NHS complaints procedure
Complaints procedures around the country
Following a lengthy evaluation and consultation process, the NHS in England published the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.
This aimed to improve the NHS complaints procedure in order to respond to patient dissatisfaction more effectively in terms of customer service and good practice.
The new regulation intended to achieve:
- More flexibility to the system
- Improvements to Local Resolution - thus avoiding escalation
- Reform of the independent review stage - responsibility placed with the Commission for Healthcare Audit and Inspection (CHAI)
- Encouraging a culture whereby the information gathered through complaints becomes integral to improving standards of care
We have produced the following to help understand the simple two stage procedure:
The NHS complaints procedure for Scotland consists of:
The procedure was developed with the full involvement of patients and NHS staff. Key to the system is faster local resolution and the chance for patients dissatisfied with that outcome to go directly to the Scottish Public Services Ombudsman, thus introducing independent scrutiny at an earlier stage.
Complaints can be made by current or former patients, by any appropriate person in respect of a patient who has died, or by someone on behalf of a patient, for example a parent or carer. Complaints can be made about a wide range of issues, not just in relation to medical care, and each complaint must be taken on its own merit. However, the NHS complaints procedure deals primarily with issues relating to patient care and issues impacting on patient care and the provision of services, and matters related to the health of the population served by an NHS organisation where an individual is personally affected.
Individuals wishing to complain should do so within six months of the relevant incident, receive acknowledgement within 3 working days and either a reason for delay or written reply within 20 working days. If they are dissatisfied with a local resolution outcome, they can refer the complaint to the Scottish Public Services Ombudsman who will generally only consider complaints which have already been through the relevant authority’s complaints procedure. Complaints to the Ombudsman should generally be made within 12 months of the events giving rise to the complaint, or within 12 months of the complainant becoming aware that there were grounds for complaint.
If a person with a complaint is unhappy with the local resolution they can ask for the case to undergo an Independent Review. This would entail making a request to the 'complaints convenor' of the local Health and Social Services Board, and should take place within 28 calendar days of the care provider's written response to the complaint.
A trained reviewer will then decide whether the case could be resolved locally with further effort or should whether it should be taken to an independent panel. In the latter instance, the person making the complaint would have the opportunity to present their case in person to a panel of reviewers. If they are still dissatisfied with the outcome, they are able to complain to the Northern Ireland Ombudsman.
For complaints dating on or after 1 April 2006, patients have the choice to make a direct referral to the ombudsman, opting out of the independent review stage. However, if the ombudsman decides not to investigate, the opportunity to have the complaint independently reviewed will have been lost. Complaints in Northern Ireland should generally be made within the six months after the relevant incident.
A new procedure for raising concerns about the NHS in Wales was implemented from 1 April 2011 under the NHS (Concerns, Complaints, and Redress Arrangements (Wales) Regulations 2011. The aim of the Regulations is to provide a clear and simple procedure.
These Regulations also introduce the redress arrangements in an attempt to reduce litigation. Redress is a range of actions that can be taken to resolve concerns where the NHS organisation may have been at fault which has resulted in harm. Redress could include a written apology and explanation of what happened, an offer of treatment or rehabilitation to help relieve the problem or financial compensation.
Guidance on the procedure can be found on the Welsh NHS website.
Support available to doctors who receive a complaint
If you are subject to investigation or action by the GMC or other body you should contact your medical defence organisation straight away. They can offer you advice and legal support if appropriate.
If you are not a member of a defence organisation, you could contact the British Medical Association who can provide expert advice and support.
Alternatively, you can get your own legal advice, at your own expense. Legal aid is not available to doctors being investigated under GMC procedures and you cannot claim costs from the other parties involved.
The NHS also has a duty of care towards it staff and your employer should offer you access to occupational health services and should ensure that proper confidentiality procedures are put in place so as to limit any damage from malicious complaints.
Receiving a complaint can be a very stressful experience for the doctor as well as the patient or advocate. For help, counselling and personal support, doctors can call the BMA’s 24 hours counselling service on 08459 200 169.
They will be given the choice of speaking to a counsellor or details enabling them to contact a doctor-adviser. These services are available to any doctor or medical student who is a BMA member.
Call Doctors for Doctors and BMA Counselling on 08459 200 169
Other sources of support for doctors
- The DoH has developed a guide called 'Listening, responding, improving: a guide to better customer care' which can be a useful resource for those involved in complaints procedures. It was designed to help complaints professionals and healthcare staff to learn from the negative experiences of patients and to improve services.
- The Practitioner Health Programme is a service which provides confidential advice to doctors in the London area who are concerned about their own health and they too can help advise doctors through periods of stress. The PHP can be contacted on: 0203 049 4505
- Mednet is a counselling service for doctors working in the London Deanery area and is provided by doctors. MedNet can be contacted on: 020 8938 2411
- Many doctors are not particularly good at visiting their own GP when they are feeling unwell. GPs can be a good port of call for offering advice to doctors who are stressed or in difficulty.
- Doctors are also advised to ensure that they have the appropriate medical insurance to meet the needs of their work - whether it is NHS or private practice. Please see below for further information.
The NHS Litigation Authority provides indemnity to employees in respect of clinical negligence claims. There are equivalent organisations in Scotland, Northern Ireland and Wales. This indemnity provides support for clinical negligence claims which arise from contracted NHS duties, but not for disciplinary issues, or referrals to the General Medical Council.
There will also be situations where NHS indemnity does not apply. We strongly recommend that you take out supplementary insurance with one of the medical defence bodies or provide yourself with other personal indemnity insurance.
BMA guidance on indemnity
Relationship between complaints and discipline
The NHS complaints process requires a clear separation of complaints from discipline. Where a decision is made to embark upon a disciplinary investigation, action under the complaints procedure on any matter which is the subject of that investigation must stop. Where there are aspects of the complaint not covered by the disciplinary investigation, they may continue to be dealt with under the complaints procedure. A similar approach is adopted in a case referred to the GMC.
If a complainant asks to be informed of the outcome of the disciplinary investigation, they will generally be given the same information as if the matter had been dealt with under the complaints procedure -what happened, why it happened and what action has been taken to prevent it happening again. They can also be told, in general terms, that disciplinary action may be taken as a result of the complaint.
If a patient is unhappy with the medical care they have received they have the right to complain. As outlined by the NHS Constitution, patients also have the right to:
- have any complaint made about NHS services dealt with efficiently and to have it properly investigated.
- know the outcome of any investigation into their complaint.
- take a complaint to the independent Health Service Ombudsman, if they are not satisfied with the way it has been dealt with by the NHS.
- make a claim for judicial review if they think they have been directly affected by an unlawful act or decision of an NHS body.
- compensation where they have been harmed by negligent treatment.
The Constitution also states that the NHS will commit to:
- providing support to relevant parties throughout any complaint process
- treating those who make a complaint with respect
- ensuring that anyone who has complained will not have their future treatment adversely effected
- acknowledge mistakes, apologise, explain what went wrong and put things right quickly and effectively
- ensure that the organisation learns lessons from complaints and claims and uses these to improve NHS services