You do not have to take legal action if you are dissatisfied with medical treatment you have received. You can simply make a formal written complaint about this.
A complaint can provide you with an explanation of what has happened to you, an apology, a reassurance about future treatment and may sometimes lead to a nominal offer of compensation.
The complaints process cannot provide you with compensation as of right, and usually will not provide you with full compensation for your injuries and other losses, unless they are very slight injuries and nominal out of pocket expenses.
Private Medical Treatment
If your treatment was paid for privately by either yourself or your insurance company, there is no formal complaints procedure in relation to individual doctors. You will have to take the matter up with the doctor direct initially, at the private Hospital or clinic concerned. If the response is unsatisfactory then you will have to complain to the General Medical Council. If the complaint relates to the private Hospital itself, or the general/nursing care provided at that Hospital, then you should complain direct to the healthcare provider, i.e. the company that owns the private Hospital. There is no set procedure or time limit for this process.
NHS Medical Treatment
If the NHS provided your medical treatment, then you must follow the NHS complaints procedure set out below.
Remember, if the NHS paid for your treatment to be carried out privately, you can still make a complaint to the NHS Trust which paid for the treatment using the complaints procedure set out below.
Stages of Complaint
There are 3 possible stages to a complaint against the NHS:
- Local resolution
- Independent review
- NHS Ombudsman
The NHS complaints procedure covers complaints about treatment received from your GP, an NHS Hospital or an NHS dentist, and NHS professionals such as nurses, midwives, occupational and physiotherapists, suppliers of medical equipment or aids, and so on.
1. Local Resolution
Minor Complaints - You can complain immediately and/or informally to the staff involved at the surgery (or the Patient Advice and Liaison Service (PALS) at an NHS Trust) or dental practice which has responsibility for your treatment.
More Serious Complaints - You should write formally to the complaints manager at the NHS Trust or practice manager at the general practitioner’s surgery or dental practice, setting out the details of your complaint. NHS Direct can help on 0845 4647 or at www.nhsdirect.nhs.uk
The Independent Complaints Advocacy Service (ICAS) can help you to make your complaint, and support you throughout the process – telephone 0845 120 3782 or click on this link: www.cabwiltshire.org.uk locally, or if you live elsewhere in England visit www.icas-network.com for further information. This is a free service.
You should receive a written response to your complaint within 28 days.
2. Independent Review
If you are unable to obtain public funding to investigate your situation at this stage, and do not have enough information to properly frame your complaint, if your complaint is about NHS services, but not the private sector, you may wish to contact your local Independent Complaints Advocacy Service (ICAS).
This is a free advocacy service to help to guide you through the NHS Complaints system. They are independent of the NHS.
If you give them your authority, they will exchange information with us and if they feel you have a good case for compensation they will refer you back to us, if they do not feel they can take things any further under the Complaints procedure.
ICAS will help with complaints against all types of NHS provider, including General Practitioner (GP); Dentist; Optician;Chemist/Pharmacist, as well as Ambulance Services, Hospitals and any services carried out in the private sector, but paid for by the NHS.
In the South West, South of England Advocacy Projects Limited have been awarded the contract by the Department of Health (DH) to offer ICAS support, in place of Citizens Advice from 1 April 2006.
Specialist caseworkers at a limited number of offices will offer free casework and advocacy support. They can advise you how to present your complaint in the most effective way by helping you to identify which service provider may be at fault. They will give you a self-help pack and, if necessary, help you draft complaint letters and tell you where to address the letters and if the NHS body offer you a meeting to discuss your complaint, they will arrange to represent you at the meeting and attend with you.
They will offer telephone advice rather than face to face meetings with your caseworker. They have access to interpreters.
They cannot help with private healthcare complaints, or where the complaint crosses boundaries. For example, if a complaint arises out of community care you may need to complain under the Social Services complaints procedure as well. ICAS cannot deal with that aspect, unless the care is co-ordinated by a Health and Social Care NHS Trust.
If they believe there is clear evidence of negligence, and therefore you may be able to claim compensation, they cannot give legal or clinical advice, but they will then refer you back to a specialist solicitor, and, if you agree, they will share information with the solicitor (including copy correspondence and notes of meetings and copy complaints documentation), so that the solicitor has a solid basis to apply for public funding or to enter into a fixed price investigation at that stage.
Initial Review
An initial review of your complaint will be carried out by a Commission case manager to decide whether or not it requires further investigation. A letter will be sent to you informing you of the decision.
Full Investigation
If further investigation of your complaint is necessary, the Healthcare Commission will decide (with you and the person/organisation being complained against) the terms of reference of that investigation. This investigation will produce a full report together with any recommendations to improve future services. The Commission may also seek an apology for you.
Independent Review Panel
If you are unhappy with this further investigation, you can ask that an independent panel be set up to look at your complaint, and the way in which it has been handled. The panel will consist of 3 members of the public, independent of the NHS, who have been trained in handling NHS complaints.
3. NHS Ombudsman
If you are still unhappy with the outcome of your complaint, or the way it has been handled, you can ask the NHS Ombudsman to investigate it.
Any complaint to the Ombudsman must be made within 12 months of the treatment complained of.
Time Limits
A written complaint must be made:
within 6 months of the treatment complained of; or
within 6 months of finding out that you have grounds for making a complaint, provided this is not more than 12 months from the date of the treatment complained of.
There is discretion to extend these time limits, but it is not often exercised.
Remember: you normally only have 3 years in which to pursue a clinical negligence claim and therefore you should make sure that the complaints process is not delayed so that it uses up too much of that 3 years, as that could affect your ability to proceed with a claim through the courts.
Complaints & Court Proceedings
Under the present procedure, you cannot pursue the NHS complaints procedure, at the same time as taking legal action in relation to the same treatment.
The complaints procedure is presently stopped by the NHS body as soon as legal action starts (i.e. if you instruct a solicitor to investigate a claim on your behalf). When the new complaints procedure is implemented in full this will no longer happen – see www.doh.gov.uk
Complaints About Social Services Care & NHS Medical Treatment
These complaints about community care can be handled as one set of complaints, by either Social Services under their complaints procedure, or the relevant NHS Acute or Primary Care Trust under the NHS complaints procedure.
General Medical Council
If your complaint concerns an individual doctor, and is serious enough to possibly be professional misconduct, or you have evidence that the doctor is too ill to carry out his job properly, a complaint can be made to the General Medical Council. Telephone 020 7580 7642 for further information.
