Guidance on Complaints Procedures in Health and Social Care

November 19, 2021
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Complaints can arise for many different reasons within the health and social care sector, and understanding how to deal with and respond to complaints effectively and appropriately is essential. Within this article we will look at the different types of complaints that can occur, why a robust complaints procedure in health and social care is important for all parties and organisations involved. 

We will also explain the different ways those wishing to make a complaint can do so, and offer some useful tips to consider when responding to a complaint to ensure it is handled in the best way possible. There are some differences between complaints procedures depending on your location, this advice is primarily aimed at those in England. 

What are the Types of Complaints in Health and Social Care?

Whether you work in the sector, have utilised health or social care services yourself or have been involved with a friend or family member’s care, you will be aware of some of the reasons why complaints occur. In an environment that can be short of resources and with the need for care sometimes bringing about feelings of frustration, anger and sadness, it can be easy for many situations to become emotionally charged.

Whilst an individual’s cause for complaint can be personal and specific to them and their circumstances, generally speaking there are some common reasons for issues to arise. Different settings bring about different causes for complaint. It is important to be aware that health care relates to the treatment, control or prevention of illness or disease, and social care focuses on providing support, protection and assistance with the needs and activities of daily living. Here are a few examples of why complaints may be raised.

Causes for complaint in health care settings include:

  • Having a long wait to receive an appointment or treatment.
  • An appointment or treatment being postponed or cancelled.
  • The quality of care or treatment received.
  • Poor communication, either between professionals and an individual, or between different health professionals or organisations.
  • The behaviour of staff, for example if they are rude or unempathetic.
  • Receiving harmful care or treatment.
  • Feeling neglected by staff or signs thereof.
  • Being discharged from hospital without adequate treatment or support in place.
  • A lack of clarity and clear explanation of diagnosis or results.

Causes for complaint in social care settings include: 

  • Disagreement over assessed care needs, or how they were assessed.
  • Having a service refused.
  • Not providing person-centered care.
  • Charges in service charges.
  • Changes to the times that care is being provided.
  • Issues with how an individual’s finances have been assessed.
  • Delays in receiving a decision or being provided with care or support. 
  • The quality of care received.
  • The amount of care received, such as care workers not staying with an individual for as long as they should or a reduction in care hours.
  • Poor communication from care providers or between staff.

It is clear from the examples provided that Promoting Effective Communication in Health and Social Care is vitally important for providing high-quality care, and minimising instances of conflict or complaints. There will always be a certain amount of change and adaptation required when the pressures and demands on a service change, but keeping all parties involved throughout is essential. 

People making a complaint to a health and social care worker

Regardless of whether an issue arises in a hospital, a dentist, a care home or within a person’s own home, by law, all those providing health or care services should have procedures in place to allow for complaints to be made and dealt with effectively. The procedure should be available for you to see upon request, and should clearly state how you can make a complaint, for example, by telephone, email, letter or via an online form. Once the complaint is made, you should then be made aware of what will happen next.

If a complaint was made in person or by telephone, the complainant should be provided with a written copy. If writing a complaint on someone else’s behalf, it can often speed up the process if you include their written consent in the letter. Written consent is not required for a non-Gillick competent child (one who still requires an adult’s consent to treatment), a deceased person or someone who lacks mental capacity. Complaints can be made by the individual themselves, a family member or friend, or even an independent advocate. 

Whilst many complaints may originate from those using health or care services, it is also worth noting that care workers themselves can also have reasons to raise concerns. For example, they may wish to raise a grievance to their manager about a colleague always leaving them with a greater share of the work. However, staff may also need to complain about the quality of care being provided if they have witnessed a situation that has caused, or risks causing, harm to a service user. 

All staff have a duty of care to protect adults at risk and ensure they are kept safe from harm and treated with dignity and respect at all times. Whistleblowing is the name given to the process that allows any wrongdoing toward service users to be reported by staff. ‘Whistleblowers’ are protected by law and there should be no risk of job loss or unfair treatment as a consequence. 

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Why not read on to find out more about whistleblowing and the importance of Duty of Care?

Why is a Complaints Procedure Important in Health and Social Care?

A complaints procedure is a set of processes that allow a complaint to be made, recorded and dealt with effectively. It should provide sufficient information to the public to inform them how a complaint can be made, and help them understand the procedure, this may involve having different user-friendly formats available. All complaints should be recorded, investigated and dealt with correctly and there should always be a response provided within an appropriate time frame. If there is a need to escalate a complaint further, details on how to do so should also be provided.

Care worker dealing with a complaint in a health and social care setting

There are numerous benefits to having a complaints procedure in place, not only for a service user but for the service provider themselves. Complaints are a way of learning, by finding out what went wrong, changes can be made to improve the  service. A complaints procedure also forces accountability, keeping an official record of the complaint and having a legal obligation to investigate, prevents it from simply being ignored. The process may also give an organisation insights into how well they are performing and whether there are any trends occurring, as well as helping to spot any training gaps that may need addressing.

We have mentioned the importance of good communication and the role it plays in reducing the need for complaints to arise. However, it is worth noting that a clear, effective and robust complaints procedure is key in preventing any issues from escalating further and causing a need for staff to resort to Whistleblowing to address the problem. 

Health and social care covers many different settings and organisations, more so than just hospitals and care homes. Some of those who are required to have a complaints procedure in place include: 

  • GPs and out-of-hours GPs.
  • Dentists.
  • Opticians.
  • Local authorities.
  • Ambulance services.
  • Private care companies, both those who do and do not provide care on behalf of a local authority.
  • Community health services.
  • Hospitals.
  • Mental health services. 

How to Make a Complaint to Care Services

How to make a complaint will depend on which organisation the complaint is about and what category it falls under, e.g. adult social care or NHS primary care. In general, and in the first instance, a complaint can be made to the service provider directly by following their complaints procedure. Remember they should be able to provide you with clear information on how a complaint can be made, who to and how it will be dealt with. There can be a time limit on making a complaint following an incident (usually within the 12 months that follow), so try raising it in a timely manner.

Outside of directly complaining to a service provider there are other bodies you may need to complain to. Finding out how to do so and who to complain to can feel daunting but there are many different resources out there to help. A great starting point is Citizens’ Advice, together with Healthwatch England (national) and Local Healthwatch, they can provide you with the information required to make your complaint, whether that be to the NHS, local authority or the CQC (Care Quality Commission). They provide useful flowcharts to show complaints processes, complaint letter templates and the do’s and don’ts of making a complaint. 

Speaking to staff directly where care was provided or services accessed and addressing any concerns in their early stages can often resolve issues more quickly and mitigate the need to raise an official complaint. However if a complaint is still required, the following information may be useful:

  • If complaining to a service provider directly, follow their procedure.
  • Patient Advice and Liaison Service (PALS) can be found in most hospitals  and can help you informally resolve issues with a hospital directly to try to avoid the need for a complaint.
  • The independent NHS Complaints Advocacy Service can offer advice, support and attend meetings with you during the complaints process.
  • When care is funded or arranged by your local council you can complain to them. You can find their information on the government website.
  • An Independent Mental Health Advocate (IMHA) can help support and advise if you have a complaint about how the Mental Health Act was used. 
  • The CQC can investigate complaints relating to the Mental Health Act, such as those receiving care while detained in hospital, on a guardianship or a community treatment order.
  • The CQC does not have a responsibility to resolve individual complaints (unless related to the Mental Health Act).
  • Generally, primary care (e.g. GPs, dentist and pharmacists) complaints can be made to NHS England.Secondary care (e.g. physiotherapists, continence care and speech therapists) complaints should be made to your local Clinical Commissioning Group (CCG).

If you are unhappy about how a complaint is handled, it is useful to know that complaints regarding the NHS can be taken to the Parliamentary and Health Services Ombudsman, and those about adult social care can be taken to the Local Government Ombudsman. If the complaint happens to involve both, then the ombudsman will work together. 

Tips for Responding to Health and Social Care Complaints

If you are a health or social care worker and you find yourself approached regarding a complaint, it is important to deal with the situation calmly, empathetically and appropriately. As we have discussed, many negative situations that arise in the sector can be fueled by highly emotive circumstances. Actively listening and communicating clearly can sometimes resolve any issues quickly. If a complaint is unavoidable, provide the complainant with all the information they require to make their complaint and ensure they understand the process. Always treat anyone making a complaint with respect.

Be mindful of what you see and what is said by a service user, you may pick up on certain comments being made or perhaps a change in atmosphere or attitude. For example, you may work in domiciliary care and notice a service user keeps commenting that their call time is getting later each day. They may not intend to make a complaint, but you could offer this feedback to your manager or, if appropriate, discuss with the service user directly to understand if the situation is causing them any issues or distress. Addressing concerns early on can prevent a situation escalating.

If you are the one making a complaint yourself, or on someone else’s behalf, it is equally as important for you to approach the situation as respectfully and as calmly as you would wish to be dealt with. Whilst there may be many frustrations surrounding the cause of complaint, it is important not to be led by emotion. Be clear, factual, specific and polite. Remember to gather as much information as you can, including dates, times, staff involved etc. Approach the situation in a collaborative way and work together to try and resolve the issue successfully. 

It is important to remember that good communication, a person-centered approach and an open empathetic environment can help minimise the need for issues to escalate into a complaint being made. Health and social care is a challenging sector both to work in and to be reliant upon. A robust and effective complaints procedure in health and social care can promote accountability and help organisations and staff learn and improve the quality of care they provide.  

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Safeguarding Adults