Complaints Policy

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2 Document Control Author/Contact Document Reference GEN 11 Version 4 Nazie Gerami PALS / Complaints Manager Floor 7 Regent House Status Draft Publication Date Review Date August 2013 Approved/Ratified by NHS Stockport CCG Date: Distribution: NHS Stockport CCG shared drive (once approved) Please note that the shared drive version of this document is the only version that is maintained. Any printed copies should therefore be viewed as uncontrolled and as such, may not necessarily contain the latest updates and amendments. Version Date Consultation Process Author Review Process Prior to Ratification: Name of Group/Department/Committee Date Complaints Policy Page 2

3 CONTENTS Page 1. Introduction 4 2. Strategic context 4 3. Aim of the policy 4 4. Principles 5 5. Objectives 7 6. Definition of a complaint 7 7. Responsibility and accountability 8 8. Who can make a complaint? 8 9. Which complaints are covered by the regulations? Confidentiality and consent Exclusions Duty to cooperate Time limits How are complaints investigated Use of / electronic communication Special considerations Corporate performance, monitoring and reporting Trend analysis and lessons learnt / service improvements Training Independent advocacy Conciliation Media interest 17 Appendix 1 Process Chart for handling complaints 18 Appendix 2 Complaints Risk Assessment 19 Appendix 3 Template Acknowledgment letter (to contact us) 22 Appendix 4 Template Acknowledgment letter (after call) 24 Appendix 5 Complaints Monitoring Form 25 Appendix 6 Complaint Resolution Plan 27 Appendix 7 Service Improvement / Monitoring Form 28 Complaints Policy Page 3

4 1. Introduction NHS STOCKPORT CCG COMPLAINTS POLICY & PROCEDURE The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 SI No. 309 came into force on 1 st April The regulations introduce new arrangements for handling complaints across health and social care. The regulations supersede the National Health Service (NHS) (Complaints) Regulations 2004 and This policy and procedure sets out local arrangements based on the national legislation and guidance. 2. Strategic Context Complaints are an integral element of improving the patient s overall experience of health care and help to assure safe, high quality care. The management of complaints needs to ensure that strategies are developed for implementing recommendations, disseminating learning. 3. Aim of the Policy The aim of this policy is to have an easily identifiable and recognisable process for dealing with complaints as a Clinical Commissioning Group (CCG) with our partners in health and social care. The complaints process should: be easily accessible and open, resolve complaints quickly and effectively; be fair to staff and complainants alike. Information gained from handling complaints should be used to: Contribute to clinical governance processes Be complementary to Patient Advice and Liaison Services (PALS) Promote learning in the organisation and, where things have gone wrong; avoid similar situations arising again Monitor complaints that come into NHS Stockport CCG to identify trends that might cause concern Identify training needs Maintain good practice and quality standards. Effective complaints handling can enhance the reputation of the CCG. All staff employed by NHS Stockport CCG should be made aware of the complaints policy Complaints Policy Page 4

5 and procedure. Training will be provided for new staff via staff induction and existing staff on a one to one basis if requested and at relevant ad-hoc training events. 4. Principles The NHS complaints procedure states that arrangements for dealing with complaints must ensure that: a. complaints are dealt with efficiently b. complaints are properly investigated c. complainants are treated with respect and courtesy d. complainants receive so far as is reasonably practical : (i) assistance to enable them to understand the complaints procedure or (ii) advice on where they may obtain such assistance e. complainants receive a timely and appropriate response f. complainants are told the outcome of the investigation of their complaint and action is taken if necessary in the light of the outcome of the complaint. Complaints should also be handled in the spirit of the Parliamentary and Health Service Ombudsman s (PHSO) principles - Principles of Good Administration, Principles of Good Complaints Handling and Principles for Remedy. The PHSO recommends NHS organisations follow these principles to ensure effective complaints handling: 1. Getting it Right 2. Being Customer focused 3. Being open and accountable 4. Acting fairly and proportionately 5. Putting things right 6. Seeking continuous improvement These Principles should not be applied as a checklist and staff should use their judgement in applying them to produce reasonable, fair and proportionate remedies. Full details of the Ombudsman s Principles can be found at Human Rights Core Values Putting human rights at the heart of the way healthcare services are designed and delivered can make for better services for everyone, with patient and staff experiences reflecting the core values of fairness, respect, equality, dignity and autonomy. Complaints should be dealt with in line with these five core values. Further information on the core values of Human Rights can be found at Guidance/DH_ Complaints Policy Page 5

6 Ensuring fairness and equity in complaints handling Stockport CCG is committed to treating all complainants equally and fairly, regardless of age, caring responsibility, disability, gender, gender identity, race, religion and sexual orientation. Under the regulations, complainants must not be discriminated against because they have made a complaint about any service commissioned by Stockport CCG or any commissioning decisions made by Stockport CCG. Stockport CCG is committed to dealing with complaints in a non discriminatory manner. Complainants can seek advice and support on how to make their complaint from the Customer Services team. NHS Stockport CCG supports the use of independent advocacy within the complaints procedure and any complainant wishing to access independent advocacy will be provided with information on the Independent Complaints Advocacy Service (ICAS) or other appropriate advocacy organisations. Process to ensure that service users, relatives and carers are not treated differently as a result of their complaint: It is important that patient care is not affected by a complaint and that complainants are not treated differently as a result of a complaint. Therefore the following steps should be taken: Ensure any service commissioned by the CCG observes the principle that details of a complaint should not be kept in the service users notes Only staff involved in the complaint should be aware of details Allow debrief time for staff and reflection on events surrounding the complaint The acknowledgment letter sent to patients asks them to contact the Complaints Department if they feel that they have been treated differently. This will then be taken up with the department concerned. (see appendix 4 and 5 for a copy of the acknowledgement letter) Staff should be aware of the CCG Being Open Policy If a complainant does feel that they have been discriminated against in any way as a result of making a complaint, they can contact the Customer Services Team to discuss how these issues will be addressed. The CCG commits to operating a learning, fair blame culture when dealing with complaints providing staff have not: Intended to cause harm Acted recklessly and taken an unjustifiable risk Negligently brought about a consequence which a reasonably competent person with his/her skills should have foreseen and avoided Acted illegally by committing a criminal act including circumstances resulting in a police investigation or prosecution Inappropriately or deliberately failed to comply with protocols or policies applicable to the CCG Repeated poor performance that has not improved with training Breached legal requirements, contractual obligations or Professional Codes of Conduct. Complaints Policy Page 6

7 5. Objectives The complaints procedure is designed to: Enable complaints to be dealt with as swiftly as possible, in a conciliatory and courteous manner Not distinguish between verbal and written complaints and to grant them a full and fair investigation, other than those minor complaints which can be dealt with immediately Empower staff to deal with complaints wherever possible, including training staff in the handling of complaints Entitle the complainants a full and fair investigation of their complaints, without fear of retribution Ensure that the complaints procedure is fair to both staff and complainants. Ensure that the complaints system is simple and accessible Use the complaints policy as a means of improving the quality of services we commission and the process by which we commission to ensure we learn lessons Keep managers, staff, clinicians and the complainant informed and involved throughout the process Ensure that all complaints are properly monitored and recorded and appropriate reports submitted Ensure that complaints are dealt with within the CCG in which they arise, with the Chief Operating Officer being responsible for the final response and Directors accountable for the investigation and any subsequent action taken within the service. The CCG has named individuals responsible for the investigation of complaints. In all cases the appropriate person will support the process. Directors may, in exceptional circumstances, appoint investigators from outside of the CCG, or the organisation if they believe the complaint is of a sufficiently serious or complex nature. Any issues highlighted by complaints investigations about service provision, clinical practice or of a disciplinary nature will always be dealt with by the Director in accordance with policies and procedures. Where appropriate, staff should have access to support throughout the investigation of a complaint. Staff may seek peer support, support from line management or, should they feel this to be inappropriate, may access the Occupational Health confidential counselling service, their professional body (if they have one) and / or trade union. 6. Definition of a Complaint A complaint may be defined as an expression of dissatisfaction or concern with any aspect of a service, including Staff performance, whether relating to Patient Care, the Complaints Policy Page 7

8 environment, facilities, systems or processes by a patient, visitor, carer, representative group or member of the public. If Stockport CCG employees have complaints or concerns that relate to other employees these should be raised through existing Human Resources policies and procedures e.g. grievance procedure, whistle blowing policy, dignity and respect policy and/or disciplinary / disagreement procedure. 7. Responsibility & Accountability The Chief Clinical Officer will retain overall responsibility for complaints and compliance with the arrangements made under the regulations and in particular ensuring that action is taken if necessary in the light of the complaint. The Chief Clinical Officer can authorise another officer(s) to act on their behalf within the complaints process. NHS Stockport CCG Governing Body will have ultimate responsibility for the implementation of the complaints procedure. Directors have responsibility for their directorate and approval of final responses. Managers have responsibility for investigating and responding to complaints and implementing any service improvements that arise from complaints. Customer Services Officer is responsible for managing the procedures for handling and considering complaints in accordance with the regulations. The Customer Services Officer has organisational responsibility for complaints handling with support of line management. The Customer Services Officer can authorise another officer(s) to act on their behalf within the complaints process. Front Line Staff should all be aware of this policy and direct queries to the Customer Services Department. Breaches of policy A failure to follow this policy will result in the continued duplication of documentation, resulting in lack of clarity and possible conflicting practice. This not only wastes CCG resources but leaves the CCG at risk of potential claims. 8. Who may make a complaint? In general terms a complaint may be made by: a. a person who has received services commissioned by Stockport CCG or b. any person who is affected by or likely to be affected by an action, omission or decision of Stockport CCG (as a commissioner) A complaint may be made by a person (referred to as a representative) acting on behalf of a person where that person: has died; is a child; Complaints Policy Page 8

9 is unable by reason of physical incapacity or lack of capacity within the meaning of the Mental Capacity Act 2005 (a) or has requested the representative to act on his/her behalf and provided written consent. Where the representative makes a complaint on behalf of a child, NHS Stockport CCG:- a. must not consider the complaint unless it is satisfied that there are reasonable grounds for the complaint being made by the representative instead of the child; and b. if it is not satisfied, must notify the representative in writing and state the reason for its decision. Where a representative - a) makes a complaint on behalf of a child or a person who lacks capacity within the meaning of the Mental Capacity Act 2005 and b) NHS Stockport CCG is satisfied that the representative is not conducting the complaint in the best interests of the person, the complaint must not be considered or further considered and the representative must be notified in writing and state the reason for the decision. Deciding who can complain can often be a complex issue. If staff are unsure they should contact the Customer Services Team for clarification and advice. 9. Which complaints are covered by the regulations? This policy and procedure applies to a complaint made on or after 1 st April 2009 to: a) an NHS body about i) the exercise of its functions or ii) the exercise of any function discharged or to be discharged by it under arrangements made between it and a local authority under s75 of the 2006 Act in relation to the exercise of the health related functions of a local authority. b) a primary care provider about the provision of its services by its arrangements with an NHS body or c) an independent provider about the provision of its services by it under arrangements with an NHS body (e.g. GP, dentist, pharmacist, optician, etc.). d) Local Authority about the exercise of its functions: (i) it s social services departments or (ii) any function discharged or to be discharged under arrangements made between it and an NHS body under s75 of the 2006 Act in relation to the functions of an NHS body. Complaints Policy Page 9

10 Where an organisation (such as an NHS Trust) receives a complaint and it appears that the complaint should be appropriately handled by another organisation (such as a local authority) then the complaint should be sent to the other organisation for investigation. The complainant is then deemed to have made their complaint to the appropriate organisation for investigation. 10. Confidentiality / Consent The use of the patient s information to investigate a complaint is a purpose for which it s not necessary to obtain the patient s express consent. Care must be taken at all times throughout the Complaints Policy and Procedure, to ensure that any information disclosed about the patient is confined to that which is relevant to the investigation of the complaint, and only disclosed to those people who have a demonstrable need to know it for the purpose of investigating the complaint. 11. Exclusions The following complaints are not required to be dealt with in line with the regulations: a) A complaint about private treatment b) a complaint made by another responsible body c) a complaint made by an employee of a local authority or NHS body about their employment. d) a complaint which is made orally and resolved to the complainants satisfaction no later that the next working day on which the complaint is made e) a complaint that has already been resolved in (c) f) a complaint which has already been investigated under these regulations, the 2004 regulations, the 2006 regulations or a relevant complaints procedure before 1 st April 2009 g) a complaint which is being or has been investigated by the Local Commissioner or Health Service Commissioner h) a complaint arising from the alleged failure to comply with a request for information under the Freedom of Information Act 2000 i) a complaint which relates to any scheme established under section 10 (superannuation of persons engaged in health services, etc) or section 24 (compensation for loss of office, etc) of the Superannuation Act 1972[5], or to the administration of those schemes Where Stockport CCG considers a complaint falls within the above exclusions it must (except in point c above) as soon as reasonably practicable notify the complainant in writing of its decision and the reason for that decision. 12. Duty to cooperate a coordinated approach When considering a complaint, where it appears to an organisation that the complaint contains issues that if sent to another organisation would be a complaint that requires investigation, both organisations must cooperate to:- Complaints Policy Page 10

11 a) co-ordinate the handling of the complaint and b) ensure the complainant receives a coordinated response to their complaint. The duty to cooperate includes in particular a duty for each organisationa) to agree which organisation takes the lead in coordinating the handling of the complaint and communicating with the complainant b) to provide information relevant to the complaint when requested by the other organisation and c) to attend any meeting reasonably required when considering the complaint. 13. Time limits A complaint must be made no later than 12 months after: - (a) the date on which the matter which is the subject of the complaint occurred; or (b) if later, the date on which the matter which is the subject of the complaint came to the notice of the complainant. The time limit shall not apply if the organisation is satisfied that (a) the complainant had good reasons for not making the complaint within that period; and (b) notwithstanding the delay it is still possible to investigate the complaint effectively and fairly. Flexibility and sensitivity should be used when considering late complaints e.g. where a complainant has suffered such distress or trauma that prevented him/her from complaining earlier. Discretion may on occasion be used to extend the time limit in discussion with the Customer Services Officer, the complainant and service provider. If a decision to process a complaint is turned down on the out of time basis then a complainant can use this policy to complain about that decision. 14. How are complaints investigated? The complaints procedure has two stages:- a) Local Resolution b) Review by the Health Service Ombudsman. a) Local Resolution (the first stage ) Receive, acknowledge, investigate, respond Ideally complaints and concerns will be and are, where appropriate, resolved on the spot by front-line staff effectively and efficiently. Staff are encouraged to make a record of locally resolved complaints including the name and reference of the Complaints Policy Page 11

12 complainant, what the complaint was about, what steps were taken to respond to the complaint and whether the complainant was happy that the complaint was resolved. Stockport CCG operates a combined Customer Services team who can provide information advice support and guidance to all staff on how to handle concerns or complaints. Receive A complaint may be made orally, in writing or electronically. When a complaint is made orally, NHS Stockport CCG must make a written record of the complaint and provide a copy of the written record to the complainant. The case must be assigned to a named individual who will be the contact the complainant can speak to regarding their case. Acknowledge All complaints must be acknowledged no later than 3 working days after day the complaint is received (except where a complaint is referred for investigation to another organisation or where a complaint is received verbally and resolved within one working day). The acknowledgement may be made orally or in writing. When a complaint is acknowledged, the organisation must offer to discuss with the complainant a) the manner in which the complaint is to be handled and b) the response period within which the investigation of the complaint is likely to be completed and the response is likely to be sent to the complainant. If the complainant does not accept the offer of a discussion, the organisation must determine the response period and notify the complainant in writing of that period. Investigate When a complaint is received, Stockport CCG must:- a) investigate the complaint in a manner appropriate to resolve it speedily and efficiently and b) throughout the investigation, keep the complainant informed as far as reasonably practicable of the progress of the investigation. Respond Once the investigation is completed, a response must be sent and signed by the responsible person or any person delegated with responsibility on their behalf. This should be done as soon as possible and include:- a) a report into the complaint containing an explanation of how the complaint has been investigated, the conclusions reached and any actions to be taken b) confirmation that any action needed as a result of the complaint will be undertaken and a timescale identified Complaints Policy Page 12

13 c) the complainants right to take their complaint to the Health Service Commissioner (Health Service Ombudsman), where the complaint relates wholly or in part to health d) the complainant s right to take their complaint to the Local Commissioner (Local Government Ombudsman), where the complaint relates wholly or in part to a Local Authority. Complainants have the right to a complete reply to their complaint as quickly as possible. In exceptional circumstances this may not be possible. If NHS Stockport CCG does not send a complaint response within 6 months of receiving the complaint, they must: a) notify the complainant in writing that the complaint is still under investigation and explain the reasons why they have not received a response and b) send the complainant a full response in writing as soon as reasonably practicable. If a complainant contacts NHS Stockport CCG after receiving the response to their complaint requesting further information or explanation, every effort should be made to answer these enquiries at local resolution. For instance, further information / explanation can be provided with consent and by agreement of all parties by the Customer Services Team or the relevant Manager. Alternatively, a meeting to discuss the issues raised in the complaint could be offered. Should a complainant raise new issues at this stage that were not included with the original complaint, these must be investigated as a separate new complaint. It is important to note that this should not be considered a review or appeal of their complaint. If the complainant remains unhappy with the response following local resolution and any further efforts to explain they should be advised to go to stage two of the procedure and contact the Health Service Ombudsman. b) Review by the Health Service Ombudsman (the second stage ) Every effort should be made to resolve a complaint at the local resolution stage but if a complainant is unhappy with the response to their complaint, they have the right to contact the Health Service Commissioner more commonly known as the Parliamentary and Health Service Ombudsman (PHSO) and request a review of their complaint. More information about the role of the PHSO can be found at Use of / electronic communication and electronic communication may be used where the complainant has consented in writing or electronically and has not then withdrawn their consent in writing or electronically. Complaints Policy Page 13

14 When complaints documentation is to be sent electronically, it can be signed by the individual authorised to sign the document by typing their name or producing their name using a computer or other electronic means (electronic signatures). 16. Special considerations Complaints of a Clinical Nature Where a complaint involves clinical issues, a relevantly qualified clinician should be involved to ensure full and appropriate investigation. Complex complaints If a complaint relates to more than one service or more than one provider Trust, or local authority, the Customer Services Team will acknowledge these complaints, explain how they will be dealt with (including timescales) and who the complainant can expect to lead on and respond to the complaint. Where matters are relatively straight forward and relate to two Trusts, then each Trust will respond to their own aspect of the complaint and write to the complainant separately. This will be explained to the complainant in the acknowledgment letter. If a complaint is very complex and involves a number of Trusts then attempts will be made to co-ordinate one response signed by a designated Chief Officer on behalf of all Trusts involved. The Customer Services Team will liaise (seeking advice as necessary) with other Trusts involved to identify a lead to co-ordinate the response (usually the Trust with the biggest portion of the complaint). Each NHS body involved in jointly co-ordinated complaints responses must continue to maintain responsibility for their own service about which a complaint is made. Clinical negligence claims, legal action and Police involvement Where the Customer Services Team considers that a complaint may result in legal action, this must be logged at the earliest opportunity. Where a possible clinical negligence claim is intimated as part of a complaint or it becomes apparent that other legal action or Police involvement is underway whilst a complaint is being investigated, NHS Stockport CCG must consider whether by dealing with the complaint it might prejudice the potential defence of any legal claim or investigation. Where there is any doubt, legal advice should be sought. Where it is thought that dealing with the complaint might prejudice the legal action, resolution of the Complaints Policy Page 14

15 complaint can be delayed until action the legal action has concluded. The complainant must be informed why the complaints process has been put on hold. 17. Corporate Performance, Monitoring and Reporting a) Publicity Information should be made available to the public on the arrangements for making complaints and how further information on those arrangements may be obtained. Staff should be made aware of the regulations and their role in dealing with complaints. b) Monitoring complaints Each organisation must maintain a record of each complaint received, the subject matter and outcome of each complaint, the agreed response period (including any amendments to that period) and whether a response was sent out within the response period. NHS Stockport CCG uses Safeguard to record all complaints activity. Directors are responsible for ensuring implementation of service improvements. c) Performance Targets On the spot verbal concerns should be resolved immediately or within one working day. (In this case, a note should be made of the complaint details) Written complaints should be acknowledged within three working days The final response to a complaint should be sent out within the timescale agreed with the individual complainant. Where the complaint is of a complex nature and the investigation might exceed these timescales, the complainant will be kept informed of the reasons for delay and the progress made and given the opportunity to respond to this to register their disagreement. d) Reporting The Complaints Manager will monitor complaints and ensure that the appropriate action is taken in line with the CCG complaints monitoring process. The CCG Governing Body shall be provided with a bi-annual report, which includes summaries of complaints which must show: Commissioning Area or Service Provider Date complaint received Completion date Justification Follow up action and progress Analysis Service improvements An annual report shall also be produced for the CCG Governing Body. Complaints Policy Page 15

16 The CCG Quality Provider Management Committee will be provided with anonymised details of any complaints made against any provider on a monthly basis. The CCG must produce an Annual Report for the Governing Body that will: a. specify the number of complaints received b. specify the number of complaints upheld by the Health Service Ombudsman c. summarise the subject matter of complaints received, any matters of importance arising out of the complaint itself or the investigation, any matters where action has been taken to improve services as a consequence of complaints d. be available to the public on request. 18. Trend analysis and Lessons learnt / Service Improvements Lessons to be learnt will be extracted from complaints wherever possible, whether or not something has gone wrong. A Service Improvement / Monitoring Form (appendix 7) form is sent out to the Director with the initial complaint. This should be completed in conjunction with the investigation in order to identify areas of improvement and should be sent back to the Customer Services Team within 10 working days of the completion of the complaint. Complaints will be monitored and analysed alongside other areas such as PALS and Incident reporting to identify if there are any wider issues that need to be addressed. This information will then be used within bi-annual reports to the CCG Governing Body. The CCG s commitment to learning from complaints will contribute to its strategic vision to improve the patient s overall experience. 19. Training All staff will be made aware by their line manager of the complaints policy and procedure. Information on PALS and complaints will be provided at staff induction. Training will be provided to staff/primary Care Providers and/or their staff and to specific staff groups where it will be tailor made to suit the group s needs. Electronic training, guidance and support may be given on an ad-hoc basis. Management of Complaints training for Senior Managers is provided as part of the CCG Corporate Induction Program. The training is delivered by the Customer Services Team. Complaints Policy Page 16

17 Ad hoc staff training can be organized to staff groups where a need has been identified. 20. Independent Advocacy All service users or their carers, who wish to make a complaint, should be made aware of their right to independent advocacy to support them to make a complaint and in particular the Independent Complaints Advocacy Service (ICAS). This is a free of charge independent service designed to give advice and support to those who wish to complain about the NHS. The Independent Complaints Advocacy Service (ICAS) can be contacted on (See Appendix 4 & 5 for paragraph informing complainants about ICAS in letter template). 21. Conciliation As part of Local Resolution ( first stage ) it may be necessary to appoint a conciliator. A conciliator is an independent lay person, not employed by the CCG, who acts as a neutral chairperson between a complainant and service complained against. The conciliator s role is to ensure both parties have an opportunity to air their views. The conciliator s role is to identify areas of conflict, ensure that all issues are fully discussed and aired and help bring the situation to a satisfactory conclusion and resolution. Conciliators can only be used for local resolution with both parties full co-operation and consenting to such a process. It cannot be used as a coercive measure or threat against either a complainant or staff members. All those involved in conciliation need to be made aware of what the process involves. Both parties need to enter the conciliation process willing to compromise and genuinely seek resolution. 22. Media interest All media enquiries should be referred to the CCG s communications lead.. Complaints Policy Page 17

18 Complaints team receive complaint Guidelines Log on Safeguard Red * Appendix 1 - Process Chart for Handling Complaints Director Convene complex complaints panel if appropriate and take advice from relevant leads on dealing with service users with additional needs. Complaint Risk Assessed by Complaints Team Acknowledgement letter sent out within 2 working days (no later than 3) explaining complaints process Amber * Green * * For information on Complaints Risk Assessment please see Appendix 2 Discussion with Investigating Officer Customer Services Team agree Resolution Plan with complainant and determine their wishes regarding complaint handling and desired outcome, including time scales Resolution plan produced & copy to complainant Disagree Further discussion with Complainant & amend accordingly Use vexatious complainants policy if required Investigate complaint within agreed time frame Respond as agreed identifying organisational learning gained as a result of complaint and send action plans with dates If complainant has further questions, they can approach Complaints team with questions or further information Confirm no further action. Close complaint. Update Safeguard. Advise of recourse to the PHSO Service Improvement monitoring Governing Body paper records lessons learnt

19 Appendix 2 Complaints Risk Assessment By assessing how serious a complaint is, the right course of action may be taken. For example, service managers may be happy with the agreement of the complainant to investigate less serious complaints themselves locally within the service. In contrast, complaints of a serious nature may be more appropriately dealt with by the PALS and Complaints team or by a Serious Untoward Incidents (SUI) investigation. A 3 step process can be used to assess: 1. the impact of the complaint on the people involved 2. the potential risks to the organisation 3. the response required Step 1: Decide how serious the issue is Seriousness Low Medium High Description Unsatisfactory service or experience not directly related to care. No impact or risk to provision of care. Or Unsatisfactory service or experience related to care, usually a single resolvable issue. Minimal impact and minimal risk to the provision of care or service. No real risk of litigation. Service or experience below reasonable expectations in several ways but not causing lasting problems. Has potential to impact on service provision. Some potential for litigation. Significant issues regarding standards, quality of care and safeguarding of or denial of rights. Complaints with clear quality assurance or risk management issues that may cause lasting problems for the organisation and so require investigation. Possibility of litigation and / or adverse publicity. Or Serious issues that may cause long term damage such as grossly substandard care, professional misconduct or death. Will require immediate and in depth investigation. May involve serious safety issues. A high probability or litigation or strong possibility of adverse national publicity Complaints Policy Page 19

20 Step 2: Decide how likely the issue is to recur Likelihood Rare Unlikely Possible Likely Almost certain Description Isolated one off vague connection to service provision Rare unusual but may have happened before Happens from time to time not frequently or regularly Will probably occur several times a year Recurring and frequent, predictable. Step 3: Categorise the risk Seriousness Likelihood of recurrence Rare Unlikely Possible Likely Almost certain Low Low Moderate Medium High High Extreme Complaints Policy Page 20

21 Examples of different levels of complaints Low (simple non complex issues) Delayed or cancelled appointments Events resulting in minor harm (e.g. cut / strain) Loss of property Lack of cleanliness Transport problems Single failure to meet care needs Missing medical records Moderate (several issues relating to Events resulting in moderate harm a short period of care) (e.g. fracture) Issues relating to Commissioning Delayed discharge Failure to meet care needs Miscommunication / misinformation Medication changes Medical errors Incorrect treatment Staff attitude or communication High (multiple issues relating to a longer period of care, often involving more than one organisation or individual) Extreme (multiple issues relating to serious failures, causing serious harm) See moderate list Event resulting in serious harm (e.g. damage to internal organs) Events resulting in serious harm or death Gross professional misconduct. Abuse or neglect Criminal offence (e.g. assault) Complaints Policy Page 21

22 Appendix 3 - Template acknowledgment letter (to contact us) Direct line: palsandcomplaints@nhsstockport.nhs.uk Our ref: NG - Date Floor 7, Regent House Heaton Lane Stockport SK4 1BS Tel: Fax: Text/voice relay: Dear Thank you for your letter dated xxxxxx, which has been passed to me as part of the complaints procedure. I am sorry to hear that you had cause to complain about NHS xxxx services. A member of our staff will contact you by telephone within the next few days to discuss your concerns and how you would like them to be investigated. (if you have their tel number) OR A member of the Customer Services Team would like to speak to you in order to discuss your concerns further, I should be grateful if you would contact us on This would assist in compiling a resolution plan in order to investigate your complaint. If we do not hear from you by (1 week after initial contact) we will compile a resolution plan, a copy of which will be forwarded to you. You are invited to amend as necessary, sign and return the complaint record to me if you agree with the contents; I am enclosing a pre-paid envelope for your convenience. Please be advised investigations will not begin until we have a signed copy of the resolution plan from you. If you would prefer not to be contacted by telephone, please inform us and we will ensure that you receive all future correspondence in writing. Should you need support with the complaints process you can contact your local Independent Complaints Advocacy Service (ICAS) provided by the Carers Federation, telephone: Complaints Policy Page 22

23 I have also enclosed a Complaints Monitoring Form and would be grateful if you could complete it and return to me in the prepaid envelope provided. NHS Stockport CCG actively encourages complaints as a means of continually improving its services and I would like to assure you that any ongoing or future treatment or care will not be adversely affected by the fact that you have made a complaint. Staff dealing with your complaint will treat any information you provide with confidence and sensitivity and any disclosure of patient information including medical records, will be confined to that which is relevant to the investigation of the complaint and only disclosed to those people who have a demonstrable need to know it for the purpose of investigating the complaint. If at any time you feel that you have been treated differently please contact a member of the Customer Services Team. In the meantime please do not hesitate to contact me on the above telephone number if you have any queries. Yours sincerely Complaints Policy Page 23

24 Appendix 4 - Template acknowledgment letter (after call) Direct line: palsandcomplaints@nhsstockport.nhs.uk Our ref: NG - Date Dear Floor 7, Regent House Heaton Lane Stockport SK4 1BS Tel: Fax: Text/voice relay: Thank you for your telephone call today, I am sorry to hear that you had cause to complain about NHS services. I have enclosed a Resolution Plan which details the concerns relayed to me during our telephone conversation and how we will investigate your complaint as agreed by you and the Customer Services Team. I would like to confirm that your complaint will be fully investigated, once the findings are known Dr R Gill, Accountable Officer will write to you with a more detailed reply. Should you need support with the complaints process you can contact your local Independent Complaints Advocacy Service (ICAS) telephone: I have enclosed a leaflet explaining the Complaints Procedure which I hope you find helpful. I have also enclosed an ethnicity questionnaire and would be grateful if you could complete it and return to me in the prepaid envelope provided. NHS Stockport CCG actively encourages complaints as a means of continually improving its services and I would like to assure you that any ongoing or future treatment or care will not be adversely affected by the fact that you have made a complaint. Staff dealing with your complaint will treat any information you provide with confidence and sensitivity and any disclosure of patient information including medical records, will be confined to that which is relevant to the investigation of the complaint and only disclosed to those people who have a demonstrable need to know it for the purpose of investigating the complaint. If at any time you feel that you have been treated differently please contact a member of the Complaints Team. In the meantime please do not hesitate to contact me on the above telephone number if you have any queries. Yours sincerely Complaints Policy Page 24

25 Appendix 5 - COMPLAINTS MONITORING FORM PCT Ref: To help us provide an effective service, we would like you to answer the following questions. All information will remain strictly confidential. Please let us have your post code: Age: Male Female Religion/Beliefs: Please tick the appropriate box to indicate your religion or belief Buddhist: Christian: Hindu: Jewish: Muslim: Sikh: None: Other: Please state: Sexual Orientation: Please tick the appropriate box to indicate your sexual orientation. Heterosexual/Straight: Gay Man: Lesbian/Gay Women: Bisexual: Other: Prefer not to say: What is your ethnic group? Choose one section from A to F, and then tick the appropriate box to indicate your cultural background. A White British Irish Any other White background, please write in C Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background, please write in B Mixed White & Black Caribbean White & Black African White and Asian Any other Mixed background, please write in D Black or Black British Caribbean African Any other Black background, please write in E Chinese or other ethnic group F Not stated Chinese Any other, please, write in Complaints Policy Page 25

26 Do you consider yourself to have a disability? Do you look after, or give any help or support to family members, friends, neighbours or others because of longterm physical or mental ill-health or disability, or problems related to old age? No Yes, hours a week Yes, 1 19 hours a week Yes, 50+hours a week YES NO Thank you for your time in completing this questionnaire. Please return in the pre-paid envelope provided. Complaints Policy Page 26

27 Complaints Resolution Plan Appendix 6 - Date: Complaint reference: Rating: Name of Complainant: Name of Patient: Agreed response date: Services Involved: Investigating Officer: Summary of Complaint: Points requiring Investigation Person responsible for each action Due Date Signed:... Investigating Officer Verbal Agreement received Written Agreement received Consent required Consent received Date: Date: Date: Date: Complaints Policy Page 27

28 Appendix 7 - Dear Date received: Department: Service Improvement / Monitoring Form CCG Ref: Complainant/Enquirer: Category: Thank you for your help with this case. We need to record any improvements made as a result of investigating patient complaints and enquiries. Please complete and return this form to the Customer Services Department as soon as possible. Problem identified (please tick may be more than one) Commissioner Provider No local policy or Guidance not being Policy of guidance not being followed implemented Choice not being offered Quality of service provision Commissioning staff attitude / Other (please specify) knowledge Other (please specify) Further details of problem identified (must be completed) Service improvements (please tick may be more than one) Policy or guidance implemented Additional resources allocated New service commissioned No improvement necessary Improved guidance issued Added to priority list Improvement to way services is Action against staff provided Contractual action against supplier Further details (must be completed) Reason for no service improvements (please tick may be more than one) Lack of funding Training not available Low priority Lack of guidance Inappropriate Other (please specify) Further details Name: Signature: Date: