Adult Social Care - Statutory Annual Report 2020-21
Contents
This report provides information about complaints made during the twelve months between the 1 April 2020 and the 31 March 2021under the complaints and representations procedures established under the NHS and Community Care Act 1990 and the Local Authority Act 1970.
From April 2012 Adult Social Care, Older People’s front line services were transferred over to Midland Partnership NHS Foundation Trust (formally Staffordshire and Stoke-on-Trent NHS Partnership Trust). From April 2017 the Trust co-ordinates all statutory complaints which relate to Adult Social Care services provided by the Trust.
The Council has a statutory obligation to operate a complaints procedure concerning statutory provision for adults. This is in accordance with the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. These regulations set expectations for the handling of complaints by Councils, NHS bodies, Primary Care providers and independent sector providers responsible for the provision of NHS and Social Care.
Who can complain?
The NHS and Community Care Act 1990 and the Local Authority Act 1970 places the following restrictions on who can access this procedure:
- Complaints under these procedures must be made by or on behalf of an eligible person and must be in respect of that person
- An eligible person is anyone for whom the Council has a power or duty to provide, or secure the provision of a service, and this need or possible need has come to the attention of the Council
- Complaints can be made on behalf of an eligible person where the eligible person lacks capacity to make the complaint themselves (In accordance with the Mental Capacity Act 2008 or has given explicit and verified consent for the Complainant to act on their behalf
Time limit:
Section 12 of the statutory regulations advise that the complaint must be made no later than 12 months after the date in which the matter which is the subject of the complaint came to the notice of the complainant, unless the complainant has good reason for not making the complaint within this time limit.
Overview
Careful consideration is given to the operation of the Complaints Procedure to ensure an appropriate and proportionate response is provided. Communication, coordination and information sharing are critical and ensure that safeguarding measures are applied where necessary. In addition, liaison with the Council’s Care Commissioning and Midland Partnership Foundation NHS Trust ensures a coordinated response to concerns about commissioned services. Similarly, dialogue with the office of the Local Government and Social Care Ombudsman ensures that the Local Authority is able to take steps to resolve complaints locally where possible.
‘Lessons Learnt’ from complaint investigations remain a key feature for the service and are always fed back to services and performance groups for action within the Council and Partnership Trust.
Key numbers
- Statutory stage 1 complaints - 145
- Local Government and Social Care Complaints - 23
- Statutory Independent Investigations - 1
- Complaints handled informally - 146
- Top 5 areas of complaint
- Financial assessment / contribution - 22
- Poor communication - 18
- Case management - 16
- Charges not discussed - 14
- Delay in receiving - 11
The total amount of monies paid to complainants as an outcome of an Ombudsman investigation is £700 in recognition for the time and trouble in raising the complaint and any distress caused.
In comparison with the previous years, we have seen a reduction in Stage 1 complaints recorded for this financial year, however there has been an increase in complaints which been resolved informally with support from the Complaints Team.
The Complaints Team takes into account that for this reporting year some clients may have chosen / or not been able to receive some services as a consequence of the Covid-19 pandemic and the subsequent lock-down restrictions. Such as home care, direct payments for support and respite services.
The Complaints Team has continued to be operational during this time, however the availability of staff within the service areas has impacted on the response timescales due to staff resource being targeted towards providing essential services and supporting communities.
Local investigation
- 2018/19 - 176
- 2019/20 - 187
- 2020/21 - 145
Independent Investigation
- 2018/19 - 2
- 2019/20 - 0
- 2020/21 - 1
Local Government Ombudsman
- 2018/19 - 27
- 2019/20 - 35
- 2020/21 - 23
Stage 1 - Local investigation - Breakdown
The complaints procedure aims to resolve complaints at a local level within 20 days. This is not a statutory time limit but a goal for effective complaints management. According to the complexity and needs for an effective investigation, this timescale can be extended by agreement with the complainant.
The current guidance suggests that the majority of complaints should be resolved locally, and frontline managers are encouraged to meet with complainants and attempt to address complaints in a swift and effective manner.
145 complaints were recorded under Stage 1 – Local Investigation during 2020-21
- Adult Learning Disability Services - 28
- South Staffordshire - 17
- North Staffordshire - 5
- Young Adults Team - 6
- Adult Social Care First Contact - 27
- Brokerage service - 7
- Commissioning service - 22
- All age disability and mental health - 2
- Older people and physical disabilities - 9
- Carers Hub - 1
- Care provider - Home care agency - 8
- Care provider - Residential / Nursing - 2
- Community Mental Health Team (North) - 1
- Contact centre - 2
- Financial services - 55
- Debt Recovery - 2
- Direct Payments Team - 1
- Non-Residential - 9
- Residential - 5
- Welfare Benefits and Fairer Charging - 38
- Fixed Equipment Team - 1
- Adult Safeguarding - 2
It is important to note that some complaints concern more than one service area and therefore require a joint response. However, each service area is recorded separately in the table above in order to capture all areas of complaint.
- 39% of the Stage 1 Complaints received were in respect of the Fairer Charging Service (including residential / non-residential). This was mainly concerning the outcome of a financial assessment and the client contribution figure. This figure is consistent with previous years and continues to be an area of concern for the client and / or their representation.
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Last financial year, the Brokerage Service investigated 24 Stage 1 Complaints. This financial year has seen the figure vastly reduced to 7 Stage 1 complaints. This is due to more concerns being resolved outside of the complaints process this financial year.
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There has been a 33% reduction in formal complaints received during 2020 / 2021. This is due to the significantly reduced numbers of complaints for the Brokerage Service this financial year.
The information below provides an overview of the nature of complaints received during 2020-21 and the outcome of the complaints investigated.
- Withdrawal of service - 1
- Standard of service - 4
- Staff attitude / professionalism - 2
- Social care assessment (quality) - 1
- Social care assessment (outcome) - 3
- Self-funder administration fee - 8
- Safeguarding (investigation / process) - 2
- Refund request - 2
- Poor communication - 19
- Policy change - 1
- Management decision - 7
- Invoice issues - 2
- Information provided - 3
- Funding process - 1
- Financial assessment (general) - 4
- Financial assessment (financial contribution) - 26
- Eligibility for - 2
- Direct payment (processes) - 2
- Delay in receiving - 11
- Charges not discussed - 14
- Case management - 17
- Care provider (quality of care) - 10
- Care provider (management decision) - 1
- COVID - PPE issue - 1
Outcomes
49% - Not upheld
33% - Partially upheld
17% - Upheld
1% - No finding
18% of complaints received were regarding the outcome of a financial assessment. 10% of complaints were regarding charges for services and not being advised by Council staff that a service is chargeable.
Adult Learning Disability Team
The number of complaints received for Adult Learning Disability Team’s this reporting year is consistent in comparison with the previous year. 27 complaints were registered last financial year compared to 28 this year. The service carried out 248 assessments of new people and 1,382 reviews of people who are already receiving care 2020 / 21.
Nature of complaint
- Care provider (Management decision) - 1
- Standard of service - 1
- Poor communication - 1
- Social care assessment (quality) - 1
- Care provider (quality of care) - 1
- Eligibility for - 1
- Staff attitude - 2
- Charges not discussed - 2
- Social care assessment (outcome) - 3
- Management decision - 4
- Case management - 11
39% of complaints were regarding Case Management from staff. This includes the management of an individual person’s case by the allocated worker.
14% of complaints were regarding Social Care Assessments – this includes the quality of an assessment and / or the outcome which has resulted in a reduction in services.
Outcome of complaint
The data below show the outcome of the complaints investigated for the Adult Learning Disability Teams during 2020/21.
Finding
48% - Not upheld
43% - Partially upheld
9% - Upheld
Recommendation / Learning action
- Charges written off - 1
- Apology - 2
- Charges reduced - 1
- Re-assessment - 3
- Explanation - 7
Organisational learning and recommentations
- Apology provided where complaints were Upheld.
- Explanation of events provided to complainant.
- For two separate complaints a full re-assessment and review of placement was recommended.
- For two separate complaints it was agreed that family can use the direct payment to pay a relative to support with care due the restrictions due to COVID-19.
- For two separate complaints an invoice was reduced.
Adults and Children's Financial Services
The detail below includes the following services;
- Welfare Benefits and Fairer Charging Services;
- Residential and Non-Residential Finance Team;
- Debt Recovery;
- Direct Payments
ACFS completed 5633 financial assessments this financial year annually. This has been broken as below;
- Non-Residential full assessments: 2194
- Non-Residential re-assessment: 1448
- Non-Residential Self Funders: 443
- Residential full assessments: 166
- Residential re-assessments: 760
- Residential interim assessments: 622
The number of complaints received for ACFS this reporting year has reduced by 31% in comparison to last financial year. 83 complaints were registered last financial year compared to 57 this year.
Nature of complaint
- Policy change - 0
- Refund request - 0
- Delay in Rec'g - 10
- Financial assessment (Client contribution) - 32
- Financial assessment (general) - 3
- Invoice issues - 2
- Direct payment process - 2
- Poor communication - 7
- Case management - 2
28% of complaints were regarding poor communication and delay in receiving a service. This also includes length of time for contact to be made with the citizen.
53% of complaints were regarding the assessed weekly client contribution. This was due to the weekly charge increasing following an assessment / re-assessment in line with the Care Act.
Finding
15% - Upheld
41% - Not upheld
44% - Partially upheld
Resolution
- Payment plan offered - 1
- Financial assessment updated - 1
- Charges written off - 1
- Apology - 8
- Explanation - 22
Resolutions and organisation learning
- Apology provided where complaints were Upheld
- Explanation of events provided to complainant.
- Explanation of financial assessment process and DRE that is included.
- Explanation of invoice and charges.
- Explanation of charges for respite care.
- 2 complaints resulted in charges being written off
- DRE appeal offered
Care commissioning
The details below includes the following services:
- Older people and physical disability and sensory impairment
- All age disability and adult mental health (AD&AMH)
- Care providers e.g. home care agency and residential homes
- Supported living / extra care
- Carers hub
45% of complaints received for Care Commissioning were regarding the service provided by a Care Provider. The Council becomes involved with the complaint if the complainant is unhappy with responses previously received by management.
20% of complaint’s received by the Commissioning Service were in respect of decisions in relation to the services a client receives following a social care assessment.
Nature of complaint
- Funding process - 1
- Refund request - 1
- Withdrawal of service - 1
- COVID PPE issues - 1
- Standard of service - 1
- Carer respite breaks - 1
- Poor communication - 2
- Management decision - 3
- Case management - 2
- Quality of care (care provider) - 9
Outcome
27% - Upheld
18% - Partially upheld
55% - Not upheld
Resolutions and organisation learning
- Council agreed to set the personal budget at the placement that was identified as meeting the needs of the citizen.
- The Council has referred the Care Home to Infection Prevention and Control Colleagues who will review practice and guidance with the Care Home in more depth to ensure continual adherence to guidance. In addition, these concerns have been shared with the Staffordshire County Council’s Quality Assurance Team for further review.
- Direct payments arranged to enable citizen can remain with provider of choice
- Apology / Explanation provided following contact with the home care agency in respect of the complaint raised.
Brokerage service
The Brokerage Service are responsible for sourcing a provider for home care and residential establishments for service users following a social care assessment when a service has been identified. It is important to note that some complaints investigated by Brokerage also required input from MPFT in order to provide a full answer to the complaint raised. This is because MPFT undertake the social care assessment.
During 2020-21, the Brokerage Service actioned / sourced 9,110 care packages and placement requests.
The number of complaints received for Brokerage this reporting year has significantly reduced by 71% in comparison to last financial year. 24 complaints were registered last financial year compared to 7 this year.
29% of complaints were regarding the ‘self funder arrangement fee’.
43% of complaints were in relation to Poor Communication from the Brokerage Service. This includes telephone calls not returned and lack of updates provided to families.
Outcome
50% - upheld
50% - not upheld
Resolutions and organisation learning
- Explanation of events provided, and processes followed by Brokerage.
- 1 complaint resulted in charges being reduced as an outcome of the complaint and the £400 Self Funder arrangement fee written off.
Adult social care first contact team
The service is point of contact for citizens who wish to request social care assistance and initial assessments are undertaken in order to establish whether a referral is made to MPFT or sign-posting to other services. During this financial year the service undertook 9130 assessments.
The service received 27 complaints which were investigated under Stage 1 of the complaints process. There has been a 37% increase in complaints received for the First Contact Team in comparison to last financial year.
Nature of complaint
- Eligibility for - 1
- Information provided - 3
- Case management - 1
- Poor communication - 3
- Self-funder arrangement fee - 6
- Charges not discussed - 13
48% of complaints received were regarding charges not being discussed during the assessment process. 22% of the complaint received were regarding the self funder arrangement fee and not being advised of this fee.
Outcome
63% - Not upheld
26% - Partially upheld
11% - Upheld
22% of complaints are regarding poor communication from the service. This includes the quality of information provided.
Resolutions and organisation learning
- Explanation of events provided
- Apology provided to those complaints upheld and partially upheld.
- The £400 Arrangement Fee written off for 5 complaints.
- Explanation provided in respect of whether charging was discussed with the service user.
- Start date for the client contribution of a home care package amended and invoice amended.
Stage 1 - Independent investigation adults social care
Independent investigation is initiated in circumstances where a complaint is complex and / or a level of seriousness is identified. This is often in circumstances of multi-agency involvement. The independent investigation is conducted by a commissioned external Investigating Officer.
A report of investigation is produced that details conclusions reached and recommends action to both resolve the complaint and make improvements for the organisation. The relevant Senior Officer adjudicates the report and provides the Council’s formal response to the complainant.
The timescale under this part of the procedure is 25 days, although there is facility to agree with the complainant an extension up to 65 days. (Again, this is not a statutory requirement but an operational goal that may be subject to negotiation)
There have been 1 complaint independently investigated during 2020/21.
This complaint was in relation to the assessments carried out, the provision (and lack of provision) of full and accurate information relating to these assessments, the delays and failure to reply to the complainants correspondence, and the failure to take reasonable steps to reach a Deferred Payment Agreement (DPA) to support his brother in funding his care.
This complaint was predominately in relation to services carried out by members of staff from the Midlands Partnership NHS Foundation Trust (MPFT) which has been commissioned by Staffordshire County Council (SCC) to provide adult social care services integrated with NHS community-based health services in Staffordshire. However, the complaints were directed to Staffordshire County Council as the public body with statutory responsibility for adult social care provision.
Recommendations
It is recommended that a Senior Officer be asked to carry out a review, working with colleagues at the First Contact Centre, the Finance Team and the Area Teams, to assess the efficiency of the existing systems to see whether the process from application for support through to an assessment can be carried out in a timelier manner.
Arrangements are now in place to prevent these types of delays accruing and the Council closely track the exceptional cases that take longer. Financial Services also have processes in place to send out financial assessments within 24 hours following receipt of a referral.
Customer Feedback and Complaints Manager carry out a review to satisfy herself that the systems in place to record receipt of correspondence from MPs and complainants and ensure these are acted upon are effective.
Review has taken place. There has been a couple of new appointments within the Complaints Team to support with representations receive by the team.
It is recommended that the systems for processing assessments be reviewed to include a check to confirm that the completed assessment has been sent to the client for signature/comment and records the date this was sent.
Practitioner’s to be reminded of the importance of this. The Council can then verify whether this is happening during quality audits.
Stage 2 - Local Government and Social Care Ombudsman complaints (to include Staffordshire County Council and Midlands Partnership NHS Foundation Trust)
The Local Government and Social Care Ombudsman (LGSCO) is empowered to investigate where it appears that a Council’s own investigations have not resolved the complaint. Whilst anyone can approach the Ombudsman at any time, the Complainant is usually required to first take up their complaint with the relevant Council to allow a local response. However, if the Complainant remains dissatisfied following local or independent investigation by the Council they then have the right to pursue the matter with the Local Government and Social Care Ombudsman.
The Local Authority has received 23 complaints which have been referred to the LGSCO, 18 complaints were fully investigated by the LGSCO and 3 were referred back to the local authority for investigation. 2 complaints were closed after enquiries were made with the Council and it was concluded that the Council was not at fault.
Compared to last financial year, the numbers of complaint considered by the Ombudsman have reduced from 23 to 18 investigations.
Summary of Local Government and Social Care Ombudsman complaints
Out of the 23 complaints which were received by the LGSCO, the Council has received 6 outcomes where the complaint was Upheld and maladministration and injustice was found. A total of £700 ‘time, trouble and distress caused’ payments was awarded to complainants following referral to the Ombudsman.
The Council is currently awaiting the outcome of 11 complaints. Of the 11, 5 are awaiting allocation to an investigating officer, 3 complaints are currently awaiting a Draft Decision and 4 remain under investigation at the time of writing this report.
Further details of the investigations can be found below:
Adult learning disability team (South)
Nature
LGSCO previously dealt with a complaint from Mrs X and found fault by the Council.
That complaint resulted in a permanent residential placement for her son. However, that placement has now broken down and her son has now returned to live with her.
Mrs X is again complaining about the lack of support from the Council.
Outcome
Premature complaint
Recommendation
Council to investigate via Stage 1 of the complaints process.
Adult learning disability (North)
Nature
The Council has failed to deal properly with the charges for his daughter’s care during the COVID-19 pandemic and has failed to take a sufficiently flexible approach to meeting his daughter’s needs during the pandemic.
Outcome
Upheld – Maladministration and Injustice
Recommendation
The Council to reconsider its decision not to allow the direct payments to fund support from within the family while they were shielding Miss Y;
The Council writes to Mr X apologising for its failings and pays him £250 for the time and trouble it has put him to in pursuing the complaint.
Care provider - home care agency
Nature
Complaint about home care agency and alleged neglect of two occasions. Concerns raised about the time that the carers arrived for the care visits in comparison to the times that they recorded in the log book. This resulted in client paying for care which was not provided.
Outcome
Awaiting allocation to investigator
Recommendation
Awaiting allocation to investigator.
Care provider - home care agency - Bees Care Ltd
Nature
The complaint is regarding the care provided by Bees Care (home care angency) to which Ms X used her direct payments to fund the care.
Outcome
Awaiting draft decision
Recommendation
Awaiting draft decision