A Scottish Executive Health Department Consultation Document

The UNISON Scotland Response

June 2003

Executive Summary

UNISON Scotland welcomes the NHS commitment to developing ‘patient focused' services and is supportive of the initiatives currently underway within NHS Scotland aimed at strengthening the voices and influence of those who use the services of the NHS in Scotland.

UNISON Scotland believes that the present complaints procedure reflects a culture of defensiveness and is in many instances unresponsive to genuine concerns of patients and public alike. As such, UNISON Scotland broadly welcomes the principles and proposals outlined in the document designed to improve the complaints procedure within the NHS.

Whilst UNISON Scotland recognises the need for each NHS organisation to have a co-ordinator to take responsibility for delivering their patient feedback and complaints process, we have concerns regarding the proposal to appoint senior members of staff from within each NHS organisation as ‘Complaints Officers'. We believes that in order for the system to gain credibility and the confidence of patients and public alike, the practices and procedures of the complaints system must be seen to be totally impartial and free from internal influences.

UNISON Scotland believes that the proposal to permit facilitation services to be administered by Primary Care Trust's will raise patient concerns about the perceived impartiality of the complaints process. In addition, UNISON Scotland seeks further clarification on what facilitation services will be provided for patients involved in cases implicating PCTs.

UNISON Scotland is pleased that the document contains proposals, which will make it a requirement for NHS Boards to establish suitable sources of independent advice and support for complainants.

UNISON Scotland is fully supportive of proposals to ensure training in handling and managing complaints becomes a compulsory element of induction training for all staff.

UNISON Scotland question's the wisdom of the document setting out roles and responsibilities for the proposed new Health Council before the outcome of the current consultation process regarding the future structure of Health Councils in Scotland.

UNISON Scotland supports dispensing with the ‘independent review' stage of the complaints process altogether and instead establish a system whereby complainants can directly request the Ombudsman to review their case if they are dissatisfied with the outcome of local resolution.

Introduction

UNISON is Scotland's biggest health union representing thousands of NHS staff throughout the country. Our members include nursing, ancillary and clerical staff, all of whom the NHS depends upon to ensure the safe and effective functioning of the Health Service in Scotland.

This paper constitutes UNISON Scotland's response to the consultation document issued by the Scottish Executive entitled: ‘Reforming the NHS Complaints Procedure '.

 Background

The consultation paper on reforming the NHS complaints procedure was developed by an advisory group, which included representatives of NHS staff, public and patients. The paper details proposals aimed at simplifying the complaints process, as the Advisory Group states in the document "a complaints procedure should be credible, easy to use, demonstrably independent, effective and sensitively applied"

The document in addition to updating the procedure and the roles of NHS organisations also proposes to increase the independence of the process by either establishing a National Complaints Authority or involving the Ombudsman at an earlier stage.

Other proposals contained in the document to improve resolution at local level include:

• a requirement for local services to implement protocols to ensure that the concerns and comments of patients are heard and dealt with quickly, sensitively and fairly
• a requirement for NHS Boards to take active responsibility for all aspects of complaints handling in their area
• a requirement for local Health Councils to prepare an annual assessment of the effectiveness of the complaints handling in their NHS Board area

Responses

Q.1 Do you agree with the roles and responsibilities set out above?

UNISON Scotland recognises the need for each NHS organisation to have someone within the organisation employed in a co-ordinating role, taking responsibility for delivering patient feedback and complaints process. However, we have concerns regarding the proposal to appoint senior members of staff from within each NHS organisation to carry out this role. We believe that in order for the system to gain credibility and the confidence of patients and public alike, the practices and procedures of the complaints system must be seen to be free from NHS influence.

UNISON Scotland agrees that the Complaints Officer within each NHS organisation should be given wide-ranging responsibilities for developing patient feedback and complaints services. In addition, UNISON Scotland also believes that one of the primary responsibilities of COs should be to be ensure that all NHS staff are provided with high quality training to allow them to deal effectively with patients complaints.

 

Q.2 Do you agree with the above proposals for supporting individuals?

UNISON Scotland agrees with the Advisory Groups assertion that for the proposed complaints system to gain the confidence of Health Service patients, it must include a means to assist individuals in navigating what can be seen as a confusing and complex system. UNISON Scotland believes it is essential that inexperienced individuals have access to support structures that will enable them to interact with the complaints system with a measure of confidence.

UNISON Scotland is pleased therefore that the document contains proposals, which will make it a requirement for NHS Boards to ensure that suitable sources of independent advice and support are established. UNISON Scotland believes that establishing the independence of these support organisations will be of paramount importance to gain the trust of Health Service users.

In addition, UNISON Scotland would welcome the proposed involvement of a newly reconstituted Health Council in commissioning and monitoring these advice and support bodies in each NHS Board area. However, UNISON Scotland question's the wisdom of the document setting out roles and responsibilities for the proposed new Health Council before the outcome of the current consultation process regarding the future structure of Health Councils in Scotland.

 

Q.3 Do you agree with the above proposals for 'facilitation'?

Whilst recognising the independent status of Health Service practitioner's within the NHS, UNISON Scotland shares the concerns of many patients groups about the inability of the NHS to enforce recommendations or impose solutions on Health Service practitioners as a result of patients complaints.

However, UNISON Scotland believes that there are potential benefits in the Advisory Groups proposal to ensure Primary Care Trusts provide access to ‘facilitation' services for those parties involved in the complaints procedure.

UNISON Scotland believes that the provision of a ‘facilitation service' can strengthen the resolution process and help to prevent the breakdown of patient -practitioner relations.

Whilst UNISON Scotland believes that the provision of a ‘facilitation service' has the potential to produce positive benefits for both parties involved in the process of resolution we question the extent to which a PCT sponsored facilitation service will be seen as truly independent.

UNISON Scotland believes that the proposed facilitation services, administered, as they will be by PCTs in support of medical practitioners, as well as patients, will undoubtedly raise concerns about the impartiality of the whole process. In short UNISON Scotland is unconvinced about the ability of PCTs to establish themselves as truly independent facilitators between medical practitioners and patients.

In addition UNISON Scotland notes that this proposal would prevent PCTs from carrying out a facilitation role if the PCT is itself one of the parties implicated in a complaint procedure. Whilst UNISON Scotland acknowledges the rational behind this decision we note that the document fails to mention what, if any, facilitation service will be provided for patients involved in a complaints procedure involving PCTs. As such, UNISON Scotland seeks further clarification on what facilitation services will be provided for patients involved in cases implicating PCTs.

 

Q.4 Do you agree with the above further recommendations for improving local resolution?

UNISON Scotland broadly welcomes the further initiatives for improving local resolution. In particular UNISON Scotland welcomes the emphasis given in the document to ensuring staff are trained to deal effectively with complaints. In addition UNISON Scotland is fully supportive of proposals contained in the document which will ensure training in handling and managing complaints becomes a compulsory element of induction training for all staff.

UNISON Scotland firmly believes that the effective training of front line Health Service staff in complaints handling techniques is essential and will empower staff to make a positive contribution to the process of local resolution.

Q.5 Do you agree with the above role and responsibilities identified for 'Liaison Officers'?

UNISON Scotland welcomes the proposal to train senior staff to act as ‘Liaison Officers' and believes that this arrangement will provide front line staff with much needed management support in dealing with patient and public expressions of concern.

UNISON Scotland believes that for far too long front line staff have been made to bear the brunt of patient frustration and anger in relation to the service they have received from the NHS. As such UNISON Scotland welcomes this proposal that will ensure that senior staff also take their rightful share of responsibility in dealing with complaints made against the NHS.

 

Q.6 Two options are offered for improving the 'independent review' stage. Which option would you support?

1. A National Complaints Authority, or

2. Widening the role of the Ombudsman?

In regards to the establishment of a National Complaints Authority, UNISON Scotland believes this option would lead to an overly bureaucratic and multi-layered complaints process in which an excessive number of appointees, panels and processes would need to be established in order to review cases.

In addition, despite proposals that the new authority be established as an 'arms length' division of NHS Quality Improvement Scotland or the Common Services Agency, UNISON Scotland believes that the NCA would be inherently dependent upon the wider NHS infrastructure for support and would therefore lack real independence.

As such, UNISON Scotland believes that the best option would be to dispense with the ‘independent review' stage of the complaints process altogether and allow complainants to directly request the Ombudsman to review their case if they are dissatisfied with the outcome of local resolution.

UNISON Scotland believes that this option would provide for a review stage in the complaints process that was genuinely independent of the NHS. UNISON Scotland believes that in order to gain the confidence of complainants it is vitally important that the practices and procedures of the complaints system must be seen to be totally impartial and free from NHS influence.

In addition, UNISON Scotland believes that this option offers an altogether more simpler and effective process of independent review of patients complaints.

7. Do you feel that there is an alternative option that we should consider?

UNISON Scotland is satisfied that widening the role of the Ombudsman would be sufficient to improve the 'independent review' stage of the complaints process.

Q.8 Do you agree with the further recommendations for improving independent review?

UNISON Scotland welcomes these recommendations aimed at improving the independent review process. In particular, UNISON Scotland welcomes the proposal contained in the document, which would ensure NHS Boards are required to take active responsibility in regards to all aspects of complaints in their areas.

In addition, UNISON Scotland is pleased that the Advisory Group envisages a role for local Health Councils in relation to monitoring compliance with agreed NHS Boards action plans.