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ITEM CH11

HEALTH & COMMUNITY SERVICES SCRUTINY COMMITTEE

OXFORDSHIRE COUNTY COUNCIL SOCIAL & HEALTH CARE COMPLAINTS SERVICE
ANNUAL REPORT 2004-2005

Report by Director for Social & Health Care

1. This is the Annual Report of the Oxfordshire Social & Health Care’s complaints service, including the service’s activity data for 2004-2005.
2. Oxfordshire Social & Health Care operates a statutory complaints procedure under the National Health Service and Community Care Act 1990, the Complaints Procedure Directions 1990, the Children Act 1989 and the Representations Procedure (Children) Regulations 1991. The procedure is managed by a dedicated Complaints Service based at County Hall.
3. The Directorate has maintained a flexible and user friendly approach whereby anybody wishing to make a complaint can do so to the staff member, team or service of their choice. Complaints are therefore received in all areas of the Directorate. The administration of all complaints however is centralised within the complaints service at County Hall. This ensures that there is a central (database) record of all complaints, that complaints can be analysed within the complaints service, trends and "hot spots" identified and the lessons to be learnt from complaints reported and acted on in order to raise standards and to improve performance.
4. This report confirms that Oxfordshire Social & Health Care receives relatively few complaints compared with the number of people with whom the Directorate is in contact and works with. This would suggest a significant amount of satisfaction with the services received. It remains important however that the Directorate continually works to be as open and receptive as possible to comments and complaints about its services.

Complaints Procedure

5. Oxfordshire Social & Health Care staff respond to a range of disagreements and dissatisfactions in the course of its day to day work. The emphasis is on trying to resolve disagreements and problems before they become formal complaints. The majority of issues are satisfactory dealt with at this problem solving stage. Where this cannot be achieved the person concerned is advised to use the formal complaints procedure which involves a three stage process. The complaints activity referred to in this report therefore represents a relatively small percentage of the work to resolve dissatisfaction by users and carers.
6. The Directorate is expected to respond to complaints within specific statutory timescales. Where the Directorate’s complaints processes are not subject to statutory timescales the complaints service has ensured that any deadlines are compatible with County Council standards.

Stage One

7. Under stage one of the procedure a manager from the service area being complained about is required to look in to the issues raised and to respond directly to the complainant. There is no set statutory timescale for stage one complaints. Oxfordshire Social & Health Care has however set a timescale of 2 working days in which to acknowledge the complaint and a further 10 working days in which to respond to the complainant. These timescales have been set to achieve consistency with the standards set by the County Council’s Corporate Complaints Service.

Stage two

8. If the complainant is not satisfied with the stage one response they may progress to stage two of the complaints procedure whereby an Independent Investigating Officer is appointed by the Complaints Service to investigate the complaint. The Investigating Officer is a member of the Directorate’s panel of Independent Investigating Officers. The statutory framework requires the Directorate, where possible, to consider the complaint and formulate a response within 28 calendar days. This is however rarely achievable due to the complexity of the issues that are sometimes raised and the amount of work required in the investigation process. The maximum statutory timescale for completion of stage two investigations within the Community Care Act procedure is 3 months. The Investigating Officer will complete a report to include findings and recommendations and this will be sent to the complainant alongside a formal response from the Directorate.
9. The complaints procedure for children and young people under the Children Act is slightly different to the Community Care Act procedure. Where a complaint relating to a child or young person reaches stage two, the Complaints Service will appoint an Independent Investigating Officer to investigate the complaint as per the Community Care procedure. In addition an Independent Person is appointed alongside the Investigating Officer to monitor the conduct of the investigation. A stage two complaint made under the Children Act procedure must be considered and responded to within 28 calendar days of receipt. There is no extension to 3 months. This is a statutory deadline and includes the Investigating Officer’s report and the Directorate’s response to the Investigating Officer’s report. Local Authorities experience considerable difficulty in meeting the deadline for Children Act complaints.

Stage Three

10. Stage three of the complaints procedure is the same for both Community Care and Children Act complaints. If the complainant is not satisfied with the way that their complaint has been dealt with at stage two they may request a Complaints Review Panel Hearing which is the third and final stage of the Directorate’s procedure. A Complaints Review Panel comprises three members including an Independent Chairperson who is totally independent of the Local Authority, a County Councillor and either a nominee of the Chief Executive to the Council or a second Independent Person.

Stage One Complaints Activity – 1 April 2004 to 31 March 2005

11. For the financial year 2004-2005 a total of 95 stage one complaints were administered by the complaints service. These comprised a total of 211 separate complaint issues. A number of staff and some teams have taken time to become familiar with the current processes and it is possible that some stage one complaints have been responded to at a service or senior management level without reference to the complaints service. This should however only be a short term problem given the complaints service is becoming more outward facing and this includes the promotion of the new processes and procedures throughout the Directorate.
12. The 95 stage one complaints and 211 complaint issues administered by the complaints service were from the following service areas:

SERVICE AREAS	COMPLAINTS		COMPLAINT ISSUES
	Number	%	Number	%
Older People	15	16	33	5
Physical Disability	5	5	9	4
Learning Disability	9	10	19	9
Mental Health	4	4	8	4
Home Support	7	7	12	6
Children & Families	45	47	111	53
Asylum Seekers	1	1	2	1
Community Development	1	1	3	1
Contracts Unit	1	1	2	1
Finance	7	7	12	6

The above table shows that 69 complaints (73%) and 163 complaint issues (77%) related to Children & Families, Older People and Learning Disability services. These can be broken down within these service areas as follows:

C = complaints I = issues

CHILDREN & FAMILIES SERVICES	COMPLAINTS	COMPLAINT ISSUES	CITY C – I	NORTH C – I	SOUTH C – I
Assessment Teams	17	41	3 – 7	4 – 11	10 –23
Family Support	11	31	0 – 0	10 –29	1 – 2
Looked After Teams	10	25	5 –12	3 – 8	2 – 5
Disability Teams	2	7	0 – 0	0 – 0	2 – 7
Residential Care	5	7

 

OLDER PEOPLE’S SERVICES
Oxford City	5	9
North	6	13
South	3	7
Hospitals	1	4
LEARNING DISABILITY SERVICES
Oxford City	0	0
North	5	11
South	2	3
Adult Placement	2	5

The number of complaints relating to individual Teams and Services is relatively low although managers will look in to the uneven distribution of complaints between the Children’s Assessment Teams where 59% relate to the South Team and between the Family Support Teams where 91% relate to the North Team. Similarly 56% of Learning Disability complaints and 58% of complaint issues relate to the North Team. This pattern is typical of other Social Services Department’s complaints.

Adherence To Timescales – Stage One Complaints

13. Responsibility for adherence to stage one timescales rests at service manager level across the Directorate. Of the 95 stage one complaints referred to in this report, 62 (65%) were responded to within the timescale set by the complaints service and 33 (35%) were therefore outside the timescale.
14. Of the 33 complaints where the timescale was not met 16 were responded to within 5 calendar days of the deadline and 6 were responded to within 6 to 10 days. 7 responses were between 11 and 25 days late and 4 were 26 days late or more. Overall performance in responding on time to stage one complaints represents a marked improvement compared to 2003-2004. Unfortunately information relating to 5 complaints in 2003-2004 is not available due to a database problem. Furthermore, because stage one complaints were only administered centrally by the complaints service from July 2003, there is only 9 months data available for 2003-2004. Coincidentally the complaints service administered 79 complaints in the last 9 months of 2003-2004 and exactly the same number in the first 9 months of 2004-2005, suggesting no change in the level of recent activity.

RESPONSE TIMESCALE	NUMBER OF COMPLAINTS 2003/2004 (9 MONTHS)	NUMBER OF COMPLAINTS 2004/2005
Deadline achieved	33 (42%)	62 (65%)
Within 5 days of deadline	21 (27%)	16 (17%)
6 to 10 days of deadline	3 (4%)	6 (6%)
11 to 25 days late	8 (10%)	7 (8%)
26 + days late	9 (11%)	4 (4%)
Not recorded	5 (6%)
TOTAL	79	95

Of the 33 complaints in 2004-2005 not responded to within the timescale set by the complaints service 20 (61%) related to Children’s Services and 7 (21%) to Older People’s services. 44% of the 45 stage one responses from Children’s services and 47% of the 15 responses from Older People’s services therefore fell outside the timescale. Other service areas performed extremely well with 83% of all other responses being made within the timescale. The Heads of Social Care and Operations Managers responsible for Children’s and Older People’s services will discuss this performance information with service managers responsible for the stage one response to complaints with a view to improving performance.

Themes Arising From Stage One Complaints

15. The complaints and issues raised at stage one of the Directorate’s complaints procedure are extremely diverse. Nevertheless by categorising complaints under broad headings common themes can be identified. The 211 complaint issues recorded for 2004-2005 can be categorised as follows:

COMPLAINT ISSUE	NUMBER OF ISSUES
Communication	53 (25%)
Assessment Issues	18 (9%)
Care Plan Issues	27 (13%)
Confidentiality	11 (5%)
Lack Of Support	28 (13%)
Unmet Need (including funding)	11 (5%)
Lack Of Contact With Family Member	10 (5%)
Quality And Reliability Of Service	13 (6%)
Unprofessional Staff Member	31 (15%)
Finance Issues	9 (4%)
TOTAL	211

The following outcomes were noted for the 211 issues addressed at stage one of the complaints procedure:

OUTCOME	NUMBER OF ISSUES
Complaint Issue Upheld	49 (23%)
Not upheld	100 (47%)
Partly Upheld	14 (7%)
Unclear response	37 (18%)
Unanswered	11 (5%)
TOTAL	211

There were 2 service areas where more than 10 complaint issues have been upheld, Children & Family services and Older People’s services as per the table below.

C & F = Children & Families OP = Older People

COMPLAINT ISSUE	ISSUES UPHELD	ISSUES PARTLY UPHELD
	C & F OP	C & F OP
Communication	6 3	3 0
Assessment Issues	1 2	1 1
Care Plan Issues	2 0	1 0
Confidentiality	2 0	0 0
Lack Of Support	0 0	3 1
Unmet Need (including funding)	2 4	0 0
Lack Of Contact With Family Member	0 0	0 0
Quality And Reliability Of Service	0 1	0 0
Unprofessional Staff Member	1 1	1 0
Finance Issues	1 0	0 0
TOTAL	15 11	9 2

Learning Disability Services had 8 complaint issues upheld and 2 partly upheld and Home Support 9 issues upheld and none partially upheld. The complaints service will provide a breakdown of the data for each service area upon request.

The Key Lessons Learnt From Stage One Complaints In 2004-2005

16. The diversity of stage one complaints presents a significant challenge when seeking to draw conclusions and to identify the lessons to be learnt from stage one activity. The categorisation of complaints is, by necessity, relatively broad otherwise there could be an overwhelming number of categories of little individual statistical significance.
17. The most frequently recurring cause of complaint is communication problems (raised in 56% of complaints and representing 25% of all issues) comprising unclear or incorrect information given, a failure to provide information, a failure to keep clients informed of decisions, a failure to respond to telephone calls and poor letter writing. With regard to communication, a number of lessons have been learnt about the way in which managers respond to stage one complaints. The quality of response varies significantly across the Directorate. Of the 211 issues responded to at stage one, 48 (23%) received an unclear response or the issue was left unanswered. A number of the written responses could be considerably improved with better grammar, clearer and more easily understood language and a change of tone and emphasis. A key learning issue for the Directorate to address is the quality of some of the letters sent to clients from Unit Managers and more senior Directorate managers. This will be something the Directorate will be addressing.
18. Although care plan issues (raised in 28% of complaints) and a perceived lack of support (raised in 29% of complaints) are also frequently recurring causes of complaint there are not a sufficient number of common themes to enable key lessons to be identified. The problems that complainants highlight are extremely diverse and include decisions not to provide services, delays in providing services, reductions in or the withdrawal of services, the level of service provision, a change of care manager, a change of care provider and not providing support to help clients resolve specific problems e.g. housing issues.
19. The professional conduct of Directorate staff was referred to in 31 representations (raised in 33% of complaints and representing 15% of complaint issues) and a breach of confidentiality in 11 representations (12% of complaints). The former included written correspondence perceived as threatening, rudeness, a lack of respect (e.g. smoking when in a car with a non smoking client), insensitive, inappropriate and indiscreet comments. These representations are similar to a number received in 2003-2004. Service managers will have seen and responded to these representations and, where they have been upheld (4 representations) or partly upheld (1 representation), have been responsible for ensuring the lessons learnt from the representations are addressed. Regardless however of the relatively small number of representations about professional conduct that have been upheld, managers will ensure that improvements in customer care and in client’s perceptions around the professional conduct of staff will be improved.

Stage Two Complaints

20. Six complaints received at stage one during 2004-2005 have been the subject of a completed stage two investigation. In addition 11 complaints received at stage one in 2003-2004 have been the subject of a completed stage two investigation in 2004-2005. Furthermore 6 complaints received at stage one in 2004-2005 are in the process of being investigated. The investigations will be completed in 2005-2006. They will be reported on in the 2005-2006 Annual Report. The breakdown by service area of the 17 investigations completed in 2004-2005 is:

SERVICE AREA	COMPLAINTS	ISSUES	UPHELD	NOT UPHELD	PARTLY UPHELD
Older People (South)	2	6	1	5	0
Physical Disability (South)	1	5	0	5	0
Learning Disability (North)	3	10	8	1	1
Mental Health	1	3	0	3	0
Children’s Disability Team (South)	3	11	6	1	4
Children’s Family Support (City)	1	4	0	3	1
Children Looked After (City)	2	7	1	6	0
Children & Families Assessment	1	4	1	3	0
Asylum Seekers	1	3	0	2	1
Finance	2	7	6	1	0
TOTAL	17	60	23	30	7

No stage two responses were either unclear or unanswered which is in marked contrast to the 23% of stage one responses that were either unclear or unanswered.

21. Whilst only 23% of complaint issues were upheld and 7% partially upheld at stage one, 38% of the complaint issues that proceeded to a stage two investigation were upheld by the independent investigator and 12% were partly upheld. Consequently 50% were not upheld. There is some evidence from the complaint files that managers have not always been vigorous enough and sufficiently impartial when looking into issues raised at stage one of the procedure. Although the numbers are relatively small, the change in outcome between stage one and stage two is most noticeable in Children’s Disability Services (South) where 91% of the issues were upheld or partly upheld at stage two, Learning Disability Services (North) where 90% of the issues were upheld or partly upheld at stage two and Finance Services, where 86% of the issues were upheld or partly upheld at stage two. Senior Managers are looking in to the reasons for these changes of outcome between stage one and stage two and will act upon their findings.
22. The complaint issue that is most likely to be upheld at stage two is Communication, where 9 of the 13 representations (69%) were upheld or partly upheld.

COMPLAINT ISSUE	NUMBER OF ISSUES	UPHELD	NOT UPHELD	PARTLY UPHELD
Communication	13 (22%)	6	4	3
Assessment Issues	10 (17%)	2	7	1
Care Plan Issues	11 (18%)	4	5	2
Confidentiality	2 (3%)	0	2	0
Lack Of Support	7 (12%)	4	3	0
Unmet Need (including funding)	2 (3%)	0	2	0
Lack Of Contact With Family Member	2 (3%)	0	2	0
Quality And Reliability Of Service	3 (5%)	2	0	1
Unprofessional Staff Member	7 (12%)	2	5	0
Finance Issues	3 (5%)	3	0	0
TOTAL	60	23	30	7

Although only 3 of the 17 stage 2 investigations were completed within the statutory timescale, the complainants concerned agreed to a lengthier investigation process. The overriding priority for the complainants was for a thorough investigation process. Delays occurred because of the complexity of individual complaints, staff absences due to annual leave and sickness and complainants being unavailable due to holidays and for health reasons.

Stage Three Complaints

23. There were 3 stage three Panel Hearings in 2004-2005 all relating to complaints that were registered at stage one in 2003-2004. One of the complaints, relating to an adult with Mental Health needs, was not upheld by the Review Panel. In one complaint, relating to the assessment of an adult with a learning disability, the Panel recommended that another assessment should take place because the complainant was unhappy with the original assessment. The other complaint related to an adult Asylum Seeker and the Panel recommended that the stage two investigation be re-commenced as new legal information had come to hand which was not previously available to the investigating officer.

Action Taken And Being Considered To Improve Performance And Raise Standards

24. There have been considerable changes to the complaints service in the past 18 months and it has taken this time for the service to collate and analyse sufficient data in order to identify where performance can be improved and standards raised. Recent refinements to the complaints database have been achieved so that the key lessons from complaints can now be identified more easily and acted upon. From the latter part of 2004-2005 onwards, the complaints service expects to be increasingly active in the drive towards improved performance and the raising of standards.
25. Although a number of improvements achieved may appear relatively small from an organisational perspective, they are nevertheless significant for clients to whom they apply. As an example the complaints service identified in 2004-2005 a number of complaints about the letters sent to parents following the raising of child protection concerns about their children. The complaints service identified that standard letters were being used which, in themselves, caused distress to their recipients. Following discussion with the relevant service manager a decision was made to change the wording of the letters to reduce the risk of causing unnecessary distress.
26. The complaints service is currently preparing material to help managers respond to complaints. There is a need to ensure all representations receive a response and are not overlooked, to improve the clarity of response, to help managers to improve their written grammar, to use clearer and more easily understood language and to achieve a change of tone and emphasis.
27. In addition to improving the response to complainants the complaints service has identified the need for staff and managers to be trained in general letter writing to clients and their carers. There are however sensitivities associated with this. The complaints service is currently collating data so that consideration can be given to the most appropriate way to improve the Directorate’s performance in this area.

Information About The Complaints Service

28. In addition to managing the statutory complaints procedure the complaints service has been involved in a range of initiatives in 2004-2005.
29. New complaints leaflets and staff documents were launched in May 2004. The new leaflets were designed with the help of service users and now include a leaflet specifically for people with a learning disability. There is a separate leaflet for children and young people in addition to the general complaints leaflet " Help us get it right - Comments, Compliments, Complaints – Tell us what you think of our services". The latter is available in a range of languages and the complaints service can provide taped versions for people who cannot read. The tapes will be "made up" on request so that any additional special needs can also be catered for. The staff documents include a Staff and Managers Guide for handling complaints and other representations and a top tips card to provide staff with information about what to do when they receive a complaint.
30. A number of changes have taken place in 2004-2005 to make the complaints service more accessible to the public. The complaints service tries to make it as easy as possible for people to make a complaint. A complaint does not have to be put in writing. The service takes telephone complaints, has an email address for representations and staff from the service will visit complainants at home in order to discuss and to take their representations. Furthermore the Oxfordshire County Council website contains information on how to complain and to whom. In addition posters have been designed and distributed both within the County Council and beyond which inform people about how to make a complaint. These are on display in all reception areas within the Social & Health Care Directorate (including area offices, residential and day care establishments) and have been made available to a range of external agencies for display in their public areas.
31. During 2004-2005 the complaints service has provided training for Social & Health Care staff in handling complaints. The service has also become more outward facing within the Directorate by attendance at team and staff meetings to discuss and promote the complaints procedure with staff from a wide range of service areas within Oxfordshire Social & Health Care.
32. By way of public consultation a Complaints Forum was held in March 2005 attended by staff from a number of statutory and voluntary organisations representing service users and carers. The purpose of the Forum was to provide information about the complaints service, including performance data, and to seek people’s views on the future development of the service. The Forum was a positive attempt to involve stakeholders in the development of the complaints Service. Feedback from the organisations that participated in the Forum was extremely positive. They welcomed the opportunity to contribute towards the development of the complaints service. The key issues that came from the Forum included:

• The need for a mechanism whereby external organisations can provide information on representations to them that are not dealt with as formal complaints.
• The importance of external agencies being confident that the Directorate is determined to investigate all complaints in an impartial way and to act on the findings of complaint investigations.
• The need to obtain information from complainants about how well the complaints service and the Directorate have managed their complaints.
• The importance of ensuring that there is a clear and easily understood procedure for handling complaints where services are provided in partnership with external agencies.
• A request that the Complaints Forum is an annual event.

33. Following the improvements made in 2004-2005 the complaints service will work towards further improving compliance with statutory and County Council timescales in 2005-2006. This will be achieved by ensuring managers and staff are fully aware of the timescales being worked to and, where necessary, the procedure for extending deadlines.
34. The complaints service will ensure that there is a clear pathway for the future management of complaints where Mental Health services have been fully integrated. This will be achieved by the complaints service finalising work that is currently in hand with the Oxfordshire Mental Healthcare Trust.
35. The following three objectives relate to the raising of standards and improving performance. The complaints service will review the way in which representations are received throughout the Social & Health Care Directorate. The review will include both formal complaints and issues that are responded to outside of the complaints procedure. This will result in public feedback, that may not necessarily represent a complaint within the statutory procedure, being recorded in a systematic way. The lessons to be learnt from this information will be identified and reported on by the complaints service.
36. The complaints service will similarly develop closer working relationships with external organisations that represent service users. This will enable the service to obtain additional information about the public’s view of the Directorate’s services and performance. The information obtained will be added to the overall database of information held within the complaints service and reported on by the complaints service.
37. The complaints service will make arrangements to obtain information from complainants about how well the complaints service and the Directorate have managed their complaints. Again the information obtained will be added to the overall database of information held within the complaints service and reported on in order to raise standards and improve performance.

Statutory Changes to the Complaints Procedure

38. There have been no statutory changes to the Social & Health Care complaints procedure in 2004-2005. The Department of Health circulated a consultation document towards the end of 2004 proposing changes to the statutory complaints procedure from 1 April 2005. The proposed changes were subsequently deferred until 1 October 2005 and it is now unlikely that they will be implemented. Hence the existing statutory procedure is likely to be maintained throughout 2005-2006.

CHARLES WADDICOR
Director for Social Health Care

Background Papers: Nil

Contact Officer: Peter Howe, Senior Complaints Manager Tel (01865) 815753.

1 June 2005

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