1. Purpose

This policy sets out how we handle complaints about us and about the services we commission and the standards we will follow. This procedure follows the relevant requirements as given in The Local Authority, Social Services and National Health Service Complaint Regulations 2009 and The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (referred to in this guidance as the 2009 and 2014 regulations).

2. Scope

This policy applies to complaints about NHS England and the services it commissions, or any other functions it exercises. Further information about NHS England is available on our website.

This policy does not relate to:

• Freedom of Information Act 2000 or Environmental Information Regulations 2004 compliance matters as they have a separate statutory process under the legislation
• complaints from doctors in training – further information is available on the Health Education England website
• complaints about postgraduate training of doctors or dentists – further information is available on the Health Education England website
• complaints about professional standards processes
• complaints about integrated care boards

3. Policy statement

The policy includes how we will put the 2009 Regulations and the core expectations in the Parliamentary and Health Service Ombudsman NHS complaint standards into practice.

4. Accountability, roles and responsibilities

Overall responsibility and accountability for the management of complaints lies with the ‘responsible person’ (as defined by the 2009 regulations). In NHS England this is delegated to national and regional directors.

We have processes in place to make sure the responsible person and relevant senior manager(s) regularly review insight from the complaints we receive, alongside other forms of feedback on our care and service. Where indicated, we will take action to learn from complaints so that improvements can be made to our service.

They demonstrate this by:

• leading by example to improve the way we deal with compliments, feedback and complaints
• understanding the obstacles people face when making a complaint, and taking action to improve the experience by removing them wherever possible
• knowing and complying with all relevant legal requirements regarding complaints
• making information available in a format that people find easy to understand
• promoting information about independent complaints advocacy and advice services
• making sure everyone knows when a complaint is a serious incident, or a safeguarding or a legal issue, and what must happen
• making sure there is a strong commitment to the duty of candour so there is a culture of being open and honest when something goes wrong
• making sure we listen to and learn from complaints and improve services when something goes wrong.

The national head of complaints is responsible for overseeing the operational handling and consideration of any complaints we receive.

The strategic head of complaints is responsible for overseeing how we identify and share learning from our complaints.

Any member of staff receiving a complaint directly should refer the matter to the Customer Contact Centre at england.contactus@nhs.net, in the first instance.

5. Identifying a complaint

When people want to make a complaint

We recognise that we cannot always resolve issues as they arise and that sometimes people want to make a complaint. The NHS complaint standards define a complaint as “an expression of dissatisfaction, either spoken or written, that requires a response”. It can be about:

• an act, omission or decision we have made or that a service we commission has made
• the standard of service we have provided or a service we commission has provided.

Feedback and complaints

People may want to provide feedback instead of making a complaint. In line with The Department of Health and Social Care’s NHS complaints guidance, people can give feedback, make a complaint, or do both. Feedback can be an expression of dissatisfaction (as well as positive feedback) but it is normally given without wanting to receive a response or make a complaint.

People do not have to use the term ‘complaint’. We will use the language chosen by the patient, service user, or their representative, when they describe the issues they raise (for example, ‘issue’, ‘concern’, ‘complaint’, ‘tell you about’). We will always speak to people to understand the issues they raise and how they would like us to consider them.

If we consider that a complaint (or any part of it) does not fall under this policy, we will explain the reasons for this. We will do this in writing to the person who has raised the complaint, and we will provide any relevant explanation and signposting information.

Complaints can be made to us:

• by telephone: 0300 311 22 33
• in writing: NHS England, PO Box 16738, Redditch, B97 9PT
• by email: contactus@nhs.net

We will consider all accessibility and reasonable adjustment requirements of people who wish to make a complaint in an alternative way. We will record any reasonable adjustments we make. 

We will acknowledge complaints within 3 working days of receiving them. This can be done in writing or verbally.  

We may receive an anonymous or general complaint that would not meet the criteria for who can complain. In this case, we will usually take a closer look into the matter to identify if there is any learning for our organisation, unless there is a reason not to.

Whilst we welcome feedback and complaints and the opportunity they provide us to improve services, there are a small number of instances where contacts become persistent and/or unreasonable. Procedures have been established to ensure that all reasonable measures have been taken to try to resolve the issues raised.

6. Complaining to us as a commissioner of NHS services

As a commissioner, we can look into complaints about the services we commission. Under section 7 of the regulations, the person making a complaint can choose to complain either to the service provider or to us as the commissioner of the service, but not both. 

When a complaint is made to us about a service we commission, we will determine how best to handle the complaint in discussion with the person making the complaint.

We will discuss whether it is best dealt with by the service provider or by us as commissioner of the service. When we agree the complaint is best dealt with by the service provider, we will seek consent from the person making the complaint to forward the complaint to the provider of the service.

When we decide that we are best placed to handle the complaint about the service provider, we will do so following the expectations set out in the Complaint standards and this policy. Before this point, we will request relevant evidence from the service provider so we can provide a full response to the person making the complaint.

7. Complaints about NHS England

We will look into complaints about actions or decisions by NHS England which fall within the scope of this policy.

On receipt of a complaint, we will liaise with the relevant internal team to look into the matters raised to enable us to take appropriate action.

8. Who can make a complaint

As set out in the 2009 regulations, any person may make a complaint to us if they have received (or are receiving) care and services from our organisation or an organisation we commission. A person may also complain to us if they are affected or are likely to be affected by any action, inaction or decision by our organisation or an organisation we commission from.

If the person affected does not wish to deal with the complaint themselves, they can appoint a representative to raise the complaint on their behalf. There is no restriction on who may represent the person affected. However, they will need to provide us with their consent for the representative to raise and discuss the complaint with us and to see their personal information (including any relevant medical records).

If the person affected has died, is a child, or is otherwise unable to complain because of a physical impairment or they lack mental capacity, then the complaint may be made on their behalf by a representative. There is no restriction on who may act as representative but there may be restrictions on the type of information we can share with them. We will explain this when we first look at the complaint.

If a complaint is brought on behalf of a child, we will need to be satisfied that there are reasonable grounds for a representative to bring the complaint to us rather than the child. If we are not satisfied, we will share our reasons with the representative in writing.

If at any time we see that a representative is not acting in the best interests of the person affected, we will assess whether we should stop our consideration of the complaint. If we do this, we will share our reasons with the representative in writing. In such circumstances we will advise the representative that they may complain to the Parliamentary and Health Service Ombudsman if they are unhappy with our decision.

 9. Timescale for making a complaint

Complaints must be made to us within 12 months of the date the incident being complained about happened or the date the person raising the complaint found out about it, whichever is the later date.

If a complaint is made to us after that 12-month deadline, we will consider it if:

• we believe there were good reasons for not making the complaint before the deadline, and
• it is still possible to properly consider the complaint

If we do not see a good reason for the delay, or we think it is not possible to properly consider the complaint (or any part of it), we will write to the person who has made the complaint to explain this. We will also explain that they can complain to the Parliamentary and Health Service Ombudsman if they are not happy with that decision.

10. Complaints and other procedures

We make sure our complaints staff are properly supported and trained to identify when it may not be possible to achieve a relevant outcome through the complaint process on its own. Where this happens, staff will inform the person making the complaint and give them information about any other process that may help to address the issues and has the potential to provide the outcomes they seek.

This can happen at any stage in the complaint handling process and may include identifying issues that could or should:

• trigger a patient safety investigation
• trigger our safeguarding procedure
• involve a coroner investigation or inquest
• trigger a relevant regulatory process, such as fitness to practice investigations or referrals
• involve a relevant legal issue that requires specialist advice or guidance
• involve decisions where an appeal process is available

When another process may be better suited to cover other potential outcomes, our staff will seek advice and give the person raising the complaint clear information. We will make sure they understand why this is relevant and the options that are available. We will also signpost them to sources of specialist independent advice.

If an individual is already taking part or chooses to take part in another process but wishes to continue with their complaint as well, this will not affect the investigation and response to the complaint. The only exceptions to this are if:

• the individual requests or agrees to a delay
• there is a formal request for a pause in the complaint process from the police, a coroner or a judge

In such cases, the complaint investigation will be put on hold until those processes conclude.

If we consider that a staff member in our organisation should be subject to remedial or disciplinary procedures, we will take appropriate action but may not be able to share this information with the person raising the complaint as we need to comply with data protection legislation.

If we consider that a staff member in our organisation, or a member of staff in an organisation we commission, should be referred to a health professional regulator, we will advise the person who has raised the complaint. We will share as much information with them as is reasonable while complying with data protection legislation. If the person raising the complaint chooses to refer the matter to a health professional regulator themselves, or if they subsequently choose to, this will not affect the way we investigate and respond to their complaint. We will also signpost to sources of independent advice on raising health professional fitness to practise concerns.

11. Confidentiality of complaints

We commit to maintaining confidentiality and protecting privacy throughout the complaints process in accordance with UK General Data Protection Regulation and Data Protection Act 2018. We will only collect and disclose information to those organisations and staff who are involved in the consideration of the complaint. Documents relating to a complaint investigation are securely stored and kept separately from medical records or other patient records. They are only accessible to organisations and staff involved in the consideration of the complaint.

Complaint outcomes may be anonymised and shared within our organisation and the organisations we commission. They may be published on our website to promote service improvement.

12. How we handle complaints

Making sure people know how to complain and where to get support

We publish clear information about our complaints process and how people can get advice and support with their complaint through their local independent NHS complaints advocacy service and other specialist independent advice services that operate nationally. Further information is available on our website.

We make sure that everybody who uses our services and the services we commission (and those that support them) know how they can make a complaint. This includes making people aware that they can also complain to us about any service we commission from others.

We do this by displaying our complaints policy and/or materials that promote our complaints policy on our website. We also make sure the services we commission have similar information available. We offer a range of ways to do this so that people can do this easily in a way that suits them.    

What we do when we receive a complaint

We want all people, patients, their family members and carers to have a good experience in their interactions with us and while using the services we commission. If somebody feels that the service did not meet our standards, we encourage them to talk to staff to see if we can resolve the issue promptly. This includes the standard of service experienced from our commissioned providers.

We want to make sure we can resolve complaints quickly as often as possible. To do that, we train our staff to proactively respond to service users and their representatives and support them to deal with any complaints raised at first point of contact.

All of our staff will handle complaints in a sensitive and empathetic way. They will make sure people are listened to and get an answer to the issues quickly wherever possible, and any learning is captured and acted on.

Our staff will:

• listen to the service user to make sure they understand the issue(s)
• ask how they have been affected
• ask what they would like to happen to put things right
• carry out these actions themselves if they can (or with the support of others)
• explain why, if they can’t do this, and explain what is possible
• capture any learning to share with colleagues and improve services for others.

 Complaints that can be resolved quickly

If a complaint is made verbally and resolved by the end of the next working day, it does not need go through the remainder of this procedure. For this to happen, we will confirm with the person who has made the complaint that they are satisfied that we have resolved the issues for them. If we cannot resolve the complaint within that timescale, we will handle it in line with the rest of this procedure.

Acknowledging complaints

All other complaints will be acknowledged either verbally or in writing/email within 3 working days. They will also discuss how we plan to respond to the complaint with the person who has made the complaint.

Focus on early resolution

When we receive a complaint, we are committed to making sure it is addressed and resolved at the earliest opportunity. Our staff are trained to identify any complaint that can be resolved quickly. If staff consider that the issues cannot be resolved quickly, we will take a closer look into the issues (see section 9.18 onwards).

When our staff believe that an early resolution may be possible, they are authorised to take action to address and resolve the issues raised and put things right for the person raising them. This may mean giving a quick explanation or apology themselves or making sure a colleague (or the provider of the service) who is more informed about the issues does.

If we think a complaint can be resolved quickly, we aim do this within 10 working days. We will always discuss with those involved what we will do to resolve the complaint and how long that will take.

If we can resolve a complaint

If we can answer or address the complaint and the person making the complaint is satisfied that this resolves the issues, our staff have the authority to provide a response on our behalf. This will often be done over the telephone, or in writing (by email or letter) in line with the individual circumstances. 

We will capture a summary of the complaint and how we resolved it, and we will share that with the person making the complaint. This will make sure we build up a detailed picture of how each of the services we provide is performing and what people experience when they use these services. We will use this data to help us improve our services for others.

If we are not able to resolve a complaint

We will look at whether we need to take a closer look into the issues if:

• we are unable to find an appropriate way to resolve the complaint to the satisfaction of the person making it
• the complaint is regarding a service we commission and requires access to relevant information, including clinical records

A closer look into the issues

Not every complaint can be resolved quickly. For example, a complaint may be very complex or serious. Or it may be a complaint about a service we commission where we do not have direct access to relevant information and records or to the clinicians/staff involved. In cases that cannot be resolved quickly, we will make sure the complaint is allocated to an appropriate member of staff (or a complaint handler) who will take a closer look into the issues raised. This will always involve taking a detailed and fair review of the issues to determine what happened and what should have happened.

We will make sure staff involved in carrying out a closer look are properly trained to do so. We will also make sure they have:

• the appropriate level of authority and autonomy to carry out a fair investigation
• the right resources, support and time in place to carry out the investigation, according to the work involved in each case

Where possible, complaints will be looked at by someone who was not directly involved in the matters complained about. If this is not possible, we will explain to the person making the complaint the reasons why it was assigned to that person. This should address any perceived conflict of interest.

Clarifying the complaint and explaining the process

The staff member (or complaint handler) dealing with the complaint will:

• engage with the person raising the complaint to make sure they fully understand and agree:
  • the key issues to be looked at
  • how the person has been affected
  • the outcomes they seek
• signpost the person to support and advice services, including independent advocacy services, at an early stage
• make sure that any staff members or service providers subject to a complaint are made aware at the earliest opportunity (see support for staff below)
• agree a suitable timescale for how long the investigation will take with the person raising the complaint, depending on:
  • the content and complexity of the complaint
  • the work that is likely to be involved, including whether information will be required from a service provider
• agree how they will keep the person (and any staff or provider subject to the complaint) regularly informed and engaged throughout
• explain how they will carry out the closer look into the complaint, including:
  • what evidence they will seek and consider
  • who they will speak to
  • how they will decide if something has gone wrong or not
  • who will be responsible for the final response
  • how the response will be communicated
• explain (where we commission the service) if they will need to contact the provider of the service to request information, and obtain consent to do so.

Carrying out the investigation

Staff who carry out investigations will give a clear and balanced explanation of what happened and what should have happened. They will reference relevant legislation, standards, policies, procedures and guidance to clearly identify if something has gone wrong.

They will make sure the investigation clearly addresses all the issues raised. This includes:

• obtaining evidence from the person raising the complaint
• obtaining evidence from any staff member or service provider involved
• reviewing any relevant records and policies from commissioned services involved in the investigation

If the complaint raises clinical issues, they will obtain an independent clinical view from someone who is suitably qualified. Ideally, they should not have been directly involved in commissioning or providing the care or service that has been complained about.

We will complete our investigation within the timescale set out at the start of the investigation. Should circumstances change we will:

• notify the person raising the complaint (and any other parties to the complaint) immediately
• explain the reasons for the delay
• give a new target timescale for completion

We will aim to provide a full response to the person raising the complaint within 40 working days. Unless we have agreed a longer timescale with the person raising the complaint within the first 6 months, we will inform them if we cannot conclude the investigation and issue a final response within 6 months. Our responsible person or a senior manager will write to the person to explain the reasons for the delay and the likely timescale for completion. They will then maintain oversight of the case until it is completed and a final written response is issued.

Providing a remedy

Following the investigation, if the complaint handler identifies that something has gone wrong, they will seek to establish what impact the failing has had on the person concerned. Where possible, they will put that right, working with the provider of the service complained about if appropriate. If it is not possible to put the matter right, they will decide, in discussion with the person concerned, relevant staff and the commissioned service provider, what action can be taken to remedy the impact.

The following remedies may be appropriate to put things right:

• an acknowledgement, explanation and a meaningful apology for the error
• reconsideration of a previous decision made by us or the provider of the service
• expediting an action
• changing policies and procedures to prevent the same mistake(s) happening again and to improve our service for others
• in exceptional circumstances, such as in response to Parliamentary and Health Service Ombudsman recommendations, we may consider waiving a fee or making a redress payment.

The final written response

As soon as practical after the investigation is finished, the person carrying out the investigation will co-ordinate a written response, signed by our responsible person (or their delegate). They will send this to the person who raised the complaint and any other interested parties. The response will include (as appropriate):

• a reminder of the issues investigated and the outcome sought
• an explanation of how we investigated the complaint
• the relevant evidence we considered
• what the outcome is
• an explanation of whether or not something went wrong that sets out what happened compared to what should have happened, with reference to relevant legislation, standards, policies, procedures and guidance
• if something did go wrong, an explanation of the impact this had
• an explanation of how that impact will be remedied for the individual
• a meaningful apology for any failings
• an explanation of any wider learning we have acted on or will act on to improve our service for other users
• an explanation of how we will keep the person who raised the complaint involved until all action has been completed
• confirmation that we have reached the end of our complaint procedure
• details of how to contact the Parliamentary and Health Service Ombudsman if the individual is not satisfied with our final response
• a reminder of where to obtain independent advice or advocacy.

Support for staff and involving service providers

We will make sure all staff who look at complaints have the appropriate training, resources, support and time to respond to and investigate complaints effectively. This includes how to manage challenging conversations and behaviour.

We will make sure staff who are complained about are made aware. We will also give them advice on how they can get support from within our organisation and external representation if required. 

We will make sure staff and service providers who are complained about have the opportunity to give their views on the events and respond to emerging information. Our staff will act openly and transparently and with empathy when discussing these issues.

The complaint handler will keep any staff or service provider complained about updated. These staff and service providers will also have an opportunity to see how their comments are used before we issue the final response.

Referral to the Ombudsman      

In our response to every complaint we will clearly inform the person raising the complaint that they can take their complaint to the Parliamentary and Health Service Ombudsman if they are not happy with the outcome of our investigation.

If the complaint is about detention under the Mental Health Act, or a community treatment order or guardianship, we will inform the person making the complaint that if they are not happy with the outcome, they can take their complaint to the Care Quality Commission.

13 Complaints involving multiple organisations

If we receive a complaint that involves other organisation(s) (including cases that cover health and social care issues) we will make sure that we investigate in collaboration with those organisations. The people handling the complaint for each organisation will agree who will be the ‘lead organisation’ responsible for overseeing and co-ordinating consideration of the complaint. 

The person who investigates for the lead organisation will be responsible for making sure the person who raised the complaint is kept involved and updated throughout. They will also make sure that the individual receives a single, joint response.

14.Monitoring, demonstrating learning and data recording

We expect all staff and the services we commission to identify what learning can be taken from complaints, regardless of whether mistakes were made. 

Our senior managers take an active interest and involvement in all sources of feedback and complaints, identifying what learning will help improve our services and the services we commission for other users.

We maintain a record of:

• each complaint we receive
• the subject matter
• the outcome
• whether we sent our final written response to the person who raised the complaint within the timescale agreed at the beginning of our investigation

We measure our overall timescales for completing our consideration of all complaints and our delivery of the NHS complaint standards by seeking feedback on our service from the people who have made a complaint, any representatives they may have, staff who have been specifically complained about and from staff who carried out the investigation.

We monitor all feedback and complaints over time, looking for trends and risks that may need to be addressed.

As soon as practical after the end of the financial year, we will produce and publish a report on our complaint handling. This will include how complaints have led to a change and improvement in our services, policies or procedures.

15. Complaints about a private provider of our NHS services

This complaint handling procedure applies to all NHS services we commission. If the complaint relates solely to private healthcare, we will direct the complaint to the relevant process.

Where we commission the provision of NHS services from a private provider, we will ensure that they follow these complaint handling procedures.  

16. Equality impact assessment

As part of the development of this policy, its impact on equality has been analysed and no detriment identified.

Publication reference: PRN01453