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Learning the lessons from complaints

Following the publication of Caring about complaints, Local Government and Social Care Ombudsman, Michael King, explains the key things care providers can learn from his organisation’s investigations into social care services.

We are well known as the place to help people with unresolved problems about their council services, but we have also been the Ombudsman for independent adult social care providers in England since 2010.

For providers, this means we investigate complaints from people claiming to have suffered because of the actions (or inaction) of a provider. We are totally impartial and look at the issues from both sides. Where we find something has gone wrong, we make recommendations for the provider to put things right.

While it is important that people who have suffered have their situation fixed, solving individual problems one by one doesn’t make the most of our investigations to benefit the wider care system.

That is why I have recently published our first thematic report sharing the valuable lessons from our investigations with care providers. Despite the very real challenges facing the sector, by working constructively together, perhaps we can help improve the care experience for everybody.

Caring about complaints

Even with the best will in the world, sometimes things go wrong. When they do, the best organisations accept this and try to learn lessons that can improve things for all of the people using their services.

When we find fault in an investigation, in addition to the individuals affected, we always look for recommendations to improve services that will prevent further injustice. These may be practical things, like asking providers to review certain practices, improving their information for services users, or undertaking staff training.

Our report – Caring about complaints – summarises the major areas where we find issues in care provider investigations, in the hope of helping other providers avoid the same mistakes. It is based around a range of real case studies from our published investigations. But it also distils some of the major ‘service improvement’ recommendations into good practice tips that providers can adopt.

Fees, charges and contracts

This area is one of the most common issues we see in complaints about care providers. People often come to choose care services at a time of crisis, while they are struggling to understand a, frankly, complex system. They rely heavily on the professionals to help them make informed decisions, and can only do so if they are given accessible, clear and complete information – before a contract is agreed.

Care providers can learn from our cases by ensuring all fee scenarios are explained at the outset, so there are no surprises later. The report features an investigation where a care provider gave inadequate and misleading information about fees, leaving a family understandably taken aback by a large increase in fees when their mother moved from NHS Continuing Healthcare funding to self-funding. This is the sort of situation that could be avoided by making sure that all parties are clear on fees and charges before they are engaged in a contract.

Billing and invoices

It will seem obvious to say that invoices should be accurate, timely, and properly reflect the services provided. However, we regularly uphold complaints where people have been charged for services they didn’t receive. Keeping accurate records and audit trails of services agreed and provided will help to resolve any disputes arising from invoicing.
Providers should also ensure that cancellation periods are clearly set out in the contract, as well as the terms under which fees may change, including fair warning of price uplifts.

Protecting belongings

It is good practice for care providers to have robust systems in place to safeguard valuable items. Typically, they should keep an updated inventory of residents’ valuables and offer a secure place, such as a safe, or a lockable drawer.

We highlight some investigations in the report where providers failed to protect peoples’ personal property and belongings. In one case, the care provider agreed to our recommendation to introduce a new procedure for logging all items moved in and out of its safe, after a care home resident’s wedding ring went missing.

If belongings do go missing, we expect providers to investigate matters properly to try to find out what happened. They should also have suitable insurance in place and the contract with the person using the services should not attempt to exclude liability for negligence.

Giving notice and family disputes

When we are investigating complaints, we expect the contract between the person using services and the care provider to be clear about when the parties can give notice and how long the notice period is.

If a care provider gives notice because it can no longer meet a person’s needs or care for them safely, the contract should also have a term that deals with this. In this event, the care records should show how a person’s needs have changed.

We have investigated cases where a care provider has given notice because the relationship between staff and relatives of the person they are caring for has broken down, or where the provider has sought to ban certain relatives from visiting. In fact, care providers that attended our recent programme of engagement events raised this as a hot topic of discussion.
If a provider is looking to give notice, it should discuss its plans with relatives beforehand to give them an opportunity to comment. When dealing with disputes with family members, providers should have clear procedures in place that they follow and, crucially, communicate to relatives. It is good practice to have a review period, after which the situation can be reassessed.

Care planning

A vital element of good quality care is having an up-to-date assessment and care plan, that clearly sets out the person’s needs and preferences. Care plans should be reviewed regularly, or when there is a change in the person’s circumstances.

When investigating complaints about the quality of care, we are likely to find fault if care is not being delivered according to the care plan, or if care plans have not been reviewed and updated to address a person’s needs.

In a case highlighted in the report, care workers giving live-in care to a man with dementia and terminal cancer decided to lock the door because they were worried he may place himself at risk by leaving the house at night. However, we found his care plans were not up to date, and made no mention of needing to lock the door. If there were concerns over the man’s mental capacity to leave the house, there should have been a proper discussion with relatives and an appropriate course of action should have been decided. The provider agreed to change its procedures so that care workers reported changes to a person’s condition, which would trigger a review of the care plan.

Complaint handling

While we investigate a relatively small number of complaints compared to the amount of care given nationally, there is useful insight from our cases.

It is common for us to find some issues with the way in which a complaint has been handled in care provider investigations. This may include things like delays in responding, poorly evidenced decisions or not explaining the reasoning.

Care providers should have complaint processes that are easy for people to find and use. The procedure should also tell people about their right to come to us for a free, independent review of their complaint if they remain unhappy with the provider’s response. Since we started investigating independent care providers nearly 10 years ago, the numbers of complaints we have received has increased year on year. I welcome that some of this can be attributed to the proactive approach of a growing number of care providers that correctly signpost people to us.

Caring about complaints includes details of the guidance we produced with Healthwatch England, in consultation with the sector, under the ‘Quality Matters’ initiative.
The key principles of managing compliments and complaints are:

  • Fairness.
  • Leadership.
  • Customer first.
  • Valuing and encouraging feedback, compliments and complaints.
  • Accepting something went wrong.
  • One complaint, one response.
  • Clear signposting to independent redress.

I would also urge care managers to welcome feedback and place the person’s needs at the heart of the complaint procedure. A full version of the guide is found on our website.

How we can help you

We work closely with the Care Quality Commission to share information about our cases to inform inspections. However, it is only us who can look at complaints from individuals where something has gone wrong that has personally affected them.

We also provide a range of resources to help care providers with their complaint handling, including:

  • Template complaint procedure documents.
  • Leaflets and posters to print.
  • Care provider e-newsletter.
  • Complaint handling training courses.

For those wanting to know more about what happens when we receive a complaint about a provider’s organisation, I would encourage you to read the section of our report that explains some of the basics of when and how we investigate.

My experience is that the vast majority of care providers work with us in a mature way to remedy injustices. I want to encourage everyone to emulate this behaviour and learn the lessons from these cases.

Michael King is Local Government and Social Care Ombudsman. Twitter: @LGOmbudsman

How do you handle complaints from the people you support? Do you have a positive experience to share? Give us your feedback on this article and spread your knowledge by leaving a comment below.

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