SCIE Guide 15: Dignity in care

Complaints

Many people find it difficult to complain for a number of reasons. It may be difficult for them to find their way around the system, for example because English is not their first language, or because they have a cognitive impairment. Some people are reluctant to complain because they worry that their service may be withdrawn. They may fear being seen as a 'trouble maker’ and being treated differently as a result of their complaint; this concern was raised repeatedly in Healthcare Commission inspections (Healthcare Commission et al., 2006). Being able to complain without fear of retribution was also raised in the Department of Health (DH) online survey (DH, 2006d), alongside a need for clear and simple complaints procedures. It may be particularly difficult to make a complaint about someone providing a face-to-face service on a daily basis - for example a home-care worker or residential staff - particularly if the complaint only applies to one aspect of their otherwise good work.

It is important to ensure that there is a fair, open and honest culture around complaints so that:

• people feel confident in bringing concerns to the attention of service providers
• staff and managers view complaints as a means of ensuring that the service is responsive, and not as a threat
• problems are picked up at an early stage and lessons are learned which lead to service improvements
• poor practice is highlighted and rectified
• vulnerable people, or those who find it difficult to make their views heard, are protected and have access to adequate support.

If people feel comfortable in raising concerns with frontline staff - and staff act promptly to address the issues raised - then escalation to the official complaints procedure is less likely and resources used on complaints can be kept to a minimum. Service user forums, particularly in residential settings, may help people to feel more comfortable in raising concerns. Such forums can also offer non-bureaucratic opportunities for service users to influence change. Acting promptly can help to reassure people that their complaints will be listened to and that it is not necessary to enter into a bureaucratic process to get a good response. As one practitioner put it: 'If you complain that your breakfast is cold, you don’t want to go through the complaints procedure - you want a hot lunch!’

As part of the drive to ensure dignity in care the Department of Health has issued new regulations on complaints procedures for adult social services. The new procedures emphasise the significance of providing an accessible, customer-focused service that encourages people to speak out about their experiences - both good and bad - and to challenge poor practice when they come across it. In addition, timescales for resolution at all stages of the process have been shortened and the independent review panels now have a more precise and focused brief to ensure less variation between local authorities and a more consistent response to complainants against measurable frameworks. The new procedures, Learning from Complaints, came into force on 1 September 2006.

There is also guidance for NHS complaints managers: 'Supporting staff, improving services - guidance to support the implementation of the NHS (complaints) amended regulations 2006'.

There is a commitment in the White Paper, 'Our health, our care our say' (DH, 2006f), to introduce a single complaints process covering both health and social care in the near future.

Standard 16 of the national minimum standards for care homes (340kb PDF file) (DH, 2003a) requires that 'there is a simple, clear and accessible complaints procedure which includes the stages and timescales for the process, and that complaints are dealt with promptly and effectively’.

How to complain

It is sometimes difficult to know who to complain to and this will depend on the type of service in question and the regulatory body concerned. For example, you may want to complain about a council activity, such as an assessment, or a service commissioned by the council such as residential care. Each organisation should have in place a complaints procedure. You should be able to get an information leaflet on this from the organisation concerned. The information leaflet should be available in different languages on request.

Points to remember

• Where possible, approach the service first to see if the problem can be resolved at an early stage. If this is not an option (for example, because the complaint is about the manager or because the service user fears reprisals) it may be more appropriate to approach the commissioning or regulatory body instead.
• If the problem cannot be resolved informally, ask for a copy of the organisation’s complaints procedure.
• Keep a record of any phone calls, letters or conversations with staff regarding your complaint.
• If you are not satisfied with the outcome of the complaint you can refer it to an external body or ombudsman. The complaints procedure should give you information on who to contact if you are not satisfied.

Help with complaining

The charity Counsel and Care have produced a factsheet that offers a comprehensive guide to complaining about health and social services.

• Complaining about community care and NHS services in England (334kb PDF file)

The Department of Health offers guidance on how to complain about

• the NHS
• local social services

Find your local council at Direct Gov.

If you find the process complicated or daunting you may be able to access local advocacy services.

For more on advocacy support, see also the section on Autonomy.

Some charities may be able to help.

• Help the Aged have a free advice line: SeniorLine 0808 800 6565
• Age Concern information line: 0800 009966

The Independent Complaints Advocacy Services (ICAS) 'supports patients and their carers wishing to pursue a complaint about their NHS treatment or care’.

All health trusts have a Patient Advice and Liaison Service (PALS), which can help explain complaints procedures.

Regulatory bodies

Each organisation is monitored by a regulatory body. The list below outlines which authorities should be contacted. (Note: Day services are Unregulated).

The Commission for Social Care Inspection (CSCI) regulates:

• Care homes (residential care homes providing personal care including the provision of intermediate care and short breaks)
• Nursing homes
• Domiciliary care agencies/home care services
• Nurse agencies
• Adult placement schemes
• Local authority social services departments

The Healthcare Commission (HCC) regulates:

• All NHS trusts and primary care trusts, which are responsible for:
  hospitals, GP practices, community teams, intermediate care services in hospital
• Hospices, private clinics and private hospitals (these are licensed by the HCC)

The Housing Inspectorate (part of the Audit Commission) regulates social housing. Complaints are handled by the Housing Ombudsman Service or, for housing association complaints, The Housing Corporation.

The Counsel and Care factsheet (334kb PDF file) gives some guidance on which organisation should be contacted under what circumstances.

The Commission for Social Care Inspection (CSCI) is responsible for the regulation and inspection of care homes and services, and the inspection and performance ratings for local councils, See the CSCI's guide to how to complain about services

The Local Government Ombudsman investigates complaints about how councils have carried out their business. This is a free and impartial service. The Ombudsman will usually only take up a complaint if the local authority’s complaints procedure has failed to resolve the matter. However, the Ombudsman can make exceptions to this policy, for example if the situation needs to be resolved urgently.

The Audit Commission 'is an independent body responsible for ensuring that public money is spent economically, efficiently and effectively, to achieve high-quality local services for the public’. Its remit covers a number of local public services, including social services and housing.

The Healthcare Commission is responsible for complaints about the NHS and independent health services that have not been successfully resolved at a local level.

The Health Service Ombudsman investigates 'complaints about unfair or improper actions or poor service by UK government departments and their agencies, and the NHS in England’.

Professional bodies

Many professionals, including doctors, nurses and social workers, are required to register with a professional body. These organisations aim to protect the public by setting and maintaining standards within the professions, by publishing codes of conduct, registering individuals and monitoring continuous professional development. Serious misconduct by an individual can be reported to these bodies.

• The General Medical Council - register all doctors
• The Nursing and Midwifery Council - register nurses and midwives
• The General Social Care Council - registers social workers
• The General Dental Council - registers dentists, dental nurses, dental technicians and orthodontic therapists
• The Royal Pharmaceutical Society of Great Britain - registers pharmacists and their premises
• The Committee on Standards in Public Life monitors the standards of people working in public office, including councils

Performance indicators

Star ratings for local authorities aim to indicate how well an authority is performing, they are published by the Commission for Social Care Inspection.

CSCI have plans to publish star ratings for individual care homes and services. Currently you can find information about a service by reading their inspection report:

Performance indicators for NHS services are set by the Healthcare Commission.

Patient Opinion is a website that allows patients to feed back and share information on their hospital experiences.

Judicial review

If you think that a public body has made an unlawful decision you may want to challenge that in the courts. The route for such challenges is judicial review. You can find more information about judicial review at the Public Law Project, which 'aims to improve access to public law remedies for those whose access is restricted by poverty, discrimination or other similar barriers’.

Ideas from practice

Practice examples are self-reported and have not been evaluated.

• Easy access to information and help (Caterham Dene Community Hospital)
• Electronic feedback for constructive criticism (Partnership Health Group (PHG)
• Linking Essence of Care into reviewing complaints (Derbyshire Mental Health Trust)
• Anticipating concerns before they become complaints (Addenbrooke’s Hospital, Cambridge University Hospitals Foundation NHS Trust)
• Gauging patient satisfaction (The West of Cornwall PCT)
• Improving first impressions (Stockport NHS Foundation Trust)