Title: Norfolk and Suffolk NHS Foundation Trust Q42: Complaints Procedure. Version 03 Page 1 of 20

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1 Title: Complaints Procedure Outcome Statement: Staff will follow Trust procedures for investigating and responding to complaints Written By: Michael Lozano, Patient Safety & Complaints Lead Reviewed by: Michael Lozano, Patient Safety & Complaints Lead Tash Nicholson Patient Safety and Complaints Practitioner In Consultation With: Trust Governors Non Executive Directors Service user and groups, Local Healthwatch s, Approved By and Date: Trust Board April 2014 Clinical Effectiveness and Policy Group June 2014 With Reference To: The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 Department of Health- Listening, Responding, Improving: A guide to better customer care 2009 Parliamentary and Health Service Ombudsman- Principles for Remedy, Principles of Good Administration and Principles of Good Complaint Handling The Health and Social Care Act 2008-Department of Health NHSLA Risk Management Standards 2012/13 Associated Trust Policies and Q11: Serious Incidents Requiring Investigation Documents Q15: Corporate Induction Q18: Risk Management Strategy and Policy Q19: Stress Management Q22: Claims Handling Q43: Patients Advice and Liaison Service HRP004: Harassment and Bullying at Work HRP015: Grievance Policy Applicable To: Trust wide For Use By: All Trust staff Reference Number: Q42 Version: 03 Published Date: June 2014 Review Date: June 2017 Equality Impact assessment June 2014 Implementation Investigation of incidents, Complaints and Claims Awareness is mandatory e-learning for all Trust staff and completed by new starters at workplace induction. This provides an introduction to complaints management which this policy builds on. Page 1 of 20

2 Review and Amendment Log Version Number Reasons for Development/Review Date Description of Change(s) 01 Developed/Reviewed for use across the merged Trust February New policy NHSLA Requirements October 2012 Section 5.0 Added information about the support that mangers are to offer Section 23.0 Monitoring 03 Review following local internal and stakeholder feedback alongside consideration of national documents Hard Truths (2013) and A review of the NHS Hospital Complaints System (2013) Contents Statement May 2014 Change in the procedure for managing complaints. 1.0 Introduction Purpose Definition of a Complaint Duties, Roles and Responsibilities Complaints Process Summary Flowchart Who can Complain How to Complain Publicity Time Limits 8 Procedure 10.0 Receipt of a Complaint Assessing/Analysing the Complaint Investigation Expectations of all Complaint Investigations Response to Complainants Parliamentary and Health Service Ombudsman Complaints about the Actions of Staff Complaints/Concerns/Queries addressed to the Chief Executive from Members of 12 Parliament 18.0 Complaints Relating to other Authorities/Joint Complaints Record Keeping Learning/Management Action Quality and Monitoring Requests for Access to Health Records and Complaints File Legal Action Persistent Complainants Training Needs 14 Page 2 of 20

3 26.0 Compliments and Suggestions Contact Received with Clinical Significance Monitoring Statement Appendices 1 Procedure for Responding to Persistent Complainants Help us to Help You. How to complain, make suggestions or compliment us information leaflet available from PALS and clinical areas. An EasyRead version is also available via PALS Page 3 of 20

4 1.0 Introduction Complaints are a valuable form of feedback, playing an important role in the Trust s Clinical Governance and Risk Management strategies, thereby maintaining and improving the quality of service provided. The Trust aims to respond in a positive and timely manner to all complaints received conducting its affairs in an open and inclusive manner. The Trust aims to work with other agencies in order to provide an integrated response to concerns received. The procedure is designed to be used by service users, carers, relatives and the general public. It should be noted that staff complaints of a personal nature would be handled under the Trust s Grievance Procedure and staff complaints about treatment of service users under the Public Interest Disclosure Policy also known as the Whistle blowing Policy. Complaints arising from the Trust s failure to comply with the Freedom of Information Act 2000 are not included in this procedure. The Trust s Complaints procedure meets the requirements within The Local Authority Social Services and National Health Service Complaints (England) Regulations The Trust supports the good practice identified within the Parliamentary and Health Service Ombudsman Principles for Remedy, Principles of Good Administration and Principles of Good Complaint Handling documents. 2.0 Purpose To provide guidance to staff on the procedures required when a complaint is received 3.0 Definitions The Trust s working definition of a complaint is: Any expression of dissatisfaction that needs a response 4.0 Duties, Roles and Responsibilities Chief Executive Has ultimate responsibility for complaints management, Will approve and sign response letters to complaints. In their absence, this duty and responsibility is delegated to the Chief Executive s deputy, Authorizes the Patient Safety & Complaints Lead to act operationally on their behalf in all matters relating to complaints, Devolves professional leadership for complaints management and performance to the Director of Nursing, Quality and Patient Safety. Trust Board To receive information on Complaints activity for the Trust. To use such information, alongside other indicators in decision making Non Executive Directors view two complaints (selected randomly) a month Director of Nursing, Quality and Patient Safety Responsible to the Chief Executive for complaints management and monitoring. Reports information on complaints to the Trust board. Deputy Director of Nursing and Patient Safety: Responsible to the Director of Nursing, Quality and Patient Safety for complaints management and monitoring, Line manages the Patient Safety & Complaints Lead. Patient Safety & Complaints Lead: Devolved responsibility for day-to-day operational management of the complaints processes Ensuring the Trust has robust systems for registering, acknowledging and responding to Page 4 of 20

5 complaints Managing the complaints policy, system and process development including complaints training Undertaking investigations into complaints Providing statistical information using a standardised template to provide qualitative and quantative analysis to meet reporting requirements. Communicating with the Deputy Director of Nursing and Patient Safety and the Director of Nursing, Quality and Patient Safety as and when issues arise relating to patient safety from complaints received. Communicating with the Care Quality Commission (CQC) and Health Service Ombudsman as required. Providing support to managers with responsibility for investigating complaints. Locality Managers, Service Managers, Modern Matrons and Ward Managers Ensuring the complaints policy is implemented and any investigations follow this guidance. Maintaining the availability of publicity materials. Implementing any learning/management actions identified from complaints. Ensuring that monthly complaints received logs are maintained and a copy, including nil returns, is sent on the first working day of the subsequent month to the Complaints Department. Supporting staff allocated to investigate a complaint. Informing any member of their team if a complaint has been made against them. Offering immediate and ongoing support to staff who have been complained about and/or who are involved in the investigation of a complaint. Any support offered to staff should be recorded within their personnel file. Support may take the form of; (immediate and ongoing) o Guidance and information to alleviate anxieties o Checking when staff are next on duty and arranging changes to shifts. o Identifying whom it may be appropriate to follow up with a telephone call at home. o Use of Chaplaincy service (The Chaplaincy service can arrange contact with other faith denominations) o Clinical Supervision o Informal support from colleagues o Support by professional colleague (e.g. Therapist Practitioner, Human Resources department) o Occupational Health They will ensure any Complaints investigations follow guidance in this policy. They will ensure any learning/management actions identified from Complaints are implemented. When a complaint investigation has been allocated to a member of staff, the appropriate Locality/ Service Manager will be advised and expected to provide support. All Trust staff Maintaining awareness of this policy and how to aid a person to make a complaint. Dealing with complaints at source if within their capability and/or position to do so. Reporting complaints where they are unable to deal with or resolve the complaint. NB: In accordance with contractual obligation it is important for staff to cooperate with any investigation that arises from complaints, in order to support this policy and NHS regulations. This does not affect the right for representation during this process. Investigating Officers Investigating complaints as set out in this policy Senior managers within NSFT who investigate complaints as and when required to do so. They will have received training to be able to fulfill this role. As a general rule, the investigating manager will hold a minimum position level of Clinical Team Leader or its equivalent. If the risk posed by the complaint is felt to be significant it may be placed on the local risk profile or Trust Risk Register. Page 5 of 20

6 5.0 Complaints Process Summary Flowchart Complaint received by Team/Service Team/Service to scan and complaint to: Original copy to be sent in the internal post The Patient Safety and Complaints Team will: - Acknowledge receipt of the complaint to the complainant (within 3 working days) - Return the complaint to the relevant Locality/Service Manager for investigation The Locality/Service Manager will allocate the complaint to a member of the team for investigation. Following investigation the draft response (in the name of the Chief Executive) will be sent to the Patient Safety and Complaints Team for checking The final draft response will then be sent to the Chief Executive for sign off and the agreed response sent to the complainant (within 30 working days) NB: For guidance on responding to verbal complaints see Section 10.0 Receipt of a Complaint 6.0 Who Can Complain Anyone who is receiving, or has received, NHS treatment or services can complain. A complaint may be made by: A service user A former service user A service user s family member/carer Any person who is affected by or likely to be affected by the action or decision of Norfolk & Suffolk NHS Foundation Trust (NSFT) that is the subject of the complaint. If a person is unable to complain them self then someone else, usually a relative or close friend, can complain for them. This may be necessary in cases when the service user: Has died, Is a child, Is physically incapacitated or lacks capacity within the meaning of the Mental Capacity Act 2005, or Has requested a representative to act on their behalf. Page 6 of 20

7 The complainant (if not the person) must, in the judgment of the Patient Safety and Complaints Lead, have an identifiable interest in the welfare of the person affected. If a complaint is made on behalf of somebody else, written and signed consent is to be sought from the person the complaint is about before the Trust can share information. In cases concerning children, the representative must be a parent, guardian or other adult person who has care of the child. If the child is in the care of a local authority or a voluntary organisation, the representative must be a person authorised by the local authority or voluntary organisation. All complainants will be assured that their concern will be treated with appropriate confidence and sensitivity and that making a complaint will not affect the service user s care. Complaint letters and investigation reports should not be filed with the patient s health record unless there is clinical need. Complaint files and information will be held by the Patient Safety & Complaints Team in accordance with the Trust's information governance policies. Information gathered during the process of a complaint will be treated confidentially. Complaints received anonymously will be assessed and investigated if there are potential or identified risks to patient safety or others. 7.0 How to Complain If the complainant feels confident enough to do so it is preferable that they complain directly to the staff involved in the service they receive. This, potentially, will help in effecting quicker resolution to the complaint at the point of service. However, it is acknowledged that people may not feel confident enough to complain directly to the staff involved in the service they have received or the circumstances of the complaint may mean it is not appropriate. There are a number of ways a person may complain To the Locality/ Service Manager (in person, by telephone, letter or ) To the Patient Safety & Complaints Team (in person, by telephone, letter or ) To the Chief Executive or Chair (by telephone, letter or ) With the assistance of PALS (Patients' Advisory and Liaison Service) With the assistance of NHS Complaints Advocacy Service With the assistance of other local advocacy service- may be signposted by PALS It is the intention of the Trust to provide reasonable support to people who require assistance to make a complaint. The Patient Safety & Complaints team will work to provide supportive means to register a complaint with those requiring such support upon awareness of such need e.g. due to a physical or learning disability. Support may include accessing advocacy service or other assessed activity. 8.0 Publicity It is the responsibility of NSFT to ensure that there is adequate publicity of its complaints procedure: who to complain to, what the process is and what support they may receive. A variety of means are to be used to ensure this, including: Leaflets Website Trust staff It is recognised that service users may not have English as their first language. Support is available to assist them through the Trust s use of the INTRAN service. Information leaflets and posters highlighting the services of the NHS Complaints Advocacy Service, Patients Advice and Liaison Service (PALS) and any local advocacy services will be available and accessible to service users. Page 7 of 20

8 The NHS Complaints Advocacy Service is commissioned to give people support if they have a complaint regarding their National Health Service treatment. The Patients Advice and Liaison Service, known as PALS, was introduced to the NHS in 2002 to support the provision of information to patients, their families and carers. PALS main functions are to: Provide on the spot help they have the power to negotiate immediate solutions or speedy resolutions of problems, Act as a gateway to appropriate advice and advocacy support from local and national sources, for example the NHS Complaints Advocacy Service, Provide accurate information to service users, carers and families about the Trust s services and other health related matters, Act as a catalyst for change and improvement by providing the Trust with information and feedback on the problems arising and gaps in services, Operate within a local network with other PALS in their area and work across organizational boundaries Support staff at all levels within the Trust to develop a responsive culture. Service users who are subject to detention under the Mental Health Act 1983 will be advised upon admission/as soon as mental state permits, of their right to complain to the Care Quality Commission. This will be evidenced in the health record. The Care Quality Commission can investigate concerns regarding the use of powers and application of duties by the Trust under the Mental Health Act. The CQC may ask the complainant to initially register their complaint with the Trust. 9.0 Time Limits The time limit for making a complaint is: Twelve months from the date on which the matter which is the subject of the complaint occurred; Or Twelve months from the date on which the subject of the complaint came to the notice of the complainant. Where a complaint is made after the expiry of that period, the Patient Safety and Complaints Lead may investigate it if they are of the opinion that Having regard to all the circumstances, the complainant had good reasons for not making the complaint within that period And Notwithstanding the time that has elapsed it is still possible to investigate the complaint effectively and efficiently. Any decision to not investigate a complaint must be agreed with the Director of Nursing, Quality and Patient Safety Procedure In accordance with NHS Regulations it is the Trust s aim that where possible complaints should be dealt with as near as possible to the point of service delivery. This is to attempt to resolve the complaint as quickly as possible with least distress to the complainant and to make efficient change where required. The Trust encourages staff to maintain open communication with complainants throughout the complaints process Receipt of a Complaint If a complaint is made verbally the receiving service is encouraged to attempt to provide resolution within one working day. If the complaint is resolved to the satisfaction of the complainant by the next working day no further action or formal recording is required. All staff receiving a complaint will treat the complainant with dignity and respect, reassuring the complainant that their complaint is being listened to. The receipt and acknowledgement of a complaint will be made by the Patient Safety & Complaints Page 8 of 20

9 Team. Where complaints are received at service points or Trust headquarters they will be scanned and ed to the Patient Safety & Complaints Team, with the hard copy sent in the internal post. Acknowledgement of the complaint received must be made within three working days. Acknowledgement of the complaint may be made verbally or in writing. Within the acknowledgement of the complaint an offer will be made to the complainant to discuss their complaint (either by telephone or in person) and detail the period within which a written response is to be expected by the complainant. Where a complaint is made verbally (either to member of staff or Patient Safety & Complaints Team) a written record will be made. A copy of this written record will be sent to the complainant for checking of accuracy before progressing to the next stage. Discretion will be applied to progress the complaint to investigation without delay if assessment identifies need for immediate action (i.e. risk to patient etc) Assessing/Analysing the Complaint Each complaint received by the Trust will be assessed/analysed by the Patient Safety & Complaints Team. Assessment will guide which service investigates the complaint... The majority of complaints will be investigated by the locality and service named within the complaint. This supports the principle of addressing concerns at a local level enabling proportionate, timely and effective responses. The complaint will be sent to the Locality Manager (from the Patient Safety & Complaints Team) for allocation to a manager to investigate. The Safeguarding team will be provided with copy of the complaint to screen for concerns that may warrant intervention under Safeguarding processes. For complaints that register issues regarding serious adverse events, long term damage, grossly substandard care, professional misconduct or abuse; Unexpected Death of Service User; High concern for the safety/welfare of the service user; High probability of litigation and/or attracting media attention discretion permits the identification of an investigating manager outside of the locality where the complaint pertains to. Assessment and decision will involve the Locality Manager and Executive Director Investigation It is the Trust s aim that complaints shall be responded to within 30 working days. However it is accepted that each complaint will have individual circumstances, which may affect the time required to provide a full response. It is the responsibility of the manager investigating the complaint to ensure expected timeframe of completion is communicated to the complainant via the Patient Safety & Complaints Team. There is no one definitive way of investigating a complaint. The following is a list of actions that may be necessary and/or helpful in making the process efficient. Meeting with the complainant to discuss complaint and/or outcomes Reading the health record Requesting statements from staff Interviewing staff Checking other records Requesting Independent Expert Opinion Discussing with staff The Investigating Manager is to analyse/evaluate all the evidence collected, testing the evidence so that conclusions based on an analysis of the facts and what can reasonably be inferred from them. It may be necessary for the investigator to compare evidence about the care or service complained about with established nationally recognised standards for care. Support and information can be obtained from the Clinical Effectiveness Lead. Page 9 of 20

10 13.0 Expectations of all Complaint Investigations The following guidance and expectation applies to all complaint investigations. Personal communication between the investigating manager/officer and the complainant is important. This can serve to: Inform the complainant who will be directly dealing with complaint, Check if the complainant has any disability which may affect their representation during the investigation process. If so, find ways to help them and/or confirm whether or not they require support with their complaint from the NHS Complaints Advocacy Service, PALS or the advocacy service, Reaffirm components of the complaint, To confirm the complainant's expectation of resolution, Agree with the complainant the method and actions for investigation gaining consent where appropriate, Agree with the complainant the period of regular contact through the complaint process Reaffirm/or explain the whole complaints process to the complainant (from beginning to Ombudsman stage) 14.0 Response to Complainants All written responses to a complaint should: Be comprehensive with all aspects of the complaint addressed directly Be honest in content and respectful in tone Use language that a person might reasonably be expected to understand i.e. it is plain with technical jargon, abbreviations or clinical terms explained Outline the investigation and the conclusions drawn e.g. include information about expert or independent advisers that will give all involved confidence in the conclusions reached, Provide appropriate redress (one or more of the following) o an explanation of the events complained about o an acknowledgement of dissatisfaction and an apology if appropriate o an account of action taken or planned to improve care of or service to the individual and/or to reduce the risk of a reoccurrence, where appropriate with an offer to remain in contact with information about progress o reimbursement of expenses or losses o other financial recompense The complaint investigator must prepare a draft response letter in the name of the Chief Executive. The draft letter is then sent to the Patient Safety & Complaints Team for quality check. The purpose of the quality check will be to check: Accuracy (i.e. name, address details) The response addresses all the points the complaint raises Appropriate conclusions are made including apology and accountability Actions taken to remedy the complaint and lessons learnt The letter is written in an empathetic manner, with avoidance of assumptions and defensive bias The Patient Safety & Complaints Team will also (based on the detail in the response) provide a check on the conclusion of whether a complaint is upheld, partially upheld or not upheld making a decision that will be recorded on the complaints database (Datix). Upheld: A complaint will be upheld where the available evidence leads to the conclusion the matter complained about more likely than not occurred (The standard of proof is that an event probably occurred). Not Upheld: A complaint will not be upheld where the available evidence leads to the conclusion the matter complained about more likely than not did not occur. Partially upheld: If a complaint has several issues raised, it is recorded as partially upheld if one of the Page 10 of 20

11 elements is upheld. The Patient Safety & Complaints Team will then present the complaint and draft letter for the Chief Executive's consideration and signature. Should any complaint pass six months without a response a review shall be held by the Patient Safety & Complaints Lead to ascertain reasons and plans for further action to ensure a response is made to the complainant in a timely manner. The complainant will be informed of this review. If, during the course of a complaint investigation, the complainant requests a hold on proceedings assessment of the ongoing investigation will be made (involving Locality Manager, Patient Safety & Complaints Team and other identified staff dependent on individual circumstances). If a suspension is agreed, then after two months from the date of the suspension if the complainant has not requested recommencement, the complaints investigation will be closed. If the complainant wishes to complain about the same circumstances again in the future this would be classed as a new complaint, which would be dependent upon the complaint being within the NHS Regulations time limits. If, during the course of applying the complaints procedure, any concerns arise which may require involvement of the police, professional regulatory bodies, the coroner or protection agencies involving vulnerable adults and children, advice is to be sought from the Line Manager and/or Directors of the Trust via the Patient Safety & Complaints Team. If a complaint is received which relates to the area of Infection Control, the Trust s Infection Prevention and Control Team is to be informed. In accordance with the Ombudsman s Principles of Remedy financial redress may form part of the response to a complaint. Consideration of the use of financial redress will be made on an individual as required basis. For these specific considerations, the Trust Secretary or Legal Services Manager and/or the Head of Risk Management and Security may be consulted to ensure compliance with NHSLA guidance Parliamentary and Health Service Ombudsman Within the complaint response letter complainants will be advised of their right to refer their case to the Parliamentary and Health Service Ombudsman. The Parliamentary and Health Service Ombudsman is an independent organisation whose role includes undertaking independent investigations into complaints regarding services provided by the NHS in England. The Parliamentary and Health Service Ombudsman aims to discover why a complaint has not been settled by the local health Trust and to determine how it may be settled. The Parliamentary and Health Service Ombudsman may request the look at the investigation again and take further action, or they will conduct a review and recommend ways to settle it. They may suggest ways for the Trust to improve or to change the way it works so it can prevent similar complaints in the future Complaints about the Actions of Staff The Patient Safety & Complaints Lead will ensure a copy of the complaint and the Trust s response is sent to any staff member who is identified as the subject of a complaint (this will be through the staff member s line manager). Locality and Service Managers are responsible for supporting and, where necessary, counselling, staff where a complaint has been made against them. If, during the complaint investigation evidence arises which indicates possible staff misconduct, this evidence is to be provided to the staff member s line manager to consider whether the matter should be dealt with under the staff disciplinary procedure. If this action is taken, the complainant is to be informed in writing that this part of the complaint will be dealt with under the Staff Disciplinary Procedure. Page 11 of 20

12 17.0 Complaints/Concerns/Queries addressed to the Chief Executive from Members of Parliament Complaints/Concerns/ Queries received from Members of Parliament on behalf of a constituent will be responded to in the following manner: Complaint/concern/query will be acknowledged by the Patient Safety & Complaints Team on behalf of the Chief Executive, Request for information and/or a draft response made to the appropriate Locality/Service or Corporate Services Manager Draft response is quality checked by the Patient Safety & Complaints Team prior to the Chief Executive s signature, Aim to provide response within 30 working days Complaints relating to other Authorities/Joint Complaints Complaints relating in part to a Local Authority If the Trust receives a complaint containing concerns which relates to the local authority, the Patient Safety & Complaints Team must ask the complainant whether s/he wishes the detail of the complaint to be sent to the Local Authority. If the complainant requests referral to the Local Authority the Patient Safety & Complaints Team must action this as soon as is practicable, and advise the complainant which aspects of the complaint have been referred. The Trust Patient Safety & Complaints Team and the relevant Social Services Complaints Manager must work together to ensure all aspects of the complaint are responded to. Complaints made to the Trust relating only to a Local Authority If the Trust receives a complaint that relates wholly to services provided by the Local Authority the Patient Safety & Complaints Team must ask the complainant if they wish the Trust to send the complaint to the local authority and, if so, refer the case as soon as is reasonably practical. Complaints that cover multiple NHS organisations If the Trust receives a complaint which includes concerns relating to another NHS body the Trust will co-operate in: o The coordination of the handling the complaint, o Ensuring the complainant receives a coordinated response to the complaint, o Providing relevant information as reasonable requested by the other body, o Attending or ensuring it is represented at, any meeting reasonably required in connection with the complaint Record Keeping All documentation pertaining to the investigation into a complaint and copies of response letters will be filed in alphabetical order (surname of complainant) by year within the Patient Safety & Complaints Team bases. Investigating Managers must ensure that further copies of documents are not retained within individual departments in order that the requirements of the Data Protection Act 1998 can be met. Copies of complaint material should not be filed in the service user s health records, unless there is an item of clinical importance. There should be no entries made regarding a complaint into a service user s health record unless there is a clinical aspect to the complaint, which requires recording. Should there be a need to make a record relating to a complaint, which does not have clinical importance, the staff member is to consider writing a file note. The file note is to be given to the line manager who will attach it to the complaint file or forward it to the Patient Safety & Complaints Team. Files should be retained for 10 years from the date a complaint was completed. The Patient Safety & Complaints Team will centrally record and analyse all complaints using the Datix computer software package. Page 12 of 20

13 Data on the number of complaints, categories and outcomes is available upon request from the Patient Safety & Complaints Team. A report on complaints will be submitted to the Service Governance Committee. This report will provide a breakdown of the complaints received according to locality/service, with an analysis (qualitative and quantitative using the Trust Template provided) of any presenting trends. The report will highlight key learning/management actions that have resulted from complaints and those complaints that are under review by the Parliamentary & Health Service Ombudsman. The report will follow the Trust standard reporting format. An annual report will be submitted for the Trust s Annual Report and Plan publications Learning/ Management Actions If any learning or management action is identified during the course of the complaint investigation that is specific to a Service/Team it is expected the Service/Team manager will implement this. If a complaint investigation identifies learning or management action which is necessary to prevent a recurrence of the same problem and/or improve the quality of patient care the Patient Safety & Complaints Team will support the sharing of this learning. Learning requiring planning and consideration will be reported to the Service Governance Committee for direction. Where a complaint response identifies further actions as part of learning or remedy, the Patient Safety & Complaints Team will coordinate a further response to the complainant to confirm that action has been completed. The Trust shares information on complaints through the Trust website Quality and Monitoring The Trust Chair and all Non-Executive Directors will receive two complaints a month (randomly selected) as part of receiving direct evidence of the types and details of concerns received, as well as monitoring the Trust's handling and response. To aid monitoring of the complaints process the Trust's response letter will refer the complainant to the Trust's website to complete a short survey on their experience of the Trust's handling of the complaint. This survey is available in paper form upon request Requests for access to Health Records and Complaints File Requests for access to a health record or complaint file under Freedom of Information are to be referred to the Compliance team. Reference the Health Records Policy Legal Action It will not be assumed that a complainant who has used a solicitor to make a complaint has decided to take formal legal action. When the Trust has written notification that formal legal action has been instigated, an assessment and decision of the Trust's next actions will be taken in conjunction with the Legal Services Department. Dependent upon the individual case, consultation with the NHSLA may be required Persistent Complainants Regrettably, from time to time, it is necessary to categorise a person as a persistent complainant. The procedure to be followed in these cases is attached as Appendix 2. Page 13 of 20

14 25.0 Training needs The Trust aims to ensure its employees have the required level of knowledge of the complaints procedure to ensure they can maintain open positive communication with complainants at all stages of the complaints process. The table demonstrates the training needs and provision. TOPIC STAFF GROUP HOW? BY WHOM Awareness of complaints procedure and personal actions relating to role in attending to a complaint. All staff Workplace Induction for all new staff Individual reading of policy e-learning programme Individual How to contact Complaints Manager All staff Workplace Induction for all new staff e-learning programme How to conduct complaints investigations and responses Any new relevant information regarding complaints Managers All relevant staff Complaints Investigator training. On as required basis. Via the Trust intranet Via Locality/Service managers Patient Safety & Complaints Team Patient Safety & Complaints Team Direct to specific staff group via , letter Compliments and Suggestions Compliments and Suggestions provide valuable feedback on how people receive the Trust s services. The Complaints leaflet encourages users to record such. Often many people who wish to express a compliment or suggestion write directly to the Service area. In order to capture this positive feedback centrally, where a service receives a compliment or suggestion they are to take following actions: Forward a copy to the Communications Department. Communications Department will select items for use in Trust publications (consent to be obtained), Forward a copy to PALS (Hellesdon, Norwich base) who will record the compliment or suggestion using its reporting system. Where the Complaints Department receives a compliment or suggestion it will be acknowledged and forwarded to the relevant service, the Communications Department and PALS. Data on the number of Compliments and Suggestions received will be included in the quarterly PALS report to the Service Governance Committee Contact received which has Clinical Significance On occasion communication may be received by the Patient Safety & Complaints Team from a complainant that has immediate clinical significance. For example, a complainant may make contact threatening to harm them self or others, or the content of the communication suggests deterioration in mental state. In such instances the Patient Safety & Complaints Team will make reasonable efforts to contact the complainants care team directly, to inform them of this information. If this is not possible then the information will be reported using the locality/service management structure. Page 14 of 20

15 On occasion where frequent communication is received by the Patient Safety & Complaints Team, which has ongoing clinical significance, arrangement is to be made between the team and the Clinical team that the communications be copied to them for information. The Patient Safety & Complaints Team should inform the complainant of this in writing (unless there is clinical need not to). The Patient Safety & Complaints Team and the Clinical Team should review the arrangement at a minimum of six monthly intervals. Page 15 of 20

16 28.0 Monitoring Statement: Aspects of the policy to be monitored Does the organisation acknowledge and respond to complaints in the stated timeframes. Does the organisation apply the processes described to support proportionate response to complaints. A report template which includes Qualitative and Quantitative analysis; A report on Complaints will be submitted to the Service Governance Committee at the prescribed times. This report will provide a breakdown of the complaints received Page 16 of 20 Monitoring method Audit of complaints Ongoing monitoring and management of complaints Quality check stage of the process Observation of two randomly selected complaints a month by Non Executive Director s Audit of Complaints and Patient Safety Lead reports as identified within the audit Terms of Reference Individual/Team responsible for monitoring Patient Safety & Complaints Lead Patient Safety & Complaints Team Frequency Quarterly For all complaints Monthly Findings: Group/ Committee that will receive the findings/monitoring report Reported to Service Governance Committee in the Patient Safety and Complaints Lead s Complaints report. Evidence with complaint process recorded on Datix Any presenting issues will be reported to the Patient Safety & Complaints Lead Clinical Audit team Bi annually Reported to Service Governance committee Action: Group/Committee responsible for ensuring actions are completed Patient Safety & Complaints Lead and Operational Managers involved in each complaint Actions to be developed as decided with locality,monitored by Patient Safety & Complaints Lead Record of completed complaints details in Service Governance Committee report Patient Safety & Complaints Lead Audit and risk committee

17 Aspects of the policy to be monitored according to locality/service, with an analysis (qualitative and quantitative) of any presenting trends Monitoring method Individual/Team responsible for monitoring Frequency Findings: Group/ Committee that will receive the findings/monitoring report Action: Group/Committee responsible for ensuring actions are completed Page 17 of 20

18 Appendix 1 PROCEDURE FOR RESPONDING TO PERSISTENT COMPLAINANTS Introduction The Trust is committed to taking all reasonable and proportionate actions to support a resolution to a complaint. This includes meeting with complainants and/or providing a number of written responses to a concern. There are occasions where a complainant has difficulty accepting the Trust's response to their complaint with the action of them making frequent contact on the same subject. In such instances it is important the complainant is addressed with respect and compassion, reminded of their right to request review of the Trust's response via the Parliamentary and Health Service Ombudsman. The difficulty in resolving such complaints satisfactorily potentially puts a strain on staff resource, particularly when there is no further action that can reasonably be considered. In addition, the best interests of the service user are often not served by a persisting complaints process, in many cases impairing the quality of care that can be provided by the appropriate Clinical Team. Purpose of this Procedure This procedure should only be used as a last resort and after all reasonable and proportionate measures have been taken to assist complainant resolution. The agreement to categorise a complainant as persistent will follow the convening of a panel that will consist of the following membership: Chief Executive or nominated deputy Patient Safety & Complaints Lead Director of Nursing, Patient Safety & Quality Medical Director Non Executive Director 3 members will constitute quoracy. The panel can seek advice from any source it deems appropriate (on a case by case basis). Criteria for definition of a persistent complainant Complainants (and/or anyone acting on their behalf) will only be deemed a persistent complainant when previous or current contact shows they meet two or more of the following criteria: Persist in pursuing a complaint where the NHS Complaints Procedure has been fully and properly implemented and exhausted. Change the substance of the complaints or continually raise new issues or seek to prolong contact by repeatedly raising further concerns or questions upon receipt of a response or whilst the complaint is still being addressed. (Care must be taken not to discard new issues that are significantly different from the original complaint. These must be assessed on their individual merit and may need to be addressed separately). Refuses to accept validated documentary evidence of treatment given as being factual e.g. drug records, medical records, nursing notes. Do not clearly identify the precise issues they wish to have investigated, despite reasonable efforts by Trust staff and others (e.g. PALs service) to help them specify their concerns. Page 18 of 20

19 Maintains a disproportionate focus on a minor aspect of a complaint after discussion with staff, to the extent that it becomes out of proportion to its significance within the complaint as a whole. (defining minor can be subjective judgement, and must be used with caution in applying the criteria). Having in the course of pursuing their concerns, had an excessive number of contacts with the Trust by telephone, letter or fax. Staff should be instructed to keep a clear record of the number of contacts to demonstrate their excessive nature. These records should be submitted to the Patient Safety & Complaints Team to facilitate central record keeping and a consistent knowledge base. Display unreasonable demands or expectations and fail to accept these may be unreasonable e.g. insist on immediate responses from senior staff when they are not available and this has been explained, and they have been given assurances about when contact will be made. Refuses to accept that different perceptions of incidents can occur, and verification of the facts can be impossible when a long period of time has elapsed. Have threatened or used actual physical violence. All such cases must be reported via an Incident Form in accordance with Trust policy. Have harassed or been personally abusive or verbally aggressive towards staff dealing with them. All cases must be reported on an Incident Form in accordance with Trust policy. Seeks repeated contact with the Trust through a range of people and refuses to use a single contact point. Consideration of Persistent Complainer Status The panel will receive a report from the Patient Safety & Complaints Lead outlining what has already happened in terms of receiving and investigating complaints so far. Where the complainant is a service user of the Trust the Consultant/Responsible Clinician will provide a report to the panel which includes: Details of the person s clinical condition Whether the patient s condition is influencing the tendency to make complaints The clinical needs of the patient Difficulties being experienced by the clinical team in delivering care Upon this information the panel will consider whether to apply persistent complainer status. Actions once status applied A response plan will be agreed. This will include a letter to the complainant outlining the following: Clarifying the position the complaint has reached Setting parameters for a code of behaviour Advising the complainant of the lines of communication and Future arrangements (e.g. name of contact person, number of calls per week to be allowed) Advising the complainant, where applicable, that further correspondence will be acknowledged but not answered Where appropriate reaffirm the arrangements for continued clinical care Where the complainant is a service user of the Trust the Supervising Consultant or Responsible Clinician will carry out a care plan review to ensure the service user s clinical needs continue to be met. It must be emphasised the classification of persistent complainant does not mean new issues having no connection with the original complaint or dispute will not be investigated and responded to via the Complaints Procedure. New complaints should be assessed individually. Page 19 of 20

20 All staff who are likely to have contact with the persistent complainant should be familiar with the required actions Review of the Status At a six month interval a review of the persistent complainer status will be undertaken. If the complainant has made reasonable and proportionate efforts to respect the Trust's response plan, responsive amendment to the plan may be made including the removal of persistent complainer status. If required the first six month review will set a timetable for subsequent review, not exceeding periods of 12 months. It is expected that this procedure will not be used often or regularly. The number of people registered with this status will be included within the complaints report provided to the Service Governance Committee. Records of all decisions will be available upon request to relevant stakeholders e.g. Commissioning and regulatory bodies. Page 20 of 20

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