Complaints: do they make a difference?

Written evidence submitted by Which? (COM 12)

1. Introduction

1.1 Which? is an independent, not-for-profit consumer organisation with around one million members and is the largest consumer organisation in Europe. Which? is independent of Government and industry, and is funded through the sale of Which? consumer magazines, online services and books. Which?’s mission is to make individuals as powerful as the organisations they have to deal with in their daily lives by empowering them to make informed decisions and by campaigning to make people’s lives fairer, simpler and safer. We work across a wide range of consumer markets including energy, personal finance and public services.

1.2 Which? research indicates that there are not only multiple barriers to people wanting to complain or give feedback about public services, but that public service providers and independent bodies must do more to facilitate feedback and ensure that more information is available about how to complain.

1.3 One of the main reasons people give for not complaining is the fact that they do not think anything will change as a result. All public service providers and regulators must provide greater clarity about how feedback will be passed on and registered at a regulatory level.

1.4 Further barriers exist in health and social care due to the complex nature of the ‘complaints architecture’. Given the recent changes in primary care, the Government must monitor how local Healthwatch are proactively seeking feedback and relaying intelligence to national Healthwatch to help identify systemic problems. Local authorities should also ensure that independent complaints advocacy is available to those with complaints about social care services as well as health.

1.5 The Government should undertake work to look at how the intelligence provided by feedback sites, such as NHS Choices and Patient Opinion, can be pooled for easy review by the public and systematic review by commissioners and regulators.

1.6 The Government should ensure that lessons are learnt and applied from best practice in complaint handling in other industries, particularly financial services, as well as recent developments in the private sector to have greater consistency in the operation of Alternative Dispute Resolution (ADR) mechanisms across different sectors.

2. What objectives should Ministers adopt when considering how complaints about Government and about public services provided by Government are handled?

2.1 A complaints mechanism in any market serves a number of purposes; it should create a dialogue between an organisation and its customers that allows individuals to give feedback when they are dissatisfied with a product or service; resolve problems and provide appropriate redress; provide feedback to the provider to make improvements; and provide evidence at a systemic level for commissioners, regulators and government to take action.

2.2 These objectives apply to public services as much as private, consumer markets. Indeed having effective mechanisms to promote feedback is more important in public services given the ‘relational’ rather than ‘transactional’ relationship that consumers have with providers. Consumers may be less able or willing to switch provider than in a consumer market due to a personal relationship, for example with a GP, the upheaval involved in switching provider, for example a school or care home, or due to a lack of market choice. This makes feedback crucial in ensuring that public services are user-focused.

2.3 These objectives are equally important in public services delivered by private and voluntary organisations. Furthermore, where services are delivered at a local level or by a range of providers, rather than centrally or by a single provider, it is important that a consistent approach to complaints is taken. All consumers should have the same opportunity to give feedback and to access redress regardless of who is delivering the public service they are using.

2.4 If public service complaints systems are to be effective then steps must be taken to address the dissatisfaction that currently exists when complaints are resolved locally; the need for advocacy and effective mechanisms to encourage feedback; and to ensure consistent complaint collection and sharing of information between public sector bodies at a local and higher level are necessary to ensure that complaints play a role in driving improvements to services.

3. How easy is it to make a complaint about a Government department or agency, and how could this be improved?

3.1 Which? research suggests that fewer people complain about public services than private companies. Just 65% of those who had cause to complain about an NHS service in the last year did so, while 69% complained about another government service, such as the DVLA, the passport service or HMRC. By contrast, 90% of those with cause to complain about a high street retailer did so, 89% complained about a bank or tradesperson and 83% complained about an energy supplier. [1]

3.2 Of those who complain, perceived resolution of complaints at a local level is lower in public services. Almost six in ten people who complained to an NHS or Government service felt their complaint was not resolved at the initial stage in comparison to 42% for energy suppliers and banks and 30% for high street retailers.

3.3 Which? research indicates that there are multiple barriers to people wanting to complain or give feedback in public services, both in terms of the perceptions of users and the means by which providers publicise feedback and complaints mechanisms. Recent research found that the main reasons people give for not complaining to GPs are because they do not think anything will change (51%) or because they fear worse treatment as a result (27%). This research also identified smaller but significant barriers with some people stating that they did not know who to complain to (11%), did not know how to complain (13%) or felt that complaining was too difficult (11%). [2]

3.4 Qualitative research by Which? with users of social care services has found similar issues, in particular people fear that their complaints will result in worse treatment or defensive behaviour by care staff. [3]

3.5 Public service providers and independent bodies must do more to facilitate feedback from users and more information should be available on how to complain. A recent Which? survey of 1,001 GPs [4] found that only 53% publicised complaints procedures using leaflets or on their website. Many GP practices could do more to solicit feedback. While 66% have a suggestions box and 61% run their own survey, only 58% have patient involvement groups, which should exist at every practice.

3.6 Access to advocacy is also an important way to encourage feedback and ensure that everyone who has cause to complain has the opportunity to do so, particularly vulnerable groups. Under the new health system, local authorities have a duty to provide independent complaints advocacy services for health, which in the majority of cases will be commissioned from local Healthwatch bodies. If local Healthwatch bodies are to fulfil their mission as consumer champions effectively, they should proactively seek feedback from service users and ensure that information and advice on how to complain is made available to those who need it. Local authorities should also ensure that this service is available to people with complaints about social care.

4. Do complaints systems succeed in making public services and Government departments more accountable and responsive to service users?

4.1 As the table [5] below demonstrates, the degree to which people feel that public services are responsive to their views varies, with people feeling that this is least the case in secondary health care and social care.

To what extent do you feel that your views are taken into account when using the following services?

Taken into account

Not taken into account

GP

41%

21%

Dentist

41%

21%

University

40%

17%

Childcare

39%

13%

Schools

35%

20%

Hospital

29%

29%

Social care

26%

26%

To what extent do you feel that you are able to influence the way you use each of the following services?

Able to influence

Not able to influence

Dentist

33%

33%

Childcare

33%

23%

GP

30%

35%

University

30%

28%

Schools

27%

30%

Hospital

22%

45%

Social care

24%

36%

4.2 This demonstrates that public service providers need to have processes in place that

allow users to understand the steps they have taken following a complaint , including how feedback is influencing providers’ decisions and holding them to account . This requires clear m echanisms to be put in place that ensure that these actions are systematically fed back to their users, such as regularly publish ing complaint handling reports.

5. How effectively do Government departments and public service providers use

complaints to improve the service provided?

5.1 Our recent survey of GPs reveals a great variation in the use of feedback from consumers. Feedback is regularly reviewed by the management team at 53% of practices, 50% review national patient satisfaction survey results and only 38% compare them in relation to local practices. The lack of visibility of complaints procedures and action taken as a result of complaints and feedback helps to reinforce the impression that nothing will happen as a result of complaining.

5.2 A growing source of insight into complaints in some public services are online review websites. Websites such as NHS Choices and Patient Opinion, provide a useful channel for service users and can increase the transparency of the complaints process and outcomes. However, the increased use of these sites presents a risk that they will provide an increasingly disparate view of complaints and feedback, with feedback being left in a variety of different places and the complete picture never being captured. As a result, work should be undertaken to look at how this intelligence can be pooled for easy review by the public, as well as systematic review by commissioners and regulators. It is also important that these services are not viewed as a replacement for less public, offline channels for complaints.

5.3 The Parliamentary and Health Service Ombudsman (PHSO) has suggested that the current approach to NHS complaints does not provide a useful source of intelligence to commissioners and regulators to look at systemic issues of performance. [6] While NHS providers are required to report on their complaint handling performance, the PHSO has indicated that there is a lack of consistency in how this is done. The PHSO has pointed to the fact that there are no clear requirements about how summaries are reported and presented or to publish reports online. As a result, the PHSO stated that it is difficult for NHS managers to identify learning from across the NHS and for commissioners and regulators to compare the complaint handling performance of one NHS body with another.

5.4 Given the number of bodies responsible for monitoring quality in social care, similar concerns could be raised about whether information is being effectively shared. For example, if a user has a complaint about their care home or home care agency, there are currently up to five different bodies that they could be expected to report their complaint to - their provider, the local authority, the Local Government Ombudsman, the CQC or Local Healthwatch. Greater clarity is therefore needed about the appropriate route to complain. Without this consumers are unlikely to have confidence that their feedback will be passed on and registered at a regulatory level.

5.5 Lessons should be learnt from those industries where the sector regulator has assumed responsibility for monitoring the complaints systems of individual providers. In financial services, the Financial Conduct Authority (FCA) oversees a three stage process that sets out the way firms must handle complaints, including the time they must take to respond to various aspects, the role of the Financial Ombudsman Service (FOS) and what consumers can do if they are not satisfied with the decision of the FOS. The FCA requires financial services companies to record and publish complaints in a standardised way to enable comparisons across the industry. These figures have to be qualified, as those firms with a larger customer base will generally show a higher level of complaints but this is not necessarily reflective of the quality of their service. The same considerations should apply to public sector organisations, for example individual hospitals.

5.6 Lessons should also be learnt from recent developments in the private sector around greater consistency in the operation of Alternative Dispute Resolution (ADR) mechanisms across different sectors. The Department of Business, Innovation and Skills (BIS) has recently announced that they will establish a Competent Authority to fulfil this role as it implements the requirements of the European ADR Directive. This Directive also makes reference to the importance of standardised methods of recording complaints by different ADR bodies. [7] If complaints in the public sector are to allow meaningful comparisons in performance across providers or agencies, then greater consistency is needed in the way that complaints are recorded and the level of detail that they provide.

6. How aware are service users of the various ombudsmen (such as the Local Government Ombudsman, Financial Ombudsman and the Housing Ombudsman)?

6.1 Our research on complaints handling in the energy sector suggests that while awareness of the Energy Ombudsman (EO) is high (70%), a small number of people escalate their complaint to the Ombudsman (6%) [8] . It is possible that the high level of awareness for the EO is reflective of ombudsmen in general, rather than of the EO in particular.

6.2 Previous Which? research suggests that that the most commonly used ombudsmen were the Financial Services Ombudsman (3%), the Energy Ombudsman (1%) and the Local Government Ombudsman (1%). One fifth of consumers (21%) said they could not remember whether they had escalated a complaint to an Ombudsman [9] . Recent research in 2013, suggests that the majority of people do not escalate their complaints beyond the service provider. The top three reasons for this were not thinking it would do any good (47%), the complaint not being serious enough (28%) and not knowing who to take their complaint to (22%). This indicates that while lack of awareness of Ombudsmen is a barrier for some, it is not the overriding reason why people fail to take complaints further [10] .

May 2013


[1] Populus,  on   behalf   of  Which?, interviewed a random sample  of  2,101 UK adults aged 18+ online between 3rd and 6th May 2013 .

[2] YouGov,  on   behalf   of  Which?, interviewed a random sample  of  5,257 UK adults aged 18+ online between 9th and 13th July 2012.

[3] In January 2012, 30 older people or their carers kept diaries of their experiences of home care for Which?. The exercise was repeated in May and June 2012 with 45 family carers. Similar issues surfaced in a Which? online forum with 50 Which? members with experience of arranging care for themselves or for a relative in the last two years, conducted in April 2013.

[4] Medeconnect , on behalf of Which?, interviewed a representative sample of 1001 GPs across the UK online between 22 nd and 31 st August 2012 . Data weighted to be representative of all GPs in the UK.

[5] Populus,  on   behalf   of  Which?, interviewed a random sample  of  2,078 UK adults aged 18+ online between 15th and 17th March 2013.  

[5]

[6] ‘Listening and Learning: the Ombudsman’s review of complaint handling by the NHS in England 2009-10’

[7] European Commission Recommendation, 12 May 2010 , on the use of a harmonised methodology for classifying and reporting consumer complaints and enquiries .

[8] Which? survey, November 2011. T otal sample of 8271, with 775 interviews with Which? Connect members.

[9] A representative sample of c.2,000 adults aged 16+ were interviewed in home in approximately 143 locations throughout the UK via the TNS Face-to-face Omnibus, September 2011.

[10] Populus, on behalf of Which?, interviewed a random sample of 2,101 UK adults aged 18+ online between 3rd and 6th May 2013

Prepared 25th June 2013