I’m unhappy with private healthcare treatment – how do I complain?

When things go wrong or you have concerns about treatment you, a friend or family member received, you may consider making a complaint. Complaints can help highlight to healthcare providers ways to improve their services, which is integral to good governance and quality management.

For NHS funded treatment the NHS Constitution guarantees the right to complain if you were treated in the NHS or independent sector. For privately funded healthcare (self-paying or through insurance), there is no “standard” complaint procedure.

If you want to make a complaint following care you have received, or behalf of someone else, you will need to ask for a copy of the complaints procedure. This will differ depending on the hospital, clinic, care home or medical professional who provided the treatment.

The Patient’s Association, an independent charity whose helpline advises on a range of issues, can provide guidance on how to take action and how to make a complaint.

 The Independent Healthcare Sector Complaints Adjudication Service (“ISCAS”)

 Many Independent Healthcare Providers (“IHPs”) subscribe to the ISCAS ‘Code of Practice for Complaints Management’. IHPs subscribe on a voluntary basis and are listed in a directory.

ISCAS has produced a helpful Patient’s Guide to the ISCAS Code with input from the Patient’s Association which explains how to make a complaint. This guide relates to IHPs who have subscribed to ISCAS and use the ISCAS Code of Practice.

The Code sets out three distinct stages of complaint resolution, below is a brief outline:

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

This ranges from an informal discussion of concerns with a care provider or manager to a more formal a letter of complaint. The Patient Guide sets out what to include in a complaint letter and the timescales for acknowledgement, investigation, and a full response.

A formal complaint should be made within six months of the incident. The IHP may be willing to investigate complaints after this time where there is a realistic opportunity of conducting a fair and effective investigation and there is good reason for a delay in making the complaint.

 Stage 2: Internal review of complaint by someone who was not involved at Stage 1 (i.e. regional/head office)

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.

IHPs are expected to have arrangements in place to conduct an objective review of the complaint and how it was handled at Stage 1. The appointed individual reviews all the relevant documents. They may interview staff and set up a meeting with the complainant as part of their investigations. Again, the Patient Guide sets out what to expect at this stage and the expected timescales for a full, written response.

 Stage 3: ISCAS Independent Adjudication

If, having gone through Stages 1 and 2, there has not been a satisfactory resolution you have the right to refer the matter to an independent external adjudicator through ISCAS. This must be done within 6 months of receiving the final response at stage 2; after 6 months you may not have access to the adjudication service. You will not need to pay for this process.

An Independent Adjudicator will have to decide to uphold or not uphold each aspect of the complaint. They will not consider any new issues, although they can consider issues with how the complaint was handled at stages 1 or 2. The adjudicator has the discretion to award a goodwill payment (limit of £5,000) and may highlight points of learning for the IHP and advise the organisation to share with you details of how it has learned from the complaint. The adjudicator’s decision is final and there is no appeal stage.

The adjudicator cannot order for the IHP to pay compensation to you, provide a refund or pay the cost of revision surgeries, if required.

 If you remain dissatisfied

The Parliamentary and Health Services Ombudsman cannot investigate complaints about privately funded healthcare services, this includes care provided by private patient units within NHS Trusts.

However, you can raise a complaint to the Care Quality Commission (“CQC”) or the equivalent bodies in Scotland, Northern Ireland, and Wales. The CQC is the independent regulator of health and adult social care in England. They inspect both NHS organisations and independent providers. The CQC will take note of your complaint and may use it as part of their inspection process. However, they will not actively deal with a complaint.

If the issue is about an individual health professional’s fitness to practice, you can make a complaint to the relevant professional regulating body:

The General Medical Council (for Doctors)

Nursing and Midwifery Council

Dental Complaints Service

Optical Complaints Service

 Legal advice and bringing a clinical negligence claim

Whilst following a complaint procedure may produce an explanation and apology, it cannot award compensation for clinical negligence. If you are concerned the that the private medical care you or a family member received was negligent and caused significant injury or loss, you may consider bringing a compensation claim. We have experienced injury and medical claim lawyers at Anthony Gold who can advise on the next steps.

Please see our website https://www.anthonygold.co.uk/services/injury-and-medical-claims/

*Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*