Complaints Management Policy

Accessibility

If you require this policy in a different format, an alternative language, or you need any help reading this document, please get in touch with the Governance Department governance@vhg.co.uk. 

Confidentiality

This document and its contents are the property of Vita Health Group. Information contained therein is confidential and privileged. It must not be used by, copied, disclosed or reproduced without written consent from Vita Health Group Directors or the Governance department.

Equality Statement

This policy embraces diversity, dignity and inclusion in line with emerging human rights’ guidance. We recognise, acknowledge and value difference across all people and their backgrounds. We will treat everyone with courtesy and consideration and ensure that no one is belittled, excluded or disadvantaged in anyway.

Document control

Owner:	Clinical Governance	Review:	Annually	Classification:	1 (Proprietary)
Author:	Clinical Governance	Version:	2.0	Status:	Published
Date Published:	16/11/20	Code:	QA9100A
Consultation history:	GQRC	Consultation date:	16/11/20

Version history

Version:	Date:	Summary of Changes
0.1	07/11/18	Draft – Full review and amalgamation of CPPG and RHW Complaints Management Policies
1.0	09/11/18	Published after review by QASSG at v1.0
1.1	10/04/19	Reviewed by QASSG.
1.2	08/08/19	Updated acknowledgement timelines for NHS compliance and republished.
1.3	02/11/20	Reviewed, updated with minor amendments
1.3	16/11/20	Ratified at GQRC.
2.0	22/07/21	Updated to include reference to Insurance Regulated complaints

Contents	Page

1. Introduction 

Vita Health Group (VHG) recognises that all colleagues work very hard to get it right first time. However, there may be occasions when people will be dissatisfied with the service received, or decisions made, and wish to make a complaint or raise a concern. 

VHG will treat all feedback seriously and proportionately and ensure that any, and all feedback including complaints, dissatisfactions, concerns or issues raised by service users, including their relatives and carers and customers are properly investigated. All investigations will be conducted in an independent, unbiased, non-judgmental, transparent, timely and appropriate manner. The outcome of any investigation, along with any resulting actions and opportunities for learning will be explained to the complainant by VHG (the investigating organisation). We will endeavour to learn from feedback and continuously improve our services.

We are committed to quality care for all as a core principle of our vision and purpose. When our service does not meet expectations, it is important that we understand why, and act to put things right where possible. To this end, we must provide all patients, clients, their family, carers, or members of the public, with the opportunity to seek advice, raise concerns or make a complaint about any of the services, or policies and procedures we have developed and implemented. 

2. Scope

This policy applies to the handling of complaints or concerns relating to VHG services. Complaints can be made by any person who is or may be affected by an action, omission or decision by VHG. This policy does not cover complaints about employment by colleagues, from customer organisations, from supplier organisations, or which involve illegal activity or safeguarding concerns. A complaint is a verbal or written expression of concern or dissatisfaction made by or on behalf of an affected person, about an act, omission or decision of VHG which requires a response and/or redress.

3. Purpose 

The purpose of this policy is to provide a framework for the management of complaints, and to ensure that our handling of complaints meets the requirements of our customers, Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. This policy includes the fundamental requirements of good complaints and concerns handling used by VHG to deliver arrangements in an easily accessible, equitable, sensitive and open manner.

This policy aims to: 

a. Detail the principles of Complaints Management

b. Document our approach to the management and investigation of complaints and ensure all colleagues are familiar with policy content

c. Provide colleagues and complainants with support and guidance throughout the complaints process

4. Duties and Responsibilities 

4.1 Executive Management Team (EMT)

The EMT have overall accountability for ensuring that the VHG Complaints Policy meets the statutory requirements as set out in the regulations, especially the National Health Service Complaints Regulations 2009.

The EMT delegate the responsibility for compliance and monitoring to the Governance, Quality and Risk Committee (GQRC) for each of the market units (Corporate, B2C and NHS).

4.2 Governance, Quality and Risk Committee 

GQRC is responsible for:

1. Ensuring that all VHG colleagues adhere to this policy and that compliance is monitored and reviewed
2. Ratification of any new versions of this policy
3. Liaison with managers, service leads, clinical leads to communicate any change in policy and to ensure information reaches all VHG colleagues
4. Review and continual improvement in the complaint management process 

4.3 Managers/Service Leads/Clinical Leads

Managers and Leads are responsible for:

1. Facilitation of the resolution of complaints and concerns
2. Recording details of the complaint on a database, the outcome, and any learning from the complaint
3. Suggesting root causes and further actions required
4. Escalation of complaints where applicable
5. Encouraging a positive, open and approachable culture in relation to complaints management/resolution

4.4 VHG Colleagues: 

VHG colleagues are responsible for:

1. Responding to complaints in a positive manner
2. Accepting and documenting complaints in line with this policy and the Complaints Management procedures
3. Resolving minor issues or complaints through immediate action or local resolution
4. Being open and honest in all circumstances in-line with company values, ethical and professional standards and duty of candour
5.  Acting as a role model to champion best practice
6. Challenging non-compliance with this policy
7. Reporting any concerns/issues/complaints through the appropriate system on the VHG intranet and escalating concerns appropriately

5. Procedure and/or Process

5.1 Principles 

The principles of Complaints Management, taken from the Health Service Ombudsman: 

a. Getting it right – Good complaint handling requires strong and effective leadership. Those at the top of VHG should take the lead in ensuring good complaint handling, with regard to both the practice and the culture

b. Being customer focused – VHG should ensure that complaints processes are easily accessible to service users and customers , and deal with complaints promptly

c. Being open and accountable – VHG should be open and honest when accounting for their decisions, and give clear, evidence-based explanations. When things have gone wrong we should make an appropriate apology and explain fully the finding of the investigation and what we will do to

put matters right

d. Acting fairly and proportionately – We must ensure that complainants and colleagues are treated fairly and complaints are managed by an impartial person. We should avoid taking a rigid, process driven approach to complaints, and consider each individual’s circumstance and the nature of the complaint. 

e. Putting things right – Where something has gone wrong, we should ensure it is put right. In some cases, this may be as simple as an apology, however remedial or further action may be required. When considering actions, we should consider: 

1) The nature of the complaint

2) The impact on the individual

3) The time taken to resolve the complaint

4) The effort the complainant has put into pursuing their complaint

f. Seeking continuous improvement - Learning from complaints is a powerful way of helping to 

improve public service, enhancing the reputation of an organisation and increasing trust among the people who use its service. Organisations should have systems to record, analyse and report on the learning from complaints and should feed that learning back into the system to improve their performance. 

5.2 Aims Of Complaint Management

The aims of complaints management, as laid down in The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009: 

a. Complaints are dealt with efficiently

b. Complaints are properly investigated

c. Complainants are treated with respect and courtesy

d. Complainants receive, so far as is reasonably practical 

1) Assistance to enable them to understand the procedure in relation to complaints or 

2) Advice on where they may obtain such assistance; e. Complainants receive a timely and appropriate response

f. Complainants are told the outcome of the investigation of their complaint 

g. Action is taken if necessary, in the light of the outcome of a complaint

5.3 Who Can Make A Complaint

Any person who is affected by, is likely to be affected by or is aware of an action, omission or decision of VHG. A complaint or concern may be made by a person acting on behalf of an affected person if the affected person: 

a. Is a child, in which case complaints may be made:

1) By a parent, guardian or other adult person who has care of the child;

2) By a suitable, authorised representative of a local authority when the child is in the care of a local authority or a voluntary organisation. The representative must be a person authorised by the local authority or the voluntary organisation, and in the opinion of the relevant Leadership Team Manager, is making the complaint in the best interests of the child

b. Is deceased. The representative must be a relative or other person who had sufficient interest in their welfare and is a suitable person to act as a representative 

c. Has physical or mental incapacity. In the case of a person who is unable by reason of physical capacity, or lacks capacity within the meaning of the Mental Capacity Act 2005, to make the complaint themselves, the representative must be a relative or other person, who has sufficient interest in their welfare and is a suitable person to act as a representative

d. Has given consent to a third party acting on their behalf. In the case of a third party pursuing a complaint on behalf of the affected person we will request the following information: 

1) Name and address of the person making the complaint

2) Name, date of birth and full address including post code, of the affected person, to allow 

positive identification

3) Contact details of the affected person so that we can seek confirmation that they consent to the third party acting on their behalf

4) This will be documented in the complaint file and confirmation will be issued to both the person making the complaint and the affected person

e. Has delegated authority to do so, for example in the form of Power of Attorney

f. Has instructed an MP to act on their behalf as a constituent

5.4 What Complainants Can Expect

As well as the right to have their complaint managed in line with the aims above, complainants also have the right: 

a. To discuss the manner in which the complaint is to be handled and know the period in which the complaint response will be sent

b. To be kept informed of the progress of a complaint

c. To take a complaint to the independent Parliamentary and Health Service Ombudsman if dissatisfied with the way we have dealt with the complaint and using an NHS service

d. To take a complaint to the NMC, HCP or BACP if dissatisfied with the way we have dealt with a complaint and not using an NHS service 

e. To take a complaint about data protection breaches to the independent Parliamentary and Health Service Ombudsman or the Information Commissioners Office, if dissatisfied with the way VHG has dealt with the complaint

f. To make a claim for judicial review if the patient thinks that they have been directly affected by an unlawful act or decision 

g. To make contact with 3rd parties such as Patient Advice and Liaison Service (PALS), Clinical Commissioning Groups (CCG’s), GP’s or referring customers

h. To make a claim for compensation if they have been harmed by medical negligence

NB. In the event of a complaint where a person has stated that they intend to take legal action, consideration must be given to whether the complaint can be investigated without prejudicing the outcome of any legal action.

5.5 How Can Complaints Be Made 

A complaint can be made in almost any way and in many different formats. We should view all feedback as an opportunity to improve, and not discount feedback because it may have come from an unusual source. Formal complaints should preferably come in writing, so that there is an accurate record of the issues, however this should be considered on a case-by-case basis taking into account the capabilities of the complainant. Examples of the formats it may be acceptable to take a complaint in: 

a. Post

b. e-mail

c. Twitter, Facebook, or other social media messages

d. Verbally by telephone  

e. Verbally in person

NB. Where a complaint is made verbally, we are obliged to create a written record of the complaint and provide the complainant with a copy.

5.6 Timescales for Complaint

Complaints can be made at any point without limitation. Complaints which arise after an extended period will still be investigated effectively and fairly. In these circumstances, a longer period may be required for investigations and the complainant should be made aware of this.

Some serious complaints may also have an extended period of time for the investigation to be completed for example an NHS StEIS reportable incident in conjunction with the complaint.

5.7 Confidentiality and Consent

There is an expectation that when capturing consent for the use and sharing of information, that the service user has made an informed decision and clearly understands the processing and potential sharing of their information. Colleagues must also understand the expectations of confidentiality that the information is provided under. 

Complaints will be handled in the strictest confidence in accordance with VHG’s Confidentiality Policy. The following general guidance applies:

 

a. Complaints records should be kept separately from patient medical records. 

b. Information shall only be disclosed to those who have a demonstrable need to have access to it. 

c. Disclosure of information to others who are not directly involved in the case may be dealt with under disciplinary procedures. 

d. Information will not be disclosed to third parties unless the complainant or appropriate authorised party has given consent to the disclosure of that information. 

NB. There may be circumstances in which information disclosure is in the best interests for the patient, or the protection, safety or wellbeing of a child or vulnerable adult. In these circumstances escalate as necessary in line with safeguarding policies and procedures.

5.8 Formal Complaints 

A formal complaint is one which is made in writing (unless the complainant has asked not to receive a response), or verbally, and requires a formal response. The management of formal complaints shall follow the “Complaints Process Flow” (appendix 1).

Some complaints may also form part of an incident investigation and will be investigated in line with VHG incident reporting procedures and for 

5.9 Minor or Informal Complaints

A minor complaint, or expression of dissatisfaction, is an issue which has been raised by a complainant that does not require a formal written response and can be resolved quickly and effectively. The Complaints Process Flow is still applicable, but may be managed more informally following local resolution, or immediate action: 

a. Where a complaint can be managed in an appropriate manner on the spot, or within 24 hours by a member of staff, and requires no further actions, this is called local resolution, or immediate action

b. Where a complaint is dealt with in this way, the complainant still has a right to make a formal complaint, and should be made aware of this

c. If the complaint or concern is resolved within twenty-four hours of it being raised then the case will be closed

5.10 Insurance Regulated Complaints

VHG may have specific arrangements with insurance customers, giving authority to handle early resolution complaints. These may have different timescales for responding, resolving, and reporting back to the customer / client. Further guidance on this can be found in service specific complaint procedures.

5.11 Persistent and Unreasonable Complainants

Persistent and unreasonable complainants will be managed on a case-by-case basis and any required assistance will be given to colleagues who feel they are dealing with a persistent or unreasonable complainant. Further guidance on this can be found in the NHS England Complaints Policy, 

5.12 Supporting Colleagues 

All documentation relating to the investigation will be stored securely in the case file. Colleagues named in the complaint (personally or by role) should be informed of the complaint, and fully supported by their relevant line manager. The investigation should be comprehensive, fair and timely, and should not apportion blame. A number of supports are available for staff, including: 

a. Line manager

b. Peer support

c. Professional bodies

d. EAP helpline

e. HR

f. Employee Representative Group

5.13 Record Keeping 

Keeping clear and accurate records of complaints is important and these should be retained for a period of eight years. 

5.14 Safeguarding 

Any complaint where a person discloses abuse of any kind, indicates an intent to harm themselves or another person, or there is any other safeguarding related concern, it must be managed following the Safeguarding Policy, Safeguarding Children Policy, and relevant Safeguarding Procedures. HR must also be informed where there is an allegation of abuse against a VHG colleague.

If there is an immediate risk of harm, or a serious concern about a vulnerable person or any child, staff should contact 999 immediately and inform the relevant Safeguarding Lead.

5.15 External Reporting

In line with the Duty of Candour and Being Open Policy, VHG will report complaints to relevant external parties, including, where required: 

a. Where a complaint is RIDDOR reportable

b. Where a complaint is StEIS reportable, or falls within the NHS Serious Incident Framework. NB. All serious incidents are notifiable to the relevant CCG within 48 hours and are investigated using Root Cause Analysis methodology

c. Where the complaint arises from delivery of an NHS Contract as part of our contract and performance management meetings

d. All complaints that fall under notifiable incidents related to CQC regulated activities, will be reported to the CQC

e. Where required, complaints related to incidents will also be notified to the HCPC, BACP, BABCP, GMC and NMC, or other regulatory body where applicable

5.16 Criminal Activity

Any complaint which includes illegal activity of any kind including financial misconduct must be reported to a Director immediately. 

Allegations of fraud of financial misconduct should be referred to one of the contacts below; details should NOT be taken by the complaints team. 

a. Action Fraud for all cases of fraud: 

1) Web: https://www.actionfraud.police.uk/ 

2) Tel: 0300 123 2040 

b. NHS Report Fraud for NHS related cases of fraud: 

1) Web: https://cfa.nhs.uk/reportfraud 

2) Tel: (via Crimestoppers) 0800 555 111

6. Mental Capacity

This policy will operate within VHG’s framework for mental capacity.

7. Training

This policy will be distributed to internal staff through the intranet site. The general public are aware of the complaints policy and procedures via the VHG web pages. Complaints management form part of induction training proportionate to individual posts.

There are no further resources required for training related to this policy.

8.  Implementation

There is no additional financial impact resultant from the development and implementation of this policy. All staff will be made aware of updates regarding the introduction and/or amendment to this policy through: 

1. GQRC summary sent to all staff by email 
2. Inclusion on Yammer in ‘all company’ area 
3. Inclusion on the intranet which can be accessed by all staff 

9. Monitoring and Audit

a. VHG will demonstrate how we use feedback to learn and improve. An annual report will be produced for the VHG Board, which will detail: 

1) numbers of complaints received

2) numbers of complaints received considered to be based on solid evidence or good reasons (complaints upheld)

3) issues and key themes that the complaints have raised; 

4) lessons learnt

5) actions taken, or being taken, to improve services as a result of the complaints made

6) number of cases which VHG has been advised are being considered or referred to the Parliamentary and Health Service Ombudsman

b. Compliance with the policy and procedures laid down in this document will be monitored by the relevant Leadership Team Managers for each department

c. The Clinical Directors, supported by the GQRC will review this document and associated procedures at least annually for effectiveness

d. The GQRC will monitor both the effectiveness of the complaints process, and how complaints information is being used to improve services and delivery of care. VHG will provide a system to: 

1) Disseminate learning from complaints across the relevant parts of the organization

2) Include the use of complaints procedures as a measure of performance and quality

3) Use complaints information to contribute to service development and planning

e. Complaints reports will be considered alongside incidents and customer feedback to form part of the Service Quality Report. This is reported to the Business Governance meeting and to all senior managers monthly

10. References

a. VHG Patient Complaints Procedure (document sent to all patients when a complaint is

    acknowledged) 

b. Information Commissioner’s Office: 

1) Constituency casework of MPs and the processing of sensitive personal data.

c. National Health Service: 

1) NHS Constitution for England

2) NHS England Confidentiality Policy

3) NHS England Data Protection Policy 

4) NHS England Serious Incident Framework 

5) NHS England Safeguarding Policy 

6) NHS England Whistleblowing Policy 

7) NHS England Funding and Resource 2017-2019: Supporting “Next Steps for the NHS Five Year Forward View”

8) Next Steps on the NHS Five Year Forward View 2017

9) The NHS Long Term Plan 

d. Legislation: 

1) Equality Act 2010 

2) Freedom of Information Act 2000 

3) Human Rights Act 1998 

4) The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 

5) Data Protection (Processing of Sensitive Personal Data) (Elected Representatives) Order 2002

e. Department of Health and Social Care: 

1) Listening, Responding and Improving – A Guide to Better Customer Care

f. Parliamentary and Health Service Ombudsman: 

1) My Expectations for raising concerns and complaints 

2) Principles of good administration 

3) Principles of good complaints handling 

4) Principles for remedy

g. Data Protection: 

1) The Data Protection Act 2018 

2) General Data Protection Regulation (GDPR)

3) Caldicott Report 1997 

4) National Data Guardian Report 2017

11. Appendices

Appendix 1: 

Complaints Process Flowchart (please note this is available on the VHG intranet)

12. End