Review of the NHS Complaints Procedure: Health Inequalities Impact Assessment

The final report of the Health Inequalities Impact Assessment of the changes proposed to the NHS complaints procedure.

1. Scope of the Health inequalities impact assessment

The Patient Rights Act (Scotland) 2011 introduced a right for people to give feedback and comments, and to raise concerns and make complaints about NHS services, and it placed a duty on the NHS to actively encourage, monitor, take action and share learning from the views they receive.

The Scottish Health Council’s ‘ Listening and Learning’ report, which was commissioned by the Scottish Government, found that, while all Boards had made progress in responding to the requirements of the Act, and several could demonstrate innovative thinking and techniques in their handling of complaints and feedback, there was evidence of variation in the way complaints are handled across the NHS. It recommended that, as experts in the field, the Scottish Public Services Ombudsman’s Complaints Standards Authority (the CSA) should lead on developing a more succinctly modelled, standardised and person-centred complaints process for NHS Scotland, in collaboration with the public, NHS Boards and the Scottish Health Council.

The NHS Model Complaints Handling Procedure ( CHP) has been developed through a partnership approach, led by a Steering Group chaired by the Scottish Public Services Ombudsman ( SPSO)’s Complaints Standards Authority and involving representatives from across NHS Scotland including territorial boards, the Scottish Health Council, NHS Education for Scotland, NHS National Services Scotland, the National Prisoner Healthcare Network, primary care and the NHS Complaints Personnel Association Scotland ( NCPAS). The independent Patient Advice and Support Service ( PASS) and Healthcare Improvement Scotland public partners have also been actively involved.

The revised procedure is intended to support a more consistently person-centred approach to complaints handling across NHS Scotland. It will bring a much sharper focus to the early, local resolution of complaints, wherever that’s appropriate, and bring the NHS into line with other public service sectors by introducing a distinct, five working day stage for early, local resolution, ahead of the 20 working day stage for complaint investigations.

The procedure reflects the broader ambition for the NHS in Scotland to be an open, learning organisation that listens and acts when unintended harm is caused. The procedure complements the Duty of Candour provisions in the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016, and the development of a national approach to reviewing and learning from adverse events. It is also complemented by the Apologies (Scotland) Act 2016, which is intended to encourage apologies being made, by making it clear that apologising is not the same as admitting liability.

The revised procedure will require amendments to the Regulations and Directions associated with the Patient Rights (Scotland) Act 2011. The Scottish Government intends these amendments to be made ahead of the proposed implementation date for the new procedure of 1 April 2017.

These include changes to the Regulations to:

  • Introduce a distinct, five working day period in which responsible bodies, including NHS boards and service providers, may attempt to resolve complaints without the need for an investigation. This brings the NHS complaints procedure more closely into line with other parts of the public sector, including local authorities since 2013, and with the revised procedure for Social Work Complaints, which is due to be implemented from April 2017. Complaints may bypass early resolution and go straight to the investigation stage if the responsible body considers it is a serious or complex complaint which cannot be resolved without an investigation.
  • Allow for investigations to exceed the 20 day limit if there are clear and justifiable reasons to do so. This is in line with other sectors and ensures that complaints can be investigated thoroughly where additional time is necessary, for example to gather essential statements, or where the person making the complaint has agreed to mediation.
  • Enable anonymous complaints to be considered as far as possible as part of the NHS complaints procedure. This will support NHS bodies to ensure their complaints data is as complete as possible by systematically recording, monitoring and learning from anonymous complaints.
  • Introduce flexibility for NHS bodies to offer to apply the complaints procedure in cases even where the complainant has stated in writing that they intend to take legal proceedings. This is intended to increase the use of the NHS complaints procedure as the initial route for resolving disputes, and to support the NHS to resolve people’s complaints in the most straightforward and person-centred way possible.

Proposed changes to the Directions are intended to:

  • Support Boards and service providers to learn from complaints and use them to continuously improve services.
  • Ensure that the data that is recorded, reported and collected nationally about complaints demonstrates evidence of learning and improvement alongside effective processes.

Policy lead and contact details:

Joanna Swanson, Person-Centred and Quality Unit, Scottish Government
St Andrews House, 2 Regent Road, Edinburgh EH1 3DG.

Telephone 0131 244 3028

Date: 14/10/2016


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