COMPLAINTS PROCEDURE. Version: 1.4. Date Approved November Interim Complaints Manager. Date issued: November 2014

Transcription

1 COMPLAINTS PROCEDURE Version: 1.4 Committee Approved by: Integrated Governance Committee Date Approved November 2014 Author: Responsible Directorate: Interim Complaints Manager Finance and Governance Date issued: November 2014 Review date: November

2 Version Control Sheet Document Title: Complaints Procedure Version: 1.4 The table below logs the history of the steps in development of the document. Version Date Author Status Comment 1.0 September August September 2014 Corporate Risk Manager / Head of Corporate Governance Adam Bassett, Senior Associate Governance and Risk Lorne Thomson Interim Complaints Manager 1.3 2/9/14 Lorne Thomson Interim Complaints Manager /11/14 Lorne Thomson Interim Complaints Manager Approved Draft Approved Draft Approved Procedure updated to take account of recommendations arising from Francis Report Procedure updated following decision to return complaints management function to the CCG and to ensure inclusion of recommendations arising from Francis, Keogh, and Clywd and Hart Reports. Approved by the Integrated Governance Committee. Procedure updated to reflect comments made by the Integrated Governance Committee regarding the role of Healthwatch and mechanisms to ensure impartiality. Further amendment were identified following a review of CCG statutory duties and those related to complaint management. Approved by Integrated Governance Committee on 20 November

3 NHS Wakefield Clinical Commissioning Group COMPLAINTS PROCEDURE Contents Section: Page Section 1 Introduction 4 Section 2 Stage 1 Local Resolution Process 5 Section 3 Stage 2 Parliamentary and Health Service Ombudsman Review 24 Appendices: Appendix 1 Complaints Procedure Flow Chart 26 Appendix 2 Consent and how to Ensure the Complainant has Appropriate Authority to Act On Behalf of the Patient 27 Appendix 3 Matters Excluded from the Complaints Procedure 30 Appendix 4 Process for Avoiding Treating Complainants Adversely 31 Appendix 5 Guidance for Dealing with Persistent or Unreasonable Complainants 32 Appendix 6 Schedule of Standard Template Documents 35 3

4 NHS Wakefield Clinical Commissioning Group COMPLAINTS PROCEDURE Section 1 INTRODUCTION This complaints procedure details NHS Wakefield Clinical Commissioning Group s (CCG) arrangements for dealing with NHS complaints. The procedure has been developed in line with the Local Authority Social Services and National Health Service Complaints (England) Regulations (2009). It should be used in conjunction with NHS Wakefield CCG complaints policy. The procedure applies where the person affected is a person for whom the CCG has responsibility, ie the person is a registered patient within NHS Wakefield CCG. The procedure covers complaints relating to services provided by NHS Wakefield CCG and NHS services commissioned by NHS Wakefield CCG where the complainant has requested the involvement of NHS Wakefield CCG as the commissioner. The majority of patients receiving care within the NHS are happy with the care provided. It is recognised however that there will inevitably be circumstances where the expectations of some of the service users are not met and they will need to voice their feelings through the complaints procedure. Complaints are viewed positively within NHS Wakefield CCG and every effort is made to identify lessons from complaints to make positive improvements in services for patients. The roles and responsibilities of individuals within NHS Wakefield CCG for complaints are detailed in section 4 of the complaints policy. 4

5 Section 2 STAGE 1 LOCAL RESOLUTION PROCESS 2.1 General Principles The local resolution stage of the complaints procedure refers to the period when NHS Wakefield CCG seeks to resolve the issues raised in a complaint locally, to the satisfaction of the complainant. The majority of complaints received by NHS Wakefield CCG are resolved at this local resolution stage. A complaint is an expression of dissatisfaction about any aspect of NHS Wakefield CCG services or those NHS services which it commissions. The complaints process has four main aims: To investigate To explain To apologise (where appropriate) To take action to prevent a recurrence 2.2 Definitions The Complaints Manager is the person responsible for ensuring that the complaints are managed in line with this procedure. The Investigating Manager is the person who will ensure that the complaint is investigated in consultation with the Complaints Manager. 2.3 Format of Complaints NHS Wakefield CCG will receive complaints in any format which the complainant wishes to use to forward the details relating to their complaint Written Complaints letters Any member of staff working within NHS Wakefield CCG could receive written complaints. All written complaints should be forwarded to the Complaints Manager for acknowledging as soon as they are received. This should not delay the investigation commencing in general terms however it is for the Complaints Manager to liaise with the complainant and agree the specific issues of complaint Written Complaints Complaints received via should be viewed as written complaints (see above 2.3.1) and processed in the same manner. Patient sensitive information will not be sent by . All correspondence letters will be sent by post Verbal Complaints telephone Verbal complaints should be viewed as seriously as written complaints. Any member of staff who is approached by a patient or their representative with a complaint should endeavour to resolve the matter there and then. Whenever possible, complaints should be resolved at 5

6 the time. Any verbal complaint that cannot be resolved at the time should be handled in the same timescale as written complaints. If the matter remains unresolved, the member of staff receiving the complaint should prepare a clear record of the details as soon as possible and refer this to the Complaints Manager. It may be appropriate for the entire process to be resolved verbally, without any written communication. Where this occurs a complaint contact sheet should be completed and forwarded to the Complaints Manager to ensure the information is recorded for monitoring purposes. However, where the complainant indicates that they are not satisfied with the verbal response, then the complainant should be referred to the Complaints Manager for formal investigation Verbal Complaints face to face As for Verbal Complaints telephone (see above 2.3.3). If a complainant attends the premises, wishing to make a complaint, they should be facilitated to do so. A suitable room should have a table and chairs, have ease of disabled access, and good lighting. In addition, staff safety must be considered when taking details of a complaint on a face toface basis. Staff must always be accompanied by a colleague and the room used must be easily accessed by other colleagues. No meeting can commence until a senior member of the team in informed that the meeting is going ahead and they must know where it is being held Out of Office Hours Should a written complaint be received out of office hours, the complaint should be passed to the Complaints Manager as soon as possible within working hours. Should a verbal complaint be received out of office hours, relevant details should be taken and the complaint should be passed to the Complaints Manager as soon as possible within working hours. Where applicable, complainants should be advised that NHS 111 is available for out of hours clinical advice. 2.4 Status of the Patient / Complainant Complaints received from a Third Party There are many occasions where a complaint is made indirectly through a third party (eg parent or sibling, MP). The process and investigation will normally follow the same procedure as a complaint that is made directly by a patient (see Appendix 2). In all cases, when a letter of complaint is received by a third party, the Complaints Manager will acknowledge the letter and gain consent from the patient to investigate. When drafting 6

7 the response, the Complaints Manager should always be aware of the confidential nature of the response. In all cases the status of the complainant should be confirmed and each request should be considered on a case by case basis. If it is evident from the complaint that the patient is unable to consent to the investigation, the Complaints Manager will require documentary evidence of an appropriate relationship between the patient and the complainant. Occasionally, a complaint will be received where the complainant has no apparent connections with the patient concerned. In such cases, before any investigation commences, the following points should be clarified: Does the patient know a complaint has been made on their behalf? Has the patient authorised the complainant to make enquiries or can an acceptable connection be established? Letters received from solicitors raising a complaint on behalf of an individual should be dealt with in the same way as all other complaints (ie evidence of the solicitors authority to act on behalf of the complainant will be required in addition to appropriate evidence that the complainant has the authority to act on behalf of the patient). If the complaint is of significant concern (see below a) an investigation may need to be undertaken without consent (as an internal investigation). However, if consent is not given, the findings of that investigation cannot be shared Complaints Regarding a Deceased Patient When a complaint has been received regarding a deceased patient consent will be sought from the appropriate family member (or appropriate other see Appendix 2) on a case by case basis, depending on the circumstances of each complaint Complaints Received from a Disabled Person NHS Wakefield CCG seeks to facilitate complaints from disabled people and will seek to assist as appropriate to that individual s disability. For example if a complainant has a sight disability the complainant should be invited to submit details in Braille, or an audio format and the Complaints Manager should arrange for this communication to be transcribed and verified by the complainant. 2.5 Complaints Relating to Specific Organisation Types or Services Complaints about Family Health Service Practitioners (FHSPs) Complaints regarding independent contractors (eg GPs, dentists, opticians, pharmacists and commissioned services) are the responsibility of NHS England or the provider concerned. Where it is identified via complaint triage that the complainant wishes to complain about these services they will be informed in writing that they should contact either the provider concerned or NHS England Complaints about Treatment Provided by any other NHS Service 7

8 Complainants can choose whether to complain to the provider or the commissioner of NHS services. In the case of the NHS services for Wakefield district residents this would be NHS Wakefield CCG. Where a complaint is received, then the Complaints Manager will inform the complainant of their options (for the CCG or the provider to lead) and facilitate the complainants choice Complaints about a Continuing Care Decision / Individual Funding Request It is important to recognise that the review procedure for continuing care or individual funding request is not a complaints procedure. The fact that someone has had their case considered by a continuing care review panel or individual funding request panel, does not affect their rights under the NHS complaints procedure. They can complain about the original decision of the continuing care review / special referrals process, through the NHS complaints procedure Complaints about NHS Choice The NHS Constitution sets out choice as a right and includes the right to information to support that choice. If a patient complains to NHS Wakefield CCG that they have not been offered a choice, and the complaint is upheld, NHS Wakefield CCG is required to make sure the patient gets that choice. This does not apply to prisoners (or those on temporary release from prison), serving members of the armed forces and persons detained under the Mental Health Act (1983). Certain services are also excluded: Where speed of access to diagnosis and treatment is particularly important, eg: emergency attendances/admissions; attendances at a Rapid Access Chest Pain Clinic under the two week maximum waiting time; attendance at cancer services under the two week maximum waiting time. Maternity services; Mental health services; and Public health services commissioned by local authorities Complaints about a Failure to meet the 18 week Referral to Treatment Target The CCG is required to notify NHS England in writing where it receives notification from the patient (or complainant) that they have not, or will not, commence treatment within 18 weeks Complaints about Multiple Organisations A requirement of the Local Authority Social Services and National Health Service Complaints (England) Regulations (2009) is that complainants should, if they wish, receive one coordinated response to their complaint where it concerns a number of organisations. Where a complaint involves more than one NHS provider, or one or more other bodies (eg Social Services), there should be full co operation in seeking to resolve the complaint as 8

9 outlined in the Local Authority Social Services and National Health Service Complaints (England) Regulations (2009). If a complaint is made to NHS Wakefield CCG regarding more than one provider the Complaints Manager will (with the agreement of the complainant) liaise with each organisation and request that a response is forwarded back to NHS Wakefield CCG who will then arrange a combined response. NHS England has advised in the Guide to Good Complaints Handling for CCGs that where a complaint concerns primary care this should be forwarded to them. NHS Wakefield CCG will therefore liaise with NHS England regarding the response. Where complaints are about both NHS and Local Authority services, the Complaints Manager will liaise with the Local Authority to co ordinate a joint response. Where NHS Wakefield CCG takes the lead on a multi organisation complaint all organisations will be copied in to the final response to facilitate their learning and service improvement functions. 2.6 Contact from other Sources MP letters When a complaint has been received from an MP, relating to a specific patient, NHS Wakefield CCG will seek consent on a case by case basis from the patient or an appropriate family member. This will be treated as a complaint received from a third party (see above 2.4.1). When an MP raises concerns, or asks a question in general terms, this will be dealt with as an MP Enquiry. Although following a similar investigation pattern it will not include any reference to a named patient and hence consent will not be necessary Correspondence from Media Organisations If correspondence is received from media organisations regarding a complaint, the Communications Manager should be contacted in the first instance Coroner The fact that a death has been referred to the Coroner s office does not mean that investigations into a complaint should not be commenced (nor should it be suspended if already commenced prior to the Coroner s involvement). It is important for NHS Wakefield CCG to initiate proper investigations regardless of the Coroner s inquiries, and where necessary to extend these investigations if the Coroner so requests. Responses to a Coroner request do not necessarily match those required in relation to a complaint and hence the Investigating Manager will be asked to provide a separate response to the complaint. 2.7 Advocacy and Patient Support Healthwatch 9

10 Healthwatch England is the independent consumer champion for health and social care in England. They ensure that the voices of consumers and those who use services reach the ears of decisions makers. At a local level, Healthwatch Wakefield works to help people get the best out of health and social care services, whether it is improving them today or helping to shape them for tomorrow. Healthwatch Wakefield is all about local voices being able to influence the delivery and design of local services; not just people who use them, but anyone who might need to in future NHS Complaints Advocacy Service Each geographic area has a NHS Complaints Advocacy Service, which offers free, independent and confidential support to guide people through the NHS complaints process. Advocacy caseworkers support complainants in drafting letters, represent them or attend meetings with then. The level of support varies according to the complainants personal needs. The complainant will be made aware of the relevant Advocacy team for their geographical area at the point of acknowledgement Patient Advice and Liaison Service Support for making a complaint can also be provided by the West Yorkshire Patient Advice and Liaison Service (PALS) who can be contacted on Procedure A flow chart for the complaints procedure is attached (see Appendix 1) Receiving Complaints Triage Any member of staff receiving a complaint must notify the Complaints Manager and a copy of all correspondence should be forwarded immediately to ensure appropriate acknowledgement. All written complaints, and subsequent documentation, should be stamped with the date of receipt. The Complaints Manager will maintain a register through the NHS Wakefield CCG records system in which each complaint is recorded (a minimum data set which will develop in response with any changing monitoring requirements) and given a unique identifier. The central register will be maintained to provide statistical returns to the Department of Health, HSCIC, to facilitate the completion of the Complaints Annual Report, report to internal committees and the Governing Body and data for quality monitoring. At the time of receipt each complaint will be reviewed and triaged to ascertain if there are any matters of concern that require immediate action, to risk grade the events, to identify the subjects of the complaint and to identify any matters which should be excluded from investigation. All of this information will be recorded. 10

11 a Complaints Concerning a Safeguarding Concern, Incident or Immediate Care Issue Where a complaint concerns either: A possible criminal offence; A safeguarding concern; A serious untoward incident involving harm to a patient; A matter of concern relating to the immediate care of the patient or A matter which should be referred to one of the professional regulatory bodies. The appropriate Head of Service must be informed immediately. This notification may be made at any point during any stage of the complaints procedure as soon as it becomes apparent that the complaint fulfills one of the above criteria. The Head of Service must refer to the safeguarding policy in relation to the alleged incident and follow the agreed procedure. On receipt of a complaint in which is becomes apparent that a serious incident may have occurred the relevant Head of Service will be notified and provided with advice from commissioning support services (Governance Team). If an immediate care issue is identified verbal consent should be sought as a matter of urgency to contact the appropriate provider. If this is not possible the matter should be discussed with the appropriate senior manager to agree actions required in the best interests of the patient. Other matters may need to be referred to the police and the Chief Officer if a possible criminal offence has been committed. This should be reported to the next Private Governing Body meeting. If an issue is referred to the police, any investigation must stop. The complainant must also be informed. The Investigating Manager must involve the Chief Financial Officer in any possible financial offence. Where a serious complaint is received about any NHS commissioned service for Wakefield district patients NHS Wakefield CCG will liaise with the provider and ascertain if the matter should also be reported as a serious incident. Please also refer to section regarding counter fraud measures. b Risk Grading All complaints will be graded in line with the standard risk matrix, being graded either low, moderate, high or severe. (See standard triage template form). c Subject of complaint All complaints will be reviewed and the subjects of complaint (as defined for the purposes of the K041 annual return) will be identified and recorded (see standard triage template form). 11

12 d Exclusions Any matter will not be investigated where: A complaint has been made by a responsible body (organisation to organisation / professional to professional) A complaint by a member of staff which relates to their employment A verbal complaint which is resolved to the complainant s satisfaction no later than the next working day after the complaint was made A complaint which has previously been fully investigated A complaint which is being considered by the PHSO A complaint arising from an alleged failure by a responsible body to comply with a request for information under the Freedom of Information Act 2000 A complaint which relates to section 10 or 24 of the Superannuation Act 1972 The complaints procedure cannot deal with complaints about non disclosure under the Freedom of Information Act. These are dealt with under a separate policy and should be referred to the Information Governance Team. Staff grievances cannot be reported through the complaints procedure but should be dealt with through NHS Wakefield CCG s Grievance Procedure (or via the HR Department of the relevant NHS organisation). Further advice can be obtained from Human Resources. For further details see Appendix 3. Where these matters are the only issues within the complaint, the Complaints Manager will notify the complainant, via an appropriate acknowledgement, that the complaint cannot be investigated and the reason for this. Where there are other issues of complaint which do require investigation, the Complaints Manager will provide a standard acknowledgement of those issues and an explanation of which matters cannot be investigated and why. A complaint should normally be made within twelve months of the incident that caused the problem, or within twelve months of the date of discovering the problem. NHS Wakefield CCG has discretion to extend this time limit where it would be unreasonable in the circumstances of a particular case for the complaint to have been made earlier and where it is still possible to investigate the facts of the case. Where NHS Wakefield CCG decides not to investigate a complaint because it is out of time the complainant must be informed of their right to refer this to the Parliamentary and Health Service Ombudsman (PHSO) Acknowledging Complaints All complaints will be acknowledged, in writing, within 3 working days of receipt by NHS Wakefield CCG. Where possible, for written complaints including e mails, the complainant will be telephoned to clarify the issues of their complaint and to verify facts prior to the formal written acknowledgement being issued. 12

13 The acknowledgement letter will include: Date their complaint was received Condolences if appropriate Apologies that they have found it necessary to complain about a service Details of the issues of complaint A summary of the investigation plan A confirmation of what the complainant wants to happen as a result of their complaint A request for consent An explanation of how their information will be used Details of the appropriate advocacy service Details of how to receive documents in a different format / language Details of how to get back in touch with the Complaints Manager Enclosed with the acknowledgement letter will be: Leaflet explaining the NHS Complaints Procedure Consent form Leaflet explaining consent and use of personal information Equality Monitoring form Leaflet explaining reason for collection of equality monitoring information The Complaints Manager will coordinate the acknowledgement of the complaint and complete the complaints register. A copy of the complaint will be sent to the relevant Head of Service and senior officers within the CCG for information purposes. No documentation will be sent outside of the CCG until the written consent has been received Patient Confidentiality Complaints information is handled in line with data confidentiality and should only be shared on a need to know basis. This should be undertaken in line with the Information Governance Policy. Health Service Circular 1998/059 NHS Complaints Procedures: confidentiality states the use of the patient s personal information to investigate a complaint is a purpose for which it is not necessary to obtain the patient s express consent. However, as a large proportion of complaints managed by the CCG relate to care provided by other NHS organisations, consent must be obtained to allow the concerns to be shared with these organisations. Care must be taken at all times throughout the complaints procedure to ensure that any information disclosed about the patient is confined to that which is relevant to the investigation of the complaint and only disclosed to those people who have a demonstrable need to know it for the purpose of investigating the complaint. Even so, it is good practice to explain to the patient that information from his/her health records may need to be disclosed to the Investigating Manager, to clinical assessors, and possibly to the convener and panel members. If the patient objects to this, then the effect on the investigation will need to be explained. 13

14 Equality Monitoring As part of the acknowledgment process, complainants are asked to complete an equality monitoring form. The collection of this data on written complaints is valuable in gauging fair and equal access to health care across the local population. There is no obligation on patients or staff members to respond to these questions and no pressure should be put on them to answer, or on staff to obtain an answer. Should the patient or staff member not respond to the question, this should be classified as not stated Investigating Complaints Upon receipt of appropriate consent a further letter will be sent to the complainant acknowledging consent and confirming when they should receive a formal response. This timescale is based on the risk grading undertaken as part of the triage process (see above b). At the same point the investigation template will be sent to the appropriate Investigating Manager / provider requesting a response by a specific deadline Timescales These timescales are from the point at which consent has been received and are provided as a guide only. The timescales for each case should be set on a case by case basis giving due regard to the complexity or the case and number of providers involved. The proposed response date will be recorded as a benchmark for the case. Grade Investigation timescale Response timescale Low 2 weeks 4 weeks Moderate 3 weeks 5 weeks High 4 weeks 6 weeks Severe 5 weeks 8 weeks The Regulations also state that the final response should be sent to the complainant within 6 months of receipt. The CCG will endeavour to ensure that a final response is sent within 3 months (of consent being received). Any case that may breach this threshold will be brought to the attention of the Chief Officer and an action plan developed to prevent any further delays. a Holding Letters In exceptional circumstances, where there is any delay in receiving back the investigation template or where it has not been possible to contact all those involved to enable a full response, a holding letter will be sent to the complainant if it is anticipated that these delays will impact on timescale set for the final response. Further contact will be made by telephone and holding letters will be sent as required. The Investigating Manager will also be contacted and required to provide a reason for the delay and asked to provide a revised timescale. 14

15 Investigation Process Any change to the planned response date will be recorded and will be monitored as part of the monitoring process. The Complaints Manager will determine how the complaint is to be investigated and by whom, and will issue an investigation template, supported by the original complaint, for completion by the Investigating Manager. In the majority of cases the Investigating Manager will be the responsible manager within a provider organisation. The investigation template requires the Investigating Manager to provide the following information: Names and job titles of all parties involved in the investigation Details of all documentation referred to in order to respond to the concerns For each issue of complaint: A detailed investigation of what happened An explanation of what happened / an explanation of what should have happened Specific apologies where appropriate Confirmation of actions taken and lessons learnt The investigation must be independent and the Investigating Manager must have the relevant skills to undertake the task and be selected according to the importance and seriousness of the complaint. It is anticipated that the Investigating Manager will normally be the senior manager responsible for the area concerned. It is desirable that the complaint is dealt with as close to the point of delivery as possible to ensure a prompt reply and that appropriate remedial action is taken. This also ensures that the team accepts ownership of any shortcomings identified. The Investigating Manager may request a confidential statement from staff members involved in the complaint. If a complaint directly concerns an individual this person must not be the Investigating Manager. If a complaint involves a member of staff who is no longer working for NHS Wakefield CCG, a report should be obtained from the ex staff member from their last known home address. Similarly, if a complaint involves a temporary member of staff who is no longer working for NHS Wakefield CCG, a report should be obtained from the ex staff member, via the agency from which they were employed. Where this is not possible, an investigation should be undertaken obtaining as many details as possible and an explanation provided to the complainant of why any issues have not been fully investigated. Investigating managers should ensure that staff are aware of their special responsibilities towards patients who would have difficulty in making a complaint on their own. They should also instruct staff to take any necessary action to protect the patient's interests. On completion of the investigation, the Investigating Manager should send the completed investigation template to the Complaints Manager. The full details of the investigation should also be provided including notes, minutes of meetings, statements and all 15

16 information included as part of the investigation. This will then be retained within the complaint file Documentation All aspects of the investigation will be clearly recorded and all documentation, including staff statements, how the facts have been ascertained etc, will be forwarded to the Complaints Manager and retained within the complaint file. In the event that the complainant subsequently requests an independent review, NHS Wakefield CCG will require copies of all documentation. Staff should be aware that, should the matter proceed to PHSO review or litigation, all the complaint documentation is subject to disclosure. Copies of complaint correspondence must not be held on the patient s health records Outcomes from Investigation a Complaints Involving Litigation or Requiring Legal Advice Where a complaint investigation identifies the possibility of litigation ensuing, the Commissioning Support Unit (Governance Team) should be asked to make contact with the NHS Litigation Authority on the CCG s behalf. Where a complaint is already a case of litigation and particularly where the approach is made by solicitors acting on behalf of the patient, the matter should be referred immediately to the Complaints Manager who will notify the Chief Officer. A letter acknowledging receipt of the complaint should be sent. Investigation of a complaint should not be delayed as a result of legal advice being sought. The Investigating Manager should initiate enquiries immediately but any correspondence with the complainant should be agreed with the Complaints Manager who will seek legal advice as necessary. Following consultation, the Investigating Manager may wish to explore with the complainant the options available, which could prevent the possibility of litigation ensuing (eg an apology, admission of liability). The NHS Litigation Authority will also be notified. Complaints received, where litigation has commenced, are not excluded from the NHS complaints procedure. Where a complaint investigation is being undertaken in parallel with a claim investigation advice will be sought from the NHS Litigation Authority. b Investigation, which could lead to Disciplinary Action Where it is likely that a complaint, if found to be justified, may lead to disciplinary action being taken against a member of staff, the Investigating Manager should ensure that the appropriate manager is notified of the complaint. The member of staff may be asked to take part in the investigation and should be kept informed of the progress being made with the investigation 16

17 Any member of staff involved in a complaint must be informed of any allegation at the outset and must be advised of their right to seek the help and advice of a professional association or trade union before commenting on the complaint. In cases of this nature the Investigating Manager remains responsible for investigating the complaint, but the decision on whether disciplinary action is called for is a decision for the line manager in consultation with the Investigating Manager or the professional Head of Service. This decision is made in accordance with the normal disciplinary procedure and must be kept separate from the complaints procedure so that the latter is only concerned with resolving complaints and not investigating disciplinary matters. c Counter Fraud Measures Where a complainant or the subsequent investigation raises a concern about potentially fraudulent activity or practice, then the Complaints Manager should, in accordance with the NHS Wakefield CCG Anti fraud, bribery and corruption policy, inform the nominated Local Counter Fraud Specialist (LCFS) or NHS Wakefield CCG s Chief Financial Officer immediately, unless the Chief Financial Officer or LCFS is implicated. If that is the case, they should report it to the Chair or Chief Officer, who will decide on the action to be taken. An employee can contact any executive or lay member of NHS Wakefield CCG to discuss their concerns if they feel unable, for any reason, to report the matter to the LCFS or Chief Financial Officer. Employees can also call the NHS Fraud and Corruption Reporting Line on free phone This provides an easily accessible route for the reporting of genuine suspicions of fraud within or affecting the NHS. It allows NHS staff who are unsure of internal reporting procedures to report their concerns in the strictest confidence. All calls are dealt with by experienced trained staff and any caller who wishes to remain anonymous may do so. d Ex Gratia Payments and Re Imbursement of Costs There may be occasions when, having investigated the complaint, the Investigating Manager believes there are grounds for making an ex gratia payment (without accepting liability) or a re imbursement of costs. An apology and gesture of goodwill may avoid subsequent litigation and offers the opportunity to deal with certain circumstances in a fair and responsible manner. It is recommended that, before any financial redress is offered in respect of a complaint involving a member of staff, that member of staff should be involved in the discussions when the subject of compensation is raised, to ensure that he does not feel compromised by the decision to award redress. Any payments should be made having regard to NHS Wakefield CCG Prime Financial Policies and with the approval of the Chief Financial Officer. Compensation cannot be offered as this falls within the responsibility of the NHS Litigation Authority. 17

18 2.8.4 Responding to the Complainant Meetings The Complaints Manager will, in consultation with other senior staff involved, decide whether it is appropriate to offer the complainant a local resolution meeting. Where the Complaints Manager arranges a meeting with the complainant, the staff involved will be consulted to determine how the meeting will be structured. The Complaints Manager will conduct the meeting and will arrange for the meeting to be recorded and ensure that notes are taken. Two members of NHS Wakefield CCG staff should normally attend any meeting and the complainant should be offered the opportunity to have someone else present at the meeting to assist them. The meeting must be formally recorded and a copy of the notes, and the recording, forwarded to the complainant. If required by the complainant, meetings should take place on neutral premises or at the complainant s residence and at a location with suitable access. If necessary, the complainant can request for an interpreter to be present and the CCG will arrange this Written Response All written complaints concerning NHS Wakefield CCG (and any verbal complaints, which are felt to be sufficiently serious) must receive a formal response in writing. Other than in exceptional circumstances or where previously agreed with the complainant, the final response should be dispatched within the timescale agreed with the complainant. (See above ) Upon receipt of the completed investigation template(s), and supporting evidence, the Complaints Manager will prepare a draft response to the complainant. The Complaints Manager will be impartial in their response, referencing the original complaint and the issues previously agreed with the complainant. Comments will be qualified by reference to evidence and where this is not possible opinion will be attributed to the individual who gave that opinion. Dependent on the quantity of information to be shared, this will be in the form of a letter from the Chief Officer or a formal report supported by a letter from the Chief Officer. The Complaints Manager will define, on the basis of the evidence provided, the outcome of the complaint, ie whether the complaint has been upheld (failings have been identified in a significant proportion of the issues raised, or one major failing was identified), partially upheld (failings have been upheld in a small proportion of the issues raised, none of which were significant) or not upheld (no failings were identified). Where it is clear that there has been a mistake or failure in procedures, this should be clearly stated and an appropriate apology given. Details of the action being taken to prevent a recurrence should also be described. Where a mistake or failure in procedures constitutes an admission of negligence or legal liability, the matter must be referred to the NHS Litigation Authority for advice. Where it is clear that there has been no mistake or failure in procedures, this should be clearly stated, to ensure that the complainant is properly informed. 18

19 Where appropriate the Complaints Manager will seek advice from clinical professionals not previously involved in the complaint (such as the clinical advisor, medicines optimisation, etc) to give a view on the appropriateness of clinical actions. Where appropriate and practical, replies to complaints will be shared with the relevant Head of Service before the reply is sent. Staff who may be the subject of a complaint can be anxious about the process and their position. It is important that they are kept informed about progress with the investigation by the Investigating Manager and that they are offered the opportunity to discuss the matter with a professional colleague. Wherever possible, they should have the opportunity to comment on the accuracy of the draft response to the complainant and they should be shown a copy of the final response to make them aware of its content. Where it has been agreed that NHS Wakefield CCG will lead on a complaint investigation, concerning a number of organisations, NHS Wakefield CCG will provide a copy of the final response to each organisation involved. Once prepared the draft response will be reviewed by the Governance and Board Secretary (or a designated alternative senior manager) against a quality assurance checklist (aligned to the NHS England guidance) to ensure all key components of a final response letter are included. They will also act as an impartial critical friend and question the response as necessary. Once quality assured, the Complaints Manager will organise review by the Assistant Clinical Leader with particular reference to any clinical issues but also acting similarly as a critical friend prior to final review and signature by the Chief Officer. The final response will invite the complainant to let the Chief Officer know if they have any outstanding concerns and inform the complainant of the next stage of the complaints procedure should the complainant be dissatisfied. (See below 2.9). A copy of the signed response for CCG complaints will be forwarded to the Investigating Manager for their records. 2.9 Action where the Complainant is Dissatisfied with the Final Response If the complainant is dissatisfied with the final response they should be asked to identify the specific further concerns that they have. Consideration should be given to how the complaint might be resolved. On a case by case basis, either a further investigation by the relevant senior manager or a meeting with staff, could be offered. If the complainant subsequently remains dissatisfied, they should be encouraged to request an independent review of their complaint by the Parliamentary and Health Service Ombudsman Learning from Complaints Learning Lessons from Individual Complaints 19

20 Following investigation of the complaint, the Investigating Manager will be responsible for identification of lessons learnt and ensuring that actions have been completed within a reasonable timescale. NHS Wakefield CCG must be able to demonstrate that following investigation of a complaint any changes, which are identified and will reduce risk, are considered and implemented if appropriate. Investigating managers are routinely requested to consider and document any lessons learnt as part of the management of complaints using the Complaints Learning Lessons Form. A key part of the complaints process is to identify how services can be improved as a result of patient feedback and ensuring that lessons are learnt at all levels. The form should be signed by the relevant Head of Service and retained within the complaint file. The Complaints Manager will also log these. These lessons learned are anonymously reported within the reporting process to both the Quality Intelligence Group and the Integrated Governance Committee. Where these are not forwarded the Complaints Manager will pursue them from the relevant Head of Service to ensure completeness of the governance cycle Learning Lessons from all Complaints The Complaints Manager has a responsibility to have an overview of all complaint cases received by the CCG. If the Complaints Manager becomes aware of issues being repeated they must bring this to the attention of the appropriate Head of Service and Quality Lead for further investigation, including root cause analysis, to ensure that action is taken quickly Reporting Arrangements All reporting will be in line with the Good Complaints Handling Guidelines. A monthly report detailing compliments, complaints, areas of concern and links with the Patient Advice and Liaison Service (PALS), Risk Management and Claims will be presented to the Integrated Governance Committee. Response times will be regularly monitored and any delays reported to the Governance and Board Secretary. Each month all new complaints will be discussed (in an anonymous form) in the Quality Intelligence Group, along with data from other sources, to identify any trends and to triangulate intelligence. The information provided will include the risk grading, brief description, provider, and subject of complaint. For those cases which have been closed during the month the outcome of the case (where the complaint was upheld, partially upheld, or not upheld) and any learning will be provided. An annual report is presented to NHS Wakefield CCG Governing Body. A complaints report will also be included in NHS Wakefield CCG s annual report. This will include specific information on: The number of complaints received 20

21 The outcome of complaints, eg the number of cases upheld The number of complainants signposted to other organisations A breakdown of the subject matter of the complaints received A register of learning outcomes that have been identified and implemented as a result of complaints. On an annual basis a return to the Department of Health (KO41)/Health and Social Care Information Centre (HSCIC) is completed. The CCG will cooperate with organisations including the Care Quality Commission, NHS England, Monitor and Healthwatch, bearing in mind the need to maintain confidentiality or obtain consent as necessary, in any request for complaint information and / or documentation Miscellaneous Information about how to Make a Complaint The complaints procedure will be advertised widely throughout premises where NHS services are provided. NHS Wakefield CCG will provide comprehensive information via its website and will ensure that all staff are aware of how to assist complainants to raise their concerns Access to this procedure This procedure shall be given, free of charge, to any person who makes such a request Provision of Care Whilst a Complaint is in Progress It is recognised that, on rare occasions, the relationship between a patient and a service may break down and the patient may feel cause to complain about that service. It is NHS Wakefield CCG s policy not to withdraw services or treatment or support as a result of a complaint and the CCG will facilitate the continuation of clinical care. The procedure to be followed to avoid complainants being treated adversely and the steps to be taken to investigate adverse treatment is attached (see Appendix 4). If a patient complains verbally to a staff member, in accordance with the local resolution procedure, the recipient of the complaint should try and resolve the matter to the complainant s satisfaction at that time or within a very short period, so as to minimise any ill effect on the patient s continuing need for care. If this is not successful the complainant should be advised to contact the Complaints Manager and be supported to do this. If a patient complains in writing, the Complaints Manger will endeavour to resolve matters quickly, also having regard to the patient s need for continuing care. If either side feels that the matter cannot be resolved and the complaint is impacting on the relationship between the patient and the service, the Complaints Manager must contact the appropriate Head of Service as a matter of urgency (ie within 24 hours) to discuss the most appropriate way to resolve the matter Persistent or Unreasonable Complainants 21

22 NHS Wakefield CCG is committed to treating all complainants equitably and recognises that it is the right of every individual to pursue a complaint. NHS Wakefield CCG therefore endeavours to resolve all complaints to the complainant s satisfaction. However, on occasions, staff may consider that a complaint is unreasonable in nature, eg the complainant raises the same or similar issues repeatedly, despite having received full responses to all the issues they have raised (see Appendix 5). There may also be occasions when staff may receive telephone calls from complainants where the complainant is abusive and/or uses threatening or bad language. In such cases, the recipient of the call should remain calm and inform the caller that they are not prepared to continue the call and will put the phone down unless the caller modifies their language. The staff member should document the phone call and fill out an incident form, providing copies to the Complaints Manager. If it is considered that a complainant is becoming unreasonable, the member of staff should refer to the guidance for dealing with persistent or unreasonable complaints. Any decision to implement the guidance will be made jointly between the Complaints Manager, Governance and Board Secretary and Chief Officer Archiving and Disposal of Records Please refer to the CCG Policy on Records Management References Associated NHS Wakefield CCG documents include: Complaints Policy Integrated Risk Management Framework Incident Reporting Policy Disciplinary Policy Information Governance Policy Staff Support Policy Regulations and Guidelines The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 Department of Health (2009) Listening, responding, improving: a guide to better customer care Department of Health (2009) Implementation of the right to choice and the information set out in the NHS Constitution Parliamentary and Health Service Ombudsman (2009) Principles for Remedy Parliamentary and Health Service Ombudsman (2009) Principles of for Good Administration Parliamentary and Health Service Ombudsman (2009) Principles of Good Complaints Handling NHS Constitution NHS England (2013) Guide to good handling of complaints for CCGs 22

23 Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive Summary The Francis Report (February 2013) Review into the quality of care the treatment provided by 14 hospital Trusts in England: overview report The Keogh Report (July 2013 A Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture. Clywd and Hart (October 2013) 23

24 Section 3 STAGE 2 PARLIAMENTARY AND HEALTH SERVICE OMBUDSMAN (PHSO) REVIEW Independent review is the second stage of the complaints procedure and is implemented when the complainant has exhausted the local resolution stage. NHS Wakefield CCG and independent contractors must inform the complainant within the final response of the next stage of the complaints procedure should they be dissatisfied and give details of how to contact the PHSO. Complainants who remain dissatisfied following the completion of local resolution may contact the PHSO, requesting an independent review of their case. This should be done within a year or receipt of the final response, unless the PHSO considers that it is reasonable to review the complaint outside of this timescale. The PHSO can conduct independent investigations of complaints about NHS providers and practitioners. The PHSO has established three sets of principles which outline the approach it believes public bodies should adopt when delivering good administration and customer service, and how to respond when things go wrong: Principles of Good Administration, Principles for Remedy, and Principles for Good Complaints Handling. The six principles for Good Complaints Handling are: Getting it right Being customer focused Being open and accountable Acting fairly and proportionately Putting things right Seeking continuous improvement The process for how NHS Wakefield CCG will handle PHSO recommendations follows: 3.1 Actions to be undertaken when a complaint is referred back or upheld by the PHSO When a complaint concerning an organisation providing NHS services is referred back from the PHSO it is usual procedure for the PHSO to request a full copy of the complaint file and all relevant supporting documentation (including medical records), by a specified deadline. The Complaints Manager will use this opportunity to re visit the complaint records, identify the points raised and ascertain if there are any points of action required by either NHS Wakefield CCG or the organisation involved. If anything is identified, under the duty of candour, the PHSO must be made aware of any shortcomings in the final response or investigation and an offer of further investigation made. If, having reviewed the case, the PHSO has criticised the handling of a complaint by an organisation providing NHS services the Complaints Manager will comply with the PHSO s requirements which may include: Re investigation of the issues raised or re investigation of some of the issues raised. Contacting the provider organisation to discuss the issues raised. Notifying and seek appropriate clinical advice where necessary. 24

25 Discussing with the organisation an action plan to address the issues raised. Responding to the PHSO regarding the action undertaken in line with requested guidelines. If the PHSO has criticised NHS Wakefield CCG directly the Complaints Manager will notify the Chief Officer and the Assistant Clinical Leader. After consideration by the Chief Officer, the Complaints Manager will ensure that a response is made within the deadline set by the PHSO, and where necessary a response is made to the complainant, outlining the action to be undertaken. 25

26 NHS Wakefield Clinical Commissioning Group Appendix 1 COMPLAINTS PROCESS FLOW CHART Complaint received (letter, , telephone call) Documents / details forwarded to Complaints Manager Complaint triaged to confirm if appropriate to manage Not appropriate to manage write to complainant, explain why and signpost to correct organisation Complaint triaged to identify any issues of concern (safeguarding, immediate care issues, serious incident, criminal activity, etc) Issues of concern identified make appropriate Head of Service aware and act in best interests of patient Try to speak with complainant to clarify and verify points. Acknowledge receipt (within 3 working days) in writing and request consent Copy to appropriate Head(s) of Service and Senior Officer(s) for information only Consent not received write to complainant, giving deadline for consent, and confirming case will be closed if not received Consent received acknowledge receipt Launch complaint to Investigating Manager(s) with deadline for response response to include robust investigation and identification of any lessons learnt and actions taken Response not received by deadline chase response escalate if ongoing delay Complaints Manager receives investigation response Response not adequate go back to Investigating Manager for further information Lessons learnt and actions taken fed into quality monitoring framework Complaints Manager drafts final response Draft final response quality assured by Governance & Board Secretary Amendment required - final response updated with any necessary changes Final draft response sent to Assistant Clinical Leader for approval and to Chief Officer (or nominated officer) for approval and sign off Amendment required final response updated with any necessary changes Approved and signed Final Response posted to complainant (1 st class) and copies sent as appropriate Complainant satisfied - Close File Complainant not satisfied Offer further local resolution (further investigation, meeting) and reiterate option of PHSO review 26

27 NHS Wakefield Clinical Commissioning Group Appendix 2 CONSENT AND HOW TO ENSURE THE COMPLAINANT HAS APPROPRIATE AUTHORITY TO ACT ON BEHALF OF THE PATIENT In general terms consent can be broken down into 3 areas: Consent provided by the patient Consent provided by the patient, who has nominated someone else to act on their behalf Consent provided by a third party who has the legal authority to act on behalf of a named patient As such the consent form is broken down into these 3 sections. However, there can be complexities which must be considered under all 3. 1 Consent provided by the patient (Section 1 of the Consent Form) Does the patient have capacity to understand exactly what consent means? Or do they actually understand what is included in the consent form? The Complaints Manager must be satisfied that the patient understands what they have signed. One common misconception from patients is that consent is transferrable between different departments in an NHS organisation, or in relation to more than one request from one department. This is not automatically the case. A patient might make a complaint and request copy medical records it would not be appropriate for the complaints team to transfer their consent to the access to records team as they relate to very different matters. A patient might raise a complaint about one issue and then 3 months later raise a differing complaint we must have two separate consent forms if the issues are different. However, if the second complaint is a continuation of the first, ie the same issues, the original consent document will be valid. Patients also may not understand that we must have their consent before we can even approach a differing NHS organisation. We must have consent if we are going to investigate matters outside of the CCG as we have to contact that other organisation. Completing the form Patient details are completed at the top of page 2 and the patient will sign and date Section 1. 2 Consent provided by the patient, who has nominated someone else to act on their behalf (Sections 1 and 2 of the Consent Form) As well as using a family member or a good friend, a patient might approach their MP to act on their behalf. This is totally acceptable. It is for the patient to decide who is acting on their behalf we cannot dictate who they use. Be aware that a GP might raise a complaint if they are doing this with the full authority of the patient as their advocate this is acceptable, if they are doing this in a professional capacity it is not as professional to professional complaints cannot be accepted under the regulations. 27

28 Review the documentation. Has the patient actually given consent is it really their signature? Eg mum is raising a complaint about the care provided to her 19 year old daughter the Complaints Manager must be confident that the signature on the form is that of the daughter, and not faked by mum. Next of Kin has no authority in law. A husband may be recorded as the next of kin to his wife. Whilst he can raise a complaint on her behalf he cannot have access to the response unless his wife has provided consent. Completing the form Patient details are completed at the top of page 2 and the patient will sign and date Section 1. Additionally the nominated complainant s details will be completed in Section 2 and the patient will again sign at the bottom (of Section 2), indicating that they are happy for this individual to act on their behalf. 3 Consent provided by a third party who has the legal authority to act on behalf of a named patient (Sections 1, 2 and 3 of the Consent Form) Children under the age of 16 It would be appropriate for a parent (or adult in a legal guardianship role) to make a complaint about the care or treatment of a child. Complaints being made by someone else must have the consent of the parent / guardian. Be aware when a parent lives at an address different to the child you need to ascertain if the parent has retained parental responsibility or not (usually following a divorce or a separation). As an example: child lives with mum but dad has made the complaint does dad have joint custody / parental responsibility for the child. This is very emotive but you must be satisfied that appropriate consent has been received. Evidence: A copy of the child s full birth certificate (not the abbreviated certificate as this does not name the parent). In a case of a separation there is usually a court document detailing the parental responsibilities that each parent holds. Children aged 16 to 18 As above, for a child under 16. However, it may be more appropriate for the child to give consent. This should be decided on a case by case basis being aware of the circumstances of the complaint and the child s maturity and understanding (described as Gillick competency and explained in the Fraser guidelines). Thought should be given to the nature of the complaint: it would be preferable to get the child s consent if the complaint related to reproductive health, GUM medicine, contraception or a long term condition which the child has extensive knowledge of such as Cystic fibrosis or diabetes, however for things like trauma and orthopaedics or general medicine it might not be necessary. 28

29 Patients lacking capacity This will include patients with severe disabilities (physical or learning), dementia, locked in syndrome etc and those who are unconscious where it is believed that this situation will continue for some time. Where no evidence can be produced (eg young healthy patient unconscious following a road traffic accident with nothing in place) it would be appropriate to manage the complaint in the patient s best interests by seeking consent from an immediate relative (a parent, spouse or child) Evidence: Lasting Power of Attorney (appropriately authorised and with a court stamp), historic record of patient giving consent for access to their information. Deceased patients If the patient is dead any individual who is a beneficiary of the estate, is the executor of the estate, or is an immediate relative, has a right to raise a complaint. Remember that next of kin has no legal standing if the patient had nominated their neighbour as their next of kin, it does not make them the appropriate person to raise a complaint on their death. Evidence: A copy of the will will name the beneficiaries and executors. Children can present their birth certificate, parents can present the deceased s birth certificate and the spouse can show their wedding certificate. Be aware that a daughter may have changed her name she will also need to show any document that confirms her name change from that on her own birth certificate to her new name (usually her wedding certificate). Completing the form Patient details are completed at the top of page 2. Additionally the nominated complainant s details will be completed in Section 2. Neither section is signed because the patient is not able to sign. Section 3 is completed by the complainant indicating the evidence that they have provided, to show their authority to act, and they should sign this section. 29

30 NHS Wakefield Clinical Commissioning Group Appendix 3 MATTERS EXCLUDED FROM CONSIDERATION UNDER THE COMPLAINTS PROCEDURE 1 a complaint made by an NHS body which relates to the exercise of its functions by another NHS body; 2 a complaint made by a primary care provider which relates either to the exercise of its functions by an NHS body or to the contract or arrangements under which it provides primary care services; 3 a complaint made by an employee of an NHS body about any matter relating to their contract of employment; 4 a complaint made by an independent provider or an NHS foundation trust about any matter relating to arrangements made by an NHS body with that independent provider or NHS foundation trust; 5 a complaint which is being or has been investigated by the Parliamentary and Health Service Ombudsman; 6 a complaint which is being or has been investigated by another NHS organisation; 7 a complaint arising out of an NHS body 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 2000; 8 a complaint about which an NHS body is taking or is proposing to take disciplinary proceedings in relation to the substance of the complaint against a person who is the subject of the complaint may be excluded depending on the circumstances of the case. 9 a complaint about an historic matter, specifically a complaint should be made not later than 12 months after the date at which the occurrence (the subject of the complaint) happened, or 12 months after the complainant became aware of the occurrence. This time limit will not apply if the complainant can show good reason for not making the complaint earlier or it is still possible to conduct a fair and effective investigation into the complaint. 30

31 NHS Wakefield Clinical Commissioning Group Appendix 4 PROCESS FOR AVOIDING TREATING COMPLAINANTS ADVERSELY NHS Wakefield CCG is committed to ensuring that complaints are managed appropriately in line with national guidance and that patients and their relatives or carers have the opportunity to complain if they are dissatisfied with any of the services provided by NHS Wakefield CCG. Staff are advised of complaints discrimination issues through essential training and of the requirement to ensure that all patients, relatives and carers are not treated adversely if they have made a complaint. Flow chart for process to follow where a complainant claims they have been treated adversely. Complainant alleges discrimination Other NHS Provider Complaint CCG Complaint Considered by Chief Officer who will request organisation affected to investigate Investigation by the Chief Officer Outcome shared with complainant 31

32 NHS Wakefield Clinical Commissioning Group Appendix 5 GUIDANCE FOR DEALING WITH PERSISTENT AND UNREASONABLE COMPLAINANTS 1 Introduction This guidance covers all contacts, enquiries and complainants. It is intended for use as a last resort and after all reasonable measures have been taken to try and resolve a complaint within the Complaints Policy. Persistent complainants may have genuine issues and it is therefore important to ensure that this process is fair and the complainant s interests have been taken into consideration. 2 Purpose of guidance To assist staff to identify when a person is persistent or unreasonable, setting out the action to be taken. 3 Definition of persistent and unreasonable complainants There is no one single feature of unreasonable behaviour. Examples of behaviour may include those who: Persist in pursuing a complaint when the procedures have been fully and properly implemented and exhausted Refuse to accept documented evidence as fact Do not clearly identify the precise issues that they wish to be investigated, despite reasonable efforts by staff, and where appropriate, the relevant independent advocacy services could assist to help them specify their complaint Continually make unreasonable or excessive demands in terms of process and fail to accept that these may be unreasonable e.g. insist on responses to complaints being provided more urgently than is reasonable or is recognised practice Continue to focus on a trivial matter to an extent that it is out of proportion to its significance. It is recognised that defining trivial is subjective and careful judgment must be applied and recorded Change the substance of a complaint or seek to prolong contact by continually raising further issues in relation to the original complaint. Care must be taken not to discard new issues that are significantly different from the original issue. Each issue of concern may need to be addressed separately Consume a disproportionate amount of time and resources Threaten or use actual physical violence towards staff Have harassed or been personally abusive or verbally aggressive on more than one occasion (this may include written abuse e.g. s) Repeatedly focus on conspiracy theories and/or will not accept documented evidence as being factual Make excessive telephone calls or send excessive numbers of s or letters to staff Make inappropriate or personal comments about staff Raising issues not relating to the NHS 32

33 4 Actions prior to designating a complainant as unreasonable or persistent It is important to ensure that the details of a complaint are not lost because of the presentation of that complaint. There are a number of considerations to bear in mind when considering imposing restrictions upon a complainant. These may include: Ensuring the complainants case is being, or has been dealt with appropriately, and that reasonable actions will follow, or have followed, the final response Confidence that the complainant has been kept up to date and that communication has been adequate with the complainant prior to them becoming unreasonable or persistent Checking that new or significant concerns are not being raised, that require consideration as a separate case Applying criteria with care, fairness and due consideration for the client s circumstances bearing in mind that physical or mental health conditions may explain difficult behaviour. This should include the impact of bereavement, loss or significant/sudden changes to the complainants lifestyle, quality of life or life expectancy Considering the proportionality and appropriateness of the proposed restriction in comparison with the behaviour, and the impact upon staff Ensuring that the complainant has been advised of the existence of the policy and has been warned about, and given a chance to amend their behaviour Consideration should be also be given as to whether any further action can be taken prior to designating the complainant unreasonable or persistent. This might include: Raising the issue with a Director with no previous involvement, in order to give an independent view Where no meeting with staff has been held, consider offering this at a local level as a means to dispel misunderstandings (only appropriate where risks have been assessed) Where multiple departments are being contacted by the complainant, consider a strategy to agree a cross departmental approach Consider whether the assistance of an advocate may be helpful Consider the use of ground rules for continuing contact with the complainant. Ground rules may include: Time limits on telephone conversations and contacts Restricting the number of calls that will be taken or agreeing a timetable for contacting the service Requiring contact to be made with a named member of staff and agreeing when this should be Requiring contact via a third party e.g. advocate Limiting the complainant to one mode of contact Informing the complainant of a reasonable timescale to respond to correspondence Informing the complainant that future correspondence will be read and placed on file, but not acknowledged Advising that the organisation does not deal with calls or correspondence that is abusive, threatening or contains allegations that lack substantive evidence. Request 33

34 that the complainant provides an acceptable version of the correspondence or make contact with a third party to continue communication with the organisation Ask the complainant to enter into an agreement about their conduct Advise that irrelevant documentation will be returned in the first instance and (in extreme cases) in future may be destroyed Adopting a zero tolerance policy. This could include a standard communication line, for example: The NHS operates a zero tolerance policy, and safety of staff is paramount at all times. Staff have a right to care for others without fear of being attacked either physically or verbally 5 Process for managing unreasonable or persistent behaviour Where a complainant has been identified as unreasonable or persistent, the decision to declare them as such is made jointly by the Complaints Manager, Governance and Board Secretary and the Chief Officer. The Chief Officer will write to the complainant, informing them that either: Their complaint is being investigated and a response will be prepared and issued as soon as possible within the timescales agreed That repeated calls regarding the complaint in question are not acceptable and will be terminated, or; Their complaint has been responded to as fully as possible and there is nothing to be added That any further correspondence will not be acknowledged by the CCG. All appropriate staff should be informed of the decision so that there is a consistent and coordinated approach across the organisation. If the declared complainant raises any new issues then they should be dealt with in the usual way. Review of the persistent status should take place at six monthly intervals. 6 Urgent or extreme cases of unreasonable or persistent behaviour In urgent or extreme cases, adopt safeguarding and zero tolerance policies and procedures. Discuss the case with the appropriate senior manager to develop an action plan that may include the use of emergency services in some circumstances. In these circumstances, carry out a review of the case at the first opportunity after the event. 7 Record keeping Ensure that adequate records are kept of all contact with unreasonable and persistent complainants. Consideration should be given as to whether the organisation should take further action, such as reporting the matter to the police, taking legal action, or using the risk management or health and safety procedures to follow up such an event in respect of the impact upon staff. 34

35 NHS Wakefield Clinical Commissioning Group Appendix 6 SCHEDULE OF STANDARD TEMPLATE DOCUMENTS no Process Element Document Name Purpose 1a Receipt Form complaint contact sheet To allow non Complaints Managers to gather relevant information in order to allow Complaints Manager to proceed with case 2a Triage Form case review and triage Safeguarding, risk assessment, picking out minimum data set, setting investigation plan 2b Triage Memo copy complaint details for Initial sharing with appropriate Heads of Service, Chief Officer, Clinical Advisor as information appropriate 3a Acknowledgement Letter acknowledgement standard Formally acknowledge of receipt (within 3 days), request appropriate consent, raise awareness of advocacy services, provide contact details for team, detail issues of complaint to be investigated, explain how the process will be managed (the investigation plan), include condolences where applicable, include SAE for consent form 3b Acknowledgement Letter acknowledgement but need further information Formally acknowledge receipt (within 3 days), request contact from complainant to discuss issues further as insufficient detail provided 3c Acknowledgement Letter acknowledgement not able to investigate Explanation of why under regulations a case cannot be accepted / Signpost to other organisation 3d Acknowledgement Leaflet more information about the NHS Explain purpose of procedure complaints procedure 3e Acknowledgement Form equality monitoring Equality monitoring form 3f Acknowledgement Leaflet equality monitoring Explains why equality information is collected 35

36 no Process Element Document Name Purpose 4a Consent Form consent request Split into sections if complainant is patient, patient's advocate, patient is deceased, complainant is 3rd party (solicitor, MP, etc) includes contacting other organisations 4b Consent Letter consent acknowledgement Acknowledge receipt of consent, return any documents as appropriate, set timescale 4c Consent Letter consent chaser letter Consent not received chasing and setting deadline / also for when consent inadequate 4d Consent Leaflet more information about consent Explanation of consent requirements and why 4e Consent Letter to MP case closed as no consent Specific letter to MP when no consent received received 5a Investigation Letter investigation request Letter requesting investigation of complaint issues 5b Investigation Form Complaint investigation template Detail when required by, specific issues to be investigated, to identify learning, and actions taken 5c Investigation Leaflet investigation guidance Advice on how to complete an investigation 5d Investigation Leaflet statement writing Guidance on how to write a statement and the information it should contain. 6a Delays Letter holding letter To complainant / advocate / 3rd party with full explanation of any delays and re set timescale for final response 7a Drafting Letter Final Response Full response to complaint in line with regulations 7b Drafting Letter covering letter for FR Report Covering letter from Chief Officer when using report format 7c Drafting Form Final Response Report Full response to complaint in line with regulations in form of report where response is lengthy or complex 7d Drafting Letter Final response copy to 3rd party Covering letter from Chief Officer when sending to 3rd party in addition to complainant (eg MP or advocate) 8a Quality Assurance Form QA form Checklist issues that must be reviewed as part of QA process and documents that should be attached / include final data checking 8b Quality Assurance Letter request for clinical review To clinical advisor asking for review detailing areas for review or concern 36

37 no Process Document Name Purpose Element 9a Closure Leaflet What should I do if unhappy with Explanation of next steps response 9b Closure Form Local Resolution Meeting notes Template for recording local resolution meetings and information to be recorded 10a Patient Letter Patient satisfaction survey Letter seeking feedback on complaints process, include SAE Satisfaction 10b Patient Form Patient satisfaction survey Review of complaints procedure Satisfaction 11a Learning Form Learning plan Form to detail action taken and learning required as result of complaint 12a All Memo Contact record / file note Record sheet for all contacts (telephone calls / face to face) not otherwise recorded in file 12b All Form case file checklist checklist of process to ensure all aspects undertaken and case file complete 37