GENERAL POLICIES AND PROCEDURES COMPLAINTS POLICY AND PROCEDURE Version 1.0 Page 1 of 65 November 2013
POLICY DOCUMENT VERSION CONTROL CERTIFICATE TITLE Title: General Policies and Procedures: Complaints Policy and Procedure Version: 1.0 SUPERSEDES Supersedes: General Policies and Procedures Complaints policy and procedure Description of Amendments: Updated to reflect changes in the developing role Trafford Clinical Commissioning Group the developing role of Trafford Commissioning Consortia. ORIGINATOR Originator/Author: Karl Taylor, Customer Care & Experience Manager Designation: Customer Care & Experience Team EXECUTIVE APPROVAL Approved by: CCG Quality, Finance and Performance Committee Date Approved: 12 th November 2013 EQUALITY ANALYSIS Date Completed: TBC Link to website: TBC CIRCULATION Issue Date: November 2013 Circulated by: Communications and Engagement Team Issued To: (as per Circulation List) REVIEW Review Date: November 2015 Responsibility of: Associate Director of Corporate Services & OD Version 1.0 Page 2 of 65 November 2013
CIRCULATION LIST Prior to 1 st Approval, this Policy Document was circulated to the following for consultation: Associate Director Corporate Services and OD CCG Quality, Finance and Performance Committee Following Approval this Policy Document will be circulated to: Notification to CCG staff via Staff News Bulletin Executive Directors CCG Intranet Version 1.0 Page 3 of 65 November 2013
CONTENTS Section Page 1 Introduction 7 2 Strategic context 9 3 Policy Statement 9 4 Purpose 10 5 Definitions 10 6 Duties and responsibilities 6.1 Duties within the organisation (9)) 7 Principles 13 8 Objectives 14 9 Complaints/PALS interface 15 10 Ensuring those who complain are not disadvantaged 15 11 Consent/Confidentiality 16 12 13 Using Health Records in complaints investigations GP Member Practices 13.1 The Primary Care Quality Improvement Group (15) 18 12 17 14 Out of Hours GP services (Mastercall) 18 15 Complaints about commissioned services providers 18 16 Complaints about funded nursing aspect of patient care 17 Independent Advocacy 19 18 Conciliation 19 19 20 Time Limits 20 Suspension of complaints procedure 20.1 Serious complaints (17) 21 Exclusions 21 22 Possible claims for negligence 21 19 20 Version 1.0 Page 4 of 65 November 2013
23 Special circumstances 22 24 Who can complain 22 25 Complaints procedure general 25.1 Local resolution stage (20) 25.2 The Parliamentary and Health Service Ombudsman (21) 23 26 Complaints procedure 24 27 Local Resolution 25 28 Focus on Early Resolution 26 29 Responses 27 30 Complaints of a clinical nature 28 31 32 Complex complaints and Mixed Sector Complaints 31.1 Children and Young People s Services (CYPS) (25) Procedure for Handling Persistent or Vexatious Complaints 32.1 Definition of Persistent or Vexatious Complaints (26) 32.2 Options for dealing with persistent or vexatious complaints (27) 32.3 Withdrawing persistent or habitual complainant status (27) 28 29 33 Performance Targets 31 34 Learning from complaints 31 35 36 37 Corporate Performance, Monitoring and Reporting 35.1 Monitoring (29) 35.2 Annual Reports (29) 35.3 Corporate Performance (29) Monitoring effectiveness of the policy and procedures and review 36.1 Monitoring effectiveness (30) 36.2 Review (30) Training 37.1 Training needs analysis (31) 38 Publicity 35 39 Media interest 35 40 Employment issues 35 32 34 34 Version 1.0 Page 5 of 65 November 2013
41 42 Separation of complaints and disciplinary procedures 36 Equality and diversity 42.1 Equality and Diversity impact assessment (32) 43 Dissemination and Implementation 36 44 Associated policies and documents 37 45 References 37 Appendices Appendix 1 Risk rating matrix 38 Appendix 2 Draft letters for acknowledging a complaint 41 Appendix 3 Complaints Monitoring Form 43 Appendix 4 Sample memo to Head of Service/Director/Associate Director Appendix 5 Guidance for Investigators 46 Appendix 6 Flowchart escalation process for Family Health Service complaints Appendix 7 Role of the independent lay conciliator 51 Appendix 8 Guidance for writing statements 53 Appendix 9 Appendix 10 Appendix 11 Appendix 12 Appendix 13 Guidance for Managers Interviewing Staff who are Involved in Complaints Guidance for Meeting with Patients, Carers and/or Family Members following a Complaint or Serious Incident Protocol on Receipt of Anonymous Complaints and Allegations Verbal complaints form 63 Flow chart for investigating officers 65 36 44 50 54 59 62 Version 1.0 Page 6 of 65 November 2013
COMPLAINTS POLICY AND PROCEDURE 1.0 Introduction The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the complaints regulations) came into force on 1 April 2009. Every provider of NHS services is required to make arrangements for the handling and consideration of complaints, in accordance with the complaints regulations, made about: a. (i). the exercise of its function; or (ii). the exercise of any function discharged or to be discharged by it under arrangements made between it and the local authority in relation to the exercise of the health-related functions of a local authority b. a primary care provider about the provision of services by it under arrangements with an NHS body; or c. an independent provider about the provision of services by it under arrangements with an NHS body The complaints regulations focus on early resolution and provide greater flexibilty in how complaints can be dealt with. The complainant is involved in their complaint every step of the way. The complaints regulations remove the distinction between formal and informal complaints. All complaints should be recorded regardless of who responds to the complaint, unless the complaint is received orally and is responded to orally by the end of the next working day. Where Trafford Clinical Commissioning Group (Trafford CCG) recieves a complaint about the provision of services by a commissioned service provider, it must obtain the complainant s consent for the complaint to be passed to the provider. The complaint will be progressed by the provider and a response sent directly to the complainant. The complaints legislation allows Trafford CCG to deal with a complaint (known as a commissioner led complaint) about a provider where it considers it is appropriate to do so. The NHS Constitution states that any individual has the right to: Have their complaints acknowledged within three working days and to have it properly investigated. Discuss how their complaint is handled and to know how long it will take to investigate and respond to their complaint. Know the outcome of the investigation into a complaint including an explanation of the conclusions and action needed as a consequence; and Request an independent review of a complaint by the Parliamentary and Health Service Ombudsman, if dissatisfied with the NHS organisation response to the complaint. The constitution commits the NHS to ensure that individuals making a complaint will: Version 1.0 Page 7 of 65 November 2013
Be treated with courtesy, receive appropriate support throughout complaint investigation, and know the complaint will not adversely affect their treatment; and Receive an appropriate explanation and apology if harmed while receiving health care. With recognition of the trauma experienced, and know that lessons will be learned to help avoid a similar incident occurring again and the organisation learns lessons from complaints and claims and uses these to improve Trafford CCG has adopted the six principles of good complaints handling published by the Parliamentary and Health Services Ombudsman. These are summarised as: 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 Trafford CCG s complaints policy and procedure complies with the findings of the Care Quality Commissions Essential standards of quality and safety and Judgement framework 2009. These are summarised as 1. Trafford CCG has an effective complaints process in place for the assessing, and preventing or reducing the impact of, unsafe or inappropriate care or treatment, for identifying, receiving, handling and responding appropriately to complaints and comments made by service users, or persons acting on their behalf and learn from them. 2. The complaints process: a. is brought to the attention of service users and persons acting on their behalf in a suitable manner and format b. provides service users and those acting on their behalf with support to bring a complaint or make a comment c. ensures that any complaint made is fully investigated and, so far as reasonably practicable, resolved to the satisfaction of complainant d. takes appropriate steps to coordinate a joint response to a complaint where that complaint relates to care or treatment provided by more that one provider. 3. If requested to do so Trafford CCG will comply with the Care Quality Commissions request for a summary of a complaint and Trafford CCG s response This complaints policy and procedure complies fully with the statutory requirements for handling complaints as set out in the complaints legislation and takes account of the Department of Health s guidance A Guide to Better Customer Care, the Ombudsman s Principles of Good Complaint Handling and the Care Quality Commission s Outcome and Judement framework. Version 1.0 Page 8 of 65 November 2013
2.0 Strategic Context Complaints are an integral element of improving the patient s overall experience of health care and help to assure safe, high quality care. The management of complaints needs to ensure that strategies are developed for implementing recommendations, disseminating learning and ensuring complaints feed into clinical governance and risk management processes. 3.0 Policy Statement Trafford CCG welcomes comments, suggestions, complaints and constructive criticism relating to the services that it provides, or commissions, on behalf of the residents of Trafford (Trafford registered population). These are important elements in enhancing the quality of work done by Trafford CCG. Trafford CCG supports the right of patients to have any complaint about NHS services investigated and to receive a full and prompt reply from the Customer Care and Experience Team, Service Lead for the area that the complaint relates to or Chief Clinical Officer. The focus of the policy and procedure is on early detection, prevention of recurrence and shared learning rather than apportionment of blame. It is important that no one (staff or service user) should be inhibited or disadvantaged when making complaints and that there is confidence that complaints will be given proper and speedy consideration. Staff directly cited in a complaint will be included in all correspondence as this increases staff confidence in a fair blame culture. Trafford CCG will ensure that patients, their carers and/or families are not discriminated against when complaints are made. Many matters that concern service users can be dealt with as they arise. Staff and managers are encouraged to be aware of and deal with these in a way that will satisfy the complainant. All staff who might need to deal with a complaint will receive appropriate training. The Patient Advice and Liaison Service (PALS), part of the Customer Care and Experience Department, is available to assist when advice or on the spot help is required (see sections on the Patient Advice and Liaison Service and PALS/Complaints interface for more information). All providers of NHS Services (including Independent Providers) are required to have in place a complaints procedure that is easy to access for patients and complainants; responsive and fair to patients and staff; and which is utilised in a positive way to secure improvement in the quality of services provided. In accordance with the principles of the complaints regulations Trafford CCG will undertake a commissioner led review in respect of a complaint where: Version 1.0 Page 9 of 65 November 2013
a. Trafford CCG has received it and the complainant declines to provide consent for the complaint to be passed to the provider concerned. b. Trafford CCG considers it appropriate to deal with the complaint and has informed the complainant and the provider of its intention to investigate. 4.0 Purpose of the Policy and Procedure The purpose of this policy and procedure is to have an easily identifiable and recognisable process for dealing with complaints from any area of Trafford CCG s services. The process must be efficient, effective and accessible. Information gained from handling complaints should be used to: Contribute to clinical governance processes Feed into claims, incidents and risk mechanisms Be complementary to Patient Advice and Liaison Service Promote learning in the organisation and, where things have gone wrong; avoid similar situations arising again Monitor complaints that come into Trafford CCG to identify trends that might cause concern Identify training needs Maintain good practice and quality standards Effective complaints handling can enhance the reputation of Trafford CCG. All staff should be made aware of the complaints policy and procedure (see circulation list and section on Training). 5.0 Definitions Responsible Body Primary care provider Independent provider Complaint Compliment Guideline The complaints regulations Complaints policy and procedure Strategy (Strategic) Local Authority, NHS body, primary care provider or independent provider A person or body who is a general medical services contractor providing primary medical services; a person or body who provides health care in England under arrangements made with an NHS body and is not an NHS body or primary care provider Is defined as an expression of dissatisfaction requiring a response. Expressions of appreciation or comments that can be recorded but do not require corrective action. A recommendation indicating how something should be done or an action that should be taken. It is used to guide conduct and acts in an advisory manner. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 The policy procedure adopted by Trafford CCG to deal with complaints. A strategy is a long-term plan of action designed to achieve a particular goal or set of goals. It is a high-level statement Version 1.0 Page 10 of 65 November 2013
Policy Procedure Patient Advice and Liaison Service (PALS) presenting a vision of what it is intended to achieve and why, and the benefits expected. A policy is a plan of action to be applied and contains approved authoritative actions to be taken and adhered to by staff. A standardised method of performing an action or task to accomplish an objective, which tends to refer to the required method rather than the result. The Patient Advice & Liaison Service (PALS) provides assistance in resolving concerns and answering queries or requests for advice raised by patients, their families and carers through negotiation and liaison with Trafford CCG or primary care practitioners. Provides information to patients, carers and families about local health services and other health related issues. Helps individuals access the complaints procedure & signposts to other agencies where appropriate. Independent Complaints Advocacy (ICA) The Parliamentary and Health Service Ombudsman for England and Wales (PHSO) Role of the Lay Conciliator Customer Care and Experience department Head of Customer Care and Experience Customer Care and Experience Manager Customer Care and Experience Officer Care Quality Commission Helps individuals access appropriate independent advice and local advocacy support The Independent Complaints Advocacy (ICA) is a free service provided by the Carers Federation on behalf of Healthwatch and is available for patients who wish to seek independent support, advocacy, assistance or guidance on the NHS Complaints Procedure. The Parliamentary and Health Service Ombudsman represents the second and final stage of the NHS Complaints Procedure. Anybody wishing to complain to the Ombudsman must first have pursued their complaint via the responsible body concerned. An independent lay person who can assist with handling complaints in the early stages of the NHS Complaints Procedure Central point of access at Trafford CCG for complaints and PALS matters. Has responsibility for the Customer Care and Experience team which consists of the complaints and PALS services and the Trafford CCG patient experience agenda The Complaints Manager defined in the complaints regulations Works with the Customer Care and Experience Manager around day to day complaints management and dealing with PALS issues The independent regulator of health and social care in England. Version 1.0 Page 11 of 65 November 2013
6.0 Duties and responsibilities Clinical Commissioning Groups are subject to a number of legal and statutory requirements in addition to applying good practice and guidance covering a wide range of subjects. In order to meet those requirements and to demonstrate sound governance principles within constraints of national directions and legislation, it is essential to have a clear and understandable operational policy. Clinical Commissioning Group specific duties and responsibilities are set out in 6.1 and 6.2 below. 6.1 Duties within the organisation 6.1.1 Role of the Chief Clinical Officer In accordance with the complaints regulations, the Chief Clinical Officer is the designated responsible person for ensuring compliance with the arrangements made under the complaints regulations, including ensuring that action is taken if necessary in accordance with the outcome of the complaint. This function may be delegated to any person authorised by Trafford CCG. 6.1.2 Role of Trafford CCG Board Trafford CCG board will be ultimately accountable for the operation of the complaints procedure. 6.1.3 Role of The Quality, Finance and Performance Committee (QFP Committee) The QFP Committee will monitor complaints arrangements via submission of quarterly and annual reports. 6.1.4 Role of Directors/Associate Director or Heads of Service Directors/Associate Directors and Services Leads will ensure that where a complaint relates to an area of their responsibility that it is processed as requested by the Customer Care and Experience Manager. 6.1.5 Role of the Customer Care and Experience Manager The complaints regulations provide that Trafford CCG must designate a person to be responsible for managing the procedures for handling and considering complaints in accordance with the arrangements made under the complaints regulations. This function may be delegated to any person authorised by Trafford CCG. 6.1.6 Role of the PALS officer The PALS officer (Customer Care and Experience officer) is responsible for the day-to-day operation of the PALS service. The PALS officer will ensure that systems are in place to enable Trafford CCG staff, Independent Contractors and the public to access the PALS service. Version 1.0 Page 12 of 65 November 2013
6.1.7 Role of all Trafford CCG staff All Trafford CCG staff have a duty to read and work within the spirit of Trafford CCG complaints policy and procedure and to ensure that they keep up to date with all procedural documentation issued by Trafford CCG. Staff must ensure that they are aware of the location of Trafford CCG complaints policy and procedure and how to access it. Staff have a responsibility to bring to the attention of the document author/lead Director, any part of a document that is identified to be no longer relevant or requires revision; staff should not wait until the identified review date of the document to notify of any suggested amendment. 7.0 Principles I. The NHS complaints procedure applies the same basic principles whether being dealt with at a CCG or any other provider of National Health Services. II. Complaints can be made verbally or in writing including by email or web site submission III. Complaints must be dealt with in a manner appropriate to enable speedy and efficient resolution. Where possible complaints should be resolved on the spot by those delivering the service in question. If a verbal complaint cannot be resolved immediately or a complainant wishes to contact someone other than the person concerned, s/he should be advised to speak with a manager for that area or a member of the Customer Care and Experience team. IV. Trafford CCG will undertake commissioner led investigations if appropriate. V. Concerns and comments generally, even those not intended as a complaint, must be dealt with in a constructive way with suggestions for improving services being readily accepted in a positive and non-defensive manner. A flexible and common sense approach is essential. VI. Clarity should always be sought regarding whether, in making a complaint, a patient s health care needs are being met. For example, the person might make a complaint about appointment availability that relates to a health need that requires immediate assistance. If unsure or concerned seek advice. VII. Any delay in investigation of a complaint, for whatever reason, should be explained to the complainant and any other person involved in the complaint. VIII. In considering complaints the following key principles will be adopted: Accessible and Open Complainants will be able to make their views known as easily as possible. Version 1.0 Page 13 of 65 November 2013
Confidentiality All complaints will be treated in strict confidence Impartial and Honest The Procedure will ensure that different points of view are listened to and investigated without prejudice. Responsive Simple The Procedures will address the issues raised and aim to satisfy concerns expressed wherever possible. The procedure will be clear and simple. IX. Trafford CCG commits to operating a learning, fair blame culture providing staff have not: Intended to cause harm Acted recklessly and taken an unjustifiable risk Negligently brought about a consequence which a reasonably competent person with his/her skills should have foreseen and avoided Acted illegally by committing a criminal act including circumstances resulting in a police investigation or prosecution Inappropriately or deliberately failed to comply with protocols or policies applicable to Trafford CCG Repeated poor performance that has not improved with training Breached legal requirements, contractual obligations or Professional Codes of Conduct 8.0 Objectives The complaints procedure is designed to: Enable complaints to be dealt with as swiftly as possible, in a conciliatory and courteous manner Empower staff to deal with complaints wherever possible Entitle the complainants to a full and fair investigation of their complaints, without fear of retribution Ensure that the complaints procedure is fair to both staff and complainants Ensure that the complaints system is simple and accessible. Use the complaints policy as a means of improving the quality of service we provide and to ensure we learn lessons Keep managers, staff, clinicians and the complainant informed and involved throughout the process Ensure that all complaints are properly monitored and recorded and appropriate reports submitted Ensure that complaints are dealt with within Trafford CCG with the Chief Clinical Officer being responsible for the final response and the Version 1.0 Page 14 of 65 November 2013
Head of Service accountable for the investigation and any subsequent action taken within the service Trafford CCG has named individuals responsible for the investigation of complaints. In all cases the appropriate person will support the process. service heads may, in exceptional circumstances, appoint investigators from outside of their service, or the organisation if they believe the complaint is of a sufficiently serious or complex nature Any issues highlighted by complaints investigations about service provision, clinical practice or of a disciplinary nature will always be dealt with by the head of service/relevant manger in accordance with policies and procedures. Staff should have access to support throughout the investigation of a complaint. Taking into account the limitations in respect of confidentially of complaints, staff may seek peer support or, should they feel this to be inappropriate, may access the Occupational Health confidential counselling service, their professional body (if they have one) and trade union. 9.0 Complaints/PALS Interface The Patient Advice and Liaison Service (PALS) forms part of the Customer Care and Experience team. PALS provides informal on the spot advice, support and information to patients, their relatives and carers in relation to local health services. This may include dealing with concerns and providing information in relation to the complaints process. Concerns raised with PALS are not subject to the complaints regulations and are not handled under the complaints process unless necessary in accordance with the complaints legislation. However, anyone who contacts PALS and makes it clear they wish to pursue a complaint will be referred to the complaints handling process. Raising a concern does not preclude the making of a complaint about the same matter at a later date. Anyone who contacts Trafford CCG and makes it clear that they wish to raise a concern rather than a complaint, should be referred either to the service concerned or to PALS to be dealt with outside of the complaints process. If it is not clear whether the person contacting Trafford CCG is raising a concern or a complaint, then the member or staff receiving the call should attempt to clarify this or refer the caller to the Customer Care and Experience Department who will explain the options available. PALS and complaints form an intrinsic link to identify common themes and service problems, often acting as an early indicator to prevent small operational problems becoming large organisational issues. 10.0 Ensuring those who complain are not disadvantaged The complaints policy and procedure is designed to ensure the handling of a complaint is in accordance with national guidance to maintain the confidentiality of the patient s information. Version 1.0 Page 15 of 65 November 2013
The process for ensuring that patients, relatives and their carers are not treated differently as a result of raising a complaint is as follows:- Patients will be given an oral explanation (where possible and appropriate) of the process to ensure they and any others involved are aware how any information related to the complaint will be handled. All enquiries will be carried out by Customer Care and Experience Manager to ensure the separation of the service provider who is directly providing the treatment from any involvement in the information collection relevant to the complaint. No information will be recorded in the patient s health records relating to the complaint. Patients/services users will be reassured that they have a right to make a complaint and that Trafford CCG encourages feedback as a means of putting right anything that has gone wrong, learning from this and sharing the learning to a wider audience (whilst maintaining confidentiality). The complaints leaflet reassures those who might wish to make a complaint that their care will not be affected. Staff who attend training on complaints handling are reminded that those who have made a complaint have a right to do so and this should not affect their care. 11.0 Consent/Confidentiality Access to health records should not be confused with access to the NHS complaints procedure - these are separate processes. It will often be the case that a complaint will relate to a clinical issue and so require disclosure of health records to the patient or their representative. All patients have a right of access to their health records, unless the contents of those records were to pose a serious threat to their mental or physical wellbeing. If a clinical decision is made that access to health records/information poses a serious threat to an individual therefore should not be disclosed, a second independent opinion should be obtained before a decision to withhold the records/information is made. If the representative for a patient competent to consent wishes to have access, or discuss any aspect of a patient s clinical records, they must supply written consent from the patient authorising Trafford CCG to reveal to, or discuss with, the representative any and all clinical information. Where a patient is unable to give consent and manage their own affairs, any person appointed by a court to manage those affairs may give consent for the release of clinical records and information to the representative of the patient (unless the representative of the patient is already the person appointed by the court). Version 1.0 Page 16 of 65 November 2013
Where a patient has died, the patient s executor or other personal representative (e.g. spouse/partner, son, daughter) may give consent for the release of clinical records and information in relation to the complaint. It is imperative that confidentiality is maintained throughout these procedures. Advice can be sought from the Information Governance Manager and/or Caldicott Guardian. Complaint records should be kept separate from patient health records, subject to the need to record information, which is strictly relevant to the patient s health. Staff are reminded that such records must be treated with the same degree of confidentiality as normal medical records and would be open to disclosure in legal proceedings. In order to respond to complainants, information about a complaint will only be shared with relevant staff whilst strictly maintaining patient confidentiality. When transferring complaints between agencies (including the Parliamentary and Health Service Ombudsman), it is essential to ensure that patient confidentiality is maintained at all times. Complaints will be logged onto Trafford CCG s risk management database. Access of this is controlled by the granting of access to specified users. Complaints, which relate to individual members of staff, will not be kept on personal files, unless the complaint results in any sort of capability or disciplinary action in which case the rules of the disciplinary procedure will apply. 12.0 Using Health Records in complaints investigations Care will be taken at all times to protect patient confidentiality and any patient identifiable information will be used on a need to know basis and will be limited to that which is relevant to the investigation of the complaint. Patients/representatives will be advised that information from their health records may be disclosed to relevant staff members in order to resolve the complaint When it is necessary to use patient s personal information to investigate a complaint it is not necessary to obtain the patient s express consent. Note - care must be taken at all times throughout the complaints procedure to ensure that any information disclosed about the patient is confined to that which is relevant to the investigation and only disclosed to those people who have a demonstrable need to know it for the purpose of investigating the complaint. Even so, it is good practice to explain to the patient that information from his/her health records may need to be disclosed to the managers/service leads relevant to the complaint and to clinical assessors. If the patient objects to this, then the effect on the investigation will need to be explained. The patient s wishes should always be respected, unless there is an overriding public interest in continuing with the matter. Version 1.0 Page 17 of 65 November 2013
13.0 CCG Member Practices Each practice is required to have in place a procedure for dealing with complaints in accordance with the complaints regulations. The patient/service user retains the right to make a complaint to NHS England, as commissioner of general practice services. Trafford CCG will provide support to GP practices to ensure that they comply with the requirement placed on them to investigate and respond to complaints be it specific case advice, meetings and training. As part of the working relationship with member practices, Trafford CCG will; Provide advice and support to practices in relation to their practice based complaints procedures and policies. Provide support to ensure that member practices effectively operate and publicise practice based procedures. Direct any complaints received where appropriate to the relevant practice for resolution Where Trafford CCG receives a written complaint relating to a member practice consent will be sought from the complainant before any correspondence is forwarded onto the relevant practice for resolution. 13.1 The Primary Care Quality Improvement Group By their subjective nature complaints do not automatically reveal concerns about performance, but occasionally they may raise issues that come within the scope of performance processes. If a complaint raises immediate and serious concern regarding the performance of a service provider, the Customer Care and Experience Manager will inform the Clinical Directorate. The Clinical Directorate will determine if the matter should be escalated to NHS England performance management process or the case referred to the Primary Care Quality Improvement Group for a decision on how the matter should proceed. The Clinical Director and the Primary Care Quality Improvement Group will be informed of complaints/pals cases and any trends indentified so that appropriate action can be taken. 14.0 Out of Hours GP services (Mastercall) Trafford CCG will treat complaints about Mastercall in the same way as though it were a complaint about any commissioned service provider. 15.0 Complaints about Commissioned Service Providers (NHS and non NHS) Trafford CCG will specify in contracts with commissioned service providers that the provider must have in place arrangements for the handling and consideration of complaints about any matter connected with its provision of Version 1.0 Page 18 of 65 November 2013
services under contract with Trafford CCG. All providers of NHS services are statutorily required to have in place a system for dealing with complaints about NHS services. Commissioned service providers will provide monitoring reports to Trafford CCG. 16.0 Complaints about funded nursing aspect of patient care Trafford CCG funds different levels of nursing care for patients in nursing homes known as a funded nursing contribution. The level of funded nursing care is based on the patient s level of need. This is assessed by a nurse assessor. For those complaints where Trafford CCG has funded the nursing aspect of a patient s care, a complainant would be advised in the first instance to approach the home concerned to make a complaint. However, if they wish to do so a complainant can access Trafford CCG s complaints procedure. The complaints regulations also apply to social service care providers and all local authority and social care providers must have a complaint process in place. 17.0 Independent Advocacy All service users should be made aware of the independent complaints advocacy service. This is a free of charge independent service designed to give advice and support to those who wish to complain about the NHS. The Independent Complaints Advocacy Service (ICA) can be contacted on 0808 801 0393. 18.0 Conciliation A conciliator is an independent lay person, not employed by Trafford CCG, who acts as a neutral chairperson between a complainant and complained against during local resolution. The conciliator s role is to ensure the parties have an opportunity to air their views. The conciliator s role is to identify areas of conflict, ensure that all issues are fully discussed and aired and help bring the situation to a satisfactory conclusion and resolution. Conciliators can only be used for local resolution with all parties full cooperation and consenting to such a process. It cannot be used as a coercive measure or threat against either a complainant or staff members. All those involved in conciliation need to be made aware of what the process involves. Parties need to enter the conciliation process willing to compromise and genuinely seek resolution. Version 1.0 Page 19 of 65 November 2013
19.0 Time limits A complaint should be made as soon as possible after the action giving rise to it. The complaints regulations state that complaints should be raised within twelve months of the date on which the event or action leading to the complaint occurred or within twelve months of the date, the complaint came to the notice of the complainant. Where a complaint is made after the period noted above the Customer Care and Experience Manager may investigate it if Trafford CCG is satisfied that the complainant had good reasons for not making the complaint within that time limit and it is still possible to investigate the complaint effectively and fairly. Flexibility and sensitivity should be used when considering late complaints e.g. where a complainant has suffered such distress or trauma that prevented him/her from complaining earlier. Discretion may on occasion be used to extend the time limit. This is a decision for the Customer Care and Experience Manager/Head of Customer Care and Experience (consulting the Chief Clinical Officer where appropriate). 20.0 Suspension of complaints procedure The normal complaint investigation shall (if it might compromise or prejudice other investigations) be suspended if a complaint requires action under any of the following; Investigation under disciplinary procedures Reference to a professional regulatory body An inquiry under Section 84 of the NHS Act 1977. An investigation of a criminal offence (subject to the requirement to do so in order to avoid prejudicing any case). A major public relations incident The person in receipt of the complaint should at once pass the relevant information to the Chief Clinical Officer or Customer Care and Experience Manager this will then be passed on to an appropriate person within Trafford CCG who can make a decision as to whether to initiate such action. 20.1 Serious complaints If a serious complaint arises, contact the Customer Care and Experience Manager who will seek further advice. Examples of serious complaints are: Gross misconduct A potential claim/litigation Involving adverse publicity The police Other agencies, e.g. Health Authority, Social Services, etc. Version 1.0 Page 20 of 65 November 2013
21.0 Exclusions The following complaints are not required to be dealt with in accordance the complaints regulations: a complaint by a responsible body; a complaint by an employee of a local authority or NHS body about any matter relating to that employment; a complaint which is made orally; and is resolved to the complainant s satisfaction not later than the next working day after the day on which the complaint was made. Or has been resolved previously using this method a complaint the subject matter of which has previously been investigated under a) these Regulations; b) the 2004 Regulations, in relation to a complaint made under those Regulations before 1st April 2009; c) the 2006 Regulations, in relation to a complaint made under those Regulations before 1st April 2009; or d) a relevant complaints procedure in relation to a complaint made under such a procedure before 1st April 2009; a complaint the subject matter of which is being or has been investigated by a) a Local Commissioner under the Local Government Act 1974(a); or b) a Health Service Commissioner under the 1993 Act; a complaint arising out of the alleged failure by a responsible body to comply with a request for information under the Freedom of Information Act 2000 and, a complaint which relates to any scheme established under section 10 (superannuation of persons engaged in health services, etc.) or section 24 (compensation for loss of office, etc.) of the Superannuation Act 1972(c), or to the administration of those schemes. The complaints policy is separate from disciplinary procedures. There are separate procedures. If the complaint is not required to be dealt with under the complaints regulations the relevant Lead Manager/Director will be expected to deal with such matters outside of the remit of the NHS complaints procedure. Complaints indicating suspected abuse of any vulnerable adult will be dealt with in accordance with the Procedures for the Safeguarding of Vulnerable Adults. The NHS complaints procedure cannot be used by those wishing to complain about decisions made by the NHS pension and NHS injury scheme. Separate procedures exist for this purpose. 22.0 Possible claims for negligence Cases that are subject to legal action are not excluded from the complaints process. On receipt of a complaint in these circumstances the Customer Care Version 1.0 Page 21 of 65 November 2013
and Experience Manager/Head of Customer Care and Experience will determine whether investigating the complaint might prejudice subsequent legal or judicial action. This will be done in discussion with the relevant authority (for example, legal advisors, the police, or the Crown Prosecution Service). When it is considered progression of the complaint may prejudice subsequent legal or judicial action the complaint will be put on hold, and the complainant will be advised of this fact. 23.0 Special Circumstances If a complaint involves any of the exclusions previously listed above, is out of time, contains consent/confidentiality issues or any of the following, then a suitably adapted acknowledgement/response will be sent to the complainant. Advice should always be sought from the Customer Care and Experience team when a complaint: Involves other agencies Is a result of a serious untoward incident Highlights conduct of a member of staff which may result in disciplinary proceedings Identifies a potential criminal offence It includes allegations of clinical negligence or other serious matters which might result in litigation 24.0 Who can complain? This can be complicated. If unsure speak with the Customer Care and Experience team to clarify if a complainant is legitimately able to use the NHS complaints procedure. In general terms a complaint may be made by: a person who receives or has received services from Trafford CCG including any commissioned service or a person who is affected, or likely to be affected, by the action, omission or decision of Trafford CCG including any commissioned service which is the subject of the complaint. A representative acting on behalf of a person noted above who: a) has died; b) is a child; c) is unable to make the complaint themselves because of (i) physical incapacity; or (ii) lack of capacity within the meaning of the Mental Capacity Act 2005; or d) has requested the representative to act on their behalf. Where a representative makes a complaint on behalf of a child, Trafford CCG must not consider the complaint unless it is satisfied that there are reasonable grounds for the complaint being made by a representative instead of the child and if it is not so satisfied, it must notify the Version 1.0 Page 22 of 65 November 2013
representative in writing, and state the reason for its decision. This paragraph applies where: (i) a representative makes a complaint on behalf of a child or a person who lacks capacity within the meaning of the Mental Capacity Act 2005; and (ii) the responsible body to which the complaint is made is satisfied that the representative is not conducting the complaint in the best interests of the person on whose behalf the complaint is made. In the case of a patient or person affected who has died or who is incapable, the representative must be a relative or other person who, in the opinion of the Customer Care and Experience Manager/Head of Customer Care and Experience has a sufficient interest in his/her welfare and is a suitable person to act as representative taking into account relevant legislation. If in any case the Customer Care and Experience Manager/Head of Customer Care and Experience is of the opinion that a representative does or did not have a sufficient interest in a person's welfare or is unsuitable to act as a representative, they must notify that person in writing, giving reasons. In the case of a child, the representative must be a parent, guardian or other adult person who has care of the child and where the child is in the care of a Local Authority or a voluntary organisation, the representative must be a person authorised by the Local Authority or the voluntary organisation. In cases where the patient is an adult and would normally be able to make a complaint themselves, express consent from the complainant (if not the patient) to act for the patient must be sought. There are caveats to the above - check if unsure. 25.0 Complaints Procedure general The complaints procedure is divided into two parts; the local resolution stage and the Parliamentary and Health Service Ombudsman review 25.1 Local Resolution stage Ideally complaints will, where appropriate, be resolved on the spot by front-line staff or referred on to a manager or service lead to resolve the complaint. The emphasis of the complaints process is to find an agreed way forward to resolve the complaint as quickly and appropriately as possible. There are no regulated time scales for responding to a complaint; however, we will reach agreement with the complainant to provide a response. This will be dependent on the seriousness or complexity of the complaint. Attempts will be made to respond to complaints within 20 working days. For more serious or complex cases; 30 working days. Where it is not possible to respond within the agreed period the complainant must be kept informed of the progress of the complaint and their agreement to any extension sought. Version 1.0 Page 23 of 65 November 2013
Where the complaint relates to a commissioned service the Customer Care and Experience Manager will contact the complainant to determine how the complaint will proceed. The options available are: a. Consent will be sought from the complainant to forward the complaint to the commissioned service provider. The commissioned service will investigate the complaint and provide a direct response to the complainant. b. Trafford CCG will under take a commissioner led investigation. This will include contacting the commissioned service provider for its response to the complaint, undertaking any further investigative work required and obtaining the views from a suitably qualified clinician, if the complaint relates to a clinical matter or other relevant expert. 25.2 The Parliamentary and Health Service Ombudsman (the Ombudsman) If the local resolution stage has not resolved the complaint to the satisfaction of the complainant, then s/he has the right to ask the Ombudsman to consider the complaint. The Ombudsman will not be able to investigate complaints until local resolution has been exhausted, unless in a particular case it is considered that this condition would be unreasonable. Staff also have the right of recourse to the ombudsman if they feel that they have been unfairly treated by the complaints procedure. Emphasis has been placed on the need for complaints to be resolved by local resolution, immediately if possible by a front line member of staff, or by investigation with a written response from the Chief Clinical Officer or the relevant service/ departmental lead. 26.0 Complaints procedure Trafford CCG will investigate or action all complaints received relating to the services provided or commissioned by Trafford CCG and to the actions, omissions or decisions taken by Trafford CCG. Actioning a complaint regarding a commissioned service includes directing the complainant to raise the complaint with the commissioned service provider if considered appropriate. The boundaries between services and the geographical areas within Trafford and other adjoining CCG are not always clear to service users and those who wish to make a complaint. As a general rule complaints will be dealt with by the CCG where the complaint originated. When a complaint is received about service provision the CCG that manages the facilities where the service was provided will acknowledge the complaint and contact the appropriate Head of Service/lead person to initiate an investigation. There will be exceptions to this general rule and each case will be considered individually. Version 1.0 Page 24 of 65 November 2013
Complaints may be made orally or in writing (including by email). Where the complaint is made verbally and cannot be resolved by the end of the next working day, the Customer Care and Experience Manager will make a written record of the complaint and provide a copy of that record to the complainant for confirmation. Complainants will be treated courteously and sympathetically by any person to whom they make their complaint and complaints will be properly addressed. The Customer Care and Experience Manager, on behalf of the Chief Clinical Officer, will manage action on complaints received at Trafford CCG. All complaints received should be passed directly to the Customer Care and Experience Manager who will keep a record of all complaints received. All complaints are held on Safeguard. The Customer Care and Experience Manager will arrange an electronic file to be set up containing letters, notes of all communications, other relevant notes and reports for each complaint. All written complaints received by Trafford CCG will be graded as to their severity based on a severity grading matrix recommended by the National Patient Safety Agency this is appended to this Policy and Procedure. All complaints that are not verbal complaints responded to by the end of the next working day, will be responded to in writing. The Chief Clinical Officer or department/ service lead will sign the final response. This response will also make clear the procedure for requesting further investigation by the Parliamentary and Health Service Ombudsman where complainants are dissatisfied with the response. 27.0 Local Resolution Verbal complaints, which cannot be resolved verbally by the end of the next working day, will be treated in the same way as written complaints. Staff will be empowered to resolve complaints on the spot. The first responsibility on receipt of such a complaint is to ensure before doing anything else that the patient s immediate health needs are being met. This may require urgent attention before any other matters are addressed. Verbal complaints (that are not resolved) should be recorded on the verbal complaints sheet and forwarded to the Customer Care and Experience Manager stating that the complainant is not satisfied and a response is required. The Customer Care and Experience Manager will contact the complainant to explain the process and if necessary establish the nature of the complaint. Any written complaints received should immediately be sent to the Customer Care and Experience Manager who will acknowledge them. Version 1.0 Page 25 of 65 November 2013