If you are thinking of making a complaint about maternity care, this guide will give you information about the procedures.
1. Before making any complaint ALWAYS obtain a copy of your case notes, the computerised records, and your baby's case notes too, and any additional letters or memos that are contained within or relate to your case notes.
You are entitled to a copy of your case notes, and your baby's case notes, under the Access to Health Records Act 1990 and the Data Protection Act 1998. The application for a copy of your maternity records and the computerised records should be made in writing to the Data Controller, Medical Records Department, at the hospital concerned.
2. Until you have a copy of your case notes you will not know what is on them.
You may find that the staff have had good reasons for their actions. Equally you may find more issues about which you should complain. For example: there may be entries which are untrue or inaccurate or entries made by staff who were not present.
Some hospitals take a request for the case notes literally, and deliberately exclude letters or memos which are relevant but are not part of the 'case notes'.
3. If there is to be an investigation into your care you need to know what the notes say. If those notes are inaccurate the staff investigating your complaint will be acting on misleading information which they believe to be true. If you find that the notes are factually incorrect you have the right to have the notes corrected, or a note from you inserted putting your view of the events.
Your complaint may involve previous obstetric or gynaecological experiences that may have occurred in other hospitals which are relevant to you current complaint. For example, you may be a Strep B carrier which the previous hospital knew about but did not inform your current hospital. Your complaint may involve your health visitor, general practitioner, or private care. You can apply for those notes too.
To obtain copies of your GP notes apply to the Practice Manager; for the health visitor's notes apply to the Health Authority that employs her/him; and private notes to the professional holding them. If social workers are involved with your care we strongly advise you to apply to the Social Services. In every case always keep a copy of your letter and date it. Do not ask verbally or over the telephone for a copy as the hospital can later deny an application was ever made.
If your application is made later than 40 days after the last addition to the notes they may make a charge up to £50.00 (which includes the cost of photocopying). Under the legislation all record holders are required to supply the records within 40 days, which is why it is important to put your application in writing, date it, and keep a copy. Some Trusts try to avoid sending the records and encourage you to view them instead.
It is useful to apply for your records shortly after an appointment, or ask for a copy so that you can leave the hospital with your notes. If you apply later and cannot afford the charge, you can VIEW YOUR NOTES FOR FREE. If you have access difficulties we suggest you contact Freedom of Information Campaign, Suite 102, 16 Baldwins Gardens, London, EC1N 7RJ.
The Data Controller may send you a form to complete to establish your identity. Although some forms ask the reason for your request, you do not have to give a reason.
If your complaint involves care in more than one hospital you will have to write to each hospital for a copy of your notes, and each hospital can charge you a fee.
4. While waiting for the notes you should write a full account of what happened to you and ask whoever accompanied you, or witnessed what occurred, to write their account and give you a copy.
5. If the Data Controller states that you can come to the hospital to view the notes you can write stating that you do not wish to view them at this stage, you want a copy and you would appreciate receiving it by return.
6. As well as getting a copy of your case notes (which should be supplied within 40 days) you are also entitled to see the originals, but we advise people to get photocopies first and study them before attending any meeting that may be offered.
Sometimes the photocopies are indistinct and it is worthwhile checking exactly what is written. It is also an opportunity to check that they have sent you copies of all the pages. You can check that the times and dates are clear, as these are near the edge of the pages it is not uncommon for them not to be photocopied.
If the staff state that they will attend so that they can discuss the notes with you, you can inform them that you do not wish to discuss the notes at this stage as you have not yet had an opportunity to examine them.
7. Contact your local Community Health Council or your local antenatal teacher to see if they would be willing to explain anything on the notes you do not understand.
8. Write a formal complaint to the Chief Executive at the hospital. (If your baby was born at home the complaint should also be addressed to this person).
The NHS Complaints procedures require that a complaint should be made within 6 months from the incident that caused the problem, or within 6 months of discovering the problem, provided this is within 12 months of the incident. However, it is not uncommon for this time period to be exceeded in maternity complaints and the time limit should not inhibit you from writing your complaint.
If you are close to the deadline, you can write to the Trust stating that: 'I intend making a complaint about my care but I am not well enough to deal with it at the moment but I shall take action as soon as I am able'. This will ensure that you are within the deadline and the Trust will be obliged to investigate under the complaints procedures.
If possible, the letter setting out your complaint should not exceed two sides of A4 paper.
If there are important and specific questions you want answered, it is clearer if you number each point. If the response to your letter fails to address a particular question it is easier in your next letter to say, 'Thank you for the information, however, you have not answered questions 5, 6 and 7'.
9. The Chief Executive may invite you to the hospital to discuss your complaint (each Trust has a slightly different system so the invitation may come from the Complaints Manager or Director of Midwifery). You may decline his/her invitation and state that you wish to receive a response, in writing, before you consider any meeting; or you may wish to go ahead and attend the meeting in the hope that your complaint can be resolved without you having to take further action. If it would be too distressing for you to attend a meeting at the hospital you can suggest that the meeting be held at another venue e.g. Community Health Council offices or even your own home or that of a relative.
If you decide to attend a meeting, do not go alone. Wherever possible, take a third party who was not involved at the time. These meetings can be very intimidating and overwhelming for a complainant who finds herself alone and facing a group of professionals (even when they are sympathetic to her complaint). Local Community Health Councils, National Childbirth Trust or AIMS members may be willing to accompany you.
10. Having sent a response in writing, the Complaints Manager may suggest that you now meet with the staff involved and finally resolve your complaint.
You do not have to have a face-to-face meeting with the staff if you do not wish to. Sometimes, however, parents attend the meeting expecting to meet the staff directly involved only to find that another consultant or manager is there in their place. You should ask ahead of the meeting who will be there. Complaints can cover obstetric, midwifery or paediatric care and you need a representative there from each specialty i.e. the consultant obstetrician, the Director of Midwifery, the consultant paediatrician, as well as an administrator.
You can agree to attend the meeting and establish that minutes of the meeting will be taken. You will receive a copy and a final letter will be written responding to the points you raised.
11. If following this meeting, you are dissatisfied with their investigation or their response to the issues you raised, particularly if they involve clinical practice, you can ask for an Independent Professional Review. It is up to the convenor, who is a non-executive director of the Trust, if this will be allowed. It is a complex process and AIMS and Community Health Councils can be approached for advice should you wish to do so.
The Convenor does not investigate the complaint him/herself and must seek independent advice on clinical complaints. The Ombudsman has criticised many Trusts where the Convenor did not obey the rules.
12. An Independent Professional Review consists of a panel of: a lay chair, a convener, a lay panel member and at least two independent clinical assessors, from another area, who have been invited to examine your complaint.
If you are dissatisfied with the decisions of the Convenor, or the Independent Professional Review, or other serious problems about the way the Trust dealt with your complaint, you can go to the Ombudsman. In some cases, where the Trust's, convenor's, or Review panel's, behaviour is unacceptable you can withdraw from the procedure and complain to the Ombudsman about their actions.
13. If your complaint is about a specific member of staff whom you believe has been incompetent you may wish to complain directly to their professional bodies - the United Kingdom Central Council for Nurses, Midwives and Health Visitors (UKCC), or the General Medical Council (GMC) (about doctors). Before you do so, you should ask the Trust for their full name, status, registration number (for doctors), Personal Identification Number (PIN) (for midwives and nurses).
If you are pursuing a complaint with a Trust the professional bodies will expect that process to be completed before you complain to them. Before approaching these organisations we would strongly suggest you contact AIMS for advice.
14. If you are dissatisfied with the findings of the Independent Professional Review you can appeal to the Ombudsman. He has a time limit of one year from when your complaint started, so you cannot delay sending a report to him.
The Ombudsman will not investigate a case if you intend taking legal action. However, he can investigate if the legal action issue is different to that which you want him to investigate. E.g. Your complaint to the Ombudsman may be about the way the Trust dealt with your complaint but part of your complaint concerned the negligence of a particular doctor.
15. You can take legal action at any time if you feel the staff have behaved negligently. Many people believe that legal action will enable the truth to come out, will give them their day in court, and will expose what happened. Unfortunately, this is rarely true and many people having taken legal action still find that they are no nearer finding out the truth. The dice are heavily weighed against a complainant in medical legal actions and the lawyers' objective is only to sue for damages and obtain a financial settlement. If you have a strong case it is very likely to be settled out of court with no hearing and a weak case will get nowhere.
16. If you decide to take take legal action your solicitors will be required to serve a writ on the Trust within three years of the incident. You should, therefore, give your solicitors all the material after two years, at the latest, as the lawyers will need time to prepare the legal case. We would strongly recommend that anyone considering legal action should contact Action for Victims of Medical Accidents, a charity which will suggest a solicitor in your area who has a track record fighting medical negligence cases. They do not advise on the complaints procedures.
Many people with serious complaints approach a solicitor immediately, unaware that a great deal of information can be obtained by going through the complaints procedure and meeting with members of the Trust. These meetings can sometimes reveal information which your solicitors cannot get. Once you have taken legal action your case will be handed to the Trusts solicitors and you will not be able to meet with the Trust officers. Furthermore, the Trust may not have information about their staff which would enable them to take action internally.
17. You may wish to inform your local MP of the sub-standard care in your area, and your local Community Health Council will be interested in your experience as they monitor local maternity care and represent the users' views to the health providers.
AIMS Helpline - 0870 7651433
Chair: Beverley Lawrence Beech
5 Ann's Court, Grove Road, Surbiton, Surrey, KT6 4BE
chair@aims.org.uk
Telephone 0870 765 1453, fax 0870 765 1454
Beverley Lawrence Beech (the Chair of AIMS, who has over 20 years experience in advising complainants about maternity care) will examine case notes and advise on which options within the complaints procedures may offer the best chance of achieving a complainant's objective. A fee is payable.
Action for Victims of Medical Accidents, 44 High Street, Croydon, Surrey, CRO 1YB. Tel: 012 8686 8333. Offers free legal advice on possible medical negligence cases.
Data Protection Registrar, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF. Tel: 01625-545745.
Freedom of Information Campaign, Suite 102, 16 Baldwins Gardens, London, EC1N 7RJ. Tel: 020-7831-7477.
General Medical Council, 44 Hallam Street, London, W1 Tel: 020-7580-7642.
United Kingdom Central Council for Nurses, Midwives and Health Visitors, 23 Portland Place, London, W1M 3AF Tel: 020 7637 7181
Beverley A Lawrence Beech - January, 2001
AIMS makes information and articles freely available on its website as a public service. We also provide advice and support to individual parents and professionals at no charge. If AIMS has helped you, please help us to help others by joining or making a donation.
©Association for Improvements in the Maternity Services. All rights reserved.
Please do not reproduce any material from this site without
permission.
Version $Revision: 1.4 $ last updated $Date: 2007/11/17 22:38:35 $ by $Author: debbie $