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

Part 3 - Encouraging, handling and learning from complaints

Detailed guidance on how to manage the process when complaints are received is given in this section. The key points are:

• A complaint, which can be made orally or in writing, is defined in the SPSO Model Complaints Handling Procedure as 'an expression of dissatisfaction about an action or lack of action or standard of care provided'
• Staff of relevant NHS bodies and health service providers will need to use their judgement and in the case of concerns should give individuals the opportunity to consider whether they want the issue to be considered under the complaints procedure rather than the arrangements for handling feedback, comments or concerns
• Complaints can be raised by patients, on behalf of patients or by anyone who is, or is likely to be affected by an action or omission of the NHS
• Where a complaint is made on behalf of a patient, in accordance with their duties under confidentiality laws and Article 8 of the ECHR, relevant NHS bodies and health service providers are expected to ascertain whether the patient has consented to that complaint being made. In circumstances where no such consent has been given, the body would have to take that into account when handling and responding to the complaint (and is likely to be constrained in what it can do in terms of investigating any such complaint)
• Generally complaints should be made within six months from the date on which the matter of the complaint comes to the complainants notice, provided that this is no later than 12 months after the date on which the matter of the complaint occurred
• Complaints must be acknowledged in writing within three days and investigated within 20 working days or as soon as reasonably practicable
• The Complaints Regulations set out how complaints are to be handled and how to deal with complaints that are not to be investigated under the NHS Complaints procedure. These are generally areas where a different policy or procedure will apply for example in the case of a disciplinary investigation
• The complaint must be investigated appropriately
• Complainants are to be informed of the support available through the Patient Advice and Support Service (PASS)
• Alternative Dispute Resolution Services in the form of mediation or conciliation may be used where both parties feel this would help resolve the complaint
• Where something has gone wrong a meaningful apology can help both sides by calming emotions and allowing them to move on to put things right. It is often the first step to repairing a damaged relationship; and
• When two bodies are involved in the complaint they will work together to investigate and respond to the complaint

3.1 Background

3.1.1 As previously mentioned the Patient Rights (Scotland) Act 2011 provides for the encouragement of feedback, comments, concerns and complaints with the aim of supporting a culture that actively encourages and welcomes views whether these are good or bad. Complaints should be valued alongside all of the other forms of feedback etc and actively welcomed and encouraged to help in continuous improvement in the way NHS services are delivered. This will also help to maintain the quality and safety of NHS services. It should always be the intention for the healthcare provider to handle the complaint as quickly and closely to the point of origin as possible. The emphasis will be on early and local resolution ensuring that learning is shared and improvements acted upon as soon as possible after the issue that gave rise to the complaint. The Complaints Regulations and Directions set out the steps to be followed in the handling and investigation of complaints. This section gives structured support to healthcare providers and their staff on the handling of complaints.

3.1.2 As highlighted earlier in Part 1, the 2009 Making it Better report suggested that people are often reluctant to make a complaint about the services provided by NHSScotland because they are concerned about the consequences. It is therefore important that local procedures and processes in relation to complaints provide re-assurance to anyone raising a complaint that it will be handled consistently across the whole of the NHS in Scotland.

3.2 Definition of a complaint

3.2.1 A complaint, which may be made orally or in writing, is defined by the SPSO Model Handling Complaints Procedure as 'an expression of dissatisfaction about an action or lack of action or standard of care provided'¹⁷ . There may also be circumstances where anonymous feedback, comments, concerns or complaints from a service user highlights a serious issue and an investigation may be appropriate.

3.3 What does the complaints procedure cover?

3.3.1 The potential subject of a complaint, as with any form of feedback etc is wide and not just related to the provision of health care. Each complaint must therefore be taken on its own merit and responded to appropriately.

3.3.2 As set down by the Patient Rights (Scotland) Act 2011 and the supporting Complaints Regulations and Directions a patient (or someone acting on their behalf) or any person who is affected by or likely to be affected by an action or omission of a relevant NHS body or health service provider may raise complaints about NHS services provided by (for example):

• Hospitals and health centres
• Prison healthcare centres
• Health service providers*
• Community Services who provide health services such as community dentists, community nurses, physiotherapists, dieticians or health visitors etc in private hospitals or care homes in which the patient is funded by the NHS
• NHS funded catering, domestic and environmental matters

*where the complainant is uncomfortable making the complaint directly to the Health service provider the complaint can be made to the appropriate relevant NHS Body directly. As a matter of best practice the relevant NHS body and Health service provider should agree locally the management of the complaint under these circumstances and advise the complainant accordingly.

3.4 Issues handled under other procedures and processes

3.4.1 Members of the public, including patients, may raise concerns with relevant NHS bodies or their health service providers, which need to be addressed, but which are not appropriate for an investigation under the NHS Complaints Procedure. Part 2 of this document provides guidance in relation to dealing with feedback, comments and concerns. Complainants should be informed that complaints which fall within the following areas are dealt with under other policies and procedures:

• complaints from one relevant NHS body to another in relation to any matter connected with the exercise of that body's functions
• a complaint made by a service provider which relates either to any matter connected with the contract or arrangement under which the service provider provides health services
• a complaint made by an employee of a relevant NHS body or health service provider in relation to any matter relating to the employment contract
• a complaint that is being or has been investigated by the Scottish Public Services Ombudsman (SPSO)
• a complaint arising from an alleged failure to comply with a request for information under the Freedom of Information Act 2002¹⁸
• a complaint about which a complainant has stated in writing that they intend to take legal proceeding
• a complaint about which a relevant NHS body or health service provider is taking or proposing to take disciplinary proceedings in relation to the substance of the complaint against the person who is the subject of the complaint; and
• a complaint which has already been investigated under the current or a former NHS complaints procedure.

3.4.2 If a complaint is received on any of these matters the member of staff receiving the complaint should immediately refer the matter to the appropriate person. In accordance with the Complaints Regulations the complainant must be informed in writing as soon as reasonably practicable that the complaint will not be investigated under the NHS Complaints procedure and given information as to the appropriate procedures to be followed for raising such a complaint. Where a relevant NHS body or health service provider considers that an aspect of such a complaint could be investigated under the NHS Complaints Procedure, the body or provider should satisfy itself that this would not compromise or prejudice the matter being investigated under separate arrangements.

3.4.3 Care Homes

3.4.3.1 Where a relevant NHS body or a service provider is advised of a complaint about a regulated care home, the person making the complaint should be advised that this should be raised with the care home in the first instance. If this has been done or the person making the complaint considers that it would be inappropriate to do so, they should be referred to the Care Inspectorate. If the Care Inspectorate¹⁹ investigates, they will liaise directly with the person making the complaint and any NHS service provider named in the complaint.

3.4.4 Private Healthcare

3.4.4.1 Where an NHS body or health service provider is advised of a complaint about a private healthcare provider, private clinic or hospice it should advise the complainant that this should first be raised with the provider directly. If the complainant has done this and is still dissatisfied they can be referred to the regulatory body Healthcare Improvement Scotland²⁰ who will investigate how the complaint was handled by the provider only.

3.4.4.2 Complaints in relation to private dental services should also be referred to the provider directly or the Dental Complaints Service²¹ .

3.4.4.3 The exception is where these private healthcare services have been commissioned by a relevant NHS Body and are being provided as part of the patient's NHS treatment and care. In these circumstances they would be handled by the relevant NHS Body in accordance with the Complaints Regulations and Directions (as supported by this Guidance).

3.4.5 Whistle blowing

3.4.5.1 NHSScotland's freedom of speech policy is contained within the implementing and reviewing whistle blowing arrangements Partnership Information Network (PIN) Policy. This sets out the arrangements and procedures for staff wishing to raise concerns about the service in a confidential way. Encouraging staff to raise any serious concern they may have about malpractice or serious risk as early as possible, and responding appropriately, is integral to achieving a safe quality focused NHSScotland. The early identification of problems or concerns by staff allows relevant NHS bodies to deal with issues before any damage is done.

3.4.5.2 All relevant NHS bodies have in place a freedom of speech policy based on the PIN. In the PIN and in the individual relevant NHS body's policies, it is emphasised that the relevant NHS body will not tolerate harassment or victimisation of any member of staff who raises a concern (including informal pressure). Any instance of such behaviour will be treated as a serious disciplinary offence under the management of conduct arrangements.

3.5 Complaints that span more than one service or sector

3.5.1 Two NHSScotland bodies

3.5.1.1 Where a complaint relates to the actions of two or more NHSScotland bodies, (e.g. two relevant NHS bodies, or a Primary Care Service Provider and a relevant NHS body) best practice is that there should be agreement about who will take the lead in co-ordinating the complaint. The organisations are expected to co-operate fully throughout the investigation and share learning from the investigation and outcome.

3.5.1.2 The person making the complaint must be informed who will take the lead in dealing with the complaint and be advised that where possible a joint response will be provided. In cases where a joint response is not possible the two organisations should work together to ensure that there is consistency in the responses provided.

3.5.2 Two public sector bodies

3.5.2.1 Given the increasing shared agenda for health and social care, particularly in relation to older peoples services where a patient receives health and social care services while living in the community, the relevant NHS body and the local authority social work department should agree who will take the lead. They should work together to ensure that all matters raised are investigated simultaneously to consistent timescales. It is recognised that different complaints handling processes currently exist for NHS and social care services and the complainant should be advised of this particularly where this may impact on the timescales for responses. Learning and opportunities for improvement should also be shared between the two organisations.

3.5.2.2 The person making the complaint must be informed who will take the lead in dealing with the complaint and be advised that, where possible, a joint response will be provided. In cases where a joint response is not possible the two organisations must work together to ensure that there is consistency in the responses provided.

3.5.2.3 A situation may also arise where a complaint raised by a patient in relation to treatment received in a prison health centre also raises issues which are not health related and should be investigated by the prison service rather than the NHS. The health care staff should identify these quickly and advise the patient how their complaint will be handled.

3.6 Timescales for making a complaint

3.6.1 Complaints are normally made at the time an individual becomes aware of an issue. They should be dealt with immediately to reduce the chance that the passage of time, with inevitable staff changes, could hamper its satisfactory investigation and resolution and to implement rapid improvement programmes as necessary.

3.6.2 However, it is not always possible to make a complaint immediately. In clinical complaints, for example, a complication or other issue may not become apparent for sometime after the procedure. Similarly the grief associated with the death of a patient may make it difficult for their representatives or family members to deal with a complaint in the period immediately after the death.

3.6.3 Given the difficulties that the passage of time can make to the resolution of a complaint the timescale for accepting a complaint as set out in the regulations is within six months from the date on which the matter of the complaint comes to the complainants notice, provided that this is no later than 12 months after the date on which the matter of the complaint occurred. The timescale for acceptance of a complaint may be extended if the feedback and complaints officer considers it would be reasonable in the circumstances.

3.6.4 Where a decision is taken not to extend these timescales and the person raising the complaint is dissatisfied with the decision they may appeal to the Scottish Public Services Ombudsman to consider.

3.7 Roles and responsibilities

3.7.1 Although it is recognised that complaints will be managed, in most circumstances, by a multi disciplinary team made up of those who are best placed to investigate complaints it is important that there are technically competent staff that can support and administer the process and assume accountability for its management.

3.7.2 The legislative requirement for the appointment of Feedback and Complaints Manager and a Feedback and Complaints Officer in terms of the Complaints Regulations are outlined in Part 1. Further detail on the responsibilities and remit for the post holders are given in Annex B.

3.8 Managing the complaints process

3.8.1 First point of contact

3.8.1.1 The majority of written complaints will be addressed directly to the Feedback and Complaints Officer or Manager but this may not always be the case.

3.8.1.2 As described in Part 2 complaints can be made to any member of staff therefore everyone needs to be mindful of the importance of the first contact on that complaint. At the outset of any investigation it is important to ensure that the complainant feels listened to and understood as well as being provided with clarity on the process that will be followed in handling their complaint. It is the nature of the complaint (i.e. non-complex/non-contentious), rather than the means by which it is presented, that should determine whether a complaint can be handled immediately and directly by the member of staff or whether it should be referred to the complaints officer.

3.8.1.3 Where a complaint is made to a member of staff their first responsibility is to ensure that the patient's immediate health care needs are being met if relevant at the time the complaint is made. The member of staff receiving the complaint should involve the person making the complaint from the outset. They should establish whether they wish the matter dealt with under the NHS Complaints Procedure by explaining the process to them as far as they are able to. In some cases this may mean signposting the person to the feedback and complaints officer or the PASS. The staff member should involve the feedback and complaints officer and confirm to the complainant that they will receive an acknowledgement and further information and guidance at the point an investigation is launched.

3.8.1.4 It is also important to ask the complainant what they want to happen as a result of the complaint to establish whether those expectations can be met. It has been suggested that a common weakness of many local procedures was seeking to investigate and respond to a complaint without first establishing the outcome the person making the complaint would wish. If their expectations are entirely unrealistic, it is important to say so up front to minimise further disappointment.

3.8.1.5 Where a complaint is made on behalf of somebody else, it will be important to determine whether the person on whose behalf the complaint is being made has consented to the complaint being made as this will obviously have an impact on the way in which the complaint may be handled. Further information in relation to consent is found in Part 4.

3.8.1.6 At the outset each relevant NHS body and health service provider must ascertain the complainants preferred method of communication and where practicable and in keeping with patient confidentiality communicate in this way. Communication may be sent to the complainant electronically where they have consented to this and the consent has not been withdrawn. When complaints are made by patients in a prison healthcare setting staff should be aware that access to certain forms of communication and information may be restricted for security reasons. Staff should seek advice from their Feedback and Complaints Manager or Feedback and Complaints Officer if they have any queries.

3.8.1.7 Where a complaint is reasonably straight forward and non complex it may be managed without the requirement for a detailed investigation. If the complaint has been successfully resolved to the complainants' satisfaction within 3 working days and the outcome has been communicated to the complainant either by face-to-face, telephone or email communication, there is no additional requirement to send further written confirmation or carry out an investigation. Complaints that fall within this category must be recorded as normal to support organisational learning.

3.9 Acknowledging a complaint

3.9.1 Complaints that cannot be resolved within 3 working days as described above should be acknowledged within 3 working days of receipt using the complainants preferred method of communication.

3.9.2 As a matter of best practice on receipt of a complaint about treatment provided to a patient within a Prison Health Centre the Centre staff should copy the complaint to their relevant NHS body to allow an acknowledgement to be sent and for recording, monitoring and progress of the investigation and response.

3.9.3 The Complaints Directions set out what must be included in a written acknowledgement of a complaint, which is as follows:

• contact details of the feedback and complaints officer
• details of the advice and support available to the complainant including the PASS
• information on the role and contact details for the SPSO; and
• a statement confirming that the complaint will normally be investigated within 20 working days or as soon as reasonably practicable (and where it is not possible to send a report within 20 working days, the complainant will be provided with an explanation as to why there is a delay and, where possible, provided with a revised timetable).

In addition, the following general information may be helpful (although this list is not intended to be prescriptive as each complainant will require an individual response):

• thank the complainant for raising the matter
• summarise the understanding of the complaint made (this may have been confirmed with the complainant via telephone prior to the acknowledgement being issued)
• where appropriate the initial response should express empathy and acknowledge the distress caused by the circumstances leading to the complaint
• outline the proposed course of action to be taken or indicate the investigations currently being conducted stressing the rigour and impartiality of the process
• offer the opportunity to discuss issues either with the investigation officer, the complaints staff or, if appropriate, with a senior member of staff
• request that a consent form is completed where necessary advising that the investigation will not commence until the necessary consent is obtained (see Part 4)
• provide information on alternative dispute resolution services and other support service such as advocacy. Further information can be found in Part 4
• provide a copy of the "patient guide to complaints" if this has not already been issued; and
• advise that if email is the preferred method of communication consent for this must be given in writing and once done will remain the method of communication until such time as consent is withdrawn.

3.10 The Investigation

3.10.1 Complaints handled by full investigation are typically those that are complex or require a certain amount of examination to establish the relevant facts before a response can be provided. At the investigation stage, staff should also be aiming to 'get it right first time'. Their goal is to establish all of the facts relevant to the points raised and provide a full, objective and proportionate response that represents the definitive position. The feedback and complaints officer and manager or the staff nominated to act on their behalf, will be the main sources of expertise in the organisation, will oversee the investigation team and in most cases provide a main point of contact for the complainant.

3.10.2 The Feedback and Complaints Officer or the person authorised to act on his or her behalf will form an investigation team of the most relevant people to investigate the complaint and then support the investigation team staff to plan their approach. The investigation team will take into account the facts of the case, the resources at their disposal and the precedents set and lessons learned from previous cases to ensure the most efficient and effective approach to investigation of the complaint.

3.10.3 The investigation team may consider:

• face-to-face meetings
• written statements which can be helpful where staff have left the organisation or are on extended leave; and
• alternative dispute resolution services in the form of mediation or conciliation (see below)

3.10.4 It is important to ensure impartiality in an investigation. The investigating officer must approach the complaint with an open mind, being fair to all parties. The investigation should not be adversarial and should be conducted in a supportive, open and transparent atmosphere that demonstrates the principles of fairness and consistency. Anyone identified as the subject of a complaint should be provided with a full account of the reasons for the investigation and an opportunity to talk to the investigating officer who should ensure they are kept informed of progress.

3.10.5 Where it becomes evident during the course of an investigation that another process should be used (e.g. disciplinary process) and the complaint is no longer a complaint which can be investigated under the NHS Complaints Procedure (see 3.4), the complainant must be informed of this as soon as reasonably practicable. In such circumstances, best practice would be to compile a report of the investigation thus far. Where appropriate, this report should be made available to the person making the complaint, with, where possible, an indication of the expected timeframe for the other investigation process. The report should balance the need to provide reassurance that their complaint has been dealt with thoroughly and satisfactorily, with the need to protect the right of staff to confidentiality. The guiding principle should be that the person making the complaint should receive the same consideration and information as if the matter had been dealt with under the complaints procedure, where this is appropriate. Any outstanding unresolved element of the complaint may recommence when the other investigation has concluded.

3.11 Alternative Dispute Resolution (mediation or conciliation)

3.11.1 The Complaints Directions also require relevant NHS bodies to consider and make provision for alternative dispute resolution services such as mediation or conciliation to help resolve complaints where this considered appropriate and agreed by the parties involved. The Directions also provide that where a Primary Care Service Provider requests alternative dispute resolution services the relevant NHS body is required to provide these services.

3.11.2 Some types of complaint are not easily resolved through written correspondence. Mediation or conciliation (referred to from now on as alternative dispute resolution) can be an effective tool in resolving dissatisfaction and can defuse problems before they escalate. Where parties agree, alternative dispute resolution can be used to facilitate communication between the complainant and the organisation that they are complaining about, helping all concerned to get to the real issues and underlying issues. Alternative dispute resolution allows the complainant to voice their concerns in a safe and respectful setting, while also offering those complained about the opportunity to explain their actions and offer an apology where appropriate.

3.11.3 Alternative dispute resolution providers ("ADR providers") appointed by relevant NHS bodies must be appropriately trained and qualified to perform the role. The Complaints Directions require that relevant NHS bodies appoint adequate numbers of ADR providers for a period to be agreed between the relevant NHS Body and the ADR provider of not more than one year (without prejudice to any re-appointment). A pool of ADR providers may be appointed and organised jointly between relevant NHS bodies.

3.11.4 Each relevant NHS body must, after consultation with any relevant area professional committee²² establish and maintain a list of persons from among whom an ADR provider may nominate a person ("a professional adviser") to assist them in the process of alternative dispute resolution. The nominated professional adviser must be a member of the same profession as the person who performed the service which is the subject of the complaint.

3.11.5 The benefits of alternative dispute resolution:

• It provides an efficient and fair process;
• It enables both parties to understand what is driving the complaint;
• It is more likely to result in mutually satisfactory solutions being reached or special arrangements being made and put in place quickly; and
• It often results in improved relationships and increased satisfaction rates.

3.11.6 It is acknowledged that the process of organising and facilitating alternative dispute resolution may mean that the 20 day timescale for completion will not be met and as such mediation is considered an allowable reason to extend the 20 day investigation period.

3.11.7 Information and guidance on arrangements for the provision of and the requirement for follow up reports after mediation have been developed and can be obtained from Feedback and Complaints handling staff or on the NCPAS²³ website which has a host of information relating to complaints handling for NHSScotland.

3.12 Report of the Investigation

3.12.1 In terms of best practice, for relevant NHS bodies, the complaints process should always be completed by the Feedback and Complaints Manager (or someone authorised to act on his or her behalf) reviewing the case to ensure that all necessary investigations and actions have been taken. For health service providers this will be the Feedback and Complaints Officer or someone nominated to act on his or her behalf. Where the complaint involves clinical issues, the draft findings and response should be shared with the relevant clinicians to ensure the factual accuracy of any clinical references.

3.12.2 If the Feedback and Complaints Manager/Officer is satisfied that the investigation process has been completed and that it has fully addressed all the issues raised, they should issue the report of the investigation. In accordance with the Complaints Directions, the report must include the conclusions of the investigation and information as to any remedial action taken or proposed as a consequence of the complaint. The quality of the report is very important and in terms of best practice should:

• be clear and easy to understand, written in a way that is person-centred and non confrontational;
• avoid technical terms, but where these must be used to describe a situation, events or condition, an explanation of the term should be provided;
• address all the issues raised and demonstrate that each element has been fully and fairly investigated;
• include an apology where things have gone wrong (see 3.12.5);
• highlight any area of disagreement and explain why no further action can be taken;
• indicate that a named member of staff is available to clarify any aspect of the letter; and
• indicate that if they are not satisfied with the outcome of the local process, they may seek a review by the Scottish Public Services Ombudsman - details of how to contact the Ombudsman office should be included in the response.

3.12.3 In drafting and finalising the report, relevant NHS bodies and health service providers must of course be mindful of their general obligation to act in accordance with the European Convention of Human Rights, or any other relevant law such as the Data Protection Act 1998.

3.12.4 As described earlier the feedback and complaints manager can delegate or nominate a senior officer to act on their behalf. Where this is the case corporate and clinical governance arrangements should be made to ensure that the feedback and complaints manager can maintain an overview of the issues raised in complaints, the responses given and be assured that appropriate organisational learning has taken place.

3.12.5 Once the final report has been signed and issued, the complaints handling staff should file all correspondence, liaise with local senior managers to ensure that all necessary follow-up action is taken, for example sharing the outcome with those named in the complaint as appropriate and providing any necessary staff support or counselling. In the interests of patient confidentiality, it might not be appropriate to copy the response letter to all those involved in the investigation, but general feedback on the main conclusions and actions should be given as appropriate. In more serious cases a formal debrief for the staff involved in the complaint may be appropriate.

3.12.6 A meaningful apology where appropriate can help both sides by calming emotions and allowing them to move on to put things right. It is often the first step to repairing a damaged relationship. It can help to restore dignity and trust. It says that both sides share values about appropriate behaviour towards each other and that when they do not behave in line with those values it is appropriate to express regret. An apology in itself need not amount to an admission of negligence or breach of statutory duty. Further information on providing a meaningful apology can be found in the Scottish Public Services Ombudsman guidance on apology.²⁴

3.13 Timescales

3.13.1 It is important that a timely and effective response is provided in order to resolve a complaint, and to avoid escalation. Investigation of a complaint should therefore be completed and a response issued, wherever possible, within 20 working days following the date of receipt of the complaint.

3.13.2 There may be circumstances where some complaints are so complex in nature that the detailed investigation takes longer than 20 working days. Difficulties accessing relevant staff and the use of alternative dispute resolution are examples of situations which may make it difficult to meet the 20 working day target

3.13.3 Where it appears the 20 working day target will not be met, the person making the complaint, their representatives if appropriate and anyone named in the complaint, must be informed of the reason for the delay with an indication of when a response can be expected. The letter should also indicate that the Ombudsman may be willing to review the case at this stage if they do not accept the reasons for the requested extension. .

3.14 Record keeping

3.14.1 Staff should ensure that all complaints are recorded even those resolved to the complainants satisfaction within 3 working days (although these do not require an acknowledgement or a written report of the investigation to be sent to the complainant). All information relevant to complaints including the investigation process is recorded as statistics from this data will be required for quarterly and annual reporting in an anonymous form. The Information Services Division's (ISD), recognised national coding ²⁵ must be used for recording of complaints ensuing the minimum dataset is always recorded to ensure the comparability of the data from year to year. Further detail can be obtained from the feedback and complaints officer.

3.14.2 If, subsequently, the complaint is referred to the Ombudsman, this may result in a request for all relevant papers and other information to be provided in good time to the Ombudsman's office. Complaints records should be kept separate from health records, subject only to the need to record information which is strictly relevant to the patient's health in their health record. These documents should be managed with regard to the 2011 Records Management Code of Practice.²⁶

3.15 Unreasonable complaints

3.15.1 Staff should be trained to respond with patience and empathy to the needs of people who make a complaint, however there will be times when there is nothing further which can reasonably be done to assist them or to rectify a real or perceived problem. People may act out of character in times of trouble or distress. If there have been upsetting or distressing circumstances leading up to a complaint, in a small number of cases this can lead to a patient, carer or service user acting in an unacceptable way. Examples of behaviour that may be considered unacceptable include:

• persistent refusal to accept a decision made in relation to a complaint; persistent refusal to accept explanations relating to what can or cannot be done about the complaint, and continuing to pursue a complaint without presenting any new information
• Aggressive or intimidating behaviour towards staff

3.15.2 Behaviour should not be viewed as unacceptable just because a patient, carer or service user is forceful or determined. In fact, being persistent can be a positive advantage when pursuing a complaint. However, the actions of people who are angry, demanding or persistent may result in unreasonable demands on time and resources or unacceptable behaviour towards staff. NHSScotland seeks to protect their staff and alongside the national Partnership Information Network (PIN) guidance on Preventing and Dealing with Bullying and Harassment in NHSScotland²⁷ and NSH bodies and health service providers should have policies and procedures in place for managing persistent or unreasonably demanding complainants. Guidance on the formulation of this policy can be found in the SPSO Guidance on a model complaints handling procedure.

3.16 Monitoring of complaints, learning and improvement

3.16.1 In accordance with the Complaints Directions, relevant NHS bodies and in turn their health service providers are required to make arrangements to monitor how they, or those providing health services on their behalf deal with the complaints they receive. In so doing relevant NHS bodies should identify areas for action in relation both to improvement. In taking this forward, such bodies must be mindful of their obligations in terms of ECHR, confidentiality law and the Data Protection Act 1998.

3.16.2 An increase in the number of complaints should not in itself be a reason for thinking the service is deteriorating. It could mean that the NHS body's or the health service provider's arrangements for handling patient feedback, comments, concerns and complaints are becoming more responsive. The important point is to ensure that complaints (and feedback, comments and concerns) are handled sympathetically, effectively and quickly and that lessons are learned and result in service improvement.

3.17 Quarterly reports

3.17.1 In accordance with the Complaints Directions, relevant NHS bodies have a responsibility to gather and review information from their own service and their health service providers on a quarterly basis in relation to complaints and those providers have a duty to supply this information to their relevant NHS body as soon as is reasonably practicable after the end of the 3 month period to which it relates. Data required for these quarterly reports is outlined below:

• numbers of complaints received;
• number of complaints where alternative dispute resolution was used;
• whether the best practice response period of 20 working days was complied with;
• summarise the key themes of complaints received; and
• summarise what action has been taken to improve services as a result of complaints.

3.18 Review by Senior Management

3.18.1 Each relevant NHS body must ensure that the feedback and complaints manager or someone senior acting on his or her behalf is involved in a review of the quarterly reports at least twice a year with a view to identifying areas of concern, agreeing remedial action and improving performance. Where appropriate, the review must also consider any recommendations made by the SPSO in relation to the investigation of NHS complaints.

3.19 Publication

3.19.1 Relevant NHS bodies must publish anonymous details annually on patient feedback, comments, concerns and complaints which provides evidence that action is or has been taken, where appropriate, to improve services and show where lessons have been learned. The reports must be easily accessible to members of the public and available in alternative formats as requested. These annual reports will build on the complaints data collected each quarter from each NHS body's own services and those of the health service providers in their respective area. Data required for the annual report includes:

• numbers of complaints received;
• number of complaints where alternative dispute resolution was used;
• whether the response period of 20 working days was complied with

a summary of the key themes of complaints received;

• a summary of what action has been taken to improve services as a result of complaints; and
• a summary of what action has been or is to be taken to improve services as a result of feedback, comments and concerns.

3.19.2 The Complaints Directions set out that the details of the publication must be sent to Scottish Ministers, the relevant PASS, Healthcare Improvement Scotland (to inform improvement, scrutiny and assurance activity), SPSO and where appropriate the Scottish Prison Service.

3.20 National Monitoring

3.20.1 In accordance with the Complaints Directions complaints statistics gathered through the quarterly reports referred to at paragraph 3.17 must be submitted by relevant NHS bodies to the The Information Services Division (ISD), a Division of NHS National Services Scotland, within 3 months of the year end²⁸ to which the details relate. The information must be in an appropriate format to allow collation and publication of national complaints statistics.