An investigator’s view: Anne Doswell-Moore
Complaints in care settings can arise through simple misunderstandings or genuine dissatisfaction. Usually, discussing the matter can determine the cause and a satisfactory solution may be found. A record should be made of the concern, whether it is made verbally or in writing.
Information from complaints often provides an opportunity to learn from any mistakes and offers opportunities not to repeat any failings. Effective complaint handling also demonstrates and promotes a culture of transparency, improvement and service development. No one should feel afraid to make a complaint or feel threatened by the outcome. The attitude should be, ‘If we get it wrong, we want to get it right’. This allows for a full, thorough, fair and open investigation.
That all sounds obvious, doesn’t it? However, you would be surprised how often this doesn’t happen. As a Complaint Investigator, the most frequent observation I hear from complainants is that they don’t feel listened to. By the time someone makes a complaint, often a lot of time has been spent deciding whether to make a complaint and emotions are running high.
This can often lead to an emotional and hard-hitting letter of complaint. It is vital that you take a step back and work through the complaint to establish what the complaint (or multiple complaints) and desired outcomes are. Once you have this, you can then begin formulating a plan on how to deal with the complaint(s) effectively.
Gathering the evidence
The providers I have worked with have fallen into two categories: I have either been investigating them on behalf of someone else, for example, a local authority, or as part of an investigation on their behalf. In both categories, a very common feature is that the expectations at director level about practice do not match what is being delivered by the wider team.
For example, a director of a company whose organisation had been complained about by a former service user gave me a thorough, open and heartfelt description of the services provided by the organisation and how it worked. Statements included: ‘That would never happen here, the staff are all trained and know what to do’ and ‘No, we just don’t allow that.’ They had undertaken an internal investigation but did not take the time to speak with individual staff members in depth, instead referring to the written recordings of the issue as their main focus of the investigation. This led to an unsatisfactory resolution and I was then commissioned to undertake an independent investigation.
During the investigation process and from talking with staff, it transpired that practice was very different. The lesson learned here is that far more information can be gleaned from speaking to people involved in an incident than taking the information from a form.
When this was highlighted, the attitude from the provider was a positive one to improve communication throughout the organisation.
I asked some of the organisations I’ve worked with what they felt the benefits of using an independent person had been. The responses were quite eye opening. People referred to feeling ‘too involved in the complaint to be impartial’, ‘feeling distressed’, and ‘witnessing first-hand the negative impact that the complaint had had on the team as a whole’. Some had been advised by their insurance companies that apologising to the complainant could be construed as an admission of fault and leave them at risk of legal action. This is in direct conflict with the provider’s responsibility to be open and transparent and can further damage the relationship with the complainant.
Even though I upheld the complaint, I was able to offer a clear and concise report of my findings, which enabled me to work with the provider to develop an action plan for improvement. Acting in this way can enhance your reputation as a provider with commissioners and regulators; it demonstrates a positive culture of transparency and honesty and should satisfy the complainant that they have been taken seriously and lessons have been learned.
Communication is key
Generally, the most common factor in why a complaint has occurred is poor communication. Whether this is down to misunderstandings, staff not being trained properly and/or a lack of understanding, all of this can be easily remedied.
I am often asked if investigating complaints is depressing. Well, it can be, but for me it is about justice, putting things right and making changes and improvements that benefit all parties involved in the service. This is the rewarding part of the job that drives me in what I do.
Investigating complaints is undoubtedly time consuming and costly; however, a care service is judged on how well it deals with complaints. If not done thoroughly and without bias, this can have a huge impact reputationally, locally with commissioners and nationally with regulators.
Conversely, if the complaint has been taken seriously, thoroughly investigated, with findings backed up by evidence, then even if the complaint is not upheld there is usually a level of satisfaction from the complainant resulting in a satisfactory resolution to the complaint for all parties.
A solicitor’s view: Neil Grant
Understandably, lawyers focus on legislation, guidance and case law when approaching matters of legal compliance in the health and social care sector. However, what Anne Doswell-Moore highlights is the importance of one’s mindset in responding to complaints. The law may provide the framework within which providers operate. However, compliance is about attitude, capacity, capability and a relentless focus on doing the right thing.
CQC is changing the way it regulates the sector in a practical sense. Details of CQC’s ambitious new strategy are available at www.cqc.org.uk/about-us/how-we-will-regulate/ In summary, its performance assessment framework is changing, as is its regulatory methodology. Scheduled inspections have been replaced with inspections based around an ongoing assessment of risk. Central to this exercise is a far greater focus on feedback from people using services, as well as from families, friends and advocates. Indeed, CQC has said it wishes regulation to be driven by the needs and experiences of people using health and social care services.
It is therefore not surprising that complaint handling forms a central component of the quality standards which are due to be implemented in 2023.
Under ‘Responsive’, there is a quality statement titled ‘listening to and involving people.’ It states: ‘We make it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. We involve them in decisions about their care and tell them what’s changed as a result.’
This quality statement is specifically linked to Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which covers receiving and acting on complaints. The statutory requirement is simple and concise:
- Any complaint received must be investigated and necessary and proportionate action must be taken in response to any failure identified by the complaint or investigation.
- The registered person must establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users and other persons in relation to the carrying on of the regulated activity.
Anne’s insightful comments cover point one above, with a focus on taking necessary and proportionate action in response to complaints. However, this needs to be underpinned by an accessible system for handling complaints by service users and other persons which must then be operated in an effective manner.
Sometimes providers try to separate out formal from informal complaints. I have come across cases where verbal complaints have not been recorded as a formal complaint, only those in writing. In another case, complaints sent into a provider from CQC were recorded separately, not on the complaints log. However, all complaints need to be logged in one place to enable any themes or trends to be identified.
Complaints policies will need to highlight the right of publicly funded service users to take their complaint to the public body funding their care. Furthermore, all service users have the right to take their complaint to the Local Government & Social Care Ombudsman, including private payers. If a complaint is investigated and upheld by the Ombudsman it will seek to put things right, which may include a request that the care provider apologises, changes its procedures or makes a payment.
Providers must also highlight how people using their services can take any concerns to CQC. While CQC is not a complaints body, it will consider whether the issues in the complaint are relevant to compliance under its jurisdiction.
CQC also highlights how it will monitor complaint handling in its closed culture guidance, which is available at www.cqc.org.uk/guidance-providers/all-services/how-cqc-identifies-responds-closed-cultures
Key to success
All complaints need to be treated seriously but that does not mean that they should be assumed to be true. There will be unmerited complaints, while some may even be malicious. However, the key point is that care providers and managers need to investigate the matters dispassionately and present evidence to show the complaint is unfounded. Of course, if the complaint is upheld then necessary and proportionate action should be taken in response.
Effective complaint handling is crucial to the success of any care business. It will point to an open and receptive culture, as well as effective governance. As well as being the right thing to do, proper complaint handling is essential to compliance and ratings. Over 50% of CQC inspections now occur because of information of concern deriving from complaints, whistleblowers and safeguarding referrals. If you have such an inspection there is a far greater chance that your rating will be downgraded. This in turn will affect the capital value of your business as well as opening you up to the risk of regulatory intervention. It is far better to get it right and place complaints at the centre of what you do well within your business – a source of pride rather than consternation.
Anne Doswell-Moore is an independent Complaint Investigator. Email: [email protected]
Neil Grant is Partner at Gordons Partnership Solicitors. Email: [email protected] Twitter: @GordonsPartners
How do you handle complaints in your service? Has this made you think of your procedures from a different perspective? Let us know your feedback in the comments section below.