National Care Service - complaints co-design: findings summary

Co-design - what we learned

1. It should be easier to find out how to complain

We heard from people that making a complaint is confusing and it can be hard to find out where to start. People told us that information is not always in plain English, clear and accessible.

Other points around this included:

• services should give people information upfront on how to complain or provide feedback
• digital routes to make a complaint can improve accessibility but it is also important to have non-digital routes, such as by phone, letter or in-person
• people should be signposted to advocacy services, which could support them to navigate the complaints process
• there should be a standard approach to how complaints are handled both across sectors and within sectors

Here are some of the things people said during our discussions:

“A ‘one stop shop’ would be the best way for people to raise issues of complaints - it could be local or national with an appropriate link.”

“People need to know complaint procedure from day one - not just at the point they need to make a complaint.”

“Create a directory of support that signposts people to organisations and people that can provide advocacy and other support, both when people make a complaint and when they receive the outcome of their complaint.”

How we will use this

There are a number of existing bodies that handle complaints issues. We will be looking at how the NCS complaints service can make it easier for people to access the right complaints process. We will also use this to explore what wider improvements can be made to the accessibility of making a complaint about social care support and community health.

2. People should be told about their rights and encouraged to raise concerns and provide feedback

We heard about the importance of telling people they have the right to make a complaint. We were also told it is important to encourage people to give feedback on the services they access, as they will know how to improve them.

Other points around this included:

• some people feel complaints should be framed as a way of upholding rights
• people should be reassured that if they complain, their care or access to services will not be affected
• some said people should be able to complain anonymously or confidentially
• the NCS should set the expectation that people will be asked for feedback
• the NCS Charter of rights and responsibilities should include information about complaints

Here are some of the things people said during our discussions:

“Reassuring people that we really, genuinely want to know. Expectation in patient that they will be asked - how are you doing? It needs to be an equal partnership.”

“I wouldn’t complain. It was really hard to get carers and you put up with what you can get. Repercussions would definitely happen.”

“It’s actually part of their care empowering the person.”

How we will use this

It is valuable for us to learn how to help people understand their rights and feel safe and empowered to make a complaint. As well as informing wider improvements, it has helped us to understand what information we should include about complaints in the NCS Charter of rights and responsibilities.

3. Services should welcome feedback to improve and to resolve issues early

We heard people would like to give regular feedback about NCS services. People also told us they would like services to intervene and resolve issues early before they build up to a formal ‘complaint’. Other points around this included:

• feedback should be welcomed by services as a way to improve
• some people want feedback to be built into regular care conversations and assessment
• others suggested sending out feedback surveys or questionnaires
• services should focus on learning from feedback rather than blaming individual staff when things go wrong
• the word ‘complaint’ can be a barrier to people raising issues. Some feel ‘concern’ would be a better word to use, as it sounds softer and less negative

Here are some of the things people said during our discussions:

“Complaints is a lot of work - if someone had come earlier, it could have been done.”

“This is not about blame, it’s about learning. I don’t think there are enough organisations that think like that and across Scotland we’re still quite performance focussed.” “Complaint has negative connotations - perception that people are just ‘whinging’, and a complaint feels serious.”

How we will use this

It is important we create a system and culture within the NCS that allows people’s complaints to be resolved early. It should also gather people’s feedback to improve the services they are accessing. We will explore this further in our next phase of co-design.

4. Good conversations with skilled complaints handlers builds trust and confidence

People told us that human contact and developing a relationship with the person handling their complaint is important to build confidence and trust. We heard that good conversations with the complaints handler can help, as it is reassuring to be listened to and heard. We also heard it is important that staff are trained on dealing with complaints and there should be appropriate resourcing for complaints handling.

Other points around this included:

• speaking to the complaints handler can mean the complaint is handled better, as they can talk through what’s happened and fully understand the issues
• staff need specific training on complaints handling skills, such as communicating with empathy, having difficult conversations, taking a trauma-informed approach and resolving conflicts
• services should be encouraged to try to resolve people’s concerns throughout the complaints process
• some people feel dedicated complaints handling staff would have more impartiality and skill, and it could reduce the time pressure on care staff

Here are some of the things people said during our discussions:

“The human bit needs to kick in early on.”

“Local authority used to have a dedicated complaints officer who was excellent.”

“There is a lot of training available for staff on how to handle complaints effectively, however, the importance of doing this training is not always seen as important.”

How we will use this

Understanding the importance of human contact for developing trust can help us build on the existing good practice in complaints handling. We will explore the existing training available to staff on complaints handling, to make sure it supports best practice.

5. People want to know their complaint or feedback will make things better

In discussions, people told us it is important they are told how their complaint or feedback has led to changes. People said they want to know their complaint has made a difference and will improve things for others.

Other points around this included:

• people want an acknowledgement and apology when something goes wrong
• accountability should be embedded in the complaints system to make sure action is taken after a complaint is upheld
• people should have the option to escalate their complaint to an independent oversight body
• there should be an effective strategy to review, monitor and learn from complaints

Here are some of the things people said during our discussions:

“People who make a complaint need to understand how that influences or changes practice on the ground.”

“Feedback loop is essential too so that people don’t become disillusioned about nothing happening even when you complain about things that have significant impacts on your dignity or quality of life.”

“There is a lack of accountability in the current system. There is no point in making a complaint because nothing happens.”

How we will use this

Understanding what people want from making a complaint can help us improve people’s experience and ensure complaints lead to satisfactory outcomes. We can also use this to look at how the NCS can learn from complaints and make improvements.