Complaints Policy. (Including expressions of Concern and Compliments)

Transcription

1 Complaints Policy (Including expressions of Concern and Compliments) 1 SUMMARY This document sets out ways in which Enfield CCG will encourage feedback and respond to comments, concerns and complaints in respect of the services it provides or commissions. 2 RESPONSIBLE PERSON: Assistant Director of Quality, Governance and Risk 3 ACCOUNTABLE DIRECTOR: Director of Service Quality and Integrated Governance 4 APPLIES TO: All staff employed within ECCG 5 GROUPS/ INDIVIDUALS WHO HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY: 6 GROUPS / INDIVIDUALS WHO WERE CONSULTED AND HAVE GIVEN APPROVAL: 7 EQUALITY IMPACT ANALYSIS COMPLETED: 8 RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL: 9 VERSION: 3 Aimee Fairbairns Director of Quality and Integrated Governance. Quality & Risk Sub Group Risk & Governance Manager, Clinical Governance Lead, Head of Corporate Services Head of Medicines Management, Head of Patient Experience (CSU PEET), Head of Clinical Quality, Enfield Referral Service Manager, Head of Communications & Engagement, Communications Manager, Director of Service Quality & Integrated Governance, Head of Primary Care Commissioning, Head of Continuing Care, CCG Complaints / Customer Care Officer, Board Secretary Policy Screened Yes Template completed Yes 28 October 2015 Quality & Risk Sub Group 25 November 2015 Quality & Safety Committee 9 December 2015 Governing Body 10 AVAILABLE ON: Intranet X Website X Version 3 Complaints Policy October 2015 Page 1 of 31

2 11 RELATED DOCUMENTS: NPSA, Being Open Process; ECCG Incident & Serious Incident Policy, Risk Management Strategy/Policy, Information Governance Policies (including Freedom of Information Policy), Safeguarding Policies, Incident Reporting Policy, Standard Operating Procedure (Complaints), Continuing Healthcare Policy, Individual Funding Request Policy, POLCE Policy, Freedom of Information Act, Guidance for Staff 12 DISSEMINATED TO: All staff in ECCG 13 DATE OF IMPLEMENTATION: October DATE OF NEXT FORMAL REVIEW: October 2017 Date Version Action Author April Revised operations with CSU providing Complaint service 30 January To bring Policy into line with Standard Operating Procedure (SOP) setting relationship between CSU & CCG 28 August Refreshed Policy and revised flowcharts. Interim Patient Experience and Effectiveness Lead Head of Governance & Risk Risk & Governance Manager Version 3 Complaints Policy October 2015 Page 2 of 31

3 Contents 1 Introduction Aims and Objectives Scope of the policy Definitions Exceptions Roles and responsibilities The Complaints process and practical application Timescales for making a complaint Complaints specific issues Learning, Reporting and Communication with the public Vexatious and Persistent Complainants Equality & Diversity Implementation of this policy Monitoring and assurance References Appendix 1: NHS Complaints Management Process...24 Appendix 2: Flowchart - Process for handling patient enquiries: comments; compliments; concerns; complaints...28 Appendix 3: Flowchart - Process for Managing MP s Enquiries/Complaints Appendix 4: Equality Analysis Tool Appendix 5: Policy Assurance Form...31 Version 3 Complaints Policy October 2015 Page 3 of 31

4 1 Introduction 1.1 Enfield Clinical Commissioning Group (ECCG) recognises that suggestions and complaints provide valuable insights into services. Every person s experience counts. Therefore Enfield CCG will use this valuable intelligence on the services it provides and commissions to ensure that quality, patient focused services are at the heart of its work. 1.2 This document sets out ways in which ECCG will encourage feedback and respond to comments, concerns and complaints in respect of the services it provides or commissions. 1.3 The CCG will make sure that the complaints process is appropriately publicised to ensure that people know how to make a complaint should they wish to do so. 1.4 Complaints are managed on behalf of ECCG by North and East Commissioning Support Unit (NEL CSU). Details of the interaction between NEL CSU (the CSU) and Enfield CCG (the CCG) are detailed throughout this policy with an additional section covering information governance arrangements between the two organisations. 1.5 Complainant's rights in the NHS are articulated by the NHS Constitution which states that any individual has the right to: Have any complaint they make about NHS services dealt with efficiently and have it thoroughly investigated Know the outcome of any investigation into their complaint Take their complaint to the independent Health Service Ombudsman if they are not satisfied with the way the NHS has dealt with their complaint Make a claim for judicial review if they think they have been directly affected by an unlawful act or decision of an NHS body Receive compensation where they have been harmed by negligent treatment 1.6 The CCG aims to implement a process to deliver the six principles of good complaints handling. O u r complaints m a n a g e m e n t approach is structured around the Parliamentary and Health Service Ombudsman s Principles of Good Complaints Handling Getting it right Being customer focused Being open and accountable Acting fairly and proportionately Version 3 Complaints Policy October 2015 Page 4 of 31

5 Putting things right Seeking continuous improvement The above principles are supported through the process of listening, responding and improving. The CCG will deal with complaints effectively and use the information received to learn and improve. 2 Aims and Objectives 2.1 Enfield Clinical Commissioning Group is committed to providing patients, families, carers and members of the public with the opportunity to raise concerns or complaints about any services it commissions, and to using the information received to improve services. All complaints will be managed in accordance with the NHS complaints regulations. 2.2 This policy aims to provide: Ease of access for complainants, by empowering all staff to receive and, where appropriate, respond to complaints. Open, fair and transparent approach to complaints which meets the needs of the complainant whilst being fair to staff One-stop approach to complaints that relate to more than one organisation, with unified handling of complaints across health and social care boundaries where possible A means of identifying and managing complainants who are persistent / habitual. Accessible tool for good complaints handling and response A means of providing information to senior managers and the CCG s Quality & Safety Committee so that learning can take place, policies can be changed, services can be improved and complainants can be reassured that their complaint has made a difference A mechanism by which improvements to patient experience of care (NHS Outcomes Framework Domain 4) can be made 3 Scope of the policy 3.1 This policy applies to all members of staff working for the CCG, and to all staff working for the CSU on behalf of the CCG. Version 3 Complaints Policy October 2015 Page 5 of 31

6 3.2 Enfield CCG s statutory duties in relation to complaints are defined by the National Health Service Complaints (England) Regulations This policy sets out the Enfield CCG process for handling and considering complaints where Enfield CCG is the responsible body. Where Enfield CCG is not the responsible body the CCG will usually pass the complaint to the responsible body for investigation, provided that the complainant consents. If the complainant does not consent to details of the complaint being passed to the responsible body, they should be advised to make direct contact with the responsible body. 3.3 NHS providers (acute and mental health services), will have their own local complaints management and investigation process. The CCG will monitor themes and trends from complaints about its commissioned services through the provider clinical quality review meetings. Further information is available in the ECCG Quality Strategy. 3.4 As Primary Care Practitioners (General Practitioner, Dentist, Pharmacist and Optometrist) and providers of NHS funded care, member practices will also have a local complaints management and investigation process. The ECCG G P Transformation Group will r e v i e w themes and trends arising from member practice complaints to ensure shared learning. 4 Definitions 4.1 The NHS Complaints Regulations (2009) make it clear that a complaint can be made relating to any matter reasonably connected with the exercise of the functions of an NHS body or the exercise of social services functions by a Local Authority. 4.2 Complaint: The NHS Executive definition of a complaint is An expression of dissatisfaction that requires a response. This is a wide definition and it is not intended that every minor concern should warrant a full-scale complaints investigation. The spirit of the complaints procedure is that front line staff are empowered to resolve minor comments or problems immediately and informally or to offer the assistance of the complaints team at the CSU. The CCG will therefore seek to distinguish between requests for assistance in resolving a perceived problem and an actual complaint. The decision whether the issue is a concern or complaint will usually be determined by the person raising the issue. The complaint must relate to someone who receives or has received services from the responsible body or who is affected, or likely to be affected, by the action, omission or decision of the responsible body which is the subject of the complaint. 4.3 Concern: If the person expressing a concern does not wish to have it labelled as a complaint it will still be dealt with under this policy unless the individual specifically Version 3 Complaints Policy October 2015 Page 6 of 31

7 requests otherwise or where it is not possible to do. 4.4 Compliment: An expression of gratitude about quality of services provided. 5 Exceptions 5.1 Complaints not covered by this policy include: Matters which are not considered a complaint as outlined in The Local Authority Social Services & National Health Services Complaints Regulations 2009 Appeals relating to Continuing Health Care (CHC) / Individual Funding Request (IFR). The CHC/IFR team deals with appeals in their area. Further details can be found in the Continuing Healthcare & Individual Funding Request Policy available on the intranet. Complaints or concerns raised verbally which are resolved to the satisfaction of the person who has raised the issue on the same day or the next working day after the complaint/concern was made Primary Care complaints - It is suggested that the first point of contact with such a complaint should always be directly to the primary care service through its practice manager (for further details see section 7.1.3). Local hospital or mental healthcare organisations complaints as they are required to investigate their own complaints under NHS statutory complaints regulations Complaints which have been previously investigated Staff grievances (staff members should use whistle blowing policies or other processes to raise concerns about services) Contractual issues between services and commissioners and complaints by health organisations or local authorities against other health organisations or local authorities which are not on behalf of a patient Any issue which will prejudice legal or any other formal proceedings (such as disciplinary or safeguarding concerns) Complaints about Freedom of Information Requests and Access to Information Requests (for complaints about Freedom of Information Requests see the Freedom of Information Procedural document on the intranet). Version 3 Complaints Policy October 2015 Page 7 of 31

8 Complaints that are being/have been investigated by the Parliamentary and Health Service Ombudsman Where disciplinary action is being taken against a member of staff, and progression of the complaint may prejudice the disciplinary process, in such cases the complaint will be closed and the complainant informed that the matter is now being investigated under Human Resources processes rather than complaints process 6 Roles and responsibilities 6.1 CCG Chief Officer (CO): Has overall responsibility for complaints handling issues, as stated in Section 4 of the Local Authority Social Services and NHS Complaints (England) Regulations Responsible for signing complaint responses. 6.2 CCG Director of Quality and Integrated Governance: Is the complaints Senior Responsible Officer for Enfield CCG Is responsible for ensuring that complaints information is reported through to the appropriate committees and monitoring the NEL CSU patient experience and effectiveness teams compliance with the objectives of the complaints process. 6.3 CCG Directors The CCG director who is responsible for the service line which a CCG complaint relates to will review and agree response letters prior to CO sign off. The CO relies on directors, senior managers and the NEL CSU complaints team to ensure investigation reports and responses are accurate, timely, fair and comprehensive. 6.4 Assistant Director of Quality, Governance and Risk Responsible for implementing and delivering the complaints process working with the NEL CSU patient experience and effectiveness teams. Version 3 Complaints Policy October 2015 Page 8 of 31

9 6.5 CCG Communications Manager: Will ensure appropriate publicity of this complaints process on the Enfield CCG website and intranets and other publicity requirements. 6.6 CCG Risk & Governance Manager CCG Complaints & Information Governance Co-ordinator Ensuring the CCG has a robust system for logging, maintaining and following up complaints delivered through the CCG Complaints and Customer Care Officer 6.7 CCG Complaints & Customer Care Officer Signposting on complaints and patient enquiries received by the CCG Operational responsibility for liaising with the NELCSU patient experience and effectiveness teams on all CCG complaints and following up progress with outstanding complaints with the NELCSU complaints team Provide administrative support on all enquiries and complaints received by the CCG which includes logging enquiries and complaints Support Managers with complaints investigation and monitor the progress of investigations to ensure that responses are made within the agreed timescales in accordance with CCG Policies and NHS Complaints Procedures. Ensure final responses received from CSU PEET are brought to the attention of the responsible Director for review and CO for sign off 6.8 NEL CSU Patient Experience and Effectiveness Team (PEET): Responsible for the operational management of the complaints procedure, as specified in the service level agreement and Standard Operating Procedure. See Appendix 2 for full details Provide complaints support, advice and guidance to the CCG Maintain an up-to-date database of all complaints and provide quarterly and annual complaints data for the CCG Monitor and analyse patient and public complaint information for themes and trends and ensure learning from complaints is reflected in quarterly and annual reports for the CCG Provide information to the Parliamentary and Health Service Ombudsman and relevant NHS regulatory bodies, ensuring actions arising from investigations are monitored, delivered and reported to the relevant committee Version 2 Complaints Policy October 2015 Page 9 of 31

10 Provide the relevant committee with regular reports about the number and type of complaints made about Enfield CCG or any other matters reasonably connected with the exercise of their functions. Co-ordinate any complaints relating to the CCG and, where appropriate, co-ordinate joint complaints responses where there is a commissioning element within the complaint, in doing so providing a single integrated complaint response. In such cases the NEL CSU complaints team will liaise with other complaints manager/s and agree who will take the lead in co-ordinating investigations and sending out the final response. Decide, in discussion with the CCG, when a complaint requires a response from another organisation providing or commissioning NHS care or services within Enfield. In such cases the NEL CSU complaints team will advise the complainant where their complaint should b e d i r e c t e d and forward t h e complaint to the right organisation with their agreement. 6.9 Enfield CCG managers (Investigating Officers): Responsible for ensuring that this policy and the CCG s complaints process is appropriately implemented within their areas. Will deal with minor complaints and problems immediately and informally, while maintaining the learning from such concerns by logging them with the Risk & Governance Manager. Will ensure all directly received formal complaints about their area of responsibility are reported to the Risk & Governance Manager. Will ensure that any member of staff who is the subject of a complaint relating to their area of responsibility, and any subsequent investigation, is informed and offered appropriate, timely support including, where appropriate, referral to Occupational Health Services. Will, where requested, act as Investigating Officer (IO) and liaise with the NEL CSU complaints team and, with their agreement, ensure that the investigation is completed within the agreed timescale and sent to the NEL CSU complaints team for quality checking and record keeping. Managers are responsible for writing draft complaint responses, ensuring that their responses are in plain English and that they appropriately address any concerns raised. They are also responsible for attending meetings with the complainant as required and facilitated by the PEET team. Version 2 Complaints Policy October 2015 Page 10 of 31

11 Responsible for implementing any action plan arising from a complaint relating to their area of responsibility and for providing a progress report on the action plan when requested. Responsible for delivering and reporting on any recommendations arising from an Ombudsman s report relating to their area of responsibility and reporting progress to the NEL CSU complaints team All Enfield CCG staff: Are responsible for co-operating with the implementation of this policy and ensuring that any concern raised is dealt with appropriately. Are responsible for ensuring a prompt and appropriate response to expressions of dissatisfaction about a policy, service or commissioning decision by Enfield CCG. 7 The Complaints process and practical application a. Is it a complaint? A number of people using the word complaint do not wish to make a formal complaint, but they do require swift and effective resolution of their concerns. Staff should ask if it is unclear whether the issue is seen as a complaint or not. It is the responsibility of all staff who receive a concern to attempt to resolve it at the point of contact. In most cases, it is essential that consent is obtained from the patient for the purposes of sharing personal information with a third party. Where the enquirer accepts the response as being satisfactory and appropriate, and where that response is communicated within the next working day, there will be no requirement for further action. If the enquirer is not satisfied with the response, they have the right to make a complaint. It remains important that all concerns resolved informally are reported to the Risk Manager and logged so that learning can take place. b. How may complaints be received? Complaints may be received verbally, (over the telephone or during a face-to-face meeting), in writing, by fax or . Where a complaint is not written then a written record must be made of the complaint and a copy of the written record provided to the complainant. Version 2 Complaints Policy October 2015 Page 11 of 31

12 If the complainant requires additional support in making their complaint, VoiceAbility provides advocacy assistance to help people make their complaint (see section 7.2). c. Who may make a complaint? Consent issues for patient representatives A complaint can be made by any person who has received or is receiving NHS treatment or services, or any person who has been affected by an action or decision of the CCG. A complaint can also be made by a representative acting on another person s behalf, if that person: a) Has requested the representative to act on their behalf b) Is a child c) Is unable to make the complaint themselves because of physical incapacity or lack of capacity within the meaning of the Mental Capacity Act 2005 d) Has died Where a patient is able to give informed consent, the written consent of the patient must be obtained in order for the complaint to be pursued. In the case of a child (under 16), a parent or guardian may make the complaint. However in some cases it may be appropriate to obtain consent from a child if that child is considered to be capable of understanding the situation and can give informed consent. The decision as to whether he/she is capable will need to be assessed on an individual basis and in line with Fraser Guidelines. Children who received NHS treatment have the right to make a complaint in their own right and have the right to use the NHS complaints process. If the patient is a minor and unable to give consent, the complaint should be discussed with the CCG s Caldicott Guardian. If the patient has died then the person making the complaint must have had sufficient interest in the person s welfare to make the complaint (in legal terms thisis usually defined as someone having a legal right to have a claim in the deceased estate). If there are concerns about whether the patient has capacity to consent (i.e. if the patient is too ill or otherwise incapacitated) this matter should be discussed with the organisation s Caldicott Guardian and guidance taken from the Mental Capacity Act Version 2 Complaints Policy October 2015 Page 12 of 31

13 2005 If the patient has given lasting power of attorney for their welfare to another person, then that person has the same rights as the patient. If the service believes that the person making the complaint does not have sufficient interest in the person s welfare, or is not suitable to act as a representative, then the person will be notified in writing stating the reasons for this decision. An example of the above could be where the case relates to Protection of a Vulnerable Adult. If a Member of Parliament makes a complaint on behalf of a constituent, it will be considered that the MP has obtained consent prior to contacting Enfield CCG (In line with requirements of the Data Protection Act 1998 processing of Sensitive Personal Data Elective Representatives Order 2002). If explicit consent is not provided the NEL CSU team will request this as a matter of good practice. There may be circumstances where patient consent is not required to pass on information, for example: a) When not revealing such information would be breaking the law. b) Where there is a risk of harm to an individual or themselves. c) Information is requested by H.M. Coroner, a court or a tribunal. d) There are reasonable grounds to suspect abuse of a child or vulnerable adult. The Caldicott Guardian will be consulted in the handling of these issues How to make a complaint, comment or compliment Enfield CCG and the Services it commissions Complaints, comments or compliments relating to a CCG Service (for example Enfield Referral Service), the way a CCG service has been commissioned or a commissioning decision made by the CCG should be made directly to the NEL CSU Patient Experience and Effectiveness Team. They can be contacted on or nelcsu.complaints@nhs.net By post to: NEL Commissioning Support Unit Clifton House, Worship Street, London EC2A 2DU (Open Monday to Friday 9-5pm) Version 2 Complaints Policy October 2015 Page 13 of 31

14 7.1.2 Hospital, Community and Mental Services commissioned by Enfield CCG. Complaints, comments or compliment about a hospital, mental health, community or other NHS service commissioned by Enfield CCG should be raised directly with the organisation. The responsibility for investigating any issue arising from a complaint remains with the organisation that provided the service to the complainant. If the complainant does not receive a response from the provider organisation, they can contact the North East London Commissioning Support Unit (details above) who can liaise with the provider organisation to ensure the complaint is investigated Primary Care Complaints (Doctor (GP), Dentist, Pharmacist or Optician) ECCG has a statutory duty to improve Primary Care Services and is working with NHS England to ensure that the necessary complaints intelligence is shared. Complaints, comments or compliments about a doctor (GP), dentist, pharmacy or optician should be directed to the practice in the first instance. However, if the complainant feels too uncomfortable to complain to the practice manager directly then they can make a complaint to the commissioner of the services instead. NHS England is responsible for purchasing primary care services such as GPs, dentists, pharmacists, optical services and some specialised services, and they should contact them if they wish to complain about any of these services at: NHS England P.O Box Redditch, B97 9PT england.contactus@nhs.net Telephone: If the complainant is unhappy with the outcome of their complaint they can refer the matter to the Parliamentary and Health Service Ombudsman, who is independent of the NHS and government: The Parliamentary and Health Service Ombudsman Millbank Tower Millbank London SW1P 4QP Tel: If they have problems with their hearing or speech they can use a textphone (minicom) on (Calls to these numbers cost the same as a call to a UK landline.) Version 2 Complaints Policy October 2015 Page 14 of 31

15 7.2. Independent Complaints Advocacy Service Advocacy provides practical support and information to people who want to complain about an NHS service. This might mean giving information so that patients can pursue a complaint by themselves or giving the support of an experienced advocate who can help patients make their complaint. NHS Complaints Advocacy Service is independent of the NHS, confidential, and free. VoiceAbility provides advocacy assistance to help people make their complaint. Not everyone needs the support of an Advocate to make their complaint. For example, some people just want to know how the complaint system works or know who they should send a letter of complaint to. Patients can get in touch with VoiceAbility if they want: a) More information. b) A self-help information pack to help you make an NHS complaint, or c) Help to compile the issues they wish to raise in their complaints. VoiceAbility contact details are: VoiceAbility, Mount Pleasant House, Huntingdon Road, Cambridge, CB3 0RN Telephone: nhscomplaints@voiceability.org Webpage: (VoiceAbility is open Monday to Friday 9-5pm) 8 Timescales for making a complaint a. Any complaint or expression of concern should be notified to the Clinical Commissioning Group within 12 months of the events it concerns. The later a complaint or expression of concern is notified to Enfield CCG the more difficult it is for Enfield CCG to investigate it and provide an adequate response. The CCG has the discretion to consider a complaint or expression of concern after this time limit in extenuating circumstances. An example of this may be where a complainant has been too unwell or unaware of the issues of complaint (e.g. something has been written in the records which the person is only just aware of). Version 2 Complaints Policy October 2015 Page 15 of 31

16 b. As the CSUs is not a legal entity in its own right but is hosted by NHS England (NHSE) with staff employed by the Business Services Authority, it cannot therefore be Data Controllers as defined by the Data Protection Act. NHS England is the Data Controller. To ensure that the CSU is compliant with the Data Protection Act and other legal obligations such as the common law duty of confidentiality, the CCG Governance & Risk Team will inform complainants that: Their complaints will be passed to NEL CSU PEET team so that it can be investigated; Consent will be requested from complainants in line with appendix 2. They can contact the Risk & Governance Manager should they have any concerns about how their information is to be used and that if they do not want their information to be disclosed to the CSU how to dissent from this. Investigating the complaint will involve the PEET team accessing their records and relevant information. Their information may be used for other purposes and providing a list of these other purposes e.g. monitoring the complaints process or improving service quality, but that wherever possible only anonymous information will be used for these other purposes. If identifiable data is needed for other purposes then their consent will need to be obtained unless there is another legal basis; c. All complaints received by the CCG will be s h a r e d with explicit or implied consent to the complaints team. d. In exceptional circumstances, a complaint may raise serious patient safety issues. Where this is the case, there may be justification on public interest grounds for using the individual s personal confidential data even where they wish to withhold their consent for its use. Such decisions should be taken by a senior clinician, with advice from the CCG Caldicott Guardian where appropriate e. Where consent has been refused then this should be escalated to the CCG Director of Quality and Integrated Governance. The CCG will be able to liaise and obtain advice from the CSU without disclosing the name of the patient or other potential patient identifiers. f. Should there be any doubt about whether a complaint will prejudice any other formal proceedings then the person in receipt of the complaint should at once pass the relevant information to the appropriate senior personnel. This senior staff member will then make a decision with regard to when to initiate such action by taking appropriate professional advice. This reference to any of the above may be Version 2 Complaints Policy October 2015 Page 16 of 31

17 made at any point during any stage of the Complaints Procedure, this should not delay any investigation of unrelated issues raised within the complaint. g. However, all feedback on issues mentioned above may provide opportunities for organisational learning and service improvement and will be captured through the reporting process, where relevant. 9 Complaints specific issues 9.1 Complaints about primary care and provider services directly received by the CCG Consent issues Complaints received about primary care and provider services directly received by the CCG will be directed to the relevant provider or commissioner of that service when appropriate consent is obtained. No complaint will be forwarded to another organisation without consent of the person making the complaint and/or a patient if it was made by someone other than the patient. 9.2 Joint complaints with other organisations There is a duty within the complaints regulations for co-operation between NHS and Social Care bodies, wherever possible the person making the complaint should receive a joint response. However if no consent for the sharing of information is forthcoming then the organisations are required to respond independently. 9.3 Safeguarding children and protection of vulnerable adults If a complaint is received which raises child protection issues or concerns the protection of vulnerable adults the responsibility for highlighting this through safeguarding processes lies with the person who has received the concern (reference to safeguarding processes is at the end of this document). If there is any doubt about how an issue should be handled then the person should contact the CCG Safeguarding/Caldicott lead and speak to their manager. If there is any immediate risk of harm then advice should be sought urgently. The safety of the child and vulnerable adult must always be paramount. It must be noted that complaints relating to safeguarding processes e.g. the passing of information from NHS to Social Care, or information which may be shared in a case conference, may form the subject of the complaint. However in responding, the safety of children and others (e.g. where domestic abuse maybe a concern) is paramount and the CCG may refuse to respond to Version 2 Complaints Policy October 2015 Page 17 of 31

18 the complaint if concerns of safety are raised. 9.4 Complaint Records & confidentiality Complaints will be handled in strict confidence at all times. Care will be taken that information is only disclosed to those who have a demonstrable need to have access to it. Information will not be disclosed to patients or complainants unless the person who has provided the information has given written consent to disclosure. Complaint records should be stored in accordance with the Records Management NHS Code of Practice Part 1 & Complaints and Litigation The NEL CSU complaints team will refer any relevant claims issues to the Assistant Director of Quality, Governance and Risk and forewarn the CCG claims process where there is an explicitly stated intention to take legal action. 9.6 Freedom of Information ( FOI ) requests and the Media Some letters of complaint may include the request for information (whether explicitly requested or not) under the Freedom of Information Act. The Risk & Governance Manager will liaise with the CSU PEET & FOI Team on how such requests should be managed. All FOI requests will be managed according to the CCG s Freedom of Information process. Where a complainant indicates they will be contacting the media as a result of their complaint/issue or where the NEL CSU complaints team feels there is a potential significant reputational risk relating to the complaint, the CCG Communications M a n a g e r will be informed of the complaint/issue within 2 working days via on communications@enfieldccg.nhs.uk or telephone Escalation If the issues raised in a complaint give rise to significant concern or serious incident, the Assistant Director of Quality, Governance and Risk should be informed immediately. Version 2 Complaints Policy October 2015 Page 18 of 31

19 10 Learning, Reporting and Communication with the public 10.1 Learning Every opportunity will be taken by Enfield CCG to learn from complaints and to use the insight and experience of complainants to resolve the complaint or issue and ensure it does not recur. Where actions have been identified following the investigation of a complaint, the Investigation Officer will prepare a robust action plan with a timeframe for implementation. The CSU PEET Team will report on learning from complaints investigation to ensure actions have been appropriately implemented. Learning from complaints will be discussed at the CCG Quality & Risk Sub Group and reported to the Governing Body Reporting Reports will be produced quarterly by the NEL CSU complaints team for consideration by the CCG s Quality & Risk Sub Group. Reports will identify the number of complaints received, performance indicators with regard to responses, issues raised and lessons learnt together with highlighting any emerging themes and trends. The reporting of complaints a n d c o m p l a i n t s o u t c o m e should demonstrate how complaints have made a contribution to ensuring that people have a positive experience of care in line with NHS Outcomes Framework Domain 4. An annual report on complaints will also be produced by the CSU and received by the CCG Quality & Safety Committee prior to being presented to the Governing Body. This report will also be made available to Healthwatch and Complaints & Advocacy Service Communication with the Public The CCG and NEL CSU PEET will ensure the dissemination of information about improvements and learning from complaints to assure the public that the NHS learns from mistakes. This kind of information can be disseminated using anonymised case studies, details of specific improvements or describe learning which has been Version 2 Complaints Policy October 2015 Page 19 of 31

20 incorporated into policy to avoid repeating past mistakes for example you said, we did. Anonymised complaints themes and trends information will be provided to Healthwatch, Complaints Advocacy Service and other local voluntary and statutory services to improve quality and patient experience. A summary of complaints received and how these were handled will be included in the annual report published by the CCG and regular updates to the Board. It is the responsibility of the CCG s Communications Manager to update and maintain the CCGs website with all relevant complaints details, including how to make a complaint, in order to ensure the public are fully communicated with at all times. 11 Vexatious and Persistent Complainants The CCG encourages users to raise concerns and complaints. However on rare occasions a vexatious or persistent complainant may place undue demands on the service. It is emphasised that this section of the policy should be used as a last resort and after all reasonable measures have been taken to try to resolve complaints using NHS complaints procedures. Complainants (and/or anyone acting on their behalf) may be deemed to be habitual, persistent or vexatious where contact within the last 12 months shows that they meet at least two of the following criteria: a. Persist in pursuing a complaint where the NHS complaints procedure has been fully and properly implemented and exhausted. b. Seek to prolong contact by changing the substance of a complaint or continually raising new issues and questions whilst the complaint is being addressed. (Care must be taken not to discard new issues which are significantly different from the original complaint. These might need to be addressed as separate complaints). c. Are unwilling to accept documented evidence of treatment given as being factual e.g. drug records, GP records, nursing notes. d. Deny receipt of an adequate response despite evidence of correspondence specifically answering their questions. Version 2 Complaints Policy October 2015 Page 20 of 31

21 e. Do not accept that facts can sometimes be difficult to verify when a long period of time has elapsed. f. Do not clearly identify the precise issues which they wish to be investigated, despite reasonable efforts of staff and, where appropriate, independent advocacy, to help them specify their concerns, and/or where the concerns identified are not within the remit of Enfield CCG. g. Focus on a trivial matter to an extent which is out of proportion to its significance and continue to focus on this point. However, what is considered 'trivial' is a subjective judgment and great care will be used when applying this criterion. h. Have, in the course of addressing a registered complaint, had an excessive number of contacts with Enfield CCG or the NEL CSU complaints team placing unreasonable demands on staff. A contact may be in person, by telephone, letter, or fax. Care will be taken in determining excessive contacts as this is a subjective judgement. i. Display unreasonable demands or expectations and fail to accept that these may be unreasonable (e.g. insist on responses to complaints or enquiries being provided more urgently than is reasonable or normal recognised practice). j. Have threatened or used actual physical violence towards staff or their families or associates at any time - this will in itself cause personal contact with the complainant and/or their representatives to be discontinued and the complaint will, thereafter, only be pursued through written communication. k. Have harassed or been personally abusive or verbally aggressive on more than one occasion towards staff dealing with their complaint or their families or associates. (Staff will recognise that some complainants may be mentally ill and some will act out of character at times of stress, anxiety or distress and will make reasonable allowances for this.) Staff will document all incidents of harassment in line with the Zero Tolerance Procedures, completing an incident form. Complainants that meet the definition of habitual, persistent or vexatious, as deemed by the Chief Officer, will be sent a formal letter or setting out the ways in which the complainant can use the complaints service, behaviour that is and is not acceptable and how to communicate with the complaints team. Version 2 Complaints Policy October 2015 Page 21 of 31

22 The letter will also set out the time period that the complainant will be considered habitual, persistent or vexatious and when the procedure will be reviewed and the complainant will be reassessed. If the NEL CSU complaints team or Enfield CCG are at all concerned that the complainant will not be able to understand the first or second letters/ s, a follow up phone call will be made by the NEL CSU Patient Experience and Effectiveness Manager or deputy and a meeting will be offered to provide a verbal explanation. In some cases it may be appropriate for other services and organisations to be informed of a complainant s status (e.g. The Ombudsman). 12 Equality & Diversity Enfield CCG is committed to ensuring that it treats all patients and staff fairly, equitably and reasonably and that it does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation, marriage and civil partnership and pregnancy and maternity. The CCG will ensure that the Complaints Policy is equally accessible to all communities and will monitor equality data to ensure better compliance and performance. The CCG recognises the needs of its diverse population and therefore will put in place measures to address both the linguistic and the access needs of all groups 13 Implementation of this policy Staff will receive complaints management and investigation training provided by the PEET team. The complaints policy and flowchart will be circulated to all staff and published on the CCG website Themes and trends and learning from provider complaints will monitored via the provider CQRG with assurance provided to the Quality & Safety Committee Managers will use the policy assurance form (appendix 5) to document embedding of this policy. An annual spot audit of randomly selected services will be carried out to confirm the assurance forms are in place. Version 2 Complaints Policy October 2015 Page 22 of 31

23 14 Monitoring and assurance Enfield CCG will monitor the effectiveness of the complaints process and how information is being used to improve services. The complaints system will: Disseminate learning from complaints Use the complaint procedure as a measure of performance Use information to inform decisions, where appropriate. There will be periodic audits of the complaints process. The timing and management of these will be agreed with NEL CSU. The policy will be reviewed annually by the CCG Quality & Risk Sub Group in conjunction with the CSU PEET team. 15 References Local Authority Social Services and National Health Services Complaints (England) Regulations 2009 The Principles of Good Complaint Handling (Parliamentary and Health Service Ombudsman) 2008 Listening, Improving, Responding a Guide to Better Patient Care (Department of Health 2009) NHS Constitution (Department of Health 2009 and 2013) Guide to good handling of complaints for CCGs (NHS England 2013) NHS Outcomes Framework: Domain 4 Ensuring that people have a positive experience of care Independent review by the Rt. Hon. Ann Clwyd, MP for Cynon Valley, and Professor Tricia Hart, Chief Executive of South Tees Hospitals NHS Foundation Trust. Mental Health Act 2005 Version 2 Complaints Policy October 2015 Page 23 of 31

24 Appendix 1: NHS Complaints Management Process From 2009 the complaints process changed from a three tier process (1.Local resolution; 2. Healthcare Commission; and 3. Ombudsman) to a two tier process with stage 1 being local resolution and stage 2 being Ombudsman. Version 2 Complaints Policy October 2015 Page 24 of 31

25 A. CSU Complaints Management Process All complaints received by NEL CSU complaints team will be risk assessed, RAG (red, amber, green) rated and where appropriate escalated in line with flowchart 1. Occasionally complaints give rise for concern about the immediate welfare or safety of the complainant or another person connected to the complainant. Contacts of this nature will be immediately prioritised for same day action the Director of Quality and Integrated Governance will be involved in the planning and handling of the case. If staff are concerned about a caller, they will speak to a risk and governance team in the CCG or CSU Quality teams who will consider informing relevant professionals either so that the matter is recorded for the future or in order to obtain immediate help for the patient. In particular, it may be appropriate to inform the caller s GP practice. If possible, the patient s agreement to this course of action should be obtained. However there may be cases where the patient is not willing to authorise any contact but staff assess that the situation is so serious that they do need to contact a third party. Before contacting anyone outside the Quality teams it must be remembered that breaking the patient s confidentiality in this way is only justified when there is perceived to be a danger to the patient or someone else. In these cases, staff must consult the Caldicott Guardian for the CCG. Any action taken without the patient s express permission must be considered very carefully and be in proportion to the assessed risk to the caller. All such cases should be logged with the risk & governance team with full details of all contacts and action taken so that there is a clear audit trail and reasoning for the action taken. If the complaint is categorised as a Serious Incident (SI), the CCG Director of Quality and Integrated Governance will be immediately informed. On completion of an SI report or investigation which is required to answer a complaint the CSU and CCG Director of Quality and Integrated Governance (or nominated deputy) will liaise on the process for feedback to the family. A formal complaint response will also be prepared to ensure that the original complaint is closed. All complaints will be formally acknowledged within three working days of its receipt by the CSU complaints team. Version 2 Complaints Policy October 2015 Page 25 of 31

26 A written copy of any oral complaint and the complaints case management plan will be sent to the complainant with an acknowledgement and a request to sign and return it. Details of Complaints Advocacy Service will be provided to ensure complainants are aware of the support available to them in making their complaint. Staff should advise complainants, at the earliest appropriate opportunity, of the support offered by the Complaints Advocacy Service. Where a complaint has been received verbally if the complaint plan is not signed within 10 working days and returned to the CSU then the CSU will send a follow up letter and/or phone call to request the complaint is agreed and investigated. Where a complaint has not been returned then the complaint will be closed. Once the appropriate CSU senior manager has approved a complaint response, it will be sent to the CCG Director responsible for the service area being complained about for review before sign off by the CO. Any changes will be sent to the NEL CSU complaints team who will make the alterations and re issue accordingly. Final letters for CO consideration will be accompanied by: Original complaint letter(s) Investigation report Other relevant documentation The response should be provided within 25 working days from receipt of complaint by NEL CSU PEET (and/or relevant patient consent) or the timeframe for complaint response agreed with the complainant Any complaints which may take longer than this timeframe then an agreed timeframe needs to be identified in conjunction with the complainant. These may be complaints of a serious nature or where a number of organisations are involved in the investigation of a complaint. If a complaint is not released for CO signature by the CSU senior manager or their nominated deputy within the appropriate timescale, the NEL CSU complaints team will escalate the case to their manager or Director and inform the CCG of progress/delays and reasons for this. Responses will be written in plain English, free of jargon, and wherever possible, include an apology. All responses will contain: Version 2 Complaints Policy October 2015 Page 26 of 31

27 An explanation as to what took place, What actions have been, or will be, taken to prevent a recurrence of the incident. Information about the Parliamentary and Health Services Ombudsman Information on Independent Complaints Advocacy Service who can support the complainant in taking forward the complaint All responses will include the contact details of a CSU named person who will discuss the complaint and the response letter with the complainant if required A meeting can be offered as part of the resolution process. The NEL CSU complaints team can also arrange dispute resolution to aid this process, including the possible use of a Lay Conciliator/Mediator. Interpreting will be offered for any meeting where this would aid communication and complainants will be informed that they are welcome to bring a friend and/or advocate to any meeting if they wish. The second Stage - Ombudsman Complainants, who are dissatisfied with the local response, may in the first instance contact the CSU Complaints Team who will review any further requests for resolution. If the request is reasonable e.g. further questions arising from a response then it is likely further work at a local level would be carried out. This must be proportionate to the complaint. Further action at a local level should be taken in a speedy capacity so not to delay any referral to Ombudsman. The person making the complaint has the right to request the Parliamentary and Health Service Ombudsman (PHSO) review the complaint. Contact details for PHSO: Parliamentary and Health Service Ombudsman Millbank Tower Millbank London SW1P 4QP Tel: phso.enquiries@ombudsman.org.uk Website: Version 2 Complaints Policy October 2015 Page 27 of 31