NHS South Kent Coast. Clinical Commissioning Group. Complaints, Comments and Compliments Policy

Transcription

1 NHS South Kent Coast Clinical Commissioning Group Complaints, Comments and Compliments Policy Version: Version 1.6 Ratified by: Date ratified: Name of originator/author: Name of responsible committee/individual: Accountable Officer Dr Sue Martin Company Secretary Date issued: 1 st October 2016 Review date: 1 st October 2017 Target audience: Related policies/tor Contact for Queries CCG staff Company Secretary 1 P a g e

2 CONTENTS Executive Summary Page 2 1 Summary and Purpose Page 3 2 Guiding principles Page 3 3 What is a complaint Page 4 4 Complaints Procedure Page 5 5 Who can complain Page 6 6 Joint complaints Page 6 7 Training and support for staff Page 7 8 Monitoring and Reporting Page 7 Appendix A Complaints flow chart Page 8 Appendix B - Complaints, comments and compliment record sheet Page 9 Appendix C Complaints about CCG staff Page 10 EXECUTIVE SUMMARY Complaints, comments and compliments help the CCG gain an insight into the standard of the services that it commissions and helps us identify what we are getting right and what areas require improvement. This allows us to take action to prevent similar problems occurring in the future and to further improve services. The Complaints, Compliments and Comments Policy sets out how South Kent Coast CCG will manage comments it receives. The CCG will always look into complaints and provide an honest answer to the person making the complaint. All complaints received by the CCG must be registered with the CCG s Risk and Assurance Manager who will ensure that they are passed to the South East CSU if appropriate and are presented to the Accountable Officer for sign-off. 2 P a g e

3 1. Summary and Purpose 1.1 To provide a framework for dealing with complaints relating to commissioned services. 1.2 To ensure that patients, relatives, carers and all other users of the local health services have their complaints dealt with in the appropriate way. 2. Guiding Principles 2.1 In line with current NHS directives the CCG has considered the following legislation and guidance when drafting this policy: - The Local Authority Social Services and NHS Complaints (England) Regulations The NHS Constitution - NHS England Guide to good handling of complaints for CCGs - The Ombudsman s Principles of Good Complaint handling 2.2 When a complaint is raised with NHS South Kent Coast CCG, we commit to: - Inviting the complainant to have a say in how the case is handled and how things can be put right - Providing an open and honest response to all concerns including a thorough and detailed explanation concerning events leading up to the complaint - Providing an apology when things have gone wrong - Providing assurance to the complainant regarding what the organisation will learn from the experience - Where appropriate, contract to provide care or treatment to reinstate the patient to the point at which the complaint was made - Where appropriate, consider making a financial contribution to the complainant if they have suffered a financial loss as a direct consequence - Signposting the complainant to the relevant organisation if responsibility for dealing with the complaint does not rest with the CCG, including gaining consent from the patient to pass relevant details on 3. What is a complaint, concern or compliment? 3.1 The CCG defines a complaint as a statement that something is unsatisfactory or unacceptable and a concern as an anxiety or worry/ a matter of interest or importance to someone and both of these will be dealt with via the complaints process. However, where the intention of the communication is not clear the CCG will seek to liaise with the customer to determine whether they would like their issue 3 P a g e

4 dealt with informally (see 4.1) or through the formal complaints process. 3.2 A complaint is not a request for a service or an enquiry about a service. 3.3 Complaints can be placed into one of the following four categories, complaints about; - Services: this covers all decisions the CCG makes about where and how it will purchase health and social care services from NHS/ private/independent and community and voluntary sector providers - Policies: this covers considerations regarding a CCG commissioning or funding decision, e.g. in relation to Independent Funding Requests (IFRs) or NHS Continuing Healthcare (CHC). A complaint can be made about the process but not the decision which needs to be considered via the appropriate appeals process. - Administration: this covers the quality of services provided - Staff: this covers those circumstances where a person experiences poor service from a member of CCG staff of one of its providers. (Appendix C) 3.4 The areas not covered by the policy include: - Health organisations wishing to make a complaint about another health organisation or local authority - Employment issues of South Kent Coast CCG staff (see Grievance Policy) - Privately funded healthcare - A matter that has already been investigated under the complaints regulations including those that are being investigated by the Ombudsman - A failure to respond to an enquiry under the Freedom of Information Act (2000) or the Data Protection Act (1998) The CCG does not purchase primary care (GP, dental and opticians services or pharmacies). Therefore any concerns or complaints about a GP, dentist, optician or pharmacist that cannot be resolved by the practice manager should be referred to NHS England 3.5 A compliment is a polite expression of praise or admiration and, where such a statement is received about individual members of our staff it will be shared with the individual and noted by the line manager on their HR file 4 P a g e

5 4. Complaints Procedure 4.1 Stage 1 Local Resolution Wherever possible we will try and resolve any comments or enquiries, where people are requiring assistance, informally through local resolution. This may include sign posting to a relevant department or providing advice regarding a process/ procedure. 4.2 Stage 2 Formal Complaints process The CCG uses a South East Commissioning Support Unit (SECSU) to process complaints and concerns (excluding complaints about CCG staff which is covered in 4.4), including producing monthly reports for the CCG. The CCG s Accountable Officer is designated as the responsible person for ensuring compliance with the regulations and in particular for ensuring that any action is taken if necessary in the light of an outcome of a complaint. (Appendix A) 4.3 Stage 3 Ombudsman The Health Service Ombudsman (HSO) is independent of the NHS and of Government and derives its powers from the Health Service Commissioners Act (1993). The role of the HSO includes the scrutiny of clinical and non-clinical complaints against GPs, NHS Dentists, NHS Opticians or Pharmacists, NHS Trusts and commissioners. The HSO will normally only consider complaints once the local procedure has been exhausted. The CCG will provide information regarding how to request a review by the Ombudsman in its correspondence to the complainant as a matter of course. 4.4 Complaints against staff The CCG has a duty to investigate any complaints made about the conduct of members of its staff. This will be done in conjunction with the individual s line manager, although to allow for impartiality the investigation will usually be led by either the Risk and Assurance Manager or Company Secretary. Depending on the circumstances of the complaint the CCG may seek to resolve informally, e.g. with an apology but where this is not possible the staff member will be given the opportunity to formally explain their position and provide any information they may feel will inform the formal investigation. (Appendix C) 5. Who can complain A complaint can be made by someone who has received, is receiving, is affected or likely to be affected by any service provided or commissioned by the CCG, or any action, omission or decision of the CCG. Carers and other representatives are able to raise a complaint as long as they can demonstrate they have the permission of the person concerned or legal status to do so. 5 P a g e

6 6. Joint complaints Where the CCG is asked to consider a complaint that also concerns another health or social care organisation, all parties should cooperate in the handling and responding to the complaint. Agreement should be reached on which organisation will take the lead and this must be communicated to the complainant. The lead organisation should then be provided with the relevant information needed to respond. 7. Training and Support for staff 7.1 All staff and members of the Governing Body of South Kent Coast CCG should know how to react and what to do if someone raises a concern or makes a complaint. Therefore any staff who deals directly with patients or members of the public should attend a Complaints Awareness training session with this built into the induction programme 7.2 There is a complaints template for the administration staff to use should they receive a complaint directly into the CCG offices. See Appendix B. 8. Monitoring and Reporting 8.1 Complaints, comments and compliments will be monitored and reported on a quarterly basis to the CCG Quality and Performance Delivery and Governing Body meetings. The report will include the number of and type of complaints received as well as compliance with time limitations, outcomes, emerging trends and lessons learnt. 8.2 The CCG will also consider complaints data from services that are commissioned and use it to assist in its monitoring of the performance of the service and to assist with identifying any gaps in services. 8.3 The South Kent Coast CCG Head of Governance will ensure that an annual report is prepared which will: o Specify the number of complaints received o Specify the number of complaints considered well founded o Specify the number of complaints referred to the HSO o Summarise the subject matter of complaints o Any matter of general importance arising out of those complaints or the way in which they are handled o Specify any matters where remedial action or service improvement has taken place as a result of the complaint 6 P a g e

7 Appendix A: Commissioning Complaints Management Flowchart Letter/ received by CCG Scanned copy is ed the same day by the CCG to the Public Affairs generic mailbox The complaint is triaged Is the complaint from a health organisation / local authority about another health organisation / local authority? Yes Refer to Quality Lead in CCG No Does the complaint fall outside of the scope of the Complaints Policy for any other reason? No Yes Risk and Assurance Manager to refer as appropriate Complaint is allocated to a Public Affairs Officer (PAO) within one day The PAO acknowledges the request within three working days of original receipt as per NHS Complaints Procedure PAO investigates issues raised in conjunction with the relevant commissioner PAO prepares an initial draft response based on advice provided and/or previous similar letters Response is checked and approved by a senior SECSU lead PAO sends through the approved letter on the CCG s letter heading to CCG together with background documents Feedback provided to the PAO within one working day if amendments are required 7 P a g e The CCG named contact sends the final signed response to the complainant (by day 25 latest after receipt) and sends the PAO a scanned copy for the file by

8 Appendix B Complaints, comments and compliment record sheet Use this sheet to record any comments, compliments or complaints. Caller Details First Name: Surname: Mr/Mrs/Ms Address: Phone No: DOB: If not patient, relationship to patient: Patient Details (if different to above) First Name: Address: Surname: Mr/Mrs/Ms Phone No: Details of Call (use separate sheet if you need more space) Service Involved: District nurse service Address of Service (if known): Staff member involved: Call Handler Details Name: Base: Phone No: Send copy of this sheet to SECSU Complaints Service Secsu.complaints@nhs.net 8 P a g e

9 Yes Appendix C CCG Staff Complaints Management Flowchart Letter/ / Phone call received by CCG Complaint passed to Risk and Assurance Manager (RAM) who leads on complaints on behalf of the CCG (within one day) RAM will log complaint and make contact with the complainant where necessary to ensure that details of the complaint are understood correctly/ get more details Yes RAM will initially assess complaint and decide Yrs whether the Yes complaint could be dealt with informally (depending on the nature of the allegation e.g. considering whether there are possibly disciplinary issues etc) Formal process Yes RAM to speak with staff member s line manager and then make final decision regarding how best to take forwards Informal process RAM to formally write to complainant to set out how the CCG intends to investigate the complaint, e.g. speaking to staff, reviewing records etc (within 3 days) No RAM to contact complainant to gain consent to progress complaint informally via internal process this may include apologising on behalf of the CCG RAM to begin the investigative process, followed by a review of the evidence gathered. RAM and Company Secretary to decide collectively if the complaint is upheld RAM to pass to staff member s line manager to complete process including any additional staff training as required RAM to draft complaint outcome letter, to include any lessons learnt by the CCG and a final outcome (with 20 days) Draft complaint response sent to AO for review and sign off 9 P a g e Final signed response to the complainant (by day 25 latest after receipt)