Service Model Policy and Guidance: Customer Care Guidance 4.0 Quality and Service Integrity (Q&SI) 1
Contents Role of the Customer Care team 5 Positive feedback 6 Complaint about our service, either an ongoing or completed case 6 Complaint about our decision, including about our methodology 8 Post Review Correspondence 11 Complaints about our service and the role of the Public Administration and Constitutional Affairs Committee (PACAC) 12 General Feedback on PHSO 12 Process and Timescales 13 ANNEX A Customer Care Quality Assurance process 15 4
Role of the Customer Care team 1. The role of the Customer Care team is to handle all feedback from those that use our service at any time throughout the customer journey. We are also responsible for handling any requests for a review 1 that a person may make after we have made a decision on a complaint. 2. Our decisions are final and can only be challenged by Judicial Review. However, we recognise that Judicial Review is a technical and expensive process, so in some circumstances the Corporate Casework Team can carry out a review of our decisions. There is no automatic right to a review. We will not normally consider complaints where a person simply says that they are unhappy with or disagree with what we have done. Instead we expect the complaint to satisfy the relevant review criteria. 3. We encourage those that use our service to contact the Customer Care team by telephone as we want to build a more personal relationship with them. However, if those providing feedback prefer to communicate another way, they can also contact us by email, online or in writing. Telling people that use our service about how to provide feedback 4. Those that use our service should be told of how they can provide feedback whenever they are notified of any decision we have made on their case. 5. 4. Below is an example of the wording we use in our decision letters to tell people about how they can contact the Customer Care Team: If you have any questions then please contact me using the details given at the top of this letter. Alternatively, you can contact the Customer Care Team if you have any feedback about our service of decisions we make during your time with us. Please call us on 0345 015 4033 (option 3) or by email at feedbackaboutus@ombudsman.org.uk. You can also submit feedback to the Customer Care Team through our website www.ombudsman.org.uk 6. Once contact is made with the Customer Care team they will consider the information provided to see what action they can take to try and assist. The contact will fall into one of the following categories: Positive feedback Complaint about our service, either on an ongoing or a completed case 1 A review request is where we are asked to look again at a decision because the individual is unhappy with it. 5
Complaint about our decision, including about our methodology Post-review correspondence General feedback about PHSO 7. The information below explains what to do with each of these types of contact. Positive feedback 8. Anyone in PHSO who receives feedback which gives a positive view of our service or decision should pass this feedback to the Customer Care team to be recorded and considered. Emails or notes of telephone calls should be forwarded to feedbackaboutus@ombudsman.org.uk. The Customer Care Team will add them to a relevant Meridio folder. Similarly hard copy positive feedback should be scanned and sent to the same e-mail address. The Customer Care Team will also receive and record positive feedback received directly to the team from those who have used our service. 9. The Customer Care Team may contact the person giving the positive feedback for more specific information about why using our service was a positive experience, to thank them for providing the feedback and to explain how we will use it. The Customer Care Team will then pass on the feedback as appropriate within PHSO to ensure learning can be obtained from these positive experiences. Complaint about our service, either an ongoing or completed case 10. A complaint about our service is where someone who has used our service expresses dissatisfaction about our contact and relationship with them. This covers such areas as delay, rudeness, not returning contact when asked etc. These complaints can relate to any aspect of our service and can relate to anyone involved in the case, not just the original case owner. In some cases, complaints will refer to our service but the feedback is essentially about our decision. The Customer Care Officer should identify whether that type of feedback should be treated as a complaint about our decision or about our service. If the outcome sought is ultimately a review or change to the decision, then the feedback is best suited to being looked at as a complaint about our decision. Service complaints on an ongoing case 11. If a complaint is raised about an ongoing case that is currently being worked on then a decision needs to be made about who is best placed to handle this, the Customer Care Team or the Line Manager of the case owner. The Customer Care Team should discuss and agree this with the case owner s Line Manager. Often, the Line Manager is best placed to address these 6
concerns immediately, if the complaint is about the way the person is handling the case, their attitude, rudeness or lack of updates. 12. If the person who brought the complaint asks for somebody else to deal with their case, then that must be directed to the Line Manager. Likewise, feedback given to the Customer Care Team that is not for the Team (for example, comments on a draft report) should be directed to the Line Manager for consideration. 13. If the Line Manager has attempted to resolve the concerns and the individual is still unhappy, then these concerns can be looked at by the Customer Care Team who will deal with this as a priority. We would expect to see that the Line Manager has spoken with the person complaining and tried to address their complaint. The Customer Care Team would then look at whether the Line Manager dealt with this reasonably. 14.. Customer Care will also deal with cases where the service complaint relates to a previous part of our process other than the one currently being worked on. For example, the case is now with an Investigator but the service complaint is about the service provided by a Customer Service Officer. 15. Customer Care will always handle complaints about any delay in allocating cases. Service complaints on a completed case 16. These types of cases will always be handled by the Customer Care team, rather than the Line Manager of the case owner. How the Customer Care Officer will look at the service complaint 17. Some service complaints can be resolved promptly and effectively at the initial point of contact. For example, where the individual complains about a delay in the allocation of the case and this is addressed by the priority allocation of the case. Or where a complaint is raised that the person has not had contact about a particular piece of correspondence and Customer Care arrange that contact. The Customer Care Officer should always look for the most effective and customer-focused way to resolve issues. If the person complaining is satisfied with the resolution proposed at that early point of contact, then the Customer Care Officer should record the service complaint as resolved at the initial point of contact. 18. If the complaint cannot be satisfactorily resolved at the initial point of contact, the Customer Care Officer should consider what information is likely to be needed to carry out an analysis of the complaint, how this information will be obtained, and by when. The Customer Care Officer 7
should ensure they have identified all the information needed to understand the complaint. If more evidence is needed later on, this should be requested. 19. The Customer Care Officer should complete an appropriate consideration of the complaint on the case management system. This analysis should: explain why the person is unhappy with the service we have provided, how they have been affected and what they want as a remedy; explain what evidence we have taken into account (we should usually speak to the staff member and to the person if necessary) and how we have considered their complaint; consider whether the Service Model has been adhered to and if not, what impact this had on the person bringing the complaint to us. explain what our proposed decision is, if we are recommending redress and how we are to explain this to the individual. Suggest any possible learning from the feedback, where appropriate. 20. Possible outcomes of a service complaint are explanations, apologies, service improvements and financial remedies. 21. The proposal should be signed off by the Customer Care Manager or Customer Care Team Senior Caseworker in line with the Customer Care quality assurances process (Annex A). 22. The Customer Care Officer will communicate the outcome to the complainant by telephone. We should ensure we have an accurate note on the case file detailing the telephone call. If the person using our service asks that the outcome be provided by other means then their preference should take precedence. 23. The Customer Care Team will ensure appropriate learning points are passed on to the relevant person/area. Complaint about our decision, including about our methodology 24. These are complaints about a decision we have reached usually following an assessment or investigation. This is usually the final decision that is given when the case is closed. However, it could sometimes be on an open case where we have decided not to investigate certain parts of the complaint, for example because they are out of remit or out of time. 25. A review will be considered where the person complaining can show that: Our decision was based on evidence that contained inaccurate facts, and which might change our decision. 8
They have new and relevant information that was not previously available and which might change our decision. We overlooked or misunderstood parts of the complaint or did not take account of relevant information, which could change our decision. 26. Occasionally we may also consider that a review would be beneficial to confirming our original decision on specific complaints, including those which are high risk or high profile. 27. We may also consider a review in some circumstances, if we have a question over the methodology we used, such as whether we obtained appropriate clinical advice or followed our service model. In particular, this may apply for cases where we decided that the complaint is out of time or out of remit. The Customer Care Officer will need to consider whether we considered all appropriate information and took appropriate advice to come to that decision. Initial contact about our decision 28. Many people who have used our service are not aware of our review criteria or process when they first give feedback to Customer Care. Therefore, from the initial feedback provided by the individual about our decision, the Customer Care Officer should decide if there is enough information at this stage to show the review criteria is met. If it is met, the Customer Care Officer should prepare a proposal and forward this to the Corporate Casework Team to consider for review. The proposal should clearly explain why the Customer Care Officer considers the review criteria (at paragraph 25) have been met. 29. If the Corporate Casework Team agrees a review is appropriate, then the Customer Care Officer should communicate this to the individual and explain what that process will entail. The Customer Care Officer should record that the case has been accepted for review and the Corporate Casework Team will complete the review and communicate the decision. 30. If the Corporate Casework Team does not agree a review is appropriate at this stage, the Customer Care Officer should contact the individual to clearly explain this and to set out what we need to see to consider a review. 31. In cases where there is no indication that the review criteria is met or it is unclear, the Customer Care Officer should proactively contact the person complaining to explain our review process and review criteria, usually by phone. The Customer Care Officer should establish if the person has more information to give us to explain why they feel they meet the review criteria. If, the individual needs more time to make a fully informed review request, then the Customer Care Officer should explain that the Customer 9
Care Team will wait to hear from them with their full review request before proceeding. The Customer Care Officer should record that this review request is not ready for us to consider at this stage. 32. If, at that stage the individual either gives more information or feels they have given all the feedback they wish to about our decision, then the Customer Care Officer should proceed to complete a consideration of the feedback. In these cases, the Customer Care Officer will decide if a review proposal is needed, depending on whether the review criteria has been met. If one is not needed, the Customer Care Officer should accurately detail on the case management system why they are declining a review. 33. In cases where a review proposal is required then a Review Proposal Sheet should be completed. The Customer Care proposal should include, where appropriate: Any relevant background before the contact with the Customer Care Team, briefly setting out what the substance of the complaint was and our assessment/investigation decision An explanation of why the individual is unhappy with the decision and the reasons they have given about why they think our decision might be wrong; An analysis of the complaint against the relevant review criteria (see paragraph 25). A consideration of whether the service model was followed and any impact of this: and Confirmation of what our proposed decision is and how we will communicate this. 34. In some case, the Customer Care Officer may need to consider the methodology we used - how we reached the decision, rather than the actual decision itself. For example, someone may complain that we did not consider the time taken by the organisation to investigate their complaint in a case we decline as being outside the time limit, or where there is a complaint that we did not obtain appropriate clinical advice. This consideration should also be clearly set out on the case management system. 35. If the Customer Care Officer finds that the review criteria is met, then they should follow the process set out above to pass this proposal to the Corporate Casework Team. A formal risk assessment should be carried out if we are proposing to review the case. 36. If the Customer Care Officer finds the review criteria are not met, they should consider whether a proposal needs to be considered by the Customer Care Manager or Customer Care Team Senior Caseworker. 10
37. The Customer Care Officer should explain to the person who has complained the outcome of their consideration and why we will not be completing a review. We should ensure we have an accurate note on the case file detailing the telephone call. If the person using our service asks that the outcome be provided by other means then their preference should take precedence. This should be completed within the relevant service standards. 38. In circumstances where the person who has complained has asked us to wait for their full submission and we then receive the relevant information, the Customer Care Officer who originally dealt with the case should be assigned the case. They should follow the process as set out at paragraph 25, recording this on the case management system as receipt of full submission of feedback about our decision. 39. There may be occasions when the Customer Care Team can clearly identify from the work we do that our decision was wrong, particularly with cases closed as premature, out of remit or out of time. In these cases, the Customer Care Officer should consider if a reassessment rather than a review would be more customer-focused. Follow up contact regarding decision 40. After we have explained why we will not be completing a review, the Customer Care Team may receive follow up contact about this decision. The Customer Care Officer should actively consider whether new information has been provided which might meet the review criteria or whether this is a repeat of earlier feedback. 41. The Customer Care Officer should also be customer-focused and decide whether we can give any further explanation about our decision. If there is no new information, then the Customer Care Officer should explain why there is nothing more we can add without evidence that meets our review criteria. Responses to follow up contact should be given within 40 working days of receipt. Post Review Correspondence 42. Any correspondence that is received after a review has been completed, should be read by the Customer Care Team and consideration given to whether there is more we can add or explain to our decision. If the correspondence suggests any flaws in our review, then the Customer Care Team will consider how best to address this. If the correspondence adds nothing new to the case then a brief letter should be sent explaining that we have reached the end of our internal complaints process and stating that we won t be taking any further action. A clear record on the case 11
management system should be added showing what consideration has been given to any post review correspondence. Complaints about our service and the role of the Public Administration and Constitutional Affairs Committee (PACAC) 43. It is often the case that even after they have been in contact with Customer Care, some of our complainants are still dissatisfied and want to complain further. Complainants can challenge our decisions through a Judicial Review. However, there is no organisation that can specifically look into an individual complaint about the service we provide. 44. PACAC monitors complaints about the Ombudsman as a way of scrutinising the work of the office and identifying systemic problems, but they will not consider individual cases. Complainants may submit details of their dissatisfaction to PACAC to inform their general scrutiny, but should not expect them to look into their complaint. If a complainant still wants to contact PACAC after you have clarified their role, they should contact PACAC directly: Public Administration and Constitutional Affairs Committee House of Commons London SW1A 0AA Telephone: 020 7219 3268 Email: pacac@parliament.uk 45. Complainants should not be directed to contact Bernard Jenkin MP (the PACAC chair) at his constituency office. General Feedback on PHSO 46. Examples of this may include general feedback about our website or about one of our published reports. These may not always be from someone who has used our service. The Customer Care Officer or Business Support Officer should discuss these with the Head of Customer Care or Customer Care Team Manager to decide who is best placed to respond. Risk Assessment 47. Staff should be mindful of casework risk throughout their contact with a person providing feedback. 12
48. Service Model general guidance says that a risk assessment should be carried out When we decide to do further work following a complaint about our service or decision. 49. As such, when we make a decision not to uphold a service complaint or where we propose to review a complaint, a formal risk assessment should be carried out by the Customer Care Officer and recorded on the case management system. 50. Assessing risk in casework. For more detail on the risk categories and how to carry out a formal risk assessment please refer to Service Model general guidance. Feedback not for Customer Care Team 51. In cases where contact is received which is not for the Customer Care Team (new enquiries or comments on draft reports), the Customer Care Team will ensure that this feedback is passed on to the appropriate staff member promptly and efficiently. Process and Timescales 52. All electronic feedback will be acknowledged upon receipt, unless it has been forwarded by the case owner and they have already sent an acknowledgement saying it is being passed to the Customer Care Team. Feedback received by post will have been acknowledged by the post room. The Customer Care Team will however send a further acknowledgement if it will take more than two weeks for the feedback to be allocated to a Customer Care Officer. In those cases, the acknowledgement Customer Care sends will give details of likely timeframes for allocation so the person providing the feedback is kept fully updated. 53. Upon allocation of feedback the Customer Care Team have 5 working days to make a decision whether to propose to review the case, and to send that to the Corporate Casework Team. The Corporate Casework Team will let the Customer Care Team know their decision within 10 working days, allowing the Customer Care Team a further 5 working days to communicate this to the service user. Complaints about our service and decisions (excluding follow-up correspondence and post-review correspondence) that do not need to go to the Corporate Casework Team should be completed within the relevant service standards, in most cases within 20 working days of allocation. Where it is not going to be possible to complete this work within 20 working days, the Customer Care Officer should ensure the person providing the feedback is kept properly updated. 13
54. All cases should be logged on the Customer Care Officer s individual case tracker and this should be kept regularly updated as the case progresses. The outcome and our decision should also be captured here. 14
ANNEX A Customer Care Quality Assurance process Quality Assurance process on Customer Care Team When we are satisfied a Customer Care Officer is delivering an appropriate quality standard, they do not need to submit a proposal to the Customer Care Manager or Customer Care Team Senior Caseworker for quality assurance in the following situations: When proposing we accept a case for review. These will go directly to the Corporate Casework Team for approval and this will avoid duplication of the quality assurance process. For complaints about our decisions where the person requesting the review has given us no information that might fit any of the three review criteria e.g. simple disagreement with our decision, repetition of the original complaint or general feedback on the decision. Any review request where the proposed outcome is for a new case to be opened by Customer Services Intake and possibly for a reassessment of the case. Any proposed action on post-review/follow up correspondence. Proposals needing quality assurance by Customer Care Manager or Customer Care Team Senior Caseworker The following will require a proposal to be put to the Customer Care Manager or Senior caseworker for quality assurance: All proposals for service complaints dealt with on Customer Care Team unless the Customer Care Officer has discussed these with the Customer Care Manager and/or had prior agreement that a proposal is not necessary. The latter could be in cases where we have arranged for a case to be prioritised for allocation or the customer is happy with the proposed resolution we have given by phone and does not require any formal response. If the customer is completely happy with what has been discussed by phone and no further contact is required, these do not need a proposal and the Customer Care Officer can record the outcome and any remedial action on CMS and their tracker. Any review requests we are declining where information the person requesting the review has given might fit the review criteria but we disagree or do not consider this might change our decision, for example, where there is a claim we have overlooked information but the Customer 15
Care Officer does not agree this is the case or where there is new evidence but this could not change our decision. Any requests requiring a written response by MPs. Written decisions (sent by post or email) When the Customer Care Officer is considered sufficiently experienced to do so, Customer Care Officers can peer check: Any non-complex review decline letters. Any responses to post-review and follow up correspondence. Any letters providing general advice on our Customer Care Team processes or covering letters. Letters that should be quality assured by Customer Care Manager or Senior Caseworker All service complaint outcome letters (unless agreed by Customer Care Manager that this can be peer checked) All review decline letters where a detailed explanation of why the review criteria has not been met is required Any letters to MPs 16