Comments, Concerns, Complaints and Compliments Policy

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1 Comments, Concerns, Complaints and Compliments Policy Policy ID CG05 Version: 1.2 Date ratified by Governing Body 29/11/13 Author Suzi Shettle, Head of Communications and Engagement Last review date: November 2013 Next review date: 01/12/15 Version History V1.0 15/10/12 First draft V1.1 26/10/12 Final version approved by the Governing Board V1.2 12/11/13 Reviewed post authorisation. Updated references to NHS organisations and change of address. EQUALITY STATEMENT Surrey Downs Clinical Commissioning Group (Surrey Downs CCG) aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account the Human Rights Act 1998 and promotes equal opportunities for all. This document has been assessed to ensure that no-one receives less favourable treatment on grounds of their gender, sexual orientation, marital status, race, religion, age, ethnic origin, nationality, or disability. Members of staff, volunteers or members of the public may request assistance with this policy if they have particular needs. If the person requesting has language difficulties and difficulty in understanding this policy, the use of an interpreter will be considered. 1

2 Surrey Downs CCG embraces the four staff pledges in the NHS Constitution. This policy is consistent with these pledges. EQUALITY ANALYSIS This policy has been subject to an Equality Analysis, the outcome of which is recorded below. 1. Does the document/guidance affect one group less or more favourably than another on the basis of: Yes, No or N/A Comments Race Yes Positive impact Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are there any exceptions valid, legal and/or justifiable? 4. Is the impact of the document/guidance likely to be negative? No No No No No No No Yes N/A N/A N/A 5. If so, can the impact be avoided? N/A Positive impact 2

3 6. What alternative is there to achieving the document/guidance without the impact? 7. Can we reduce the impact by taking different action? N/A N/A Names and Organisation of Individuals who carried out the Assessment M Sanderson J Dix Date of the Assessment Mar

4 Contents Equality Impact Assessment 2 1. Introduction 7 2. Purpose and scope 7 3. Summary of the complaints procedure 9 4. Legal obligations Definitions Types of complaints Who can complain? Timescales for complaints Serious complaints Complaints that cannot be dealt with under this policy Hosted Services 12. Roles and responsibilities Standards to be met Complaints against healthcare providers Complaints shared with local authorities Feedback Informal complaints Patient Advice and Liaison Service (PALS) Compliments Investigating complaints: On receipt of a complaint Investigation Response Meetings Outcome for complainant 22 4

5 23. Concluding local resolution and learning lessons If the complainant is dissatisfied with the final response Second and final stage (independent review of NHS Complaints Procedure) Withdrawal of a complaint Risk management Sensitivity and support Support for staff Consent Confidentiality Logging, record keeping and retention Improving services and learning lessons Independent Advocacy Service (SEAP) Legal matters Compensation Habitual complainants Monitoring and governance Evaluation of Patient Experience Service Training Media interest Review 29 Appendix A Process charts Diagram 1 process for handling comments, concerns, complaints and compliments Diagram 2 Responding to complaints (local resolution) Diagram 3 Responding to complaints (second stage independent review) 30 5

6 Appendix B NHS Complaints Process - summary of timescales 33 Appendix C Complaint form 34 Appendix D Surrey Independent Conciliation Service 36 Appendix E Useful contacts details 38 Appendix F Confidential questionnaire Appendix G Consent Form

7 1. Introduction 1.1 Surrey Downs Clinical Commissioning Group (CCG) welcomes feedback from patients, service users, carers, members of the public, family members and stakeholders on the services it commissions and the services it hosts on behalf of other CCGs. 1.2 Feedback plays a vital role in identifying what s working and what isn t. It can highlight potential service problems and risks, enabling Surrey Downs CCG to act on these, working with partners, to deliver improvements for patients. 1.3 This policy sets out the process Surrey Downs CCG will follow in response to any feedback it receives. This policy relates to the full range of patient experience and sets out the framework and the process that Surrey Downs CCG will follow when dealing with comments, concerns, complaints and compliments. 1.4 It covers the local resolution (first stage) of the NHS complaints procedure and includes guidance on relevant subjects such as access, timescales, support, informal resolution, investigation, monitoring and learning from complaints. It will also provide details for service users who may wish to seek further advice from the Parliamentary and Health Service Ombudsman (PHSO). 1.5 This policy complies with the responsibilities for NHS organisations set out in the Local Authority Social Services and National Health Service Complaints England Regulations 2009 (and Clarification of the Complaints Regulations issued January 2010), which came into effect on 1 April These regulations were designed to improve the way in which service user s complaints are handled and to bring real benefits for health and care organisations and for the staff working in them. 1.7 Since April 2009 there has been a single approach for dealing with complaints about the NHS and Adult Social Care Services. The complaints approach is structured around three main principles: listening, responding and improving. 1.8 All staff employed by the CCG are responsible for ensuring any feedback received is managed in line with this policy. 2. Purpose and scope 2.1 If a person is unhappy about any matter relating to the CCG they are entitled to make a complaint; have it considered; and receive a response (including an acknowledgment within 3 working days). 7

8 2.2 The purpose of this policy is to provide a consistent approach to the handling of comments, concerns, complaints and compliments received by the CCG. 2.3 Surrey Downs CCG will strive to respond to any concerns raised in a supportive, honest and open way and aim to resolve any complaints quickly, fairly and, where possible, through local resolution. The purpose of local resolution is to provide an opportunity for the complainant and the CCG to attempt a prompt and fair resolution of the complaint and to provide the opportunity to put things right for complainants as well as improving services. This policy aims to ensure the CCG: Listens, responds and learns from people s experiences so services can be improved Provides accessible, flexible and responsive person-centred complaints handling, integrally linked to continuous service improvements and patient safety Ensures that complaints are handled efficiently and in a timely manner Ensures all complaints will be dealt with in an honest, open, confident and sensitive way. Achieves a good outcome for the complainant Identifies any areas of risk and takes appropriate action where necessary Learns from complaints and shares good practice throughout the CCG Enables a simple procedure common to all complaints about any services commissioned and provided by Surrey Downs CCG Undertakes root cause analysis of complaints and takes appropriate action to reduce reoccurrences Ensures local people are aware how to provide feedback and provides them with the necessary guidance and assistance Ensure complainants are not discriminated against in any way as a result of making a complaint. 2.4 This policy provides an approach that is fair, conciliatory and encourages communication between all parties. It also provides guidance to all staff who are involved in the handling of feedback to ensure that responses from the CCG are made in accordance with the Local Authority Social Services and National Health Service Complaints (England) Regulations The complaints procedure is for the resolution of concerns raised by the complainant and for an improvement in the quality of services wherever possible, rather than the apportionment of blame. 2.6 This policy applies to all staff employed by Surrey Downs CCG and will act as a guide to the NHS Complaints Procedure and the recording and reporting of compliments received by the CCG. 8

9 2.7 It also has implications for other NHS Trusts and CCG s, independent contractors and social care; all of which have a responsibility to have a complaints policy in place in line with national requirements. 2.8 Members of staff, permanent or temporary, volunteers or members of the public may request assistance with this policy if they have particular needs. If members of staff have language difficulties and difficulty in understanding this policy, they should speak to their Line Manager and the use of an interpreter will be considered. 2.9 This policy will be subject to review on an annual basis or when there is new guidance or legislation from the Department of Health. 3. Summary of the complaints procedure 3.1 Ideally, any concerns should be raised with relevant healthcare professionals at the time by speaking to a member of staff. Healthcare professionals are often best placed to deal with the issues and they will try to put things right on the spot. If it is not possible to resolve the matter in this way, the Patient Advice and Liaison Service (PALS) may be able to assist through liaison and informal resolution. 3.2 A verbal complaint, which can be dealt with by the close of the following working day, should not be dealt with through the NHS complaints procedure. Verbal complaints which have not been resolved informally and need to proceed to the formal complaints process should be clarified in writing with the complainant. 3.3 Written complaints shall be handled through local resolution, following national and local guidelines. Every effort should be made to obtain a satisfactory outcome for the complainant. 3.4 If, following the completion of local resolution, complainants remain dissatisfied, they will be advised that they have the option of asking the Health Service Ombudsman for an independent review of their complaint. There is no appeal beyond that to the Ombudsman. 3.5 Surrey Downs CCG recognises that complaints are a valuable tool for improving the quality of health services and identifying any training needs among CCG staff. 3.6 As well as ensuring the efficient handling of complaints, the CCG will identify areas of risk, implement good practice and put measures in place to prevent a recurrence. 3.7 Each complaint will be considered on its own merit and responded to accordingly. The amount of time and effort spent on investigating and resolving a complaint will be proportionate to its seriousness and/or risk of recurrence. 9

10 4. Legal obligations 4.1 The Local Authority Social Service and National Health Services Complaints (England) Regulations 2009 state that NHS organisations must have arrangements in place to deal with patient complaints. The Health Act 2009 draws attention to the NHS Constitution, which sets out the following rights for patients: A right to have any complaint about NHS services dealt with efficiently and to have it properly investigated A right to know the outcome of any investigation into the complaint A right to take a complaint to the independent Health Service Ombudsman, if not satisfied with the way the complaint has been dealt with by the NHS. 5. Definitions Policy 5.1 A policy is a Governing Body approved document that sets out the expectations of the organisation in respect of the area covered by that policy. It applies to all relevant staff, compliance with which is legally binding on all staff as part of their contract of employment. Procedure 5.2 A procedure is a document written to support a policy. A Procedure is designed to describe Who, What, Where, When, and Why by means of establishing corporate accountability in support of the implementation of a policy. A procedure would normally set out the steps and the order in which they will be taken as part of a logical approach to task completion. Comment 5.3 A comment is an observation that may provide ideas for the CCG to act on or consider. Concern 5.4 A concern is a matter that relates to or affects one, that is of importance and at the request of the individual the CCG will informally investigate. 10

11 Complaint 5.5 A complaint is an expression of discontent, regret, pain, or grief and at the request of the individual the CCG will formally investigate. Compliment 5.6 A compliment is an expression of approval, admiration or respect and is used to congratulate individuals, teams and services. 6. Types of complaints 6.1 A complaint is defined as an expression of dissatisfaction (written) about a service provided or not provided, which requires a response. 6.2 A complaint will usually relate to either a concern or dissatisfaction about a service the CCG commissions or hosts. Commissioned services are those that are paid for by the CCG but provided by other organisations such as hospitals and community care providers. Concerns may be expressed about: Something which is against the choice or wishes of a patient The way treatment, service or care has been provided to a patient Discrimination against a patient How a service has been managed Lack of a particular service The attitude or other behaviour of staff 7. Who can complain? 7.1 Patients themselves or a representative (e.g. a family member, friend, MP or other agency who has been given consent to act on behalf of the patient) can raise complaints or concerns. If consent is in doubt, the patient will be asked to sign a consent form. In cases where the CCG seeks consent from the patient, the response time will be agreed with the complainant, and will also take into account the date of receipt of consent. 7.2 A complaint can be made by: (a) (b) a person who receives or has received services a person who is affected, or likely to be affected, by the action, omission or decision of the responsible body which is the subject of the complaint. 11

12 7.3 A complaint can be made by a person acting on behalf of someone who: has died is a child has physical incapacity or lack of capacity within the meaning of the Mental Capacity Act 2005 has requested the representative to act on their behalf. 7.4 Where a representative makes a complaint on behalf of a child, the responsible body to which the complaint is made: (a) must not consider the complaint unless it is satisfied that there are reasonable grounds for the complaint being made by a representative instead of the child (b) if it is not satisfied the complaint must not be considered under the regulations and the provider must notify the representative in writing, and state the reason for its decision. 7.5 The same applies where a representative makes a complaint on behalf of a person who lacks capacity under the Mental Capacity Act The Patient Experience Manager can advise on who is, and is not, a qualifying individual. 7.6 Our Patient Experience Manager will be happy to assist any individuals who require help or support regarding the CCG s complaints policy and the process we follow. This includes supporting individuals or complainants who are unable to read English or have sight or hearing difficulties. 8. Timescales for complaints 8.1 Complaints should be made within 12 months of the event, unless the complainant could not reasonably be expected to know about the incident or had appropriate reasons for not complaining within this time period. 8.2 Complaints should be acknowledged within three working days and inform complainants inviting complainants to agree a plan for how the complaint will be handled, including the timescales for response. 8.3 Timescales for investigating complaints are not intended to be rigid and the CCG will negotiate individual timescales with complainants which reflect the complexity of the issue. Complainants should be kept informed during a lengthy investigation and advised of any delays. An extension of the timescale will be agreed with them, if necessary. Should a case continue unresolved for more than six months, it will be considered good practice to review the case and investigate the reasons for the slow progress. 12

13 8.4 There is discretion to investigate a complaint outside the timescales if there is good reason for the delay and if it is still possible to carry out an investigation. 8.5 The complainant has 12 months from raising the complaint in which to apply to the Health Service Ombudsman for a review, although all possible attempts to resolve the complaint through Local Resolution should be attempted, including the offer of independent conciliation, where appropriate. 9. Serious complaints 9.1 If an allegation or suspicion of any of the areas below is received, it should immediately be reported to the Chief Officer and investigated as a formal complaint or referred to the appropriate agency (e.g. Police if a possible criminal offence has been committed or regulatory bodies): Physical abuse Sexual abuse Financial misconduct Criminal offence Safeguarding 9.2 Where a complaint leads to the identification of a serious untoward incident, the CCG s policy for the management of incidents including SUIs shall be followed. In the case of financial misconduct the CCG s Standing Financial Instructions must be followed. Abuse and assault, verbal or physical towards staff, is not acceptable under any circumstances. 10. Complaints that cannot be dealt with under this policy 10.1 The following are excluded from the scope of this policy: A complaint made by another primary care body, NHS body, independent provider or local authority about any matter relating to arrangements made by Surrey Downs CCG with that provider A complaint made by an employee about any matter relating to his/her contract of employment A complaint which is made orally and which is resolved to the complainant s satisfaction not later than the next working day after the day on which the complaint was made A complaint which has previously been investigated under these or previous regulations A complaint which is being or has been investigated by the Health Service Ombudsman A complaint arising out of NHS Surrey s alleged failure to comply with a data subject request under the Data Protection Act 1998 or a request for information under the Freedom of Information Act

14 A complaint about children s social services If any of these complaints contain other concerns, which are not specified above, these may be able to be dealt with under the complaints regulations. The CCG will notify complainants in writing if it decides not to consider the complaint and the reason for the decision Complaints may be raised with Surrey Downs CCG which it needs to address but which do not fall within the scope of this policy. Examples of these are staff grievances, disciplinary procedures and legal action etc. Privately funded healthcare will not fall within the complaints policy. 11. Hosted Services 11.1 Surrey Downs CCG hosts the following services on behalf of all Surrey CCG s NHS Funded Healthcare team Medicines Management team Individual Funding Request team 11.2 The Patient Experience Service is responsible for the coordination of complaints on behalf of the above teams When a complaint is directly received by the above teams, the complaint must be sent to the Patient Experience Service the same working day. The Patient Experience Service will then log and acknowledge this complaint and be responsible for coordinating the response, which will be sent from the Chief Officer or deputy If the patient who is making the complaint falls under a different CCG, this CCG will be sent a copy of the formal response for their information, unless the patient requests that their complaint must not be shared. 12. Roles and responsibilities 12.1 The CCG Board, Chief Officer and senior managers are responsible for ensuring Surrey Downs CCG handles complaints according to the Local Authority Social Services and National Health Service Complaints (England) Regulations and good practice Surrey Downs CCG will ensure there is a designated Patient Experience Manager who will be readily available to the public and to staff. S/he shall be responsible to the Head of Communications and Engagement for the handling of all complaints made against the CCG and considering complaints in accordance with the arrangements made under these regulations. 14

15 12.3 The Patient Experience Service Manager and Patient Experience Coordinator will record all written complaints received by Surrey Downs CCG and ensure that they are dealt with in accordance with this policy, reporting as necessary to the Head of Communications and Engagement, Chief Officer, Chair and relevant Committees. They will liaise as required with other CCG staff, Commissioning Support Service colleagues and practitioners at all levels to ensure that the appropriate information is available to enable full and open responses to be drafted within the appropriate timescale for the Chief Officer or deputy to consider The Patient Experience Service is responsible for: managing the comment, concern, complaint or compliment from start to conclusion acknowledging complaints within three working days of receipt agreeing with the complainant the manner in which the complaint will be dealt with, including the timescale updating the Head of Communications and Engagement and Chief Officer or deputy on the progress of the complaint updating the complainant if there is any delay in responding ensuring that target dates and deadlines for responses are achieved or extensions agreed producing reports for the CCG Quality Committee and other relevant committees on the number and type of complaints, lessons learnt action taken and reflecting trends. liaising closely with Senior Managers and the CCG Board to ensure they are regularly updated on issues of particular interest and learning from complaints maintaining suitable records, including the logging of comments, concerns, complaints and compliments liaising with colleagues from other health and/or social care organisations to produce a joint response, when required producing an annual report and submiting statistical returns as required providing training and support to staff in handling complaints and investigations, including assistance with drafting responses providing induction training for new members of staff ensuring independent conciliation is available to complainants and practitioners, if required monitoring the implementation of any recommendations made by the Ombudsman 12.5 Senior managers/line managers are responsible for: agreeing with the Patient Experience Service on how a complaint will be investigated undertaking complaint investigations 15

16 root cause analysis of complaints informing staff involved in the complaint and supporting them through the process ensuring staff are familiar with the NHS Complaints Procedure ensuring that any written statements made by staff as part of the investigation process are accurate, legible, signed and dated reporting complaints to the Patient Experience Service on the same day they receive them (telephone, fax or ) and following up by sending the original letter of complaint to the team. ensuring that the investigation is carried out as soon as possible and findings are sent to the Patient Experience Service within deadlines given. providing a draft response letter or a statement addressing all points raised liaising - information sharing and feedback - where the investigation indicates that external partner agencies should be involved e.g. Health and Safety Executive, Housing, Police, social care and other trusts using complaints/findings as a learning opportunity for staff by cascading good and bad practice identified, and ensuring actions are taken to minimise and prevent future complaints advising relevant staff of the outcome of a complaint against them 12.6 All staff are responsible for: ensuring they are familiar with, and follow, the NHS Complaints Procedure knowing where to access the complaints policy or relevant information. (e.g. line manager, Patient Experience Manager, extranet and website) 13. Standards to be met 13.1 The Care Quality Commission (CQC) requires NHS organisations to investigate complaints effectively and learn lessons from them Surrey Downs CCG will adhere to the Care Quality Commission Essential Standards of Quality and Safety - Outcome 17 Complaints Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations The Care Quality Commission regulate this procedure and the CCG will provide a summary of complaints to the Commission when requested and within the timescale set. Complainants can contact the Care Quality Commission to inform them of any concerns they may have about the carrying out of a regulated activity NHS Litigation Authority (NHSLA) standards also apply: 16

17 The organisation has approved documentation which describes the process for ensuring that all staff involved in traumatic/stressful incidents, complaints or claims are adequately supported. The organisation has approved documentation which describes the process for ensuring that patients, their relatives or carers, have suitable and accessible information about and clear access to procedures to raise concerns informally. The organisation has approved documentation which describes the process for ensuring that patients, their relatives and carers, have suitable and accessible information about and clear access to procedures to register formal complaints The organisation has approved documentation which describes the process for investigating all incidents, complaints and claims The organisation has approved documentation which describes the process for ensuring a systematic approach to the aggregation of incidents, complaints and claims on an on-going basis. The organisation has approved documentation which describes the process for encouraging, learning and promoting improvements in practice, based on individual and aggregated analysis of incidents, complaints and claims. 14. Complaints against healthcare providers and independent contractors 14.1 Surrey Downs CCG has contracts in place with a range of healthcare providers. Under the NHS Complaint Regulations 2009 a patient can choose to approach either the provider or commissioner to make a complaint, but not both. Each contracted provider has its own complaints procedure based on the national NHS procedure for complaints If a complaint received by the CCG concerns a provider of contracted services, the Patient Experience Manager will decide on the most appropriate body to handle the complaint. In most cases it is anticipated that providers will handle any complaints which concern their services. However, in some cases this may not be appropriate and the Patient Experience Manager will contact both the patient and the relevant organisation to explain what action will be taken and who will be managing the complaint Surrey Downs CCG may decide to undertake the handling of the complaint itself, act as a contact point, or if it deems it appropriate and has the complainant s consent, refer the complaint to the practice or NHS Trust concerned. The CCG is not obliged to accept a complaint under these circumstances and in normal circumstances will wish to direct the complaint to the responsible organisation. In cases where an independent investigation is required, or there is another compelling reason, Surrey Downs CCG may oversee the complaint throughout. Although the CCG can be part of local 17

18 resolution, it should not be used as a second stage. The final decision on who should investigate a complaint in these circumstances will rest with the CCG Primary care practitioners (GPs, dentists, pharmacists and optometrists) also have their own practice-based complaints procedures. If a complaint refers to one of these services the complainant should discuss it with the relevant practice in the first instance or contact NHS England who are responsible for the commissioning of core primary care services. 15. Complaints shared with local authorities 15.1 Where a complaint includes issues that relate to a local authority, the Patient Experience Service will work together to ensure a full investigation takes place and that, where possible, a single response which answers all concerns is provided to the complainant The Patient Experience Service will obtain consent from the complainant to share the details of the complaint with the local authority. If the complainant does not consent then the Patient Experience Service will advise on which parts of the complaint the CCG can respond to and which parts will need to be dealt with separately by the local authority. 16. Feedback 16.1 The complaints procedure encourages a culture in which feedback from patients and the public is actively invited and facilitates service improvements Views, comments, concerns, compliments as well as complaints, requiring a response, whether major or minor issues, will be recorded and used to inform service improvements. In this way trends and themes can emerge over time, indicating a recurring or persistent problem that should be addressed. 17. Informal complaints 17.1 Surrey Downs CCG recognises the importance of informal complaints and will ensure matters are dealt with quickly so that issues do not progress unnecessarily to a formal complaint. Information from informal complaints will also inform organisational learning. 18. Patient Advice and Liaison Service (PALS) 18.1 Every effort will be made to resolve an issue or complaint as close to the source as possible, through discussion and negotiation, to effect a quick 18

19 resolution. The Patient Experience Service includes a Patient Advice and Liaison Service and this may be able to assist through informal resolution in order to prevent matters escalating unnecessarily through the formal complaints process The purpose of PALS is to: Advise and support patients, families and carers Provide information on NHS services Listen to concerns, suggestions and queries Help sort out problems quickly on behalf of the client 19. Compliments 19.1 Compliments are important to Surrey Downs CCG and should be seen as a means of understanding where things have gone well. Letters of compliment will be acknowledged and compliments statistics will be reported to the Quality Committee and cascaded to the staff involved. If staff receive compliments, they should forward these to the Patient Experience Service to be recorded Recordable compliments include expressions of appreciation by letter, card, gift or donation. Verbal compliments are not formally recorded in the overall statistics, although these compliments should be reported and the service or member of staff recognised as a result. 20. Investigating complaints local resolution (first stage) 20.1 The CCG has a clear process in place for local resolution. (See Appendix 1). On receipt of a complaint Formal complaints against Surrey Downs CCG should be made in writing. If the CCG accepts a verbal complaint, it will be put in writing and the complainant should be asked to confirm its accuracy. Acknowledgement will be made within 3 working days orally, electronically or in writing. The acknowledgement should invite the complainant to discuss the manner in which the complaint will be investigated, the desired outcome and the timescale. If the offer of a discussion is not accepted, the Complaints Officer should determine the response period and notify the complainant in writing about how the investigation will proceed. All written complaints should be sent to the Patient Experience Service immediately upon receipt. The Patient Experience Service will advise the relevant service manager on receipt of a complaint. A complaint form (Ref. Appendix 4) or file note 19

20 can be completed if there is no written correspondence as long as the content is agreed with the complainant. The Patient Experience Service will log the complaint. There should be one central tracking system in place for all complaints against Surrey Downs CCG, overseen by the Patient Experience Manager. Independent Review A comprehensive investigation, which may include a root cause analysis for complex issues, should be undertaken by senior members of staff identified to carry out the investigation for the service the complaint is about. The amount of time spent on a complaint investigation should be proportionate to its seriousness. Investigations should be thorough, with statements and information being obtained as necessary in order to identify the circumstances of the complaint, why it happened, what could have been done to prevent it, and what actions, if any, are needed to prevent a similar complaint being made. This process should endeavour to support a culture of learning and continuous improvement in the CCG. Complainants shall be advised of the outcome of the investigation. If a response cannot be sent within the agreed timescale, an explanation should be given for the delay and an extension agreed with the complainant. If agreement cannot be sought then a holding letter should be sent giving the reason for the delay and an indication of when a response will be sent. It is expected that most complaints will be resolved at the local resolution stage. Exceptionally, in the case of serious complaints, it may be necessary to involve an independent investigator but most complaints will be investigated by a Surrey Downs CCG staff member. All statements, letters, phone calls and actions taken in an investigation must be documented and kept in the complaint file in chronological order. A complete complaint file is required should the complaint be referred to the Parliamentary and Health Service Ombudsman. Response Upon completion of the investigation, the Patient Experience Service or investigating officer will prepare a draft response addressing all points raised in the complaint. The response should be succinct, jargon-free, conciliatory in tone and clear on all clinical and other issues. The final response letter will be signed by the Chief Officer, or a designated deputy, and sent to the complainant within the agreed timescales or any agreed extensions. An opportunity will be given in the letter to come back to a named person if the complainant is not fully satisfied with the outcome, or if they would find it helpful discuss the matter further either on the telephone or in person with a senior manager. 20

21 Should they remain dissatisfied at the conclusion of local resolution, complainants will be advised of their right to contact the Health Service Ombudsman to review their complaint within twelve months of raising their complaint. A response letter should: explain how the complaint has been considered address the concerns expressed by the complainant and show that each element has been fully and fairly investigated report the conclusion reached including any matters for which it is considered remedial action is needed include an apology where things have gone wrong report the action taken or proposed to prevent recurrence indicate that a named member of staff is available to clarify any aspect of the letter advise of the complainant s right to take their complaint to the Ombudsman if they remain dissatisfied with the outcome of the complaints procedure. Where appropriate, alternative methods of responding to complaints must be considered. This may be through a meeting, or direct action by a senior person. It may be appropriate to conduct a meeting in: complex cases in cases where there is serious harm/death of a patient in cases involving those whose first language is not English in cases where the complainant has a learning disability or mental health illness if this is more appropriate Letters of response should be written in plain English and clinical and other technical information should be explained. They should be drafted in a format which meets the complainant s needs. 21. Meetings 21.1 In some cases, a complainant may wish to meet with Surrey Downs CCG staff (with or without the assistance of an independent Lay Conciliator) to address any outstanding queries, either initially or following an exchange of correspondence. Complainants can be supported if they wish, e.g. by a friend, relative, carer, advocate or SEAP The CCG will explore every opportunity to resolve a complaint through local resolution. Once the final response has been signed and issued, the Patient Experience Service will liaise with relevant managers and staff to ensure that all necessary follow-up action has been taken or is in hand Arrangements should be made for any outcomes to be monitored to ensure that they are actioned. Where possible, the complainant and those named in 21

22 the complaint should be informed of any change or improvement in practice that has resulted from the complaint. 22. Outcome for the complainant 22.1 An outcome following acknowledgement of the complainant's concerns can include: an apology, if appropriate an explanation for what happened assurance that measures have been put in place to prevent a similar incident in the future, if appropriate 23. Concluding local resolution and learning lessons 23.1 The CCG should offer every opportunity to exhaust local resolution. Once the final response has been signed and issued, the Patient Experience Service, on behalf of the Chief Officer, should liaise with relevant managers and staff to ensure that all necessary follow-up action has been taken. Arrangements should be made for any outcomes to be monitored to ensure that they are actioned. Where possible, the complainant and those named in the complaint, should be informed of any change in systems or practice that has resulted from their complaint All correspondence and evidence relating to the investigation should be retained. The Patient Experience Service should ensure that a complete record is kept of the handling and consideration of each complaint. Complaints records should be kept separate from health records, subject only to the need to record information which is strictly relevant to the complainants ongoing health needs. 24. If the complainant is dissatisfied with the final response 24.1 The final response should invite the complainant to let the CCG know if they have any outstanding concerns. In such cases, consideration should be given to arranging further action which might resolve the complaint, including offering a meeting with members of staff. A response should be sent to the complainant confirming the outcome of any further action If the complainant subsequently remains dissatisfied, they may request the Parliamentary and Health Service Ombudsman to review their complaint. 22

23 25. Second and final stage (independent review) of Complaints Procedure 25.1 The Ombudsman promotes doing it once and doing it well. However if a complainant is dissatisfied with the outcome of local resolution they can take their complaint to the Ombudsman In the case of complaints which span health and social care issues, the Health Service Ombudsman will work closely with the Local Government Ombudsman. If remaining dissatisfied following Local Resolution, a complainant can approach the Ombudsman, which is independent of the NHS, to request a review The Ombudsman will only usually consider complaints, which have been through the NHS complaints procedure. Complaints should usually be referred to the Ombudsman within 12 months of the complainant raising the complaint. There is no appeal against a decision made by the Ombudsman, although a complainant is able to seek a legal remedy e.g. judicial review Information on this further stage is provided to complainants in the final response letter. Details will also be available on the CCG website. Surrey Downs CCGs will co-operate with the PHSO in any relevant independent review The Ombudsman s office has published a series of principles of good administration, of remedy and of good complaint handling. Further information on the role and work of the Ombudsman is available from: The Parliamentary and Health Service Ombudsman Millbank Tower Millbank London SW1P 4QP Tel: Website: The address of the Local Government Ombudsman is as follows: Local Government Ombudsman 10th Floor Millbank Tower Millbank London SW1P 4QP 23

24 26. Withdrawal of a complaint 26.1 If a complainant withdraws a complaint at any stage of the procedure, the complained against should be informed immediately in writing and the complainant should also be sent a letter confirming that the decision of the complainant has been noted by Surrey Downs CCG. Any identified issues should be followed up within the service area and any learning cascaded to staff. 27. Risk management 27.1 In instances where the complaint or concern identifies that there may be a risk to the patient or other people s safety, then this will be considered in light of the arrangements the CCG has in place. This will include consideration of: Claims Management Procedures Safeguarding arrangements Equality and Diversity Strategy HR framework and policies 28. Sensitivity and support 28.1 Persons expressing dissatisfaction with the CCG or the services it commissions may be grieving, vulnerable or overwhelmed by technicalities and can find the process intimidating. Equally employees who are the subject of complaints may be hurt, angry and confused All parties will be dealt with in a sensitive, compassionate and supportive manner. The CCG seeks to act fairly towards complainants and staff, involved in complaint investigations, alike. The purpose of this policy is not to apportion blame but to identify problems or weaknesses, address these and identify remedies and improvements The Patient Experience Service will be able to offer advice and act as a guide through the complaints procedure as well as providing information on the Independent Advocacy Service (SEAP) SEAP is a separate service and provides independent advice and support to people who wish to raise a complaint about the NHS. Their services will include, amongst other tasks, the drafting of letters for a complainant or accompanying them to a meeting with NHS staff or with primary care practitioners or their staff Complainants can also obtain information about the complaints process from NHS Direct. The Local Citizens Advice Bureau may also be able to assist complainants. 24

25 29. Support for staff 29.1 Any Surrey Downs staff who are involved in a complaint are entitled to be supported, both professionally and personally, through the supervision process by their line manager or other agreed supervisor. This support will include advice, assistance and attendance at meetings if required. Staff subject to a complaint may also seek support from their union representative, where appropriate Any members of staff named in the complaint, either personally or by role, should be informed of the complaint by their manager. Staff should be fully supported by their line manager and consulted during the investigation. The investigation should be full, fair and timely, and should not apportion blame. 30. Consent 30.1 There are occasions where a complaint received relates to another NHS body, independent contractor or local authority and not to Surrey Downs CCG. In these circumstances consent must be obtained from the complainant before the complaint is forwarded to the relevant organisation for investigation If a third party is making a complaint against the CCG, written authorisation should be obtained from the patient both for the complaint to be investigated and for any release of clinical records or confidential information in order to clarify any issues raised. There may be instances where consent may not be provided, for example a child or a person who lacks mental capacity, in which case the designated Patient Experience Manager, taking advice where necessary, is an appropriate person to advise whether the need for the patient s consent can be waived. 31. Confidentiality 31.1 All Surrey Downs CCG staff shall be aware of their legal and ethical duty to protect the confidentiality of patient information. The legal requirements are set out in the Data Protection Act 1998 and the Human Rights Act The common law duty of confidence must also be observed. The Caldicott Guidelines provide relevant guidance to ensure confidentiality is maintained at all times Particular care will be taken when a patient s records contain information provided in confidence by, or about a third party who is not a health professional. Only that information which is relevant to the complaint will be considered for disclosure and then only to those within Surrey Downs CCG who have a demonstrable need to know in connection with the complaint investigation. Third party information will not be disclosed to the complainant unless the person who provided the information has expressly consented to 25

26 the disclosure. Disclosure of information provided by a third party outside Surrey Downs CCG also requires the express consent of the third party. If the third party objects, then it can only be disclosed where there is an overriding public interest in doing so. 32. Logging, record keeping and retention 32.1 The Patient Experience Service will prepare and retain files for the various complaints and where appropriate will include: chronology of the case copies of correspondence copies of any relevant medical records notes from any local resolution meetings any local investigation documents relevant/related policies or procedures Surrey Downs CCG s views on the complaint These files will be made available to the Ombudsman in the event of a request for an independent review by a complainant. The CCG will comply with any requests from the Ombudsman and adhere to their deadlines. It will also support independent practitioners in meeting these deadlines wherever possible Complaints records should be kept separate from health records, subject only to the need to record information which is strictly relevant to the complainant s ongoing health needs. Complaints records will be kept for at least ten years. 33. Improving services and learning lessons 33.1 Following the conclusion of a complaint or resolution of a PALS issue, all actions will be clearly documented, acted upon and monitored If an action has been identified, the Patient Experience Service will log the details of the action to be taken on the complaints or PALS database and share these with the organisational lead involved. The organisation will demonstrate how feedback is used to learn and improve services by reporting to the CCG The Patient Experience Manager will report the number and nature of complaints and PALS received on a quarterly basis to the CCG Quality Committee. Improvement as a result of feedback the CCG has received will also be reported. 26

27 33.4 Surrey Downs will monitor the content of complaints and PALS issues and the way in which they have been handled, identify trends, take action to deal with areas of concern and share good practice. The Quality Committee will receive quarterly reports in order that they can be confident that complaints and PALS issues are being dealt with appropriately. They will note any trends and ensure that identified improvements are, where practicable, implemented Any recommendations from the Ombudsman s office will be implemented and monitored by the appropriate people as determined in the organisation. This will provide an opportunity for sharing lessons across the local health community. Investigation of complex cases will follow a root cause analysis approach. 34. Independent Advocacy Service (SEAP) 34.1 The Independent Advocacy Service (SEAP) offer an independent service to advise complainants about making a complaint about NHS services. The Patient Experience Service will provide information about the service that SEAP offers to complainants and members of the public as requested. 35. Legal matters 35.1 A complainant may take legal action. Depending on the circumstances, it may or may not be necessary for the complaints procedure to cease. Particular care is needed in order not to prejudice any legal action. Complainants may obtain advice through AvMA (Action against Medical Accidents), Citizens Advice Bureaux or a Solicitor. The Patient Experience Service should seek advice from the CCG s legal support team as required If it is necessary for the NHS complaints procedure to cease, or for some of the issues subject to litigation to cease, the complainant and complained against will be advised in writing. 36. Compensation 36.1 The NHS complaints procedure cannot assist complainants with claims for compensation. Depending on the complaint investigation, the Ombudsman s guidance on redress and remedy may be relevant. This can include an apology, reassessment of a need, provision of a service or changes in procedure. 27

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