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CHAPTER 7 COMPLAINTS HANDLING
Summary
Complaints information was seen to play a useful role in the scrutiny of public services. More specifically, there was widespread agreement that services receiving a large number of complaints should be subject to investigation (no participants suggested that a large volume of complaints could be seen in a more positive way, as an indicator of a successful complaints procedure or of a confidence in that system). Participants agreed that complaints should be analysed in the course of inspections but disagreed about whether inspectors should focus on the complaints procedures or on the substance of the complaints themselves. Five barriers that might prevent or deter service users from making a complaint were identified:
1. a lack of knowledge about how to complain
2. a lack of ability to complain e.g. being unable to express oneself in writing
3. a concern about the repercussions of complaining
4. a fear of appearing to 'nag'
5. scepticism about whether anything would happen as a result of complaining.
Participants provided several suggestions as to how such barriers could be overcome.
There was a consensus that, where possible, complaints should be made to the service provider in the first instance and that only when a complaint was seen to be very serious should the complainant go directly to an external body.
Participants were introduced to the idea of a single complaints phone line that would deal with all public services in Scotland. Overall, the perceived problems clearly outweighed the perceived benefits.
The role of complaints in scrutiny
7.1 There was little doubt that complaints should play a role in the scrutiny of public services. To what degree and in what capacity was less clear cut. There were two ways in which the role of complaints in public scrutiny was considered:
1. as a trigger for inspections
2. as a performance indicator during the inspection process.
7.2 There was little debate in terms of the first point, with widespread agreement that any service provider receiving an unusually large volume of complaints should be subject to action, such as an extra inspection or the appointment of new management. No participants suggested that a large volume of complaints could be seen in a more positive way, as an indicator of a successful complaints procedure or of a confidence in that system.
7.3 Opinion on the second point varied. A common perspective was that inspection teams should not analyse individual complaints but should focus solely on whether an effective internal complaints procedure was in place:
There's two things - the complaints itself and the procedure. And I think the inspector should be looking at the procedures, not any individual complaint. (Parent of secondary school pupil)
7.4 Another view was that complaints should be filed in preparation for inspections, making them easily accessible for scrutineers, offering an overall picture of complaints lodged regardless of satisfactory resolution. There was some suspicion, however, that the service provider might simply remove the most serious complaints from the file prior to an inspection: ' I wouldn't put it past them to just take a leaf out' (Parent of child in a nursery). To avoid this, inspection feedback forms completed by parents could include:
… a box that actually says - have you felt the need to complain about anything? … [If] parents were ticking - yes, but there are no complaint letters, that's something amiss. (Parent of child in a nursery)
7.5 It was felt that it would be useful for scrutineers to access data from any external body that was responsible for handling complaints. This would allow the results of any nursery, for example, to be placed into context to ' get a better picture' (Parent of child in a nursery).
7.6 Finally, it was suggested that the findings of the scrutineers, in relation to complaints, should then be included in the inspection report.
Barriers to complaining/suggestions for improving complaints procedures
7.7 Several barriers to complaining about public service providers were reported and many suggestions were made about how to minimise these barriers and make the complaints process simpler. Five types of barriers emerged:
1. lack of knowledge about how to complain
2. lack of ability to complain e.g. being unable to express oneself in writing
3. concern about the repercussions of complaining
4. fear of appearing to nag
5. scepticism about whether anything would happen as a result of complaining.
Lack of knowledge about how to complain
7.8 While some idea of how to complain was common among participants, there was concern, particularly among the group of recent NHS hospital patients, that some people would simply not know where to begin if they wanted to make a complaint. The group of users of council services suggested that the creation of an independent body to investigate complaints about local councils would enable complaints to be:
… handled … right the way through. … [I] f you just go to the telephone book and look at the number of Departments in… [a] council, you could quite easily get a run around, passed from one department to the other before you actually find the department that you needed (User of council services)
7.9 This sentiment was echoed among recent NHS hospital patients who felt the procedures were confusing and unclear. This group also felt that there was too great a jump from internal hospital procedures to the SPSO. They thought they would be deterred from complaining to the Ombudsman if they perceived their complaint as insufficiently serious and, therefore, the complaint would be taken no further than the hospital. An independent complaints body - which could handle all types of complaints, minor and serious - might provide a solution to this problem.
Lack of ability to complain
7.10 The perception among recent NHS hospital patients that everything needed to be in writing was of concern to them because some people ' are not good at putting pen to paper' while others ' don't have the time' to document everything. Suggestions included a service to help those who were not good at writing, a specific person to speak to, or the option of taping the complaint:
… if they have to have it in writing, then there should be some sort of service where if somebody is not very good at putting it down on paper, then somebody else would help them. (Recent NHS hospital patient)
Concern about repercussions
7.11 There was a perception that service users might suffer as a result of making a serious complaint direct to the service provider involved.
There is a concern if you have somebody that is an inpatient that they'll not be treated properly that's definitely a fear, if you have somebody that is vulnerable, they are in a ward, and that's definitely from my experience. (Recent NHS hospital patient)
If it's a complaint about a specific issue, with a specific teacher, then some parents might feel … will it have an affect, will it be detrimental to my child's progression through the school?
Are you making it worse? (Parents of secondary school pupils)
7.12 While it was acknowledged that the reverse is sometimes the case and that, for example, hospital treatment is often better after a complaint, it was common for people to feel that they would be put off complaining for this reason. Suggestions for countering this were bypassing the service provider involved and going straight to an independent body' or having anonymous internal processes - such as complaints forms or satisfaction questionnaires - in which people could note any concerns that they have without putting themselves or their relative at risk.
Fear of appearing to nag
7.13 The two groups of indirect service users with most day-to-day contact with service staff (parents of children in a nursery and relatives of care home residents) were concerned they would be seen as ' nagging … if you mention something they … just look at you' (parent of child in a nursery). This was a barrier to mentioning small concerns they may have had.
7.14 This was compounded by thoughts that everyone else must be happy:
It would be quite intriguing if you have a concern about something in the Nursing Home and you actually found, if you spoke to five other people, they have concerns and three of them had made complaints. Pull all the information together and begin to ask something that's more tangible than something only that you have floating around. (Relative of care home resident)
7.15 To this end, relatives' meetings were suggested by the group of people with relatives in care homes, because if several relatives expressed similar concerns, reassurance would be provided and there would be more chance of the concern being reported.
7.16 It is worth noting that, although relatives of older people in care homes can discuss any concerns with their care manager, this was not mentioned - suggesting a lack of awareness of this facility.
Scepticism that anything would happen
7.17 Finally, while there was a degree of scepticism as to whether or not complaints were investigated among the users of council services and the 6 th year secondary pupils, the young people who had been through the care system felt most strongly about this issue. They felt that there is no point in completing the complaints forms that they are instructed to complete:
That famous complaint sheet, it always mysteriously disappears. (Young person who had been through the care system)
The compulsory use of internal complaints procedures
7.18 There was a consensus that concerns or complaints should generally be raised with the relevant service provider first and that service users should only go to an external body from the start if they perceived the complaint to be very serious.
7.19 The main reason for using internal procedures was a perception that it was often only constructive criticism or comment that the service user wanted to make. The line between what constitutes a complaint, a criticism and a comment is, at times, a fine one: ' I have not had to complain I have had concerns … I wouldn't register it as a complaint just concerns' (Relative of care home resident). When complaints or comments are very minor, service users often feel bad about even mentioning them. Rather than make an official low-level complaint it was generally regarded as preferable to discuss the concern with a staff member.
7.20 A common perspective, particularly among parents of children in a nursery and relatives of older people in care homes, was that complaints should only be taken to an external body in the first instance if the relative was likely to be in danger (due to the original concern or because they would be treated badly as a reaction to the complaint). There was a feeling that most things can be sorted out at a lower level and that internal procedures should be working well enough that the external bodies do not receive many complaints. It was also seen as being fair to the service provider to afford them the opportunity to resolve the issue before it is taken to an external level. However, as noted above, the groups of users of council services and recent NHS hospital patients, who were less clear about complaints procedures, felt that there should be an independent, external body as the first point of contact when making a complaint.
Views on a 'complaints line'
7.21 While the idea of a 'complaints line' was spontaneously suggested on a couple of occasions, the perceived problems overwhelmingly outweighed the perceived benefits, in terms of strength of feeling and weight of opinion, when the idea of a single complaints phone line (dealing with all public services in Scotland) was put to participants.
7.22 The perceived benefits of such a phone line were that it would:
- simplify the complaints process
- make the complaints process very obvious
- be less time consuming for the complainant
- eliminate being passed round various departments
- eliminate the need to complain in writing
- be accessible for everyone (if it was well advertised)
- eliminate different practices across the country.
7.23 While the above represent the positive comments, it must be stressed that there was little enthusiasm for the idea among many participants. The negative reaction far outweighed the positive comments. On occasion, there was an initial reaction of surprise (in a negative sense):
If you want a load of trouble ring this number…
I'd like to know who thought it up. (Relatives of care home residents)
7.24 Perceived problems of such a phone line were that:
- other similar phone lines work badly
- callers would not reach the correct department
- there was a risk of being cut-off
- it would be too cumbersome to use
- those answering the calls could be uninformed
- the call centre might be abroad
- complaints would be too wide ranging for one centre to deal with effectively.
7.25 Reactions to the complaints line seemed to have been coloured by negative reports and experiences of other phone lines, such as NHS 24, National Rail Enquiries and call centres in general. It should be noted that the researchers did not have enough information to inform participants of the exact nature of the proposed complaints line and so only participants' initial reactions to the suggestion were explored. Thus, while NHS 24 may not be a comparable service, the perception was that centralised phone lines, in general, are associated with many problems and NHS 24 was mentioned as an example of a service which should not be mirrored.
I can see it being one of these multi numbers - if this is to do with the elderly press 1, if this is to do with prisons press 2 you know…. (Relative of care home resident)
7.26 While fears that the call centre would be abroad exacerbated concerns, there was widespread unease that service users would end up speaking to people who had neither the interest nor the expertise to be able to help:
If you have a complaint … and you're taking it to that level, then you really are so anxious … you want somebody there to listen to you, to deal with it. If it is a hot line that deals with all public services all over Scotland, the last thing that anybody is going to be able to [do is] deal with you. (Relative of care home resident)
7.27 One line covering all services in Scotland could also lead to the line being blocked with minor grievances, such as ' people who are annoyed that wheelie bins aren't being collected' (Parent of child in a nursery) and other seemingly trivial calls.
7.28 The suggestion that it might work if there were separate lines for different services (put forward in the group of relatives of people in care homes) was rejected by the group of 6 th year secondary pupils, who felt that even having separate lines for specific services would lead to overload and to complaints getting lost. This group considered that any such phone lines would only work at a local level.
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