Who can make a complaint?
Anyone can make a complaint, including:
- the person who experienced the problem
- a parent or guardian of the patient or child concerned
- a relative, friend or representative chosen by the patient to make a complaint on their behalf
- a health service provider or other concerned person.
If a complaint is made on behalf of a patient who experienced a problem, the Commission will ask for their written authority unless the patient is deceased, under-aged or otherwise incapable of giving their consent. The patient's consent to access their medical records will also assist the Commission in dealing with the complaint.
What and who can be complained about?
A complaint may be made to the Commission about any health service provider in NSW. This includes:
- registered health practitioners, such as doctors, nurses and midwives, dental practitioners, pharmacists, psychologists, chiropractors, podiatrists regarding the clinical care and treatment of an individual or their professional conduct
- health organisations, such as public or private hospitals, clinics, medical centres or day surgerieswhere the clinical care or treatment of an individual was affected.
- health practitioners who currently do not require registration to practise in NSW, such as naturopaths, psychotherapists, massage therapists, dieticians, audiologists and others.
What does the Commission do when a complaint is received?
All written complaints to the Commisison must be assessed. An Assessment Officer will manage the complaint during 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 respond. In some instances, the Commission may request a copy of the patient's medical records. The Commission has access to internal medical and nursing advisers, who can provide clinical advice. When the Commission has sufficient information it makes a decision about the best way to manage the complaint. This is known as an assessment decision.
In some instances, the Commission can decide not to notify the health service provider of the details of the complaint. This is only done 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 person making a complaint 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. Sometimes, in complex matters, it may take longer to get all necessary information to make an assessment of the complaint. When the Commission has made its assessment decision, and if required, has consulted with the relevant professional Council all the parties involved will be notified of the decision in writing within 14 days.
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 complain just to cause trouble.
Please note that anyone has the right to make a complaint free from harassment or intimidation. It is an offence for any person trying to intimidate a complainant or witness.
How do I respond to a complaint and what does it need to include?
Every complaint is different, so the approach to addressing it will differ depending on:
- the nature of the complaint, the seriousness and the complexity
- the wishes and expectations of the person who made the complaint
- the issues the complaint raises
- how the complaint came to you.
Your response to a complaint should be in writing. You may:
- acknowledge the person's distress or experience
- apologise, if appropriate
- 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, you may wish to consult with your professional association, indemnity insurer, employer or 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 the clinical governance unit of your Local Health District.
What decisions can the Commission make?
After the assessment, the Commission may decide to:
- refer the complaint the Commission's Resolution Service.
- refer the complaint to the relevant professional Council (for example the NSW Medical Council) for their management. This can lead to the Council disciplining, counselling or re-educating the provider involved.
- refer the complaint for formal investigation where it raises a serious issue of public health and safety or may result in disciplinary proceedings.
- take no further action regarding the complaint.
- refer the complaint to a more appropriate agency (for example the Office of Aged Care Quality and Compliance).
- Refer the complaint to the relevant public health facility to resolve the complaint directly with you. This is called local resolution.
The person who made the complaint may request a review of the Commission's assessment decision. Such a request must be made in writing to the Commission within 28 days of being notified of the decision. A review must include any new or additional information that may affect the initial assessment decision.
Is there anything else I need to know?
Anyone has the right to make a complaint free from harassment or intimidation. The Health Care Complaints Act provides penalties for any person trying to intimidate a complainant or witness.
Anyone making a complaint to the Commission must act in good faith. There are penalties for any person providing false information to the Commission.
In addition, the Commission:
- has the discretion not to deal with complaints where the incident occurred more than five years ago.
- 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.
- cannot compel a health service provider to provide you with a refund or to alter their fees.
- cannot enforce a health service provider to provide you with treatment.
- cannot enforce a health service provider to alter a medico-legal document if you are unhappy with the content.
- cannot deal with matters that occurred outside of NSW.
- 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 (02)9219 7444.