POLICY FOR THE REPORTING AND MANAGEMENT OF COMPLAINTS, COMMENTS & CONCERNS October 2017 Authorship: Patient Experience Manager, Directorate of Quality & Assurance, NLCCG Quality & Experience Manager, Directorate of Quality & Assurance, NLCCG Committee Approved: NHS North Lincolnshire Clinical Commissioning Group Quality Group Approved date: 25 October 2017 Review Date: September 2019 Equality Impact Assessment: Y Sustainability Impact Y Assessment: Target Audience: All Policy Reference No: Version Number: V6.0 The on-line version is the only version that is maintained. Any printed copies should, therefore, be viewed as uncontrolled and as such may not necessarily contain the latest updates and amendments.
AMENDMENTS Amendments to the policy guidance and template document may be issued from time to time. A new amendment history will be issued with each change. New Version Number Issued by Nature of Amendment V2.0 YHCS Updates per changes to national guidance and good practice V3.0 CCG Amendments requested at the CCG Quality Group on 23 July 2015: 7.Roles/Responsibilities/Duties (page 6) o Head of Programme Management and Integrated Governance to be amended to the Director of Risk and Quality Assurance 8.1. Complaints Procedure (page 7) o Amendment to be made: A complaint must be made no later than 12 months after the date the incident occurred, however in exceptional circumstances the time limit may be waived if it is considered by the Chief Officer or Delegated Executive that the complainant had good reason for not making the complaint within the timeframe and it is possible to investigate effectively and fairly V4.0 CCG Updated per changes to national guidance and good practice V5.0 CCG Updated per changes to national and local good practice V6.0 CCG Update to incorporate changes requested by members of the Quality Group Approved by & Date CCG Quality Group 23 July 2015 Date on Intranet Page 2 of 34
CONTENTS Page 1.0 Introduction 4 2.0 Impact Analyses 5 3.0 Scope 6 4.0 Purpose 7 5.0 Policy Statement 7 6.0 Definitions 7 7.0 Roles/Responsibilities/Duties 8 8.0 Implementing this Policy 8 9.0 Correspondence received from Members of Parliament (MPs) and Councillors 15 10.0 Complex/Multi-agency Complaints 15 11.0 Unreasonable Persistent Contacts 16 12.0 Complaints Not Covered by the Policy 16 13.0 Training & Awareness 17 14.0 Monitoring & Audit 17 15.0 Policy Review 17 16.0 Useful Contacts 18 17.0 References 18 18.0 Appendices 20 Appendix 1 - NLCCG Complaints Process 20 Appendix 2 - NLCCG Complaints Handling Procedure 22 Flowchart Appendix 3 - Procedure for the Management of 24 Unreasonable or Persistent Contacts Appendix 4 - Integrated Impact Assessment 28 Page 3 of 34
1.0 INTRODUCTION The NHS North Lincolnshire Clinical Commissioning Group (hereafter referred to as the CCG ) is committed to working in partnership with patients, CCG staff, members of the public and other key stakeholders to inform the improvement of health service delivery across the North Lincolnshire area. Ensuring good handling of complaints is one way in which CCGs can help to improve quality of care for patients, and learning from complaints enables organisations to continually improve the services they provide and the experience for all patients. 1.1 Regulations This policy meets the requirements of the Local Authority Social Services and National Health Service Complaints [England] Regulations 2009 1 (hereafter referred to as the regulations ) and conforms to the NHS Constitution and reflects the recommendations from the Francis report (2013). The regulations set out an outcome based approach to complaints handling and cover both NHS services and social care. 1.2 Best Practice In 2009, the Department of Health published Listening, Responding and Improving a guide to better customer care 2009 2. This guidance supplements the 2009 regulations and provides support and direction to health and social care staff on how to build organisations that listen, respond and learn from people s experiences of care. An excerpt from this guidance is provided below; By listening to people about their experiences of health and social care services, managers can resolve mistakes faster, learn new ways to improve and prevent the same problems from happening in the future. In short, by dealing with complaints more effectively, services can get better, which will improve things for the people who use them as well as for the staff working in them. This policy incorporates the learning points and principles that are provided in the guidance described above and the guidance provided within the NHS England Guide to Good Handling of Complaints for CCGs, published May 2013 3. The CCG also applies a user-centred approach to the investigation and management of complaints, comments and concerns, as recommended by the Care Quality Commission (CQC) in the Complaints Matter 4 report published by the CQC in December 2014. The CQC s approach underpins the 1 http://www.legislation.gov.uk/uksi/2009/309/contents/made 2 http://webarchive.nationalarchives.gov.uk/20130104224337/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/do cuments/digitalasset/dh_095439.pdf 3 https://chcfunding.files.wordpress.com/2014/05/good-complaints-handling-for-ccgs-nhs-may-2013.pdf 4 http://www.cqc.org.uk/publications/themed-work/complaints-matter Page 4 of 34
CCG s complaints handling process and this is reflected in section 18 of this policy. 1.3 Local Context With a growing population of approximately 170,000 people, it is acknowledged that some people will occasionally be dissatisfied with the services or the care they receive. The CCG recognises the importance of using the information gained through complaints, concerns, comments and compliments to improve and develop services, with the aim of maintaining and improving safety, improving effectiveness and thereby improving patient experience. 2.0 IMPACT ANALYSES 2.1 Equality A key principle of this policy is to ensure that all complainants and enquirers will be treated equally and will not be discriminated against. In developing this policy, an assessment of the potential impact of the policy in relation to the protected characteristics of the Equality Act 2010 has been undertaken; please see Appendix 4 for details. The equality assessment included the protected characteristics of race, disability, gender, sexual orientation, age, religious or other belief, marriage and civil partnership, gender reassignment, pregnancy and maternity as well as to promote positive practice and value the diversity of individuals and communities. As a result of performing the analysis, this policy does not appear to have any adverse effects on people who share protected characteristics and no further actions are recommended at this stage. The CCG is committed to ensuring that patients whose first language is not English receive the information they need and are able to communicate appropriately with healthcare professionals. All information in relation to the complaints process can be made available in alternative languages and formats on request. 2.2 Sustainability As a result of performing the analysis, the policy does not have any effects in terms of sustainability. Please see Appendix 4 for details. 2.3 Bribery Act 2010 The Bribery Act is relevant to the CCG s complaints handling process, although there are no specific requirements to the provisions of the Bribery Act 2010 within this policy. Page 5 of 34
Under the Bribery Act it is a criminal offence to: Bribe another person by offering, promising or giving a financial or other advantage to induce them to perform improperly a relevant function or activity, or as a reward for already having done so Be bribed by another person by requesting, agreeing to receive or accepting a financial or other advantage with the intention that a relevant function or activity would then be performed improperly, or as a reward for having already done so Bribe a foreign public official by offering, promising or giving a financial or other advantage to a foreign public official, either directly or through a third party, where such an advantage is not legitimately due Fail to embed preventative bribery measures (commercial organisations). This applies to all commercial organisations which have business in the United Kingdom. Unlike corporate manslaughter this does not only apply to the organisation itself; individuals and employees may also be guilty. These offences can be committed directly or by a third person when considering whether to offer or accept gifts and hospitality and/or other incentives. Anyone with concerns or reasonably held suspicions about potentially fraudulent activity or practice should refer to the Local Anti-Fraud and Corruption Policy and contact the Local Counter Fraud Specialist. 3.0 SCOPE This policy shall be applied to all members of the public (and/or their representatives) who have been in receipt of NHS care commissioned by the CCG, or any services directly provided by the CCG who wish to provide feedback, raise a concern or a formal complaint. For the purpose of this policy, NHS care is defined as receiving care or treatment under the NHS Act 1977. The responsibilities defined in this document apply to CCG staff members, CCG staff should make themselves aware of their responsibilities outlined within this document as part of their duties. This policy is not for use by CCG staff who wish to raise a complaint/issue in relation to the CCG and/or its employees during the course of their employment. CCG staff should use the appropriate Human Resources policies for this purpose. Page 6 of 34
4.0 PURPOSE The purpose of this policy is to define the CCG s approach to handling, investigating and learning from complaints that are received into the organisation, in accordance with the regulations (see section 1.1 of this policy for details). This policy also outlines the CCG s commitment to co-operate with the wider health and social care community in North Lincolnshire in order to ensure that a patient centred and outcome focused response to complaints is maintained. In order to achieve this, the CCG has embraced the approach developed by the Department of Health 5 to handling complaints. The CCG responds to patient complaints on an individual basis and encourages a culture that seeks to work with complainants in an open and honest way to achieve positive outcomes. 5.0 POLICY STATEMENT The CCG understands that complaints, comments, concerns and compliments provide valuable insights into services. The CCG uses this feedback to continually drive improvements in the services that it commissions and the CCG will place equal emphasis on all feedback that it receives. All feedback received by the CCG, including the outcome of formal investigations, will form part of the CCG s continuous quality improvement process and will be managed with the relevant service provider via the contract management process. 6.0 DEFINITIONS 6.1 Complaints A complaint is a written (letter or email) or oral expression of dissatisfaction about any aspect of a service commissioned or provided by the CCG that requires a formal response. 6.2 Issues/Concerns An issue or concern is a written or oral expression of dissatisfaction that can be resolved without the need for formal investigation; or correspondence which can usually be responded to within one working day of the issue being raised. 5 https://www.gov.uk/government/publications/the-nhs-constitution-for-england/how-do-i-give-feedback-or-makea-complaint-about-an-nhs-service Page 7 of 34
7.0 ROLES/RESPONSIBILITIES/DUTIES 7.1 Chief Officer The Chief Officer, as the Accountable Officer for the CCG, is responsible for ensuring that the CCG has a process in place for the management of patient complaints, in accordance with the regulations, relating to CCG functions. 7.2 Chief Nurse/Director of Quality & Risk Assurance The Chief Nurse/Director of Quality & Risk Assurance has delegated responsibility, from the Chief Officer, for the CCG s complaints handling process. 7.3 Quality & Experience Manager The Quality & Experience Manager is responsible for the day to day management of the CCG s complaints handling process. 7.4 Patient Experience Manager The Patient Experience Manager is responsible for the case management of each complaint, in line with the NHS Complaints Regulations 2009. 7.5 All CCG Staff All staff must ensure that they are aware of the contents of this policy and cooperate fully with any investigation. 7.6 Delegated Authority The CCG will delegate authority for the management of a complaint to other organisations or teams where there are contractual and/or governance arrangements in place. In these circumstances, there will be a clear line of accountability between the delegate and the CCG Patient Experience Manager to investigate and manage each complaint. Investigating managers will be responsible for the management of the complaints investigation and responses, in line with this policy. 8.0 IMPLEMENTING THIS POLICY 8.1 CCG procedure for the management of formal complaints Receiving a complaint Formal complaints can be made to the CCG via letter, email or via telephone. Contact details are available via the CCG s website, see link below for details. http://www.northlincolnshireccg.nhs.uk/getinvolved/patient-relations/ A complaint can be made within 12 months of the incident, or within 12 months of the complainant being made aware of the issue/incident. This time limit can sometimes be extended as long as it is still possible to investigate your complaint The Patient Experience Manager will contact the complainant by telephone to acknowledge receipt of the complaint, gain more detail on the concerns/issues raised, discuss consent and specific preferences with regards to communication and confirm timescales Page 8 of 34
A timescale for submission of the response letter to the complainant will be agreed between the complainant and the Patient Experience Manager. The timescale will be dependent upon the complexity of the complaint The Patient Experience Manager will agree with the complainant the points to be answered and the complainant s expected outcomes An acknowledgement letter will be sent to the complainant within 3 working days of receipt of the complaint, the letter will include details of the complaint management plan Investigating a complaint Investigation of the complaint commences once consent has been received from the complainant. This may be provided as part of the original correspondence provided by the complainant, or if the complaint is made by a third party, further written consent is required in order to progress the investigation Each investigation will be co-ordinated by the Patient Experience Manager. The Patient Experience Manager will assign a Service Manager to each investigation; the Service Manager will be selected according to their skill, independence and experience in the specific area of concern raised by the complainant. The Service Manager will be required to respond to the specific concerns/issues raised, the response must be submitted to the Patient Experience Manager for processing within the agreed timeframe If the complaint relates to the care and/or service(s) delivered by one of the CCG s providers, the complaint may be redirected to the Patient Experience Manager at the relevant provider for action, as they will be better placed to answer the specific concerns raised. In these circumstances, the NLCCG Patient Experience Manager will inform the complainant of this decision and will ensure that the complaint is redirected to the provider in the appropriate manner (e.g. via recorded delivery and/or via secure email) On receipt of the investigation response from the Service Manager, the Patient Experience Manager will prepare the final response letter. This letter should be received by the complainant within the timescale agreed at the beginning of the process The response letter should include a summary of the complaint, an explanation of the steps taken to investigate the complaint, an apology if something has gone wrong and detail of any action taken as a result of the complaint If the timescale is likely to be breached, the complainant must be informed of this delay and the reasons for the delay must be made clear The final response letter must be signed by the Accountable Officer or the Chief Nurse, the Chief Nurse has delegated authority to sign complaint letters on behalf of the Chief Officer Complainants may be offered a local resolution meeting at any point during the complaints process Page 9 of 34
A complaints conciliation meeting will be considered when investigations and response letters have failed to resolve the complainant s questions and concerns. If a meeting is required, the Patient Experience Manager will co-ordinate arrangements, ensuring that all parties are informed of the purpose of the meeting, and given details of who will be attending the meeting in advance Learning lessons from complaints The Patient Experience Manager will: Monitor patient experience data held by the CCG in order to learn from concerns and improve service delivery Identify specific actions that need to be taken by the CCG to prevent a reoccurrence Provide a quarterly report to the CCG s Quality Group on themes and trends identified from patient experience data Please note, as part of the process described above, the Patient Experience Manager will liaise directly with the NLCCG Risk Manager, to review potential risks and or incidents that may be identified as part of the complaints and concerns management process. 8.2 CCG procedure for the management of verbal comments and concerns Receiving a verbal comment and concern Verbal complaints can be made to the CCG in person (face to face) or via telephone. CCG contact details are available via the CCG s website, see link below for details. http://www.northlincolnshireccg.nhs.uk/get-involved/patient-relations/ If the CCG is unable to answer/resolve the comment or concern, the enquirer/complainant will be signposted appropriately, if necessary If the comment or concern is deemed to require an immediate resolution, the CCG will aim to provide a response within 1-5 working days, depending on the complexity of the issues/concerns raised The CCG will clarify whether the enquirer wishes to complain formally. The complainant may be advised to submit a formal complaint if the complaint is complex and requires an in-depth investigation Investigating a verbal comment and concern If further investigation is required, the Patient Experience Manager will request consent from the enquirer/complainant to proceed with the enquiry The Patient Experience Manager will liaise with the relevant service and will provide full details of the comment/concern, consent and timescale The service manager will undertake an investigation of the concern/comment On receipt of the investigation response from the Service Manager, the Patient Experience Manager will prepare the final response letter Page 10 of 34
This letter should be received by the complainant within the timescale agreed at the beginning of the process The response letter should include a summary of the concerns raised, an explanation of the steps taken to investigate the complaint, an apology if something has gone wrong and detail of any action taken as a result of the complaint Learning lessons from verbal comments and concerns The Patient Experience Manager will: Monitor patient experience data held by the CCG in order to learn from concerns and improve service delivery Identify specific actions that need to be taken by the CCG to prevent a reoccurrence Provide a quarterly report to the CCG s Quality Group on themes and trends identified from patient experience data Please note, as part of the process described above, the Patient Experience Manager will liaise directly with the NLCCG Risk Manager, to review potential risks and or incidents that may be identified as part of the complaints and concerns management process. 8.3 Response As soon as reasonably practicable following completion of the investigation, the Patient Experience Manager will oversee the preparation of a written response, ensuring the response is quality assured and submitted for sign off by the CCG s Accountable Officer or their nominated responsible person. The response should be clear, accurate, balanced, simple and easy to understand. It should avoid technical terms, but where these must be used to describe a situation, event or condition, an explanation of the term should be provided. 8.4 Record Keeping All statements, letters, phone calls and actions undertaken as part of the investigation must be documented and kept in the complaint file in chronological order. A complete complaint file is required should the complaint be referred to the Parliamentary and Health Service Ombudsman and its contents may be made available to the complainant or patient via a Subject Access Request. Complaint files are required to be kept for 10 years. Where further local resolution is to be attempted, it may be appropriate to conduct a meeting or provide a further response, arrange mediation, or take another action. Page 11 of 34
A meeting may be offered within the initial response if any of the following apply: It is a complex case and it would help to present the response in person Serious harm or the death of a patient has occurred The complainant s first language is not English and the response may need to be presented in person to aid understanding (perhaps with an advocate/translator present as support) Where the complainant has a learning disability or mental health illness (or other capacity challenges) and they would benefit from this 8.5 Commissioned Services All services commissioned by the CCG are required to have an established process in place for handling complaints, in line with the regulations. The CCG will monitor complaints and concerns within its commissioned services. The CCG may consider that a complaint is indicative of a wider concern or trend which, through the contract management process, may prompt an in-depth review of the service. Patient complaints that are notified to the CCG that give rise to significant concerns will, with the consent of the patient, be reported to the relevant provider by the Quality & Experience Manager. This will be undertaken as part of the contract management process to ensure that appropriate investigations are undertaken and that lessons are learned. 8.6 Non-Commissioned Services This policy largely relates to services that are/have been commissioned by the CCG. However, the CCG will also support complainants queries/complaints relating to services that are not commissioned by the CCG, where it is appropriate or necessary to do so, in order to identify a suitable solution and to discharge the CCG s duty of care for the population of North Lincolnshire. Duty of Care The National Health Service Act 1977 charges the Secretary of State with a duty to provide healthcare to the public. Healthcare professionals, by virtue of their relationship with the patient and their employment within the NHS, owe a duty of care to the patient. A duty of care is expected of all practitioners and is both a professional and legal obligation. 8.7 Being Open with Patients and Relatives The CCG is committed to improving communication with patients and carers. When things go wrong, the CCG recognises that it is essential that the relevant parties are kept fully informed and feel supported throughout the complaints investigation process. Page 12 of 34
The CCG s complaints handling process incorporates the principles of the National Patient Safety Agency s Being Open framework 6. The Being Open framework involves acknowledging and explaining when things go wrong, undertaking a thorough investigation and providing reassurance and support to those that are involved. The principles of the Being Open framework have been developed to promote a culture of openness and transparency across health and social care organisations. These principles have been integrated within this policy and underpin the CCG s complaints handling process. 8.8 Closure of Complaints, Comments and Concerns The Patient Experience Manager will identify a date by which the complainant/enquirer should contact the CCG s Patient Experience Team to notify them if they are not satisfied that their complaint or enquiry has been addressed fully; otherwise the case will be closed. This is in line with the regulations. The response letter provided to the complainant/enquirer by the Patient Experience Manager will provide information on how to contact the Ombudsman, if they are unhappy with the outcome of the complaint investigation and handling by the CCG. Once a case is closed, the case review documentation will be completed and the relevant complaints data files will be updated to ensure that accurate records are maintained. 8.9 Parliamentary and Health Service Ombudsman The Health Service Ombudsman is an independent organisation that is appointed by the Queen and is not part of the Government or the NHS. Its role is to investigate complaints relating to the NHS in England. Its service is free for everyone. The Ombudsman s powers are set out in the Health Service Commissioners Act 1993. The Ombudsman has very wide powers to gather evidence in relation to the complaints put to them, including looking at clinical records and interviewing staff. The Ombudsman wants NHS organisations to be given the chance to resolve complaints. This means that they may refer complaints back to the CCG at an early stage if they think that there is more that can be done at local level. The Ombudsman considers all complaints that are submitted to them. If they think that something has gone wrong that the CCG organisation has not put right, they may contact the CCG to explore opportunities to resolve the complaint quickly. See section 16 of this policy for contact details of the Parliamentary and Health Service Ombudsman. 6 http://www.nrls.npsa.nhs.uk/beingopen/?entryid45=83726 Page 13 of 34
8.10 Duty of Candour The CCG is committed to improving communication with patients and carers. When things go wrong, it is essential that the relevant parties are kept fully informed and feel supported. The Being Open process (see paragraph 8.5 above) underpins the local resolution stage of the complaints process. The CCG has pledged the following, in relation to duty of candour and complaints. The CCG will: Work collaboratively to promote a culture of openness, transparency and inclusiveness, to drive the delivery of high quality care; Ensure we apply the values of transparency, honesty and candour within our own organisation and in our dealings with healthcare service providers Hold healthcare service providers to account on their contractual duty of candour Ensure healthcare service providers engage with their workforce and genuinely challenge inappropriate attitudes and behaviours Support whistle-blowers, by providing easily accessible processes to allow all NHS staff to raise concerns The CCG will also ensure that the actions taken as a result of complaints are implemented and published annually in its annual report. 8.11 Safeguarding Considerations This policy should be read in conjunction with NLCCG s Safeguarding Policy. Where any complaint indicates that There may be concerns about the welfare of children, or adults with care and support needs, OR The complainant indicates that there are safeguarding issues, It is the responsibility of the CCG member of staff who is first aware of the safeguarding concerns, to Respond to the Concerns about a Child or Adult s Welfare in accordance with NLCCG Safeguarding Policy. This will include discussing the issues with one of the CCG Safeguarding Specialists, i.e. Designated Nurse for Safeguarding Specialist Nurse for Safeguarding Named GP for Safeguarding in addition to following the processes included in this policy. Contact details for these individuals can be found in Appendix 1 of the Safeguarding Policy. The relevant Safeguarding lead will liaise with the Patient Experience Lead and other relevant CCG staff involved in the management of the complaint to ensure that any safeguarding issues are addressed in accordance with CCG and multi-agency processes, during the course of the complaint investigation and resolution. Page 14 of 34
9.0 CORRESPONDENCE RECEIVED FROM MEMBERS OF PARLIAMENT (MPs) AND COUNCILLORS The CCG may receive correspondence from local MPs and Councillors which raise concerns on behalf of constituents about the services provided or commissioned by the CCG. The CCG is not required to deal with this correspondence in accordance with the regulations, unless this is specifically requested by the constituent. However, the CCG will deal with this correspondence in parallel with the complaints local resolution process to ensure that good practice is maintained. The Chief Nurse, together with the Patient Experience Manager, will determine the level of investigation required in order to respond to the query. The CCG will aim to provide a response to the MP and/or Councillor within 15 working days. The Patient Experience Manager will ensure that appropriate consent is obtained to deal with any matter raised by MPs or Councillors in relation to an individual patient. There are occasions when a general response can be sent where consent would not be required; this is where personal information about the constituent does not need to be disclosed. 10.0 COMPLE/MULTI-AGENCY COMPLAINTS Where the complaint is complex, the investigation may require input from more than one organisation. These types of complaints raise a number of governance issues in relation to consent, responsibility for response, assurance of a coordinated approach and multiple investigations taking place simultaneously (which will invariably carry different timescales for completion). Where feasible, the CCG will ensure that there is a coordinated approach to multi-agency complaints. The CCG may take the lead role in terms of the coordinated response, although any decisions made will depend on the wishes of the complainant, the result of discussions that have taken place with the various parties involved and feedback from the organisation that is considered to have the greater role in the complaint. Details on the lead organisation will be provided in the complaint plan. The complaint plan will also include details of the mutually agreeable timescale between all parties for a coordinated response. The CCG may (with the complainant s consent) choose to coordinate the response or lead the investigation; as opposed to a third party leading the investigation, where serious patient safety/quality issues have been identified or if there is a risk to local health service delivery. Where a coordinated approach is determined to be unachievable and/or inappropriate the CCG will ensure that the complainant is informed of the options available to take the matter forward, and of any potential limitations of any subsequent investigation. In cases where the complaint (in part) relates to care commissioned by NHS Page 15 of 34
England, it is generally expected that NHS England will assume the role of lead coordinator on behalf of the CCG, although this will be determined on a case-by-case basis and in consultation with the complainant. 11.0 UNREASONABLE PERSISTENT CONTACTS NHS staff are trained to respond with patience and empathy to the needs of all contacts, but there are times when there is nothing further which can reasonably be done to assist the person or to rectify a real or perceived problem. In these cases, the CCG will implement the approach to dealing with unreasonable persistent contacts, which is provided at Appendix 3 of this policy. 12.0 COMPLAINTS NOT COVERED BY THIS POLICY This policy applies to complaints made by or on behalf of service users and carers. This policy also applies to any complaint/enquiry/concern received from a Member of Parliament or Councillor making or forwarding a complaint on behalf of a constituent. The policy does not apply to: Complaints and grievances by members of staff relating to their contract of employment Complaints by practitioners that relate either to the exercise of the CCG s functions or to the contract or arrangement under which the practitioner provides primary care services Complaints solely about primary care contractors. These complaints will be dealt with by NHS England Complaints about a provider, unless the enquirer requests the CCG to investigate or the CCG feels it is appropriate to investigate the complaint and the complainant consents Complaints about the non-disclosure of information requested under the Freedom of Information Act 2000 or the failure to comply with a Data Subject Access request made under the Data Protection Act 1998. However, applicants do have the right to request an internal review if they are not satisfied with the outcome of their Freedom of Information request. If the complainant is not satisfied with the outcome of the internal review, the complainant can contact the Information Commissioners Office to investigate further Complaints that have already been investigated and the complainant has already received a written response Complaints where the investigation is already in progress by another NHS body or has been investigated by the Parliamentary and Health Service Ombudsman (PHSO) Page 16 of 34
13.0 TRAINING & AWARENESS The CCG will ensure that staff members receive relevant training, relating to implementation of this policy, at the appropriate level, as required. Where CCG staff members are the subject of a complaint from a member of the public/patient, the CCG will ensure that support is available to the individual through line management structures, Occupational Health, the Human Resource Team and where staff are members of a trade union/organisation, staff side organisational support. All feedback and lessons learnt from complaints will contribute to service improvement. The CCG will: Ensure that learning is identified (at organisational and service levels) through complaint investigations Actively capture learning from complaints from all commissioned services to gather themes and interpret the findings to monitor the quality of commissioned services and to inform contracting and commissioning decisions Ensure that learning is disseminated internally and externally 14.0 MONITORING AND AUDIT All information gathered as part of the CCG s complaints handling process is collated and recorded onto a secure data system from which anonymised reports are produced for internal and external reporting. The CCG Quality Group will routinely receive update reports in relation to patient experience. These reports will include themes and trends identified in connection to contacts made to the Patient Experience Team and will triangulate patient feedback with other quality data such as incidents, serious incidents, comments, compliments and PALS queries. Complaints information will be proactively considered as part of all service redesign projects undertaken by the CCG, this is to ensure that patient feedback is routinely used to improve services and inform commissioning intentions. The CCG will: Prepare anonymised Patient Experience Reports as requested Undertake complaints satisfaction audits and ensure that lessons learnt from this are used to inform future updates of this policy Produce an Annual Complaints Report for the Governing Body which will be publicised on the CCG website 15.0 POLICY REVIEW This policy will be reviewed two years after the date of approval, or sooner should changes to national and/or local guidance require it. Page 17 of 34
16.0 USEFUL CONTACTS Department of Health. NHS complaints guidance. 14 October 2015 https://www.gov.uk/government/publications/the-nhs-constitution-forengland/how-do-i-give-feedback-or-make-a-complaint-about-an-nhsservice The Local Authority Social Services and NHS Complaints (England) Regulations 2009 (the regulations) http://www.legislation.gov.uk/uksi/2009/309/contents/made The NHS Constitution for England. October 2015 https://www.gov.uk/government/publications/the-nhs-constitution-forengland/the-nhs-constitution-for-england Principles of Good Administration, Principles of Good Complaint Handling and Principles for Remedy (the Ombudsman s Principles). https://www.ombudsman.org.uk/about-us/our-principles The Scottish Public Services Ombudsman (SPSO). Guidance on Apology https://www.spso.org.uk/leaflets-and-guidance 17.0 REFERENCES Making Experiences Count (MEC): The Proposed New Arrangements for Handling Health and Social Care Complaints (2007) The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (2009) National Patient Safety Agency: National Reporting and Learning Service: Being Open (November 2009) The Mid Staffordshire NHS Foundation Trust Public Inquiry: Chaired by Robert Francis QC (February 2013) NHS England: Guide to Good Handling of Complaints for CCGs (May 2013) A Review of the NHS Hospital Complaints System: Putting Patients Back in the Picture (Clwyd, October 2013) My Expectations for Raising Concerns and Complaints (November 2014) Care Quality Commission: Complaints Matter (December 2014) House Of Commons Health Committee: Complaints and Raising Concerns Fourth Report of Session 2014 15 (January 2015) Page 18 of 34
The NHS Constitution (July 2015) NHS Litigation Authority Risk Management Standards Page 19 of 34
Appendix 1: NLCCG Complaints Process 18.0 APPENDICES Appendix 1 - NLCCG Complaints Process 1.0 Introduction The CCG s complaints process is in line with The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, which aim to resolve the issue at the most local level. 2.0 The Process The CCG s complaints process should be used by staff when managing and investigating a complaint. This process applies to complaints received by the CCG, with regards to its commissioning functions and those regarding independent contractors. The flow chart below provides a basic overview of the NLCCG complaints handling process. Incoming Complaint Initial instruction sheet completed Complaint logged Initial risk rating applied Acknowledgment of complaint Response to complaint to be provided within the agreed timescale Incidents and/or potential risks are identified. Details are submitted to the NLCCG Risk Manager for review. Risk Manager uploads details onto the NLCCG Incident App, as necessary Investigation Detailed review of complaint & issues identified Initial risk rating reviewed Issues for investigation confirmed with complainant Investigation templates completed and distributed to named contacts involved in the investigation. Response dates identified and highlighted Reminders sent to investigators (if appropriate) & progress update provided to complainant Response Draft response prepared (for review by all parties involved) and approved Risk rating reviewed and final rating applied Response provided to complainant Feedback form sent to complainant within 6 weeks Learning Learning outcomes transferred to an action plan and tracker Action plan monitored/implemented
Appendix 1: NLCCG Complaints Process 3.0 Parliamentary and Health Service Ombudsman Should the complainant remain dissatisfied following receipt of the final written response, they have the option to contact the Parliamentary and Health Service Ombudsman (PHSO) to request an external review. 4.0 Responsibilities of Staff For CCG staff who believe they have witnessed bad practice, both within hospitals and within the wider regulatory system, the CCG Whistleblowing Policy outlines the procedure that should be followed. It is important that all CCG staff members are aware of the timescales which are defined in the regulations and regulated by the Department of Health and are outlined within this policy, to ensure that complaints are acknowledged, investigated and responded to in a timely way. These timescales will also be monitored and reported as an element of the CCG s Organisational Performance targets through the Patient Relations Report presented to the CCG Quality Group. Page 21 of 34
Appendix 2: NLCCG Complaints Handling Procedure Flowchart Appendix 2 NLCCG Complaints Handling Procedure Flowchart The flow chart below provides further detail on the NLCCG complaints handling process. Email Letter Telephone call Face to face Complaint received by the CCG, via any of the above routes. Complaint passed to the CCG s Patient Experience Manager within one day for processing Patient Experience Manager reviews complaint to determine the most appropriate method/style of management, and informs the CCG s Risk Manager of any risk and or incident. Complaint is logged; a new complaints file is created and is stored in a secure location. Patient Experience Manager acknowledges the complaint within three working days of receipt into the CCG and requests necessary consent Consent received? Yes Consent received? No Patient Experience Manager contacts the complainant to agree a suitable timescale for the CCG s response Patient Experience Manager forwards the complaint to a suitable Service Manager for investigation/ review. Investigation response timescale is agreed, in line with the date agreed with the complainant Patient Experience Manager to check 5 days before due date that investigation feedback will be ready Patient Experience Manager to contact complainant after two weeks of sending consent form to check if the complaint wants to pursue If no, file is closed & complaints handling tracker is updated
Appendix 2: NLCCG Complaints Handling Procedure Flowchart Investigation feedback submitted to the Patient Experience Manager for review and quality assurance checking. Patient Experience Manager drafts response for the CCG s Chief Officer or nominated officer for approval and sign off Once approved, the letter is posted to the complainant via recorded delivery, including any copies as appropriate (e.g. MP, Local Healthwatch and or Advocacy service). The final response letter includes options and process for contacting the Parliamentary and Health Service Ombudsman. Complainant satisfied? Yes Complainant satisfied? No Complaints file closed Patient Experience Manager invites the complainant to submit any outstanding issues to the CCG and informs/assists the complainant with a referral to Page 23 of 34
Appendix 4: Integrated Impact Assessment Appendix 3 - Procedure for the Management of Unreasonable or Persistent Contacts 1.0 Purpose The CCG has contact with a small number of individuals who absorb a disproportionate amount of NHS resources. The aim of the procedure for unreasonable, persistent contact is to identify situations where the contact might be considered to be unreasonable or persistent and to suggest ways of responding to these situations. In order to be defined as an unreasonable, persistent contact, the Parliamentary Health Service Ombudsman (PHSO) must have been engaged with and the CCGs response must be deemed satisfactory. It is emphasised that this procedure should only be used as a last resort and after all reasonable measures have been taken by the CCG to try to resolve issues and complaints. Judgment and discretion must be used in applying the criteria to identify potential unreasonable or persistent contacts and in deciding what action will be taken in specific cases. This procedure should only be implemented following careful consideration by, and with the authorisation of, the Chief Officer. Where deputies are nominated, the reason for the non-availability of the Chief Officer and the Clinical Commissioning Group Clinical Chair should be recorded in the case file. 2.0 Definition of an Unreasonable Persistent contact Individuals (and/or anyone acting on their behalf) may be deemed to be an unreasonable persistent contact where previous or current contact with them shows that they meet two or more of the following criteria: Where individuals Persist in pursuing a complaint where the NHS complaints procedure has been fully and properly implemented and exhausted (e.g. where investigation has been denied as out of time) Change the substance of a complaint or concern, continually raise new issues or seek to prolong contact by continually raising further concerns upon receipt of a response, whilst the complaint or concern is being addressed (care must be taken not to discard new issues which are significantly different from the original contact. These might need to be addressed as separate concerns or complaints) Are unwilling to accept documented evidence of treatment given as being factual, such as drug records, General Practitioner manual or computer records, nursing records or deny receipt of an adequate response, in spite of correspondence specifically answering the complainant s questions, or do not accept that facts can sometimes be difficult to verify when a long period of time has elapsed Do not clearly identify the precise issues which they wish to be
Appendix 3: Procedure for the Management of Unreasonable or Persistent Contacts investigated, despite reasonable efforts of the CCG or its Patient Experience staff and where appropriate, the Independent Contacts Advocacy Service supporting the complainant, or where the concerns identified are not within the remit of the CCG to investigate Focus on a trivial matter to an extent which is out of proportion to its significance and continue to focus on this point. (It is recognised that determining what a trivial matter is can be subjective and careful judgment must be used in applying this criteria) Have threatened or used actual physical violence towards staff or their families or associates at any time - this will in itself cause personal contact with the individual and/or their representatives to be discontinued and the contact will, thereafter, only be pursued through written communication. (All such incidents should be documented and staff should refer to the CCG Violence and Aggression Policy regarding all instances) Have harassed or been personally abusive or verbally aggressive on more than one occasion towards staff dealing with their concern or complaint, or their families or associates. (Staff must recognise that individuals may sometimes act out of character at times of stress, anxiety, or distress and should make reasonable allowances for this. They should document all incidents of harassment). Have in the course of addressing a concern or formal complaint, an excessive number of contacts with the CCG/its Patient Experience staff placing unreasonable demands on staff. (A contact may be in person or by telephone, email, letter or fax. Discretion must be used in determining the precise number of excessive contacts applicable under this section, using judgment based on the specific circumstances of each individual case). Are known to have recorded meetings or face-to-face/telephone conversations without the prior knowledge and consent of other parties involved Display unreasonable demands or expectations and fail to accept that these may be unreasonable (e.g. insist on responses to contacts or enquiries being provided more urgently than is reasonable or normal recognised practice). 3.0 Options for Dealing with Unreasonable Persistent contacts For individuals that the CCG has identified as unreasonable or persistent, in accordance with the above criteria, the Chief Nurse (with delegated authority from the Chief Officer) will determine what action to take. The Chief Nurse will implement such action and will notify individuals in writing of the reasons why they have been classified as unreasonable persistent contacts and the action to be taken. This notification may be copied for the information of others already involved in the concern or complaint, e.g. Practitioners, Independent Complaints Advocacy (ICA), Members of Parliament. A record must be kept for future reference of the reasons why an individual has been classified as unreasonable or persistent. The Chief Nurse may decide to deal with individuals in one or more of the Page 25 of 34
Appendix 3: Procedure for the Management of Unreasonable or Persistent Contacts following ways: Try to resolve matters, before invoking this procedure, by drawing up a signed agreement with the individual, which sets out a code of behaviour for all those involved if the CCG is to continue processing the concern or complaint If these terms are contravened by the individual, consideration would then be given to implementing other action, as indicated in this section. Once it is clear that any individual meets any one of the criteria above, it may be appropriate to inform them in writing that they may be classified as an unreasonable or persistent contact, and provide a copy this procedure to them. It is important to advise them to take account of the criteria in any further dealings with the CCG. In some cases it may be appropriate, at this point, to copy notification to others involved in the concern or complaint and to suggest that individuals seek advice in processing their concern or complaint, e.g. through the Independent Complaints Advocacy (ICA). Decline contact with the individual either in person, by telephone, fax, letter, email or any combination of these, provided that one form of contact is maintained, or alternatively to restrict contact to liaison through a third party. (If staff are to withdraw from a telephone conversation with the individual it may be helpful for them to have an agreed statement available to be used at such times). Notify the individual in writing that the Chief Nurse has responded fully to the points raised and has tried to resolve the concern or complaint but there is nothing more to add and continuing contact on the matter will serve no useful purpose. The individuals should also be notified that the correspondence is at an end and that further letters received will be acknowledged but not answered. Inform the individual that in extreme circumstances the CCG reserves the right to pass unreasonable or persistent contacts on to their legal team and temporarily suspend all contact with the individual or investigation of a complaint whilst seeking legal advice or guidance from NHS England, or other relevant agencies. 4.0 Withdrawing Unreasonable Persistent Contact Status Once individuals have been determined as unreasonable or persistent there needs to be a mechanism for withdrawing this status at a later date if, for example, they subsequently demonstrate a more reasonable approach or if they submit a further concern or complaint for which normal procedures would appear appropriate. Staff should previously have used discretion in recommending unreasonable or persistent status at the outset and discretion should similarly be used in recommending that this status be withdrawn when appropriate. Page 26 of 34