Coronavirus (COVID-19): care home outbreaks - root cause analysis

15. Raising concerns

Complaints about the quality of care in care homes and complaints from staff members are dealt with by the Care Inspectorate. Members of the public can make complaints directly to the CI and generally other agencies, such as SPSO^[23], if it receives a complaint, will also signpost complainants to the Care Inspectorate. If SPSO is made aware of significant concerns about a care home through its casework, it has the power to share information with the Care Inspectorate. Two of the four homes included in this review had a complaint made against them, by families or agency staff, prior to or during the outbreak in relation to IPC, the care environment, or staffing issues. The Care Inspectorate does require organisations to have a 'raising concerns' policy in place, as does Healthcare Improvement Scotland for the NHS in Scotland, however an alternative route of raising concerns has been developed as a 'whistleblowing' function for the NHS, overseen by an independent body (SPSO) Trades' Union representatives informed the review team that there is a low membership amongst care and nursing home staff, and many private employers do not have recognition agreements with Trades' Unions in place.  

The SPSO has been given the responsibility of introducing a whistleblowing function by early 2021, however the function will relate only to NHS services, and to all services funded by the NHS.  It is likely that most care homes would not, therefore, fall within this remit, unless they receive NHS funding; however, many care homes receive funding via Local Authorities and therefore are financially resourced through public spending. Acknowledging the roles in complaint management by the various agencies, the blurring of professional boundaries, and provision of services which span across NHS and independent sectors makes it likely that concerns raised in relation to one part of the system may have implications for the delivery of care across all sectors. It is unclear to what extent this is a justifiable demarcation, and that intelligence and information relating to concerns about quality of care are equally valuable, whether this originates from the public or from the private domain. An integrated systematic approach across all agencies to the early identification of concerns, triangulation of information, and the sharing of learning would be of great benefit to the overall delivery of care and may support early warning of potential cross-cutting issues.

Recommendation: 

• Consider extension of the whistleblowing service to all staff across the health and care sectors.