Self-help guide
Complaining about private healthcare
If you are unhappy about treatment you have received in a private hospital or clinic, it is your right to make a complaint about this, to have the matter investigated, and to receive a full and prompt response to your complaint. There are a number of options open to you:
- Discuss your concerns with your consultant. If you are concerned with the outcome of your treatment, you should first try talking 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, talk to your GP about your concerns and possible options. This may include obtaining a referral for a second opinion.
- Make a formal complaint to the hospital or clinic. Under the Health and Social Care (Community Health and Standards) Act 2003, hospitals and clinics must operate a complaints procedure. This should be similar to that used by the NHS. ISCAS, the Independent Sector Complaints Adjudication Service, has a code of practice for handling patients’ complaints; however, this will only apply to private healthcare providers who are ISCAS subscribers and to patients treated by an Independent Doctors Federation (IDrF) member (IDrF itself a subscriber of ISCAS).
- Complain to the Care Quality Commission (CQC). Under the Health and Social Care (Community Health and Standards) Act 2003, the CQC is responsible for regulating and inspecting independent healthcare in England. If for any reason you are unable to get the 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, Wales, or Northern Ireland).
- 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 (for example, the General Medical Council for doctors or the Nursing & Midwifery Council). For more information, read our guide on fitness to practise.
Is there a time limit for making a complaint?
Complaints usually should be made as soon as possible, within six months of the incident complained of (or six months of becoming aware that you had cause to complaint). Providers may consider complaints outside this period, but you would have to provide then with a good reason (such as ill health).
You can ask someone to complain on your behalf, but you will usually have to give written permission. If you are complaining on behalf of a family member, you will usually be asked to present written consent from the person on behalf of whom you are complaining.
The health provider’s complaints procedure should follow the same pattern as that of the NHS. First, attempt local resolution by speaking or writing to the organisation concerned. If there is a head office for the company running the hospital or clinic, you may want to copy your complaint to the Chief Executive.
Helpful hints on making a complaint
Here are a few helpful hints on making a complaint about healthcare:
- keep a record of all phone calls, including dates and contacts,
- keep copies of all correspondence sent and received, and
- keep copies of meetings attended and reports on the content and outcomes of the meetings.
If the organisation about whom you wish to complain is a subscriber of ISCAS or the doctor you are complaining about is a member of the IDrF, in accordance with their code of practice they are required to investigate your complaint and provide you with a full and detailed response. Under this code, the healthcare provider can:
- acknowledge that things have gone wrong,
- offer an apology,
- take action to put the matter right,
- share information on the investigation and learning from the incident, including changes made as a result, and
- offer an ex gratia payment or goodwill offer of money.
You can make a complaint at the same time as seeking legal advice or pursuing a legal claim, but the provider may not respond on issues which are central to the clinical negligence claim, such as breach of duty of care and causation, but should deal with any other issues in your complaint. The fact that you are intending to take legal action should not be used as a reason not to investigate your complaint.
ISCAS Code of Practice
The ISCAS Code of Practice has three progressive stages:
- Stage 1 — local resolution,
- Stage 2 — internal appeal, and
- Stage 3 — independent external adjudication.
Stage 1: Local resolution
At the local resolution stage, it is the responsibility of the member hospital concerned to look into and respond to the complaint. The aim is to try and sort out any problems as quickly and informally as possible.
In some cases, a discussion with a member of staff may be all that is needed to put things right. If the complaint is about a clinician or independent practitioner, it should be addressed to them and the registered manager.
You can make a verbal complaint, but it is advisable to make your complaint in writing. You should receive a written acknowledgement within two working days and a full response within 20 days. If this is not possible, the registered manager should explain to you why it is not possible to reply within these time limits and should update you every 20 days until a full response can be made.
Although usually you should have exhausted each tier before moving onto the next, if you feel that the registered manager is taking an unreasonable amount of time to respond, you can request a complaints review.
Attending meetings
If you are given the opportunity of a meeting, it is advisable to discuss how you would like it to be conducted before agreeing. Meetings can be very helpful, particularly where there are complex medical issues. However, you should be well briefed and prepared for such meetings. You may wish to request the written response in advance of the meeting to assist you in preparing.
At the conclusion of any meeting, it is a good idea to remind the registered manager that you wish to have a full written response.
It is open to you to talk over the meeting with the registered manager beforehand and you may wish to consider:
- What form will the meeting take? Meetings can be useful to ensure the organisation understands your complaint, how they should investigate and respond, and after the investigation has been carried out, explain the process and findings, that the relevant issues have been dealt with, and explain what actions will be taken as a result.
- Who will attend? Think about whether you would like the staff members involved in the incident to attend or you would prefer not to see them.
- Where will the meeting be held and how long will it take? This is important if you are still recovering from an illness, as you may not feel able to attend the whole meeting. Tell the complaints manager in advance if you have any difficulties with this.
- Do you need any adjustments? If you have mobility, hearing, or sight difficulties, you should let the complaints manger know in advance so they can make any necessary arrangements.
- What issues do you want addressed? It is a good idea to give the complaints manager a short list of your questions or concerns before the meeting. Keep a copy to take with you.
- Do you need any support? Think about taking a friend, relative, or advocate to the meeting for support and to take notes.
Stages 2 and 3
If you are not satisfied with the outcome of stage 1, you can request an internal review (stage 2), which should be made in writing within six months of your final written response and addressed to the investigating director.
The complaint will be considered by the investigating director and the correspondence and handling of the local resolution stage will be reviewed. The investigating director will either uphold the original decision or offer an alternative course of action.
If you are dissatisfied with the outcome, you can write to the independent external adjudication secretariat for an independent external adjudication (stage 3) within six months of receiving the investigating director’s response. This should be submitted in writing with all supporting documentation.
You should note that:
- you must agree that that this would be the final resolution of all matters related to the complaint, and
- any payment offered is in full and final settlement of the complaint. In other words, you could not subsequently seek further compensation.
You would be advised to seek your own advice at that stage from Avma or a specialist clinical negligence solicitor.
Care Quality Commission
You can request that the adjudicator’s decision be sent to the Care Quality Commission (CQC). You can also forward copies of the documentation on you complaint to the CQC. If you’re outside England, you will need to direct this to the Care Directorate (in Scotland), Care Directorate Wales (in Wales), or the Regulation and Quality Improvement Authority (in Northern Ireland).
The CQC can only investigate complaints about providers who need to register with them. In general, it does not have the legal powers to investigate complaints about private medical care, but it does invite feedback from the public and can use that information when looking at individual services for investigative or regulatory purposes. This may then lead to use of the CQC’s legal powers to make private healthcare providers improve their services.
It is a statutory duty on providers registered with the CQC to have a complaints system in place which is brought to the attention of service users, provides complainants with support where necessary, and should ensure the complaint is fully investigated to satisfy the service user as far as reasonably practicable.
Fertility clinics
If your complaint concerns a clinic licensed by the Human Fertilisation and Embryology Authority (HFEA), once your have completed the initial stages of the clinics complaints procedures you can complain to HFEA. Complaints should be made within six months of you becoming aware of the problem.
HFEA has no specific statutory duty to investigate patient complaints, but such complaints may impact their duty to provide patients with advice and information, and under the Human Fertilisation and Embryology Act 1990 they have a duty to investigate serious adverse incidents and reactions. A patient’s complaint may therefore give rise to such an investigation.
HFEA cannot intervene in cases involving contractual issues or in relation to funding or treatment costs, and has only limited remit over issues of refusal of treatment. They cannot order compensation or apology, but will:
- acknowledge the complaint within five days, and
- inform you of the outcome of their investigation and the actions identified to secure improvement, and if any learning points have been derived from the complaint.
Private dental treatment
You should first try to resolve the complaint at the local level by contacting the private dental provider. If, however, this does not resolve your complaint, you should contact the Dental Complaints Service (DCS). They can:
- help you to obtain an explanation and apology,
- recommend a full or partial reimbursement of fees paid for the treatment that has gone wrong,
- arrange for the dental practitioner to provide remedial treatment if both parties agree, and
- arrange a contribution to the costs of remedial treatment by another dental practitioner up to the costs of the original treatment.
They cannot, however, recommend compensation for pain and suffering, for which you would need to see a specialist dental negligence solicitors. Avma can recommend suitable specialists. Complaints have to be made within 12 months of the treatment (or becoming aware you had something to complain about, such as when the treatment fails).
Private health insurers
If your treatment was paid for by private health insurance, it may be worth contacting the insurer, who should have an interest in the standard of care being provided.
Withholding payment
If you believe you have a justified complaint and are considering withholding payment for the treatment in question, you should be aware that it is likely that the hospital or practitioner will sue to recover fees and can employ debt collection agencies to pursue this on their behalf. Your credit rating may also be adversely affected and it may be more difficult to get loans or a mortgage.
Some people have legal expenses cover in household, motor, or personal insurance policies that will cover your costs in the event of a compensation claim. Even if you are considering a complaint, you should check all your insurance policies and if there is legal expenses cover, check the policy terms in relation to time limits for making a claim to the insurers. If there is a time limit, you should submit details to the insurers within this period to avoid a refusal of cover at a later stage. If the period for making a claim is not clear, then you should speak to the insurance provider.