Everyone has the right to complain about their medical treatment. Usually, a patient only wants an explanation of what has occurred.

TThe Hospital Complaints Procedure

Most treatment received in hospital goes well, however what redress is available to those who are treated badly or worse, fall foul of medical negligence? Who do you complain to?

Do I have a right to complain?

All NHS organisations have a complaints procedure. If you are unhappy with the care or treatment you have received or you have been refused treatment for a condition, you have the right to complain.

Your complaint will be investigated and you should receive a full reply. A complaint can also be made on behalf of a patient or person, with their consent.

When it comes to making a complaint, the NHS constitution explains each individual’s rights:-

• You have the right to have your complaint dealt with efficiently, and properly investigated;
• You have the right to know the outcome of any investigation into your complaint;
• You have the right to take your complaint to the independent Parliamentary and Health Service Ombudsman if you’re not satisfied with the way the NHS has dealt with your complaint;
• You have the right to make a claim for judicial review if you think you’ve been directly affected by an unlawful act or decision of an NHS body, and to receive compensation if you have been harmed.

How do I make a complaint?

In April 2009, the NHS introduced a two-step procedure to be followed when making a complaint:-

Step One
• This stage is referred to as ‘Local Resolution’ and most cases are resolved at this stage:-
It begins when you first tell the organization what you are unhappy about and that you wish to complain. A complaint should be made ideally within twelve months of the incident happening or within twelve months of realizing you have something to complain about.

Who do I complain to?

You can complain either verbally or in writing directly to the organization that your complaint concerns eg, GP Surgery. Ask to speak with the Complaints Manager or Practice Manager for practice specific details. You can also send a copy of your letter of complaint to the chief executive of your local Primary Care Trust (PCT). For hospital trusts you can write directly to the chief executive of the relevant NHS Trust.

Once your complaint is received, the Complaints Regulations states that organisations should:-

- Acknowledge your complaint either verbally or in writing within three working days;
- Offer to contact you to discuss your complaint; arrange a ‘plan of action’ to help resolve your concerns and agree a timescale with you to revert back with updates and keep you informed of progress;
- Contact you to agree an amended timescale if necessary;
- Carry out an investigation into the issues/concerns raised;
- Offer individual assistance to enable you to understand the Complaints Procedure.

Once investigations have been completed, you should be informed of the findings in writing. In some cases a meeting is offered to discuss this.

The letter of response should include a summary of your complaint, what the investigation found and an explanation of the next steps available to you should you be dissatisfied with the answers given.

The letter may also contain an apology and an explanation of future action to be taken, the individual responsible for carrying out this action and details of when it will be completed. The letter may also detail steps which have since been taken to prevent the same concern happening again.

If you do not receive a response to your letter within six months of your original complaint and the organization has not agreed an extension to the six month period, you are able to refer your complain directly to the Ombudsman.

Step Two

• If you are unhappy with the response to your complaint after local resolution you may then commence the second stage, in which you refer your complaint to the Parliamentary and Health Service Ombudsman (PHSO). The PHSO is independent of the NHS and government. It is a free service and is open to everyone.

It is important to note however that the Ombudsman will normally only take on a complaint after
you have first tried to resolve the complaint with the organisation involved and have received a response from them.
Once your complaint is received by the PHSO you should receive an acknowledgement within two working days and a case specific reference number. Your complaint will then be reviewed.
The Ombudsman can only investigate complaints where they have the legal power to do so. There is therefore no automatic right for your complaint to be investigated but if it isn’t, you will be provided with a full reason behind the decision.
If you are still unhappy after you have completed this process, then you could consider contacting your local MP to refer the complaint onwards.

Help and support available?

Should you at any time feel unable to deal with matters by yourself, the Patient Advisory and Liaison Service (PALS) are available to help. PALS have officers available in all hospitals. Your concerns will be discussed with you and help and support provided by PALS staff. If a complaint is necessary, relevant information and support will be provided to you and the current complaints process will be followed.
An alternative organization to consider is the Independent Complaints Advisory Service (ICAS) which provide independent advice outside of the NHS.
You will not receive any financial compensation through the NHS complaints procedure. If you wish to pursue financial compensation, you will need to take legal advice on making a medical negligence claim.

What if I have Private Healthcare?

The Health Care Commission assumed responsibility in 2004 for regulating and inspecting the independent health care sector. Under the Commission’s inspection requirements, all private hospitals must have a complaints procedure and be able to provide information to their patients about how to complain. Unfortunately, as there is no standard complaints procedure for private healthcare, you must rely on each individual hospital/clinic’s in-house complaints system.

Ask for a copy of the hospital or insurance company’s complaints procedure and, if you are making a formal complaint, keep a record of all correspondence (phone calls, letters, emails, face to face conversations, names, dates and times) as you may need to refer to these at a later date.

For private treatment paid for by the NHS you must still follow the private company’s complaints procedure but you can complain to the NHS if you are unhappy about how the private treatment was arranged by the NHS.