Who can make a complaint?
Any person, including the following, can make a complaint:
- The person who experienced the problem
- A parent or guardian of the person or child concerned
- A relative, friend or representative chosen by the person concerned for the purpose of making the complaint
- A health service provider or other concerned person.
If a complaint is made on behalf of the person who experienced the problem, written authority from that person is required for the Commission to process the complaint. Written authority is also required where the Commission requires access to the medical records of the person who experienced the problem.
Signed authority from the person who experienced the problem is not required if they are under the age of 18 or deceased.
What and who can be complained about?
A complaint may be made to the Commission about any health service provider in NSW. This includes:
- Practitioners such as doctors, nurses, dentists, pharmacists, psychologists, chiropractors, podiatrists and others, regarding the clinical care and treatment of an individual or their professional conduct, and
- Health service organisations such as public or private hospitals, clinics, medical centres, day surgery centres, the Ambulance Service and others, affecting the clinical care or treatment of an individual.
- Complaints can also be made about service providers who currently do not require registration to practice in NSW. This includes acupuncturists, naturopaths, psychotherapists, dieticians, audiologists and others.
What does the Commission do when a complaint is received?
Once the Commission receives a complaint, it will be allocated to an Assessment Officer who will be managing the complaint through the assessment process. The Commission is required to notify a health service provider that a complaint has been made about them. The Commission will usually give the health service provider a copy of the complaint and ask them to provide a response. In some instances the Commission may request a copy of the person's medical records. The Commission has access to Internal Medical and Nursing Advisors, who can review the complaint to provide clinical advice. When the Commission has all of this information it makes a decision, known as an assessment decision, about the best way to manage the complaint.
In some instances the Commission can decide not to notify the health service provider of the details of the complaint. This is done only where the notification would put at risk the health or safety of a person, prejudice an investigation, place a person at risk of intimidation or affect the employment of an employee of a provider. If a complainant believes that any of these may occur in respect of their complaint they must clearly explain why in their written complaint.
The Commission has 60 days to assess a complaint. When the Commission has made its assessment decision all the parties involved will be notified of the decision in writing within 14 days of the decision being made.
How can I resolve concerns about the health care I have provided?
It is generally recommended to deal with complaints directly when they occur and try to resolve them locally with the patient or person that complains.
It is important to keep in mind that people generally complain because they are dissatisfied. A complaint can be an opportunity to increase understanding of the patient's perspectives. It can also help to improve the service that you offer.
Please remember that the person making the complaint may have found it quite distressing to do so and may have had difficulties in putting their experiences down on paper. In the vast majority of situations people make complaints because they genuinely believe that something went wrong. Only very few people complaint just to cause trouble.
Please note that anyone making a complaint has the right to make a complaint free from harassment or intimidation. The Act provides penalties for any person trying to intimidate a complainant or witness. Link to section of the Act.
How do I respond to a complaint and what does it need to include?
Every complaint is different, so the approach to resolving it will differ depending on:
- The nature of the complaint (the seriousness and the complexity)
- The issues the complaint raises
- How the complaint came to you
Your response to a complaint should be made in writing and include the following:
- Acknowledgement of the person's distress or experience
- State what has been done to investigate the complaint
- State what has been done/ could be done to address their concerns
- Mention any changes or actions taken or that are being considered as a result of the complaint
- Offer of an opportunity to discuss the complaint further
- Reassure the person that they can receive further service, if needed, without any concern about having made a complaint
- Provide your perspective in relation to the complaint
For further information refer to Responding to a Complaint
Who can assist me to write a response? When you receive a complaint, it is recommended that you consult with your insurer and a relevant senior person - supervisor, manager, consultant, while keeping in mind the obligation to protect the confidentiality of the complaint.
If you are employed in the Public Sector you may wish to contact the Complaints Manager or Clinical Governance Branch of your Area Health Service.
What decisions can the Commission make?
- Refer the complaint to the Area Health Service, to resolve the complaint directly with you. This is called local resolution.
- Refer the complaint to the relevant professional Registration Board (for example the NSW Medical Board) for their management. This can lead to the Board disciplining, counselling or re-educating the provider involved.
- Refer the complaint to a more appropriate agency (for example the Office of Aged Care Quality and Compliance).
- Refer the complaint for investigation where it raises a serious issue of public health and safety or may result in disciplinary proceedings.
Is there anything else I need to know?
- The Commission has the discretion not to deal with matters that occurred more than 5 years ago.
- The Commission has no power to award damages or determine compensation and it cannot direct a health service provider to take specific action to resolve a complaint.
- The Commission cannot compel a health service provider to provide a person with a refund or to alter their fees.
- The Commission cannot enforce a health service provider to provide a person with treatment.
- The Commission cannot enforce a health service provider to alter a medico-legal document if the complainant is unhappy with the content.
- The Commission cannot deal with matters that occurred outside of NSW.
- The Commission acts to protect the public health and safety. It does not represent individual interests.
If you have any questions, please call the Commission's Inquiry Service toll free on 1800 043 159 or 9219 7444.
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