The complaint was made by the parents of a young girl with a terminal illness who was cared for at a children's hospice early in 2008 before her death at home in August 2008. The Ombudsman investigated actions taken by HIW in response to concerns the parents had raised about their daughter's care at the hospice. The complaint to the Ombudsman also considered the role and actions of CSSIW and the Assembly Government in investigating subsequent complaints about the hospice and HIW's actions.
The Ombudsman upheld most aspects of the complaints against HIW and a complaint against the Welsh Assembly Government but not the Care and Social Services Inspectorate Wales (CSSIW). Specifically:
- The Ombudsman upheld a complaint that HIW failed to seek the child's perspective on her care, nor did HIW seek to ensure that the hospice was taking account of her views;
- The Ombudsman did not uphold complaints that HIW had mis-advised the hospice or threatened it with breaching the Regulations; however he upheld an aspect of the complaint which was that HIW focussed on the interests of hospice staff, rather than the child and her family;
- The Ombudsman upheld the complaint that there was a conflict of interest in HIW's investigation; the HIW reviewer was appointed as an 'independent investigator';
- The Ombudsman upheld the complaint that HIW's report failed to properly address the consent issues;
- The Ombudsman did not uphold a complaint that HIW threatened the hospice would be in breach of regulations if the child was not examined;
- The Ombudsman upheld the complaint that HIW failed to handle the complaints in accordance with the Welsh Assembly Government's Code of Practice on Complaints;
- The Ombudsman did not uphold a complaint about the roles and actions of CSSIW in investigating concerns about HIW and the hospice;
- The Ombudsman upheld a complaint to the limited extent that the Welsh Assembly Government could have intervened at an earlier time even though this is not part of WAG's Code of Practice on complaints.
In his report, the Ombudsman commented on his lack of jurisdiction for the hospice and that there was no other independent body that could investigate. He has asked the Welsh Assembly Government to consider what action, if any, it could take to bring the hospice into his jurisdiction.
The Ombudsman has also made a series of recommendations about improvements that can be made as a result of his consideration of this case, and these have been accepted by HIW and the Welsh Assembly Government.
A spokesman for HIW said:
"HIW apologises unreservedly for any additional distress that has been caused to the family by our actions in handling their complaints about aspects of their daughter's care.
"We accept the findings of the Ombudsman and have made improvements to our systems for investigating and handling complaints to avoid the risk of similar issues arising again.
"We will also be ensuring the recommendations made by the Ombudsman are fully implemented."
"We offer them our sincere condolences on the loss of their daughter."
A Welsh Assembly Government spokesman said:
"We accept the report's finding that we could have intervened at an earlier stage. We would like to assure the family that the recommendations will be pursued including that of introducing measures to improve our handling of complaints"
The Ombudsman's report is available on his website and that of the Assembly Government, HIW and CSSIW.