COMPLIMENTS, CONCERNS AND COMPLAINTS POLICY Document information Document type: Document reference: Document title: Policy Compliments, Concerns and Complaints Policy Document operational date: 1 st February 2013 Document sponsor: Chief Operating Officer, BaNES CCG Document manager: Corporate Services and Planning Lead Approving Clinical Commissioning Committee Committee/Group: Approval date: Version: Draft 2, Version 2 Recommended review December 2014 date: Internet location: TBC Please be aware that this printed version of this document may NOT be the latest version. Please refer to the internet for the latest version. Summary The policy has been developed to provide clear best practice guidelines on the approach and procedures to be followed when handling and managing compliments, concerns and complaints to ensure this is undertaken effectively, responsively and complies with revised complaints regulations which came into force on 1 April 2009 entitled The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 ('the Regulations'). Consultation LINKs no longer in existence at the time of consultation Practice level participation Groups ICAS Care Forum Further consultation will be required in future to review the functioning of policy and when any changes are made.
Review Log Version Review Date Reviewed By 1 Nov 12 CCC 2.2 Dec/Jan Consulters 12 Changes Required? (If yes, please summarise) Changes Approved By Approval Date Acknowledgements
C O N T E N T S 1.0 INTRODUCTION & PURPOSE 2.0 SCOPE & DEFINITIONS 2.1 Scope 2.2 Definitions 3.0 WHO CAN COMPLAIN? 4.0 ROLES & RESPONSIBILITIES 5.0 PROCESS/REQUIREMENTS 5.1 How to raise a concern, complaint or compliment 5.2 Monitoring concerns, complaints or compliments 5.3 Timescales and outcomes 5.4 Other enquiries 5.5 Services regulated under the Care Standards Act 2000 5.6 Help in making a complaint 5.7 What falls outside of the policy 5.8 Other investigations 5.9 Safeguarding 5.10 Legal Proceedings 5.11 Personnel procedures 5.12 Unreasonable complainants 6.0 TRAINING 7.0 EQUALITY, DIVERSITY AND MENTAL CAPACITY 8.0 SUCCESS CRITERIA / MONITORING EFFECTIVENESS 9.0 REVIEW 10.0 REFERENCES AND LINKS TO OTHER DOCUMENTS 1
COMPLIMENTS, CONCERNS AND COMPLAINTS POLICY 1.0 INTRODUCTION & PURPOSE 1.1 Bath and North East Somerset Clinical Commissioning Group (BaNES CCG) is committed to responding to service user needs and encouraging a culture that seeks and uses people s experiences of care to improve the commissioning of services. In line with the NHS Constitution, this will be accomplished by ensuring that when something goes wrong it is acknowledged, an apology and explanation is given and things are put right as quickly and effectively as possible. The organisation will seek also to learn from service users who have a positive experience of care. Service users have the right to express their views of their health care experience and need to have easy access to responsive procedures to do so. 1.2 This policy has been developed to provide clear best practice guidelines on the approach and procedures to be followed when handling and managing compliments, concerns and complaints and to ensure this is undertaken effectively, responsively and complies with revised complaints regulations which came into force on 1 April 2009 entitled The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 ('the Regulations'). The CCG will ensure the visibility of this policy and procedure. 1.3 This Policy has been developed with reference to the following document: Principles of Good Complaint Handling and Principles of Good Administration Developed by The Parliamentary & Health Service Ombudsman which set out the six principles which it advises public organisations use when handling complaints. In summary, the six principles are: 1. getting it right 2. being customer focused 3. being open and accountable 4. acting fairly and proportionately 5. putting things right 6. Seeking continuous improvement 2
1.4 The aims of this policy are to: Ensure that our procedure is easy to understand and simple to use; Make sure that any investigations are thorough, fair, responsive, open and honest; Demonstrate that we will learn from compliments, concerns and complaints and use them to improve the services we commission for patients; Ensure that our services are accessible to everyone; To answer complaints in a timely manner; Show we will respect individuals rights to confidentiality; Ensure the CCG Governing Body is accountable for improving the quality of services through performance management of commissioned contracts; Enable staff to respond positively to compliments, concerns and complaints and endeavour to resolve issues as soon as possible; Satisfy the complainant by conducting a thorough investigation and providing a full explanation where appropriate; Ensure that patients, relatives and their carers are not treated differently as a result of making a complaint. To seek assurance from providers that learning from complaints is a philosophy that is fully embedded and seek evidence of this. 1.5 The CCG is committed to ensuring that those who receive services commissioned by the CCG are treated with courtesy and receive appropriate support throughout the handling of a complaint. The fact that they have complained will not adversely affect their future treatment and the CCG will endeavour to correct and deal satisfactorily with problems and concerns, be responsive to comments and suggestions and welcome positive feedback and learn from that to improve quality and safety. All complaints will be treated as confidential and investigated fully in accordance with the Local Authority Social Services and National Health Services Complaints (England) Regulations 2009. 2.0 SCOPE & DEFINITIONS 2.1 SCOPE The CCG commissions services from a variety of organisations including ambulance trusts, mental health trusts and acute trusts. People using services provided by other organisations: community trusts, independent providers and providers of 111 services may choose to complain directly to the service provider but they can also complain to the CCG as commissioner. The CCG is not responsible for commissioning Primary Care services provided by general practitioners, dentists, pharmacists or optometrists and 3
complaints relating to these services need to be directed to the Area Office of the National Commissioning Board. Similarly any complaints or concerns relating to services commissioned by Public Health will be directed to the Local Authority. A decision about how to proceed with complaints regarding provided services will be taken by the Complaints Manager in liaison with the Commissioning Team. In general the provider of the service is best placed to investigate the complaint and respond directly to the complainant. In this instance, with the appropriate consent of the complainant, the complaint will be passed to the provider, and will be logged as a Concern. If consent is not received the complainant will be advised to contact the provider of the service directly. If the complaint is deemed sufficiently serious the CCG will, in liaison with the provider, investigate the complaint and respond to the complainant directly. 2.2 DEFINITIONS The following is a list and description of the meaning of the terms used in this document: a complaint is an expression of dissatisfaction about a service which is provided, or the failure to provide a service, which requires a response. It is usually a problem which has not been resolved, or which concerns past treatment. All complaints made in writing will be considered to be formal complaints. In addition, any verbal allegations or suspicion of abuse, serious neglect or serious misconduct, and incidents which appear to have resulted in permanent harm or possible criminal offence, will be considered as formal complaints. All formal complaints must be forwarded to the Complaints Team in the Central Southern Commissioning Support Unit (CSU) immediately. a concern is a verbal issue which, following a risk assessment of the severity and likelihood, is not deemed significant but requires further investigation and response by a senior manager or a complaint which is resolved within 24 hours of becoming aware of the issue to the satisfaction of the individual raising the concern or a complaint made about commissioned services, a partner organisation or provided by independent contractors, which go on to be investigated and responded to by those organisations. a compliment is where a favourable report has been received or satisfaction has been expressed. To be forwarded to CSU for recording. a comment is a suggestion(s) for improvements to commissioned services. Details should be forwarded to the CSU and or the Director of Nursing and Quality. the Regulations refers to The Local Authority Social Services and National 4
Health Service Complaints (England) Regulations 2009 and so amended by The Local Authority Social Services and National Health Service Complaints (England) (Amendment) Regulations 2009. 3.0 WHO CAN COMPLAIN? 3.1 A person is eligible to make a complaint where they receive services commissioned by the CCG. This includes anyone who is affected or is likely to be affected, by the decision or action of the CCG. 3.2 A complaint may be made by a representative acting on behalf of an eligible person who has asked the representative to act on their behalf or is not capable of making the complaint themselves (this includes a child or a person who has died). Health professionals may also raise concerns regarding the quality and provision of services. 3.3 It is important to ensure that there is appropriate consent to share the results of the investigation, including any personal information with the person complaining on their behalf. If consent has not been given the complaint will still be investigated but the response will not be shared with the person making the complaint. 3.4 People who use Primary Care Services, including general practices, dentists, pharmacists and optometrists, have the option of complaining to the Commissioning organisation. As the CCG is not responsible for commissioning these services, and complaints received relating to Primary Care Services will be acknowledged and redirected to the National Commissioning Board (NCB) or Local Area Team (LAT) within three working days. 3.5 Anonymous complaints should always be recorded and referred in the same way as other complaints. Anonymous complaints fall outside of the scope of the statutory procedure and the decision on what action to take will be on a case by case basis. The fact that the complaint is from an anonymous source should not in itself justify a decision not to pursue the matter. 4.0 ROLES & RESPONSIBILITIES 4.1 The Accountable Officer (or nominated deputy) is accountable for ensuring effective management of complaints across the Trust and is the responsible signatory for written responses to Formal Complaints. The Director of Nursing & Quality has the delegated responsibility for ensuring the efficient and effective implementation of this Policy and for the Patient Advice and Liaison Service. The Director of Nursing and Quality will be responsible for acting as the liaison point between the Commissioning Support Service and the CCG in relation to patient feedback. 5
4.2 Complex cases will be discussed with other officers of the CCG as required. The Director of Nursing & Quality will present reports to the Quality and Patient Safety Committee and the CCG Governing Body. 4.3 The Lay Member for Patient and Public Involvement (PPI) will scrutinise reports to ensure that complaints, compliments and concerns are managed effectively with appropriate outcomes for individuals and that the organisation learns from this feedback. The Lay member for PPI will endorse the Annual Report to the Board. 4.4 The Complaints and PALS service at the Commissioning Support Unit will apply agreed procedures to support this policy in accordance with the Service Level Agreement with the CCG. 4.5 The Quality Committee will receive reports providing summary and agreed detailed information to inform the commissioning process. 4.6 The CCG Governing Body will receive regular reports regarding complaints and patient feedback. The Governing Body will also receive an Annual Report prepared by the Director of Nursing & Quality with endorsement from the Lay Member for PPI. 4.7 All concerns and complaints require investigation by an Investigation Manager. During the investigation, the Investigation Manager is required to produce an action plan to address any identified weaknesses in the service or process. It is then the responsibility of the relevant CCG manager(s) to implement the improvement actions and report back to the PALS and Complaints Service. The Quality Committee will be monitoring the completion of a consolidated action plan detailing all improvement actions from concerns and complaints. 4.8 The CSU will liaise directly with the provider of 111 services locally and log any concerns raised about the services but, will forward them to 111 for investigation and response. 5.0 PROCESS/REQUIREMENTS 5.1 How to raise a concern, complaint or compliment The most effective way for someone to raise a concern, complaint or compliment is by speaking directly with the person with whom they are involved. This is usually the quickest way to resolve a problem or report a compliment. Compliments, concerns, or compliments are welcomed in any format in the first instance, prior to being forwarded to the complaints team: In writing (letter or fax) to any officer of the CCG 6
Verbally (talking with the person providing the service or their manager over the telephone or face-to-face) Electronically (e-mail) See Flow Chart at Appendix 1 5.2 Monitoring concerns, complaints or compliments The CCG will establish effective monitoring systems with the CSU to enable the capturing, analysis and reporting of concerns and complaints. The purpose of the monitoring system is: to ensure that procedures are complied with; to enable service users to see their concerns are being taken seriously; to enable service users to see a fair and thorough investigation has taken place; to inform future service planning; to identify problem areas so that remedial action can be taken; to help in preparation of the quarterly and annual reports. These reports are also made available to the public. In terms of complaints the following information must be recorded: the details of each complaint received; a risk assessment and score for the complaint; the timescales agreed for looking into the issues and whether these were met; the agreed method for resolving the complaint; the outcome of each complaint; decisions made against each complaint and any action taken as a result; the ethnicity of the complainant if provided on the monitoring form In terms of compliments, managers are asked to record the feedback received. It is important that complaints or compliments received locally by staff of the CCG are recorded and shared with the PALS and Complaints Service at the Central Southern Commissioning Support Unit within one working day. The PALS and Complaints Service will produce a quarterly report to be presented by the Director of Nursing and Quality to the Quality Committee which will outline the feedback received, the outcomes, identified themes and 7
trends and any lessons learned from the complaints and concerns in the previous period. It is the responsibility of the Committee to: review the information provided; request further detail on any issue which they identify as significant; approve the report; recommend any additional actions including further opportunities to share learning. The Director of Nursing & Quality will produce an annual report reviewing activity and feedback received, through the PALS and Complaints Service to be presented to the Governing Body and giving information about service improvements that have taken place. This report will also reflect on compliments received and how they have been acted on and the wider learning from positive feedback. Complaints feedback is an important element of the annual complaints report, which provides: statistical information on the types and volume of all forms of feedback received; a summary of enquiries received; information on trends in complaints; types of complaints made; outcome of complaints; an analysis on who is using the complaints procedure; information about advocacy or support to people making complaints during the year; information about service improvements, which have taken place in response to lessons learned from feedback received and a review about the effectiveness of the complaints procedure. The Director of Nursing & Quality will also include in this report a performance assessment of the PALS and Complaints Service provided by the Southern Central Commissioning Support Unit in line with the Service Level Agreement. The Lay Member of the Governing Body for Patient and Public Involvement will review the annual report and provide an endorsement as a forward to the CCG s Annual Report. Following approval by the Quality Committee, the report will be presented to the Governing Body and will be made available to the public. 5.3 Timescales and outcomes The CCG aims to resolve all concerns within 24 hours. Where a complaint is made verbally and can be resolved to the complainant s satisfaction 8
within one working day, it will be recorded as a concern. All written complaints will be acknowledged within two working days and processed under this complaints procedure. Under the legislation, there is no fixed and specified response time criteria. Response and resolution timescales are agreed with the complainant and the complaint progressed and resolved in line with this agreement. The CCG anticipates that all but the most complex complaints will receive a response within 25 working days. The complainant s desired outcomes as a result of the complaint are also determined in advance, through negotiation between the complainant and the PALS and Complaints Service (with input as appropriate from the CCG). The complaint is progressed and resolved in line with this agreement. Complaints that involve issues that happened more than 12 months previously are often difficult or impossible to investigate in a full and fair manner. However, the decision whether or not to consider the complaint will be made on a case-by-case basis. Possible reasons for accepting the complaint beyond the twelve month time limit are: The complainant had good reason for not making the complaint at the time 5.4 Other enquiries It is still possible to investigate the complaint effectively and fairly Enquiries from Councillors or MPs on behalf of their constituents need to be considered on an individual basis. Most are general enquiries, requests for information or requests for services. However, a small number may be concerns or complaints. These enquiries will be dealt with under this policy. If the matter giving rise to the complaint or concern relates to suspected fraud or corruption, then action must be taken immediately to bring the matter to the attention of the CCG s Local Counter Fraud Specialist and or the Council s Audit Manager. 5.5 Services regulated under the Care Standards Act 2000 Complaints about services regulated under the Care Standards Act 2000, such as residential homes and home care providers will have their own complaints procedure. In most cases, and only with the Complainant s consent, the complaint will be passed as soon as practicable to the service provider and copied to the social care commissioner with the complainants consent. This allows the provider the opportunity to address the complaint. If the complainant remains 9
dissatisfied with the response from the provider they may contact the CCG to discuss further options to resolve the complaint. The CCG can consider the complaint under its own procedures and where it is deemed serious enough, can decide to investigate the complaint in the first instance and respond to the complainant directly. 5.6 Help in making a complaint The CCG will ensure that all complainants are treated with courtesy and receive appropriate support throughout the handling of a complaint. Making a complaint should not be difficult or cause unnecessary worry. There are a number of providers of advocacy services which include: Healthwatch Independent Complaints Advocacy Service (ICAS) Advocacy Services @ The Care Forum (see also their web based database www.wellaware.org.uk) Bath Mind Age Concern Citizen s Advice Bureau Shout Out! At Off The Record Details of how to access advocacy services can be obtained by contacting the PALS and Complaints Service at the CSU. Details are provided on our website All complainants must be informed how to make contact with advocacy services. Complainants may, however, choose to be supported by someone else, such as a family member or friend, or an advocate from another organisation. The complainant must be reminded that it is likely that personal information will be shared with the person supporting them. Face to Face meetings may be offered with the complainant and their advocate if a complaint has not been addressed to the complainant s satisfaction. The Parliamentary and health Service Ombudsman independently reviews NHS complaints. They can only review a complaint if it has already been raised with the responsible organisation and the complainant is dissatisfied with the written responses. The final letter from the CCG will include information on referring complaints to the Ombudsman. In Managing complaints the PALS and Complaints Service will aim to ensure that: the risk of a complaint escalating into a court case or judicial review is minimised; 10
risk control systems are strengthened and lessons can be learnt and actions can be taken where non-compliance occurs; decisions and the complaints process can withstand external scrutiny; accountability is improved. Service users should be signposted to agencies offering specialist advice as early as possible, to help decide on the best course of action as the issue may not actually be a human rights concern, or that it is a combined human rights and discrimination issue, or that it relates to a different part of the law entirely. Agencies offering specialist guidance and advice: Advice UK; A UK network of advice-providing organisations. They do not give out advice themselves, but the website has a directory of advice-giving agencies. Telephone: 020 7407 4070 Email: general@adviceuk.org.uk www.adviceuk.org.uk Citizens Advice provides free, independent and confidential legal advice and provide advice on a range of topics, including human rights. www.adviceguide.org.uk www.citizensadvice.org.uk Community Legal Advice explain the law and help you get the right advice. General information and legal factsheets are available in Welsh, Arabic, Bengali, Chinese, Gujarati, Hindi, Punjabi, Turkish and Urdu. Helpline: 0845 345 4 345 www.communitylegaladvice.org.uk Liberty is an independent civil liberties and human rights organisation, which runs an advice service for members of the public with human rights queries. They also have an advice website, which gives comprehensive information on the Human Rights Act. Advice line: 0845 123 2307 (Monday and Thursday: 6.30-8.30pm; Wednesday: 12.30-2.30pm) www.liberty-human-rights.org.uk www.yourrights.org.uk (You can download a written advice request form from this website 5.7 What falls outside of the policy The complaints policy does not apply when: the person wishing to complain does not meet the requirements of who may complain and is not acting on behalf of such an individual; a complaint made by an employee relating to their employment; a complaint made verbally, which is resolved to the complainant s satisfaction within one working day. This should be recorded as a concern; the complaint is in regard to actions and decisions which fall outside the CCG s responsibilities and remit for example relating to services the CCG does not commission; 11
the same complaint has already been fully considered in the view of the PALS and Complaints Service, in consultation with the relevant senior managers and appropriate advice sought; the same complaint has already been investigated by a health or local commissioner; the complaint is unclear or it is frivolous or vexatious; the complaint is about the handling of a Freedom of Information (FOI) request. These would be considered under the appeals route as outlined in the relevant organisational FOI policy and procedures; matters that should be dealt with under other proceedings such as, personnel procedures, services for which an alternative statutory appeals process already exists, criminal investigation where Court action is pending, matters that involve a suspicion of fraud or corruption and other procedures supersede the complaints procedure e.g. Grievance Policy and Whistleblowing Policy. Each complaint is considered on an individual basis. The PALS and Complaints Service will take advice from necessary sources including personnel and service managers as to whether a complaint may be considered under this procedure. It may be that some elements may need to be considered under different procedures. If this is the case the PALS and Complaints Service will inform the complainant of this and the reasons why. 5.8 Other investigations There may be circumstances where to consider a complaint may prejudice other procedures, investigations and enquiries, for example: Safeguarding children Safeguarding vulnerable adults Court or other legal proceedings Personnel procedures Insurance claims It is at the discretion of the CCG to decide whether to investigate the complaint in these circumstances. Where a complaint is not investigated or suspended in these circumstances, then the PALS and Complaints Service will notify the complainant of this and the reasons why. Once the other investigation or enquiries are complete or discontinued then the PALS and Complaints Service, taking advice from relevant sources, will consider whether the complaint investigation should be started or resumed. It may be that the complaint has been fully considered through these other investigations. Where the CCG decides not to consider the complaint in this 12
circumstance, the PALS and Complaints Service will notify the complainant and the reasons why. 5.9 Safeguarding Allegations of abuse must first be considered under the relevant safeguarding policy (adults or children) as this takes precedence over this policy. 5.10 Legal Proceedings The PALS and Complaints Service will consult with appropriate legal representatives if appropriate. To determine whether to seek legal advice, there should be an initial discussion with the CCG. There are occasions where matters which are being brought to the court either by the CCG or the complainant may need to be considered first. 5.11 Personnel procedures Where the complaint involves matters of serious employee performance or conduct the Personnel Manager will be consulted. Whilst it is important to respond to the complainant on the concerns they have raised this must be balanced with the right to confidentiality owed to the employee. The Complaints Manager in conjunction with the relevant manager from the CCG and Personnel Manager will need to discuss how best to respond to the complainant. 5.12 Unreasonable complainants Where, despite all the efforts that have been made to resolve the complaint, a complainant has become either aggressive or unreasonably persistent, there are number of steps that can be taken to manage the situation: All contact with the complainant will be overseen by a manager at an appropriate level. The complainant should be provided with a single point of contact with an appropriate member of staff. The complainant can be asked to make contact in only one way e.g. by letter. A time limit should be placed on contact with the complainant. The complainant should be told that repeated complaints about the same issue will not be registered. If these measures are not effective, consideration should be given to invoking procedures on dealing with vexatious complainants. 6.0 TRAINING 13
6.1 The CCG will ensure that all new staff are made aware of this policy on induction and that signposting is available on the CCG intranet. 7.0 EQUALITY, DIVERSITY AND MENTAL CAPACITY An Equality Impact Assessment (EIA) has been completed for this policy and no significant issues were identified. The EIA will be published on the CCG internet. This policy has been assessed and meets the requirements of the Mental Capacity Act 2005. 8.0 SUCCESS CRITERIA / MONITORING EFFECTIVENESS 8.1 The effectiveness of the policy will be demonstrated by carrying out a survey of complainants. A survey form will be sent to complainants between three and six months following the final response to the complaint. The survey will be sent by the PALS and Complaints Service with a reply paid envelope. The service will collate responses on a quarterly basis and include summary information in the quarterly reports prepared for the CCG. 8.2 Should complainants express their dissatisfaction with the process by other means, the CCG will investigate the issue(s) with findings resulting from the review incorporated into CSU procedures and/or an update to this policy as appropriate. 8.3 Activity under this policy will be monitored and reported to the Quality Committee as described within the policy. 9.0 REVIEW 9.1 This document may be reviewed at any time as appropriate but will be reviewed after three years. 10.0 REFERENCES AND LINKS TO OTHER DOCUMENTS 10.1 This policy is consistent with: Local Authority Social Services and National Health Services Complaints (England) Regulations 2009. The Principles of Good Complaint Handling (Parliamentary and Health Service Ombudsman) 2008. Listening, Improving, Responding a Guide to better Patient Care (Department of Health 2009). NHS Constitution (Department of Health 2009) 10.2 This policy should be read in conjunction with: Information Governance Policy 14
Safeguarding Policy Human Resources Policies Whistleblowing Policy 15
Support available from ICAS and other Advocacy Services Aiming to Respond as quickly as Possible Flow Chart detailing the process for managing Compliments, Comments, Concerns and Complaints Appendix 1 Compliment Comments Concerns Complaints V E R B A L F A C E T O F A C E E L E C T R O N I C W R I T T E N Notified to a Member of staff 24 hrs Suggestion for Improvement made by a patient/member of the public 24 hrs Verbal issue Low risk Complaint resolved in 24 hrs Complaint about a Commissioned Service Written Complaint Suspicion of abuse, serious neglect or misconduct* Resulting in permanent harm * Possible criminal offence* 24 hrs Forwarded to CSU for recording in regular reports Forwarded to Director of Nursing and Quality for action and to CSU to record and monitor outcome Regular Reports prepared by CSU for review by the Quality Committee detailing all activity and feedback received 24 hrs Forwarded to CSU for: Investigation, response and action plan Recording and maintaining outcome Forwarding to provider organisation to investigate and respond Final letters to be signed off by Accountable Officer or Deputy *see Section 5.8 and 5.9 of Policy Forwarded to CSU 24 hrs for: Facilitate investigation with response within 5 days Acknowledge - within 2 working days Formal response maximum 25 working days Final letters to be signed by Accountable Officer or Deputy To identify actions and follow up 16