The key to resolving many complaints is handling them early on at a local level. Terri Bonnici, MPS medical complaints adviser, presents a case study showing what could happen if you don’t get to grips with a complaint in the early stages.
Case Study
Mr X had seen a GP about a long-standing problem with his bowels and had asked to be referred to the hospital for investigations as he didn’t feel he was getting any better with the medications he had been prescribed. His GP was reluctant to do the referral as he felt the patient should try other treatment options first, as well as change his diet, but eventually relented.
He promised the referral would be done that week but when Mr X had not heard anything for several weeks he called the surgery back to find that the GP had dictated the letter, but the secretary had gone on leave and forgotten to send the referral off. A new referral was sent, but when he called the hospital was told they had not received it. Mr X called the surgery back to be told it had been faxed and they would call the hospital. On doing so they were told they had received it and had written to the patient with an appointment. Mr X was adamant he had not received anything and on closer looking it was established the hospital had written to a patient with a similar name but different address.
Mr X was eventually seen, but he was very unhappy with the way he was treated in that his colonoscopy procedure was delayed on arrival because they could not find his notes. He was also made to feel he was a nuisance when he verbalised his dissatisfaction about how he was being treated.
The Complaint
Mr X made a complaint against his practice and the hospital about the care and treatment he received.
How the compliant was handled
The practice did not address his complaint properly, which included failing to provide a timely and full response to all his questions.
They did not have a discussion with him to talk about how the complaint would be handled, who would be involved, negotiate a timescale within which a response would be forthcoming, or establish what outcome he was looking for – this is called the planning stage.
They also failed to inform him at any stage that he could contact the NHS Complaints Advocacy Service if he needed help with his complaint.
The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 state in Section 9.1(b) that:
"If it appears to the first body that the complaint contains material which, if it had been sent to another responsible body, would be a complaint& which would fail to be handled in accordance with these Regulations by the second body” then (9.2) “the first body and the second body must co-operate for the purpose of co-ordinating the handling of the complaint and ensuring the complainant receives a co-ordinated response to the complaint"
The practice overlooked this at the planning stage when the complaint was first made, when they should have discussed the patient’s wishes with regards to what he could expect from the investigation. Therefore they missed an opportunity to obtain comments from the hospital departments involved.
They also failed to provide him with information about the next stage of the complaint process should he remain unhappy with the outcome of local resolution. This meant that it was not clear that local resolution had ended and he did not know where he could take his complaint next.
Your complaints procedures plan should include:
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Summary of complaint with dates of incidents
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List of issues to be investigated
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Outcome the complainant is seeking
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Agreed investigation plan (eg, use of conciliator, who is doing the internal investigation, who is doing the external investigation)
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Consent to share information with those involved in the investigation, including other organisations
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Agreed timescale for a response
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How the practice will provide the response
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Details of source of advocacy suggested
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A copy of the plan sent to the complainant so they can confirm they agree with how the matter will be investigated.
Conclusion
The practice’s handling of Mr X’s complaint did not meet the requirements set out in the NHS Complaints Procedures and guidelines. The information given by the practice was vague and they failed to provide open and honest answers to his questions. On top of this, failure to involve other NHS organisations caused unnecessary stress to Mr X at what was already a difficult time for him.
Therefore, Mr X was left not knowing what had gone wrong with his care and wondering whether his condition could have been avoided or at the very least treated earlier.
Learning points
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It is important to keep in mind that all complaints should have a planning stage to discuss and agree with the patient /complainant how a complaint is going to be managed. This gives a focus on the investigation and reassures the patient the matter is being taken seriously.
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It is important to review your complaint procedures to ensure that they meet the current set of guidelines and regulations to avoid possible criticism from the Ombudsman, which has in some cases attracted financial remedy in favour of the patient.
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It is important for all staff to be trained on your practice complaints policy and procedures as you will be measured on this not only by the Ombudsman but also the CQC.
"We have found that poor complaint handling itself constituted maladministration or service failure leading to an injustice or hardship for the complainant. This was so even in cases in which we did not uphold the original complaint"
(The Parliamentary and Health Service Ombudsman, Principles of Good Complaint Handling)
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