This Event Toolkit provides a structured process for recording, managing, and resolving complaints across the organisation. It supports oversight, accountability, and compliance with complaints handling procedures.
Legislative Requirements
Care Act 2014
Care providers must have an effective and accessible system for receiving, handling, and responding to complaints from residents, their representatives, or other stakeholders. All complaints must be thoroughly investigated, and proportionate action taken to address them. If a complaint is not resolved satisfactorily, there must be the opportunity for further escalation. Complaints involving safeguarding or abuse must be reported to local authority safeguarding teams. Organisations must maintain records of all complaints and responses, and be able to provide complaint summaries to CQC/CI/CIW within 28 days of request.
Health and Social Care Act 2008
Mandates safe and effective complaint handling.
Mental Capacity Act (2005)
Individuals have the right to complain about their care or the care of a loved one. Service users are encouraged to raise concerns directly with the health/care provider.
Equality Act 2010
Ensures complaints processes are accessible to all.
Data Protection Act 2018 (GDPR)
Protects confidentiality during complaints.
Regulatory Guidance
CQC
Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ensures that people receiving care have the right to complain and that providers must respond appropriately. Providers must have a clear, effective, and accessible system for identifying, receiving, recording, handling, and responding to complaints. All complaints must be investigated, and actions taken to address them. Requests to see complaint summaries by CQC must be sent within 28 days.
Care Inspectorate (Scotland)
Registered adult social care services in Scotland must follow a complaints framework based on principles of accessibility, fairness, and responsiveness. Complaints procedures should be easy to understand and accessible to all service users. Complaints must be handled promptly, respectfully, and thoroughly. Services are expected to learn from complaints and use them to improve care quality.
Care Inspectorate (Wales)
Providers must acknowledge complaints promptly and explain the investigation process. Complaints procedures must be easy to understand and available/accessible in multiple formats. A designated person (e.g., Registered Manager) should oversee complaint handling and be accountable. Complaints should be used to identify areas for service improvement through learning and development.
CQC Key Questions
Responsive: Concerns and complaints are listened to and acted upon. There is a clear, accessible complaints process, and complaints are used to improve care. People are supported to make complaints without fear of reprisal. This ensures that care providers have a transparent and effective complaints procedure. Organisations must investigate complaints thoroughly and fairly and learn from complaints to improve service delivery.
CI Health and Social Care Standards
Providers must have a clear complaints process. The CI scrutinizes how feedback and complaints are used to improve services. Following the Scottish Public Services Ombudsman’s guidance, it emphasizes accessibility, support, and fairness.
CIW National Minimum Standards
Regulation 34: Complaints require providers to have robust complaints procedures and demonstrate how they use feedback to improve care.
Statutory Guidance
- Duty of Candour: Encourage a culture of openness and continuous improvement.
- Safeguarding: Staff should be trained to recognise and escalate concerns appropriately.
- Listening, responding, and learning from feedback: Emphasize the importance of these actions.
HealthCare Guidance
Department Health Social Care
Service users are advised to complain directly to the health/care provider. Service users must follow the health/care provider's complaints policy. If unresolved, escalate to the Local Government and Social Care Ombudsman. Poor care can also be reported to CQC.
Scottish Government for Health & Social Care Directorate
Individuals have a clear right to raise complaints with the care provider, ensuring concerns are addressed fairly and promptly. If unresolved, complaints can be taken to the Scottish Public Services Ombudsman (SPSO) or Care Inspectorate (CI).
H&S Service Group (Wales)
Organisations are legally required to have a clear complaints procedure. Service users must raise concerns directly with the health/care provider, and if unresolved, they can go to the Local Government and Social Care Ombudsman. Poor care can also be reported to CIW.
NICE England/Wales
Key principles encouraged by NICE include:
- Transparency: Patients should be informed about their rights to make a complaint.
- Empowerment: Patients should be supported to raise concerns and complaints when care falls short.
- Improvement: Complaints should be used to identify barriers and improve service delivery.
Scottish Intercollegiate Guidelines
The guidelines refer to the Scottish NHS Model Complaints Handling Procedure, designed to be person-centred, streamlined, and focused on learning and improvement. Key principles include:
- Accessibility: Complaints can be made in person, by phone, email, or writing.
- Transparency: Clear communication and updates throughout the process.
- Learning: Complaints are used to identify areas for improvement.
- Accountability: Senior management is actively involved in oversight.
Evidence-Based Practice
The Local Government and Social Care Ombudsman (LGSCO) Good Practice Guide emphasizes accessible, proportionate, and timely complaint resolution. It encourages councils to:
- Promote early resolution and avoid unnecessary escalation.
- Ensure clear communication and transparency.
- Use complaints to drive service improvement.
Under the Local Authority Social Services and NHS Complaints (England) Regulations 2009, complaints must:
- Acknowledge complaints promptly—ideally within 3 working days.
- Provide a full response within a reasonable timeframe, often within 20 working days for straightforward cases.
For more complex complaints, providers should:
- Inform the complainant of any delays.
- Provide regular updates.
- Aim to resolve the issue within 3 months, unless exceptional circumstances apply.
Best Practice Principles
- Accessibility: Complaints should be easy to make, in multiple formats.
- Transparency: Clear communication about process and outcomes.
- Timeliness: Prompt responses, with realistic timeframes.
- Learning culture: Complaints should be used to improve care quality and safety.
- Fairness: Impartial investigations and respect for complainants.
Toolkit Statistics
Rather than counting complaints, the CQC integrates them into its judgment of whether a service is “Outstanding,” “Good,” “Requires Improvement,” or “Inadequate.” So poor complaint handling can directly impact a provider’s rating.
Local Government and Social Care Ombudsman’s Annual Review for 2023–24:
- Total complaints received: 2,982 about adult social care.
- Uphold rate: A striking 80% of complaints investigated in detail were upheld.
Value Proposition Ideas
- Toolkit meets all statutory, regulatory, legislation, and best practice.
- Captures Senior Manager sign-off of responses before being sent to complainant.
- Workflow timescales can be matched to each organisation's policy.
- Includes Ombudsman signposting.
- External forms meet the required accessible information standards – WCAG AA.
References
- Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - CQC
- CQC Key Lines of Enquiry - KLOEs
- CI Health and Social Care Standards
- CIW National Minimum Standards
- Complaint Handling Code by the Local Government and Social Care Ombudsman
- Local Government and Social Care Ombudsman (LGSCO) Good Practice Guide
- Local Authority Model Complaints Handling Procedure (MCHP) by SPSO
- Social Services Complaints Procedure (Wales) Regulations 2014
- Statutory Guidance - Wales (2014)
- Care Act 2014
- Health and Social Care Act 2008
- Mental Capacity Act 2005
- Equality Act 2010
- Data Protection Act 2018 (GDPR)
- Department of Health and Social Care (DHSC)
- Scottish Government Health and Social Care Directorate
- Health and Social Service Group – Wales
- NICE guidelines (England/Wales)
- Scottish intercollegiate guidelines Network (SIGN)
- Local Authority Social Services and NHS Complaints (England) Regulations 2009
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