Navigating NHS Complaints: Your Guide

Understanding the NHS Complaints Procedure in England

When you receive care or treatment from the National Health Service (NHS) in England, you have fundamental rights. One of these is the right to make a complaint if you are dissatisfied with any aspect of your experience. The NHS and social care complaints procedure is governed by law, specifically the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. This framework ensures a structured and fair process for addressing concerns, aiming for local resolution first, with avenues for escalation if necessary. This article will delve into the intricacies of this procedure, empowering you with the knowledge to navigate it effectively.

Who is a Responsible Body?

The complaints procedure applies to a wide range of organisations that provide NHS services. These include:

• NHS bodies and all NHS healthcare providers: This encompasses commissioning bodies and primary care providers, such as GP practices.
• 'Independent providers': These are voluntary and independent sector organisations delivering healthcare in England under agreements with an NHS body.
• Local authority adult social services: Services provided or commissioned by local authorities for adults also fall under this procedure.

All these entities are identified as 'responsible bodies' within the regulations, meaning they are obliged to follow the established complaints process.

The Stages of a Complaint

The NHS complaints procedure is designed with a clear two-stage process:

Stage One: Local Resolution

This is the primary and most common stage where complaints are addressed. It involves the organisation directly responsible for your care. This could be:

• Your GP practice.
• The hospital where you received treatment.
• Your local Integrated Care Board (ICB), which commissions services in your area.

In many instances, complaints are resolved swiftly and efficiently at this initial stage. It's often the most effective way to address issues, as the people involved can provide direct explanations and solutions.

Stage Two: Parliamentary and Health Service Ombudsman (PHSO)

If you remain dissatisfied with the outcome of your complaint after the local resolution stage, you have the right to escalate your concerns to an independent body. This is the Parliamentary and Health Service Ombudsman (PHSO) for NHS complaints in England. The PHSO acts as a final arbiter, investigating unresolved complaints impartially. The usual time limit for submitting a complaint to the PHSO is 12 months from the date of the local resolution's final response. For clinical matters, the PHSO often involves a clinical adviser to provide expert opinion as part of their investigation.

Where to Direct Your Complaint

Complaints can be made directly to the organisation providing the care, such as a hospital or GP surgery, or to the relevant commissioning body. The commissioning body will then determine if they can handle the complaint directly or if it's more appropriate for the provider to respond. Importantly, you should direct your complaint to either the primary care provider or the commissioning body, but not both.

If a complaint is made to one responsible body but involves concerns about another, there is a duty for these bodies to cooperate. For example, if you complain to a hospital trust about both hospital care and GP care, the hospital's complaints team will typically liaise with your GP practice to gather a response.

Should a responsible body receive a complaint that it believes should have been directed to a different organisation, it has the power to forward the complaint. The receiving body will then handle it as if it had been submitted to them initially, but they must still acknowledge the complaint within three working days.

Excluded Complaints

Certain types of complaints are not covered by the standard NHS complaints procedure:

• Complaints made by one NHS body against another.
• Complaints from employees relating to their employment.
• Oral complaints that are resolved to the complainant's satisfaction within one working day (though it's advisable to keep a record).
• Complaints that have already been addressed and resolved.
• Allegations of failure to comply with a Freedom of Information Act 2000 request.
• Complaints about non-NHS funded care provided solely by the independent sector, which will have its own distinct procedures.

If a responsible body believes a complaint is outside its remit, it must inform the complainant in writing, clearly stating the decision and the reasons behind it.

Who Can Make a Complaint?

Typically, complainants are current or former patients. However, the procedure also allows for:

• Nominated or elected representatives of patients.
• Patients aged 16 or over with unimpaired mental capacity can complain themselves or authorise someone else to do so.
• Children under 16 can make their own complaint if they are deemed capable.

Crucially, when someone complains on behalf of a patient, their authority to do so must be confirmed, and patient consent is required to share information. If a patient lacks the capacity to consent, their representative must demonstrate a sufficient interest in the patient's welfare and be an appropriate person, such as a partner, relative, or someone appointed via a lasting power of attorney under the Mental Capacity Act 2005.

The 'Appropriate Person' Clause

In some circumstances, a responsible body may need to verify that a representative is indeed an 'appropriate person'. This is particularly relevant when a complaint involves a child, where the representative must have reasonable grounds to complain instead of the child. For both children and adults lacking capacity, the representative must be acting in the patient's best interests. If the responsible body is not satisfied with the appropriateness of the representative, it must decline to consider the complaint and provide written reasons.

Time Limits for Complaints

Complaints must generally be made within 12 months of the incident occurring or from the date the complainant became aware of it. However, this time limit can be extended if the complainant has a good reason for the delay and if it remains possible to conduct a fair and effective investigation despite the delay. This decision is typically made by the complaints manager in consultation with the complainant.

While regulations don't stipulate exact timescales for the entire complaints process, a response should be timely and appropriate. If a response is not provided within six months from the date of the complaint (or an agreed later date), the complaints manager must inform the complainant in writing, explaining the delay. It is essential to provide an estimated timeframe for a full response upon acknowledging a complaint and to keep the complainant updated if any delays occur.

The Importance of Apologising

Many patients who complain are seeking several key outcomes:

• A thorough investigation and explanation of what happened and why.
• Assurance that similar issues will not recur.
• A sincere apology.

The General Medical Council (GMC) guidance, 'Good medical practice', emphasises the importance of openness and honesty with patients when things go wrong, stating that apologising does not automatically equate to admitting legal liability. Healthcare organisations in England are also subject to a statutory duty of candour since April 2015, requiring them to be open and transparent. Apologising where appropriate is actively encouraged, as it can foster trust and aid resolution.

Disciplinary and Criminal Procedures

It's important to distinguish the complaints procedure from disciplinary or criminal proceedings. The complaints process is designed to address patient concerns, not to discipline healthcare professionals. Where disciplinary action is being considered against a healthcare professional who is the subject of a complaint, these processes must remain entirely separate and confidential. Complainants do not have a right to know the details or outcomes of disciplinary procedures.

In rare instances, a complaint may overlap with a police investigation. In such cases, investigating the complaint could potentially prejudice the police investigation or the rights of the individual involved. If you are in such a situation, seeking advice is recommended.

Clinical Negligence Claims

A patient can pursue both a complaint and a clinical negligence claim concurrently. The complaint investigation can sometimes provide information relevant to a negligence claim. Clinical negligence claims against NHS GPs in England, arising from care provided on or after 1 April 2019, are handled by the Clinical Negligence Scheme for General Practice (CNSGP). GPs are obligated to report matters that may lead to claims promptly.

Getting Support: NHS Complaints Advocates

You have the right to make a complaint about any NHS service. If you need assistance, you can access free support from an NHS complaints advocate. These advocates can help you articulate your complaint, draft letters, and even attend meetings with you. However, they cannot make the complaint on your behalf or provide medical or legal advice. You can find an advocate by searching online for 'NHS complaints advocacy' in your area or by contacting your local Healthwatch organisation, which is an independent body that ensures feedback is heard.

Complaining About Social Care Services

If you are unhappy with social care services, such as a care home or home care, and you are self-funding your care, you should initially speak to the service provider. If you wish to make a formal complaint, the organisations providing these services will have their own complaints procedures. If your care is funded or arranged by your local council, you can raise your concerns directly with the council if you prefer not to approach the provider first.

Complaining About the Mental Health Act

For complaints regarding mental health services, you should contact either the service provider or the commissioner (usually your local ICB). However, if your complaint specifically concerns the use of the Mental Health Act on someone detained in hospital, subject to guardianship, or under a community treatment order, you should complain to the Care Quality Commission (CQC).

What to Expect When Making a Complaint

Upon receiving your complaint, you should expect:

• An acknowledgement within 3 working days.
• An offer of a discussion about how your complaint will be handled.
• An estimated timeframe for a response, agreed during the discussion.
• Regular updates if there are any delays in providing a response.
• A final written response detailing the findings, any apologies offered, and actions being taken.

This response should also inform you of your right to escalate the complaint to the relevant ombudsman if you remain unsatisfied.

What If You're Still Not Satisfied?

If, after the local resolution process, you are still unhappy with the outcome or the way your complaint was handled, you can take your complaint to the relevant ombudsman:

• Healthcare Complaints: Contact the Parliamentary and Health Service Ombudsman (PHSO). They make final decisions on unresolved NHS complaints in England and are independent of the NHS. You can reach them on 0345 015 4033 or visit their website.
• Social Care Complaints: Contact the Local Government Ombudsman (LGO). They are independent of local authorities and care providers and can be reached on 0300 061 0614 or via their website.

Key Takeaways

Navigating the NHS complaints procedure can seem daunting, but understanding the steps involved empowers you to seek resolution effectively. Remember to:

• Act promptly within the 12-month time limit.
• Clearly state your concerns to the responsible body.
• Seek support from a PALS service or an NHS complaints advocate if needed.
• If unsatisfied with the local resolution, escalate to the appropriate Ombudsman.

Your feedback is valuable in improving NHS services, and the complaints procedure is a vital mechanism for ensuring accountability and quality care.

Frequently Asked Questions

Q1: Can I complain about something that happened a long time ago?
Generally, complaints must be made within 12 months. However, this can be extended if you have a good reason for the delay and if a fair investigation is still possible.

Q2: Do I need a lawyer to make an NHS complaint?
No, you do not need a lawyer. You can use the NHS complaints procedure yourself, and NHS complaints advocates can provide free support.

Q3: What's the difference between PALS and an NHS complaints advocate?
PALS (Patient Advice and Liaison Service) can help resolve issues informally and quickly. An NHS complaints advocate provides more formal support throughout the complaints process, helping you to write letters and attend meetings.

Q4: Can I complain about a private healthcare provider if they are contracted by the NHS?
Yes, if an independent provider is delivering healthcare under arrangements made with an NHS body, they are considered 'responsible bodies' and must follow the NHS complaints procedure.

Q5: What if my complaint involves multiple NHS organisations?
Organisations are required to cooperate to provide a coordinated response. The initial organisation you complain to should help facilitate this.

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