The NHS Complaint Procedure

STAGE ONE: LOCAL RESOLUTION

The first stage of the complaints process is called "local resolution". It begins when you first tell the people responsible for the service you are unhappy about that you want to complain.

The aim of Local Resolution is to try to sort out your problem directly with the NHS organisation. The NHS aims to respond to you efficiently, sensitively and promptly.

Local Resolution is your opportunity to explain what it is you are unhappy about and what you would like to happen. It gives you and the NHS organisation time to listen and discuss the incident. Local Resolution is important because it aims to resolve your concerns and, where appropriate, use your experiences to improve local services.

Generally, you should make your complaint within:

• Twelve months of the incident happening or
• Within twelve months of you realising that you have something to complain about

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.

Who do I complain to?

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 to the Primary Care Trust (PCT) if you wish to do so. The PCT is responsible for all NHS services in your local area.

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 primary care and independent providers such as your GP, dentist, optician, pharmacist, health centre or other independent NHS contractor, you have two options:

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

Or

b) You can complain to the Primary Care Trust (PCT). The PCT is responsible for all care in your local area and they work closely with primary care practitioners such as GPs and dentists.

If you choose to make a complaint directly to the organisation (Option A) and you are not satisfied with their response you cannot then raise the issue with the PCT but must go straight to the Health Service Ombudsman (HSO).

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.

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

If you need support with any of these processes a free independent ICAS advocate will be able to help you.

You can explain what happened to you:

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

Trusts tend to prefer having complaints in writing, however 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.

It is important to raise everything that concerns you at this stage as new issues cannot be introduced at a later stage of the process. If your complaint is not resolved at this stage and you want to take it further, whatever you have raised here will be referred to later.

It may be helpful to keep a record of any phone calls you make or letters you write or receive about your complaint. To help you do this, you can use this Log Sheet. 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.

If you would like advice on how to write a complaint letter, please take a look at our online complaint letter guide and sample complaint letter.

What will happen next?

Sometimes it may be possible to resolve your concerns immediately.

If this is not the case they:

• Should acknowledgement your complaint either verbally or in writing within three working days.
• Must offer to contact you to discuss your complaint and arrange a plan to resolve your concerns with you. This means that they will discuss how best to resolve your concerns and what you hope to achieve from raising them. They should also agree with you a timescale for resolving the issues and 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 NHS 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.
• Should offer assistance to enable you to understand the complaints procedure or advice on where to obtain such assistance, such as, from your local ICAS provider.

Useful tip: if you send a written complaint, keep a copy of your letter to refer to later.

How should the NHS handle your complaint?

The Trust should try to resolve your issues in the most appropriate way, this may include:

• An investigation into the facts of your complaint.

• a meeting to discuss your complaint which gives you the chance to speak to staff directly about what has happened.

• 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 differs from Trust to Trust so if this is offered you should ask the Complaints Manager to explain how it operates in your area.

You can take a friend, relative or advocate with you to any meetings that you might have.

Useful tip: If you can, prepare a list of questions you want to ask and bring this with you to your meeting.  Try and keep these questions as clear as you can.  You may find it helpful to number your questions and tick them off as the meeting progresses. If you have any relevant paperwork, take this with you to refer to.

What will happen next?

Once the investigation is finished and any meetings have been held, the Complaints Manager should send you a letter signed by the trust's 'Responsible person' or someone authorised to act on their behalf. This letter should contain
Chief Executive 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 still unhappy with the answers given

Depending on the Trust’s investigation, the letter may contain:

• An apology if relevant
• What will be done, by 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 again to other people

The letter should be:

• Balanced, factual and impartial
• 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 in the plan you may want to ring or write to check when you can expect to receive it.

If you haven't received a response letter within six months of your original complaint and the Trust haven't agreed an extension to this period they should write to you explaining the reason for the delay. The final response must then be sent as soon as reasonably practicable.

If you have agreed, this letter may be sent in electronic form 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.

This is the end of the first stage of the NHS Complaints Procedure.

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

If you are not satisfied with the reply ask yourself exactly what you are still unhappy 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 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 unhappy
• 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 the options at Step 2.

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.