The Trust has a responsibility to establish a complaint procedure in line with the statutory requirements and take steps to publicise the arrangements. The arrangements must be accessible and ensure that complaints are dealt with speedily and efficiently and that complainants are treated courteously and sympathetically.
2.1 Who might complain?
Complainants may be existing or former patients using the Trust’s services and facilities, as well as relatives/carers. Members of hospital staff and other health professionals including the General Practitioner may also complain about aspects of a patient’s care or raise it through the Raising Concerns Policy “Whistleblowing”. If the person complaining is not a patient, but is complaining on behalf of a patient, it is important to check that the patient knows about the complaint. The complainant must be told that, in order not to be in breach of patient confidentiality, any matters relating to the patient’s care and treatment can only be answered with the patient’s consent. (This does not mean that the matters raised cannot be investigated, but means that the Trust’s response will not divulge any information about the patient’s care and treatment).
Relatives/carers or others complaining on behalf of patients will be sent an acknowledgement letter and consent form for the patient to sign and asked to return it to the Customer Care Department. The patient will sign to confirm their agreement to a reply being sent to the person who made the complaint or directly to themselves. If the patient is unable to act for him or herself, the Trust will take reasonable steps to ensure that the complainant is an appropriate person to receive information. In any event, if there is no signed consent from the patient as to what personal information can be passed on, there is a greater limitation on the content of the Trust’s response.
Where a complaint is made on behalf of a patient who has died, it is important to check that the person making the complaint is the deceased patient’s next of kin. Where this is not the case, the consent of the next of kin will be sought in writing and they will be asked to complete a consent form. In doing so the Trust will offer the next of kin the opportunity to review the complaint that has been made.
Children and young people who are competent to consent
If children are competent to give consent for themselves, consent should be sought directly from them. The legal position regarding ‘competence’ is different for young people aged over 16 than under 16.
Young people aged 18 and Over
Once a person reaches their 18th birthday they are deemed to be a competent adult capable of consenting or refusing treatment unless, following assessment, they are deemed unable to make informed decisions for themselves.
Children aged 16 and 17
A person who is the age of 16 is assumed to have the same capacity as an adult to consent to treatment in accordance with the Mental Capacity Act 2005. As such, they do not need parental consent for medical treatment or interventions unless, following assessment, they are deemed to lack capacity. Medical staff also have a duty of confidentiality to such patients and should not disclose information to parents without the person’s consent.
If a complaint is made on behalf of a 16 or 17 year old, unless there is clear medical evidence that they lack capacity, then their express authority should be obtained before responding to the complaint as it will involve disclosing confidential patient information.
Children under the age of 16
Children under 16 can consent to medical treatment if they fully understand what is being proposed. It is up to the treating clinician to decide, after assessment, whether the child has the maturity and intelligence to fully understand the nature of the treatment, the options available, any risks involved and any potential benefits. A child who has such understanding is considered ‘Gillick competent’ (a standard which is based upon UK case law).
The parents cannot overrule the child’s consent when the child is judged to be Gillick competent. Children under 16 who are not Gillick competent and very young children cannot either give or withhold consent. Those with parental responsibility need to make the decisions on their behalf.
If a complaint is made on behalf of a child who is under the age of 16, unless there is clear medical evidence that they have been assessed and still are Gillick competent, then no authority from the child will be needed to respond to a complaint made by those with parental responsibility. If however there is clear evidence that the child is Gillick competent, then their express authority should be obtained before responding to the complaint as it will involve disclosing confidential patient information.
2.2 Time limit for making a complaint
The timescale in which a complaint can be made is 12 months from the date on which the matter occurred, or the matter came to the notice of the complainant. The Trust will have the discretion to investigate beyond this time, especially if there are good reasons for a complaint not having been received with the 12 months and it is still possible to investigate the case effectively. This decision will be taken locally and where it is decided not to investigate, the complainant will have the opportunity to approach the Parliamentary and Health Service Ombudsman.
2.3 What people can complain about
People will be able to use this policy and procedure about any matter reasonably connected with the exercise of Salisbury NHS Foundation Trust’s services for patients.
2.4 What people cannot complain about
Ø A complaint made by an NHS body about the functions of Salisbury NHS Foundation Trust.
Ø Staff working within, or contracted to, Salisbury NHS Foundation Trust cannot use the arrangements to complain about employment, contractual or pension issues.
Ø Complaints that have already been investigated under the complaints regulations.
Ø Complaints arising out of the alleged failure to comply with a data subject request under the Data Protection Act 1998.
Ø Complaints arising out of an alleged failure by an English NHS body to comply with a request for information under the Freedom of Information Act 2000.
2.5 Disciplinary action
A complaint can be investigated even if disciplinary action is being considered or taken against a member of staff, provided the organisation has regard to good practice around restrictions in providing confidential/personal information to the complainant.
The Trust believes it is important, wherever possible, to ensure the potential implications for patient safety and organisational learning are investigated as quickly as possible, to allow urgent action to be taken to prevent similar incidents arising. However, although the complaints handling arrangements will operate alongside the disciplinary arrangements, the two arrangements will remain separate.
2.6 Cases involving legal action
On receipt of a complaint where legal action is being taken or the police are involved, the Government will expect discussions to take place with the relevant authority, e.g. legal services, the police, or the Crown Prosecution Service, to determine whether progressing the complaint might prejudice subsequent legal or judicial action. If so, the complaint will be put on hold, and the complainant advised of this fact. If not, an investigation into the complaint should take place. Again it is important to ensure the potential implications for patient safety and/or organisational learning are investigated as quickly as possible to allow urgent action to be taken to prevent similar incidents arising.
2.7 Serious Incidents (see Serious Incident Immediate Response policy)
A Serious Incident (SI) is an incident which has occurred in relation to NHS funded services. The SI is a situation in which one or more individuals (patients, staff, visitors, contractors) are involved in an event which is likely to produce significant legal, media or other interest. This may have resulted in permanent serious harm, unexpected or avoidable death, or where actions of health service staff are likely to cause significant public concern. This extends to include incidents that may indirectly affect patient safety and the organisation's ability to delivery ongoing healthcare.
Such events include:
· Unexpected or avoidable death
· Allegations of abuse
· Adverse media coverage
· Data loss and information security
· In-hospital development of grade 3 or 4 pressure ulcer
· Failure of a screening service that has actual or potential consequence for clinical outcomes
· Child protection
· Suicide or serious self-harm
· Rogue staff
· Events that affect multiple patients e.g. rogue staff, outbreak of infection such as legionella, incorrect interpretation of specimens
· Large scale theft or fraud
Events also include the core set of 'Never Events' which include:
· Wrong site surgery
· Retained instrument post-operation
· Wrong route administration of chemotherapy
· Misplaced naso-gastric or orogastric not detected prior to use
· In-patient suicide using non-collapsible rails
· In-hospital maternal death from post-partum haemorrhage after elective caesarean section
· Intravenous administration of mis-selected concentrated potassium chloride
If a complaint is received and the key points are being investigated under the serious incident investigation, the complainant is kept informed and a longer timescale is agreed to respond. The Head of Risk should keep the complainant informed of the progress of the investigation. If the person has raised issues that are not being investigated under the serious incident investigation, then they will be investigated under a complaint investigation.
2.8 Roles and Responsibilities
The Chief Executive is the designated responsible person whose duty it is to ensure overall compliance with the Statutory Instrument. The Trust will have a designated Head of Customer Care to whom the Chief Executive will delegate the day-to-day management of the process and whose role is to oversee the complaints procedure.
The Chief Executive will sign all complaint acknowledgement letters within three working days of receipt of the complaint. A copy of the Trust’s leaflet ‘Comments, Concerns, Compliments and Complaints’, which explains how the complaint will be handled will also be enclosed. The response letter will be signed by the Chief Executive, and in his absence, responses will be signed by the Deputy Chief Executive.
Head of Customer Care
The appointed Head of Customer Care has the delegated responsibility to manage the complaint procedure on behalf of the Chief Executive. The prime responsibility is to oversee the complaints handling procedure, provide guidance and support, and to provide the Trust with an overview of its complaints.
The Head of Customer Care is readily accessible to the public. Complainants may refer complaints directly to the Head of Customer Care if they do not wish to raise issues with the staff directly involved in their care.
In relation to complaints received about other NHS bodies or Social Services, the consent of the complainant shall be sought prior to transferring the complaint to that organisation. In the case of complaints that are a mixture of health and social care issues, it will be agreed with the complainant, which organisation will lead and co-ordinate the final response.
Any complaints that involve a sudden unexpected death, serious harm or potential safeguarding issues, should be escalated to the Head of Customer Care who will discuss the management of the complaint with the most appropriate Head of Service/Lead Clinician.
The Head of Customer Care will co-operate with the requirements of the Parliamentary and Health Service Ombudsman (PHSO) by providing information, files and copies of relevant medical records if required.
Customer Care Staff
Customer Care Staff are responsible for trying to resolve concerns/complaints when the issue if brought to their attention. If the issues cannot be resolved quickly then they will co-ordinate the concerns/complaints procedure, ensuring compliance with the complaint regulations, agreeing a plan with the complainant for the management of the complaint.
Any complaints where there has been a sudden unexpected death, serious harm or potential safeguarding issues, should be escalated to the Head of Customer Care immediately.
The Customer Care Staff will contact the complainant to discuss the complaint at the outset and explore the feelings of the complainant and identify their preferred outcome - what they hope to achieve from the process if this has not already been established; identify and explain any consent issues to the complainant and assess what further action might best resolve the complaint e.g. a meeting with staff.
The Customer Care Staff will prepare the acknowledgement letter for the Chief Executive to sign within three working days of receipt. The acknowledgement will indicate that a written response from the Chief Executive for complaints or relevant manager for concerns will follow within an agreed timescale and will include a leaflet about the Trust’s Comments, Concerns, Complaints and Compliments Procedure, which also gives information about local advocacy services and the PHSO.
When a complaint is received by e-mail, the Customer Care Staff will acknowledge the complaint and ask the sender to supply an address so that all future correspondence can be in writing. It is not possible to be certain that the sender is who they appear to be, that the message will be read by them and that they understand or accept the risks. Whilst we understand the need for people to communicate by e-mail, to ensure security of information, the Trust must positively identify the named individual and address. (Acceptable use of Email and SMS Text Messaging policy).
Verbal complaints will be acknowledged with a written record of the conversation sent to the complainant. The complainant will be asked to confirm if the record clearly captures the issues they want investigating or if they wish to add or amend the information.
Ø The Customer Care Staff will record all relevant information about the issue on Datix and set up the agreed response timescale alerts.
Ø Track complaints and send reminders to facilitate the meeting of deadlines and keep the complainant informed of any delays.
Ø Telephone/e-mail the Investigating Manager one week before the final deadline to find out if there are any problems with the investigation and to offer assistance by contacting the complainant and agreeing a longer timescale, giving the reasons for the delay.
Ø Record the conversation and set the new timescales on Datix.
The Customer Care Staff will check completed response letters for content, format, grammar and spelling, before forwarding to the Head of Customer Care. After sign-off by the Chief Executive, the Customer Care Staff will send the signed letter of response to the complainant and a copy to all staff named in the letter.
Helpdesk Managers (HDM) are responsible for manning the Helpdesk in accordance with the Helpdesk rota. The shifts are either 9.00am–1.00pm or 1.00pm–4.30pm. If the HDM cannot attend their designated shift, it is their responsibility to find a replacement/swap and inform the Customer Care Staff who will be covering for them in order that the rota can be updated on the Intranet.
HDM’s are responsible for dealing with comments and concerns face-to-face, by e-mail or by telephone. If the complainant wishes to make a formal complaint, the HDM can write down the complainant’s complaint on the Record of Discussion form (Appendix A) and refer it to the Customer Care Team to co-ordinate. If the HDM is dealing with the complainant face-to-face, they should give a copy of the leaflet to the complainant.
HDM’s should complete a Record of Discussion form for all concerns and complaints dealt with in order that any themes arising can be addressed. Comments or compliments can be recorded on the Helpdesk log.
Any complaints where there has been a sudden unexpected death, serious harm or potential safeguarding issues, should be escalated to the Head of Customer Care immediately.
At the end of the HDM’s shift they should e-mail their Record of Discussion forms, whether they have completed the matter or not to email@example.com so that the Customer Care Staff can log the information on Datix. The HDM should take any outstanding concerns with them to resolve and keep the complainant updated. The HDM must record all their actions, including dates and people who they have discussed the case with, and when it is resolved they should e-mail it again to firstname.lastname@example.org so that Datix can be updated and the case closed. If the PHSO is asked to review a case that the Trust has dealt with, it is very important that a full audit trail of actions taken can be shown.
Directorate Management Team (Investigating Manager)
Directorate Management Teams have the responsibility to undertake an investigation into all complaints, ensuring that the complainant’s concerns are fully addressed, and are available within the agreed deadlines.
The Investigating Manager will undertake a preliminary assessment of how best to investigate the complaint. Formal complaints should be thoroughly investigated in accordance with Adverse Events: An Organisation Wide Approach to Investigation, Analysis, and Learning policy.
Provide support to staff involved in an investigation, particularly those named, and make sure they are aware of the contents of the complaint and response. If a named member of staff has left the Trust, the Investigating Manager has the responsibility to ensure all efforts are made to obtain their comments, particularly if harm has been alleged. If the complaint involves a junior member of staff, the Investigating Manager must obtain a senior review as well as obtaining comment from the junior member of staff involved. The draft complaint response letter needs to be shared and agreed by all named in the response letter and by those who have contributed to the investigation.
If admissions of error are to be made, the draft response must be shared with the Head of Litigation. If the complainant is explicitly requesting compensation/ recompense, findings of the investigation must be shared with the Head of Litigation.
If harm is alleged to have been caused, Investigating Managers must assure themselves of the evidence when they read the medical records.
Ensure that agreed actions arising out of investigations are implemented across appropriate teams/departments and to ensure that the Directorate fosters an ethos of learning in order to minimise future occurrence.
To ensure improvements arise out of complaints, Action Plans (Appendix B) must be completed and monitored following the investigation of all complaints. The information from the Action Plan will be recorded on Datix and timescales set for follow-up. The Customer Care Advisors will e-mail the Investigating Manager or person responsible for implementing the action for an update/closure. Complaints should be shared with staff within each ward/department by the manager for learning purposes.
All managers have a responsibility within the complaints handling procedure. It is part of the role of the manager to ensure that staff are fully assisted and feel fully supported throughout the handling of any complaint.
Staff should ensure that complainants, having made a complaint, are assured that it will not prejudice the patient’s future treatment and care. The Trust policy and procedure for handling complaints is considered as part of the ward/department induction.
Further information on how to deal with comments, concerns and complaints is available at Appendix C.
Front line staff will distinguish those serious issues that, even if raised verbally need to be brought to the attention of senior managers within the Trust.
Non Executive Director
An appointed non-executive director will be responsible for reviewing a sample of complaints on a quarterly basis as an important assessment of the quality of investigations.
2.9 Safeguarding Adults
The Trust has in place systems and processes to promote the safeguarding and wellbeing of patients. These are reflective of local and national guidelines. It is important that when a complaint is received, consideration is given as to whether it may meet the Safeguarding Adults threshold and this must be done in a timely manner in line with the Safeguarding Vulnerable Adults/Adults at Risk Policy.
Before commencing a complaint investigation, Customer Care Staff will review the complaint for potential safeguarding adult issues. If there are safeguarding concerns these should be escalated to the Head of Customer Care and the complaint will be referred to the Trust Adult Safeguarding Lead. They will consider the complaint and confirm to the Head of Customer Care whether there are safeguarding issues that require referral to the appropriate social care, learning disability or mental health team. This may mean that the formal complaint investigation has to be delayed although it should be remembered that the two investigations can run in parallel if it is agreed that this would not compromise the safeguarding investigation.
As part of the local resolution process and in agreeing with the complainant how they wish their concerns to be handled, consideration will be given to arranging a meeting with hospital staff. However, this will be discussed with the relevant members of staff before it is agreed with the complainant.
Once a meeting has been agreed the complainant will be asked to provide a list of questions to form an agenda so the meeting can be structured with the most appropriate staff in attendance. Meetings will take place in a sensitive venue. Complainants requiring support will be advised to contact their local Advocacy Service. A letter will be sent to the complainant giving details of the meeting and who will be attending.
Staff should attend a pre-meeting to discuss the case. The meeting will have a chair/facilitator and someone to take the minutes. Following the meeting with the complainant, if necessary, staff will meet to discuss the outcome and any further actions that need to be taken to achieve local resolution for the complainant.
The minutes will be circulated to all staff members involved in the meeting for checking the clinical content before they are sent to the complainant.
2.11 Parliamentary and Health Service Ombudsman (PHSO)
The PHSO investigates complaints about the National Health Service and is completely independent of the NHS and the government. The PHSO will consider cases where the complainant is not satisfied with the Trust’s efforts to resolve their concerns at a local level. The complainant has to send their complaint to the PHSO no later than a year from the date when they became aware of the events, which are the subject of complaint. The PHSO can sometimes extend the time limit, but only if there are special reasons.
The PHSO can investigate complaints about hospitals or community health services which are about:
Ø a poor service;
Ø failure to purchase or provide a service a complainant is entitled to receive;
Ø mal-administration - that is administrative failures such as unavoidable delay, not following proper procedures, rudeness or discourtesy, not explaining decisions or not answering the complaint fully and promptly;
Ø complaints about the care and treatment provided by a doctor, nurse or other health care professional;
Ø other complaints about family doctors (GPs) or about dentists, pharmacists or opticians providing a NHS service locally.
The PHSO cannot look into:
Ø complaints which one could take to court or an independent tribunal - unless the PHSO does not think it reasonable for the complainant to do so;
Ø personnel issues such as appointments of staff, pay or discipline;
Ø commercial or contractual matters, unless they relate to services for patients provided under a NHS contract;
Ø properly made decisions an NHS authority or other body or individual providing NHS services has a right to make, even if the Complainant does not agree with the decision;
Ø services in a non-NHS hospital or nursing home, unless they are paid for by the NHS;
Ø complaints about government departments, such as the Department of Health;
Ø complaints about local authority departments, such as social services.
The PHSO will decide whether or not an investigation will be carried out. If the PHSO cannot look into a complaint or decides not to, the complainant will be told why. If the PHSO decides to investigate, the complainant and the Trust will be sent a statement of complaint, which sets out what matters the PHSO, will look into. The complainant and relevant hospital staff may be interviewed by the PHSO’s investigator. At the end of the investigation, a report will be sent to the complainant and the Trust. If the complaint is found to be justified, the PHSO will seek for the complainant an apology or other remedy. Sometimes that may include getting a decision changed, or a repayment of unnecessary costs to patients or their relatives/carers. The PHSO does not recommend damages (compensation). The PHSO may also call for changes to be made so that what has gone wrong does not happen again. Where the Trust tells the PHSO that it will make such changes, the PHSO checks that it has done so.
Following receipt of the PHSO’s draft report, this will be circulated to the relevant staff involved in the case for their comments. The Trust must confirm to the PHSO that the content is accurate and state whether it accepts the PHSO’s decision.
Further to receipt of the final report, if recommendations are made the Trust must convene a meeting of the relevant senior staff to review the recommendations and carry out the necessary actions. Clear action planning must be carried out. It is likely that the Ombudsman will wish to review actions taken as a result of their recommendations three months later. The Head of Customer Care will oversee this process.
A complaint to the PHSO represents the final stage in the procedure for pursuing a complaint. The PHSO’s decision on a complaint is final.
Healthwatch's sole purpose is to understand the needs, experiences and concerns of people who use heath and social care services and to speak out on their behalf. People who want to make a complaint about a particular service can contact Healthwatch to find out how to get help with making their complaint.