Understanding why someone complains and what they hope to achieve is the essential first step in the journey towards resolution. Supported closure aims to help the complainant to let the matter go once the complaints process is complete.

See: Diagnostics– what does the complainant want to achieve? Is it realistic?

Reviewing the outcome
That initial contact will have identified the key aims of the complainant, and these now need to be reviewed.

The ICAS advocate can do this in a step by step process – looking at the outcome of the complaint with the complainant to ensure that

• the complaints procedure has been correctly implemented as far as possible
• no material element of a complaint has been overlooked or inadequately addressed, including
  • what was investigated
  • why actions were taken, or treatment given, or decisions made
  • who was involved, and how
  • what the findings of the investigation were
• an apology has been given as well as an explanation
• there is evidence that action will be taken as a result of this April 24, 2007 be made and a timescale for their introduction should be given
• there are checks in place to ensure that this will happen so that other people do not find themselves in the same situation again.

Action to improve services and treatment could mean changes in:

• the procedures used, e.g. for appointments, consultations, timing
• the premises and their provision for patients (e.g. waiting areas, privacy)
• the way in which staff deal with patients (e.g. respect, courtesy)
• other matters designed to benefit patients (e.g. explanations, treatment)

If the response answers all these aspects to the satisfaction of the complainant, then from the procedural perspective the complaints journey is completed successfully. If not, the complainant can ask for the outstanding matters to be looked at again.

If a complainant remains dissatisfied

If a complainant remains dissatisfied at the end of local resolution, they can

• go back to the organisation complained about raising these concerns

See: Local Resolution

After this discussion and further exchange of correspondence and meetings, the complainant may still feel dissatisfied and want to take matters further. The NHS Trust may also get to a point where they feel they have done all they can to answer the complaint.

The NHS complaints procedure then allows the complainant to

• request an independent review by the Healthcare Commission (see: Independent Review Healthcare Commission). Local resolution must be completed unless there are exceptional circumstances (see: Eligibility definition)

If the complainant remains dissatisfied after independent review they may complain to the Ombudsman. (see: Ombudsman)

The Ombudsman will not normally look at a complaint until it has been through local resolution and independent review.

The only exceptions to this are

• if there has been maladministration (e.g. unreasonable delay in responding)
• if a request for an Independent Review has been refused by the Healthcare Commission.

Supported closure for habitual complainants

A small number of complainants persist in pursuing a complaint even where the NHS complaints procedure has been fully and properly implemented and has run its course. These complainants are sometimes called “vexatious” complainants, but it would be more accurate to call them “habitual” complainants. Some habitual complainants may become “vexatious” and behave in an unacceptable way.

Whether they are right to persist with their complaint or not, is not for the ICAS advocate to judge. Whatever the case, they need support to resolve the issue. This is called supported closure. Some habitual complainants may be difficult to relate to, because of feelings of anger, grief or guilt. This does not mean that their complaints are not justified, but it can mean that it may be very difficult to satisfy their expectations.

On some occasions, habitual complainants may become “vexatious” and behave in a way which is unacceptable. In these cases, supported closure can be very challenging and needs careful handling.

Every care must be taken to exhaust all normal avenues

With these more challenging cases it is often necessary to exceed the usual level of support before reaching a conclusion that someone is

• an habitual complainant
• exhibiting such challenging behaviours that they cannot be supported by ICAS. This step should only be taken in exceptional circumstances and with the agreement of the ICAS line manager.

How do I recognise an habitual complainant?

This is not an easy judgement, as persistence is often essential in pursuing a complaint because the organisation complained about may have failed to fully investigate all the points complainants raise.

What if their behaviour becomes unreasonable or threatening?

Here are some indicators which may help:

Unreasonableness

• they deny receiving an adequate response, despite evidence of correspondence specifically answering their questions or where the concerns identified are not within the remit of the NHS organisation or practitioner to investigate
• they do not clearly identify the issues which they wish to be investigated, despite reasonable efforts of staff and, where ICAS staff have helped them specify their concerns
• they are unwilling to accept documented evidence of treatment given as being factual e.g. drug records, GP records, nursing notes
• in pursuit of their complaint, they have had an excessive number of contacts with Complaints and ICAS staff and made unreasonable demands on them. For example, they insist on responses to complaints or enquiries being provided more urgently than is reasonable or normal recognised practice.

Threatening or violent behaviour

• they have harassed or been personally abusive or verbally aggressive on more than one occasion towards staff dealing with their complaint, or their colleagues or families. (ICAS advocates must recognise that complainants may sometimes act out of character at times of stress, anxiety or distress and should make reasonable allowances for this.) ICAS advocates should document all incidents of harassment in line with the Zero Tolerance Campaign.
• they have threatened or used actual physical violence towards staff or their families or associates at any time. Where this has happened, personal contact with the complainant and their representatives should be stopped and the complaint, thereafter, only pursued through written communication. All such incidents should be documented in line with the Zero Tolerance Campaign.

Steps to supported closure

In borderline cases where the advocate’s concerns arise from difficult social behaviours which make meetings or conversations hard to manage, the complainant could be asked to sign a contract that lays out the accepted standards of communication which should be adhered to in order to secure their continued use of the service.

See: Client –advocate contract

With advice from the ICAS line manager, the ICAS advocate (or line manager) should write a letter informing the complainant

• what action has been taken so far
• why it is that ICAS is unable to help any further
• that there is nothing more that can be added
• that the correspondence is now at an end.

The letter could also say that future letters will be acknowledged but not answered. In some cases it may be appropriate to state that no further phone calls will be taken from the complainant.

This letter should explain that if any new issue does arise, the complainant may write to the ICAS line manager to request support.

The complainant should be informed of how to take up a complaint against the ICAS provider and about the arrangements you have in place to provide independent advocacy support for complainants pursuing a complaint against the service.

It is recommended by the Department of Health that letters should be sent recorded delivery.

Dealing with further contacts

All ICAS staff should be informed of the habitual complainant (in line with any complainant confidentiality codes) and advised
in telephone calls to

• identify the caller as the habitual complainant
• explain that the complainant will have received a letter from the ICAS line manager and that there is nothing you can add to that correspondence. Explain that you are putting the phone down.

in correspondence to

• pass all future correspondence to the ICAS line manager.

New complaints
Complaints about matters unrelated to previous complaints should be approached objectively and without any assumption that they are bound to be unjustified or vexatious.

Full file notes should be kept on any contact with the complainant. A complainant seeking information under the Data Protection Act link has a right to receive any information held by ICAS on them and this will include information that the provider considers the complainant to be habitual and the reasons for that.

Next: Supported closure resources