NHS Complaints Advocacy - How to make a complaint

Raising Concerns or Complaints about NHS services

A step by step guide

Questions to ask yourself:

1. What am I concerned or dissatisfied about?

2. What do I want to achieve if I complain?

3. Who do I raise my concerns with?

The NHS Complaints Procedure

Local Resolution

The process:

  • Local Resolution - Speak to your NHS service provider
  • If not resolved, send a letter to your NHS service provider
  • You may need to go to a meeting to discuss the issue, But this isn’t always the case.
  • Receive a response to your complaint
  • Complaint resolved / Complaint not resolved (go back to local resolution or contact the health service ombudsman)

Health Service Ombudsman

Introduction

The National Health Service (NHS), and other providers of NHS services, work hard to treat everyone properly and promptly. Most people using health services are satisfied with their treatment (or the treatment of family/friends/partners) but sometimes things can go wrong.

If you are dissatisfied with the service you, or others, have received from a hospital, doctor, dentist, local surgery or any other NHS service, you can raise your concerns about it.

By raising your concerns it can help put things right quickly and the NHS can learn from your experience. A response to your concerns could include an explanation, an apology and information about how the NHS provider has used your experience to improve services or care.

How to use this pack

This pack, produced by VoiceAbility NHS Complaints Advocacy Service, aims to help you feel confident about raising your concerns yourself.

The pack:

  • Explains the different options for raising your concerns about the NHS
  • Offers practical tips and things for you to think about
  • Tells you how NHS Complaints Advocacy can help you.

This booklet is divided into sections that explain each step of the process in detail.

How can NHS Complaints Advocacy help?

NHS Complaints Advocacy can help you raise a concern about NHS care or treatment.

NHS Complaints Advocacy is:

  • Free,
  • Independent of the NHS
  • Confidential.

 

You can contact our NHS Complaints Advocates by telephone, email, letter or through our website if you require assistance to raise your concerns. They will take time to listen to your experience and, if you need assistance, they can then talk to you about what support you need to make your complaint.

Your Advocate will be able to give you information about the different ways that you can raise your concerns with the NHS provider (see Step 3) so that you are able to choose how you want to proceed.

Your Advocate can also help you think about what you would like to achieve from your complaint. People want different outcomes when they complain such as an apology, an explanation or an improvement to NHS services.

 

NHS Complaints Advocates can:

  • Give you an opportunity to speak confidentially to someone who is independent of the NHS
  • Explore the options available to you at each step of the complaints procedure
  • Help you with writing an effective letter to the right people if required
  • Prepare you for meetings and accompany you where necessary
  • Contact and speak to third parties if you wish us to
  • Help you decide whether you are satisfied with the response you receive from the NHS provider.

 

Your Advocate will not try to persuade you to take a particular course of action and will always respect your decisions.

This pack, and our other resources, are designed to support you make your complaint.

You can find other helpful information on the VoiceAbility NHS Complaints Advocacy

website: www.nhscomplaintsadvocacy.org.

 

Raising concerns and complaints about the NHS

First Steps

Step 1

What are you concerned about?

Before you start, it is important to be clear about what your concerns are with the NHS treatment or care received. This can be any aspect of NHS care and services, but might include:

  • Treatment or care
  • The attitude of staff
  • Poor communication
  • Waiting times
  • Lack of information
  • Failure to diagnose a condition.

Here are some ‘real-life’ examples of issues raised:

  • An emergency ambulance took over an hour to arrive
  • A patient was given incorrect information about a medical procedure and suffered pain as a result
  • A GP refused to do a home visit
  • An elderly patient frequently had to wait a long time for routine transport home from hospital appointments
  • A patient felt that a nurse had treated him without respect
  • A patient did not get the support they needed following discharge from hospital because of a lack of communication between the hospital and social care services.

Useful tip: Write down what your concerns are as simply and clearly as you can so that you can refer back to it later.

If you need help to write down what you want to complain about or would like to talk though the issues with an advocate you can contact VoiceAbility NHS Complaints Advocacy Service.

 

Step 2

What do you want to achieve?

Think about what you want to achieve. Your issues are more likely to be dealt with smoothly if you can be specific and realistic.

When raising a concern with the NHS you can expect:

  • To be treated with respect and courtesy
  • To be offered support to help you raise your concerns
  • A speedy solution to be offered where possible
  • An explanation of what happened
  • An apology if appropriate
  • Changes to be made so that the same thing will not happen to anyone else
  • Better communication between NHS staff and patients.

 

NHS Complaints Advocacy can only support you if your complaint is about NHS funded healthcare

There are some limits on what can be achieved using the NHS Complaints Procedure.

Where the outcome you are looking for would be more likely to be achieved through another route your Advocate can explain this and give you information about who best to contact instead.

Financial compensation for clinical negligence

  • This is usually possible only through legal action
  • You need to speak to a solicitor who specialises in medical or clinical negligence
  • There are time limits for making a legal claim and it is best to contact a solicitor within three years of the incident.

 

Disciplinary action against any NHS staff member

  • The NHS Complaints Procedure cannot be used to take disciplinary action against a member of staff
  • This could however, happen under a separate procedure as a result of an investigation into your complaint.

Private healthcare complaints

  • If you have paid for private treatment or used medical insurance you cannot use the NHS Complaints Procedure to make a complaint. The private healthcare service will have its own complaints procedure that you can follow
  • If, however, your treatment was funded by the NHS you can still use the NHS complaints procedure.

Care home and nursing home complaints

  • If the care home or nursing home is paid for by the NHS you can make a complaint using the NHS Complaints Procedure
  • If the care home or nursing home is paid for privately you cannot make a complaint using the NHS Complaints Procedure. Most care homes and nursing homes will, however, have their own complaints procedure so you can make a complaint using this.

The VoiceAbility NHS Complaints Advocacy service can give you information about other options and who to contact if the outcome that you are looking for cannot be obtained through the NHS complaints process.

 

Step 3

Where to send your complaint?

Formal complaints about the NHS are usually made in writing, however NHS providers should be able to take your complaint verbally if required.

If your complaint is about a hospital this should be made to the Chief Executive of the NHS Trust. You can also choose for the Commissioner of the service you are complaining about to handle your complaint instead. This may be the local Clinical Commissioning Group or NHS England (for some specialist services). However, you cannot ask for both the NHS Trust and the Commissioner to investigate it.

If your complaint is about Community NHS services such as District Nursing, Podiatry, and Chiropody this should be made to the appropriate NHS Trust. If you are unsure who this is you can ask VoiceAbility’s NHS Complaints Advocacy helpline Tel: 0300 330 5454 or NHS England Tel: 0300 311 22 33. You can also choose for the Commissioner of the service you are complaining about to handle your complaint instead. However, you cannot ask for both the NHS Trust and the Commissioner to investigate it.

If your complaint is about a GP, Dentist, Optician or Pharmacist you should make your complaint direct to them or to the Manager of the service.

If you do not wish to make your complaint to the NHS GP, Dentist, Optician or Pharmacist directly, you can send your complaint to NHS England. They will contact the NHS Provider and investigate your complaint and respond to you. However, you cannot ask for both the Provider and NHS England to investigate it. You can make you complaint to NHS England:

By post to NHS England PO Box 16738, Redditch B97 9PT, by email to england.contactus@nhs.net with ‘For the attention of the complaints manager’ in the subject line, by telephone: 0300 311 2233 (Monday to Friday 8am to 6pm, excluding English Bank Holidays).

Provide as much information as possible to allow NHS England to investigate your complaint. Include some or all of the following:

  • Your name
  • A clear explanation of your complaint
  • Copies of earlier associated correspondence between yourself and NHS England; and
  • Any valid correspondence case referral numbers.

The timescale for responding to your complaint will be discussed with you and will depend upon the complexity of the complaint. Where the agreed timescale cannot be met NHS England will inform you of this.

If your complaint is about commissioning of services, including NHS 111 complaints and out-of-hours services, you can write your complaint to the local Clinical Commissioning Group. You can find out details of your local Clinical Commissioning Group from your Local Authority or local Healthwatch or by going to www.nhs.uk/ServiceDirectories/Pages/CCGListing.aspx

If your complaint is about a Public Health Services such as Prevention and Lifestyle services such as Health Visitors, which come under Local Authorities, the complaint is no longer NHS related and should be made to your Local Authority.

If you are unsure about who to make your complaint to, then you can discuss your options with VoiceAbility’s NHS Complaints Advocacy helpline. Tel: 0300 330 5454 or visit www.nhscomplaintsadvocacy.org

If you are not satisfied with the response from the NHS Provider or Commissioner you can request for a meeting with them to discuss what you are not satisfied with.

If you are still not satisfied you can apply to the Parliamentary and Health Service

Ombudsman Tel: 0345 015 403 and request an independent investigation into your complaint. The final decision of the Parliamentary and Health Service Ombudsman brings the end of the NHS Complaints Procedure. There is however a right to appeal their decision if you think you have reason to do so. For this you should contact the Parliamentary and Health Service Ombudsman directly for advice.

The NHS Complaints Procedure

The NHS Complaints Procedure focuses on resolving your complaint locally.

Local Resolution

The aim of Local Resolution is to try to sort out your problem directly with the NHS service.

The NHS healthcare provider should respond to you efficiently, sensitively and promptly.

Local Resolution is your opportunity to explain what it is you are concerned or dissatisfied about and what you would like to happen. It gives you the opportunity to raise your concerns to the NHS service and be heard. Local Resolution is important because it aims to resolve your concerns and, where appropriate, use your experiences to improve local services.

It is important to raise everything that you are concerned about at this point, as new issues cannot later be introduced as part of the same complaint.

It is helpful to keep a record of any telephone calls you make and letters you write or receive about your complaint. To help you do this, a Log Sheet is included in this pack. You can fill in all the details of who you wrote or spoke to, what was agreed and when it needs to be done by.

 

Are there time limits for making a complaint?

Generally, you should make your complaint within:

  • Twelve months of the incident happening or
  • Within twelve months of you realising that you have concerns.

The NHS can use its discretion to look at issues that are beyond these timescales. For instance, if you were too ill to make the complaint straight away the NHS will consider if it is still possible to investigate the complaint effectively and fairly.

How do I raise my concerns?

You can explain what happened to you or the person you are complaining on behalf of:

  • In person
  • On the telephone
  • By email
  • In a letter.

NHS organisations tend to prefer having complaints in writing but if you would rather telephone or go in person, the Complaints Manager should make a written record of your complaint. The issues you raise should be written down and a copy given to you.

Useful tip: if you send a written complaint, keep a copy of your letter to refer to later whether you sent it by post or email.

All NHS organisations have complaints procedures and in most cases they will probably be best placed to deal with your complaint. However you can complain about the NHS provider to the Commissioner of that service if you would prefer to do so.

If you want to complain about your hospital or ambulance service, contact the Complaints Manager or the Chief Executive of the NHS Trust.

For complaints about service provision in primary care or by independent providers such as your GP, dentist, optician, pharmacist, health centre or other independent NHS contractor, you have two options:

• You can complain directly to the NHS organisation and service by contacting the person in charge of complaints. In most GP and dental practices, this will be the Practice Manager

Or

• You can complain to the Commissioner of the service.

If you choose to make a complaint directly to the organisation and you are not satisfied with their response you cannot then raise the same issue with the Commissioner of that service but must go directly to the Health Service Ombudsman (HSO). You can find a link to the HSO on www.nhscomplaintsadvocacy.org.

If you are not clear where to send your complaint, ask for advice from PALS or the Complaints Department in larger organisations such as hospitals. Many NHS organisations will have details of how to contact them about complaints on their website. Alternatively, contact VoiceAbility NHS Complaints Advocacy Service and we will be able to support you to find out the right information.

Remember, if your complaint concerns more than one NHS organisation, you only need to send a letter to one of the organisations. They will liaise with the other organisation(s) involved and provide a co-ordinated response.

If you need support with any of these processes, contact the VoiceAbility NHS Complaints Advocacy Service who will be able to help you.

 

What will happen next?

Sometimes it may be possible to resolve your concerns immediately, where you receive a quick response from the NHS provider that you are satisfied with. If this is not the case, the NHS provider should acknowledge your complaint either verbally or in writing within three working days.

The NHS provider, will, in most cases:

  • Offer to contact you to discuss your complaint and how best to resolve your concerns. They should agree with you a timescale for resolving the issues and discuss how they will keep you informed of progress. The suggested timescales can be influenced by things like how many staff they need to speak to, how easy it is for them to access your medical records and if other organisations are involved in your complaint. If there is a problem in keeping to the agreed timescale they should contact you before it expires to agree an amended timescale
  • Undertake an investigation in order to be able to provide a written response to your Complaint
  • Write to you once they have looked in to your complaint and respond to the issues you raised and offer a resolution
  • Offer assistance to enable you to understand the complaints procedure or advice on where to obtain such assistance, such as, from your local NHS Complaints Advocacy provider.

Investigating and resolving your complaint:

  • You may be offered a meeting to discuss your complaint and speak to staff directly about what has happened. You can take a friend, relative and/or Advocate with you to any meetings that you might have
  • Sometimes the NHS uses Conciliation or Mediation services. A conciliator/mediator is a neutral and independent person who can arrange a meeting with you and those involved (either separately or together) so you can all express your views and try to resolve your differences. A conciliator will become involved only if everyone affected agrees. The conciliation process is confidential
  • Conciliation and Mediation Services differ from Trust to Trust so if this is offered you should ask the Complaints Manager to explain how it operates in your area.

 

Useful tip: Where your complaint is not resolved with a written response from the provider and a meeting is arranged instead, it may be helpful to prepare a list of questions you want to ask at your meeting and take this with you.

Try to keep these questions clear and concise. It is also helpful to take any relevant paperwork with you to the meeting.

An NHS Complaints Advocate can assist you to prepare for the meeting and attend it with you.

After the investigation:

Once the investigation is finished and any meetings have been held the Complaints Manager should send you a letter containing:

  • A summary of your complaint
  • What the investigation found and any actions that are going to be taken as a result
  • What to do if you are dissatisfied with the answers given.

 

Depending on the investigation the letter may contain:

  • An apology, if relevant
  • What actions will be taken and when, as a result of your complaint
  • Who is responsible for making this happen
  • What steps have been taken to prevent the same thing happening to other people.

 

The letter should:

  • Be balanced, factual and impartial
  • Address all the issues raised and acknowledge the resolution sought
  • Be clear and easy to understand.

It should avoid technical terms and, if they are used, it should explain what they mean.

If you haven’t received this letter within the timescale agreed, or as per their complaints procedure, you may want to ring, email or write to check when you can expect to receive it.

If you have agreed, this letter may be sent to you by email.

The Health Service Ombudsman (HSO) has produced a set of six clear principles for good complaints handling. All NHS organisations are expected to follow these principles when dealing with your complaint.

You can request details of this guidance from your local NHS Complaints Advocacy office or access this from the VoiceAbility NHS Complaints Advocacy website at:

www.nhscomplaintsadvocacy.org. Alternatively you can find out more by visiting the

HSO website at: www.ombudsman.org.uk.

What if I am not satisfied at the end of Local Resolution?

If you are not satisfied with the reply ask yourself exactly what you are still dissatisfied about so you can decide what to do next. It may help to review:

  • The letters
  • Any meetings
  • Any conciliation or mediation process
  • Whether the plan you agreed, if relevant, was followed
  • Whether parts of your complaint have yet to be answered
  • Whether you feel evidence you gave was not properly considered
  • Whether you have achieved the outcome you wanted
  • What more, if anything, could have been done to achieve the outcome
  • Whether the Complaints Manager has followed the Ombudsman’s good complaints handling principles.

What are my options?

  • You could write another letter explaining what you think has not been covered
  • You could call the person handling your complaint and explain why you are still dissatisfied
  • You could request a meeting to discuss your outstanding concerns
  • You may choose to try a different route to achieve the outcome you want – review your options on the next page.

Further investigation into your complaint may be carried out. Again, the NHS organisation should discuss this with you and agree a plan for doing this, including timescales.

The NHS organisation you are complaining about may feel that everything has been done to answer your complaint and if so, they should advise you of that in writing.

This is the end of Local Resolution.

The Parliamentary and Health Service Ombudsman

Once Local Resolution has finished, if you remain unhappy with the way your complaint has been dealt with by the NHS provider, you have the right to take your complaint to the Ombudsman. The Ombudsman help resolve complaints about the NHS. The Ombudsman is independent of the NHS and of Government and their powers are set down in law. Their service is confidential and free.

You can find out more about how they can help by contacting them on the following:

  • Visit www.ombudsman.org.uk
  • Tel: 0345 015 4033
  • You can contact them via textphone on 0300 061 4298 if you have a hearing impairment or have problems using a standard telephone
  • Email: phso.enquiries@ombudsman.org.uk
  • Text ‘call back’ with your name and mobile number to 07624 813 005 and they will call you back
  • Fax: 0300 061 4000
  • Write to: Parliamentary and Health Service Ombudsman, Millbank Tower, Millbank, London SW1P 4QP.

By law, you should usually submit a complaint to the Ombudsman within one year of when you first became aware of the problem you are complaining about. If it was more than one year ago, the Ombudsman may still be able to help you if there were good reasons for the delay.

When receiving your complaint the Ombudsman will first look at whether it is something that they are able to look at by law. To find out more about what organisations and issues the Ombudsman can look at, visit their website (www.ombudsman.org.uk) or Tel: 0345 015 4033.

The Ombudsman will usually only investigate a complaint after the NHS have had the chance to try and sort it out. The Ombudsman may find that they can get your problem resolved quickly by talking to the organisation you are unhappy about. If the Ombudsman can see that there is more that the organisation could do to resolve your issues locally they will ask them to do more work.

When the Ombudsman carries out an investigation they will look in detail at what’s happened. They will look at all the facts. When doing that they may need to gather additional information by speaking to you and the organisation concerned. They may need to see your clinical records and other papers relating to your complaint and may take expert advice to make sure they have a clear view of what happened and what should have happened. Every complaint is different and the steps they will take during an investigation may vary.

What happens next?

If the Ombudsman decides that the NHS have got things wrong, they will explain that decision and recommend how things can be put right. This could mean asking the organisation to acknowledge their mistakes and providing an apology to you. It could also include asking the organisation to compensate you or give you a better explanation of their actions.

The Ombudsman also looks closely at ensuring that organisations learn from complaints to ensure that any mistakes are not repeated in the future. Therefore the Ombudsman may ask the organisation to take steps to make sure mistakes do not happen again. Alternatively, the Ombudsman may decide that the organisation have acted correctly or that there was a problem but they have already done enough to put things right. When this happens, the Ombudsman will always explain why they have decided this. Often that means sharing any expert advice they have received and giving more information about what happened.

The Ombudsman’s decision

The Ombudsman’s decision about your complaint is final. This includes their decision whether or not to investigate your complaint and their decision whether or not to uphold your complaint following an investigation.

If you think that the Ombudsman’s decision on your complaint is wrong, they can however, under certain circumstances, review their decision. Please note that a review does not mean that the Ombudsman will look at your original complaint again. Instead it means the Ombudsman will look to see if they took account of all the relevant evidence and made a fair decision based on this.

If you still disagree with the Ombudsman’s response you can challenge it through the courts using judicial review.

Useful tip: Complete the Ombudsman’s form and gather together all supporting information at the time of submitting this to the Ombudsman. Our NHS Complaints Advocates can support you to do this if you require assistance.

Questions and Answers

Who can complain?

Any NHS patient can complain about any NHS service, or NHS funded care, they have received and are dissatisfied with. You can complain on behalf of someone else in certain circumstances (see more below). NHS services include treatment and care given by your GP, dental surgery, opticians, pharmacist, hospital, community health service and the ambulance service. Anyone who is affected, or likely to be affected by the action, omission or decision of an NHS body can make a complaint.

My mother is elderly and I don’t feel she could manage a complaints process. Can I complain for her?

You may complain for a friend, partner or relative as long as they agree to let you complain on their behalf. It is useful to get their permission in writing. We have included a ‘consent and confidentiality form’ in this pack which you could use.

My partner has Alzheimer’s Disease. Do I still need her permission to make a complaint?

If your friend, partner or relative is very ill, or does not have the capacity to give permission because of an impairment or a disability, you may complain on their behalf without their permission, although the NHS Trust will confirm the patient’s lack of capacity before accepting the complaint. If they do not accept the complaint, they must inform you in writing if they do make this decision and tell you why.

My father died and I didn’t have his consent to act for him. Can I make a complaint about his treatment?

Yes. You may raise a complaint or take over a complaint on behalf of a friend, partner or relative who has died, even if you do not have their written permission. In some cases the NHS may decide not to accept you as a suitable representative. They will discuss this with you.

My nephew is 15 and has Down’s Syndrome.

Can I complain on his behalf without his written permission?

A complaint can be made on behalf of a child (under 18) if the child is unable to make the complaint themselves.

NHS organisations must not consider a complaint made by a representative of a child unless they are sure that the child is unable to complain themselves. They must inform you in writing if they make this decision and tell you why.

Can I complain about something that happened in the past?

It depends on how long ago it happened. You should make your complaint:

• Within 12 months of the incident happening

Or

• Within 12 months of you realising you had something to complain about.

NHS organisations are allowed to waive this time limit if there are good reasons why you could not complain earlier. One such case might be if you were too ill to complain at the time.

I had an operation in a private hospital. Can I complain to the NHS?

It depends. If the NHS paid for your operation in a private hospital, you can complain to the NHS. If you paid for your treatment yourself, or with private medical insurance, you cannot complain to the NHS. The private hospital will have its own complaints procedure that you should follow.

I want to sue the surgeon who operated on me. How do I go about it?

You will need to take legal action if you want to make a claim for clinical negligence.

The NHS Complaints Procedure does not deal with these cases. You can find details of local specialist solicitors by contacting the Law Society Tel: 0207 424 1222 or visit

www.lawsociety.org.uk, or Action Against Medical Accidents (AvMA) Tel: 0845 123 2352 or visit www.avma.org.uk. Details can be found on the VoiceAbility NHS Complaints Advocacy website at: www.nhscomplaintsadvocacy.org.