Complaining & giving feedback
about healthcare associated infections
Using the NHS Complaints Procedure
The NHS Complaints Procedure is designed to provide explanations of what happened and, where appropriate, apologies and information about action taken to ensure similar incidents do not happen again. The NHS Constitution sets out rights which patients, the public and staff are entitled, and the responsibilities owed to one another to make the NHS operate fairly and effectively.
Complaints or feedback relating to healthcare associated infections
Before deciding if you wish to formally complain, think about the resolution you require
- an apology
- information about your care or that of a loved one
- appropriate treatment in the future, for you and for others
- independent investigation
- legal action, we have added a page of frequently asked questions about taking legal action please contact us if you would like to discuss this further
If you are making a formal complaint then you are under no obligation to tell the organisation that you may wish to consider taking legal action at some future point, you are within your rights to say you have not decided if asked, in many cases it is often through not being able to come to a satisfactory resolution that patients decide legal action is the only way to bring about justice or change.
Practical things to do if you have concerns about standards of care
During your care or that of a friend or loved one, raise any concerns or questions you may have with the Senior or Duty Nurse if you are in hospital, or directly with the GP or nursing team providing the care if you are at home / or nursing home. This is important for the safety of the patient and in the interests of aiding recovery and recuperation.
If after you have raised concerns things do not improve then it is often a matter of judgment whether you decide to take this up with the care giver again or to raise with further with a more senior clinician or Chief Executive, depending on the nature of your concerns and the urgency of the situation, if you are worried about a healthcare infection and need immediate support and advice then please contact NHS 111 who can help you with urgent questions on the care of a patient with an infection and are available 24 hours, 7 days a week. It is always best to talk to the team looking after the patient in the first instance, however if you are not comfortable with this or need a second opinion then NHS 111 can give you some guidance.
If you have had to raise any concerns regarding the standard of care then keep a diary, make a note of what happened, who you spoke to, including times and dates, and the response you received when raising your concerns. There will have been people involved in your care or the care of your loved one who were competent and there will have been practices that you thought were good, mention these and draw comparisons - it is useful for the care provider to know how they could have done better and what works.
If you have raised concerns about the standard of care on more than one occasion and things have not improved then it is likely that you may wish to pursue a complaint, PALS can help and some people have found them helpful, you may wish to involve NHS Complaints Advocacy, they are independent and come highly recommended from those of us who have used them.
The questions listed below cover the basics involved in good infection prevention and control, and anyone who has a meeting with the Trust to discuss what went wrong would do well to establish answers to these questions and include them in the letter of complaint. They are not an exhaustive list, and may not cover what you need to ask. They are based on the experiences of those of us who have been through the complaints procedure raising issues about hospital acquired infections that affected us or our families.
You are entitled to see your medical records or if you are complaining about a relative's care and if you are their next of kin you can obtain these with their permission. We would recommend that if you are going to make a complaint you get a copy of the records just prior to the period of time that your complaint relates to, to the present day. If your complaint relates to care in hospital we recommend that you obtain records up to 3 months prior to admission, this would establish any screening that took place and the results.
The principal legislation that you can refer to in obtaining medical records and requesting information about your treatment or the treatment of a dependant is:
Data Protection Act 1998. This Act governs processing of personal data about all living people in the UK. It sets out principles for information handling which all data controllers must comply with. Its remit includes access to health records of living people, and patients' rights to have inaccurate information corrected
Access to Health Records Act 1990. This Act has mostly been superceded by the Data Protection Act 1998, and now only governs access to the health records of deceased people
Access to Medical Reports Act 1988. This Act governs access to medical reports produced about patients, by the clinician normally concerned with their care, for employment and insurance purposes
Questions to ask if making a complaint about MRSA or Clostridium difficile (C.diff)
The questions refer to MRSA and C.diff, however there are other infections that can be acquired relating to healthcare that you may wish to know more about, and these questions may equally apply
Was the patient screened prior to admission to hospital? What was the result? What measures were taken if the screen was positive?
What strain of MRSA or C.diff was it?
Is this strain of MRSA or C.diff and it's effects usually regarded as life threatening? [Was the patient's life in danger?] [If your loved one has passed away - Was this a contributory factor in the patient's death, and is this recorded on the death certificate?] If healthcare infections are a contributory factor or a main cause of death the Chief Medical Officer has issued an instruction in July 2007 stating that this should be included on the death certificate.
What risk does MRSA present to patients and visitors, and how is that risk managed, for example through isolation and barrier nursing?
At what stage do you normally inform the patient and visitors of the acquisition of MRSA, once this has been established?
What precautions do you tell patients and visitors to take when the acquisition of MRSA has been established?
Do you have an information leaflet that outlines the precautions needed to protect visitors and patients?
Have the Trust thought of personalising leaflets so that patients know what type of MRSA or other infection they have, and what is being done to treat it?
How do patients/relatives access the Infection Prevention and Control nurse? Are they mentioned in the MRSA or C.diff information leaflet?
Are all clinical staff trained in aseptic technique for invasive procedures?
How do you audit aseptic technique and competence of staff?
Do all nurses including agency nurses receive training in hand washing practice, and aseptic technique?
How do you audit compliance with hand washing?
Do you have an anti-microbial prescribing policy? Can I see a copy? Do you have an anti-microbial pharmacist? Who is responsible for overseeing the judicious use of antibiotics?
Was information about the patient's infection shared with the Primary Care Trust, and other Healthcare Teams or Agencies? I would like to see copies of any correspondence relating to the sharing of this information.
Have all clinicians and consultants access to laboratory results? Are there follow up mechanisms on computer for the results and actions needed on this system? Are all relevant staff trained on how to use the system? I'd like to see all copies of the laboratory results.
Does the hospital have the Clinical Negligence Scheme for Trusts accreditation for the quality of entries in health records?
Does the Trust screen patients for MRSA prior to prescribing chemotherapy or radiotherapy / palliative or curative treatment? Is this screening ongoing throughout the treatment?
Does the Trust have policies for the management of diabetic or renal patients who may be immuno-compromised and at risk from infection?
Does the Trust's Healthcare Facilities Cleaning Manual reflect the latest changes in cleaning technologies and practices? Are cleaning teams directly managed on wards, and are staff trained in the Trusts Infection Prevention and Control procedures? How do you audit the training?
Do patients and carers know who to raise concerns with if they are unsure or not satisfied with outcomes of care or with information provided?
Do you offer patients and carers contact with support agencies, such as MRSA Action UK, or CRUSE?
Ask if your Hospital Trust is Compliant with the Hygiene Code and if there are any measures in the Hygiene Code they have not met, what date they will be compliant. Compliance with the Hygiene Code is a statutory requirement and is regulated by the Care Quality Commission, a copy of the Hygiene Code is available here
You may wish to ask additional questions relating to the Trust's performance, they should be showing a year on year reduction in the numbers of MRSA and C.diff cases
Ask if the Trust continuously and systematically reviews and improves all aspects of their activities that directly affect patient safety and if they apply best practice in assessing and managing risks to patients, staff and others, particularly when patients move from the care of one organisation to another.
Your first step should be to complain to the organisation or practitioner involved so that they can have the chance to resolve your complaint. They should give you full details of the complaints procedure and try to sort out your complaint. If you have exhausted the organisations complaints procedure and you are still unhappy then you can contact the Parliamentary & Health Service Ombudsman
If your complaint involves both health and social care, please telephone the Ombudsman for further advice on 0345 015 4033, regardless of where you are in the complaints process.
Your local Healthwatch can also give you contact details of who to complain to about an NHS service.