Helping patients in complaints limbo

Patients in NHS PPUs are not allowed to make complaints through the Parliamentary Health Service Ombudsman. The Independent Sector Complaints Adjudication Service is working to ensure they are aware of the relevant route for private patients to use. Sally Taber explains.

A patient in any healthcare environment who finds it necessary to complain is, unfortunately, unlikely to be well informed about the process to follow. 

For patients treated by the NHS, there is a clear path leading to the Parliamentary Health Service Omb­udsman (PHSO) and, for patients in the independent sector, to the Independent Sector Complaints Adjudication Service (ISCAS) code.  

Confusion arises for private patients treated in NHS hospitals in their private patients units (PPUs). In the environment of an NHS hospital, it might be natural to assume that a complaint would be handled through the NHS system to the PHSO, but this is not, in fact, the case. 

PPUs exist as treatment centres financially independent of the NHS and with no call upon Gov­ern­­ment funds, being the product of local economically-driven initiative.  

For this reason, the Care Quality Commission (CQC) lays down in its inspection framework for PPUs that ‘where . . . the patient is receiving non-NHS funded care…patients do not have access to the PHSO.’ Instead, the CQC points the way to the ISCAS Code for Handling Complaints as a suitable alternative.

According to data from the Private Healthcare Information Network, 277 PPUs currently do not have access to an external review of unresolved complaints. 

That leaves many private patients of PPUs in jeopardy, paying for treatment but with no safety net in case of dispute. This is not a good situation.

Defensive system 

In the First Do No Harm report published in July 2020, Baroness Cumberlege referred to a defensive healthcare system that does not listen to the concerns of patients. 

The NHS website ‘How to complain to the NHS’ is only relevant for NHS-funded treatment and refers to escalating complaints to the PHSO. Therefore, this and other information for NHS-funded care should not be provided to private patients treated in the NHS.

ISCAS is provided as a link for complaints about private healthcare by the CQC on their website ‘Complain about a hospital, community or mental health service’. 

This section of the CQC website signposts patients who remain dissatisfied with the response from the provider. The CQC differentiates the point of escalation based on how healthcare has been funded; namely PHSO for NHS-funded treatment and ISCAS for privately funded treatment.

ISCAS is provided as a link for complaints by the PHSO website page on private healthcare.

Pilot schemes

ISCAS, in conjunction with the PHSO, will be carrying out pilot schemes – hopefully with the Great Ormond Street Hospital PPU and the University Hospital South-ampton PPU – to provide PPUs with true guidance on the correct route for processing complaints so that their PALS (Patients Advice and Liaison Service) can confidently continue to advise, support and inform PPU patients.

NHS and private patients continue to say they do not understand how to escalate complaints in both the NHS and the independent sector. 

This was highlighted in the Paterson Inquiry Report published in February 2020, which recommended: ‘Information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and independent sector.’

Listening to patients is an important component in any management system, public or private.

In July 2020, the Patients Assoc­iation facilitated a focus group with patients who had received private and NHS-funded healthcare and had complained about their treatment. 

The focus group concluded: ‘It would not be clear to the person on the street that private patient complaints cannot be escalated to the PHSO. The focus group stated that ‘most patients wouldn’t know where to find it [information] or that it even existed’. 

The focus group said that information about how to escalate private patient complaints should be simple information guides in one page if possible and should:

 ‘Be part of the information sent with the admission letter and then explained by the consultant at the initial consultation.’

 Consist of ‘a pack of information, including how to complain given to the patient at the outset. A leaflet, posters around the hospital, in GP waiting rooms etc.’

Another bureaucratic cost?

No. Listening to users and understanding their point of view is an important link in any management improvement system; economically valuable and therefore worthy of investment.  

The lessons from the Paterson Inquiry point out the need for good complaints-handling processes and Baroness Cumberlege states organisations should designate a non-executive member of the board to oversee the complaint-handling processes and outcomes and ensure that appropriate action is taken.

The NHS invests in the PHSO. PPUs, independent of the NHS, need to invest into ISCAS by subscribing to us to give patients an avenue for complaints.

Sally Taber (right) is director of ISCAS