New regulations on NHS complaints in Wales came into force on 1 April 2011. The regulations, along with guidance, are designed to make complaints handling open and accountable, fair and proportionate, and patient-focused – with a view to seeking continuous improvement.
Regulations and principles
The regulations aim to make it easier for patients to raise concerns if they are dissatisfied, or if things go wrong with their care. The new system builds in more support and advice for patients and staff, better training for those who investigate incidents, and a named individual who will be a patient’s point of contact throughout an investigation. The emphasis is on resolving concerns in a timely fashion, openly and honestly, and a philosophy of “investigate once, investigate well”.
Key changes include:
- Any patient, including children and young people, can make a complaint, as long as they have sufficient support
- More involvement of the complainant in how their complaint will be investigated
- A single common method of investigation of concerns to include complaints, claims and reported patient safety incidents – proportionate to the issue raised
- Health Boards to be able to investigate primary care complaints
- The introduction of the concept of NHS redress, which places a duty on NHS bodies in Wales to consider liability. This does not apply to concerns relating to primary care practitioners, although the Ombudsman’s Principles of Remedy include the option of financial recompense as part of resolution to a complaint. Previously, patients may have had to take legal action to obtain an admission of liability.
- The right for an independent review has been removed. Instead, complaints will be investigated solely by the health board or NHS organisation concerned, followed by the right to request a review by the Public Services Ombudsman for Wales.
Part 7 of the regulations details how the redress arrangements will operate when a Welsh NHS body is notified of a concern by an NHS body in England, Scotland or Northern Ireland, where joint arrangements are in place. This will not come into force until 1 October, to allow more time for discussion with the Department of Health in England.
Raising a concern
Although it is usually the patient who raises a concern, anyone, including the patient’s representative or NHS staff, can do so, although patient consent is still required when appropriate.
- Concerns can be raised in any format, including verbally (in person or by telephone), by email or letter
- Anyone who wants to raise a concern and have it dealt with in the Welsh language should be able to do so.
Investigating a concern
The regulations bring the process for managing complaints, claims and patient safety incidents together into a single process administered by a specific, integrated team in each NHS organisation. Each team will have at least one senior investigation manager (SIM), who is responsible for administering the new arrangements.
This role can be delegated to another member of the team. In addition, each NHS organisation must designate a ‘responsible officer’ from the board or a partner in a practice setting, who is responsible for day-to-day operation of the process.
Support for patients
The new arrangements aim to improve support for patients by ensuring they are kept fully informed throughout the process:
- A named individual will be the patient’s point of contact throughout
- Patients are involved at the planning stage of an investigation
- Information must be clear, accessible and available in a range of formats.
Support for staff
The regulations stress that as well as resolving issues for patients, it is equally important that staff are supported throughout the process. This means:
- Trained investigation staff should provide support and advice
- Staff affected by the complaint should receive the same information throughout the process as the person raising the concern.
Concerns should usually be raised within a year of the incident; however, in certain circumstances, the time limit can be extended to three years.
An initial acknowledgement that the concerns have been received must be sent within two working days, either in writing or electronically (even if the concern was raised verbally).
Concerns should be responded to in 30 working days. If this is not possible, for example for more complex concerns, an interim response should be sent within 30 days, and the patient should be kept updated regularly.
All investigations should be concluded within six months, unless liability issues are identified. In this case, the time limit is one year.
The patient or complainant has the choice of raising a concern about primary care either to the practitioner concerned or to the Health Board (HB). GPs, dentists, community pharmacists and opticians will be obliged to co-operate with investigations undertaken by the HB.
Primary care practitioners can also request that the HB investigates a concern, if they believe it would be beneficial. The HB cannot investigate a complaint if it has already been responded to by the practice.
Planning a response
At the same time as acknowledging it has received a concern, the responsible body must offer to discuss with the complainant, at a time to be agreed:
- How the complaint will be handled
- Consent to the use of medical records
- What support is available
- The likely timescale for investigating their concern.
The response should contain the following:
- A summary of the concern
- A description of the investigations carried out
- Copies of any expert opinions received during the investigation (however, do not include correspondence or advice received from MPS)
- Copies of relevant medical records
- An explanation of what happened and why in relation to each issue
- An apology, where appropriate
- What action will be taken, if any
- Details of the right to notify the Ombudsman
- An offer to discuss the response with the responsible officer
- Signature of the responsible officer (or their delegate).