Roundtable report: complaint handling in adult social care and social housing (part 1)
By Chris Gill (University of Glasgow)
This blog post (the first of two) provides a summary of a roundtable event held on 9 June 2021 organised by Chris Gill (University of Glasgow), Carolyn Hirst (Hirstworks), Jane Williams (Queen Margaret University), Richard Simmons (University of Stirling), and Isidoropaolo Casteltrione (Queen Margaret University).
This invitation-only event brought together 31 leading practitioners, policymakers, advocates. regulators, ombuds, and others with an interest in complaint handling in social housing and adult social care, to discuss current issues, challenges, and opportunities for learning and improvement. The aim of the roundtable was to provide a forum for discussion and exchanging ideas on these issues, as well as prompting discussion of where research is needed to support and enhance complaint handling in future. In this post (the first of two), we provide a summary of the presentations delivered in the first part of the roundtable. The second post (to be published shortly) will provide a summary of the subsequent small group discussions.
Presentations were given by Rosemary Agnew (Scottish Public Services Ombudsman – SPSO), Karen Sykes (Local Government and Social Care Ombudsman – LGSCO), and Rebecca Reed (Housing Ombudsman Service – HOS).
Rosemary Agnew (SPSO)
Rosemary Agnew outlined the work of her office, noting that it involved both classic ombuds functions and distinctive features such as: the ability to set and oversee model complaint handling procedures, being the final stage of appeal for the Scottish Welfare Fund, and the INWO (Independent National Whistleblowing Officer for NHS Scotland) function. The INWO sets whistleblowing principles and standards, monitors compliance and is the final stage for whistleblowing complaints in the Scottish NHS. Unlike in England, there is no separate housing ombudsman in Scotland.
Social housing is an area that has been of concern to the SPSO in the past, with proportionately very high numbers of premature complaints, or complaints made to the ombuds without first having exhausted the complaints procedure of the body complained about. However, social housing was among the first sectors to implement a model complaint handling procedure and this has brought down the number of premature complaints significantly, suggesting that more people are now able to access local complaint procedures.
The model complaint handling process in the social housing sector is supported by a very strong and active complaint handler network, and complaint handling in social housing is generally seen as a success story. The biggest current area of complaints in social housing anecdotally has been driven by the pandemic, which has led to a rise in complaints about anti-social behaviour.
In relation to social care the SPSO’s remit has been expanded in recent years to enable her to make decisions about professional social work decisions taken in relation to adult and children’s social care. The main issue in relation to the adult social care sector relates to inconsistency and complexity caused by service delivery structures. Private service care home providers are under the jurisdiction of the Care Inspectorate (the Scottish social care regulator), and only local authority care homes are under the jurisdiction of the SPSO. The SPSO also considers decisions taken by local authorities in relation to assessment, eligibility, commissioning, and adult protection.
A key strategic theme (which also applies in social housing) for the SPSO is the idea of transitions (e.g. from childhood to adulthood, from prison to the community, from a hospital to a care home). Transitions are an area of concern because these are often areas where service failures occur and where it can be difficult for people to complain. Service provision is increasingly complex and integrated, but things can go wrong when things do not connect up effectively.
The Feeley review of adult social care (and independent review commissioned by the Scottish Government) found a 30% increase in complaints about adult social care since 2016/ 2017 and the SPSO’s uphold rate in relation to adult social care is also significant. Resources are a key issue in adult social care, however, an important theme in the SPSO’s work has been that some local authorities focus narrowly on questions of resources, at the expense of taking a rights-based approach and considering the needs of individuals more broadly.
As a result of the more complex service delivery structures in adult social care, it is harder to achieve and evidence learning from complaints. This could be supported in future by enhancing advocacy, since some of the complaints that had the biggest potential to bring about change were brought to the SPSO by advocacy organisations. Currently, advocacy is not available as of right in social care and the user journey needs to be more of a focus given the number of different players potentially involved in this sector.
Karen Sykes (LGSCO)
Karen Sykes noted that the LGSCO is currently restricted by outdated legislation, which has only been marginally amended since it was made. One of the biggest recent changes is that people who self-fund their care are able to bring complaints about privately delivered care services to the ombuds. Another change has been that some (but not all) of the LGSCO’s housing jurisdiction was transferred to the Housing Ombudsman Service in 2013.
Indeed, although the LGSCO’s jurisdiction for councils’ landlord functions has been transferred to the Housing Ombudsman Service, certain aspects remain (e.g. homelessness, allocation). 19% of complaints to LGSCO are about housing, and housing accounts for 25% of complaints investigated. Homelessness complaints are subject to a very high uphold rate.
Overall, there is a clear understanding in the adult social care sector that local authorities remain responsible for the delivery of contracted out service provision. There is, however, a great deal of variation in the quality of complaint handling between local authorities. Some are very good, some see it as a nice to have. Generally, there has been an erosion in the complaint handling functions of some local authorities.
Previously most complaints were about poor process, but LGSCO is now seeing more complaints about the introduction of policies which seek to push the boundaries of what is legally permissible. For example, policies might introduce additional tests (not required or sanctioned by statute) about what individuals need to show to be entitled to care and funding. This was driven by resource issues.
Where individuals are self-funding, care providers deal with complaints. An issue here is that the market in England is very fragmented. The 5 biggest care providers in England account for only 13% of the market, and the rest is composed of many small providers. Few providers signpost effectively to the LGSCO and some know little about the ombuds. Reaching so many different providers to raise the ombud’s profile is challenging.
Covid has had an impact on complaint handling. It has led to a further erosion in investment in complaint handling. Complaint handling has been put on the back burner in some areas, and some local authorities even suspended their complaint procedures at the start of the pandemic. Where service provision had already been poor, the pandemic has exacerbated this. As with the SPSO, there is a view that more rights-based approaches are required, but the evidence of the LGSCO’s casework suggests that rights rarely feature explicitly in decision making.
In terms of the complaints themselves, the LGSCO finds more fault in relation to adult social care than the average overall. This is despite the fact that the LGSCO, unlike the SPSO, does not look at the merits of adult social care decision making, and is limited to considering maladministration. Nearly 20% of the remedies recommended and agreed are completed late and are not prioritised, again due to resourcing issues.
There are various reforms that would help address current problems including: a jurisdiction over all care settings (currently the jurisdiction only extends to care regulated by the Care Quality Commission), own initiative powers of investigation, a requirement for providers to signpost to the LGSCO and to publish data on complaint volumes and outcomes, and the greater provision of advocacy support for complainants.
Rebecca Reed (HOS)
Rebecca Reed noted that the Housing Ombudsman Service carries out significant systemic work, using a range of tools including powers of systemic investigation, calls for evidence on particular topics, and complaint handling failures orders. The latter has been a very helpful driver of improvement, as it has enhanced the perception of the ombuds as having teeth. While not an own initiative power, the ombuds can also carry out wider investigations where there is evidence that systemic issues exist. This allows the ombud not only to look at individual issues, but consider broader patterns.
The ombud issues a complaint handling code under their Scheme that social housing providers are required to comply with or justify why they have not. The ombud will accept good reasons to deviate from the code. Two stage complaint processes are expected and any 3 stage complaints processes must be justified.
The ombud’s aim is to promote a positive complaints culture, where complaints are seen as a ‘canary in the goldmine’. The idea is for complaint handling to be seen positively by social housing providers and act as an early warning system for when their service provision is starting to cause issues. There is a requirement for providers to adhere to the code and complaint handling failure orders can be issued if there is a failure to comply without good reason. Blocking access to a complaint procedure and failing to deal with a complaint are also both examples of when an order might be issued. Orders are reported to the Regulator of Social Housing.
The ombud aims to work collaboratively with housing providers to identify best practice. A recent example has been the work carried out on heating and hot water, which had identified a range of issues. The ombud uses spotlight reports to raise the profile of issues arising from complaints and the opportunities for wider learning.
Current challenges for the HOS including overlapping jurisdictions (e.g. with the LGSCO and the Regulator of Social Housing) as well as gaps in jurisdiction (e.g. as cited by the LGSCO, people living next door to social housing who wish to complain about it). Another challenge was awareness of the HOS and what it could and could not do as an organisation. Currently, there is no standard housing provider approach to recording, categorising, and reporting on complaints and no centralised data collection.
Some challenges relate to issues that are bigger than individual landlords, such as cladding, aging stock, housing shortages, overcrowding, and a reduction in advocacy and support for vulnerable people. In some cases landlords were simply trying to cope with these issues.
There also some opportunities. The government has committed to strengthen the role of the HOS and to enshrine the complaint code in statute. Complaint handling failure orders have the potential to drive further improvement. The regulator’s tenant satisfaction measures could provide a helpful launching point for systemic investigations. Calls for evidence are helping look beyond complaints to issues that are either not raised formally or do not reach the HOS. A newly constituted resident panel is assisting the HOS by providing feedback and ensuring the resident voice is heard. And a new Centre for Excellence is being designed to ensure that the HOS maximises the outreach of their knowledge and expertise and is facilitating social providers to self-learn.
We are grateful to Rosemary Agnew, Karen Sykes, and Rebecca Reed for their contributions to the roundtable and for commenting on a draft of this post. The second part of this blog (to be published shortly) will summarise the roundtable’s subsequent discussions.
NB: Representatives from the following organisations took part in the event: Scottish Public Services Ombudsman, Local Government and Social Care Ombudsman, Housing Ombudsman Service, Association of Retained Council Housing, West Berkshire Council, Healthcare Regulation UK, Independent Age, Darlington Council. Lancashire County Council, London School of Economics, Scottish Housing Regulator, Access Social Care, Regulator of Social Housing, Castlerock Edinvar Housing Association, Clarion Housing, Care Inspectorate, Northern Housing Consortium, Administrative Justice Council, Leicestershire County Council, Advice Services Alliance, National Complaints Managers Group, Placeshapers, South Lakes Housing, Sefton Council, Equality and Human Rights Commission, Bromley Council, TPAS (Tenant Engagement Experts), Housing Complaint Network, Devon Council.