Wigan Borough Clinical Commissioning Group Complaints Policy & Procedure
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3 Contents 1. Introduction 5 2. Complaints Policy 7 3. Implementation 9 4. Annual Reports 12 5. Complaints relating to Other NHS Trust / Other Agencies / Organisations 13 6. Complaints about services procured From Private Providers & Independent Contractors 13 7. Complaints that involve more than one Organisation 13 8. Complaints Service Evaluation 14 9. Equality & Diversity 14 10. Other Procedures 14 11. Compliments 14 12. General Information 15 Complaints Policy & Procedure
4 Contents continued Appendices: Appendix 1 Complaints Process Flow Chart 17 Appendix 2 Complaints Form 18 Appendix 3 Complaints Cover Letter and Evaluation Form 20 Appendix 4 Ethnicity Questionnaire 24 Appendix 5 Useful Contacts 25 References and Associated Documents Freedom of Information Act (2000) available at www.legislation.hmso The DOH Local Authority Social Services & National Health Services Complaints (England) Regulations 2009. The Parliamentary Health Service Ombudsman Access to Health Records Act 1090Data Protection Act 1998.
5 1. Introduction Wigan Borough Clinical Commissioning Group (WBCCG) places a high priority upon the handling of complaints. The organisation recognises that suggestions, constructive criticisms and complaints can be valuable aids to improving services. Complaining is one of several ways in which patients, their families, friends and carers make their views known about the NHS. This complaint s policy outlines the process by which complaints will be handled when raised by or on behalf of service users. The organisation recognises that many patient / clients served may find difficulty in expressing their concerns and all staff need to encourage people to state their opinions. The primary function of the policy is to ensure that procedures are in place to address complaints made by service users. This will include: Giving an explanation Giving an apology (where necessary) Assurance that the matter has been looked into and action has been taken to prevent the same thing happening again. Providing a response in a format to assist understanding of information / explanation, for example, Braille, Large Print, Audio, other Languages and / or telephone. The secondary function is to ensure that information, findings and recommendations are acted upon and shared to help improve quality standards. The WBCCG is committed to ensuring that no one should be inhibited or disadvantaged when making complaints and that there is confidence that these will be given proper and speedy consideration. No one making a complaint will be discriminated against in any way, or be refused services that they should otherwise receive. In dealing with complaints made against members of staff the organisation will adopt a supportive and just approach and will not seek to blame individuals involved in complaints unless negligence, malpractice or other misconduct is proven. Compliance with this Policy and Procedure is mandatory for all NHS staff. See flow chart Appendix 1. 1.1 Scope This policy applies to all complaints received by the WBCCG. Complaints will be accepted orally, in writing and electronically. Complaints can be received by any member of the organisation s staff who should be aware of the actions they will be required to take if they are in receipt of a complaint. All issues outside of the scope of this policy should be referred under the Whistleblowing Policy. This can be found on the staff intranet and the internet website and advises all staff and service users of the policy purpose and ensures correct procedures to follow. Complaints Policy & Procedure
6 1.2 Principles The purpose of this policy is to reflect the best practice in the management of complaints. The primary objective of this procedure is to provide the fullest opportunity for investigation and resolution of the complaint as quickly as is possible in the circumstances, aiming to satisfy the complainant, whilst being scrupulously fair to all parties involved. confined to that which is relevant to the investigation of the complaint and only disclosed to those people who need to know for the purpose of investigating the complaint. Complaints records must be kept separate from health records, subject to the need to record any information, which is strictly relevant to his or her health in the patient s health records. This document has been produced in line with the Department of Health s guidance to support the implementation of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. Regulations 3,4,7,8,9,12,13,14,18, details the procedure which should be followed when dealing with the following: Complaints relating to Primary Care Contractors. Complaints relating to any action or purchasing decision taken by the organisation, including those relating to commissioning of health services for the local population. Complaints relating to other NHS Trusts. Complaints relating to services purchased from the independent sector. Complaints relating to more than one organisation. 1.3 Confidentiality Care must be taken at all times throughout the complaints procedure to ensure that any information disclosed about the patient is
7 2. Complaints Policy Once a complaint has been accepted (see 3.3), the complainant has the right to have their concerns investigated and a full and prompt written explanation given. The complaint final response will be signed by the Chief (Accountable) Officer or a nominated senior officer. The response should be provided in an appropriate format agreed with the complainant. 2.1 Monitoring Compliance To monitor compliance, records will be kept of all complaints to provide anonymised evidence of outcomes, trend analysis and resulting changes to service / practice. Compliance will be monitored by the following: Quarterly Report to Clinical Governance Committee Annual Report Annual report to Local Involvement Network (LINKs) and the subsequent organisation Healthwatch. 2.2 Roles and Responsibilities 2.2.1 The Designate Accountable Officer will see all CCG complaints relating to the CCG and sign the final written response. A medical professional opinion will be sought from a clinical lead when required. 2.2.2 Head of Governance The Head of Governance will: Maintain an overview of complaints made across services Co-ordinate investigations including the final responses to complainants. Ensure the complaints database is maintained to produce soft intelligence reports for senior management review and commissioning purposes. Prepare an Annual Report for the NHS Commissioning Board Local Area Team as per the new complaint regulations 2009. Keep under review the Complaints Procedure systems in line with good governance. Develop training and awareness campaigns to promote best practice and raise awareness across the borough. Ensure compliance with the Counter Fraud and Head of Governance protocol and report any matters concerning fraud to the Trusts Local Counter Fraud Specialist (LCFS). 2.2.3 All Employees All employees will deal sensitively and promptly with informal complaints (oral complaints not resolved by the next working day) even those which do not apply directly to their area of work. Employees must make a genuine attempt to resolve the problem whenever possible, passing on complaints promptly when this is not possible. It is important to provide information that is accurate, if in doubt then assistance should be sought from a line manager, or Head of Governance. Alternatively staff should take the complainant details ensuring that the information requested is confirmed as soon as possible. Complaints not resolved by the next working day must be forwarded to the Head of Governance. Complaints in writing should be sent without delay to Head of Governance. Complaints Policy & Procedure
8 2.2.4 Independent Contractor Complaints Handling In line with the Complaints Procedure the complainant has the choice (this should be offered at the outset) to have their complaint handled by the Independent Contractor / Provider or the commissioning organisation in this case the NHS Commissioning Board Local Area Team. Where the independent contractor handles the complaint, they are required to follow the Local Authority Social Service and National Health Services Complaints (England) Regulations 2009. Note: In line with the above procedure where a complainant is not satisfied with the Independent Contractor response it cannot be escalated to the NHS Commissioning Board Local Area Team but the Parliamentary Health Service Ombudsman. Where the WBCCG is handling the complaint investigation the Independent Contractor / Provider has a duty to co-operate with the investigation, which will be carried out in a thorough and timely manner proportionate to the topic and in accordance with item 3.1 local resolution.
9 3. Complaint Implementation 3.1 Local Resolution - First Stage of procedure It is expected that in many cases, an immediate informal response by a front line member of staff or practitioner, will resolve the issue/s as they arise. It is recommended that this should be recorded and used for Customer Care purposes. The role of front-line staff is critical in dealing with complaints and satisfying complainants early on. The WBCCG provides, wherever possible on the spot resolution of queries and concerns. If the organisation / department or contractor does not resolve a complaint by the next working day it must be formally registered and placed within the complaints process appropriately. A complaint may be received verbally, in writing or electronically. Where the complaint is taken verbally a written record of the complaint will be made and sent to the patient / complainant. The WBCCG offer a freepost facility for individuals wishing to make a complaint and the e-mail address is provided on the complaints leaflet to allow those with Internet access to complain online. A complaint s hyperlink is available via the Website. Criteria for Identifying Complaints 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 complainant. The individual handling the complaint must acknowledge (orally or in writing) a complaint no later than three working days from receipt, and discuss the following with the complainant: Discuss with complainant their choice of complaint handler, either WBCCG or Independent Contractor or Provider. If the complaint can be resolved by the next working day with the complainant s agreement this would then be recorded as such for information and trend analysis. The manner in which the complaint is to be handled, i.e. a meeting is offered or response in writing. Consent to share the information with other parties, on a need to know basis only. Notification and explanation if any delays occur with the investigation. The period of time in which the investigation of the complaint is likely to be completed (no later than six months as this may result in referral to the Ombudsman). Information about the Independent Complaints & Advocacy Service (ICAS). Complaints Policy & Procedure
10 Following a full investigation the complainant will receive; 1) A written response signed by the Chief (Accountable) Officer or nominated Senior Officer for complaints. 2) Offer of a meeting. 3) Offer to provide information about Ombudsman. Should the complaint signify fraudulent activity, the involvement of the CCG s LCFS is required (as per the CCG Anti Fraud & Corruption Policy). This ends the Local Resolution process and it is anticipated that most cases will be resolved at this stage. 3.2 The Parliamentary & Health Service Ombudsman - Second Stage of procedure Every effort will be made to assist the complainant to resolve their complaint at local level. Complainants who are not satisfied with the outcome of a complaint will be provided with details about the Parliamentary and Health Service Ombudsman, an independent body. Details are provided in a leaflet and in Useful Information Appendix 5. the complaint came to the notice of the complainant. This time limit shall not apply if following a review of the complaint the Head of Governance is satisfied that the complainant had good reasons for not making the complaint within the time limits and it is still possible to investigate the complaint effectively and fairly. 3.4 Litigation & NHS Complaints Procedure In the event of a complainant s initial communication being via a solicitor s letter, the inference should not be that the complainant has decided to seek redress through the courts. It is possible for a complaint and legal action to be progressed at the same time. Further clarification by WBCCG will be sought. Where it is thought that dealing with the complaint might prejudice the legal action, resolution of the complaint is delayed until after the legal action has concluded. The complainant will be informed in writing why the complaint process has been put on hold. If the complainant explicitly indicates in writing an intention to take legal action in respect of the complaint the complainant will be advised appropriately. 3.3 Time limits for making a complaint A complaint must be made no later than 12 months after the date on which the issue / incident / complaint occurred. Or, if later, the date on which the matter that is the subject of
11 3.5 Challenging & Vexatious Complainants Occasionally there might be vexatious complainants. It is important that all reasonable measures are taken to resolve the complaint. Therefore, and only as a last resort should the following points be considered if the NHS complaints procedure has been fully and properly implemented and exhausted. If a new issue is raised or complainants seek to prolong contact by unreasonably raising further concerns or questions upon receipt of a response whilst the complaint is being dealt with. If the complainant is unwilling to accept documented evidence of treatment given as being factual or deny receipt of an adequate response despite correspondence specifically answering the questions / concerns. If the complainant does not clearly identify the precise issues they wish to be investigated despite reasonable efforts to help them to do so and / or the concerns indentified are not within the remit of the WBCCG to investigate. If the complainant focuses on a trivial matter to an extent, which is out of proportion to its significance, and continues to focus on this point. If physical violence, harassment, bullying and / or abusive behaviour has been used or threatened towards staff or their families / associates at any time. All such incidents will be documented and reported, as appropriate to the police. If unreasonable demands or expectations are made to the WBCCG and / or Independent Contractors. 3.5.1 Managing Challenging and Vexatious complaints. In all circumstances complainants and their complaints will be dealt with in accordance with the regulations. However, if complainants have been identified as making inappropriate or vexatious complaints, in accordance with the above criteria, the Director of Quality and Safety will decide what action should proceed. Complaints Policy & Procedure
12 4. Annual Report Due to changes in the new complaints procedure all complaints not resolved by the next working day must be included in the complaints annual report. The annual report should include: The number of complaints received. The number of complaints which were wellfounded. The number of complaints which have been referred to the Parliamentary & Health Service Ombudsman, and in such cases must include a summary: (a) The subject matter of complaints that were received. (b) Any matters of general importance arising out of those complaints, or the way in which the complaints were handled. (c) Any matters where action has been or is to be taken to improve services as a consequence of those complaints. The WBCCG annual complaints report will be appraised by the Clinical Governance Committee. The report is available on request and available on the WBCCG Website. 4.1 Annual Complaints information. All annual returns required by the Department of Health regarding annual complaints data, for example the KO41b, will be submitted as required.
13 5. Complaints relating to other NHS trusts / other agencies / organisations Verbal and Written Complaints Staff receiving any complaint about another organisation must forward it to the Head of Governance to handle in line with the 2009 complaints guidance. 6. Complaints about services procured from private providers and independent contractor Service Level Agreements All Contract Specifications and Service Level Agreements (SLA) with all providers of NHS treatment are required to have a system in place for service users to make a complaint. The system must be in line with the Local Authority Social Services and National Health Services Complaints Procedure (2009). 7. Complaints that involve more than one organisation Written Complaints A pathway for handling complaints involving more than one public service organisation has been agreed with Heath and Social Care colleagues across the health economy. The pathway was introduced at the start of the New Complaints Procedure (April 2009) which entitles a complainant to receive one coordinated response. The organisation with the most outstanding issue/s of complaint will take the lead and co-ordinate the final response, itemising each individual issue investigated by the respective organisations. The Head of Governance on receiving such a complaint will acknowledge the complaint within three working days identifying those areas within the remit of the Trust and those within the remit of other organisations. Permission will be sought from the complainant to agree the complaint handling. Complaints Policy & Procedure
14 8. Complaints service evaluation A patient questionnaire relating to the management of the complaint will be sent to the complainant on completion of the local resolution procedure See appendix 3. 9. Equality and diversity monitoring An ethnic monitoring form will be sent to the complainant on completion of local resolution. This will be attached to the patient s / complainant s questionnaire - See appendix 4. 10. Other procedures Where a complaint leads to the identification of a serious untoward incident, the CCG policy for Incident Reporting must be followed and this can be found on the intranet. Should fraud be identified then the protocol must be followed and the CCG s Local Counter Fraud Services consulted. 11. Compliments Compliments are welcomed as they acknowledge patient satisfaction and can evidence good practice.
15 12. General Information 12.1 Who may make a Complaint All Service Users are entitled to make a complaint, which will be considered in line with the Regulations shown in 1.2 of this document. The information is available on the intranet and internet. N.B. In the event of a staff member complaining against another staff member the appropriate guidance / policies are available on the intranet. 12.2 Openness in the NHS If a patient is harmed as a result of a mistake or error in their care, we believe that they, their family or those who care for them, should receive an apology, be kept fully informed about what has happened and have their questions answered. This is something that we call Being open, see CCG s policy on Being Open. The CCG s Policy will be available on the intranet and internet. 12.3 Publicity / Information Notices about making a complaint, comment and compliments are displayed in public areas within CCG premises and independent contractor premises. Complaint leaflets are provided in the above premises and can be accessed from the intranet and internet. The leaflets include information about the complaint process, the right to Independent Complaints Advocacy Service (ICAS), and the right of access to the Health Service Ombudsman. On request leaflets can be provided in various formats including other languages. 12.4 Access to Health Records Related CCG Policy - General Policies & Procedures Access to relevant records is very important in the context of complaints. The CCG operates in accordance with the provisions of the Access to Health Records Act 1990; Data Protection Act 1998; Freedom of Information Act 2000 Policy. 12.5 Referral to Professional Bodies Should the investigating manager have concerns arising from complaints that he / she feels should be referred to either the professional regulatory bodies, the police, the CCG s Local Counter Fraud service or the coroner, clear guidance on referral procedures can be obtained from the Head of Governance. If an investigation results in the need to pursue disciplinary action and / or criminal prosecution against an individual, and / or an organisation, then that will be undertaken in strict accordance with the relevant policy applicable to the subject of the complaint. The material and evidence obtained during the investigation of the complaint may be used at any subsequent hearing. 12.6 Vulnerable Adults/Children When a member of staff has concerns regarding a vulnerable adult / child, principals of best practice can be obtained from the Protecting Vulnerable Adults Policy and / or the Safe Guarding Children Policy and Procedure available on the intranet. Complaints Policy & Procedure
16 12.7 Fairness & Equality CCG staff must also ensure that patients and their carers are not discriminated against when a complaint is made and that their ongoing treatment will be unaffected. Complaint records must be kept separate from clinical records. Systems are in place to provide information in a format for vulnerable groups, for example, in Braille, large print, other languages and audio. This policy is compliant with the Human Rights Act 1998 and all the Equality Legislation, e.g. DDA, Race, Age, Gender, Disability, Ethnicity and Sexual Orientation.
17 Appendix 1 Wigan Borough Clinical Commissioning Group Process for Handling Complaints Complaint made to: Provider Area including GP/Practice WBCCG Accountable Officer Chairman s Office GOVERNANCE Team or Member of Staff GOVERNANCE TEAM Head of Governance acknowledges within 3 working days Complaints Leaflet given Check validity (consent, time-limit etc) Record on Database Identity Type of Complaint Serious GP/Practice Managers Provider of Commissioned NHS Services Serious concerns raised at Local Area Team Refer to service provider for review and report Director of Quality and Safety to investigate prepare report and response Report to Governance Team Response to complainant Monitor through Clinical Governance Committee Lessons Learned Complaints Policy & Procedure
18 Appendix 2 PRIVATE AND CONFIDENTIAL Complaints Form (Patient) Full Name of Complainant Relative/Carer/Other (please delete as applicable) Full Name of Patient (If different from above) Complainant Address Patient Address Post code: DOB: Post code DOB: Telephone Contact Complaint regarding Please state Name, Address and Telephone Number of Contractor or Department complaint about e.g. Doctor, Dentist, Pharmacist, Optician, Primary Care Trust.
19 PRIVATE AND CONFIDENTIAL OUTLINE OF COMPLAINT (Please use reverse side if necesssary, thank you) Signed (Complainant) Signed (Patient if applicable) Date Please forward to: Head of Governance, Wigan Life Centre, College Avenue, Wigan. WN1 1NJ Complaints Policy & Procedure
20 Appendix 3 Date: As postmark. Dear With reference to the complaint we recently handled on your behalf I would be grateful if you could spare the time to complete the attached questionnaire and return in the FREEPOST envelope provided. It is our intention to provide a high quality service to complainants who make a complaint to the Head of Governance, Wigan Life Centre, College Avenue, Wigan WN1 1NJ and to try and ensure that complaints are handled satisfactorily. Where they are not we wish to make improvements if shortfalls are highlighted to us. If you prefer not to fill in the form but would still like to make a comment you are very welcome to do so. You can do this by writing in using the envelope or by telephoning 01942 482711 and asking for Complaints Department. I do hope that you are able to find time to provide your comments, as your feedback will be very much appreciated. Yours sincerely Head of Governance NHS Wigan Borough Clinical Commissioning Group
21 COMPLAINTS SERVICE EVALUATION Patient Questionnaire (Please tick appropriate box) Management of Complaint 1. How did you make contact with the complaints team? Telephone Letter Email Fax Visit 2. How helpful did you find the staff involved? Very helpful Fairly Not really Not at all 3. Did you feel comfortable discussing your concerns with the complaints staff? Yes, very much Fairly Not really Not at all 4. Did you feel the complaints staff listened to and understood your concerns? Yes No If no, please explain Complaints Policy & Procedure
22 Specific Case 1. Were you satisfied with the outcome of your complaint? Yes No If no, please explain 2. Did you receive feedback on any actions taken to improve the provision of service as a result of your complaint? Yes No If no, would you like to receive any feedback? If you have any suggestions or comments regarding the service you have received from the complaints team or any comments regarding the NHS complaints procedure, please write them in the space below: If you would like a member of the complaints team to contact you regarding any outstanding concerns, please provide contact details in the space below: Name: Address Tel: Mobile: Email:
23 Thank you for taking the time to complete this questionnaire Please return to: Head of Governance, Wigan Life Centre, College Avenue, Wigan. WN1 1NJ Complaints Policy & Procedure
24 Appendix 4 Equality & Diversity Monitoring Form It would be helpful to us if you would supply the following details about yourself. THIS INFORMATION WILL BE HELD IN CONFIDENCE AND WILL NOT BE ATTRIBUTED TO ANY INDIVIDUAL. Please tick the appropriate box. Age range: 18-24 25-44 45-54 55-64 65-74 Over 75 You are the patient. You are complaining on behalf of a patient. What is the patient s ethnic origin? White British Irish Any other white background Mixed White and Black Caribbean White and Black African White and Asian Any other mixed group Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background Black or Black British Caribbean African Any other black background Other ethnic Groups Chinese Any other ethnic group Not Stated Not stated Please return the completed form in the enclosed pre-paid envelope.
25 Appendix 5 USEFUL CONTACTS: Head of Governance Corporate Office Wigan Life Centre College Avenue Wigan WN1 1NJ The Department opening times are: Monday to Friday 9am to 5pm Tel: 01942 482711 Email: Publicenquiries@wiganboroughccg.nhs.uk A telephone answering service is available and calls will be acknowledged no later than the next working day. Bridgewater NHS Trust Community Healthcare (Community Services e.g., District Nursing) Complaints & PALS Team Bevan House 17 Beecham Court Smithy Brook Road Wigan WN3 6PR Tel: 01942 482765 Or 01942 482778 Fax: 01942 482671 Wrightington, Wigan & Leigh NHS Foundation Trust Patient Relations (for all Complaints and Concerns relating to Hospital Services) Royal Albert Edward Infirmary (RAEI) Wigan Lane Wigan WN1 2NN Tel: 01942 822323 or 01942 822376 Fax: 01942 773111 Email: Patient.relations@wwl.nhs.uk Independent Complaints & Advocacy Service (ICAS) Suite 2 The Unicentre Lords Walk Preston PR1 1DH Tel: 0300 456 8350 Local Counter Fraud Specialist Kerry-Ann Wheat Mersey Internal Audit Summerfield House, Eccles New Road Salford. M5 5AP. Tel 0161 206 1911 Email: Kerry.Ann.Wheat@miaa.nhs.uk Parliamentary & Health Service Ombudsman Millbank Tower, Mill bank London SW1P 4QP Tel: 0345 015 4033 Email: www.ombudsman.org.uk Complaints Policy & Procedure
26 Customer Relations Unit Wigan Council Civic Centre Millgate Wigan WN1 1AZ Tel: 01942 827879 Wigan Family Welfare St. Nathaniel's Vicarage, Ridyard St, Platt Bridge, Wigan, Lancashire WN2 3TD Tel: 01942 867888 Age Concern 68 Market Street Wigan Lancs WN1 1HX Tel: 01942 241972
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