Communicating complaint escalation

Accept

The PHSO is currently piloting the NHS Complaint Standards, which set out in one place the ways in which the NHS should handle complaints, including the need for organisations to ensure people know how to escalate to the Ombudsman. These have been developed with ISCAS, who have included it in their code of practice. We will continue to work closely with key organisations involved to ensure that standards are reinforced.

The government accepts this recommendation in full and agrees the means to escalate a complaint to an independent body should be clearly communicated in both the NHS and the independent sector. We have split out the recommendation into 2 parts in the interests of the coherence of our response.

CQC assesses all registered healthcare providers against the fundamental standard of ‘complaints’ (Regulation 16: receiving and acting on complaints) including ensuring information is available and accessible on how to complain.

For organisations providing NHS-funded care Services (NHS and independent) The NHS Complaint Standards, model complaint handling procedure and good complaint handling guides set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. This is a contractual requirement via the NHS Standard Contract (Service Condition 16).

In December 2022, the Parliamentary and Health Service Ombudsman (PHSO) issued NHS Complaints Standards which include expectations on how providers and commissioners will handle complaints, together with a model complaint handling procedure and detailed guidance on how the Complaint Standards can be applied in practice. PHSO has been rolling out supporting materials for the NHS Complaints Standards across the NHS from end March 2023. This is to improve how providers meet patient expectations when they make a complaint, including increasing awareness of independent resolution across the NHS.

All providers and commissioners of NHS services are subject to a statutory duty to handle complaints in accordance with the requirements of the 2009 Complaints Regulations. This includes primary care providers and independent sector providers.

Information on how to complain will be available through:

• The NHS website
• The provider and local PALs service
• The Parliamentary and Health Service Ombudsman

Patient advice and liaison

If complainants need assistance in making a complaint, patients and their carers should also have access to a Patient Advice and Liaison Service (PALS) operated within the provider organisation. This is intended to offer confidential advice, support and information on health-related matters and should be available as a point of contact.

Additionally, assistance can also be provided by the Independent NHS Complaints Advocacy Service. This supports people who wish to make a complaint about their NHS care or treatment. If a complainant decides they need some support, it’s never too late to ask for help. People can also contact their local Healthwatch to find out who provides NHS complaints advocacy in their area.

Independent sector only

The Independent Sector Complaints Adjudication Service (ISCAS) is a voluntary subscriber scheme for independent healthcare providers. ISCAS has incorporated the NHS Complaint Standards into its Code of Practice for Complaints Management and engaged independent providers in taking them up. All ISCAS subscribers were reminded of their responsibilities to incorporate the Complaint Standard Framework on renewal of their annual subscription in April 2023.

Action 4.1

This recommendation has been implemented. CQC assesses all registered healthcare providers against the fundamental standard of ‘complaints’ (Regulation 16: receiving and acting on complaints) including ensuring information is available and accessible on how to complain.

PHSO has been rolling out supporting materials for the NHS Complaints Standards across the NHS from end March 2023 - to improve how providers meet patient expectations when they make a complaint, including increasing awareness of independent resolution across the NHS.

The Independent Sector Complaints Adjudication Service (ISCAS) incorporated the Complaint Standards into its Code of Practice for Complaints Management and engaged independent providers in taking them up. All ISCAS subscribers were reminded of their responsibilities to incorporate the Complaint Standard Framework on renewal of their annual subscription in April 2023.

CQC assesses all registered healthcare providers against the fundamental standard of ‘complaints’ (see Regulation 16: receiving and acting on complaints) – including ensuring information is available and accessible on how to complain.

The PHSO has piloted the NHS Complaint Standards to improve how providers meet patient expectations when they make a complaint – including increasing awareness of independent resolution.

ISCAS has incorporated the Complaint Standards into its Code of Practice for Complaints Management and engaged independent providers in taking them up.

The government has appointed the first ever Patient Safety Commissioner for England, who will ensure that patient voices are heard across both NHS and privately delivered healthcare.

Action 4.1:

Accepted by the government / accepted in principle so far as mandatory independent resolution for private patients.

The Parliamentary and Health Service Ombudsman is piloting NHS Complaint standards, which set out in one place the ways in which the NHS should handle complaints, including the need for organisations to ensure people know how to escalate to the Ombudsman.

The standards are included in the code of practice for independent providers, as developed by the Independent Sector Complaints Adjudication Service.

The government has conducted a review of the data which confirmed that 94% of recorded patient episodes by the Private Health Information Network, were at providers who subscribed to the Independent Sector Complaints Adjudication Service.

The Care Quality Commission has strengthened its guidance on this issue to clarify that there is an expectation that patients should have access to independent resolution, and that providers who do not provide such a mechanism must be able to show that patients are not disadvantaged by this.