4.1.17 Complaints

1. Introduction

A complaint can be made by an adult who has applied for or is in receipt of a service in relation to care and support, including a carer, or a person acting on their behalf. A service should not be delayed, withdrawn or suspended because a person has made a complaint.

The local authority’s complaints procedure should aim to achieve the best outcome for the

• adult receiving the service,
• the complainant (if different)
• and the service.

Each complaint should be seen as an opportunity to improve the service offered.

Complaints about adult social care are governed by The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the Regulations).

Adult Social Care in Lambeth takes complaints seriously. We can put things right that have gone wrong and learn the lessons to avoid the problem happening again.

2. Principles of Good Complaint Handling

Responding appropriately to complaints includes:

• getting it right (legally and procedurally);
• being customer focused;
• being open and accountable;
• acting fairly and proportionately;
• putting things right;
• seeking continuous improvement.

See Principles of Good Complaint Handling (Parliamentary and Health Service Ombudsman).

3. Complaints Criteria

The local authority’s complaints procedure may be used in relation to:

• assessment and care planning by assessors, occupational therapists and social workers;

• our work in commissioning and contract management of social care service providers;

• financial assessment and charging in relation to adult social care;

• handling direct payments for social care;

• client affairs work;

• protection of property;

• management of affairs, such as through appointeeship

• management of affairs through the Mental Capacity Act 2005, such as acting as a deputy;

• in-house social care provision such as day centres that Lambeth Council manage.

There are things that the adult social care complaints process cannot be used:

• for matters that should be dealt with through other procedures. This includes things that should be dealt with under:
  • disciplinary or grievance proceedings;
  • criminal investigations;
  • where a statutory appeals process is in place;
• where the complainant intends to take legal proceedings in relation to the substance of the complaint;
• a complaint by another organisation, unless that organisation is acting as the representative of the person as described in Section 6, Giving People Support and Advice when they Complain;
• complaints which relate to contractual arrangements or other business arrangements made with the local authority;
• complaints by an employee of the local authority about any matter relating to that employment;
• complaints that have already been dealt with in line the Regulations;
• any complaint which is being or has been investigated by the Local Government & Social Care Ombudsman (LGSCO) ;
• complaints arising out of the alleged failure to comply with a request for information under the Freedom of Information Act 2000;

• complaints arising out of the alleged failure to comply with a request for information under the Data Protection Act 2018.

Some particular issues:

• complaints about accessible transport services come under the corporate complaints process (see Make a Complaint, Lambeth Council);
• complaints about social care services provided by independent and voluntary providers will need to be responded to by that service using its own complaints process. However, the Regulations allow the local authority to use its complaints process to ‘top-and-tail’ the provider service’s process, which allows the local authority to track the progress of the complaint and scrutinise the outcome. Whether to pass the complaint over entirely or to use the ‘top-and-tail’ approach will need to be a decision on a case-by-case basis. Guidelines will be produced on this;
• where a complaint relates to concerns about abuse or neglect of a person with care needs consideration will need to be given to how the complaints process and the safeguarding adults enquiry will relate to each other.

4. Action to be taken on receiving a Complaint

The initial contact the service has with a person who is unhappy with the service they have been given is key.

4.1 Informal Resolution

Any person expressing a concern about a service should be listened to, so that the nature of the complaint is properly understood and wherever possible the issue causing concern can be quickly resolved locally and informally for example by a change in arrangements which can be managed easily within the person’s overall plan.

Where a quick resolution is possible without further investigation, for example through an apology, this should be done with the agreement of the relevant operational team manager so long as the complainant is happy with this outcome and there are no risks to others using services, for example because the complaint raises serious issues (see Section 7, Assessing Seriousness of the Complaint).

Any complaint received should be recorded even where a quick resolution is achieved.

4.2 Formal Complaints

If it is clear that the person wishes to make a formal complaint, this should be passed to the relevant operational team manager or equivalent. It is crucial for this manager to obtain all information that will allow the seriousness of the complaint to be assessed correctly (see Section 7, Assessing seriousness of the Complaint) and to enable the complaint to be resolved quickly if possible.

After receiving a complaint where a quick resolution is not possible, the Complaints Unit delegated responsible manager should be notified within one working day and the complaint should be acknowledged within three working days.

The delegated complaints manager must acknowledge the complaint within three working days of the Council’s receipt of the complaint (not when it was passed to the department). This acknowledgement can be by phone or letter and the method of acknowledgement must be logged within the MOSAIC work step. The auto acknowledgement from the email accounts does not count as an official acknowledgement.

Where the complaint relates to two organisations, it should be agreed between the relevant organisations which of them will take the lead and a single point of contact should be given to the complainant.

The delegated complaints manager will then be responsible for liaising with the other organisation throughout the duration of the complaint.

The delegated complaints manager should contact the person making the complaint to arrange a face-to-face meeting to discuss the complaint and what the investigation can achieve.

Complaints can be resolved more effectively if it has been made clear from the outset what the person complaining expects as an outcome. If this is not a feasible or realistic outcome, then this must be explained to the complainant.

The delegated complaints manager should agree a complaints plan with the complainant about the action required in relation to any support to be provided to the person making the complaint, and the process of the investigation including how and when the complainant will receive progress reports and the timescale for a final response (usually 10 to 25 working days but in exceptional circumstances this may be longer).

4.3 Safeguarding

Where any safeguarding issues are identified, the member of staff or manager should immediately refer the concerns under the local Safeguarding Adults partnership / Board procedures (see the chapter on Responding to Safeguarding Concerns) as appropriate.

5. Publicising the Complaints Procedure

People using services should be informed of the Complaints Procedure and how they can use it.

People must have access to advice and information about making complaints including how to complain and who to. Information should be jargon free, user friendly, available in different formats and languages and give advice on how to obtain more information and support.

Translation and interpretation facilities should be available if needed (see Interpreting, Signing and Communication Needs chapter).

People using services should also be advised that they can make a complaint directly to the Local Government and Social Care Ombudsman.

6. Giving People Support and Advice when they Complain

There are many reasons why someone might need support (e.g. disability, language, age) and there are a number of services that help.

• the Complaints Unit can provide advice and support to people who receive services and their representatives;
• advocacy can be used to help some people to make a complaint and to provide support given during the investigative process (see Independent Advocacy chapter).

7. Assessing Seriousness of Complaints

In order to ascertain the best course of action, it is essential to assess the seriousness of the complaint using a three step process (see Making a Complaint, Local Government  and Social Care Ombudsman).

Low

• Unsatisfactory service or experience not directly related to care;
• No impact or risk to provision of care or of not meeting persons eligible needs; or

• Unsatisfactory service or experience related to care, usually a single resolvable issue. Minimal impact and relative minimal risk to the provision of care or the service. No real risk of litigation.

Examples – cancelled appointments, missed call.

Medium

• Service or experience below reasonable expectations in several ways, but not causing lasting problems. Has potential to impact on service provision; and some potential for litigation.

Examples – delayed discharge from hospital, miscommunication or misinformation.

High

• Significant issues regarding standards, quality of care and safeguarding of or denial of rights. Complaints with clear quality assurance or risk management issues, which may cause lasting problems for the organisation and therefore require investigation. Possibility of litigation and adverse local publicity; or

• Serious issues that may cause long-term damage, such as grossly sub-standard care, professional misconduct or death. Will require immediate and in-depth investigation. May involve serious safety issues. A high probability of litigation and strong possibility of adverse national publicity.

Example – event resulting in serious harm, multiple failures, abuse or neglect, gross professional misconduct.

Likelihood

• rare: isolated or ‘one off’ -slight or vague connection to service provision;
• unlikely / rare: unusual but may have happened before;
• possible: happens from time to time – not frequently or regularly;
• likely: will probably occur several times a year;
• almost certain: recurring, frequent, predictable.

This will be determined by taking account of the seriousness of the complaint and the likelihood of its recurrence.

Identifying the delegated responsible person and the delegated complaints manager who hold the delegated roles will depend upon the outcome of the risk assessment, as outlined in the table.

The delegated responsible person and the delegated complaints manager may themselves delegate actions to others, but the responsibility for the work will remain with them.

The job titles used are those for the assessment and care and support planning teams, and should be taken to apply to equivalent roles in other teams and services. Equivalence should be determined by the nature of the role and the level of responsibility, rather than based on pay scales or grading.

The delegated responsible person is responsible for ensuring organisational learning takes place, irrespective of whether or not the complaint is upheld.

Complaints management scheme of delegation: risk level delegated

Risk level	Delegated responsible person	Delegated complaints manager
	Ensures compliance with the Regulations, and ensures that action is taken if necessary in the light of the outcome of the complaint	Responsible for handling the complaint in accordance with the Regulations
Low   (Green)	Team manager	Practitioner manager
Moderate (Light amber)	Head of Service	Team manager
High (Dark amber)	Assistant Director	Head of Service
Severe (Red)	Director of Adult Social Care	Assistant Director

8. Investigating the Complaint

The purpose of the investigation into the circumstances and nature of the complaint is to establish the facts of what occurred. This should include – where appropriate – reviewing records, interviewing staff, conducting visits to the location involved and receiving specialist advice.

The person appointed as complaints investigator should be independent of the service to which the complaint relates and appropriately experienced and trained. Some serious cases will warrant the appointment of an independent external investigator.

Once evidence has been collated and analysed the investigator should produce a written report setting out a summary of the complaint, methodology used during the investigation, key findings, conclusions and recommendations for action. The decision made by the investigator should be fair and reasonable.

It should be noted that mediation may be useful in some cases.

9. The Outcome

Following the production of the report from the investigation findings, a written summary / explanation should be given to the complainant outlining:

• the complaint;
• how it was considered;
• lessons learned;
• proposed resolution of the complaint;
• recommendations for action which have either already been taken or are proposed.

Prior to the letter to the complainant being sent, the outcome should be agreed with the delegated responsible person, who should also sign the letter.

It may be agreed that an invitation to the complainant for a meeting in person to go through the points in the letter would be useful.

The complainant should also be informed of their right to take the matter to the Local Government and Social Care Ombudsman, if they are not satisfied.

10. Persistent and Unreasonably Persistent Complainants

From time to time the local authority will come across complainants who seek to raise a number of complaints or who become unreasonable in their conduct or expectations around contact. Whilst every effort should be made to address objectively any concerns that are raised, the local authority must also seek to be proportionate and not to expose its staff to unreasonable situations.

Persistent and  unreasonably persistent complainants are those complainants who, because of the nature or frequency of their contacts with an organisation, hinder the organisation’s consideration of their or other people’s, complaints.

The local authority distinguishes between ‘persistent’ complainants and unreasonably persistent complainants. People bringing complaints may be ‘persistent’ because they feel the organisation has not dealt with their concern and are not prepared to leave the matter there. Almost all complainants see themselves as pursuing justified complaints.  For example, criticising a procedure when the standards that are set out are not met is not unreasonable. If the procedures are working properly, then responding to expressions of dissatisfaction and requests for information should not cause particular problems.

However, some complainants may have justified complaints but may pursue them in inappropriate ways. Others may pursue complaints which appear to have no substance or which have already been investigated and determined. Their contacts may be amicable but still place heavy demands on staff time, or they may be emotionally charged and distressing for all involved.

Situations can escalate, and sometimes complainants become abusive, offensive, threatening or otherwise behave unacceptably. In response an organisation may have to restrict access to its premises or staff, or accordance with its own procedures protecting their staff from harassment and harm.

Behaviour which is unreasonable may include one or two isolated incidents, as well as unreasonably persistent behaviour, which is usually a build-up of incidents or behaviour over a longer period.

10.1 Unreasonable behaviour

On occasion, a complainant may become obstructive to the process, abusive or threatening to staff including those who are investigating the complaint.  In such circumstances restriction of access to the process can be considered.

These are some of the actions and behaviours which can be problematic. Single incidents may be unacceptable, but more often the difficulty is caused by unreasonably persistent behaviour that is time consuming to manage and interferes with proper consideration of the complaint:

• refusing to specify the grounds of a complaint, despite offers of help;
• refusing to cooperate with the complaints investigation process;
• refusing to accept that certain issues are not within the scope of a complaints procedure;
• insisting on the complaint being dealt with in ways which are incompatible with the adopted complaints procedure or with good practice;
• making unjustified complaints about staff who are trying to deal with the issues, and seeking to have them replaced;
• changing the basis of the complaint as the investigation proceeds;
• denying or changing statements they made at an earlier stage;
• introducing trivial or irrelevant new information at a later stage;
• raising many detailed but unimportant questions, and insisting they are all answered;
• covertly recording meetings and conversations;
• submitting falsified documents from themselves or others;
• adopting a ‘scatter gun’ approach: pursuing parallel complaints on the same issue with various organisations;
• making excessive demands on the time and resources of staff with lengthy phone calls, emails to numerous council staff, or detailed letters every few days, and expecting immediate responses;
• submitting repeat complaints with minor additions / variations the complainant insists make these ‘new’ complaints;
• refusing to accept the decision;
• repeatedly arguing points with no new evidence;

• requiring communication only in writing;
• requiring communication through a designated officer;
• putting time limit on contact;
• placing restrictions on the number of contacts;
• reaching an agreement on acceptable conduct.

When the delegated responsible manager believes the relationship with a complainant has become unworkable:

• they will raise the matter with the senior complaints manager and legal department for review;
• the senior complaints manager will review the matter and, if appropriate, will refer the matter with recommendations for action to the senior responsible person;
• the senior responsible person will make a decision on actions to be taken and the review date for any of these actions. Further information is detailed in Lambeth’s Adult Social Care Complaints Procedure – Where to get Further Information (Lambeth Council).

In extreme circumstances risk assessments may be conducted and the police involved (see Risk Assessments chapter). It may be necessary to seek early referral to the Local Government and Social Care Ombudsman should the relationship between the complainant and the local authority staff become too challenging.

11. Learning Lessons

The Adult Social Care Complaints Lead should ensure a record of complaints is kept, including outcomes and lessons learned, together with any actions taken to improve services. This information will be regularly shared with all managers.

An annual report must be produced by the Complaints Lead and presented to senior managers, including:

• the number of complaints received;
• analysis of the issues raised by the complaints;
• the number of complaints upheld;
• actions taken to improve services as a result; and
• the number of cases referred to an Ombudsman.

12. Further Reading

12.1 Relevant information

Principles of Good Complaint Handling (Parliamentary and Health Service Ombudsman)

Making a Complaint (Local Government and Social Care Ombudsman)

Adult Social Care Resources (Local Government and Social Care Ombudsman)