How to complain about your doctor
...without ambulance-chasing the legal vultures getting A PENNY
THE NHS is expected to pay out a staggering £1.4billion for clinical negligence claims this year. And where will that money go? Well, some goes to patients and their families who have suffered harm or distress. But about a third is paid to the legal profession, and most of that goes straight into the pockets of patients’ lawyers.
Having spent 25 years as a medical expert advising patients, doctors and hospital trusts on clinical claims, I see patients going down the stressful, expensive and often futile legal route when their complaint could have been resolved at a much earlier stage.
I know of a relatively straightforward case where damages of £30,000 were dwarfed by legal fees of hundreds of thousands of pounds. The money settled the matter, but I don’t think the patient himself felt he had the answers, or the heartfelt apology, he was after.
I think one of the reasons people end up being channelled into the clutches of ambulance-chasing lawyers is the often bewildering NHS complaints system, at times a frustratingly slow and impersonal process. But in almost all cases, you can air grievances, and resolve disputes, quickly, with the minimum amount of fuss, without paying a penny – and here’s how...
WHAT CAN I COMPLAIN ABOUT?
Anything you are unhappy about. Of the 4,159 investigations completed by the Parliamentary Health Service Ombudsman in 2014-15, 30 per cent were to do with diagnosis, including delays or misdiagnosis. Other complaints included staff attitude, and communication and information issues, including confidentiality.
Under the NHS constitution, patients have the right to have complaints dealt with efficiently, properly investigated and resolved, and receive compensation if it is found they have been harmed.
I’ve been involved with more than 8,000 medical legal cases on both sides and people complain for a whole range of reasons. Maybe their expectations were not achieved and they’ve suffered financial loss as a result – such as the man who was told he’d be back at work days after a hernia operation but who was still at home three weeks later.
Perhaps you feel you’ve been unfairly treated by your GP, or you just have a niggling sense that not everything went according to plan during your treatment and you want to know why. Or you could be in hospital, and find the environment or staff aren’t up to scratch.
FIRST STEP: TRY TO NIP THINGS IN THE BUD
In my experience, many problems that spiral out of control could have been tackled sooner. You may have been kept waiting a long time for your hospital appointment, or a member of staff was rude to you. Perhaps you felt an elderly relative wasn’t getting adequate pain relief, or even enough to drink. In these circumstances, do as you would in any restaurant when you aren’t happy: ask to speak to a manager.
Of course, this isn’t always easy. You may be feeling frustrated or anxious (or just too unwell!). Maybe you don’t want to feel like a nuisance or you’re worried your care will suffer if you say something. But if something is really bothering you, don’t be afraid to speak up.
Jot your concern down on a bit of paper, and how you want it put right. Be calm. Approach a member of staff, explain your problem briefly and ask to see someone senior. Most doctors and nurses are generally compassionate people and trained in dealing with patients, so they should be willing to listen to your complaint. It’s much more satisfying to receive an explanation from a member of staff who already knows you than a faceless person at the end of a phone.
STILL UNHAPPY? THEN PUT IT IN WRITING
If you feel your initial complaint is handled unsatisfactorily, you can start to go down the formal NHS complaints process (but see your GP if there is something acutely wrong medically).
Every NHS organisation has its own complaints process. You usually need to put your complaint in an email or a letter to the service provider. If it’s about your GP, you can complain to the surgery directly or, if you feel uncomfortable doing this, contact NHS England (0300 311 2233, or email england.contactus@ nhs.net).
For hospital-related complaints, hospital trusts usually have a complaints manager you can write to, or address your letter to the trust’s chief executive. Check the complaints section of the hospital trust’s website for who to contact.
FEELING LOST FOR WORDS?
Complaints can be daunting, especially if writing letters isn’t your forte. My advice is keep it simple. Focus on the key issues. If your main concern is that you feel you were given the wrong treatment, just mention this, rather than also complaining about the state of the toilets on the ward.
Make it clear what you want to happen – whether it’s an explanation, an apology, a change to the system or compensation, for example.
Of course no one expects you to have kept copious notes when you had, say, a hip replacement, but try to include any details of dates, times and names you may have.
Have a friend or family member read your letter before sending it off. Get a file together with copies of any correspondence.
You can get free advice about putting your complaint together. Most hospitals have a Patient Advice and Liaison Service (PALS) who offer confidential advice on healthrelated matters to patients, families and carers. Search for PALS on the trust website for more details.
The Citizens Advice Bureau can help, and it has a very detailed webpage on NHS complaints (citizens advice.org.uk). Your local branch of consumer organisation Healthwatch (healthwatch.co.uk) will also offer free advice.
YOU’RE TOLD YOUR ISSUE IS HISTORIC
You may be told you only have 12 months to submit a complaint, which is the official NHS line. Don’t let that put you off.
Some problems may not become apparent for months or even years after the event, or it can take time for it to dawn on you that not all is as it should be. Time limits can be extended, for example if you were grieving or undergoing trauma.
Having said this, the earlier you can complain, the easier you may find it.
CAN I ASK TO SEE MY MEDICAL RECORDS?
Yes, and you might find it helpful. Records contain letters, charts, correspondence, outpatient and inpatient clinical notes and so on.
Under the Data Protection Act, you have a legal right to apply for access to information held about you. It’s known as a Subject Access Request and includes your NHS or private health records held by a GP, dentist, optician or hospital.
Apply via email or in writing to the relevant place – your GP surgery, optician, dentist or your hospital trust’s health records manager or patient service manager.
Your hospital website should have contact details. Most organisations have a standard Subject Access Request form that you can fill in online.
Requests for access should be met within 40 days, but be aware that you may be charged up to £50.
WHAT HAPPENS THEN?
Hospital complaints must be acknowledged by the complaints manager or similar within three working days verbally, or in writing.
Once your complaint has been received, you should be offered a meeting to discuss it and give you an idea of the likely timescales involved.
Unfortunately there are no limits on how long they can take to deal with your complaint, and it can depend on factors such as how many staff they need to speak to and how easy it is to access your medical records. But be persistent. You can report it to the independent Scottish Public Services Ombudsman.
FACE TO FACE IS BEST
Always take up the offer of a faceto-face meeting, and ask that it includes staff involved in your care – nurse, doctor, consultant.
Again, prepare some notes in advance to keep your focus. Keep to the key reasons why you have a complaint and what you want to achieve.
Have a list of questions ready. For example, if you feel you have suffered harm or distress following an operation, ask: What did the procedure involve? Why do I have this problem? What can be done to put it right? A health professional worth their salt will be able to explain things clearly to you, and if you don’t understand, ask them to repeat it.
You may find it helpful to have a friend accompany you to take notes, and for moral support.
WHAT HAPPENS NEXT?
You should be given a timescale at the meeting of when to expect your complaint to be resolved. At the end of the investigation, the complaints manager will send you a written response explaining how the complaint was handled, an explanation or apology if appropriate and any compensation offered.
YOU’RE NOT HAPPY WITH THE OUTCOME
If you haven’t received a decision six months after your complaint or are unhappy with the outcome, you can contact the Scottish Public Services Ombudsman.
The ombudsman will need details of your complaint, when it happened, how it affected you and what you want them to do to put it right.
The ombudsman can make recommendations to the organisation and can ask it to make a payment to you. While free of charge, this option could take up to a year and in my opinion the decisions can be variable.
I’d advise instead to try mediation, a grossly underused method that is effective, less stressful and a hell of a lot cheaper than going to court. Mediation is a relatively new concept in the NHS and takes the form of an independent, voluntary and confidential meeting in which a trained neutral sits with patients and NHS staff to allow both sides to outline their position, and see if common ground can be established and if issues can be narrowed and an agreement reached.
About three-quarters of mediations result in a satisfactory outcome, often within a day, but mediation is not legally binding until a written agreement is signed and the case can proceed to court. The Tutu Foundation offers a mediation service (tutufoundationuk.org, tel 01865 514830).
ANYONE ELSE THAT WILL BE ON MY SIDE?
Every doctor and nurse has a legal duty to provide a good standard of care. If you feel they have fallen short, you can report them to their regulatory body. For doctors, this is the General Medical Council (gmc-uk.org), or the Nursing and Midwifery Council (nmc.org.uk) for nurses. These bodies can investigate serious mistakes in clinical care, dishonesty or abuse of position, but can’t make a doctor or nurse apologise to you, impose a fine or help you with a compensation claim.
IF ALL ELSE FAILS… GET OFF TO A LAWYER
If mediation fails and you feel you deserve compensation, you can seek legal advice. You have three years from when the incident occurred to bring about a claim. First, contact a solicitor who will assess whether you have grounds for a claim.
And remember, legal aid isn’t usually available for cases of clinical negligence and they are often complicated. The process can be stressful, lengthy – I’ve been involved with cases lasting four years – and the outcome is uncertain.
John Scurr is a former consultant surgeon at University College Hospital, London, and head of Medico-Legal Chambers.