COMPLAINTS POLICY & PROCEDURE

Last Review Date

April 2016

Approving Body

Quality & Patient Safety Committee

Date of Approval

7 September 2017

Date of Implementation

October 2017

Next Review Date

September 2019

Review Responsibility

Chief Nurse

Version

1.0

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Date of Review

Amendment Details

October 2012

CCG Complaints policy developed using PCT policy as a template. Version control re-set to version 0.1. Will be held in draft until April 2013.

November 2012

Approved by CCG Committee November 2012. Version control re-set to v1.0.

April 2014 Amended to clarify the procedure where complaint cases may be subject to litigation, inquests or serious investigations (Procedure section 1.5 and 1.6) as per guidance from NHSE March 2014 Amend approved by Lead Office Chief of Corporate Services

June 2015

Reviewed to clarify the signposting of complaints to providers for local resolution and to include reference to Healthwatch.

August 2015

Approved by Engagement & Experience Committee. Version control re-set to v 1.0

April 2016 Reviewed to include delegated authority for primary care (GP Practices) from 1 April 2016 and changes in reporting requirements to HSCIC from 1 April 2015

October 2016

Amended to include new Healthwatch Doncaster address

April 2017 Amended to include revised name of Acute Trust to Doncaster & Bassetlaw Teaching Hospital NHS Foundation Trust

August 2017

Reviewed;

Addition on appendix C – Dispute resolution within CHC.

Healthwatch Doncaster replaced with Voicability as the provider of complaints advocacy support.

Policy Approval to change from Engagement & Experience Committee to Quality & Patient Safety Committee.

Review Responsibility to change from Chief of Corporate Services to Chief Nurse.

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CONTENTS

Page Definitions 4 Section A – Policy 5 1. Policy Statement, Aims & Objectives 5 2. Legislation & Guidance 6 3. Scope 6 4. Accountabilities & Responsibilities 6 5. Dissemination, Training & Review 7 Section B – Procedure 10 1. Overview 10 2. What is a complaint 11 3. Who can make a complaint 11 4. Complaints outside the scope of this policy 12 5. Time limits for making a complaint 13 6. How to make a complaint 14 7. Complaints investigation – Local Resolution 14 8. The Parliamentary and Health Service Ombudsman 16 9. Complaints which span more than one organisation 17 10. Unreasonably persistent complainants 17 11. Publicising the policy 21 Appendices Appendix A: Inter-agency complaints procedure 22 Appendix B: Staff operational guidance for handling habitual or

unreasonably persistent complainants Appendix C: Continuing Healthcare – Dispute Resolution

23

24

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DEFINITIONS Term

Definition

Clinical Commissioning Group (CCG)

The local clinically-led organisation that commissions community and secondary care.

Complaint An expression of dissatisfaction that requires a response. The complaint can be received orally or in written form via letter, email or fax.

Complainant Refers to the individual who raises or makes the complaint.

Concern A matter that engages a person's attention or interest, or that affects a person's welfare or happiness

Gillick Competence

A term used in medical law to decide whether a child (16 years or younger) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge.

Policy A plan of action adopted or pursued by an individual organisation

Procedure A way of acting or progressing a course of action, an established method for performing a task.

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SECTION A – POLICY 1. Policy Statement, Aims & Objectives 1.1. NHS Doncaster Clinical Commissioning Group (CCG) is committed to

providing the public, patients and carers with the opportunity to raise concerns or to complain about any services it provides or commissions. Patient experience feedback is essential to service improvement and NHS Doncaster CCG will take a proactive approach to asking for people’s views, dealing with complaints effectively and efficiently and using the information received to improve the quality of services that we commission.

1.2. This policy and procedure outlines the statutory regulations all staff

must adhere to regarding the handling, reporting and investigation of any complaint, concern, comment or compliment received within NHS Doncaster Clinical Commissioning Group (CCG) about the actions of the organisation, its staff and services. NHS Doncaster CCG will adopt a transparent approach to all its activities, which are undertaken in line with the Nolan Principles.

1.3. The complaints procedure aims to meet the following:

Getting it right

Being customer focused

Being open and accountable

Acting fairly and proportionately

Putting things right

Seeking continuous improvement 1.4. It is imperative that patients, relatives and carers feel able to raise both

complaints and concerns as appropriate and are comfortable that any concerns or complaints that are raised will not lead to them receiving a detrimental service in any way.

1.5. To ensure continuous improvement in the management of standards of

business conduct and conflicts of interests and to monitor the effectiveness of this policy, NHS Doncaster CCG has the following key performance indicators (KPIs):

No Key Performance Indicator Method of Assessment

1 Complaints Annual Report. Publication of Complaints Annual Report.

2 Provision of a simple, clear procedure for managing complaints that is accessible to all.

Publication of patient information leaflet “Listening – Responding – Improving – How to tell us what you think”.

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No Key Performance Indicator Method of Assessment

3 Quarterly Report To Quality & Patient Safety Committee and Engagement & Experience Committee. Also a quantitative report to NHS Digital.

2. Legislation & Guidance 2.1. The following legislation and guidance has been taken into

consideration in the development of this policy and procedure:

Local Authority Social Services & National Health Service Complaints (England) Regulations 2009.

The Principles of Good Complaint Handling (Parliamentary and Health Service Ombudsman, 2008).

Listening, Improving, Responding – a Guide to Better Patient Care (Department of Health, 2009).

NHS Constitution.

The Equality Act 2010 3. Scope 3.1. This policy applies to those members of staff that are directly employed

by NHS Doncaster CCG and for whom NHS Doncaster CCG has legal responsibility. For those staff covered by a letter of authority / honorary contract or work experience this policy is also applicable whilst undertaking duties on behalf of NHS Doncaster CCG or working on NHS Doncaster CCG premises and forms part of their arrangements with NHS Doncaster CCG. As part of good employment practice, agency workers are also required to abide by NHS Doncaster CCG policies and procedures, as appropriate, to ensure their health, safety and welfare whilst undertaking work for NHS Doncaster CCG.

4. Accountabilities & Responsibilities 4.1. Overall accountability for ensuring that there are systems and

processes to effectively manage all complaints received by NHS Doncaster CCG and for responding to complaints about the actions and / or commissioning responsibilities of the organisation lies with the Accountable Officer, who is known as the Chief Officer. The responsibility for the management of complaints is delegated to the following individuals:

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Chief Nurse)

Has delegated responsibility for:

Organisational compliance with the Local Authority Social Services & National Health Service Complaints (England) Regulations 2009.

Ensuring that action is taken following the outcome of any complaints investigations.

Ensuring an organisational Complaints Policy is in place.

Providing clinical input to complaints investigations and responses.

Patient

Experience Team

Have delegated responsibility for:

Provision of advice and/or support to staff regarding complaints and concerns.

Acknowledging and facilitating the investigation of complaints that have been directed to the organisation.

Arrangement of training on complaints handling where appropriate.

Co-ordination of complaints investigations.

Maintenance of the complaints database.

Proposing policy changes in response to revisions to complaints regulations.

Liaising with complaints teams in other organisations where appropriate.

Staff

Responsibilities of Staff (including all employees, whether full/part time, agency, bank or volunteers) are:

Forwarding all complaints and concerns to the Patient Experience Team as soon as possible in order to ensure a full and accurate complaint register is held within NHS Doncaster CCG.

Dealing with concerns as soon as possible to reduce the need to make a formal complaint.

Cooperating with and responding appropriately to any complaints investigations in line with this policy and procedure.

5. Dissemination, Training & Review 5.1. Dissemination 5.1.1. The effective implementation of this Policy and Procedure will support

openness and transparency in decision making. NHS Doncaster CCG will:

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Ensure all staff and stakeholders have access to a copy of this Policy and Procedure via the organisation’s website.

Communicate to staff any relevant action to be taken in respect of complaints issues.

Ensure that relevant training programmes raise and sustain awareness of the importance of effective complaints management.

5.1.2. This Policy & Procedure is located in the General Policy Manual. A set

of hardcopy Procedural Document Manuals are held by the Governance Team for business continuity purposes and all procedural documents are available via the organisation’s website. Staff are notified by email of new or updated procedural documents.

5.2. Training

5.2.1. All staff will be offered relevant training commensurate with their duties

and responsibilities. Staff requiring support should speak to their line manager in the first instance. Support may also be obtained through their union representative or HR Department. Managers should contact the Patient Experience Team if there are specific training needs.

5.3. Review 5.3.1. As part of its development, this policy and its impact on staff, patients

and the public has been reviewed in line with NHS Doncaster CCG’s Equality Duties. The purpose of the assessment is to identify and if possible remove any disproportionate adverse impact on employees, patients and the public on the grounds of the protected characteristics under the Equality Act 2010.

5.3.2. The Policy & Procedure will be reviewed every three years, and in

accordance with the following on an as and when required basis:

Legislatives changes

Good practice guidelines

Case Law

Significant incidents reported

New vulnerabilities identified

Changes to organisational infrastructure

Changes in practice 5.3.3. Complaints management will be performance monitored to ensure the

following and the results will be published in the Complaints Annual Report:

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The CCG is aware of its compliance with response timescales and in accordance with equality duties.

Appropriate management processes are being undertaken.

Patients, relatives and their carers are not being treated differently as a result of submitting complaints/concerns.

Changes are being made as a result where appropriate.

5.3.4. Complaints returns will be made in line with requirements of the Department of Health. This currently comprises the number and cause of written complaints, the age group of the patient and the relationship of the complainant if not the patient, and the number that are upheld, partially upheld or not upheld. This data is submitted quarterly to NHS Digital.

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SECTION B - PROCEDURE

1. Overview 1.1. The Department of Health published Regulations (Local Authority

Social Services and NHS Complaints (England) Regulations 2009) which were introduced on 1st April 2009. The Regulations provide the statutory basis for the single approach to complaints handling in health and social care.

1.2. The complaints approach is structured around the three main principles

of listening, responding and improving:

Listening Taking a more active approach to asking for people’s views and working in partnership

Responding Dealing with complaints more effectively by finding out

what the complainant wants to happen

Improving Using the information received to learn and improve services by agreeing a clear plan of action

1.3. Comments, suggestions and complaints about the CCG and health

services commissioned by the CCG are welcomed. It is important for staff to acknowledge all comments and suggestions and to let the person making them know that they will be treated constructively and confidentially.

1.4. Complaints will be handled in strict confidence at all times. Care will be

taken that information is only disclosed in line with the Data Protection Act 1998 and information will not be disclosed to patients or complainants unless the person who has provided the information has given consent to disclosure.

1.5. Where the complainant is taking, or plans to take, legal proceedings, a complaint may only be put on hold where there are exceptional reasons to justify it, or the complainant has requested that investigation be delayed. Exceptional circumstances for putting a complaint on hold may include formal requests to do so by the police, a coroner or a judge.

1.6. Any concerns about continuing with the investigation of a complaint should be raised during the discussion with the complainant of how the complaint is to be handled in order to allow the complainant’s view to be heard. If, exceptionally, the CCG decides to put a complaint on hold against the wishes of the complainant, the complainant should be informed of this as soon as is practicable and provided with a full explanation (in writing, unless request not to) of the reasons for this.

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Any decision to put the complaint on hold in these circumstances would be made by the Chief Officer.

2. What is a complaint? 2.1. A complaint is an expression of dissatisfaction or concern about a CCG

staff member, about a service which is commissioned by NHS Doncaster CCG or about an action, omission or decision of the CCG that requires a response. The complaint can be received in written form via letter, or email.

2.2. The term “complainant” refers to an individual who raises or makes the

complaint. 2.3. Not all issues raised are formal complaints and it is important that staff

who are handling complaints understand the difference. Staff must be able to recognise when a person is making an enquiry, raising a concern, asking for advice or making a constructive suggestion and not to misconstrue this as a complaint. Many concerns can be sorted out by the member of staff in direct communication with the contact. This should be the normal practice and staff will be empowered to resolve these quickly without the need for them to go through a more formal complaints process.

3. Who can make a complaint? 3.1. A complaint can be made by any person who has received or is

receiving NHS treatment or services or any person who has been affected by an action, omission or decision of the CCG.

3.2. A complaint can also be made by a representative acting on another

person’s behalf, if that person:

Has requested the representative to act on their behalf;

Is a child;

Is unable to make the complaint themselves because of physical incapacity or lack of capacity within the meaning of the Mental Capacity Act 2005;

Has died. 3.3. If a complaint is made by a representative then consent will be required

so that a full investigation can be commenced. In the case of an individual being unable to provide consent (for example, due to physical or mental capacity or in the case of a minor), their legal guardian, parent or other verified appropriate representative will be accepted to act on their behalf.

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3.4. If a parent or guardian complains on behalf of their child and that person is sixteen years old or older, then their consent will be sought prior to further action. Complaints made on behalf of children and young people under the age of sixteen will be considered on an individual basis (subject to Gillick competence) and according to the nature and subject of the complaint before consent is requested.

3.5. In the case of a representative acting on behalf of a deceased patient,

the relationship of the representative to the deceased must be clarified and confirmed as either the next of kin or Executor / Administrator or have an interest in the person’s estate.

3.6. If a Member of Parliament makes a complaint on behalf of a

constituent, it will be considered that the MP has obtained consent prior to contacting NHS Doncaster CCG (in line with requirements of the Data Protection Act 1998 processing of Sensitive Personal Data – Elective Representatives Order 2002).

4. Complaints outside the scope of this policy and procedure 4.1. The following types of complaint are outside the scope of this policy:

A complaint which is made orally and resolved to the complainant’s satisfaction with 3 working days following receipt of the complaint.

A complaint which has already been investigated under the complaints regulations;

A complaint which has been or is being investigated by the Health Service Ombudsman;

A complaint arising out of the CCG’s alleged failure to comply with a data subject request under the Data Protection Act 1998 or a request for information under the Freedom of Information Act 2000;

A complaint made by an employee or potential employee of the CCG about any matter relating to their employment;

A complaint made by CCG staff about colleagues or managers, which will normally be dealt with under the CCG’s Grievance Policy and Procedure or Whistleblowing Policy;

A complaint made by another NHS body, Independent Provider, health organisation or Local Authority;

A complaint from a Member Practice which is eligible to be managed under the Dispute Resolution process contained in the NHS Doncaster CCG Constitution;

Complaints about private services or treatment unless provided under commissioning arrangements with the NHS.

4.2. Complaints solely regarding Independent Contractors (General

Practices, Dental Practices, Pharmacies, Opticians or Prison Healthcare) should, wherever possible, be directed to the Complaints Lead for the organisation responsible for delivering that care or to NHS England. If these complaints are received by NHS Doncaster CCG, the

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complainant will be contacted and either signposted to the appropriate lead within the relevant provider or their consent sought to pass their complaint onto the appropriate lead. From 1 April 2016, NHS Doncaster CCG has delegated responsibility from NHS England for commissioning primary medical care services (GP Practices) but this does not include complaint management. NHS England remains legally responsible for complaint management but complainants would be encouraged to contact the GP Practice Manager in the first instance wherever possible or appropriate.

4.3. Complaints solely regarding a Single Provider such as our local Acute

Trust (Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust) and local Community & Mental Health Trust (Rotherham Doncaster & South Humber NHS Foundation Trust) should, wherever possible, be directed to the Complaints Lead for the organisation that is responsible for delivering that care. If these complaints are received by NHS Doncaster CCG, the complainant will be contacted for a discussion regarding the handling of their complaint and will be signposted to the appropriate lead, or their consent sought to pass their complaint onto the appropriate lead in the organisation responsible for delivery for that care. NHS Doncaster CCG will not undertake an investigation into a complaint solely regarding care provided by a provider organisation. It is the responsibility of the organisation providing the services to investigate the complaint under local resolution arrangements. It should be noted that no complaint will be investigated without the provider of the service being involved and having the opportunity to respond.

4.4. Complaints which span multiple Providers should be directed to NHS

Doncaster CCG’s Patient Experience Team (see below for further details).

4.5. Full details of all types of complaint which fall outside this procedure

can be found in regulation 8 of the Local Authority Social Services and NHS Complaints (England) Regulations 2009. There are also circumstances where further discussions will take place before determining whether or not to investigate a complaint and these include:

Where the Police are involved;

Where legal action is being taken or the intent to take legal proceedings has been stated in writing.

5. Time limits for making a complaint 5.1. A complaint must be made within 12 months from the date on which a

matter occurred or the matter came to the notice of the complainant, unless there are exceptional circumstances. The time limit will not apply if the CCG is satisfied that the complainant had good reasons for

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not making the complaint within the time limit and, notwithstanding the delay, it is still possible to investigate the complaint effectively and fairly.

6. How to make a complaint 6.1. All formal complaints should be directed to the Chief Officer at NHS

Doncaster CCG’s Headquarters (full details available on our website at http://www.doncasterccg.nhs.uk/contact-us/complaints-information/ or by telephone 01302 566300).

7. Complaints Investigation – Local Resolution 7.1. Any member of staff approached verbally by a complainant should try

and resolve the issue or concern. If the complainant is satisfied at this stage no further action need be taken. The concern should be recorded and sent to the Patient Experience Team for logging. These will not be recorded as a formal complaint, however NHS Doncaster CCG will ensure that these issues are logged and tracked to ensure resolution and that the organisation captures all concerns of service users.

7.2. If the issue cannot be quickly resolved it should be forwarded to the

Patient Experience Team for action. Any complaint that is received that could be potentially serious or include possible litigation must be reported the Patient Experience Team immediately.

7.3. The Patient Experience Team upon receiving the complaint shall:

Log the complaint and open a folder for the complaint correspondence;

Risk assess the complaint where appropriate, using NHS Doncaster CCG’s Integrated Risk Management Framework, Strategy, Policy & Procedure.

Acknowledge the complaint raised by the complainant within 3 working days and deal with any issues of consent where relevant.

Voicability Complaints Advocacy Services are available locally and play an important role in supporting individual complainants and particularly in representing the needs of vulnerable groups when making complaints.

7.4. NHS Doncaster CCG will ensure that complaints are investigated in an

appropriate manner aiming to resolve them as soon as possible. 28 days is good practice. All complaints should be investigated to ensure lessons are learnt. During the investigation complainants will be kept informed, as far as is practical, as to the progress in respect of their complaint. Investigation may take the form of gathering of documents,

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interviewing relevant staff, review of policies and procedures, and will be co-ordinated by the Patient Experience Team, who will stipulate timescales in accordance with each case.

7.5. If a complainant wishes to meet with an appropriate member of NHS

Doncaster CCG staff or complaints department staff to discuss their complaint, this will be facilitated by the Patient Experience Team. Notes will be taken of all meetings and the Patient Experience Team will endeavour to ensure that these are confirmed by all involved before being accepted as a file copy.

7.6. Any member of staff named or implicated in a complaint should be

informed of the complaint and fully supported by their line manager. The management style and culture within NHS Doncaster CCG will be to promote a positive attitude towards dealing with complaints. Where appropriate, staff will also be signposted to other forms of support such as Occupational Health and professional colleges or indemnity organisations. Where a Chief of Service /Director or equivalent is associated with a complaint, the matter will be investigated directly by the Chief Officer.

7.7. If a complaint is received that involves a serious allegation of

misconduct about a member or members of staff warranting a management investigation, this will be handled separately through line management arrangements, Human Resource policies and Fraud and Whistleblowing Policies.

7.8. Following a complaint or investigation of a complaint, if it appears or is

alleged that a criminal offence may have been committed, the matter should be reported immediately to the Chief Officer (or the most senior manager available) who will give advice on whether the Police should be called. On conclusion of any criminal proceedings or, having been brought in, the Police decide not to institute criminal proceedings; the organisation must then itself consider what further investigation is required.

7.9. In its investigations, NHS Doncaster CCG should take care not to

prejudice police enquiries or court proceedings. If there appears to be any risk that investigations by the CCG may prejudice or potentially prejudice police enquiries or court proceedings, NHS Doncaster CCG should consult the Police and their own legal advisers before proceeding.

7.10. If appropriate, NHS Doncaster CCG will review what action needs to be

taken to reduce the risk of a recurrence of the incident leading to the complaint. Where appropriate, action plans should therefore form part of the conclusion of a complaint, highlighting what steps will be taken, by when and to what timescale.

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7.11. Following completion of the investigation, a response will be sent to the complainant signed by the Chief Officer, which should include:

An explanation of consideration of the complaint

An honest explanation

Conclusions reached in respect of the complaint

Any remedial action that is considered to be appropriate

Confirmation that the action has been taken or satisfaction that it will be actioned

7.12. If a complainant remains dissatisfied following receipt of the

investigation response, Conciliation and/or Mediation is a way of dealing with complaints that helps to avoid adversarial situations. By bringing the two sides together with a neutral Conciliator/Mediator it aims to achieve a satisfactory conclusion for both the complainant and the CCG.

7.13. Complainants who remain dissatisfied at the end of local resolution will be informed of their right to ask the Health Service Ombudsman to review their complaint.

8. The Parliamentary and Health Service Ombudsman 8.1. A complainant can ask the Parliamentary and Health Service

Ombudsman to review a complaint if they remain dissatisfied following local review. Contact details for the Parliamentary and Health Service Ombudsman will be provided with complaint responses.

8.2. The Parliamentary and Health Service Ombudsman provides a service

to the public by undertaking independent investigations into complaints that the NHS in England has not acted properly or fairly, or has provided a poor service. The Parliamentary and Health Service Ombudsman will normally only take on a complaint after the NHS organisation complained about has first tried to resolve the issues and has responded to the complainant. The Parliamentary and Health Service Ombudsman believes that the CCG should be given a chance to respond and, where appropriate, put things right before they become involved. They are, therefore, the second stage of the NHS Complaints Procedure.

8.3. The Parliamentary and Health Service Ombudsman may investigate a

complaint if:

The complainant is not satisfied with the outcome of the investigation/does not feel their concerns have been resolved;

The complaint has not been investigated on the grounds that it was not made within the required time limit

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8.4. When NHS Doncaster CCG is advised that a complainant has approached the Ombudsman it will ensure that:

The Ombudsman receives full co-operation and all information requested in relation to the complaint is provided;

The Chief Officer is informed

Any recommendations from the Ombudsman are appropriately actioned and used as a learning tool for handling future complaints.

8.5. The Chief Officer will contact the complainant informing him/her of any

action the CCG is taking as a result of any independent review. 9. Complaints which span more than one organisation 9.1. If the CCG receives a complaint which appears to span both Health

and Adult Social Care Services and/or other healthcare organisations, it will work with the other organisation(s) under the Regulations to ensure co-ordinated handling and to provide the complainant with a single response which covers all aspects of the complaint.

9.2. With consent from the complainant a copy of the complaint will be

forwarded to the organisation concerned. The lead organisation will be established by discussion with the complainant and organisation/s concerned, which may depend on which organisation has to address the majority of the issues raised and whether the complainant is happy with the proposed lead. Joint complaints can be more complex and may require more time in which to respond and deadlines will be agreed between all parties concerned.

9.3. If a complainant remains unhappy with the other organisation after

receiving a joint response, the CCG will endeavour to arrange a meeting with appropriate staff from that organisation for further resolution (a conciliation/mediation meeting may be considered).

9.4. A flowchart appended as Appendix A captures the process. 10. Unreasonably persistent complainants 10.1. Unreasonably persistent complainants are an increasing problem for

NHS staff. The difficulty in handling such complainants places a strain on time and resources and causes unacceptable stress for staff who may need support in difficult situations. NHS staff are trained to respond with patience and understanding to the needs of all complainants, but there are times when there is nothing further that can reasonably be done to assist them or to rectify a real or perceived problem.

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10.2. Any complaints received by the CCG will be processed in accordance with the Complaints Policy & Procedure, and requests for information will be processed in accordance with the CCG’s Freedom of Information Policy. During this process, CCG staff inevitably have contact with a small number of individuals who may take up an unwarranted amount of NHS resources. This section of the Complaints Procedure aims to identify situations where this could be considered unreasonably persistent and to suggest ways of responding to such situations.

10.3. The unreasonably persistent complainant’s procedure will only be

used as a last resort and after all reasonable measures have been taken (i.e. an effort to resolve complaints following the NHS complaints procedures or exhaustion of all reasonable measures under the Freedom of Information Act).

10.4. Complainants or persons requesting information (and / or anyone

acting on their behalf) may be deemed to be unreasonably persistent where current or previous contact with them shows that they have met two or more (or are in serious breach of one) of the following criteria:

Persisting in pursuing a complaint where the NHS complaints procedure has been fully and properly implemented and exhausted. For example, where investigation is deemed to be 'out of time' or where the Ombudsman has declined a request for independent review

Persisting in pursuing a request for information where the Freedom of Information Act Policy has been fully and properly implemented and exhausted.

Changing the substance of a complaint or persistently raising new issues or seeking to prolong contact by unreasonably raising further concerns or questions upon receipt of a response whilst the complaint / request is being dealt with. Care must be taken not to disregard new issues, which differ significantly from the original complaint / request - these may need to be addressed separately.

Unwillingness to accept documented evidence of treatment given as being factual (e.g. drug records, GP records, nursing records) or denying receipt of an adequate response despite correspondence specifically answering questions / concerns raised. This could also extend to include those persons who do not accept that the facts can sometimes be difficult to verify after a long period of time has elapsed.

Focusing on a trivial matter to an extent which is out of proportion to its significance and continuing to focus on this point. It should be recognised that determining what is trivial can be subjective and careful judgement must be used in applying this criterion.

Physical violence has been used or threatened towards staff or their families / associates at any time. This will, in itself, cause personal contact to be discontinued and will thereafter, only be pursued through written communication. All such incidents should

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be documented and reported using the CCG’s Incident Policy, and notified as appropriate, to the Police. Staff should also refer to the CCG’s Personal Safety Policy.

Had an excessive number of contacts with the Trust when pursuing their request or complaint, placing unreasonable demands on staff. Such contacts may be in person, by telephone, letter, fax or electronically. Discretion must be exercised in deciding how many contacts are required to qualify as excessive, using judgement based on the specific circumstances of each individual case.

Have harassed or been abusive or verbally aggressive on more than one occasion towards staff - directly or in-directly - or their families and / or associates. If the nature of the harassment or aggressive behaviour is sufficiently serious, this could, in itself, be sufficient reason for classifying the complainant as unreasonably persistent. Staff must recognise that complainants may sometimes act out of character at times of stress, anxiety or distress and should make reasonable allowances for this. All incidents of harassment or aggression must be documented in accordance with the CCG’s Incident Policy.

Are known to have electronically recorded meetings or conversations without the prior knowledge and consent of the other parties involved. It may be necessary to explain to a complainant at the outset of any investigation into their complaint(s) that such behaviour is unacceptable and can, in some circumstances, be illegal.

Displaying unreasonable demands or expectations and failing to accept that these may be unreasonable once a clear explanation is provided to them as to what constitutes an unreasonable demand (i.e. insisting on responses to complaints or enquiries being provided more urgently than is reasonable or recognised practice, presenting similar or substantially similar requests for information).

10.5. Careful judgement and discretion must be used in applying the criteria

to identify potential unreasonably persistent complaints and requests for information and in deciding what action to take in specific cases.

10.6. This procedure should only be implemented following careful

consideration by, and with authorisation of, the Chair and Chief Officer or nominated deputy and subsequently ratified by the Governing Body through the confidential agenda.

10.7. When complainants / persons requesting information have been

identified as unreasonably persistent, in accordance with the above criteria, the Chair and Chief Officer (or their nominated deputy) will decide what action to take. The Chief Officer (or deputy / representative) will implement such action and notify the individual(s) promptly, and in writing, the reasons why they have been classified as unreasonably persistent and the action to be taken.

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10.8. This notification must be copied promptly for the information of others

already involved such as practitioners, conciliator, Independent Complaints Advocacy Service, Member of Parliament, advocates etc. Records must be kept, for future reference, of the reasons why the decision has been made to classify as unreasonably persistent and the action taken.

10.9. Prior to formal classification, once it is clear that one of the criteria

above has been breached, it may be appropriate to inform the individuals, in writing, that they are at risk of being classified as unreasonably persistent. A copy of this procedure should be sent to them and they should be advised to take account of the criteria in any future dealings with the CCG and its staff. In some cases it may be appropriate, at this point, to copy this notification to others involved and suggest that complainants seek advice in taking their complaint further (e.g. via the Independent Complaints Advocacy Service).

10.10. The CCG should try to resolve matters before invoking this procedure,

and / or the sanctions detailed within it, by drawing up a signed agreement with the complainant / persons requesting information (if appropriate, involving the relevant practitioner) setting out a code of behaviour for the parties involved, if the CCG is to continue dealing with the complaint. If this agreement is breached, consideration would then be given to implementing other actions as outlined below.

The CCG can decline further contact either in person, by telephone, fax, letter or electronically, or any combination of these, provided that one form of contact is maintained. Alternatively, a further contact could be restricted to liaison through a third party. A suggested statement has been prepared for use if staff are to withdraw from a telephone conversation. This is shown in the attached staff operational guidance at Appendix B.

Notify complainants / persons requesting information in writing that the Chair or Chief Officer (or delegated deputies / representatives) has responded fully to the points raised and has tried to resolve the issues but there is nothing more to add and continuing contact on the matter will serve no useful purpose. This notification should state that that correspondence is at an end and that further communications will be acknowledged but not answered.

Inform complainants / persons requesting information that in extreme circumstances the CCG reserves the right to refer unreasonably persistent complaints to the organisation’s solicitors/ the Information Commissioner and / or, if appropriate, the police.

Temporarily suspend all contact, whilst seeking legal advice or guidance from the NHS Commissioning Board, Information Commissioner’s office or other relevant agencies.

10.11. Once classified as unreasonably persistent, there needs to be a

mechanism for withdrawing this status if, for example, a more

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reasonable approach is subsequently demonstrated or if they submit a further complaint/ request for information for which the normal complaints procedures or Freedom of Information Act procedures would be appropriate. Staff should have already used careful judgement and discretion in recommending or confirming unreasonably persistent status and similar judgement / discretion will be necessary when recommending that such status should be withdrawn. Where this appears to be the case, discussions will be held with the Chairman and Chief Executive (or their delegated deputies / representatives) and, subject to their approval, normal contact and procedures will be resumed. Regular monitoring of the application of this procedure will be reported to the confidential section of the Governing Body.

11. Publicising the policy 11.1. It is important that patients and their relatives or carers know about the

CCG’s Complaints Policy and how to make comments, compliments, suggestions or complaints about services which the CCGs commission and provide.

11.2. Patients and their relatives or carers may contact the Patient

Experience Team if they have any questions or concerns about the Complaints Policy & Procedure.

11.3. Patients may also contact the Complaints Advocacy Service at

Voicability if they need help in making a complaint. 11.4. It is important to remember that complainants may be unable to read or

write, may not have English as their first language or may suffer from disabilities which make formal written complaints difficult to make. The CCG has access to interpretation/translation services and other services for those unable to put their complaint into writing and details can be obtained from the Patient Experience Team.

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Complaint made to agency

Agree lead and identify responsibility for each aspect of complaint

Obtain consent* to share complaint with other

agencies (See Appendix I-attached)

Share complaint with other agencies

Consent

Obtained

Advise complainant unable to respond to

all aspects of the complaint

Agree if response will be joint or separate

All agencies to investigate within timescales

Respond to complainant within agreed timescale

(refer to individual complaint plan)

*To be requested within five days of

receiving complaint

No

Yes

Investigate aspects of complaint within

restrictions

Appendix A

Inter-Agency Complaints Procedure

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Appendix B

STAFF OPERATIONAL GUIDANCE FOR HANDLING HABITUAL OR UNREASONABLY PERSISTENT COMPLAINANTS

The following form of words – or a very close approximation – should be used by any member of staff who intends to withdraw from a telephone conversation with a complainant. Grounds for doing so could be that the complainant has become unreasonably aggressive, abusive, insulting or threatening to the individual dealing with the call or in respect of other NHS personnel. It should not be used to avoid dealing with a complainant's legitimate questions / concerns which can sometimes be expressed extremely strongly. Careful judgement and discretion must be used in determining whether or not a complainant's approach has become unreasonable. Attention is drawn to the fuller provisions set out in the body of this procedure for handling unreasonably persistent complainants (see section 10). FORM OF WORDS "I am afraid that we have reached the point where your approach has become unreasonable and I have no alternative but to discontinue this conversation. Your complaint(s) will still be dealt with by the CCG in accordance with the NHS complaints procedure. I am now going to put the telephone down but wish to assure you that the situation will shortly be confirmed in writing to you." FOLLOW-UP ACTION The incident should immediately be reported to the Chief Officer / Chief Nurse or equivalent and agreement reached on future means of communication with the complainant, together with any further action deemed necessary.

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Appendix C

Dispute Resolution within Continuing Healthcare (CHC)

1 Introduction

This procedure is created in accordance with the National Framework for

NHS Continuing Healthcare revised 2012 which reflects the new NHS

framework and structures created by the Health and Social Care Act 2012.

The Regulations under the Act set out the Standing Rules to be followed

when determining eligibility for NHS CHC and NHS Funded Nursing Care

(FNC). This procedure is designed to set out a clear pathway for

individuals or their representatives to raise concerns, or complain about

the CHC process or an application outcome.

The Continuing Healthcare and Funded Nursing Care Appeal Procedure is

in place for appeals which are managed by the CCG Appeals Shared

Service.

2 Consent

The CHC process allows for a patient representative to be present at a

CHC assessment. This representative is then sent an outcome letter and

a copy of the Decision Support (DST) tool. In cases where the individual

does not have the mental capacity to manage their own affairs a

representative may hold one of the following which should be noted on the

DST:

A Lasting or Enduring Power of Attorney which has been registered

with the Office of the Public Guardian. This can be either for

Health and Welfare or for Property and Financial Affairs.

An order of the Court of Protection appointing them as Deputy or

deciding that review of eligibility should take place.

Where no person holds any of the above documents, each case should

be considered on an individual basis taking into account the best interest

of the individual. If the representative wishes to make a formal

complaint about the CHC process or outcome, a consent form should be

completed by the individual or the representative (where appropriate).

3 Concerns

A concern raised by an individual or their representative may be received

verbally, by email or by letter. A concern is something that can be

resolved quickly (within 3 working days) to the satisfaction of the

individual or their representative. A concern should be logged with the

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Patient Experience Team but, where possible, should be dealt with by the

CHC Team dealing with that particular case.

Most concerns, if responded to quickly and by the member of staff with

knowledge of their particular circumstances, can be resolved without

escalating to a formal complaint.

4 Complaint

A complaint raised by an individual or their representative is usually

received by email or letter. If the complainant needs help to make a

complaint they should be signposted to Voicability for support. All

complaints should be logged with the Patient Experience Team as soon

as possible. The Patient Experience Team will then initiate the formal

complaint procedure.

The Patient Experience Team will work with the CHC Team to investigate

the complaint and to draft up a response for consideration by the Chief

Officer. The complaint response will be signed by the Chief Officer

5 Dispute resolution during the CHC process

Checklist

An individual or their representative can challenge or complain about the

outcome of a Checklist. Checklists may be completed by the Hospital

Discharge Team, Social Care or by the CHC Team. The individual should

be advised of the outcome of the Checklist in writing (enclosing a copy of

the Checklist) if the Checklist did not trigger a full CHC assessment. They

should be advised who they can contact if they have any concerns. The

individual or their representative can raise a formal complaint about a

Checklist (within 12 months of receiving the outcome) but they cannot

request an Independent Review.

Assessment for CHC

If the individual screens in for an assessment for CHC, a concern or

complaint may be raised about the process or the outcome. If a concern

is raised, the CHC Team should endeavour to deal with the concern to

avoid it escalating into a formal complaint.

A formal complaint may be submitted up to 12 months after the

event/outcome. If a formal complaint is received, the Patient Experience

Team will work with the CHC Team to investigate the complaint and to

draft up the response for consideration by the Chief Officer. The

complaint response will be signed by the Chief Officer. If the complainant

is unhappy with how the complaint has been investigated and responded

to, a mediation meeting may be offered where appropriate and they will

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be advised that they can contact the Parliamentary and Health Service

Ombudsman.

If an appeal is received, this is forwarded to the Appeals Shared Service

and will be managed as per the CHC and FNC Appeal Procedure.

Solicitor’s letter

If a solicitor’s letter is received which relates to a current CHC case, a

request for a retrospective review or a ‘previously unassessed period of

care’ (PUPoC), it should be passed to the Patient Experience Team for

logging and processing. The Patient Experience Team will acknowledge

the letter and will liaise with the relevant CCG Shared Service Team

dealing with the case.