Health and Community Services Complaints

Contributed by JodiMather and current to 1 May 2016

Health and Community Services Complaints Commission (HCSCC)

The Health and Community Services Complaints Commission (HCSCC) is an independent statutory body that deals with complaints about health, disabilty and aged care services in the NT. It is established by the Health and Community Services Complaints Act 1998.

Overview

A complaint may be made about any public or private health (including mental health), disability or aged care service provided in the NT.

A complaint to the HCSCC can be made by anyone who uses a health, disability or aged care service. A parent or guardian, authorised representative of a service user or a service provider may also lodge a complaint. The Commissioner may also accept a complaint from any other person if they consider public interest requires that the person should be permitted to make a complaint.

The HCSCC cannot accept complaints about the process of writing a health report or the content of a health report. It also cannot assess a complaint issue which has already been determined by a court, tribunal or board, or by a person or other body established by a law of the Territory, Commonwealth, a State or any other Territory.

Generally complainants have two years to lodge a complaint from the time they become aware of the circumstances they are complaining about.

Some complaints are better managed by other agencies. While the Commissioner can accept complaints about aged care services in the NT, the Aged Care Quality and Safeguards Commission is the most appropriate agency to handle these complaints. Complaints about NDIS funded services should be made to the NDIS Quality and Safeguards Commission.

In most cases the HCSCC will ask complainants to attempt to resolve their complaint directly with the service provider in the first instance. If they are not comfortable doing this, or they have already contacted their service provider and are not satisfied with their response they are encouraged to contact the HCSCC.

If a complaint involves an individual service provider who is registered with a National Board, the HCSCC will consult with the Australian Health Practitioner Regulation Agency (Ahpra) to decide which agency is best suited to manage the complaint.

Complaints are assessed against the rights and responsibilities set out in the Code of Health and Community Services Rights and Responsibilities.

Objectives of the HCSCC

The objectives of the HCSCC are to:

• Resolve complaints
• Contribute to service improvement
• Promote the rights and responsibilities of service users and service providers
• Protect service user safety
• Engage with the NT community

The HCSCC does not represent anyone or take sides in a complaint.

What can be achieved by making a complaint?

Complaints can provide valuable feedback for service providers and sometimes lead to quality improvements for other service users. Outcomes from complaints might include:

• Explanation
• Apology
• Change in policy or procedure
• Access to counselling or other support
• Access to a service
• Training or education for the service provider
• Fee waiver or reimbursement
• Compensation

Complaints process

Informal resolution

The HCSCC refers to complaints suitable to be managed informally as enquiries. The following scenarios are managed informally:

• The person requires information only. Once the information has been provided the enquiry will be closed.
• The complaint is out of jurisdiction and therefore no further action is taken. The HCSCC will provide information to the complainant regarding an appropriate complaints body.
• The complaint is most appropriately managed by another body, in which case the HCSCC may assist the complainant with the referral. The complaint will be closed.
• The complaint is within jurisdiction, however the complainant has not attempted to resolve the complaint directly with the provider and it is considered reasonable for them to do so in the circumstances. The HCSCC may either forward the complaint to the provider for direct response to the complainant, or the complainant may be asked to approach the provider directly. The complaint will then be closed.
• The complaint is within jurisdiction, requires management by the HCSCC and is suitable for informal resolution. The HCSCC will contact the provider by phone and/or email with the aim of achieving resolution, and relay any outcome achieved or information obtained to the complainant.

Formal resolution

Where a complaint is unsuitable for informal resolution (usually due to complexity and/or seriousness) it will be managed formally. The HCSCC will confirm the issues with the complainant, draft questions for response by the provider/s and request provision of a written response via formal letter. The HCSCC may also request copies of medical records, incident reports and policy and procedure. In some cases an expert/peer opinion will be obtained. Once a response to the complaint is received from the provider, a copy will be provided to the complainant for comment. The HCSCC will then assess the adequacy of the response, seek the view of the complainant, and determine whether any further response from the provider is necessary and/or likely to assist resolution, or whether the complaint is resolved. The complaint will be assessed and the Commissioner will decide whether to:

• conciliate
• investigate
• refer the complaint to another body; or
• take no further action.

Conciliation

Conciliation is a formal complaints resolution process, which may be suitable for complaints which involve serious or complex issues. It is voluntary. All discussions and documents produced during concilation are privileged and confidential. This means they cannot be discussed outside the conciliation and cannot be used in any future legal proceedings.

Investigation

A complaint will only be referred to investigation if the complaint, or a pattern of complaints, appears to raise significant concern about the practices and procedures of the service provider; or if it appears to raise a significant issue of public health or safety or public interest. The HCSCC has wide powers during an investigation, including the power to require persons to attend to give evidence in person, and require service providers to provide documents requested by the HCSCC.

When its investigation is complete, the HCSCC may propose remedies or make recommendations which are set out in a report. A copy of the finalised report is provided to the service provider and may be provided to the complainant and other relevant bodies.

Contact details

Health and Community Services Complaints Commission NT

The HCSCC prefers that complaints are lodged via its online form

Address: Level 4, NT House, 22 Mitchell Street, Darwin, NT 0800
Phone: (08) 8999 1969 or 1800 004 474
Email: hcscc@nt.gov.au

Australian Health Practitioner Regulation Agency (AHPRA)

The Australian Health Practitioner Regulation Agency (AHPRA) is the organisation responsible for the registration and accreditation of 10 health professions across Australia.

AHPRA supports the 14 National Boards in implementing the National Registration and Accreditation Scheme.

National Boards

Each health profession that is part of the National Registration and Accreditation Scheme is represented by a National Board.

While the primary role of the Boards is to protect the public, the Boards are also responsible for registering practitioners and students, as well as other functions, for their professions.

The 14 National Boards are:

• Aboriginal and Torres Strait Islander Health Practice Board of Australia
• Chinese Medicine Board of Australia
• Chiropractic Board of Australia
• Dental Board of Australia
• Medical Board of Australia
• Medical Radiation Practice Board of Australia
• Nursing and Midwifery Board of Australia
• Occupational Therapy Board of Australia
• Optometry Board of Australia
• Osteopathy Board of Australia
• Pharmacy Board of Australia
• Physiotherapy Board of Australia
• Podiatry Board of Australia
• Psychology Board of Australia

All Boards are supported by AHPRA.

Complaints To AHPRA

AHPRA can investigate complaints about the conduct, health and performance of a registered health practitioner.

Activities considered as breaches of professional conduct are categorised as professional misconduct, unprofessional conduct, and notifiable contact. Practitioners are health impaired if they have a physical or mental impairment, disability, condition or disorder that detrimentally affects, or is likely to detrimentally affect their capacity to practise their profession. The professional performance of a registered practitioner is defined to be unsatisfactory if it is below the standard reasonably expected of a practitioner of an equivalent level of training or experience.

Notifications (Includes Complaints)

Members of the public may make a notification or complaint to AHPRA about the conduct, health or performance of a practitioner or the health of a student.

Practitioners, employers and education providers are all mandated by law to report notifiable conduct relating to a practitioner or student. Registered practitioners who fail to report notifiable conduct may face disciplinary action by their National Board.

AHPRA will assess all notifications/complaints to determine whether a Board must consider taking immediate action to protect public health or safety.

This may result in changing the registration status of a student or practitioner. If immediate action is not required, AHPRA will assess the notification thoroughly to enable the relevant Board to make an informed decision about it. Each investigation is tailored to the complaint received, and complex matters take more time. AHPRA aims to complete most investigations within six months.

Stages Of The Notification/Complaint Process

All notifications/complaints pass through stages 1-2, and depending on the outcome of the preliminary assessment may pass through any of the following stages, 3-5.

Stage 1: Receipt of Notification/Complaint

AHPRA receives notification/complaint either by online form, hardcopy form, letter or telephone.

Stage 2: Preliminary Assessment

A preliminary assessment determines if the matter will be handled by AHPRA or referred to another health complaints entity.

Preliminary Assessment Outcome

The outcome of the preliminary assessment may be for the Board to:

• take immediate action on the practitioner's or student's registration
• investigate the notification
• request a health assessment of the practitioner or student or a performance assessment of the practitioner
• refer the matter to a health or performance panel hearing
• refer the matter to a tribunal hearing
• issue a caution
• accept undertakings
• impose conditions
• take no further action

Stage 3: Investigation

An investigation may need to be conducted to determine the appropriate course of action, which may be to:

• take immediate action
• request a health or performance assessment
• refer matter to a health or performance panel hearing
• refer matter to a tribunal

A decision may be made to:

• issue a caution
• accept undertakings
• impose conditions
• refer all or part of the notification to another body
• take no further action

Where an undertaking or condition applies, the registrant will be subject to monitoring to ensure compliance.

Stage 4: Panel Hearing

A panel hearing will be conducted to determine the appropriate course of action, which may be to:

• refer to a tribunal

A decision may be made to:

• issue a caution or reprimand (performance and professional standards panel only)
• impose conditions
• refer to another body
• suspend (only by a Health Panel)
• take no further action

Where an undertaking or condition applies, the registrant will be subject to monitoring to ensure compliance.

Panel hearing outcomes are published.

Stage 5: Tribunal Hearing

A tribunal hearing will be conducted to determine the appropriate course of action, which may be to:

• issue a caution or reprimand
• impose conditions
• fine registrant
• suspend registration
• cancel registration
• take no further action

Where an undertaking or condition applies, the registrant will be subject to monitoring to ensure compliance.

Tribunal hearing outcomes are made available to the public.

Contact Details

Australian Health Practitioner Regulation Agency (AHPRA)

AHPRA can investigate complaints about the conduct, health and performance of a registered health practitioner.
Ph: 1300 419 495
Opening Hours: Monday to Friday 9.00am - 5.00pm (Australian Eastern Standard Time)

Aged Care Complaints Commissioner

Complaints against Australian Government funded aged care services can be made to the Aged Care Complaints Commissioner (Complaints Commissioner). The Complaints Commissioner took over responsibility for handling complaints about aged care services from the Aged Care Complaints Scheme (previously run by the Department of Health) on 1 January 2016.

Australian Government funded programmes that are within the Complaints Commissioner's jurisdiction include:

• residential aged care services, including permanent care and respite care;
• Home Care Packages delivered on a Consumer Directed Care basis;
• flexible care where a person is receiving 'residential care' or 'home care': this includes services provided through transition care, innovative care or multi-purpose services (MPS);
• Commonwealth Home Support Programme (CHSP); and
• National Aboriginal and Torres Strait Islander Flexible Aged Care Programme (NATSIFACP). The Complaints Commissioner can advise whether or not a particular service provider is funded by the Australian Government.

Service users (or their representatives) are encouraged to attempt to raise any concerns with the aged care service provider in the first instance. If they are unable to do this or the provider is unable to resolve their concern, they should then contact the Aged Care Complaints Commissioner (see Contact points). Complaints may be open, confidential or anonymous. All complaints are taken seriously.

The Complaints Commissioner can consider complaints relating to providers' responsibilities under the Aged Care Act 1997 (Cth).

Complaints may be resolved using one or more of the following methods:

• Provider resolution;
• Conciliation;
• Mediation; or
• Investigation. Possible outcomes may include:
• the circumstances giving rise to the complaint are addressed.
• the Complaints Commissioner issues a direction to the provider to demonstrate how they will meet their responsibilities.
• the Complaints Commissioner refers the information in the complaint to another agency, such as the Australian Aged Care Quality Agency or the Department of Health, for action.
• no further action is taken by the Complaints Commissioner (this may occur if, for example, the circumstances are the subject of other legal proceedings).

If a service user (or their representative) or a service provider are not satisfied with the outcome of their complaint, they may request a review, stating the reasons for the request, within 42 days of receiving the decision letter from the Complaints Commissioner.

If a service user (or their representative) or a service provider are not satisfied with the way their complaint or review has been handled by the Complaints Commissioner, they may wish to raise this with the Commonwealth Ombudsman.

Complaints are managed in accordance with the Aged Care Complaints Commissioner's Guidelines. For more information, see the Aged Care Complaints Commissioner's website (see Contact points).

Contact Details

Aged Care Complaints Commissioner

Complaints against Australian Government funded aged care services can be made to the Aged Care Complaints Commissioner (Complaints Commissioner).
Ph: 1800 550 552 (free call)
Email: enquiries@agedcarecomplaints.gov.au