Complaints Policy and Procedure

Complaints Policy and Procedure REFERENCE NUMBER DraftAug2012V1MH APPROVING COMMITTEE(S) AND DATE THIS DOCUMENT REPLACES REVIEW DUE DATE March 2014 RATIFICATION DATE/DRAFT No

NHS West Lancashire Clinical Commissioning Group (CCG) including those who work on behalf of the CCG is committed to ensuring that, as far as it is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their age, disability, gender, race, religion/belief or sexual orientation. Should a member of staff or any other person require access to this policy in another language or format (such as Brail or large print) they can do so by contacting the NHS West Lancashire CCG. All staff are responsible for ensuring staff within their area of responsibility and seconded staff from commissioning support working on behalf of NHS West Lancashire CCG are aware of NHS policies and that staff adhere to them. 1

CONTENTS 1.0 INTRODUCTION 3 1.1 Scope 3 1.2 Purpose 3 1.3 Aims 4 1.4 Definitions 4 2.0 WHAT IS A COMPLAINT? 2.1 Criteria for complaints 5 2.2 Who can complain? 5 2.3 Time limits for making a complaint 5 2.4 Litigation and the NHS Complaints Procedure 6 2.5 Serious complaints 6 2.6 Complaints that cannot be dealt with under this policy 6 2.7 Roles and Responsibilities 6 2.8 Equality Impact Assessment 7 3.0 IMPLEMENTATION PROCESS FOR RAISING CONCERNS 3.1 Complaints shared with the local authority 7 3.2 Complaints against providers of healthcare services/other organisations 7 3.3 Complaints about services purchased from the independent sector 7 3.4 Complaints involving more than one organisation 8 3.5 Complaints about purchasing decisions of the organisation 8 4.0 PROCEDURE BEFORE INVESTIGATION 4.1. Local resolution 8 4.2 Written complaints 8 4.3 Verbal complaints 9 4.4 Primary Care Services 9 4.5 Investigation 9 5.0 PROCEDURE AFTER INVESTIGATION 5.1 Response 10 5.2 Concluding local resolution and learning lessons 10 5.3 Lesson learnt 10 5.4 Further resolution including conciliation 10 5.5 Monitoring and Governance 10 5.6 Equality & Diversity 11 5.7 Monitoring Compliance 11 5.8 Openness in the NHS 11 5.9 Challenging and Vexatious Patients 11 5.10 Risk Management 11 5.11 Staff Training 12 5.12 Evaluation of complaints procedure 12 Appendices 2

1.0 INTRODUCTION This policy outlines the process by which complaints will be handled by the clinical commissioning group (CCG) when raised by, or on behalf of, service users. NHS West Lancashire CCG places high priority upon the handling of complaints and recognises that suggestions, constructive criticisms and complaints can be valuable aids to improving services. The policy also has implications for providers of services to the CCG and they also have a responsibility to have a complaints policy adhering to national policy. This policy applies to all complaints received by the CCG. Complaints can be received by any member of the CCG staff about the organisation or anyone providing a service to it. Staff should be aware of the actions they will be required to take if they receive a complaint. All staff of commissioned services are responsible for ensuring that no one should be inhibited or disadvantaged when making complaints and that these are given proper and speedy consideration in compliance with equality and diversity principles. 1.1 Scope This policy is designed to reflect best practice for NHS West Lancashire CCG in the management of complaints. A full and prompt written explanation will be given by the chief officer which will be in accordance with the NHS constitution. This policy has been produced in line with the Local Authority Social Services and National Health Services Complaints (England) Regulations 2009, which came into force on 1 April 2009. It details the procedures which should be followed when dealing with the following: Complaints relating to primary care contractors in conjunction with National Commissioning Board (NCB); Complaints relating to any action or purchasing decision taken by the organisation, including those relating to commissioning of health services for the local population and provision of community services; Complaints relating to other NHS trusts, local authority services; Complaints relating to services purchased from the independent sector; Complaints relating to more than one organisation. 1.2 Purpose The views and opinions of the people the CCG commission services for are vital in helping us to deliver the best healthcare to our communities. The CCG is committed to providing accessible, equitable and effective services and welcome views about services commissioned by the CCG. If a person is 3

1.3 Aims unhappy about any matter of the CCG functions they are entitled to make a complaint, have it considered and receive a response (acknowledgement within 3 working days). The CCG aims to provide a complaints process which has easy access, is supportive and open and that results in a speedy, fair and, where possible, local resolution. The complaints procedure aims to: Be well publicised and easy to access Be simple to understand and use Be fair and impartial, and be seen to do so Allow complaints to be dealt with promptly and as close to the point where they arise Provide answers or explanations quickly and within established time limits Ensure that rights to confidentiality and privacy are respected Ensure all complaints will be dealt with in an honest, open, confident and sensitive way Guarantee that no complaint will form any part of a medical record and complainants will not be discriminated against in any way as a result of making a complaint Provide a thorough and effective mechanism for resolving complaints and also investigating matters of concern Enable lessons learnt to be used to improve the quality of services and to have action plans in place Be regularly reviewed and amended if necessary. Be consistent with national guidance. 1.4 Definitions This procedure applies to any complaint, whether this is received from the user of the service or their representative, or a member of the community who comes into contact with the service by other means. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 are designed to improve the way complaints are handled with a view to creating real benefits for healthcare organisations. This policy sets out the process the CCG will follow when dealing with a complaint and provides further guidance for service users who may wish to seek further advice from the Parliamentary and Health Service Ombudsman (PHSO). The regulations details a single approach to be used for dealing with complaints structured around the three principles of listening, responding and improving. The organisation will take an active approach in asking for people s views, dealing with complaints more effectively and in using information received to learn and improve. 4

2.0 WHAT IS A COMPLAINT? 2.1 Criteria for complaints Members of NHS West Lancashire CCG staff will be accustomed to dealing with enquiries from patients, clients and carers regarding the organisation s services, its commissioning intentions or the care being provided to individuals. It is recommended that a matter should be considered to be a complaint when: The person raising the matter has expressly stated that they want to make a complaint; The manager considers that serious issues have been brought to his/her attention; The manager considers that he/she is unable to investigate the matter adequately or independently; The manager considers that he/she cannot give the assurances being sought by the patient, client, carer or resident. A complaint may be as a result of the way treatment or care has been provided to the patient or how a service has been managed. It may also relate to discrimination against a patient, something carried out against the patient s choice or wishes or the attitude and behaviour of staff. 2.2. Who can complain? Any person who is affected by or likely to be affected by the action, omission or decision of NHS West Lancashire CCG may make a complaint. If the person is unable to act for him or herself, the complaint will be accepted from a relative, friend or other organisation or other individual suitable to represent them. The lead for complaints must ensure that where the person is capable, the complaint is being made with their knowledge and consent in a manner suitable to them Where a member of staff believes a complaint is warranted but the patient or his or her advocate does not wish to complain and wishes to withdraw a complaint then the staff member has a duty to pursue the matter. This may be achieved through normal management processes or by reference to Concerns at Work Policy (Whistleblowing). 2.3. Time limits for making a complaint A complaint should be made as soon as possible after the action giving rise to it. The time limit for making a complaint is within twelve months of the event, with the exception that if a complainant was not immediately aware that there was cause to complain, the complaint should be made within twelve months of the person becoming aware. 5

There is discretion to extend this time limit where it would be unreasonable in the circumstances of a particular case for the complaint to have been made earlier, and where it is possible the facts of the case should be investigated. This discretion lies with the chief officer of the CCG or, in the case of a complaint relating to a primary care contractor, with the primary care contractor concerned. 2.4. Litigation and the NHS Complaints Procedure Where the complainant has expressed an intention to take legal proceedings, the organisation will seek to continue to resolve the complaint unless there are clear legal reasons not to do so. 2.5 Serious complaints If an allegation or suspicion of physical or sexual abuse, financial misconduct, a criminal or safeguarding offence is received with regard to CCG functions then it should be reported immediately to the chief officer and if appropriate referred to the appropriate regulatory body. It should also be reported as a Serious Incident Requiring Investigation (SIRI) either by the commissioner or by the provider it is related to. 2.6. Complaints that cannot be dealt with under this policy The following complaints will not be dealt with under the NHS Complaints Regulations 2009: A complaint made by a local authority, NHS body, primary care provider or independent provider; A complaint made by an employee of a local authority or NHS body about any matter relating to employment; A complaint made orally and is resolved to the complainants satisfaction within 24 hours; A complaint which has previously been made and resolved to the same complainant and where local resolution has been exhausted; A complaint which is, or has been, investigated by a Health Service Commissioner under the 1993 Act; A complaint arising out of the alleged failure by the CCG to comply with a request for information under the Freedom of Information Act 2000; On the advice of the NHS Litigation Authority, the investigation of a complaint through the complaints procedure may cease immediately if the complainant explicitly indicates an intention to take legal action in respect of the complaint. 2.7 Roles and Responsibilities The chief officer has accountability for the management of complaints relating to services provided by NHS West Lancashire CCG and ensuring these are actioned in compliance with the Local Authority Social Services and National 6

Health Service Complaint (England) Regulations. He/she will review and sign a written response to formal complaints. Operational responsibility for ensuring that complaints received by the CCG are managed effectively lies with the head of corporate affairs through commissioning support. The latter will be responsible for managing the procedures within a timely and sensitive manner and is responsible for the day-to-day handling of complaints on behalf of the CCG. The head of corporate affairs will keep the CCG s complaints procedure under review. 2.8 Equality Impact Assessment This is a legal requirement under the Equality Act 2010. 3. IMPLEMENTATION PROCESS FOR RAISING CONCERNS 3.1. Complaints shared with the local authority If a complaint received by the CCG includes issues relating to the local authority then permission should be sought from the complainant to share details with the other responsible body. The lead will then work with the local authority to ensure a full investigation takes place and that a single response that answers all concerns is provided to the complainant. If permission is not received to conduct this process from the complainant then the complaints lead advises which parts the CCG can respond to and which parts will need to be dealt with separately by the local authority. 3.2. Complaints against providers of healthcare services/other organisations Any complaint received will be acknowledged with an explanation that it may be necessary to pass the complaint details to any other responsible body. Consent must be obtained from the complainant/patient to share this information prior to forwarding the complaint to the other responsible body for investigation. 3.3. Complaints about services purchased from the independent sector 3.3.1 Service Level Agreements NHS West Lancashire CCG will specify in any Service Level Agreement (SLA) with an independent provider, which the provider will set up and run a Local Resolution process in line with the NHS Complaints Procedure and will cooperate with the NHS Independent Review process where necessary. 7

3.4. Complaints involving more than one organisation The complaint will be acknowledged in writing before an agreement is sought as to which organisation will take the lead and provide the response. The complainant will be consulted on this. The non-lead body/bodies will provide the lead body with the information to assist with the complaint and NHS West Lancashire CCG will address the part of the complaint within its remit. 3.5. Complaints about purchasing decisions of the organisation Staff may also receive queries about general commissioning decisions made by NHS West Lancashire CCG and its officers. These should be forwarded to the lead for complaints who will arrange for an appropriate response to be made on behalf of the organisation. 4 PROCEDURE BEFORE INVESTIGATION 4.1. Local resolution The first stage of the complaints procedure is called local resolution. It applies equally to verbal, electronic or written complaints, in the first instance. A detailed flowchart showing the process for dealing with complaints is shown at Appendix 2. A written account of any NHS West Lancashire CCG complaint that is satisfactorily concluded at this level must be made in: The organisation s incident/complaint reporting system If the complainant is not satisfied they must be given the opportunity to progress their complaint and offered advice and assistance on how this should be done. At this point the complaint becomes a formal complaint. It is essential that these more complex matters be reported to the chief officer via the formal process without delay. 4.2. Written complaints Most written complaints will come directly to the chief officer or the lead for complaints. However, a written complaint may be directed in the first instance to another member of staff or to a member of the Governing Body or Clinical Executive Committee. 8

In this event, the complaint should be forwarded to the lead for complaints immediately in order that it may be acknowledged within 3 working days of receipt and the appropriate action taken. 4.3. Verbal complaints A complainant may go through the process of making a verbal formal complaint and if not satisfied a written formal complaint to the CCG before progressing to a further stage in the complaint procedure. It may be appropriate for the entire process to be conducted verbally in which case the matter should be resolved immediately All verbal complaints should be briefly recorded in writing on the appropriate form (Appendix 5) and submitted to the lead for complaints in order that information may be collated for monitoring purposes. 4.4. Primary Care Services Primary care services are responsible for the local resolution of complaints through operating practice-based complaint procedures, which they are required to establish under their contract. If local resolution cannot resolve the complaint, the NCB lead for primary care complaints is responsible for organising the conciliation. A primary care contractor may seek the help of a lay conciliator to assist in the process of resolving a complaint at local level. This process will be provided by the local area office of the NCB. 4.5. Investigation The lead for complaints will arrange for the complaint to be investigated in the most appropriate manner to resolve it speedily and efficiently. The investigation into a complaint must: Be undertaken by a suitable person and the lead for complaints must ensure an appropriate level of investigation; Be conducted in a manner that is supportive to all those involved; Uphold the principles for fairness and consistency; Apply a risk assessment process to allow serious complaints to be identified; Follow the principles set out by the National Patient Safety Association (NPSA). 9

5. PROCEDURE AFTER INVESTIGATION 5.1. Response The letter of response will: Be polite, sympathetic and non-bureaucratic in tone Address all the points, which the complainant has raised Summarise its conclusions and demonstrate if appropriate, alterations to service improvements The CCG will aim to provide a response to a complaint within 25 working days of the complaint being made. Where a full response cannot be provided an update will be given. 5.2. Concluding local resolution and learning lessons The response should be approved and signed by the chief officer and the head of corporate affairs should ensure that all necessary follow up action has been taken. All correspondence and evidence relating to the investigation should be retained. 5.2.1 Lesson learnt Complaints will be presented at the quality improvement committee quarterly and a detailed proposed action plan to ensure service improvements and inform commissioning decisions will be produced. This will be the responsibility of the head of corporate affairs. 5.3. Further resolution including conciliation Should the complainant be dissatisfied with the CCG s response, where appropriate, alternative courses of resolution can be offered to the complainant, with the agreement from all the parties involved. This could include further correspondence/discussions or conciliation meetings with the complaints lead and appropriate staff. All meetings should be recorded and a written record sent to those involved to confirm accuracy before documenting in the complainants file. The complainant will also have the right to refer their complaint to the Parliamentary and Health Service Ombudsman, who is completely independent of the NHS and Government. The complainant will be reminded of the support available from the Independent Complaints and Advice Service. 5.4. Monitoring and Governance Details of the complaint will be recorded in the complaints register managed by the commissioning support service. This will include: 10

Complainant and patient details Relevant dates, times etc. Type of complaint Summary of the issues raised The service complained against Any action taken and date of action Date acknowledged and response due date 5.5. Equality & Diversity NHS West Lancashire CCG aims to ensure that access to the complaints arrangements is designed to be inclusive to all groups and that specialist, high quality support is available as necessary. The policy seeks to ensure equality of access, irrespective of age, disability, race, religion, belief, gender or sexual orientation and other protected characteristics. 5.6 Monitoring Compliance The complaints policy seeks to promote equality amongst all patients, service users and their representatives who wish to progress a formal complaint about health care services by placing the patient at the centre of the system. Compliance with the complaints policy will be monitored by the following means: Quarterly report submission to the quality improvement committee; Standard form for lessons learnt reported back to quality improvement committee; Annual report submission to governing body/annual general meeting; Service improvement informed by complaints process reported to quality improvement committee. 5.7 Openness in the NHS Where part of a complaint about services is that information has been refused (and provided the chief officer has been given the opportunity first to review the circumstances), complainants should be advised of their right to pursue this aspect separately with the Parliamentary and Health Service Ombudsman without waiting for the outcome of the NHS investigations into the rest of the complaint. At all times in the procedure, the complainant will be advised of the Independent Complaints Advice Service. 5.8. Challenging and Vexatious Patients Please refer to NHS West Lancashire CCG guidance document entitled Guidance for Managing Habitual and Vexatious Behaviour. 5.9 Risk Management 11

In the event that a complaint/concern may be a risk to the patient or other people s safety this will be considered in light of arrangements the CCG has in place including claims management procedures, HR framework and policies, equality and diversity strategy, safeguarding adults and children arrangements. 5.10 Staff Training All staff must be made aware of the complaints procedure and contact number and location of the lead for complaints to enable them to refer patients/clients. Training will be needed to ensure that staff attitudes are positive and do not deter legitimate complaints. Staff must also be clear about the local resolution process and what sorts of issues they will be able to resolve, and what should be placed into the formal process. 5.11 Evaluation of complaints procedure A patient questionnaire about the management of the complaint will be sent to the complainant on completion of local resolution. At approximately six month intervals an evaluation will be carried out with regard to the way complaints are handled and this will allow the CCG to monitor the effectiveness of the complaints policy. 12

Appendix 1 COMPLAINTS PROCEDURE A complaint is an expression of dissatisfaction, which requires a response. In many cases, complaints are made orally. All complaints whether verbal, electronic or written, will receive a positive and full response with the aim of satisfying complainants that their concerns have been listened to, providing an explanation, an apology when appropriate, and information about actions taken as a result of the complaint. If it becomes apparent during the course of an investigation that there may be a disciplinary issue, this will be referred to the appropriate senior manager by the chief officer, for separate investigation and action. The organisation will normally only investigate complaints that are made within 12 months of the event or if later, within 12 months of the complainant realising that they have something to complain about. These time limits can be waived if there are good reasons why the complainant could not complain sooner. Existing or former users of services provided by West Lancashire CCG may complain. Other persons may complain on behalf of existing or former users where the organisation accepts them as a suitable representative and where consent has been obtained. Any person who is affected by or likely to be affected by the action, omission or decision of the NHS body which is the subject of the complaint, may complain. Any complaint received by any employee of NHS West Lancashire CCG which indicates a prima facia need for referral to any of the following: (at first sight a case that appears to warrant further investigation). an investigation under the disciplinary procedure; one of the professional regulatory bodies; an independent inquiry into the serious incident under Section 84 of the National Health Service Act 1977; an investigation of a criminal offence. NB. The person in receipt of the complaint should at once pass the relevant information to the chief officer. Communications regarding complaints are to be kept completely separate from patients records.

1 Appendix 2

Appendix 3 USEFUL CONTACTS CCG Website www.westlancashireccg.nhs.uk CCG Chief Officer (designate) Mike Maguire Chief Officer Designate NHS West Lancashire CCG Trust HQ Wigan Road Ormskirk L39 2JW Head of Corporate Affairs Katie Wightman NHS West Lancashire CCG Trust HQ Wigan Road Ormskirk L39 2JW Health Service Ombudsman for England Millbank Tower Millbank London SW1P 4QP Helpline Telephone Number: 0845 015 4033 Independent Complaints & Advocacy Service Tel: 0161 237 2397 Social Services (Adults) Tel: tba Social Services (Children) NCB information to go here once known 2