Complaints handling

Accepted.
A fundamental principle of the current complaints arrangements for handling NHS and adult social care complaints is that a case should be handled according to the needs of that individual case. Investigation should be proportionate to the needs of the case, but any concern about patient safety needs to be robustly investigated. The Department of Health strongly agrees that complaints amounting to a serious or untoward incident warrant independent local investigation and we want to see all NHS Trusts using their statutory powers to offer this to patients.
NHS England’s guidance The Serious Incident Framework (http://www.england.nhs.uk/wp- content/uploads/2013/03/sif-guide.pdf) sets out how Serious Incidents should be managed. It states that ‘Initial incident grading should err on the side of caution, categorising and treating an incident as a serious incident if there is any possibility that it is.’ Furthermore it states that ‘All serious incidents should be investigated using best practice methodologies such as root cause analysis.’ Any complaint alleging that a Serious Incident has occurred should therefore be investigated. The Care Quality Commission already uses a range of information about complaints to inform the timing and focus of its inspections, and through the Chief Inspectors, is currently exploring how it can give greater prominence to complaints and safety alerts in its revised surveillance and inspection model.
The definition of a Serious Incident is:
• an incident that occurred during NHS funded healthcare (including in the community), which resulted in one or more of the following:
• unexpected or avoidable death or severe harm of one or more patients, staff or members of the public;
• a never event – all never events are defined as serious incidents although not all never events necessarily result in severe harm or death;
• a scenario that prevents, or threatens to prevent, an organisation’s ability to continue to deliver healthcare services, including data loss, property damage or incidents in population programmes like screening and immunisation where harm potentially may extend to a large population;
• allegations, or incidents, of physical abuse and sexual assault or abuse; and/or
• loss of confidence in the service, adverse media coverage or public concern about healthcare or an organisation.
The current NHS England Serious Incident Framework is a working draft and will therefore be updated and clarified in relation to this recommendation.

Where a complaint is made by someone other than another NHS body, local authority or by an employee of the relevant NHS body and such complaint is unresolved to the satisfaction of the complainant within 1 working day there is a statutory requirement on NHS bodies to investigate and respond to complaints made to them regarding the provision of health services (see regulations 8 and 14 of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009).

Guidance on engaging and involving patients, families and staff following a patient safety incident is available under the Patient Safety Incident Response Framework. Where possible, and if the complainant agrees, the complaint investigation and patient safety incident investigation should be combined so that the patient/family get all the answers they are seeking together. Note, however, that the complaint may not limit itself to learning issues. When it is not possible to combine the two responses, how communication with those affected is best managed needs to be considered (see also PHSO Complaints Standards Framework).

NHS England’s guidance The Serious Incident Framework sets out how Serious Incidents should be managed. NHS England is reviewing the Serious Incident Framework, but it agrees it is important that the level of investigation required following a serious incident will vary according to the severity of the incident. In some circumstances, fully independent investigation by an external team will be appropriate.

NHS England will be publishing an update of the Serious Incident Framework in due course.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Department of Health said it agreed that complaints amounting to serious untoward incidents warranted independent local investigation. The Government referring to NHS England’s Serious Incident Framework, which set out how serious incidents should be managed, and which was published in March 2015.