A Scoping Study of Complaints Procedures in Wales. for the Older People s Commissioner for Wales

Transcription

1 A Scoping Study of Complaints Procedures in Wales for the Older People s Commissioner for Wales Susan Lambert July 2010

2 The Older People s Commissioner for Wales Cambrian Buildings Mount Stuart Square Cardiff CF10 5FL Tel: ask@olderpeoplewales.com Designed at Design Stage

3 Contents Contents Page Acknowledgements 7 Foreword 9 Chapter 1 Executive Summary Introduction Overview of statutory complaints procedures in the public sector Complaints procedures in local authorities Complaints about services regulated by Care and 14 Social Services Inspectorate Wales (CSSIW) 1.5 Complaints procedures in the NHS Public Services Ombudsman for Wales Complaints procedures in Wales, future developments Conclusion 18 Chapter 2 Introduction Introduction Aim Objectives Methods and timescale of study Older People and complaints 24 1

4 A Scoping Study of Complaints Procedures in Wales Chapter 3 Overview of Statutory Complaints Procedures 25 in the Public Sector 3.1 Welsh Assembly Government guidance to local authorities Private and independent care sector provider complaints regulations Welsh Assembly Government guidance to the NHS Public Services Ombudsman for Wales Joint complaints arrangement across public services UN Principles for Older Persons (1991) Other key principles of complaints procedures 28 Chapter 4 Complaints procedures in Local Authorities What is a complaint? Who may make a complaint? Information about how to complain Encouraging service users to complain Complaints procedures Volume of complaints to local authorities Reasons for complaints to local authorities by all 36 complainants and older people 4.8 Equality monitoring Older People and complaints Advice, Support and Advocacy Complaints involving independent providers and the NHS Commentary on complaints procedures Corporate complaints Pressures on complaints teams Examples of good practice Making complaints arrangements more accessible to older people Issues for the Older People s Commissioner to consider 47 2

5 Contents Chapter 5 Complaints about services regulated by the 48 Care and Social Services Inspectorate Wales 5.1 CSSIW regulations and remit CSSIW: Complaints statistics Domiciliary care Adult protection: domiciliary care CSSIW complaints statistics: care homes Adult protection: care homes Compliance and enforcement: domiciliary care and 53 care homes 5.3 CSSIW staff interview Issues for the Older People s Commissioner to consider 55 Chapter 6 Complaints procedures in the NHS NHS complaints definition and model NHS Complaints Statistical Data 2008/ Hospital and community services Complaints to Family Health Services 2008/ Community Health Council Complaints Advocacy Services 59 Report 2008/ Survey of NHS Complaints Officers Examples of good practice Feedback from NHS Complaints Officers Network meeting Making complaints arrangements more accessible to older people Issues for the Older People s Commissioner to consider 69 Chapter 7 Public Services Ombudsman for Wales Complaints by public sector provider Outreach, advice, voluntary and advocacy organisations Interview with PSOW staff 72 3

6 A Scoping Study of Complaints Procedures in Wales 7.4 PSOW and Older People NHS complaints Private Care Providers Inter-agency complaints Advocacy Issues for the Older People s Commissioner to consider 74 Chapter 8 Complaints procedures in Wales, future developments Model Concerns and Complaints Policy Interview with PSOW staff Research findings: the adequacy of local authority 78 Independent Panels 8.4 Interview with Welsh Assembly Government staff Putting Things Right - NHS complaints reforms Complaints Signposting Service Issues for the Older People s Commissioner to consider 83 Chapter 9 Conclusions 84 Objective 1 Working definition of complaints as referred to in the 84 Commissioner for Older People (Wales) Act 2006 Objective 2 Identification of principles against which current 85 arrangements can be judged Objective 3 Overview of Welsh Assembly Government guidance 85 on public sector complaints arrangements Objective 4 Overview of how complaints arrangements are 86 monitored and reviewed Objectives 5-6 Variations in practice, examples of complaints 87 procedures 4

7 Contents Objective 7 Overview of research evidence about the operation 87 and adequacy of complaints arrangements Objective 8 Issues of concern for the Older People s Commissioner 88 References 90 Appendices 92 Appendix 1 List of participating organisations 92 Appendix 2 Other relevant legislation around complaints arrangements 94 Appendix 3 UN Principles for Older Persons (1991) 95 Appendix 4 Principles for public services (Welsh Assembly 97 Government 2007). Appendix 5 Draft principles for dealing with complaints 98 (PSOW / Complaints Wales Group 2010) Appendix 6 Public policy definitions of complaints 101 Appendix 7 Issues for the Older People s Commissioner for Wales 103 to consider 5

8 A Scoping Study of Complaints Procedures in Wales List of Tables Table 3.1 Summary of complaints models in public services in Wales 27 Table 4.1 Reasons for complaints to local authorities by all 35 complainants and older people Table 4.2 Sample of local authority complaints data 2008/09 36 Table 4.3 Satisfaction that Stage One procedures capture problems 38 experienced by users of contracted-out services Table 4.4 Complaints involving Social Services and the NHS 39 and Independent Providers (all complainants) Table 4.5 Complaints involving Social Services, NHS and 40 Independent Providers (older people) Table 4.6 Complaints procedures: process-driven or person-centred 42 Table 4.7 Commentary on complaints procedures (all complainants) 42 Table 4.8 Commentary on complaints procedures (older people) 43 Table 5.1 CSSIW complaints about care homes 2008/09 51 Table 6.1 Age bands of NHS complainants supported by CHC 59 Table 6.2 Satisfaction with capturing problems experienced 62 by patients at Stage One Local Resolution Table 6.3 Multi-agency complaints as a cause of concern 63 Table 6.4 Complaints procedures: process-driven or person-centred? 64 Table 6.5 Commentary on complaints procedures (all complainants) 64 Table 6.6 Commentary on complaints procedures (older people) 65 Table 7.1 Complaints to the PSOW by Older People 2005/ /

9 Acknowledgements Acknowledgements I am grateful to the many people in local authorities, social care, housing and health organisations at national and local levels in Wales who gave their time willingly to support this study. This report would not have been possible without the invaluable assistance of local government and NHS complaints officers who ed reports and information when requested and answered questions, tested the questionnaires and completed them. Thank you to my colleagues Ioan Humphreys for the tables and graphs, Stephanie Jones for assistance with literature searches and proof reading, Sarah Cole for administrative support and Andrew Dunning and Judith Phillips for their advice. The study was commissioned and funded by the Older People s Commission for Wales. For more information about this study please contact: Susan Lambert Centre for Innovative Ageing School of Human and Health Sciences Swansea University Singleton Park Swansea SA2 8PP S.E.Lambert@swansea.ac.uk 7

10 Foreword 8

11 Foreword Foreword As the Older People s Commissioner for Wales I have a particular interest in the arrangements bodies have in place for older people to make complaints. My objectives set out in the 2010/13 Strategic Plan are to promote awareness of the interests of older people in Wales, promote the provision of opportunities for, and the elimination of discrimination against, older people in Wales and encourage best practice in the treatment of older people in Wales. I am committed to looking at complaints arrangements in Wales with a view to seeking any improvements necessary over the coming years. In order to support this work I commissioned this Scoping Study of Complaints Procedures in Wales from the Older People and Ageing Research and Development Network at Swansea University. This report is a companion document to a report on the scoping of advocacy and older people produced as part of the same research project. This informative Report forms the initial scoping work to map out the often complex landscape of complaints procedures and identify effective ways for the Commission to make progress in this area for the benefit of older people. I recognise that the area of complaints is currently subject to changes throughout the public sector in Wales. I welcome the drive to secure clarity, speed and simplicity for those wishing to make a complaint. I will continue to stand up for older people in this area and strive for best practice across all sectors aimed at ensuring that complaints procedures are open, transparent, efficient, timely and promote service improvement through learning. This Report represents just the start of this important work. Ruth Marks Older People s Commissioner for Wales 9

12 A Scoping Study of Complaints Procedures in Wales Executive Summary 1.1 Introduction This Scoping Study explores statutory complaints arrangements in local authorities, the NHS and care providers in Wales with the overall aim of setting out issues for the Older People s Commissioner for Wales to consider. The study provides an overview of guidance and outcomes of complaints handling together with a discussion about developments and reforms that are underway to change complaints arrangements. The Older People s Commissioner for Wales has significant legal powers in relation to older people, aged 60 years and over, and their interests. These include the powers to: a) review the way many public bodies in Wales discharge their functions; b) review the complaints, advocacy and whistle-blowing arrangements of most public bodies in Wales; c) conduct examination of individual cases where they are of wider relevance to older people; and d) issue guidance following review or examination. The Commission is required to have regard to the UN Principles for Older Persons in considering the interests of older people in Wales. The bodies which the Commissioner can review include health and social care bodies and local government. Older people s lives are not just about public services and should not be circumscribed as such. However, the quality of life of some older people relies on interdependence with care providers to support their daily activities. The House of Lords & House of Commons Joint Committee on Human Rights (2007) has reported that older people in healthcare face barriers when trying to voice their concerns about the quality of care they receive. A power imbalance exists between older people and those who care for them that can lead to poor treatment of some older people and an unwillingness to complain. 10

13 Executive Summary The objectives of the study are to provide: 1. A working definition of complaints, as referred to in the Commissioner for Older People (Wales) Act; 2. An identification of principles against which current arrangements can be judged; 3. An overview of Welsh Assembly Government (Welsh Assembly Government) guidance or regulation on complaints arrangements in local authorities, the health service and care providers; 4. An overview of how complaints arrangements are measured, monitored and reviewed; 5. An indication of variation in practice in different localities and organisational sectors across Wales; 6. Examples of complaints procedures identifying practice in different localities; 7. An overview of recent research evidence about the operation and adequacy of complaints arrangements; 8. Issues of concern for the Older People s Commissioner to focus on and areas for improvements in current working arrangements around complaints. Research methods included a web-based search of public sector policies and procedures, interviews with key informants from complaints departments in national and local health, social care and care provider organisations and surveys of complaints officers in health and social care. The study period was January - April Overview of statutory complaints procedures in the public sector Local authority social services complaints arrangements are based on Welsh Assembly Government guidance Listening and Learning (Welsh Assembly Government 2006). The guidance sets out a three-stage complaints process including Local Resolution when complaints are resolved with frontline staff, Formal Resolution for complaints not resolved at Stage One investigated by a senior member of staff not involved in the case, and thirdly, if not 11

14 A Scoping Study of Complaints Procedures in Wales resolved, an external Independent Panel hearing. The guidance includes two definitions of complaints: a complaint is a complaint when the person making it says it is and Any written or verbal expression of dissatisfaction or disquiet about something that has happened to an individual child or adult on which they require a response (Welsh Assembly Government 2006, p.34). Regulations under the Care Standards Act 2000 require providers and managers of registered services, such as domiciliary care agencies and care homes in the private, local authority and independent care sector, including Registered Social Landlords (RSLs), to have their own complaints procedures. All NHS organisations and independent providers of NHS health care are required to have a written complaints procedure, in line with the principles set out in Complaints in the NHS: A Guide to Handling Complaints in Wales (Welsh Assembly Government 2003). The guide sets out a two-stage complaints process with Local Resolution and Independent Review. The National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2010 reform the way the NHS in Wales handles complaints. Proposals were made public in the consultation document Putting Things Right (NHS Wales / Welsh Assembly Government 2010) and comprise a one-stage complaints procedure with external review by the Public Services Ombudsman for Wales (PSOW). Under the Public Services Ombudsman Wales Act (2005) the PSOW investigates complaints reported by members of the public about the way they have been treated by a public body. Complainants may go direct to the PSOW with their complaints as well as when they are dissatisfied with the outcomes of previous investigations at any stage. Public policies around complaints procedures are based on common sets of principles primarily around accessibility to the public, fairness, courtesy, dignity and respect, safeguarding, timeliness, monitoring and continuous service improvement. 12

15 Executive Summary Listening and Learning (Welsh Assembly Government 2006) is informed by the following interpretations of the UN Principles for Older Persons (1991): n Older people should have access to social and legal services to enhance their autonomy, protection and care; n Older people should be able to utilise appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a humane and secure environment; n Older people should be able to enjoy human rights and fundamental freedoms when residing in any sheltered, care or treatment centre, including full respect for their dignity, beliefs, needs and privacy and for the right to make decisions about their care and the quality of their lives. 1.3 Complaints procedures in local authorities The study focused on statutory complaints procedures for adult social services. Local authorities are responsible for collating, monitoring, and improving practice arising out of complaints. Reports are prepared by Complaints officers, scrutinised by councils and published in annual reports. Unlike health bodies, local authorities are not required to submit complaints reports to Welsh Assembly Government. Local authority practice varied in terms of the amount of information available to the public about how to complain and in the language used to describe the process. Data collated in complaints reports varied considerably with some authorities providing detailed data on complaints by client group, whether timescales were met, service user satisfaction with the process, outcomes and lessons learned. Most complaints are dealt with at Stage One. Local authority complaints officers are working together to produce standardised guidelines for reporting complaints and outcomes. Issues for the Older People s Commissioner to consider: n Common reasons for complaints were staff attitudes and behaviour, poor standards of care, with lack of communication a feature of most complaints; n The lack of an all Wales dataset of complaints to local authorities across Wales; n The lack of standardised information about complaints by older people; 13

16 A Scoping Study of Complaints Procedures in Wales n Most complaints officers reported that they were satisfied that complaints procedures adhered to good practice principles, but were concerned about the complexities involved when investigating complaints across care sectors; n Low levels of involvement of older people or their representatives in the development of complaints procedures; n The need for dedicated advocacy services for older people. 1.4 Complaints about services regulated by Care and Social Services Inspectorate Wales (CSSIW) Under the Domiciliary Care Agencies (Wales) Regulations 2004 and The Care Homes (Wales) Regulations 2002, it is the care provider manager s responsibility to investigate complaints and to notify CSSIW of complaints and their outcomes. Providers are expected to try to resolve complaints themselves with the service user. CSSIW investigates: n Complaints that have not previously been resolved with the provider, complaints that by-pass the provider and those that are referred directly to them; n Complaints that have not been resolved within 28 calendar days; n Complaints referred to them that are regulatory issues; n Complaints from people who self-fund their own care as well as those with care funded by social services or the NHS. Issues for the Older People s Commissioner to consider: n The main topics of complaints include responsiveness of services and continuity of carers; care practices around the provision of personal care and staffing and management; n Adult protection investigations involved neglect and abuse; n Ensuring that people who use non-regulated services have avenues of redress; n Looking at how organisations can work together to share information in the service user s interest including people who self-fund their own care. 14

17 Executive Summary 1.5 Complaints procedures in the NHS The NHS Wales guide to handling complaints in Wales, defines a complaint as: An expression of concern about NHS treatment or services, whether verbal or written, which requires a response. A complaint that is made orally but is unresolved after the first time it has been aired or the complainant wants to pursue further should be put in writing and the complaints procedures should start (Welsh Assembly Government 2003, p.19). The NHS has a two-stage complaints procedure covering Health Boards (HBs), NHS Trusts and primary care practitioners. Stage One Local Resolution aims to resolve complaints between patients and health staff. Stage Two Independent Review investigates complaints not resolved at Stage One. In primary care, practice managers, or healthcare professionals themselves, deal with complaints. Complainants have the right to go straight to Stage Two or to PSOW. Complainants may be supported by a Community Health Council (CHC) advocate. Issues for the Older People s Commissioner to consider: n The main topics of complaints were all aspects of clinical treatment, outpatient appointments and communication; n NHS complaints reporting to Welsh Assembly Government does not identify complaints by older people; n Independent contractors in primary care undertake their own investigations and are not required to provide complaints data to HBs or Welsh Assembly Government; n Less than 40% of complainants to the NHS are supported by a CHC; n Fifty per cent of complainants who are supported by a CHC are people aged over 60 years; n Most complaints officers reported that they were satisfied that their complaints procedures adhered to good practice principles, but were concerned about complexities involved when investigating complaints across care sectors with separate procedures. n HBs cannot compel primary care practitioners to co-operate with complaints investigations. 15

18 A Scoping Study of Complaints Procedures in Wales 1.6 Public Services Ombudsman for Wales The PSOW service deals with complaints about the Welsh public sector. It seeks redress for individuals and identifies broader lessons to ensure public service improvement. The majority of complaints received by the PSOW are about local authorities, partly due to the fact that they are the largest direct providers of a wide range of services to the public. The level of complaints about this sector has remained fairly constant. On the other hand, complaints about NHS bodies increased over the past year. The Ombudsman s service handles a disproportionate amount of complaints from older people, with some considered to have good access to resources and complaints procedures. However, there were concerns about older people who lacked advocacy support. Issues for the Older People s Commissioner to consider: n The lack of advocacy for residential care and people receiving support from private care providers; n Increase in public interest reports relating to continuing healthcare funding; n Inadequate resources for housing-related advocacy; n Gaps in regulations e.g. day care not regulated or covered by the Care Standards Act or the PSOW Act; n The lack of standardised monitoring and reporting of complaints received by local authorities to Welsh Assembly Government. 1.7 Complaints procedures in Wales, future developments Changes to complaints arrangements are being planned. A Model Concerns and Complaints policy for public service providers has been developed by the Complaints Wales Group (CWG), chaired by the Public Services Ombudsman, to streamline and simplify complaints arrangements. The purpose of the policy, out for consultation at the time of writing, is to establish a common concerns and complaints model across public service providers with common sets of: n Principles for effective handling of concerns and complaints; n Data collection procedures; 16

19 Executive Summary n Methods for learning from concerns and complaints and n Means to identify and disseminate good practice. The policy defines a complaint as: An expression of dissatisfaction or concern either written or spoken made by one or more members of the public about a public service provider s action or lack of action or about the standard of service provided which requires a response (PSOW/CWG 2010, p.11). Putting Things Right (NHS Wales / Welsh Assembly Government 2010) is designed to deal with concerns and complaints and to offer redress to NHS patients. It is intended to remedy shortcomings in the current system including duplication of investigations, inconsistency between organisations and a tendency for organisations to focus on defending actions rather than resolving concerns. A concern is defined as: issues identified from patient safety incidents, complaints and claims, which can be raised either by patients or staff (NHS Wales / Welsh Assembly Government 2010, p.2). The proposals include a simplified process of Local Resolution by frontline staff, followed by referral to PSOW if the complaint is not resolved (thus removing the Independent Review stage); a single common method of investigation of concerns including complaints, claims and reported safety incidents within one department. Statistics and other information will be collected for quality assurance purposes and organisations must demonstrate they have learnt lessons. A Complaints Signposting service is to be launched in 2010/11. It is being developed by the PSOW service and will be a first point of contact for people who wish to make a complaint about a public body and are not sure how to or whether they should. Issues for the Older People s Commissioner to consider: n The UN Principles for Older Persons and proposals to reform complaints procedures in the NHS and the rest of the public sector; n A focus on concerns as well as complaints may give more older people confidence to assert their views; 17

20 A Scoping Study of Complaints Procedures in Wales n Putting Things Right proposes reforms to existing complaints procedures with an emphasis on concerns and redress; n HBs will be able to investigate complaints about primary care if the patient requests it and primary care practitioners will be obliged to co-operate, but it is not clear how this will be enforced. 1.8 Conclusion Definitions of complaints in public policies vary across health and social care. The new language of complaints policies (NHS Wales / Welsh Assembly Government 2010, PSOW/CWG 2010) focuses on concerns as well as complaints and is clearer about redress for complainants. Complaints definitions should avoid jargon, cover standards of service, failure to act and a requirement to respond to the complainant. Complaints definitions and principles should leave people in no doubt, when they are faced with a problem relating to a care provider, that they have a legitimate reason to speak out. It should also be clear to whom they need to speak. Processes should be explained clearly, in a step-by-step fashion; people should make their complaint once and receive regular feedback on progress. All frontline staff in all care organisations should be trained to listen out for and to respond appropriately to people s concerns. Organisations should demonstrate institutional learning from complaints monitoring, both as a measure of quality assurance, and to give complainants confidence that their complaints are welcomed and taken seriously. Complaints definitions and principles should take account of older people s views about the importance of person-centred communication when dealing with health and social care providers. They should be informed by the UN Principles for Older Persons. The key principles for complaints procedures are accessibility and simplicity, fairness, courtesy, dignity and respect, safeguarding, timeliness, monitoring and continuous service improvement. Gaps in complaints regulations include concerns about people who selffund their own care and who do not have recourse to PSOW. At present CSSIW does not regulate day care, or new initiatives such as self-directed care. Extra Care schemes are covered by domiciliary care and not care home regulations. People living in care homes do not have the same rights of tenure as people living in other forms of rented accommodation (House of Lords / House of Commons Committee on Human Rights 2007). 18

21 Executive Summary Local authority and NHS complaints officers are responsible for collating complaints data, compiling reports for submission to their managers, relevant committees, councils and boards of management. These are publicly accessible documents. Care providers complaints data has to be made available to CSSIW. Only NHS providers must submit standardised complaints statistics to Welsh Assembly Government. However, primary care providers are not obliged to comply with this requirement or to co-operate with HB investigations into complaints from their patients. The Assembly receives reports of local authority Stage Three Independent Panels. Local authority complaints officers are working together to produce consistent datasets. On the whole, age is lacking in complaints monitoring data making it difficult to draw conclusions about the extent of complaints made by and on behalf of older people. The annual report of the Board of Community Health Councils (CHC) is an exception and is an example of how the experiences of older people can be more fully understood. There are variations in procedures between health and social care and within healthcare. These are particularly significant for people whose complaints span both sectors, or whose complaints begin in primary care, continue through the emergency services and into secondary care. Service users and patients have to negotiate separate complaints procedures with different staff, stages and timescales. Most complaints are resolved at the local level with relatively few proceeding to Independent Review or scrutiny by CSSIW or PSOW. Further detailed research is required to investigate the adequacy of arrangements and the views of complainants who have used the system, and in particular the views of older people. This study highlights examples of good practice as well as weaknesses. Participants in the study revealed a willingness to embrace change and to improve the quality of complaints arrangements. The main areas of concern about complaints arrangements for the Older People s Commissioner to consider are as follows: n Lack of robust, comparable data about older people aged over 60 years in complaints reports; 19

22 A Scoping Study of Complaints Procedures in Wales n Variations in practice particularly across health and social care; n Variations in definitions of complaints and concerns; n A requirement for tailor-made advocacy support for older people; n The main reasons for complaints are staff attitudes and behaviour, poor standards of care, care practices around personal care and communication. 20

23 Chapter 2 Introduction Chapter 2 Introduction 2.1 Introduction This Scoping Study explores statutory complaints procedures in local authorities, the NHS and care providers in Wales with the overall aim of setting out issues for the Older People s Commissioner to consider. The study provides an overview of guidance and outcomes of complaints handling together with a discussion about developments and reforms that are underway to change complaints arrangements. It sets out organisational structures of complaints arrangements and roles and responsibilities at national and local levels. Complaints arrangements enable members of the public to express concerns and complaints when they are dissatisfied with their care and treatment. Welsh Assembly Government policies around local authority complaints are informed by the UN Principles for Older Persons relating to matters such as independence, participation, care, self-fulfilment and dignity. This study includes an overview of the kind of support preferred by older people and their expectations around service delivery. The Older People s Commissioner for Wales was established by the Commissioner for Older People (Wales) Act It is an independent body set up to promote and safeguard the interests of older people in Wales, who are aged 60 or over. The Commissioner has significant legal powers in relation to older people and their interests. These include powers to: n review the way many public bodies in Wales discharge their functions; n review the complaints, advocacy and whistle-blowing arrangements of most public bodies in Wales; n conduct an examination of individual cases where they are of wider relevance to older people; and n issue guidance. 21

24 A Scoping Study of Complaints Procedures in Wales The Commissioner is required to have regard to the UN Principles for Older Persons in considering the interests of older people in Wales. The Commissioner therefore possesses unique legal powers to consider the adequacy of complaints arrangements in Wales. The bodies which the Commissioner can review include health and social care bodies and local government. Reviews carried out by the Commission will reflect the concerns and questions brought to it by older people. The purpose of a review will be to determine how well a body or bodies are serving older people. The UN Principles for Older Persons will be used as a benchmark for best practice. 2.2 Aim The aim is to inform the work of the Older People s Commissioner (OPC) and to identify areas of concern in working arrangements around complaints. 2.3 Objectives The objectives are to provide: 1. A working definition of complaints, as referred to in the Commissioner for Older People (Wales) Act; 2. An identification of principles against which current arrangements can be judged; 3. An overview of Welsh Assembly Government guidance or regulation on complaints arrangements in local authorities, the health service and care providers; 4. An overview of how complaints arrangements are measured, monitored and reviewed; 5. An indication of variation in practice in different localities and organisational sectors across Wales; 6. Examples of complaints procedures identifying good practice in different localities; 7. An overview of recent research evidence about the operation and adequacy of complaints arrangements; 8. Issues of concern for the Older People s Commissioner to focus on and areas for improvements in current working arrangements around complaints. 422

25 Chapter 2 Introduction 2.4 Methods n Web-based search of national and local government and NHS policies and procedures, evidence of operation and outcomes; n Telephone and face to face interviews with key informants from complaints departments in health, social care and care provider organisations at national and local levels (n=12); n Electronic surveys with complaints officers in 22 local authorities, 7 Health Boards and 2 NHS Trusts (n=34); n Observation at NHS Complaints Officers Network Group meeting (n = 11); n Secondary data analysis of research and policies. Appendix 1 lists the organisations that took part. The study period was January - April Complaints statistical information was derived from annual reports published for the year 2008/09. The study was undertaken in conjunction with a Scoping Study of Advocacy Arrangements in Wales. The study was informed by Social Research Association ethical guidelines. Informants were assured of confidentiality and gave permission for organisations titles to be used to identify examples of good practice. The study posed a number of challenges: firstly, age is not a category routinely collected in complaints monitoring; secondly, complaints data is collected differently in different local authorities and there are differences between the reporting requirements of NHS bodies and social services departments. Private and independent care providers follow their own complaints procedures and do not have to make their complaints publicly available; thirdly, reforms are currently being discussed and consulted upon that will alter existing arrangements for complaints handling in the public sector. The report describes current complaints arrangements, draws out the implications for older people and summarises issues for the Older People s Commissioner to consider. Chapter 3 provides an overview of legislation governing complaints procedures, Chapter 4 explores local authority complaints procedures and Chapter 5 covers independent care provider complaints arrangements and the work of CSSIW. Chapter 6 looks at complaints and the NHS, while Chapter 7 focuses on the role of the Public Services Ombudsman for Wales. Finally, reforms are brought together in 235

26 A Scoping Study of Complaints Procedures in Wales Chapter 8, before a conclusion that addresses the aims of the study. The appendices include supporting documentation together with summaries of definitions of complaints and all the issues of concern raised in the report. 2.5 Older people and complaints Older people s lives are not just about public services and should not be circumscribed as such. However, for some older people their quality of life relies on interdependence with care providers to support daily activities. The House of Lords & House of Commons Joint Committee on Human Rights (2007) has reported that older people in healthcare face barriers when trying to voice their concerns about the quality of care they receive. A power imbalance exists between older people and those who care for them that can lead to poor treatment of some older people and an unwillingness to complain. Trying to sustain an ongoing relationship with a care home or longstay hospital makes it difficult to be assertive. Some older people, especially those who are without family or friends, from a black and minority ethnic community or who have mental health problems, are particularly vulnerable. Other factors include fears of eviction or loss of service, an unwillingness to make a fuss, internalised ageism and lower expectations of what is fair. The committee was alarmed at how little protection care home residents appeared to have against eviction compared to tenants of rented accommodation and recommended that this anomaly should be considered as a matter of urgency. Empowering older people depends partly on removing barriers to enable them to raise concerns and in providing them with sufficient information about standards and their rights. Strong information, advice and advocacy systems should be informed by the perspectives of older people; with common datasets of up to date information that older people, carers and staff can access, as well as opportunities for staff to learn from each other and from other organisations (Horton, 2009). Characteristics of services that older people value include: up to date, accessible sources of information, someone to talk to about options, easier access to social services and for people with whom they come into contact to be focused on them. On many occasions older people feel they have hurdles placed in their way, hurdles they cannot get over (Clough 2007). 624

27 Chapter 3 Overview of Statutory Complaints Procedures Chapter in the 2 Public Introduction Sector Chapter 3 Overview of Statutory Complaints Procedures in the Public Sector This chapter sets out the policy and legal framework informing statutory complaints procedures in local government and the NHS, regulations governing the private and independent care sectors and key principles of complaints arrangements. 3.1 Welsh Assembly Government guidance to local authorities Welsh Assembly Government guidance on complaints procedures in local authority social services departments came into force in 2006 (Listening and Learning, Welsh Assembly Government 2006). The guidance was issued under Section 7 of the Local Authority Social Services Act The Social Services Complaints Procedures (Wales) Regulations 2005 underpin Listening and Learning and are made under the Assembly s powers in the Health and Social Care (Community Health and Standards) Act The guidance sets out a three-stage complaints process including Local Resolution, where complaints are resolved with frontline staff, Formal Resolution, for complaints not resolved at Stage One and investigated by a senior member of staff not involved in the case, and thirdly, if not resolved, an external Independent Panel hearing. 3.2 Private and independent care sector provider complaints regulations Regulations under the Care Standards Act 2000 require providers and managers of registered services, such as domiciliary care agencies and care homes in the private, local authority and independent care sector, 257

28 A Scoping Study of Complaints Procedures in Wales including Registered Social Landlords (RSLs), to have their own complaints procedures. These are subject to regulation and inspection scrutiny undertaken by Care and Social Services Inspectorate Wales (CSSIW). The governance arrangements of RSLs are also regulated and inspected by the Wales Audit Office. National Minimum Standards for Care Homes for Older People (Care Standards Inspectorate Wales 2004) state that inspectors should assess whether residents have access to a robust, effective complaints procedure and service users have rights to use those procedures. 3.3 Welsh Assembly Government guidance to the NHS All NHS organisations and independent providers of NHS health care are required to have a written complaints procedure, in line with the principles set out in Complaints in the NHS: A Guide to Handling Complaints in Wales (Welsh Assembly Government 2003). The guidance sets out a twostage complaints process with Local Resolution and Independent Review for dissatisfied complainants so that complaints handling could become more independent of NHS organisations (Welsh Assembly Government 2003, p.1). Community Health Councils (CHC) are funded by Welsh Assembly Government in order to provide advocacy services to NHS complainants. The National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2010 reform the way the NHS in Wales handles complaints. The new proposals were made public in the consultation document Putting Things Right (NHS Wales / Welsh Assembly Government 2010) and comprise a one-stage internal complaints procedure with external review by PSOW (see Chapter 8). 3.4 Public Services Ombudsman for Wales Under the Public Services Ombudsman Wales Act (2005) the PSOW investigates complaints reported by members of the public about the way they have been treated by a public body. Complainants may go direct to the PSOW with their complaints as well as when they are dissatisfied with the outcomes of previous investigations at any stage. The PSOW investigates complaints and, if upheld, the Ombudsman states how the public body should make amends to the individual complainant, as well as issuing recommendations for service improvements. 26

29 Chapter 3 Overview of Statutory Complaints Procedures in the Public Sector The Ombudsman has powers over Welsh Assembly Government, local government, health and social care bodies, housing associations, fire services, police forces, environment agencies and education and training bodies. 3.5 Joint complaints arrangement across public services Complaints that span more than one care provider have to be dealt with under separate complaints procedures in each organisation. Since the Health and Social Care (Community Health and Standards) Act 2003, Welsh Assembly Government has sought to build clearer links between social services and NHS complaints procedures. A Complaints Wales Working Group, chaired by the Public Services Ombudsman for Wales, has produced draft guidance for a shared concerns and complaints procedure for the public sector. The two-stage model is due to go out for consultation in the summer of 2010 and if approved by Welsh Assembly Government it could be implemented in April This model is compatible with Putting Things Right. Table 3.1 summarises models of complaints arrangements. Table 3.1 Summary of complaints models in public services in Wales Stages Local authority current model NHS current model NHS Putting Things Right (2010) Draft Model (PSOW / CWG 2010) Stage 1 Local resolution Local resolution Local resolution Informal resolution Stage 2 Formal resolution Independent Review PSOW Formal internal investigation Stage 3 Independent Panel PSOW PSOW Stage 4 PSOW 27

30 A Scoping Study of Complaints Procedures in Wales 3.6 UN Principles for Older Persons (1991) Listening and Learning (Welsh Assembly Government 2006) is informed by the following interpretations of the UN Principles: n Older people should have access to social and legal services to enhance their autonomy, protection and care. n Older people should be able to utilise appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a humane and secure environment. n Older people should be able to enjoy human rights and fundamental freedoms when residing in any sheltered, care or treatment centre, including full respect for their dignity, beliefs, needs and privacy and for the right to make decisions about their care and the quality of their lives (Welsh Assembly Government 2006, p. 21). See Appendix 3 for the full list of the UN Principles. 3.7 Other key principles of complaints procedures Public policies around complaints procedures are based on common sets of principles primarily around accessibility to the public, fairness, courtesy, dignity and respect, safeguarding, timeliness, monitoring and continuous service improvement. The following key principles were set out in Listening and Learning (Welsh Assembly Government 2006): n Safeguarding and promoting the welfare of service users; n Complaints procedures must be clear and easy to use; n Complainants should be treated with dignity and respect and have their concerns taken seriously; n Concern about the protection of vulnerable adults and children must be reported immediately to social services or the police; n Complaints should be resolved as quickly as possible and satisfactorily resolved at the local level; n Local authorities should ensure that processes are fair and support people who complain; 28

31 Chapter 3 Overview of Statutory Complaints Procedures in the Public Sector n At least one part of the process should be fully independent from the authority complained about; n Complaints processes should enable local authorities and Care and Social Services Inspectorate to exercise their duty of care and enforcement duties where needed; n As far as possible, complainants should experience social services and NHS complaints processes as one single, seamless system; n Rights of access and redress to bodies such as the OPC and PSOW should be safeguarded; n Local authorities must monitor the performance of their complaints procedures and use performance information to inform improvements in services. The PSOW (2006) sets out the following elements of good complaints processes: n Comprehensive, covering all of the services provided by or on behalf of the authority; n Clearly defined, with procedures which are easy to understand and straightforward to use; n Quick but sufficiently thorough; n Fair and objective; n Sensitive to the special needs and circumstances of the complainant; n Ensures effective communication with the customer; n Decisive and capable of putting things right where necessary; n Effectively managed and regularly analysed to spot patterns of complaint and lessons for service improvement. See also Appendices 4 and 5. 29

32 A Scoping Study of Complaints Procedures in Wales Chapter 4 Complaints procedures in local authorities This chapter focuses on current practices around statutory adult social services and describes what the procedures are, what complaints are received, what complaints officers think about the current procedures and what the issues are for older people. It draws on scrutiny of local authority websites and complaints data, as well as the survey of complaints officers accessed via the All Wales Complaints Officers Group (AWCOG). AWCOG comprises local authority complaints officers and its aims are to share good practice, common concerns, training and to inform policy through membership of Welsh Assembly Government and PSOW complaints groups. Local authorities are responsible for collating, monitoring, and improving practice arising out of complaints. Reports are prepared by Complaints Officers and scrutinised by councils and the relevant committee and published in councils annual reports. Unlike health bodies, local authorities are not required to submit complaints reports to Welsh Assembly Government. Responsibilities for complaints officers include recording complaints, monitoring the progress of complaints, ensuring Local Resolution with the complainant wherever possible, ensuring that the authority has sufficient trained people to undertake investigations, keeping complainants informed and ensuring timescales are met, contributing to staff training, evaluating outcomes and trends, compiling reports and making recommendations to improve practice. 4.1 What is a complaint? Welsh Assembly Government guidance includes two definitions of complaints: a complaint is a complaint when the person making it says it is and Any written or verbal expression of dissatisfaction or disquiet about something that has happened to an individual child or adult on which they require a response (Welsh Assembly Government 2006, p.34). 30

33 Chapter 4 Complaints procedures in local authorities Local authority definitions of complaints vary as these examples show: You may complain if you are unhappy with the service that you have been provided by the Authority (Bridgend). A complaint is an expression of dissatisfaction about the standard of service, action or lack of action by us (Denbighshire). A complaint is an expression of dissatisfaction, however made, about: n The behaviour / actions of members of staff; n The standard of service provided or the manner in which it was provided; n Lack of action (Pembrokeshire). Some local authorities provide examples of the kinds of problems that people may complain about: neglect and unhelpful attitudes of staff, delay in responding to a request within appropriate timescales, failure to fulfil statutory responsibility, or discrimination. Most local authorities distinguish between what is not a complaint, e.g. reporting unlit street lights for the first time. This is considered a request for service and becomes a complaint when councils have failed to take action. 4.2 Who may make a complaint? Services users or their representatives may make complaints. A time limit between the event complained about and the complaint is not specified in Listening and Learning. Most complaints are made by relatives or carers, followed by the service user themselves, then third parties including the voluntary sector, councillors, AMs or MPs. 4.3 Information about how to complain Complaints policies and information is included on all council websites and distributed via day centres, residential care settings, voluntary organisations and libraries. One local authority provides a link to their most recent annual report setting out complaints statistics on their complaints pages. Policies define complaints, list contact information, set out time scales for complaints and explain how local authorities intend to learn from complaints in order to improve services, with variations across councils in the details provided to the public. 31