7.1 There are various ways that residents of care homes and nursing homes and their representatives can make and progress complaints about any aspects of the services supplied by those homes. The options are partly influenced by who arranged or pays for the care provided. The aim of the inquiry team was to seek views on whether those options were generally known about, whether they were used, and whether they were effective. In order to determine this, it examined the responses to the questions it put, and carried out an analysis of the complaints procedures of 105 care homes to see what information they contained, and how that information was presented. In addition, the OFT’s survey of residents included questions about complaints.

7.2 The Residential Care Homes Regulations 1984 require residential care homes in England and Wales to provide a complaints procedure, to make it known to all their residents, and to keep related records available for inspection. There is no equivalent requirement covering nursing homes. In Scotland, while there is no statutory requirement for either residential homes or nursing homes to establish a complaints procedure, the published core standards require them to provide a written policy on complaints. In Northern Ireland, legislation requires the owners of residential care homes and nursing homes to have a complaints procedure, the operation of which must be made known to residents, and to keep related records available for inspection.

7.5 Inspection units, however, do investigate complaints mainly to collate evidence and determine whether the care-home owner is a ‘fit person’ to run the home, and in order to raise and maintain standards. Such investigations may highlight areas an announced or unannounced inspection visit may not have detected, and can provide an insight into the overall standards within a care home.

7.8 The Ombudsman can investigate: poor service; failure to provide a service the resident is entitled to receive; and administrative failures (including avoidable delay, not following proper procedures, rudeness or discourtesy, not explaining decisions and not answering the complaint fully and promptly). Where the cause for complaint occurred after 31 March 1996, the Ombudsman can also investigate the care and treatment provided by trained professionals such as doctors, nurses or dentists, pharmacists, opticians providing an NHS service locally.

7.10 A complainant who is not happy with the outcome of an investigation by the care manager or the local authority inspection unit can ask for the matter to go before a review panel at the local authority. The panel will consider the outcome of the local authority’s investigation of the complaint but only if the complaint is about a home run by that authority.

7.11 If the complainant is dissatisfied with the decision of the review panel, an approach can be made to the Local Government Ombudsman. That approach would have to be in regard to the conduct of the care manager, the inspection unit, or the purchasers of the care provided, but not the conduct of the home.

7.12 In homes owned by the local authority the inspection units have no powers of enforcement. The complaint would have to be progressed through the local authority procedures. In addition to the reasons mentioned in paragraph 7.11, residents of a home owned by the local authority may - in this case - also approach the Ombudsman to raise concerns about the conduct of the home.

7.13 Most of the residents funded by health authorities are in nursing homes. Those who are dissatisfied with an inspection unit’s ruling on a complaint they have made can make use of the NHS complaints procedure. This involves writing to the chief executive of the health authority (trust, or board) that is funding their placement, and the chief executive will appoint a convener, a non-executive director of the authority, to deal with the matter.

7.14 If they are still dissatisfied with the convener’s findings, complainants have the right to ask the convener to set up an independent review panel. Such a request might be refused, in which case the convener would so inform the complainant concerned. Where a review does take place, the convener will advise the complainant of the outcome.

7.15 Finally, if the complainant is still not happy with either the convener’s or the review panel’s decision the Health Service Ombudsman can be contacted. Normally, however, the Ombudsman will only become involved once the processes described have been completed.

7.16 Several owners of residential homes and nursing homes and one trade association commented that the current complaints procedures were satisfactory and needed little amendment. In their view, the most effective way of handling complaints was to ensure that the procedures were clear: they should be included in brochures and contracts, and displayed on notice boards in homes.

7.17 Nevertheless, of the 155 care-home brochures examined by the OFT (see Chapter 4), only 27 (17%) mentioned a complaints procedure. Furthermore, a lay inspector told the inquiry that he had rarely seen any display of such information within the homes he had visited. The low profile these procedures appear to have in relation to preadmission information material and in public areas of care homes is of concern.

7.18 It was suggested to the inquiry team that many homes worked on a ‘need to know’ basis, and did not fully advertise the complaints procedures. A lack of knowledge of these procedures was a situation commented on by several residents and relatives. It was further claimed that a large number of friends and relatives were unaware of their right to complain, or how to go about making a complaint, whether from inside or outside the home.

7.19 The OFT was told that, even when they had been made aware of the procedures, residents had been reluctant to use them for fear of alienating staff who dealt with them on a daily basis. The fear of victimisation or other unwelcome attention was a further underlying theme in the responses of many residents, relatives, and charities. Relatives told us that, if they made a complaint, the home viewed them as troublemakers. For residents themselves, expressing dissatisfaction could be rather more problematic. Those who provided written evidence to the inquiry cited five examples of residents having been asked to leave homes after they had made complaints, while another four residents believed that they had been victimised as a result of complaining.

7.20 Some care-home owners mentioned regular residents/relatives meetings as providing a good opportunity to raise specific problems. But one relative of a care-home resident said that when she tried to set up a relatives’ association she was thwarted by the home’s head office. The OFT’s analysis of 105 care-home complaints procedures (see paragraph 7.22) found just one reference to residents/relatives meetings.

7.23 Several organisations told the inquiry team that the existing procedures relating to the investigation of complaints in nursing homes were confusing. For example, it was often not easy to determine which path should be taken to pursue a particular complaint - through the inspection unit, the local authority contracting staff, or the local authority itself. It was claimed that, with little knowledge of the system, residents and their relatives were thwarted by the confusing network of possible routes available. The OFT, too, has found the issues less than easy to follow.

7.25 One charity maintained that many complaints took too long to resolve because of the various systems in use. It also said that some investigations were conducted without reference to the complainant, and that the findings were notified to the body or person against whom the complaint was made ahead of the complainant.

7.26 Three-quarters of those residents who responded to the survey said that they were very satisfied with the services and facilities of the care homes they were in. Nevertheless, 41% of those who responded to the survey considered that staff were too busy to sit down and talk. Another indicator is the fact that, at some time, 12% of those interviewed had felt worried about standards in the home or how things were done and would change something in the home if they could (if they had ‘had a magic wand’), or had felt dissatisfied or very dissatisfied about the arrangements for looking after their money.

7.27 The four most common attributes of their care homes which respondents liked were: kind and helpful staff; companionship; the care they received; and the friendly, pleasant atmosphere. The four most common concerns mentioned were: not enough experienced staff; deteriorating standards or maintenance; insufficient food; and not enough staff to look after residents or take them out.

7.28 Of those residents who had complaints or concerns, only 67% had told anyone about them. Where complaints had been made (69 in total), 40 had been made to staff. Twenty-nine (46%) of the complaints had been made to others, mostly (18) to a relative. Just two complaints had been made to an officer from the inspection unit, and one complaint had been put in writing. Only in a minority of cases (18%) had residents felt that their complaint had resulted in a ‘change for the better’.

7.29 The isolation faced by some older people in care homes is illustrated by the fact that a quarter of all the residents interviewed knew of no-one outside the home to whom they could complain if their concerns were not dealt with satisfactorily. For the 70% who did know someone outside the home to whom they could turn, relatives were seen as the main source of support. Social workers were named by just 3%.