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The original Cornwall complaints were brought under the NHS complaints procedure, which differs slightly from its social care counterpart. However, there are national plans to align both complaints procedures by 2009.

A number of things struck me on first reading the report. Many of the individual complaints have been around for years - W's family had been raising "disagreements" with the trust since the early 1990s; X's family had been raising "concerns" since 1999; Y's family had a number of "unresolved issues" which dated back "several years". Indeed, they made a formal complaint in January 2004, which is now with the health service ombudsman.

Sometimes it can be difficult to work with people who raise concerns over time and easy to dismiss them as "vexatious" or "unreasonably persistent" and, in effect, stop listening to what they are saying. Serious concerns, therefore, often rumble on for years, relationships break down and communication dries up. Organisations need ways for dealing with these complaints, to make sure serious issues don't get "lost".

Many of the Cornwall complaints seemed to drift at a local level for years and not get "escalated" up to another stage of the procedure or into vulnerable adult or staff disciplinary procedures. An advantage of the NHS and social care complaints procedures should be their structure: if a complaint is not resolved locally it can be taken higher, to more senior officers or ombudsman. However, in Cornwall these safety nets seemed ineffective.

Why so long?
Although raising the complaints, why did East Cornwall Mencap take so long to take its concerns outside the health trust? A voluntary organisation can be a powerful advocate, and I would have liked to have seen Mencap escalate these issues sooner.

Likewise, some trust staff had been expressing concerns for years, but to no avail. Staff need clear whistle-blowing procedures.
They need to know what to do when the person to whom they initially air their concerns does not act. They also need to feel empowered to take their concerns to the highest level, and outside the organisation, if necessary.

The report also highlights poor access to the trust's complaints procedure. Children have a legal right to an independent advocate when making or preparing a complaint about social care services.

How long will it be before this right is extended to other vulnerable groups and other services? A good advocate can help, not only with dealing with a complaint, but also with building or rebuilding relationships between staff and service users, and helping them communicate more effectively.

Especially when relationships have become fraught and complaints are long-running, the involvement of someone new who is separate from the organisation who has no axe to grind or hidden agendas can help address power imbalances and get people working together again.

There seems to have been a lack of openness and communication between service users and their families and the trust.

Complaints could not be investigated because care records were "lost"; incident reports were not completed; staff were mysteriously "moved" after allegations were made. While staff are entitled to their confidentiality as much as services users, no complaints procedure can ever be effective unless people making complaints are given meaningful feedback about what the investigation of their complaints found and what will happen as a result.

Undervalued managers
There is no mention in the report of complaints staff within the trust. Although complaints managers are often undervalued, they are a complainant's best ally. They hold the key to information, advocacy and support; they can escalate complaints; and most important recognise serious issues either in a single complaint or where several complaints arise in the same service or about the same thing.

It is a scandal and a tragedy that the abuse of vulnerable people in Cornwall should have been raised so often by so many people and still not been dealt with. It's said we can judge a society by how it treats its most vulnerable members: we have been judged and we have failed.

Sarah Baalham is customer care manager, Suffolk Council