Healthcare Complaints Guide

Every day hundreds of thousands of patients are successfully treated in hospitals across the UK, but what happens when care standards drop and issues arise from the negligence of a healthcare professional?

If you are the victim of medical negligence, you need to be aware of the healthcare complaints process.


Department of Health figures highlight that approximately 850,000 medical accidents occur in the UK every year, with half of these incidents being deemed as avoidable. These figures show that, while a high standard of care remains the norm, many incidents are taking place that have potentially life threatening consequences.

It can seem daunting to complain about a GP or hospital; however making a complaint is an important step in ensuring that issues are highlighted and can go a long way to improving the service provided by healthcare suppliers, whether this be the NHS or private practices

If you have been the victim of negligent healthcare, or if an incident has occurred that you were not happy about, it is important that you are aware of healthcare complaints process that you can take.

This guide is designed to outline the process of making a complaint against a healthcare provider and will highlight:

  • When a complaint can be made
  • The process for making a complaint
  • Poor standard of cleanliness
  • Erroneous, or lost, medical records
  • Delayed diagnosis

There are no restrictions on who can make a complaint; anybody that has received care that is below a reasonable standard can undertake the healthcare complaints process.

When Can I Complain?


You can lodge a complaint against a healthcare provider when you feel that you have not received a reasonable level of care. It is important to remember that there is a time limit of 12 months to complain and this 12 months runs from the date of the incident itself, or from the date that you realised that you have received sub-standard care.

The issue of 'reasonable level' can manifest itself in a number of ways, ranging from serious malpractice to long waiting times at a GPs.

When deciding whether you are going to make a complaint, it is important to consider the reason for complaining. Complaints help to improve services and feedback, whether this be positive or negative, is usually welcomed by healthcare providers.

If anything has taken place during your provision of healthcare that you feel was not acceptable and should not have happened, then you should lodge a formal complaint – to try and ensure that the same thing does not happen to other patients in the future.

Due to the personal nature of most complaints it is impossible to outline a definitive list of incidents that could warrant a complaint, as individuals may judge standards of care differently. You should not be put off making a complaint because of the opinions of other people and you should judge for yourself whether you feel that a formal complaint should be lodged.

Outlined below are some of the main incidents that could warrant a formal complaint against a GP, hospital, or individual healthcare professional.

Remember that this is not an exhaustive list and you should lodge a complaint whenever you are unhappy with the level of care, the incidents outlined here are just some common occurrences that could warrant a complaint.

They include:

  • An inability to get an appointment with your GP
  • Incorrect diagnosis and treatment
  • Problems with a GP's out-of-hours service
  • Poor communication or behaviour from a GP, hospital, or healthcare professional
  • Unreasonable delays in any aspect of healthcare provision
  • Negligent practices
  • Discrimination
  • Cancelled or delayed operations
  • Poor standard of cleanliness
  • Erroneous, or lost, medical records
  • Delayed diagnosis

There are no restrictions on who can make a complaint; anybody that has received care that is below a reasonable standard can undertake the healthcare complaints process.

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What Is The Healthcare Complaints Process?


Who can I turn to?

The process for lodging a formal complaint will depend upon the healthcare provider, as well as the nature of the complaint.

Most organisations will have a specific complaints procedure and the first step for complaining is to ask the service for their guide, which will explain what you need to do. Complaints can be made in writing (by post or email) or in person. Complaints made in person may be more informal but can result in practices being altered and can help patients who do not wish to go through the official complaints process.

These informal complaints may result in a local resolution, which aims to resolve complaints quickly before a formal complaint is made in writing. If you are unhappy with the result of your complaint, or you do not feel comfortable complaining directly to the particular healthcare service, you can follow the more general NHS complaints guide – which takes the complaint beyond the individual service.

When complaining about care provided by the NHS there are various organisations and services that can help you complain.

These organisations include:

  • Patient Advice and Liaison Services (PALS): PALS officers are located in most hospitals and can offer confidential advice and support on health-related matters. They may be able to give advice on your specific case and will be able to inform you whether a complaint is necessary.
  • NHS Complaints Independent Advocacy Service: Independent advocacy services are organised by local authorities and should provide support to patients, or their family members, who are thinking of making a complaint.
  • Citizens Advice Bureau: The Citizens Advice Bureau should give independent and impartial advice to those who are thinking about making a complaint about care provided by the NHS.
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GP Complaints


If you have received unacceptable care from a GP then the following steps can be taken to lodge a complaint:

  1. Lodge a complaint directly to the GP surgery:

    You can discuss your concern on the spot with a member of staff at the GP surgery. This can be appropriate for minor issues that you would like to flag up to staff, so that they can try to keep the issue in mind moving forward.

    Despite this seeming like a more informal way to make a complaint, there are still some guidelines that should be followed. The GP's complaints procedure should be referred to, a record should be kept of the complaint and all of the details of the formal complaint should be kept on record and investigated by the GP.

    You should be alerted to any outcome of an investigation into the practice that caused the complaint.

  2. Contact the NHS directly:

    If you do not feel comfortable talking to your GP about your complaint, then it is advisable to complain to the NHS directly, who will be able to investigate the incident independently.

    The NHS complaints procedure in your region may differ from the complaints procedure at the GP surgery, so it is important that you follow the guidelines relevant to your region to ensure your complaint is handled efficiently.

  3. Complain to ombudsman:

    If you are unhappy with the outcome of your complaint to the GP surgery or the regional NHS complaints board then you could take your complaint further and contact the ombudsman.

    Complaining to the ombudsman is beneficial as they are independent of the NHS and are completely free of charge.

    Once they've investigated the complaint the ombudsmen will be able to tell the NHS how they can correct the issue, however a complaint can only be lodged with ombudsmen after a complainant has been to, and a final response has been received from, your GP practice.

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Hospital Complaints


It is likely that complaints about care provision at a hospital will also fall under the NHS complaints procedure; as such the complaints procedure for hospitals is similar to that of GPs. There are differences to consider, namely in regards to who is responsible for hospital care, as this changes depends on the type of NHS hospital treatment you are complaining about.

The organisation responsible for your hospital care will change depending on the following factors:

  • If you were treated in an NHS hospital:

    Every NHS hospital service is run and managed by an NHS trust. NHS trusts are responsible for ensuring that hospitals provide an adequate level of healthcare and it is NHS trusts that review individual practices when medical negligence occurs.

    A hospital's Chief Executive has responsibility for the hospital's service.

  • If you were provided with NHS care in a private hospital:

    In some cases a Clinical Commissioning Group (CCG) may decide to pay for hospital services on your behalf, this happens in extreme cases and usually surmounts to the commissioning of treatment in a private hospital.

    If you would like to make a complaint in these circumstances then you can complain directly to the hospital itself, however the CCG that recommended the treatment can also receive the complaint.

The main steps that can be taken to lodge a formal complaint about care provision at a hospital will depend on the severity of the incident and what you hope to achieve with your complaint.

Generally speaking your options in the healthcare complaints process at a hospital are as follows:

  1. The NHS complaints procedure:

    Clearly defined, the NHS complaints procedure will launch an internal investigation and should result in practices being amended to ensure the incident that caused the complaint does not happen again.

  2. Take legal action:

    This is appropriate in cases of medical negligence causing serious injury, as it can result in a compensation claim that is designed to mitigate the loss caused by medical negligence.

  3. Report concerns to other bodies:

    Other organisations, including the Care Quality Commission, the CCG, or the Parliamentary and Health Service Ombudsman are able to receive complaints about hospital care. These bodies can be effective as they can launch an external review of practices and can recommend thorough changes to ensure patient care is improved throughout a hospital.

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Doctors & Nurses Complaints


In some instances the hospital or GP itself can provide exceptional levels of care, however an individual healthcare professional, whether this be a doctor or a nurse, can do something that warrants a complaint.

In circumstances such as these, it could be appropriate to lodge an official complaint against an individual doctor or nurse, which relates to independent regulatory bodies.

The regulatory bodies that handle complaints for doctors and nurses are as follows:

Nursing & Midwifery Council (NMC):
The NMC regulates nurses in England, Wales, Scotland, and Northern Ireland. Set up to protect members of the public against poor nursing standards, the NMC can receive official complaints about nurses and midwives.

The NMC keeps an updated register of nurses and midwives who are allowed to practise in the UK. Making a complaint about a nurse or midwife via the NMC requires the completion of a referral form, which can help raise concerns about nurses who are not fit to practise medicine.

General Medical Council (GMC):
The GMC is an independent organisation that oversees the regulation of doctors in the UK. It provides medical education and training to doctors and is designed to ensure all patients receive a high level of care from their doctor.

If your complaint is substantiated the GMC can move to restrict a doctor's practice, or stop them from practising altogether. If you would like to make a complaint about a doctor it is advisable to read the GMC's complaint guide before continuing.

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Complaints About Private Healthcare


Due to its independent nature, the healthcare complaints process for the private healthcare provision does not follow the NHS complaints guide (unless the NHS referred a patient to a particular private healthcare provider).

The steps that can be taken to lodge an official complaint against private healthcare provision are as follows:

  1. Complain to healthcare provider directly:

    Much like a complaint to a GP, making an immediate complaint to the private healthcare provider directly can help to achieve a swift investigation to practices. Managers or Executives within the private healthcare provider can receive official complaints and can often be the best point of contact for lodging an immediate complaint.

  2. Advisory service:

    If an internal complaint to the private healthcare provider does not yield a satisfactory result then you can escalate your complaint to an advisory service that represents your private healthcare provider.

    Examples of advisory services include the Association of Independent Healthcare Organisations (AIHO) and the Independent Healthcare Sector Complaints Adjudication Service (ISCAS). Both of these voluntary organisations outline codes of practices and complaints processes that their members must adhere to.

  3. Financial Ombudsman Service (FOS):

    The Parliamentary and Health Service Ombudsman that handles complaints for NHS treatment is not able to receive official complaints for care from a privately funded service.

    You can lodge any official complaint that you feel necessary to the FOS, however it is important to note that the nature of the service means that the FOS can only take action on complaints relating to administrative and service issues.

Time Limits For Complaints

Time-Limit Medical Negligence

When you have received a level of healthcare that you are not satisfied with, it is important to remember that there is a time limit to making a complaint. In most instances the organisations that handle healthcare complaints require complaints to be lodged within 12 months of the incident taking place, or within 12 months of gaining knowledge of the incident.

In some special circumstances, namely if you were incapacitated and were unable to make a complaint within 12 months, this time limit could be lifted.

It is not advisable to leave a complaint and usually complaints with the best outcomes are those that are filed in the immediate aftermath of an incident. This is due to the fact that the event is still fresh in the minds of those involved, so witness statements and evidence is easier to gather than it would be if the complaint was lodged 12 months after the incident.

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Could I Be Entitled To Compensation?


Why complain?

Depending on the seriousness of the complaint, you may be eligible for a compensation claim. Healthcare compensation claims relate to medical negligence and can be claimed for injuries that are caused when medical care goes wrong.

Making a compensation claim in the aftermath of medical negligence – also known as clinical negligence – can go some way to mitigate the adverse effects of the negligent practice of a healthcare professional.

Claims against medical negligence are often complex and can result in lengthy negotiations; however it is important to know your rights to compensation if you have been injured as a result of medical negligence.

The law requires two key factors to be proven for a medical negligence claim to be considered genuine:

  • The standard of care provided fell below a reasonable level that could be given by a competent healthcare professional in the same area of medicine
  • The sub-standard level of healthcare received caused a physical or mental injury

Compensation claims are not limited to negligent actions that caused additional pain and suffering, as compensation can be claimed when an injury occurs because a healthcare professional failed to act in a patient's best interest.

It is important to note that compensation claims do not exist separately from complaints, as before you make a compensation claim it may be necessary to lodge an official complaint with the negligent healthcare provider, as evidence of such a submission may be used to build your case.

Receiving compensation for medical negligence can help recover from the injuries sustained by negligent practices and will help to ensure mistakes are not repeated. The damages that can be awarded in medical negligence cases are the same as those of personal injury claims.

The awards for damages fall into two categories:

 

 

Description

Included in the Claim

Calculating Amount of Damages

General Damages

General damages relate to the physical and emotional pain caused by an incident. General damages are designed to compensate an individual for the suffering and anguish caused by an incident

Some of the aspects considered within general damages include:

·         The physical pain and suffering caused by an incident

·         Any decrease in quality of life because of the incident

·         Mental anguish caused by the accident

It can be difficult to calculate general damages, as it can be difficult to put a price on the physical and emotional turmoil caused by an accident. The amount of anguish felt by each individual may be different, meaning that calculations must be made on a case by case basis

Special Damages

Special damages are awarded for the actual direct financial loss caused by an incident. They are designed to financially compensate an individual for any money that they have lost, or have had to spend, because of any injury that they suffered during the incident

Some of the factors that can be claimed under special damages include:

·         Loss of earnings due to inability to attend work

·         Medical expenses; this does not simply include the cost of care and travel expenses to and from specialists can also be claimed

Unlike general damages, it is relatively easy to place a price on special damages, this is because the latter claims for a tangible monetary value, which can be easily proven via the submission of receipts


Once you have made your complaint it is worth considering the merits and potential drawbacks that could arise from pursuing a compensation claim, however there is a pressing time limit on when a claim can be made.

Time limits For Compensation Claims

In most cases, compensation claims need to be made within 3 years of the incident taking place, or within 3 years of knowledge of the negligent practice.

There are some conditions on this time limit, for example if mental capacity is affected by medical negligence then the 3 year limit starts when mental capacity returns, similarly if a child is involved in negligent medical practices then the 3 year time limit runs from the day of their 18th birthday.

Making a compensation claim for medical negligence is advisable as it can help to reduce the financial burden caused by negligent acts. In many cases medical mistakes are avoidable, so claiming compensation against such mishaps is a way to ensure that such mistakes do not happen to other patients.

Ultimately, while they can become complex, compensation claims for medical negligence are important in righting an inherent wrong.

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Contact Simpson Millar


This guide was designed to outline the healthcare complaints process for sub-standard healthcare provision.

No matter what the scenario or reason for medical negligence, it is important that it is highlighted via a complaint or a compensation claim, especially as these processes can mitigate the loss caused by poor healthcare and can go a long way to ensure medical mistakes are not repeated.

Due to the time limit on both healthcare complaints and medical negligence compensation claims it is advisable to seek assistance in the immediate aftermath of the provision of sub-standard care.

As an official complaint is often a necessary precursor to a compensation claim, some patients may find it beneficial to seek legal advice from a solicitor before they make a complaint. This is advisable as the same solicitor could assist with a compensation claim after they have explained the full process for navigating the NHS complaints procedure.

At Simpson Millar LLP, we have a team of leading medical negligence solicitors, who have helped to recover millions of pounds for victims of medical negligence. We offer a free consultation service to talk you through the process for making a medical negligence complaint and can advise on whether your complaint could warrant a compensation claim.

As we have a Legal Aid Franchise, we have been approved to carry out medical negligence work and are one of a small number of firms that holds this specialism. Being in benefit of a Legal Aid Franchise means that any subsequent compensation claim after a complaint could be made may be eligible for legal aid (subject to qualifying conditions).

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