NHS Complaints and Pals Advice

How to Complain to the NHS.

Introduction to NHS Complaints 1. The need for a Complaints Service.

There is perhaps no surprise in the fact that the NHS pours millions of pounds into its complaint process. There is a whole industry of “quality managers” – “resolution workers” – Complaints officers and other such titles. They all have their own strengths and weaknesses but overall, they have just one aim, to reduce patient complaints. The NHS is a huge organisation and has more high level interactions with its patients than any other organisation on earth. Few people can properly comprehend the sheer size of the NHS. Did you know for instance, that if the NHS were a country, the size of its economy would be larger than that of the entire of Romania and Bulgaria? With such an organisation, it is inevitable that some people will simply not get the level of service that they expect. If there is a surprise here, it is that the NHS doesn’t actually get more complaints. There is it should be said, an old saying in the world of complaints handling;

If there are no complaints from your customers- its because people have ceased to care…

Here is the truth of all complaints, if done properly and handled properly, it’s not just about you and your grievance, its about avoiding reputational damage that these events cause and making the system better, better for everyone as the circumstances may be avoided in the future. You, therefore, do not just have the right to make a complaint about any aspect of NHS care, treatment or service, you almost have an obligation to do so. You know as well as I however, that this process is stealth combat and to get our point across will take cunning, persistence and resilience. Some of the NHS complaints / quality officers have one aim in mind that is simply to get you to give up and accept that you are wrong or that the process has “done the right thing”

What is my authority to make a NHS complaint?

NHS Complaints 2. Is there a legal basis that governs patient complaints.

You as a patient or even on behalf of a patient, you have the absolute right to make a NHS complaint about any aspect of NHS care, treatment or service. That includes NHS Dental Treatment. Whilst many people doubt this, authority can be found in the NHS constitution. (I shall refer to the constitution for England here but I will add devolved institutions below for Wales, Northern Ireland and Scotland). The constitution sets out the appropriate rights for patients, public and in fact even for its own staff. It outlines the various NHS commitments to patients and any responsibilities that the public, patients and staff owe to one another. This network of obligations in fact sits at the heart of the NHS culture (well its supposed to do that anyway). The constitution is filled with pledges, promises, values and commitments. Sounds impressive doesn’t it.

What you will not find though, no matter how far or deep you look, are RULES. make no mistake, while the rhetoric will always be about resolution, understanding and improvement. what they really want is as few justified complaints as possible. Quite right too – after all how else would they measure success? – When was the last time you gave positive feedback? About anything?

It is worth noting, though, particularly as the 21st Century proceeds at its current galloping pace, all NHS private and third sector providers supplying NHS services are required by law, to take account of the constitution in their decisions and actions. That will be increasingly important as more and more services move from public ownership and public staffing to privately contracted and privately staffed contractors to NHS services. Already it is hard to know if you are talking to a NHS employee or a contractor. If you doubt that have a good long hard look at the next ambulance you see and read every bit of text painted on it.

The complaints guidance contained within the constitution explains how patients can give “feedback” or make a complaint about NHS care or treatment. It includes comprehensive information on the complaints arrangements, and what the patients can expect when they make a complaint. Of note to patients is the issue of NHS pledges, the legal authority for which is clearly set out in the introduction section. I reproduce it below:

Everyone who uses the NHS should understand what legal rights they have. For this reason, important legal rights are summarised in this Constitution and explained in more detail in the Handbook to the NHS Constitution, which also explains what you can do if you think you have not received what is rightfully yours. This summary does not alter your legal rights.

The Constitution also contains pledges that the NHS is committed to achieve. Pledges go above and beyond legal rights. This means that pledges are not legally binding but represent a commitment by the NHS to provide comprehensive high quality services.

So what about your NHS Complaint itself, is that set out in the constitution? Actually yes it is, in fact it is set out with a clarity and brevity that is admirable. It is produced in a glorious monochrome, again, it is worth reproducing this section in full from the constitution below:

Complaint and redress – Your rights

You have the right to have any complaint you make about NHS services acknowledged within three working days and to have it properly investigated. You have the right to discuss the manner in which the complaint is to be handled, and to know the period within which the investigation is likely to be completed and the response sent. You have the right to be kept informed of progress and to know the outcome of any investigation into your complaint, including an explanation of the conclusions and confirmation that any action needed in consequence of the complaint has been taken or is proposed to be taken. You have the right to take your complaint to the independent Parliamentary and Health Service Ombudsman or Local Government Ombudsman, if you are not satisfied with the way your complaint has been dealt with by the NHS. You have the right to make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body or local authority. You have the right to compensation where you have been harmed by negligent treatment.

So, we can see here that you can complain and nobody can stop you. Reading between the lines, you can also see, you are likely to get a complaint response pretty quickly (3 days) and that it will be filled with bluster about timescales and processes. The presence of the PHSO and the LGO though, is your big clue to the value of those processes. Ultimately, the PHSO can only be activated if there has been a failed intervention by the NHS.

So both you and the Complaints handler allocated to your claim at the early stage of the Nhs process, should start the investigation as though every single line written down in it will be read by the PHSO team. You can bet, that regardless of whether you do or do not adopt that mentally, the Nhs team certainly will. So this leads us to the first principle in our dealings: Always, Always Always, Stay Calm! Remember, you can smile, nod and be polite and you dont have to accept anything, remember no matter what they say or do, this is a long game and you are prepared to go as far as you have to. Todays time waster is just another box for you to tick on the route to the top. Don’t blow it with outbursts.

Be on your best behavior, they are secretly crossing their fingers you will present an unreasonable and incomprehensible account of yourself. that will make brushing the complaint away easy for an investigator who just wants to see the back of you

What is Pals?

NHS Complaints section 3.
The Patient Advisory and Liaison Service.

The Patient Advice and Liaison Service (PALS) is billed by the NHS on its England website as “offering confidential advice, support and information on health-related matters. They provide a point of contact for patients, their families and their carers.” Now reading these very carefully crafted lines, tell me, can you spot anything about them being independent? Does it say that they have any power to bring about disciplinary action, or regulatory investigations? Does it include any guarantees about further legal action or the involvement of the Quality Care Commission? I dont suppose you noticed anything about compensation or expenses did you? No. Nor did I.

In many of the NHs institutions the Pals department is staffed by the same people who sit in the legal department. In fact some external Defence panel Solicitors actually insist that their trainee Solicitors are seconded to the Pals departments – to “lend a hand”. Make no mistake, Pals is not the system that the patients would design themselves. While I have no doubt that many of the people involved in the Pals complaints process are orientated toward improving the NHS. Some just want to close complaints down as quickly as possible. If there was a complaints process for Pals – and it was advertised and published as widely as it publishes its own services, it would be the busiest department in any hospital.

Do I have to use Pals then?

No. In fact there is no obligation for you to engage with them at all in a NHS complaint. In some cases (increasingly in fact) where a complaint has been intimated but not yet made – you might even get a call from Pals to introduce themselves. They will offer help. How nice. You dont have to accept.

Strangely perhaps, I would advise you to definitely accept this help. You see in spite of their poor reputation and limited facility to actually resolve anything, they can prove to be a useful facility. You see, they are, like all such organisations, confined by the rules they set to govern themselves. As my canny Australian boxing coach once said “lead your opponent to the corner – he will happily follow you there, thinking you you are in retreat, he will feel suddenly confined and not know why”. Pals are happy to boast that their place is to help you look at this quote from the NHS Website:

PALS provides help in many ways. For example, it can: help you with health-related questions, help resolve concerns or problems when you’re using the NHS, tell you how to get more involved in your own healthcare. PALS can give you information about: the NHS, the NHS complaints procedure, including how to get independent help if you want to make a complaint, support groups outside the NHS. PALS also helps to improve the NHS by listening to your concerns and suggestions.

So use them, use them to do the heavy fetching and carrying. Ask them about what information you are entitled to. Ask them to put it in writing. Ask them about freedom of information requests and the doctors health and safety record. Ask them if there have been similar events before, ask them about disciplinary records, adverse event reports, ask them everything you can think of. You can if you want ignore their questions to you, after all they exist to help you right? if they stop helping , ask them why? GET IT ALL IN WRITING.

They will try as soon as they can to get you in a room with a senior doctor or even a consultant, their training has told them that a heartfelt apology from a posh speaking pro in a suit with a cup of tea and biscuit is miracle cure for some of the squeaky wheels they come across. Are they right? Remember, you dont get to bring a lawyer with you but is everyone in that room on your side? If you are not ready for that meeting, politely decline, questions need to be answered before the tepid tea is poured and the stale cake is cut.

I do not want to use Pals is there an alternative?

Yes. In fact there is a blizzard of helpful sounding alternatives. Take your pick. First and foremost is, probably the Public Health Commissioner contact NHS England for complaints about primary care services (GPs, dentists, opticians or pharmacists). NHS England also commissions military health services and some other specialised services. Find out more on the NHS England website

Remember your local clinical commissioning group (CCG) – These used to be called NHS Foundation Trusts. You dont need to know why they changed their name but for complaints about secondary care, such as hospital care, mental health services, out-of-hours services, NHS 111 and community services like district nursing, for example they are likely to have reporting procedures for complaints. it is of course worth mentioning that every single CCG will have its own complaints procedure, which is often displayed on its website with varying degrees of obfuscation.

What about Time limits on a Compliant?

You have 3 years to bring a legal claim. the courts are getting better at recognising the delay in complaints procedures but dont rely upon that. In most cases, there is no appetite to tell you that this time runs against you, even while the NHS compliant process is in full flow. So dont let it. Ask the Hospital to confirm in writing that the limitation of any legal action will be suspended until the complaint process has stopped. if they will not do this then you know why. Do not be surprised when they suddenly stop responding to you on the 3rd anniversary of the complaint. Seek legal help as soon as you now that this is the way you want to go.

So when do I instruct a Solicitor

That is not so easy, sometimes you just want an apology and frankly no matter how empty that feels when you get it, the process of complaint will probably deliver it. there is no need for a lawyer in that, there is in fact no need for a complaint service. the Doctor himself or herself is probably aching to apologise, They are in my experience the best of what humans have to offer, if a mistake has been made, they have a statutory duty of candour to admit it and frankly it is a matter of honor to most them that they must do so as soon as practically possible. It really is humbling how the majority of these people see themselves as our servants. In almost every case you will see, they are in the first instance holding patient safety above all things.

But there are some who are less than canderous and there as others who are not so honorable.

As soon as you believe a legal action is a probability, the complaint is over. dont hesitate contact a lawyer. In fact there is nothing to prevent you speaking to a lawyer at any point. Even before the complaint begins. No decent lawyer will turn you away for wasting time.

Useful Links.

Published by Orange Law

A UK based Solicitor Advocate and Clinical - Dental - Surgical Specialist Outsourcing Legal Service.

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