There is a common complaints procedure for health and social care in Northern Ireland. The procedure has two stages.
- Stage 1 - local resolution.
- Stage 2 - referral to the Northern Ireland Commissioner for Complaints (Ombudsman).
There is a statutory obligation for organisations to co-operate to resolve complaints that involve more than one organisation - for example, a GP surgery and an acute hospital or a health and social care provider.
The procedure offers the chance to learn from complaints. Monitoring and reporting requirements are intended allow healthcare commissioners and the public to evaluate a health or social care body's complaints record.
Four core principles of the complaints procedure
- Openness and accessibility; flexibility in how complaints are investigated, support for complainants.
- Responsiveness; to provide an appropriate, proportionate response to complaints.
- Fairness and independence.
- Learning and development.
As described in 'Standards & Guidelines for Resolution & Learning'
Scope of the complaints procedure
A patient or their representative can complain about care or services provided by any health or social care organisation. However, some possible causes for complaint are excluded from the procedure:
- data protection disputes related to an alleged failure to comply with a subject access request
- an alleged failure to comply with a request under the Freedom of Information Action 2006
- staff grievances about their employment
- a complaint about which the HSC body is taking or proposing to take disciplinary action, or which has resulted in referral to a regulatory body
- independent inquiries (eg, coroner's inquests).
Healthcare organisations aren't prohibited from responding to complaints about access to a deceased patient's clinical records (to avoid court proceedings under the Access to Health Records (Northern Ireland) Order 1993).
The procedure doesn't allow investigations to run parallel to disciplinary or regulatory body action brought against the same healthcare professional. But investigations can take place where the subject matter is separate from the disciplinary or regulatory body issues.
In this case, a trust chief executive or senior partner in a GP practice should write to a complainant and outline which issues the complaint investigation will cover.
Complaint versus claim
Sometimes patients make their complaint through a solicitor, but this doesn't necessarily mean the patient is or will be taking formal legal action. The complaint can continue, but must stop if a patient indicates they intend to bring a civil claim for clinical negligence.
Some complaints aren't investigated, or the investigation stops before it is complete. In some types of cases, the investigation may start or continue when the matter that led to the complaint is resolved.
This doesn't apply in all cases; for example, complaints about employment contracts or child protection inquiries are excluded from these procedures.
If a complaint is not to be investigated, or an existing investigation is stopped, the chief executive (or senior partner) must tell the complainant and any subject of the complaint. They must also tell the complainant and subjects of the complaint when a previously excluded complaint is to be investigated. All these notifications must explain the reason for the decision (again, a requirement of the regulations), and we recommend you give these notifications in writing.
Making a complaint
A complaint can be defined as 'an expression of dissatisfaction that requires response'.
The person who makes the complaint might be:
- current or former patients of a healthcare organisation
- someone acting with the patient's authority, such as someone with parental authority for a child, or an appropriate person for a deceased patient
- a competent child, who may make a complaint in their own right.
A GP may also complain to the health board about the behaviour of a patient, but this is very rare. In this situation, contact us before deciding what action, if any, to take.
In the case of a person who has died or is incapable, a complaint may be brought by a representative. That representative must be a relative or other person who had or has sufficient interest in the welfare of that person and who is suitable to act as a representative. A complaints manager, in consultation with a trust chief executive or practice senior partner, must make these assessments.
If it's decided that the complainant doesn't have sufficient interest to make a complaint, the senior person in the healthcare organisation must write to them to explain why.
In the case of children, a complaint may be brought by a parent or, in the absence of both parents, a guardian or someone who has care of the child. If the child is in the care of the authority or voluntary organisation, then any person bringing the complaint must be authorised by the authority or organisation.
- Always make sure a representative acting for a competent patient has their authority to act for them and to receive confidential information.
- Tell complainants how their personal information will be used to investigate their concerns; explain and seek permission for sharing information with another organisation or a third party as part of the complaints investigation.
- If someone objects to their personal information being used, respect their wishes but explain how this will affect the investigation.
Oral and written complaints
- Complaints can be made orally or in writing.
- Oral complaints must be recorded (or at least summarised) in writing.
- A copy of the written record must be sent to the complainant.
Certain oral complaints might be able to be resolved on the spot by front-line staff, in which case further action under the complaints procedure is unnecessary. While the regulations state that all complaints must referred to the complaints manager, HSC guidance refers to discussion with complaints manager to identify complaints that could be readily resolved and not require formal investigation.
- Complaints may be made to any staff member, but the complaints manager is responsible for investigating them.
- Every health and social care organisation must have a nominated complaints manager.
Complaints about GPs are normally made to the practice but complainants can also go direct to the health board, which must offer them the option of forwarding the complaint to the practice.
Alternatively, the health board can act in the role of 'honest broker', where the health board's complaints manager acts as an intermediary in an attempt to resolve the complaint.
This will normally be best achieved by mediation, which allows individuals to respond, or through conciliation services. The health board must record and monitor the complaints it receives and responds to.
- Complaints should normally be brought within six months of the incident that gave rise to the concerns.
- Where the complainant became aware of the cause for complaint later than this, the period is either six months from the date of knowledge or 12 months from the date of the incident, whichever is shorter.
There is discretion to extend these time limits, and we would encourage you to investigate complaints where possible (for example, where notes still exist and where it is reasonable in the circumstances to investigate the matter).
If it's not possible to extend the time limits, explain why to the complainant.
Accountability and publicity
Health and social care trusts and boards must appoint a senior person within their organisation to take responsibility for making sure a procedure is in place that can adequately investigate and consider complaints.
This would usually be a director of the trust or a clinical governance lead in primary care. They can also delegate responsibility for checking the organisation complies with complaints regulations and learns lessons.
Organisations must publicise the complaints procedure adequate so that patients and their relatives understand and know how to use it. This may include posters or notices in waiting rooms and practice/trust literature as well as information provided by health boards and trusts.
Duty to co-operate
All relevant organisations must cooperate to make sure that complaints involving more than one health or social care body are investigated thoroughly and the complainant receives a full and comprehensive response.
HSC guidance also says (para 3.22, 'Joint complaints') that where a complaint relates to more than one HSC organisation, the complaints manager should notify the other organisation(s) involved. The complainant's consent must be obtained before sharing the details of the complaint across HSC organisations.
This would include providing information to the person coordinating the response, attending meetings and answering questions asked of individual organisations.
Each health or social care organisation must designate a complaints manager whose function is to acknowledge, investigate, consider and draft responses to complaints, and check that relevant matters are considered under the organisation's clinical governance procedures.
Directions issued to health and social care services on procedures for complaints.
Our guide to responding to complaints in Northern Ireland.
This guidance was correct at publication 27/07/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.