Complaints about treatment and care are inevitable, but involving the Independent Complaints Advocacy Service in the process can help make a real difference to all concerned.

Despite the positive experiences of the majority of patients, even within the best healthcare services things can, and do, go wrong. What happens next can often impact enormously on the way in which any resultant complaint is both managed by the NHS organisation and resolved.

Involving ICAS in the NHS complaints process can make a difference, not just in terms of its dealings with the individual making the complaint (and the impact this can have), but also for the NHS staff tasked with managing the NHS organisation’s response.

To add some context to ICAS and its role, the service operates independently from the NHS – it is free and confidential. Like the complaints process itself, ICAS’s remit is based in law. The Health & Social Care Act 2001 includes a legal requirement to provide an independent advocacy service designed to help anyone who wants to make an NHS complaint.

Individual needs

What this means in practice can depend very much on the needs of the individual. Some people just want to know what’s involved and how things work so that they can manage the complaint themselves; those with more complex needs are allocated an advocate to help them through the process.

Every NHS body, whether a mental health trust, GP practice or ambulance service will have a local ICAS office to which they can refer potential complainants; each is run by one of three charitable organisations: the Carers Federation, POhWER and South of England Advocacy Projects. Referrals are also made by third parties such as solicitors and community groups, and a significant number of complainants self-refer.

Although many trusts enjoy close relationships with their local ICAS provider and are very switched on when it comes to complaints management, a year after the NHS complaints process was simplified from a three to a two-stage system, confusion still exists among healthcare professionals as to how this works in practice.

Today, the emphasis is very much on local resolution, in other words, settling disputes at trust level. Only if the complainant believes the complaint is still unresolved can an application be made to the Parliamentary and Health Service Ombudsman for further investigation.

With this in mind, how can ICAS help achieve local resolution? It’s probably worth looking first at what ICAS cannot do. Advocates are unable to help a patient to claim compensation, get involved in staff disciplinary matters or push someone further up the queue for treatment. An advocate will not give legal or medical advice; they will not try to persuade a person to take a certain course of action, nor will they mediate or investigate a complaint on a patient’s behalf.

Instead, it is the advocate’s job to ensure clients know their rights and are given access to information to enable them to make informed decisions which will in turn help to progress their complaint.

Managing expectations

This is important because by ensuring people are properly informed an ICAS advocate can help manage the client’s expectations - and keep outcomes realistic - from the outset. This prevents the process from getting out of hand and helps separate the emotion from the facts, making it easier for the NHS organisation to understand the exact nature of the problem and respond appropriately.

Advocates also provide practical support with letter writing, helping the client to set out exactly what the issue is and what they are looking for in terms of resolution. This, in itself, is often seen as a real benefit to complaints managers because it gets straight to the crux of the issue and clarifies exactly what the complainant is looking for by way of resolution.

For one complaints manager, Russell Smith of the Tees, Esk and Wear Valleys foundation trust, ICAS advocates take on an important role in liaising with both the complainant and the trust: “Sometimes this is about managing complainant expectations, perhaps in explaining the reasons why the trust might not be able to offer any more information about a particular complaint. ICAS advocates are approachable and friendly. They are also professional in their dealings with us and knowledgeable about the NHS complaints procedure, all of which helps to assist the trust in its attempts to resolve complaints.”

Complaints are very rarely about simple criticism or complaining for the sake of it; in fact many people just want answers. They want to know why things went wrong and for those mistakes to be acknowledged. Others want to be assured that processes will change so that others don’t have to go through a similar experience. Many others just want to hear the word “sorry”.

Properly managed, complaints provide very valuable information about the quality of healthcare services and often highlight where improvements can be made, thereby acting as a catalyst for organisational learning and development to the benefit of both staff and patients.