1. society
2. welfare
3. healthcare

Valuing
Concerns
and
Complaints
Paul Durham
Strategy Team
Complaints for Clinicians and Managers Conference
11 February 2015
1
CQC purpose and role
Our purpose
We make sure health and social care
services provide people with safe, effective,
compassionate, high-quality care and we
encourage care services to improve
Our role
We monitor, inspect and regulate services to
make sure they meet fundamental standards
of quality and safety and we publish what we
find, including performance ratings to help
people choose care
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Listening to, and acting on,
people’s experiences of care
People’s experiences of care are
valuable, positive or negative
We use this information to help inform
where, when and what we inspect
Outside our inspections we try to make it
easy for people to tell us about their care
If people have experienced or know
about poor care, we want to know
A safe, responsive and well-led service should treat
concerns and complaints as opportunities to improve
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Learning culture
The NHS should be:
“a system devoted to continual
learning and improvement of
patient care, top to bottom and
end to end”
and should:
“embrace wholeheartedly a
culture of learning”
Don Berwick
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Concerns and complaints in our
new approach
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What do people complain about?
Most common
subjects of written
complaints in
NHS hospital and
community health
services 2013/14
(Health and Social
Care Information
Centre, 2014)
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How do we receive and act upon
concerns and complaints?
• CQC is not responsible for resolving individual
complaints, but we want to hear from people who
experience or know about poor care, and use this
information
• CQC receives 50 complaints every day
• Embedding complaints and concerns into our model
aims to:
• Improve how we use the intelligence to better
understand the quality of care
• Consider how well providers handle complaints and
concerns to encourage improvement
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How do concerns and complaints
inform our regulatory approach?
• Intelligent monitoring
• Priority bands
• More comprehensive picture where complaints
handling is tested
• Enforcement if necessary
• Partnership working
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What questions do we ask during
inspections?: Complaints
Responsive: How are people’s concerns and
complaints listened and responded to and used
to improve the quality of care?
1. Do people know how to make a complaints? Are they
encouraged?
2. How easy is the system to use? Are people treated
compassionately?
3. Are complaints handled effectively and confidentially? Is
the outcome explained? Is there openness and
transparency?
4. How are lessons learned? Are lessons shared?
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What questions do we ask during
inspections?: Staff concerns
Well-led: How are people who use the service,
the public and staff engaged and involved?
1. How are people’s views and experiences gathered and
acted on?
2. How are people actively engaged and involved?
3. Do staff feel actively engaged?
4. How do leaders prioritise the participation and
involvement of people?
5. Do both leaders and staff understand the value of staff
raising concerns? Is appropriate action taken?
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How well do providers value
concerns and complaints?
• Not taken seriously for far too long
• Met with a defensive culture instead
of a willingness to listen and learn
• Rate of complaints per 1,000 patients
has changed little over three years
• Wide variation in the way complaints
are handled – people not given
information and responses untimely
• Much more could be done to
encourage an open culture
• More data is needed
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Concerns and complaints figures (1)
• Healthwatch England estimates
250,000 incidents are
unreported/year
• In 2013/14, 18,455 concerns received
by CQC – about 50 a day
• Healthwatch England suggest 82% of
people more likely to raise a concern
if they knew information would be
used by CQC
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Concerns and complaints figures (2)
• 280 items of feedback/month from partners
• Of these, 42 (15%) are positive and 238
(85%) are concerns about care
• Of the 238, c 24 (10%) are serious enough
for a safeguarding referral to the council
• 14 concerns (6%) prompt us to carry out a
responsive inspection or bring forward the
date of a planned inspection
• On average, 57 concerns (24%) prompt us
to raise issues with the service provider and
seek a response
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Improving the way concerns and
complaints are valued
• We have a programme of work to improve the way
concerns and complaints are valued
• Three workstreams:
• improving how providers handle concerns
• improving our customer experience
• supporting improvements in the wider system
• The first workstream led to publication in December
2014 of Complaints Matter
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Workstream 1: Improving how
providers handle concerns
To use concerns, complaints and whistleblowing to effectively assess quality
and to encourage improvement in how providers handle concerns
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2
Improve how we use
the intelligence
provided by
complaints/concerns to
understand quality
Look at how well
providers handle
complaints/concerns in
every inspection,
recognise good practice
and encourage
improvement
Every complaint is
an opportunity for
us to better
understand
potential risks of
poor quality
A service that is
safe, responsive
and well-led
should treat
every concern
raised as an
opportunity to
improve
Workstream 1: what we have done
so far
Pre•
inspection
•
•
Improvements made to the intelligence available to our inspection
teams regarding concerns and complaints
Provider self-report for complaints introduced for acute, community
and mental health services
Provider information request for acute, community and mental health
services now asks for survey of complainants
Consistent framework for the assessment of provider handling of
concerns and complaints embedded in our Key Lines of Enquiries
and prompts – aligned with the PHSO/LGO/Healthwatch England
expectations of good complaints handling
Pilot work with Patients Association and wide engagement with
people who have complained, staff who raised concerns, providers
and national partners on inspection methods
Lead inspector on large inspection teams
Review case notes from complaints as part of evidence gathering
Reporting •
on
findings
•
Evaluation •
Updates made to our inspection report templates to give complaints handling
prominence
Complaints Matter published December 2014
Developing method of evaluating our approach
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•
•
Inspection •
methods
•
Workstream 2: improving our
customer experience
To Improve the End-to End Management of Direct Feedback from Individuals
Feedback about care quality, from …
Users of service and
their families and
carers
People are
encouraged to give us
good quality feedback
People understand what we
have done as a result of
receiving feedback
Feedback is easy
to analyse and
report on
Employees within
provider
organisations
Feedback about CQC, from …
Individuals
complaining about
CQC
Improving the experience of
individuals giving us
feedback
Virtuous Circle
Better quality information
available to improve our
regulatory activities
Employees within the
organisation raising
concerns about CQC
People understand
what we will do with
their feedback
Easy for people to
give us good
quality feedback
People do not feel
they need to
complain about CQC
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Workstream 3: supporting
improvements in the wider system
To support improvements in people’s experience of making concerns,
complaints and whistleblowing
Aims For Wider System Improvements
To improve the experience
that people have when
making a complaint or raising
a concern in the current
system
• Be clear what CQC can and
cannot do
• Work with partners so there is
‘no wrong door’ for complaints
• Coordinate communications
and language with partners
To challenge ourselves and
our strategic partners on
further improvements
• Use evidence to contribute to informed debate
on improving the system
• Lead by example – develop CQC’s unique
contribution (e.g. inspection) and engage
Engage at a lead and working level with major
reviews of the wider system e.g. Francis, NAO
• Make regular and positive contribution to DH coordinating group
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Workstream 3: working with the
wider system
DH
Aligns with other
bodies
Addresses Francis
Public Inquiry
recommendations
PHSO
Consistent vision
of good practice
Clarify info to
share & who
takes action
LGO
Consistent vision
of good practice
Clarify info to
share & who
takes action
CQC
NAO
Review new CQC
approach
Learn from other
sectors
Expert Partners
Learning from
other sectors &
models e.g.
PCAW
Francis Review
Contribute &
learn
Improve future
system for staff
raising concerns
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Possible future developments
• Framework for analysing providers’ handling of complaints
in adult social care and primary care
• Strengthening inspection approach for assessing the
handling of concerns raised by staff
• Piloting quicker access to complaint case summaries from
strategic partners and the value to inspectors
• Responding to the Francis Review on Freedom to Speak
Up, Kirkup Review on Morecambe Bay Hospital, DH ‘One
Year On after Francis Report
Thank you
www.cqc.org.uk
enquiries@cqc.org.uk
@CareQualityComm
Paul Durham
Strategy Team
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