Responding to written complaints in the Republic of Ireland

Getting a complaint response right first time is the best way to settle concerns and to reduce the risk of a complaint escalating.

Timescales

  • The HSE has produced guidance on handling complaints but you will also need to be familiar with your organisation's own complaints policy.
  • The Health Act says that complaints should be investigated and responded to if they are received within 12 months of the events that caused concern, or of the date on which the patient became aware of the events. However, this time limit can be set aside at the discretion of a complaints officer.
  • We therefore recommend responding to complaints even outside this 12 month period whenever practicable. If for whatever reason you are considering not responding to a complaint, discuss this first with the MDU.

On receiving a written complaint, the organisation's complaints officer should contact the complainant within two working days with an offer to meet with them, along with the clinical director or another senior member of staff. If the complaint is resolved at this meeting, a letter is sent to the complainant summarising this process, and the doctors involved may be sent a summary of the concerns that were raised. The HSE calls this an informal investigation.

If the complaint is not settled after this meeting, or if the complainant declines the initial offer to meet with the complaints officer, a letter acknowledging receipt of the complaint should be issued within five working days and a formal complaint investigation begins.

This is when a doctor might first become aware of the complaint, as the complaints officer may at this point ask for their response to concerns raised about their involvement in the patient's care. The organisation is expected to issue a full response to the complainant within 30 working days or, if this is not possible, to update the complainant every 20 days regarding progress.

The ombudsman

The ombudsman has powers to investigate complaints from patients who have been treated by a public body, which includes public and voluntary hospitals and private nursing homes. The ombudsman will consider any concerns which, if upheld, might amount to maladministration on the part of the public body.

The ombudsman cannot investigate complaints relating solely to clinical care, or complaints arising from private medical care, regardless of where that has been provided.

Writing a response to a complaint

Getting a complaint response right, and getting it right first time, is the best way to settle patients' concerns and to reduce the risk that a complaint will escalate. Any personal feelings should be dealt with before writing the response. Set aside adequate time to review the relevant clinical records and discuss the concerns raised with a colleague, other team members, or your appraiser.

The very best complaint responses will usually include the elements below.

A sympathetic opening statement

Begin by apologising that the patient has had cause to raise concerns and explaining how their complaint has been investigated. These opening sentences set the tone for the whole complaint response, which should be as conciliatory and reflective as possible.

An acknowledgement of the upset experienced by the complainant

Even when we don't fully understand what prompted the complaint or when we feel it has no merit, it can be very helpful to acknowledge the patient's unhappiness.

A factual, chronological account of our involvement in the events leading to the complaint

This should be written with close reference to the clinical records, and you might also want to refer to (for example) any relevant guidelines you followed. It is perfectly reasonable to refer to your recollection of events or your usual practice, even if not detailed specifically in the records, if this helps you to explain what you did and why. This is the part of the response where you can (gently) correct any inaccuracies in the patient's recollection of events.

A response to all of the concerns raised

If a complainant raises concerns about more than one aspect of their care, it can be tempting to concentrate on those that are easiest to answer, but you should make sure all of the concerns are addressed, either by you or by someone else within the organisation. Not doing so may increase the chances of the patient returning with the same concerns after they receive your initial response.

Complaints mentioning a doctor's attitude or approach to a patient can be particularly difficult to address, since the patient's experience of the consultation may not match your own recollection. In such cases it can be useful to acknowledge the patient's upset and apologise for the distress they have experienced.

Reflections on the issues raised by the complaint

It can be helpful to structure these along the following lines:

  • what learning points you have identified
  • how you have addressed these
  • how your practice might alter in the future.

Including your reflections in an initial complaint response may not only be helpful to the complainant, but stands as evidence of contemporaneous reflective practice, which can be particularly useful in the small number of complaints that do not settle at a local level.

Apologies for anything that, with hindsight, you feel could or should have done differently

Including apologies in a complaint response can cause some doctors to be concerned that this is an admission of wrongdoing, or even an acceptance of liability. This is not the case; in our experience, lessons can be learned even in cases where the care was exemplary.

An offer to meet with the complainant to discuss any outstanding issues they might have

We can distil this advice further into a simple three-point plan that will ensure your complaint responses carry the best chance of addressing a complainant's concerns while maximising our own learning.

  1. Explain.
  2. Apologise.
  3. Put things right.

We are aware of how stressful it can be to receive complaints, and we are always happy to help members with responses to complaints. If you would like to speak to one of our medico-legal advisers about this or any other issue, contact us here.

This page was correct at publication on 02/03/2021. Any guidance 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.