(To be read in conjunction with the Patient Relations (Complaints, Comments and Compliments) Policy and Procedures, the Investigation Policy, the Being Open Policy and the Supporting Staff Policy) Version: Ratified by: Final Quality and Safety Committee Date ratified: 26 May 2009 Name of originator/author: Name of responsible committee: Simon Trickett Quality and Safety Committee Date issued for publication: 30 April 2009 Review date: April 2012 Expiry date: March 2012 Target audience: All Staff including agency and temporary staff CONTRIBUTION LIST Key individuals involved in developing the document Name Simon Trickett Kath Garrad Designation Head of Communications and Community Engagement Patient Relations Manager April 2009 Page 1 of 24
This document supports The Local Authority Social Services and National Health Services Complaints (England) Regulations 2009 (Statutory Instruments 2009 No. 309) (27 February 2009) The Handbook to the NHS Constitution (21 January 2009) Department of Health Listening, Responding, Improving A guide to better customer care (26 February 2009) Principles of Good Complaint Handling, Parliamentary and Health Service Ombudsman (1 December 2008) Principles for Remedy, Parliamentary and Health Service Ombudsman (10 July 2008) National Health Service (Complaints) Amendment Regulations 2006, [SI 2006 No. 2084] EL(96)9 and Guidance on implementation of the NHS Complaints Procedure National Health Service (Complaints) Regulations 2004 Circulated to the following individuals for consultation: Name Bryan Smith Paul Bates Teresa French Sandra Rote Dr Richard Harling Brian Hanford Jane Pugh Vicky Preece Dr Bernie Gregory Ursula Hare Gill Thomas Jackie Cockrell Maureen Whitehead Finbarr Costigan Dr Sumit Bhaduri Richard Stringfellow Dave Kendall Rob Neill Pat McQueen Patsy Sweetland Lesley Way Richard Brine Janie Thomas Stella Baldwin Neal Palmer Designation Chairman Chief Executive Director of Provider Services Director of Clinical Development and Lead Executive Nurse Joint Director of Public Health Director of Finance, Information and Contracting Deputy Director of Provider Services Associate Director of Nursing Clinical Lead Prison Services Prison Health HMP Long Lartin HMP Hewell HMP Long Lartin Joint Medical Director Provider Services Joint Medical Director Provider Services Head of Corporate Development Head of Governance, Provider Services Information Governance Officer Staff Side Representative Expert Patient Facilitator Citizens Panel Patient Safety Manager PPI Representative PPI Representative PPI Representative Worcestershire Link April 2009 Page 2 of 24
CONTENTS 1 Introduction 4 2 Summary of NHS complaints procedure 4 3 Definition 5 4 Roles and Responsibilities 5 5 Complaints in prisons 6 6 Summary of the complaints procedure for prisons 6 7 Recommended process for dealing with healthcare 7 complaints in a prison setting 8 Parliamentary and Health Service Ombudsman 8 9 Access to information on the NHS complaints procedure 9 10 Access to Patient Advice and Liaison Service (PALS) and Independent Complaints Advocacy Service (POhWER ICAS) within a prison setting 9 11 Learning from complaints and PALS 9 12 Involvement of solicitors 10 13 Vexatious complainants 10 14 Document Archiving 10 15 Review 10 Appendices list Appendix 1: Healthcare complaint form 1 for healthcare team Appendix 2: Healthcare complaint form 1a) for appeal to healthcare management team Appendix 3: Healthcare Complaint form 1b for appeal to Chief Executive Appendix 4: Flow chart of healthcare complaints in a prison setting Appendix 5: Healthcare complaint poster 18 Appendix 6: Procedure for dealing with habitual or vexatious behaviour 11 13 15 17 19 April 2009 Page 3 of 24
1. Introduction This paper recommends an approach regarding the implementation of the NHS complaints procedure. 2. Summary of NHS complaint procedure 1 Each NHS body and primary care provider has a designated person responsible for complaints and a complaints manager. NHS bodies include hospital trusts and Primary Care Trusts. Primary care providers include general medical practitioners (GPs), dentists, ophthalmic opticians, ophthalmic medical practitioners and pharmacists. The most satisfactory outcome to complaints often comes when complaints are dealt with fully and effectively at local resolution. Local resolution seeks to provide a prompt investigation and resolution of the complaint at local level, aiming to satisfy the complainant whilst being fair to staff. The procedure should be open, fair, flexible and conciliatory and should encourage communication on all sides. The primary objective is to resolve the complaint satisfactorily. The NHS complaints procedure has two stages, i) local resolution and ii) independent review. At the local resolution stage, a patient who wants to make a complaint, or someone acting on their behalf, contacts a member of staff or the complaints manager of the organisation concerned. If either the member of staff cannot resolve the problem on the spot or the complaint is in writing, the member of staff passes it on to the complaints manager. After acknowledging receipt of the complaint in writing, the complaints manager arranges for an investigation of the complaint and prepares a written response to the complainant signed by or on behalf of the Chief Executive. If the complainant remains dissatisfied with the outcome of an investigation at local resolution, or the NHS body has decided not to investigate a complaint because, for example, it was not made within the specified time limit, the complainant can request an independent review by the Parliamentary and Health Service Ombudsman. Requests for independent review are made in writing. At any stage the complainant can contact the Independent Complaints Advocacy Service (POhWER ICAS) for advice and support in making a NHS complaint. ICAS is a national service, totally independent of the NHS, which provides free confidential support, help and advice to NHS patients or their representatives on all aspects of complaints relating to the NHS. The support provided includes a range of support for complainants from advising on the wording of letters to attending complaints meetings with them. A designated complaints manager will need to keep a complete documentary record of the handling and consideration of each complaint these records will be particularly important if the complaint is referred to the Parliamentary 1 Taken from The National Health Service (Complaints) Regulations 2004, the National Health Service (Complaints) Amendment Regulations 2006 (Statutory Instrument 2006 No. 2084) and the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. April 2009 Page 4 of 24
and Health Service Ombudsman. Complaints records should be kept separate from health records, subject to the need to record information which is strictly relevant to their health in the patient s health records. Complaints records should be held for 8 years. The Patient Advice Liaison Service (PALS) have an important role to play in addressing people s concerns on the spot, avoiding the need for the formal procedure. (This role is carried out by healthcare staff within the Prisons in Worcestershire). The initial response to someone who feels aggrieved is often crucial in establishing the confidence that his or her grievance will be properly treated. By responding quickly and efficiently, there will be a better chance of early resolution. In the early part of the process, it may be clear whether the complainant simply wants an explanation and apology, with the assurances that any failures in service will be rectified for the future. An open and sympathetic approach and response may satisfy the complainant. An apology is not an admission of liability. The potential subject of a complaint is wide, and each complaint must be taken on its own merit and responded to appropriately. Complaints are most likely to be initiated through front-line staff or with the healthcare manager. Front-line staff can deal with complaints, either by resolving the concern on the spot or passing them to a relevant colleague. The first responsibly of a recipient of a complaint is to ensure that the patient s immediate healthcare needs are being met. Staff should, where possible, deal with the complaint rapidly and in an informal and sensitive manner. Complainants should be encouraged to speak openly and freely about their concerns and should be reassured that whatever they may say will be treated with the appropriate confidence and sensitivity. 3. Definition A complaint may be made orally or in writing. A complaint is an expression of dissatisfaction, however made, about the standard of service, actions or lack of action by the organisation or its staff affecting an individual. Examples of complaints may include: Failure to provide a service at the right time or to the standard expected of the service. Dissatisfaction in answering a query or responding to a request for a service. Failure to follow the Service s agreed policy, orders or procedures. Failure to take proper account of relevant matters in coming to a decision. Discourteous or dishonest behaviour by a member of staff. 4. Roles and Responsibilities The Head of Communications and Community Engagement is responsible for overseeing the complaints function. The PCT has a complaints manager to oversee the investigation of each complaint. April 2009 Page 5 of 24
5. Complaints in prisons The culture of a prison setting allows people who access any service provision or service delivery the opportunity to have more time to reflect on the services provided, and ultimately potential frustration about their perception of the quality and standards of service delivery afforded to them. The challenge for staff and professionals involved is to ensure a high quality, equitable service for all. 6. Summary of the complaints procedure for prisons 2 Within the prison complaints system, prisoners can initiate a complaint by speaking to a member of staff or completing the appropriate form. There are specific forms designated for this purpose, for example, for ordinary complaints, appeals and confidential access complaints. Confidential access complaints are complaints about serious or sensitive issues which the prisoner might not want to discuss with prison wing staff. They are made to the Governor, the Area Manager or the Chair of the Independent Monitoring Board (IMB) in a sealed envelope that can be opened only by the addressee. Confidential access complaints can include complaints about healthcare. If a prisoner s complaint concerns a reserved subject, for example, an allegation against the Governor, it is handled by the Area Manager or Prison Service Headquarters. Like the NHS complaints procedure, the prison system encourages early resolution of issues through discussions between the complainant and frontline staff. This is a relatively informal process which involves prisoners speaking initially to wing staff, then using the applications system if they remain dissatisfied. Applications are held daily out of the hearing of other prisoners and provide an opportunity for staff to listen to a prisoner s problems in a more private environment. Prisoners can make written complaints on the appropriate form at any time. They are not required to use the informal procedure described above. Complaints forms must be freely available to prisoners on the wing and kept at or near the complaints box used for the receipt of completed forms on each wing. To handle formal complaints, prisons have a manager with responsibility for the complaints system and at least one complaints clerk. In addition, they have one or more designated officer(s) responsible for emptying the complaints boxes. This is done daily, except on weekends and public holidays. Designated officers either pass the complaints forms to the complaints clerk or directly to staff for reply. Before allocating complaints, the complaints clerk or designated officer must log them and add a serial number to the form. The serial number for confidential access complaints is written on the outside of the unopened envelope. 2 Taken from Prison Service Order 2510, Prisoner s Request and Complaints Procedure, issued 21 February 2002. April 2009 Page 6 of 24
The response to a complaint can go through three stages. Stage 1 is handled by the wing staff or appropriate person. Most formal complaints should be resolved at this stage. If the prisoner is dissatisfied with the Stage 1 response, they can take their complaint to Stage 2 where it is handled at management level. If they remain dissatisfied, they can make a final appeal to the governor at Stage 3. The response to a complaint is entered on the complaints form and returned to the prisoner directly or through the complaints clerk. A copy of the completed form is placed on the prisoner s file (F2050) and the complaints clerk retains a copy. The Prison Service retains copies of centrally held complaints for at least three years. The recipient of a confidential access complaint decides how to handle it. There is no formal appeal mechanism for a confidential access complaint. A prisoner may, however, take it to the Prisons and Probation Ombudsman. The response to a confidential access complaint is returned through the complaints clerk to the prisoner in a sealed envelope. Prisoners are entitled to ask the Independent Monitoring Board to look at a complaint or review a response at any point in the prison complaints system. Independent Monitoring Boards have a statutory duty to hear prisoners complaints and one of their roles is to monitor the complaints system. 7. Recommended process for dealing with healthcare complaints in a prison setting To ensure healthcare complaints are handled effectively, and to avoid confusion in the complaints process for prisoners, it is recommended to adopt, and adapt the prison complaints process forms, and name them Healthcare Complaint Form 1 (appendix 1), Healthcare Complaint Form 1a (appendix 2) and Healthcare Complaint Form 1b (appendix 3). Forms 1 and 1a will be produced on yellow paper and form 1b on green. This process enables prisoners to access the NHS complaints procedure at the local resolution stage. Introducing this initial local resolution form will not prevent prisoners from making face to face complaints to prison healthcare staff. It is worth noting that prisoners can also write letters freely with postage paid by the prison. To encourage local resolution the healthcare process initially follows the same process as the prison complaints process for form 1. A written response is made on the back of this form by a member of the healthcare team and passed directly back to the prisoner within 3 working days. If the prisoner remains dissatisfied then he should complete form 1a for a member of the healthcare management team to investigate and respond within 10 working days. Should the prisoner still remain dissatisfied with the outcome, the opportunity is there for the prisoner to pursue their complaint through the new national complaints system described in the Department of Health document Listening, Responding, Improving: A guide to better customer care April 2009 Page 7 of 24
(February 2009) and in the Local Authority and Social Services and National Health Service Complaints (England) Regulations 2009. The new system incorporates a new way of handling complaints that aims to: Resolve complaints more effectively by responding more personally and positively to individuals who are unhappy; and Ensure that opportunities for services to learn and improve are not lost. The arrangements for dealing with complaints must ensure that: a) complaints are dealt with efficiently b) complaints are properly investigated c) complainants are treated with respect and courtesy d) complainants receive, so far as is reasonably practical i) assistance to enable them to understand the procedure in relation to complaints, or ii) advice on where they may obtain such assistance e) complainants receive a timely and appropriate response f) complainants are told the outcome of the investigation of their complaint g) action is taken if necessary in the light of the outcome of a complaint The attached Flow Chart for healthcare complaints in a prison setting (Appendix 4) gives a guideline for response times. However, where complaints are referred to the Chief Executive, the PCT would expect 95% of all complainants to receive a full response within 25 working days. From 1 April 2009, if complainants are not satisfied with the outcome of their complaint at local level, they are able to ask the Parliamentary Health Service Ombudsman to independently review their case. 8. Parliamentary and Health Service Ombudsman 3 As indicated above, if a prisoner is dissatisfied with the response they receive from the PCT Chief Executive, they are at liberty to involve the Parliamentary and Health Service Ombudsman. The PCT will ensure that the prisoner is made aware of their rights to refer to the Ombudsman where appropriate. Where the Parliamentary and Health Service Ombudsman decide to investigate, they will require the same level of access to prisoners, prison staff and information as is currently afforded to the Prisons and Probation Ombudsman in the course of their investigations. In order to undertake their investigations, both organisations will need support from Prison Governors in the following ways: i Access to prison premises for Primary Care Trust investigation staff Parliamentary and Health Service Ombudsman and staff Lay panel member for independent reviews of complaints Expert clinical advisors 3 Handling Complaints about Prison Healthcare, draft document. April 2009 Page 8 of 24
ii iii Access to prisoners and prison staff for interviewing purposes Access to clinical records, prison records, local operational protocols and processes. The expectation is that Parliamentary and Health Service Ombudsman staff, lay panel members and expert clinical advisers would be treated as Official and Professional visitors. 4 Access to medical records and other prisoner sensitive information would be dealt with in accordance with the Data Protection Act and would only be accessed with appropriate consent. The Parliamentary and Health Service Ombudsman has agreed that the PCT and Prison Governors will be kept fully informed of complaints made concerning services being provided in their establishments. Concerns have previously been voiced to the West Midlands Prison Task Force about the logistics of the involvement of the Ombudsman. It can be several months before either organisation is aware and acts on the receipt of the complaint, or as such the prisoner may have moved on within the prison service or even have completed their stay within the prison service. 9. Access to information on the NHS Complaints procedure Information on the healthcare centre is provided to all prisoners on arrival to the prison. This leaflet contains information on the services provided, and explains the process by which to access these services. Information leaflets are also within the healthcare centre and posters will be been placed on the wings (appendix 4) advising prisoners that if they wish to make a complaint about healthcare then yellow forms are required to be filled in. 10. Access to Patient Advice and Liaison Service (PALS) and Independent Complaints Advocacy Service (ICAS) within a Prison Setting The PALS role is currently carried out by healthcare staff and the Healthcare Manager within the prisons. The Worcestershire-based ICAS offer a support service to prisoners if requested and access to this is by writing to POhWER ICAS, County Buildings, St Mary s Street, Worcester WR1 1LT. Analysis of all PALS enquiries and their resolutions will be shared in aggregate form to the PCT as part of the normal feedback reporting arrangements. 11. Learning from complaints and PALS All complaints against provider staff will be discussed by the professional advisory network to ensure learning across the PCT. The Healthcare Manager from the prison setting will be invited to attend these meetings. Complaint forms 1, 1a and 1b will be retained by the PCT, and reported within the quarterly board reports. Likewise any reports from the Parliamentary and Health Service Ombudsman and POhWER ICAS will be discussed at this group and reported in the quarterly board reports to the Board. 4 Memorandum from Peter Atherton, 22 July 2004 and Memorandum from Michael Spurr, 30 July 2004. April 2009 Page 9 of 24
12. Involvement of solicitors As soon as the PCT receives a letter from a solicitor requesting compensation, the NHS complaints procedure decrees that the letter must be treated as a claim against the PCT and so the complaints procedure is either suspended or not started. It is understood that the culture of the prison is such that it is likely that the PCT will receive more letters from solicitors. If a letter is received from a solicitor complaining about the healthcare service and treatment provided by a member of staff/primary care contractor, it is suggested that it is returned and requested that the prisoner goes through the channels as outlined above. If the letter claims compensation for treatment provided by a member(s) of staff directly employed by the PCT, it will be treated as a claim against the PCT and will be referred to the NHS Litigation Authority. If the letter claims compensation for treatment provided by a primary care contractor, it will be forwarded to the appropriate contractor. 13. Vexatious complainants The PCT has adopted a vexatious behaviour policy; this will apply to prisoners. 14. Document Archiving Documents will be archived in accordance with the PCT policy. 15. Review Kath Garrad April 2009 Appendices This procedure will be reviewed two years from publication, unless circumstances arise requiring an early review or updating of the procedure. Appendix 1: Appendix 2: Appendix 3: Appendix 4: Appendix 5: Healthcare Complaint form 1 for healthcare team (yellow - 2 pages) Healthcare Complaint form 1a) for appeal to healthcare management team (yellow 2 pages) Healthcare Complaint form 1b for appeal to Chief Executive (green - 2 pages) Flow chart of healthcare complaints in a prison setting (1 page) Healthcare Complaint poster (1 page) April 2009 Page 10 of 24
Healthcare Comp Form 1 WORCESTERSHIRE PRIMARY CARE TRUST HEALTHCARE PROVISION AND COMPLAINTS Appendix 1 INITIAL LOCAL RESOLUTION FORM Please read these notes first: 1. This form can be used if you wish to make a comment or raise a complaint about healthcare provision within prison. In the first instance you should bring this to the attention of a member of healthcare staff as part of trying to resolve things locally (local resolution). 2. This form is ONLY to be used in relation to healthcare provision. 3. If you are making a healthcare complaint, investigating your complaint will mean that others not just prison staff will have to know about it. However, confidentiality will be respected as far as possible. The response will be sent back to you in a sealed envelope. 4. Say why you have complained, what the healthcare complaint you are making is about, and what you would like to achieve from making a healthcare complaint. 5. When you have completed the form, post the form in the healthcare application box. 6. A response will be provided within 3 working days. 7. If you are unhappy with the response, you can complete form Healthcare Comp 1a. 8. This form is available from the healthcare manager in large print, audio and other languages as required. 1 Your details (please use BLOCK CAPITALS) Last name: Prison number: First name(s): Location: 2 Do you give your consent for us to contact third parties, i.e. other clinicians/ managers, in order to resolve this healthcare complaint? Yes No (Please be aware your healthcare complaint might not be investigated fully if you do not give your consent) Signed Date. 3 Have you discussed your healthcare complaint with anyone? Yes No If so, who did you speak to? April 2009 Page 11 of 24
4 What is your healthcare complaint about? a. Treatment b. Appointments c. Other d. Medication e. Manner / attitude of staff Please explain more fully 5 What would you like to achieve from making this healthcare complaint? 6 Healthcare team response (including any action taken) If you are unhappy with the response provided, you can complete form Healthcare Comp Form 1a. RESPONSE DATE: HEALTHCARE TEAM MEMBER S SIGNATURE:.. TITLE:.. Copy to: Healthcare April 2009 Page 12 of 24
Healthcare Comp Form 1a WORCESTERSHIRE PRIMARY CARE TRUST HEALTHCARE PROVISION AND COMPLAINTS Appendix 2 Prisoner s appeal to Healthcare Management Team Regarding Healthcare Comp Form 1 Please read these notes first: 1. This form can be used if you wish to make a comment or raise a complaint about healthcare provision within prison. In the first instance you should bring this to the attention of a member of healthcare staff as part of trying to resolve things locally (local resolution). 2. This form is ONLY to be used in relation to healthcare provision. 3. If you are making a healthcare complaint, investigating your complaint will mean that others not just prison staff will have to know about it. However, confidentiality will be respected as far as possible. The response will be sent back to you in a sealed envelope. 4. Say why you have complained, what the healthcare complaint you are making is about, and what you would like to achieve from making a healthcare complaint. 5. When you have completed the form, post the form in the healthcare application box. 6. A response will be provided within 10 working days. 7. If you are unhappy with the response, you can complete form Healthcare Comp 1b. 8. This form is available from the healthcare manager in large print, audio and other languages as required. 1 Your details (please use BLOCK CAPITALS) Last name: Prison number: First name(s): Location: 2 Do you give your consent for us to contact third parties, i.e. other clinicians/ managers, in order to resolve this healthcare complaint? Yes No (Please be aware your healthcare complaint might not be investigated fully if you do not give your consent) Signed Date. 3 Have you discussed your healthcare complaint with anyone? Yes No If so, who did you speak to? April 2009 Page 13 of 24
4 What is your healthcare complaint about? a. Treatment b. Appointments c. Other d. Medication e. Manner / attitude of staff Please explain more fully 5 What would you like to achieve from making this healthcare complaint? 6 Healthcare management team response (including any action taken) If you are unhappy with the response provided, you can complete form Healthcare Comp Form 1b. RESPONSE DATE:.. HEALTHCARE MANAGEMENT TEAM S SIGNATURE:.. TITLE: Copy to: Healthcare April 2009 Page 14 of 24
WORCESTERSHIRE PRIMARY CARE TRUST Appendix 3 Healthcare provision and complaints Prisoner s appeal against the response on Healthcare Comp Form 1a Please read these notes first: 1 This form can be used to say why you are not satisfied with the response to the written healthcare complaint which you have made on Healthcare Comp Form 1a. 2 Please say why you are not satisfied with the response to your complaint. Please be brief and to the point. 3 When you have completed the form, sign it and post it in the healthcare application box. 4 An acknowledgment letter will be sent to you from the Primary Care Trust (PCT) within 3 working days. 5 A full response from the Chief Executive of the PCT will be sent to you as soon as possible and, in most cases, we would expect this to be within 25 working days. If the response cannot be made within this time then you will be informed of the delay. 6 If you are still not satisfied with the response, you can appeal to the Parliamentary and Health Service Ombudsman. 7 This form is available from the healthcare manager in large print, audio and other languages as required. 1 Your details (use BLOCK CAPITALS) Healthcare Comp Form 1b Last name: Prison number: First name(s): Location: 2 Do you give your consent for us to contact third parties, i.e. other clinicians/ managers, in order to resolve this healthcare complaint? Yes No (Please be aware your healthcare complaint might not be investigated fully if you do not give your consent) Signed Date. 3 Say why you are not satisfied with the initial response to your healthcare complaint: April 2009 Page 15 of 24
4 What remaining issues do you have about your healthcare complaint? 5 What would you like to achieve from making this healthcare complaint? 6 Other advice in relation to healthcare issues If you have a healthcare concern, or need advice in relation to healthcare provision in Prison then the Patient Advice and Liaison Service (PALS)/Patient Relations team can provide a confidential service to: Advice and support to patients, families and carers. Provide information on NHS services Listen to your concerns, suggestions or queries Help to resolve problems on your behalf 7 Other advice in relation to healthcare complaints Contact the Independent Complaints Advocacy Service (POhWER ICAS) who can provide, free, confidential assistance in making a healthcare complaint. Please discuss how to contact POhWER ICAS or PALS with the healthcare manager FOR OFFICE USE ONLY: Date Received: Acknowledgment letter sent: Final Response sent: April 2009 Page 16 of 24
Appendix 4 Healthcare Complaints in a Prison Setting Prisoner has a healthcare complaint / issue Options Complains orally to a member of prison staff Fills in Complaints form 1 Contacts PALS or ICAS Contacts the PCT by letter PALS resolves issue or PALS, ICAS & PCT signpost to complaints form 1 & formal complaints procedure Local resolution Response provided 3 working days Prisoner satisfied no further action Prisoner dissatisfied Complaints form 1a response provided within 10 working days & 1b response within 25 working days (in most cases) Conciliation Local resolution Complaint will be acknowledged within 3 working day of receipt. A full Chief Executive response will be proved as soon as possible; in most cases this will be within 25 working days Parliamentary and Health Service Ombudsman Complaint forms 1, 1a and 1b to be retained by the PCT, and reported within the quarterly board reports, and reviewed at the professional advisory network (Closing the Loop) to monitor trends and lessons learnt. Likewise any reports from the Parliamentary Health Service Ombudsman will be discussed in this forum. Key: PALS Patient Advice and Liaison Service ICAS Independent Complaints Advocacy Service PCT Primary Care Trust April 2009 Page 17 of 24
WORCESTERSHIRE PRIMARY CARE TRUST Appendix 5 Prison healthcare Are we giving you a good service? We are committed to ensuring that the care you receive is of the highest quality. We would like your help to improve the service and would welcome any comments about the care or service you have received. Use the yellow Healthcare Comp Form 1 and post in the healthcare application box. A response will be given within 3 working days. If you are dissatisfied, please use Healthcare Comp Form 1a and post in the healthcare application box. The Healthcare Management Team will provide a response within 10 working days. If you remain dissatisfied, please use Healthcare Comp Form 1b and post in the healthcare application box. The Chief Executive of the Primary Care Trust will review your complaint and respond to you within 25 working days. You must use Healthcare Comp Form 1 first, then Healthcare Comp Form 1a, then Healthcare Comp Form 1b. April 2009 Page 18 of 24
Policy for dealing with habitually demanding or vexatious complainants and/or habitually demanding or vexatious behaviour Version: Ratified by: Final Quality and Safety Committee Date ratified: 26 August 2008 Name of originator/author: Name of responsible committee: Simon Trickett Quality and Safety Committee Date issued for publication: 26 August 2008 Review date: August 2010 Expiry date: September 2010 Target audience: All Staff including agency and temporary staff CONTRIBUTION LIST Key individuals involved in developing the document Name Simon Trickett Kath Garrad Designation Head of Communications and Community Engagement Compliments and Complaints Manager April 2009 Page 19 of 24
CONTENTS 1 Introduction 2 Purpose of Policy 3 Definition 4 Roles and Responsibilities 4.1 Management responsibilities 4.2 Employee responsibilities 5 Options for dealing with habitually demanding or vexatious complainants and/or habitually demanding or vexatious behaviour, including: Stage 1 Stage 2 Stage 3 6 Withdrawing habitual or vexatious status 7 Freedom of Information Act 2000 8 Document Archiving 9 Review April 2009 Page 20 of 24
1. INTRODUCTION Habitually demanding or vexatious complainants, and/or people who exhibit habitually demanding or vexatious behaviour, are an increasing problem for NHS staff. Handling such people or complainants could place a strain on time and resources and cause unacceptable stress for staff, who may need support in difficult situations. The following procedures set out the Primary Care Trust s policy in dealing with such people or complainants. It must be stressed that the vast majority of people who do come into contact with staff employed by Worcestershire PCT do not display such behaviour. This procedure is for the small minority who do. Execution of these procedures would only take place in exceptional circumstances. The procedures outlined in this document will only be used as a last resort and after all reasonable measures have been taken to try to resolve issues locally or through the NHS complaints procedure. Judgment and discretion must be used in applying the criteria to identify such behaviour and in deciding on the action to be taken in each case. The procedure will only be implemented following careful consideration by, and with the authorisation of, the Chief Executive of the PCT and any relevant Director (or their deputy). References to habitually demanding or vexatious complainants should be considered in conjunction with the PCT s Compliments and Complaints Policy and Procedure. 2. PURPOSE OF THIS POLICY 2.1 To identify situations where someone might be considered to fall into these categories and establish a procedure whereby they can be treated equitably and fairly. 2.2 To protect staff from the nuisance, abuse and threatened or actual harm, which may be caused by such behaviour. 3. DEFINITION 3.1 It is accepted that complainants, or others coming into contact with the PCT may act out of character. They may show signs of vexatious behaviour for several reasons and may be unaware that their attitude/behaviour is causing unnecessary distress to others. Unacceptable behaviour that continues through several contacts however, should be considered against this procedure. 3.2 One definition of vexatious behaviour is to harass, distress, annoy, tease, cause trouble, agitate, disturb or pursue issues excessively. 3.3 Behaviour exhibited by a person (and/or anyone acting on their behalf) may be deemed to be habitually demanding or vexatious where previous or current contact with them shows that they meet any of the following criteria: a) persisting in pursuing a complaint where the NHS complaints procedure has been fully and properly implemented and exhausted, but no appeal has been made to the Healthcare Commission. April 2009 Page 21 of 24
b) seeking to prolong contact by continually raising further concerns or questions upon receipt of a response. (Care must be taken not to discard new issues, which are significantly different from the original issue. These might need to be addressed as separate issues.) c) unwilling to accept documented evidence as being factual or denying receipt of an adequate response in spite of correspondence specifically answering their questions, or does not accept that facts can sometimes be difficult to verify when a long period of time has elapsed. d) does not clearly identify the precise problem, despite reasonable efforts of PCT staff and, where appropriate, the Independent Complaints and Advocacy Service (ICAS), to help them specify their concerns, and/or where the concerns are not within the remit of the PCT to investigate. e) focuses on a matter to an extent, which is out of proportion to its significance and continues to focus on this point. f) has threatened or used actual physical violence towards staff or their families or associates. This will, of itself, cause personal contact with the person and/or their representatives to be discontinued and the issue will, thereafter, only be pursued through written communication. g) has harassed or been personally abusive or verbally aggressive on more than one occasion towards staff dealing with their issue or their families or associates. However, staff must recognise that people may sometimes act out of character at times of stress, anxiety or illness and should make reasonable allowances for this. h) has had, in the course of addressing an issue, an excessive number of contacts with the PCT, placing unreasonable demands on staff time or resources. (A contact may be in person, or by telephone, letter, fax or e- mail.) Judgement must be used in determining what is an "excessive number" of contacts and this will be based on the specific circumstances of each individual case. i) has electronically recorded meetings or face to face/telephone conversations without the prior knowledge or consent of the other parties involved. j) displays unreasonable demands or expectations and fails to accept that these may be unreasonable (e.g. insists on responses to enquiries being provided more urgently than is reasonable or normally recognised practice). 4 ROLES AND RESPONSIBILITIES 4.1 Management Responsibilities The Head of Communications and Community Engagement is responsible for overseeing the complaints function. The PCT has a complaints manager to oversee the investigation of each complaint. April 2009 Page 22 of 24
4.2 Employee Responsibilities Staff need to fully record any suggestion of vexatious behaviour. Good documented evidence will be required and the completion of incident forms is mandatory for incidents relating to possible verbal or physical abuse (this includes telephone conversations). 5 OPTIONS FOR DEALING WITH HABITUALLY DEMANDING OR VEXATIOUS COMPLAINANTS AND/OR HABITUALLY DEMANDING OR VEXATIOUS BEHAVIOUR 5.1 Where people have been identified as exhibiting "habitual or vexatious" behaviour in accordance with the above criteria, the Chief Executive and the relevant Director (or their deputy) will decide what action to take. The Chief Executive will then implement the action and will notify complainants in writing of the action that has been taken and the reasons for it. 5.2 If appropriate, notifications under this policy may be copied for the information of others already involved e.g. General Practitioners, ICAS, and Member of Parliament. A record will be kept of the reasons why someone has been classified as "habitual or vexatious". Once classified as "habitual or vexatious", people will be dealt with as follows: Stage 1: Once it is clear that an individual meets the criteria above, it may be appropriate to inform them, in writing, that their conduct is unacceptable and that, if it continues, they may be classified as "habitual or vexatious". The letter should state clearly which elements of their behaviour are causing problems and be accompanied by a copy of this policy. If people are using the NHS complaints procedure, they should also be advised to seek advice e.g. from their local ICAS provider in presenting their complaint. Stage 2: It may be appropriate to try to resolve matters by drawing up a signed agreement with the person, which sets out a code of behaviour for the parties involved, if the PCT is to continue communication or to process a complaint. If these terms are contravened consideration will be given to implementing Stage 3 of the procedure. A code of behaviour could include the following: An agreement relating to appropriate behaviour and conduct. Any such agreement should normally not extend beyond six months. Restricting contact to one or two individuals within the PCT. Restricting the method of communication (e.g. by letter only, not fax/email). Offering a meeting to attempt to resolve outstanding issues. Stage 3: Where the PCT has responded fully to the points raised by the person and has tried to resolve the issues, without success, and continuing contact on the matter would serve no useful purpose, the individual will be notified by April 2009 Page 23 of 24
the Chief Executive that the contact is at an end and that further contact will be acknowledged, but not answered. In extreme cases, or where the safety of staff is at risk, the individual will be informed that the PCT reserves the right to pass habitually unreasonable or vexatious behaviour to their solicitors. All contact with the person and/or investigation of the complaint will be suspended whilst seeking legal advice or guidance from the West Midlands Strategic Health Authority or other relevant agencies. Any further complaints received from a person who has been designated as habitually demanding or vexatious, under this policy, will be subject to a reasonable investigation as deemed necessary by the Chief Executive in conjunction with advice received from staff dealing with complaints. The Chief Executive (or deputy), in conjunction with the Chairman, may, at their discretion, choose to omit one or two of the above stages. 6 WITHDRAWING HABITUAL OR VEXATIOUS STATUS When individuals have been classified as habitual or vexatious, the status will continue to apply for six months, at the end of which period habitual or vexatious status will automatically be withdrawn. In exceptional circumstances, the PCT will consider withdrawing this status earlier if, for example, the person subsequently demonstrates a more reasonable approach. The status of habitual or vexatious will only apply to specific issues, not general. If a new issue comes to light, an individual may not be deemed habitual or vexatious unless their behaviour demonstrated this relating to the new issue. Where it appears to be appropriate to withdraw "habitually demanding or vexatious" behaviour status, the approval of the Chief Executive and relevant Director (or their deputy) will be required. Subject to this approval, normal contact with the person will be resumed. 7 FREEDOM OF INFORMATION ACT 2000 Where a freedom of information act request is made by a complainant or person who has been designated as habitually demanding or vexatious, the pct may, in assessing whether that individual request is a vexatious request, take into account the habitually demanding or vexatious complainants/behaviour if it considers this to be relevant. In doing so, the pct will also follow information commissioner guidance on vexatious requests. 8. DOCUMENT ARCHIVING Documents will be archived in accordance with the PCT policy. 9. REVIEW This policy/procedure will be reviewed two years from publication, unless circumstances arise requiring an early review or updating of the policy. Kath Garrad August 2008 April 2009 Page 24 of 24