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Learning from complaints

Following its latest review of adult social care complaints, Dr Jane Martin explains the Local Government Ombudsman’s role in the care sector and how to realise the full benefits of the complaints system.

Winston Churchill said that all men make mistakes, but only wise men learn from them. This saying gets to the heart of why we, the Local Government Ombudsman, in our role as social care ombudsman, publish all of our social care complaints statistics on an annual basis.

In 2010, our powers were extended to look at complaints about all social care providers that can be registered with the Care Quality Commission. So we look at care complaints regardless of how the care is funded or who it is provided by, giving us a unique oversight of the whole market.

We recently published our second Annual Review of Adult Social Care Complaints to present the national picture of social care complaints.

Openness and Transparency

The reason we release our data is to support openness and transparency across the whole complaints system. I encourage care providers to use this data, alongside any other information they have, to scrutinise their own complaints system and to inform their conclusions on the quality of care and support given.

Our report builds on other work across the health and social care sector to ensure that complaints are welcomed and lessons are learned to improve standards of service.

Problems with signposting

Complaints to us about adult social care are on the rise. We received just over 2,800 complaints and enquiries last year. This is an 18% increase on the previous year’s total. While the amount we receive is small in comparison with the many thousands of social care users in England, each complaint and enquiry represents a story of an individual whose needs were not met by the local complaints process.

We know that the best way to resolve a problem is for the body responsible to put things right. We are the last port of call in the complaints process. Last year, we referred 37% of our complaints and enquiries back to the local council or care provider because they had not been given the chance to respond. This indicates to me that more could be done to help service users understand how they can raise their concerns locally.

We would recommend that:

  • Information is given in all care settings about how to raise a concern.
  • A complaint procedure is in place that sets out clear stages with timely responses.
  • Any information has a clear explanation of the Local Government Ombudsman’s role and details of how to signpost people to us.

Types of complaint

In the report, we distinguish between complaints about how a council carried out its duty to arrange care and complaints about quality of the care provided.

The greatest number of complaints about the quality of care provided relates to residential care. Some of the common issues include:

  • A lack of proper consideration of individual needs.
  • Poor communication with residents and family members.
  • Inconsistent and ineffective liaison with other agencies, including health providers.
  • Incorrect administration of medication.
  • Incomplete or inaccurate care records.

In one of the stories we highlight in the report, Stephen was asked to find another care home for his father who had dementia. His father had lived there for some years but staff could no longer cope with his deteriorating behaviour. The manager at a new care home expressed concerns that the medical administration records for Stephen’s father, which had been passed to her, had substantial gaps in them. Stephen complained to us on behalf of his father.

We found that a medication prescribed for problems with behaviour was frequently marked as not given, either because Stephen’s father was sleeping or refused it. There was no record that this had been raised with his GP or that other approaches had been considered, such as giving the medication before he went to bed.

As a result of our investigation, the care home reviewed and updated its policy on medications, apologised to Stephen and offered £500 for the distress caused by moving his father to another home. The story demonstrates the importance of properly understanding and meeting people’s individual needs to administer medication. It is possible that with a more systematic approach Stephen’s father may not have had to move home.

Putting things right

The Local Government Ombudsman has the powers of the High Court to investigate complaints. We are independent and impartial. If we find fault that has caused an injustice, we will recommend ways to remedy the situation. If we don’t find fault, we can help bring the matter to a conclusion. We made recommendations in more than 500 adult social care cases last year. Our recommendations always aim to put the people raising the complaint back in the situation they were in before the problem occurred, rather than ‘penalise’ the organisation at fault.

If we recommend a remedy payment, it could relate to a specific service that was missed or costs that were incurred because of a fault. Sometimes a payment will be recommended to reflect the distress caused and time and trouble somebody has gone to in pursuing their complaint.

We also always look at whether procedural changes are warranted to encourage learning from the complaint and avoid the same issue recurring. We know that one of the most common reasons for people deciding to complain is to hear somebody take responsibility for the issue and ensure others do not suffer. As such, a full apology is usually the first step to putting something right.

We have also published our staff guidance on recommended remedies. By doing this we hope that it will help those dealing with complaints to understand what we would consider a suitable remedy for different situations. Providers may also want to take a look at the published decisions of our investigations on our website to see examples of our decision making in specific situations.

Tip of the iceberg

It is worth remembering that complaint numbers alone are not an indication of good or poor service. On the contrary, high volumes may show an open attitude and accessible procedure. I would be more concerned about a service provider with little or no complaints than one that welcomes complaints as an opportunity to improve.

Where we carried out a detailed investigation, we upheld on average 55% of complaints, which means we found fault in how the council or care provider acted.

It is important that the public understand that they can come to us with any complaint about social care. The number of complaints we receive about self-funded care continues to rise year-on-year, but remains just over 10% of our total adult care caseload. The self-funded market exceeded £10bn in 2011, so it is likely that we are only seeing a small proportion of independent care complaints.

We know that not enough people are being advised of their right to access the Ombudsman if they cannot resolve their problem. Our customer research shows that nearly half of people using our service were not signposted to us. Care providers and councils need to ensure they provide clear information about complaints, including the right to access the Local Government Ombudsman.

Good practice

We use our annual review of complaints to make a number of proposals for the sector. Many partners are involved in arranging and providing social care. The end user should not be expected to navigate a complex maze. Care providers ought to take a ‘no wrong door’ approach to the complaints they receive and take responsibility for ensuring the right organisation receives the complaint.

If providers have contracts commissioned by councils, it is important that they check that those contracts clearly set out processes and responsibilities for responding to complaints and concerns.

Last year, alongside the Parliamentary and Health Ombudsman and Healthwatch England, we published My Expectations. This framework was produced with health and social care users and describes people’s own expectations of what good complaint handling looks like. We recommend adopting this person-centred structure as the framework by which to receive and respond to complaints.

Things go wrong. There’s no getting away from it. But only by welcoming feedback and reflecting on what can be learnt, will we see the benefits of the complaints system realised for everybody.

Dr Jane Martin is the Local Government Ombudsman. Web: Twitter: LGOmbudsman

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