Patient and Service User Feedback Policy (Compliments, Concerns and Complaints) V1.2

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1 (Compliments, Concerns and Complaints) V December 2014

2 Contents 1. Introduction Purpose of this Policy/Procedure Scope Definitions / Glossary Ownership and Responsibilities Role of the Complaints Review Panel Role of Individual Staff Standards and Practice Training and Staff Support Diversity Monitoring Principles for Remedy Habitual or Unreasonable Complainants Processes separate to the NHS complaints procedures Retention of Complaints Files Dissemination and Implementation Monitoring compliance and effectiveness Updating and Review Equality and Diversity Appendix 1: Governance Information Appendix 2: Initial Equality Impact Assessment Form Appendix 3: Complaints Procedure Overview Appendix 4: Achieving Excellence in Complaints Handling (Key Drivers) Appendix 5: Understanding Your Rights in relation to this Policy Appendix 6: Guidance for Investigating and Responding to a Complaint, Concern and/or Feedback Appendix 7: Guidance for the handling of Habitual or Unreasonable Complainants Page 2 of 25

3 1. Introduction 1.1. Feedback on the services provided at the Royal Cornwall Hospitals NHS Trust, suggestions for improvement and complaints are actively solicited by the Trust. They are viewed as a positive means of enhancing the quality of services through early detection and resolution of errors. Complaints are therefore seen as an opportunity for improvement This policy sets out the way in which feedback (comments and/or concerns) and complaints are handled by the Royal Cornwall Hospitals NHS Trust The Royal Cornwall Hospitals NHS Trust will endeavour to use the principles of this policy to resolve concerns as soon as they arise, demonstrating our Trust values of Care + Compassion This policy is based on the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the Regulations) which came into effect from 1 April This policy for the handling of complaints is entirely separate from the Trust s Disciplinary Procedures An Equality Impact Assessment has been undertaken and no actual or potential discriminatory impact has been identified relating to this document This version supersedes any previous versions of this document. 2. Purpose of this Policy/Procedure 2.1. The aim of this policy is to provide all those involved in the complaints process with a clear understanding of the Trust s expectations and requirements. The policy is based on legislation, best practice and guidance from national bodies to ensure that complaints are dealt with promptly and learning is gained from patient experiences to improve services The policy also contains guidance on the assessment and management of complaints that may be termed vexatious Patients, friends, relatives and carers should be encouraged to speak openly about any comments or concerns they have in relation to their experience Staff must be familiar with the Trust s processes for dealing with feedback and complaints. 3. Scope 3.1. This policy is applied to all disciplines of staff across the Trust and the degree of responsibility will vary This policy should be applied to the management of all complaints made about the services provided by the Trust. 4. Definitions / Glossary 4.1. Complaints A complaint is defined as an expression of dissatisfaction which requires a response. It is a generic term used for types of complaints raised verbally or in writing (e.g. letter, and patient feedback forms). The procedure for dealing with different types of Page 3 of 25

4 complaints is detailed in Appendix Datix Datix is the Trust s risk management system which is used for the recording and reporting of incident, complaints, PALS, claims and organisational risks Patient Advice and Liaison Service (PALS) PALS provide frontline support to patients, their friends, relatives and carers to resolving their concerns on-the-spot by working together with staff. They help to resolve concerns quickly and efficiently. Information leaflets regarding the PALS service are available in clinical and non-clinical areas throughout the Trust Independent Complaints Advocacy (SEAP) SEAP help individuals to pursue complaints about the NHS, ensuring that complainants have access to the support they need to articulate their concerns, maximising the chances of complaints being dealt with quickly and effectively. SEAP will determine the level of support required according to the complainants needs. As well as providing advice, the service provides advocacy to write letters and attend meetings to speak on the complainants behalf Parliamentary and Health Service Ombudsman (PHSO) If the Trust cannot achieve resolution to a complaint, the complainant has the option to approach the Parliamentary and Health Service Ombudsman (PHSO) for their concerns to be considered. The Ombudsman will assess if the Trust has acted fairly in the complaint investigation and if the response has adequately addressed the concerns raised. 5. Ownership and Responsibilities 5.1. The Chief Executive The Chief Executive has overall responsibility for the management of complaints and, together with the Trust Board, Executives, Divisional Directors and Senior Management teams, is responsible for ensuring that lessons are learnt from poor experiences. We are committed to continuously improve the standard of care and treatment to patients, carers and relatives following the investigation of complaints. They are also responsible for ensuring the successful implementation of this policy across the organisation Complaints Manager The role of the Trust s Complaints Manager is fulfilled by the Patient Experience Manager who reports to the Head of Quality, Safety and Compliance in all matters relating to the implementation of the Trust s policy and procedures for handling complaints. They are responsible for the implementation of a training programme for effective complaints handling to ensure that all staff receive adequate help, guidance and support Divisional General Managers and Directors Divisional General Managers and Directors are responsible for overseeing and monitoring complaints within their Directorate. They will nominate investigating officers and provide support and assistance throughout the complaint investigation Divisional Nurse The Divisional Nurses are responsible for ensuring effective complaints management Page 4 of 25

5 within their Division and for providing clinical support to investigations. They will ensure that all nursing and midwifery staff receive training in the effective handling of complaints The Divisional Management Team Divisional General Managers, Divisional Directors and Divisional Nurses are responsible for ensuring investigations are comprehensive, open and honest. They will ensure action plans are robust and that immediate action is taken to improve services where this is identified. All complaints, concerns and feedback received should be discussed through Divisional governance procedures to ensure best practice and learning is shared widely Designated Complaints Handlers All designated complaints handlers will be responsible for ensuring that this policy is adhered to and that the processes as described are followed. 6. Role of the Complaints Review Panel The Complaints Review Panel is responsible for: Monitoring and identifying trends and themes that may appear in relation to complaints, concerns and/or patient feedback. The panel will receive assurance of the completion of Divisional action plans and will provide recommendations on preventing the recurrence of complaints where necessary. 7. Role of Individual Staff All staff members are responsible for: Managing, and wherever possible resolving complaints in line with the Trust policy. Distinguishing the seriousness of concerns raised and bringing these to the attention of Senior Managers within the Trust for example if the concerns raised relate to Patient Safety and/or Safeguarding. To co-operate within the investigation of a complaint, including meeting with complainants, if requested. All employees have a responsibility to abide by this Policy and any decisions arising from its implementation. 8. Standards and Practice 8.1. The Parliamentary and Health Service Ombudsman s Principles The PHSO is responsible for investigating NHS complaints that cannot be resolved locally and published The Ombudsman s Principles which consists of best practice standards for achieving resolution. There are six principles which include Getting it right Being customer focussed Being open and accountable Acting fairly and proportionately Putting things right Page 5 of 25

6 8.2. Defining feedback The Trust welcomes all types of feedback including compliments, comments, concerns and complaints. The feedback handling arrangements are summarised in Appendices 3 and Compliments The Chief Executive replies personally to all letters of thanks and commendation received by their Office. Compliments are shared with Divisional managers and reported monthly Comments and Concerns General feedback received and/or concerns that can be dealt with immediately may be resolved directly by staff at the first point of contact or with support from the Patient Advice and Liaison Service (PALS) Complaints A complaint is an expression of dissatisfaction that can be made in writing, by telephone, and/or through web enquiries. A complaint is confirmed in agreement with the individual Who Can Make a Complaint Any patient or person who is affected, or likely to be affected by the actions, omissions or decisions taken by the Trust or by anyone acting on their behalf provided they have the authority of the patient Time Limits The time limit for making a complaint is no later than 12 months after: The date on which the matter which is the subject of the complaint/s occurred; or If later, the date on which the matter which is the subject of the complaint/s came to the notice of the complainant; The time limit shall not apply if the Trust is satisfied that the complainant had good reasons for not making the complaint within that time limit; and Notwithstanding the delay, it is still possible to investigate the complaint effectively and efficiently Confidentiality and Consent (including Third Party Complaints) All staff are expected to treat information in confidence and with sensitivity. Staff must also be aware of and comply with the Confidentiality: NHS Code of Practice. The Patient Experience Team will obtain appropriate patient permissions prior to the release of any confidential information to the complainant. Investigation of a complaint does not remove the need to respect a patient s confidentiality. In cases where a complaint is made on behalf of a patient, who has not authorised someone to act on their behalf, care must be taken not to disclose any personal health information to the complainant without first seeking the patient s permission to do so. Page 6 of 25

7 Where a patient lacks the mental capacity to make decisions, as defined by the Mental Capacity Act 2005(a), a complaint can be made by someone acting on behalf of the patient provided that the Patient Experience Manager, or in their absence a Deputy, is satisfied that the person complaining is acting in the best interest of the patient. If this is not the case the complaint will not be considered under the Regulations and the Patient Experience Manager will notify and explain the reasons for this decision in writing to the complainant Children and Young People A child is any person who has not yet reached 18 years of age. Children under 16 are not automatically presumed to be legally competent to make decisions about their healthcare, however, as the law currently stands under 16s are deemed competent to give valid consent if they have sufficient understanding and intelligence to enable him or her to understand fully what is proposed. If this is the case the child is classed as being Gillick or Fraser competent. When a complaint is made about the care and treatment involving a child who is deemed not to have sufficient mental capacity it will be necessary to obtain consent from someone with parental responsibility for him/her. Once a child reaches the age of 16, they are presumed in law to be competent to give their consent, however it is still good practice to encourage them to involve their families in decision making. If a child of 16 or 17 is not competent to make decisions, then a person with parental responsibility can take decisions for them. This will often, but not always be the parent of the child. The Children s Act 1989 sets out the following as people who would have parental responsibility: The child s parents provided they were married to each other at the time of conception/birth. The child s mother, but not father if they were not married unless he has acquired parental responsibility via a Court Order; has a parental responsibility agreement; the couple has subsequently married; or the child was born on or after the 1 December 2003 and the father is named on the birth certificate. The child s legally appointed guardian appointed by a Court or by a parent with parental responsibility in the event. Where the child is in the care of a local authority or a voluntary organisation, the representative must have appropriate authority to act. However, if it is considered by the Patient Experience Manager or their Deputy that the person making the complaint is not acting in the best interests of the child then the complaint will not be considered under the Regulations and the complainant will be notified in writing of the reason/s for this decision Being Open Page 7 of 25

8 The Trust is committed to ensuring that the philosophy for the NPSA document Saying Sorry When Things Go Wrong Being Open is underpinned in all responses provided to complainants. Furthermore the Trust will be proactive in contacting patients and/or relatives to provide explanations of any remedial action that has or will be taken to prevent similar events occurring in the future Multi-Agency Complaints Where a complaint involves more than one organisation and/or agency the complaint will be managed in accordance with the South West Multi-agency Complaints Procedure Acknowledgment All complaints will be acknowledged in writing within 3 working days. Acknowledgement to complaints can also be made by and telephone. When a complaint is received by the Trust the Patient Experience Team will contact the complainant to agree the issues they would like to be addressed within the complaint investigation. A meeting with relevant staff will be offered for resolution should this be appropriate. We will keep the complainant informed throughout the progress of the investigation and we will advise them if more time is needed to respond to their concerns. See Appendix 5 to understand your rights as a complainant. The Patient Experience Team will also request appropriate patient and/or next of kin permission to release confidential information following the complaint investigation in accordance with our Information Governance requirements Investigations into Complaints and Concerns Complaint investigations will be conducted by a nominated investigation officer. The Patient Experience Team will advise complainants of the anticipated timescale for the completion of the investigation and will keep the complainant update on progress accordingly. Where a complaint involves several areas within the Trust, a lead Division will be nominated to liaise with all other specialties involved. This is to ensure that all the information provided is accurate and that joint learning actions can be identified and implemented. An external investigation can be undertaken if it is believed that an internal investigation may not offer an independent view. In such circumstances the Patient Experience Manager will liaise with senior colleagues to identify an external specialist. All investigation and relevant documentation will be reviewed and approved by Divisional Management Teams and quality checks undertaken by the Patient Experience Team before being submitted for Chief Executive review. Clinicians and staff should not investigate complaints made about them. In such instances, independent opinion and review will be arranged by the Patient Experience Team Responses The Trust aims to investigate and provide a full response to complaints within 25 Page 8 of 25

9 working days. However, in cases which are graded as high, are complex complaints, or where other NHS organisations or the Local Authority are involved, the response period may be extended to 60 working days. When a complaint is graded as high risk it is expected that a root cause analysis will be undertaken by the complaint investigating officer and an action plan devised. The timeframe will be determined by the Patient Experience Team handler dealing with the complaint and in consultation with the complainant. If any delay occurs in the investigation, the Patient Experience Team will telephone or write to the complainant explaining the reason for the delay as soon as this is anticipated and will agree a revised response time. The Chief Executive and/or nominated deputy will respond in writing to all investigated complaints. The written response will include a summary of actions taken and where service improvements have been identified to put things right. Complainants will be advised on what to do if they remain dissatisfied with their response i.e. they will be given the details of the Parliamentary and Health Service Ombudsman. Complainants will be offered a meeting with relevant staff if it is believed this will result in the resolution of their concerns. Meetings with staff will take no longer than 1 hour to discuss the key elements of the complaint. Senior Managers and/or nominated staff members can respond to concerns raised with assistance from PALS as required. The Patient Experience Team is responsible for sending out the signed Chief Executive response to the complainant following the complaint investigation. A copy of the final response will also be sent to complaint investigating officer for their records and to discuss the outcomes with relevant staff Record Keeping Complaints records must be kept separate to a patient s health records and documentation must not be filed in a patient s medical records. Details of complaints received by the Trust are recorded on the Datix system Reporting and Monitoring The Trust will maintain an accurate record of complaints received including date, subject, response, investigation documentation and/or contact notes. The Trust will prepare an annual report which will be available to any person on request. Divisional Management Teams will receive bi-weekly, monthly and quarterly complaints performance reports for monitoring patient feedback and ensuring that learning is cascaded to all relevant staff. Trust Management Committee Group (TMCG) will receive a quarterly report on patient experience activity including service user feedback prepared by the Patient Experience Manager. Complaints should be monitored and discussed within Divisional specialty governance arrangements and disseminated through the Divisional quality meetings. Complaints Review Panel (CRP) will meet quarterly to review patient feedback Page 9 of 25

10 activity (complaints, comments and concerns), identifying trends and themes and providing recommendation on organisation wide learning from complaint investigation outcomes. Patient Experience Group will meet quarterly to review patient experience activity (Surveys, Friends and Family Test, Patient Ambassador feedback and Kindamagic) Learning from Patient Feedback The Trust is committed to implementing actions following the investigation of complaints and patient feedback to prevent similar events recurring and improving the standards of care provided to patients. The Trust has systems in place to ensure lessons have been learnt from complaints and patient feedback. Action plans are developed within the complaint investigations and are shared with the complainant for assurance. In addition to this patient feedback is shared with staff (e.g. Friends and Family Test comments are cascaded to all relevant staff on a weekly basis). It is important that lessons are learnt when things go wrong and blame is not apportioned to any individual. However, staff will be held accountable if a complaint is upheld against any of their actions Patient Experience Satisfaction Survey We are committed to listening to the views of our patients, their friends, relatives and/or carers in an effort to continuously improve our processes and systems for complaints handling (also see the Trust Patient Experience Strategy). The Trust will ensure that every complainant receives a feedback form and is offered the opportunity to comment on their experience of the Trust complaints procedures. Feedback will be monitored for satisfaction in the complaints handling processes and not the outcome of the complaint Other possible Investigations If during the investigation of any complaint the Patient Experience Manager or their Deputy identifies that the complaint requires action under any of the following: An investigation under the Trust disciplinary procedure One of the professional regulatory bodies An independent inquiry into a Serious Incident under Section 84 of the NHS Act 1977 An investigation of a criminal offence A major public relations incident They will notify the Head of Quality, Safety and Compliance, the Nurse Executive or nominated Deputy. If it is decided that disciplinary action is to be taken then the complaints procedure will stop with regard to that aspect of the complaint and the complainant will be informed. Page 10 of 25

11 If a complaint is also a serious incident there would normally be no need to produce two separate reports, the root cause analysis used should cover all aspects of the investigation. However, if the complaint has other issues unrelated to the incident then this will need to be answered separately. In such instances, the Patient Experience Manager and Quality Improvement Manager will agree the boundaries of the investigation to ensure it is comprehensive and answers all aspects of both the complaint and incident. 9. Training and Staff Support Being implicated in a complaint can be distressing to the member/s of staff concerned. Therefore, Line Managers have a duty to support staff in those circumstances. Staff can also approach the Patient Experience Team for advice on the process and additional support. Staff who are the subject of a complaint must have the opportunity to see the relevant information contained in the complaint and in the final response letter. Training will be delivered through a robust programme of sessions based on different levels of staff responsibility within the complaints process. The Patient Experience Team is available to meet with staff on an individual or team basis to provide additional support and guidance. Investigating Officers will be expected to attend Complaint Investigating Officer Training every two years at a minimum. Support will be given to staff throughout the complaints investigation process by their immediate Line Managers and/or the Patient Experience Team. See Appendix 6 which describes the role of the investigating officer and support available. 10. Diversity Monitoring The Trust is required to collect ethnicity information for monitoring and evaluating the service it provides. Provision of this information is optional. 11. Principles for Remedy The Trust recognises that in the event that our services have fallen below the expected standards it will be necessary to consider appropriate remedies. The Trust s objective is to be fair and reasonable, acknowledging failures and/or shortfalls and apologise for them. We will also take the required action to improve services. 12. Habitual or Unreasonable Complainants A small minority of people will take up a disproportionate amount of staff time and resources dealing with a complainant s perceived problem even when explanations have been given and all reasonable attempts have been made to resolve their concerns. These cases can cause undue stress to staff and staff members are advised to refer to Appendix 7 which offers guidance on the handling of habitual and/or unreasonable (vexatious) complainants. Page 11 of 25

12 13. Processes separate to the NHS complaints procedures NHS Private Pay Beds Complaints relating to medical care provided under private arrangements must be pursued with the practitioner concerned. The Trust will address complaints in accordance with this policy that refer to facilities and NHS support staff involved in private patient treatment Loss and Compensation Claims The Trust has separate policies and procedures for the management of loss and compensation. These will be dealt with by the Legal Department and/or the General Office Legal Proceedings and Disciplinary Processes The complaints procedure is a separate and distinct process from both legal and disciplinary proceedings. Claims made under civil law will be handled by the Legal Services Department under the Trust Claims Management Policy. The complaints procedure cannot be used in human resource or staff disciplinary matters Coroners The fact that a death has been referred to the Coroner s Office does not mean that all investigations into a complaint need to be suspended. It is important for NHS bodies to consult the Coroner s Office, and where appropriate, initiate proper investigations. The Patient Experience Manager will initiate investigations and where necessary, will arrange to extend these investigations if the Coroner so requests. A copy of the final report following completion of the complaints investigation will be forwarded to the Coroner for information Counter Fraud If any member of staff involved in the investigation of a complaint believes that the complaint is of a potentially fraudulent nature, the Patient Experience Manager must be advised. They will refer this in confidence to the Trust s Counter Fraud Specialist who will investigate all allegations about fraudulent matters in a professional and confidential manner. If any member of staff believes that fraud could be happening in the workplace they should report their suspicions directly to the Trust s Counter Fraud Specialist. All complaints of this nature will be treated in confidence and staff can remain anonymous. It is important that members of staff do not take any action directly themselves. 14. Retention of Complaints Files Divisional Management Teams should ensure that in all cases, complaints correspondence which contains patient identifiable and confidential information should be stored in a secure cabinet which is locked and that information and files are only shared in the groups/directorates on a need to know basis. Requests for copies of files by complainants must be made in writing to the Data Protection Officer, clearly stating the reason for the request. Complaints files are disclosable should a legal claim be made to the Trust following the outcome of a complaint. Complaint files will be shared with the Parliamentary and Health Service Page 12 of 25

13 Ombudsman on request. Complaint files will be kept for 8 years from completion of action before being destroyed in accordance with the Trusts Retention of Records Policy. 15. Dissemination and Implementation This policy will be disseminated to all staff and will be accessible on the Trusts Documents Library, replacing the 4C s Policy. Arrangements will be in place for staff training and support as part of the Patient Experience Team training programmes. 16. Monitoring compliance and effectiveness Element to be monitored Implementation of the across all areas of the Trust. Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Nurse Executive/ Deputy Chief Executive Head of Quality, Safety and Compliance Patient Experience Manager Complaints Review Panel Patient Experience Group Patient Experience and Engagement Strategy Implementation Plan (separate enclosure to this Policy) Progress will be monitored and reported to the Complaints Review Panel on a quarterly basis. Exception and summary reports will be provided to Trust Management Committee Governance accordingly. Required actions will be identified and completed in a specified timeframe as agreed by the Complaints Review Panel and relevant Trust Committees and Groups. Required changes to practice will be identified and actioned within agreed deadlines for completion. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders. 17. Updating and Review The Policy will be reviewed in no less than three years. Where appropriate, the author may set a shorter review date. Revisions can be made ahead of the review date when the document requires updating. Where the revisions are significant and the overall policy is changed, the author should ensure the revised document is taken through the standard consultation, approval and dissemination processes. Where the revisions are minor, e.g. amended job titles or changes in the organisational structure, approval can be sought from the Executive Director responsible for signatory approval, and can be re-published accordingly without having gone through the full consultation and ratification process. Page 13 of 25

14 Any revision activity is to be recorded in the Version Control Table as part of the document control process. 18. Equality and Diversity This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Royal Cornwall Hospitals NHS Trust is committed to promoting and creating equal right and diversity and working towards all forms of discrimination, inequality, exclusions, victimisation, harassment and bullying. There is nothing in this policy to suggest that one group of people will be affected or treated differently to another, this has been determined by using the Trust initial equality impact assessment screening tool. Page 14 of 25

15 Appendix 1: Governance Information Document Title Date Issued/Approved: 17 December 2014 Date Valid From: 17 December 2014 Date Valid To: 17 December 2017 Directorate / Department responsible (author/owner): Quality, Safety and Compliance Lana-Lee Jackson (Patient Experience Manager) Contact details: Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: The aims to ensure that staff are aware of the statutory requirements and what is expected of them in terms of handling comments, concerns and complaints. It also promotes a culture of openness and transparency when dealing with all feedback and ensures that lessons are learnt and that service improvement takes place as a direct result of feedback. Complaints, Concerns, Compliments, Plaudits, Patient Experience, Feedback RCHT PCH CFT KCCG Nurse Executive Date revised: 17 December 2014 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Compliments, Comments, Concerns, Complaints (4C s) Policy and Procedures Trust Management Committee Governance (TMCG) Head of Quality, Safety and Compliance Not required {Original Copy Signed} Internet & Intranet Intranet Only Quality, Safety and Compliance CQC Outcome 17 NHSLA Risk Management Standards Page 15 of 25

16 Criterion 5.3; 5.5;5.6;5.7;5.10 Related Documents: Training Need Identified? The Local Authority Social Services and National Health Service Complaints (England) Regulations The Human Rights Act 1998 Data Protection Act 1998 Department of Health Listening Responding Improving A Guide to Better Customer Care. The Ombudsman s Six Principles of Good Complaints Handling. The NHS Constitution. Confidentiality: NHS Code of Practice. NHS Code of Conduct for Managers. RCHT Patient Experience Strategy RCHT Disciplinary Procedure. Being Open Policy and Procedure. Health & Safety Policy on Prevention of Abuse, Violence and Aggression in the Workplace. Risk Management Strategy Serious Incident Management Policy and Procedure Incident Reporting and Management Policy and Procedure Equality & Diversity Policy Core Training Policy Yes Version Control Table Version Date No Summary of Changes V1 Policy re-written for consultation V1.1 Amends made following consultation and policy approved by Complaints Review Panel Changes Made by (Name and Job Title) Lana-Lee Jackson (Patient Experience Manager) Lana-Lee Jackson (Patient Experience Manager) V1.2 Amends made following Trust Management Committee Governance review. Reference made to Trust Values (Care + Compassion). Lana-Lee Jackson (Patient Experience Manager) All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 16 of 25

17 Appendix 2: Initial Equality Impact Assessment Form Directorate and service area: Quality, Safety and Compliance Name of individual completing assessment: Lana-Lee Jackson (Patient Experience Manager) 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Is this a new or existing Policy? Existing (previously 4C s Policy) Telephone: All staff Patients Relatives and/or Carers 2. Policy Objectives* Improving patient experiences by promoting greater feedback from patients, relatives and/or carers in relation to the services provided by the Trust. 3. Policy intended Outcomes* Robust complaints handling procedures in accordance with national legislation. See appendix 4 in relation to key drivers. 4. *How will you measure the outcome? See appendix 4 5. Who is intended to benefit from the policy? Patients Relatives and/or carers Staff 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? Yes b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. Yes Patient Ambassadors Healthwatch groups (Cornwall and Isles of Scilly) Commissioners (KCCG) 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age X Promotes involvement, engagement and feedback from all service users regardless of age and encourages the development of initiatives targeted at seldom heard groups i.e. young people Sex (male, female, transgender / gender reassignment) X Promotes involvement, engagement and feedback from all service users regardless of gender Race / Ethnic communities /groups Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs X X X Promotes involvement, engagement and feedback from all service users regardless of ethnicity Promotes involvement, engagement and feedback from all service users regardless of disability Promotes involvement, engagement and feedback from all service users regardless of religious belief Page 17 of 25

18 Marriage and civil partnership X Promotes involvement, engagement and feedback from all service users regardless of marital status Pregnancy and maternity X Promotes involvement, engagement and feedback from all service users. Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian X Promotes involvement, engagement and feedback from all service users regardless of sexual orientation You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No X 9. If you are not recommending a Full Impact assessment please explain why. Not required as no protected groups are adversely compromised or affected by the implementation of this policy. Signature of policy developer / lead manager / director Date of completion and submission 28 July 2014 Names and signatures of members carrying out the Screening Assessment 1. Richard Johnson (Head of Quality, Safety and Compliance) 2. Lana-Lee Jackson (Patient Experience Manager) Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 18 of 25

19 Appendix 3: Complaints Procedure Overview Patient Advice and Liaison Service (PALS) 0-10 working days On the spot support ( here and now issues ) General advice and signposting Facilitate 1:1 support from staff to resolve concerns in a timely manner Attend meetings to provide support in the resolution of concerns Concerns, comments and/or feedback shared with Divisional complaints handlers for review and action Divisional Manager and/or Service Lead to contact individual/s as required, discussing the issues raised and agreeing any actions of remedy Divisions to share details of the PALS contact outcome, learning actions and/or final contact details with the PALS Team to be recorded onto the Datix system and the file closed Feedback Received (Verbal/ Letter/ / Web) All complaints and concerns are risk assessed using the Trust s risk assessment matrix Legal/Criminal or Disciplinary Proceeding (i.e. ineligible cases for investigation under the NHS complaints procedures) closed and confirmation sent to the complainant Concerns resolved Complaint Acknowledgement 3 working days Acknowledged by phone, letter, All details logged onto the Datix system Permissions requested (as necessary) Multi-agency protocol initiated (as necessary) Identify Lead Division/ Investigating Officer/s Complaint Investigation working days Investigation Plan agreed with the complainant All relevant documentation sent to Lead Division (and Investigating Officers) Investigation completed within agreed timescales Divisional Management Team approval of the investigation outcomes and learning actions All documentation submitted for quality checks (ceresponses inbox) Response finalised and submitted for Chief Executive review and approval File Closed Service Evaluation Form Sent Escalate concerns to the Complaints Team Concerns unresolved Provide details of the PHSO Offer a meeting (if appropriate)

20 Appendix 4: Achieving Excellence in Complaints Handling (Key Drivers) Aim Processes and Structures Activities To provide a customer focussed patient feedback and complaints service. Measured by A reduction in written complaints Reduction in breached timescales Improved quality of investigations Increased complainant satisfaction Increased staff satisfaction Our Culture: We welcome and learn from patient feedback, comments, concerns and complaints We have robust complaints procedures to achieve local resolution We monitor trends and themes in complaints and patient feedback to detect problems early and take action to put things right We achieve good patient and service user experiences Staff training programmes for dealing with complaints and concerns appropriate to their role Complaint investigating officer support and coaching Increased opportunities for patient feedback through PALS, SEAP, Healthwatch and events Accessible and well-publicised patient feedback procedures. Patient Experience focussed noticeboards Standard operating procedures monitoring of complaints and alert systems for escalation Systems for collecting and acting of patient feedback Reporting mechanisms to collect data at all levels of the Trust Regular monitoring (Ward to Board) Staff encouraged to act on feedback through CARE Campaign and Ward Safety Briefings

21 Appendix 5: Understanding Your Rights in relation to this Policy As a patient, your legal rights are summarised in the NHS Constitution which also explains what you can do if you think you have not received the service expected. You have the right not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, religion or belief, sexual orientation, disability (including learning disability or mental illness) or age. You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. You have the right to privacy and confidentiality and to expect the NHS to keep your confidential information safe and secure. You have the right to have any complaint you make about NHS services dealt with efficiently and to have it properly investigated. You have the right to know the outcome of any investigation into your complaint. You have the right to take your complaint to the independent Health Service Ombudsman, if you are not satisfied with the way your complaint has been dealt with by the NHS. You have the right to make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body. You have the right to compensation where you have been harmed by negligent treatment. The NHS also commits: to ensure you are treated with courtesy and you receive appropriate support throughout the handling of a complaint; and the fact that you have complained will not adversely affect your future treatment (pledge); when mistakes happen, to acknowledge them, apologise, explain what went wrong and put things right quickly and effectively (pledge); and to ensure that the organisation learns lessons from complaints and claims and uses these to improve NHS services (pledge).

22 Appendix 6: Guidance for Investigating and Responding to a Complaint, Concern and/or Feedback These guidelines are intended to assist any individual who has been asked to investigate a complaint, concern or prepare a written statement and response in reply. Investigating A Divisional lead person will be identified to co-ordinate the investigation of the complaint under the Divisional operational procedures in place in line with the Patient and Service User Feedback Policy. In order to successfully resolve a complaint or concern, a thorough and complete investigation must be taken. Read the letter of complaint and any supporting information at least twice and where appropriate review case notes before deciding who you need to speak to. If you re uncertain which aspects of the investigation are your responsibility ensure that you check this with the Patient Experience Team. Unless there is a good reason not to, ensure that staff who are being asked for information see the complaint letter. This will be your request in context and help you in getting as much relevant information as possible. Approach the investigation by thinking what you would like to know if you had made this complaint about your own care or the care of one of your relatives. Establish all the facts (i.e. what happened, what should have happened and what is the difference between these two things?). If it isn t possible to answer all the questions say why. Complete all complaint investigation documentation including all relevant evidence. Do not be defensive, openness and honest will help to ensure the best outcome for everyone as quickly as possible. Responding Tell the story (what happened and why) The response should be factual detailing events and any subsequent actions clearly as possible. The response must answer all aspects of the complaint and/or concerns When referring to other people, state clearly their full names and designations. Refer to relevant other documents (e.g. Policies, assessment and procedures etc.) Avoid jargon and short hand. If medical terminology must be used provide explanations and translations. Dates and time should always be referred to in full (e.g. 07:30 hours on Friday 03 January 2014, not 7.30 on 03/07) The response must make sense. Present a coherent explanation of events, if this cannot be done then the investigation has not concluded. Include details of the investigation outcome; an explanation of planned action must be included. Where appropriate an apology must be given for any identified shortfalls. Before submitting your investigation findings check that it Answers all the questions and explains things in a way that can be easily understood by a nonmedical person Provides an appropriate apology Tells the complainant how we are going to put things right Remember Never place copies of complaint investigation documents in a patient s records Respond by the timescale that has been given to you If you need further help or support preparing a response please contact the Patient Experience Team for advice Page 22 of 25

23 Appendix 7: Guidance for the handling of Habitual or Unreasonable Complainants 1. Introduction These guidelines identify situations where a complainant is considered to be habitual or unreasonable and provide staff with a strategy to handle these situations. These guidelines must only be used as a last resort and after all reasonable measures have been taken to try to resolve the complaint in accordance with local resolution under the NHS Complaints Procedure. 2. Local Resolution (NHS Complaints Procedure) Complaints about the services provided by the Royal Cornwall Hospitals NHS Trust are processed in accordance with the local resolution stage of the NHS Complaints Procedure, which is summarised below: Acknowledgement letter sent out within 3 days of receipt of the written complaints. Acknowledgement may also occur through and on the telephone. Patient Experience Team request appropriate Division(s) to undertake an investigation. Patient Experience Team to receive the outcome of the Divisional investigation within allocated timescale. Within working days of receipt of the complaint the Patient Experience Team will formulate a final response for the Chief Executive to sign. Complainant is provided information about what to do if they remain dissatisfied with the Trust response. The Trust responds fully to all complaints and ensures that The is adhered to rigorously. Complainants are given the opportunity to exhaust local resolution. Complainants are provided with information on further action that can be initiated should they remain dissatisfied e.g. Parliamentary and Health Service Ombudsman. The above steps ensure that the rights of complainants are safeguarded and that there is a consistent approach to all complaints, reducing the risk of the Trust s handling of the complaint being criticised by external agencies. 3. When Local Resolution Fails There will be occasions when complainants remain dissatisfied with the response they receive and in such circumstances can request the Parliamentary and Health Service Ombudsman to undertake and independent review of their concerns. 4. Definition of a Habitual or Vexatious Complainant All Trust staff endeavour to respond with patience and sympathy to the needs of complainants. However, there are times when a complainant will remain dissatisfied with the outcome of local resolution and nothing further can reasonably be done by the Trust to assist or rectify a real or perceived problem. A small number of complainants who remain dissatisfied with the Trust response to their complaint will persist to voice their dissatisfaction verbally or in writing and inevitably absorb a disproportionate amount of NHS time and resources. It is accepted that a person making a complaint is usually already distressed because of the event/s leading to the complaint itself and therefore may act out of character. Page 23 of 25

24 The Trust recognises that everyone is unique, some people may find it difficult to communicate, some may be aggressive, have mental health problems, have social or emotional problems, or be lonely or lack support. Staff should be sensitive to these circumstances and make some allowances for types of behaviour that may be unreasonable or out-of-character. It is difficult to give a definite description of a vexatious complainant. There is no particular feature of vexatious behaviour, and most types of behaviour may be understandable in certain circumstances. However, a person may be indicative of being a habitual or vexatious complainant when they meet one or more of the following criteria: - Persistent in pursuing a complaint where the NHS complaints procedure has been fully and properly implemented and exhausted. Changing the substance of a complaint or continually raising new issues to seek to prolong contact by continually questioning receipt of a response whilst the complaint is being addressed. Care must be taken not to discard new issues, which are significantly different from the original complaint and may need to be addressed as a separate complaint. Unwillingness of the complainant to accept documented evidence of treatment given as being factual, accept that facts can be difficult to verify if a long period of time has elapsed or denial of receipt of an adequate response despite the response specifically answering their questions. Identification of the specific issues the complainant wants investigating being unclear despite reasonable efforts by Trust staff and where appropriate, the involvement of advocacy services (e.g. SEAP) to help the complainant identify their concerns and/or where the concerns identified are not within the remit of the Trust to investigate. Threatened physical violence or actual violence against staff. Harassment, personal abuse or verbal aggression towards staff dealing with the complaint. Meetings or face-to-face/telephone conversations tape recorded by the complainant without the prior knowledge or consent of the other parties involved. Unreasonable demands/expectations made and failure to accept these may be unreasonable. Complete unwillingness by the Complainant to comply with the NHS Complaints Procedure and determination to proceed with their own agenda. Complainants who do not fall within any of the above categories may nevertheless be considered to be habitual or vexatious depending on the circumstances and with the discretion of the Trust. 5. How to deal with Habitual or Vexatious Complainants When a complainant is categorised as habitual and/or vexatious in terms of the above criteria, any action to be taken will be determined by the Patient Experience Manager or Deputy. Action should be specifically targeted to try to assist the individual and staff involved. The action that might be taken could be one or more or the following: - Draw up a signed agreement with the complainant which sets out a code of behaviour for the parties involved, if the Trust is to continue to process the complaint. If the agreement is then contravened, other action may be considered. Decline contact with the complainant either in person, by telephone, by fax, by letter, by or any combination of these, provided that one form of contact is maintained, alternatively restrict contact to a third party. Notify the complainant in writing that the Chief Executive (or Deputy) has responded fully to the points raised and has tried to resolve the complaint; and that there is nothing to add and continuing contact on the matter would serve no real purpose. The complainant should also be notified that the correspondence is at an end and that further correspondence will be acknowledged but not answered. Inform the complainant that in extreme circumstances the Trust reserves the right to pass unreasonable or vexatious complaints to its solicitors; and/or Page 24 of 25

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