This section explains how you can complain about NHS services, including child and adolescent mental health services (CAMHS).
We look at:
- who can help you to write a complaint
- time limits for making a complaint
- how complaints may be resolved
- taking legal action.
Your right to make a complaint
You have the right to complain if you're not happy with the standard of care your child has received from an NHS service. For example, you may wish to complain if your GP has refused to refer your child to a diagnostician, a diagnostician has refused to assess your child, or you haven't been satisfied with the level of care your child has received from CAMHS.
If you have a complaint about a private diagnostician they should have their own complaints procedure, as required by the Care Standards Act 2000.
Who can help you to write a complaint?
Going through the complaints process can be quite stressful and difficult, but there are people who can help.
Advocates
If you are about to make a complaint, advocates can help you explore your options. For example, they can advise you on whether it would be best to go through the complaints procedure or whether the situation is too serious and urgent – in which case judicial review may be the best option.
Advocates can help you to write letters, contact third parties for information on your behalf and provided support by accompanying you to meetings.
Advocates are on your side. They work on your behalf and their aim is to achieve whatever it is that you want. They make sure that your voice is heard and that your opinions are taken seriously.
The Independent Complaints Advocacy Service (ICAS) in England
ICAS supports patients and carers who wish to make a complaint about an NHS service. Advocates who work for ICAS are independent of the NHS and can help you explore all the options that are available to you.
The advocates can help write letters to the relevant person in the NHS and support you at any meetings that you have to go to. They can also contact third parties and act on your behalf (if instructed to do so by you). Your local Patient Advice and Liaison Service (PALS) will be able to put you in touch with your local ICAS. You can get details of your local PALS from the yellow pages, your doctors’ surgery or local hospital, or online at www.pals.nhs.uk
Community Health Councils (CHCs) Wales
CHCs work to enhance and improve the quality of Welsh NHS services. They are your statutory and independent voice in local health services provided throughout Wales. The key function of CHCs is to represent the interests of the public in their district and provide a free and independent advocacy service that offers confidential support, advice and guidance for those wishing to make a complaint against the NHS.
To find out your local CHC, contact the Board of Community Health Councils in Wales on 0845 644 7814 or 02920 235 558 or go to www.communityhealthcouncils.org.uk
Health Rights Information Scotland (HRIS)
HRIS provides people with information about their health rights and about the health services that are available from the NHS in Scotland.
The Patient and Client Council (PCC) Northern Ireland
The PCC aims to provide an independent voice for patients on health and social care issues by representing the interests of the public and engaging with health and social care organizations. It promotes involvement of patients in the delivery of health and social care and provides assistance to individuals making or intending to make a complaint about health and social care services.
Time limits for making a complaint
You should make your complaint as soon as possible. The time limit for complaints made in England is usually 12 months from when the matter you are complaining about occurred, or 12 months from the date you first became aware of the problem. In Wales, Scotland and Northern Ireland, the time limit is usually six months from when the matter occurred, or from when you became aware of the problem.
These time limits can be overlooked if it would be unreasonable to expect you to have complained within the suggested time limit, for example because of grief or trauma. However, it must still be possible to investigate the complaint.
You cannot use the NHS complaints system to get any financial compensation. If you are seeking financial compensation you will need to get independent legal advice. The NAS Autism Helpline (0808 800 4104) has a small database of solicitors with an understanding of autism.
Resolving complaints locally
You should always try and resolve your complaint through your local service’s own complaints procedure in the first instance. Contact the health practice, hospital or NHS Trust concerned (we’ll refer to them as ‘services’ from now on) and ask for a copy of their complaints procedure. You should also ask why you have been refused a referral or assessment and whether the decision is based on clinical or financial grounds. You could request this information over the phone or in writing. Additionally it might be useful to ask for access to your medical records, under the Access to Health Records Act 1990.
Complaints about any service provided by the NHS should be addressed to the Chief Executive of the NHS Trust, the Complaints Manager or to whoever is stated as the appropriate contact in the service’s complaints procedure.
A large service will probably have a designated person who deals with complaints but smaller services may not. If the complaints procedure does not state who to address the complaint to, you should address it to the Chief Executive of the relevant NHS Trust (who may not deal with the complaint directly but would forward it to the most relevant person) or the Complaints Manager.
State that you expect acknowledgement of your letter and a response within the stated time frame.
You may be invited to a meeting with the relevant staff involved in the matter to discuss the complaint but you don’t have to go if you don’t want to. Instead, you can ask for all contact to be in writing. You should be informed of how the complaint will be handled and when you can expect to receive a full response. Hopefully your complaint will be resolved at this level.
Independent Review (Wales only)
If after the agreed amount of time you do not receive a full response (without being informed why) or you are not satisfied with the response, you can make a request to have an independent review of your complaint carried out by the Independent Complaints Secretariat.
Your request for an Independent Review will have to be made in writing within 28 working days of receiving the local resolution response.
The independent review may consist of further investigation at the local resolution stage or the setting up of an independent review panel where you will have the opportunity to discuss the complaint with a panel of (usually) three independent lay people.
Independent investigation in England, Wales, Scotland and Northern Ireland
If you are unhappy with the final response you receive (either from the local resolution in England, Scotland or Northern Ireland or from the Independent review in Wales) or you have waited longer for a response than expected or what was agreed (without being told why), you can ask the Parliamentary and Health Service Ombudsman (England), Public Services Ombudsman (Wales), Northern Ireland Ombudsman (Northern Ireland) or Scottish Public Services Ombudsman (Scotland) to investigate the matter.
Referral to an ombudsman
The ombudsman is a free, independent service that investigates complaints against local authorities by looking into maladministration that has caused injustice. Maladministration is where the correct procedures and considerations in setting up a service, delivering a service or making decisions have not been upheld. This maladministration may have resulted in injustice to the person who needed help.
Maladministration can include delays, unsatisfactory responses and errors in clinical practices, so the ombudsman can investigate complaints about treatments, wrong advice, incorrect diagnosis, etc. A referral to the ombudsman usually has to be made within 12 months of the local resolution (England, Scotland and Northern Ireland) or Independent Review (Wales) response being received.
Most of the offices of the ombudsmen provide an application form for making a complaint but you do not need to use an application form. You can contact them with the following information instead:
- the name and address of the person making the complaint
- the name and address of the organisation the complaint is being made about
- details of what the complaint is about (ie what the service did wrong or failed to do)
- what personal injustice, financial loss or hardship was suffered
- what the service should do to put the situation right
- details of how the complaint has been followed up before you contacted the ombudsman
- the date when you first identified the event you are complaining about.
You should also send copies of any relevant paperwork involved in the complaint. The Citizen’s Advice Bureau has more information about this on its website (www.adviceguide.org.uk) or you can visit your local Citizens Advice Bureau and speak to someone. Your local Citizens Advice Bureau will be listed in the telephone directory or Yellow Pages.
Judicial review
A judicial review is not an appeal. It does not involve deciding whether the right or wrong decision was made but whether the correct legal basis has been used to make it. A court cannot decide what action an NHS service should take. Sometimes, the result of a judicial review may mean that the same decision can be made again, as long as it is done in a lawful way.
A judicial review must take place within three months of the incident occurring. If the Parliamentary and Health Service Ombudsman is going to be investigating your case, the case cannot go to judicial review.
If you are considering judicial review, you may be eligible for legal aid. Legal aid is funding from the Government to help people access the courts and resolve disputes. Legal aid helps with the costs of legal advice and representation. Your eligibility will depend on the type of problem, your income and capital (savings, properties etc), and whether there is a possibility of you winning the case. Community Legal Advice has legal aid calculator that you can use to work out if you could get legal aid at www.communitylegaladvice.org.uk/en/legalaid/index.jsp
You can find out more about judicial review at www.publiclawproject.org.uk/downloads/WhatIsJR.pdf
The Citizen’s Advice Bureau may also be able to help you.
Taking legal action
Taking legal action against the NHS can be costly and complex. You should ask a solicitor for professional advice if you decide to do this. The NAS Autism Helpline (0808 800 4104) has a small database of solicitors with an understanding of autism.
Appendix 1
NHS Complaints Procedure for Children’s Services in England
Appendix 2
NHS Complaints Procedure for Children’s Services in Scotland and Northern Ireland
Appendix 3
NHS Complaints Procedure for Children’s Services in Wales
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