NHS Complaints Procedure


NHS Complaints Procedure

Introduction

On 1 April 1996, a new NHS complaints procedure was introduced. This replaced the previous hospital and GP complaints procedure with a single two stage procedure. The change was in response to a growing number of concerns about the previous “hotchpotch” system, including those of lack of openness, inaccessibility, perceived unfairness of the system and the time it took for an investigation to be completed. Also, the system for complaints to Trusts and GPs differed widely.

The aim of the new system is to make complaining simpler, quicker and more accessible and to encourage greater openness, increasing patient satisfaction and consumer confidence.

The new system has the following main stages:

  • Local resolution
  • Independent Review

If you are still not satisfied with the outcome of a complaint, it is possible for the matter to be referred to the Health Service Ombudsman. These stages apply whether the complaint is about a hospital doctor or nurse, a GP, a dentist, an optician, an NHS pharmacist or a member of the ambulance service.

You have the right to make a complaint about any aspect of NHS treatment using the NHS complaints procedure. To use the procedure you must usually be a patient or a former patient of the practitioner or institution concerned. However it is possible to complain on behalf of someone else. The hospital or practice must agree that you are a suitable representative.

Time Limits

Your complaint should be made within six months of the date of the incident, or within six months of discovering the problem provided that this is within twelve months of the incident. NHS organisations have discretion to waive this time limit if there are good reasons why you could not complain earlier. However, you should make your complaint as soon as possible after the incident occurred.

Stage 1 – Local Resolution

The NHS complaints procedure stresses that, wherever possible, issues should be addressed and resolved locally.

All GP surgeries, hospitals, dentists, opticians and other NHS care providers should have leaflets and information concerning how complaints can be made. The first thing you should do is ask for this information.

Minor complaints

Minor complaints can be dealt with straight away, either orally or in writing and can be made to the Complaints Manager or any other member of staff of the NHS body that is the subject of your complaint. All NHS trusts and Primary Care Trusts have Complaints Managers who can advise you. If you feel awkward about making a complaint to the member of staff that treated you, you can make a complaint to the Complaints Manager at the Health Authority. The aim is that most minor complaints can be dealt with on the spot by frontline staff without having to call upon more formal procedures. All members of staff should listen to your concern and try to resolve the matter there and then, in a sympathetic and positive manner. They should offer a full explanation and apology, if appropriate.

More serious complaints

If the person to whom you make a complaint cannot deal with the complaint, that person must obtain guidance from the Complaints Manager. Where your complaint is made orally, the Complaints Manager must make a written record of your complaint, including your name, the subject matter of your complaint and the date of the complaint. Where your complaint is made in writing, it is treated as being made on the date on which the Complaints Manager or other relevant NHS staff member receives it.

If your complaint cannot be dealt with immediately then you should receive an acknowledgement from the Complaints Manager, by letter, within two working days. If your complaint was made orally, the acknowledgement must be accompanied by the written record of your initial complaint, and an invitation for you to sign and return it. The Complaints Manager must then send a copy of your complaint and acknowledgement to any person that you have complained about.

The Complaints Manager must investigate your complaint to the extent necessary to resolve the matter speedily and efficiently. The Complaints Manager, if you agree, may make arrangements for conciliation, mediation or other assistance to resolve the complaint. The Complaints Manager must keep you reasonably informed about the progress of the investigation.

The Complaints Manager must prepare a written response to your complaint which summarises the nature and substance of your complaint, describe the attempts made to resolve the complaint and summarise any conclusions made.

You should receive a response within twenty working days of receipt of your complaint. If attempts at resolving your complaint locally have been unsuccessful, you will be informed that you have the right to a review of your case by the Healthcare Commission. This letter, advising you that the first stage of the procedure is at an end, must include this option.

Stage 2 – Independent Review

On 30 July 2004 , the Healthcare Commission took over responsibility for reviewing complaints about the NHS in England that could not be resolved locally. This is the ‘second tier’ of the NHS Complaints Procedure (also known as the ‘independent review stage’), which was formerly administered by NHS conveners.

The emphasis of the NHS Complaints Procedure remains local resolution. If you wish to make a complaint about an NHS service, you must first make the complaint to the NHS organisation or practitioner concerned. If you are not satisfied with the outcome of the local resolution stage or a complaints manager has decided not to investigate your complaint within the time limits, you may request the Healthcare Commission to consider your complaint.

You can contact the Healthcare Commission in the following ways:

Telephone: 0845 601 3012

In writing: FREEPOST NAT 18958
Healthcare Commission
Manchester
M1 9XZ

Online: www.healthcarecommission.org.uk

Email: [email protected]

Trained staff will log your call, letter or email and advise you on how to proceed.

If you are eligible to take your complaint to the Healthcare Commission, you will be encouraged to fill in a complaints form. This form is available from local trusts, independent complaints advocacy services, online or the Healthcare Commission can send it by post. Alternatively, you can write or email your request to the Healthcare Commission with a copy of the report or letter that you were given at the end of the local resolution stage.

The case review

When the Healthcare Commission receives your complaint, a named case manager will be allocated your case and your complaint will be acknowledged within two working days. If your complaint is against a Foundation Trust, your complaint will be copied to the Independent Regulator of Foundation Trusts.

If there is not enough evidence to make a judgement, the Healthcare Commission team may contact the relevant organisation or practitioner and ask for your case file. The request will be sent electronically and a response will be expected quickly. The Healthcare Commission may also contact you for further information or clarification. The Healthcare Commission can ask for expert advice from independent advisers, such as health professionals, clinicians and NHS specialists, if necessary.

The Healthcare Commission will seek your permission to access your medical records in order to investigate your complaint. Only those people involved in your case will have access to your medical records.

Once sufficient information is available, the case manager will recommend a course of action. You will be informed of this decision as well as the organisation or practitioner that you are making the complaint against. The possible decisions at this stage will include:

  • Taking no further action, giving reasons. They may decide that your case has been thoroughly investigated and answered locally.
  • Referring your case back to the NHS organisation or practitioner that you are complaining against. The Healthcare Commission may suggest, in writing, what further action it may take to resolve your complaint or review its procedures or services. This may include arranging a meeting, conciliation or mediation, corrective action or reference to the process related to clinical negligence or the National Clinical Assessment Authority. If your complaint is referred back for further action locally, you can come back and ask the Healthcare Commission to look at the complaint again and decide on the most appropriate action.
  • Referring you to the Health Service Ombudsman. Cases where this will be appropriate will be agreed between the Healthcare Commission and the Health Service Ombudsman.
  • Referring your case to other procedures, for example, statutory professional regulatory bodies such as the General Medical Council. This would be the case if the matter is outside the Healthcare Commission’s jurisdiction or relates to something the Healthcare Commission cannot achieve, for example disciplinary action against a health professional.
  • Further investigating your complaint, and following the investigation, setting up a panel if you want this.
  • Referring your complaint to The Healthcare Commission’s system of inspection or investigation to follow up issues raised in your complaint.

Further action by the Healthcare Commission

The Healthcare Commission may decide that your case should be investigated because:

  • The investigation at local level was inadequate and there is uncertainty about the events that occurred, or
  • The complaint covers more than one service and some issues were not answered locally, or
  • There is reason to believe that underlying circumstances which have led to your complaint have not been fully exposed and a Healthcare Commission investigation is likely to expose this information, or
  • Your relationship with the body you have complained against has broken down to such an extent that resolution is not possible, or
  • The response of the organisation or practitioner that you complained against appears to be unreasonable or incomplete, or
  • The events raise serious issues about local services or complaints handling that may be clarified by a Healthcare Commission investigation.

Healthcare Commission staff will undertake the investigation, with expert advisers if necessary, and write a report. If there are any options for resolution at this stage, they will be explored. Both you and the organisation or practitioner that you complained about will be given the report. It will include any recommendation for improving services or actions to rectify the situation.

Panel hearing

After you receive the report, both you and the organisation or practitioner complained against have the right to a panel to hear and consider the issues.

If either party request a panel hearing, a panel of three lay people will be brought together to hear the case. The case will be based on your representations, representations of the organisation or practitioner that you are complaining against, any witnesses and the investigation report.

The panel must uphold principles of fairness and consistency and will conduct proceedings in line with the following rules:

  • Proceedings must be held at a time and place convenient for both parties.
  • Both parties to the complaint should have access to the same information on which the panel will base its considerations.
  • You and any person complained against must be given a reasonable opportunity to express any views on the complaint.
  • The standard of proof is the standard of the “balance of probabilities”.
  • The majority view of the panel prevails.
  • Accurate records approved by the panel members are kept of conclusions and recommendations and the reasons for reaching those conclusions.

The panel will normally conduct their proceedings with you and the person(s) you have complained about together in the same room to hear the evidence given by others. The panel will then make recommendations based on their findings. Panels will be asked to make two sets of recommendations. The first is concerned with redress for you. The second is regarding improvement of the services when called for.

A full version of the report will be available to you and a report protecting your anonymity will be published on the Healthcare Commission’s website.

Summary of timescales for Healthcare Commission review 

The term ‘days’ means working days and excludes weekends and bank holidays.

Action Time
Acknowledge complaint. Within 2 days of receipt
If a Foundation Trust, copy to Office Information System Within 2 days
Obtain consent forms Up to 5 days
Call for papers, including views of organisation complained against on the complaint Up to 20 days
Expert evidence identified and received Up to 30 days
Decision on what will happen to the case communicated to all parties Up to 10 days
If investigation agreed, terms of reference drafted 2 days
Comments from parties Up to 10 days
Identify and secure experts Up to 20 days
Arrange interviews, call for further papers, write report, quality assurance Must be completed within 90 days of decision to investigate unless there is good reason
Request for a hearing by panel from you or organisation complained against Within 40 days of the report issue date
Panel established Within 48 days of the receipt of the request
Draft report for checking by parties for factual accuracy Within 10 days of panel
Receipt of comments and checks for quality Within 10 days of the deadline for comments
Issue report  

Stage 3 – the Health Service Ombudsman

If you are not happy with the Healthcare Commission’s decisions, you may appeal to the Health Service Ombudsman.

Time limits

You have to send your complaint to the Ombudsman no later than a year from the date when you became aware of the events that are the subject of your complaint. The Ombudsman can waive this time limit in special circumstances, such as the local investigation taking longer than it should have done. However, you cannot rely on this discretion being exercised.

Making your complaint

You can contact the Health Service Ombudsman in the following ways:

In writing: The Health Service Ombudsman
Millbank Tower
Millbank
London SW1P 4Q 

Online: www.ombudsman.org.uk/hse/england/putting_complaint.html

You will need to:

(1) Say what happened, when, where and (if possible) who was involved
(2)  Provide all information that you can, including any relevant documents. You should also explain which stages your complaint has already been through
(3)  Provide your contact details, including daytime telephone number, fax number and email if possible.

If you experience difficulty putting your complaint in writing, or would like any further advice on the work of the Ombudsman, you should call the Health Service Ombudsman’s enquiry line on 0845 015 4033 or email [email protected] .

The Ombudsman can consider complaints about:

  • unsatisfactory care or treatment
  • failure to provide a service that ought to have been provided
  • poor administration

Poor administration covers such things as:

  • significant mistakes over appointments to see a doctor or go to hospital
  • poor complaint handling
  • rudeness
  • misleading advice
  • refusal to give you information to which you are entitled.

There are some things that the Ombudsman can’t investigate, due to the rules that govern her Office.

The rules that govern the Ombudsman’s Office mean that she can’t consider complaints about:

  • private health care
  • NHS personnel matters such as recruitment, pay, or discipline
  • contractual disputes between NHS organisations and their suppliers

The Ombudsman does not usually investigate complaints about matters that you are taking, or intend to take, to court.

If you are refused access to your own medical records you should complain to:

The Information Commissioner
Wycliffe House
Water Lane
Wilmslow
Cheshire SK9 5AF
Information Line: 01625 545 745

If you are wrongly refused access to the medical records of a person who has died, you should put your complaint to the Ombudsman.

What won’t the Ombudsman usually investigate?

There are certain other things that the Ombudsman may or may not investigate.  She needs to consider whether her intervention would be helpful and whether it would be likely to achieve anything for you.  She has discretion whether to investigate a complaint, and exercises her judgment in the particular circumstances of each case.

  • She will not usually take action if the organisation or practitioner complained against has done all that could reasonably be expected to put things right.
  • The Ombudsman will not consider a complaint about a decision by an NHS organisation or practitioner simply because you disagree with it.  She will require some evidence that the decision was wrongly taken, for example that a relevant fact was not taken into account.

If the Ombudsman thinks that your complaint may be valid, she will make some initial enquiries. Depending on the outcome of these enquiries she may launch a formal investigation. If the investigation shows that your complaint is justified, she will ask the NHS organisation or practitioner to provide a suitable remedy. She does not normally recommend financial compensation.

The Ombudsman will usually acknowledge receipt of your complaint within two working days. The Ombudsman aims to respond to most correspondence within eighteen days. However, a letter with the decision on how to deal with your complaint may take up to two months. This will depend on the complexity of your complaint.

Your letter will be passed to one of the Ombudsman’s staff who will look at the complaint in detail and decide whether or not they can take it further. They may need to see your medical records and other documents to make this decision.

However the Ombudsman’s staff decide to deal with your complaint, they will normally inform the NHS organisation concerned of the outcome. This helps the NHS to change practices or procedures and to learn from any shortcomings identified.

There are a number of ways that the Ombudsman may resolve your complaint. These include:

  • Detailed letter – You may receive a detailed letter explaining exactly what happened and why.
  • A request for the NHS to take further action – The Ombudsman may ask the NHS organisation or practitioner concerned to take some further action to resolve matters
  • A formal investigation – The Ombudsman may carry out a formal investigation, resulting in a detailed report about your case. If so, you and the organisation or practitioner complained about will be sent a statement of complaint setting out the matters being investigated.

The Ombudsman will then obtain all relevant papers, including medical records, from the NHS organisation or practitioner. An investigator may wish to interview you, NHS staff and any other relevant witnesses.

The investigation is likely to take at least nine months. A detailed report will be sent to you, the NHS organisation concerned and the Secretary of State for Health.

There is no appeal against the Ombudsman’s findings.

Medical Negligence Claims & Clinical Compensation