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(1)

Improving your local

complaints process:

Setting the standard for complaints handling

in your service

Dr. Kieran Mullan

Independent Advisor to the review of NHS complaints & Past Project Director Patients Association

(2)

In the next 30 minutes…

Speaking Up Project

Principles of the methodology

Standards

(3)

About me

Trained as a doctor but before practising

worked at the Patients Association and

then worked there part time as I

continued clinical training

Project Director of the Speaking Up

Project

Served as an independent advisor to the

Clwyd/Hart review of complaints handling

Still working as A&E doctor now

(4)

Speaking Up Project

Funded by the Health Foundation

Working with Mid Staffordshire NHSFT

and other Trusts

Improving complaints handling

Advocates

Survey

(5)

Peer review process

NCEPOD methodology

Develop a mixed quantitative/qualitative

scorecard

Detailed standards

8 ‘markable’ standards

(6)

Peer review process

Individual cases

Reviewed by mixed groups

Discussion encouraged but individual scoring

maintained

Some sub standards hard quantitative

standards-clear objective yes or no

Some more subjective judgement

Substandards inform but don’t dictate the

overall score for that standard and the case

overall

(7)

Peer review process

Unreliable for individual cases

Based on the records

But use individual case and performances

on sub standards and standards to build

picture of performance

We found correlation with the early

(8)

The Standards

12 overall standards

4 organisational “traditional”

(9)

Francis Recommendation113 states that “the

recommendations and standards suggested in

the Patients Association’s peer review into

complaints at the Mid Staffordshire NHS

Foundation Trust should be reviewed and

implemented in the NHS.”

(10)

Standard 1: The Complainant has a single point of contact in the Organisation and is placed at the centre of the process. The nature of their complaint and the outcome they are seeking is established at the outset.

Standard 2: The complaint undergoes initial assessment and any necessary immediate action is taken. A lead investigator is identified.

Standard 3: Investigations are thorough (Regulation 3 (2) (b) and Regulation 14 (1)), where appropriate obtain independent evidence and opinion and are carried out in accordance with local procedures, national guidance and within legal frameworks. Standard 4: The investigator reviews, organises and evaluates the investigative

findings.

Standard 5: The judgement reached by the decision maker is transparent, reasonable and based on the evidence available

Standard 6: The complaint documentation is accurate and complete. The

investigation is formally recorded, the level of detail appropriate to the nature and seriousness of the complaint.

Standard 7: Responding adequately to the complainant and those complained about (Regulation 14 Investigation and response).

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The complainant was given contact details for a named person with whom they could liaise

throughout the process.

Yes □ No/Not recorded □

Best thought of as a ‘case worker’, complainants should be able to establish a working relationship with a named person who can act as their liaison throughout the process. References to “on behalf of the team” or similar would not constitute a named person. If a case worker is absent then ideally complainants should be informed of an alternative point of contact.

(12)

There is evidence of a clear management plan for the investigation.

Yes □ Partly□ No/Not recorded □

It is critical that one person be responsible for the conduct of the

investigation and thus for establishing the framework for the investigation. Ensuring that the planning stage is well done will have a major influence on the ultimate success of the investigation. Has the investigator

identified what questions need to be answered, what information is required to answer those questions and the best way to obtain that information? If there is evidence of an individual simply dividing up the complaint and requesting responses from the relevant departments or individuals (for example through internal emails or proforma) select

‘Partly’. A ‘Yes’ requires evidence of an overall and complete plan in terms of evidence required from each area and bringing that together for

(13)

There is sufficient evidence to show that statements were obtained from relevant members of staff involved with (or witnessing) the complaint.

Yes □ Partly □ No/not recorded □

Statements will form a key part of an investigation and are relatively easy to obtain in comparison to interviews. They may include accounts of events but also opinions on the appropriateness of treatment provided. Collecting statements from all those involved or able to act as witnesses is particularly important where there is an apparent dispute over events. In some circumstances where accounts are provided on behalf of a junior (e.g. Consultant giving a view on behalf their registrar who gave treatment) you may select ‘Partly’ but only when the statement is complete and comprehensive and has no apparent need for further clarification. However generally, the threshold should be high for selecting ‘Partly’ or ‘Yes’. If the

investigator was unable to obtain a statement from a key member of staff, this should have been recorded with reasons why. A staff member being on night duty is not an acceptable reason for not conducting an interview. Where they are a crucial witness the organisation should evidence they have made efforts to contact ex-employees. Where they are regulated professionals (e.g. nurses and doctors) they have a duty to cooperate.

(14)

Where necessary, there is sufficient evidence to show that relevant members of staff involved with (or

witnessing) the complaint were interviewed.

Yes □ Partly □ Not applicable □ No/not recorded □

In certain circumstances, an interview may be warranted. This may be because of a serious complaint with conflicting accounts being provided by staff or third party witnesses. Use your

judgement as to whether an interview was warranted for this complaint. Where only some people who think should have been were interviewed select ‘Partly’. Where you think an interview was not warranted select ‘Not applicable’.

(15)

Appropriate further independent opinion was secured on complaints relating to clinical issues

Yes □ Partly□ No/Not recorded □ Not applicable □

This sub standard relates specifically to independent opinion from those divorced from the handling of the complaint and the issues complained about. Where the complaint relates to serious harm or death, opinions from clinicians from outside the Trust (e.g. another Trust, a medico legal review, a Royal College review) will likely be required to secure a ‘yes’-for lesser complaints a Consultant

colleague providing an opinion on an anonymised scenario may suffice. Where, in your opinion, insufficient attempts have been made select ‘partly’. If you feel independent opinion of some form was warranted but none obtained select ‘no’. If it was not

(16)

Scored

Level 1 Poor practice

Level 2 Less than satisfactory

Level 3 Satisfactory

Level 4 Good practice

(17)

Common pitfalls

Lack of investigation=poor response

Conflicting accounts stated but not

acknowledged/tackled

‘X doesn’t happen/wouldn’t happen here’

Meaningless apologies-sympathise not

apologise

‘All staff have been reminded/it has been

reiterated’ Evidence of that?

Lack of detail-person X who is Y and has

(18)

Good practice

Initial phone call-use your judgement

Independent investigators

Internal proforma’s which evidence senior

involvement and independent review

Sharing of documentation e.g. minutes of

meetings with staff to review complaints

Reference to best practice/treatment

(19)

Contact the Patients Association for

latest on survey and peer review work

http://patients-association.com/Portals/0/Complaints%20

Management%20Scorecard%20-%20Guidance%20notes%20Version%2011.

pdf

http://patients-association.com/Portals/0/Complaints%20

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