Changes throughout in relation to processes

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1 Policy and Procedure for the Management of Complaints State whether the document is: State Document Type: Trust wide Business Group Local Policy Standard Operating Procedure Guideline Protocol APPROVAL VALIDATION Approval: Risk Management Committee Validation: Quality Governance Committee DATE OF APPROVAL DATE OF VALIDATION INTRODUCTION DATE DISTRIBUTION REVIEW CONSULTATION EQUALITY IMPACT ASSESSMENT (Tick) RELATED APPROVED TRUST DOCUMENTS Risk Management Committee Quality Governance Committee Business Groups Original Issue Date March 2010 Review Date January 2015 Patient and Customer Services Team Risk Management Committee Screening Initial Full Incident Reporting and Management Policy Claims Policy and associated SOPs Investigating Incidents, Complaints and Claims SOP Duty of Candour Policy and SOP SUI and SAE SOP Management of formal complaints SOP Management of informal complaints SOP Arrangement of meetings SOP Management of Ombudsman investigations SOP Habitual and vexatious complaints SOP Handling of PALS enquiries SOP AUTHOR/FURTHER INFORMATION THIS DOCUMENT REPLACES Document Change History: Issue No Page Changes made (include rationale and impact on practice) Version 6 Changes throughout in relation to processes Kieren Done Complaints and Customer Service Team Manager Policy and procedure for the management of complaints Version 5 Date January 2015 Page 1 of 17

2 POLICY AND PROCEDURE FOR THE MANAGEMENT OF COMPLAINTS 1. Introduction 1.1 Stockport NHS Foundation Trust recognises the importance of having a consistent, accessible and impartial process for dealing efficiently and effectively with complaints. Feedback from complaints allows the Trust to learn valuable lessons from patient experiences and improve the quality of the services provided. 1.2 The Trust recognises that the formal and informal complaints process must be responsive, robust, flexible and fair. This policy sets out a framework for the management of complaints in the acute and community environments. It meets the requirements of the NHS Complaint Regulations 2009 and outlines the best practise management of complaints in line with the expectations of the Parliamentary and Health Service Ombudsman (PHSO) and Care Quality Commission (CQC). 2. Definitions 2.1 Complaint: A complaint can be defined as an expression of dissatisfaction with the care, services or facilities provided by the Trust and that requires a response. 2.2 Formal complaint: A complaint which requires formal investigation and formal response. 2.3 Informal complaint: A complaint which can be resolved satisfactorily within one working day, and which does not require formal investigation and formal response. 3. Application: To Whom this Policy Applies 3.1 This policy applies to all those working for the Trust, in whatever capacity. Failure to follow the requirements of the policy may result in investigation and management action being taken as considered appropriate. This may include formal action in line with the Trust s disciplinary or capability procedures for Trust employees; and other action in relation to other workers, which may result in the termination of an assignment, placement, secondment or honorary arrangement. 4. Roles and Responsibilities/Duties 4.1 Chief Executive: has overall responsibility for ensuring that effective controls are in place to support the management of complaints. 4.2 Director of Nursing and Midwifery: The Director of Nursing and Midwifery is the delegated Executive Director of the Trust responsible for the management of complaints. 4.3 Deputy Director of Nursing and Midwifery: To provide line management and performance review of the Patient and Customer Service department function. 4.4 Head of Risk and Customer Services: The Head of Risk and Customer Services is the person designated by the Trust to have lead responsibility for management of all complaints and to ensure that operational procedures and protocols are in place to facilitate the NHS Complaints Procedure in accordance with the Regulations. The Head of Risk and Customer Services will be responsible for producing information for the quality dashboard for complaints, including information regarding complaints being upheld by the PHSO. Also responsible for producing an annual report for trend comparison and patient satisfaction survey. Page 2 of 17

3 4.5 Complaints and Customer Services Team Manager: The Complaints and Customer Services Team Manager is responsible for the day-line management of the complaints team and monitoring of complaint handling. Also responsible for producing quarterly reports. 4.6 Associate Directors: Associate Directors will ensure that adequate resources are allocated to the reporting, management and investigation of complaints within their area of responsibility for compliance with this policy and other related policies and procedures. They must ensure that they have clear structures and operational procedures in place within their own Business Group for complaints handling, and that designated staff receive appropriate training. 4.7 Associate Directors will also: Ensure that an adequate improvement strategy is prepared as necessary when trends arising out of complaints are highlighted. This will then be monitored through the Business Group Quality Board. Ensure that all recommendations and changes to practice are fed back to all staff involved in the complaint. Ensure key learning points are disseminated through appropriate forums. 4.8 Designated Complaints Handlers (Business Groups): Responsible for ensuring that this Policy is adhered to and that the processes as describe are followed. In addition this person is responsible for the monitoring of complaints handling within their own Business Group and any actions arising out of complaints. 4.9 All Staff: Every member of staff employed by the Trust has a responsibility to provide a good patient/customer service. Therefore, every effort should be made to deal with concerns raised by users of our services as they arise. 5. Duty of Candour 5.1 The Trust is committed to the principles and philosophy of Duty of Candour. The Trust aims to ensure that the principles of Duty of Candour are underpinned in responses to complaints, in that responses will be open and honest, provide clear explanations of care, treatment and incidents, and apologise where it is appropriate to do so. Please refer to the Duty of Candour policy for further information. 6. Who Can Make a Complaint 6.1 A complaint can be made by any patient or person who is affected, or likely to be affected by the actions, omissions or decisions taken by the Trust, or by anyone who has authority to act on the patient s behalf. 7. Confidentiality 7.1 The patient s confidentiality must be maintained throughout investigation of a complaint. Consent must be obtained from the patient to disclose personal information where a complaint has been made on behalf of a patient. 7.2 In the case of a patient or person who has died or who is incapable of providing authority, a representative may be designated to act on his/her behalf. This is provided that the representative is the next of kin, a relative or other person who in the opinion of the Complaints and Customer Service Team Manager has or has had a sufficient interest in the patient s welfare and is suitable to act as representative. If the Complaints and Customer Service Team Manager is of the opinion that a representative does not have sufficient interest in the patient or person s welfare or is unsuitable to act as a representative, he/she will notify that person in writing, giving the reasons for his/her decision. In the absence of the Complaints and Customer Service Team Manager necessary action will be taken by the Head of Risk and Customer Services. Page 3 of 17

4 7.3 Where a patient lacks the mental capacity to make decisions, as defined by the Mental Capacity Act 2005(a), a complaint can made by someone acting on behalf of the patient provided the Complaints and Customer Service Team Manager, or in their absence the Head of Risk and Customer Services, is satisfied that the person complaining is the patient s next of kin, a relative or other person who is acting in the best interests of the patient. If this is not the case the complaint will not be considered under the NHS Complaint Regulations 2009 and the Head of Patient and Customer Services will notify and explain the reasons for the decision in writing to the complainant. 8. Children/Young Adults 8.1 The Regulations refer to a child as being anyone person who has not yet reached 18 years of age. When a complaint is made about care and treatment involving a child it will be necessary to obtain consent from someone with parental responsibility for him/her. Once a child reaches the age of 16, they are presumed in law to be competent to give consent, however it is still good practice to encourage them to involve their families in decision making. 8.2 Children under 16 are not automatically presumed to be legally competent to make decisions about their healthcare. However, as the law currently stands under 16s are deemed competent to give valid consent if they have sufficient understanding and intelligence to enable him or her to understand fully what is proposed. If this is the case the child is classed as being Gillick or Fraser competent. 8.3 If a child of 16 or 17 is not competent to make decisions, then a person with parental responsibility can take decisions for them. This will often, but not always be the parent of the child. The Children s Act 1989 has set out the following as people who would have parental responsibility: The child s parents provided they were married to each other at the time of conception/birth. The child s mother, but not father if they were not married unless he has acquired parental responsibility via a Court Order; has a parental responsibility agreement; the couple has subsequently married; or the child was born on or after the 1 December 2003 and the father is named on the birth certificate. The child s legally appointed guardian appointed by a court or by a parent with parental responsibility in the event 8.4 Where the child is in the care of a local authority or a voluntary organisation, the representative must have appropriate authority to act. However, if it is considered by the Head of Risk and Customer Service that the person making the complaint is not acting in the best interests of the child then the complaint will not be considered under the Regulations and the complainant will be notified of the reason(s) for this decision. 9. Complaints Excluded from the Formal Complaints Procedure 9.1 The following complaints are excluded from the Regulations and as such do not have to be dealt with under this Policy: A complaint made by another NHS organisation or local authority A complaint by an employee relating to their employment A complaint about private care provided by staff outside of their NHS contract A complaint that is made orally and is resolved to the complainant s satisfaction not later that the next working day after the complaint was made. A complaint that has previously been investigated and resolved under the NHS Complaints Regulations A complaint that is being, or has been investigated by the Health Service Commissioner A complaint that arises out of the alleged failure to comply with data subject requests under the Freedom of Information Act Page 4 of 17

5 A complaint that relates to any scheme established under section 10 (superannuation of persons engaged in health services etc) or section 24 (compensation for loss of office etc) of the Superannuation Act 1972[5], or to the administration of those schemes. 9.2 Where any complaint is made that falls into one or more of the above categories the Head of Patient and Customer Services or deputy will advise the complainant in writing of the decision not to investigate and the reason why their complaint is excluded under the NHS Complaint Regulations However, the Head of Patient and Customer Services may pass the complaint to the relevant Business Group if it raises concern about an incident in which serious harm was caused, if it raises safeguarding concerns or if it is considered to be high-profile. 10. Time Scales for Receipt of Complaints 10.1 Ideally, a formal complaint should be made no later than 12 months after the date on which the matter which is the subject of the complaint occurred, or no later than 12 months after the date on which the matter which is the subject of the complaint came to the notice of the complainant. The Head of Risk and Customer Services or nominated deputy has the discretion to extend this time limit where it is felt 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. In these cases the complaint shall be treated as though it had been received during the period specified. 11. Process For Ensuring Patients, their Relatives and Carers are Not Treated Differently as a Result of a Concern or Complaint 11.1 On no account should a service user feel discriminated against because they have raised a concern/complaint Letters of complaint or the responses to them should on no account be incorporated into a patient s notes. This is to maintain the confidentiality of both the patient and any member of staff involved in the complaint If discrimination is alleged and proven then the Trust s disciplinary procedures will be invoked and where applicable, the matter will be referred to a professional body. 12. Out of Hours Arrangements 12.1 The Patient and Customer Service department is available from 9am to 5pm, Monday to Friday. Complaints made outside these hours should be recorded and the complainant s contact details taken. The Patient and Customer Service department should be notified of the concerns as soon as possible but by no later than the end of the next working day. 13. General overview of the complaint handling process 13.1 The Trust is committed to an accessible complaints service. Concerns can be made to the Patient and Customer Service department in person, by telephone, by , in writing or through the Trust s website. 14. Informal complaints 14.1 Informal complaints are expressions of concern which can be resolved to the complainant s satisfaction by the end of the next working day after the complaint was made. The Trust endeavours to respond to informal complaints in a swift, informal and sensitive manner. The Trust recognises the importance of resolving complaints in a flexible and proportionate way and that some concerns do not need to trigger the formal complaints process It is likely that informal complaints will be made to front-line staff such as doctors, nurses, therapists, administrative staff or support services staff. Staff should listen to the concerns and be Page 5 of 17

6 as open and sensitive as possible. The Trust has a Complaints, comments and concerns leaflet which includes information on how to make a complaint and staff should give it to all complainants. Every department will display a poster which provides advice to staff on handling informal complaints It is important that staff make sure the patient s immediate healthcare needs are being met and that there is no immediate risk to the patient or others. Staff should escalate to their line manager or to senior staff if they are unsure of how to proceed or do not feel confident in resolving the concerns. The Patient and Customer Services department is available for advice to staff Complainants should only be directed to Patient and Customer Services where it is not realistic or possible to address the complaint informally, where the complainant is dissatisfied with the response they received or if the complainant specifically requests a formal investigation Please see the Standard Operating Procedure on the Handling of Informal Complaints for more information. 15. Formal complaints 15.1 Formal complaints are expressions of concern which are made in writing and require formal investigation Formal complaints should be sent to the Patient and Customer Service department. The Complaints and Customer Service Team Manager assesses each complaint on receipt and considers: Whether the complaint falls within the remit of the NHS Complaints Regulations 2009 in terms of timescale and eligibility Whether another organisation should lead on the complaint Whether the case is high-profile, or is of such significant concern that it may attract media interest Whether there are safeguarding concerns or allegations of abuse Whether there is indication of a negligence claim or Coroner s Inquest Whether there is significant harm Complaints are allocated a complaint level, which reflects the estimated timescale for response. Please see Appendix A When a complaint is so serious that serious harm has been caused, it will be investigated under the SUI and SAE procedures. Please see the SUI and SAE SOP. It will also be designated a complex complaint The Complaints and Customer Service Team Manager will allocate formal complaints to senior case officers to manage. On allocation, the Complaints and Customer Service Team Manager will highlight the lead Business Group, the complaint grading, whether consent is required, and whether the complaint is high-profile Case officers in the Patient and Customer Services department will acknowledge new complaints in writing within three working days of the complaint being received. The acknowledgement letter will enclose the Complaints, comments and concerns leaflet. All complaints will be added electronically to the Datix module Verbal complaints can be made where a complainant is either unable or unwilling to make a written statement or account of their concerns. Their complaint should be documented by the person who receives it. It should then be returned to the complainant prior to processing to be signed, dated and agreed as being a true reflection of their complaint. It is important that the Page 6 of 17

7 complainant signs the document so that the Trust is assured it has a full and accurate understanding of the complainant s concerns. 16. Investigation 16.1 Each complaint will require prompt, efficient and thorough investigation. An overview of the complaints process can be found in Appendix B. The case officer will send the complaint to the lead and associate Business Group for investigation If a complaint is recognised within the Business Group to meet the criteria of a Serious Untoward Incident or Serious Adverse Event, the Associate Director must ensure that the Patient and Customer Services team and the Risk and Safety team are advised as soon as is reasonably practicable. The investigation will be undertaken following the guidelines set out in the Incident Management Policy. Please see Appendix C for guidelines on risk gradings. Please see Appendix G for SAE and SUI criteria The lead Business Group will investigate the complaint using their identified structures and will draft a response. The lead Business Group will co-ordinate responses from associate Business Groups, who will send their responses to the lead Business Group to incorporate into a draft response. Draft responses should be forwarded to the Patient and Customer Services Department within the timescales shown in Appendix A Draft responses should include a summary of events, an outline of the investigation process, identify the staff involved, answer all aspects of the complaint, identify any contributory causes and include an outline of any action taken or change made as a result of the complaint. The draft response should be sent to the Patient and Customer Services Team accompanied by an action plan. The action plan template can be found in Appendix D A senior case officer will contact the complainant when a delay is possible and a written response is unlikely to be sent out within the timescale previously advised. The Trust recognises that delays can be a source of distress and will provide explanations of the reasons for the delay. The lead Business Group should provide as much information on the reasons for the delay as possible. The Head of Risk and Safety will notify the Director of Nursing and Midwifery and relevant Assistant Director if it is identified during the investigation that the complaint requires action under any of the following: An investigation under the disciplinary procedure One of the professional regulatory bodies An independent inquiry into a serious incident under Section 84 of the NHS Act 1977 An investigation of a criminal offence A major public relations incident If it is decided that disciplinary action is to be taken then the complaints procedure will stop with regard to that aspect of the complaint and the complainant informed. 17. Response 17.1 Case officers within Patient and Customer Services will review responses sent by the lead Business Group and will make sure that response addresses all aspects of the complaint, and gives a clear and open explanation. Where appropriate, an apology will be offered. The Trust recognises that many patients want their complaint to make a difference. The Trust will endeavour to explain any action taken as a result of the complaint. If it is felt that the draft response does not answer all the questions raised by the complainant, the Patient and Customer Services team will take appropriate action to further investigate a complaint to the extent needed in order to resolve the complaint speedily and efficiently. The complainant will be informed of any anticipated delays in responding to their complaint. Page 7 of 17

8 17.2 The Trust aims to investigate and provide a full response to 95% of all complaints within 25, 35 or 45 working days. The timescale for response to complaints which include an SAE investigation is extended to days. High profile complaints are automatically investigated as an SAE and as a result a root cause analysis will be undertaken by the appropriate business group and an action plan devised It may be appropriate in some cases for senior staff to meet with the complainant in order to resolve their complaint. This must be with the agreement of the complainant. The lead Business Group will provide the Patient and Customer Service with the availability of senior staff who are to attend the meeting. A senior case officer will then contact the complainant to propose potential meeting dates All meetings are recorded, with the consent of those present. The Director of Nursing and Midwifery will send the complainant a CD recording of the meeting after it has taken place The Director of Nursing and Midwifery, or nominated deputy, will sign all final response letters to complainants. The response will include information of their right to refer their complaint to the PHSO if the complainant remains dissatisfied The Patient and Customer Services department are responsible for sending out the signed response to the complainant. A scanned copy will be saved onto the Datix file and the file will be closed. Please see the SOP for the management of formal complaints for more information. 18. SUPPORT TO STAFF 18.1 It is recognised that being implicated in a complaint can be distressing for staff. Therefore line managers have a duty to support staff in those circumstances. Staff can also approach the Patient and Customer Services Department for advice on the process. Staffs who are the subject of a complaint must have the opportunity to see the relevant information contained in the final response letter. 19. INDEPENDENT PROVIDER COMPLAINTS 19.1 Independent providers are expected to have local complaints procedures that are comparable with those operated in the NHS. Complaints relating to care commissioned by the Stockport NHS Foundation Trust from the independent sector, which are directed to the Trust will be forwarded to the appropriate provider and its progress monitored. 20. PROCESS FOR HANDLING OF JOINT COMPLAINTS BETWEEN ORGANISATIONS 20.1 Where a complaint spans more than one health service provider discussions should take place between the relevant complaints managers, in conjunction with the complainant, as to whether the issues should be handled separately or as part of a joint response. In the case of a joint response one officer should be nominated to co-ordinate the investigation and to be the main point of contact for the complainant during the investigation. The complainant should be provided with details of how the investigation will take place and the appropriate NHS timescales should apply If a written complaint is received where it is recognised that it is solely concerned with areas properly dealt with by another organisation, the complaint will be referred to the appropriate organisation, with the consent of the complainant, forward the complaint to the appropriate organisation. Please see the SOP for the management of formal complaints for guidance on the principles of handling joint complaints. Page 8 of 17

9 21. HABITUAL/VEXATIOUS COMPLAINANTS 21.1 A small minority of people will take up a disproportionate amount of staff time and resources dealing with a complainant s perceived problem even when explanations have been given and all reasonable attempts have been made to resolve their concerns. These cases can cause undue stress to staff and therefore staff members are advised to refer to Appendix E with offers guidance on the handling of habitual and vexatious complainants in these instances. 22. POSSIBLE CLAIMS FOR NEGLIGENCE 22.1 The Head of Patient and Customer should be informed if a complainant reveals a prima facie case of medical negligence, or has indicated the intention to start legal proceedings. However, if a complainant s initial communication is via a solicitor s letter, the inference should not necessarily be that they have decided to take legal action. Thus the NHS Complaint Procedure should not cease unless the complainant explicitly indicates an intention to take legal action in respect of a complaint Where legal action is being pursued at the time that a complaint is made, or where an investigation is ongoing into a criminal offence the Head of Risk and Customer Services or deputy will consider whether by dealing with the complaint it might prejudice the potential defence of the clinical negligence claim or judicial action. If this is the case the Trust must inform the complainant why the complaints process has been ceased or put on hold In those circumstances where following an investigation under the complaints procedure there is a prime facie case of clinical negligence, a full explanation will be provided and if appropriate, an apology offered to the complainant. Such cases will also be reported to the NHSLA under the CNST scheme reporting guidelines. 23. CORONER S CASES 23.1 The fact that a death has been referred to the Coroner s office does not mean that an investigation into a complaint is suspended. Copies of all statements to the Coroner will be obtained by Patient and Customer Services and the Trust response will be copied to the Coroner together with notes of any meeting that has taken place. 24. PROCESS OF LEARNING FROM COMPLAINTS 24.1 Complaint themes and trends will be reported in the Patient and Customer Services department s annual report which is presented to Quality and Governance Committee. Following discussion any recommendation for actions will be sent to the relevant committees/person Trends identified that relate to individual staff members will be reported to appropriate directors and appropriate action taken Where a complaint has been investigated and has led to a change in practice the Associate Director of the relevant Business Group will disseminate this across their area of responsibility. Each complaint should have a Complaints Resolution Plan, which is completed by each Business Group for each complaint it is involved in. the Complaints Resolution Plan should be sent to Patient and Customer Services, for adding to the Datix module. Complaints Resolution Plans will be monitored through the quality dashboard, produced by the Head of Risk and Customer Services It is the responsibility of each Business Group to ensure that they have appropriate governance structures in place to identify possible risks to patients and to take actions to reduce these. Themes arising from complaints will be highlighted to the business groups annually. Page 9 of 17

10 25. PARLIAMENTARY AND HEALTH SERVICE OMBUDSMAN 25.1 If a complainant remains dissatisfied at the conclusion of local resolution they can ask the PHSO to review their case. The Ombudsman s role is to review each case independently and impartially. They may intervene in complaints where it is felt that questions have not been answered, where they identify improvements for an NHS service, identify ways in which an NHS service might resolve a complaint, or identify an outstanding remedy for an injustice which could include an ex-gratia payment Should the Ombudsdman decide after consideration of a case to take any action they will contact the Trust. The Ombudsman may advise the Trust of further action that could be taken to resolve the complaint. Alternatively, they could decide to fully investigate the case themselves Where complaints are referred to the PHSO, the Head of Risk and Customer Services will coordinate a response in conjunction with the appropriate governance leads, associate directors, clinical directors or heads of nursing. Please see the SOP on the handling of Ombudsman investigations for further information. 26 Equality Impact Assessment 26.1 Stockport NHS Foundation Trust is committed to creating and promoting equal rights and diversity and working towards eliminating all forms of discrimination, inequality, exclusion, victimisation, harassment and bullying. There is nothing in this policy to suggest that one group of people will be affected by or treated differently to another. In determining the question the Trust has used the Equality Assessment Tool. Page 10 of 17

11 27. MONITORING OF POLICY Process for monitoring e.g. audit Responsible individual/ group/ committee Frequency of monitoring Responsible individual/ group/ committee for review of results Responsible individual/ group/ committee for development of action plan Responsible individual/ group/ committee for monitoring of action plan Annual report Head of Risk and Safety Annual Quality Governance Committee PCS and business groups PCS and business groups Quarterly report Complaints and Customer Service Team Manager Quarterly Quality Governance Committee PCS and business groups PCS and business groups Monthly dashboard Head of Risk and Safety Monthly Quality Governance Committee PCS and business groups PCS and business groups Page 11 of 17

12 Appendix A Guidelines on timescales for responses to complaints Complaint Level Time Frames Allowed (Response to complainant) Time Frames Allowed (Lead BG) Time Frames Allowed (Associate BG) Examples Complex 45 working days 40 working days 35 working days Multiple issues relating to one or more areas and/or one or more professions Routine 35 working days 30 working days 25 working days Mixed issues relating to one area/profession Simple Less than 25 working days 20 working days 15 working days Appointment delay Page 12 of 17

13 APPENDIX B Stage 1 Complaint received and allocated Stage 2 Case officer reviews complaint Stage 3 Acknowledgement letter sent Acknowledgement letter sent and consent requested Consent received Consent not received Stage 4 Sent to Business Group for investigation Closed Stage 5 Response received Stage 6 Response signed off and case closed Stage 1 If comeback received Comeback Stage 2 As per process above Meeting arranged Stage 3 Closure Stage 4 Ombudsman Page 13 of 17

14 Appendix C GRADING OF COMPLAINTS/CLAIMS Introduction Stockport NHS Foundation Trust has an established process for managing complaints. It has an integrated service which incorporates the complaints/claims functions and works closely with colleagues in Risk Management to ensure a seamless service and aid prevention of similar incidents. Risk assessments are undertaken at all levels within the Trust, to ensure that organisational, financial, clinical and other risks are analysed. All risks are graded and as such a grading system also applies to complaints and clinical claims and are graded according to impact/consequence and likelihood. 1 LEVEL DESCRIPTER DESCRIPTION 5 Almost Certain Likely to occur on many occasions, a persistent issue 1 in 10 4 Likely Will probably occur but is not a persistent issue 1 in Possible May occur/recur occasionally 1 in Unlikely Do not expect it to happen but it is possible 1 in 10,000 1 Rare Can t believe that this will ever happen 1 in 100,000 Consequence Impact on Individual Patient Experience Potential Impact on the Trust 1 Minor No obvious harm Single easily Minimal impact on service No injury/illness resolvable problem disruption requiring treatment Action taken by staff Complaint limited to staff to resolve/assist involved within the Trust individual. 2 Moderate Minor injury/illness Temporarily Litigation Unlikely requiring first aid unsatisfactory Possible increased length of stay treatment Action taken by staff in hospital No permanent harm to resolve/assist 1 Day local press coverage 3 Major Significant injury/illness Perceived negligence by individual/relatives Vexatious complaint 4 Severe Fatality Permanent disability Multiple injuries Extreme distress caused 5 - Catastrophic Fatality/Multiple Fatalities individual Patient outcome below reasonable standard. No action taken by staff to resolve/assist individual Failure to meet national standards. Patient experience fell significantly below reasonable standards Failure to meet national standards with care falling significantly below a reasonable standard. Litigation Likely 7 Day local media coverage Increased hospital stay. Possible independent opinion required. Damaged reputation MP concern National media coverage Temporary service closure High risk of litigation Increased length of stay in hospital Reported to outside agencies i.e. Coroner Significant damage to reputation of Trust National media coverage Public Enquiry Litigation almost certain Page 14 of 17

15 Grading the complaint/claim The matrix for grading of a complaint, as demonstrated below reflects the corporate risk matrix i.e. consequence x likelihood. Therefore consequence possible x likelihood minor would be graded as Low. This scoring and grading must be documented by staff working in the Patient and Customer Services Department on Datix and reflected in the Complaints/Claims file. Investigation The grading of the complaint has the potential to influence how the complaint is managed and investigated. Complaints graded as Minor or Moderate can follow the routine process for investigation of complaints. Complaints graded as Major Severe or Catastrophic should be brought to the attention of the Head of Patient and Customer Services. Dependant on the nature of the complaint consideration should also be given in regards to contacting the Head of Risk and Safety, Deputy Director of Nursing, Medical Director, Communications Manager and Chief Executive. All complaints which receive a risk scoring of High will require a Root Cause Analysis to be completed by the Business Group(s) and should be brought to the attention of the appropriate Associate Director. LIKELIHOOD CONSEQUENCE 1 Minor 2 Moderate 3 Major 4 Severe 5 Catastrophic 5 Almost Certain High High High High High 4 Likely Moderate Moderate High High High 3 Possible Low Low Moderate Moderate Moderate 2 Unlikely Very Low Very Low Low Low Low 1 Rare Very Low Very Low Very Low Low Low On completion of Investigation Once an investigation has been completed the complaint can be re-graded if necessary. Lessons learnt should also be recorded on Datix at this point. Action plans are to be attached to Datix by the Complaints/Governance lead in the Business Group(s). Page 15 of 17

16 Appendix D Complaints Resolution Plan Service Improvement, Evidence & Feedback FC reference number and patient name Problem identified (May be more than one) Communication Service Provision Documentation Staff Attitude Equipment Staff Knowledge Fixtures / Fittings Staffing Levels Environment / Cleanliness Timekeeping / Delay Other (please specify) Radiation exposure Summary of problem identified (must be completed) Service Improvement(s) (May be more than one) Additional Resources Allocated Procedure Implemented / Reinforced / Reviewed Change in Work Practice Training Need Addressed Change in Service Provision No Improvements Made Guideline Implemented / No Improvements Necessary Reinforced / Reviewed Policy Implemented / Reinforced / Reviewed Other (please specify) Reason For No Service Improvement(s) (please ü - may be more than one) Lack of Guidance Lack of Resources Lack of Funding Training Unavailable Other (please specify) Inappropriate Further Details (must be completed, if relevant, & evidence attached) Feedback On Action Taken Resolution Plan drafted by Name Approved by Name Date fowarded to AD/ governance lead Date Date fowarded to AD/ governance lead Date Page 16 of 17

17 Appendix E Criteria for SUI and SAE SERIOUS ADVERSE EVENT CLINICAL Failure to act on Imaging or Pathology Result Pathology or Imaging Result to Wrong Patient Equipment Failure Potentially leading to Patient Injury or Distress Lifting or Handling Mismanagement Resulting in Patient Harm Breach of Confidentiality (not reportable under DPA Issues regarding consent Grade 4 pressure sore (developed in hospital from intact skin and was avoidable) All unexpected deaths occurring within 48 hours of discharge from Emergency Department SERIOUS UNTOWARD INCIDENT (CLINICAL) Unexpected Avoidable Death NPSA Never Event Serious Incident with Adverse Publicity Post Mortem Wrong Body Medical Equipment that Causes Patient Harm Drug Administration Error that Causes Patient Harm Patient Hospital Acquired Infection (life threatening) incl C Difficille All MRSA Bacteraemia (not pre hospital acquired) All child deaths except expected death or arrived in ED in Cardiac Arrest All interpartum still births All neonatal deaths All Maternal Deaths SERIOUS ADVERSE EVENT NON CLINICAL Passenger Life Failure Struck by Machinery/Moving Object Utility Failure (gas, water, electricity) Intruder Staff Hospital Acquired Infection Fire SERIOUS UNTOWARD INCIDENT (NON CLINICAL) Visitor Exposure to Radiation Serious Assaults and Wounding Staff Exposure to Radiation Allegations of Abuse to patient by staff member Death of Staff or Visitor Failure of Trust IT Systems leading to failure to carry out required systems and procedures Page 17 of 17

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