fy rhan.

12.4 Signing correspondence

Routine correspondence (e.g. acknowledgements, updates, requests for information) will normally be signed by theauthor.

Decision letters and reports will be issued as indicated in the matrix below:

Decision Type

Signature

Comments

Reject

Case holder & above

After approval of AIM/IM if appropriate

Minded to reject

Case holder & above

After approval of AIM/IM if appropriate

Discontinue Investigation

Case holder & above

After approval of AIM/IM if appropriate

Response to challenge

RSQO

After review by RSQO, DoI or Ombudsman

Draft Non Public Interest report

Case holder & above

After discussion with AIM/IM if appropriate

Final Non Public Interest report – no challenge to draft or all comments

Case holder & above

Final Non Public Interest report – draft challenged and comments not all

Case holder – or as agreed by IM or DoI

After review by IO and AIM/IM and/or DoI

Draft Public Interest report

IO

After approval of Ombudsman via AIM/IM & DoI

Final Public Interest report

Ombudsman or DoI with specific

After Ombudsman agrees any changes proposed in response

Draft Special Report

IO

After approval by Ombudsman via AIM/IM

Final Special Report

Ombudsman

After Ombudsman agrees any changes proposed in response

Policy Approver Group

CMRG

Date of Policy/Policy Review (& EIA if applicable) approval

by Approver Group

As required

Due date of next Review

(1 year after previous unless otherwise stated in policy)

June 2021

For publication to:

(If a summary version is to be published, then state NO for full version, and YES for the separate Summary version)

Intranet (Yes) PSOW website (No)

(if yes to website – please arrange translation)

 

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