Caring and complaints

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.

Yesterday, 1 February, was Dignity Action Day organised annually by Dignity in Care which campaigns to put dignity and respect at the heart of UK care services.

The campaign led by the National Dignity Council was launched in November 2006 and since then has registered over 60,000 Dignity Champions working together to ensure people have a good experience of their care when they need it.

While a national day helps to raise awareness, dignity in care is something we all need to strive for 365 days of the year (or 366 given this is a leap year!) and the 10 Dignity Do’s set out by the campaign are a good reminder of what needs to happen all the time in care services.

We know how important it is for people using services that they are treated with compassion, kindness, dignity and respect which is why all CQC comprehensive inspections ask “is the service caring?” We explore how positive caring relationships are developed with people using the service; how the service supports people to express their views and be actively involved in making decisions about their care, treatment and support; and we also ask how people’s privacy and dignity is respected and promoted.

It is the question that gets the most positive response in all our inspections — in Adult Social Care 85% of services are rated Good or Outstanding for Caring. A clear sign that the vast majority of staff really do care. Take a look at our reports for some great examples and comments — this from Peregrine House in Whitby, recently rated Outstanding in all 5 questions:

“I can’t explain how wonderful they are. They are just everything; kind and helpful. They can make anything happen.” Another person told us, “They are kindness in action. They think ahead and imagine what it’s like for me. They all mean the world to me.”

Complaints

One of the Dignity Do’s is that people should be able to complain without fear of retribution. Again, this is something we look at on our inspections. When we ask the question ‘is the service responsive?’ we explore how the service routinely listens and learns from people’s experiences, concerns and complaints. It is also an important aspect of assessing whether the service is well-led when we look at how it promotes positive culture that is person-centred, open, inclusive and empowering.

While there is good practice in encouraging people who use services, their families and carers to raise concerns and ensuring they are responded to appropriately, we also see many examples of complaints policies not being accessible, people unsure of how to raise issues, complaints not being responded to and promised action not happening. This is a breach of the statutory regulations which require complaints to be investigated and action taken in response and a process for handling complaints to be in place. CQC will take action when we find these failings in a service.

Fear

But despite these safeguards we know that people using services, their carers and relatives are often fearful of raising concerns — worried that they or their loved one may receive poorer care, or worse, be asked to leave. This was the topic of debate on Friday BBC Radio 4’s You and Yours involving myself and the chair of the Relatives and Residents Association, Judy Downey with the Care Minister, Alistair Burt also commenting at the end of the programme.

As I said in the programme, there may be some circumstances when a transfer to another service is necessary to meet someone’s increased care needs. And not every story ‎is as simple as family v care home with the care home in the wrong. But I know from my own correspondence and discussions, the calls to the Relatives and Residents Association helpline and the experiences people share with CQC, too many people have either experienced retribution for raising concerns or are too fearful of the consequences to do so.

This situation is not acceptable. And it is completely unacceptable for care homes to respond to concerns being raised by ordering the eviction of the resident. These are people’s homes and especially when they are at the end of life, or in vulnerable circumstances that’s when people need to be treated with the greatest dignity and respect.

Dignity and respect

One of our Experts by Experience Suzy Webster tweeted recently “If hospital staff remove the words ‘aggressive patient’ and replace them with ‘frightened patient’. They understand #dementia better.”

I think this wise sentiment can apply to complaints. Instead of thinking that someone raising a problem is troublesome, fussy or demanding, put yourself in their shoes and consider how you would feel if you had to cope with these huge changes in your life, when others seem to have more control than you. How would you feel?

So instead of saying aggressive, say worried. Not argumentative but anxious. Give a human, caring response to the concern being raised. The best services we see are those that see complaints not as a criticism but as an offer of help and an opportunity to improve. If all services did this, then more would feel confident to raise concerns and care would be better for everyone.

Originally published at www.cqc.org.uk.