ISCAS responds to Keogh Review statements regarding independent sector complaints redress
ISCAS entirely agrees with Sir Bruce Keogh that those who have been treated poorly by private healthcare providers should have a means of redress.
We are concerned at his apparent assumption that the PHSO (Parliamentary and Health Service Ombudsman) will achieve this at the expense of the public purse for the entire independent healthcare sector.
As submitted in our evidence to the Cosmetic Interventions Review, there is already an independent sector means of redress that costs the taxpayer and complainant nothing and has a proven record of bringing resolution to complainants. Known as the Independent Sector Complaints Adjudication Service (ISCAS), it is operated as a not-for-profit company limited by guarantee, funded at arms length by its membership, and overseen by an independent governance board chaired by Lady Fiona Hodgson CBE. It publishes outcomes publicly and annually. It has been established for twelve years.
ISCAS has an effective relationship with, and recognition by, the UK system regulators CQC, HIS, HIW,RQIA and by the Medical Defence Organisations. The PHSO recognises and signposts enquiries from outside the NHS to ISCAS.
Among those who abide by the ISCAS Code are all the Members of IHAS, and a number of others such as the Independent Doctor's Federation.
From the standpoint of the Review, the problem with ISCAS is that it cannot compel independent sector providers to accord with its Code of Practice for the handling of patients complaints, and its membership is comprised of those providers who have ethical concerns about handling complaints. We believe that it has proved effective in achieving the aim, and is ready for application by the very many smaller organisations providing private healthcare.
NHS run Private Patient Units who remain outside any systematic route to redress of complaints and independent review stage, and we believe that ISCAS would be a satisfactory Code for such organisations to use.
We intend to engage with the Cosmetic Intervention implementation team to present ISCAS as the solution to the recommendation that those who believe they have been treated poorly should have a route to resolution. We will look confidently for support from the system regulators and PHSO who have supported ISCAS in the past. We will advocate that the public purse should not be touched for this purpose, and that the state should not be involved other than to make membership compulsory to achieve state recognition of an independent provider. Our proposal will be for them to make it compulsory for all independent healthcare providers to adopt the ISCAS Code as a condition of CQC/HIW/HIS/RQIA registration.
Sally Taber DirectorISCAS, Andrew Wilby, Secretariat
ISCAS sought comments on our revised ISCAS Code of Practice up until 14 January to ensure it was up to date and accessible to everyone needing to use it.
The proposed new version of the Code places greater emphasis on what complainants can expect to happen in the complaints process, and the roles played by ISCAS members, ISCAS and the complaints adjudicators. It sets out clearer standards in a more accessible format.
ISCAS are currently considering all comments through the ISCAS Governance Board and would like to thank all those that contributed.
The ISCAS Annual report will be published on the ISCAS web page from Monday 15 October 2012. The Report looks back at the work of the Adjudicators and the Secretariat over 2011. ISCAS has continued to receive a similar level of enquiries from members of the public compared to 2010. The majority of the enquiries can be signposted back to an ISCAS member's local resolution procedures. However ISCAS continues to receive calls about non members, 25% of all enquiries, where the complainant has no access to an independent review. The costs of adjudication have continued to fall for the 4th year with an increase in the number of people coming to the adjudication stage, 28 for the reporting year. The Report contains details about significant milestones for ISCAS, the Governance Board and the Adjudicators, as well as recomendations for improved complaint handling for members. Enquiries to ISCAS Secretariat.
WIHA has an Operating Protocol with HIW for the ISCAS Code of Practice for Handling Complaints which helps to ensure that patients and the public are signposted to the Independent Sector Complaints Adjudication Service (ISCAS) more easily.
Read more about the updated WIHA & HIW protocol under WIHA publications
It is not uncommon for complaints to reach the adjudicator that stray into the field of clinical negligence. Complaints tend to be multifaceted, and concern about clinical failings often runs alongside upset about hospital services and staff attitudes for example.
It is perfectly valid for complaints about clinical issues to be dealt with under the complaints procedures in circumstances where the complainant is seeking an explanation or apology. What the Independent Sector Code of Practice for Management of Patient Complaints is not designed to address is the type of complaint where there is an allegation of injury or death that was caused by a breach of a duty ofcare, and the motivation is to establish causation. The complaints procedures are also not there to decide whether a doctor or other clinician has fallen short of professional standards, or establish breach of contract for substandard treatment.
ISCAS members are expected to advise complainants to seek independent advice where clinical negligence may have occurred – usually where serious errors have caused or contributed to an injury. Where a complainant has started, or intends to start legal proceedings, handling the complaint under The Code is generally not appropriate. However, it is still worth considering whether any aspects of the complaint are suitable for consideration under the complaints procedures.
Getting the message across to complainants about clinical negligence is not easy. The Code is currently under review and this is one of the areas where, with the help of organisations like the Patient's Association, the aim is to be much clearer about the interface between the complaints procedures and clinical negligence. The views and experiences of ISCAS members in this area are invaluable, so please feed these into the review process by contacting
Some complaints centre on the appropriateness of a diagnosis, the treatment received by a complainant, or about side effects and clinical outcomes. Adjudicators do not have specialist clinical knowledge, and so complaints that are very clinically focused will often require an expert clinical view. This will usually come from a consultant who works in the relevant clinical field, or sometimes a specialist nurse or other type of clinician. They will review the complainant’s file and provide a written response to specific questions raised by the adjudicator.
When seeking experts to fulfill this function, ISCAS is at pains to identify consultants who have no links to the organisation the complaint is about, or any other conflict of interest. The ISCAS Secretariat will often start with the Expert Witness Institute, which holds a register of clinicians experienced at serving in an expert capacity, for example in relation to personal injury or medical negligence claims.
Finding an expert who does not have any connection to the clinician complained about can be challenging for small specialties. In these circumstances, emphasis is placed on finding an expert who feels able to review the complaint without bias. All experts are required to declare any conflicts that would undermine the impartiality of their opinion.
ISCAS members sometimes seek an expert review at stages 1 and 2 of the complaints procedures. Unfortunately the adjudicator often still needs to commission independent expert advice. This is because the expert review at the earlier stages may have been sought informally and there is no documentation trail, or the independence of the expert, both from the hospital and any clinicians involved, tends to be unspecified. Experts also need to understand the importance of indicating the evidence that underpins their opinions, which might mean giving references, as well as being explicit where the evidence base is uncertain.
ISCAS is planning to develop a tool to help adjudicators decide when an expert is required to ensure consistency of approach. If you have any views on this area that you would like to contribute, please feed these through by 1 October 2012.
As an adjudicator, it often strikes me that some complaints could be resolved more swiftly if the hospital or clinic could meet with the complainant early on. Many complainants who reach the independent adjudication stage are seeking an explanation for events that happened months earlier. A letter I recently received from a complainant is typical; the complainant stated: ‘For my own piece of mind I must know what actually happened’.
It can sometimes be hard for hospitals to convey explanations effectively by letter. Complaints are often multifaceted, and where the complaint concerns clinical issues it can be particularly difficult to provide the level of detail necessary to explain what happened and why.
Not all complainants will take up the offer of a meeting (some feel anxious about returning to the hospital or clinic), but for those who do there are a few things to bear in mind. Try to choose a venue for the meeting that is on neutral ground, ideally away from the ward or clinic where the complainant received treatment. Invite the complainant to bring along a friend or family member for support. Agree with the complainant the parameters for the meeting in advance, including the length of the meeting, the issues you plan to cover, and the outcomes you hope to achieve. Follow up any meeting with a letter to the complainant, confirming what was discussed and any actions that were agreed.
A meeting will not satisfy every complainant, but it shows willing on the part of the hospital and can be helpful in taking the heat out of the situation. So what is there to lose?
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ISCASAnnual Report2011 / 2012now published