COMPLAINTS MANAGEMENT PROCEDURES

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COMPLAINTS MANAGEMENT

PROCEDURES

Clinical Governance

& Risk Management

Department

Warning – Document uncontrolled when printed Policy eLibrary Reference: Date of Issue: May 2010 Prepared by: Patient Focus Manager Date of Review: April 2012 Lead Reviewer: Head of Clinical

Governance and Risk Management Version: 2 Ratified by: Corporate Team Date Ratified:

EQIA: Yes / No Date EQIA:

Distribution

• Executive Directors • Associate Directors • Clinical Directors • General Managers

• Assistant General Managers • Locality Managers

• Service Managers

• CHP Lead Nurses / Nurse Managers

• Out of Hours Operational & Development Manager • Head of eHealth

• Head of Facilities Management • Nurse Consultants

• AHP Professional Leads • Director of Pharmacy • Head of Public Involvement • Head of Corporate Affairs

• Head of Internal Communications • Head of Service Planning

• Head of Community & Health Improvement Planning • Clinical Dental Manager

• Service Manager Mental Health Method

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COMPLAINTS MANAGEMENT PROCEDURES

Warning – Document uncontrolled when printed

Version: 4.1 Date of Issue: May 2010

Page: 2 of 22 Date of Review: April 2012

1. INTRODUCTION

1.1 NHS Highland aims to provide effective and efficient healthcare to the people of the Highlands. The people who work for NHS Highland are committed to providing the highest quality of care possible. However in the many contacts between NHS Highland and the people it serves each day, there will inevitably be occasions when we will fail to meet our expectations, or those of the people that use our services. How we handle and respond to complaints is an important part of the work to improve patients’ experience.

1.2 NHS Highland has in place a Complaints Policy, the main aims of which are: o to make it easy for people to voice their concerns;

o to have in place a system that ensures issues raised are dealt with effectively and quickly;

o to ensure it is easy for patients to get a response to their concerns;

o to respond to concerns and complaints in an open, honest and constructive manner;

o to ensure the process is fair for both people raising concerns and complaints, and NHS Highland staff;

o to meet the required time schedules in at least 90% of the complaint responses;

o to ensure adequate management of organisational risk.

2. COMPLAINTS MANAGEMENT PROCEDURES

2.1 The Complaints Management Procedures have been developed to provide guidance to staff to ensure that the aims of the Complaints Policy can be achieved. They are set out in 5 parts as follows:

Part 1 - Procedures for the management of Concerns

Part 2 – Procedures for the management of Formal Complaints Part 3 – Procedures for Family Health Services Complaints

Part 4 – Procedures for Multi Agency (including Out of Hours) Complaints Part 5 – Policy for handling Habitual or Vexatious Complainants

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PART 1

PROCEDURES FOR THE MANAGEMENT OF CONCERNS

1. Concerns or information requests raised directly with members of staff 1.1 If an individual raises a concern or a problem with, or requests information from,

a member of staff every attempt should be made to resolve this locally. This is normally done by arranging for the nurse in charge, or the local departmental manager to talk to the complainant to see if the matter can be resolved there and then.

1.2 If the individual raising the concern is not the patient then they must be able to demonstrate that they have the consent of the patient to discuss the matter (see section 3.5 of the Complaints Policy).

1.3 Unless the patient is unable to do so, further discussion in an attempt to resolve the situation should be directly with the patient. The patient should be encouraged to speak freely.

1.4 Staff should provide an honest and objective response. The response should be given verbally unless the individual has requested a written response or the member of staff considers a letter is appropriate.

1.5 Oral responses should be given on the spot or, where this is not appropriate, a timescale for the way forward should be agreed with the individual.

1.6 The response should include the following: o An explanation;

o An apology where appropriate;

o An indication of what is being done to avoid the problem happening again. 1.7 If the individual has requested a written response then this should be sent as soon as possible and within the timescale agreed with the individual. Details of the concern and a copy of the written response should be sent to the appropriate Investigating Officer

1.8 Any oral or written response about a clinical matter should be agreed with the appropriate clinician.

1.9 If the member of staff feels unable to respond themselves they should either: o Call on the support of an appropriate senior member of staff, including the

on-call senior manager for the area if this is appropriate; or

o Offer the individual the option of discussing the matter with a member of the Complaints Team who can provide further advice and information as necessary.

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2. Concerns or information raised with the Complaints Team or member of the NHS Highland Board

2.1 Concerns should be passed to the designated Investigating Officer of the area concerned who is then responsible for responding directly with the individual as described above.

2.2. If a written response is required this should be signed by the relevant Investigating Officer using the template provided by the Complaints Team. A copy of the response should be sent to the Complaints Team. If the concern was originally addressed to a member of the Executive Team the response should indicate that they will be receiving a copy of the response letter.

2.2 If the individual remains unhappy after receiving an oral or written response, they should be advised to contact the Complaints Team who will be able to assist the individual to make a formal complaint or, if they wish, put them in touch with an independent advice and support service.

2.3 Each Operational Unit (CHP, Raigmore, Facilities, Pharmacy etc) and department within Corporate Services should ensure that they have systems in place to capture the details of concerns in order to ensure that they take any necessary action; that information is shared as appropriate and that lessons are learned as a result.

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PART 2

PROCEDURES FOR DEALING WITH FORMAL COMPLAINTS 1. Contact by phone or in person

1.1 When a complainant contacts any other member of staff, including any senior manager, about a complaint she/he should be re-directed to the Complaints Team. This is essential for a properly managed complaints system, and ensures that no mixed messages are given to the complainant.

1.2 A Complaints Officer should establish that the person wishes the matter dealt with under the NHS complaints procedure by explaining the process to them. It is also important to ask the person what he or she wants to happen as a result of the complaint. If the complainant’s expectations are entirely unrealistic it is important to say so at once.

1.3 Where the complaint is made on behalf of somebody else, the Complaints Officer should make sure that the person making the complaint can show that they have obtained the patient’s consent to:

o Make a complaint on their behalf;

o Members of staff examining the patient’s health records, if this should prove necessary as part of the investigation of the complaint.

1.4 Where the person wishes to go ahead the Complaints Officer should agree the details of the complaint with the complainant over the telephone. The Complaints Officer will ensure these are detailed in a letter to the complainant and will ask them to confirm that these are correct.

2. Contact by e-mail, fax or letter

2.1 Ideally, formal letters of complaint should be sent to the Complaints Team at the following addresses:

The Complaints Team, NHS Highland,

PO BOX 5713 Inverness IV1 9AQ

[email protected]

2.2 On receipt of the formal complaint the Complaints Team will send an acknowledgement letter within 3 working days of receipt of the complaint. This letter should:

o Outline the proposed course of action to be taken or the investigations being conducted;

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o Offer the opportunity to discuss issues either with a member of complaints staff or if appropriate with a senior member of staff;

o Provide information about the availability of independent support and advice or the possible use of conciliation where this may help and may be available to both parties.

2.3 The complaint will be sent to the relevant Investigating Officer within 1 working day of the complaint being received, by the Complaints Team. When referring the complaint, the Complaints Team will:

o Advise the Investigating Officer of the issues that have been recorded in relation to the complaint and the risk assessment applied to the complaint o Advise the Investigating Officers if an action plan should be produced as

part of the investigation, as determined by the risk rating

o Advise the Investigating Officer if any other units or agencies are involved in the complaint, and their role in the investigation.

o Inform the Investigating Officer of the date the response is due by

2.4 It is recognised, however that formal complaints will be received within other parts of NHS Highland and in these situations the following arrangements should apply:

2.4.1 If a formal letter / e-mail of complaint is received directly by a CHP or Raigmore then the letter should be passed to the appropriate Investigating Officer who will then acknowledge the letter within 3 working days (using a standard template provided by the Complaints Team) and initiate the investigation. A copy of the complaint letter and the acknowledgement letter should be passed to the Complaint Team to allow logging on the database and subsequent follow up 2.4.2 If a formal letter / e-mail of complaint is received by the Chief Executive or

Chairman then the letter will be passed immediately to the Complaints Team who will log it on the complaints database and initiate the investigation.

2.4.3 If a formal letter / e-mail of complaint is received by any other department or member of staff it should be passed immediately to the Complaints Team who will log it on the complaints database and initiate the investigation.

2.5 All formal complaints should be date stamped immediately on receipt as the date the complaint is received determines the timescales associated with any response.

2.6 First class post should be used in correspondence to the person making the complaint.

2.7 Information and papers will be sent, wherever possible, using the Keyfile system or by e-mail, to Investigating Officers by the Complaints Team. All communications should be marked private and confidential or personal.

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2.8 Details of the complaint should be logged on the complaints database by the Complaints Officer as close as possible to the receipt of the complaint.

3. Investigating Officers

3.1 It is the responsibility of each Operational Unit to identify appropriate Investigating Officer(s) who will be responsible for coordinating the investigation of any complaint. Details of Investigating Officers are shown in Appendix 1. 3.2 The investigation element of a complaint is to be completed within 15 working

days following the date of receipt of the complaint. This is an internal target. This will allow a response to be sent to the complainant within the national target of 20 working days. Where it appears that the 20 day target will not be met the Investigating Officer must inform the Complaints Team immediately, informing them of the reason for the delay and when they expect to provide the response. 3.3 The Complaints Officer will ensure that the person making the complaint and

anyone named in the complaint is informed of the reason for the delay with an indication of when the response can be expected. The investigation should not normally be extended by more than a further 20 working days. However if there is no response after 40 working days the complainant has the right to go straight to the Ombudsman.

3.4 Because of the requirement to respond to complaints within the above timescales, it is the responsibility of the Investigating Officer to ensure that there is a nominated deputy available to deal with complaints in their absence and that the details of this deputy are made available to the Complaints Team.

4. Conduct of the investigation

4.1 It is important to ensure impartiality in an investigation. The Investigating Officer must approach the complaint with an open mind being fair to all parties. The investigation must not be adversarial and must be conducted in a supported way. 4.2 Where more than one unit/ directorate is involved in the investigation of a

complaint, the Lead Investigating Officer will be identified by the Complaints Team. This will be communicated when the new complaint is sent out. The designated Lead Investigating Officer will be responsible for drafting the complaint response, using input provided by the Investigating Officer from the other area(s).

4.3 Anyone identified as subject of a complaint should be provided with a full account of the reasons for that investigation and should be informed of the support services that are available to them.

4.4 A complaint may best be resolved through face-to-face meetings being arranged with members of staff during the investigation of a complaint, and early consideration should be given to this approach. The Complaints Team are

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available to provide support with this. If this approach is taken, the complainant should be informed that they can be accompanied by a friend or other supporter at these meetings. The member of staff attending the meeting should also be accompanied, and a record of the meeting should be kept. The outcome of the meeting should be shared with the complainant – ideally as part of the response, or as a separate letter if the response cannot be issued promptly after the meeting.

4.5 Where the complaint involves clinical issues, the draft findings and response must be shared with the relevant clinicians to ensure the factual accuracy of any clinical references.

4.6 If the complaint has been identified as having a High or Extremely High Risk Rating by the Complaints Officer, an action plan should be developed as part of investigation. The action plan should identify what actions are being taken by the operational unit to prevent a reoccurrence of the complaint. Where possible, the action plan should be returned to the Complaints Team with the draft response, however if this is not possible the return of the response should not be delayed to achieve this.

4.7 If the Investigating Officer or other staff involved in the complaint investigation have a query or need assistance in developing an action plan, they should contact the Complaints Team.

5. Draft investigation report

5.1 The Investigating Officer is responsible for preparing a response to the complainant in the form of a report. The report should:

o Address the issues raised individually and show that each element has been fully and fairly investigated

o Provide an outcome for each issue (upheld, not upheld etc) o Be timely, accurate, factual, signed, dated & clearly expressed o Include an apology where things have gone wrong;

o Report action taken or proposed to prevent any recurrence;

o Highlight any areas of disagreement and explain why no further action can be taken.

5.2 The draft report should be sent to the Complaints Team electronically within 15 working days of the complaint being received by the Investigating Officer (see above). The draft investigation report should be accompanied by all of the relevant staff reports obtained during the investigation, including a record of questions posed & answers given as part of any interview (this can be sent separately if elements are not available electronically).

5.3 If the Investigating Officer or other staff involved in compiling the investigation report have a query on how to proceed or wish to seek guidance on any particular aspects of the complaint, before completing the report, they should

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contact the Complaints Team. A Complaint Resource Pack is also available on the intranet.

5.4 Staff should be aware that all documentation created in the investigation and response to a complaint is disclosable, and should be kept separately from a patient’s medical records.

6. Final investigation report

6.1 The Complaints Team will ensure that the report is clear, factual, accurate, balanced, simple, fair and easy to understand. All the points raised in the complaint should be addressed and have an outcome linked to them. Explanation of planned action should be included where the investigation has found that something can be done differently.

6.2 The Complaints Team will draft the covering letter of the investigation report. This letter will explain what steps the complainant can take if they feel that there are outstanding issues that remain to be addressed, or if they are unhappy with the outcome of the complaint. This will include how to request a review by the Scottish Public Services Ombudsman.

6.3 The covering letter of the investigation report to the complainant will be signed off by the Chief Operating Officer. The original letter of complaint, investigation report and covering letter will be sent electronically to the Chief Operating Officer by the Complaints Team. If the Chief Operating Officer wishes further clarification of the issues covered by the complaint then the complete complaints file will be sent by the Complaints Team.

6.4 If the Chief Operating Officer is unavailable, or unable to sign the final response within 2 working days of receipt, their deputies should be asked to sign the response. The first choice deputies are:

o Chief Executive o Medical Director

o Associate Medical Director o Director of Nursing

6.5 All responses should be marked “Private and Confidential” and should be sent by first class post. The response will be sent to the complainant within 20 working days or as soon as is reasonably practicable.

6.6 The report and covering letter is sent out by the secretary of the Director who is signing the response letter. A signed copy of the letter must also be sent to the Complaints Team.

6.7 If for any reason it is not possible to provide a response within 20 working days an interim letter will be sent to the complainant by the Complaints Team. This letter should include a reason for the delay and a revised target date, as provided by the Lead Investigating Officer.

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7. Sharing of information and lessons learnt

7.1 Once confirmation has been received from the Chief Operating Officer’s PA that the report has been sent, the Complaints Team will inform the Investigating Officer. The Investigating Officer is responsible for sharing the final version of investigation report with the staff who were involved in the investigation and any others as appropriate (bearing in mind the responsibility for protecting both patient and staff confidentiality.) and ensure that agreed actions are taken.

7.2 The Complaints Team will also send a copy of the final report to the Chief Executive or Chairman if the original complaint letter was addressed to them. 7.3 The Complaints Team will, on a monthly basis, prepare a summary Complaints

Report for each Operational Unit which will detail the number of complaints received, the response time, the issues raised, the response to these and any actions taken as a result.

7.4 The Complaints Team will follow up the agreed actions to ensure that they have been implemented. A follow up letter will be sent to the original complainant with this information if appropriate.

7.5 The Complaints Manager will ensure that monitoring reports on key performance indicators for complaints are produced for the Clinical Governance & Risk Management Groups and for the Clinical Governance Committee on a quarterly basis.

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PART 3

PROCEDURES FOR FAMILY HEALTH SERVICES (FHS) COMPLAINTS 1. Introduction

1.1 These procedures are for the guidance of NHS staff when dealing with Family Health Services (FHS) complaints, i.e. services provided by GPs, general dental practitioners, opticians and pharmacists. It covers all concerns expressed to members of staff either formally or informally, in writing or verbally.

1.2 The procedure covers all FHS complaints, both clinical and non clinical, from users of family health services, or from persons acting on their behalf.

1.3 If a person wishes to make a complaint about a Family Health Service he/she should be directed to contact the Complaints Team:

The Complaints Team NHS Highland PO BOX 5713 Inverness IV1 9AQ Telephone: 01463 705997 [email protected]

1.4 A Complaints Officer will then be able to explain how the FHS complaints procedure works and the options open to them.

2. Who can complain?

2.1 Complaints may be received from a variety of sources, e.g. patients, patients’ relatives or carers, MPs, MSPs, Councillors. Care should be exercised that the patient’s consent is obtained, where applicable.

2.2 Complaints may be made by telephone, by letter or sometimes by the complainant making a personal call.

2.3 Wherever possible, direct verbal complaints should be addressed at the time by the Complaints Officer and the details recorded in the Complaints Contact Record Sheet.

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3. What can be complained about?

3.1 The FHS complaints procedure is intended to deal with complaint made about the NHS services provided by the practice. It does not deal with complaints about non-NHS services, for example privately supplied spectacles, private dental treatment etc.

3.2 If it is unclear whether a service is an NHS service, the Complaints Officer is responsible for helping to establish the facts without being drawn into the investigation of the complaint.

4. What is not covered?

4.1 If any complaint received by NHS Highland in relation to a family health service appears to raise matters normally dealt with:

o Under the disciplinary procedures; o By a professional regulatory body;

o An independent inquiry into a serious incident under Section 76 of the National Health Service (Scotland) Act 1978;

o An investigation of a criminal offence, including fraud; o A possible claim of negligence;

this should be raised with the Head of Clinical Governance and Risk Management in the first instance.

5. Dealing with complaints

5.1 It is a term of service obligation on family health services practitioners to have in place and to operate practice-based complaints procedures. Complainants are therefore advised in the first instance to register their complaint with the practice. 5.2 If they decline to do this, e.g. because of breakdown in the practitioner/patient

relationship, NHS Highland can offer to act as an “honest broker” and contact the practice on the complainant’s behalf in an attempt to resolve the problem promptly.

5.3 In cases where the complaint cannot be resolved informally, duly completed forms or letters of complaint will be processed by the Complaints Officer.

5.4 The complaint will be acknowledged by the Complaints Officer within 3 working days of receipt of the complaint. A NHS Complaints Procedure leaflet will be enclosed for information.

5.5 The acknowledgement letter will advise the complainant to contact the practitioner in the first instance. If the complainant is unhappy about doing this they may ask NHS Highland to act as an “honest broker”. This involves the complainant’s letter/complaint details being sent to the practitioner and a

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response being requested within 10 days. This course of action requires the consent of both parties.

5.5 In the case of complaints against Locum GPs, Personal Medical Service Practices, and out of hours complaints against GPs and other staff employed by NHS Highland, the Hospital and Community procedure should be followed. 5.6 When the practitioner’s response is received, it is forwarded to the complainant.

The complainant will also be advised of their right to request an independent conciliator if they are dissatisfied with the practitioner’s response.

5.7 Where a complaint relates to the actions of a Family Health Service Practitioner and the NHS Board, there should be agreement about who will take a lead in co-ordinating the complaint and full co-operation between the organisations to resolve the complaint. (See Part 4 – Multi-Agency Complaints for more detail). 5.8 The Complaints Officer will monitor the handling of complaints and ensure that

response times are met whenever possible. 6. Conciliation

6.1 Complainants who remain unhappy at this stage may request the appointment of a conciliator to look at the complaint. The Complaint Officer will ensure that the consent of both parties is received.

6.2 Conciliation is a voluntary process which seeks to resolve difficulties and which may help the resolution of a complaint at local level. It is a process which is often useful in resolving difficulties arising from a breakdown of a relationship for example between a clinician and a patient. The aim of conciliation is to enable both parties to address the issues in a non- confrontational manner with the aim of reaching an agreement that both will accept. Confidentiality is vital in the conciliation process and neither the conciliator nor the participants should make the details known to anyone else. The conciliator will merely advise NHS Highland of the result of the conciliation and no further details will be provided. The Complaint Officer will then write to the complainant and the complained against advising of the result of conciliation and advising of the next stage in the complaints procedure.

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PART 4

PROCEDURES FOR MULTI AGENCY COMPLAINTS 1. Introduction

1.1 These procedures outline the arrangements within NHS Highland for dealing with complaints relating to two or more NHS bodies. These include Family Health Service practitioners, NHS 24, Scottish Ambulance Services, Out of Hours services and other NHS Boards.

1.2 The purpose of these procedures is to ensure that complaints which involve more than one organisation or are about jointly provided services are handled efficiently and within the appropriate time-scales. The complainant should receive a co-ordinated response from one organisation/partner.

1.3 The complaints process, no matter how complex, should ensure that the complainant receives one response that addresses their concerns across all the professional and organisational boundaries concerned.

2. Initial handling of multi agency complaints

2.1 When a formal complaint is received within NHS Highland that relates to more than one organisation this should be passed to the Patient Feedback Team who will coordinate the further handling of the complaint.

2.2 The Patient Focus Manager will review the complaint and decide which category applies:

1. The complaint does not cover a service which is provided by NHS Highland;

2. The complaint covers a service provided by NHS Highland but the lead organisation (see below) is another agency;

3. The complaint involves a number of agencies but the lead organisation involved is NHS Highland.

2.3 In many instances the distinction will be clear but in others assistance should be sought from the OOH Operational & Development Manager or from the Complaints Manager of the other agencies involved.

2.4 The lead organisation is responsible for coordinating the complaints handling process and for sending the final response to the complainant. In most cases the lead organisation will be the one with the largest involvement, but if there is any doubt, the case should be discussed and agreed at the time.

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3. Acknowledging the complaint

3.1 In all cases where the complaint is received by NHS Highland, the complaint should be acknowledged by the Complaints Team within 3 working days of the date it was made or received. This acknowledgement should inform the complainant that they will receive further details within the next few days to confirm who will be dealing with their case.

3.2 If the complaint was made verbally, a copy of the written record of the conversation should be sent for to the complainant for confirmation of the content of the complaint. Copies of all documentation should be sent to the relevant organisations.

3.3 Where it is agreed that NHS Highland is to take the lead, the Complaints Team should write to the complainant to provide contact details and information regarding support and advocacy which may be available.

4. Investigating the complaint

Complaints which do not require further action by NHS Highland

4.1 If the complaint does not relate to a service provided by NHS Highland the Complaints team should acknowledge the letter as above and then send the documentation to the Complaints Manager of the identified lead organisation. The should be done within 2 days of the complaint being received

Complaints where NHS Highland is not the lead organisation.

4.2 The Complaints Team will pass the details of the complaint to the appropriate Investigating Officer (see Appendix 1) who is responsible for investigating the issues relating to NHS Highland and passing this to the lead investigator within the designated time-scales.

Complaints where NHS Highland is the lead organisation

4.3 The Complaints Team will pass the details of the complaint to the Investigating Officer within 1 day of the complaint being received.

4.4 The Investigating Officer is responsible for initiating a full investigation of the complaint. This involves ensuring that any part of the complaint relating to NHS Highland services is considered in accordance with procedures for dealing with a formal complaint (see Part 2). In addition the Investigating Officer is responsible for co-ordinating the responses of ht other partner agencies and liaising with staff in these organisations as necessary.

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4.5 The Complaint Officer should ensure that the complainant is kept fully informed about the progress of the investigation and is involved in the investigation as appropriate.

4.6 In the event of a delay in providing a response, holding letters should be sent on an as required basis to the complainant in accordance with the normal policy of the lead organisation.

4.7 When drafting the final response to the complaint the Investigating Officer must ensure that the response includes any matter which was within the responsibility or control of any other NHS organisation, primary care provider or, if appropriate, local authority. The final response should be approved by all partner organisations in advance of it being sent to the Chief Operating Officer for signing.

5. Final response

Complaints where NHS Highland is not the lead organisation.

5.1 Where the final response to a complaint is sent by a partner organisation, a copy should be sent to the NHS Highland Complaints Team who will log the details on the complaints database.

5.2 The Complaints Team will send the final response electronically to the appropriate Investigating Officer. The Investigating Officer is responsible for sharing this response letter with the staff who were involved in the investigation and any others as appropriate (bearing in mind the responsibility for protecting both patient and staff confidentiality) and forward copies to all those staff who contributed to the NHS Highland aspect of the complaint investigation.

Complaints where NHS Highland is the lead organisation

5.2 Once the final response has been drafted, it must be shared with the other organisations/partners and agreed prior to being sent to the complainant.

5.3 The response must be signed by the Chief Operating Officer in line with the procedures for dealing with formal complaints.

5.4 Once the formal response has been sent, the Complaints Team are responsible for sending a copy to the Investigating Officer for onward internal distribution as necessary.

5.5 The Complaints Team will also send a copy of the final response to the Complaints Managers of the other partner organisations involved in the complaint.

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Dealing with Multi Agency Complaints NON-LEAD

ORGANISATION/ PARTNER

Complaint received LEAD ORGANISATION/PARTNER

Acknowledged by receiving organisation/partner within 3

working days Each organisation/partner

investigates the issues relating to their involvement

All relevant organisations contacted as soon as possible after receipt of complaint. Contact to be

made on same day if possible, next day at latest

Complaint documentation faxed/emailed to lead organisation/partner on same

day complaint is received

Information passed to lead organisation within 10

working days

Inform complainant of lead organisations name and contact details within 3 working days of receipt of complaints

documentation Agree response letter ASAP

when received from lead organisation/partner

Undertake full investigation of the issues relating to lead organisation/partner

involvement Review the investigation and

develop local action plan to learn lessons from the vent

Overall analysis of the issues identified and feedback provided to the appropriate governance/risk

management committees

Draft response and circulate to other organisation/partners within 15 days of

the complaint being received by the receiving organisation/partner

Send agreed response to the complainant within 20 working days of

complaint being received by receiving organisation/partner

Copy of final response sent to non-lead organisations/partners

Review the investigation and develop local action plan to learn lessons from

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PART 5

UNREASONABLY DEMANDING OR PERSISTENT COMPLAINTS 1. Introduction

1.1 The vast majority of NHS complainants are responsible in how they act and behave, and act courteously and fairly. However, unreasonably demanding or persistent complainants are becoming an increasing problem for NHS staff. The difficulty in handling such complaints is causing undue stress for staff and placing a strain on time and resources.

1.2 Staff are trained to respond with patience and sympathy to the needs of all complainants but there are times when nothing further than can reasonably be done to assist or rectify the real or perceived problem.

1.3 This policy document, which has been incorporated into the NHS Highland Complaints Procedures, may be made available to members of the public to raise its awareness albeit that its primary use is for NHS Highland staff. It should be recognised however that implementation of such a policy will only occur in exceptional circumstances.

2. Purpose of the policy

2.1 Complaints about NHS Highland are considered in accordance with the NHS Complaints Procedure. The aim of this unreasonably demanding or persistent complaints policy is to:

• Outline the criteria that will be used by NHS Highland in defining a unreasonably demanding or persistent complaint;

• Set out how such a complaint will be handled.

2.2 This policy will be used as a last resort and after all reasonable measures have been taken to try to resolve complaints during the NHS Complaints procedures, for example, through local resolution, conciliation or involvement of independent advice and support services as appropriate. Judgement and discretion will be used in applying the criteria to identify potential unreasonably demanding or persistent complaints and in deciding action to be taken in specific cases. The policy will only be implemented following careful consideration by, and with the authorisation of the Chief Executive and Board Medical Director or their nominated deputies.

2.3 When the NHS Board is considering its implementation, this policy will be shared with all complainants to give them prior notification of its possible implementation, should the complainant's unreasonable actions/behaviours continue.

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3. Definition of an unreasonably demanding or persistent complaint

3.1 Complainants (and/or anyone acting on their behalf) may be deemed to be unreasonably demanding or persistent where pervious or current contact with them shows that they meet TWO or more of the following criteria:

Where complainants-

i. Persist in pursuing a complaint where the NHS Complaints Procedure has been fully and properly implemented and exhausted.

ii. Persistently change the subject of a complaint or continually raise new issues to seek to prolong contact by continually raising further concerns or questions upon receipt of a response whilst the complaint is being addressed. Care must be taken however, not to disregard new issues which are significantly different from the original complaint as they need to be addressed as separate complaints. This may happen if a complaint has not had adequate information and support in making the complaint.

iii. Are repeatedly unwilling to accept documented evidence of treatment given as being factual, for example, drug records, nursing records, or deny receipt of an adequate response in spite of correspondence specifically answering their questions or do not accept that facts can sometimes be difficult to verify when a long period of time has elapsed.

iv. Repeatedly do not clearly define the precise issues which they wish to be investigated, despite reasonable efforts being made to help them specify their concerns, and/or where the concerns identified are not within the remit of the NHS Board to investigate.

v. Regularly focus on a trivial matter to an extent which is out of proportion to its significance and continue to focus on this point. It is recognised that determining what is a trivial matter can be subjective and what is trivial to one person can be important to another, therefore careful judgement will be used in applying this criterion.

vi. Have threatened or used physical violence towards staff at any time - this

will, in itself, cause personal contact with the complainant and/or their representative to be discontinued and the complaint will, thereafter, only be continued through written communication. All such incidents will be documented. NHS Highland has determined that any complainant who

has threatened or used physical violence towards staff will be regarded as a vexatious complainant and will receive such written confirmation on this subject from the Chief Executive. This letter will also inform the complainant of what action may be taken with regards to any further communication received. It will give the Ombudsman's address should the complainant wish to "appeal" the decision and the Chief Executive's letter will be copied to the Ombudsman, for information. Again the complainant will be informed of the fact that the letter is being copied in this manner.

vii. Have, in the course of addressing a registered complaint, had an excessive number of contacts with NHS Highland - placing unreasonable demands on

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staff. For the purposes of determining an excessive number, a contact may be in person, by telephone, letter, e-mail or fax. Discretion will be used in determining the precise number of excessive contacts applicable under this section, using judgement based on the specific circumstances of each individual case.

viii. Have harassed or been personally abusive or verbally aggressive on more than one occasion towards staff dealing with the complaint. Staff recognise, however, that complainants may sometimes act out of character in times of stress, anxiety or distress and will make reasonable allowances for this. They will document all instances of harassment, abusive or verbally aggressive behaviours.

ix. Are known to have recorded meetings or face-to-face/telephone conversations without the prior knowledge and consent of other parties involved.

x. Make unreasonable demands on the patient/complainant relationship and fail to accept that these may be unreasonable, for example, insist on responses to complaints or enquiries being provided more urgently than is reasonable or within the NHS Complaints Procedure or normal recognised practice.

4. Dealing with unreasonably demanding or persistent complaints

4.1 Where complaints have been identified as unreasonably demanding or persistent in accordance with the above criteria the Chief Executive and Medical Director will ultimately determine what action to take. They will implement such action and will notify the complainant, in writing, of the reasons why their complaint has been classified as unreasonably demanding or persistent and the action that will be taken.

4.2 For completeness, this notification may be copied to any other individual involved for example a Conciliator, Advocate, MSP etc. A record will be kept for future reference, of the reasons why a complaint has been classified as unreasonably demanding or persistent. The complainant will be informed that the information is being copied and stored in this way.

4.3 The Chief Executive and Medical Director may decide to deal with such complaints in one or more of the following ways:

• Set out in a letter a code of commitment and responsibilities for the parties involved if NHS Highland is to continue processing the complaint. If these terms are contravened, consideration will then be given to implementing other actions are indicated below.

• Decline contact with the complainant, either in person, by telephone, by fax, by letter, by e-mail or any combination of these, provided that one form of contact is maintained. This may mean that only one named Board officer will be nominated to maintain contact (and a named deputy in their absence). The complainant will be notified of this in person.

• Notify the complainant in writing that the Chief Executive has responded fully to the points raised and has tried to resolve the complaint but that in his view

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there is nothing further to add and continuing contact on the matter will serve no useful purpose. The complainant will also be notified that the correspondence is at an end and that further letters received on the same matter will be acknowledged advising the complainant that they are being treated as a unreasonably demanding or persistent complainant, in the context of this complaint, and as such NHS Highland does not intend to engage in further correspondence dealing with the complaint.

• Inform the complainant that in extreme circumstances NHS Highland reserves the right to seek advice on unreasonably demanding or persistent complaints from their solicitors.

• Temporarily suspend all contact with the complainant, in connection with the issues relating to the complaint being considered unreasonably demanding or persistent, while seeking advice or guidance from the NHS Scottish Executive or other relevant agencies, such as the Scottish Public Services Ombudsman.

5. Withdrawing unreasonably demanding or persistent status

5.1 Once complaints have been determined unreasonably demanding or persistent there are mechanisms for withdrawing this status at a later date if, for example, a complainant subsequently demonstrates a more reasonable approach or if they submit a further complaint for which the normal Complaints Procedure would appear appropriate.

5.2 As was the case in originally identifying the complaint as unreasonably demanding or persistent, staff will use the same discretion in recommending that this status be withdrawn when appropriate. Where this appears to be the case, discussion will be held with the Chief Executive and Medical Director and, subject to their approval, contact under the terms of the Complaints Procedure with the complainant will then be resumed. The complainant will be advised of this, in writing, by the Chief Executive.

6. Monitoring arrangements

6.1 The Head of Clinical Governance & Risk Management will report quarterly to the NHS Board with statistical information on the number of complainants being categorised as unreasonably demanding or persistent.

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Appendix 1 DESIGNATED INVESTIGATING OFFICERS

OPERATIONAL UNIT SERVICE AREA / LOCALITY INVESTIGATING OFFICER

Oban and Islands Locality Manager

Mid Argyll Locality Manager

Cowel & Bute Locality Manager

A&B CHP

Helensburgh & Lochside and

Addiction Services Locality Manager

Ross & Cromarty and Skye Locality Manager

Lochaber Acting Locality Manager

Lochalsh Acting Locality Manager

MID CHP

Out of Hours

NORTH CHP All localities Management Assistant

Inverness, Nairn & Ardersier Locality Manager Badenoch & Strathspey Locality Manager

Community Dental Services Clinical Dental Manager or Dental Services Development Manager

SOUTH EAST CHP

Mental Health Services, New

Craigs Hospital Manager

A & E Emergency Care Centre

Manager

Cancer Services DGM

Clinical Services DGM

E health Head of Ehealth Infrastructure

Facilities

Domestic Services Portering and Security Telecommunications Accommodation Catering Services

DGM DGM

Raigmore Business Support Manager

Raigmore Accountant Chief Operating Officer

Medical Directorate PA to DGM

Surgical Directorate Relevant Service Manager RAIGMORE

Women and Child DGM

CORPORATE