DHSC Annual Complaints Report 2017-2020

Summary

The requester asked for clarification on Nobles Hospital complaint figures, specifically regarding 'simple complaints' logged as concerns, and requested copies of DHSC policies and IRB report follow-ups. The authority responded by providing the full 'Complaints Policy and Guidance' document, which defines the distinction between formal complaints and informal concerns, but the provided text cuts off before answering the specific statistical questions or detailing IRB follow-up procedures.

Key Facts

• Nobles Hospital recorded 196 complaints in 2017/18, 226 in 2018/19, and 227 in 2019/20.
• Simple complaints resolvable within 5 working days are logged as 'concerns' rather than formal complaints under the Hospitals Directorate.
• The DHSC policy defines a 'Concern/Informal Complaint' as an issue with potential to become formal but resolved informally with priority.
• The Independent Review Body (IRB) reported in 2019/20 that local resolution for complex cases was less effective and file management was incomplete.
• The provided response document was last reviewed in November 2018 and ratified by Cath Quilliam.

Data Disclosed

• 196
• 226
• 227
• 2017/18
• 2018/19
• 2019/20
• 5 working days
• 24 hours
• November 2018
• November 2021
• January 2018
• 8 November 2016
• April 2018

Original Request

DHSC laid their annual complaints report before Tynwald in November 2020, this report covered 3 years. Complaints about Nobles Hospital were as follows: 2017/18 196 2018/19 226 2019/20 227 It is noted from the DHSC complaints report that 'Simple complaints which could be dealt with, within 5 working days were logged as concerns as the Hospitals Directorate aligned its complaints process, to that of the Community Care Directorate under the leadership of the Director of Nursing.' Question 1. Please can DHSC advise if 'simple complaints' have been included in the above complaint figures for Nobles Hospital? Question 2. If not, how many 'simple complaints' were logged by DHSC for the years in question? Question 3. How many 'simple complaints' were not dealt with within 24 hours for the years in question ? Question 4. The UK Parliamentary Ombudsman states that 'If a concern cannot be sorted out by the end of the next day, then it has to be treated as a complaint." Please can DHSC explain the difference between the UK standard and the DHSC revised procedure of treating a simple complaint as 'concern' for 5 days. Question 5. Please can DHSC provide a copy of their procedure and policy for the treatment of concerns, simple complaints and complaints, which also details how they are analysed, logged, publically reported, treatment of the complainant Question 6. If not included in the above policies, please provide copies of the DHSC procedure and policy which deals with complaints and Human Rights Act/Equality/Candour considerations. Question 7. The Independent Review Body ('IRB') reported in 2019/20 that (a) 'Additionally, in the view of the IRB, there is a less effective performance of the local resolution system on complex and contentious cases'. (b) The IRB report also stated 'Indeed, the quality of investigations at local level resulted in Dr Malcolm Couch, then DHSC Chief Executive, issuing a Department-wide checklist on how to undertake the review of a complaint together with the procedure to be followed when compiling a complaint management file. It is apparent that this directive has not been fully followed and, possibly due to staff resources/changes within one Division, documentation received by the IRB has been incomplete. As a consequence many recent IRB reports have included a recommendation that best practice needs to be followed in dealing with complaints at local level including recording meticulously the processes undertaken and providing to the IRB exact copies of all papers. " Please can DHSC confirm that the issues raised by the IRB at (a) & (b) above have been reported to Tynwald. Question 8. Please can DHSC advise what procedures they have in place to ensure that recommendations by the IRB are followed? It is concerning that basic file management recommendations do not appear to have been followed. Are there other instances? How do DHSC follow up on IRB recommendations and audit same?

Data Tables (9)

Full Response Text

DEPARTMENT OF HEALTH AND SOCIAL CARE

COMMUNITY CARE DIRECTORATE

COMPLAINTS POLICY AND GUIDANCE

Reader Information Primary author contact details Cath Quilliam (Head of Care, Quality and Safety) Original publication date

Last reviewed date November 2018 Next review date due November 2021 Ratified by Cath Quilliam (Head of Care, Quality and Safety) Superseded Documents  Community Health Services Guidelines & Standard Operating Procedure for Dealing with Complaints – January 2018  Adult Social Care Services Complaints Policy & Guidance – 8 November 2016  Mental Health Service Guidance for Managing Complaints – April 2018

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1. Introduction/Criteria

The Department of Health and Social Care (DHSC) is committed to maintaining the highest possible standards of care. Feedback from patients, service users, carers and members of the public is essential to this. The DHSC welcomes compliments, comments and complaints; all of which enable the Department to continually review its services, thus ensuring optimal care delivery.

1. Aims/Objectives

In all cases the Department will:

 Fully support people through the complaints process.

 Always treat a person making a complaint as an individual; acknowledging their right to make a complaint and ensuring that they feel able to complain without fear of retribution.

 Signpost to Advocacy Services for independent support – see Appendix 1 for contact details.

1. Definitions

3.1. Complaint: an expression of dissatisfaction about the standards of service, action (or lack of action) by the DHSC or its staff which affects an individual patient or service user.

3.2. Concern/ Informal Complaint: an issue with the potential to become a formal complaint which may be resolved informally but with priority (usually within five working days).

3.3. Compliment: an expression of satisfaction about a service or an individual.

3.4. Process for ensuring that complainants are not treated differently as a result of raising a complaint

Complainants must have the assurance that they will not be treated differently as a result of raising their concerns (this information is provided in the complaints information booklet which should be issued along with the standard acknowledgement letter sent to complainants).

Any member of staff involved in complaint investigations must ensure complaint correspondence is kept in a separate complaints file and copies must not be uploaded onto the patient’s/service user’s electronic or paper clinical records.

1. Who Can Complain

A complaint can be made by:

 An existing or previous patient or service user.

 The representative of a patient or service user (i.e. a person acting on their behalf with their written consent).

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 The representative of a patient or service user who does not have the capacity to make a complaint themselves, as long as they are seen to be acting in the interests of the service user.

 A relative of a patient or service user who is deceased.

 Someone who has been refused treatment by a service which they believe they are eligible for.

 Members of the public.

 A representative body, provided they have written consent from the patient/service user.

1. How can complaints be raised?

Complainants can raise a complaint or concern verbally, in writing or electronically by any of the following means:

• Directly with any member of staff employed by the service.

• By writing to the Operational Manager or Director of the Service.

• By writing to the Chief Executive Officer of the Department of Health & Social Care (DHSC).

Complainants may, in some cases, raise their concerns via the media or through web based forums.
In these cases it may not be possible to investigate the individual concerns; however, if contact details are available, the individual should be contacted by the Care, Quality and Safety Team to ascertain if they would like their concerns to be investigated.

The DHSC Head of Communications should be contacted for advice regarding any complainants who air their grievances via social media platforms.

1. Grading of complaints:

Generally speaking, informal complaints should be capable of being resolved within five working days. Where this is not possible, or if more complex issues arise during initial investigation, these should be re-graded as formal complaints.

There may be occasions where the complainant requests that their complaint is dealt with as a formal complaint; in which case a Senior Manager will contact the relevant Operational Manager who will investigate and respond formally. Complaints which raise complex issues or which require a detailed or lengthy investigation will generally be graded as formal.

1. Meeting with complainants

All complainants should be offered a meeting to discuss their concerns either at the start of the investigation or following the response. Where possible the meeting should include members of senior staff who are involved in the complaint and/or the Complaint Investigator.

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1. Timescales for acknowledging and responding to complaints

Formal complaints must be acknowledged within two working days of receipt of the complaint. Acknowledgement should be made in writing. A response to formal complaints should be made within 20 working days of receipt.

Where it is apparent the complaint is complex, cross cutting services and/or lengthy in nature, it may not be possible to investigate and respond within 20 working days. In these circumstances the complainant will be contacted by the Complaint Investigator and an extension agreed. Any extensions must be clearly documented in the Datix complaints file together with the reasons for the extension. Delays due to staff sickness/absence should not be routinely used as a reason for extensions.

Where it is not possible to contact the complainant directly, a letter advising on a proposed extension to the agreed deadline; along with reasons for the delay, should be sent.

Where the complainant does not agree to the extended timescale, a response letter will be drafted addressing as many issues as possible and identifying which issues remain under investigation.

1. Investigation

The level of investigation required will depend on the complaint status. Informal complaints will generally be investigated at Ward/Operational Manager level by speaking to staff, reviewing notes and establishing facts.

Formal complaints of a serious nature (which may have contributed to patient harm for example) will require an investigation led by a Senior Manager or Clinical Director.

Flowcharts demonstrating the usual processes to follow are available in Appendix 2.

Involved staff members are expected to engage in the complaints process and will be supported to do so by their line manager.

1. Mental Health Commission (MHC)

If a patient makes a complaint to the MHS, and they are detained under the Mental Health Act 1998, the Mental Health Commission do not need to be automatically advised of the complaint; however the patient does have the option of approaching the MHC in the first instance. The MHC should be made aware of the complaint if the patient is not satisfied at the local resolution stage when investigated by the MHS. The MHC may then conduct an investigation of the complaint. If the complainant is not satisfied with the local resolution response from the MHC they then have the option to escalate the complaint to the Independent Review Body for further review.

If a patient complains about their detention under the Mental Health Act 1998, this cannot be investigated under the NHS Complaint Procedure. In such circumstances the patient must be advised of the process to make an application to the Mental Health Review Tribunal. Further advice regarding this process can be obtained from the MHS Mental Health Act Administrator.

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1. Registration and Inspection Unit’s role in a Complaint

Registration and Inspection officers have a statutory duty to undertake inspections of registered services to ensure that requirements imposed are being adhered to; and that users of these services are being looked after in accordance with the law and agreed standards.

Where a complaint has been made about treatment in regulated care services; inspectors also have the statutory power to interview, in private, any service user.

The Department does not have a specific statutory duty to investigate complaints about registered services. Due consideration will, however, be given to the nature of the complaint and to whether or not providers have breached any statutory requirement placed upon them. In many instances it will be deemed inappropriate for the Registration and Inspection Unit to conduct an investigation and more appropriate to refer the complaint back to the service provider to investigate under their own procedures or for other services to investigate i.e. Safeguarding or the Police.

1. Standards of final responses

The DHSC strives to provide complainants with a response which:

 Is of high quality, easy to read and factually correct.

 Avoids the use of medical jargon.

 Fully addresses the issues raised by the complainant.

 Provides a full explanation of treatment/care given.

 Apologises for any shortcomings identified during the investigation.

Complaint responses should explain what happened and why it happened.

The response should include:

 A record of thanks to the complainant for bringing the matter to the attention of the service and an apology for having to make a complaint.

 An expression of condolence where bereavement has occurred.

 An explanation of the reasons for any failure in service.

 Actions implemented to improve the service as a result of the complaint.

 A response to each issue or question raised by the complainant.

 An apology for each concern raised where the service did not meet the complainants expectations.

 Reassurances that the complaint has been taken seriously.

 An offer of a meeting/further meeting to discuss the response.

 A paragraph informing the complainant of their right to refer to the IRB.

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Where a complaint takes longer than 6 months to complete local resolution, a separate letter should be sent to the complainant informing them of the right to immediately refer to the IRB.

Involved staff members will be provided with an outline of the findings and recommendations specific to their practice.

1. Process for handling joint complaints between services/organisations

It is not uncommon for a service to receive a complaint which also raises issues about care provided by another service or part of the organisation.

In such circumstances one organisation should take the lead role in the co-ordination of a single response. It should be made clear to the complainant that they have one point of contact and will receive one response which incorporates all of the investigations.

The person investigating is responsible for notifying external organisations of any complaints which involve them and for notifying the complainant that their concerns will be investigated by both organisations. Wherever possible, the person investigating should notify the complaints department of the external organisation and the contact details of that person should be recorded in the complaints file.

When deciding which organisation will lead on the investigation, the organisation with the majority share of the complaint should agree to take leadership unless the complainant has stated which organisation they would prefer to take the lead in the investigation.

1. Complaints regarding colleagues

This policy does not apply to members of staff wishing to make a complaint about another member of staff. OHR and/or line management should be contacted for advice in such circumstances; alternatively other procedural documents should be considered, for example the Fairness at Work Policy, Grievance Procedure or Whistleblowing Policy.

1. Commissioned Services

Complaints may be received from service users, their relatives and/or carers who are receiving care from a commissioned service. All commissioned providers are bound, under the terms of their contract, to have their own complaints policy and procedures; therefore, unless the matter relates to an allegation of abuse, in the first instance a complainant should contact the manager of the commissioned services providing the care. If, after the commissioned service has investigated the complaint (and reported its findings) the complainant is still not satisfied with the outcome; they should be advised to write to the Director of Community Care requesting that their complaint be independently investigated.

1. Complaints involving allegations of suspected or alleged abuse

If a complaint is received that involves suspected or alleged abuse of a service user within a regulated DHSC Adult Social Care service, the Department’s INTER AGENCY ADULT PROTECTION POLICY AND PROCEDURES (2020) need to be followed.

The incident must also be immediately brought to the attention of the Registration and Inspection Unit (R&I) and followed up in writing on R&I’s prescribed Notification of Event form. COMMUNITY CARE DIRECTORATE

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In the event of an allegation of abuse, the Department’s procedures in respect of Adult Safeguarding/Protection take precedence and the matter must be dealt with in accordance with the respective policy.

1. Confidentiality and Consent

The patient’s/service user’s right to confidentiality must be respected at all times. The Common Law duty of confidentiality applies (if information is given in circumstances where it is expected that a duty of confidence applies, that information cannot normally be disclosed without the information provider’s consent). The DHSC’s Data Protection Policy gives further guidance.

Personal clinical information will not be disclosed to a person complaining on behalf of a patient/service user unless the patient/service user has provided written consent for that person to act on his/her behalf; or it is clear that the patient/service, through death, illness or infirmity, is unable to act for himself/herself. In addition, consent does not extend to the disclosure of all personal information, but only that relating to the complaint and it is good practice to check with the patient/service

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