Annex A - Chronology of key complaints handling events

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1. An independent evaluation of the existing NHS complaints procedure was commissioned by the Department of Health in 1999. Between 1999 and publication of the evaluation, in September 2001, a number of other NHS developments (detailed below) took place.

2. The NHS Plan: a plan for investment, a plan for reformOpen in new window was issued in July 2000 detailing the Government's plans for investment, reform and 'a health service designed around the patient'. The Plan said that patient advocates would be set up in every hospital, along with patients' forums, to help services become more patient centred. (With the independent evaluation of complaints procedures continuing during 1999-2000, the NHS Plan committed Ministers to acting on the results of the evaluation.)

3. The report of the inquiry into children's heart surgery at the Bristol Royal InfirmaryOpen in new window was issued in June 2001. That recommended in chapter 23:

  • ' 36. Complaints should be dealt with swiftly and thoroughly, keeping the patient and carer informed. There should be a strong independent element, not part of the trust's management or board, in any body considering serious complaints which require formal investigation. An independent advocacy service should be set up.
  • '37. There should be an urgent review of the system for providing compensation to those who suffer harm arising out of medical care. The review should be concerned with the introduction of an administrative system for responding promptly to patients' needs in place of the current system of clinical negligence and should take account of other administrative systems for meeting the financial needs of the public. .
  • '55. There also needs to be an open and easily accessible system for the patient or carer to [complain]. Currently, the complaints system operated in trusts is widely acknowledged to be cumbersome and bureaucratic. Despite efforts to reform it in the mid-1990s the system has too many layers and lacks a sufficient element of independence. . The decision to establish Patient Advocacy and Liaison Services within trusts is a first and important component of a broader system to identify and respond to problems as early as possible. .
  • '57. Patients, for the most part . do not want to complain. Often they feel forced to because their concern has been ignored or not properly addressed. The message is clear: improve communication generally, be more open with patients, and complaints will go down. For the complaints which remain, the system in place must be open, minimally bureaucratic, receptive, and appropriately independent.'

Parallel policy developments on patient/public involvement in healthcare and clinical negligence

4. In July 2001 the Secretary of State for Health announced plans to produce, early in 2002, a White Paper setting out reforms to the system for dealing with clinical negligence claims.

5. In September 2001 the Department of Health issued a discussion document outlining proposals for involving patients and the public in healthcare. Proposed developments included:

  • introducing Patient Advocacy and Liaison Services (PALS) - providing information and on the spot help - in every Trust;
  • providing locally based Independent Complaints Advocacy Services (ICAS) in England, operating to core standards;
  • introducing Patients' Forums in every Trust, to bring the patient's perspective to Trust management decision-making. These Forums would also be able to elect one of their members to sit on the Trust Board as a Non-Executive Director;
  • setting up a "Voice" in every Strategic Health Authority area, a professional group acting as a local resource for helping communities;
  • setting up a new national patients' body to set standards and provide training, and to monitor the new arrangements.

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6. Details of the final arrangements were published in November 2001. PALS were now to be Patient Advice (rather than Advocacy) and Liaison Services. Rather than both the local 'Voice' and a national patients' body, a national Commission for Patient and Public Involvement in Health (CPPIH) was to be established with local networks and community outreach workers. It was envisaged that PALS would be available in all Trusts from April 2002, CPPIH and Patients Forums would be established at the beginning of 2003, and Community Health Councils would cease to operate in April 2003. (Provision for these changes was subsequently made in the National Health Service and Health Care Professionals Act 2002.Open in new window)

Progress on complaints systems

7. In September 2001 the Department of Health published the evaluation of the old procedure (commissioned in 1999) as two documents, an evaluation report, NHS complaints procedure: national evaluationOpen in new window, and Reforming the NHS complaints procedure - a listening document.Open in new window The evaluation report found a high level of dissatisfaction amongst complainants about the operation of both the local resolution and independent review stages. Most found both stages stressful, unfair and biased and they were dissatisfied with the outcome. Amongst Community Health Councils (which often advised and supported complainants) only a small minority thought the systems of local resolution and independent review worked well.

8. The summary of the evaluation report said (paragraphs 6 and 10):

'The main causes of dissatisfaction among complainants are operational failures: unhelpful, aggressive or arrogant attitudes of staff, poor communication and a lack of information and support. The most important structural failure is the perceived lack of independence in the convening decision and in the review process generally'.

'Among those operating the procedure there is a broad consensus about the elements which need to be improved:

  • There is a wide measure of agreement that independent review should be more independent and should be seen to be so. Irrespective of the impartiality of a convenor, it is accepted that complainants do not perceive the current procedure to be independent.
  • There is a perception that current procedures, particularly those involving independent review, are time-consuming and costly to operate.
  • Performance targets relating to the convening decision, the appointment of panel members and drafting a report of a panel are all perceived to be difficult to meet.
  • There is agreement that procedures need to be improved to ensure that services improve following a complaint.

9. The report went on to identify a range of policy implications and made 27 recommendations for change. These recommendations were summarised in the listening document as follows:

  • 'a uniform national procedure, applied equally to primary care and hospital services, and with clear and consistent time limits;
  • dissemination of good practice, and more use of conciliation to achieve results swiftly and effectively;
  • clear guidance to clarify how the complaints procedure should be applied, and standard targets nationally for managing the performance of staff handling complaints;
  • standardised administrative and financial support, and standard expenses and retainers for chairs and lay members;
  • clear lines of responsibility for making sure the complaints system is run properly, with Chairs and Chief Executives answerable to the Department of Health for their performance in this area;
  • Trust Boards responsible for ensuring this work is funded properly and staff are trained appropriately to handle complaints;
  • Trust Boards also responsible for ensuring their clinical governance framework reflects complaints work as core business;
  • a system of quarterly reporting by complaints staff to the Trust Board, summarising the causes and trends underlying complaints, and making recommendations for action. These reports to be copied to relevant patient representative organisations, and the Board to be responsible for implementing recommendations;
  • as this would apply equally in primary care services, support from Trust Boards and PCGs [Primary Care groups - the predecessors of the current Primary Care Trusts - PCTs] would be needed for individual practices in managing the system, with a named individual responsible for handling practice complaints.'

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10. The report also recommended the following reforms for the second level Independent Review stage:

  • 'Consistently applied criteria for convening Independent Review Panel;.
  • Regional NHS bodies, or a new independent national complaints authority to be responsible for holding the panels to account and managing their performance to minimum standards.
  • Possible wider powers for panels to summon witnesses and hear evidence, supported by an up to date database of clinical assessors, and also the potential to handle some cases on a "fast-track".
  • Wide circulation of the Panel's final reports to relevant patient representative bodies and the Commission for Health Improvement, with the Trust Board being responsible for implementing any recommendations for remedial action.
  • new options for how Panels should be convened: by the Health Authority, neighbouring Trusts/Health Authorities, or introducing a separate regional or sub-regional panel.'

11. The listening document said that the Department of Health believed that to be effective and to work for the people it affects, the NHS complaints procedure needed to:

  • be easy for patients to access;
  • resolve complaints quickly;
  • be an open process, which is independent where appropriate;
  • be responsive to the outcome of complaints so effective improvements are made as a result.

12. Comments on the evaluation report's recommendations and certain key questions were sought by 12 October 2001. As well as seeking written responses, a series of regional events was held across the country to gauge views from NHS staff and patient groups and research was carried out with hard-to-reach groups.

13. When in January 2002 the Department of Health published its formal response to the Bristol Royal Infirmary Inquiry, it said (para 13) that its programme of reform included 'a reformed NHS complaints procedure by December 2002'. However it was not until 28 March 2003 that the Department published, NHS complaints reform - making things right, outlining the Government's plans for improving the complaints procedure.

NHS complaints reform - making things right - March 2003

14. This Department of Health publication described the vision of a new complaints procedureOpen in new window as being:

  • 'open and easy to access - by being flexible about the ways people could complain and with effective support for people wishing to do so,
  • fair and independent - with the emphasis on early resolution so minimising the strain and distress for all those involved,
  • responsive - providing appropriate and proportionate response and redress,
  • learning and developing - ensuring complaints are viewed as a positive opportunity to learn from patients' views to drive continual improvement in services.'

15. This would involve:

  • changing attitudes and forming positive relationships, through better access to information; developing customer awareness; improving communication skills; and through the demonstrable use of patient feedback to improve services;
  • acting on concerns and getting the response right. This would involve Patient Advice and Liaison Services; modern matrons (who would make sure standards were met); promoting good practice in local resolution (e.g. by producing a good practice toolkit). Access to the complaints procedure would also need to be made easier, for example by enabling complaints to be made direct to a Primary Care Trust (PCT) where there are concerns about a Family Health Service practitioner;
  • providing remedies, responses and support which people want. This would involve tailoring responses, delivering explanations and apologies as well as practical measures, quickly and directly and broadening the options for resolving complaints - including promoting the use of methods of alternative dispute resolution such as conciliation. It would also include reviewing existing guidance in relation to financial redress and the relationship between the systems for dealing with complaints and clinical negligence claims; and providing easy access to ICAS (ICAS performance standards would be set by CPPIH, and commissioned by Patients' Forums);
  • introducing 'Truly Independent Review'. Responsibility for this stage would be placed with the new Commission for Healthcare Audit and Inspection (eventually known as the Healthcare Commission). This would provide a direct link into the quality improvement process and enable robust assessment of cases and more options, as cases could be investigated in detail as an individual complaint or considered as part of an inspection or enquiry about failures in an organisation. This would also provide harmonisation with social care complaints, as the equivalent body for social care - the Commission for Social Care Inspection (CSCI) - would have similar powers for social services complaints and the two organisations would be under a duty to co-operate with each other;.
  • integrating complaints into wider systems, for example, individuals at Board level would be required to take overall responsibility for the investigation of and learning from adverse events, complaints and negligence claims. Quality and the patient's experience would also be improved by promoting the use of complaint material within wider initiatives such as clinical governance, a new adverse incident reporting system, reform to professional regulation and development, and risk management. In addition, the skills and competencies needed to deal with complaints effectively would need to have a high profile within education, training and professional development;

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16. Because of the need for primary legislation to establish CHAI and CSCI, those bodies could not be established before April 2004.

Reforming the approach to clinical negligence in the NHS - June 2003

17. In the interim, in June 2003, the Department of Health published a report by the Chief Medical Officer - Making amends. A consultation paper setting out proposals for reforming the clinical negligence system.Open in new window The report recognised that the system is complex, unfair, slow, costly in legal fees, and that it encourages defensiveness. It also found that patients were dissatisfied with the lack of explanations and apologies or reassurance that action has been taken to prevent repetition.

18. This report proposed a new NHS-based system of redress for patients who have been harmed as a result of NHS hospital care. The system would be administered by a body 'building on the work' of the current NHS Litigation Authority (NHSLA). Payment would only be made if there were serious shortcomings in the standards of care, the harm could have been avoided or if the adverse outcome was not the result of the natural progression of the illness.

19. Initially this system of redress would be limited to payments to families of neurological impaired babies, payments under £30,000 and those treated in hospital or community health settings (e.g. not in primary care). Consideration would be given to extending it later. The new arrangements would have four main elements:

  • investigating the incident;
  • providing an explanation to the patient and action to prevent repetition;
  • developing and delivering a package of care;
  • providing payment for pain and suffering, out of pocket expenses and care or treatment which the NHS could not provide.

20. Access to the scheme would be available following local investigation of the adverse event or complaint; investigation of a complaint by CHAI; delivery of a recommendation by the Health Service Ombudsman; or following the investigation of a claim made directly by a patient or relatives to the NHS Litigation Authority.

21. Other recommendations included:

  • setting a new standard for after-event/complaint management by local NHS providers with CHAI assessing compliance through its inspections;
  • removing the current NHS complaint procedure rule requiring a complaint to be halted pending resolution of a claim (this was seen as providing a potential benefit in reducing the number of people who pursue litigation and reducing the dissatisfaction complainants and claimants currently feel);
  • providing communication training for NHS staff within the context of complaint handling;
  • introducing a duty of candour, together with exemption from disciplinary action when reporting incidents, with a view to improving patient safety.

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Response of the Health Service Ombudsman to 'Making amends'

22. In October 2003 the Ombudsman wrote to the Chief Medical Officer commenting on the paper and welcoming the review. Issues raised included the lack of clarity in the interface between the proposed scheme and the work of the Health Service Ombudsman's Office, and the narrow approach taken on the question of financial redress. (When the Ombudsman upholds a complaint about the NHS, an appropriate remedy is recommended, which may include an element of financial redress. If the operation of the scheme fell outside the Office's jurisdiction, complainants would potentially lose a right of access to an independent Ombudsman.) Making amends only recognised harm as a result of sub-standard care as eligible for possible financial redress, whilst Making things right referred only to apologies, explanations and practical measures. The Ombudsman expressed the view that the NHS needed to consider redress in a much wider sense if it wished to make amends for poor service and service failures as well as addressing clinical negligence.

Health and Social Care (Community Health and Standards) Act 2003 Open in new window

23. This Act received Royal assent in November 2003 and contained several elements relevant to reform of the NHS complaints procedure, most notably:

  • providing for NHS Foundation Trusts to be established, and for an Independent Regulator (now known as Monitor) to be established for them;
  • enabling the Commission for Healthcare Audit and Inspection (CHAI) and the Commission for Social Care Inspection (CSCI) to be set up, along with a duty for them to work together when appropriate;
  • abolishing the National Care Standards Commission (only set up in April 2002) and the Commission for Health Improvement (CHI);
  • making some provision on complaints about the NHS, e.g. giving the Secretary of State power to make relevant regulations and to give CHAI and independent panels the powers to consider them;
  • making similar provision about complaints about social services and CSCI;
  • imposing a duty on NHS bodies to have arrangements for monitoring and improving the quality of health care;
  • providing for the Health Service Ombudsman to consider complaints about the handling of complaints by any person or body under the regulations.

Consultation on new draft regulations and guidance on the NHS complaints procedure

24. Draft regulations went out for consultation in December 2003, with responses due by March 2004, with a view to introduction of the regulations on 1 June 2004. The Healthcare Commission also consulted on their proposals for the independent stage of the procedure. (The Health Service Ombudsman responded to both consultations on 30 March 2004, copying letters to each of the other consulting organisations.)

25. The Ombudsman's main concern about the regulations was that the timescale for effective introduction of the arrangements was too tight. As expected, CHAI was being given responsibility for the second stage of the NHS complaints procedure, and the Ombudsman expressed concern that it would be difficult, if not impossible, for them to deliver an effective complaints handling process from 1 June 2004. The Ombudsman suggested a three way discussion with the Department and CHAI.

26. The Ombudsman also had a range of other concerns. These included concern that focusing on process and timescales might provide a perverse incentive in terms of quality of response and that unrealistic timescales might jeopardise the credibility of the procedure. Other issues included the failure to include any specific mention of redress and the degree of ambiguity about the role of panels. The relevant Act and regulations seemed to suggest CHAI could investigate or set up a panel, whereas CHAI seemed to be proposing an investigation, followed by a panel if the complainant asked for one.

27. The Ombudsman raised a number of similar issues with CHAI, including the points about timescales, panels and redress, as well as raising additional issues around:

  • delivering secure mechanisms for obtaining clinical advice;
  • considering the proposal that complainants could pursue a complaint whilst taking legal action;
  • ensuring sufficient patient focus;
  • ensuring some of the detailed time targets were realistic.

28. The Health Service Ombudsman was given another opportunity to comment on further revisions to the regulations and did so in May 2004 raising a number of further points.

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29. During the consultation period the Public Administration Select Committee took evidence on NHS complaints reform and associated matters (including Making amends) at a session on 29 January 2004. The Health Service Ombudsman also expressed concerns about the proposals in a memorandum to the Committee, as did the Consumer's Association (CA) and Action against Medical Accidents (AvMA), from whom evidence was taken. The two bodies suggested that:

  • an opportunity to address adverse events in a joined-up way had not been grasped (AvMA) and that the proposals did not represent a comprehensive framework of patient-focused redress (CA);
  • the NHS should offer compensation in straightforward cases where an internal investigation has identified a clear case for this;
  • PCTs should see all complaints about primary care in their area (rather than just receiving retrospective reports) to enable them to manage clinical governance and protect patient safety;
  • bodies have a duty to implement recommendations made by CHAI investigations (AvMA) or to take further measures to ensure they are implemented (CA);
  • the role of the panel in the independent stage should be clarified;
  • the proposals do not adequately recognise the complexity of issues, particularly the increasing diversity of different providers of NHS care and overlaps between these providers and between primary and secondary care.

30. In giving evidence about the relationship between complaints and claims for negligence the Chief Medical Officer said;

'I think we... will have a single gateway... Ministers have not yet ... decided how they want to take forward the medical litigation proposals. The two systems must be very closely aligned. Whether they are completely integrated - I think there are arguments in a number of directions on that one...

...Many people who are seeking compensation through the courts will do so after they progress the complaint to a certain stage, and they will often do so partly because of the inherent nature of the complaint but partly because the complaint has been handled badly, they have become more aggrieved during the process of handling the complaint. So the improvement in the complaints system will have a direct bearing, I think, on the way that redress, compensation, litigation is handled. The second thing is, I think there is a distinction between complaints which have to do with the diagnosis, treatment and care and complaints which have to do with the convenience of services. . Finally I think there is the whole question of the threshold for offering compensation and indeed the fact that most surveys show that patients, on the whole, want an explanation, an apology and a reassurance that what had been learned from the complaint will be used to benefit future patients. Compensation is not top of their list. .'

31. When asked about arrangements for training to support complaints handling the then Chief Nursing Officer said:

'... A lot of the issues around complaints have their roots in not communicating well. So we are at the moment working to look at the programme for training. We are working with higher education institutes to look at both pre-registration medical and non-medical training to see whether we can improve the component of communication training that goes into those programs. We are also working with the NHSU to look at introducing a common orientation programme to the NHS; and part of that component on day one will include, although basic, work around communication skills. We are also doing some more segregated work. For example, we are running programmes with front of house staff - medical receptionists, porters, reception desks - to get them to improve their communication skills. Then, specifically around the management of complaints, we have some pieces of work that are already on-going. For example, we are doing some work around developing national specifications for training in complaints and investigations. That specifically will be targeted at those front-line staff dealing with that - complaints managers, PALS services. We also are beginning to put together some work around training seminars specifically for primary care trusts, wards and staff around managing complaints, and we are in the very last stages of putting together a good practice tool kit which is around supporting improvements in local resolution. We have also had some other programmes going. For example, over the last three years we have put 40,000 ward team leaders - ward sisters, modern matrons, charge nurses - through leadership programmes; and a very specific component of that has been around communications skills and also resolution of issues and also about how you should proactively seek comments from patients and users.'

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Beginning to implement the changes

32. On 1 April 2004 the Healthcare Commission became operational, having existed in shadow form for some time. On 9 July the NHS (Complaints) RegulationsOpen in new window were laid before Parliament and came into force on 30 July 2004. Although the intention had been to implement the Complaints Regulations in full from June 2004, Ministers decided on a phased implementation following an approach from the Shipman Inquiry. The Inquiry's 5th report was likely to address complaints handling in some detail and was due to be published later in 2004. Reports from the Ayling and Neale Inquiries (about doctors who had repeatedly failed to observe proper standards of care) were also expected. Therefore, the local resolution stage of the complaints procedure remained broadly unchanged. The 2004 Regulations consolidated and rationalised the statutory requirements for local resolution by NHS bodies and introduced the reformed independent review stage carried out by the Healthcare Commission. They do not require NHS Foundation Trusts to have a complaints procedure in line with the provision regarding local resolution in the regulations, although the independent review stage does apply to them and they are in the Health Service Ombudsman's jurisdiction. The Department intends to issue revised regulations in 2005.

Further changes - abolition of the Commission for Patient and Public Involvement in Health (CPPIH)

 

33. On 22 July 2004 the Secretary of State for Health announced the outcome of a review of the Department of Health's arm's length bodies. The aim was said to be to streamline them, reduce bureaucracy and release resources to frontline NHS care. Among those to be abolished is the CPPIH. Patients' Forums will continue and the Department said that 'stronger, more efficient arrangements to provide administrative support and advice' to them would be set up. A clear quality framework for Forum activities would be established and communicated to Forums. The best body to do that would be identified in discussion with the Healthcare Commission and stakeholders. Responsibility for appointing Forum members would move to the NHS Appointments Commission.

Neale and Ayling Inquiry reports

34. The inquiries into how the NHS handled allegations relating to the performance and conduct of these two doctors reported on 9 September 2004. Recommendations from the Neale InquiryOpen in new window included:

  • `Doctors should spend time observing the Patient Advocacy and Liaison Service (PALS) process and be familiar with the process...
  • All PALS appointees should be of middle/senior grade...
  • Unified and centralised training should be provided for all PALS officers.
  • Complaints handling should be aligned to quality management and patient services rather than claims management...
  • The head of the unit dealing with complaints should be an appropriately trained middle manager...
  • Complaints handling should be mandatory for all levels of clinical, nursing and administrative staff...
  • Complaints statistics should be included in the Profiles of Trusts and used by the Healthcare Commission in routine audit procedures...'

35. The recommendations from the Ayling InquiryOpen in new window included:

  • providing accredited training for all PALS officers in dealing with sensitive and intimate concerns - Strategic Health Authorities (SHAs) should require confirmation from NHS Trusts of the completion of such training within the next 12 months;
  • addressing the emerging issue of visibility and accessibility of PALS in primary care settings by getting the Modernisation Agency to develop a model of best practice - if appropriate, patients' forums could monitor the effectiveness of service provision against this model. The implementation of this model and associated performance measures should be a formal component of CHAI's reviews of PCTs;
  • providing ICAS staff with the same training in handling concerns and complaints of an intimate and sensitive nature as that recommended for PALS staff, with this forming part of the service specification for ICAS. Satisfaction surveys should be built into the work of ICAS on completion of their work with each complaint so that their performance can be routinely monitored and a cycle of continuous improvement be established;
  • requiring all NHS Trusts and health care organisations, such as deputising services, directly employing staff to make a formal declaration of any other concurrent employment, not only for health and safety reasons but also to ensure a record is kept of other organisations with an interest in the individual's performance. Failure to make such a declaration should be a disciplinary matter. This requirement should be appropriately adapted for PCTs to be kept informed of other professional employment undertaken by general practitioners (GPs);
  • ensuring that copies of any written records regarding complaints and concerns which name an individual practitioner are placed on that practitioner's personnel file, to be kept for the length of their contract with that organisation. This should be made known to the practitioner;
  • ensuring that the regular reports on patient complaints and concerns, made to NHS Trust Boards and other corporate governance bodies, not only analyse trends in subject matter and clinical area but also indicate whether a named practitioner has been the subject of previous complaints.

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Changing the social services complaints procedures

36. In September 2004 the CSCI consulted on their proposals for the independent review stage of the social services complaints procedures. That consultation said that capacity for joint reviews with the Healthcare Commission would be developed in 2005-2006. Two separate consultations by the Department for Education and Skills and the Department of Health respectively, on the children's and adults' parts of the social services complaints regulations, were issued in October 2004. The intention was to introduce the new procedure in April 2005 (but it is now likely to be implemented later in the year).

37. Both the Health Service Ombudsman and the Local Government Ombudsmen for England responded to the consultations. Both expressed concern about the complexity of the process, the lack of clarity for complainants and the lack of alignment between CSCI and the Healthcare Commission in relation to health and social care complaints.

The Fifth report of the Shipman Inquiry

38. This report, Safeguarding patients: Lessons from the past - proposals for the futureOpen in new window was published in December 2004. It considered the handling of complaints against and the raising of concerns about GPs, General Medical Council procedures and its proposal for revalidation of doctors. The report proposed a significantly different system for handling complaints about GPs. The recommendations included:

  • extending the time limit for lodging a complaint to 12 months;
  • ensuring all complaints about GPs are reported to the PCT within two days of receipt and giving patients the option to lodge complaints directly with the PCT;
  • ensuring a member of PCT staff conducts a triage (initial assessment) of all complaints to decide whether they are 'private grievances' or if they raise clinical governance issues. Private grievances should be dealt with by the PCT staff (or the GP, if lodged there). Clinical governance complaints should be called in by the PCT if lodged with the GP, and all such complaints should receive a second triage by a group of two or three senior people from the PCT. The aim of that would be to decide whether the PCT should arrange an investigation or whether the complaint should be referred instead to some other body such as the police, the General Medical Council or the National Clinical Assessment Authority (NCAA);
  • setting up joint teams of investigators from across PCTs to investigate clinical governance complaints. They should be properly trained in investigation. The aim of the investigation should be decide what happened and report to the PCT;
  • ensuring that the group which conducted the second triage considers what action to take, either itself or by referring the matter elsewhere. If the investigation team's report is inconclusive then the complaint should be referred to the Healthcare Commission;
  • ensuring that intended or actual legal proceedings are not a bar to an NHS body investigating a complaint. If the NHS body is taking disciplinary proceedings relating to the subject matter of the complaint against the person complained of, a complainant should be entitled to see the substance of the report of the investigation on which the disciplinary proceedings are to be based;
  • allowing, in some circumstances, an NHS body to defer or discontinue its own investigation if the matter is being investigated by the police, a regulatory body, a statutory inquiry or some other process. However, an NHS body should never lose sight of its duty to find out what has happened and to take whatever action is necessary for the protection of the patients of the doctor concerned. It should also provide such information to the complainant as is consistent with the need, if any, for confidentiality in the public interest;
  • allowing PCTs to refer a complaint to the Healthcare Commission at any point during the first stage of the complaints procedures. Cases raising difficult or complex issues or involving issues relating to both primary and secondary care might be referred to the Healthcare Commission for investigation at the time of the second triage, or later if the investigation raises more complex issues than were initially apparent. Referral to the Healthcare Commission should also take place in cases where an investigation has found that it cannot reach a conclusion because there remain unresolved disputes of fact. The referral would be so that the Healthcare Commission could carry out any further necessary investigation and, if appropriate, set up a panel to hear oral evidence about the facts in dispute and decide where the truth lay;
  • establishing objective standards, by reference to which complaints can be judged, as a matter of urgency. These standards should be applied by those making the decision whether to uphold or reject a complaint and by PCTs and other NHS bodies when deciding what action to take in respect of a doctor against whom a complaint has been upheld. Those standards must fit together with the threshold by reference to which the GMC will accept and act upon allegations, so as to form a comprehensive framework;
  • ensuring there is a 'single portal' by which complaints or concerns can be directed or redirected to the appropriate quarter. This service should also provide information about the various advice services available to persons who are considering whether and/or how to complain or raise a concern, including advice services for people concerned about the legal implications of raising a concern;
  • dealing with concerns raised by someone other than a patient or patient's representative (e.g. a fellow healthcare professional) in the same way as patient complaints.

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