Complaints and Concerns Policy

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1 Policy No: RM21 Version: 7.0 Name of Policy: Complaints and Concerns Policy Effective From: 20/07/2015 Date Ratified 17/07/2015 Ratified PQRS Committee Review Date 01/07/2017 Sponsor Director of Nursing, Midwifery and Quality Expiry Date 16/07/2018 Withdrawn Date Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version This policy supersedes all previous issues Complaints and Concerns Policy v7

2 Version Release Author/Reviewer 1.0 February August April 2006 Version Control Ratified by/authorised Date by Clinical Feb 2003 Improvement Group Trust Board Aug 2004 Clinical Improvement Group April 2006 Changes (Please identify page no.) 4.0 Nov 2006 Clinical Improvement Group 5.0 S A Gair, PQRS Acting Complaints Manager /10/2009 S A Gair, Risk Facilitator 5.2 Feb 2010 S A Gair, Risk Facilitator /07/2012 H Rogerson Complaints Manager /07/2015 H Rogerson, Complaints Manager/S Hazeldine, PALS Manager Director of Health Development & Modernisation PQRS PQRS PQRS Nov 2006 May 2009 Updated to take account of 2009 NHS Complaints regulations Oct 2009 Updated into OP27 format 11/12/2009 Amendment in relation to the submission of reports to the Health & Social Disability forum 18/05/2012 Updated to take into account the restructuring of the organisation 17/07/2015 Updated to take into account the restructuring of the organisation Complaints and Concerns Policy v7 2

3 Contents Section Page 1. Introduction Policy scope Aim of policy Duties, roles and responsibilities Definition of terms Complaint management process Process for raising queries and concerns Formal complaints; Stage 1 - Local Resolution... 7 Stage 2 - Independent Review Health Service Ombudsman Trust procedures Monitoring and management of complaints Information Governance Non discrimination Support for staff Lessons learned and shared Records retention Training Equality and diversity Monitoring compliance with this policy Consultation and review Implementation of this policy Reference Association documentation Appendices Appendix 1 Arrangements for dealing with informal concerns and queries Appendix 2 PALS and complaints flowchart Appendix 3 Complaints handling procedure note Risk grading of complaints Guidelines for investigating officers in dealing with complaints Complaints investigation and action plan Appendix 4 Procedure for handling habitual and/or vexatious complaints Appendix 5 Arrangements for dealing with cross organisational complaints Appendix 6 Communications with external organisations Complaints and Concerns Policy v7 3

4 Complaints and Concerns Policy 1. Introduction The Health Service continuously works towards providing the best possible care but there are occasions when patients, their families and friends do not feel the outcome has been up to their expectations. The Trust will ensure it provides honesty and openness and a willingness to listen to the complainant, and to understand and work with the patient to rectify the problem. Front line staff are expected to try to resolve any concerns as they arise. However, if those raising issues remain dissatisfied they have every right to formally complain. However good our services are today we want them to be better tomorrow. Complaints offer an important opportunity for us to review our services and from this to seek to make improvements. The Trust has produced this policy collaboratively with staff handling complaints and is in line with good complaint practices already established. NHS guidance and regulations gives a number of specific requirements as to how every NHS organisation should deal with complaints. The procedures set out below provide a framework for the Trust to meet the national requirements, provide a fast, informative and proportionate response to complaints and provide a Trust-wide process giving consistency and reliability. 2. Policy scope This policy is Trust wide and applies to all members of staff working within Gateshead Health NHS Foundation Trust. 3. Aim of policy The purpose of this policy is to: Give all staff guidance on how to respond to complaints and concerns raised by patients, relatives, carers and service users, in line with national guidance and standards. Provide a framework to make sure that service improvements result from the complaints process. The Trust is keen to encourage service users to provide feedback as a means of helping staff to continually review the services they provide. We aim to reflect national good practice for responding to patient feedback, by: Having a well-publicised process for Compliments, comments, concerns and complaints that is clearly understood by patients, carers, their families and friends and staff. Implementing the NHS Complaints Regulations (SI 2009 No 309). Responding promptly and fully to people making a complaint. Apologising when it is clear there have been shortcomings in our service or the patient or carer has suffered distress or inconvenience. Offering appropriate support to staff involved in complaints. Learning from complaints and making improvements where possible. 4. Duties - roles and responsibilities Trust Board and Chief Executive The overall responsibility for complaints about Gateshead Health NHS Foundation Trust services ultimately lies with the Trust Board. The Chief Executive, as accountable officer and supported by the Director of Nursing, Midwifery & Quality are the nominated officers responsible for overseeing Complaints and Concerns Policy v7 4

5 the complaints procedure, handling arrangements and actions taken in respect of all complaints received. Complaints Manager The Trust Complaints Manager is responsible for the day to day management of all complaints handling issues. This includes making arrangements for an appropriate investigating officer to investigate each complaint received and making sure that handling procedures are in line with all NHS Complaints statutory regulations and Department of Health guidelines. The Complaints Manager also acts as the Trust s nominated officer to liaise with the Health Service Ombudsman for any actions required by them in relation to complaints that are not resolved at a local level and proceed to the stage of the Independent Review procedure. Patient Advice and Liaison Manager (PALS Manager) The role of the PALS Manager is to manage the Patient Advice and Liaison Service which is a confidential service providing On the Spot help and advice for patients, relatives and carers and staff. The service aims to resolve problems quickly and provide advice. Where appropriate the PALS Manager may refer more serious or complex issues to the Complaints Service and may take referrals from the Complaints Service where a speedy resolution is a viable option for the benefit of the individual raising the issue. Medical Director The Medical Director is involved in the monitoring and risk-grading of all complaints to ensure appropriate and proportionate responses. They will be responsible for identifying trends in terms of clinical practice which may need resolution. Head of Risk Management The Head of Risk Management is responsible for the development, implementation and maintenance of a robust Trust-wide incident reporting and investigation system working as part of the Risk Management Team in conjunction with legal services and health & safety, occupational health, the complaints team, SafeCare and the Patient Advice and Liaison Service (PALS). Patient, Quality, Risk and Safety Committee (PQRS) The PQRS has responsibility for ensuring that effective systems are in place for the management of complaints including appropriate analysis to ensure service improvement and learning from complaints. The PQRS Committee: Oversees monitoring of complaints on behalf of the Trust Board Provides a forum that focuses on learning from complaints Oversees the sharing of good practice on a Trust wide basis. Risk Management (CLIPA) Group The specific arrangements for monitoring complaints are carried out on behalf of the PQRS by the Trust Risk Management (CLIPA) Group. The Risk Management (CLIPA) Group: Monitors complaints on behalf of the PQRS, undertaking regular analysis of all complaints received in order to determine what, if any, lessons can be learned and shared throughout the Trust. Monitors performance and produces regular quarterly combined reports Ensures that remedial action has been taken where appropriate and identifies any further actions required to minimise future risk to the Trust. Complaints and Concerns Policy v7 5

6 Liaises closely with Business Units/Departments undertaking investigations and assists in ensuring that actions identified within Complaints Action Plans are completed within specified time scales. Head of Business Units & Clinical Leads Head of Business Units & Clinical Leads will be advised of all complaints relating to their specific Business Unit/Department and may be required to provide in-house clinical opinion on specific cases. They are responsible for overseeing the implementation of any changes to practice or service improvements as a result of lessons learned from complaints received. Associate Directors, Service Line Managers and Heads of Services Associate Directors, Service Line Managers and Heads of Services are responsible for overseeing arrangements in each Business Unit/Department to make sure that complaints about services they manage are fully investigated in accordance with Trust policy and procedures. This includes making sure that all appropriate remedial actions are taken, including the implementation of any changes to practice, and the signing off of all action plans when the implementation of changes have been completed. Investigating Officers Investigating officers are responsible for the investigation of complaints as allocated by Associate Director, Service Line Manager, Heads of Services or Complaints Manager in line with the complaints policy and procedures. This includes responsibility for the completion of draft replies to complaints, complaints investigation records and action plans. Investigating officers have a responsibility to support staff involved in investigations and complaints. Complaints handling will be included within the induction process for all investigating officers. All Staff All staff have a responsibility to respond helpfully to informal concerns, deal with day to day problem solving issues and queries as they arise. Additionally, all staff have a contractual responsibility to contribute to the investigation of complaints, providing information and written statements for any complaints that they have been involved in or have witnessed, as required by investigating officers. 5. Definition of terms There are no terms within this policy which require defining. 6. Complaint management process 6.1 Process for raising queries and concerns Complaints are dealt with in a number of stages. Before any concerns turn into a formal complaint it is, of course, very important that the staff dealing with the patient, carer, and their family/friends seek to address any issues as they arise. Very often a moment spent in this way avoids difficulties being perpetuated and concerns escalating. It is also important that staff give reassurance at this stage to anyone raising a concern that these will be dealt with confidentially and that their/the patient s care will not be compromised as a result. Staff need to ensure they provide a record of these discussions and their resolution by recording information on the Complaints and Concerns module available within Datix. The Patient Advice and Liaison Service (PALS) can give valuable assistance at this stage to resolve concerns and queries. The arrangements for dealing with concerns and queries are outlined in Appendix 1. Complaints and Concerns Policy v7 6

7 6.2 Formal complaints Where front-line handling does not satisfy someone s concerns they may then turn to the formal complaints process, which is as follows: Stage 1 Complaints are made formally via the Trust Chief Executive s Department. The Trust itself investigates the complaint and the Chief Executive responds directly to the complainant. The first thing that needs to be done when a complaint is received is to identify any issues in the patient s ongoing care particularly where there is concern over their immediate care. It is also important at this stage to reassure people raising formal complaints that they/the patient will not be discriminated against as a result of having made a complaint and that their complaint will be dealt with in confidence. All complaints will be investigated and responded to in accordance with the regulations, but immediate care concerns need to be addressed as quickly as possible. In line with this need, all complaints are risk graded on receipt, before being issued to Investigating Officers for investigation. The risk grading helps identify actions that may need to be taken. Following completion of the investigation the initial risk grading is reassessed by the Chief Executive and Trust Medical Director and amended where required, in light of the findings. The final risk grading is then signed off by both the Chief Executive and Medical Director. The Chief Executive and Medical Director review the complaints received, reviewing the risk grading and identifying appropriate actions and Trust wide implications. During this first local resolution stage of the procedure, every effort is made to respond fully and openly to all the concerns raised and this often involves meetings and/or ongoing discussions and liaison with the complainant. Complainants will be able to address their complaint directly to the commissioning body instead of (though not in addition to) making a complaint to the provider of services i.e. complaints about this Trust can be made directly to Gateshead Clinical Commissioning Group. Commissioners may in certain cases take the lead, co-ordinate and maintain an overview of the complaints process and the complaints management staff will co-ordinate the internal arrangements. Stage 2 The Health Service Ombudsman If a complainant remains dissatisfied with the Trust s response following completion of all local resolution actions they have the right to seek an independent review of their outstanding concerns by the Health Service Ombudsman. To be eligible for review by the Health Service Ombudsman the complaint must be about a service funded by the NHS and the complainant must ask the Health Service Ombudsman to review the complaint within 12 months of receiving a final written response to their complaint from the Trust. Complaints and Concerns Policy v7 7

8 6.3. Trust Procedures The Ombudsman is not obliged to investigate every complaint put to them and they will not generally take on a case which has not been through the NHS Complaints Procedure or a case which has been dealt with by the courts. Appendix 1 Arrangements for dealing with informal concerns and queries: includes handling processes for dealing with and recording concerns and queries. This includes: verbal concerns raised / possible complaint proforma and flowchart of individual s responsibilities Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 PALS and Complaints flowchart Formal complaints handling procedure note including investigation process, risk grading, guidance for investigating officers and complaints investigation and action plan template. Procedure for handling habitual and/or vexations complaints: From time to time the Trust has to handle habitual and / or vexatious complainants. This can be both sensitive and difficult and a handling note setting out the Trust s policy and procedures for this is included at Appendix 4. Joint Complaint Agreement: On occasions complaints are received within the Trust that involve other organisations e.g. Local Authority (social care), Primary Care and other NHS Trusts etc. It is important that appropriate arrangements are in place to ensure that the complainant receives a coordinated response to their complaint. Details of external organisations which may be communicated with in respect of individual complaints or complaints management. 6.4 Management and monitoring of complaints The PQRS and Risk Management (CLIPA) Group are responsible for ensuring appropriate monitoring of complaints (see para 4 above for the roles and responsibilities of each committee/group). 6.5 Information governance All complaints will be dealt with in a confidential manner in accordance with the Trust s confidentiality policy and data protection legislation. Copies of documentation relating to formal complaints raised must not be kept in case notes. Any referral letters should not include reference to the fact that a complaint is/has been made. Complaints and Concerns Policy v7 8

9 Where a complaint is raised by someone other than the patient (or next of kin in respect of deceased patients) a consent form will be required and information will not be disclosed to that third party until an appropriate consent has been received Non discrimination Patients, relatives and carers will not be discriminated against for making a complaint or raising a concern and their future ongoing health care needs will not be affected. Reassurance is given in the Trust patient information leaflet and in the acknowledgement letters in respect of the complaints received. This standard will be reinforced through Business Units/Departments and at staff training, induction and customer care programmes. See also monitoring arrangements Support for staff RM67 Supporting staff involved in an incident, complaint or claim details arrangements for providing support to staff and should be read in conjunction with this policy. The aim is to investigate concerns raised by the complainant thoroughly and fairly and to verify the facts so that any allegations can be shown to be true or false. Staff will have every opportunity to respond: this can be via , phone, letter or meeting with the investigating officer. The Complaints Manager and Investigating Officer will help clarify which questions need answering in the final response letter from the Trust. The Trust recognises it can be stressful for staff involved in the complaints process and will endeavour to make sure that appropriate support is provided. On occasions a manager may decide to take more proactive action to support a member of staff. This may include a management referral to Occupational Health or options for further training. This will be discussed on an individual basis, if considered necessary. Counselling for staff is available on the request of individual members of staff through the Occupational Health Department. Doctors can access the BMA Counselling Service (details at Lessons learned and shared Informal comments, surveys and complaints can provide a valuable opportunity to assess our service. Complaints should be seen as essential and helpful information and welcomed as necessary for continuous service improvement. It is essential that we use that opportunity to see whether lessons can be learned by the service in question and for the Trust as a whole. Designated staff within the Business Units and Heads of Departments are able to access all information relating to complaints and concerns via the Datix Dashboard. Associate Directors and Head of Departments are responsible for: Disseminating lessons learned to colleagues within their Business Unit/Department Complaints and Concerns Policy v7 9

10 Sharing lessons learned with colleagues in other Business Unit/Department where appropriate Providing feedback to the Complaints Manager on lessons learned and whether further action is needed The Director of Nursing, Midwifery and Quality is responsible for: Identifying lessons learned in relation to nursing issues and disseminating them through the Business Units. The Complaints Manager is responsible for: Disseminating lessons learned to other organisations where the complaint has been made to more than one Trust Ensuring that external stakeholders such as MPs, Councillor s and other healthcare professionals raising complaints on a patient s or carer s behalf are made aware of lessons learned Recording the actions arising from the Investigation report and Action plans and following up to ensure implementation. Where appropriate sharing those lessons learned across the Trust. Ensuring implementation of the recommendations of the Health Service Ombudsman Reporting to Risk Management (CLIPA) Group and other groups as appropriate on a quarterly basis Ensuring that changes in practice are implemented where appropriate 6.9 Records retention 7. Training The NHS Code of Practice for Records Management indicates the following retention periods for complaints records: Correspondence, investigation and outcomes - 8 years from completion of action Returns made to the Department of Health - files closed annually and kept for 6 years following closure. All staff will, on induction, be given training on dealing with informal concerns and queries and about the procedures in relation to Compliments, comments, concerns and complaints All staff involved in investigating and handling complaints will receive appropriate training which is provided through the OD & Training Department, in partnership with, and involving, the Trust s Complaints Manager. See also Section 7 of the Trust Incident Reporting and Investigation Policy. All staff can access Complaints and Concerns training via e-learning. Ad hoc training is carried out for various groups e.g. Senior Staff Nurse Management course, as and when requested. 8. Equality and diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the grounds of any protected characteristic (Equality Complaints and Concerns Policy v7 10

11 Act 2010). An equality analysis has been undertaken for this policy, in accordance with the Equality Act (2010). 9. Monitoring compliance with this policy Monitoring compliance with this policy will be the responsibility of the Trust Complaints and PALS Managers. This will be undertaken by: Standard/process/issue Monitoring report of complaints and the complaints process including how the organisation responds to complaints, internal and external communication, collaboration with other organisations, improvements made as a result of formal complaints and action plans is provided to Risk Management (CLIPA) Group. Monitoring of action plans to ensure these are completed within the agreed timescale. Monitoring report of concerns, the PALS process and changes as a result of concerns raised is provided to Risk Management (CLIPA) Group. Review of outstanding and delay responses for both Complaints and Concerns are discussed at the business Units Board to Board Meetings. Evaluation questionnaires seeking comments on the quality of the complaints service and compliance with regulations are issued to a number of complainants and a summary report submitted to Risk Management (CLIPA) Group. Evaluation questionnaires seeking comments on the quality of the PALS service are issued to a number of complainants and a summary report submitted to Risk Management (CLIPA) Group Diversity monitoring forms are sent to complainants with the final response to identify and help analyse complaints and the complaints service to ensure services do not discriminate on the grounds of gender, age, race or disability Monitoring and audit Method By Committee Frequency Review of Complaints Risk Quarterly complaints and Manager Management collation of (CLIPA) Group information for period Review of actions outstanding in the formal complaints module Review of PALs enquiries for period Collation of outstanding responses for Board to Board meetings Collation of responses to evaluation questionnaires Collation of responses to evaluation questionnaires Collation of responses to diversity monitoring forms Complaints Manager PALS Manager Complaints and PALS Manager Complaints Manager PALS Manager Complaints Manager Risk Management (CLIPA) Group Risk Management (CLIPA) Group Board to Board Risk Management (CLIPA) Group Risk Management (CLIPA) Group Risk Management (CLIPA) Group Quarterly Quarterly Monthly Six monthly Six Monthly Six Monthly Complaints and Concerns Policy v7 11

12 Standard/process/issue Diversity monitoring forms are sent to 1:10 PALS clients to identify and help analyse concerns and PALS service to ensure services do not discriminate on the grounds of gender, age, race or disability Monitoring and audit Method By Committee Frequency Collation of PALS Risk Six Monthly responses to Manager Management diversity (CLIPA) Group monitoring forms 10. Consultation and review The views of Associate Directors/Heads of Service, Service Line Managers, Matrons, Heads of Service, PQRS members and SafeCare Council Members and Legal Services Manager on the revised policy have been sought. 11. Implementation of this policy (including raising awareness) The policy will be implemented in accordance with OP27 Policy for the development, management and authorisation of policies and procedures. Publicity for patients and carers is available via Trust publications and website and leaflets are available throughout Trust premises 12. References NHS Complaints Regulations (SI 2009 No 309) The NHS Code of Practice for Records Management NHS Litigation Authority Risk Management Standards for acute trusts 2011/12 A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. Clwyd A, Hart P Care Quality Commission Fundamental Standards Associated documentation RM04 Incident/Near-miss reporting and investigation policy (includes serious untoward incidents) RM67 Supporting staff involved in an incident, complaint or claim RM23 Claims Management RM49 Being open and Duty of Candour Policy OP27 Policy for the development, management and authorisation of policies and procedures Complaints and Concerns Policy v7 12

13 Appendix 1 Arrangements for dealing with informal concerns and queries There may be some problems or queries that patients, their relatives or carers, members of the public wish to raise and would like to have help with, without making a formal complaint. Concerns and queries can be raised either: By telling a member of staff or the person in charge of the department or ward about a concern or query that they require help with. All staff are expected to provide prompt on the spot assistance to deal with any problems and answer queries as they arise. In dealing with any concerns staff are required to give reassurances that issues raised will be dealt with confidentially and the patient or person raising the concern will not be discriminated against either then or in the future as a result. Many concerns can be resolved satisfactorily at this level by means of a simple explanation or apology. Through the Patient Advice and Liaison Service (PALS) which is a confidential service offering On the Spot help and advice for patients, relatives, carers and staff. They may be able to help resolve any concerns quickly and provide information for patients. The PALS service is also available to assist staff in the resolution of any problems raised with them and can be contacted on freephone telephone number or extension However, if a member of staff is unable to resolve the problem they are required to seek help immediately from someone, usually their line manager. Line managers will support staff to resolve any issues and discuss ways in which the problem can be resolved, providing advice to answer queries and questions raised. Following discussions with line managers or other colleagues the staff member concerned will return to the person who has raised the concern to offer a solution or provide answer to any questions. This needs to be carried out as soon as possible and by no later than 24 hours, to reassure the person that their concern is being appropriately dealt with. If it is not possible to reach a solution or provide information within 24 hours the person raising the concern must be informed and given a new timeframe as to when they will be provided with an answer and must be kept informed of progress. Staff must complete a record of any issues they deal with and actions taken on the Complaints and Concerns module within Datix. PALS will be notified if the concern is not able to be resolved in 24 hours. Where immediate resolution is not possible via these measures and the person raising the concern is still not satisfied the line manager will take over and lead on the issues raised. The line manager may obtain assistance from senior colleagues or the Complaints Manager to do so. A flow chart identifying individual responsibility and the process for dealing with concerns and complaints is also attached for information. Complaints and Concerns Policy v7 13

14 Appendix 2 PALS and Complaints Protocol Person raises and issue, concern or makes a complaint about a service Dealt with on the spot by staff member. * Explanation given. with apology if appropriate Concern raised by telephone or , by letter or in person with PALS Manager. Concern raised by telephone, , letter or in person with Complaints Manager Staff log concern on Datix Concerns/complaints module Resolved PALS team try to resolve concern after agreeing course of action with person and investigation carried out. Informal concerns refer to PALS No Yes Offer opportunity to discuss with line manager. Resolved Unresolved Refer to Complaints Manager Formal Complaint Investigated Accepted Declined Meeting and discussion takes place. Explanation & apology is given. Issue resolved & person satisfied. Person signposted to PALS/Complaints Service & given leaflet Outcome Satisfactory Person not satisfied. They refer to Ombudsman. Notes: * Ensure appropriate consent obtained Version 4 Published by Hazel Rogerson and Shirley Hazeldine Complaints and Concerns Policy v7 14 Review date Feb 2017

15 Appendix 3 COMPLAINTS HANDLING PROCEDURE NOTE 1. Formal complaints can be received via a letter, telephone call, or personal visit to: the Chief Executive s Office the Complaints Manager the PALS service a complaint letter to any other member of staff. All complaints to be forwarded to the Complaints Office, Trust Headquarters, Queen Elizabeth Hospital. Details of complaints raised verbally will be documented and sent to complainant to confirm accuracy. 2. Formal complaints can be received from/via: The person who is affected by the actions of the Trust A third party e.g. a relative, carer or representative (e.g. MP), next-of-kin acting on their behalf with consent The commissioning body of the organisation i.e. the Clinical Commissioning Group 3. On receipt, the Complaints Department records and logs details of the complaint onto Datix allocating a reference number to each one and an initial risk grading score. This initial risk grading is checked and confirmed by the Chief Executive and/or Medical Director. The complaint will be triaged with a view to identifying the issues raised, who will investigate and how and an appropriate timescale for dealing with the complaint. Investigations and timescales should be proportionate to the complexity of the complaint. The complainant will be contacted if possible, to agree the complaint plan. 4. An acknowledgement letter with the following information will be sent within three working days which: Offers the complainant the opportunity to discuss, either by telephone or face-to-face, how the complaint is to be handled or details the agreement reached about the plan if the complaint manager has been able to contact the complainant by telephone. Gives reassurances that their concerns will be treated confidentially and that they/the patient will be not discriminated against as a result of having made a complaint. Encloses the Trusts Compliments, comments, concerns and complaints leaflet. Gives information about the Independent Complaints Advocacy (ICA) Where the person raising the complaint is not the patient (or next of kin in respect of deceased patients) a consent form will be enclosed. The signed consent form must be returned by the complainant and its receipt logged prior to any information being disclosed to the complainant. 5. A copy of the complaint will be forwarded by to the appropriate Investigating Officer for investigation with details of the complaint plan. For complaints involving more than one specialty the Complaints Manager will act as the identified lead officer and will co-ordinate the reply to the complainant. The investigation will commence immediately and will not be delayed by awaiting return of a consent form. Complaints and Concerns Policy v7 15

16 If the complaint involves more than one organisation, the Complaint Manager will liaise with that organisation to agree the lead to provide a single response, with the consent of the complainant. 6. On receipt of any complaint the Complaints/PALS department, will log the details via the Datix complaints/concerns module. All ward/departments are also responsible for documenting any informal complaints that are highlighted to them direct and are handled and resolved in the ward/department area via the Datix complaints/concerns module. Reference number Risk grading score Patient name & details Complainant s name & details Date received Brief summary of the nature of the concerns raised Action undertaken Summary of outcome of investigation Date of submission of draft reply and Investigation Record to Complaints Office 7. Investigation of complaints will be completed as soon as possible. 8. Early personal contact by the investigating officer with the complainant is paramount particularly in complex complaints. This can be by telephone contact or meeting. The Investigating Officer must agree an appropriate safe venue if a meeting is to take place. The investigating officer must also give verbal reassurance where required that any ongoing/future care needs will not be compromised as a result of a complaint being made. 9. A draft reply to the issues raised in the complaint will be drawn up by the Investigating Officer and forwarded to the Complaints Manager, wherever possible within the timescale agreed with the complainant in the complaint plan. Where the complaint plan cannot be met due to such issues as complexity of the complaint, availability of staff etc. the investigating officer must inform the Complaints Manager who can keep the complainant up to date with the situation and the reason for any changes to the plan. 10. A final copy of the complaint reply will be returned to the Service Line Manager/Head of Service by the Complaints Department for distribution to those involved in the complaint. 11. All documentation will be recorded and attached to the Complaints and Concerns module within Datix which can be accessed by the Business Unit/Head of Department. 12. For formal complaints, an Investigation Record (for every complaint) and Action Plan (where appropriate) will be completed by the Investigating Officer and forwarded with the draft reply to the Complaints Manager. Any complaints that carry a risk grading that involves Trust-wide relevance/implication will be submitted to the Risk Management (CLIPA) Group to share lessons learned throughout the Trust. Where no action is taken, the reason for this should be documented. 13. To ensure that lessons are learned and outcomes improved all actions outstanding need to be recorded onto the action plan and these will require signed off by the investigator from within the Departments concerned. 14. The initial risk grading score will be reviewed, in the light of the investigation findings, and the final score will be signed off by both the Chief Executive and the Medical Director and reported to Risk Management (CLIPA) on a quarterly basis. Complaints and Concerns Policy v7 16

17 15. A complainant can begin legal action in pursuance of their complaint until the point where Legal Services receive a formal Letter of Claim or Court Proceedings then the formal NHS Complaints procedure ceases. The decision to stop the complaints procedure for this reason is taken by the Chief Executive or his nominated deputy if he is not available. However, in any such case the internal investigation will still be completed in line with the rest of this procedure, so that the Trust secures any learning possible from the complaint and so that any possible service improvements are made. 16. Under Stage 2 procedures any Health Service Ombudsman investigations/enquiries will be coordinated by the Complaints Manager in accordance with the Ombudsman s instruction. 17. Any requests made by the Care Quality Commission for information about a complaint must be provided within 28 days. The 28-day period starts the day after the request is received. Complaints and Concerns Policy v7 17

18 Complaint no:... Name of Patient/Complainant:... Gateshead Health NHS Foundation Trust Complaints Monitoring- Risk Grading of Complaints Initial Risk Grading Category:... Upheld Agreed by either Chief Executive or Medical Director:... (Grade given on receipt) Final Risk Grading agreed by: Not Upheld Chief Executive...Date:... Final Risk Grading Category:... (After review following investigation) Medical Director:... Date:... Grading of Clinical Complaints All formal complaints should be graded for risk/severity both on receipt of the complaint then reviewed and re-graded following receipt of the investigation findings. Each complaint should be noted/marked with both a letter and grade number as follows:- A requires urgent and immediate clinical attention B does not require urgent clinical need and attention Grade Category Action 1 (Insignificant) Unfounded/insignificant None required or minor local resolution required in the case of insignificant complaints. 2 (minor) Single resolvable problem in patient experience/management. Local action only. Share as necessary through Risk Limited exposure to the Trust 3 (moderate) Patient outcome or experience below reasonable expectation in a number of areas and/or risk of outcome or experience being repeated for other patients, and/or adverse publicity for the Trust involving local media. No long-term health impact for patient(s) 4 (major) Unacceptable patient outcome or experience and/or risk of outcome or experience being repeated for other patients and/or adverse publicity for the Trust nationwide or featured prominently in local media for more than one day. Probable health impact for patient(s). 5 (catastrophic) Complaint with major and serious implications for patient care, the organisation and the wider NHS. Strong possibility of adverse media publicity. Management (CLIPA) Group Local +/- Trust-wide action required. Consider Trustwide implications and sharing through the Risk Management (CLIPA) Group Individual(s) education & training, process re-design. Trust-wide sharing & learning through Risk Management (CLIPA) Group Consider reporting to NHS reporting systems. Urgent & immediate attention & investigation. Further action as for 4. Action plan discussed at Risk Management (CLIPA) Group and signed off by Trust Medical Director & Chief Executive. Report to NHS incident reporting systems. Complaints and Concerns Policy v7 18

19 GUIDELINES FOR INVESTIGATING OFFICERS IN DEALING WITH COMPLAINTS N.B. The following guidelines should be used in conjunction with the Trust Incident and Investigation Policy. Simple Complaints Check the clinical risk grading of the complaint in case any urgent or immediate clinical attention is required Obtain patient medical and nursing notes Consider whether you require other professional notes e.g. PAM s, Social Workers etc Identify members of staff involved and discuss complaint with them to clarify all points/issues Check for any incident forms related to the event and ensure completion of such as necessary Check for any file notes or records related to the event Complete Complaint Investigation Record & Action Plan and forward to Complaints office with draft reply Complex Complaints (in addition to the above) Investigating Officer will: Decide if written statements are required from individual practitioners or not Determine the level of investigation required carrying out a Root Cause Analysis (RCA) if considered necessary as determined by the nature and severity of the complaint. Guidance on the RCA process is included within RM04 Incident Reporting and Investigation policy. Make contact with the complainant early in the process by telephone or meeting. The Investigating Officer must agree an appropriate/safe venue. Give reassurance to complainant that they/the patient will not be discriminated against as a result of making a complaint and that their concerns will be treated in confidence. Assess risk to self before deciding on venue of any meeting Discuss draft response with the Trust s Complaints Department or Legal Department, if appropriate, for precise wording Complete a Complaint Investigation Record & Action Plan to be sent to the Complaints Department with the draft reply. Ensure that remedial actions/changes that are identified in the Action Plan are implemented and signed off on completion Make sure that staff are adequately supported throughout the investigation process. * Please Note: Investigating Officers should inform the Complaints Manager immediately if it becomes clear that the complainant is making a claim for compensation Complaints and Concerns Policy v7 19

20 GATESHEAD HEALTH NHS FOUNDATION TRUST Complaints Investigation and action plan To be completed for all complaints and sent to Complaints Manager with draft complaint reply Complaint Number: Date Received: Risk rating: Investigating Officer: Response by: Name of patient: Hospital number (if available): Address: Name of complainant: Contact tel. no (if available) Address: Issues to be investigated Organisations involved: Timescales for completion of investigation and response: Completion of investigation by: Response to be sent by:..(date)..(date) Document review Medical Notes: Nursing notes: Other notes: Incident reports: Copies given to/staff involved informed - date: List of staff involved in complaint (Name and role title) Complaints and Concerns Policy v7 20

21 Staff interviewed - Name & date: Written Statements taken from Name & date taken: Record of any meetings held with patient/complainant Date & venue of meeting: In attendance: Summary of Discussion Held: Continue on additional sheets as required Record of Telephone or Other Conversations held (please record all telephone calls including messages left and no reply) Date Details Continue on additional sheets as required Feedback & Action Plan Demonstrate action / benefits carried out as a result of the complaint (good practice) Actions Identified/Action Plan Name of Staff Member Responsible for Implementation Complaints and Concerns Policy v7 21

22 Actions Carried Out Date and Sign upon completion Lessons learned shared with: (please detail meeting with dates) Signed off:- (Service Manager) Date: Final Reply Date Copy Received from Complaints Department: (Copy of Final Reply forwarded onto relevant Ward Manager / Consultant/ Staff Ward Manager: Staff Members (as necessary): Consultant: Date: Date: Date: Complaints and Concerns Policy v7 22

23 Appendix 4 Procedure for handling habitual and/or vexatious complaints 1. Introduction Habitual and/or vexatious complainants are becoming an increasing problem for trust staff. The difficulty in handling such complaints is placing a strain on time and resources and is causing undue stress for staff some may need support in difficult situations. Trust staff are trained to respond with patience and sympathy to the needs of all complainants but there are times when there is nothing further which can reasonably be done to assist them or to rectify a real or perceived problem. In determining arrangements for handling complainants there are two key considerations. The first is to ensure that the complaints procedure has been correctly implemented so far as possible and that no material element of a complaint is overlooked or inadequately addressed and to appreciate that even habitual or vexatious complaints may have issues which contain some genuine substance. The need to ensure an equitable approach is crucial. The second is to be able to identify the stage at which a complainant has become habitual or vexatious. A recognised approach to this is to have an approved policy which is formally incorporated into the complaints procedure. It is important to note that implementation of such a policy would only occur in exceptional circumstances. 2. Purpose the procedure Complaints about Trust services are processed in accordance with NHS complaints procedures and the complaints policy and procedures adopted by the Trust. During this process Trust staff inevitably have contact with a small number of complainants who absorb a disproportionate amount of NHS resources in dealing with their complaints. The aim of this procedure document is to identify situations where the complainant might be considered too habitual or vexatious and to suggest ways of responding to these situations. It is emphasised that this procedure should only be used as a last resort and after all reasonable measures have been taken to try to resolve complaints following the NHS complaints procedures, for example, through local resolution, conciliation, or involvement of ICA as appropriate. Judgment and discretion must be used in applying the criteria to identify potential or vexatious complainants and in deciding action to be taken in specific cases. The procedure should only be implemented following careful consideration by, and with authorisation of, the Chairman and Chief Executive of the Trust or their deputies in their absence. Where deputies are used, the reason for the non-availability of the Chairman or Chief Executive should be recorded on file. 3. Definition of a habitual or vexatious complainant Complainants (and/or anyone acting on their behalf) may be deemed to be habitual or vexatious complainants where previous or current contact with them shows that they meet TWO OR MORE of the following criteria: Where complainants: Persist in pursuing a complaint where the NHS complaints procedure has been fully and properly implemented and exhausted (e.g. where investigation has been denied as out of time, where a request for Independent Review has been declined). Complaints and Concerns Policy v7 23

24 Change the substance of a complaint or continually raise new issues or seek to prolong contact by continually raising further concerns or questions upon receipt of a response whilst the complaint is being addressed. (Care must be taken not to discard any new issues which are significantly different from the original complaint. These might need to be addressed as separate complaints). Are unwilling to accept documented evidence of treatment given as being factual, e.g. drug records, manual or computer records, nursing records or deny receipt of an adequate response in spite of correspondence specifically answering their questions, or do not accept that facts can sometimes be difficult to verify when a long period of time has elapsed. Do not clearly identify the precise issues which they wish to be investigated, despite reasonable efforts of Trust staff and, where appropriate, the Independent Complaints Advocacy Service (ICA) help them specify their concerns, and/or where the concerns identified are not within the remit of the Trust to investigate. Focus on a trivial matter to an extent, which is out of proportion to its significance, and continue to focus on this point. (It is recognised that determining what is a trivial matter can be subjective and careful judgment must be used in applying the criteria). Have threatened or used actual physical violence towards staff or their families or associates at any time. (This will in itself cause personal contact with the complainant and/or their representatives to be discontinued and the complaint will, thereafter, only be pursued through written communication. All such incidents should be documented). Have in the course of addressing a registered complaint, had an excessive number of contacts with the Trust placing unreasonable demands on staff. (A contact may be in person or by telephone, letter, or fax. Discretion must be used in determining the precise number of excessive contacts applicable under this section, using judgment based on the specific circumstances of each individual case). Have harassed or been personally abusive or verbally aggressive on more than one occasion towards staff dealing with their complaint or their families or associates. (Staff must recognise that complainants may sometimes act out of character at times of stress, anxiety, or distress and should make reasonable allowances for this. They should document all incidents of harassment). Are known to have recorded meetings or face-to-face/telephone conversations without the prior knowledge and consent of other parties involved. Display unreasonable demands or patient/complainant expectations and fail to accept that these may be unreasonable (e.g. insist on response to complaints or enquiries being provided more urgently than is reasonable or normal recognised practice). 4. Options for dealing with habitual or vexatious complaints Where complainants have been identified as habitual or vexatious in accordance with the above criteria, the Chief Executive and Chairman (or appropriate deputies in their absence) will determine what action to take. The Chief Executive (or deputy) will implement such action and will notify complainants in writing of the reasons why they have been classified as habitual or vexatious complainants and the action to be taken. This notification may be copied for the information of others already involved in the complaint, e.g. practitioners, conciliator, ICA, Member of Parliament. A record must be kept for future reference of the reasons why a complainant has been classified as habitual or vexatious. Complaints and Concerns Policy v7 24

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