Roundtable report: complaint handling in adult social care and social housing (part 2)

Roundtable report: complaint handling in adult social care and social housing (part 2)

This post 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. An earlier post provides a summary of the presentations given at the roundtable.

In the present post, we provide a summary of the small group discussions held at the roundtable and the research agenda we are developing to investigate complaint handling in adult social care and social housing. For the discussion, we randomly allocated delegates into four small groups of around 8, with a member of our research team taking notes of discussions and then providing plenary feedback. The summary below highlights the key themes arising from across the group discussions.

The issues discussed fell within three broad areas: access to justice; the design and operation of complaint systems; and learning and complaint data.

Access to justice

The lack of availability of legal aid has resulted in a greater volume of issues being considered under complaints procedures and has resulted in cases that are harder to process. Access to advocacy and advice is patchy and there is no requirement for advocacy support (this contrasts with the NHS where such advocacy is required). This leaves people scrabbling around to find third sector providers who can assist individuals in making a complaint. There is a need for mapping work to look at the current availability of advocacy.

Younger people feel that complaining using email or complaint forms is outdated. Forcing people to use particular channels limits access to justice. At the same time, while there is potential benefit in enhancing digital accessibility to complaint systems, there needs to be caution about how this is used to ensure people are not left behind. There is also a danger that more digital approaches could lead to greater use of algorithmic approaches to decision making that would not be suitable in the public service complaint handling setting.

There is some ongoing work being carried out by the Legal Services Board on the relation between advocacy and advice and scoping this out may lead to some insight about enhancing support for complainants to make complaints. In Scotland, the emphasis is being placed on open government partnerships, and involving citizens proactively in service design rather than focusing on dissatisfaction. This is a potential route to reduce and prevent access to justice gaps.

There is a lack of data about what happens to non-complainants and who they are. There is concern that drops in complaint levels have been seen in some areas but that this is not a result of improved services, but limited access to justice. Where have those complaints gone and why are people not complaining? There is a need for a universal set of codes to be developed that would allow for demand to be mapped and to understand which complaints get through and which do not.

Complaining is still seen and experienced as being negative. People are often fearful of making complaints (in terms of repercussions for the service they receive and taking on powerful organisations) and lack the knowledge and confidence to make complaints. They also are not convinced about the benefit of complaining, particularly when they would like to see a wider change taking place, as organisations tend not to tell them about actions resulting from their complaint.

Design and operation of complaint systems

Resourcing is a fundamental issue. In adult social care, many local authorities do not provide sufficient resources for the service or complaint teams, leaving staff feeling unsupported and less able to provide a good service. The focus as a result is on dealing with cases rather than carrying out wider value adding activity such as learning and improvement. Many complaints teams have been whittled down so that they are only able to do the basics. Covid has put huge increased pressure on services that are already strained (both at front line and in relation to complaints handling)..

Earlier intervention and the use of mediation techniques have potential advantages. There is a need for more proactive approaches that seek to resolve issues earlier and ensure that complaints do not escalate. An issue here relates to the definition of a complaint as ‘any expression of dissatisfaction’. This might be too broad, particularly given the resourcing issues facing organisations. A focus on genuine and legitimate concerns would help, and might help reduce defensiveness in organisations.

The question of where complaint teams should sit within organisations remains open for debate. There are advantages to having a centralised team, separate from service delivery departments, in terms of impartiality and being able to provide feedback as a critical friend. But this could also lead to the impression that complaints were separate from service delivery or not the concern of service delivery managers – something that is done elsewhere.

One of the issues relates to authority. If complaints require redress to be provided or service changes to made, the complaint managers need to have the authority to say that change is needed. There is a huge amount of variety currently in terms of how complaint handling is organised and where complaints teams sit – no two organisations operate in the same way. An issue in some organisations is the number of people involved in deciding in complaints – this can lead to more corporate responses that do not focus as much on the issues in the complaint.

Complexity in service provision and oversight is a pressing issue. There are challenges relating to managing the expectations of complainants where an issue isn’t within the remit or control of an organisation. It is often not clear who is responsible for what and there are multiple paths to redress. It is difficult for professionals working in these areas to understand the systems involved, let along for citizens. A particular challenge arises in the interface between services and organisations where there could be both gaps and overlaps.

Some of these difficulties include social care working with the NHS. There is a duty to work together in complaints but there are variations in process that makes this difficult (e.g. timescales). At the ombudsman level, the Local Government and Social Care Ombudsman and the Housing Ombudsman Service would like to do more joint working but are prevented from doing so by legislation. The legislation for ombuds could be reformed to focus on what ombuds should achieve rather than prescribing how they should do it. A more proactive approach from ombuds and regulators with a focus on promoting better practice for all was welcomed, as was a more explicit rights-based approach.

Learning and complaint data

The issue of authority of complaints teams also came up in relation to learning. Isolated complaint teams that are under-resourced and do not always have buy in from senior management could not deliver effective learning. There is a question about who is best placed to drive learning within organisations and how it can be transferred across departments and teams.

There is often a lot of learning and reflection on complaints within teams at a local level. However, this learning is hard to evidence. Much of what gets reported is procedural and box ticking learning. It is perhaps the lower level reflective learning that can make the most difference to the culture of an organisation. It was agreed that there is value in learning from the experiences of other organisations.

Leadership is crucially important if complaints are going to be valued and acted upon. Often individual managers are keen to learn, but there is insufficient support for learning. Governance is key to make sure that organisational leaders are being scrutinised and held to account in relation to learning from complaints. There needs to be clear accountability and visibility of actions taken in relation to complaints.

One of the problems in terms of learning from complaints is that no one sees all the data holistically. People see only the tip of the iceberg. There are very significant differences between how organisations record and analyse complaints. There is a huge opportunity for a database to be developed that could be analysed by academics and others. One of the questions here relates to skills – the skill of analysing complaint data is very different to the skill of complaint resolution, but currently there is an expectation that the same people carry out both roles.

There have been, and there are ongoing attempts, to standardise approaches to recording and categorising complaint data but there are huge obstacles to this. There is huge variance between organisations. There would however be significant benefit to this as organisations are often unmoved by individual complaint ‘stories’ and need robust data to allow change. The social housing white paper may help here in introducing new requirements on how complaint information is collected and reported.

One way of overcoming categorisation issues would be to centralise raw data (e.g. the actual content of complaints) that could then be subjected to secondary analysis. There are also developing areas of good practice e.g. the SPSO’s model complaint handling procedures and their approach to benchmarking through networks.

Currently, even where there are statutory reporting requirements, publication of complaint data is patchy. In adult social care in England for example it is very difficult to access information and only about a third of authorities are publicly reporting their complaint data. There is a need initially to do more with existing data, making it more transparent and allowing greater pooling and synthesis.

There are also questions about what complaint data is a reported, with a need for more focus on outcomes, themes, recommendations, actions and learning (rather than timescales and processing issues). The importance of learning from ‘lived experience’ was recognised along with the need for more qualitative research to better understand complainant experiences.

Finally, there is a need to improve the evidence base for complaint handling. For example, being able to demonstrate the value of complaint handling over and above the associated effort. Cold case reviewing might be a way in which evidence for enhanced complaint handling could be developed. There could also be experiments with more principles-based approaches – current approaches focus heavily on process and ‘what you must do’ and can prevent flexibility and seeking resolution at every stage.

A research agenda for complaint handling in adult social care and social housing

As part of the roundtable, we proposed a research agenda for complaint handling in adult social care and social housing. This has been developed in collaboration with stakeholders and the roundtable provided a further opportunity for consultation and collaboration. Our research agenda has identified six gaps for further research:

• Gap 1: the scale and nature of complaints systems
• Gap 2: complaining behaviour and access to justice
• Gap 3: online voicing channels
• Gap 4: experiences of complaint systems
• Gap 5: learning, change, and accountability
• Gap 6: values and public perceptions of complaining

The roundtable helpfully highlighted the key role of advocacy both in relation to access to justice and learning, and we plan to address this more explicitly in developing our research and addressing these gaps.

We will now continue to work with stakeholders to develop this research agenda. Our overall aim in doing so is to provide an evidence base for improving public service complaint systems’ capacity to deliver individual redress, organisational learning, and public accountability. Our website, aimed at communicating research findings to practitioners and policymakers, brings together some of our existing work in this area. The next steps for this project include further stakeholder events and the development of a specific programme of research to implement the research agenda set out above.

We are very grateful to all those who contributed their experience and expertise to the roundtable event and for their enthusiastic support for conducting further research in this area.