Resolving problems and making a complaint about NHS care

Factsheet 66 August 2011 Resolving problems and making a complaint about NHS care About this factsheet The factsheet explains the approach to handling complaints about National Health Service (NHS) services, including situations where services from both the NHS and social services are involved. It describes what to expect when your complaint is investigated and what you can do if you remain dissatisfied with the outcome of a local investigation. This factsheet describes the situation in England. There are differences in the rules for making a complaint in Northern Ireland, Scotland and Wales. Readers in these nations should contact their respective national Age UK offices for information specific to where they live see section 8 for details. For details of how to order other Age UK factsheets and information materials mentioned inside go to section 8. Factsheet August 2011 1 of 16

Inside this factsheet 1 Recent developments 3 2 Your right to complain about NHS services 3 3 The joint health and social care complaints system 4 3.1 Who is responsible for complaints handling? 5 3.2 Finding out how to make a complaint 5 3.3 Who can make a complaint and about what? 6 3.4 Complaints time limits 7 3.5 Who can you make your complaint to? 7 3.6 Support to help you raise concerns or make a complaint 7 3.7 Complaints involving more than one organisation 8 4 Stage 1 local resolution 9 4.1 What to expect when you make a formal complaint 9 4.2 Acknowledging and pursuing your complaint 9 4.3 Investigating and responding to complaints 10 4.4 Monitoring and reporting on complaints handling 11 5 Stage 2 taking a complaint to the Ombudsman 11 6 Care Quality Commission 12 7 Useful organisations 12 8 Further information from Age UK 13 Factsheet August 2011 2 of 16

1 Recent developments Listening and learning - the Ombudsman s review of complaint handling by the NHS in England 2009 2010 - was published in October 2010. It covers the first full year of the new NHS complaint handling system introduced in April 2009. It is the first of what will be an annual series of reports examining NHS complaints handling. Care and compassion? a report by the Health Service Ombudsman on ten investigations into NHS care of older people over the age of 65 in England was published in February 2011. 2 Your right to complain about NHS services Everyone has a right to expect good quality services from public bodies such as the NHS and for things to be put right if they go wrong. In many cases, raising concerns as soon as possible after an event makes it more likely that things can be put right quickly and prevented from getting worse. Approaching the staff concerned or the PALS service can mean an issue is resolved promptly and satisfactorily. See section 3.6. Before you approach anyone, it is helpful to have a clear idea of what you want to raise concerns or complain about and what you would like to see happen as a result. You may want to raise a formal complaint when you feel your concerns have not been adequately addressed or the seriousness of the issue warrants a wider investigation or the event you wish to complain about is in the past. When you make a complaint you have a right to have your concerns listened to and properly investigated as quickly as possible and to know the outcome. These are some of your rights that feature in the NHS Constitution published in January 2009. The NHS Constitution brings together in one place what patients, staff and the public can expect from the NHS. It establishes a number of rights and pledges the NHS is committed to achieve, together with the duties and responsibilities of patients and staff. You can order a copy of the NHS Constitution from the Department of Health Publication orderline (see section 7) or read it on the NHS Choices website: Factsheet August 2011 3 of 16

www.nhs.uk/choiceinthenhs/rightsandpledges/nhsconstitution/pages/over view.aspx The Health Ombudsman s Report Listening and Learning assesses the performance of the NHS against the commitment in its Constitution to acknowledge mistakes, apologise, explain what went wrong and put things right, quickly and effectively. Based on the data published in the report, the Ombudsman concludes that the NHS needs to listen harder and learn more from complaints. The Ombudsman will produce a report annually to examine NHS complaint handling and chart the progress that has been achieved. You can read the first report published in October 2010 at http://nhsreport.ombudsman.org.uk/ 3 The joint health and social care complaints system A two-stage system for resolving complaints, introduced in April 2009, operates for the NHS and local authorities with adult social care responsibilities. Stage one involves trying to resolve your complaint by investigating it locally. Stage two, if you remain dissatisfied following a local investigation, involves taking your complaint to the relevant Ombudsman. The complaints system is governed by The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. The Regulations can be found at: www.opsi.gov.uk/si/si2009/uksi_20090309_en_1#l1g3 In addition to helping you receive a timely and appropriate response to your complaint, the aim is to help organisations get better at listening, responding to and learning from people s experiences. Organisations should: work with the you to develop and agree a plan to investigate your complaint in a timely manner and provide a comprehensive report explaining the conclusions reached (see section 4) be open and flexible when seeking to resolve a complaint Factsheet August 2011 4 of 16

provide a joined up service: have procedures in place for managing complaints that involve more than one organisation ensure they see complaints as an opportunity to make care better and to improve services. Guidance is available to support those managing complaints Listening, Responding, Improving a guide to better customer care. The guidance can be found at: www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicya ndguidance/dh_095408 3.1 Who is responsible for complaints handling? Trusts and local authorities must have someone, at chief executive level or its equivalent, who takes responsibility for ensuring that their arrangements for handling complaints are in line with the Regulations and that action is taken, where necessary, in the light of the outcome of a complaint. GP practices, dental surgeries and other businesses providing NHS services must have someone with similar seniority to take on this responsibility. Each organisation must have someone responsible for managing complaints, although they do not have to be called the complaints manager. They can choose what they call the staff or department with a complaint handling or joint customer service role. Complaints handling is part of a wider programme to seek and learn from patients experiences both positive and negative. 3.2 Finding out how to make a complaint If you prefer not to raise concerns or complaints directly with the staff involved, all staff should know who is responsible for complaint handling in their organisation and be able to signpost to the appropriate person or to the Patient Advice and Liaison Service (PALS). See section 3.6. Organisations offering NHS services should provide information explaining their arrangements for dealing with complaints and how you can find out more about them. They should take account of the diverse needs of people who use their services when deciding how this information is made available. Factsheet August 2011 5 of 16

3.3 Who can make a complaint and about what? You can raise concerns or make a complaint if you are unhappy with an NHS service you are receiving or have received. This includes NHS services provided by your GP or practice-based staff; community staff such as district nurses, dentists, optometrists, pharmacists; services provided by or staff working for a hospital trust, foundation trust, mental health trust, ambulance trust or an independent hospital or treatment centre treating you on behalf of the NHS. Concerns and complaints could involve issues ranging from your diagnosis, specific treatment or general care to the attitude of staff, poor or inadequate communication about your care, difficulty making appointments or late running appointments. It is important to identify exactly what you wish to complain about and what you would like to happen as a result. Complaints do not have to be made by the person receiving services. You can complain if you are, or are likely to be, affected by the issue being complained about. You can complain for a friend or relative if they agree to you acting on their behalf. If you are making a formal complaint, you may find it useful to have their permission in writing. You can complain on behalf of a relative or friend who, within the meaning of the Mental Capacity Act 2005, lacks the capacity to complain. If the NHS organisation believes you are not acting in best interests of the person who lacks capacity it can refuse to pursue your complaint but it must tell you in writing why it is has taken this decision. The Directgov website and the Office of the Public Guardian has more information about the Mental Capacity Act (see section 7). You can also make a complaint on behalf of a relative or friend who has died. Factsheet August 2011 6 of 16

3.4 Complaints time limits You should make a complaint within 12 months of an event occurring or within 12 months of the date that the matter about which you wish to complain first came to your notice. A complaint made after this time can be investigated at the discretion of the complaints manager if it is believed that it is still possible to investigate the complaint fairly and effectively. 3.5 Who can you make your complaint to? You have always been able to make a complaint to the provider of an NHS service by speaking to the staff concerned, their managers, PALS or the complaints manager. However, since April 2009 you can, if you prefer, complain to the PCT the organisation that commissioned the NHS service. This facility was introduced because patients reported finding it difficult to raise concerns directly with their GP practice or other service providers. If you choose to complain to the PCT about a service at your GP practice, they must ask if you mind them forwarding details of your complaint to the GP practice. If you consent, the PCT must forward your complaint within a reasonable time. If the PCT considers it appropriate to deal with the complaint, it must tell you and the practice, and handle the complaint according to the Regulations. If the PCT considers it more appropriate for the GP practice to handle the complaint, it must tell you and the practice. The practice must then handle the complaint according to the Regulations. Being aware of patients concerns about services can help inform a PCT s future decisions about who should deliver local services. 3.6 Support to help you raise concerns or make a complaint When you first identify a problem, you may not want to raise it directly with the staff concerned or, having raised it, you may feel your concerns have not been adequately addressed. Under these circumstances, you may like to contact your local Patient Advice and Liaison Service (PALS). Factsheet August 2011 7 of 16

There is a PALS for every PCT, hospital trust, mental health trust and ambulance trust. NHS staff should be able to tell you how to contact the appropriate PALS. NHS Direct also has their details. See section 7. Early involvement or intervention by PALS staff can often help resolve problems or concerns before they become a major issue. If their intervention does not resolve the issue, PALS can explain the complaints procedure and put you in touch with the complaints manager. You may also like to contact the Independent Complaints Advocacy Service (ICAS). ICAS is an independent service and can support you to raise your complaint, help you prepare for and go with you to meetings and help you explore your options at every stage of the process. PALS can provide contact details of the local ICAS or you can call NHS Direct. See section 7. 3.7 Complaints involving more than one organisation If your complaint involves services provided by more than one organisation, the organisations involved have a duty to co-operate. This means the organisation that receives your complaint must approach the other organisation and they must agree between them and tell you who will: take the lead in handling the complaint be your point of contact and take responsibility for communicating with you co-ordinate the handling of the complaint and any investigations ensure you receive a single response, addressing all issues agreed at the outset. An example of this might be a complaint involving services provided by a hospital and a local authority you want to make a complaint to the hospital about your discharge but part of the complaint relates to social care services provided when you arrived home. Or there could also be occasions when two NHS organisations are involved, such as a hospital trust and GP practice. If you make a complaint to the wrong organisation, the person receiving your complaint should tell you and the organisation concerned, and tell you the name of the organisation and person they will forward your complaint to. Factsheet August 2011 8 of 16

4 Stage 1 local resolution Local staff should respond flexibly and promptly to reach a fair and satisfactory outcome to individual concerns or complaints. It may not always be necessary to raise a formal complaint. The staff member you approach or member of the PALS team may be able to respond straight away or within days of an issue being drawn to their attention. A prompt response such as an apology from the appropriate person, where an apology is called for could produce the outcome you want. 4.1 What to expect when you make a formal complaint If you do make a formal complaint, the Regulations say that complaints must be handled efficiently and properly investigated and that action must be taken, if necessary, in the light of the outcome of the investigation. They say that complainants must: be treated with respect and courtesy receive as far as reasonably practical, assistance to enable them to understand the procedures to be followed OR be advised on where to get such assistance (see section 3.6) receive a timely and appropriate response be told the outcome of the investigation of their complaint. 4.2 Acknowledging and pursuing your complaint The Regulations do not stipulate the form local resolution must take. They want to allow organisations to be flexible and address complaints appropriately and proportionately. However there are fundamental elements that must be observed. You can make a complaint in person, by phone, letter or email. If made in person or by phone, the person you speak to must send you a copy of their interpretation of your complaint so you can check they have it right. When your complaint is acknowledged - orally or in writing within three working days of receipt you must be offered the opportunity to discuss your complaint, at a mutually agreed time. See section 4.3. Factsheet August 2011 9 of 16

If an investigation is required, you can expect it to be completed and a response received no longer than six months from the date your complaint was received. If it is to be longer than that or longer than the timing agreed, you should be told why the delay is occurring and receive a response as soon as possible. 4.3 Investigating and responding to complaints When your complaint is acknowledged, you must be offered the opportunity to discuss your complaint and how it might be handled. This can be a face to face meeting or a phone call. This allows you to: explain your complaint in your own words outline what you would like to see happen as a result of raising the issue hear what can realistically be achieved by investigating your complaint discuss how your complaint might be taken forward, who to be involved and what type of investigation offers the best way to bring about a satisfactory outcome consider if support from ICAS would be helpful develop a plan of action and agree a timescale agree how you would like to be kept informed of developments. Any investigation to understand what happened and why should be proportionate, thorough and completed as quickly as possible. A plan of action might involve a face-to-face meeting between you and the staff concerned, involving a mediator if necessary. If you do not want a discussion, the complaints manager will let you know in writing how your complaint is to be managed. At the end of an investigation, you should receive a written response, electronically if you prefer, that includes: an explanation of how the complaint has been considered, conclusions reached in relation to the specifics of the complaint and any remedial action, which the complaint specifies or the organisation believes, should be taken Factsheet August 2011 10 of 16

confirmation that the organisation is satisfied that any action that needs to be taken as a result of the complaint has been or will be taken details of your right to take your complaint to the Health Service Ombudsman if you remain dissatisfied. See section 5. 4.4 Monitoring and reporting on complaints handling Organisations must keep a record of: each complaint received, what it was about and the outcome whether they met the agreed timeframe for providing a response or whether they had to amend the time frame. Their annual report must include: how many complaints they received how many they decided were well founded how many were referred to the Ombudsman a summary of the subject matter of complaints, matters of importance arising from them or the way they were handled any action taken or to be taken as a result to improve services as a consequence of their investigations. 5 Stage 2 taking a complaint to the Ombudsman If you are not satisfied with the way your complaint has been dealt with locally you can ask the Parliamentary and Health Service Ombudsman (HSO) to look into it. The HSO is independent of the NHS and the government. The HSO helpline can tell you if they are able to help and give you advice on how to make your complaint. For information on how to contact the HSO helpline see section 7. If your complaint involves services from both the NHS and a local authority, it will involve the HSO and the Local Government Ombudsman. Both Ombudsmen can work together to resolve such complaints. Factsheet August 2011 11 of 16

6 Care Quality Commission The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. It is not required to investigate individual complaints. However it is keen for individuals to share their experiences of health services them. This feedback is added to information already held about each service provider, known as its Quality Risk Profile. This information helps assessors and inspectors make judgments about services and influence decisions around registration and inspection of services. See section 7 for information on how to contact CQC. 7 Useful organisations Care Quality Commission The Care Quality Commission is the independent regulator of all health and adult social care services. Contact their national call centre or email to enquiries@cqc.org.uk if you would like to share experiences of NHS services that you, a family member or friend has received. Tel: 03000 616 161 Website: www.cqc.org.uk Directgov The Directgov website provides information on Mental Capacity Act 2005 and its implications. http://www.direct.gov.uk/en/governmentcitizensandrights/mentalcapacityandt helaw/makingdecisionsforsomeoneelse/dg_186479 Department of Health Publications orderline Materials are available in large print and other formats and in several languages. Delivery is within 10 working days. Tel: 0300 123 1002 Email: dh@prolog.uk.com Factsheet August 2011 12 of 16

NHS Direct NHS Direct has contact details for PALS and ICAS services in England, as well as local services such as GP practices and dentists. It can also give you information on a range of health topics and on looking after your health. Tel: 0845 4647 Website: www.nhsdirect.nhs.uk/ Office of the Public Guardian The Office of the Public Guardian supports and promotes decision-making for those who lack capacity or would like to plan for their future within the framework of the Mental Capacity Act 2005. You can download forms for making Lasting Powers of Attorney and publications for individuals and carers from the websites below. Tel: 0300 456 0300 Website: www.publicguardian.gov.uk or www.justice.gov.uk/guidance/protecting-the-vulnerable/mental-capacityact/index.htm Parliamentary and Health Service Ombudsman The Parliamentary and Health Service Ombudsman is the second and final point of contact if you remain dissatisfied after the local NHS organisation has investigated your NHS complaint. Tel: 0345 015 4033 Website: www.ombudsman.org.uk 8 Further information from Age UK Age UK Information Materials Age UK publishes a large number of free Information Guides and Factsheets on a range of subjects including money and benefits, health, social care, consumer issues, end of life, legal, issues employment and equality issues. Factsheet August 2011 13 of 16

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