Feedback concerns & complaints

FEEDBACK, COCERNS AND COMPLAINTS
Introduction

I aim to actively listen to people about their experiences. I can identify the areas where I are meeting or exceeding the expectations of the people I provide treatment and their circle of support. Where things have gone wrong, I can identify quickly and put them right. I aim to resolve mistakes faster and learn new ways to continually improve further and disseminate new ways of working to prevent the same problems from happening in the future.

By dealing with all types of feedback effectively, services can advance, making things better for the people who use them as Ill as for the staff working in them, consequently ensuring Wiltshire ear clinic are the employer and provider of choice.

This policy provides the framework by which Wiltshire ear clinic receives feedback on its services, including concerns, complaints and compliments.
Wiltshire ear clinic is committed to the following values and principles:
It Ilcomes and actively seeks feedback, comments and suggestions about all aspects of the service provided.

It is open and happy to receive valid feedback and concerns at any level in order to improve the service it delivers.
Everyone should have suitable information and clear access to methods of resolving their concerns.
This information and access will take into consideration individual’s needs that may arise from different languages, beliefs or abilities. Care will be taken to ensure that individuals or groups do not experience discrimination that might prevent their full involvement in the feedback or complaints process.
A person-centered and non-adversarial approach, focused on achieving timely, proportionate local resolutions that actively involve each complainant.
Concerns or complaints are managed fairly, openly and promptly, in line with best practice. Investigations are rigorous and impartial.

People I provide treatment or their representatives should be able to raise concerns and give feedback without fear that their service provision might be adversely affected. Working in partnership with Health and Social Care commissioners, providing ease and choice of access in making a complaint or providing feedback and joined-up responses.

Wiltshire ear clinic learns from all feedback received and ensures that services advance as a result.
An effective feedback and complaints process is fair to the people I provide treatment, their representatives and staff.

Purpose of this Policy/Procedure

The main objective of the procedure is to ensure Wiltshire ear clinic can receive ALL types of feedback, resolve concerns as quickly, appropriately and as close to the source of the problem as possible and constantly seek to learn and advance as a result of feedback.

The policy aims to achieve:

To give feedback and make valid complaints (including, those with needs; e.g. other languages or cognitive impairment).
A flexible, person-centered approach to problem solving
A rapid, open, conciliatory response which, as far as possible, meets the needs of the complainant whilst considering the perspective of staff.
Confidence from the people I support and their circle of support, that their feedback and complaints will be taken seriously and that services will improve as a result of their experience.
A high profile for Feedback and Complaints within the organisation.
A means of providing information to management in order that, where appropriate, the individuals I support receive an enhanced experience.
Compliance with statutory requirements and regulatory standards.
A clear plan to seek feedback at relevant points in a variety of ways from the people I provide treatment, regarding our services and lay groups who may review our services and provide feedback to be used in service planning and development.
A method to provide analysis and timely feedback, ensuring outcomes are completed and embed in learning across the organisation from all methods of feedback.
A method to ensure exceptionally positive feedback is also analysed in order to enable good service to be delivered consistently.

All staff have a responsibility to:

Ensure they are aware of the feedback, concerns and complaints policy and procedures.
Be aware of how to deal with feedback, including overt expressions of dissatisfaction, formal complaints and exceptional compliments and all other feedback they may receive from the people I provide treatment and their circle of support.
Ensure they seek support from their line manager when they have had a person I support or their representative, who has been unhappy with any area of the service.
Record and report verbal expressions of positive feedback where possible.
Record and report expressions of concern or complaint as soon as they receive them and manage these in line with the Safeguarding Adults Policy where relevant.

Complaint Stages:
There will be three stages of concern or complaint:

Stage One
Stage 1 feedback is where the concern, feedback or complaint is resolved at the source within 4 days and does not require further investigation, the complaint and its resolution will be recorded for learning purposes.
Stage Two
Stage 2 is where the concern, feedback or complaint is written, electronically recorded via social media, emailed or passed directly through to be investigated and/or handled and managed by a home or area manager.
Stage 2 complaints will be held and managed by the Manager to collate the relevant investigation outcomes and ensure the communication with the complainant is complete.

A complaint will be investigated by the most relevant manager according to the complaint type e.g. Relating to a staff member, a clinical issue, a safeguarding allegation, a facilities issue, a process issue and its severity.
The complaint, it’s investigation, root cause, actions, all communication and resolutions will be recorded for audit and learning purposes.

Stage Three
A stage 3 complaint is where a complaint is received from a Governing Body, CCG, Local Authority commissioner, Trading Standards or from an independent such as an MP and they request formal investigation.

The complaint will be overseen by a member of the Executive Management team and investigated by a relevant Senior Manager. The complaint, it’s investigation, root cause, actions, all communication and resolutions will be recorded for learning and audit purposes.

How and when will Feedback be sought?
Feedback from the people I provide treatment by way of a 1:1, review meeting or other relevant way will occur as a minimum every 3 months or again as regularly as identified.

Feedback will be sought from the circle of support (family/NOK/advocates) for the people I provide treatment too (where relevant/possible) as a minimum every 3 months or again as regularly as identified.

Feedback from our staff will be sought on an annual basis via a survey hoIver supervisions every 6 Ieks will also be a defined point for feedback.

Who can raise a Concern, Complaint or give Feedback?

Concerns may be raised by a person I provide reatment too, their nominated representative or any persons who are affected by or likely to be affected by the action, omission or decision of the Wiltshire ear clinic.

Staff of the Wiltshire ear clinic can give feedback or raise concerns as above or using the grievance procedure or whistleblowing policy as relevant.
A concern may be raised by a representative acting on behalf of a person I proved treatment too or any person who is affected by or likely to be affected by the action, omission or decision of the Wiltshire ear clinic, where that person:
• Has died
• Is unable by reason of physical or mental incapacity to raise the concern himself/herself.
• Who has requested the representative to act on his/her behalf and who has given consent for them to act?

Such a representative may be a friend or relative of the person I provide treatment too, a Member of Parliament acting on behalf of their constituent or Healthwatch.
Where a person I provide treatment too lacks mental capacity, the representative must be a relative or other person who, either holds the legal poIr do so, or in the opinion of the delegated Senior Manager, has or has had a sufficient interest in his/her Ilfare and is a suitable person to act as representative and is doing so in their Best Interests.

The need to respect the confidentiality of the person I provide treatment too is a guiding principle. If in any case the Senior Manager is of the opinion that a representative does not or did not have enough interest in the person’s Ilfare or is unsuitable to act as a representative, that person is notified of this in writing and given reasons for the decision. It is likely this will be discussed with a Manager or other relevant statutory representative.
If a complaint is instigated where the person I provide treatment too is deceased, in all cases the Senior Manager should establish whether the death is the subject of a Coroner’s Inquest

How can a Concern, Complaint or Feedback be given?

A concern, complaint or feedback can be made in the following ways:
• By phone directly to the Head Office on the numbers included on all Wiltshire ear clinic correspondence or on the confidential anonymous number 07962559684
• When contacted for feedback
• In person to staff in the home
• By email including using admin@wiltshireearclinic.com
• By letter – post
• By completing feedback survey
• Via advocacy
• To the local authority where I have not provided a satisfactory response.

I do not require any specific forms to be completed. I will accept a concern, complaint or feedback in the format that the complainant wishes to use and will request any further information or details required after receiving this.

Time limits

Concerns should be raised within 12 months of the event which has given rise to the concern or within 12 months of becoming aware that there was cause for concern.
This time limit shall not apply if the organisation is satisfied that the complainant had good reason for not making the complaint within the time limit, and if it is still possible to investigate the complaint effectively and fairly.

Confidentiality and consent

The information about complaints and all the people involved is strictly confidential and is only disclosed to those with a demonstrable need to know and /or a legal right to access those records under the GDPR and DPA 2018. It is only necessary to gain express consent to use personal information when investigating a complaint when the complainant is not the person to whom it relates and/or does not have a legal right to do so (or it is considered in the person’s Best Interest to investigate on the request of the complainant).

It is good practice to explain that information from health and support records may need to be disclosed to those involved. Where a complaint is
made on behalf of an existing or former person we support, consent must be obtained from the person we support to disclose personal information and the results of any investigation in order to uphold the duty of confidentiality to the person we support.
If the person we provide reatment is deceased, then the personal representative appointed should give written consent for the complainant to receive the personal health information.

If the person we support lacks capacity the representative must declare that they are making this complaint on behalf of the person we support, and this is done in their Best Interests as per the MCA guidelines.

Training

The clinic induction will provide training to all employees to help them understand their duties and responsibilities under this Policy, this will ensure that staff possess sufficient resolution seeking skills.
All staff involved in investigating complaints will have access to root cause analysis training.

Regulation 16: Receiving and Acting on Complaints
The Relevant Regulation
Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, states the following:

• any complaint received must be investigated and necessary and proportionate action must be taken in response to any failure identified by the complaint or investigation
• the registered person must establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users and other persons in relation to the carrying on of the regulated activity

• the registered person must provide to the Commission, when requested to do so and by no later than 28 days beginning on the day after receipt of the request, a summary of:
• complaints made under such complaints system,
• responses made by the registered person to such complaints and any further correspondence with the complainants in relation to such complaints, and
• any other relevant information in relation to such complaints as the Commission may request.

Explanatory Notes
A complaint is defined by the CQC as an expression of dissatisfaction with something. This can relate to any aspect of a person’s care, treatment or support and can be expressed verbally, in gesture or in writing.

Summary of the Regulation

In Guidance for Providers on Meeting the Regulations, published in February 2015, the Care Quality Commission state that the intention of Regulation 16 is to ensure that people can make a complaint about their care and treatment if they wish. To meet the Regulation providers must have an effective and accessible system for identifying, receiving, handling and responding to complaints from people using the service, people acting on their behalf or other stakeholders.

All complaints must be investigated thoroughly and any necessary action taken where failures have been identified. When requested to do so, providers must provide CQC with a summary of complaints, responses and other related correspondence or information.

Compliance Guidance
Guidance for Providers on Meeting the Regulations, includes the following notes about how compliance should be achieved. Providers must take this guidance into account. CQC inspectors will take it into account when they make regulatory decisions and will therefore use it when deciding whether a service meets the regulations. The CQC state that the guidance is not exhaustive. Registered providers and managers who do not follow it will be asked to provide evidence that their approach enables them to meet the requirements of the regulations.

Guidance note 16(1) relates to the need for any complaint received to be investigated and necessary and proportionate action taken in response to any failure identified. The guidance states that:
• people must be able to make a complaint to any member of staff, either verbally or in writing
• all staff must know how to respond when they receive a complaint
• unless they are anonymous, all complaints should be acknowledged whether they are written or verbal
• complainants must not be discriminated against or victimised — in particular, people’s care and treatment must not be affected if they make a complaint, or if somebody complains on their behalf
• appropriate action must be taken without delay to respond to any failures identified by a complaint or the investigation of a complaint
• information must be available to a complainant about how to take action if they are not satisfied with how the provider manages and/or responds to their complaint
• information should include the internal procedures that the provider must follow and should explain when complaints should/will be escalated to other appropriate bodies
• where complainants escalate their complaint externally because they are dissatisfied with the local outcome, the provider should cooperate with any independent review or process.

Guidance note 16(2) relates to the need for the registered person to establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints. The guidance states that:
• information and guidance about how to complain must be available and accessible to everyone who uses the service
• information should be available in appropriate languages and formats to meet the needs of the people using the service
• providers must tell people how to complain, offer support and provide the level of support needed to help them make a complaint, this may be through advocates, interpreter services and any other support identified or requested
• when complainants do not wish to identify themselves, the provider must still follow its complaints process as far as possible
• providers must have effective systems to make sure that all complaints are investigated without delay, this includes:
• undertaking a review to establish the level of investigation and immediate action required, including referral to appropriate authorities for investigation, this may include professional regulators or local authority safeguarding teams
• making sure appropriate investigations are carried out to identify what might have caused the complaint and the actions required to prevent similar complaints
• when the complainant has identified themselves, investigating and responding to them and where relevant their family and carers without delay
• providers should monitor complaints over time, looking for trends and areas of risk that may be addressed
• staff and others who are involved in the assessment and investigation of complaints must have the right level of knowledge and skill, they should understand the provider’s complaints process and be knowledgeable about current related guidance
• consent and confidentiality must not be compromised during the complaints process unless there are professional or statutory obligations that make this necessary, such as safeguarding
• complainants, and those about whom complaints are made, must be kept informed of the status of their complaint and its investigation, and be advised of any changes made as a result
• providers must maintain a record of all complaints, outcomes and actions taken in response to complaints
• where no action is taken, the reasons for this should be recorded
• providers must act in accordance with Regulation 20: Duty of Candour in respect of complaints about care and treatment that have resulted in a notifiable safety incident.

Guidance note 16(3) relates to the need for the registered person to provide information about complaints to the CQC. The guidance states that:

• CQC can ask providers for information about a complaint — if this is not provided within 28 days of our request, it may be seen as preventing CQC from taking appropriate action in relation to a complaint or putting people who use the service at risk of harm, or of receiving care and treatment that has, or is, causing harm
• the 28-day period starts the day after the request is received.

Links to Service Rating Judgements

From October 2014, a five key question test has been used during CQC inspections in England to determine a published rating for each service. Key question judgments are made with reference to Key Lines of Enquiry (KLOE) guidance published in the CQC Provider Handbook Appendices for each service sector.

With reference to complaints, inspectors are directed to ask the following mandatory question:
how does the service routinely listen and learn from people’s experiences, concerns and complaints?

To answer this question, inspectors are prompted to look for:
• how people’s concerns and complaints are encouraged, explored and responded to in good time
• people knowing how to share their experiences or raise a concern or complaint, and feeling comfortable doing so
• arrangements to encourage relatives and friends to provide feedback
• arrangements to make sure that information and concerns received about the quality of care are investigated thoroughly and recorded
• concerns and complaints being used as an opportunity for learning or improvement.
The Handbooks include “Rating Characteristics” which describe to inspectors what they should be looking for in services with different ratings. With respect to complaints, in a service rated as “good” inspectors are directed to look for:
• it being easy for people to complain or raise a concern and
• people being treated compassionately when they do so.

Achieving Compliance
In Regulation 16 the CQC sets out how it expects complaints to be managed by registered health and social care providers.
No organisation is perfect and most will receive a complaint or a criticism from time to time. Complaints are an inevitable fact of life for all service providers, and how they deal with them is of vital importance, both to the success and image of the organisation and to the experience of their service users and their families.
All service providers should have “an effective complaints system” in place for identifying, receiving, handling and responding appropriately to complaints and comments.

The Fundamental Standards state that service users should be sure that if they make a complaint it will be listened to and acted upon. Service users should never be made to feel guilty or uncomfortable about making a complaint, and they should never have to worry that they will be victimised in some way or given substandard care if they complain.

This is of vital importance. Complaints are an important part of a service provider’s quality assurance processes, in that they give the provider information and feedback about parts of their service that may not be working, or about low standards. In addition, the complaint may be about something critical, such as an allegation of abuse or malpractice, and service users must be encouraged and supported to come forward in such circumstances.

When service users make a complaint, their experience should be that:
• their right to complain is upheld
• they feel they are given adequate information about the complaints system, about how to complain and about who to complain to — the information should be written in appropriate language and distributed to all service users and their representatives
• the system has been designed to be accessible, simple, easily understood and clear
• their complaint is accepted in a sensitive, polite and professional manner and they are not made to feel guilty or uncomfortable about complaining or fearful of repercussions
• they are helped to complain if they need assistance, either by a member of staff or by a member of their family, a friend or an advocate, where required
• their complaints are not ignored, but are taken seriously and investigated thoroughly, in a timely manner, by an identified and competent person
• they are told how long the investigation will take and kept informed as the investigation progresses
• if their complaint is justified, they receive an apology and immediate action is taken to rectify the issue.

Carers, Relatives, Friends and Representatives
Service providers should provide carers, relatives, friends and representatives with information about how to complain on a service user’s behalf. Many service users, particularly if they are elderly or have learning or emotional difficulties or communication issues, find complaining very difficult and would rather “suffer in silence”. Such service users will rely on relatives, friends, carers and representatives — such as advocates — to complain for them.

An additional group who rely on others to help them complain, or to complain for them, are those with mental capacity issues, such as those with dementia.

Complaints from relatives, friends, carers and representatives should always be treated with the same care and attention as complaints from service users, and they should be acknowledged and responded to in the same way.

Good Practice in Complaints Handling
Established good practice in complaints handling indicate that complaints procedures and policies should:

• be accessible to service users and their relatives, friends, carers and representatives — they should be available, understood and well publicised
• be simple, easily understood by staff and service users, and capable of being activated quickly when needed
• be clear, without ambiguities that might allow reasonable complaints to escape investigation and action
• be written in appropriate language, and distributed to service users and their representatives
• involve all complaints being investigated in a manner which is both proportionate and sufficiently thorough
• involve the service provider keeping full records and a documented audit trail of the steps taken and the decisions reached
• identify the person responsible for dealing with complaints
• include an assurance that complaints will always be dealt with in a timely manner
• set out other relevant details of the timescale for complaint handling
• make it possible for complaints to be dealt with promptly and effectively.

To comply with this, service providers should ensure that a full record of each complaint is logged in line with the service’s complaints policy.
The procedure should ensure that all complaints and comments are effectively considered and investigated. Complaints must never be ignored or dismissed without consideration. Comments and complaints should be investigated and resolved to the satisfaction of the person raising the complaint, unless the complaint falls outside the remit of the provider’s responsibility or the complaint cannot be upheld.

Consideration of the complaint should be undertaken by staff who are competent to address the issues raised and who can provide honest explanations that are based on facts, and include the reasons for the decisions made. Whenever possible, complaints should be reviewed by someone not involved in the events leading to the complaint.

Patient should:
• know how to obtain or access information about the complaints system
• be able to make comments and complaints either verbally, through sign language or in writing
• be helped to make a complaint by staff wherever they lack confidence or capacity to do so alone.

Responding to Complaints
Complaints should always be welcomed by the service provider. Providers should view complaints as an opportunity to investigate a potential problem or fault in their service, thus enabling them to rectify matters.

Complaints should be dealt with according to the health or care service’s written complaints procedures. All complaints should be thoroughly investigated by a named person who is competent to deal with the issues raised and who was not involved in the original complaint. The named person should respond to the complainant in writing and should give a timescale of how long it will take to investigate the complaint.

The complainant should be kept appraised of progress in the investigation and be told of the conclusions.

Where a complaint is found to be justified, an apology should be made and immediate action taken to address the issue in compliance with Regulation 20: Duty of Candour. Action may include training, disciplinary or other action in relation to the staff involved, and changes in procedures or practices to ensure that the matter complained about does not recur.

Links to Quality Assurance
Service providers should recognise that complaints are not to be avoided or ignored, but should instead be welcomed as an integral part of their approach to quality assurance. All organisations receive complaints from time to time and it is how they respond to them that is important.

Providing an effective route for complaints to be made, recording the complaints, and properly investigating and dealing with them is the best way for an organisation to ensure that the cause of the complaint can be rectified.
By being proactive and actively seeking feedback from all involved in the organisation, managers can prevent the need for service users to make formal complaints and improve quality. Managers who are in the habit of continuously monitoring the quality of care will also be able to pick up on any concerns and complaints at an early stage.

Sending Information on Complaints to the CQC
As part of its intelligent monitoring system, CQC inspectors will monitor complaints against any provider. Inspectors will also request information about complaints prior to any inspection or may request additional information about a single complaint. When they make such a request, service providers must sent them the requested information within 28 days.

Enforcement
CQC can prosecute providers for a breach of the part of this regulation (16(3)) that relates to the provision of information to CQC about a complaint within 28 days when requested to do so. CQC can move directly to prosecution without first serving a Warning Notice.
In addition, CQC may take any other regulatory action in response to breaches of this regulation.

The CQC will refuse registration if providers cannot satisfy us that they can and will continue to comply with this regulation.