If you feel unhappy about a NHS service you have received, we are here to help. Our NHS Complaints Advocacy Service will ensure you know all your options, your rights and how to make sure your voice is heard.
Our service is free, independent and confidential and available to all Reading residents. Last year (2016-17), we helped 56 people make formal NHS complaints, and assisted a further 257 with advice about sorting out problems before they escalated.
Our NHS Complaints Advocacy Service is part of the Reading Voice Advocacy Hub based in the town centre. Our service offers three levels of support:
- Simple Self-Help: Use our online or paper guides to support yourself through the complaints process
- Supported Self-Help: A one-off meeting with an advocate and/or telephone support to guide you through the complaints process
- Full Advocacy Support: For people with extra communication or other needs, this could include drafting your complaint letters and/or attending resolution meetings with you
You can find answers to common questions below.
Everybody has the right to make a complaint about the NHS. This is set out in the NHS Constitution.
The NHS organisation you complain to must acknowledge your complaint within three days, properly investigate your concerns and tell you how long the investigation will take.
This part of the process is called ‘local resolution’. If you are satisfied with the NHS organisation’s response, the complaints process ends here.
If you are dissatisfied with the response and the way the NHS organisation handled your complaint, you can ask the Parliamentary and Health Services Ombudsman (PHSO) to look at your complaint. If the PHSO decide to look into your case, they will talk to both you and the NHS organisation, and also consult their own expert doctors, before deciding if they will uphold your complaint.
Any Reading resident can use our service, even if the NHS care was provided outside of Reading. A Reading resident is a person who pays their council tax to Reading Borough Council. You can find out if you are a Reading resident, by putting your postcode into this checker.
If you live immediately outside of Reading (such as in Wokingham, West Berkshire, or Oxfordshire), but are making a complaint about NHS care received in Reading, you will need to use a different advocacy organisation, called Seap, on telephone 0330 440 9000.
If you live in another area and are not sure where to get help, you can call your local Healthwatch to find out which organisation can assist with NHS complaints. You can find your local Healthwatch using a search tool on the home page of Healthwatch England’s website.
A family member, carer, friend, or your local MP, can complain on your behalf with your permission, or in certain situations where the person lacks capacity to make a complaint.
Organisations usually require proof that the person has given their permission for another person to handle their complaint, such as a signed consent form.
If you are a parent, you can make a complaint about the NHS care of a child aged under 16, but organisations may still seek permission from the child for you to do this, if they think the child is capable of this.
You can also make a complaint about the care of a person who has died.
Complaints can involve looking at people’s medical records, which are confidential. Relatives, spouses, or partners do not have automatic rights to know what are in the medical records of loved ones and the NHS organisation will have procedures on when and how it will share this information to others.
Healthwatch Reading advocates will also usually seek to talk to the individual directly affected by the NHS concern, to check their wishes, and obtain their consent for another person to handle their complaint.
Your concern will be unique to your own circumstances, but people usually come to us for help resolving issues about:
- Care or treatment
- Staff attitude
- Waiting times
- Poor communication
- Problems with hospital discharge
- Denial of access to treatment, medications or equipment
- Charges for some treatment or items
- NHS access for overseas visitors
- NHS access for refugees, asylum seekers or trafficked people
- Missed or wrong diagnosis
- Care before death
You can make a complaint about any NHS funded service. This includes:
- GP surgeries
- Hospitals (including A&E, outpatient clinics, or inpatient stays)
- Ambulance services, including emergency response and non-urgent patient transport
- Any private treatment funded by the NHS
- Mental health services
- Maternity services
- NHS 111 helpline
- NHS walk-in centre or minor injury unit
- Community care such as district nursing or health visitor services
- Community pharmacies
- Community opticians
Our advocates offer three levels of support:
Level 1: Simple self-help advice – whether that’s giving you the telephone number of a particular local NHS PALS or complaint department, an overview of your complaints rights, and/or advice on how to manage your own complaint, including signposting to all our online guides. This will suit literate people who are able to manage their own correspondence and speak for themselves.
Level 2: Supported self-help. This includes all the help offered at Level 1, plus some extra input for people who would might need more time or assistance to empower them to handle the complaint themselves. This might involve a one-off, 60-minute meeting with an advocate at our central Reading office to get detailed advice; telephone feedback from an advocate on the wording of your draft complaint letter; or a quick call to check your options once an organisation has responded to your complaint.
Level 3: Full advocacy support. This service is for people who need an advocate to manage the complaint on their behalf because they have extra needs or are vulnerable due to factors such as ongoing illness, being recently bereaved, having a disability, or being unable to fully understand or communicate. Some people who feel very let down or whose concerns are very serious, may also feel emotionally unable to directly communicate with the NHS service. If an advocate manages your complaint, their support could include:
- Meeting you at your home or place of care
- Adapting to your communication needs, such as Easy-Read, a translator, or an interpreter
- Writing and submitting complaints on your behalf
- Ensuring the NHS organisation responds by the deadline
- Ensuring the NHS organisation responds in a way you can understand
- Putting across your views at a local resolution meeting
- Regular updates on the progress of your complaint and your options at every stage
- Taking your case to the Parliamentary and Health Service Ombudsman if you choose
Our NHS Complaints Advocates have gained, or are studying towards, the Level 2 City and Guilds Award in Independent Advocacy.
All our advocates must also:
- be DBS-checked
- have undergone Level 1 safeguarding training
- follow the nationally recognised Code of Practice for Advocates
- follow Healthwatch Reading policies, including those on equality and diversity, data protection and lone working.
Most people who seek our help tell us they are motivated to make a complaint because they don’t want the same thing happening to future patients.
The NHS complaints process can help you get:
- an explanation on why something went wrong
- an explanation about why you are receiving a particular course of care or treatment
- a further appointment or review of your care if the NHS agrees this is needed
- an explanation about what the NHS organisation will do to make any necessary improvements
- an apology
- a meeting with senior staff from the organisation to discuss your case in more detail.
You cannot request that a particular member of NHS staff be disciplined, but patient complaints may prompt NHS organisations to launch their own disciplinary procedures.
If you believe a particular doctor, nurse or other NHS staff member has made a serious mistake that has caused harm or behaved inappropriately, you have the option of reporting them to their professional regulatory body. These organisations decide if health or care professionals need to be investigated, re-trained, or in the most serious cases, banned from working. You can find out names and contact details for all regulators in this leaflet.
NHS Complaints Advocacy does not cover helping people to claim compensation, or to ‘sue the NHS’.
We refer people who are seeking compensation, to a national patient safety and justice charity called AVMA (Action Against Medical Accidents). Visit their website at www.avma.org.uk or telephone their helpline on 0845 123 2352.
AVMA encourages people to first pursue their concerns through the NHS Complaints Process before taking any legal action.
The public has 35 legal NHS rights, covering everything from free care, waiting times, access to medical records, patient confidentiality, making a complaint, and many more.
Your rights (as well as nine main patient ‘responsibilities’ such as keeping your appointments), are set out in the NHS Constitution. Detailed information on maximum waiting times, are contained in The Handbook to the NHS Constitution.
You have six key rights covering complaints:
You have the right:
- To have any complaint you make about NHS services acknowledged within three working days and to have it properly investigated;
- 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;
- 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;
- To take your complaint to the independent Parliamentary and Health Service Ombudsmanor Local Government Ombudsman, if you are not satisfied with the way your complaint has been dealt with by the NHS;
- 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;
- To compensation where you have been harmed by negligent treatment.
The constitution also says that the NHS commits to:
- ensure that you are treated with courtesy and you receive appropriate support throughout the handling of a complaint; and that the fact that you have complained will not adversely affect your future treatment;
- ensure that when mistakes happen or if you are harmed while receiving health care you receive an appropriate explanation and apology, delivered with sensitivity and recognition of the trauma you have experienced, and know that lessons will be learned to help avoid a similar incident occurring again;
- ensure that the organisation learns lessons from complaints and claims and uses these to improve NHS services.
You can check whether your NHS treatment or medication follows national or local guidelines, to help you decide if you have any grounds for a complaint. These guidelines are drawn up after experts have checked all the available clinical evidence about how good treatments are. Some guidelines will also be based on funding decisions.
The main national guidance is published by the National Institute for Health and Care Excellence. NICE gives very detailed guidance to the NHS and doctors about how certain conditions and disease should be diagnosed, treated, or managed.
People can also get guidance on What to expect from a good care service, from the Care Quality Commission, the national body that inspects NHS services and which can take action such as ordering improvements or closing down failing services.
The organisation that funds and plans NHS services for people in Reading (Berkshire West Clinical Commissioning Groups) also produces local information on what NHS services they will not normally fund and how people can apply for an individual decision about their treatment.
Find out the costs of NHS prescriptions, dental work, eye tests, wigs, and patient transport on the Help with Health Costs section of the NHS Choices website.
Charges and exemptions are decided on a range of factors such as your age, income or benefits, clinical condition, or circumstances.
Our service can give you information about the Continuing Healthcare (CHC) process, and help to appeal any decisions by the local NHS which reject a CHC application.
CHC is a package of health care outside of hospital, and sometimes personal care, funded solely by the NHS, for people who have serious, ongoing conditions or needs. It can pay for things like specialist nurses or therapies in your own homes, or care home costs.
If you need free, expert advice about CHC applications quickly, you can contact a national social enterprise called Beacon that gives the public a free 90 minute phone consultation with CHC caseworkers, call 0345 548 0300.
Here are some common questions and answers about CHC:
Who is eligible for CHC?
Anyone over 18 who has a certain level of care needs. You do not get it automatically if you have a particular disease, diagnosis or condition. Instead, health and/or social professionals assess you, looking at:
- what help is needed
- how complex these needs are
- how intense or severe these needs can be
- how unpredictable they are, including any risks to the person’s health if the right care isn’t provided at the right time
How do I apply for CHC?
The first stage involves a health professional or social worker completing an initial national check list to see if you would be eligible to apply for full funding. If you are eligible, you move on to the second stage, which involves a full assessment being carried out by a multidisciplinary team, looking at your needs in more detail to decide whether to recommend full funding.
This team will use a national document called a Decision Support Tool. You should be present at the decision-making meeting – or be able to pass on your views through prior conversations, or by having a representative such as a relative or advocate at the meeting.
The final decision is made by your local clinical commissioning group, ideally within 28 days of the referral to full assessment. This can be fast-tracked in urgent cases, such as when somebody is terminally ill.
Decisions on CHC applications by Reading people, are made by Berkshire West Clinical Commissioning Groups. They have a special team to advise the public on how to request an assessment, and how the local process works.
What can I do if my application for CHC is rejected?
If the initial check list results in your application being unsuccessful, you can ask the clinical commissioning group (CCG) to reconsider the decision. I
If your application is unsuccessful after going through the full Decision Support Tool process, you can ask the CCG to carry out a local review of the decision, or to send it to an NHS England independent review panel.
You can get information, advice or help with appeals from the national social enterprise Beacon. It claims a 70% success rate in appeals, and can offer people a free 90-minute phone consultation. Beacon grew out of a service initially run by Age UK Oxfordshire.
If these actions do not change the original decision, and you are still unhappy, you can make a complaint to the Parliamentary and Health Service Ombudsman (PHSO). Healthwatch Reading can help people, once they have exhausted the appeals procedures, by advising or assisting them to put forward complaints to the Parliamentary and Health Service Ombudsman (PHSO).
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