Bolstering the system for patients’ complaints

Signposting patients to the Independent Sector Complaints Adjudication Service (ISCAS) is now essential to implement recommendation 6 of the Paterson Inquiry and ensure good complaints management, says Sally Taber.

Good complaints management was highlighted in the Paterson Inquiry report published back in February 2020.

It has been very encouraging to see progress being made in the private healthcare sector in recent months.

The Paterson Inquiry report said: ‘We recommend that information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and independent sector.’ 

And this was reiterated when the Government released its long-awaited response to Paterson in December.

In a oral statement to Parliament on the Paterson Inquiry report in December, junior health minister Maria Caulfield said: . . .‘regardless of how their care is funded, all patients should be confident the care they receive is safe, meets the highest standards, with appropriate protections. . .’ 

She went on: ‘The inquiry did not jump to a demand for the NHS and the independent sector to invent multiple new processes, but to actually get the basics right, implement existing processes and for all professional people to behave better and to take responsibility.’ 

To us at ISCAS,that means having an external review stage to an independent sector organisation’s complaints process. 

Patients who are looking beyond the organisation where they were treated are increasingly being signposted to our service. 

For instance:

The Royal College of Surgeons of England signposts to ISCAS and has a hyperlink directly to the ISCAS website. See signposting here: 

The Patients Association 

The Private Patients Forum

Independent Doctors Federation 

Parliamentary and Health Service Ombudsman (PHSO) 

Action Against Medical Accidents is signposting to the PHSO only:, although it does mention private patients.

ISCAS has been talking about signposting too with both the Federation of Independent Practitioner Organisations (FIPO) and the London Consultants Association (LCA).

Consultants co-operating on patient complaints

As part of their practising privileges at an ISCAS subscriber hospital or an NHS private patients unit (PPU), the consultant agrees to co-operate with the hospital’s complaints policy as part of their practising privileges with the provider. 

For ISCAS subscriber hospitals, this is a three-stage process: 

  1. The registered manager is responsible for Stage 1 of the complaint when the complaint is first raised. 
  2. Stage 2 is conducted by the corporate head office – in the case of group hospitals – or in the case of individual hospitals by the chairman of the board or appointed non-executive director. 
  3. ISCAS is enacted at Stage 3 if the patient remains dissatisfied. 

Patient complaints are an inevitable aspect of a consultant’s professional career and the ISCAS Code of Practice provides an invaluable framework for specialists to manage them. 

A direct entry mediation scheme has been introduced for those small organisations who do not have the infrastructure to undertake adjudication. 

We have considered recommendation 6, in two parts. The first part calls for more effective communication to patients of the means to escalate a complaint to an independent body, namely ISCAS. 

Involving the Ombudsman

The Parliamentary Ombudsman is piloting the NHS Complaints Standards which set out in one place the ways the NHS should handle complaints. This includes the need for organisations to ensure people know how to escalate a complaint to the Ombuds­man. 

These have been developed with ISCAS and we have included the framework in our 20-page updated code of practice that we have just launched – see

The second part of recommendation 6 proposes that all private patients are given the right to mandatory independent resolution of their complaints. 

Now the Care Quality Commis­sion (CQC) will be strengthening its guidance to make clearer that it expects to see arrangements in place for patients to access independent complaints resolution. 

The Department of Health will review the impact of this guidance in the coming year and will explore whether legislative action is needed if insufficient action is taken.

 Subscriptions for ISCAS start at £515 a year and rise in relation to private patient turnover.

Sally Taber (right) is director of Independent Sector Complaints Adjudication Service (ISCAS)

Ten points from the ISCAS Code of Practice for Complaints Management

1. Good complaints management is an integral component of good governance, quality management and an organisational commitment to customer focus. 

2. Good complaints management and learning from complaints should be part of the wider quality management system.

3. Actively seeking feedback from patients, focusing on enhancing customer satisfaction and maximising opportunities for continuous quality improvement through learning from complaints enables organisations to enhance and improve the quality of care and service. 

4. ISCAS, an independent not-for-profit organisation, is recognised by subscribing independent healthcare providers as an appropriate body for the escalation of complaints in the UK. It is independent of all private healthcare providers and is owned by the Centre for Effective Dispute Resol­ution, which is a registered charity.

5. ISCAS is recognised by the following regulators, with whom it has an information sharing agreement: The CQC, Health­care Improvement Scotland, Healthcare Inspectorate Wales and the Regulation and Quality Improvement Authority. It is recognised by other relevant bodies, such as the Parliamentary and Health Services Ombudsman (PHSO) as an appropriate body for the escalation of complaints in the independent sector. 

6. The ISCAS Code sets out good practice standards for independent adjudication services, which are provided by ISCAS, and offers an impartial way of resolving disputes between complainants and subscribers. 

7. The Standards, where appropriate, refer to the requirements made by the systems regulators across the UK who oversee compliance with good practice principles and quality and regulatory standards in each of the four UK countries. 

8. Costs associated with independent adjudication are met by the relevant subscriber and not  the complainant. 

9. ISCAS is not a regulator and has no powers to take enforcement action against a subscriber. But it will take ‘appropriate’ action including termination of a subscriber’s participation in the scheme for organisations who fail to meet the standards or who bring the code into disrepute. 

10. The code does not exclude other good practice models – such as using patient partners – and encourages subscribers to continuously improve the effectiveness of their complaints handling in the light of best practice and good governance. 