ISCAS considers complaints for privately funded care, whether paid for through a Private Medical Insurance (PMI) scheme or self-funded. ISCAS can consider complaints about subscribing providers once Stages 1 and 2 of the local complaints procedure has been concluded without resolution.
Doctors and other healthcare professionals with practising privileges are covered by the Code if they are working with a subscribing provider. Practising privileges requires the self employed doctor to follow the provider’s policies including their complaints policy. They have a duty to cooperate fully in a complaint investigation. We can also deal with complaints about doctors who are part of the Independent Doctors Federation (IDF) where the complaint has been through Stages 1 and 2 of the IDF procedure.
See the Patients Guide to the ISCAS Code for more information.
At Stages 1 and 2, ISCAS subscribers can:
- Carry out an investigation into a complaint and offer an explanation for what happened
- Offer to make an apology, or some other statement of regret
- Take steps to put matters right and reassure the complainant that they have done so
- Make a gesture of goodwill offer, where appropriate (please ask the subscribing provider for information on goodwill payments)
At Stage 3, ISCAS Adjudicators can ask ISCAS subscribers, including NHS Private Patient Units where they subscribe, to:
- Provide an explanation and apology, where appropriate
- Take action to put things right
- Share details of how the organisation has learnt from the complaint and any changes made as a result
- Offer a goodwill payment in recognition of shortfalls in complaints handling, inconvenience, distress, or any combination of these
- NHS patients receiving care with an ISCAS subscriber are entitled to use the providers’ local complaints procedure and have recourse to the Parliamentary and Health Service Ombudsman (PHSO) rather than ISCAS. For more information on complaining about NHS-funded care you can contact the Patients Association helpline on 020 8423 8999 or email them at firstname.lastname@example.org.
- Clinical negligence. If you believe there has been a breach in professional standards you should contact the relevant professional or system regulator. If you are seeking compensation, it may be appropriate to seek legal advice. The Law Society provides advice about accredited practitioners in Clinical Negligence.
- Private medical insurance (PMI) products or financial disputes. Complaints about the product should be taken up with the PMI provider. The Financial Ombudsman Service is the organisation to go to where you remain dissatisfied, and if you’re seeking a refund or money owed to you then you should make a claim to the courts.
- Any organisation that is not a subscriber to ISCAS – please see the providers who are covered. Patients should complain directly to the organisation and where no independent stage is provided patients may want to contact a support organisation for advice – see Helpful Links for more information.
- Professional concerns about a doctor, nurse or other healthcare professional. These are dealt with by the relevant professional regulator – see Helpful Links for more information on professional regulators.
- NHS GP that have seen you privately – patients should complain directly to the organisation and where not satisfied with the outcome seek advice from the organisation on how to escalate matters. Also see information above on organisations not covered by ISCAS.
- Compensation and refunds – compensation is not achievable under the ISCAS Code: the term ‘compensation’ implies that there is a duty on the provider to compensate you for something that went wrong, and to prove that you need to take the matter to the courts. Refunds are also outside the scope of the Code and are a matter for the courts.
- Revision surgery – there is no requirement on providers to offer revision surgery, however this may be considered to be relevant as part of the ISCAS Code, which expects providers to take action to put things right.
- Suspend the registration of a healthcare professional – however, the Code expects providers to refer relevant matters to the professional regulator and take steps to protect patients where it finds that a health professional has not met professional standards and this may impact on patient safety.
- Undertake investigatory visits to subscribers – ISCAS shares information with the relevant system healthcare regulator but does not undertake visits. For more information see ISCAS and Healthcare Regulators.