The general principles of good complaint handling in the private sector are broadly the same as in the NHS. This is now the case more than ever, after a new code of practice brought both approaches even more in line with each other.

Code of Practice for Complaints Management

The Code of Practice for Complaints Management was published by the Independent Sector Complaints Adjudication Service (ISCAS) on 1 February 2022. Significantly, it aligns with the Parliamentary and Health Service Ombudsman (PHSO)'s Complaint Handling Framework.

ISCAS sits within the Centre for Effective Dispute Resolution (CEDR) and provides independent adjudication on complaints for the private healthcare sector, specifically for those organisations that subscribe to it. The PHSO provides an independent complaint-handling service for complaints that have not been resolved locally by the NHS in England.

Scotland

Healthcare Improvement Scotland (HIS) currently regulates independent healthcare in Scotland. At the time of writing, ISCAS is working towards a statement of understanding with HIS, but HIS reserves the right to investigate complaints about independent healthcare providers at any stage of the complaints procedure.

HIS has a guide on how it deals with complaints, which gives more information and indicates that ISCAS can only investigate their subscribers because they are not a regulatory body - unlike HIS.

Therefore, ISCAS may still be relevant in Scotland, but HIS is likely to be where any external review of complaints takes place.

Three-stage process

In the NHS, the complaints process outlines two stages: local resolution, followed by the PHSO if the complainant remains dissatisfied.

By contrast, the ISCAS code sets out a three-stage process for addressing complaints with each stage escalating to the next if the complaint remains resolved.

Stage one: a complaint is raised directly with the hospital or clinic, which is where the relevant clinician will contribute to a response.
Stage two: an internal review is conducted by someone not involved in responding at stage one.
Stage three: ISCAS independent adjudication; the aim of this stage is to bring a final resolution of the complaint for all parties. There is no right of appeal against the decision reached.

After the ISCAS has accepted a complaint for adjudication, it asks the complainant for written confirmation that they want to participate in the process and then outlines the terms.

Patient's consent

The complainant's/patient's consent will also be obtained for the subscriber - the hospital or clinic - to give ISCAS, the independent adjudicator and any instructed clinical experts a copy of their clinical records and complaint correspondence to date.

Knowing about this step could reassure clinicians if they receive unexpected ISCAS requests for medical records and letters.

During the adjudication process, the adjudicator compiles a timeline and identifies the key themes of the complaint. These are then shared with the complainant and the subscriber, both of whom are then invited to respond.

After the complaint has been defined and agreed, the adjudicator can instruct an expert witness as part of their investigation, who will give an opinion on the complaint's clinical aspects. If this happens, the complainant and subscriber will be given a list of questions intended for the expert and invited to suggest amendments.

At the end of the investigation, the adjudicator writes to the subscriber (usually within three to six months for most cases) to let them know their final decision.

They will set out:

a summary of the case and the final decision
any learning points for the subscriber organisation
advice to support resolution, such as when an apology is needed
how to improve compliance with the ISCAS code.

The adjudicator also has the authority to award a goodwill payment. This may recognise shortcomings in the service, but it can also be made for poor complaint handling, distress or inconvenience, up to a maximum limit of £5,000.

This highlights why it's important to get the local complaint handling right before ISCAS becomes involved, as the handling of the complaint can be scrutinised as well as the incident that gave rise to it.

Involving the watchdog

The ISCAS shares its adjudication decisions with the Care Quality Commission (CQC) in England and the Healthcare Inspectorate Wales (HIW). Individual clinician details are anonymised, but the hospital/organisation will still be identifiable.

The CQC considers issues arising from complaints as part of the information it holds on each hospital/organisation, and might use this to recommend improvements.

As an alternative to adjudication, and with both parties' agreement, mediation may be offered as an alternative route to resolution, but the complaint can still go through the adjudication process if this isn't successful.

Visit the ISCAS website to learn more about ISCAS subscribers, and for more information on the goodwill payment structure and managing unacceptable behaviour by complainants.

This article first appeared on Independent Practitioner Today and has been edited for publication.

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