COMPLAINTS PROCEDURE

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1 COMPLAINTS PROCEDURE AUGUST 2004 Revised July 1996 Revised March 1997 Revised November 1997 Revised May 1998 Revised November 1998 Revised July 1999 Revised May 2002 Revised March 2004 Revised June 2004 Next review date February

2 COMPLAINTS PROCEDURE 1. INTRODUCTION 1.1 The staff and management of the Trust provide a high quality service and work hard to avoid giving cause for complaint. In situations where complaints or comments are received they will be dealt with positively and used to improve services and prevent similar experiences from recurring. It is important that all staff deal with people who are dissatisfied with the service they have received in a courteous, professional manner, respecting the need for patient confidentiality. Staff should make every effort to handle a complaint either by dealing with it there and then to the complainant's satisfaction or by asking the help of a more suitable senior person or the Complaints Co-ordinator. Information on the Complaint Procedure is available in all main areas of the Trust in leaflet format (Appendix i). This leaflet also details the external agencies available to assist the complainant. A further leaflet on the Complaint Procedure (Appendix ii) is sent to the complainant with the Chief Executive s acknowledgement letter. If the matter is not a complaint, then it may be appropriate to refer the matter to the Patient Advice & Liaison Service (PALS) for on-the-spot help. Formal complaints are those that are communicated through the Chief Executive or the Complaints Manager and require formal investigation and reply. Complainants must feel free to give their opinions and be satisfied in the way in which their complaint is handled. However it is equally important that staff are supported by management when a complaint is made about them. It is important to recognise that involvement in a complaint can be very stressful for staff and senior staff and managers should be prepared to support and advise on external sources of support if appropriate. It is also important to remember that all responses to complaints are disclosable and could become public documents. For time limits see Appendix iii. A Complaint should be made as soon as possible after the event. Normally this is within 6 months of the incident or within 6 months of the date of discovery, provided this is within 12 months of the incident. There is discretion to extend this time limit, where it would be unreasonable for the complaint to have been made earlier and it is still possible to investigate the facts of the case. 1.2 Key Objectives (i) (ii) Ease of access for patients and complainants a simplified procedure, with common features for complainants about any of the services of the NHS 2

3 (iii) making it easier to extract lessons on quality from complaints to improve services to patients (iv) fairness for staff and complainants alike (v) more rapid, open processes (vi) an approach that is honest, thorough, with the prime aim of satisfying the concerns of the complainant 2. WHO MAY COMPLAIN? 2.1 Complainants will be existing or former patients of the Trust s services, or their representative. A representative is anyone who has the patient s explicit knowledge and consent to act on their behalf. Where the patient has died, or is not competent to give consent, for example, because of mental illness or disability, the individual circumstances should be considered, with particular attention to the confidentiality of the patient, and to any wishes expressed by the patient previously. Written authority from the patient s official next of kin should be obtained in line with the Data Protection Act 1998 (or for patients who have died the Access to Health Records Act 1990) Should the complainant indicate an intention to take legal action, the complaints process should cease. If a complaint reveals a prima facie case of clinical negligence, the matter should be referred to the Litigation Manager, the Corporate Services Director and Clinical Risk Advisors. If a complainant s initial letter is via a solicitor this does not necessarily mean that formal legal action is intended. A hostile, or defensive reaction at this stage, may encourage the complainant to seek information and remedy through the courts. It may be that an open and sympathetic approach will satisfy the complaint. AN APOLOGY DOES NOT CONSTITUTE AN ADMISSION OF LIABILITY. All complaints correspondence is disclosable should the matter proceed to litigation. If the case has been referred to the Coroner, the complaints investigation should continue. The fact that a death has been referred to the Coroner s office does not mean that all investigations into a complaint need to be suspended. It is important for the trust to initiate investigations regardless of the Coroner s inquiries, and where necessary, to extend these investigations if the Coroner so requests 3. VERBAL COMPLAINTS 3.1. Within Clinical Areas (i) The first responsibility of a recipient of a complaint is to ensure - before doing anything else - that the immediate health care needs of the patient are being met. 3

4 (ii) Staff should wherever possible deal with the complaint rapidly and in an informal and sensitive manner. They should seek to understand the nature of the complaint and nuances that are not immediately obvious. (iii) When the recipient of a complaint is unable to investigate adequately, or feels unable to give the assurances that the complainant is obviously looking for, then the complainant should be referred on to the Complaints Manager, either for advice or for handling. If the complaint is out of hours and escalates, the on-call manager should be contacted through switchboard. They can then contact the Head of Patient and Public Involvement or Corporate Services Director if appropriate. (iv) Any concerns raised and action taken should be recorded in the nursing Kardex/medical records. (v) Some complainants may prefer to make their complaint to someone who has not been involved in their care. In these circumstances the complainant should be advised to address their concerns to the Chief Executive. (vi) While front line staff should always encourage complainants to be forthcoming in expressing their concern, anxiety and apprehension this should never be done at the expense of overriding their right to make their complaint to the Chief Executive. (vii) Front line staff are also empowered to use the information they gain from complaints to improve service quality. Mechanisms for achieving this will be agreed at directorate level. Action of changes made should be communicated to the Head of Nursing as an improvement in the quality of the service. It will be particularly important to share information relevant to the work of other teams within the hospital so that they can take appropriate action. (viii) When deciding whether or not to pass the complainant on to the Complaints Manager, front line staff will need to take account of the seriousness of the oral complaint and the possible need for more independent investigation and assessment. When recording a verbal complaint all the issues should be checked with the complainant for accuracy. The Complaints Manager will advise and support front line staff in the resolution of complaints. 3.2 By Telephone This should be handled as for 3.1 If the matter cannot be resolved, the complainant should be referred to the Complaint Co-ordinator and the standard complaints procedure followed. Verbal complaints should be recorded and sent to the Patient Services Manager/Complaint Co-ordinator at the end of each month. (Appendix iv) 4

5 4. WRITTEN COMPLAINTS All written complaints to the Chief Executive will receive a response in writing from the Chief Executive (or a Director in his absence). The response letter should include the name of a contact within the Trust. Oral complaints that are sufficiently serious or difficult to resolve should be recorded in writing by the Complaints Manager and receive a response from the Chief Executive. 4.1 Written complaints follow a formal structure: - (i) (ii) All complaints must be dated upon receipt and sent immediately to the Complaints Manager. This will be registered and an acknowledgement letter will be sent within two working days, signed by the Chief Executive. (iii) The complaint will be allocated a reference number and be investigated by the Complaints Manager. (iv) The Complaints Manager will identify staff involved with the care or service complained of and will request their response within 21 days. Failure to receive a response to this request will result in the Complaints Manager 'chasing up' so as to try to resolve the complaint within 28 days. Where a response will take longer than this, the complainant will be advised of the reason for the delay, in writing by the Chief Executive every 28 days until a response is finalised. In the absence of the Chief Executive another Director will sign response letters to avoid unnecessary delay. Advice to staff involved in any aspect of a complaint (recipient / investigating manager / or subject of the complaint) is given initially at induction and during clinical governance meetings. Additional external training is also provided. Written guidelines are also available (Appendix vi). In some cases it may be necessary to involve external bodies e.g. the Health and Safety Executive, Police or Coroner in the investigation. This should be done in conjunction with the Risk Manager and in accordance with the Risk Management Policy of the Trust. If external advice is required, the Complaint Manager would be responsible for liaising with external agencies e.g. local PCT and the Briefing Co-ordinator / Complaint Lead at West Midlands South Strategic Health Authority (on behalf of Shropshire & Staffordshire Strategic Health Authority) who provides nominated specialists from the Department of Health database." (v) The Complaints Manager will consider whether the response should be in the form of a letter or whether a meeting would be more conducive to a satisfactory outcome. Meetings with the complainant and their advocate e.g. ICAS officer, may be more appropriate when the nature of the complaint is sensitive or emotional, where explanations may be complicated or where there is dispute. Meetings should be set up within 4-6 weeks and any reason for delay communicated to the complainant as outlined above. The Complaints Manager should be present at meetings and should involve those staff necessary to deal with the issues to be raised. When a meeting is thought necessary it can be arranged in the absence of the Chief Executive (with the consent of the 5

6 complainant). The Complaints Manager should be present and/or a Clinical/Executive Director in attendance if considered appropriate. (vi) If the response involves clinical matters it is essential that the clinicians involved are satisfied with the final reply. All communication will be aimed at satisfying the complainant that the issues have been fully and fairly investigated, with a suitably worded apology where things have gone wrong, an explanation and any action to be taken to prevent a recurrence. Any letter concluding Local Resolution must indicate the right to request an Independent Review within the time limit of 20 working days, in line with statutory guidelines. (vii) All complaint letters will be copied to the Directorate Manager, who will be asked to ensure that the deadlines are met. They will also receive a copy of the final response. Service Managers will be asked to provide a quarterly report on improvements made as a result of complaints, which will be presented to the Trust Board. (viii) A copy of the complaint and the final response will be sent to the Clinical Director for information. The Clinical Director or another appropriate independent clinician may be asked for advice when there is a disagreement over clinical judgement. (ix) (x) (xi) Where a member of junior medical staff is concerned copy will be sent to their Consultant. Where nursing staff are involved copies will be sent to the Head of Nursing. It is important that patient confidentiality is maintained and complaint letters are not placed in the patient's medical records. (xii) Any person who has been the subject of a complaint, will be informed in writing of the result of the investigation. 4.2 Performance Targets for Local Resolution (i) (ii) (iii) (iv) Most oral complaints should be resolved on the spot or within two working days. Written complaints should all be acknowledged in writing within two working days. Written complaints and oral complaints recorded in writing should be fully investigated and resolution sought within twenty-eight days. Meetings should be set up within 4 weeks of agreement to do so. These targets should be used with discretion and when not being met the complainant informed of the delay and the reasons for it together with the likely time scale for completion and response. When there is multi agency involvement i.e. another Trust or GP, the agreed Interorganisation Protocol should be followed (Appendix v) 6

7 5. MEETINGS On some occasions it may be more helpful to arrange a face-to-face meeting with complainants. The following format is recommended 5.1 People Present The meeting will be chaired by a Service Manager, Director or the Trust s Complaints Manager. Complainants are invited to bring a friend or advocate and are requested to notify the Trust of who is attending. Also invited will be the members of staff most likely to be responsible for the event or behaviour being complained about and/or their manager. 5.2 Meeting Agenda The meeting will be organised so that everyone will have an opportunity to make a statement describing events and their feelings. The recommended order should be: - 1. Complainant s statement of outstanding issues 2. Clarifying questions from staff 3. Staff statements 4. Complainant s questions and requests 5. Staff responses 6. Summary of actions 5.3 Following the meeting The meeting will be summarised in writing to the complainant with a covering letter from the Chief Executive and a copy to staff. If the complainant remains dissatisfied following a meeting, their rights are unaffected, i.e. they may ask for Independent Review. 6. COMPLAINANTS ACTION A complainant may make a request for an Independent Review if they are dissatisfied with the response made as a result of the Local Resolution process. Independent Review requests are now considered by the Healthcare Commission and details of how contact may be made are included both in the Complaint Leaflet and in the Local Resolution response. 7. HEALTHCARE COMMISSION The Commission will appoint a Case Manager who will acknowledge the complainant s request and request all the information concerning the case from the Trust. 7

8 An initial review will then be undertaken to determine whether or not it is possible, or appropriate, for the complaint to be considered further by the Commission. A number of options are available following this review: To decide the complaint is not eligible because it does not meet the Healthcare Commission criteria. To take no further action. To refer the complaint back to the Trust for further action. To refer the complaint to another body for further action or investigation e.g. the General Medical Council or the Health Service Ombudsman. To refer the complaint for action by another section of the Healthcare Commission. To carry out a full investigation of the complaint. To refer the complaint for a panel hearing. The initial review will be completed ten days after the Case Manager has received all the documentation requested from the health care provider. If the complained against is unhappy about the way a review has been undertaken, they may ask for a panel hearing (or refer to the Ombudsman). 8. INVESTIGATION BY THE HEALTHCARE COMMISSION If the Case Manager decides to investigate, he / she will finalise the terms of reference. Both the complainant and complained against will be able to comment on the draft terms. Independent expert advice will be sought as required and the Case Manager may also decide to interview people connected with the complaint. When the investigation is completed, a draft report will be prepared and sent out for comment or accuracy. The report will then be finalised and distributed to: The complainant The patient, if different from the complainant The complained about The Chief Executive of the Trust Any experts consulted The Strategic Health Authority The Healthcare Commission Standards Committee. The investigation will normally be completed within six months of the decision made to undertake it. 9. THE INDEPENDENT REVIEW PANEL If a complaint is referred to a Panel, the Healthcare Commission will set up a panel of three people a chair and two members. 8

9 Terms of reference will be agreed between the Case Manager and Chair following comments from the complainant and complaint against. A panel co-ordinator will organise the panel and produce the report of the outcomes. 9.1 Panel Reports All parties involved with the panel will have the opportunity to check the draft report for accuracy before it is finalised and distributed. Each panel hearing will produce two reports: One for the complainant / complained against which will have limited circulation A second report placed in the public domain. The panel process will normally be completed within four months of the date of the request. 10. RECORDING AND MONITORING OF COMPLAINTS The Trust Board will receive quarterly reports on complaints in order to (i) (ii) (iii) Monitor arrangements for local complaints handling including meeting time limits Consider trends in complaints Consider service improvements made as a result of complaints The Trust will publish annually a report on complaints handling and send copies to all Trusts/Health Authorities and GP fundholders with which it has NHS contracts as well as to the Community Health Council (for Wales). All reports must avoid any possible breaches of patient confidentiality. 11. THE HEALTH SERVICE COMMISSIONER (OMBUDSMAN) Should the complainant be dissatisfied with the outcome of the Healthcare Commission s review or panel, they may refer their complaint to the Ombudsman. If the person or organisation complained about is dissatisfied about the way a review has been conducted, they may also complain to the Health Service Ombudsman. The Ombudsman is independent of the NHS and Government and is in a position to ensure that there are high standards of healthcare and public administration. The Ombudsman has the same powers as the Courts to obtain papers during an investigation. The Ombudsman may decide that a formal investigation is not appropriate, or that action short of investigation can be taken, or that a formal investigation should be initiated. This may involve reviewing the relevant papers, seeking independent clinical advice if appropriate, or rarely, face-to-face interviews. A report will be issued setting out the findings and any recommendations. If the complaint is upheld the health organisation will be asked to apologise to the complainant. Periodically reports are laid before Parliament and published. If the health body is unwilling to act on the recommendations, the matter may be referred to 9

10 the Parliamentary Select Committee on Public Administration, and senior officers may be required to account for their actions. Such proceedings are usually held in public. 12. PROCEDURE FOR HANDLING HABITUAL OR SERIAL COMPLAINANTS 12.1 SERIAL COMPLAINANTS Serial complainants are becoming an increasing problem for NHS staff. The difficulty in handling such complainants is placing a strain on time and resources and is causing undue stress for staff who may need support in difficult situations. NHS 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 such complainants staff are presented with 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 complainants 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 a serial complainer. One approach to the situation is to develop an approved policy which is formally incorporated into the complaints procedure. Implementation of such a policy would only occur in exceptional circumstances. Information on the handling of serial complainants could also be made available to the public as part of the material on the complaints process as a whole THE PURPOSE OF THE PROCEDURE The aim of the procedure is to identify situations where the complainant might be considered to be habitual 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 measure have been taken to try to resolve complaints following the NHS complaints procedures, for example through local resolution, independent review, or involvement of local advocacy services as appropriate. Judgement and discretion must be used in applying the criteria to identify potential serial complainants and in deciding action to be taken in specific cases. The procedure should only be implemented following careful consideration by, and with the authorisation of the Chief Executive or the Chief Operating Officer or their deputies in their absence. Where deputies are used, the reason for the non-availability of the Chief Executive or Chief Operating Officer should be recorded on the file. In addition a non-executive Director of the Trust will be asked to review the complaint file and to give an opinion on the appropriateness/reasonableness of the Trust s proposed action DEFINITION OF AN HABITUAL OR SERIAL COMPLAINANT 10

11 Complainants (and/or anyone acting on their behalf) may be deemed to be a serial complainant 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 (eg where investigation has been denied as out of time or a request for Independent Review has been declined). 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 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 eg. drug records, General Practitioner 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 the 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, ICAS to help them specify their concerns, and/or where the concerns identified are not within the remit of the Trust to investigate. Focus on 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 judgement must be used in applying this 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. (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 judgement 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. This will include racial harassment. (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). 11

12 Are known to have recorded meetings or face-to-face/telephone conversations without the prior knowledge and consent of other parties involved. Make unreasonable demands and fail to accept that these expectations may be unreasonable (eg. insist on responses to complaints or enquiries being provided more urgently than it reasonable or normal recognised practice) OPTIONS FOR DEALING WITH HABITUAL OR SERIAL COMPLAINANTS Where complainants have been identified as serial in accordance with the above criteria, the Chief Executive or Chief Operating Officer (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 serial complainants and the action to be taken. This notification may be copied for the information of others already involved in the complaint, eg. staff, local advocacy groups, Member of Parliament. A record must be kept for future reference of the reasons why a complainant has been classified as serial. The Chief Executive or Chief Operating Officer (or deputies) may decide to deal with complainants in one or more of the following ways: Try to resolve matters, before invoking this procedure, by drawing up a signed agreement with the complainant (and if appropriate involving the relevant staff in a 2-way agreement) which sets out a code of behaviour for the parties involved if the Trust is to continue processing the complaint. If these terms are contravened consideration would then be given to implementing other action as indicated in this section. Once it is clear that complainants meet any one of the criteria above, it may be appropriate to inform them in writing that they may be classified as habitual or serial complainants, copy this procedure to them, and advise them to take account of the criteria in any further dealings with the Trust. In some cases it may be appropriate, at this point to copy this notification to others involved in the complaint and to suggest that complainants seek advice in processing their complaint, eg. through local advocacy services. Decline contact with the complainants either in person by telephone, by fax, by letter or any combination of these, provided that one form of contact is maintained or alternatively to restrict contact to liaison through a third party. (If staff are to withdraw from a telephone conversation with a complainant it may be helpful for them to have an agreement signed by the Chief Executive or Chief Operating Officer. Notify the complainants in writing that the Chief Executive has responded fully to the points raised and has tried to resolve the complaint but there is nothing more to add and continuing contact on the matter will serve no purpose. The complainants should also be notified that the correspondence is at an end and that further letters received will be acknowledged but not answered. The complainant should be advised of how to contact the Health Service Ombudsman. 12

13 Inform the complainants that in extreme circumstances the Trust reserves the right to pass unreasonable complaints to the Trust s solicitors. Temporarily suspend all contact with the complainants or investigation of a complaint whilst seeking legal advice or guidance from the NHS Executive, or other relevant agencies WITHDRAWING HABITUAL OR SERIAL STATUS Once complainants have been determined as habitual or serial there needs to be a mechanism for withdrawing this status at a later date if, for example, complainants subsequently demonstrate a more reasonable approach or if they submit a further complaint for which normal complaints procedures would appear appropriate. Staff should previously have used discretion in recommending serial status at the outset and discretion should similarly be used in recommending that this status be withdrawn when appropriate. Where this appears to be the case, discussion will be held with the Chief Executive and/or Chief Operating Officer (or their deputies). Subject to their approval, normal contact with the complainants and application of NHS complaints procedure will then be resumed. 13

14 APPENDIX iii Summary of Time Limits/Performance Targets Original complaint EVENT TIME ALLOWED 6 months from event, or 6 months of Becoming aware of a cause for Complaints, but no longer than 12 months from event: discretion to extend Oral complaint Acknowledgement LOCAL RESOLUTION Dealt with on the spot or referred 2 working days of receipt, or full reply within 5 working days Full response by trust/health authority, or Family health services practitioner 20 working days of receipt, or 10 working days of practice-based complaints, with Extended period if health authority Becomes involved 14

15 Appendix iv RECORD OF VERBAL COMPLAINTS To be forwarded to the Patient Services Manager. DATE NAME OF COMPLAINANT DETAILS OF COMPLAINT ACTION TAKEN 15

16 CROSS ORGANISATION COMPLAINTS Appendix v On occasion a Trust receiving a complaint will not be able to respond fully if there are implications for other services located outside the trust. Staff have a duty to assist colleagues in other organisations in investigating complaints so that they are not dealt with in a fragmented way. Step one If a complaint is raised against Trust/GP Practice A and it appears to A that B is either directly implicated or could have a role in providing a fuller response, then A has a duty to call for patients records held in other organisations. Therefore, if the receiving Trust requires records from another system, they should obtain these before meeting complainant and also may decide to have the records present at any meeting with the complainant, including a resolution meeting. Step two The complainant must be informed by letter that other records will be accessed in order to obtain a fuller picture in an attempt to help resolve the complaint. The express consent of the patient must be obtained and a reply paid envelope and consent form (Appendix VII) should be sent to the patient. A suggested 10-day deadline should be indicated in the letter after which it will be assumed consent is not given. Step three If, on reading other records, the receiving Trust feels that the other service can help in providing another/more adequate response then the second Trust/Practice should respond favourably to such a request. N.B. One Trust/Organisation cannot provide a response on behalf of another but can agree to a joint reply. Step four Where multiple organisations are involved, then Complaints Managers will agree on a single point of contact for the complainant throughout the process. The agreed contact point will notify complainant of their role. 16

17 GENERAL ADVICE ON COMPLAINTS HANDLING Appendix vi The Complaints Procedure is designed to help staff handle complaints. Responsibility for carrying out the procedure lies not only with the Chief Executive, Patient Services Manager and Senior Managers for its development and implementation it but also with frontline staff who handle complaints. The effective handling of complaints relies on all staff playing their part in being open, fair, flexible and conciliatory in their approach to the complaint s resolution. The impression that a complaint is an irritating intrusion is not helpful. The emphasis of Local Resolution is based on the principles that should guide good complaint practice and understanding what complainants want, rather than simply the processes by which resolution should be achieved. 1. General GOOD PRACTICE IN LOCAL RESOLUTION 1.1 For oral complaints, offer a sympathetic and immediate response from front-line staff wherever possible. The majority of complaints can be dealt with appropriately by discussion. 1.2 Always apologise for any distress caused to the complainant (remember that an apology does not constitute an admission of liability). 1.3 Offer an early meeting with the complainant to discuss the matter to facilitate speedy resolution if this is appropriate. 1.4 Where delays are expected in responding to a complainant, let the Complaints Department know the reason and indicate when they should expect a response, so they can advise the complainant. 1.5 Where the complaint involves the death of a patient, the tone of the response should sensitively reflect the grief that the complainant may be experiencing. 1.6 If the issue of compensation is raised, this should not alter the handling of the complaint, or the tone of the response. The Complaints Department will ensure that an appropriate response is made to any question of compensation. In the service areas the investigation should continue as normal. 1.7 Service Area complaints investigators should ensure they are fully aware of the Trust s Complaints Procedure. 17

18 2. Responding to the Complainant 2.1 Specify the issues raised by them point by point in your response and address them separately. 2.2 Give full information about how the investigation was carried out and from whom statements were sought. 2.3 The Consultant responsible must approve any responses to complaints that involve clinical care before being sent to the complainant. At present the Consultant responsible also receives a copy of any complaint about a junior member of staff in his/her team. Clinical Directors will also receive copies of all complaints so that they are aware of, and can support staff during this time. 2.4 Explain clinical terms clearly and avoid using jargon. 2.5 Check very carefully the details, particularly in relation to dates and times etc. Give a full explanation of any circumstances that may relate to the complaint. 2.6 Provide open and honest explanations that address each of the issues raised by the complainant. 2.7 Offer sincere apologies, or statement of regret, where appropriate. 2.8 Offer reassurance that action will be, or has been, taken to address any problems identified and indicate how. We should remember that one of the main reasons why people complain about their care is to ensure that what happened to them will not happen to others. When voicing their grievance, complainants often ask for action to be taken to prevent re-occurrence and one of the outcomes they seek in response is a commitment from the Health Service that the necessary improvements will be implemented. Information about the specific measures is what the complainants want. 2.9 Offer to meet the complainant if they are not happy with the written response, but remember that they may not wish to do so Inform the complainant of their rights under the NHS Complaints Procedure if they are not happy with the response. 3. Investigation In relation to investigations ensure that there is clarity regarding the complainant s concerns and account of events. This can be achieved by:- 3.1 Ensuring that a thorough and prompt investigation is conducted, taking full written statements from all staff concerned. Staff should be advised to; Remind themselves of the case through a careful reading of the relevant medical, paramedical and/or nursing notes. 3.2 Write a narrative of precisely what they recall of the events, what they did and did not do, whom they spoke to, who they called, and at what time they ceased to be involved in the case. Use and explain the words that

19 they recorded in the patient s notes. 3.3 They can include your impressions but clearly differentiate between this and fact. They should use their own words 3.4 Staff should explain their actions and omissions. Though desirable it is not essential to have statements typed. If handwritten ensure it is legible and written in black ink that will permit photocopying. 3.5 The lead clinician should give an opinion on the standard of care if the complaint relates to this. When statements are written it is helpful to ask a senior colleague to read through and approve it. Please remember that in the event of the matter going further, either through a request for Independent Review or if the matter becomes the subject of litigation, all complaints correspondence is disclosable and in the public domain. UNDER NO CIRCUMSTANCES store reports/statements in the patient s medical notes. 4. Feedback It is important that all Service Areas use complaints positively to improve services. When Local Resolution is concluded this information should be sent to the Patient Services Manager so that the Board can be advised of the positive steps taken. There is a form for this purpose is issued to Service Areas with each complaint.. Root cause analysis is undertaken by the investigating team so that measures may be taken to prevent re-occurrence. 5. Meetings 5.1 Allow enough time for a full discussion of the complaint. 5.2 Discuss with the complainant whom they would like to be present and suggest the involvement of the Independent Complaint Advocacy Service of Community Health Council for Welsh patients. 5.3 Handle the meeting sensitively and effectively i.e. do not be defensive or dismissive and listen to the complainant s concerns. 5.4 Always follow-up the meeting with a written record of what was said and agreed. 5.5 If no further action at local resolution is required following the meeting, ensure the complaint is closed with a formal written response.

20 6. Useful Phrases When someone has died It is important to acknowledge that there had been a death. May I personally offer my condolence for the loss of. I am very sorry to hear of the loss of. Acknowledging the Complainant s feelings This helps to set a conciliatory tone, adds warmth to your response, and lets the complainant know that someone in a position of authority has understood his/her feelings. It builds bridges. I have read your letter carefully and am sorry that you felt so dissatisfied with aspects of the care you received on Ward... Your. s illness and admission into hospital has clearly been a distressing time for you and your family. I do appreciate that, as a close relative, you have been very concerned for.. I am glad that you seem to have found your meeting with the staff helpful. Thanking the complainant where appropriate Thank you for bringing your concerns about your care to our notice. Thank you so much for taking the time to come to the hospital to meet.

Contents. Appendices. 1. Complaints Relating to Commissioned Services Page 15

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