Adult social care compliments and complaints annual report

Complaints and compliments annual report 1 April 2020 to 31 March 2021.

Executive summary

The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 combined the statutory complaints procedures for the NHS and Social Care under a single set of rules. This report, therefore, includes service user feedback in relation to Adult Social Care and Public Health.

Leeds City Council Adults & Health Directorate provides a range of services. Some services are provided by commissioned independent providers in residential care, supported living and commissioned home and day care. This annual reporting, therefore, includes services provided by commissioned independent providers.

This report provides information about compliments and complaints received during the twelve months between 1 April 2020 and 31 March 2021. As the reporting year commenced, the Council and its partners faced exceptional operational challenges. It was a difficult year for everyone due to the COVID-19 pandemic. Staff had to adjust to new operational realities of arranging and delivering care by telephone or virtually where people could achieve this. If this wasn't achievable then staff visited subject to PPE guidelines. Some services were paused.

Review of compliments and complaints provides an opportunity to assess some of the impact of the COVID-19 Pandemic on health and social care users and how the staff responded to some of the challenges.

In the said reporting year 10,632 people received a service from Leeds City Council Adults & Health Directorate. When looking at a total number of complaints of 424, therefore, 4% of service users or someone acting on their behalf raised a complaint about a service that they received and 884 or 16% of service users or their representative raised a compliment about the service that they received.

This report highlights how various services within the Adults and Health Directorate have performed in line with key principles outlined in the complaints regulations and provides information about the nature of complaints, the compliments received and actions being taken to improve the quality of health and social care services.

The year under review has been difficult and challenging for everyone due to the COVID-19 pandemic. The aim for the Complaints Team has been to try and maintain a good customer service by focussing on keeping people informed. An update on some of the initiatives is as follows:-

• In response to the COVID-19 pandemic, the complaints training was re-designed to online delivery and delivered in March, April, May, June, July 2020 and in January and February 2021. The training was delivered to internal Adults and Health staff but mainly to staff of the commissioned independent sector covering Homecare, Supported Living, Residential and Nursing Care staff, Real Life Options and CAB staff.
• The Complaints Team has continued its close working and sharing of intelligence with the Working Age Adults Commissioning Team, Homecare Commissioning Team, the Residential and Nursing Older People Commissioning Team and the Quality Team to support commissioned providers to attain good or outstanding Care Quality Commission ratings.
• Continued to share key messages with operational teams by attending their management team meetings: these changed to virtual meetings when COVID-19 set in.
• The Leeds city wide complaints group continued with its joint working and meetings albeit vitually. In the 2020-2021 reporting year, there were 86 mixed-sector complaints recorded by Leeds Teaching Hospitals NHS Trust, Leeds & York Partnership NHS Foundation Trust, Leeds Community Healthcare NHS Trust, NHS Leeds Clinical Commissioning Group and Leeds City Council Adults and Health. Poor communication runs through as a theme in the majority of mixed-sector complaints.
• 884 compliments were received compared to 1680 in the previous year, 48% decrease. The compliments received evidence how the Adults and Health Directorate is meeting the key qualities people expect from Health and Social care Services. The decrease in compliments is not considered as an indicative of a reduction in customer satisfaction in Council services – rather is most likely as an impact of the pandemic and lack of face to face engagement with staff and some services having been paused.
  Examples were received praising social workers for the excellent partnership working with other agencies, for going the 'extra mile', being kind and supportive. Relatives thanked care home staff for regular updates during lockdown and that they felt at peace that their relatives were being cared for. Other relatives thanked staff arranging Zoom calls with their families, for caring for their family members during the final years of their lives and also thanked them for the kindness and sensitivity shown in their relatives' final days.
• 424 complaints were recorded compared to 651 in the previous year, representing a 35% decrease. The decrease is most likely the impact of the COVID-19 Pandemic as some services were paused, others redesigned to online and others delivered face to face whilst observing the government's PPE guidelines.
• 24 enquiries were made to the Local Government and Social Care Ombudsman compared to 25 the previous year. A breakdown of the 24 enquiries is detailed in Appendix 5 of the Report. It is pleasing to note that despite the challenging year Adults and Health achieved a 100% compliance with the Ombudsman's recommendations.
  
  The Ombudsman's upheld statistics include those complaints where the Ombudsman would determine that Adults and Health Directorate had already provided a satisfactory remedy before the complaint reached the Ombudsman. In this reporting year that was 16% where the Ombudsman agreed with remedy Adults and Health had provided before a complaint reached them against a national average of 10%.
• Complaints data and analysis is used to commission improvement activities and training, where appropriate, and in informing individual Managers to take the initiative at service/team level or with individual staff members to address areas for development and manage local improvements. The complaints data has again led to a number of actions and areas for development as set out in Appendix 7 of this report. 
  

Judith Kasolo
Head of Complaints

1. Purpose of report

The purpose of the annual report is to review the operation of the complaints procedure over a twelve month period and to provide information about complaints themes, the compliments received and actions being taken to improve the quality of social care services.

This report provides information about compliments and complaints received during the twelve months between 1 April 2020 and 31 March 2021.

2. Background

2.1 Local authorities and the National Health Service are legally required to establish complaints procedures to deal with complaints about their health and social care functions.

The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 applies to Adult Social Care. Similarly the NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012 applies to Public Health functions.

3. What is a complaint

The Department of Health defines a complaint as:

The Adults and Health Directorate uses this definition.

In addition, it is important to note that service users or their representatives generally view complaints in its every day sense i.e. to mean any statement about a service or member of staff that has not met the standard that they can reasonably expect.

If it is possible to resolve the matter immediately, there is no need to engage the complaints procedure.

4. Who can make a complaint

Anyone coming into contact with Leeds City Council can make a complaint. The Corporate Complaints Procedure provides a process for all service users to use. If the complaint is about Adult Social Care or Public Health functions, the statutory complaints procedure for Health and Social Care services must be used.

A person is eligible to make a complaint under the statutory complaints procedure where the Local Authority and the Health Service have a power or duty to provide or secure a service. This includes a service provided by an external provider acting on behalf of the Local Authority. In such cases service users or their representatives can either complain directly to the provider or to Leeds City Council, as commissioner of the service.

Commissioned providers are encouraged to attempt to resolve complaints at the first point of contact in line with good practice highlighted by the Local Government and Social Care Ombudsman. However, they are equally advised to direct service users or their representatives to commissioners of the service, where local resolution is not possible or appropriate, or where the complainant remains dissatisfied.

A complaint can be made by the representative of a service user who has been professionally defined (under the Mental Capacity Act 2005) as having no capacity to make decisions as long as the representative is seen to be acting in the best interests of that service user.

Anyone can complain who is affected (or likely to be affected) by the actions, decisions or omissions of the service that is subject to a complaint.

5. The complaints procedure

The complaints procedure is a two-stage complaints system, focusing on local resolution and, if unresolved, an investigation by the Ombudsman.

The aim of the Local Authority Social Services and the National Health Service complaints regulations is to make the whole experience of making a complaint simpler, more user-friendly and more responsive to people's needs. The emphasis is to offer a more personal and flexible approach which is effective and robust. Complaints are risk assessed. The level of investigation needed is informed by the level of risk and complexity and the wishes of the complainant.

Complaints Officers contact the complainant to agree the complaint and sought outcome. They then determine the level of risk and complexity. Options include mediation, resolution by the Service Manager or an independent investigation.

Each complaint is treated according to its individual nature and the wishes of the complainant.

In the reporting year 10,632 people received a service from Adult Social Care. 

When looking at the total number of complaints of 424, therefore, 4% of service users or someone acting on their behalf raised a complaint about a service that they received and 884 or 8.3% of service users or their representative were happy with the service that they had received from adult social care or public health.

6. Review of compliments received

Table 1 - Compliments received by service area

6.1 884 compliments have been received this reporting year, compared to 1680 in the previous year. Compliments evidence how the Adults and Health Directorate are meeting the key qualities people expect from health and social care services i.e. being treated with dignity, respect, staff being caring, responsive to people’s needs, being effective and well-led.  

6.2 The decrease in compliments is not considered as an indicative of a reduction in customer satisfaction in services – rather is most likely as an impact of the pandemic and lack of face-to-face engagement with staff and some services having been paused.

The Adults and Health Complaints team and frontline staff continue with their efforts to increase the number of people talking to us and providing feedback either good or bad. The complaints leaflets which are provided to service users at assessment or at review encourage service users or their representatives to tell us what they think of the service. Service users are informed that learning is taken from compliments in the same way as complaints and are recorded and used to influence and promote best practice. 

6.3 Service users or their families have made compliments in person or in writing through personal thank you letters, cards, using the feedback forms or by email. As part of the continuing complaints training both Adults and Health staff and staff of commissioned providers are actively encouraged to forward any compliments to the Complaints Team in order to ensure that they are recorded and we can learn from the said feedback.

6.4 The largest number of compliments were received by the In-house Mental Health Residential and Day Services who received 293 compliments, which was an increase from 186 the previous year.

Clients thanked workers for their support and the positive impact this had had on their lives. Comments were made about workers showing kindness or going the extra mile. One homeless client thanked workers for getting him housed in a hotel during lockdown. Others were grateful to workers for the food and clothes parcels or assisting them in obtaining support such as assistance with benefits. One client commented "I would just be stuck in a miserable situation not knowing how to get out if you hadn’t have done this for me”. Some clients felt the support was ‘invaluable’ particularly during the pandemic.

Many clients were thankful for being listened to “Thanks for the support and letting me talk about things I couldn’t discuss with my family I wanted to thank you for being there for me - you noticed, you listened, you cared”. A worker assisted a client in getting a train ticket and passenger assistance otherwise they would have spent Christmas alone. 

The In-house Older People Residential and Day Service received 163 compliments. Family members commented on the kindness and care staff had shown their relatives. "Words are not enough to say what we feel. All the family appreciate all the kindness and care you have all done to make our Mum so comfortable and happy". Others sent their appreciation for keeping their loved ones safe and well in these difficult times, during the pandemic. One relative thanked them for their 'wellness' calls during lockdown and others were grateful of receiving Zoom calls during lockdown. Some sent in thank you cards and gifts to the workers to express their gratitude. One Client said "It's people like you that are helping to keep this country going". One family member commented on the dedication the staff have shown. One family member thanked staff for the dignity, affection, warmth and gentleness she was shown during her end of life care and the support shown to him during this time. Some service users commented on the good quality of the meals in the care homes.

115 Compliments were received by Skills/Reablement. The service temporarily changed this reporting year due to the COVID-19 pandemic. As the situation in the hospital remained very difficult and discharges had to be the priority in order to enable more people to be admitted, the Skills/Reablement Team were only supporting people at the point of discharge from the hospital. Many clients commented on the kind, caring, friendly and compassionate manner of the staff and how they felt comfortable with them and never felt rushed. Other clients mentioned that the service increased their confidence in their own abilities. One client commented that "nothing was too much trouble since coming out of hospital they have helped me build my confidence and almost got back to my old self again". One client commented that the service has enabled her to stay in her own home.

72 compliments were received for the Independent Sector. One client was grateful for the support calls during the lockdowns due to the COVID-19 pandemic. One relative thanked "the team for caring so beautifully and thoughtfully for all our loved ones". Many clients who lived alone in the Jewish community were grateful for a Kosher meal service which was provided during lockdown and felt this was a "brilliant initiative".

One member of the public commented "We're always impressed with the kindness, patience and professionalism observed when they see the team and residents on the street."

The Blue Badge Team received 63 compliments. Due to COVID-19 restrictions many of the assessments this year were conducted over the phone. Clients and their family members commented that the staff were very helpful, very professional and were very informative about the process. Some clients commented that the workers showed them great understanding. Others commented that they were treated with dignity and how everything was clearly explained during the assessment. Others mentioned that helpful advice was also given to them about other services which may be of use to then.

Learning Disability Housing and Day Services received 33 compliments.

Many family members thanked workers for caring for their loved ones during lockdown or isolation periods and sending updates and photographs and for arranging birthday celebrations for the clients. "We really appreciate this and are so thankful he lives somewhere so wonderful." One described the workers as "amazing". Other relatives commented on workers commitment, kindness and dedication in supporting their relative. Other family members praised the support given in assisting them with a move or in the passing away of a relative.

One relative praised staff for supporting the client's physical and mental wellbeing in-spite of events being cancelled by creating alternative activities with the residents. Two relatives thanked the workers for making their family members Christmas special.

28 Compliments were received for Area Social Work.

A Social Worker was praised whilst dealing with a complex situation with a vulnerable client. The comments include that the Social Worker was "Kind, caring and showed compassion and "She went above and beyond to help the victim and made sure that she was safe and comfortable in her new home". Other family members commented on the Social Worker going the 'extra mile' and dealing with their situation in a sensitive and professional manner and said the Social Worker did "remarkable work". One Service user thanked their Social Worker for their support and guidance and the huge impact they have had on their life and was grateful for the Social Worker's support through a difficult period. One client mentioned that the Social Worker "instantly put them at ease and they said that they trusted her straight away". One compliment praised the Social Worker for their partnership working with other agencies involved.

Independent Sector Care Homes received 24 compliments, an increase from the previous year. Many relatives thanked the care homes for regular updates during lockdown. Many felt "peace of mind" that their loved one was safe and being cared for. One family member commented "You have all done incredible work and your commitment has shown through, never more so than these times we have experienced. None of it could have been easy, but your hard work and dedication and level of care has been outstanding." Other relatives thanked workers for caring for their family members during the final years of their lives and also thanked them for the kindness and sensitivity shown in their relatives' final days.

Learning Disability Social Work received 19 compliments. Service users thanked social workers for their professionalism. One commented "I don't know what I would do without you". Relatives commented on Social Workers' positive relationship with family members. "Thank you for all your help, support and patience over the past months it's been much appreciated and helped me through difficult times." Another Parent mentioned that the Social Worker "Has made a huge difference to us and we are extremely grateful for the effort she has made and continued support." Other compliments came from professionals in other organisations, one commented "We are very thankful that you always put him first and encouraging him to make his own decisions as much as possible". "Thank you again for continuous support throughout this process".

17 Compliments were given to Equipment and Adaptation. Clients expressed their gratitude of the service they received and wanted to pass on their thanks to the workers. "… the service, speed and attitude of your staff has been fantastic". Others commented on the difference the equipment has made to their lives. The daughter of a 100 year-old client expressed her thanks for a ramp which had enabled the client to go into her garden during the COVID-19 pandemic and has enabled them to go for walks together. One relative was appreciative of some handrails to assist his mother. "This will make a massive difference to her and especially to my back." Compliments were given to the Telecare installation team who were described as enthusiastic, friendly and patient.

Resource and Strategy received 17 compliments. Compliments for the Finance Team were received. Finance staff were praised for being understanding and for their sympathetic attitude and professionalism. Comments included "Thank you very much for your help in expediting this matter. I truly appreciate your swift work." And "Your personal service overall was second to none and a shining example".

Compliments were also received for the Complaints Team for keeping complainants up to date during the complaints process. One client said "Thank God for people such as yourself in these positions who show human kindness and go the extra mile for other humans."

12 Compliments were received for Strategic Commissioning. Thanks were received from care home Managers for the support they had received during the COVID-19 pandemic and the vaccination roll out which they found 'invaluable'. One Manager said "Every little query was answered instantly and enthusiastically and we are very grateful."

Two compliments were received from complainants who praised Commissioning Managers for the thoroughness of their investigation into their complaints.

Leeds Shared Lives received 10 compliments which is a 100% increase on the previous year. Clients mentioned how much they had enjoyed their time with the workers and for their positive attitude and kindness shown. One family member commented that the worker had "enriched" the client's life. There were compliments for the Homeshare service, one person commented "I have a lot of respect for everything you do and for Homeshare".

7 Compliments were received for Mental Health Social Work.

Compliments were received from partners in Health. A Doctor commented "It was a difficult and acute situation and all concerned showed great compassion towards him." Compliments were also made about the improvements that Clients had made due to their Social Workers' involvement. A compliment was given in the Social Worker's involvement in a challenging situation involving different agencies. One Client said his Social Worker was professional and caring.

Independent Sector Home Care received 5 compliments.

Comments were made regarding workers kindness, and them showing the utmost dignity even in difficult circumstances. The husband of a client commented that "Despite the weather they have still been on time, not rushed, fully supported his wife"

3 Compliments were received for the Hospital Social Work Teams. The client felt that the Social Worker instantly put them 'at ease' and the Social Worker was well informed about their case. A family member of a client who has suffered a stroke felt the Social Worker was a source of support and 'nothing was too much trouble'.  The relative said that the Social Worker was "constant support, hard-working and such a lovely person". 

Physical Disability Residential & Day Services received 1 compliment this year. The client thanked workers for facilitating a group which they found beneficial.

1 compliment was received for Performance Review. Thanks were received for support during the Pandemic, this was with care and understanding.

EDT (Emergency Duty Team) received 1 compliment. Family complimented a worker on their excellent service and how efficiently they resolved an emergency situation. 

7. Review of complaints received

Table 2 - Complaints received by service area

7.1

The Adults and Health Directorate provides a range of services in a range of settings and where the Council commissions care from the independent sector, the Ombudsman is very clear that the Council remains accountable for the actions of the commissioned service provider. It is usually best to tell the care provider and give it chance to put things right. However, if the problem cannot be sorted out there and then and the person continues to be unhappy, they have a right to complain to the Council, as commissioner of the service. In these circumstances, service users or their representatives are advised to raise concerns with the Adults and Health Directorate Complaints Team. The Complaints Team recorded 424 complaints in this reporting year compared with 651 complaints the previous year. The decrease is most likely the impact of the COVID-19 pandemic as some services were paused and some re-designed to online and others delivered face to face whilst following government PPE guidelines.

The monitoring and oversight of complaints made directly to commissioned providers is in response to recommendations made by the Ombudsman in their Annual Review of Adult Social Care Reports. The Ombudsman has made it very clear that it will hold commissioners accountable for the commissioned service providers' failings and further that it is the commissioner who will be held accountable to remedy any identified failings. In view of this, Adults and Health Directorate has an Information Sharing Protocol with its commissioned service providers in relation to any complaints and compliments relating to the Council's Adults and Health commissioned services. This should provide the Council an opportunity to gain an overview of compliments and complaints of commissioned services.

8. Nature of complaints

The most common category of complaints are as follows:

• 86 complaints about Quality of service
• 61 Challenge Assessment Outcome
• 60 complaints about Staff Attitude Conduct
• 58 complaints about Inconsistent Home Care Service
• 47 complaints about Lack of Social Work Support 
  

Quality of Service:

Was the most common cause for concern with 20% citing this as a reason for their complaint. A summary of these issues are:-

Independent Home Care

26 complaints were received regarding the quality of the commissioned provider's service.

• Client commented that the carers were not competing the assessed tasks, such as personal care or supervising the client eat her meals. This in one case resulted in the client not eating. One complainant mentioned that dirty washing is being left on the floor and clean clothes are not being put away. Another relative complained that the carers had forgotten to make her father a sandwich. This was of particular concern as he is diabetic.
• Poor communication with family members, family not being updated, one home care provider was failing to leave the rolling time sheets at the client's property. Another complained that they were assured they would have access to online call logs but this was never set up. Two separate family members complained that they had not received a reply to a complaint they had made directly to the home care provider. One complainant was not notified of a fall which her mother (the client) advised the carer of the following day.
• One carer took the key fob home and the family had to re-purchase.
• Some family members mentioned they felt the hygiene levels were poor, such as cross contamination of cleaning cloths, used gloves and soiled items being left in the kitchen bin, or soiled items being left out. One client complained that a carer had re-used PPE. A family member complained that his father's sheets were not being changed when soiled and he was being put back into a wet bed
• Others commented on carers not tidying up after themselves or leaving food out for long periods of time
• Family members commented that carers were rushed which resulted in them not completing tasks or the carers not spending enough time with the client trying to get them to engage with them. This was more pertinent for clients who suffered from dementia. One family said that the carers were continually calling family members to assist which increased carer strain on the family. Another Complainant commented that a lot of temporary staff were being used. One family member commented that the client had lost weight as the carers were not encouraging the client to eat.
• Some family members complained that they felt the staff were not adequately trained. One family member felt that their loved one was not moved or dressed correctly. There was an incident when a urine back had not been fitted correctly which resulted in damage to the client's property. One client had food poisoning from food that was insufficiently heated in the microwave. A complainant mentioned that her mother wasn't assisted with choosing weather appropriate clothing and was in sheer short-sleeved top during sub-zero temperatures.
• One family member felt the call times are to suit the care company as opposed to the needs of the client. This can result in too long between care visits, which affects personal care, the client's medication and being left for long periods without food or a drink or being put to bed very early.
• Several complaints were made about time sheets not being completed correctly and the carers were not staying for the duration of the visit which resulted in them being overcharged.

Commissioned Learning Disability

13 Complaints were received regarding the quality of service for commissioned learning disability residential and day services.

• A complaint was received from a neighbouring property of a learning disability establishment regarding the residents causing a disturbance.
• The mother of a client was upset that her complaints had not been responded to. She had raised concerns regarding a lack of activities and workers using their mobile phones. Two other complainants commented on the lack of engagement from workers.
• Concerns were raised regarding the use of untrained and unsupervised staff which caused tasks to be missed or service to be delivered incorrectly.
• Several complaints were made regarding poor communication. In one instance staff had not informed a client about the death of a relative or sought to establish the correct time of the funeral so the client could attend. One relative commented about the poor communication during handover between the night and day staff which potentially could lead to distress for the client. Comments were made by relatives about better reading of client's support plans before delivering service so that workers have a better understanding of client's needs.
• One client felt the service not being person-centred. He felt that staff were doing too much for him and he wanted more independence. He also mentioned that he would prefer to go out more.
• The family of a client complained about a lack of organisation which caused bills not to be paid for services and utilities in the shared accommodation.
• One relative complained about the incorrect mix of clients in a shared accommodation whereby one client had challenging behaviour which resulted in some of the residents staying in their rooms which then caused the client's skills to deteriorate. They also suffered from a lack of sleep due to the disturbances.
• Complaints were raised regarding inadequate staffing levels and a family felt that the staff on duty's time could be utilised more effectively
• A concern was raised about care delivery being rushed when a client arrived at their day service provision with shoes on the incorrect feet and their coat rolled up at the front and the back.
• Comments were made about the need for better and healthier meal planning and weather appropriate clothes and activities for clients.

In-House Older People Residential

11 complaints were received concerning the in-house older people's residential service. Please see the below summary of the complaints we received-

• A complaint was received from a resident of a care home regarding the lack of television signal in the home. It had been challenged by the home whether the repair was deemed as 'essential' under the COVID-19 regulations at that time. The resident was concerned about residents deteriorating due to lack of stimulation during lockdown.
• A relative raised concerns over infection control; she complained that her father was sent to hospital by the home with someone else's clothes and personal care items. This was particularly concerning for the Complainant due to the COVID-19 situation.
• One resident complained about the portion sizes of the food and that residents were being put to bed at 17.30.
• A client raised concerns about maintaining her independence. The client self-administered medication but felt she was unsupported with this whilst at the care home. The medication was removed from her and stored by the home.
• Two family members raised concerns regarding communication, these concerns included that they were not informed when their relative was admitted to hospital and there was miscommunication around hospital outpatient appointments.
• Two complaints were received from members of the public regarding the brightness of the outside lighting of a residential home which was disturbing them and having a detrimental effect on their sleep.
• A resident was informed by a worker that the 'kitchen was closed' instead of being advised about what snacks were available outside of mealtimes, one resident did not like a worker's personal manner.   
  

8.1 Challenge Assessment Outcome. 15% of complaints were received from people challenging the outcome of an assessment of their eligibility for services and / or eligibility for financial support towards the cost of their care. Below is a summary of some of issues raised.

Blue Badge Team: 20 complainants appealed the outcome of their Blue Badge assessments. 12 appeals were successful and resulted in the award of a Blue Badge. 8 appeals were declined due to there being insufficient evidence that the applicant met the eligibility criteria, but applicants were advised to recontact the service if their condition worsened and if they had any further relevant evidence to support their application.

• Most complainants felt that evidence relating to medical conditions had not been taken into consideration. In these cases any expert opinion the complainants provided was taken into consideration and in many cases this resulted in the appeal being successful.
• Nine people who appealed had hidden disabilities, which they felt made them eligible under the legislation introduced in 2019, which allowed hidden disabilities to be considered. In these cases assessors sought expert evidence to establish if the applicants met the criteria. Five appeals were successful. 
• Four appeals were received from parents of children. Two of these appeals were successful.
• Three complainants appealed because they felt their incontinence had not been taken into account. In two of these cases evidence was not available to show that this was a significant and enduring condition that affected the applicant's ability to walk, so only one of these appeals was successful.

Finance: 17 complaints related to the outcome of financial assessments of a person's ability to pay towards the cost of their care.  A summary of the issues raised included the following:

• Some complainants said they had not been informed of an increase in their charges following the annual review of their financial assessment. They had been upset to receive a higher invoice than they were used to.
• Some complaints arose because service users had not informed the Council that their financial circumstances had changed, and this meant they received large back-dated invoices. These complaints were not upheld. All service users are informed that they must inform the Council immediately their circumstances change, so that their assessment can be updated promptly to ensure they are paying the correct contribution to their care.
• Some complainants where unhappy with the outcome of their Direct Payment Audits, which had resulted in them being asked to make payments, for example, to repay unspent funds to the Council; or to pay their assessed client contribution into their Direct Payment bank account.
• Complaints were received from executors of the estates of deceased service users when they had received final invoices for care fees. In these cases executors often wished to be satisfied that the charge was valid and that the financial assessment had been carried out appropriately when their relative had been alive. In some case a retrospective financial assessment was offered if executors were able to provide information that had not been made available to assessors when the deceased was alive.
• A number of complaints were about decisions relating to notional capital, which service users or their attorneys had been assessed as depriving themselves of with the intention of avoiding care fees. For instance, if they had gifted money and this had brought them under, or closer to, the capital threshold for state funding. 
• Some complainants felt that not all relevant information had been considered under the assessment.  In these cases, assessments were reconsidered if complainants submitted any further information.
• Complaints received were from Service Users who felt they have less capital than they have been assessed as having or certain assets should be disregarded and not form part of the assessment.
• Several complaints where the Service User's contribution has increased due to a change in their circumstance but disagreed with the increase in their contribution
• One complaint related to a request to repay an overpayment of state funding. A "light touch" financial assessment had been carried out initially, pending a full assessment, so the Council only asked the service user to make a minimum contribution. Once the full assessment had been completed, the service user's contribution increased and was backdated.
• Complaints were received from Service Users who felt some of their disability related expenditures should have been disregarded when taking into consideration their contribution and their assessed contribution should be reduced to reflect this.
• A Working Age Adult whose income was from benefits questioned why they were required to contribute to their care costs. It was explained that by law some benefits can be included in a person's assessed income, subject to a cost of living buffer being applied to ensure they were left with enough money to live on.

Area Social Work: Issues raised include the following:

• Complaints were raised by family members whose relatives had been discharged from hospital to a temporary placement so that their long-term needs could be assessed. Relatives in this situation expressed anxiety about not knowing the implications for the future, in terms of both finances and where their relative would live and receive care. Many complainants expressed frustration that their relatives had not been discharged to their own homes.
• One complainant who was in receipt of Direct Payments complained that they had not had a review of their care and support plan for a number of years, and this had meant that difficulties managing their own care plan had not been picked up on as soon as they could have been. This resulted in a request for them to repay funds to the Council when their Direct Payment bank account was audited. This complaint was upheld and the repayment request was cancelled.
• Many complainants alleged that social workers had not, when they carried out assessments of a person's care needs, informed them and their relatives of the fact that they would be charged for their care. In most cases there was evidence that social workers had provided service users and relatives with information about charges and the financial assessment process.
• One complainant challenged the fact that their care and support had been reduced on review. This was a complex situation where the service user was often out when the care provider called. The care plan was increased pending a further review by another social worker.
• One complainant had requested an assessment for their relative with a view to moving to a specific care home of their choice which does not accept the Council rate. The complainant was unhappy that the social worker suggested alternative care homes. As the relative is a self-funder the complainant decided to place them in the home of their choice, and they were made aware that once their relative's funds reduce below the funding threshold, a third party top-up shall have to paid to meet the full cost.

8.3 Inconsistent Home Care was the fourth most common cause for complaint. 58 complaints were received about this issue, compared with 105 the previous year and 68 the year before that. A summary of the issues raised are as follows:-

• Complaints were received about the numbers of different carers attending to deliver care. COVID-19 was an exacerbating factor this year as providers were less able to create small care teams due to needing to draft workers in from neighbouring areas to deal with COVID-19 related staff absences; and family members and service users were more anxious about this issue due to perceptions of a higher risk of infection as a result. Complaint investigations therefore focussed on whether providers had done all they could to meet central government guidance on limiting the size of care teams; whether they had policies and procedures in place to mitigate the risks; and if they had followed best practice in terms of PPE and infection control. 
• A number of complaints were raised regarding missed call visits. 
• A number of complaints were received about visits being too close to each other – for example if a lunchtime visit took place shortly after the breakfast visit.
• A number of complaints mentioned that the time of visits varied too much, i.e. they were not consistently taking place at or close to the time given on the rota.  Family members of people with dementia said that this would unsettle their relatives as they were not able to establish a daily routine, for example people would not settle at bed-time if the visit was too early.
• Some people worried about the intervals between taking doses of medication were either too short or too long as a result of visit times not being consistent. 
• Some complainants said their visits were too late and they had therefore attempted to carry out their care tasks themselves. Some people said this had caused them to have an accident. 
• Where care visits are going to be late, care providers are expected to call ahead to let the service user or their carer know. Some people said this had not happened.
• It was very common for people to request a partial refund if they felt that they had not received a full service, or if the quality of service they received had been affected by the issues described above.
• Investigations sometimes found that workers had taken it upon themselves not to follow the order of the visits on their rotas.  Providers are increasingly using Electronic Call Monitoring (ECM), including GPS location tracking, so that office-based supervisors can check workers' whereabouts and contact them if they appear to not be in the right place at the right time.
• Some complaints alleged that workers had recorded that they had spent more time on the visit than they actually had.
• Some complaints referred to workers not staying for the planned duration of the care visits. In these cases, providers were asked to ensure that if workers completed all care tasks sooner than planned, they are expected to ask the service user if there is anything else they can do to support them in the remaining time available, and that they can only leave early if the service user is happy for them to do so (and this should be recorded in their care notes). Where visits are consistently being completed in less time than expected, providers must contact the relevant social work team to request an unscheduled review of the care and support plan. 
  

8.4 Staff Attitude/Conduct: 60 complaints related to this issue this year, compared to 98 last year and 78 the previous year. As in previous years, these complaints were sometimes raised as part of a larger complaint where the Complainant is challenging an assessment or a decision.   

Skills / Reablement Service. Seven complaints were received about this issue:

• Most of the complaints related to the way workers spoke to service users when they were encouraging them to complete tasks that designed to assess or support them to regain their independent living skills. In response managers would explain the delicate balance between support and encouragement sometimes meant that offence was taken when none was intended. However, in some cases the working relationship had broken down and workers were taken off an individual's care team.

Recovery Hubs. Four complaints were made about the attitude of workers at Recovery Hubs:

• A patient who was supported by staff to avoid a fall was upset that workers had raised their voices to her during the incident. The manager explained that workers had been extremely concerned and felt the need to raise their voices but in interview accepted that they could have handled the situation differently. The manager pointed out to them the need to speak respectfully at all times.
• A family member who had a 30 minute visiting slot during the pandemic felt that staff had spoken to them and their relative abruptly at the end of their allocated time. The manager undertook to speak to the staff team about how this affects people's confidence in the service and to stress the need to speak compassionately and with sensitivity at all times.
• One patient felt that workers had spoken abruptly when supporting them. One worker was moved to other duties until they had completed a training course.
• A relative said their repeated attempts to call the Hub had gone unanswered, and that when they finally did get through, they mentioned this, to which a worker responded rudely, telling them that staff were extremely busy. The worker concerned offered a personal apology and undertook training in customer care.

Commissioned Learning Disability Services: Some complaints were raised as a result of a Service User's frustration over other matters which had caused them distress.

• Service users with learning disabilities raised dissatisfaction with the way workers had spoken to them. These cases often related to workers having to address issues about a service user's behaviour which had an impact on other service users and therefore potentially could put their placement at risk. In these cases, managers often conducted reflective conversations with workers to see if they could have handled the conversations better.
• Relatives complained about the way workers had conducted difficult conversations with them about sensitive issues, for example if staff felt the relatives had behaved inappropriately, or otherwise in a way that was not in the service user's best interests.
• One Service User alleged theft by a worker, but following a joint investigation involving a social worker, no evidence was found to substantiate this.

Finance:

• Three complainants were received about this issue. In each case the complainant was challenging the outcome of their financial assessment or direct payment audit and complained about the way an officer had spoken to them.

Blue Badge Team:

• Two complaints who appealed the outcome of their Blue Badge assessments felt the assessor had been unprepared, dismissive and rude.

Independent Sector Home Care:

• Complaints were made where care workers had needed to challenge unacceptable behaviour by a service user, as service users or their relatives were unhappy about the way this was done.
• Some complaints were about the conscientiousness of home care workers, for example that workers would be using their mobile phones – in some cases this could be explained by providers' increasing use of work issue mobile phones for electronic call monitoring and care planning purposes. One complaint referred to a worker being asleep.

Area & Hospital Social Work: Seventeen complaints related to Area and Hospital Social Work:

• A number of complaints were made by people involved in safeguarding investigations. People reporting allegations complained that they felt individual workers had not taken their concerns seriously or followed them up. People about whom allegations were made complained that workers were biased against them when carrying out investigations.
• Several complaints were raised about the way in which workers spoke to Service Users or family members, in particular during complex or stressful situations. For example, when a relative was in hospital and their discharge needed to be planned; or when different family members did not agree with one another and the social worker was unable to keep all parties happy.
• Some complaints were from relatives whom it had not been possible to involve in meetings or discussions when an urgent change to a service user's care and support had to be made.
• Some complaints were made when family members disagreed with best interest decisions that had been taken by social workers. It was explained that where no Lasting Power of Attorney is in place, family members are consulted, but ultimately social workers are the decision makers.

Learning Disability Social Work: 5 complaints were made about Learning Disability social workers. 

• A family member was upset because a social worker had informed them that their behaviour had caused disruption and distress to other service users and workers at their relative's placement, as a result of which a behaviour management plan would have to be put in place. 
• A parent of a service user whose behaviour was impulsive, self-harming and sometimes violent felt that the social worker did not listen to her concerns and that sometimes the social worker's interventions made things worse. This complaint was not upheld, the worker was found to have a thorough knowledge and understanding of the service user, to have kept her assessments and care plans up to date and to have been responsive when required. 
• A service user was upset that a social worker had questioned her mental capacity in relation to the care of her horse. This was a difficult situation where the service user's behaviour had caused a breakdown in the relationship between the service user and the stable owner, which meant the horse's welfare was at risk.  
  

8.5 Lack of Social Work Support: 11% of the complaints received this year were regarding this.

Area Social Work - some of the concerns highlighted included:

• Complaints were received from family members who felt they should have been consulted more in their loved one's care, some disagreed with services which had been put in place without their awareness. Two had resulted in a debt being allowed to accrue which the relative was unaware of, whilst another just received an increased invoice with no awareness what the increases were for. One complainant felt the Social Worker should have done more to locate them when their relative lost capacity. They felt the Social Worker should have spoken to them so that they could be involved in the care and support of their loved one. Others complained about poor communication
• A complaint was made about the difficulties the daughter of a client had navigating the Social Care system and felt she needed more support. She spoke to many workers who gave her conflicting information, she found the process very confusing.
• One client felt that their Social Worker should do more and feels other clients received more support than they did. Some clients felt that if they had received more support from their Social Worker then their situation would not have deteriorated. Clients felt particularly unsupported when they were having difficulties with their service provision, sometimes with commissioned providers and needed more support navigating the social care system or during meetings with agencies and service providers.
• A few complaints were from clients or their relatives where the Complainant disagreed with information the Social Worker had given them.
• There were some instances where the client or family member's request for support was outside of the remit of a Social Worker but the Complainants challenged this. One neighbour felt that a Social Worker should have been doing more for their vulnerable neighbour.
• Two complaints were received from a relative who disagreed with the Social Worker's involvement ending and felt there should be more social work involvement in their relative's case.
• An autistic client struggled to be placed with either the Area Social Work team or the Mental Health Social Work Teams as both felt the client did not meet the team's criteria. This caused anxiety to the client, particularly due to their Autism and their need for consistency.  
• Some Complainants found it difficult to contact their Social Worker and commented on delays in receiving information from them.

Learning Disability Teams:

• Concerns were raised over the lack of contact from the Social Worker when the Service User was having difficulties with their service provider or in obtaining services. Complainants felt they were left to resolve any problems. Others mentioned difficulties in being allocated a worker so that services could be put in place and delays were causing strain on the family.
• One complainant wanted the Social Worker to assist her more in finding appropriate housing.
• Parents complained about a client's Social Worker allowing the client to make what they deemed were unwise choices and they felt more boundaries were required. One relative felt the client was living in poor conditions and the Social Worker should have done more to support them to change this.
• A client felt that his Social Worker was not on their side when with other agencies. Whist another client commented that they didn't feel listened to and was talked over.

Hospital Social Work:

• A relative complained about a lack of Social Work involvement when her mother was being discharged from hospital into a care home. The Complainant felt they were not informed of the process or the associated charges.
• The daughter of a client was unhappy about the ceasing of Hospital Social Work support and a new Area Social Worker becoming involved when her mother was discharged into a temporary specialist nursing placement under the COVID-19 funding.
• A relative of a client was unable to get a response from the Hospital Social Worker when her family member was admitted during the COVID-19 19 lockdown. This lack of communication caused additional distress during an already tense time.
• The son of a client was unhappy with the Social Work support when his mother was admitted to hospital during the COVID-19 pandemic. He disagreed with decisions which caused his mother to isolate and also the discharge. He felt these decisions were distressing for his mother and left her vulnerable to catching COVID-19.

Mental Health Social Work:

• A client felt unsupported by her Social Worker following a meeting which she found distressing. The client has a diagnosis of Autism but does not meet the threshold for eligible support needs.
• A client felt unsupported with her housing needs as she was residing in Bed and Breakfast accommodation and was seeking more permanent accommodation.
• A relative felt a Social Worker should have supported his mother during a meeting instead of her having to attend alone.
  

9. Outcome

The table below shows the outcome of complaints following an investigation. The three main categories for classifying the outcome of a complaint are "Upheld", "Partly Upheld" and "Not Upheld". Also included is a proportion that were "inconclusive" and those that were "Withdrawn". It will be noted from the table that 61% of complaints were either upheld or partially upheld.

10. Formal investigation

This reporting year 1 of the 424 complaints received were escalated to formal investigation by Independent Investigating Officers. In addition, 1 independent investigation that began in the previous year was concluded in this reporting year.

As is standard practice, complaints requiring formal investigation are investigated by Investigating Officers who are independent of Leeds City Council. Independent investigation has proved effective in resolving complex complaints.  

Appendix 7 of this report contains examples of action taken in response to investigation findings to improve the quality of services.

11. Mixed sector complaints – joint working across health and social care in Leeds

The Leeds Citywide Complaints group continued to meet virtually during the COVID-19 Pandemic. The group provides learning, expertise and sharing of good practice.

In the 2020-2021 reporting year, there were 86 mixed-sector complaints recorded by Leeds Teaching Hospitals NHS Trust, Leeds & York Partnership NHS Foundation Trust, Leeds Community Healthcare NHS Trust, NHS Leeds Clinical Commissioning Group and Leeds City Council Adult Social Care.

Poor communication runs as a theme through the majority of mixed-sector complaints. Recurring themes includes

• Poor communication with patients, service users and/or their families
• Poor communication between professionals
• Delays in accessing services, assessments and provision of aides and adaptations
• Challenging Assessment outcomes that either the process around the assessment was not explained or clearly communicated 
• Lack of joined up discharge planning - again poor communication between the provider and families is the main theme alongside a lack of joined up support following discharge and
• Poor care was also a recurring theme.

Next Steps:

The group continues to work on developing a system which can draw together lessons learned from people's experiences of health and social care across Leeds which should:

• Highlight more clearly the trends in city wide complaints and develop a process to draw together and share lessons learned from the people's experience of health and social care across Leeds.
• To continue to challenge that learning is not done in 'silos'. This means greater drawing out of actions and recommendations for improvement which relate to improving systems across Leeds. Whilst this happens already where individual cases are high profile it is not sufficiently consistent where system learning opportunities are present.
  

12. The Local Government & Social Care Ombudsman – update

The Ombudsman has statutory powers to carry out joint investigations with the Parliamentary and Health Service Ombudsman (PHSO). They operate a joint team of both health and social care investigators and undertake a single investigation which as previously stated in the report provides a more effective way of ensuring that complaints are resolved and lessons learned.

The Ombudsman's role in providing independent redress extends to all adult social care providers registered with the Care Quality Commission (CQC). This means that the Ombudsman investigates unresolved complaints about care arranged, funded and provided without the involvement of local authorities.

COVID-19: Handling of complaints – Key messages from the Local Government and Social Care Ombudsman

In order to support Councils and care providers during the pandemic, at the end of March 2020 the Local Government and Social Care Ombudsman (the Ombudsman) took the unprecedented step of temporarily suspending all case work activity that demands information from or action by local authorities in order to allow local authorities and care providers to concentrate efforts on vital frontline services.

During this period the Ombudsman stated that they would not issue Final Decisions and cases still in progress would be frozen until they resumed operations. 

During the suspension of their casework activity, the Ombudsman made it clear that they expected local authorities and care providers to respond to any complaints they received during this time.

The Adults and Health Complaints Team put arrangements in place to maintain the service during the COVID-19 pandemic whilst bearing in mind that there may be delays in responding to postal correspondence.

The Ombudsman restarted its casework activity in late June 2020 after a 3 month pause and made it clear that if at all we are unable to meet deadlines and need more time to provide a response to inform the investigator as soon as possible These arrangements have worked well for the Adults and Health Complaints Team.

In the Ombudsman's 2020/21 Annual Review letter sent to Council Chief Executives in July 2021, the Ombudsman has reiterated its focus on the outcomes of complaints and what can be learned from them as opposed to focusing on volumes of complaints.

12.1 Summary of Ombudsman Cases

The Council is required by Law to inform people of their right to complain to the Ombudsman if for whatever reason they are unhappy with the way the Council has dealt with their complaint. The Adults and Health Directorate complaints leaflets, therefore, provides people with the Ombudsman contact details and informs people of their right to escalate their complaint to the Ombudsman. In addition, complainants are provided with the Ombudsman contact details as part of the response letter to their complaint.

In view of the above, it is envisaged that more service users will escalate their dissatisfaction to the Ombudsman either because they would have liked something more or a different outcome from the Council in response to their complaint.

In the reporting year, 24 complaints and enquiries in total were made to the Local Government & Social Care Ombudsman compared to 25 the previous year.

The 24 includes invalid/incomplete complaints/enquiries or from people who may not have initially contacted the council and, therefore, recorded as 'premature' and referred back to the Council. Below is the breakdown:

• 1 was invalid or incomplete
• 1 advice given
• 5 were premature and referred to the council for investigation
• 7 were closed after initial enquiries
• 0 were not upheld
• 10 were upheld

Total: 24

Of the 10 upheld cases 6 were in relation to commissioned services provided by the independent sector, 4 related to Adults and Health directly provided services

• 3 were remedied before it reached the Ombudsman, as part of the complaint process although included in the Ombudsman's figures, as per Ombudsman practice.
• 4 cases involved financial remedy.
• 3 cases had been brought by 1 complainant complaining to the Council as commissioner of the homecare service provided by independent care providers.

A breakdown of the Ombudsman enquiries and the findings are detailed in Appendix 5 of this report.

13. Local settlements and public reports

Where the Ombudsman finds fault - he may recommend a local settlement or issue a public report. In this reporting period none of the complaints resulted in a public report.

The Council agreed to pay financial remedies in local settlement of seven complaints to the Ombudsman.

In one case the Leeds NHS Clinical Commissioning Group (CCG) was asked to make a payment of £700 to a service user, and £500 to their family who had complained on her behalf. The payments were in recognition of the fact that at times not all the care and support needs had been fully met. The service user's care was commissioned by the CCG hence the CCG being asked to pay the settlement. The case was managed by the Council's Learning Disability Social Work service on behalf of the CCG.

In one case the Council agreed to pay £500 to a person whose care needs had not been met in full by a supported living provider and £500 to his parent who had made up the short-fall in their care.

In one case a family member had refused to pay their parent's care fees because they felt the quality of home care had not been sufficient. The Council accepted there had been confusion over the timing of visits and agreed to reduce the person's debt for outstanding care fees by £200 and pay the complainant £100 in recognition of their time and trouble in making the complaint.

In one case the Council agreed to pay £250 to a relative in recognition of a delay in advertising their parent's house for sale (the Council was this person's financial deputy). This had not been done by the time the person died, at which point the Council ceased to be the deputy and the relative had to dispose of the person's assets.  

In one case the Council agreed to make a payment of £250 in recognition of delays in completing a complaint investigation.

In one case the Council agreed to make a payment of £500 to a relative in recognition of the uncertainty, distress and lost opportunity of not being offered the support of an advocate being involved in a safeguarding investigation may have caused.

In one case the Council agreed to reconsider its previous decisions that a person had intentionally deprived themselves of income prior to requiring care and establish their true motivation. The Council agreed to the £2,000 notional income and removed this amount from the financial assessment calculation.

The total of financial remedies provided as a result of Ombudsman investigations was £5,500 compared with £5381.07 in the previous year.  

14. Timescale performance

14.1 The statutory timescale for acknowledging complaints is 3 working days. In 2020/21 performance against this timescale was 96%. Good performance in acknowledging complaints within timescale has been maintained.

14.2 Whilst the statutory timescale for fully resolving a complaint is now up to six months based on level of risk and complexity, the service aims to provide an initial response to complaints risk assessed as low within 20 working days. This year performance against this timescale improved from 96.4% to 98%.

15. Compensation payments

Under Section 92 of the Local Government Act 2000, Local Authorities are empowered to remedy any injustice arising from a complaint. It is now practice to consider small ex gratia payments by way of recompense for costs incurred or compensation for a distress caused as a result of a matter complained about. In some cases it may be appropriate to waive care fees. The Local Government Ombudsman also has powers to direct the authority to pay compensation and to recommend the amount.

As noted at paragraph 13, £5,500 was paid as a result of Ombudsman investigations.

Payments were also offered as a result of internal complaints investigations. Including payments made as a result of Ombudsman investigations, the Adults & Health Directorate provided financial remedies totalling £23,834.92 this year. This compares with £46,000.83 in the previous year. 

The payments and/or waiving of fees fall into three main categories, as follows:

• Payments or Waivers made in recognition of fault / poor quality, or delay in the provision of services. In total £5858.26 was paid (or care fees waived) for this reason. Individual payments are usually modest and can reflect the reimbursing of care fees where isolated incidents have occurred, or a payment in recognition of distress, anxiety and inconvenience caused as a result of failings. Larger payments can be made where a problem has persisted for a long period of time. 
• Fees repaid due to people being incorrectly charged: £12,484.1 was paid to customers for this reason, comprising:
• Where the service user had been charged for services that were either not provided (e.g. a home care provider had not turned up for the care visit or stayed for the full duration) or were not required (e.g. where the service user had cancelled the service)
  
• Where service users or their representatives had not been given adequate information about their contribution to the cost of their care. These payments are often substantial as they reflect the fact that the service user has received a backdated invoice for care fees which they were not expecting
  

16. Methods of notifying complaints

16.1 There is no requirement that a complaint must be written, although a person making a complaint is always encouraged to be as specific as possible. Consequently, complaints can be received via a number of different channels and the chosen channel of communication is recorded. Leaflets providing information on how service users or their representatives can send compliments and complaints are widely available across all service areas and the leaflet contains a simple form, which people can use.

16.2 This year most people (28.8%) chose to make their complaints by e-mail – this was a slight increase of this method compared to last year when 26.3% of complaints were made by email. The numbers of people making complaints directly to a member of staff has slightly reduced this year, with 100 (23.6%) people using this method compared to 167 (25.7%) last year, this may be due to the COVID-19 pandemic restrictions and not all services having actual face to face contact with relatives or service users. We saw an increase in the numbers of people who made their complaints by telephone to the corporate complaints team (20%) and to workers (8.7%). The numbers of people writing letters of complaint (5.9%) or completing the complaints forms included in our complaints leaflet (2.6%) reduced from last year. Again, this may be down to the COVID-19 restrictions and lockdowns. Few people made complaints using other channels, such as Healthwatch Leeds (1 person this year from 12), the Care Opinion website (1 down from 13). People making complaints through a advocacy services rose to 5 up from 4 the previous year (1.2% up from 0.6%).

16.3 Overall the number of complaints is down. There was an increase in complaints made by parents from 12 to 20. In percentage terms we saw an increase from 26.4% to 34.9% of complaints being made by relatives, this was also the largest group making complaints. Complaints made by parents increased from 1.8% to 4.7%, there was also a slight increase in complaints received via other agencies 1.7% to 3.3%

17. Equality monitoring

17.1 All complaints are subject to equality monitoring, which now includes all the equality characteristics protected through legislation (age, disability, gender, race, religion or belief, sexual orientation). Information is most frequently provided on ethnicity, gender and disability. No information has been provided about other characteristics. 34.2% of all complaints have ethnicity recorded, reflecting a slight decrease from 37.3% the previous year. 96.7% have gender recorded. 27.8% of complaints state whether the person was disabled or not.

Where complainants haven't provided this information, the Complaints Team relies on CIS. However, CIS isn't always up to date.

A breakdown of the equality related information provided by complainants is detailed in Appendix 6 of this report.

18. Lessons learned

18.1 Where a complaint has been upheld, it is often the case that the manager undertaking the resolution of the complaint will make recommendations on how the service should be improved to avoid a similar situation arising for another service user. These actions will be brought to the attention of the complainant and there is a system in place for recording the action and the person with responsibility for implementing the action. Appendix 7 of this report contains some examples of the lessons learnt during the course of the reporting year and actions taken to improve the quality of service.

19. Service user satisfaction surveys

19.1 The Complaints Service sends a satisfaction questionnaire to all complainants after they have received a response to their complaint. The purpose of the questionnaire is to seek complainants’ views on how easy they found it to complain and how satisfied they are with key aspects of the process and outcome. The return rate in this reporting period was less than 1.4% Of the satisfaction questionnaires which were returned, 60% were either very satisfied or quite satisfied with the response to their complaint. The main reservations complainants had about completing the satisfaction questionnaire was that ‘they were not sure it would do any good” or they “were unsure who to complain to”. The Complaints Team is looking into how the satisfaction questionnaire return rate can be improved. One worried about reprisals.

20. Developments and updates 2020/2021

2020/2021 has been a challenging year for everyone. Some of the priorities set for 2020/2021 were paused due to the COVID-19 pandemic. During 2020/2021 the overall number of complaints decreased by 35%. Although the numbers of complaints received decreased, the Complaints Team has experienced having to deal with increasingly more complex complaints and the challenge of operational managers who have had to support the front line and this particularly affecting the timescales to investigate complaints. Commissioning Officers have been supporting front line providers so they too have had no capacity to investigate complaints. Finance Officers too have been involved in providing support payments to the independent sector hence challenges in trying to maintain good performance in resolving complaints.

The focus for the Complaints Team has been to maintain good customer service by focussing on good communication by keeping complainants informed of any progress. 

21. Training

21.1 The Adults and Health well established complaints training helps Adults and Health staff and commissioned care provider staff improve their complaints handling.

In response to the COVID-19 pandemic, the complaints training was re-designed to online delivery and delivered in March, April, May, June, July and in January and February.  The training was delivered to internal Adults and Health staff but mainly to staff of the commissioned independent sector staff covering Homecare, Supported Living, Residential and Nursing Care staff, Real Life Options and CAB staff.

We received excellent/positive feedback with delegates saying it will improve their practice. Some examples of the feedback:

"Thank you – this is so powerful" "Thank you this is so helpful"

"Overall learned so much difficult to put it in words"

"enjoyed it and found it engaging and informative", "I will start to take complaints seriously"

"I will record better than I do – if it is not written down it did not happen, I now know how to go about it"

"I will engage with the family more.." " I will stop taking things personally"

"I will be calmer and deal with the situation right there and then"

"I will look at complaints positively" "I will act on things quicker"

"to make making complaints more visible"

"Its been very good to understand that there is a human element to complaints, resolve and not respond!"

"I will be more patient with staff, be more accessible and not defensive"

22. Guidance for dealing with unreasonable behaviour from service users

Occasionally the behaviour or actions of some service users or their representatives has made it very difficult for staff to deal with them. In a small number of cases the actions of individuals become unreasonable and can be considered to be unacceptable because they involve abuse of staff and has a huge impact on Council resources.

In view of this, Adults and Health Directorate has Guidance for staff to guide them when dealing with customers whose behaviour is unacceptable or unreasonable and with action that can be taken.

23. Protocol on complaints handling with commissioned service providers - updated

The Local Government and Social Care Ombudsman has made it clear that where a Council commissions care from the independent sector, that the Council remains accountable for the actions of the provider it has commissioned. In view of this, Leeds City Council, Adults and Health Directorate has a protocol with its commissioned service providers.

The purpose of the protocol is to provide a framework for collaboration in handling complaints and ensuring regular communication in relation to commissioned services between Leeds City Council, Adults and Health Directorate and its commissioned service providers. This should also allow the Council to gain an overview of service user feedback in relation to commissioned services as well as provide an opportunity to collate information to ensure that learning points arising from compliments and complaints are used to inform contract monitoring and/or used to improve services and inform commissioning activities.

Unfortunately, only a few providers are adhering to the protocol. The Complaints Team continue to remind providers to share information as requested in the protocol.

The Protocol has been updated and the Council as Commissioner is now asking commissioned service providers to share their draft responses to allow the same to be quality assured by the Council's Adults and Health Complaints Team and/or the Commissioning Team. This practice is in response to the Ombudsman's practice which stated that they will treat provider's responses as the final response, as follows:

"The care provider has responded to the complainant about the matter. The law says we can treat its complaint response as your Council's response. We do not expect people to go through two successive complaints procedures, so we are satisfied we do not need to refer the matter back to you."

In view of the above, with immediate effect, providers have been asked to send all draft complaint responses for Leeds residents to the Adults and Health Complaints Team at complaints.socs@leeds.gov.uk and to the Adults and Health Commissioning Team at olderpeoplescare-homes@leeds.gov.uk; Homecare.Providers@leeds.gov.uk and waa.contracts@leeds.gov.uk for quality assurance and approval before they are sent to the complainant. 

24. Review of information literature for service users and their representatives

24.1 Monitoring and review of information for service users or their representatives in order to try and ensure that the Complaints Procedure is accessible is one of ongoing monitoring, development and review. The action to review information literature was paused and has been carried forward to the 2021/2022 reporting year. Information for people with a learning disability and the main generic complaints leaflet will be updated.

24.2 Deaf people using British Sign Language can contact the Complaints Team using mobile telephone number 07800 005 460.

25. Complaints handling – national developments

25.1 Local Government and Social Care Ombudsman (LGSCO) Review of Adult Social Care Complaints 2020/2021.

The Ombudsman published its Annual Review of Adult Social Care complaints in September 2021. The Ombudsman reported that a key part of their work in the early part of the year was to lay the foundations for investigations complaints about COVID-19. That this involved building a specialist team and closely tracking the rapidly changing legislation to allow it to come to balanced and proportionate decisions about what was happening at the time.

In the reporting year the Ombudsman has reported that it refreshed its 3 year corporate business plan and in order to help Local Authorities and Care Providers it relaunched

• The Best Practice Guidance on retaining good administrative practice during the crisis.
• It also published its 50 investigations about the Homelessness Reduction Act looking at how Councils are implementing the new legislation
• It also issued a report on its investigations involving Council services for 'looked after children'

In the independent care sector, the Ombudsman reported the following:

• More could be done to increase awareness of adult social care complaints systems
• More could be done to increase transparency around how care providers manage complaints and that
• Better support to providers for them to learn and improve when things go wrong

The Ombudsman has reported that it is now calling for the government to use the planned social care reforms to require providers to tell people, if they are unhappy with the service they are receiving how to complain not only to the providers themselves but also how to escalate to the Ombudsman.

The Ombudsman's Complaints Annual Review Report has also highlighted that the Ombudsman works closely with partners across the social care landscape to share intelligence and experience of complaints. This includes sharing information about complaints investigations with the Care Quality Commission (CQC) in order to inform regulatory action.

It is also reported that the Local Government and Social Care Ombudsman are signatories of the Emerging Concerns Protocol. This is a mechanism for sharing information and intelligence that may indicate risks to people who use services, their carers, families or professionals.

As reported in previous years, it has reiterated that it will hold commissioners to account for their commissioned service providers' failings. It encourages all councils and care providers to have systems in place to ensure learning from complaints is shared widely.

Included in the Ombudsman's Annual Review Report is data on how each local authority and/or independent care provider complied with its recommendations to remedy complaints about them. Leeds City Council, Adults and Health Directorate achieved a 100% compliance rate i.e. percentage of cases the Ombudsman were satisfied that it had successfully implemented the Ombudsman recommendations.

Lessons to be learnt from the Ombudsman's findings are shared with staff via the complaints training.

26. Other priorities to be taken into account during 2020/2021

These include:

• Contributing to gathering intelligence on the impact of COVID-19 on care users and their families and lessons that can be learned to inform improvements
• Contributing to the Best Council ambition to be efficient, enterprising and a healthy organisation and meeting this by ensuring that staff are effective and have the right knowledge and skills
• Contribution to the Council Climate strategy by adopting practice which contributes to addressing this emergency.
• Contributing to the Council achieving its vision of a more enterprising Council, working with partners and businesses who are more civic and a more engaged public.
• Evidencing how the Adults and Health Directorate is meeting its priorities of keeping people safe from harm, people feeling safe and people living with dignity and staying independent for as long as possible because the Complaints Service is a useful tool for indicating where services may need adjusting and/or where they are not working well.
• Continuing to work closely with operational and support services' teams, sharing lessons learned from service user feedback to inform commissioning activities and service improvements.
• Continuing with the Complaints training via virtual classroom on the statutory complaints procedure, incorporating learning from service user feedback.
• Continuing to provide briefings to voluntary sector organisations so that they understand the health and social care complaints procedure so that they can effectively support people who may wish to access the complaints process.
• We will continue to push forward a learning culture throughout the organisation.  We will continue to do this by ensuring learning is followed up by simple action plans with the Heads of Service at the time the complaint is closed. Learning which has a wider impact will be shared widely with the relevant teams/partners.
• We will continue to monitor and evaluate information to ensure that the complaints procedure is accessible to all service user groups.
  
• Continuing to promote the complaints service across all Adults and Health operational teams by attending their management team meetings to share key messages, the national picture and the impact this will have on their practice.
  

27. Conclusion

The reporting year witnessed communities, the Council and its partners face a range of unprecedented challenges responding to the COVID-19 Pandemic and spent the year adjusting to ongoing disruption and operational challenges.

Review of compliments and complaints has provided an opportunity to assess some of the impact of the COVID-19 pandemic on health and social care users and their families and how the staff responded to some of the challenges.  It can be noted from the compliments recorded in the annual report that despite the challenges overall health and social care and its commissioned providers responded well to the unprecedented challenges it faced.  Care users and their families thanked staff for their support and the positive impact this had on their lives.  Comments were made about workers showing kindness or going the extra mile.  Others were grateful to staff for the food and clothes parcels or assisting them in obtaining support. Some care users felt the support from staff was invaluable; others thanked staff for being listened to, others for assisting with zoom calls with their families and some commented on the good quality of meals in the care homes.

At a time of such pressure, it is now more important than ever to listen to public concerns in the form of complaints as they provide free intelligence to spot problems and drive improvements.  As can be evidenced in appendix 7, the complaints informed commissioning improvement activities and training, where appropriate; some complaints data and analysis informed individual Managers to take the initiative at service/team level or with individual staff members to address areas for development and local improvements.

From the compliments received, it can be seen that overall the Adults and Health Directorate and its partners responded well to the unprecedented challenges it faced.

Complaints are a crucial early warning sign when something has gone wrong and the person complaining could be without a crucial service at a critical time.   Our strategy, therefore, is to continue to encourage as many people as possible to provide us with this feedback so that issues can be resolved early and for these to drive service improvements.

The focus for the Complaints Team during these challenging times has been to ensure that we communicate clearly with complainants and keep them informed.

As in previous years, it is important that the Council takes even greater measures to evidence that lessons learned from complaints are used to improve and maintain the quality of the services it provides and commissions.  Complaints continue to be a complex and difficult service area with both legal and financial implications.  

If you would like to comment on this report, or to receive it in large print, Braille or other format, please contact complaints.socs@leeds.gov.uk.

Appendices