Volunteer Escalation

Escalation Policy – Healthwatch England Escalation Guidance.   This guidance provides information,on how to do four things:  
  1. Collating people’s views and experiences,of care services from local Healthwatch.  
  2. Highlighting health and care issues,for consideration by Healthwatch England.  
  3. Deal with an immediate safeguarding concern.  
  4. Deal with a quality and safety issue,relating to service providers.
Purpose of this document.   Healthwatch England and the Care Quality Commission (CQC) understand the importance of acting appropriately,on intelligence and service users’ feedback,to ensure that individuals are not subjected,to poor quality health and care services. This document sets out how the Healthwatch network,is expected to work together with the CQC,to ensure that we are able to develop a comprehensive picture of the state,of care. It aims to ensure that we do not miss opportunities,to identify poor care, or shed light on failings affecting people,using health and social care services.   This guidance assumes,that each local Healthwatch will be building,an effective relationship with their local CQC manager. This will enable the local Healthwatch,to routinely share appropriate feedback,and for the CQC to inform the local Healthwatch,about its inspection findings.   The CQC will provide information to local Healthwatch,about working with local inspection teams. Healthwatch England and the CQC,would encourage local Healthwatch,to share relevant feedback they have received from the public,with local providers and commissioners of services. This should help to resolve any concerns,as quickly as possible, reducing the risk of these concerns,escalating into significant problems and leading to improved services.   Healthwatch England will review this policy on a regular basis.   Sharing people’s views and experiences,of health and social care with Healthwatch England.   Healthwatch England would like to know,about people’s views and experiences of health and social care. This intelligence (e.g. individual comments and feedback, local Healthwatch surveys and Enter & View reports, etc.) should be captured by local Healthwatch,using the Hub to record the information in a manner,in which the service user can not be identified.   Based on this rich source of intelligence,provided by local Healthwatch, Healthwatch England will produce special reports, as well as raising areas of concern,with the Care Quality Commission (CQC). Where appropriate, Healthwatch England will recommend that the CQC,undertake special reviews or investigations.   Highlighting health and care issues,for consideration by Healthwatch England.   Local Healthwatch responses to Adult and Children’s Safeguarding alerts (Section 3) and safety issues relating to services,providing health and care (Section 4) are set out in subsequent sections. This section focuses on how local Healthwatch,can raise issues and trends to the attention,of Healthwatch England for consideration. It also sets out how Healthwatch England,will respond to issues brought to our attention by local Healthwatch:  
  • The issue or area of concern,should be raised with Healthwatch England,via the Healthwatch Hub using the Escalate function,or by email, letter or over the telephone. The particular issue for investigation,should be flagged and clearly identified.  
  • All issues flagged for consideration,will be acknowledged by Healthwatch England,within 10 working days of being raised.  
  • We will develop a set of key principles,which will guide us in evaluating each issue. Once fully developed, these principles will be published. Issues, trends or areas of concern identified by this process,will be passed on to the Healthwatch England Committee for consideration.  
  • Topics for Healthwatch England’s special reports,will be decided by the Healthwatch England Committee quarterly, using information provided by local Healthwatch,and from the Hub, as part of the business planning cycle.  
  • Healthwatch England will communicate decisions and rationale,in writing to the originating local Healthwatch,with any recommendations for alternative courses of action, where appropriate.  
  • Where Healthwatch England has recommended,that the CQC undertake a special review or investigation, the CQC will respond in writing stating,whether or not they accept Healthwatch England’s recommendation,and the reason for their decision.
Dealing with safeguarding issues.   There will be times where a local Healthwatch,identifies an immediate risk to the safety,and wellbeing of people using services,whose circumstances make them particularly vulnerable,to abuse, neglect or harm. These matters should be referred immediately,to the relevant Local Authority’s Safeguarding Team,and or the police. This applies to both Adult and Children’s Safeguarding concerns.   Local Healthwatch should also share Children’s Safeguarding issues,or concerns with Ofsted,if the issue relates to a social care setting,and may share their concern with the Care Quality Commission (CQC) if the issue relates to a health setting.   If Healthwatch England becomes aware,of an Adult or Children’s Safeguarding issue,we will also independently escalate the safeguarding issue,to the CQC or the Local Authority’s Safeguarding Team as appropriate.   We ask each local Healthwatch,to notify Healthwatch England on a quarterly basis,a summary of the number of adult and children’s safeguarding referrals,made to Local Authorities.   If the safeguarding issue is not resolved to your satisfaction,we would ask you to escalate them using the process below.   Escalation Process.  
  1. Firstly you should follow up directly with the organisation,to which you raised the alert (Local Safeguarding Authority, the police or the CQC) setting out your concerns,to their initial response.  
  2. If the local Healthwatch is not satisfied,with the final response, you should the organisations complaints procedure,and also make Healthwatch England aware of this,by email, letter or over the telephone. This will enable us to identify problems,in the organisation’s capacity to respond,and act effectively on safeguarding information.  
  3. Please copy Healthwatch England in to any further correspondence,regarding the escalated safeguarding issue.  
  4. Healthwatch England will quickly evaluate the situation,to determine the best course of action. We will review each case individually.  
  5. When escalating an issue, Healthwatch England will take the issue to the CQC,or to your Local Authority (as appropriate) within 3 working days of it being raised with us. The CQC will be obliged to respond,as set out in their safeguarding policy. This would involve an acknowledgement,and identification of case handler,within 3 working days and more detailed response of actions being taken,in 15 working days.  
  6. Healthwatch England will write to you to inform you,if any or no action is being taken,and update you periodically until the actions are closed.  
  7. On occasion, Healthwatch England may be asked to escalate an issue,by a neighbouring local Healthwatch. Where Healthwatch England escalates an issue from your local area, we will notify you of this concern,and then provide feedback,as well as inform you of any actions that have taken place,as a result of this.  
  8. All the issues escalated to Healthwatch England,will be reviewed by the Healthwatch England Committee,or appropriate sub-Committee,at least quarterly so that trends,or areas of concern can be identified and monitored.
Quality and safety issues related to local services.   Local Healthwatch may have reason to be concerned,about the quality and safety of a service,because of feedback from the public including patients. This information may not amount to a safeguarding issue,where an immediate risk is posed to an individual,but is of sufficient concern,that it must be acted on appropriately.   Local Healthwatch should flag these concern,to Healthwatch England via the Healthwatch Hub’s Escalate function,or by email, letter or over the telephone. The particular safety concern and the service provider,should be identified. This will enable Healthwatch England to check,for relevant information that may be held,by other local Healthwatch.   In these instances, as part of their ongoing local CQC relationship, the local Healthwatch must also contact,their local Care Quality Commission Compliance Manager. The Compliance Manager can then determine,if there has been any breach of regulations. Where this information related to children’s care services, this information should also be shared with your Local Authority and Ofsted.