Berkshire West Clinical Commissioning Groups

Berkshire West Clinical Commissioning Groups Corporate Policy 1 (CP1) CCG Policy for the Handling of Complaints Version: 1 Ratified by: Date ratified: April 2013 Name of originator/author: Name of responsible committee/individual: Name of executive lead: Date issued: April 2013 Review date: April 2015 Target audience: To be ratified by the four Boards of the Berkshire West Clinical Commissioning Groups Cathy Winfield, Chief Officer Head of Corporate Affairs and Governance Cathy Winfield, Chief Officer All Staff V1.0 April 2013 Page 1 of 14

Contents 1. Introduction 4 2. Policy Statement/aims/objectives 4 3. Scope 4 4. Definitions 5 5. Roles & Responsibilities 5 5.1 Any staff member receiving a verbal complaint 5 5.2 Chief Officer 5 5.3 Head of Corporate Affairs and Governance 5 5.4 Operations Director 6 5.5 The CSU 6 5.6 Who can complain? 7 5.7 Complaints not covered by this policy 7 6. Access to records 8 7. Possible claims for negligence 8 8. Parliamentary & Health Service Ombudsman 8 V1.0 April 2013 Page 2 of 14

Review and Amendment Log Version No Type of Change Date Description of change V1.0 New Policy April 2013 New Policy V1.0 April 2013 Page 3 of 14

1. Introduction This policy describes the procedure that the Clinical Commissioning Group (CCG) will follow when dealing with formal complaints made by patients or their representatives. It incorporates the requirements of the NHS (Complaints) Regulations 2004, 2006 & 2009, as amended, and Department of Health Guidance. 2. Policy statement/aims/objectives The main objective of this policy and procedure is to deal with complaints made by patients and service users about commissioned services as quickly and appropriately as possible. Patients will also be able to access the Patient Advice and Liaison Service (PALS) that assists people to deal with their queries and concerns in an informal manner wherever possible. Information about the complaints procedure and how concerns and complaints from patients and members of the public can be made will be readily available in a format, which is simple and understandable. This information will be available on the CCG web-site in local GP Practices and other public places. It is in the interests of patients and the CCG that patients concerns and complaints are resolved as quickly, efficiently and professionally as possible. The CCG will respond to complaints within a maximum of 25 working days. In principle the CCG believes that local resolution is the best way of achieving this and will strive to use this approach wherever possible. The CCG will also ensure that any learning from complaints is used to improve the quality of services going forwards. The CCG will maintain an overview of concerns and complaints received, trends will be analysed and used to inform commissioning plans. This analysis will be reviewed in the CCG s Quality committee. In addition to responding to individual patients, actions taken as a result of concerns or complaints will be reported as part of the Quality Report at CCG Board meetings and other public forums such as Patient Participation Groups. 3. Scope This policy covers services commissioned by the CCG and the actions or decisions of staff employed by the CCG. The CCG must have consent from the complainant to forward the complaint to another organisation as part of any investigation. Where it is more appropriate for the complaint to be dealt with by the service provider, and the complainant consents, the provider will be requested to handle the complaint in accordance with NHS policy. Where the CCG commissions services from an independent provider, it must ensure that the independent provider has in place arrangements for the handling and consideration of complaints about any matter connected with its provision which meets the requirements of national policy. Patients who are dissatisfied with an individual case decision made by the CCG s Case Review Committee should first pursue the appeals procedure. Patients who remain dissatisfied after an appeal have the right to make a complaint through the NHS complaints procedure. The CCG places great emphasis on resolving complaints as speedily and efficiently as possible in a courteous and sympathetic manner, particularly through an immediate response by V1.0 April 2013 Page 4 of 14

members of staff who are empowered to deal with complaints in an open and non-defensive way. 4. Definitions A complaint is usually described as an expression of dissatisfaction requiring a response. These expressions can be face to face or over the telephone (verbal complaints), or by letter and e-mail (written complaints). Clearly this is a wide definition and it is not the intention of this policy that every complaint should warrant a full-scale complaints investigation. Rather, the spirit of the complaints procedure is that the CCG will respond to all patient feedback in the form of comments, concerns and problems immediately and informally and offer the assistance of PALS. The CCG will distinguish between requests for assistance in resolving a perceived problem and an actual formal complaint. Once an issue or concern becomes a formal complaint it will be dealt with strictly according to the complaints procedure. All staff should prioritise the resolving of issues or concerns before they become a formal complaint. However if there is a specific statement of intent on the part of the caller/correspondent that they wish their concerns to be dealt with as a complaint, they will be treated as such. 5. Roles and Responsibilities 5.1 Any staff member receiving a verbal complaint Any member of staff in either the CCG or a member practice receiving a verbal complaint should encourage and listen to comments raised; listening in itself may help to resolve the issue and often the complaint is not personal but about the system. If they are not able to resolve the complaint in person they should direct the individual to PALS or the Corporate Affairs Manager 5.2 Chief officer The Chief Officer has overall responsibility for complaints handling within the CCG. The Chief Officer, with the assistance of the Head of Corporate Affairs, will ensure that the complaints procedure is followed and complaints are investigated and reported by the CSU, as part of the overall approach to improving the quality of care. Each complaint requiring a written response will receive a reply from the Chief Officer that has been prepared by the Corporate Affairs Manager or the Commissioning Support Unit (CSU). This response will also give information regarding making complaints to the Parliamentary & Health Service Ombudsman 5.3 Corporate Affairs Manager The CCG Corporate Affairs Manager is the named individual whom complainants can access for advice on how to use the CCG s complaints procedure. The Corporate Affairs Manager will: Liaise with the Commissioning Support Unit (CSU) to ensure that any complaint that is written or has been made verbally and requires a written response is acknowledged no later than 3 working days after the day on which it is received. V1.0 April 2013 Page 5 of 14

Provide advice and support on handling complaints to member practices and other health or social care organisations where joint complaints are under investigation or the CSU. Ensure that the CSU conducts the complaints investigation according to national guidelines. Review the investigation report produced by the CSU and the written response to the complainant prior to signature by the Chief Officer Ensure that the final response is sent to the complainant within the agreed response time. If it is not possible for this response time to be met ensure that the CSU contact the complainant and seek agreement to extend the time limit in which to respond. Maintain a log of complaints received, dates referred to CSU, response received, and response issued to complainant. Ensure that mechanisms for making complaints are understood by member practices and publicised via leaflets, CCG website, staff induction and other publicity material where appropriate. The CCG will also be capturing other patient feedback in a wide variety of ways including through its Patient Participation Groups and through the Friends and Families Test 5.4 Operations Director The Operations Director is responsible for ensuring that the complaints policy is adhered to within the CCG, liaising with the Corporate Affairs Manager as required. They will ensure robust reporting to the CCG Board on complaints. 5.5 The CSU The CSU will ensure that contracts/service Level Agreements have a requirement for all providers to have complaints procedures in place that comply with the requirements of the NHS Complaints Regulations. They are also responsible for ensuring that when complaints are made, the issues raised by complaints are discussed with the responsible provider. The CSU is responsible for investigating complaints on behalf of the CCG, preparing an investigation report and drafting a response to the complainant; monitoring the trends and improvements relating to complaints, and ensuring that a log of formal complaints are kept and actions taken. The CSU must ensure that their Investigating Officers have been trained in investigating skills and can communicate appropriately and sensitively with both patients and providers. The CSU will ensure that reporting to the CCG Quality Committee and the CCG Board takes place. The CSU should ensure that all investigation notes, investigation reports, written communications and completed complaint responses are filed and stored appropriately; communications with the Parliamentary & Health Service Ombudsman are dealt with appropriately; complaints are risk graded; trends are analysed and evidence from lessons learned is shared both within the CCG, and externally with other health and social care organisations as appropriate; best practice in complaints management is implemented. The CSU will be required to obtain feedback from complainants on how their complaints were handled V1.0 April 2013 Page 6 of 14

The CSU will also provide a Patient Advice & Liaison Service (PALS) which will have an important role in working in an advisory capacity with patients, CCG staff and member practices to help resolve concerns on the spot before they escalate into formal complaints. PALS will advise patients on the complaints process if an informal approach to resolving the problem has been unsuccessful and the patient wishes to take the matter further. The CSU will ensure that PALS liaise and work with emerging Health watch bodies, capturing broader patient feedback from them and advising of any necessary actions required. The CSU will capture and log compliments about commissioned services to promote the spread of good practice 5.6 Who can complain? Complaints may be made by existing or former users of the services commissioned by the CCG. If the complainant is unable to give consent, another person may be nominated to act on their behalf, including those with a legal authority for patients who are unable to give consent. A consent form is attached as Appendix A. Where a complaint is made on behalf of a deceased patient, consent will be sought from the Executor of the Will or the Administrator of the Estate. A consent form is attached as Appendix B. If the deceased has no will, Executor or Administrator of their Estate then Next of Kin status may be used depending on individual circumstances. In the case of a child (under the age of 16 years) the representative must be a parent, guardian or other adult person who has care of the child, or authorised local authority representative if the child is in care. Any person who is affected by or likely to be affected by the action, omission or decision of the CCG may also make a complaint. 5.7 Complaints not covered by this policy 5.7.1 Complaints made outside of the time limits. Complaints should normally be made within twelve months of the event or within twelve months of the date on which the matter coming to the complainant s attention. Complaints received after the expiry period can only be considered at the discretion of the CCG Chair. The time limit shall not apply if the Chief Officer is satisfied that the complainant had good reasons for not making the complaint within this time limit and notwithstanding the delay, it is still possible to investigate the complaint effectively and fairly. 5.7.2 When it is a staff grievance. 5.7.3 A complaint made by another NHS organisation which relates to the exercise of the CCG s function. 5.7.4 A complaint made by an employee about any matter relating to their contract of employment. 5.7.5 A complaint made by an independent commissioned service about any matter relating to arrangements made by the CCG with that commissioned service. V1.0 April 2013 Page 7 of 14

5.7.6 A complaint which is being or has been investigated by the Parliamentary and Health Service Ombudsman. 5.7.7 A complaint arising out of the CCG s alleged failure to comply with a data subject request under the Data Protection Act 1988 or a request for information under the Freedom of Information Act 2000. 5.7.8 A complaint that has already been investigated under the 2009 or previous regulations 5.7.9 A complaint which relates to any scheme established under section 10 (superannuation of persons engaged in health services, etc) or section 24 (compensation or loss of office etc) of Superannuation Act 1972, or the administration of those schemes. 5.7.10 A complaint where the complainant has stated that s/he intends to take legal proceedings (see para 7) 5.7.11 A complaint in relation to services that are commissioned by the NHS Commissioning Board 6 Access to records Where a complainant seeks access to records, these should be provided promptly in accordance with the Data Subject Access Policy (records of living patients) or Access to Health Records Policy (records of deceased patients) as appropriate without charge. 7 Possible claims for negligence If the complainant explicitly instigates legal action, the complaints procedure will normally cease. However, the 2009 regulations make provision for the two to continue in parallel. Organisations are advised to use this option cautiously, and to take legal advice from all parties solicitors to confirm that the complaints investigation will not compromise any legal proceedings: i. The complainant and the complained against will be advised of any suspension of the complaints process in writing. ii. The appropriate Risk Lead should be informed as soon as possible who will then take appropriate action, including notifying the NHS Litigation Authority. If the complainant s initial communication is via a solicitor s letter, the inference should not necessarily be taken that the complainant has decided to take legal action. This should not prevent a full explanation being given and if, appropriate, an apology offered to the complainant. An apology is not an admission of liability. 8 Parliamentary & Health Service Ombudsman Complainants who are dissatisfied with the CCG s response as a result of the local resolution process may make a complaint to the Parliamentary & Health Service Ombudsman. The final response under local resolution should explain to the complainant how they can pursue their complaint further if they remain dissatisfied. V1.0 April 2013 Page 8 of 14

Complainants should be advised that they must ask the Health Service Ombudsman to review their complaint within twelve months of the matter which is the subject of the complaint occurred. However the Ombudsman s office can exercise their discretion. All complaints made to the Health Service Ombudsman will be recorded on the complaints database together with the details of action taken by the Ombudsman to resolve the matter and any subsequent action by the CCG. When the Parliamentary & Health Service Ombudsman receives a request for independent review of a complaint, the case file is requested from the CCG. Failure to provide this information, or a reasonable explanation of the delay, will be classed as an indication of a potential lapse of good complaints handling. If the Parliamentary & Health Service Ombudsman investigates a complaint it will, as soon as reasonably practicable, prepare a written report of its investigation. The report may include suggestions, which it considers would improve the services of the CCG or which would otherwise be effective for the purpose of resolving the complaint. All complaints made to the Ombudsman and their outcomes will be shared with the Integrated Governance Committee. 9 Help Available to Complainants Complainants who require help and support in pursuing their concerns should be guided to the PALS or the Independent Complaints Advocacy Service (ICAS). 10 Vexatious or unreasonably persistent complainants There are times when nothing further can reasonably be done to assist the complainant or to rectify a real or perceived problem. Under such circumstances and as a last resort after all reasonable measures have been taken to try and resolve the complaints under this policy, the following should be considered: 10.1 Complaints made by persistent complainants should be reviewed by the CSU to establish whether the same issues are being raised again. Complaints about matters unrelated to previous complaints should be approached objectively and without any assumption that they are bound to be frivolous, vexatious or unjustified. 10.2 If a complainant is abusive or threatening, it is reasonable for the CSU to require him/her to communicate in a way that still allows the complaint to be investigated. For example, this could be in writing and not by telephone, or solely with one or more designated members of staff. It is not reasonable to refuse to accept or respond to communications about a complaint until it is clear that all practical possibilities of resolution have been exhausted. 10.3 Complainants regarded as unreasonably persistent or vexatious should be pursued in accordance with the following procedures: i. The Chief Officer will review the complaint and make a decision as to whether or not it is appropriate for the CCG to investigate the complaint further. ii. If the Chief Officer makes the decision that the complaint should be investigated further, the case will be returned to the CSS for further action in accordance with this policy. If it is felt at this time that restrictions should be placed on the complainant V1.0 April 2013 Page 9 of 14

these should be explained together with the reasons why the restrictions are being put in place. iii. iv. If the Chief Officer makes the decision that the complaint should NOT be pursued he/she should ensure that the case receives ratification by the CCG Chair. If the CCG Chair ratifies the decision made by the Chief Officer the complainant should be immediately informed of this decision and advised of his/her right to take the case up with the Health Service Ombudsman if they remain dissatisfied. 11 Compliments Compliments received by the CCG relating to commissioned services should be logged by the CSU and included in the reporting of patient experience to the Quality and non financial performance committee. They should also be shared with the relevant provider. 12 Policy Review This policy will be reviewed on an annual basis by the Corporate Affairs Manager. Feedback from patients, the CCG and CSU will be taken into account and revisions to the CSU service specification may be required. This policy will also be amended should national guidance / legislation change. V1.0 April 2013 Page 10 of 14

Appendix A Consent Form I,.. [Name in block letters] of Address:... Date of birth:... hereby authorise the CCG to investigate the complaint regarding the care I received at..and consent to the response being sent to: Name:. Address:.... Please state your relationship with this person: I understand the CCG s response letter may include details of a personal and intimate nature concerning my care and I am happy for this person to receive any and all such information as may be relevant to the complaint. Signed:.. Date:.. If the patient is unable to sign this form for any reason, please contact the Corporate Affairs Manager. V1.0 April 2013 Page 11 of 14

Appendix B FORM OF AUTHORITY (deceased patient) The CCG has a continuing duty of confidentiality to patients after they have died. Therefore, we require proof that you are the Executor of the Will or the Administrator of the Estate or that you are authorised by the person who is, to receive confidential information about the care given to your friend/relative. This proof can be shown by providing: A copy of the portion of the Will appointing you as Executor of the Will, or The Grant of Probate or The Letters of Administration If you are the Executor/Administrator you need only provide that proof and complete this form. If, however, you are not that person, would you please provide a letter from the Executor/Administrator giving consent for us to provide you with confidential information, with a copy of one of the documents from the list above, giving proof of their appointment. We are sorry to have to ask for this documentation at such a distressing time. Deceased patient s details Name: Date of Birth: Hospital and/or NHS Number: To be completed by the Executor/Administrator I confirm that I am the Executor/Administrator of the deceased and able to receive any and all such information as may be relevant to the complaint. Signature: Print Name: Date: V1.0 April 2013 Page 12 of 14

COMPLAINT RECEIVED GP SURGERY CCG CORPORATE AFFAIRS MANAGER DOES THE COMPLAINT RELATE DIRECTLY TO SERVICES PROVIDED BY GP PRACTICE? CAN THE COMPLAINT BE RESOLVED INFORMALLY? YES NO YES NO Respond Forward to CCG Corporate Affairs Offer assistance of PALS Send to CSU to Implement Formal V1.0 April 2013 Page 13 of 14

Complaint Received (either to CCG or Corporate Affairs Manager) Within 24 hours Corporate Affairs manager to send to CSU Complaints Manager CSU Complaints Manager to Risk Grade and log information Within 3 working days CSU Complaints Manager to acknowledge within 3 working days, offering the opportunity to discuss their complaint Send copy of complaint to the identified Investigating Officer appropriate to the level of complaint 1 week before agreed response deadline Investigating Officer to agree timescale for investigation and liaise with complainant, with assistance from Complaints Manager where appropriate Investigating Officer to provide investigation report to CSU Complaints Manager to formulate a written response for the complainant CSU Complaints Manager to send response to CCG Corporate Affairs Manager to check prior to Chief Officer signature Send response to complainant and CSU to log outcome, including lessons learned and any action plans V1.0 April 2013 Page 14 of 14