Bringing PPUs in line with private hospitals
Handling complaints in NHS private patient units
The Independent Sector Complaints Adjudication Service (ISCAS) is planning to take a pilot study forward with two NHS private patient units to make it easier for private patients to complain. ISCAS director Sally Taber reports.
Patients have rights to candour by their healthcare provider and to complain and to escalate a complaint to an external review stage.
For patient complainants treated by the NHS, there is a clear path leading to the Parliamentary Health Services Ombudsman (PHSO) and, for patients in the independent sector, there is the ISCAS Code.
But confusion arises for private patients treated in an NHS hospital private patient unit (PPU).
Patients in NHS PPUs, which are commercial entities, are not allowed to take forward complaints through the PHSO – and this is unlikely to change in the foreseeable future.
The closest equivalent to the PHSO is ISCAS. The majority of larger and small independent hospitals are signed up to ISCAS, which provides independent, third-party arbitration if complaints are not resolved directly with the organisation, as recommended by the Paterson Inquiry in 2020.
Common standards
Both the NHS and ISCAS incorporate a common complaints standard framework in their complaints code:
Promoting a just and learning culture;
Welcoming complaints in a positive way;
Being thorough and fair;
Giving fair and accountable responses.
Now the long-established ISCAS has made a proposal to the Department of Health and Social Care to work with two NHS PPUs to trial its Code for Handling Patient Complaints in the PPU environment.
These proposals have been made to the University Hospital Southampton NHS Foundation Trust NHS PPU and the Royal National Orthopaedic Hospital – Private Care, in Stanmore, Middlesex.
Elements of the trial would consist of a review of the documentation used for handling a complaint from a private patient within the trial NHS PPU to see:
How they have included the Complaints Standard Framework within their policy;
How they handle the second stage, which is when the patient cannot agree on resolution and the complaint is passed outside the immediate service provider.
Typically in independent hospitals, this would be to the company head office. In the case of PPUs, it is envisaged that the hospital’s Patient Advice and Liaison Service (PALS) organisation would undertake this stage.
Upon any disagreement at this stage, a complaint goes to an independent adjudicator appointed by ISCAS.
ISCAS sees PALS as well suited to this task of resolving a complaint which has been rejected by the provider at operational level. They are already tasked to:
- Respond to a patient’s concerns if they are unhappy with an aspect of their health care;
- Give advice about the complaints process and deal with problems confidentially;
- Listen to suggestions for improving medical services and health care;
- Talk to staff on patients’ behalf;
- Advise patients on the advocacy services available;
- Direct patient to other services or agencies, where appropriate, to address their concerns.
ISCAS believes that most PALS already feed back useful improvement lessons to help management improve performance and would continue to do so for PPUs.
As far as consultants are concerned, we foresee that those using PPUs will have suitable clauses in their practising privileges contracts that require candour and co-operation in resolving complaints.
Costs of adjudicating complaints are expected to be borne by the providing organisation: the PPU. If the adjudicator recommends a financial award to the patient, it must be within a ceiling of £5,000 and is paid by the provider.
According to Private Healthcare Information Network (PHIN) data, there are 277 PPUs in England that do not have an external review stage.
This pilot study will offer a way for PPUs to remedy this unfortunate situation and to fulfil the requirements of the Paterson inquiry. PHIN issues useful guidance on making a complaint as a private patient.
Complaints arise in any organisation. Coming from a unique perspective, they provide valuable indication that the service provided may be suboptimal.
So complaints handling should be integral with the management improvement cycle.
A timely and fair settlement of a patient’s concerns avoids disquiet in the community and leads to improved output by the organisation. A good complaints handling system is essential to any organisation.
