Raising concerns or complaints about the NHS

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1 Independent Complaints Advocacy Northumberland You can, We can, ICAN Raising concerns or complaints about the NHS A step by step guide to help you raise a concern or complaint about any service provided by the NHS

2 Contents Introduction How to get the most from this guide 3 How does ICAN help? 3 Making a complaint about the NHS 4 The NHS complaints procedure 6 Stage 1: Local resolution 6 Stage 2: The Parliamentary and Health Service Ombudsman 9 Writing a complaint letter 12 More information Letter of complaint guide 13 Getting your patient records 15 More about PALS 17 Useful addresses 18 ICAN: Independent Complaints Advocacy in Northumberland 1

3 Introduction The National Health Service (NHS) works hard to treat everyone properly and promptly. The majority of people who use the health service are happy with their treatment; however, sometimes things can go wrong. If you are unhappy with a service you or someone else has received from a doctor (GP), hospital, dentist, optician or any other NHS service, you can raise your concerns and/or make a complaint. Raising your concerns can help ensure things are corrected quickly and the NHS can learn from your experience. This may include an explanation, an apology and information about how the NHS has learnt from your experience to improve services. The Independent Complaints Advocacy Northumberland (ICAN) service is provided by Healthwatch Northumberland and is here to support you as a resident of Northumberland to raise a concern or complaint about the NHS. Remember - You can raise concerns, We can support you Through the ICAN service! Healthwatch Northumberland is run by Adapt (North East), a social enterprise working with and for communities. ICAN: Independent Complaints Advocacy in Northumberland 2

4 How to get the most from this guide This guide aims to help you feel confident to raise your concerns. It can also be used if you simply want to share your thoughts with staff about something that has happened. We hope this guide will give you the information you need to make a complaint yourself. It will: Explain the different ways you can complain Offer helpful tips Tell you how ICAN may help you Services provided by the NHS include: Family doctors Dentists Opticians Pharmacists (chemists) Hospital departments Ambulance services NHS services in prisons How does Independent Complaints Advocacy Northumberland (ICAN) help? ICAN is part of Healthwatch Northumberland and can help residents of the county complain or raise a concern about NHS care and treatment, including in care or nursing home places provided by the NHS. ICAN is a free, independent and confidential service. An advocate will contact you as soon as possible, listen to your concerns and then discuss any support you may need to make your complaint. They will provide information on the different ways you can raise your concerns and on the processes involved. Advocates are skilled and experienced in providing support and will consider what you wish to achieve from your complaint. This may be an explanation, an apology or improvements to NHS services. ICAN advocates can: Give you an opportunity to discuss your concerns confidentially with someone independent of the NHS Explore the options available to you at each stage of the complaints process Help you with writing letters to the right people Help you prepare for meetings and attend them with you, if you wish ICAN: Independent Complaints Advocacy in Northumberland 3

5 Contact and speak to others, if you wish Help you consider whether you are happy with the responses from the NHS Advocates will not try to influence your course of action and will always respect your decisions. ICAN advocates cannot: Support you to make complaints about healthcare and/or nursing home provision that you have paid for yourself. In both cases you will need to follow the complaints procedure of the organisation that provided the service. Help you complain about social care services provided or commissioned by Northumberland County Council. However, Healthwatch Northumberland can give you information about these processes. Telephone us on , or Making a complaint about the NHS You may wish to complain about something that happened to you or someone else. If you are complaining on someone else s behalf: You will normally need to get their permission in writing and provide this with the complaint. If the individual is unable to give their permission because of illness or another reason, you may still be able to complain if you explain this. The NHS will consider what you say and reply to you. As a parent or guardian you can complain on behalf of a child. However, you must have their permission if they are old enough to understand the process. (Young people aged under 18 can complain without getting the permission of an adult if they wish.) You can submit a complaint after someone has died even if you did not get written permission beforehand. If the NHS decides you are not the right person to make the complaint, they will explain why. Step 1: Why are you unhappy? As you start the process it is important to be clear what elements of your NHS care you are unhappy with. This can be any part of the NHS care you have received, and could include: How long you had to wait Failure to diagnose, or misdiagnosis of, a condition Your medical or other treatment Your nursing care Attitude of staff Communication problems ICAN: Independent Complaints Advocacy in Northumberland 4

6 It may be helpful to make a note of what you wish to complain about, as you may wish to refer back to this later. Step 2: What do you wish to achieve? Think about what you hope will happen because of your complaint. Be as specific and realistic as you can and be aware there are limits to what can be achieved using the NHS complaints procedure. You can discuss this with an ICAN advocate. If the outcome you seek is more likely to be reached through another route, ICAN advocates can provide information on who best to contact. Step 3: Who should I raise a concern with? Once you are clear on precisely what you are unhappy about you need to decide how best to raise your concerns. There are different ways you can do this and it helps to think about what you feel comfortable with. Speak to a member of staff Many complaints or concerns are caused by misunderstandings or poor communication that can often be quickly put right. If you feel able to, discuss your concerns with a member of staff directly involved in your care, or their manager. This will often be the quickest way to rectify the situation and stop it getting worse. Speak to the Patient Advice and Liaison Service (PALS): PALS is an NHS service. There is a PALS for each NHS Trust, including the North East Ambulance Service. The service usually can be found in hospitals, and staff can provide immediate help for people who have concerns. Speak to PALS if you are unsure who to talk to or do not feel able to talk to staff yourself. PALS gives information, advice and support not just to patients but also to their carers and families. It can be contacted on Freephone: , and sms/text: Complain through the NHS complaints procedure This may be the best route to take if: You have raised concerns that have not yet been resolved What happened raises serious questions about the quality of care in the NHS You wish to raise complex issues which may require investigation Your concerns cover more than one organisation ICAN: Independent Complaints Advocacy in Northumberland 5

7 The NHS complaints procedure The NHS complaints procedure aims to resolve your complaint locally. Stage 1: Local resolution The aim of local resolution is to try to address your concern directly with the NHS organisation in question. The NHS aims to respond to you efficiently, sensitively and promptly. Local resolution is an opportunity to explain what it is you are unhappy with and how you wish this to be addressed. It gives both you and the NHS organisation time to listen and consider the incident. Local resolution is important because it works to resolve your concerns and, where possible, use your experiences to improve services. It is important to identify everything you are unhappy with at this point, as you cannot add more issues later. It may be helpful to keep a note of all phone calls you make and any letters or e- mails you write or receive. Write down who you spoke or wrote to, any important points and any dates that were agreed. How long you have to complain You should make your complaint within: Twelve months of the incident happening, or Twelve months of realising that you have something to complain about The NHS can use its discretion to look at issues beyond these timescales. For example, if you were too ill to make the complaint straightaway, the NHS will consider if it is still possible to investigate the matter effectively and fairly. How do I complain? You can: Send an or letter Make a phone call Go in person NHS organisations tend to prefer having complaints in writing. However, if you would rather telephone or go in person, the complaints manager should make a written record of your complaint and provide you with a copy. Helpful tip: If you write a letter or keep a copy for yourself. ICAN: Independent Complaints Advocacy in Northumberland 6

8 Who to complain to? All NHS organisations have complaints procedures, and in most cases they will be best placed to deal with your complaint. However, for complaints about primary care and independent providers such as your GP, dentist, optician, pharmacist, health centre or other independent NHS contractor, you have two options: 1. You can complain directly to the organisation by contacting the person in charge of complaints; in most GP and dental practices this will be the practice manager. 2. If you do not feel comfortable about raising the matter with your GP or the practice manager, you can complain to either the NHS Commissioning Board or your local clinical commissioning group (CCG). All CCGs will have a complaints manager who can advise you about making a complaint. If you want to complain about your hospital or ambulance service, contact the complaints manager or chief executive of the NHS Trust. If your complaint is about more than one NHS organisation, you only need to send a letter to one of them; it will liaise with the others and provide a coordinated response. What will happen next? Sometimes it may be possible to resolve your concerns immediately. If not, they: Should acknowledge your complaint either verbally or in writing within three working days Must offer to contact you to discuss your complaint and arrange a plan to resolve your concerns; this means they will discuss how best to resolve your concerns and what you hope to achieve from raising them. They should also agree a timescale for resolving the issues and how they will keep you informed of progress. The timescales can be influenced by things like how many staff they need to speak to, how easy it is for them to access your medical records, and whether other NHS organisations are involved. If there is a problem in keeping to the agreed timescale they should contact you before it expires to amend it. Resolving your complaint: The NHS organisation should offer assistance to enable you to understand the complaints procedure, or advice on where to obtain such assistance. You may be offered a meeting to discuss your complaint and speak to staff directly about what has happened; you can take a friend, relative and/or advocate with you to any meetings. ICAN: Independent Complaints Advocacy in Northumberland 7

9 Sometimes the NHS uses confidential conciliation or mediation services. A conciliator/mediator is an independent person who can arrange a meeting with you and those involved (either separately or together) so you can all express your views and try to resolve your differences. A conciliator will only become involved if everyone agrees. Helpful tip: Prepare a list of questions to ask at the meeting and bring it with you; try to keep questions clear and concise. Remember to bring any relevant paperwork with you. After the investigation: When the investigation is finished and all meetings have taken place, the complaints manager should send you a letter containing: A summary of your complaint What the investigation found and any actions to be taken What to do if you are unhappy with the answers given Depending on the investigation, the letter may contain: An apology What actions will be taken and when Who is responsible for making this happen What steps have been taken to prevent the incident happening again It should be balanced, factual and impartial, and easy to understand, with any technical terms explained. If you have not received this letter within the timescale agreed you may wish to telephone or write to check when it will be sent. With your agreement, it may be sent by . The Parliamentary and Health Service Ombudsman (PHSO) has produced a set of six clear principles for good complaints handling, and all NHS organisations are expected to follow these. You can request details of this guidance from the ICAN service at Healthwatch Northumberland. Contact us on or access the information on our website: Alternatively, visit the PHSO website at ICAN: Independent Complaints Advocacy in Northumberland 8

10 What if I am not happy at the end of local resolution? If you are not satisfied with the reply, consider what you are still unhappy with so you can decide what to do next. It may help to review: The correspondence Meetings Any conciliation or mediation process, and whether the plan you agreed was followed Whether parts of your complaint have yet to be answered Whether you feel evidence you gave was not properly considered Whether you have achieved the outcome you wanted What more, if anything, could have been done to achieve the outcome Whether the ombudsman s good complaints handling principles have been followed What are my options? You could: Write another letter explaining what you think has not been covered Telephone the person handling your complaint and explain why you are still unhappy Request a meeting to discuss your outstanding concerns Try a different route to achieve the outcome you want review the options at step 3 on page 5. It may be that your complaint will be investigated further. The NHS organisation should discuss this with you and agree a plan, including timescales. The NHS organisation you are complaining about may feel that everything has been done to answer your complaint. If so they should advise you of that in writing. This is the end of local resolution Stage 2 The Parliamentary and Health Service Ombudsman (PHSO) You have the right to take your complaint to the ombudsman if you are not satisfied with the way it has been dealt with by the NHS. The ombudsman is independent of the NHS and of government, and its services are free and confidential. You should submit a complaint no later than one year from the date of the events you are complaining about (or from when you first became aware of the matter). The ombudsman can extend this time limit for example, if the local resolution process took longer than a year. ICAN: Independent Complaints Advocacy in Northumberland 9

11 The ombudsman is not required to investigate all the complaints referred to it; this is a matter for its discretion. It normally will not investigate your case unless you have already tried to resolve the problem using local resolution. The ombudsman can refer you back to the local resolution stage of the NHS complaints procedure if it thinks you have come to the ombudsman too soon, or that the NHS organisation has not done all it can to resolve your issues locally. The ombudsman usually will not investigate a complaint where: You do not agree with a decision made by your NHS provider but cannot offer any evidence as to why the decision is wrong or unsatisfactory It decides there is no evidence to suggest that the NHS provider acted wrongly It decides that the NHS provider or practitioner has done all they reasonably could to put things right It decides there would not be a worthwhile outcome from an investigation (for example, if the remedy sought by the complainant is not possible through this procedure) Initially, a member of the ombudsman s staff will consider whether your case meets the ombudsman s criteria for investigation. To carry out this assessment, they may need to see clinical records and other papers related to your complaint. They will contact you to ask for any papers they need and write to let you know the outcome of the assessment. At this stage, there are three possible outcomes. The ombudsman may decide: 1. Not to investigate the case, and to take no further action. 2. Not to investigate the case, but to ask the NHS provider or practitioner to take action which the ombudsman thinks would resolve your complaint more quickly, without the need for an investigation. This is called an intervention. 3. To carry out an in-depth investigation resulting in a detailed report about the case. The Ombudsman aims to complete 90% of investigations within 12 months. ICAN: Independent Complaints Advocacy in Northumberland 10

12 If your complaint is investigated by the ombudsman The ombudsman will write a detailed report about the case. If the complaint is upheld the ombudsman can make recommendations to the NHS provider or practitioner on how to put things right The Ombudsman s decision The ombudsman s decision about your complaint is final. This includes its decision whether or not to investigate your complaint, and their decision whether or not to uphold it following an investigation. Disciplinary action against an NHS staff member The NHS complaints procedure cannot be used to take disciplinary action against a member of NHS staff. However, action may be taken under a separate procedure as a result of an investigation into your complaint. Financial compensation for clinical negligence This is usually possible only through legal action. You need to speak to a solicitor who specialises in medical or clinical negligence. There are time limits for making a legal claim; you should contact a solicitor within three years of the incident When raising a concern with the NHS you can expect: To be treated with respect and courtesy To be offered support to help you raise your concerns A speedy solution to be offered where possible An explanation of what happened An apology, if appropriate Changes to be made so the same thing will not happen to anyone else Better communication between NHS staff and patients ICAN: Independent Complaints Advocacy in Northumberland 11

13 Writing a complaint letter Explain clearly what your complaint is about, and that you want it looked at under the NHS complaints procedure. If you are making a complaint on behalf of a friend or family member, include a letter from them to show you have their permission. Tips for writing a complaint letter Keep it brief: If you can, write no more than two pages Make sure your main points are clear If your complaint is long or complicated, include a diary of events Keep it clear and straightforward: Short sentences are best Explain what has upset you without using an aggressive or blaming tone Try not to repeat yourself Keep it constructive: Make your points firmly but politely Say what you want to get out of your complaint. This could include an explanation, an apology or for the service to be improved. Keep records of everything: Copy all letters you send and receive. Date them and keep them in a safe place. If you are using , file them in a similar way and make sure you have copies backed up. If you send documents to help your complaint, keep the originals and send photocopies instead Make sure your letter arrives: If you are posting it, use recorded delivery, keep the receipt and check it has been delivered by using the Track and Trace facility on the Royal Mail website Use the Request a Delivery Receipt and Request a Read Receipt options if you are sending your letter by ICAN: Independent Complaints Advocacy in Northumberland 12

14 Letter of complaint guide Below is a step to step guide to writing a letter of complaint. It may help you plan how to write your own letter. Add your address, phone number and details The chief executive and/or complaints manager (and their name) Name and address of their organisation Date Dear, Complaint about the NHS: Name and date of birth of person complaint is from or is on behalf of This is a letter of complaint about Add name of staff Where the problem happened e.g. where you were getting treatment If you are making a complaint for somebody else add: I am making it on behalf of (add name). They have agreed to this in writing. I have enclosed this letter. If are you making a complaint for someone who has died, is too ill or too young to give written permission, instead add: I am making it on behalf of (add name). He (or she) cannot complain themselves because (and add the reason). What happened to me: Describe what happened, where and when. If you have a detailed list of events you can include it with this letter as a separate sheet. Say in this section where the reader can find it. Also include what, if anything, you have done so far to try to sort things out. What I want you to look into Put the most important things first Explain why you are not happy List the questions you would like answers to, in order of importance Be brief and clear Number or bullet your points ICAN: Independent Complaints Advocacy in Northumberland 13

15 What I want from you Say what you want to happen because of your complaint e.g. o An explanation of what happened and why o An apology o Action to be taken to put things right I want you to look into my concerns in line with the NHS Complaints Procedure. I look forward to your acknowledgement of this letter. Please get back to me if you need any extra information. Yours faithfully (if the letter is to someone you do not know the name of.) Or Yours sincerely (if you have used the person s name.) Add your signature Print your name If you are also sending the letter to other people put cc. plus their names You may wish to mark the envelope as Private and Confidential. ICAN: Independent Complaints Advocacy in Northumberland 14

16 Getting your patient records When you make a complaint you may need to use your patient records. Sometimes a complaint may be about what is in your records or who has seen them. This section of the guide looks at the law regarding patient records, and what your rights are. All patient records are confidential Everyone who works for the NHS must make sure that patients records are confidential and not misused. These include records made by: Your family doctor Hospital doctors Nurses and other NHS workers Health staff paid for by the NHS but employed by private companies or charities All information on your records is confidential This includes: Visits you make to the practice, clinic or hospital Home visits Most personal information you share, e.g., about your home life Information about diagnosis, tests and referrals, medication and other treatments You can allow other people to see your records if you want. In exceptional cases the Courts can also overturn your right for confidentiality. Your right to see your own records: The Data Protection Act 1998 says you have a right to see your records except: If your doctor believes to do so would seriously harm you or other people. You can then be stopped from seeing part or all of your records. You may not be told if some of your details are kept from you. It is therefore worth asking if any parts of the records you request are not being given to you. When providing them would mean disproportionate effort by, for example, your family doctor or an NHS Trust. Disproportionate effort is not clearly defined. However, the Data Protection Information Commissioner warned against misusing this to hide information from patients. Asking for your records: Some NHS trusts and family doctors have a form to complete to get your records. They can charge you up to 10 if nothing has been added to them in the last 40 days. They can charge up to 50 for the cost of photocopying extra copies and sending them to you (this includes the original 10 charge). Costs may differ for the records of someone who has died. You should request your records if you need them as part of your complaint ICAN: Independent Complaints Advocacy in Northumberland 15

17 You should get your records within 40 days of asking for them. However, if they have been added to within the last 40 days you should get them within 21 days. NHS Trusts and GP practices must explain anything in your records that is not easy to read or understand Asking for someone else s records: You must get the person s permission in writing before applying for their records They may be too ill or is unable to give you written permission for some other reason. In this case you might need legal advice and court authorisation. People under 18 can complain without getting the permission of an adult. If they are too young to understand how to complain, someone else can do this on their behalf. You cannot complain on their behalf if they are mature enough to say that they do not want you to. You can complain after someone has died even if you did not get written permission beforehand. If the NHS decides that you are not the right person to make the complaint they must explain why. Correcting or complaining about your records: You can ask for your records to be changed if you think they are wrong. If the NHS trust or doctor disagrees with your changes you can request that a note explaining your views is added to your records. Complaints about problems with your records should be made to the Data Protection Information Commissioner (see the list of useful addresses on page 18). ICAN: Independent Complaints Advocacy in Northumberland 16

18 More about PALS What does PALS do? PALS is the Patient Advice and Liaison Service. It is part of the NHS, and you can find PALS staff in all NHS hospitals. It provides on the spot help for people who have any problems with the NHS. PALS can Tell you about the NHS and answer questions you have about health services Tell you how to get more involved in your own healthcare Give you information about other agencies and support groups Show you how to get involved in your local NHS Help you sort out problems you have when using services paid for by the NHS Tell you about the NHS complaints procedure and how to get independent support if you want to submit a complaint Pass on your concerns and suggestions to help the people running health services make improvements Look out for common problems or where services are lacking in, and warn NHS managers and policymakers ICAN: Independent Complaints Advocacy in Northumberland 17

19 Useful addresses ICAN Independent Complaints Advocacy Northumberland Healthwatch Northumberland Free post PO Box 205 Hexham NE46 9EA Action Against Medical Accidents 44 High Street Croydon Surrey CR0 1YB Telephone (Helpline): Telephone (Admin): Fax: Web: Care Quality Commission (CQC) CQC National Customer Service Centre Citygate Gallowgate Newcastle upon Tyne NE1 4PA Telephone: Fax: Care Quality Commission (CQC) Head Office Finsbury Tower Bunhill Row London EC1Y 8TG Telephone: Data Protection Information Commissioner Head Office Information Commissioner's Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF Telephone: or Fax: ICAN: Independent Complaints Advocacy in Northumberland 18

20 Community Legal Services Telephone: Website: General Dental Council 37 Wimpole Street London W1G 8DQ Telephone (UK local rate) Telephone (from London) Telephone (from abroad) General Medical Council Customer Service Manager 350 Euston Road London NW1 3JN Telephone (inside the UK): Telephone (outside the UK): Fax: Web: GMC Scotland - GMC Wales - GMC Northern Ireland - General Optical Council 41 Harley Street London W1G 8DJ Contact numbers Telephone: +44 (0) Fax: +44 (0) Healthwatch England Citygate Gallowgate Newcastle upon Tyne NE1 4PA Telephone: Fax: Media enquiry: ICAN: Independent Complaints Advocacy in Northumberland 19

21 The Law Society of England & Wales 113 Chancery Lane London WC2A 1PL Telephone: Fax: Website: National Patient Safety Agency (Corporate Office) 4-8 Maple Street London W1T 5HD Telephone enquiries: Formal complaint about the NPSA Media enquiries: NHS Commissioning Board Special Health Authority 4-8 Maple Street London W1T 5HD Telephone: Freedom of Information Act (FOI) Queries Northumberland Clinical Commissioning Group Bevan House 1 Esh Plaza Great Park Newcastle upon Tyne NE13 9BA Telephone: Fax: PALS (North of Tyne) FREEPOST RLTC-SGHH-EGXJ The Old Stables Greys Yard Morpeth NE61 1QD Telephone: ICAN: Independent Complaints Advocacy in Northumberland 20

22 PALS (Northumberland, Tyne and Wear NHS Foundation Trust) Colin Stephenson Head of Communications Northumberland, Tyne and Wear NHS Foundation Trust St Nicholas Hospital Gosforth Newcastle upon Tyne NE3 3XT Telephone: The Parliamentary & Health Service Ombudsman Millbank Tower Millbank London SW1P 4QP Complaints Helpline Telephone: Textphone (Minicom): Request a call back: Fax: Freedom of Information request Pharmaceutical Council The General Pharmaceutical Council 129 Lambeth Rd London SE1 7BT Telephone: Optical Consumer Complaints Service OCCS PO Box 219, Petersfield Hampshire GU32 9BY Telephone Fax ICAN: Independent Complaints Advocacy in Northumberland 21

23 Use this page for notes ICAN: Independent Complaints Advocacy in Northumberland 22

24 ICAN: Independent Complaints Advocacy in Northumberland 23

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