In February this year CQC launched its ‘Declare Your Care’ campaign, encouraging people to share their experiences of care with CQC to support it with its regulatory work. The associated press release included data from a consumer research study commenting on people’s regrets about not raising concerns about health and social care services when they had them.
The consumer research was carried out over a two-week period in November/December 2018 and included 2002 people in England who had had a health or social care service experience in the last 5 years. Despite the limited data set, this led to a number of overarching conclusions including:
- Almost 7 million people in England who have accessed health or social care services in the last 5 years have had concerns about their care but never raised them;
- Of the 7 million, over half expressed regret about not having raised their concerns;
- The most common reasons for not raising a concern were not knowing how (20%) or who (38%) to raise it with, not wanting to be seen as a troublemaker (33%) and worries about not being taken seriously (28%).
While it is positive that the regulator is trying to connect directly with service users and their families to better understand their experiences of care, this can create issues for providers if people go directly to CQC without having raised concerns with them first. At Ridouts, we have seen multiple examples of CQC criticising providers for not taking action in response to stakeholder concerns that had been raised with CQC inspectors during inspections, without considering the fact that the provider had not been made aware of the concerns previously. This is clearly unfair as a provider is unable to investigate or take action in response to something they are not aware of. However, it is clear from the campaign that complaints are in the spotlight and providers should be taking time to reflect on their complaints processes to ensure they are fit for purpose.
Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 sets out the legal requirement for providers when receiving and acting on complaints. It states that:
“(1) Any complaint received must be investigated and necessary and proportionate action must be taken in response to any failure identified by the complaint or investigation.
(2) The registered person must establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users and other persons in relation to the carrying on of the regulated activity.”
The regulation should form the basis of a complaints policy but it also needs to go further than this to ensure it reflects other regulatory requirements such as good governance of a service. This can help to elevate a services rating to Good or even Outstanding.
Some key factors to consider when reviewing the effectiveness of a complaints system include:
- Staff knowledge – do staff know how to identify a complaint, how to respond when they receive a complaint (e.g. supporting the person to make a complaint) and how to report it?
- Accessibility – Can people easily access the policy? Is it on display at the service? Is there an easy read format? (where relevant, consider the Accessible Information Standard).
- Details – Is your policy clear about how people can raise a concern? Are clear contact details provided? Is there a clear process for logging complaints and a clear timeline for providing a response?
- Recording – Are all complaints being properly recorded including outcomes and actions taken? CQC has the power to request information about complaints and can take action if this is not provided or the records are insufficient.
- Monitoring – are complaints being monitored to identify potential patterns that could be addressed to improve the overall service?
Services should ensure they are actively encouraging stakeholders, including service users, family members and loved ones, staff, visiting professionals and others to express their views of the service directly with the provider. This can help encourage positive feedback which can be used to demonstrate good practice, ensure any concerns are dealt with at an early stage and help avoid any unexpected criticism from CQC.