Health and Community Services Complaints Commission (HCSCC)

Contributed by JodiMather and current to 1 May 2016

The Health and Community Services Complaints Commission (HCSCC) is an independent statutory body established under the Health and Community Services Complaints Act.

The Commission works with all parties to complaints (service users and/or their representatives and service providers) to ensure that the complaint process is understood, is fair and transparent.

The HCSCC resolves complaints about health, disability and aged care services in the Northern Territory and makes recommendations to improve the quality of these services.

A complaint may be made about:

• Any aspect of treatment, individual rights, communication, behaviour or administration;
• A hospital, nursing home, supported accommodation, community health centre, health clinic, a private clinic;
• Any other place, or person providing a health or community service;
• The health care and treatment received from all kinds of practitioners. This includes alternative and natural therapies, such as acupuncturists, masseurs and naturopaths, as well as doctors, nurses, dentists, chiropractors, psychologists and counsellors.
• Carers and home care are also included.

Complaints are assessed against the rights and responsibilities set out in the Code of Health and Community Rights and Responsibilities. Details of the Code can be found by clicking on Code of Health and Community Rights and Responsibilities

Role Of The HCSCC

The HCSCC:

• Is independent of government.
• Advocates for complainants and aims to be fair to all, both complainants and providers.
• Aims to make impartial decisions in the public interest, not necessarily to satisfy every complainant.
• Does not have the power to direct or coerce a provider to take certain action the way a court does.
• Make recommendations for action.

The HCSCC Is not required by statute to take up every complaint made. Priority is given to complaints that appear to indicate a systemic problem, a significant issue of public health or safety or a significant question as to the practice of a provider.

Functions

The HCSCC functions are outlined in the legislation which can be found at the following links:

• The Health and Community services Complaints Act
• The Health and Community Services Complaints Regulations

Generally these functions include:

• Ensuring, as far as practicable, that persons who wish to make a complaint are able to do so;
• Undertaking the receipt, conciliation and investigation of complaints;
• Encouraging and assisting users and providers to resolve complaints directly with each other;
• Reviewing and identifying the causes of complaints;
• Taking steps to bring to the notice of users and providers details of complaints procedures;
• Assisting providers in developing and improving complaints procedures and the training of staff in handling complaints;
• Providing information, education and advice in relation to the Act, the Code and the procedures for resolving complaints;
• Inquiring into broader issues arising out of complaints received;
• Publishing information about the work of the office; and
• Providing advice generally on any matter relating to complaints.

Before Contacting The HCSCC

Persons who are thinking about making a complaint to the HCSCC are encouraged to contact their service provider to discuss their concern. Often this is a good way of resolving complaints. It can also help people to maintain a good relationship with their service provider.

The HCSCC is available to help if:

• This approach does not resolve the concern;
• Assistance is required in approaching the provider; or
• The complainant is unwilling or deems it inappropriate to contact the provider personally.

COMPLAINTS

Who Can Complain?

A complaint can be made by:

• The person who received the service;
• Their nominated or authorised representative;
• An advocacy service or a relative;
• A health or community service provider; or
• A concerned member of the community if the issue is determined to be in the public interest.

How To Make A Complaint

A complaint can be made in writing, over the phone, via the HCSCC website, or in person. It may be useful to consider the following information before lodging a complaint:

• Exactly what it is that the complaint is about;
• Concise summary of what occurred, names, dates, times etc;
• Any problems which may be a direct result of what occurred;
• What outcomes may be sought in response to the complaint; and
• What additional documentation might assist with the assessment of the complaint

When contacting the HCSCC, staff will:

• Discuss the problem and provide advice as to whether the HCSCC can help;
• Explain what happens when a complaint is made;
• Encourage and assist with the resolution of the complaint directly with the provider where possible and appropriate;
• Help with the lodgement of complaints; and
• Provide special support to assist people with special needs, Indigenous people and people from non-English speaking backgrounds to access the HCSCC.

Assessing And Resolving Complaints

The HCSCC aims to resolve complaints as quickly and informally as possible.

INFORMAL RESOLUTION

When receiving a complaint, the HCSCC will assess whether:

1. The person requires information only. Once the information has been provided the enquiry will be closed.
2. The complaint is out of jurisdiction and therefore take no further action.
3. The complaint should be referred to another body and therefore assist the complainant with the referral. Once referred the complaint will then be closed, as the HCSCC has no further authority to consider the matter.
4. The complaint is within jurisdiction and the complainant, with their agreement, can approach the provider direct without the need for any assistance from the HCSCC. Once the direct approach is agreed the complaint will be closed.
5. The complaint is within jurisdiction and the complainant, with their agreement, requires assistance from the HCSCC to approach the provider direct. The HCSCC will assist the complainant to approach the provider and monitor progress. Once resolved the complaint will be closed.

FORMAL RESOLUTION

Another option available is formal resolution of the complaint. If the complaint is within jurisdiction and cannot be resolved at 'point of service' the HCSCC will attempt to facilitate the resolution of the complaint by:

• Providing information;
• Organising meetings;
• Facilitating/mediating meetings; and
• Providing advise and options.

If the complaint is within jurisdiction and after taking into account its issues, will not be resolved expeditiously by directly approaching the provider, the complaint will be registered and formally assessed by the HCSCC. Tasks undertaken during preliminary inquiries can include:

• Notifying various parties of the complaint;
• Exploring and arranging resolution options;
• Gaining responses to complaint issues;
• Obtaining relevant documents and information, eg medical records, x-rays, etc;
• Initiating and/or facilitating meetings; and
• Obtaining independent clinical advice.

The objective of the Assessment process is to determine whether the complaint warrants further enquiry or investigation. The HCSCC has 60 days from receipt of the complaint to make one of the following decisions:

• Take no further action;
• Conciliate;
• Investigate; or
• Refer to a Professional Registration Board or other body.

Once the assessment determination is made by the HCSCC, all parties to the complaint are advised.

Time Limitations

Complaints to the HCSCC must be made within 24 months of the user becoming aware of the circumstances giving rise to the complaint. Some discretion exists if there is a good reason for the delay.

Complaints That Cannot Be Accepted

Complaints commonly received that are not accepted include:

• Environmental health complaints - contact the Department of Health (see Contact points)
• Contents of a medical report
• Complaints relating to health insurance - contact the Private Health Insurance Ombudsman (see Contact points).
• Complaints about services provided outside the Northern Territory.

No Further Action

The HCSCC will take no further action on a complaint once satisfied that:

• The complainant is not eligible to make the complaint;
• The complaint does not relate to a health service or community service;
• The circumstances giving rise to the complaint are more than 2 years old and there are no exceptional reasons for the delay;
• The complainant has not tried to resolve the complaint with the provider;
• There is no justification, or it is unnecessary, to investigate the matters raised by the complaint further;
• The complaint lacks substance;
• The complaint is vexatious, frivolous or was not made in good faith;
• The complaint is resolved;
• The complainant has commenced civil proceedings seeking redress for the subject matter of the complaint; or
• The complainant fails to provide additional information or documentation when requested to do so.

Conciliating Complaints

• Cases involving serious or complex issues or substantial disputes that warrant compensation or a detailed explanation may be referred to a Conciliator. The functions of a Conciliator are clearly defined in the Act.
• The conciliation process has statutory privilege. This means anything discussed during conciliation, or any document prepared specifically for conciliation remains confidential and cannot be used anywhere else.
• The process is non-adversarial, free of charge and is an alternative to civil litigation where claims for compensation form part of the substantive complaint.
• Enforceable agreements, documenting the outcome of conciliation, can be made as part of the conciliation process.

Investigating Complaints

The HCSCC is only likely to investigate a complaint using statutory powers if:

• It appears to raise a significant question as to the practice of the provider;
• It appears to raise a significant issue of public health or safety or public interest; and
• The complaint is not suitable for resolution by conciliation.

The HCSCC has wide powers during the investigation process and may propose remedies, or make recommendations which are usually furnished in a report. A notice of the investigation findings is provided to the complainant and the appropriate provider or body able to implement the actions.

Any information, documents, reports, etc produced as a result of an investigation cannot be used for any other purposes, eg. as evidence in a court of law.

Referring Complaints

On receipt of a complaint, the HCSCC will consult with the Australian Health Practitioner Regulation Agency (AHPRA) if the complaint is about the practice of a registered provider. After this consultation, the complaint may be referred to AHPRA or may remain with the HCSCC.

After the HCSCC has conducted their assessment of a complaint the Commissioner may refer the matter to another body.

Contact Details

Health and Community Services Complaints Commission

The HCSCC resolves complaints about health, disability and aged care services in the Northern Territory and makes recommendations to improve the quality of these services.

Level 5, NT House, 22 Mitchell Street, Darwin NT 0800
GPO Box 4409, Darwin NT 0801
Phone: 08 8999 1969 or Fax: 08 8999 6067
Freecall: 1800 004 474
Email: hcscc@nt.gov.au

Relevant Links

Website

http://www.hcscc.nt.gov.au/

Legislation & Code

Health and Community Services Complaints Act

Health and Community Services Complaints Regulations

Code of Health and Community Rights and Responsibilities

Complaint Forms

http://www.hcscc.nt.gov.au/complaints/making-a-complaint/make-a-complaint-online/

http://www.hcscc.nt.gov.au/wp-content/uploads/2010/04/HCSCC_Complaint-Form.pdf

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