PROCEDURE FOR DEALING WITH COMPLAINTS BY OR ON BEHALF by Takeme

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									       PROCEDURE FOR DEALING WITH COMPLAINTS
            BY OR ON BEHALF OF PATIENTS
                - LOCAL RESOLUTION




                               Issued by:



                  The Director of Integrated Governance




Classification:                      Procedure No:
Corporate                            PRC CP002
Issue No:                            Date Issued:
005                                  1st June 2006
Page No:                             Review Date:
1 of 26                              30th June 2009
                BROMLEY PRIMARY CARE TRUST
PROCEDURE FOR DEALING WITH COMPLAINTS BY OR ON BEHALF OF
              PATIENTS - LOCAL RESOLUTION



                                CONTENTS


  Definitions                                                 Page 3
  Procedure Statement                                         Page 4
  Scope of Procedure                                          Page 5
  Responsibilities                                            Page 6

  Organisational Arrangements:

            General                                           Page 7
            Who may complain?                                 Page 8
            Handling Complaints & Concerns                    Page 8
            Initial Contact                                   Page 8
            Informal Response                                 Page 9
            Formal Response –Initial stage                    Page 9
            Investigation of the complaint                    Page 10
            Draft responses                                   Page 11
            Response from Chief Executive                     Page 11
            Legal action and negligence                       Page 12
            Complaints involving more than one organisation   Page 12
            Closing a complaint                               Page 12
            Monitoring complaints                             Page 12

  2.     References                                           Page 14

  Appendices

  1. Practical advice on dealing with a complaint             Page 15
  (includes preventing complaints)

  2. Guidance on investigating complaints                     Page 18

  3. Guidance on writing complaint responses                  Page 21

  4. Complaints Action Pro – Forma                            Page 23

  5. Flow chart – Local Resolution                            Page 26




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                   BROMLEY PRIMARY CARE TRUST
   PROCEDURE FOR DEALING WITH COMPLAINTS BY OR ON BEHALF OF
                 PATIENTS - LOCAL RESOLUTION


                                  DEFINITIONS

‘Complainant’      A complainant may be an existing or former patient using Bromley
                   Primary Care Trust’s (BPCT) services and facilities. A complainant
                   may also be an existing or former patient of an independent contractor
                   who has a contract with Bromley PCT to provide primary care health
                   services.

                   A complaint may be made on behalf of an existing or former patient by
                   anyone who has the patients consent. If the patient is unable to act
                   then consent is not needed.

‘Complaint’        A complaint is an expression of dissatisfaction that requires an
                   investigation and a response. Complaints that are to be dealt with
                   under the NHS Complaints Procedure need to be made by
                   complainants, as described above.
                   Where there is doubt as to whether a complaint is a ‘formal’ complaint
                   or a concern, the ‘complainant’ should be asked whether (s)he wishes
                   the matter to be dealt with through the PCT NHS complaints process
                   leading to a formal response from the Chief Executive.


‘Patient’          For consistency the term ‘patient’ is used throughout this document to
                   include any person who is or has been receiving a health service
                   provided by Bromley PCT or an independent contractor in Bromley.
                   The term ‘patient’ is synonymous with ‘client’ and ‘user’.

‘Independent Contractors

                   General Practitioners (GP’s), Dentists, Opticians, Pharmacists who
                   have a contract with Bromley PCT to provide family health services.




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   PROCEDURE FOR DEALING WITH COMPLAINTS BY OR ON BEHALF OF
                 PATIENTS - LOCAL RESOLUTION


                             PROCEDURE STATEMENT

This procedure is intended as a practical guide to the local resolution of complaints. It should
be read in conjunction with Bromley PCT’s Complaints Policy.




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                               SCOPE OF PROCEDURE

This procedure applies to all staff employed by Bromley PCT.

A complaint may be made by any existing or former patient using Bromley PCT’s clinical
services. The complaint may relate to the clinical care offered or provided or to any service or
facility offered or provided in relation to that care. A complaint may also be made on behalf
of an existing or former patient by anyone who has the patient’s consent. If the patient is
unable to act then consent is not needed.

Bromley PCT carries out certain administrative functions in relation to the services provided
by Independent Contractors. An existing or former patient of an Independent Contractor may
complain to the PCT about the way in which it has carried out those administrative functions.

Complaints about services provided jointly and for which another Trust or the Social Services
Department is responsible will be subject to the complaints procedure of the appropriate
managing organisation. However, the PCT will work closely with its partners to resolve
complaints about joint services, which cross provider boundaries.

The Complaints Procedure will be suspended where the complainant explicitly indicates an
intention to take legal action in respect of the complaint.

This procedure is concerned with resolution of complaints and is not part of any BPCT
disciplinary process. However, the result of any complaints investigation may be taken into
account in considering the need for or conclusions of the disciplinary process.

BPCT has no powers to investigate complaints in relation to services provided by
independent contractors (General Practitioners, Dentists, Opticians, and Pharmacists). Such
complaints are referred to the independent contractor’s local practice based procedures.
However if a complainant does not wish to have a complaint dealt with by the practice
concerned, or is having difficulty in getting the complaint dealt with by the practitioner,
BPCT will, if both parties agree, act as an ‘honest broker, between the complainant and the
practitioner to resolve the complaint at practice level. BPCT will also make available lay
conciliators as a service to complainants and practices.




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                                   RESPONSIBILITIES

The Chief Executive of the PCT is responsible for the implementation of the NHS
Complaints Procedure within the PCT. He or she will represent the PCT in responding to all
formal complaints.

In accordance with the NHS complaints regulations the Trust have assigned the Director of
Clinical Services & care environment as the Complaints Champion.

The Patient Relations Manager must be available to respond to complainants who do not wish to
raise their concerns with those directly involved in their care. He or she will need to give support
and advice to staff dealing with all complaints and co-ordinate the investigation and response to
formal complaints. He or she will also be required to give advice to complainants about the NHS
Complaints Procedure, including details of their rights of appeal.

Further responsibilities for dealing with complaints are detailed in Bromley PCT Complaints
Policy.




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                 PATIENTS - LOCAL RESOLUTION


                     ORGANISATIONAL ARRANGEMENTS

General
1.1 This procedure covers the complaints ‘Local Resolution’ process for Clinical Services
provided by Bromley PCT. In the case of Independent Contractors (GP’s, dentists, opticians,
pharmacists) local resolution is the responsibility of the practitioner. Bromley PCT has a
limited role in FHS Local Resolution as outlined in the previous section ‘Scope of
Procedure’.

1.2 This procedure incorporates the guidelines contained within EL (96)19 ‘Implementation
of the New Complaints Procedure: Final Guidance.’ In the event of any doubt or omission
from these guidelines reference should be made to that Guidance and the associated
Directions of the Secretary of State. This procedure also incorporates the Trust Board’s
requirements for the monitoring and review of complaints.

1.3 This procedure applies to all staff who may receive complaints (written, telephone, face
to face).

1.4 The Trust’s complaints procedure is designed to address patient’s complaints, not staff
grievances, which will continue to be handled separately under the PCT policies and
procedures.

1.5 All front line staff should be aware that they are responsible for, and empowered to take
initial action with regard to any complaint or concern which they might receive in line with
the guidance contained within this procedure. The emphasis should be on resolving
complaints as quickly as possible. Staff should also be aware of the Patient Advice and
Liaison Service (PALS) and how to refer patients to the service. Directors, Service Managers
and Heads of Service should ensure that the procedure for dealing with complaints and
concerns forms part of induction training and is periodically reinforced.

1.6 Strict patient confidentiality will be observed at all times and information will only be
shared with staff need to know.

1.7 Oral and written complaints should receive the same consideration and sensitive
treatment.

1.8 Heads of service and service Managers must ensure that PALS and Complaints
information leaflets are available within their Departments at all times in a prominent
position where they can be seen and are readily accessible to patients.

1.9 Interpreter service, translations and face to face support can be provided for any patient or
relative to ensure they are informed of the complaints process.




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2.0 Who may complain?
(See also ‘Definitions’ and ‘Scope of Policy’)

2.1 A complaint may be made by any existing or former patient using Bromley PCT’s clinical
services. The complaint may relate to the clinical care offered or provided or to any service or
facility offered or provided in relation to that care. A complaint may also be made on behalf
of an existing or former patient by anyone who has the patient’s consent. If the patient is
unable to act then consent is not needed.

2.2 A complaint may be made by existing or former patients of Independent Contractors
(GP’s, dentists, opticians, pharmacists) in relation to the service(s) provided by that
practitioner. However, in this case, local resolution is the responsibility of the Independent
Contractor. Bromley PCT is not able to investigate such complaints and has a limited role as
outlined in the previous section ‘Scope of Procedure’

2.3 Bromley PCT carries out certain administrative functions in relation to the services
provided by Independent Contractors. An existing or former patient of an Independent
Contractor may complain to the PCT about the way in which it has carried out those
administrative functions.


3.0 Handling Complaints and Concerns
3.1 Initial contact

3.1.1 An initial contact may come in a verbal face to face meeting, via a telephone call or as a
written complaint or concern by letter or email.

3.1.2 In any case, the member of staff should try to determine whether the person expressing
the concern wishes to have the concern dealt with through the formal NHS Complaints
Procedure, with a response from the Chief Executive or whether they are looking for a more
immediate or informal response.

3.1.3 Where the initial complaint is in writing, the recipient member of staff should make
contact with the complainant as soon as possible to determine whether the person expressing
the concern wishes to have the concern dealt with through the formal NHS Complaints
Procedure. It is entirely the decision of the complainant as to which approach is preferred.

3.1.4 If in doubt, a written complaint or concern should always be treated as a formal
complaint

3.1.5 Any complaint or concern which arises from a situation in which it appears that action
by a senior manager might be required to resolve the complaint; where actual harm to a
patient appears to have occurred or was likely to have occurred; or where it appears that
media interest might be generated, should be treated as a formal complaint.




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3.2 ‘Informal’ response
3.2.1 In many cases, it will be possible for the member of staff receiving the complaint /
concern to deal with the situation immediately and to provide a response which satisfies the
person expressing the concern.

3.2.2 If the member of staff does not feel able to deal with the situation immediately, or if the
person expressing the concern appears not to be satisfied with the response, the member of
staff should again try to ascertain whether the ‘complainant’ wishes to progress their concern
through the formal complaints process.

3.2.3 If the patient does wish to proceed via the formal process, the member of staff should
write down the patient’s details and details of their concerns and pass this information to the
Patient Relations Manager at Bassets House. The Patient Relations Managers will be happy
to provide advice and can be contacted on 01689 880664.

3.3 Formal Response – initial stage.
3.3.1 Complaints requiring a formal response must be passed as soon as possible to the
Patient Relations Manager.

3.3.2 The Patient Relations Manager will, in writing, acknowledge the complaint. This
acknowledgement will inform the complainant that an investigation will be carried out, and that
the Chief Executive will write to them as soon as the outcome of the investigation is known. It
should also state that a response can be expected within 20 working days and give contact details
of the Patient Relations Manager, as a point of contact for the complainant while the
investigation is proceeding. A copy of the complaints leaflet should always be enclosed with the
acknowledgement letter giving details of the complaints procedure, rights of appeal, and the
support available from the Independent Complaints Advocacy Service.

3.3.3 The Patient Relations Manager will then pass on details of the complaint to the relevant
service manager / head of service who will carry out an appropriate investigation.

3.3.4A copy of the complaint details will be sent to the relevant Service Director. .

3.3.5 A copy of the Complaints Action Planning pro – forma will at the same time be sent to
the Service Lead / Head of Service. The Service Lead / Head of Service should complete the
pro-forma, send a copy to the Patient Relations Manager with the final response and use the
pro-forma to monitor and record progress of any action required as a result of the complaint.

3.3.6 Where there are aspects to a complaint which refer to different
departments/Directorates/professionals the Patient Relations Manager will, in consultation
with the Associate Director of Clinical Governance (Risk) and the services involved, agree a
Service Director and Service Lead/Head of Service to lead the investigation or and response
to the complaint.




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3.4 Investigation of the Complaint

3.4.1 The Service Director with responsibility for the service that is the subject of the
complaint will be the designated investigating officer. However, this task will normally be
delegated to the relevant Head of Service. He or she will be responsible for undertaking the
investigation and drafting an initial response which will be provided to the Patient Relations
Manager within 10 working days.
If it seems unlikely to be able to provide this response within the ten days, the Patient Relations
Manager should be informed as soon as possible about the estimated time for completion of the
investigation and the reasons for delay

3.4.2 The investigating officer will then proceed as detailed in the Appendix ‘Guidance on
investigating complaints’

3.4.3 The Patient Relations Manager will assist any manager who finds that through personal
involvement or other reason they are unable or have difficulty in conducting an investigation.

3.5 Draft responses

3.5.1 The investigating officer will provide the Patient Relations Manager with a draft
response for the Chief Executive’s signature together with supporting documentation (i.e.
statements from staff involved, extracts from the records and any other relevant
correspondence) within ten days of receipt of the complaint. The draft letter should be written
in accordance with the advice given in the Appendix – ‘Guidance on writing complaint
responses’.

3.5.2 If it is not possible to provide this information within the ten days, the Patient Relations
Manager should be informed about the estimated time for completion of the investigation and
the reasons for delay.

3.5.3 The Patient Relations Manager will carry out an initial review of the response. If the
response appears to be appropriate the Patient Relations Manager will add information on the
Independent Review Process to the letter and will then pass the response to the relevant
Director for comment and any amendments. The response will then be returned to the Patient
Relations Manager.

3.5.6 At any stage where significant amendments to the response are required, these will be
made in consultation with the relevant Head of Service.




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3.6 Response from Chief Executive
3.6.1 Following approval of the draft response by the relevant Service Director, the Patient
Relations Manager will pass the response to the Chief Executive for any final amendments,
approval and signature.

3.6.2 The draft response must be provided to the Chief Executive’s Office in sufficient time
to allow the signed response to be sent to the complainant within 20 working days from the
date of receipt of the original complaint.

3.6.3 Once signed by the Chief Executive, the final response will be returned to the Patient
Relations Manager for posting to the complainant.

3.6.4 If it is not possible to send a full reply to the complainant within the 20 working days
limit, a letter will be sent by the Patient Relations Manager explaining the delay. Further
progress updates will be provided by the Patient Relations Manager.

4.0 Legal action and negligence

4.1.1 The complaints procedure will cease if at any time during the local resolution process if
the complainant indicates an intention to take legal action in respect of the complaint. If,
during the course of investigation of a complaint, a prima facie case of negligence is
revealed, the Patient Relations Manager and the Associate Director of Clinical Governance
(Risk) should be informed immediately.

5.0 Complaints involving more than one organisation

5.1.1 Where a complaint involves more than one organisation, the Patient Relations Manager
should ensure that the complainant receives a response from the PCT stating which other
organisations are involved and that the complaint will be forwarded to the other organisation.
Where it is appropriate, and there is agreement between the organisations involved, a
coordinated response may be formulated.

5.1.2 In certain cases the complainant’s written permission should be sought before the
complaint is passed on to the other organisations. The Patient Relations Manager will consult
with the relevant Head of Service to agree this.

6.0 Closing a Complaint

6.1.1 The Chief Executive’s written response will normally be considered the end of the local
resolution stage of the complaint. However, the letter should invite the complainant to contact
the Chief Executive or Patient Relations Manager if they require further information or
clarification. The letter must also explain that if the complainant remains dissatisfied and
does not wish to pursue the complaint further by local resolution, (s)he has a right to request
an Independent Review. Details of how to make the request should be given and the
complainant advised that any such request must be made within two months of receipt of the
Chief Executive’s letter.




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6.1.2 The Trust should consider the option of mediation by professional mediators in cases
where the complainant wishes to continue with local resolution following receipt of the Chief
Executive’s formal response.

6.1.3 If the complainant requests an independent review to the Healthcare Commission
(HCC) the Patient Relations Manager will send on any documentation or information
required within the timescale given by the HCC.

If after assessing the complainants request, any suggestions made by the HCC for the Trust
e.g further local resolution or a list of recommendations, the Patient Relations Manager will
ensure that these suggestions are actioned and any response notified to the Board via the
quarterly complaints report and a full copy of the Trust’s response to the complainant and the
HCC are copied to the Strategic Health Authority.

7.0 Monitoring Complaints

7.1.1. The Patient Relations Manager will request on a monthly basis via a form that any
information relating to complaints handling at local level be forwarded from Heads of Service to
the Patient Relations Manager to ensure that all complaints data is monitored at all levels across
the Trust.
.
7.1.2 The Patient Relations Manager will provide three reports a year on complaints for the
Healthcare Governance and Risk Committee.

7.1.3 A report on complaints received will be made in the Trust’s Annual Report in
accordance with the guidance from the NHS Executive. An annual report on complaints will
also be produced and presented to the Board. This report may be shared with external
stakeholders such as Independent Complaints Advocacy Service and the South East London
Strategic Health Authority.

7.1.4 The Patient Relations Department will be responsible for ensuring that any requests for
information regarding General Practitioner complaints, which have been notified to the Trust
by the HCC in response to a request for Independent review by a complainant, comply to the
response times required by the HCC. The Patient Relations Department will write to the
General Practitioners concerned when such requests are received, asking for their cooperation
in complying with the timescales and providing us with copies of their response to these
requests.

7.1.5. It will be the responsibility of the Patient Relations manager to keep record of service
improvements; this will be reported to the Director of Clinical Services and Care
Environment.

7.1.6 It is the responsibility of Heads of Service to complete complaints action plans detailing
service improvements and include complaints data as part of Service Profiles and Business
planning.




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                                    REFERENCES

The National Health Service (Complaints) Regulations 2004 (the ‘Complaints
      Regulations’) 30 July 2004.


Guidance to support implementation of the NHS (Complaints) regulations 2004 DOH Handling



        Complaints in the NHS - good practice toolkit for local resolution. 2004 DOH




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                                       Appendix 1

  PRACTICAL ADVICE ON DEALING WITH A COMPLAINT


WE’RE HERE TO HELP…

….For all matters relating to patient complaints: Patient Relations Manager/s, 01689 880607,
01689 880664.

….For all other patient enquiries or concerns: Patient Advice and Liaison Service
Coordinator, 0800 389 5118

Supplies of complaints information and PALS leaflets can be obtained from the Patient
Relations Manager and the PALS Co-coordinator, who will also distribute their leaflet to all
Independent Contractors in Bromley, as well as the Independent Complaints Advocacy
Service.

TRY TO AVOID COMPLAINTS ARISING…

Whilst we may never be able to prevent some complaints, there are others we can work towards
preventing. ‘Communication’ and ‘attitude’ consistently feature in the top 4 categories of
complaint year after year.

       Communication

Many complaints arise as a result of poor communication. Some of the complaints we have
received could have been avoided by clear and regular communication with the patient. It is
important to keep patients informed and communicate the next steps of their treatment to them.
It may be necessary to explain how other health professionals may be involved in their care too.
Always ensure any calls or messages from patients are returned promptly, and that any messages
you leave for other health professionals are received and acted upon.

       Attitude

Experience has shown that attitude is key. How you initially come across to a patient is very
important. We all need to be aware of the tone of our voice, the language we use and our body
language. All of these have the potential to antagonize patients or exacerbate a situation. Try
not to adopt a defensive attitude or take a complaint personally – most complaints are actually
about a service, not an individual.




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FACE TO FACE OR TELEPHONE COMPLAINTS - INITIAL CONTACT

Many complaints can be prevented from progressing further if the initial contact is handled
personally with sensitivity, sympathy and respect. Always treat a complainant as you would
wish to be treated yourself. A complainant should never be passed from pillar to post. Do not
take the complaint personally or adopt a defensive attitude. Be aware of the issues of privacy - a
patient may wish to go somewhere quiet where they cannot be overheard.

Any person within the PCT who receives a complaint of any kind should ensure, before doing
anything else, that the patients immediate health needs are being met. They should make every
effort to resolve the issue immediately if at all possible:

       Actively listen – Let the complainant speak and do not interrupt them, but also let them
       know you are actively listening. Be sympathetic and sincere.

       Express regret – Say how sorry you are they have had cause to complain and that they
       feel so distressed/upset about the matter.

       Review – Find out what went wrong from the patient’s perspective and ensure you have
       understood them correctly. If it is not obvious from the conversation what they actually
       want, you can ask “What do you feel would resolve this matter to your satisfaction?”

       Resolve – Explain to them what you are going to do to help resolve the matter. You may
       be able to resolve a simple matter yourself, or speak to your line manager or another
       member of staff before coming back to the patient. You should aim to do this within 48
       hours. Whatever you do, keep the complainant informed of what you are doing. If the
       patient wishes to make a formal complaint, or does not wish you to deal with their
       complaint, pass their details on to the Patient Relations Manager immediately. If the
       patient raises a concern or enquiry which you cannot answer yourself pass their
       details on to the Patient Advice and Liaison Coordinator straight away.

       Advice – Any member of staff who receives a request for information on how to
       complain should pass the patient a copy of the leaflet ‘How to make a complaint about
       NHS services’ which explains the complaints procedure in Bromley. These leaflets are
       available from our clinic receptions, GP & dental surgeries, opticians and pharmacists in
       Bromley. Supplies can be obtained from the Patient Relations Manager and fron the
       Bromley PCT Intranet. You should also give them the contact number for the Patient
       Relations Manager.




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   Interpreter service, translations and face to face support can be provided for any patient
   or relative to ensure they are informed of the complaints process. Please contact the
   Patients Relations Manager/s for advice.

     Inform – Your appropriate manager/ the Patient Relations Manager/ the PALS
     Coordinator as soon as possible. If you have been able to deal with the matter yourself it
     is important you fill out an IR1 (incident reporting) form, ticking the ‘complaint’ box.
     This enables the PCT to monitor all the oral complaints/concerns we receive.

     Confidentiality – Remember, strict patient confidentiality should be observed at all times
     and information should only be shared with staff that need to know.




WRITTEN COMPLAINTS

     Any member of staff who receives a written complaint should ensure it is passed to the
     Patient Relations Manager immediately, by fax to Bassetts House on 01689 855 662.
     They should also call the Patient Relations Manager on 01689 880 664/607, who will
     advise on how the complaint will be dealt with.




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                                     APPENDIX 2

     GUIDANCE ON INVESTIGATING COMPLAINTS


INTRODUCTION

The investigation of complaints can vary from making a simple enquiry about what happened
from the staff concerned, to detailed examination of records and the taking of formal statements
from witnesses.

The degree of investigation carried out should reflect the depth of response expected by the
complainant.

In some cases a complaint may relate to the actions of two NHS bodies, for example a
Independent contractor and the PCT (i.e. a GP and a District Nurse). In such instances there
should be cooperation between the two bodies in seeking to resolve the complaint through each
one’s local complaints procedure. It is good practice for the investigating officer or the Patient
Relations Manager to explain to the complainant which matters will be dealt with under which
procedure, and that the two bodies will need to liaise whilst investigating the complaint.



INVESTIGATIONS

On receipt of a complaint, the investigating officer must ensure that (s)he has accurately
identified all the issues the complainant wishes to be investigated. This may entail arranging a
meeting, or telephoning the complainant for a detailed discussion.

Experience has shown that meetings can be very beneficial. From the complainant’s point of
view this gives them an opportunity to talk about the problem(s) giving more background
information than is possible in a letter and reassures them that their complaint is being taken
seriously and considered as a matter of importance.

If a meeting is arranged the complainant should be advised of the existence of, and the
assistance provided by, external advocates e.g. Independent Complaints Advocacy Service,
and/or the complainants right to bring a friend or a relative to the meeting. It may be appropriate
for the investigating officer to request that another member of staff is present to record the
decisions made. Special attention will be paid to the needs of vulnerable groups for support and
representation in making complaints.



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Following any meeting or telephone discussion between the investigating officer and the
complainant, a written communication should be sent to the complainant identifying the agreed
areas for investigation and, as far as possible, the action to be taken by the Trust in order to
provide an outcome satisfactory to the complainant. A copy of this and any other
correspondence between the investigating officer and the complainant should be sent to the
Patient Relations Manager.

A thorough investigation of the complaint should include a careful examination of all
available sources such as:

•   Case notes

•   Communications books

•   Personal diaries

•   Accident/incident reports

Relevant staff should be interviewed. It is very important that all staff involved in the
patient’s care have the opportunity to comment, especially if there are details which do not
agree. The aim is to produce a balanced, factual, impartial response to the complaint.

Individual members of staff should see any letters of complaint in which they are mentioned.
All staff complained about need to be supported by their manager, since the complaints
process is acknowledged to be stressful. Managers should also update staff during the
process and inform them of the outcome of the complaint.



WRITTEN STATEMENTS

It may necessary to obtain a written statement from a member of staff, or produce a statement
yourself, in the course of the investigation. Guidelines as to what this statement should
contain are as follows:

       The statement should be in plain English, without abbreviation (or abbreviations fully
       explained), use of jargon, and in black ink.

       The statement should be typed, or at the very least in legible handwriting.

       The total number of pages should be noted on the front page and stapled together;
       with a paragraph confirming the witness has had sight of all relevant health records
       prior to making the statement.

       Any technical or medical terms must be clearly explained.




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     The statement should include a chronological diary of events (where appropriate with
     detailed timings), with reasons for any actions/omissions.

       The statement should be signed by the witness, dated and name printed with the
       relevant professional qualification of the witness. If any clinicians are referred to in
       the statement there should be an indication of their status.

       The statement should include brief CV details that indicate the experience and
       professional standing of the statement writer, i.e. “I qualified as an RGN in 1984 and
       following 2 years spent on a surgical ward as a D grade I undertook District Nursing
       training and qualified in 1987. I have been practicing as a District Nurse in the
       Orpington area ever since.”

       Any changes to the statement should be initialed in the same black ink pen used to
       sign the statement.

       Contents of the statement should be confined to fact rather than opinion.

       The witness should only deal with issues they are involved in with respect to the
       complaint.


If staff have any concerns about writing or providing a written statement they can contact
Patient Relations Managers on 01689 880 664/607.

It should be remembered that all documentation generated in relation to the complaints
process is disclosable, in that it may be seen by the complainant and their representative (if
any).

Staff members who provide written statements should be aware they can have a union
representative present, and that their statement may be used at a later date if the complaint
proceeds further. Staff should also be aware they can check their statements with their
professional body, and the PCT’s solicitor can check statements, where appropriate. Staff
may obviously wish to retain a copy of their statement.




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                 PATIENTS - LOCAL RESOLUTION
                                       APPENDIX 3

      GUIDANCE ON WRITING COMPLAINT RESPONSES


INTRODUCTION

Writing letters to complainants can be difficult, but a well-written letter can quickly help resolve
a complaint, whereas a carelessly worded one can upset the complaint and make the situation
worse.

Before you start writing……

….Think about what you are writing. A good approach to adopt when replying to any letter is
RSVP:

Reader

Think about the reader. Who are you writing to? What is their level of understanding? What is
the nature of the relationship between you and the reader? Imagine the patient is sitting in front
of you reading the letter, how will they react? Write as if you are talking to them and
immediately your style will become warm, personal and conversational. And you will use more
everyday language. Always ensure the style of the letter is appropriate for the audience. Try
putting yourself in their shoes.

Subject

What is the subject of your letter? How does this fit with the reader’s level of understanding –
lay person/expert/professional?

Viewpoint

What is the reader’s viewpoint and how does it differ from your own?



Purpose

What is the reason for your writing? What do you hope to achieve? (hopefully to resolve the
complaint!) What does the reader expect from you?




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GETTING STARTED

It can be difficult to know where to start. Remember your first attempt at a reply does not have
to be in the form of a full draft. You may wish to start ‘brainstorming’ - writing down key
words/points/ phrases at random, as a way of generating ideas. You can then link these together
to form outlines of paragraphs. Whatever you do, do not delay getting started – a complainant
expects a timely response.



Whilst you are writing remember your ABC:

Accuracy – the content and style of a letter need to be accurate. Check and check again any
dates or times you mention (from the relevant records). Contents should generally be confined
to fact, not opinion, and ensure any facts mentioned can be substantiated. Check for spelling,
grammar and punctuation too.

Brevity – keep the response to a minimum without in any way being discourteous or abrupt or
disregarding any of the queries which have been raised.

Clarity – Avoid abbreviation, jargon, legalistic and pompous words or long-winded expressions.
If you read your letter out loud any pompous and over-formal words will immediately stand out.
Keep vocabulary simple - is the information you are providing as clear as possible?



MAIN COMPONENTS OF AN NHS COMPLAINT RESPONSE TO GO FROM
THE CHIEF EXECUTIVE

       Personalisation

The letter should be personalised – always use the patient’s name (correctly spelt) where
appropriate. Check the correct title of the patient (from the complaint letter) and use this.
Ensure you also use the correct address and postcode.



       Acknowledgement

Thank the complainant for their letter and acknowledge their right to complain. Say you are
sorry that they have had cause to complain.




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                 PATIENTS - LOCAL RESOLUTION
     Condolences

If there has been a bereavement offer condolences. If you feel in any way that your response
may cause distress you can write a covering letter (to send with the response) to say something
to the effect: “I am aware, given your sad loss, that my reply may cause distress by revisiting
events that are still very upsetting to you. As such I enclose my full response as a separate letter,
in the envelope enclosed, in case you wish to delay reading it until you want to.” This is
obviously a matter for personal judgment



        Apology

Complainants expect to receive an apology, irrespective of whether their complaint is
demonstrated or not. An important point - the complainant may have misunderstood you or be
mistaken, but they are never wrong! A well-worded, sincere apology early on in the letter can
do a great deal to appease a dissatisfied patient. An apology at the end can look like an
afterthought, although it is useful in the conclusion of the letter to reiterate the apology. Even if
the complaint is not demonstrated you can still say how sorry you are for any distress the matter
has caused them.



        Reference to other bodies

Where a complaint relates to the actions of two separate bodies, for example a independent
contractor and the PCT, or Social Service and the PCT, explain to the complainant which
matters you are able to address and which the other body will address.



        Explanation

The explanation should include details of the investigation method and the circumstances
surrounding the matter. Keep the explanation to a minimum without in any way being
discourteous or abrupt or disregarding any of the queries that have been raised. The explanation
should not undermine the apology. Always answer all the points raised by the complainant – it
may be useful to take each issue in turn (as the complainant has raised them) or put events in a
chronological order. Give all the facts as objectively as possible and include those which differ
from those given by the complainant. Where authorities, policies, or people exist to support
your response, mention them without hiding behind their existence.




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                             PATIENTS - LOCAL RESOLUTION
If the complains is not demonstrated:
         If you need to refute a particular allegation, empathise first, i.e. “I fully appreciate your
         point of view, however…..”
         Avoid being judgmental, trivializing the complaint or responding emotionally.
         Always allow the complainant to save face. An embittered complainant is an aggrieved
         complainant and will come back time and time again. Remember – you hope your
         response is going to help resolve the complaint!

If the complaint is demonstrated:
         An acknowledgement for taking the time to write maintains good relations.
         Acknowledge the complaint is justified and apologise with dignity.
         Be sincere and credible. Do not make excuses or pass the blame.



        Remedy

The response should include the reasons for any failure in the service, with steps taken to
prevent a recurrence.



        Reassurance

Reassure the complainant that you have taken the matter seriously and that the situation has been
resolved. Avoid saying definitively that the problem will not reoccur unless you are absolutely
sure it will not!



        Independent Review

It is a statutory obligation to let the complainant have details of their right to redress through the
Independent Review process. This is now undertaken by the Healthcare Commission. The
Healthcare Commission is an Independent body established to promote improvements in
healthcare. The Patient Relations Manager will add this relevant paragraph at the end of the
letter and ensure an information leaflet goes out to the complainant with the response.




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                           THIS FORM MUST BE COMPLETED
           (keeping one copy for yourself and returning one to the Patient Relations
                                         Department)

         ACTION PLAN DETAILING THE CHANGES AS A RESULT OF COMPLAINTS.

Name:                                         Complaint Date:


Service Involved:                             Manager Investigating:
                                              (Please print)




Brief overview of complaint:




 Action for change as result of complaint       By whom         Target date     Date
                                               (please print)                 completed




If no action required, please state reasons why.




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                      BROMLEY PRIMARY CARE TRUST
   PROCEDURE FOR DEALING WITH COMPLAINTS BY OR ON BEHALF OF
                 PATIENTS - LOCAL RESOLUTION
Guidance on completing Complaints Action Plan Form

1.Please state clearly proposed changes to be made. If there are no proposed changes this
must be noted on the form.

2.One form can be used if there are several complaints concerning one particular aspect of the
service (e.g same complaint about waiting times over Christmas period from several service
users)

3.Make the target date realistic as the Patient Relations Department will be in touch one week
prior to target date suggested to enquire as to progress.

4.Three months after the target date has been reached, the Patient Relations Department will
contact the investigating Manager to ascertain how the implemented changes are affecting the
service and whether any positive outcomes have emerged.

 5.If at this time all parties concerned are happy that the relevant changes have been
completed, this date will be added to the form in order to formally close the matter.

If you require any further information please do not hesitate to contact us on
01689 880607/880664.




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                   PATIENTS - LOCAL RESOLUTION
  Appendix 5 - LOCAL RESOLUTION OF CONCERNS AND COMPLAINTS:

Verbal or written                    Concern                                Front line staff or
  expression of                                                             PALS Coordinator
concern received
     (day 0)
                                                                         Some concerns may require
                              Concern resolved                           written response- should be
                              to patients                                provided within 20 working
                              satisfaction when
   Complaint



                              expressed to staff/
                              service manager.               No              Individual satisfied?

                      Patient wishes to pursue and
                                                                         Yes                   Resolution
                      Relates to care provided by PCT

                                                         Acknowledge within 2 wd
Patient Relations Manager                           (Include offer for Head of Service /
                                                     Service Manager to to meet with
                                                               complainant)

  Service Lead / Manager                                                                           Complaints
                                                Investigates and drafts response plus
                                                 action plan: Provide to pt. relations             Champion-
                                                 manager by 10 wds from complaint                  Director of
                                                                                                   clinical
                                                                                                   services & care
Patient Relations Manager                      Add info on Independent Review to
                                                         draft response
                                                                                                   environments.
                                                                                                   Informed by
                                                                                                   quarterly
Relevant Assistant Director                           Comment / Amend draft                        reports.



Patient Relations Manager                                    Approval


                                                                                                       Response
  Chief Executive                                      Approval and signature                          out within
                             --------------------
                                                                                                        20 wd of
                                                                                                        original
                                                                                                       complaint

Complainant satisfied?                                              No
                                                                                        Option for further local
                                                                                          investigation and
                                                                                              resolution.

               Yes        Resolution
                                                                                           Option to Request
                                                                                             Independent
                                                                                                Review

                                       Page 26 of 26

								
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