Agenda item

Following an approach to the Carers Federation (which delivered the North East NHS Independent Complaints Advocacy (ICA) service in Stockton-on-Tees) earlier in 2025, a presentation was given to the Committee outlining the current local ICA offer and the themes that were emerging in relation to complaints about health and care provision.  Introduced by the Operations Manager from the Carers Federation, content included the following:

·       Stockton contract: The NHS ICA service was a statutory requirement commissioned by the Local Authority, and provided free, confidential and independent advocacy support to people wishing to raise a complaint about their NHS-funded treatment or care.  The current contract began on 1 October 2024, with the offer available to all residents in the Stockton-on-Tees postcode area, regardless of where NHS-funded care was delivered.  The service had been awarded the industry standard Quality Performance mark, and all advocates held the national independent complaints advocacy qualification (City and Guilds).

·       Our service: The staff team consisted of an Operations Manager, a Senior Advocate, and the advocates themselves (including a Deaf Advocate (British Sign Language (BSL)-supported)).  The administrative base was in Gateshead, and in addition to the freephone helpline, website, email address and text number, there was access to interpreters and a signposting resource to independent medical advice.

·       How we can help: The service offered a wide range of assistance – this included signposting, listening and understanding problems, explaining outcomes / options / time-limits, identifying where a complaint should go, help with letter-writing, facilitating communication (e.g. interpreting), empowering individuals (so they communicated how they want to, not how providers wanted them to), attending meetings, providing information, following-up with the NHS, and liaison with the Parliamentary and Health Service Ombudsman (PHSO).  The service also dealt with healthcare-related prison complaints.

In contrast, the service did not advise clients what to do, nor deal with private healthcare or with clinical negligence claims.  It also did not investigate cases, nor, importantly, take sides.

·       Working in partnership: Anonymous information was provided to Healthwatch, and the service liaised with hospital complaints teams / Practice Managers (which it had good relationships with) to explain what clients wanted from the complaints process.  It also represented patient voices at the local NHS Trust ‘Experience of Care Committee’, signposted clients to other services, and promoted itself through the voluntary sector (e.g. Wellbeing Hub) and GPs.

·       The process: Referrals could be made by phone / email / writing (or even WhatsApp video) either directly by the client or via an organisation.  A self-help information pack was provided and first contact with an advocate would be within five working days.  Once consent was obtained, a complaint letter would be collated, a response received, and a local resolution meeting (face-to-face or virtual) may follow (if necessary, there was also an option to liaise with the PHSO).  The service had no waiting lists.

·       Who we support: Anybody who had a complaint about NHS treatment or care.  It was acknowledged that some people may need more support (e.g. those with mental health problems, who did not speak English, who had suffered a bereavement, carers, those with a learning disability, or deaf clients).

·       Complaints standards framework: The PHSO had developed over the last 24 months, and the North East NHS ICA was a member of the national working group and had co-authored advocacy guidance.  The framework was about making the NHS complaints system more user-friendly for both the NHS and anyone wishing to raise a concern.

·       Year 1 performance: A table illustrating data on enquiries, new cases, closed cases, re-opened cases, active cases, and service hours was provided for each quarter across the first year of the current contract.  The total numbers for the year-end were considered healthy for a new contract.

·       Usage and access: For new cases across the Borough, 78% identified as female, 17% were from other ethnicities, 58% were below 55 years-old, 20% were over 66 years-old, 63% had a declared disability, and 57% were in the ‘unemployed / retired’ category.  The service was mostly accessed via telephone or email (75%), with the remaining 25% via an external referral from a professional.

·       Complaints referrals: In terms of who signposted / referred residents for advocacy support, 42% came from the NHS, 35% from the statutory / voluntary sector (including Healthwatch), 13% from current / previous users (or word-of-mouth), and 10% via the internet / media.

·       Themes and locations: The NHS services that the Borough’s residents complained against were the North Tees and Hartlepool NHS Foundation Trust (50%), out-of-area provision (the majority being South Tees Hospitals NHS Foundation Trust) (23%), general practices (11 out of 21 active practices) (22%), and the mental health trust (5%).

30 themes were recorded in the first year of the contract, with the top 10 listed within the presentation.  The top two (multiple aspects of clinical treatment, and attitude of staff) accounted for 37% of all complaint enquiries.

·       Outcomes: Regarding complaint outcomes, cases usually followed the NHS complaints process which involved an explanation, apology, service improvements, and possible redress.  7% were re-opened for further explanation, 5% involved satisfactory local resolution meetings, 28% had satisfactory apologies and explanations in writing provided, and 10% saw the PHSO rulings not upheld as all local work was deemed sufficient.  The remaining 50% of cases covered clients who decided not to progress through the whole process as they received verbal assurances / discussions with the health provider or re-considered their position after advocacy support for the best course of action (i.e. legal route).

Thanking the Operations Manager for his informative presentation, the Committee asked whether the 75% figure for those accessing the service via telephone and email could be broken down into a percentage for each as there was ongoing debate around how comfortable / able some residents were in using digital means of engagement with providers.  Members heard that families often supported their relatives in using digital platforms to make contact with required services.

AGREED that the Stockton-on-Tees Independent Complaints Advocacy information be noted.