How do I make a complaint about my private healthcare? A simple guide for patients and families

Summary

At Patient Safety Learning we often get asked by patients and families who have received poor healthcare what they need to do to make a complaint. Although we cannot get directly involved in individual cases, we have put together a simple guides on the steps you can take if you need to make a complaint about your private healthcare.

We also have the following guides:

• How do I make a complaint about my NHS care in England: a simple guide for patients and families
• How do I make a complaint about my NHS care Northern Ireland: a simple guide for patients and families
• How do I make a complaint about my NHS care in Scotland: a simple guide for patients and families
• How do I make a complaint about my NHS care in Wales: a simple guide for patients and families
• How do I make a complaint: Sources of help and advice

Content

By law, the Parliamentary Health Service Ombudsman (PHSO) cannot look into complaints about privately funded healthcare services. This includes care provided by Private Patient Units within NHS Trusts. However, they will look at complaints about healthcare services provided in a private hospital if the NHS paid for it. They will also look at complaints about NHS-funded healthcare services which privately funded patients get in an NHS hospital. See our ‘Making a complaint about your NHS care' guides above if this applies to you.

If you are unhappy about treatment you have received in a private hospital or clinic, it is your right to:

• Make a complaint.
• Have the matter investigated.
• Receive a full and prompt response to your complaint.

If you are concerned with the outcome of your treatment, then you should first talk to your treating consultant in order to obtain an explanation and advice. If your consultant is unhelpful or unresponsive, and you believe you are in need of further treatment, you should talk to your GP about your concerns and possible treatment options. This may include obtaining a referral for a second opinion.

Making a formal complaint to the hospital or clinic

If you are unhappy with the response, you can make a complaint using the Independent Sector Complaints Adjudication service (ISCAS) who have a code of practice for handling patients’ complaints. However this will only apply to private healthcare providers who are ISCAS subscribers or to patients treated by an Independent Doctors Federation Member

ISCAS is one of the recognised independent adjudication services of complaints for the private healthcare sector. ISCAS has produced a patients’ guide with input from the Patients Association which explains how to make a complaint about using the ISCAS Complaints Code of Practice. 

Here are the stages to take if you would like to make a complaint about private care you received. More information on each step is given below. See the full Patients’ Guide to the ISCAS Code for more information.

Stage 1: Complaint raised directly with the clinic or hospital where care was provided

Complaining can be stressful, so the aim should always be to try and sort out any problems as quickly and informally as possible. If your complaint is responded to effectively when you first raise your concerns, then it is unlikely that matters will need to be escalated through stages 2 and 3.

Before you make a formal complaint, ask the provider for a copy of their complaints procedure.

If you do not wish to speak to a member of ‘frontline’ staff, or if you are unhappy with how they have responded, you can take your complaint to someone more senior within the organisation, such as the unit Manager or Hospital Manager.

You should normally make your complaint within six months. The provider may be willing to investigate complaints after this time where there is a realistic opportunity of conducting a fair and effective investigation, and if you have a good reason why you could not act sooner (for example, if you were unaware of the matter, if you were unwell or grieving).

If you are not satisfied with the outcome, you can escalate your complaint to stage 2.

Stage 2: Internal review of complaint by someone who was not involved at stage 1

If you wish to escalate your complaint to stage 2, you should do so in writing, within 6 months of the final response at stage 1.

Normally the complaint review at stage 2 will be conducted by a senior member of staff who has not been involved in the handling of the complaint up to that point and is not involved in the daily operation of the hospital/clinic.

The person conducting the complaint review is expected to send you a full, written response on the outcome of the review within 20 working days. Where the investigation is still in progress, you should receive a letter explaining the reasons for the delay. The aim is to complete the review at stage 2, in most cases within 3 months.

Stage 3: External review

If you are not satisfied with the complaint review at stage 2, you have the right to refer the matter to stage 3 independent external adjudication through ISCAS (for subscribing providers). Please see the providers who are covered. You need to do this within 6 months of receiving the final response at stage 2 and ISCAS aims to complete its adjudications within 3-6 months. The person making a complaint does not pay for the complaints process.

Stage 3 adjudication will not consider ‘new’ issues that have not previously been raised with the provider, with the exception of concerns raised about the way the private healthcare provider has handled the complaint, which may not surface until after a response has been made at stage 2.

If you wish to escalate your complaint to ISCAS at stage 3, you should do this in writing.

Your letter should include the information in the Patients’ Guide to the ISCAS Code, which also provides more information on prompts to help you think through what you want to achieve, and whether it is achievable under the ISCAS Code.

The Independent Adjudicator will decide to uphold or not uphold each aspect of your complaint. They have the discretion to award a goodwill payment up to a limit of £5,000, in accordance with the ISCAS Goodwill Payments Guide.

There is no appeal to Stage 3 adjudication and the Independent Adjudicator’s decision is final. However you can seek legal action at any point during or after the ISCAS complaints process and your statutory rights are not affected. If you are not satisfied with the way ISCAS has managed the stage 3 process you are entitled to make a complaint about ISCAS.

AvMA (Action against Medical Accidents) have a number of self-help guides that provide clear and straightforward explanations of the procedure and guide you through making a complaint about your treatment.

Unlike PHSO for the NHS, ISCAS cannot deal with complaints related to clinical negligence (e.g. injuries caused by poor hospital hygiene or failure to follow proper procedures). Clinical negligence complaints should go straight to the relevant professional regulator, or patients should seek accredited legal advice. Patients with private medical insurance can take their financial (but not clinical) complaints directly to their insurer, and escalate to the Financial Ombudsman Service.

These routes to resolution should always result in satisfying a patient’s reasonable demands without needing to resort to the civil courts.

Complain to the Care Quality Commission

Under the Health and Social Care (Community Health and Standards) Act (2003), the Care Quality Commission (CQC) is now responsible for regulating and inspecting independent healthcare in England. If for any reason you are unable to get the private health provider to respond to a complaint, or if you are unhappy with their response, you can make a complaint to the CQC (or the equivalent body in Scotland Northern Ireland and Wales).

• England: Care Quality Commission; Telephone: 03000 616161
• Northern Ireland: The Regulation and Quality Improvement Authority; Telephone: 028 9051 7500, Email: [email protected]
• Scotland: Healthcare Improvement Scotland; Telephone: 0131 623 4300, Email: [email protected]
• Wales: Healthcare Inspectorate Wales; Telephone: 0300 062 8163, Email: [email protected]

It is a statutory duty on providers registered with the CQC to have a complaints system in place that is brought to the attention of service users, which provides complainants with support where necessary and which should ensure that the complaint is fully investigated to satisfy the service user as far as reasonably practicable.

Complain to the professional regulating body

If the issue is about an individual health professional’s fitness to practise, make a complaint to the relevant professional regulating body, such as the General Medical Council (for doctors) or Nursing and Midwifery Council.

AvMa has a self-help guide.

Complaint about private dental care

If your complaint is about privately funded dental care, contact the Dental Complaints Service.

Complaint about private eye treatment

If your complaint is about privately funded eye treatment, contact the Optical Consumer Complaints Service.