Involving Users and Carers

Engaging users and carers

Supporting and empowering users and carers to participate

Managing complaints and compliments

 

Engaging users and carers

Councils need to ensure that a range of initiatives are in place to engage effectively with service users and carers. Such arrangements are of fundamental importance to the empowerment of users and carers in all aspects of the delivery of social care services. Engagement needs to be at all levels:

At a strategic level by:

  • Being involved in the consideration of major strategic issues such as the implementation of new legislation and central government requirements
  • Helping to shape new local policies
  • Having a voice in the determination and implementation of major service change programmes that affect them as users and carers (for example the reconfiguration of day services for people with a learning disability to provide less centre-based care and more community-based activities)
  • Getting feedback from the monitoring of performance against key national indicators and service improvement targets
  • Receiving overview reports regarding the outcome of complaints

At a service level by:

  • Judging the performance of service delivery units against stated quality standards - See Good Practice - Worcestershire County Council - Involving Service Users in Staff Training
  • Contributing ideas about how services could be improved
  • Monitoring the implementation of agreed service change programmes
  • Becoming involved in staff recruitment and appraisal processes
  • Becoming involved in staff training initiatives
  • Being involved in letting contracts with independent sector providers, for example sampling meals from shortlisted providers of community meals

At an individual case level by:

  • Receiving information about assessments and care plans to deliver services, and monitoring the delivery of those services to the stated quality standards
  • Using case review processes to inform care managers about the outcomes from care plans
  • Using the formal complaints procedures when there are serious concerns about the quality of the services

 

Supporting and empowering users and carers to participate in decision-making

Councils need to ensure that suitable arrangements are in place to support users and carers in order to help them participate effectively. Arrangements need to include the provision of relevant information, the commissioning of specialist advocacy and support arrangements, and forums for participation to enable a structured approach to engagement at a strategic and service level. Arrangements at each level would need to include:

At a strategic level:

  • Establishing specific forums for dealing with the development and monitoring of strategic plans, including strategic targets, and policy development. For example:
    • Including user and carer representatives in partnership boards that frame future strategic plans. For example, a joint partnership board for services for people with learning disabilities involving social service, health, housing, voluntary sector and user/carer representation
    • A carers group to develop the carers' plan and to monitor its implementation
    • Looked after children and care leavers' groups to advise on the development of services and monitor the effectiveness of those services
    • A Direct Payments user group to oversee the operation of the Direct Payments scheme, including the quality of the support services, and advise on improving user uptake
  • Commissioning advocacy and representation services to offer specialist independent support to users and carers to enable them to participate. Advocacy requires special skills that have to be properly commissioned by councils to cover the range of interests and needs of various users and carers. Advocates must be independent of the council if they are to adequately represent users and carers. An example at a strategic level would be a Children's Rights and Representations service to provide independent support and advice for Looked After Children and Care Leavers
  • Establishing focus groups that can be consulted about satisfaction with the overall performance of the council's social services
  • Carrying out user and carer surveys to gather views about performance from users and carers. This approach has been adopted by Joint Reviews throughout the programme and has enabled the team to compare the performance of councils being reviewed and monitor trends over time. Councils can use this mechanism to track their own progress in key areas - Read More

At a service level:

  • Establishing user consultative groups to engage in the running of specific services such as day and community support services for people with a learning disability, or supported living schemes for adults with mental health problems
  • Supporting user groups and individual service users or carers using specialist advocacy or mentoring arrangements to enable them to participate fully in the running of their services and in monitoring of performance
  • Providing all users and carers with information about the quality standards for the services they are receiving
  • Using focus groups or user and carer surveys to gather information about the performance of specific services and overall satisfaction with those services

At an individual case level:

  • Providing service users and carers with all the necessary information to enable them to judge the quality of the services they receive, and how to make complaints or compliments
GOOD PRACTICE TIPS

Empowering service users through the provision of relevant information

 

  • Information to service users should be easily understood, comprehensive and readily available. There should be a register of public information leaflets for social services that need to be available to different user groups, and processes to ensure the effective management of public information at all public access points
  • Information should be made available in different languages
  • Information should be available in different formats - such as large print, Braille or cassettes for people with a visual impairment, and with symbols for people with a learning disability
  • Information should help users and carers feed back information on the quality of services received and their own experiences, record their compliments, and when necessary initiate a formal complaint - this could be done by having a tear-off, prepaid slip on information leaflets that users and carers can complete and return
  • Information should be given out at the appropriate time. For example, information about contacts, how to complain, and about the assessment process should be provided at the time of the initial assessment, while information about quality standards for services and how to make contact with service providers should be made available at the finalisation of the care plan
  • Information should include contact details for the relevant advocacy service, particularly for children looked after
  • The provision of information should be proactive for groups where there are particular difficulties, such as people with a learning disability or for people whose main language isn't English
  • Ensuring that service users and carers are actively engaged in assessment, care planning and review processes, and are provided with copies of assessment documentation and care plans
  • Ensuring that the advocacy arrangements also provide support to individuals, particularly to allow them to participate in assessment, reviews and agreeing care plans, or to voice concerns about the quality of services they are receiving

 


Managing complaints and compliments


All councils in England providing a social work service have to implement complaints procedures that operate under the Children Act 1989 and the NHS and Community Care Act 1990.

The provision of an effective and timely complaints process is important and empowering for users and carers as it gives them right of redress where it is felt services have not been provided effectively. In addition, intelligence gathered from complaints provides a rich vein of information for senior managers and elected members about the performance of their social services. This includes information about which parts of the service are working well and which parts are not performing to a satisfactory level, together with information about the achievement of agreed quality standards and targets. This information can then be used to influence future service planning, to deliver improvement, or review policy.

EXHIBIT 11 The management of complaints is an essential part of monitoring performance and influencing service improvement



Source: Joint Reviews

Organisation and role of a complaints service

Complaints units should be properly resourced, have a clear role in the performance management framework for social services and maintain a degree of independence from the direct line management of services. Councils seeking best practice in this area will:

  • Be open to the receipt of complaints. Low numbers of complaints is not necessarily evidence of good performance; it may indicate that people do not know how to complain, that the organisation is not receptive to complaints or that recording of complaints is poor
  • Encourage complaints - staff should be encouraged to assist users and carers in making their complaints, and work with independent advocacy organisations - especially for hard to reach and particularly vulnerable groups
  • Ensure that an independent person is available to support children and adult complainants - especially where people are particularly vulnerable
  • Have a dedicated complaints officer in place for children's and adult services because of the different requirements of the two services
  • Invest in a complaints management system such as Acolaid or Respond 3 to help manage the service
  • Ensure that complaints processes dovetail with arrangements in partner agencies such as health, particularly when a complainant has raised issues which affect both agencies
  • Ensure that complaints processes dovetail with the formal disciplinary arrangements, and ensure that individual members of staff are not disadvantaged through the need to invoke both procedures in some situations
  • Have monitoring arrangements such as user surveys to encourage feedback from users. This will help to judge user satisfaction with both the outcome of investigations and the timescales achieved for responding to and investigating complaints

 

Services for children and families

The Children Act 1989 requires every Council responsible for the provision of these services to establish a procedure for considering representation made by or on behalf of children looked after or in need. Authorities are required to publicise their procedure and monitor its operation. Complaints processes for children have been strengthened by the Representations Procedure (Children's) Regulations 1991. Key additional features include:

  • A designated officer to co-ordinate consideration of complaints
  • An independent person to be appointed when representations have been received
  • A response to be given within 28 days (with no extension of time)
  • A review panel to consider and resolve complaints within 28 days of being notified. This panel must include an independent person who cannot be the same as that originally considering the representations

The Waterhouse Report in 2000 on the abuse of children in care in North Wales emphasised the need for all authorities to review the effectiveness of their procedures.

 

Adults

Key features of the Local Authority Social Services Act, 1970, incorporated into the NHS and Community Care Act, 1990, include the requirement for Social Services Authorities to have a complaints procedure for adult services. Key features include:

  • A designated officer to co-ordinate complaints
  • A three-stage approach, emphasising the resolution of complaints informally at the first stage. Most councils expect this to be managed by the first line manager responsible for the service
  • A second stage at which a complaint becomes registered. Most councils would then expect a more senior manager to handle the complaint
  • A third stage requires a panel hearing, if the complainant is still dissatisfied with the local authority's response and notifies the council in writing of their dissatisfaction within 28 days of receiving this response. The panel should be chaired by an independent person and frequently involve a council member
  • A registered complaint has to be dealt with within 28 days, or up to 3 months if this is not possible. The complainant should be informed of the reasons for any delay.

These powers are set out again in the Complaints Procedures Direction 1990 and have been amplified in policy guidance from the Department of Health, 'Community Care in the Next Decade and Beyond', published in the same year.

 

GOOD PRACTICE TIPS

Ensuring an effective approach to handling complaints

Councils need to ensure that their complaints procedure meets legislative requirements and is effective by:

  • Identifying a time limit for eligibility to make a complaint and ensuring that long-term service users are able to raise issues
  • Clarifying timescales for investigations and ensuring that the speed of response in investigating and resolving complaints is monitored and reported to managers
  • Ensuring effective procedures for informal resolution of complaints. Making arrangements to support a speedy response to users' concerns so that they do not feel they have to implement the complaints processes
  • Making effective use of the independent person in registered complaints
  • Enabling service users to complain effectively through good and timely information and the support of advocacy arrangements. The best authorities are promoting advocacy to help children and adults frame their complaints and pursue them vigorously. This approach empowers individual users through encouraging them to have the confidence to raise concerns and helps to ensure that minimum standards are maintained - See Good Practice - Tameside Metropolitan Borough Council - Video About How To Complain for People with Learning Disabilities
  • Ensuring that care management decisions are not made while a complaint is being investigated, particularly if the decision has a bearing on the complaint
  • Ensuring that decisions about complaints which reach second stage or review panel are monitored and reported on regularly. The process can be strengthened by identifying an individual responsible for implementing agreed panel recommendations and keeping complainants informed of progress.
  • Ensuring the boundaries between complaints procedures of different agencies are managed positively by developing joint protocols for responding to users who receive services from both health and social care agencies. The Health Act, 2000, has made provision for joint health/social services complaints procedures and these have been implemented in a number of authorities. As the commissioning and provision of services becomes more integrated, authorities will need to ensure complaint processes are aligned, if not combined, effectively

 

Using intelligence from complaints to improve performance

All councils are required to produce annual reports on complaints and these should be considered by senior managers and councilors. The best councils have also instituted a routine monthly or quarterly reporting system to ensure that complaints information is incorporated within the performance management framework and regularly reported to departmental and corporate managers and councilors. Councils can learn from complaints when similar or connected problems keep arising which may indicate that policy needs revision, or that specific policies or procedures have not been effectively implemented.

GOOD PRACTICE TIPS

Monitoring the reasons for complaints and outcomes in order to improve services

 

Complaints are a rich source of intelligence about what is, and is not, working well. Authorities where the information from complaints is used effectively will have the following features:

  • Information is collected and reported about the numbers, types and outcomes of informal complaints where the complaint is investigated by a first line manager
  • Regular reports that detail the number and nature of complaints, by service and locality are made to the senior management team. These reports are in addition to the requirement for an annual report
  • A summary of performance regarding complaints is included in routine data sets provided for first line managers
  • A mechanism for cascading learning from complaints is in place
  • Changes are made following investigations into complaints that focus on improving outcomes for service users as well as processes - for example, not just changing the 'falls protocol' in residential care homes as a result of an accident, but making real improvements in the care provided
  • Monitoring arrangements identify 'outliers' in performance that are investigated and followed up
  • Complaints contribute to monitoring the performance of specified quality standards. For example, where a quality standard for a service has been agreed, but a complaint has been made about failure to meet this standard, then this feeds into a broader monitoring of the quality of the service
  • Outcomes from complaints monitoring should be used to determine staff training programmes to address problems in the quality of service delivery

 

Local Government Ombudsman

As well as being able to utilise the council's complaints procedure for social services, it is also possible to make representation to the Local Government Ombudsman. Councils need to ensure their procedures provide an adequate response to dealing with complaints made to the Ombudsman, and act on the findings of the Ombudsman when it is felt that the complaint represents maladministration by the council.

Compliments

It is good practice to maintain a record of compliments received about social services and report the outcomes to senior managers and councilors. Details of compliments received should also be made known to staff responsible for the delivery of that service. Experience shows that compliments usually outweigh complaints about services when records are maintained, and this provides a balance for staff, senior managers and councillors who inevitably tend to focus on problem areas.