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We must improve the social care complaints system

Carer holding hands with an older person

For the first time the Local Government Ombudsman has published complaints statistics for all social care providers. Ombudsman Dr Jane Martin explains what this means for social care complaints…

Adult social care is the fastest growing area of our work and with the highest uphold rate.

Our report highlights some of the challenges that are currently faced in the social care complaints system.

Perhaps more importantly it also identifies some opportunities which, if acted upon, could offer greater accessibility, effectiveness and accountability in social care complaints.

More accessible

An essential element of making the complaints system more accessible is ensuring that people know about their right to complain. We have proposed that there should be an obligation on all providers of social care to clearly explain how to make a complaint. This could include having a sign in every care setting as a simple means of ensuring that people are more aware of how to complain when things go wrong.

Of course, fear and lack of support can also act as a barrier to complaining. We are therefore also calling for the availability of advocacy to cover social care provision so that users would have access to greater support and reassurance.

More effective

An effective complaints system is one where complaints are handled properly at the local level. It seems that the effectiveness of local complaint handling varies from provider to provider. If we were to set common complaint standards for all providers and commissioners of care services it could provide reassurance that complaints will be looked at properly irrespective of where you live or how your care is funded. These standards could be underpinned by the existing regulatory regime to further demonstrate the importance of effective, local complaint handling.

More accountable

If we are to measure whether the complaints system is becoming more accessible and effective, providers need to be accountable for the way they respond to complaints. An annual review of complaints by all providers and commissioners would encourage reflective local leadership about learning from complaints and would provide the information needed to support local scrutiny and accountability. Similarly a mandated data return on patterns of complaints to the Care Quality Commission would be a step towards a more open and transparent approach to complaints.

What has been your experience of social care? Do you think the proposals above would make complaining about services better for you?

Which? Conversation provides guest spots to external contributors. This is from Dr Jane Martin, the Local Government Ombudsman – all opinions expressed here are Jane’s own, not necessarily those of Which?.

Comments
Member

An issue you might address urgently is to provide a confidential reportiing system for complaints from “insiders” (I hate the somewhat derogatory term “whistleblower”). These are people who may see accumulations of bad practices or mistreatments that merit speedy investigation.

I also am suspicious of the wish for “learning from complaints”. We hear a lot about “lessons will be learned” when responding to criticism of failures. However, in many cases I believe the lessons are fundamental, and should have already been dealt with in an individual’s training. We are supposedly employing professionals to manage our social care and to train those who work under them.

Member

I couldn’t agree more with the need for confidential reporting from “insiders”.

My wife was a Senior Carer for 11 years while I was the Community Engagement Worker for the Shropshire LINk. I had as many comments from “insiders” in the NHS as in the private sector, working in hospitals, GP surgeries and care homes, as I had from patients, carers, family members, etc. The insiders were all too scared to speak openly in fear of retribution or being sacked.

In the NHS case, this was often ascribed to the management culture created and enforced by Sir David NICHOLSON, now living comfortably on his publicly funded pension. The private employees had the same fears, but based on being seen to undermine the care providers profits.

The main concern amongst family members was the perceived lack of care and compassion, while being unable to understand why fees were so high, but staff (who were supposed to provide care and compassion) were paid little more, if at all, than the minimum wage, usually the main cause for high ratios of patients to staff.

In both sectors, sharp end staff saw management systems, whether officially imposed or by choice, to be unnecessarily complicated and often duplicated, while providing no assurance that the data provided could be applied to improve services. Regretfully, this appears to be the growing problem in so many public service areas where highly paid managers have little, if any experience of sharp reality, such as in social care for children.

As for “learning from complaints” the evidence shows quite the opposite with the same problems in the services allow the same disasters to happen to the vulnerable, followed by yet another manager claiming “we will ensure that this never happens again” … until the next time.

And my wife has no intention that either of us will ever end up in a care home, however much we may be able to afford!

Member
Gerald says:
10 June 2014

Dear Vixl,
I have seen the developement of both the Private Sector and the Public sector over a period of 30 years and have been directly involved in the transition between the Care of the elderly from the 20 bed Geareatric Wards in Hospitals Run by so called experts into Nursing Homes with single ensuite bedrooms with spacious Lounges and dining rooms with in house entertainment etc. mostly managed and run by staff from the old wards unencombered by the so called experts and all done at a quarter of the cost of the NHS . I am proud of what we have acheived, all done at a pittance of what has been thrown at the NHS .Why has no one done a “value for money exercise” on this I am sure if one involves the client/ patient in this exercise they will soon get the message that the Public ,in general, really do appreciate the value for money that the Private Sector offers as in hotels one cannot expect a the Ritz at the price of a Travel Lodge. Bye the way I do not class the NHS provision as the Ritz in this equation

Member
Gerald says:
28 May 2014

At last , now we might get a balanced picture instead of the previous paranoia concentrating solely on the Private Sector care homes.Recent events has shown quite clearly that the Public Sector including the NHS and BBC are responsible for massive coverups including bribery and intimidation of whistle blowers

I have often criticized WHICH? in the past ,it looks like they seem to have woken up at last, keep up the good work and help me to restore my confidence in WHICH?

Member
Lessismore says:
29 May 2014

Carers are underpaid and are overtimetabled by their employers. (After all most people want to get up/eat their meals/go to bed within a certain time zone. 3 people @ half an hour each in different places at 9am just doesn’t work!) It is totally ridiculous that travelling time between people is not taken into account when allocated time per person can be as little as 15 min. This means that they have to cut corners which upsets the people who they care for and those who pay for the care. If one person has a problem/fall etc they can’t just leave them and go to the next – they have to stay longer. Whoever is less visibly needy suffers with less care.

This caring routine causes stress to conscientious carers. who are the switched-on ones who can walk into a house and immediately have a good idea of what to do/needs doing. Whereas the less conscientious carers do the absolute minimum, rushing in and out not staying for the allocated time implying that someone needs them more, and make it uncomfortable for the cared for to ask for help with anything – even though it may be something simple like having a look for a hearing aid (not a full scale search) or changing a hearing aid battery (fiddly and nigh impossible when your fingers don’t work well and you can’t see but a doddle if this is not the case). The elderly won’t ask for this help when they feel that there is someone in a worse situation than they are – making their situation worse. This job is not something that should be treated as a tick box one but too often is – both by the Local Authority and the less conscientious carer.

A switched-on carer will be able to assess the situation as soon as they walk into the house. The unconscious one won’t see the obvious because they don’t want to.

Member

Our appreciation of adult social care provision comes down fundamentally to the quality of care delivered by the people employed: the specialists, the care staff, the domestic staff, and the management, and this is heavily conditioned by training, supervision, and organisational culture. I would say that the organisational culture has been the big weakness and stumbling block, and whether it is driven by the profit motive in the private sector or the need for economies in the state sector the outcome has been the same. Until there is a perpetual condition of honesty and openness about the quality of care, and avenues for listening to complaints, addressing them meaningfuly and protecting those who raise them, things will not get better. But until all the people involved in the delivery of care are appropriately valued, respected, rewarded [not just financially]. and invested in through support, training, and development better complaints monitoring and reaction are not enough to bring about all the change required.

Member

ABSOLUTELY John.

Your comment covers everything but the biggest problem of getting them implemented is that they will have to be put in place by the very people who appear to be, on past and existing experience, the least likely to understand why and how… and unwilling to involve others who do.

Still, when their example is set by our politicians, what else can one expect?

Member

I agree with you and it perplexes me. In the UK we have top flight Universities and Schools in every appropriate discipline, Royal Colleges rich in eminent practitioners in every field of mental and physical illness or disability, a Civil Service stuffed with golden brains, a whole legion of Commissions and Champions, and a voluntary sector that is intelligent, observant, supportive, and compassionate – and not without resources. I cannot see why these powerful forces cannot be brought to bear on the problems; obviously it is not a national priority in the same way as other issues are [like plastic bags, wind farms and the TV licence fee]. Of course, we also have politicians, a taxation system that does little to assist those struggling to care for their elderly relatives [unlike the tax benefits for raising children], and a private care sector that has access to capital but cannot repay it from its nett income at commercial rates of interest and still provide the quality of care required; in that scenario something has to give and since the bankers won’t relent the standard of care has to suffer, and the residents and their families and the staff also have to suffer. Do we just put up with this depressing state of affairs or can we do something about it collectively, as a country, with a goal, and an ambition to achieve it against all odds? I have a feeling that once we crack the problem of looking after our elderly in a decent and dignified way a lot of other issues will pale into insignificance and so much competent energy will be released into more productive activities that the benefits would be out of all proportion to the costs [for those that must first have an economic justification for everything]. I also think we should not overlook the role of domicilary care in looking after those who do not need full-time residential care but nonetheless require help and support at certain times every day. At the moment this is also a fragmented, haphazard, inadequate, and grossly under-regarded part of our social care system subject to the whims and caprices of local and national politicians in the allocation of resources.

Member
Gerald says:
5 June 2014

Dear John,
As you have offered an answer to the problems of the Private Sector (Bankers etc.) faults may I veture to give you a similar simplistic answer to your first oberservation regards to the Public and Voluntary Sector, may I suggest that if they practised a half of what they preached a considerable number of them would be redundant is it maybe all a matter of self preservation.
At least the Private Sector have to give value for money otherwise the Public would not support them, this is not the case for others mentioned.
I am sorry if you think this is to simplistic but space is limited and I have not enough time to go into years of pratical experience which leads me to this conclusion.
You are also correct in stating that the Politicians haven’t the guts for it, maybe Gerry Robinson someone else quoted might be the man ?
You seem to haved missed a very big player in this farce and that is Unison , this Union is very involved in the Publuc Sector and has members in all levels including even places like the BBC.
Over the years I have noticed many instances where they have been involved in policy making decisions, I realy think they could easily be as important as say the Bankers.
Just making room for thought as they say

Member

I think it is commendable of you, Gerald, to stand up for the residential homes providers in the way that you do because these Conversations are immeasurably improved when an insider or an industry spokesman joins in and shows us the other side of the coin.

Although I appreciate the points you make about how the failings of the public sector attract little criticism whereas any adverse report on a privately-run institution is pounced on by the media, I am not sure whether that is strictly relevant since the provision of virtually all residential care – except where clinical treatment is necessary and then only temporarily – is in the hands of the private care home industry. And the point of this article is that there needs to be a shake-up in the complaints system by making access to it easier, its actions more transparent, and its outcomes more widely circulated. I do not think it is targetting any particular branch of the “adult social care” field or seeking to cover up the contribution of the public sector to the public’s dissatisfaction since the Local Govt Ombudsman must also encompass the domiciliary care side of social care which is largely under the auspices of the local authorities and is an utter shambles. Unfortunately, the Preamble to this Conversation was not a model of clarity and transparency itself for the ordinary reader outside the system!

You have identified the trade unions as a factor in the quality of welfare provision. Although you are not suggesting this yourself, could it be said that the trade unions are instigators of the prevailing media attitude [castigating private providers] as clearly the unions have an agenda for getting more social care workers under their umbrella and the privatisation of residential care has not only t aken potential members away but also thwarted their efforts to recruit new ones?

I don’t have a view on the role of Unison but if it is standing up for decent pay and conditions for staff, for better standards of care [and not just because it would require more personnel, i.e. potential members], and for protection for staff who raise concerns, report bad practices, and submit complaints to the local authority, the CQC or their MP, then I would say that was a positive thing.

The point everyone has to grasp is that all governments have tried to get adult social care on the cheap, which is either cynical or hypocritical. Now, faced with a rising life-expectancy and a higher survival rate from previously terminal illnesses – largely attributable to success of the NHS in my view – plus certain other demographic factors there is an explosion of demand and a shortage of family members who can carry the burden of adult social care. All I am saying is that, as a country, we cannot let this defeat us – whatever the causes, which we can debate until the cows come home.

Member
Gerald says:
6 June 2014

Dear John,
I did say my comment was simplistic, but since you ask, UNISON actual have tried to enroll both Nursing and |Care staff from within the Private Sector with little success.
After the vote rigging scandal which was so well dealt with by the Labour Party are you honestly telling me that our Unions including Unison are lilly white and not prone to political pressuring.

If Unisons intentions wer as well meaning why do the only concetrate their efforts against the private sector, why do they not do more to support whistleblowers within the NHS etc why do they not encourage their members at the BBC to highlight the massive problems at say the midstaffs hospital, surely this one sided approach taints what good work they do with nepotism (I think this is the correct word).

I do not agree with your statement with regards to either Government trying to get something on the cheap ,over the years, all Governments have thrown billions at the NHS and other Public Services and they always ask for more. On discusion with friends, who are Public Servants,
most are prepared to admit this and when pressed most of them agree the problem lies in bad senior management and collosul wastage. It seems however that they would rather promote blatantly bad management to more senior positions (BBC & NHS)rather than grasp the nettle an sack them. The Public Sector needs to get its act together and give the British Publlic “Value for Money” ,just out of interest are you aware that the NHS hs millions of pounds outstanding for treat ment given to so called medical tourist and cannot be bothered to collect it.

Member

Gerald . . . a few points in response:

I am not surprised Unison have little success in recruiting nursing and care staff in privately-run establishments. That is unfortunate because I see trade union involvement as a positive influence in not only improving workers’ conditions but in supporting management in resolving issues and raising standards. Having disgruntled staff with no trade union support and an unresponsive management is not a recipe for a happy and well-run care home. I appreciate managements’ difficulties but I have seen how responsible trade union consultation and participation can actually make things much easier. A lot of little niggles can get nipped in the bud and the organisational culture improves for everyone’s benefit.

I presume Unison always acts in support of its members in dealing with workplace issues. I know nothing about any political involvement and I don’t know enough about the “vote rigging scandal” to judge whether that is relevant.

I expect Unison believes adult social care services would be better run by the public sector [as indeed the domicilary side largely is – by local authorities]; that is probably the collective view of Unison’s membership and they naturally seek to represent that view to government and the media. This Conversation is about adult social care which is outside the responsibility of the NHS and the BBC.

I said that governments have been “trying to get adult social care on the cheap”. Of course they have spent billions on the NHS, as well as on education, defence, and many other state functions. But the NHS is not the chief provider of adult social care and no party has yet suggested that there be any cuts in the NHS to fund better adult social care. My point is that the under-funding cannot go on for ever and serious money will have to be found from somewhere, whether this is to directly invest in better domicilary care and provision, or in the residential sector, or through fiscal support to families and individuals to enable them to have the care they need in a suitable way at an affordable cost.

I don’t know how the BBC comes into the question again – it is not even run by the government. The NHS always has been lax in collecting payments for medical treatment where another party is liable [road accidents are a classic case and the insurance companies have got off lightly]. If the NHS were as bad as it is portrayed there would be no “medical tourists” to worry about; I’m not saying it’s a feather in our cap but I suspect it’s a consequence of the NHS being largely governed and managed by people with the health and welfare of others at heart rather than by accountants.

Getting back to the topic, the Ombudsman is telling us that “adult social care” is giving rise to an increasing number of complaints and that the majority of them are upheld. That is deeply worrying and needs addressing in a focussed way without casting aspersions over other areas of public provision.

Member
Gerald says:
7 June 2014

Well John we are now fully aware on which side of the fence you are sitting ,yes let us get back to the ombudsman ,as far as I am aware a large number of the complaints you are referring to actually refer to complaints against the Public Sector and ,as you state the have increase significantlly ,particularly since the formation of the CQC in fact if you check the numbers you might find a corellation between the time when the NHS and the Council were self monitoring and the time when the CQC took over the inspection of the Public Sector, particularly when certain senior managers of the CQC got the sack for covering up the Mid staffs hospital mess and intimidating certain inspecting officers .I refer to the BBC and Unison because of their completely unfair and biased approach and I do not believe that this sort of smear campaigning is actual for the Public good.
I once again reiterate my point regards the Publics freedom of choice (promised by all governments) the figures speak for themselves, the Public want the Privalte Sector and are prepared to pay for it, I wonder what they know and you just do not seem to understand,
When you refer to “the NHS being governed and managed by people with the heaalth and welfare of others at heart ” I wonder how you can make this statement in the light of recent revelations, please explain how the promotion of the Chief exec. of the Mid Staffs to the top job in the NHS and other massive cover ups at Leeds, Bristol and currently Wales go any way towards supporting your statement..I would also like to know where Unison has been involved in protecting all their members who have been involved with whistleblowing, how have the management got away with massive intimidation and even bribery do Unison cndone these payoffs I wonder..
I believe that any discussion ralaiting to Adult Social Care has to encompass all providers, Public and Private and not just be a one sided smear campaign which some of thes discussions are turning into.

Member

I hold no brief for either “side of the fence” and I think it would be better if we did not have this divisive approach. I have no problem with adult social care being largely provided by private organisations [and the charity sector] so long as it meets society’s requirements, and the needs of its clients. I also happen to think that private companies could make a better job of delivering daily home care sevices than local authorities, although I believe the big thing lacking in this area is consistent national standards and adequate ring-fenced funding commensurate with the needs of the local population and the realities of life in each area [e.g. delivering home care in a rural county cannot be as efficient as it might be in a city’s suburbs so it’s no good having the same targets or per capita funding]. So far as trade unions are concerned, I accept that they have many faults just as many managements are not perfect and some employees are recalcitrant; nevertheless, I firmly believe it is impossible to deliver personal social services in a residential setting or in the client’s own home without a lot more engagement with the staff employed, a proper process of participation and consultation, and an organisational culture free of blame, fear and victimisation.

Member

alas when the local councils realised that money for social care of the elderly was not ring fenced and could be used to fund other projects or meetings was the downfall,when local councils decided that value for money was more important than care that was the sighn of local care home closures to save money , private care homes realised if they took a loss for 12 months on the care of elderly they could beat the VFM table, so local councils filled the homes with social tenants as soon as that happened local run homes where deemed too expensive, and closed down, as soon as they were closed the prices then crept up on the private homes and now they are too expensive, to cover costs manpower and funding is reduced in the care packages they have to offer, so staff cutbacks, not being paid when travelling to clients then feeding out to private again cheaper and meeting the rules ,council care close private prices go up again, so for the same services 20 years ago we are now paying an extra 50% in fees whereas the true funding has dropped but the demand has increased by around 75% so someone has to loose and private staff paid the lowest wages as a profit is being sought, means cheap labour, abused staff and here is your p45 and the use of zero hour contracts being pushed by the DWP after training courses (if you complain you get no work, being self employed you are not entitled to benefits anymore) so move to Scotland where its still free and the old folk are happier if only we could move the border down 50 miles…

Member
Gerald says:
7 June 2014

Dear Papagray,
You are correct when you say that some Local Councils misdirected funding away from Care Home provision of Adlut Social care and various methods were uised to do this inclding changing criteriors , means testing etc.this was not done to save money it was mainly done to promote the”Care in your own home” dogma which these Councils supported and encouraged I am not getting involved with the merits of this scheme as I think that will resolve itself in time , I will only say that when you refer to value for money coming from the Private Sector and thick you might find that the General Public might agree with you that the Private Sector Care Homes are better value than the Public Sector.
The main reason for Councils closing down their homes to the lack of Public support because they had had not been kept up to the new standards required by CQC the” independant” regulators.
Your point regards fee setting is off the mark as all Council funded placements are set by the Councils and in general for a number of years now have been depressed by Social Services at times against their own officers recomendations .

Member

Last week I wanted to raise issues regarding the private Telecare System[ usually press button emergency help] .There had been power cut I must have made over 100 calls some Political trying to find those who make the decisions to no avail.What was the result.They are now blaming me away taking away my access to reassuring telephone calls on an automatic system .So automatic cannot be tailored to what needed. The fact no one wants risk is now allowing Insurance Companies to discriminate against those who need it most, not fully overseen by NHS .

My life could be reduced by 10 years as could end up with stroke as comotosing now daily on injestion & noone investigating yet know my pulse drops extremely low especially with the interaction of preventative medication.The NHS pretends I am inventing & it is a mental issue when had cardiac arrest never having been referred to Specialist because of policy.