NHS Dorset Clinical Commissioning Group. Customer care and complaints policy

Transcription

1 NHS Dorset Clinical Commissioning Group Customer care and complaints policy Supporting people in Dorset to lead healthier lives

2 PREFACE This policy sets out the mandatory framework for managing all comments, concerns, complaints and compliments received within the Dorset Clinical Commissioning Group (CCG) to ensure that appropriate action, accountability and responsibility for service improvement is identified, taken and shared. This policy requires all staff to manage any customer concern, compliment, comment or complaint received appropriately and takes responsibility for learning from the patient experience.

3 Document Status: Approved/ Current Policy Number 12 Date of Policy September 2012 Next Review Date September 2014 Sponsor Director of Quality Approved by / on Trust Board September 2012 Version Date Comments By Whom 1.0 July Reviewed for authorisation Kath Florey-Saunders Target Audience All staff within NHS Dorset Clinical Commissioning Group Distribution Intranet Trust Website Communications Bulletin Title of Evidence Listening Responding and Improving: Guidance to support implementation of the Local Authority Social Services and National Health Services Complaints (England) Regulations 2009 Secretary of State, Houses of Parliament - Local Authority Social Services and National Health Services Complaints (England) Regulations N309 Department of Health - Making Experiences Count: A new approach to Date Published responding to complaints NHSE - Implementation of the NHS Complaints Procedure 1996 NHSE - Clinical Governance: Quality in the New NHS 1999 Parliamentary and Health Service Ombudsman - Ombudsman Principles 2009 ASSOCIATED DOCUMENTS : This policy/ protocol/guideline/standard should be read in conjunction with: Implementation of the NHS Complaints Procedure (NHSE 1996) Date:

4 CUSTOMER CARE AND COMPLAINTS POLICY CONTENTS Page 1. Introduction 1 2. Purpose 1 3. Definitions 1 4. Values 2 5. Parameters 3 6. Persistent / repeated complaints 5 7. Mental health act 1983 as amended Legal proceedings 5 9. Disciplinary procedure Duties/responsibilities and accountability Patient confidentiality Complaints involving different organisations Process for handling complaints and concerns Local resolution Independent review parliamentary and health services ombudsman Complaints about other NHS organisations Committee with overarching responsibility for subject Other committees/groups with responsibility for complaints Training Process for completing risk assessments linked to subject Monitoring compliance Internal communication Equality impact assessment 17 APPENDICES APPENDIX A: Habitual or vexatious complaint and or requests for information policy 19 APPENDIX B: Local resolution flowchart 25 APPENDIX C: Local resolution flowchart: service providers 26 APPENDIX D: Parliamentary and health services ombudsman 27 APPENDIX E: Equality impact assessment form 28

5 CUSTOMER CARE AND COMPLAINTS POLICY 1. INTRODUCTION 1.1 The statutory responsibility for Clinical Governance and subsequent guidance (NHSE 1999, Clinical Governance: Quality in the New NHS) emphasises the management of complaints as a key performance indicator in the assurance of quality improvement. This policy sets out how the Clinical Commissioning Group will ensure compliance with the mandatory framework for managing complaints ensuring accountability and responsibility. 1.2 This policy incorporates national guidance on the implementation of the NHS Complaints Procedure (NHSE 1996) and the Statutory Complaint Handling Regulations 2009 which can be found at It also incorporates the Department of Health s changes to legislation for managing complaints and concerns under Making Experiences Count which came into effect in April PURPOSE 2.1 The purpose of this policy is to outline the statutory regulations all staff must adhere to regarding any comment, concern, compliment or complaint received within the CCG and the appropriate course of action and associated management responsibility regarding handling that issue. 2.2 This policy aims to ensure that any feedback received on a service is given the due attention needed to ensure appropriate learning outcomes are both identified and implemented. Patient experience feedback is paramount to service improvement and reducing any potential risk by identifying the need for training or process review. The policy aims to support patients, relatives, carers and staff when any service has fallen short of delivering the appropriate level of care. 3. DEFINITIONS 3.1 Complainant refers to the individual who raises or makes the complaint. A complaint is defined as an oral or written expression of dissatisfaction from an individual(s), which requires a response (Citizen s Charter Complaints Task Force 1995). 3.2 Front-line staff refers to any staff that have direct contact with patients, relatives or carers either in person or by other modes of communication, such as a telephone, on a regular weekly or daily basis. 3.3 Clinical Commissioning Group (CCG): this organisation commissions community and secondary care services for their local population. 1

6 3.4 Health Watch: Consumer Champion that provides the complaints advocacy service that helps service users to pursue complaints within the NHS. 3.5 PHSO The Parliamentary and Health Service Ombudsman (or Health Service Ombudsman) provides an independent referral service to the public when they feel that an NHS body has not investigated a complaint properly or fairly or have provided a poor service. 3.6 A complaint is defined as an oral or written expression of dissatisfaction from an individual (s), which requires a response (Citizen s Charter Complaints Task Force 1995). A complaint may be received from the patient / carer or a third party acting on their behalf through any of the following methods: in writing, by telephone, in person, by fax or to the Accountable Officer or customer care lead. 3.7 The complaint is valid if received within 12 months of the date on which the matter that is the subject of the complaint occurred; or 12 months of the date on which the matter that is the subject of the complaint came to the notice of the complainant. However, complaints made outside of this time scale will be considered sympathetically with the aim to resolve them wherever possible. The customer care lead should be contacted for all complaints received outside this advisory time scale and a decision agreed with the Director or Investigating Officer as to whether or not it is practical to investigate the complaint. 4. VALUES 4.1 This section outlines the values that the CCG promotes when handling complaints: I. a commitment to ensure that all complaints and concerns are accepted and treated in a non-judgemental way, thereby ensuring that service users/ complainants feel complaints are taken seriously and that this will not compromise future relationships between the user and the CCG. II. III. IV. a commitment to ensure that all complaints are handled as quickly as possible, with sensitivity, maintaining confidentiality and ensuring fairness to both the complainant and member(s) of staff. a commitment to ensure that staff and the complainant are kept informed of progress and developments throughout any complaint investigation and to ensure the organisation learns from the experience. a recognition that service users/ complainants need to be involved at all stages of the complaints procedure and the importance of their role in the planning and development of services. V. the acknowledgement and recognition of the role of the patients, relatives and carers in informing the CCG about services, that enables lessons to be learned, and actions to be taken to minimise the risk of similar occurrences in the future. 2

7 VI. commitment to ensure that complainants feel able to inform the CCG should they feel like they have been treated differently as a result of raising a concern or complaint. 4.2 The CCG is committed to ensuring complaints and concerns are resolved in accordance with Making Experiences Count (MEC). The Department of Health (DH) has revised the way in which complaints across health and social care are managed and these changes came into effect on 1 April Simplification and unification of the complaints systems across health and social care is part of the drive to make services safer, more effective and personal. 4.3 The DH summarises that the MEC regulations for the handling of complaints should: increase people s confidence that their complaints will be taken seriously and that services will improve as a result of their experiences; deliver a flexible approach to resolving people s complaints, which includes effective support; provide a simple, consistent, unified approach across health and social care; develop a culture of openness and fairness when dealing with complaints; deliver an approach which is fair to people using and delivering services; provide an emphasis on early and effective resolution; place a greater emphasis on excellent local leadership and accountability that supports the resolution of complaints. 5. PARAMETERS What complaints are the CCG responsible for? 5.1 The CCG is responsible for: complaints about the commissioning decisions that the CCG has made; complaints about continuing health care funding and process; complaints about individual cases funding if dissatisfied following an appeals process; 3

8 complaints received about providers of services that the CCG commissioned: the complainant will be contacted to advise them to either complain directly to the organisation or the CCG will forward the complaint to the relevant organisation, once written consent to do this has been received. This will enable the organisation that is being complained about to manage the complaints process under local resolution, in accordance with the complaints regulations and making experience count guidance; * Should there be a need, the CCG will facilitate the complaints process between a provider that it commissions and the complainant should they wish not to communicate directly with the provider, or if they are dissatisfied with a previous response. What complaints are the CCG not responsible for? 5.2 Services commissioned by the National Commissioning Board including: GPs; dentists; pharmacists; opticians; prison and custodial services. 5.3 It is recommended that complainants raise their concerns in the first instance with the organisation that is responsible for delivering the care that has caused the concern. Who can complain to the Dorset Clinical Commissioning Group? 5.4 Any person or organisation that wishes to raise a complaint, including those NHS patients whose first spoken language is not English or who communicate via British Sign Language, is known as a complainant. 5.5 Complainants can include: carers and other representatives of NHS patients as long as they can demonstrate that they have the consent of the patient concerned to act on their behalf; a person raising a complaint on behalf of a child as long as they can demonstrate that have the legal responsibility to do so; 4

9 a person raising a complaint on behalf of NHS patients who are suffering from mental health problems, learning difficulties or physical disabilities and lack capacity to make a complaint themselves or require support. Written consent with supporting documentation will be required; a person raising a complaint on behalf of a deceased person, as long as they can demonstrate that they have written confirmation of being appointed as a representative or equivalent e.g., executor. 5.6 If the customer care lead does not feel that the person claiming they are representing the complainant/ child/ deceased is appropriate, then this must be put in writing to that person. 5.7 Complaints must be made not later than 12 months after the date on which the matter occurred or came to the attention of the complainant. 6. PERSISTENT / REPEATED COMPLAINTS 6.1 Please see appendix A for the Habitual or Vexatious Complaint Policy. 7. MENTAL HEALTH ACT 1983 AS AMENDED Complaints relating to the appropriateness of detention under the Mental Health Act 1983, i.e. patients expressing disagreement with their detention and a wish to be released from the Section of the Mental Health Act, under which they are detained, should be asked to apply for a Mental Health Act Hospital Manager s Review and/or Mental Health Act Tribunal. 8. LEGAL PROCEEDINGS 8.1 If a complainant at any time during the complaints process explicitly indicates an intention to initiate legal action, then the matter will no longer be handled through the complaints procedure. The complainant will be notified in writing that the complaints process has ceased forthwith. The customer care lead will notify the risk manager of this intention so that the appropriate authorities are notified. 9. DISCIPLINARY PROCEDURE 9.1 The complaints procedure will be kept separate from the staff disciplinary procedure. The purpose of the investigation carried out under the complaints procedure is to resolve complaints and not to apportion blame or to make recommendations regarding disciplinary action against members of staff. 5

10 9.2 In the event of a complaint being received that involves serious allegations of misconduct about a member, or members of staff warranting a management investigation, involvement of a professional regulatory body or a criminal investigation, the accountable officer or customer care lead should immediately inform the human resources business partner and the relevant director. 9.3 If a formal management investigation is initiated and in particular in these circumstances if instigation of the disciplinary procedure is required there is a need to balance obligations relating to confidentiality of staff with reassuring the complainant. The complainant will receive an appropriate explanation, apology and informed of any action taken to prevent recurrence. 9.4 The complaints procedure will not deal with any matter already the subject of a disciplinary procedure and the CCG will inform the complainant of this. If there are other parts of the complaint, which are not related to a disciplinary procedure, these issues will be pursued in line with this policy. 10. DUTIES/RESPONSIBILITIES AND ACCOUNTABILITY 10.1 The Accountable Officer has a statutory accountability for the management of complaints and assuring quality improvement within the clinical governance framework. Within this remit is an explicit responsibility for ensuring that a Complaints Policy is in place The CCG s Directors and Investigating Officers are accountable on a day-to-day basis for complaints arising within their areas of responsibility. In collaboration with the customer care lead, Directors and Investigating Officers will investigate complaints received in line with this policy. Throughout the complaints process they will ensure that there is effective communication and liaison with the customer care lead at all stages. Their role in investigating complaints is as the Investigating Officer(s) Organisations that the CCG commission such as Acute Hospitals, Mental Health Trusts and Trusts responsible for providing community services will continue to handle enquiries and complaints received about their services at local resolution level, in the first instance. The CCG will facilitate the complaints process at the request of the complainant, should the complainant not wish to raise concerns with the organisation involved directly The role of the customer care lead is to support managers and staff who are undertaking the management of complaints. In addition, the customer care lead will co-ordinate the complaints process and monitors compliance with this Policy to ensure that the CCG complies with national standards and guidance. They are also responsible for supporting customers through MEC, giving regular updates and ensuring that no-one is treated differently as a result of raising a concern or complaint. 6

11 10.5 All staff who are involved in the investigation stages of a complaint must provide factual written statements as stated in the complaints policy and co-operate in the investigation All staff must also be supported by their immediate line management structure to ensure that any investigation is carried out fairly and in a non-judgemental supportive manner. 11. PATIENT CONFIDENTIALITY 11.1 Care should be taken at all times to ensure that only information required for the complaint investigation is disclosed and that people with a demonstrable need to know will have access to that information Where the complaint is received directly from the patient it is essential to obtain a signed consent form to access relevant personal information from their health records and share information with relevant organisations Where a complaint is made on behalf of a patient, for example by a relative or outside agency, care needs to be taken not to disclose personal information without the expressed consent of the individual concerned. A signed consent form for Disclosure of Information should be obtained from the patient concerned or authorised representative The suitability of a complainant to represent a patient / client who is unable to give consent depends on the need to respect confidentiality and on any known wishes expressed by that individual that information should not be disclosed When a third party (including other agencies) is involved e.g. local Authorities, either written permission must be given prior to disclosure of any information. 12 COMPLAINTS INVOLVING DIFFERENT ORGANISATIONS Joint NHS and Local Authority Complaints 12.1 Complaints relating to local authorities should be dealt with under the MEC Regulations. Where complaints solely concern one organisation, that organisation must respond to the complaint. Where complaints are about both NHS and local authority services, and where the complainant so wishes, the organisations involved must co-operate to deal with the part of the complaint that relates to them and provide a co-ordinated response to the complainant. Each organisation must adhere to the joint working policy for handling complaints. 7

12 12.2 On receipt of a complaint, the CCG should check whether it appears also to raise issues around local authority handling of the case. If so, within ten working days of receiving the complaint, it must seek to obtain the consent of the complainant to share details of the complaint to the local authority. Where the complainant does not want the details to be shared, the CCG should advise them on the parts of the complaint it is able to deal with, adding that if the complainant wants to pursue the Local Authority s part of the complaint, they should approach the relevant authority Where the complainant consents to the details being shared, the local authority must deal with its part of the complaint and co-operate with the CCG to resolve the entire complaint and provide a co-ordinated response The duty to co-operate by all parties includes the duty to share relevant information, and attend joint meetings to consider the complaint Additionally, the two relevant bodies should seek to agree which organisation should take the lead in co-ordinating the handling of the complaint and dealing with the complainant. The lead body s complaint manager must: co-ordinate the handling of the complaint by working closely with all those involved; ensure a comprehensive and appropriate response is sent; ensure that they keep the complainant informed and, where possible, coordinate a single reply The lead organisation should be determined by the nature of the complaint. Some complaints will be clearly weighted towards one organisation, in which case that organisation should take the lead. Where the complaint is more evenly weighted alternate lead roles will be taken. The role of the lead organisation is to co-ordinate a single response to the complainant The CCG s Accountable Officer should sign the response, except where there are good reasons for them not being able to do so. Responses will be signed by an executive Director in these circumstances. Irrespective of lead responsibility, each body retains its duty of care to the complainant and must handle its part of the complaint in accordance with its own regulated procedures Joint handling of a case should not affect the need to meet statutory deadlines for providing a response to the complainant. Both agencies should seek to avoid any unnecessary delay. The relevant CCG and local authority should consider a joint meeting with the complainant if this will facilitate a more effective outcome. 8

13 12.9 Close co-operation between complaint managers should help identify which issues should be referred to the appropriate body, should the complainant wish to go forward to independent review. The co-ordinated response must identify which parts relate to the relevant aspects of the complaint letter. This will be of great assistance to an independent body that might subsequently review the complaint. The response should advise the complainant of their right to pursue the complaint further and provide details of which regulatory organisation would deal with each aspect of the complaint Where services are provided in a package but delivered by separate bodies (e.g. some by NHS and some by a local authority) the lead complaint manager should still ensure that all aspects of the complaint are investigated by the appropriate body and that the complainant is kept informed of the progress of the complaint and who is involved In order to understand and analyse all aspects of the complaint it is imperative that the organisations involved communicate as effectively as possible The receiving organisation will normally acknowledge the complaint within three working days, advising the complainant of any referral to another organisation that is involved, from whom to expect a response and the anticipated date of response or next contact. A copy of the complaint and letter of acknowledgement will be sent to all organisations involved as agreed with the complainant on receipt of the appropriate consent. Complaints to the CCG only relating to a Local Authority There are occasions where the CCG will receive a complaint about the actions of a local authority. This can happen where the complainant does not understand which organisation is responsible for the service The CCG will refer such complaints to the appropriate local authority if the complainant consents to this. The customer care lead must ask the complainant whether he or she wishes for the complaint to be referred: referral must be made within five working days of receipt of consent. If the complainant agrees, the customer care lead must forward the complaint to the local authority. Where the complainant does not want the complaint forwarded they should be advised that the CCG is unable to deal with the complaint and that if they wish to pursue it further, they must contact the local authority. The action taken by the CCG must be recorded in writing. 13. PROCESS FOR HANDLING COMPLAINTS AND CONCERNS 13.1 The local procedure for handling complaints has two elements: Local Resolution involves the CCG undertaking actions to resolve the concerns that have been raised and ensuring that appropriate actions are taken to learn from the complaint. Please refer to Appendix B and Appendix C which detail the appropriate flow chart process. 9

14 Complainants or people raising concerns are made aware that, should they feel that they have been treated differently as a result of raising a concern or complaint, they can contact the customer care department to raise their concerns. Independent Review by the Parliamentary and Health Services Ombudsman. From the start of the complaints process, complainants must be made aware of their right to refer to the Parliamentary and Health Services Ombudsman if they are unhappy with the outcome of their complaint or the way in which it was handled during the local resolution stage. Details can be found in Appendix D Complainants should be made aware, in the first instance, of the free external advocacy support available through either Health Watch or the Mental Health Forum Complainants with communication difficulties e.g. language or learning disability, will be supported in making complaints. 14. LOCAL RESOLUTION 14.1 Any member of staff approached by a complainant or enquirer should try to resolve the issue or concern on the spot if possible or refer to their Manager / Investigating Officer. Resolution at this stage will often prevent a minor grievance escalating to a formal complaint. If it is not possible to resolve the issue quickly, the enquirer/ complainant should be referred to the customer care lead Staff should to take into account the seriousness of an oral complaint and the possible need for more independent investigation and assessment. Any complaint that includes serious or potentially serious allegations, including possible litigation, must be reported to the Accountable Officer or customer care lead within one working day If sustained, the person receiving the complaint should respond to the main concerns by: acknowledging the concerns raised; responding appropriately; offering an apology, and either giving an explanation, or refer to the customer care lead and line manager; taking action to learn and prevent recurrence in the future If the complainant is satisfied at this stage no further action need be taken. The complaint should be recorded and a copy sent to the customer care lead. 10

15 14.5 In the event of the complainant remaining dissatisfied, the member of staff should review the situation with their line manager and the customer care lead to determine the best way forward. Written Complaints 14.7 When a letter of complaint is received by the Accountable Officer, Director, Investigating Officer, or by a member of staff action must be taken immediately in line with this policy. The letter should be date stamped on arrival and forwarded to the customer care lead within one working day. Acknowledgment of the complaint must be within three working days of receipt of the complaint by the customer care team. This can be done by letter or verbally The customer care lead will ensure that: the complaint is valid and acceptable within the parameters set out in this policy; the complaint is categorised as Green, Amber or Red according to seriousness and likelihood of recurrence under the risk matrix; the complaint is acknowledged within three working days. Should a letter be sent it should invite the complainant to telephone/ contact the customer care lead should no telephone number have been provided, so that a resolution action plan can be agreed prior to investigation. If every effort made to contact the complainant fails, the customer care team must determine an appropriate action plan based on the complaint originally raised; timescales for the resolution of concerns must also be mutually agreed with the complainant and the appropriate method for feeding back the outcome of the investigation confirmed e.g. meeting and / or written response. As a guideline, the CCG will aim to respond to complaints within 25 working days from receipt of any required consent. A meeting between the appropriate staff member and the complainant must also be offered. Should no further contact be made from the complainant following receipt of the complaint, an investigation must still be carried out into the concerns raised; it is important to keep comprehensive and well-maintained records of complaints that has been received, investigated and responded to. All complaints received by the customer care lead are recorded and maintained on the CCG s relevant database. 11

16 Setting up the Investigation 14.9 The customer care lead will brief the appropriate Investigating Officer (appropriate Director or manager) and ensure that a full investigation is undertaken into the concerns raised. Throughout this process the nominated manager should work closely with and seek advice from the customer care lead however it is the responsibility of the Investigating Officer to ensure all points are addressed and the action plan is implemented and responded to The Investigating Officer s brief for complaints investigations provides a framework for the complaints investigation. This structure will assist in writing the report and provide a method for highlighting the learning points and action to be taken. This should be incorporated into the resolution action plan Staff involved personally in the complaint will be informed by the Director/ Investigating Officer that a complaint has been made and will be notified of the outcome of the complaint following the investigation All staff involved in a complaint are required to provide a statement proportionate to the concerns raised. Meeting the Complainant At an early stage of the investigation it may be useful to offer complainants the opportunity to meet with the appropriate manager or Investigating Officer accompanied by a relative or friend or an independent person, e.g., Health Watch at a time and place of mutual convenience. The purpose of such a meeting should be clearly stated, with notes being taken of the discussions held. It is the responsibility of the Investigating Officer to arrange the meeting venue, attendees and for a minute taker to be present. The customer care lead will liaise with the complainant Following completion of any meeting, the notes taken and any agreed action should be sent to the complainant by the customer care lead. It is the responsibility of the Investigating Officer to ensure all complaint investigation documentation reflects a true and accurate account of events. Analysis of the Investigation If, as a result of the complaint investigation, disciplinary proceedings are to be taken against a CCG employee, either the whole or relevant section of the complaint will be set aside until such time as this has been completed. The complainant will be advised of this process and the timescale involved. 12

17 14.16 Within 20 (working) days of the complaint being received or sooner the Director / Investigating Officer should either: respond to the customer care lead with a draft letter of response for the complainant for signature by the Accountable Officer and where considered necessary, an invitation to attend a meeting. Copies of all information collated as part of the investigation, the investigation report and the action plan for implementation of the learning points identified as a direct consequence of the complaint investigation, should also be submitted or provide an explanation as to why the investigation cannot be completed within twenty five days of the complaint being received. A telephone call or letter will be made/sent to the complainant by the customer care lead to discuss/ inform the complainant of the revised response date. Writing the Response Letter The format for the complaint response should have been determined in the Complaint Resolution Action Plan i.e. by meeting and / or written response. All complaints still require a formal written response to be drafted by the Director / Investigating Officer to be sent to the customer care lead who will finalise the letter and arrange for signature by the Accountable Officer. This response will also be used to verbally communicate the findings of the complaint and may be used at a later stage, or for audit purposes or for submission to the Parliamentary Health Services Ombudsman The written reply must be provided in MS Word via / or in electronic format (with appropriate safeguards for patient confidentiality) should: be sympathetic in tone, use plain English and avoid the use of technical terms and jargon which the recipient may not readily understand; give a full explanation of the investigation findings and a judgement about the quality of service received; give an appropriately worded apology where things have gone wrong and an indication of the action taken as a result of the complaint, to improve services and prevent recurrence; offer the opportunity, for the complainant to request further clarification or discussion on any points arising from the complaint investigation; indicate that the letter marks the end of the local resolution stage unless the complainant wishes to seek further clarification from the CCG on any of the issues addressed within the response, or there are any outstanding issues not resolved; 13

18 advise the complainant of the independent review process via the Parliamentary Health Services Ombudsman and provide full contact details The draft letter of complaint will then be submitted to the Accountable Officer for signature. The Accountable Officer will ensure the letter addresses the points made by the complainant and complies with the guidance in this policy. S/he may amend the letter accordingly or request a revised draft from the Director / Investigating Officer via the customer care lead. The customer care lead may also ask for the draft to be amended or request further information from the Director or Investigating Officer or request to that the complaint is responded to more fully Supporting documentation relating to the complaint may be made available to the complainant under Freedom of Information guidance Following signature of the final letter by the Accountable Officer, copies of the reply will be sent by to the Director / Investigating Officer by the customer care lead for dissemination to the staff involved in the complaint for implementation of action plans and for staff to reflect on and learn from the issues raised by the complainant Throughout the complaints process, the customer care lead may at any time seek clarity and/or advice from staff within the organisation who possess relevant knowledge and expertise. 15. INDEPENDENT REVIEW PARLIAMENTARY AND HEALTH SERVICES OMBUDSMAN (PHSO) 15.1 Complainants who remain dissatisfied with the response at the end of the local resolution stage have the right to request a review of their complaint by the Parliamentary and Health Services Ombudsman. Refer to appendix D for full details of the independent review process The PHSO will appoint a case manager. The case manager will request all appropriate information from the CCG and the complainant to carry out an initial review. The CCG will be informed of the outcome, i.e. what further action, if any, needs to be taken It is essential that clear and complete records of all complaints are retained, including correspondence, statements, reports, telephone message/conversation records and s It is the responsibility of the Director / Investigating Officer to ensure that any appropriate feedback or action received as a result of the review is implemented and an update is provided to the customer care lead. 16. COMPLAINTS ABOUT OTHER NHS ORGANISATIONS THAT THE CCG COMMISSION 16.1 Providers of NHS services are responsible for investigating complaints regarding their services in line with Making Experiences Count guidance. 14

19 16.2 The customer care lead will liaise with any complainant who contacts the CCG directly regarding their complaint and provide guidance to the complainant regarding contacting the appropriate organisation The CCG will not undertake an investigation into a complaint regarding a provider organisation: it is the responsibility of the organisation providing the services to investigate a complaint regarding their service under local resolution The CCG, if requested, will act as the contact point for the complainant and/ or liaise with any complainant and provider organisation who fail to resolve the concerns at local resolution stage, in an attempt to facilitate an outcome When complaints are not resolved at the local resolution stage the complainant has the right to request an Independent Review by the PHSO. 17. COMMITTEE WITH THE OVERARCHING RESPONSIBILITY FOR SUBJECT 17.1 The Integrated Governance Committee is responsible for overseeing the CCG s arrangements for managing and following up all formal complaints. This is to ensure that the arrangements are robust and in accordance with national guidance, that issues for the quality of patient care are identified and addressed and that learning from complaints takes place The customer care lead in conjunction with the appropriate Directors will ensure that the policy is adhered to by staff and raise any concerns regarding non-compliance to the appropriate Director or Committee should they arise The customer care lead will review the policy annually The customer care lead will ensure a quarterly report is prepared for the Integrated Governance Committee. This will include the numbers of complaints and concerns received during the quarter, giving comparative information to demonstrate trends, where possible. It will also summarise cases to give examples of complaints handling, outcomes and changes implemented as a direct consequence of the complaints received. 18. OTHER COMMITTEES/GROUPS WITH RESPONSIBILITIES FOR COMPLAINTS Learning Lessons and Developing the Action Plan 18.1 The Director / Investigating Officer with the appropriate line manager(s) will identify the learning points from the complaint investigation and implement an action plan for future improvement. 15

20 18.2 The Director/Investigating Officer should also keep customer care lead informed of progress with implementing action plans where the nature of the complaint warrants this. Each action requires a scheduled completion date and an update on all actions must be given to the customer care lead on a monthly basis. This information will be provided to in the quarterly reporting of complaints The lessons learned will be shared in the CCG to ensure that risks of similar issues occurring again are reduced. The Directors are responsible for ensuring that any areas identified in the quarterly reports are acted upon and disseminated appropriately within their respective Directorates working in conjunction with governance committees. The quarterly reports will also inform the commissioning cycle and input into performance reviews with the service providers that the CCG commissions The customer care lead will report any concerns or complaints specifically regarding, gender, race, religion, disability and sexual orientation to the CCG s Equality and Diversity Lead on a quarterly basis. 19. TRAINING 19.1 Managers will be offered training on investigating, responding to and following up complaints Directors should ensure that there are sufficient managers trained as investigators to undertake investigations in line with the policy for Undertaking a Management Investigation, incorporating Root Cause Analysis training The training programme will enable all trained staff to have an awareness of their role and responsibilities relating to how complaints and comments about the services provided should be handled, including the need to ensure that patients, relatives and carers are not treated differently as a result of raising a concern or complaint. 20. PROCESS FOR COMPLETING RISK ASSESSMENTS LINKED TO SUBJECT 20.1 The customer care lead will initially grade each complaint based on the initial complaint information using the risk matrix as Green, Amber or Red and this rating will be reevaluated at the close of the complaint The customer care lead will report any Amber or Red issues in the complaints report. It is the responsibility of the Integrated Governance Committee to take forward any further appropriate action. Assurance will be provided through requesting the Integrated Governance Committee to note the quarterly report outlined in 17.4, and for the annual report to be noted by the Board. 16

21 21. MONITORING COMPLIANCE 21.1 The Head of Patient Safety will: undertake an annual review of a random sample of five red complaints and five amber complaints to assess if the correct process has been followed as outlined in appendix B and appendix C; this audit will concern complaints received the previous financial year and will be undertaken by the end of July each year; the results of the audit will be reviewed by the Integrated Governance Committee who will monitor the outcome on a yearly basis and recommend improvement targets for the following year. 22. INTERNAL COMMUNICATION 22.1 This policy will be communicated to the following staff via the CCG s staff e-bulletin. all staff; CCG Board members; Non Executive Directors 23. EQUALITY IMPACT ASSESSMENT 23.1 An Equality Impact Assessment has been undertaken and is outlined in appendix E. 17

22 APPENDIX A HABITUAL OR VEXATIOUS COMPLAINT AND OR REQUESTS FOR INFORMATION POLICY 1 1 Introduction 2 Purpose of this procedure 3 Definition of Habitual and Vexatious Complaints / and or requests for information 4 Options for dealing with Habitual or Vexatious Complaints / and or requests for information 5 Withdrawing Habitual or Vexatious Status 6 Monitoring 7 Staff Operational Guidance for handling Habitual or Vexatious Complaints 1 Taken from Doncaster Primary Care Trust s Policy G14 18

23 HABITUAL OR VEXATIOUS COMPLAINT AND OR REQUESTS FOR INFORMATION POLICY 1 INTRODUCTION 1.1 Habitual and / or vexatious complainants are an increasing problem for NHS staff. The difficulty in handling such complainants is placing a strain on time and resources and is causing unacceptable stress for staff who may need support in difficult situations. NHS staff are trained to respond with patience and understanding to the needs of all complainants, but there are times when there is nothing further that can reasonably be done to assist them or to rectify a real or perceived problem. 1.2 Following the introduction of the Freedom of Information Act (2000) from January 2005, the public and press have a right to make requests for information held or owned by NHS Dorset and NHS Bournemouth and Poole. The majority of those requests will be processed using the Trusts Freedom of Information Policy. However, there may be occasions where the requests for information may be deemed vexatious or habitual (see definition in 3 below). In those instances, the principles and procedures held within this Policy apply to those requests. The Trusts do not have to comply with repeated or substantially similar requests from the same person other than at reasonable intervals. 1.3 In determining arrangements for handling such complainants and / or requests for information staff are presented with two key considerations: to ensure that the Complaints Policy and / or the Freedom of Information Act has been correctly implemented and that no material element has been overlooked or inadequately addressed. In doing so it should be appreciated that even habitual or vexatious complainants may have issues, which contain some substance. The need to ensure an equitable approach is, therefore, crucial; to be able to identify the stage at which a complainant / person requesting information has become habitual or vexatious. 1.4 One approach is implementation of this approved policy on how to deal with vexatious / habitual complaints or requests for information. Implementation of this policy would happen only in exceptional circumstances. Information on the handling of habitual or vexatious complainants would be available to the public as part of the material made available on the complaints process. 2 PURPOSE OF THIS PROCEDURE 2.1 The purpose of this procedure is to give the CCG a framework to implement and take appropriate action against those complaints and requests for information that are deemed to be vexatious or habitual. 19

24 2.2 Any complaints received by the CCG must be processed in accordance with this Complaints Policy, and requests for information must be processed in accordance with the Freedom of Information Policy. During this process, staff will inevitably have contact with a small number of individuals who may take up an unwarranted amount of NHS resources. The aim of this procedure is to identify situations where this could be considered habitual or vexatious and to suggest ways of responding to such situations. 2.3 This procedure should only be used as a last resort and after all reasonable measures have been taken (i.e. an effort to resolve complaints following the NHS complaints procedures or exhaustion of all reasonable measures under the Freedom of Information Act). 2.4 Careful judgement and discretion must be used in applying the criteria to identify potential habitual or vexatious complaints and requests for information and in deciding what action to take in specific cases. This procedure should only be implemented following careful consideration by, and with authorisation of, the CCG chair and Accountable Officer or nominated deputy. 3 DEFINITION OF HABITUAL AND VEXATIOUS COMPLAINTS / AND OR REQUESTS FOR INFORMATION 3.1 Complainants or people requesting information (and / or anyone acting on their behalf) may be deemed to be habitual or vexatious where current or previous contact with them shows that they have met two or more (or are in serious breach of one) of the following criteria: persisting in pursuing a complaint where the NHS complaints procedure has been fully and properly implemented and exhausted. For example, where investigation is deemed to be 'out of time' or where the Health Services Ombudsman has declined a request for independent review; persisting in pursuing a request for information where the Freedom of Information Act Policy has been fully and properly implemented and exhausted; changing the substance of a complaint or persistently raising new issues or seeking to prolong contact by unreasonably raising further concerns or questions upon receipt of a response whilst the complaint / request is being dealt with. Care must be taken not to disregard new issues, which differ significantly from the original complaint/request - these may need to be addressed separately; unwilling to accept documented evidence of treatment given as being factual (e.g. drug records, GP manual or computer records, nursing records) or deny receipt of an adequate response despite correspondence specifically answering their questions / concerns. This could also extend to include those persons who do not accept that the facts can sometimes be difficult to verify after a long period of time has elapsed; 20

25 focusing on a trivial matter to an extent, which is out of proportion to its significance and continue to focus on this point. It should be recognised that determining what is trivial can be subjective and careful judgement must be used in applying this criterion; physical violence has been used or threatened towards staff or their families / associates at any time. This will, in itself, cause personal contact to be discontinued and will thereafter, only be pursued through written communication. All such incidents should be documented and reported using the Incident Policy, and notified as appropriate, to the police. Staff should also refer to the Personal Safety Policy; had an excessive number of contacts with the CCG when pursuing their request or complaint, placing unreasonable demands on staff. Such contacts may be in person, by telephone, letter, fax or electronically. Discretion must be exercised in deciding how many contacts are required to qualify as excessive, using judgement based on the specific circumstances of each individual case; have harassed or been abusive or verbally aggressive on more than one occasion towards staff - directly or in-directly - or their families and / or associates. If the nature of the harassment or aggressive behaviour is sufficiently serious, this could, in itself, be sufficient reason for classifying the complainant as vexatious (see paragraph 3.1). Staff must recognise that complainants may sometimes act out of character at times of stress, anxiety or distress and should make reasonable allowances for this. All incidents of harassment or aggression must be documented in accordance with the Adverse Incident Policy; are known to have electronically recorded meetings or conversations without the prior knowledge and consent of the other parties involved. It may be necessary to explain to a complainant at the outset of any investigation into their complaint(s) that such behaviour is unacceptable and can, in some circumstances, be illegal; display unreasonable demands or expectations and fail to accept that these may be unreasonable once a clear explanation is provided to them as to what constitutes an unreasonable demand (i.e. insisting on responses to complaints or enquiries being provided more urgently than is reasonable or recognised practice, presenting similar or substantially similar requests for information. 21

26 4 OPTIONS FOR DEALING WITH HABITUAL OR VEXATIOUS COMPLAINANTS AND/ OR PERSONS REQUESTING INFORMATION 4.1 When complainants / persons requesting information have been identified as habitual or vexatious, in accordance with the above criteria, the chair and Accountable Officer (or their nominated deputy) will decide what action to take. The Accountable Officer (or deputy / representative) will implement such action and notify the individual(s) promptly, and in writing, the reasons why they have been classified as habitual or vexatious and the action to be taken. 4.2 This notification must be copied promptly for the information of others already involved such as practitioners, conciliator, Health Watch, Member of Parliament, advocates etc. Records must be kept, for future reference, of the reasons why the decision has been made to classify as habitual or vexatious and the action taken. 4.3 The chair and Accountable Officer (or delegated deputies/representatives) may decide to deal with habitual or vexatious complainants in one or more of the following ways: once it is clear that one of the criteria in section 3 (above) has been seriously breached, it may be appropriate to inform the individuals, in writing, that they are at risk of being classified as habitual or vexatious. A copy of this procedure should be sent to them and they should be advised to take account of the criteria in any future dealings with the CCG and its staff. In some cases it may be appropriate, at this point, to copy this notification to others involved and suggest that complainants seek advice in taking their complaint further (e.g. via Health Watch, Health Services Ombudsman, Patient Advice and Liaison Service); the CCG should try to resolve matters before invoking this procedure, and / or the sanctions detailed within it, by drawing up a signed agreement with the complainant / persons requesting information (if appropriate, involving the relevant practitioner) setting out a code of behaviour for the parties involved, if the Trust is to continue dealing with the complaint. If this agreement is breached, consideration would then be given to implementing other actions as outlined below; the CCG can decline further contact either in person, by telephone, fax, letter or electronically, or any combination of these, provided that one form of contact is maintained. Alternatively, a further contact could be restricted to liaison through a third party. A suggested statement has been prepared for use if staff need to withdraw from a telephone conversation. This is shown in the attached staff operational guidance; 22