We must improve the social care complaints system

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!

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.

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.

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…