Can I Help You? Guidance for handling and learning from feedback, comments, concerns or complaints about NHS health care services.

Part 1 - Introduction

1.1 Background

1.1.1 This document provides guidance for relevant NHS bodies and their health service providers, which will mainly consist of Primary Care Service Providers, on encouraging, handling and learning from feedback, comments, concerns and complaints received in relation to NHS treatment and care. Responsibility for the provision of healthcare for prisoners was transferred to Health Boards with effect from 1 November 2011. Feedback, comments, concerns and complaints from patients who receive NHS treatment within a prison health centre should therefore also be handled in accordance with this guidance.

1.1.2 The aim of the guidance is to support the development of a culture within NHSScotland that actively encourages and welcomes feedback and views from its users in order to learn from their experiences. A culture that values all forms of feedback whether this is good or bad. The guidance sets out the need for systems and processes to facilitate and support staff to capture, respond to, and learn from the spectrum of feedback from a range of people and sources in order to appropriately focus continual improvements in the delivery of quality care.

1.1.3 The focus is on early and local resolution where possible and on well trained staff being empowered to deal with feedback, comments, concerns and complaints where it is appropriate for them to do so.

1.1.4 The document is set out in four parts with additional supporting information given in Annexes A, B and C:

Part 1 Introduction, background, policies, legislation

Part 2 Encouraging, handling and learning from feedback, comments and concerns

Part 3 Encouraging, handling and learning from complaints

Part 4 Information that may be useful in the handling of feedback, comments, concerns or complaints

Annex A Patient Rights (Scotland) Act 2011 and Secondary legislation

Annex B Role of Feedback and Complaints Manager and Feedback and Complaints Officer

Annex C References and links

1.1.5 "Can I help you?" which should be read in conjunction with statutory provisions, provides further information in relation to the requirements outlined in the Patient Rights (Scotland) Act 2011 and the supporting Regulations and Directions. Individual relevant NHS bodies and their health service providers are responsible for ensuring the appropriateness of their actions and their interpretation of the associated legislation when dealing with feedback, comments, concerns or complaints.

1.2 Policies and strategies

1.2.1 The Better Health Better Care: Action Plan³ published in 2007, set out the Scottish Government's programme to deliver a healthier Scotland by helping people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care. The plan sets out actions to create a mutual NHS in order to:

• Strengthen public ownership of the NHS by improving rights to participate;
• Embed patient experience information in the performance management of the NHS; and
• Further strengthen the collaborative and integrated approach to service improvement that is the hallmark of Scotland's NHS.

1.2.2 The plan introduced Better Together⁴ Scotland's first patient experience programme which supports NHS Boards, frontline staff and patients in driving forward service improvement through the systematic collection and use of patient experience information. The programme also supports and facilitates the sharing of best practice across the NHS.

1.2.3 The NHSScotland Quality Strategy⁵ , published in 2010, is a development of Better Health, Better Care and aspires to create high quality person-centred, clinically effective and safe healthcare service that is world-leading in approach. Three Quality Ambitions - person-centred; safe and effective, provide the focus for everything NHSScotland does in its aim to deliver the best quality healthcare to the people of Scotland and, through this, make NHSScotland a world leader in healthcare quality. The Better Health Better Care Action plan also set out the vision for the development of the Patient Rights Act.

1.3 Previous research

1.3.1 The Making It Better⁶ research on patients and carers' experiences of the NHS complaints system has helped inform the development of the Patient Rights (Scotland) Act 2011 which provided an opportunity to be explicit in relation to the provision of feedback. The aim was to help address the concern and reluctance that many patients have expressed about raising issues or making complaints because of the effect this might have on their relationship with the healthcare provider and on their future treatment and care.

1.3.2 The research also indicated that differences between the relevant NHS bodies' hospital complaints processes and Primary Care Service Provider's complaints processes caused some confusion. There were concerns about the capacity to properly investigate a complaint about a Primary Care Service Provider within the shorter 10 day response timescale rather than the 20 days afforded to hospitals. The Patient Rights (Scotland) Act 2011, read together with the Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) (Regulations) 2012 aligns both procedures to 20 days and requires individual relevant NHS bodies to ensure that their respective health service providers have appropriate arrangements in place for the handling of feedback, comments, concerns and complaints.

1.4 The Patient Rights (Scotland) Act 2011

1.4.1 The Patient Rights (Scotland) Act 2011⁷ builds on existing policies, strategies and legislation in relation to the handling of feedback and complaints etc. The Act raises the status and focus of patient's rights and aims to improve patients' experience of using health services. Its implementation will be taken forward in conjunction with existing work, such as the NHSScotland Quality Strategy and the Better Together patient experience programme. The aim is to ensure that:

• patients recognise their rights and can access independent advice and support to help ensure these are met;
• patients work in partnership with staff to support their own health, where this is possible;
• staff fully recognise that patients have rights and feel comfortable with patients articulating them; and
• patients recognise and accept that they also have responsibilities to support their own health and in their use of the health care system treat staff with dignity and respect.

1.4.2 The Act introduces a right to provide feedback, comments, raise concerns and make complaints. It aims to underpin a person-centred NHS in which individual needs are considered and where patients feel that they have a say in their own treatment, and that their wishes are listened to and respected. It takes a principles based approach to patient rights and will have a positive effect on equal opportunities. The development and implementation of the Act has been informed by the context of equalities legislation⁸ , the Human Rights Act 1998⁹ , the European Convention of Human Rights¹⁰ , as well as Article 12 of the International Covenant on Economic, Social and Cultural Rights.

1.4.3 A number of provisions in the Act are central to this guidance document and are detailed below. Secondary legislation has also been developed in relation to aspects of the Act. For the purposes of this guidance, the Patient Rights (Complaints Procedure and Consequential Provisions) (Scotland) Regulations 2012 ("the Complaints Regulations")¹¹ and the Patient Rights (Feedback, Comments, Concerns and Complaints) (Scotland) Directions 2012 ("the Feedback, Comments Concerns and Complaints Directions") are of greatest relevance and are included at Annex A.

1.5 Patient Charter and Health Care Principles

1.5.1 The Act places responsibility on Scottish Ministers to publish a Charter of Patient Rights and Responsibilities by 1 October 2012. The purpose of the Charter is to set out a summary of the rights and responsibilities of patients using the NHS in Scotland, and of people who have a personal interest in such patients' welfare. This reflects a patient's right to be treated with dignity and respect; to have their privacy and confidentiality upheld; the right that the NHS services they receive take into account their individual needs, abilities and circumstances; the right to information and communication that helps them participate and make informed choices and decision about their health care; the right to give feedback, comments, concerns and complaints.

1.5.2 Care, compassion, understanding and empathy all contribute to the health care experience and can have a direct impact on outcomes for patients. It is also essential that we ensure that staff and health care practitioners are reciprocally treated with dignity and respect by patients. This is reflected in the Charter which sets out the responsibility on patients to treat staff with dignity and respect. This is also supported by the national Partnership Information Network (PIN) on Preventing and Dealing with Bullying and Harassment in NHSScotland¹² which sets out the right of all healthcare staff to be treated with dignity and respect in the workplace regardless of situation.

1.5.3 The Schedule to the Act reflects these rights and provides a set of Health Care Principles to be upheld by relevant NHS bodies, as well as relevant service providers to the NHS. In the context of the Health Care Principles, the reference to "relevant service providers" means any person with whom a relevant NHS body enters into a contract, agreement or arrangement to provide health care. This includes health care providers such as GPs, dentists, opticians, pharmacists, as well as other contractors such as cleaning or catering providers.NHSScotland. A link to the Act is included at Annex A.

1.6 Access to independent advice and support

1.6.1 The Act also provides for the establishment of the Patient Advice and Support Service (PASS) to provide independent advice and support services to patients and other members of the public in relation to the NHS in Scotland. In particular it will promote an awareness and understanding of existing rights and responsibilities and an awareness of the Charter. It will advise and support those who wish to give feedback, comments, raise concerns or make complaints about health care and will make them aware of other sources of advice and support such as advocacy, communication support and also the alternative dispute resolution services. Relevant NHS bodies and health service providers should make people aware of this service and promote its use. Further information is contained in Part 4 of this guidance.

1.7 Roles and responsibilities

1.7.1 The legislation sets out the requirement for each relevant NHS body and health service provider to appoint a Feedback and Complaints Officer. Relevant NHS bodies must also appoint a Feedback and Complaints Manager to ensure compliance with the arrangements. These roles will support operational and strategic implementation of the legislation and supporting guidance ensuring that a culture of valuing feedback and learning from it is embedded in their organisation. The size and nature of the health care provision will determine the overall remit of the post holders, how these roles are combined with other duties, and how many staff will be employed in the actual handling and investigation of feedback and complaints. Further guidance can be found in Annex B, Role of Feedback and Complaints Manager and Officer.

1.8 Training

1.8.1 Training, initially through induction, is key to ensuring that staff are empowered to handle feedback, comments, concerns and complaints if the procedures are to work effectively. Relevant NHS bodies and their health service providers have a responsibility to ensure that their staff are competent and confident, as appropriate to their role in dealing with feedback, comments, concerns and complaints in a manner that is person-centred and aims to resolve issues as they arise and to get it right first time. A two year education programme led by NHS Education Scotland (NES), the Scottish Public Services Ombudsman (SPSO) and Scottish Government Health and Social Care Directorates will be taken forward from 1 April 2012 to provide core education, training and learning materials for use by relevant NHS Bodies and Health service providers to support existing training and education programmes.

1.8.2 The development and improvement of these skills must be a high priority for those delivering NHS services. It is important that training is delivered via a range of approaches suitable for all front line staff. Related training in issues around equality and diversity are pre existing requirements for NHSScotland. Relevant NHS bodies and health service providers are encouraged to consider this related agenda when delivering any feedback, comments, concerns and complaints training.

1.9 Accountability

1.9.1 The legislation places an increased accountability on relevant NHS bodies for the annual publication of information about the feedback, comments, concerns and complaints they receive. These reports must also demonstrate to the public that action has been taken, where appropriate, as a result of the feedback etc to improve services. These reports must be easily accessible by the public and available in alternative formats if requested.

1.10 Role of the Scottish Public Services Ombudsman (SPSO)

1.10.1 The Public Services Reform (Scotland) Act 2010¹³ (PSR Act) gave the Scottish Public Services Ombudsman (SPSO) the authority to lead the development of simplified and standardised complaints handling procedures across the public sector. A Statement of Complaints Handling Principles¹⁴ was published by SPSO in January 2011 and this guidance reflects those principles. SPSO has also set up an internal unit, the Complaints Standards Authority (CSA), to lead the development of sector specific standardised complaints handling procedures. The CSA will work in partnership with NHSScotland to ensure our processes and procedures are in keeping with good practice on complaints handling. Further information is available at www.valuingcomplaints.org and in Part 4.