Investigating and Handling Complaints

By Jenny Wilde, Partner, Acuity Law (https://acuitylaw.com)

Working in the health and social care sector obviously comes with its challenges. The expectations of service users and their families can be at odds with practices, and this can lead to complaints.

Dealing with complaints is a specific focus of the Care Quality Commission (“CQC”) under Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Registered service providers are scrutinised on how they receive, handle and resolve complaints and the way that a service handles complaints will be judged under the Well-Led key question during inspection.

The Competition and Markets Authority and the Chartered Trading Standards Institute also consider how care services deal with complaints, and providers should review the most up-to-date thinking from those bodies.

It is crucial to be absolutely clear on the organisation’s complaints policy and how the procedure works – ensuring that staff, service users (and their advocates) and their loved ones know exactly what to do when something is not right.

Complaints policies and procedures
A clear and easy to navigate complaints policy is an essential building block for ensuring compliance (and building good relations with service users and staff).

The policy must be unambiguous about what people should do when they have a complaint about the service and who they should approach with any concerns. This person should be senior enough to take responsibility for the complaint and undertake necessary investigations. There should also be a provision for when that person is the subject of the complaint.

Service users and their families need to be know where the policy is kept and how it can be accessed. They should also feel confident that any complaint they bring to the attention of senior staff will be dealt with in confidence and with sensitivity.

It is likely that this policy will be reviewed by the CQC during inspection.

Staff engagement with complaints
A good policy will only be effective if staff have full training on its contents, its importance and how to conduct themselves when a complaint is raised. Providers may create role play scenarios with staff to rehearse the correct process or use a case study based on a previous difficult complaint.
Staff need to know how to recognise a complaint (they can be made informally and formally), when to escalate a complaint and how to respond in the moment. Sensitivity is important, and all complaints should be taken seriously.

Staff dealing with complaints must respond to complaints in a timely way as dictated by the policy. This may also mean providing a holding response to reassure the complainant that the matter is being investigated.

Complaints can intensify unnecessarily when a person feels that they have not been heard. Staff empathy and proactivity will give a complainant confidence that the concerns are being dealt with and make them less likely to escalate the matter.

Staff should also be aware of how to record or log complaints. The CQC will review any formal record of complaints, which should not only be a list of issues raised but also, for example, a comprehensive summary of dates, actions taken and next steps. Creating a complaints matrix is an easy way to help CQC to track the issues and assess how the provider and its staff performed.

A complaints matrix will also allow the provider to spot trends or identify (and potentially discipline) staff members that regularly appear in complaints.

Complaints investigations
There are some simple steps for investigating a complaint:

• The investigation should be undertaken by a senior person who was not involved in the incident. It should refer to any available documentary evidence, staff statements and the perspective of the complainant.

• An impartial view of the matter should be taken and documented clearly.

• Providers should not conduct any investigations into matters that are subject to police involvement as this may prejudice those investigations.

• Responses to complaints should be delivered clearly and sensitively. It is prudent to ask at the earliest opportunity what outcome the complainant would like to see.

• If the complaint is not upheld, then the complainant should be reassured that a full investigation took place and offered details of how to escalate the matter if they are not satisfied. This may be to the Chief Executive of an organisation or to the Local Government and Social Care Ombudsman.

Limiting complaints
A provider can also take steps to reduce the number of complaints in the first instance. Regular opportunities for feedback can reveal any dissatisfaction informally and give the provider the opportunity to resolve the issue before a complaint is made.

This may also limit complaints made directly to the CQC or their commissioning authority, which can lead to intense scrutiny. People are less likely to go “over the head” of the care home if they feel confident that a matter can and will be addressed.

Open lines of communication can help service users and their representatives feel more comfortable in approaching the service’s senior team with a minor issue before it snowballs. Transparency and trust is essential and if staff are open and willing to engage on any issue, this will positively influence culture within the service.

In addition, a “no blame” culture among staff can go some way to ensuring mistakes are not covered up, which can result in more serious issues. Staff performance should be dealt with through regular training, supervision and support where appropriate.

Staff should also be alerted to the service’s whistleblowing policy to further promote an openness and transparency.

Such a culture will promote trust within the staff team and encourage quick identification and resolution of issues.

Conclusion
Handling complaints is an excellent indicator of a service’s culture. All staff must be clear on the policy, and their own responsibilities in relation to it.

Gathering best practice regularly, coupled with good communication throughout the service, should reduce the number of complaints being made and ensure that services are delivered in a safe and personalised way.