Reviews, appeals and complaints

The care and support statutory guidance says ‘anyone who is dissatisfied with a decision made by the local authority would be able to make a complaint about that decision and have that complaint handled by the local authority. The local authority must make its own arrangements for dealing with complaints in accordance with the 2009 regulations’.

Councils may have internal review and appeal mechanisms that allow adult social care service users to challenge certain decisions about their care, entitlement to financial support or their contributions towards the cost of their care. Councils should have clear and accessible policies telling people about any decisions that are subject to a review or appeals process.

The Ombudsman would not normally expect complainants to go through a review process and a complaints procedure in succession. Where a council operates an internal review or appeal process in relation to adult social care, our view is this forms part of the adult social care complaints process. Therefore, councils should signpost the person to the Ombudsman once the review or appeal is concluded. The Ombudsman is not an appeal body but we can look at whether there was fault in the way a decision was made.

The only exception to this is in relation to reviews about financial assessments or charging issues. Paragraph 8.70 of the Care Act guidance says:

‘Where a local authority has established a special panel or fast track review processes to deal with financial assessment/charging issues, they should remind the person that they still have access to the statutory complaints procedure.’

In these cases, councils have discretion over whether to refer complainants to us following the conclusion of the review or appeal or accept a complaint under the regulations. The council should set out its approach in its policies and processes so complainants understand what to do if they are unhappy with the outcome of the process.

A model review and appeal process

We consider it good practice for any review or appeal process to follow the principles set out in this guide. Processes should:

• be well publicised and accessible;
• set clear timescales for requesting an appeal following a decision. We think one month from the date of the original decision is a reasonable timescale. However, councils must consider complaints within 12 months of the person becoming aware of the matter so may still decide to accept a complaint or appeal about the decision if an appeal is requested outside of the one-month deadline;
• enable individuals to be represented where appropriate;
• ensure individuals are able to voice their opinions and concerns through well designed processes;
• avoid distressing individuals by forcing them to repeat background information or views throughout the process;
• ensure any panel type hearings are carried out in the presence of all parties with equity of access and representation for the council and complainant;
• provide fair, transparent, robust outcomes for complainants;
• communicate the decision in a clear, accessible manner, that makes adjustments for any communication-related disabilities;
• use learning from reviews and appeal outcomes to inform service improvements; and
• signpost to the Ombudsman at the end of the process.