Care & Support Services - Safeguarding Standards
Complaints
Complaints
Around 3.3 million people contact adult social services each year. The majority of those are happy with the service they receive.
Sometimes, however, mistakes are made and individuals may not always receive the care they require. This can be due to inappropriate placement within a facility or a shortfall in the level of care provided.
Many individuals fail to complain or report any problems, perhaps through fear or not realising that the care they are receiving is not appropriate.
This section explains the complaints procedure:
- Why individuals in social care are reluctant to complain
- What is a complaint?
- What do people complain about?
- Who can make a complaint?
- Complaints to Social Service departments
- Complaints to the NHS
- Complaints to professional bodies
On 18th October 2004, Stephen Ladyman, The Health Minister unveiled proposals to ensure that the adult social services complaints system is made simpler and faster and helps local authorities improve services by learning from mistakes. Although Ladyman's quote below refers to social services complaints and procedures, most people would identify with the central comments it contains. Response to complaints should ensure that recognition of the individual's needs are central to and appropriately involved in a process that is 'clear to understand', 'swift' and 'fair'.
"About 3.3 million people contact adult social services each year and the vast majority of users are happy with the service. However, people do not always receive the service they should, and mistakes are sometimes made. People deserve to be told what has happened when things go wrong, the resolution must be swift and the service should learn from its mistakes.
"I want to ensure that the service has the needs of the user at its centre, that it is a listening, learning and responsive service. The complaints process should not be an obstacle but a lever to improve services. Effective handling of complaints is part of delivering a better quality social service. This modernisation will ensure a user focussed service so that those who need to complain will find it a straightforward process with a swift, clear and fair response."
Reluctance to complain
Traditionally most people have been reluctant to complain, particularly about care and support services. There are many reasons for this including: - Knowing something is wrong, but just not having the courage to complain
- Fear of being seen as a nuisance
- Being worried that they will get labelled as a "troublemaker" and things will become more difficult for them
- Not being confident enough to complain on their own, needing support
- Reluctance to be identified, wishing to remain anonymous
- Concern that advice services may not be free of charge
Individuals with a learning disability response to making a complaint.
In 1995 Ken Simons, researching on behalf of the Joseph Rowntree Fund into Complaints Procedures and People with a Learning Disability, held a number of discussion groups with individuals with learning disabilities and their families exploring their wider attitudes to complaining. Simon's findings revealed the following 'barriers' to using the complaint procedures: - The negative connotations of being seen as 'moaning'
- Lack of knowledge about the procedures
- Concerns about the consequences of complaining and the complaint running away and becoming 'out of control'
- Concern over complaining about an otherwise valued service
- Reluctance to be critical of front line staff
- Concerns about pushing themselves forward at the expense of others in greater need
- A conflicting 'mixed' message from Social Service Departments as a result of previous experiences such as:
- Generally discouraging responses
- Poor experiences in other forms of participation
- Lack of commitment
- Implicit threats of withdrawal of service
- Particular difficulties about questioning a service in the independent sector
What is a complaint?
A complaint may not be widely defined in most regulations, however the Department of Health suggest a complaint may be generally viewed as:
'an expression of dissatisfaction or disquiet, which requires a response'.
In examining this description, it is perhaps the 'action' component of this representation that is key to how we consider the matter of making a complaint in the first instance.
On numerous occasions we may feel unhappy about something but we decide to limit how we express this. Furthermore we may choose, although still feeling unhappy, not to actively pursue the matter, so therefore there will be no response. Considering this statement, a formal complaint is the act of expressing the problem, either verbally or in writing, and wishing for it to be addressed. However we are aware that there are clearly many influences (see previous paragraphs) which can come into play affecting the initial decision as whether to activate a complaint.
What sort of matters do people complain about?
A decision to complain may surround such things as:
- An unwelcome or disputed decision
- Concern about the quality or appropriateness of a service
- Delay in decision making about services
- Delivery or non-delivery of services
- Decisions relating to placement or aftercare
- The management or handling of a case
- Quantity, frequency or cost of a service
- Attitude or behaviour of staff
- Application of various eligibility or assessment criteria
Of course it is possible that a matter can be resolved at a very early stage. In such cases there is no need to engage the formal complaints procedure, as this would be considered more as constructive feedback than a complaint.
Who makes a complaint?
This is generally the person who is the subject of the service provision (or service dispute) and/or their representative. A representative can act on behalf of someone who is considered incapable of making a complaint him or herself.
Complaints to Social Service Departments (Local Authority)
Some local authority complaint procedures are apparently approaching a point of change. Concerns about the membership, independence and decision making of Social Services Complaints Review Panels have been highlighted in the Department of Health consultation exercise 'Listening to People'.
New guidance has been issued in the form of the Department of Health Guidance document 'Learning from Complaints - Consultation on Changes to Social Services Complaints Procedure for Adults' (October 2004).
This guidance is due to be considered from April 2005 onwards. Some of its proposed changes surround: - Changes in investigation procedure and time limits. A reduction from three stages to two stages of by the local authority. These two stages are now deemed as (1) Local Resolution and (2) Formal Investigation
- Introduction (at what was previously the local authority third stage) of Independent Reviews by the Commission for Social Care Inspection
- Appointment of a Complaints Manager
- Time limit (in most cases) of 12 months for lodging of a complaint
- Procedures to operate alongside Vulnerable Adult Procedures
- Consideration given as to what advice and advocacy can be provided for the complainant
To make a complaint contact your Social Services Department who will inform and assist you in the process.
Complaints to the National Health Service
New guidance for National Health Service complaints was also introduced recently. The document 'Inspecting, Informing, Improving - Reforming the N.H.S. Complaints Procedure' was released by the Health Commission in July 2004.
A national evaluation of complaints was undertaken in 1999. The findings highlighted widespread dissatisfaction with the level of independence at the second stage of complaint and the lengthy nature of the procedure. In August 2002, the Department of Health decided that the second stage of the procedure should be removed from local NHS bodies and given to an independent organisation - the Healthcare Commission.
The Healthcare Commission is charged to establish and operate a demonstrably independent, consistent and timely process. The key elements to this process are: - Everyone will have the right to have their complaint reviewed by the Healthcare Commission
- Trained Healthcare Commission staff, working to defined time scales, will undertake the case review. This will reduce delays and ensure greater consistency in decision making
- The Healthcare Commission staff will have a wider range of options available to them to try to resolve the complaint
- Where the Healthcare Commission decides to take further action and investigate a complaint, and no resolution is secured following the completion of the investigation, the complainant will have the right to a hearing by a panel of three lay people
- Where complaints involve different aspects of care, such as a GP service, an acute trust or an ambulance trust, the Healthcare Commission will look at the whole of the patient's experience (removing the previous requirement to make separate requests for an independent review from each trust responsible)
- Where complaints involve both health and social care, there will be provision for joint investigations, panels or hearings with the Commission for Social Care Inspection (CSCI)
- The Healthcare Commission, with its responsibilities for inspection and audit of healthcare, is in a position to ensure that information from complaints is used to improve services by local organisations
The new NHS complaints procedure stresses that, wherever possible, issues should be addressed and resolved locally. Complaints therefore should be made in the first instance to the local trust that delivered the care under which the complaint is being made. The Department of Health has proposed ways of managing this local complaint process and has outlined these in the publication 'Making Things Right (2003)'. It should mean that the Healthcare Commission will only receive cases that are either serious in nature or the result of a breakdown in the relationship between the patient and the service. Over time, the Healthcare Commission would hope to see a reduction in the number of cases reaching the independent stage of the complaints procedure.
If attempts at resolving complaints locally are unsuccessful, every complainant will be informed that they have the right to a review of their case by the Healthcare Commission.
Mental Health Act Commission (www.mhac.trent.nhs.uk)
Patients who are detained under the Mental Health Act 1999 have the same rights as any other NHS patient to complain about their treatment and care. However, they have additional rights under this Act. The Mental Health Act Commission can investigate complaints made by a person who is legally detained about any aspect of their care.
Use of the Ombudsman
There are separate Ombudsman Services for:
Local Government Ombudsman.(www.lgo.or.uk)
Complaints can only be investigated if:
-It is about a matter of the law which underpins the services an authority is required to provide
-It is about maladministration by, or on behalf of, a council
-A person has been caused 'injustice' by the maladministration
-The council have had the opportunity to see the complaint, address and respond to it
National Health Service Ombudsman(www.ombudsmans.org.uk)
Anybody wishing to complain to the NHS Ombudsman must first have put their complaint to the NHS organisation or practitioner concerned, such as the hospital trust, Health Authority, the GP or the dentist.
Complaints to Professional Bodies
If you think that a professional person working in one of the caring professions has behaved towards you with unethical or unprofessional conduct*, you might want to complain to the body which is in charge of discipline for that profession. They cannot change decisions in cases or award compensation. Such governing bodies' role is to evaluate whether someone is fit to practice in that profession. It is a very serious matter to report an individual of the caring profession for unprofessional conduct. If allegations are proved, the person could be fined, struck off or suspended from the register of that profession.
The procedures surrounding this type of complaint are usually very formal. You have to prove your complaint and evidence can be challenged or be cross examined. You may be able to get some help to prepare your case but there is no legal aid to help pay any legal bills.
(*Unprofessional conduct means conduct that is not fitting for a professional person. It could include misuse of alcohol or drugs; sexual or emotional involvement with a patient/client or being convicted of certain criminal offences.)
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