Monday, November 24, 2008

Comments on proposals for a national health complaints system

HCCA has lodged a submission on the Consultation Paper on Proposed arrangements for handling complaints, and dealing with performance, health and conduct matters. The development of a national complaints system is a part of the national health workforce registration and accreditation implementation. The emphasis is therefore on the development of national health profession registration boards and related performance and professional standard issues. However, the opportunity is also being taken to produce a single national health complaints system incorporating the complaints systems existing in the States and Territories. In the ACT that system is in the Human Rights Commission and headed by Mary Durkin, Health Services Commissioner. The submission which is summarised here, can be viewed in full at http://www.hcca.org.au/cms/index.php?page=submissions, raises some general issues followed by comments on the some of the specific issues and proposals raised in the Consultation Paper.
Overview
HCCA strongly supports the National Registration and Accreditation Scheme for Health Professions which should bring considerable benefits to consumers. The development of a comprehensive health complaints system as part of those national workforce proposals has the potential to provide additional benefits in terms of quality of care and patient safety.
The development of a national system for handling complaints and related performance issues will need concessions and flexibility. An unstated issue is that the system will only deal with complaints relating to individual health professionals. The broader issues of conciliation and systemic and organisational failure in public and private health care are not addressed; there is therefore a need for much of the jurisdictional complaints and health care quality and standards structure to remain and often to be enhanced. The proposal to “build on the best aspects of State and Territory schemes, rather than replicating one existing disciplinary scheme” is supported as a general principle. This does offer an important opportunity to develop a health care complaints system that provides a coordinated linked system that could enable both individual and systemic concerns to be addressed.
Principles
As a health consumer body, HCCA, wishes to see a number of principles and features included in the structure and processes of the joint national registration system. These include existing charters, standards and guidelines relating to rights and handling complaints.
The following aspects are critical in a national complaints system: consistency between jurisdictions, streamlined and transparent processes between agencies, coverage of both individual and systemic health care, easy access to the complaints system, simplify the decision making process and provide support and assistance to consumers, boards and tribunals should include a community /consumer voice and regular reporting of complaints outcomes to health authorities and the public.
From the health consumers’ point of view the actual complaint structure is not the critical issue. The issue is the service provided within that structure, which must be responsive to the concerns of consumers, result in improved health outcomes, be free of both professional and bureaucratic conflicts of interest, have a seamless flow of information with other relevant bodies, be transparent, communicate well and be timely in its decision making.
The national complaints system, together with State and Territory systems, has the potential to provide an invaluable national database on a number of aspects of the operation of the Australian healthcare system. These data could provide current, reliable, validated, national information on the safety and quality issues as well as the national health workforce. This data should be reported both to health authorities and made available publicly.
Roles of national and jurisdictional complaints bodies
The Consultation Paper’s lack of clarity in defining the respective roles of the jurisdictional Health Complaints Commissioners (HCCs) and their relationships with the boards is regarded as a major issue. The Paper notes the value of the HCCs and comments that the “contribution of health care complaints bodies to the maintenance and improvement of health services is important and valuable” However, the it then goes on to suggest that the HCC role should simply be that of conciliation. It appears that the new system based on the boards is to address shortcomings of individual, not those due to systemic or organisational failure. ACT health consumers would be concerned if the role of the ACT Health Services Commissioner was reduced to a conciliation role. Currently the ACT Commissioner is able to initiate independent reviews and investigate systemic issues. While accepting the need for coordinated action and consultation with appropriate boards it is important that the Commissioner retain this role.
The lack of clarity does also result in the potential for complex and unresolved complaints “falling into cracks” or the resolution being paralysed.
A keystone of the current ACT health complaints system is its independence from the health bureaucracy and the health registration boards. HCCA sees this independence as an important issue in giving assurance to consumers that the complaint resolution mechanism is independent from the health care professions and the health arm of government.
The ACT experience is that while the contribution from conciliation is important, the wider contribution by investigation of professional competence and standards and systemic issues are also critical contributions. Certainly in the ACT the HCC has developed a reputation for independence and impartiality. If the boards are designated as the only recipients of complaints regarding professional competence there needs to be a careful explanation to consumers and consumer bodies about the rationale, processes and safeguards.
The Consultation paper is available at http://www.nhwt.gov.au/documents/National%20Registration%20and%20Accreditation/Call%20for%20submissions%20on%20proposed%20complaints%20arrangements.pdf Further consultation, including national and State based forums will be held in March 2009. Further consumer input is therefore very welcome.

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