Concerns about a care service
The Social Care Institute for Excellence (SCIE) provides guidance on what works in social care to enable those in the sector to improve practice. It is not within the remit of SCIE to deal with, respond to or advise on complaints about individual care or health services.
There are a number of ways in which you can challenge poor standards of care or raise concerns or complaints. This short guide provides the options open to you if you are unhappy with a social care service.
Call 999 for an emergency (e.g. a crime is currently being committed). You can also contact the police on 101 for non-emergency situations.
Safeguarding concerns about a child or young person (under 18 years of age)
Safeguarding concerns about an adult
Poor care or service quality
- Raise a concern with the care provider in the first instance, this would usually be with the manager. If your concern is about the manager you could contact more senior staff such as trustees or directors.
- Contact the local authority, they should be able to direct you to the relevant team. The local authority also has a team dedicated to dealing with complaints.
- Information is available on how to complain about NHS services
- Contact the Care Quality Commission (CQC), it is responsible for registering care and health care providers and monitoring the standards of care. The CQC will not investigate individual complaints but it can file information for intelligence about services or take measures to look into the quality of a care if concerns are raised about a service.
- The Office for Standards in Education, Children’s Services and Skills, OFSTED, can be contacted for concerns about children’s residential care services.
- The Children’s Commissioner is a relatively new service They offer support and can deal with complaints from people in or leaving care (to the age of 25 years old).
Both the care provider and the local authority should give you information on the relevant complaints procedures. If you follow the complaints procedure and you are dissatisfied with the outcome you can contact the ombudsman.
- The Local Government Ombudsman considers complaints about councils and all types of care service for adults in England. Everyone has access to the same independent ombudsman service, regardless of how the care service is funded. There is a complaints scheme for self-funders (people paying for their own care and whose care is not arranged or provided by local authorities).
- The Parliamentary and Health Service Ombudsman investigates complaints about unfair or improper actions or poor service by UK government departments and other public organisations, and the NHS in England.
- Unresolved complaints about housing are handled by the Housing Ombudsman Service.
How to complain about care services
When making a complaint about a service:
- Try to resolve the problem at an early stage by talking to staff or managers at the service first.
- If your concern is about the manager you could contact more senior staff such as trustees or directors.
- If the problem cannot be resolved informally, ask for a copy of the organisation’s complaints procedure; it should outline the process for taking the matter further. At this point you may also want to make contact with the Care Quality Commission (CQC) or the local authority that funds the service.
- Put your complaint in writing and keep a record of any related correspondence or phone calls.
- If the outcome of the complaint is unsatisfactory, it can be referred to the commissioning or funding authority (usually the local authority or NHS). The complaints procedure should give information on who to contact.
- If the service or local authority is unresponsive you can approach your local councillor or MP They may be able to help.
- If the complaint is not satisfactorily resolved locally, contact The Local Government Ombudsmanor The Parliamentary and Health Service Ombudsman.
- If the complaint is about poor quality or standards, The Care Quality Commissionshould be informed.
- If all other avenues have been exhausted, and the commissioning authority is thought to have failed in its statutory duties, the issue can be taken to judicial review. This is a High Court hearing that will examine whether the authority in question has correctly interpreted and followed the law. This option can, however, be very costly as legal assistance may be needed. Some campaigning charities may provide legal support to pursue certain cases.
Help with complaining
- If you need support with making a complaint, ask the service if it can provide it. Your local authority should provide, or have links with, a local advocacy service. The Care Act 2014 entitles people with care and support needs and carers to advocacy support in certain circumstances.
- Some charities, for example Age UK, the Alzheimer’s Society or Mencap may be able to provide support with complaining.
- If you think that a public body has made an unlawful decision, you may want to challenge that in the courts through judicial review – The Public Law Projectmay help you with this process.
- Citizens Advice offers guidance on complaining about health and social care services.
- For NHS complaints, The Patient Advice and Liaison Serviceis there to help.
- Healthwatch England gathers and represents the public's views on health and social care in England. It operates both on a national and local level and ensures that the views of the public and people who use the services are taken into account.
- Patient Opinionis a patient feedback website for sharing information on hospital experiences.
Social care complaints regulations
The complaints procedure for adult social care is set out in regulations, which cover both the local authority and NHS procedures.
- The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009
- The Local Authority Social Services and National Health Service Complaints (England) (Amendment) Regulations 2009
The regulations provide a framework for those handling a complaint relating to a local authority’s social care functions – this includes directly provided services and independent services provided through commissioning. The actions, omissions or decisions of the local authority in respect of a social care function are covered; the regulations do not, however, apply more generally to independent providers.
People who are paying for their own social care (self-funders) may complain to the local authority, for example about assessment, or failure to assess. Services people have arranged or purchased themselves are not covered but the local authority could be challenged if they commission those services. For example, on why they have commissioned a sub-standard service, or whether they are performance managing contracted services sufficiently.
Self-funders should raise concerns about their service with their care provider in the first instance. All providers are required as part of their registration requirements with the CQC to have a complaints procedure. If the complainant is not satisfied with the response they receive, they also may ask The Local Government Ombudsmanto investigate.
The duty of candour
The duty of candour requires registered persons (carrying out a regulated activity in health and care services) to be open and honest. When things go wrong they must make an apology and explain to those concerned how things will be rectified.
The duty is a direct response to recommendation 181 of the Francis Inquiry report into Mid Staffordshire NHS Foundation Trust (2013). The duty comes under Regulation 20 (the Care Act amends the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014).
See the CQC for further information.
Many professionals, including doctors, nurses and social workers, are required to register with a professional body. These bodies 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 Health and Care Professions Councilregisters 16 different professions including social workers in England, speech and language therapists, physiotherapists, occupational therapists, chiropodists and dieticians.
- The General Medical Council– registers all doctors.
- The Nursing and Midwifery Council- registers nurses and midwives.
- 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 Lifemonitors the standards of people working in public office, including councils.
Information for workers and service providers
Preventing formal complaints:
- Be clear about what people can expect from your service.
- Promote a fair, open and honest culture around complaints.
- See complaints as an opportunity to improve things, not as a threat.
- Encourage feedback, whether positive or negative — forums for people who use services and their families may help people to feel more comfortable and confident in raising concerns.
- Encourage early identification of problems to help prevent complaints at a later date.
- Try to resolve complaints at the earliest stage – known as the 'informal' stage – to instil confidence in the organisation.
- Make sure that people who may have difficulty making their voice heard (e.g. people with dementia or people from black and minority ethnic groups) receive appropriate support including advocacy.
- Empower staff to feel that they can influence change.
- Document informal concerns and complaints.
- Provide support for staff who are the subject of complaints.
Dealing with formal complaints:
- Ensure staff are properly briefed on the complaints procedure.
- Offer support such as independent advocacy to the complainant where required.
- If the complaint is about a staff member, try to focus on the reasons for their actions rather than blame and ensure they have access to support.
- Keep response timescales as short as possible.
- Ensure the complainant is kept informed of progress.
- Give a clear report of the outcome of the complaint and information on what to do if the complainant is not satisfied.
- Where the complaint is justified – make a sincere apology.
- Learn from complaints and implement changes so that people can see that their complaint has made a difference.
- Monitor complaint outcomes and levels of satisfaction.
Whistleblowing for employers
Staff should be encouraged to raise concerns, at first internally, so that they can be dealt with promptly.
Organisations that do not respond to such concerns put themselves at risk to exposure of any wrongdoing through employees blowing the whistle externally.
The advantages of supporting people who raise concerns include:
Why it's important
- protecting staff, people using the service and the public
- maintaining and protecting the organisation’s reputation
- deterring wrongdoing
- minimising risk by picking up potential problems early
- improving performance and management awareness
- improving staff morale and reducing turnover
- demonstrating that the organisation is accountable and well managed
- reducing the risk of anonymous and malicious leaks
- minimising costs and compensation from accidents, investigations and litigation.
- implement a whistleblowing policy
- encourage staff to report concerns and ensure they understand they will be supported and offered protection if they make a disclosure
- take time to listen to new staff – they will have a fresh perspective on practice within the organisation
- ensure that staff understand how to raise concerns outside the organisation and how to get independent support
- include whistleblowing awareness in induction, supervision and training
- give staff information on external means of support such as Public Concern at Work and Citizens Advice
- support trade union membership.
See the Department of Health Whistleblowing Guidance for Employers and Code of Practice
Whistleblowing for employees
Where there is no threat of immediate danger, whistleblowers should protect themselves. Potential whistleblowers should prepare carefully to make a disclosure, making a note of any relevant evidence (for example, record dates, times and the names of any witnesses), seek support and take external advice, possibly from Public Concern at Work, Speak Up, a voluntary advice service or trade union.
Consider the following whistleblowing do’s and don’ts:
- keep calm
- think about the risks and outcomes before you act
- remember you are a witness, not a complainant
- seek confidential advice
- forget there may be an innocent or good explanation
- become a private detective
- use a whistleblowing procedure to pursue a personal grievance
- expect thanks.
(Van Den Hende, 2001)
The law offers some protection to people who blow the whistle under the Public Interest Disclosure Act 1998. The Act offers protection, from victimisation in employment following a disclosure, to public, private and voluntary sector workers. The parameters of ‘protected disclosure’ are set out in the Employment Rights Act 1996 (ERA). The person making the disclosure should not commit an offence in doing so (e.g. breach the Official Secrets Act 1989) and must reasonably believe one or more of the following:
- that a criminal offence has been committed, is being committed or is likely to be committed
- that a person has failed, is failing or is likely to fail to comply with any legal obligation to which he is subject
- that a miscarriage of justice has occurred, is occurring or is likely to occur
- that the health or safety of any individual has been, is being or is likely to be endangered
- that the environment has been, is being or is likely to be damaged
- that information tending to show any matter falling within any one of the preceding paragraphs has been, is being or is likely to be deliberately concealed. (ERA,1996)
Seek advice from:
- Public Concern at Work is a whistleblowing charity. It offers advice to individuals and support organisations with their whistleblowing arrangements
- Speak Up offers free, independent, confidential advice on the speaking-up process (whistleblowing). It is specifically aimed at employees and managers of NHS and social care organisations in England and Wales. Tel: 08000 724 725.
- The NSPCC has a dedicated whistleblowing advice line
- A quick guide to raising a concern with the CQC
- The Department of Health: Whistleblowing for employees
- SCIE film on whistleblowing