Responding to complaints in Northern Ireland

In our related quick guide, we introduced the common complaints procedure for health and social care in Northern Ireland. Here we cover the practical aspects of responding to complaints in line with that procedure.

Initial response

  • Discuss the complaint at the outset with the complainant.
  • This will make sure both parties agree on the scope of the complaint.
  • It will also let you draw up an investigation plan and clarify what outcome the complainant expects.

It's important to keep the complainant informed of relevant developments, particularly if you expect any delays. If you need to extend the statutory timescales in order to make a thorough investigation and provide a report, both parties need to agree.

Acknowledging complaints

  • Trusts must acknowledge complaints within two working days
  • Complaints in primary care must be acknowledged within three working days.

In primary care, you must provide the health board with a copy of the complaint within three working days, where the complainant allows it. If the complainant refuses permission, we recommend that you tell the health board you have received a complaint, but that permission to disclose it has been withheld.

When acknowledging a complaint, you must also tell the complainant that they have the right to seek assistance from the Patient and Client Council.

Investigations

  • The investigation into the complaint should normally be completed within 20 working days for trusts.
  • This limit drops to 10 working days for GPs.
  • If the investigation can't be completed in these timescales, explain why to the complainant and tell them when they'll receive a response.

In joint complaints, the organisations involved should liaise appropriately (with the complainant's permission) and will need to agree which aspects of the complaint each will address.

Investigations must be non-adversarial, fair and consistent. The thoroughness of the investigation should be proportionate to the concerns, sufficient to identify all relevant factors to inform the response, and be able to identify anything that contributes to learning from the complaint.

How the investigation is handled is largely at the discretion of the complaints manager, but it's a good idea to agree the general approach with the complainant to begin with. It's essential to obtain detailed statements from the complainant, the organisation/person(s) complained about and other relevant witnesses.

You could also use external services, such as conciliators, independent medical assessors, and support/advocacy services for the complainant.

Standards

The complaints guidance lists eight standards that should be followed in order to be consistent with how complaints are handled between organisations.

  • Accountability: in terms of the procedures and checking that relevant directions are complied with.
  • Accessibility: making the complaints procedure open and easily accessed by patients and their representatives.
  • Receiving complaints: all complaints will be dealt with seriously, with courtesy and in a timely manner and will respect confidentiality.
  • Supporting complainants and staff: including making sure that complaints managers are trained, conciliation and lay/medical advice is used appropriately, and that complainants can access advice and support.
  • Investigation of complaints: these must be conducted promptly, thoroughly, openly, honestly and objectively.
  • Responding to complaints: timescales will be met, where practicable, and all aspects of the complaint addressed.
  • Monitoring.
  • Learning.

Meetings

In our experience, meetings can be an effective way of gathering information, and can sometimes help resolve a complaint.

It's often helpful to agree areas of discussion with the complainant in advance, as well as who will be at the meeting. You could suggest that the complainant seeks support from a friend, or advocacy service, and there might also be benefit in using a conciliator.

Keep minutes of the meeting and agree them afterwards, and reflect the key points in the final response to the complaint.

The response

When the investigation is complete, the response must accurately reflect the evidence obtained and the findings made.

If medical staff have given a statement, it's vital they have the chance to comment on a draft of their evidence and, ideally, on any conclusions and recommendations drawn from it, so they can check its accuracy.

The complaints manager and anyone else involved in drafting the response should weigh the findings in order to reach fair, balanced conclusions that can be justified from the evidence obtained. Recommendations should also be fair, achievable, proportionate and take all opportunities to learn lessons from the complaint.

It's not unusual to ask the complainant if they would like to respond to your response, but it's important that this doesn't lead to protracted back and forth if an agreement cannot be reached, and the complainant should be notified of the formal ending of local resolution.

Ombudsman

Complainants who are dissatisfied with the response can take their complaint to the Office of Northern Ireland Public Services Ombudsman (NIPSO). The Ombudsman will normally only consider complaints brought within 12 months of the date when the complainant knew they had cause for complaint.

The senior person responsible for the organisation should normally sign off on the final report, though this responsibility may be delegated. If the task is delegated it does not remove the overall accountability of the senior person.

Reporting and monitoring arrangements

  • Health and social care organisations have a duty to monitor complaints.
  • This is to ensure they are addressed in an effective, efficient manner and that lessons are learned and applied, as appropriate.
  • Records of complaints must be kept, as well as outcomes and action taken as a result of complaints investigations.

Health boards will produce quarterly statistics on those from whom they commission services (notably GPs), as well as a detailed annual report setting out the number, nature and timescales of complaints received and investigated. The report should also state when the board acted as an 'honest broker'.

The reports must be suitably anonymised and not include information that might identify patients. Annual reports will be publicly available and will be sent to the relevant Health and Social Services Councils, the Regulation and Quality Improvement Authority (RQIA), the Ombudsman and the DHSSPS.

There is a reciprocal obligation on GPs to provide statistics to health boards to support quarterly and annual reports, as well as to notify the board of new complaints as they emerge. Health trusts have similar monitoring and reporting obligations.

Complaints data will be analysed and occasionally disseminated by the RQIA.

Learning

The complaints procedure emphasises that health and social care trusts and boards must make sure that organisational learning flows from the analysis of complaints.

We advise members to consider complaints in line with local clinical governance arrangements to encourage and support organisational, regional and national learning. Practices should consider integrating complaints investigation and clinical governance procedures where practicable.

For further information see the Department of Health NI website.

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.

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