1.97. Sometimes in a complaints investigation, serious issues emerge which need to be addressed by the Boards of NHS bodies. The Complaints
Procedure is concerned only with resolving complaints and learning lessons for improving services. It is not for investigating disciplinary matters.
1.98. The overriding principle is the safety of patients. If at any stage in the complaints procedure, a member of staff of a Trust or Local Health Board feels serious concerns are raised they should pass the information
immediately to the Complaints Manager, who will ensure that it is passed on to a appropriate person who can make a decision on whether or not action
is required in the interests of patient safety. Any concerns should be raised with the appropriate senior person in the Trust or Local Health Board who may decide to:
• Carry out an investigation under the disciplinary procedure;
• Where abuse of a child or vulnerable adult is suspected, refer to professional abuse and the child protection and vulnerable adult procedures;
• Refer a professional to one of the professional regulatory bodies;
• Refer individual clinicians to the National Clinical Assessment Authority;
• Refer to the Counter Fraud Officer of the NHS Trust or Local Health Board.
1.99. If the Trust or Local Health Board decides to take any of these actions before a complaint investigation has been completed, consideration will need to be given to how far the investigation under the NHS Complaints Procedure can continue and whether other investigations can run alongside it.
1.100. As a principle, when disciplinary or other procedures are invoked, the complainant should receive the same consideration and level of
information as if the matter had been dealt with through the complaints procedure. The complainant should be able to understand what happened, why it happened, and what action has been taken as a consequence to ensure that it does not happen again. The complainant should be informed in general terms of disciplinary sanctions imposed on any staff member. A judgment will need to be made between reassuring the complainant that the matter they raised has been taken seriously and dealt with satisfactorily, while protecting the confidentiality of the member of staff.
Trusts and Local Health Boards
1.101. Disciplinary investigation can be suggested at any point during the complaints procedure, but consideration as to whether or not disciplinary action is warranted is a separate matter for management outside the
complaints procedure. Papers from the investigation of the complaint may be passed to the appropriate person in the organisation responsible for
disciplinary or other action. Only the minimum information that identifies the patient and is necessary to the investigation should be supplied.
Family health services practitioners
1.102. For family health services practitioners, local disciplinary procedures cannot be considered until after the complaints procedure, including
Independent Review, is exhausted. Disciplinary investigations can only interrupt the handling of a complaint if action is considered necessary to protect patients, for example the need to involve the police, or a professional registration body. When a decision is made to hold a disciplinary
investigation, the complaints investigation of all matters subject of the disciplinary proceedings must stop.
1.103. Information gathered in the complaints process by the practitioner, as part of Local Resolution, belongs to the practice. The Local Health Board has no right of access to it and will only be able to require that the practitioner concerned provides the Local Health Board with information about action taken during or because of Local Resolution. Information acquired during the Independent Review process cannot automatically be used in disciplinary investigations.
Suspected or alleged abuse or assault
1.104. Where the complaint alleges assault or abuse, the case should be referred to Social Services or the Police as directed by the All Wales Child Protection Procedures and Abuse by Professionals policy. All Trusts must have a procedure for ensuring that such issues of abuse are referred to the
appropriate statutory agency. If the Crown Prosecution Service decides not to press charges against the alleged perpetrator and/or there is no
conviction, the Professional Abuse Policy, including some aspects of the Complaints Policy, should still be followed.
1.105. Occasionally parents make use of complaints procedures to prevent the proper child protection action being taken. If a complaint received is about a health professional making a Child Protection referral to the statutory agencies or about sharing information with other agencies, then the
Complaints Manager should immediately seek the views of the Named Doctor and/or Named Nurse Child Protection for the Trust or person in the Local Health Board with responsibility for Child Protection (or the designated Doctor or Designated Nurse Child Protection), who can advise the
Complaints Manager whether the action was in line both with the multiagency All Wales Child Protection Procedures and that health
organisation’s child protection procedures and assist in drafting the reply.
Professional regulatory bodies
1.106. Once Local Resolution is completed, the Trust or Local Health Board may refer a complaint to a statutory professional regulatory body. The complainant should be informed of this decision and be given as full a response as possible to the complaint. It must be made clear to the complainant that any information obtained during the complaints investigation may need to be passed on to the regulatory body.
1.107. An individual can complain directly to a professional regulatory body at the same time as going through the NHS Complaints Procedure. The fact that a complainant has also made contact with a professional regulatory body is not grounds for stopping the complaints procedure at any stage.
Advice on this can be sought on individual cases from the regulatory body.
National Clinical Assessment Authority
1.108. Local Health Boards and Trusts can invite the National Clinical Assessment Authority (NCAA) to assist them with doctors who cause them concern. The NCAA provides advice and support to Health Boards and Trusts on dealing with doctors causing concern. This includes advising on the
development of effective local procedures for the handling of cases of poor performance. The NCAA will also undertake assessments and make
recommendations where problems cannot be dealt with locally. The NCAA’s main role is in education and development and it has no disciplinary
functions or sanctions (www.ncaa.nhs.uk).
Fraud
1.109. If the allegation involves fraud, the case should be referred to the Counter Fraud Officer in the Health Board or Trust.
Coroner’s Cases
1.110. If the complaint concerns a death that has been referred to the
Coroner’s office, the NHS body should investigate the complaint regardless of the Coroner’s inquiries and where necessary extend these investigations if the
whereas the complaint may cover other issues. Where relatives are
concerned about the cause of death, staff should advise them that they can contact the Coroner’s office directly and ask for an independent post-mortem and investigation.