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For most of us working as care providers the word 'complaint' fills us with trepidation and we often feel defensive when someone lets us know they are unhappy about something. So what is a complaint? A complaint is often defined as a statement that something is unsatisfactory or unacceptable. Ironically a complaint can also be defined as an illness or medical condition, especially a relatively minor one.
Why do people complain?
Most medical care and treatment goes well, but things occasionally go wrong and patients may decide to complain. It’s natural for people to complain, even more so when patient expectations are growing rapidly. Many people complain because they believe something is unfair or out of their control, and some people are just very unhappy about a situation. Some complainants may lack understanding, they complain that something isn't being done correctly and they would have done it differently if they were in that situation. When we lack understanding we are unable to put ourselves in someone else's position. Receiving occasional complaints is normal but to expect no complaints is unrealistic.
NHS Data on Written Complaints in the NHS, 2012-13 highlighted the service area with the second highest percentage of written complaints at 26.4% (13,933) was General Practice. This figure has risen from 9,042 in 2008-09. The biggest subject of complaints in 2012-13 was Clinical, followed by Communications/attitude, then General Practice Administration, Other, Practice Surgery Management, and finally Premises. It will be interesting to see if the number of complaints about premises rises over the next few years due to lack of capital funding and rapidly deteriorating premises in some areas.
NHS organisations must make arrangements for dealing with complaints in accordance with The Local Authority Social Services and NHS Complaints Regulations 2009 (the regulations).
In April 2009 the NHS introduced a revised complaints process which has two stages:
- Local resolution with the care provider, or with the relevant commissioning body such as NHS England or a local CCG.
- If the complainant is still unhappy, they can refer the matter to the Parliamentary and Health Service Ombudsman, who is independent of the NHS and government.
The regulations specify the requirements for the management of complaints by NHS organisations which include:
- the need to identify a ‘responsible person’ and a ‘complaints manager’ (who may be the same person) to deal with complaints;
- the time limit for making a complaint;
- what the response must include;
- the requirement to tell the complainant of their right to put the complaint to the Ombudsman if dissatisfied; and
- the recording of complaints.
Complaints relating to the same subject matter as that of a complaint previously investigated under the regulations do not have to be dealt with in accordance with the regulations.
The procedure for making a complaint is fairly straight forward. Complaints should normally be made within 12 months of the date of the event that is being complained about, or as soon as the matter first came to the complainants attention. Complaints can be made orally, in writing or electronically and the complaint must be acknowledged not later than 3 working days after the day on which the complaint was received. The reply should give an estimate of the time required to investigate the complaint and the complainant should be given the opportunity to agree an alternative timescale if necessary.
Handling complaints, getting it right
Making a complaint can be daunting for some, and poorly handled responses to complaints can cause distress so it’s important to get it right. It must be remembered that some people don’t complain because they fear reprisals if they raise a concern, some patients believe they will be removed from a Practice list simply for making a complaint. Interestingly, last year the Patients Association claimed that their patient survey showed that 4.4% of patients had been removed from their GP Practice list, and 21% of complaints about GPs to the Ombudsman related to inappropriate deregistration.
Good handling of complaints is one way in which care providers can help to improve quality for their patients. Monitoring trends and patterns in complaints and concerns raised by patients about organisations facilitates early detection of systemic problems. Learning from complaints helps organisations to continually improve the services they provide and the experience for all their patients.
Ensuring that patients have a positive experience is a key outcome for the NHS. Making sure that organisations are open and receptive to hearing people’s views, and honest about how they will use this information to develop and improve its service is an important part of this, and a requirement for CQC.
The Regulations for the handling and consideration of complaints state that the arrangements for dealing with complaints must be such as to ensure that:
a) complaints are dealt with efficiently;
b) complaints are properly investigated;
c) complainants are treated with respect and courtesy;
d) complainants receive, so far as is reasonably practical—
(i) assistance to enable them to understand the procedure in relation to complaints; or
(ii) advice on where they may obtain such assistance;
e) complainants receive a timely and appropriate response;
f) complainants are told the outcome of the investigation of their complaint; and
g) action is taken if necessary in the light of the outcome of a complaint.
Local advocacy services
The Patient Advice and Liaison Service, known as PALS, has been introduced to ensure that the NHS listens to patients, their relatives, carers and friends, and answers their questions and resolves their concerns as quickly as possible. PALS also helps the NHS to improve services by listening to what matters to patients and their loved ones and making changes, when appropriate.
Tips for handling complaints
- Ensure you have an up to date protocol for handling complaints.
- Act proportionately, a serious complaint may require involving the complainant in the process, but a simple procedure review may be all that's required.
- Be sensitive as well as objective, complainants may be complaining at a time of grief but that doesn't make their concerns unfounded or unreasonable as a result.
- Provide a comprehensive response within the agreed timescale if possible.
- Making assumptions.
- Getting key facts incorrect.
- Glossing over missing information.
- Being defensive.
- Apologising indirectly. Try to avoid phrases such as "we are sorry that you felt the care provider or an individual did something wrong". Apologise for it going wrong instead.
The QCS Complaints Policy and Procedure provides advice to Practices to support them in handling and responding to complaints within the Regulations.
The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009
Data on Written Complaints in the NHS - 2012-13
Patients Association Report September 2012
Alison Lowerson – QCS Expert GP Practice Manager Contributor