HEALTH CARE COMPLAINTS COMMISSION Annual Report 2015-16

A I Health Care Complaints Commission Annual Report 2015-16

Annual Report 2015-16

HEALTH CARE COMPLAINTS COMMISSION

Disclaimer – Rounding of statistical figures

As percentages have been rounded, there may be discrepancies between the totals and the sums of the component items. Published percentages are calculated prior to rounding, and therefore there may be some discrepancy between these percentages and those that are calculated from rounded figures.

Contact the Commission

Office address

Level 13 323 Castlereagh Street Sydney NSW 2000

Business hours

Monday – Friday 9.00am – 5.00pm

Postal address

Locked Mail Bag 18 Strawberry Hills NSW 2012

Document exchange service

DX 11617 Sydney Downtown

Telephone and fax

Telephone: (02) 9219 7444 Freecall: 1800 043 159 Fax: (02) 9281 4585 TTY: (02) 9219 7555

Email and website

Email: [email protected] Website: www.hccc.nsw.gov.au

01 I Health Care Complaints Commission Annual Report 2015-16

Table of contents

Letter of submission 02

Commission at a glance 03

A message from the Commissioner 04

Complaints management framework 06

Performance summary 08

Executive summary 10

Profile of complaints 14

Assessing and resolving complaints 26

Investigating complaints 36

Prosecuting complaints 42

Access and outreach 48

Focus area – Mental health complaints 56

Organisation and governance 60

Finance 69

Appendices

A Complaints statistics

B Performance in 2015-16 against key indicators

C List of experts

D List of tables

E List of charts

F Access applications received under the Government Information (Public Access) Act

G Index of legislative compliance


The Hon. Jillian Skinner, MPMinister for Health 52 Martin PlaceSYDNEY NSW 2000

Dear Minister

Report of activities for the year ended 30 June 2016

I am pleased to provide the Annual Report and financial statements of the Health Care Complaints Commission and the Health Care Complaints Commission Staff Agency for the financial year ended 30 June 2016 for presentation to the NSW Parliament.

The report has been prepared and produced in accordance with the provisions of the Annual Reports (Statutory Bodies) Act 1984, the Public Finance and Audit Act 1983 and the Health Care Complaints Act 1993.

Yours faithfully

Sue Dawson

Commissioner

Letter of submission


Commission at a glance

Our aims and objectives The Commission has a unique and central part to play in maintaining the integrity of the NSW health system, with the overarching consideration of protecting the health and safety of the community.

The Commission is established by the Health Care Complaints Act as an independent body to deal with complaints about all health service providers in NSW, including:

• registered health practitioners, such as medical practitioners, nurses and dental practitioners

• non-registered health practitioners, such as naturopaths, massage therapists and alternative health care providers

• health organisations, such as public and private hospitals, and medical centres.

Our strategy is to do this through:

• Informing the public about options for raising concerns about their experiences in the health system and learning about what works best for people who need to make a complaint – through the Commission’s Inquiry Service, our web based information, our outreach programs and our user survey process.

• Receiving, assessing and resolving complaints about health service providers.

• Working with the health professional councils to ensure that practitioners who are below the required professional standards are assessed and directed into programs designed to ensure they meet those standards and that the public is not at risk from any impairments or skill gaps they may have.

• Providing resolution and conciliation services where there is a need for a safe and respectful process to bring parties to a complaint together to better understand and resolve the issues.

• Investigating and prosecuting more serious complaints that raise significant issues of public health and safety.

• Making recommendations to public health services where investigations show that there are procedures or practices that need to improve and monitoring/auditing implementation.

• Analysing complaints data to identify areas where there may be patterns across complaints or system wide issues to be addressed.

• Contributing to the development of health regulation policies and practices nationwide.

Our principles and valuesThe Commission is guided in all aspects of its work by a core set of principles and values which are to:

• be accountable

• be open and transparent in its decision making

• maintain an acceptable balance between the rights and interests of clients and health service providers

• be effective in protecting the public from harm

• strive to improve efficiency

• be flexible and responsive.

These principles are reflected in the Commission’s Code of Conduct and Code of Practice, both of which are available on the Commission’s website.

StakeholdersThe Commission’s diverse stakeholders comprise:

• health consumers, including:

» patients, their families and carers

» health consumer bodies

» the diverse communities of NSW.

• health service providers, including:

» registered and non-registered health practitioners

» health organisations, such as hospitals and clinics

» health professional councils and registration bodies

» colleges and associations

» universities and other health education providers.

• NSW government stakeholders, including:

» the Parliament and the Joint Parliamentary Committee on the Health Care Complaints Commission

» the Minister and Assistant Minister for Health

» the Ministry of Health

» Local Health Districts

» the Clinical Excellence Commission

» other public sector agencies.


A message from the Commissioner

The work of the Commission is well recognised as being substantial and influential. I have an aspiration and commitment to make a difference and to work closely with partners

across the health professions and the health service system to continue to deliver the best outcomes for all health consumers in NSW.

At the heart of the work of the Commission is strong appreciation that effective complaints handling is central to any highly functioning health system. When things go wrong it is essential that we all feel able to ask questions and to have them answered. When complaints are managed well, there is an expected improvement in both consumer experiences and health service delivery. Individual, organisational and system-wide learning is fostered.

This year has been one of rising to the challenges posed by the increasing volume and complexity of complaints. The substantive increases seen in previous years continued in 2015-16, with 6,075 complaints received – a 15.4% increase from the previous year. I anticipate that the increase will continue in future years.

I am regularly asked about the reasons underpinning this increased volume. The Commission has considered its own complaints data and also the research and experiences of other jurisdictions. The consistent picture is that there is no single cause or factor. Population growth and aging play a part, as they lead to more interactions with the health system. Equally important are the wider social trends relating to patient choices and expectations, technology and social media, and consumer reliance on independent bodies where there are serious and complex issues involved.

Complaints are also extremely diverse. This diversity stems from the Commission’s broad jurisdiction and the rapidly changing health services landscape.

Registered, non-registered health providers and health organisations are all subject to complaints. The services these providers offer range from simple, single procedures to very clinically complex multiple procedures. The types of services offered also continue to expand as medical research and technology combine to deliver treatments that were previously not possible. Increasingly, individuals are making use of the expanding range of complementary therapies.

I am pleased to report that the Commission responded very well to the high volume and diversity of the complaints. With the benefit of additional funding we were able to invest in additional assessment, investigation and legal staff. The Commission significantly increased the number of complaints assessed, investigated and prosecuted. Nevertheless, a significant rise in complaint numbers has had an impact on the Commission’s timeliness.

The Commission has embarked on a transition to more flexible and modern complaints management processes, systems and partnerships, to ensure that it can adapt to the reality of increased complaints and to maintain a customer focus in everything that it does. This involves identification of those complaints which may be able to be ‘fast tracked’ or deemed suitable for early resolution. This allows more time to devote to complaints of a more complex clinical nature or which involve conduct allegations that may pose higher risk.

I am pleased that the Commission has received a further 7.1% increase to its budget for 2016-17. This will assist in further progressing the necessary process and systems changes and resource the high pressure complaints functions.

The Commission is also increasingly looking to deliver system wide quality improvement informed by issues raised in individual complaints, wherever that is possible. We know from experience that an individual complaint that may draw attention to weaknesses in common practices or procedures that, if tackled, have the potential reduce risks to health service users and/or deliver systemic improvements (no matter how small or large). This report highlights examples of this evolving strategic focus. These include use of a newly available power under section 94A(1) of the Health Care Complaints Act to issue a public warning about unsafe treatment that is detected during the course of an investigation. The practice of making recommendations to health organisations to implement fundamental changes to avoid a recurrence of issues that have been the subject of substantiated complaints also continues.

Partnerships remain central to the effectiveness and influence of the Commission.

It is with great pleasure that I introduce the 2015–16 Annual Report – my first as Commissioner. I was honoured and privileged to be appointed to this position in December 2015, for a five year term.


I have been impressed with the constructive collaboration and co-operation that exists between the Commission and its co-regulators – the Health Professional Councils Authority and the 14 individual professional councils. I have also appreciated the open and productive rapport with the colleges and associations, whose contribution is so critical to maintaining and building professional standards.

I consider the Commission to be very fortunate to be able to continue to build on a legacy of strong connection with public health service providers across the state. During 2015-16 I began a series of visits to the Justice Health Network and to all Local Health Districts across the state. I can attest to their commitment and resolve in delivering quality health services across NSW, as they implement the core incident and complaints management elements of the National Safety and Quality Heath Service Standards. I can also see that there are areas where the Commission needs to strengthen its connection even further, particularly by ensuring that it receives feedback on the outcomes of matters referred for local resolution, provides support and training and shares analysis of complaints trends and outcomes. These areas will be a priority going forward.

I wish to thank Ms Karen Mobbs, who acted as Commissioner for six months prior to my appointment. Building on the very strong complaints management processes and disciplines established by former Commissioner Mr Kieran Pehm, Karen’s deep knowledge of the legal and administrative processes and her strong stewardship and management ensured that the Commission kept its focus on its core business whilst also addressing a number of external challenges. I am extremely fortunate that Karen continues as an executive member in her role as Director of Proceedings. The Commission benefits greatly from her skills and experience.

Finally, I take this opportunity to recognise all staff at the Commission. Since my first day, I have been struck by the professionalism and dedication that they bring to their work. In the face of an increased volume of complaints, the staff responded in kind and increased their productivity to address this challenge. I thank them for their diligence and effort, and for sharing my passion and commitment to protecting the public health and safety of the NSW community.

Sue Dawson Commissioner

A MESSAGE FROM THE COMMISSIONER


Complaints management framework

Complaint about

Health practitionerComplaint about

Health organisation

2Discontinue

13Make comments

12Public warning

9Prohibition order/public statement

17Complaint provedComplaint not proved

16Make recommendations

1Refer to professional council

8Local resolution

4Refer to another body

14Refer to the Director

of Public Prosecutions

10Refer to professional council Monitor implementation of recommendations

5Resolve during assessment

15Terminate

11Refer to the Director of Proceedings

6Resolution Service

7Formal investigation

No prosecution

Assessment

Investigation

Prosecution

3Discontinue with comments


COMPLAINTS MANAGEMENT FRAMEWORK

The Commission deals with complaints about both individual health practitioners and health organisations.

Complaints about individual practitioners can be about registered practitioners, such as medical practitioners, nurses and dental practitioners, or non-registered health practitioners, such as naturopaths, massage therapists or other alternative health service providers.

Where the complaint is about a registered practitioner, the Commission must consult with the relevant professional council about the most appropriate outcome.

Possible outcomes of assessment are:1 Refer a complaint to the relevant professional

council to consider action to address poor performance or conduct, or an impairment of a registered practitioner.

2 Discontinue the complaint – for example, if records or responses gathered do not support the allegations or the complainant does not wish to provide details that are needed to proceed.

3 Discontinue with comments if issues are minor but corrections to practices or procedures required.

4 Refer the complaint to another body that is more suitable to deal with the issues of concern. For example, a complaint about conditions in a nursing home can be referred to the Aged Care Complaints Commissioner.

5 Complaints may be resolved during assessment, if the complainant is satisfied that the health service provider has addressed their concerns.

6 Refer to the Commission’s Resolution Service provides an option of independent facilitation to help bring the provider and complainant to a better understanding and agreement on action.

7 Investigation of complaints that raise a significant risk of public health or safety or, if substantiated, would provide grounds for disciplinary action.

8 Refer for local resolution where a public health provider is able and willing to work directly with the complainant to address concerns.

Where the Commission investigates a complaint, it may:9 In the case of a non-registered practitioner,

impose a prohibition order to ban or limit the health practitioner from providing health services and issue a public statement about the order.

10 In the case of a registered practitioner, refer the complaint to a professional council to address poor performance, conduct or health concerns.

11 In the case of a registered practitioner, refer the complaint to the independent Director of Proceedings who determines whether a registered health practitioner should be prosecuted before a disciplinary body based on the risk to the public, the seriousness of the allegation and the prospects of a successful prosecution.

12 In the case of a practitioner or a health organisation, issue a public warning during or at the end of the investigation to address any immediate risk to public health and safety.

13 Make comments to practitioners where there has been poor care or treatment, but not to an extent that would justify prosecution, and where there is no risk to public health or safety.

Make comments to a health organisation where the health care was inadequate, but the organisation has already taken measures to prevent a re-occurrence in the future.

14 Refer the complaint to the Director of Public Prosecutions to consider criminal charges.

15 Terminate the complaint (take no further action) where the investigation has not found sufficient evidence of inappropriate conduct, care or treatment.

16 In the case of a health organisation, make recommendations where there has been poor health service delivery and systemic improvements are required. The Commission also provides its recommendations to the Secretary of the Ministry of Health and the Clinical Excellence Commission and monitors implementation. If the Commission is not satisfied with implementation, it may make a special report to Parliament.

Where a registered health practitioner has been prosecuted:

17 A Professional Standards Committee or the New South Wales Civil and Administrative Tribunal (NCAT) can reprimand, fine and/or impose conditions on the practitioner if a complaint is proven. Only NCAT can suspend or cancel the registration of a practitioner.


Performance summary

Investigating complaints

in investigations finalised

More complaints resolved during assessment

More complaints referred for investigation

Robust investigations

investigations finalised

within 12 months

82.8%

complaints resolved after referral to Resolution Service

76.9%

in complaints assessed

2014-15 262

2011-12 4.4%

2015-16 350

2015-16 11.9%

96.4% Matters referred for prosecution that did not need further information

Assessing and resolving complaints

complaints received

6,075

25.8%increase

16.1%increase


Access and outreach

visitors to Commission website

More complaints referred for prosecution

more inquiries received

Success rate in prosecutions

First public warning issued during an active investigation

complaints considered within three

months

of complainants were satisfied

with service

93.5%

87.5%

7.8% 366,241

97.2%increase in legal matters finalised

14.6%

2014-15 93

2014-15

10,390

2015-16 139

2015-16

11,197

Prosecuting complaints


Executive summary

As well as an increase in volume, complaints to the Commission are also increasing in their complexity and diversity.

Over the last 10 years the volume of complaints has more than doubled and the rate of increase has intensified in recent years. This mirrors experience of health care complaints bodies nationally and internationally and the increase is attributed to a complex range of factors that are discussed in the chapter, Profile of Complaints.

Complaints receivedDuring the year, 6,075 complaints were received, an increase of 15.4% on the previous year and building on the 10.5% increase in 2014-15.

This represents a 47.1% increase since 2011-12 and a 101.0% increase in complaints received over the last ten years (3,023 in 2005-06).

The Commission has been challenged to adapt its business processes and priorities.

Increased output over the year shows that the Commission has responded well to this challenge, with the benefit of additional funding complemented by efficiency measures and systems improvements. This enabled the Commission to:

• increase the volume of complaints assessed by 16.1%

• increase the number of investigations finalised by 25.8%

• increase the number of legal matters finalised by 14.6%.

However, the report also shows the impacts of the increased volume and complexity and diversity of complaints. There has been reduced timeliness in completing assessments and investigations. The intensive focus on the core business of complaints management has also detracted from efforts on the outreach and education functions that are also important to the work of the Commission.

The increase in the number of complaints received by the Commission has continued and intensified in 2015-16 with 6,075 complaints received.

Chart 1 – Number of complaints received from 2011-12 to 2015-16

Counted by provider identified in complaint

2011-12 2014-15

5,266

2015-16

6,075

4,130

2012-13

4,554

2013-14

4,767


EXECUTIVE SUMMARY

Assessing complaints The Commission assessed 5,805 complaints in 2015-16 compared to the 5,002 complaints assessed in 2014-15. This is an increase of 16.1%.

The proportion of complaints assessed within the 60-day timeframe has declined and the average time taken to assess each complaint has increased. In 2015-16, 85.8% of complaints were assessed within 60 days, compared to 92.7% in 2014-15 and 94.2% in 2013-14. On average, new complaints were assessed in 47 days compared to 40 days in 2014-15 and 38 days in 2013-14.

Resolving complaints A complaint can be resolved through three possible pathways: early resolution, referral to the Commission's Resolution Service or referral for local resolution by the health organisation.

In the early resolution stream, early intervention techniques are applied in managing complaints that are amenable to quick, informed intervention to solve misunderstandings and minor problems. In 2015-16, 692 complaints were resolved during assessment.


2014-15

5,002

2015-16

5,805

2013-14

4,742

2012-13

4,544

2011-12

4,103

Chart 2 – Number of assessments �nalised from 2011-12 to 2015-16

In addition to those complaints resolved during assessment, 329 complaints were referred to the Commission’s Resolution Service following assessment.

The Commission’s Resolution Service finalised 371 complaints in 2015-16. Of these, 33.4% were finalised within two months of referral, compared with 36.8% in the previous year, and 88.1% were finalised within six months, compared with 87.4% in 2014-15. Of the complaints that proceeded to resolution or conciliation, 76.9% were fully or partially resolved.

There is increasing utilisation of the local resolution pathway under the complaints management framework. The Commission has long observed that the best solution is likely to occur where there is a speedy and direct response to issues raised. Local resolution, when operating in an increasingly effective way, offers this. As the National Safety and Quality Health Service Standards are implemented across the NSW public health system, complaints management systems, practices and accountabilities and governance systems are being strengthened. During 2015-16 411 complaints were referred for local resolution, an increase of 56.9% over 2014-15.

More information can be found in the chapter, Assessing and resolving complaints.


EXECUTIVE SUMMARY


Chart 3 – Number of investigations �nalised from 2011-12 to 2015-16

2014-15

194

2015-16

244

2013-14

226

2012-13

201

2011-12

222

Investigating complaints In 2015-16, 350 complaints were referred for investigation compared to 262 the previous year – a 33.6% increase.

Care should be taken in interpreting this increase as there are many reasons for it and the investigations were across a range of health service providers, both private and public, and a range of service areas.

Some of the key issues and drivers of increased complaints referred for investigation were:

• many substandard practices and procedures in unlicensed facilities

• 23 complaints about one health organisation and its health practitioners, equating to 6.6% of all complaints referred

• infection control in dental surgeries

• illegal prescribing and compounding by pharmacists

• a small number of individual practitioners generating multiple investigations.

The Commission finalised 244 investigations in 2015-16, compared to 194 in 2014-15.

The timeliness of investigations was affected by the increased complaint load, with 84.8% of investigations finalised within 12 months, compared to 86.6% in the previous year. Investigations were finalised on average within 275 days in 2015-16, compared with 230 days for 2014-15.

More information can be found in the chapter, Investigating complaints.


EXECUTIVE SUMMARY

Prosecuting complaintsThe Commission referred 139 investigations to its Legal Division, compared with 93 in the previous year. This is an increase of 49.5%.

In the same period, the Director of Proceedings made 140 determinations whether or not to prosecute a complaint, 113 of which recommended prosecution before NCAT and 24 before a Professional Standards Committee. In three complaints, the Director of Proceedings determined not to prosecute.

As shown in chart 4, the Legal Division finalised 94 matters in 2015-16. The overall success rate of prosecutions before Professional Standards Committees and NCAT was 97.2%.

In 2015-16, the registration of 32 health practitioners was cancelled or disqualified. Four practitioners were suspended and had conditions placed on their registration. A further 33 health practitioners had conditions placed on their registration and were reprimanded or cautioned.

More information can be found in the chapter, Prosecuting complaints.

Combining strategies to target key areasThe Commission analyses its complaints data and trends to identify cohorts of health consumers that may be more vulnerable and to guide strategies to improve outcomes.

In 2015-16 this included a focus on consumers with mental health issues. More information on this focus area can be found in the focus area feature on page 56.

Financial summaryThe Commission greatly benefited from additional funding in 2015-16, which increased resourcing for assessments and investigations and facilitated important systems and process improvements.

The Commission’s Net Result was a deficit of $118,000 which was lower than the $229,000 budgeted and primarily due to higher than projected legal cost recoveries.

The full financial statements for both the Health Care Complaints Commission and the Health Care Complaints Commission Staff Agency are included in the Finance chapter.

The Commission will continue to benefit from the 7.1% ($874,675) increase to its budget that has been secured for 2016-17. There will be additional recruitment and training of assessment officers, continued refinement of business processes and systems, and greater focus on early resolution strategies. The additional funding will also allow the Commission to add further resourcing to the investigation and prosecution of the most serious complaints.

Corporate goalsThe Commission’s performance, measured against its corporate goals for 2015-16, is summarised in Appendix B and throughout this report:

• Comprehensive and responsive complaints handling – pages 26 – 35

• Investigating serious complaints – pages 36 – 41

• Prosecuting serious complaints – pages 42 – 47

• Accountability – pages 48 – 55

• Our organisation– pages 60 – 68

Counted by legal matter

2014-15

82

2015-16

94

2013-14

71

2012-13

88

2011-12

94

Chart 4 – Number of legal matters �nalised from 2011-12 to 2015-16


It covers the volume of complaints received, analysis of who is complained about and the service areas involved, as well as the issues raised in complaints. Some initial analysis of complaints by location is also provided.

It is important to note that the Commission’s data is not a comprehensive indicator of the overall standard of health care delivery in NSW. The number of complaints to the Commission is relatively small considering the volume of services provided. Often complaints are addressed by the relevant health service provider directly, without the Commission being involved. This is increasingly the case as the National Safety and Quality Standards require health service organisations to have an incident management system, a complaints management system that includes partnerships with patients and carers, and an open disclosure process.

It is also important to also note that the Commission receives complaints about both individual health practitioners and health organisations. Some complaints involve a number of practitioners and organisations and a number of issues are raised in a single complaint. The relevant counting method is indicated underneath the graphs in the following section, with "counted by provider" indicating that each complaint about a unique health service provider has been counted, and "counted by issue" indicating that each individual issue has been considered.

Volume and nature of complaints received

Complaints receivedThe Commission received 6,075 complaints in 2015-16 – a 15.4% increase compared to the previous year. This exceeds the 10.5% rise in 2014-15.

The complexity of the complaints received by the Commission is also increasing which is borne out in a variety of ways. A complaint may:

• involve many different health service providers over extended time for an individual patient

• be about one practitioner but cover multiple patients

• relate to new medical interventions and techniques

• concern a matter that is also under investigation by another entity such as the coroner or the Local Health District

• be in rapidly expanding frontiers (such as cosmetic procedures conducted by providers who are non-registered and therefore much more difficult to identify, or pharmacists compounding products)

• raise issues that involve breaches of other legislation or criminal matters and therefore involve other national or state based regulators or the police.

Complaints received by type of health service provider Chart 5 shows the number of complaints received by the Commission in the past five years and breaks this down by the type of health service provider complained about.

The proportions of complaints for each category of health service provider has remained consistent over the five years. Individual health practitioners continue to make up the highest proportion of all complaints. Over the five years an average of 35.5% of complaints received were about health organisations, 62.1% were about registered health practitioners and 2.4% were about non-registered health practitioners.

This section outlines the characteristics of complaints received by the Commission in 2015-16 and over the past five years.

Profile of complaints


2,160(35.6%)

1,821(34.6%)

1,670(35.0%)1,607

(35.3%)

2012-13 (4,554)

2013-14 (4,766)

2014-15 (5,266)

2015-16 (6,075)

2,821(62.0%)

2,971(62.3%)

3,335(63.3%)

3,780(62.2%)

1,521(36.8%)

2011-12(4,130)

2,516(60.9%)

93(2.3%)

126 (2.7%)

135 (2.2%)

125 (2.6%)

110 (2.1%)

Non-registered health practitioner

Registered health practitioner

Health organisation

Chart 5 – Complaints received 2011-12 to 2015-16 by type of health service provider


PROFILE OF COMPLAINTS

Factors driving increases in health care complaints

Significant escalation in the volume of health care complaints over the last decade is the consistent pattern across Australian jurisdictions and internationally. There are no signs that this trend will abate.

In Queensland for instance, the Office of the Health Ombudsman (OHO) has reported that in 2015–16 Queenslanders made more complaints about health services than ever before. The 5,435 complaints received represented a 28 per cent year-on-year increase. Similarly, the Office of the Victorian Health Services Commissioner has reported a 28 per cent increase in complaints on 2015-16.

A similar picture emerges from the UK. There, complaints from the public to the General Medical Council were found to have doubled between 2007 and 2012, to reach around 6,000.

To understand this trend in the UK, a study seeking to identify and understand the factors driving the increase was commissioned from Plymouth University, Schools of Medicine and Dentistry. A central finding of the research is that the increase in complaints shows that wider social trends are in action – not localised causes.

The factors identified in that study are also identifiable in the NSW and Australian context, and work alongside other drivers such as our population growth, ageing and the impacts of mandatory reporting requirements.

2014 Plymouth University Study: “Understanding the Rise in Fitness to Practice Complaints from Members of the Public”– by Dr Julian Archer, Dr Sam Regan de Bere, Dr Marie Bryce, Dr Suzanne Nunn, Dr Nick Lynn, Dr Lee Coombes and Mr Martin Roberts.

The report indicated that it was not possible to point to discrete causes for the increase in health care complaints from members of the public. However, it was able to clearly identify a number of trends which highlight the centrality of consumer expectations and actions as a key drivers:

• Patients have taken greater ownership of their health, becoming better informed, developing higher expectations and treating doctors with less deference than in the past.

• Increased usage of social media and other internet platforms has seen people become more accustomed to discussing their experiences in public spaces, and has also allowed information to be more easily accessed and exchanged.

• Where a health consumer has a negative experience, there is understandable distress and grief and often a loss of confidence and trust. Those experiencing this may prefer a recognised independent body to handle their complaint.

• The reputation of the medical profession, though positive overall, may have been undermined in public consciousness by negative press coverage and media portrayals may exert an influence on complaint-making behaviour.

• Consumers will respond to actions to increase the accessibility and visibility of the complaints organisation.

• Although clinical care remains the largest allegation category, complaints about doctor-patient communication have increased more significantly than those in other categories, highlighting the importance of the doctor-patient relationship.

• A large number of inquiries were closed because the issues raised could not be identified.



Complaints about health practitionersChart 6 shows the number of complaints about individual health practitioners received by the Commission in the past five years.

In 2015-16, the Commission received a total of 3,915 complaints about individual registered and non-registered health practitioners, 13.6% more than in the previous year.

Medical practitioners, dental practitioners, nurses and midwives, pharmacists and psychologists were the health professions most commonly complained about. Complaints about these professions accounted for 90.7% of all complaints received about individual practitioners in 2015-16.

The other types of health practitioners complained about are diverse and cover the wide range of health services accessed by consumers. They include complaints about registered health practitioners such as chiropractors and occupational therapists and non-registered health practitioners such as cosmetic therapists, massage therapists and venopuncturists.

For a more detailed breakdown by profession, please refer to Table A.3 in Appendix A.

Complaints about medical practitioners Complaints about medical practitioners continue to be the most common. In 2015-16, the Commission received 2,134 complaints about medical practitioners, a 10.0% increase on the 1,939 received in the previous year. Complaints about medical practitioners made up 54.5% of all complaints about health practitioners in 2015-16.

As shown in Chart 7, in 2015-16, complaints about medical practitioners most commonly related to general medicine (38.8%; 2014-15: 36.3%), surgery (12.0%; 2014-15: 14.1%), mental health care (5.4%; 2014-15: 3.7%), emergency medicine (4.4%; 2014-15: 3.0%) and psychiatry (3.4%; 2014-15: 5.2%). Complaints about these areas accounted for 64.1% (2014-15: 62.3%) of all complaints received about medical practitioners during the year. The remaining 35.9% of complaints were across a wide range of service areas such as obstetrics, anaesthesia, aged care, oncology, and drug and alcohol.

The high proportion of complaints relating to general medicine should be seen in the context of the number of patient-practitioner interactions in the primary health care sector – Medicare Australia reports over 39,000,000 GP attendances in NSW in 2015-16.

A more detailed breakdown of complaints received about medical practitioners by service area over the past five years is included in Table A.4 in Appendix A of this report.

Chart 6 – Complaints received about health practitioners 2011-12 to 2015-16


2012-13 2013-14 2014-15 2015-162011-12

Medical practitioner Pharmacist Psychologist Other practitionersNurse/midwifeDental practitioner

1,496

482

227

103 97

203

435377

148 137

224

1,6731,622

363

480

167 149264

1,939

349

506

211149

291

2,134

542 501

197 177

364



Complaints about other health practitioners The Commission received 542 complaints about dental practitioners during 2015-16, a 55.3% increase on the 349 received in the previous year. While this was a clear reversal of the trend of falling complaint numbers for this profession, it is largely attributable to one person who made 143 separate complaints about a particular aspect of dental practices' websites. There was also an intensive campaign by the Dental Council of NSW to address infection control in dental surgeries during the year.

In 2015-16, the Commission received 501 complaints about nurses and midwives. This is a decrease of 1.0% from the year before.

The Commission received 197 complaints about pharmacists in 2015-16. While this is a 6.6% decrease from the previous year, it still reflects an 18.0% increase from 2013-14. As outlined in the Commission’s 2014-15 Annual Report, the Commission has worked with the Pharmacy Council of NSW to identify specific pharmacists involved in complaints about pharmacies, which is likely to see a medium term increase in complaints about pharmacists.

In addition, 177 complaints about psychologists were received during the year, which is an 18.8% increase from 2014-15.

General medicine

Mental health

Psychiatry

Surgery

Emergency medicine

Other service areas


Chart 7 – Most complained about areas of practice for medical practitioners, 2015-16

257(12.0%)

116(5.4%)

94(4.4%)

73(3.4%)

766(35.9%) 828

(38.8%)



Complaints about health organisationsChart 8 shows the number of complaints received about health organisations over the past five years.

In 2015-16, the Commission received 2,160 complaints about health organisations, an 18.6% increase on the previous year.

Public hospitals, correction and detention facilities, medical centres, private hospitals and psychiatric hospitals/units were the health organisations most commonly complained about. Complaints about these organisations accounted for 74.9% of all complaints received about health organisations in 2015-16.

The other types of health organisations complained about included pharmacies, community health services, day procedure facilities and pathology centres.

Complaints about public hospitals In 2015-16, the 926 complaints about public hospitals constituted an increase of 6.7% but made up a lower proportion of complaints received about health organisations as a whole than the previous year.

In 2015-16 complaints about public hospitals made up 42.9% of the total number of complaints received about health organisations, compared to 47.7% in 2014-15.

The number of complaints about public hospitals should be seen in the context of the number of services provided. In 2015-16 there were 2,733,853 emergency department attendances in NSW public hospitals (2014-15: 2,692,838), 1,885,913 discharges from hospital (2014-15: 1,839,979) and 13,478,446 outpatient services provided (2014-15: 21,401,717).

Chart 9 shows the public hospital service areas that were subject to the most complaints in 2015-16. The complaints most commonly related to emergency medicine (20.5%; 2014-15: 20.4%), general medicine (19.7%; 2014-15: 9.8%), mental health care (10.9%; 2014-15: 10.3%), surgery (10.0%; 2014-15: 15.2%) and obstetrics (6.7%; 2014-15: 7.0%). Complaints about these areas accounted for 67.8% (2014-15: 62.7%) of all complaints about public hospitals during the year. The high proportion of complaints about emergency medicine and surgery is largely attributed to the fact that these are health services associated with high risk, where complications and unexpected treatment outcomes can be more prevalent.

A more detailed breakdown of complaints about public hospitals by service area over the past five years can be found in Table A.7 in Appendix A.

Chart 8 – Complaints received about health organisations 2011-12 to 2015-16

Public Hospital Private Hospital Psychiatric hospital/unit Other healthorganisations

Medical centreCorrection and detention facility

698

171

97 82

32

405

187

99 81

32

389

761763

249

9682

31

396

868

192

98 100

41

436

926

301

189

11388

543


2012-13 2013-14 2014-15 2015-162011-12



Counted by issues raised in complaint

Chart 9 – Most complained about service area in public hospitals, 2015-16

182(19.7%)

101(10.9%)

93(10.0%)

62(6.7%)

298(32.2%)

190(20.5%)

Emergency

General medicine

Mental health

Surgery

Obsetrics

Other service areas

Complaints about other health organisations Complaints about health organisations other than public hospitals were a higher proportion of the total number of complaints received about health organisations in 2015-16.

Complaints about correction and detention facilities increased from 192 to 301 in 2015-16. Issues relating to access to the methadone program appeared to be a dominant driver of these complaints.

The number of complaints about private hospitals also increased with 113 received in 2015-16, an increase of 13.0% from the previous year.

In 2015-16, the Commission received 189 complaints about medical centres compared to 98 in 2014-15. While this is a large (92.9%) increase it is possible that the different classification of complaints across the years explains some of the differences.

A five-year breakdown of complaints about all types of health organisations can be found in Table A.6 in Appendix A of this report.



Issues raised in complaints A single complaint will often raise a number of issues. Chart 10 shows the issues raised in complaints over the last five years. In 2015-16, the Commission received 6,075 complaints raising 11,842 issues – an average of 1.9 issues per complaint, which is consistent with the previous year.

In 2015-16, the three most common issue categories were treatment (42.3%), communication (17.2%), and the professional conduct of the health service provider (14.9%). The proportions for these common issues were similar to the previous year: treatment (2014-15: 39.4%); communication (2014-15: 16.5%); professional conduct (2014-15: 14.2%).

Complaints about treatment As shown in Chart 11, the most common issues raised in the treatment category were inadequate treatment (34.8%; 2014-15: 33.9%), unexpected outcome (14.6 %; 2014-15: 11.8%), and diagnosis (11.7%; 2014-15: 11.9%). Other common treatment-related issues were inadequate care (11.6%; 2014-15: 9.5%), delay in treatment (6.6%; 2014-15: 7.0%), inadequate or inappropriate consultation (5.3%; 2014-15: 5.7%), rough and painful treatment (3.3%; 2014-15: 3.2%,) and coordination of treatment or follow up of results (2.9%; 2014-15: 3.0%). Other treatment-related issues accounted for 9.2% of all complaints raising treatment issues.

Treatment

Communication/information

Environment/management of facilities

Professional conduct Access

Fees/costs

Medication Discharge/transfer arrangements

Grievance processes

Reports/certi�cates


Chart 10 – Issues raised in all complaints received 2011-12 to 2015-16

Consent

Medical records

2011-12(7,253)

0% 20% 40% 60% 80% 100%

2012-13(8,345)

2013-14(8,061)

2014-15(8,940)

2015-16(11,482)

3,350

3,340

3,241

3,519

5,008

1,096

1,731

1,328

1,471

2,035

795

1,000

1,150

1,272

1,763

482

647

520

577

700

304

250

374

413

453

300

301

282

317

402

194

269

317

282

348

132

207

203

255

260

133

181

134

246

258

130

178

163

242

237

221

121

202

207

191

147

139

187

120

116

Complaints about communication As shown in Chart 12, more than half of communication and information-related issues concerned the attitude and manner of the health practitioner, and this is an increased proportion compared to 2014-15 (57.6%; 2014-15: 53.2%) Other issues in this category related to inadequate (31.2%; 2014-15: 32.1%) or incorrect/misleading (9.9%; 2014-15: 13.3%) information provided by the health service provider. In a small number of cases (1.3%; 2014-15: 1.5%), the complaint was about the failure to accommodate the special needs of a patient.



Complaints about professional conduct As shown in Chart 13, where the complaint related to professional conduct, most complaints related to breach of guidelines or law (19.1%; 2014-15: 8.4%), the practitioner’s competence (17.8%; 2014-15: 16.0%), or a practitioner possibly suffering from an impairment (14.2%; 2014-15: 20.2%). Illegal practice accounted for 12.6% (2014-15: 21.3%), followed by inappropriate disclosure of patient information (7.1%; 2014-15: 6.1%). Other professional conduct-related issues (such as misrepresentation of qualifications, sexual assault, boundary violations and financial fraud) accounted for 29.2% of all complaints raising a professional conduct concern.

A detailed breakdown of all issues in complaints received in 2015-16 is included in Table A.2 in Appendix A.

Attitude/manner

Inadequate information provided

Incorrect/misleading information provided

Special needs not accommodated


Chart 12 – Most common communication or information issues raised in complaints received, 2015-16

1,17257.6%

63431.2%

2029.9%

271.3%


Chart 13 – Most common professional conduct issues raised in complaints received, 2015-16

Breach of guideline/law

Competence

Impairment

Illegal practice

Inappropriate disclosure of information

Other professional conduct issues

33719.1%

31317.8%

25014.2%

22312.6%

126 7.1%

51429.2%

Inadequate treatment

Unexpected treatmentoutcome/complications

Diagnosis

Inadequate care

Delay in treatment

Inadequate/inappropriateconsultation

Rough and painful treatment

Coordination of treatment/results follow-up

Other treatment issues


Chart 11 – Most common treatment issues raised in complaints received, 2015-16

4609.2%

1462.9%

732 14.6%587

11.7%

57911.6%

3316.6%

2645.3%

1673.3%

1,74234.8%



Issues raised about health practitionersChart 14 sets out the types of issues raised in complaints about medical practitioners, dental practitioners, nurses and midwives, psychologists and pharmacists, compared to all practitioners in 2015-16.

Communication issues were common in complaints across all professions, however, were more prominent in complaints about medical practitioners and nurses, and less prominent in complaints about pharmacists. Communication issues are often coupled with treatment issues in complaints.

As in the previous two years, treatment issues were most prominent in complaints about medical practitioners (49.1%, 2014-15: 44.4%) and dental practitioners (44.6%, 2014-15: 50.4%). The proportion of treatment-related complaints about nurses and midwives remained relatively low (27.2%, 2014-15: 22.0%).

Pharmacists attracted a higher proportion of complaints about professional conduct this year compared to last year (42.8%; 2014-15: 24.0%) including complaints relating to illegal practice, breaches of guidelines or laws, impairment and medication (41.8%; 2014-15: 47.0%).

The proportion of complaints about the professional conduct of nurses and midwives was also high (41.9%; 2014-15: 46.9%).

Treatment




Fees/costs


Grievance processes



Consent

Medical records

0% 20% 40% 60% 80% 100%

Chart 14 – Issues raised in all complaints received about health practitioners, 2015-16

All health practitioners

Medical practitioner

Nurse/midwife

Dental practitioner

Pharmacist

Psychologist

3,000

2,137

445

226

69

1,650

542

235

348

121

127

1,205

772

105

149

62

26

453

260

11

50

124

269

109

103

2

11

6

223

180

1

1

25

1

166

80

32

17

9

3

133

75

21

14

6

1

100

84

8

3

3

1

39

22

8

1

8

70

37

15

8

3

43

35

5

92



Issues raised in complaints about health organisationsChart 15 shows a breakdown of the issues raised in complaints about public and private hospitals compared to all health organisations in 2015-16.

Issues relating to treatment accounted for over half of all complaints about public hospitals (53.5%, 2014-15: 50.1%), and 42.7% of all complaints about private hospitals (2014-15: 43.4%).

Communication and information-related issues were the second most commonly complained about issue in relation to both public and private hospitals, and also medical centres. Communication and information-related issues accounted for 20.1% (2014-15: 20.0%) of complaints about public hospitals, 21.1% of complaints about private hospitals (2014-15: 15.4%) and 23.5% of complaints about medical centres (2014-15: 13.9%).

In 2015-16, complaints about the environment and management of the facility accounted for 9.5% of complaints about private hospitals (2014-15: 7.7%) and 5.9% of complaints about public hospitals (2014-15: 5.2%).

As in the previous two years, treatment issues were less prominent in complaints about medical centres, with only 25.5% raising this issue (2014-15: 22.6%). This may reflect that patients at medical centres present with less serious conditions or for continuity of care for chronic conditions.

Complaints about medical records were more likely to be received about medical centres than to any other health organisation, with 11.6% of complaints about medical centres raising this issue (2014-15: 10.9%). These complaints mainly concerned access to, or transfer of records.

Consistent with previous years, correction and detention facilities attracted a higher proportion of complaints about access than other health organisations (30.0%; 2014-15: 21.4%), mostly relating to waiting lists and service availability. Medication issues were also raised in a large proportion of complaints about correction and detention facilities (17.0%; 2014-15: 14.6%).

Complaints about fees and costs were more prominent in complaints about private hospitals (9.5%. 2014-15: 8.2%) than any other health organisation.

Chart 15 – Issues raised in all complaints received about health organisations, 2015-16

All health organisations

Public Hospital

Medical centre

Correction and detention facility

Psychiatric hospital/unit

Private Hospital

2,008

1,193

171

77

99

64

830

447

28

71

49

24

353

79

129

40

3

10

256

132

7

19

22

17

247

72

68

10

11

10

144

113

10

13

133

15

18

22

3

121

60

1

14

9

5

113

23

3

10

3

5

104

48

2

1

2

28

94

36

1

35

2

2

35

11

2

7

4

Treatment




Fees/costs


Grievance processes



Consent

Medical records

0% 20% 40% 60% 80% 100%



Complaints by location Location information is not always provided in a complaint, for example when a complaint is made online or via email. Analysis of the location-based data needs to take this into account. Furthermore, locational analysis of a complaint can be done in relation to the location of the complainant or the location of the service. A patient may travel, for example, from regional NSW to visit a Sydney-based specialist.

Location of complainantsChart 16 shows breakdown of complaints received by the location of complainants. In 2015-16 location details were not provided by 811 complainants. In 2015-16, the Commission received 3,241 complaints from complainants located in metropolitan NSW, which represents 60.3% (2014-15: 65.5%) of all complaints. 1826 complaints were received from complainants located in regional NSW, representing 33.9% (2014-15: 28.8%) of all complaints where the complainant location was known. 295 complaints were received from interstate complainants (5.5%, 2014-15: 5.3%) and 13 from international complainants (0.2%, 2014-15: 0.4%).

For a more detailed breakdown of the location of complainants, please refer to Table A.13 in Appendix A of this report.

Chart 16 – Location of complainants

Counted by complainant

Metropolitan NSW

Regional NSW

Interstate

International

60.3%

33.9%

5.5%

0.2%

Chart 17 – Issues raised by metropolitan and regional complainants, 2015-16

4.2%Fees/costs 2.2%

4.2%4.6%Access

44.7%

17.8%

10.6%

6.2%

2.4%

1.7%

1.4%

45.0%

16.9%

14.2%

5.2%

2.7%

1.8%

2.0%

Treatment


Professional conduct

Medication


Grievance processes

Discharge/transfer arrangements

Metropolitan NSW

Regional NSW


2.4%1.8%Reports/certi�cates

2.0%1.9%Medical records

2.3%1.8%Consent



Issues raised in complaints from metropolitan and regional complainantsChart 17 shows the issues raised by individual complainants located in metropolitan and regional NSW, excluding complaints made by organisations. The chart shows a broad similarity in the issues raised by individuals in regional and metropolitan locations. Treatment issues were no more likely to be raised by regional complainants than metropolitan complainants.

The most notable differences were that professional conduct issues were more likely to be raised by regional complainants (14.2%) than metropolitan complainants (10.7%) and issues relating to fees or costs were more likely to be raised by metropolitan complainants (4.3%) than regional complainants (2.2%).

Location of providers In 2015-16 location details were not able to be identified for 171 providers.

Chart 18 shows the breakdown of complaints received by the location of health service providers. In 2015-16, the Commission received 4,147 complaints about health service providers in metropolitan NSW, which was 70.2% of all complaints. This is consistent with the previous year’s figure of 71.5%.

1,569 complaints (or 26.6%) were about health service providers in regional areas, which is marginally above the previous year’s figure of 25.7%. A small number of providers were from interstate (184, or 3.1%) and only four were international (0.1%). These are consistent with last year’s figures of 2.8% and 0.1% respectively.

For a more detailed breakdown of the location of providers, please refer to Table A.14 in Appendix A of this report.


Chart 18 – Location of providers

Metropolitan NSW

Regional NSW

Interstate

International

70.2%

26.6%

3.1%

0.1%


The nature and purpose of the assessment process When the Commission receives a written complaint, the complaint must be assessed.

If the complaint contains sufficient information, the Commission may make its assessment without further inquiries, but this is not common. More common is that further information is required and the Commission will typically seek further information from the complainant if necessary, gather appropriate medical records, access any relevant reports that may have been undertaken by other bodies, and seek a response from the relevant health service provider or any person who may have knowledge of the matter. For clinical matters, internal medical or nursing advice will usually be obtained, and where necessary, external expert opinion will be sought.

In all cases relating to registered medical practitioners, the Commission must consult with the relevant professional council to determine the assessment outcome.

As has been outlined in the overview of the Complaints Management Framework, there are a number of possible outcomes from an assessment process. The determination of an outcome is based on the nature and severity of the issues raised. In summary, the suite of possible outcomes of a complaint may be:

• referred for investigation

• referred to a professional council

• referred for local resolution

• referred to another body or person

• resolved during assessment

• referred to the Commission’s resolution service

• discontinued with comments

• discontinued.

In some cases, the information gathered during assessment which could suggest a potentially significant issue of public health or safety, significant departures from clinical treatment standards that have caused harm to patients, or grounds for disciplinary action. These cases are referred for investigation.

In complaints involving registered practitioners, there may be evidence of a less significant departure from clinical standards or that a practitioner is impaired or lacking in relevant professional knowledge. In these cases the complaint would generally be referred to the relevant professional council. The council would be able to undertake assessments of the practitioner, place them in an impairment or performance program and if they pose an immediate risk to public health and safety or it is in the public interest, they may place conditions on the practitioner or suspend them. If new information is presented during the council's

management of the complaint that suggests that there is a significant risk to public health and safety, the council may refer the practitioner back to the Commission for investigation.

In some instances the Commission determines that health service provider is in the best position to take immediate steps to address concerns that have been identified. In these cases, the complaint can be referred for local resolution by the provider.

The Commission is mindful of the importance of ensuring that complaints that are referred to professional councils or health service providers are managed in an effective and timely way and the focus is on getting the best possible resolution for the consumer at the end of the process. It is for this reason that the Commission is now establishing more structured arrangements for provision of feedback on the outcome to the Commission where complaints that have been referred to a professional council or a health service provider for action.

In a proportion of complaints, there are issues raised that are within the purview of other bodies. Where that is the case the Commission will refer the complaints to that body. For instance a complaint may raise a concern about access to or content of a health record and in these cases, it is referred to the Information and Privacy Commission. Or a complaint may raise a concern about systems at an aged care facility in which case referral to the Aged Care Complaints Commissioner would be most appropriate.

Increasingly, the focus is on identifying those complaints that can be resolved more quickly and informally during the assessment process. The Commission continues to develop its early resolution capability and processes, noting that quick resolution of a complaint is the most desirable outcome wherever it can be achieved.

Referral to the Commission’s Resolution Service will apply in those cases where there have been significant and complex issues with treatment and care and also a loss of rapport or trust between the service provider and the complainant. This offers complainants and health service providers experienced complaint management staff to assist in the resolution of their complaint, where the parties consent to participate and the parties are willing and able to resolve their complaint with assistance. The process is voluntary, and tailored to meet the needs of the parties. In most cases Resolution Officers assist to identify the outstanding issues, the outcomes sought and a reasonable path to successful and timely resolution. In these situations the Commission is an independent third party who can bring the parties together to identify and address matters of concern.

Assessing and resolving complaints


ASSESSING AND RESOLVING COMPLAINTS

The Resolution Service model is effective in a wide variety of circumstances to achieve positive outcomes, allowing patients and their families to see beneficial results from their complaints including improvements in service delivery, changes to procedures, policies and staff training.

A proportion of complaints raise lower level issues (such as practitioner rudeness, poor information or long waiting times). These issues are of understandable concern to the consumer but do not raise more significant issues of risk to public health and safety. In these cases, the priority for the Commission is to provide guidance to the practitioner or service about necessary improvements in practice. The outcome of “Discontinue with Comments” has been introduced for this purpose.

A complaint will be discontinued where:

• assessment uncovers information that corrects misapprehensions in a complaint

• a clinical expert examines all relevant records and responses and is not critical of the treatment and care provided

• the complaint is found to be made in bad faith.

Case study – Misdiagnosis of stage 4 liver cancer

A woman had a cancerous tumor removed from her bowel and was reviewed by her surgeon three years later. The surgeon was concerned about the possibility of metastasis in the liver, and referred her for a CT scan and CEA tumor marker levels.

The surgeon reviewed these findings and without repeating or ordering any other tests diagnosed the woman with stage 4 liver cancer. The surgeon referred the woman to an oncologist, who recommended a course of chemotherapy. The oncologist did not conduct any further test to confirm the surgeon’s diagnosis of stage 4 liver cancer.

The woman received chemotherapy for six months, but during this time the tumors in her liver did not show any signed of improvement. The oncologist ceased the chemotherapy due to her toxic levels of the chemotherapy drugs and the atypical response of the tumours to the chemotherapy.

Concerned with the lack of improvement and the woman's general condition, the oncologist ordered a review of the original CT done by the surgeon and a subsequent PET scan. This revealed that the woman had benign tumors in her liver rather than stage 4 liver cancer. The woman was treated by the oncologist for the chemotherapy toxicity and has made a full recovery.

The Commission sought a response from the doctors involved, and had an expert oncologist and gastroenterologist review the woman’s treatment records. In consultation with the Medical Council of New South Wales, the Commission determined to refer both the surgeon and the oncologist to the Medical Council for further action to address their poor performance as the evidence indicated that both the surgeon and the oncologist failed to exercise adequate care and skill in the provision of the woman’s treatment.

The departure for the surgeon related to the fact that they did not conduct sufficient tests to confirm the definitive diagnosis of stage 4 liver cancer. The oncologist departed by commencing chemotherapy without confirming the surgeon’s diagnosis of stage 4 liver cancer by either reviewing the surgeon’s test results or ordering her own test to confirm the diagnosis.




Chart 19 – Assessments �nalised from 2011-12 to 2015-16

2011-12

4,103

2012-13

4,544

2013-14

4,742

2014-15

5,002

2015-16

5,805

Assessment outcomesThe Commission assessed an unprecedented volume of complaints in 2015-16. It assessed 5,805 complaints, which is an increase of 16.1% on the 5,002 complaints assessed in 2014-15. As shown in Chart 19, it contributes to an overall 41.5% increase on the 4,103 complaints assessed in 2011-12.

Chart 20 shows the Commission’s assessment outcomes for complaints over the past five years.

In 2015-16:

• 692 (11.9%) of complaints were successfully resolved during assessment

• 344 (5.9%) of complaints were referred for formal investigation by the Commission

• 1,211 (20.9%) of complaints were referred to the professional councils to take appropriate action regarding a registered health practitioner

• 192 (3.3%) of complaints were referred to another more appropriate body for their management

• 411 (7.1%) of complaints were referred to the relevant public health organisation to try to resolve the complaints locally

• 329 (5.7%) of complaints were referred to the Commission’s Resolution Service

• 288 (5.0%) of complaints were discontinued with comments

• 2,338 (40.3%) of complaints were discontinued, with no further action to be taken.

The notable increase in complaints assessed for investigation is addressed in detail elsewhere in this report (in the chapters covering the changing profile of complaints and investigation of complaints), where it is noted as being a result of the increasing volume, diversity and complexity of complaints.

Over recent years there has been a decline in the number of complaints being referred to the Resolution Service. The Commission is currently analysing this, but it seems relatively clear that the increased emphasis on other resolution pathways (being the introduction of the early resolution of complaints during assessment and the increase in the complaints referred for local resolution) are reducing reliance on the Resolution Service. The Service is therefore appropriately focussing on the most serious and complex complaints (such as those where there may be multiple parties to the process, a serious deterioration in trust between the complainant and the provider, or very serious and clinically complex outcomes). There is a real benefit from an independent party assisting to develop a clear understanding of the facts and appropriate and accessible responses to the concerns of the complainant.



The number of complaints that are resolved during assessment is slowly increasing and this is a very positive trend. The Commission is anticipating even further increases in this outcome going forward, as we continue to build our early resolution capacity and skills.

The decline in the number of complaints discontinued is largely attributable to the introduction of a new outcome category ‘Discontinue with Comments’. The number of complaints discontinued with comments is likely to increase over the next year with a corresponding fall in the discontinued rate, consistent with the emphasis on distinguishing and acting on those complaints that raise legitimate concerns but of a less serious nature.

Chart 20 – Outcome of assessment of complaints 2011-12 to 2015-16


* new outcome for 2015-16

2013-142012-132011-12 2014-15 2015-16

40.3%

49.2%47.3%52.4%46.7%

Discontinued

2,017 2,148

2,483 2,334 2,338

20.9%

18.4%19.5%17.8%18.8%

Referred to professional council

753

887 842

942 1,211

11.9%

4.4%5.3%5.5%

13.2%Resolved during assessment

180 240 260

662

692

5.9%

4.7%4.6%4.3%5.0%

Investigation by Commission

194 209 206

250 344

Referred to the Commission's Resolution Service

5.7%

15.0%15.7%

9.3%8.2%

615 714

442 409

329

5.0%

Discontinued with comments*

288

3.3%

2.6%2.1%2.6%2.9%

Referred to another body or person

105 94

125 143 192

7.1%

5.5%8.1%5.2%

Referred for local resolution

239 252

384 262

411

5.8%



Assessment decisions by type of health practitionerChart 21 below sets out how the Commission dealt with complaints in 2015-16, by the type of health practitioner involved. The chart compares the assessment decisions for each of the top five most complained about health practitioners to the assessment decisions for all complaints about health practitioners.

In 2015-16, less complaints about medical practitioners were discontinued (49.6% compared to 61.5%, 2014-15). Slightly more were resolved during assessment (10.6% compared to 10.0% in 2014-15) and this is a trend that the Commission seeks to build on. An increased number and proportion were referred to the Medical Council of NSW (16.4% as compared to 14.9% in 2014-15).

Complaints about pharmacists continued to be most likely to be referred to the Pharmacy Council (64.1%, 2014-15: 67.4%). The proportion investigated by the Commission also increased significantly (being 13.0%

in 2015-16, 2014-15: 9.8%). This is attributable to proactive regulatory detection of non-compliance with standards regarding compounding of pharmaceuticals and in relation to the management of scheduled drugs. Consistent with the seriousness and the often strong evidence base behind complaints about pharmacists, they were also less likely to be discontinued (17.9%, 2014-15: 17.7%).

The most likely outcome for complaints about dental practitioners and nurses was referral to the relevant professional council. In 2015-16 58.6% (2014-15: 32.0%) of complaints about dental practitioners and 55.6% (2014-15: 54.3%) of complaints about nurses were referred to the relevant professional councils.

For more detailed information about assessment decisions by the type of health practitioner complained about, please refer to Table A.19 in Appendix A of this report.

Chart 21 – Outcome of assessment of complaints by health practitioner

Discontinued Investigation by Commission

Referred to professional councilReferred to the Commission's Resolution Service

Discontinued with comments

Referred to another body/person

Resolved during assessment

0% 20% 40% 60% 80% 100%


Dental practitioner

Nurse/midwife

Pharmacist

Psychologist

All health practitioners

1,027

137

131

33

62

1,520

339

299

269

118

65

1,194

219

32

20

4

5

296

176

26

42

24

18

333

49

2

1

54

173

11

9

2

8

232

88

5

11

3

3

137




Assessment decisions by type of health organisationChart 22 below sets out how the Commission dealt with complaints in 2015-16, by the type of health organisation. The chart compares the assessment decisions for each of the top five most complained about type of health organisations to the assessment decisions for all complaints about health organisations.

Complaints about public hospitals were more likely to referred to the Commission’s Resolution Service (24.1%, 2014-15: 31.7%). There is collaboration between the Commission and all LHDs to provide assistance in resolving the more complex complaints and well established processes for doing so. The Resolution Service can assist people to resolve concerns about their care and treatment directly with the hospital involved, and help to restore people’s confidence in their local health service. Assisted resolution is particularly useful in cases where a health consumer is likely to be dependent on ongoing treatment from the hospital, but has lost confidence or trust in that provider. Private facilities are typically less inclined to agree to assisted resolution.

Commission staff were often able to resolve complaints about medical centres while assessing the complaint (37.0%, 2014-15: 42.1%). In many cases these

complaints involved a dispute about fees and costs associated with treatment or waiting times, which could be clarified with assistance from the Assessment Officer. Complaints about medical centres were also more likely to be discontinued (54.3%, 2014-15: 55.8%).

A significant proportion of complaints about correction and detention facilities (71.0%, 2014-15: 61.5%) were referred back for local resolution to Justice Health, the provider of health services in most of these facilities. For security reasons assisted resolution is not commonly used in that context. Complaints about psychiatric hospitals were also more likely to be referred back for local resolution (17.0%, 2014-15: 27.0%). Local resolution can be a fast and appropriate way to address complaints that do not raise serious issues of public health and safety, but still need to be resolved. It is noted that local resolution is not available for complaints about private health service providers.

For more information about assessment decisions by type of health organisation complained about, please refer to Table A.18 in Appendix A of this report.

Chart 22 – Outcome of assessment by health organisation

Discontinued Investigation by Commission

Referred to professional councilReferred to the Commission's Resolution Service





0% 20% 40% 60% 80% 100%

Public Hospital

Correction and detention facility

Medical Centre

Private Hospital


All health organisations


333

54

94

53

45

818 17

158

22

64

23

10

396

150

196

15

411

4

1

1

11

212

4

16

14

275

18

13

4

2

56

5

1

4

1

55

1



Assessment decisions by service areaChart 23 looks at the assessment decisions for complaints in 2015-16 by the type of health service that was provided. The chart compares the assessment decisions for each of the top five most complained about service areas to the assessment decisions for all service areas.

In 2015-16, 17.0% of complaints about emergency medicine and 16.6% of complaints about general medicine were resolved during the assessment process – which is a substantial increase in early resolution in these areas compared to 2014-15 and a higher proportion than other service areas.

In terms of complaints referred to the Resolution Service, complaints about emergency medicine (11.6%), surgery (11.5%) and mental health (10.1%) were more likely to be referred than complaints about other service areas.

Complaints relating to dentistry were often referred to the relevant professional council for appropriate action (49.6%, 2014-15: 27.8%) and were less likely to be discontinued. This reflects the specialised technical knowledge required to determine what if any clinical departures have occurred and the seriousness of those.

It is noted that a higher proportion of complaints about mental health were discontinued. While this may be a function of the incidence of complaints questioning involuntary orders and diagnoses, this data is being, monitored closely in the context of the Commission's commitment to ensuring the effective management of mental health complaints as a key focus area, given the vulnerability of this consumer cohort.

For more information about the assessment decisions by the type of service area, please refer to Table A.18 in Appendix A.

Chart 23 – Outcome of assessment of complaints by most common service area 2015-16

General medicine

Dentistry

Mental health

Surgery

Emergency medicine

All service areas


Referred to professional council


Discontinued


Investigation by Commission



552

167

226

221

115

2,338

228

299

46

54

27

1,211

229

58

40

48

47

692

137

25

55

18

28

411

68

26

23

22

11

344

49

3

46

50

32

329

94

15

12

15

16

288

24

10

7

6

-

192


0% 20% 40% 60% 80% 100%



Assessment decisions by type of issue raisedChart 24 compares the assessment decisions made by the Commission in 2015-16 by the type of issue raised in the complaint. By comparing the assessment decisions for all complaints, to the assessment decisions for the different types of issues raised the analysis can determine whether particular assessment decisions are more or less likely to be made.

Complaints concerning the treatment provided to a patient were less likely to be referred to the Commission’s Resolution Service than last year (11.0%, 2014-15: 16.2%). Patients and their families often do not fully understand the reasons for the outcome of a particular treatment, and may have lost confidence in the service provider. Using an independently facilitated process to convey further information and explanation can help address concerns.

This year, issues relating to the professional conduct of a health practitioner were more likely to be referred for investigation by the Commission (20.3%, 2014-15: 16.6%), referred to the relevant professional council (44.3%, 2014-15: 43.0%) or referred to another body (7.3%, 2014-15: 7.0%).

Where a complaint raises significant issues of public health and safety, or where there appears to be evidence of gross negligence or a significant departure from relevant professional standards, the Commission investigates the complaint. Where the issues do not reach this threshold, which is set out in s23 of the Health Care Complaints Act, the complaint may be referred to the relevant professional council to take appropriate action. Complaints about professional conduct were less likely to be discontinued (21.0%, 2014-15: 28.9%).

Complaints about communication issues are often suitable for resolution, including by referral to the Commission’s Resolution Service (9.1%, 2014-15: 11.9%) or by being resolved during the assessment process (15.3%, 2014-15: 17.2%). Often, complaints about communication are based on a lack of understanding, or a misunderstanding, on the part of the patient or their family about the health service they received.

For more information about the assessment decisions by the type of issue raised, please refer to Table A.17 in Appendix A of this report.

Chart 24 – Outcome of assessment of complaints by issues raised 2015-16

2,076

839

352

212

163

157

4,468

644

189

742

187

7

51

1,982

513

275

48

42

86

110

1,275

496

163

4

35

11

3

827

273

120

9

60

132

8

692

182

38

339

62

7

673

242

135

58

31

17

13

569

103

34

122

19

4

14

328

Treatment

Communication/ information


Medication

Fees/costs

Access

All issues raised

Discontinued Referred for local resolution

Referred to professional council Investigation by Commission





0% 20% 40% 60% 80% 100%




Assessment timelinessThe increased assessment workload has noticeably reduced the proportion of complaints assessed within 60 days, with 85.8% of complaints assessed in this timeframe in 2015-16 (compared to 92.7% in 2014-15). The number of days taken to assess a complaint has risen to 47 days (compared to 40 days in 2014-15).

Another noticeable impact of the increase in complaints is on the timeliness of advising the parties to the complaint of the Commission’s reasons for decision within 14 days. The 88.7% compliance with the statutory timeframe in 2015-16 is lower compared to 97.7% in 2014-15.

On review of the reasons the 60 day timeframe was not met, it was found that 43.1% of complaints that exceeded the statutory 60 day timeline were due to delays in obtaining specialist input to the decision. Many complaints involve complex treatment issues and these complaints require the involvement of internal medical or nursing advisors and peer opinions. This increase in complexity and demand for specialist advice during the assessment of a complaint has been a significant contributing factor in the decrease in the proportion of complaints assessed within 60 days.

A further 37.3% of assessments were delayed as the Commission was waiting for health service provider responses, including more information and medical records.

The Commission has applied a number of strategies to improve timeliness, including:

• Increasing assessment resources.

• Introducing administrative efficiencies such as electronic signatures on decision letters.

• Streamlining administration of setting up complaints.

• More proactive approaches to securing responses from practitioners.

• Applying a risk based approach within which the formality and intensity of the assessment process is determined by the complexity and seriousness of the matters raised in the complaint.

• Strengthening the focus on Early Resolution techniques to deal with less complex complaints in a more informal and expeditious way.

• Introduction of additional case management reporting to flag complaints that are over 60 days and to identify and correct the identifiable causes of delays.

Reviews Complaints are provided with the opportunity to request a review of the Commission’s assessment decision.

During 2015-16, 307 (5.3%) requests for review were

received (2014-15: 274, 5.5%). It is pleasing to note that the review rate has not risen in line with the growth in the numbers of complaints assessed. This appears to be attributable to strategies that have been introduced to improve customer centrism, including fuller explanation of the reasons for assessment decisions in assessment decision letters.

Of the reviews completed this year the original decision made by the Commission was confirmed in 91.2% of reviews, which compares with 92.4% in 2014-15.

However, the timeliness of reviews has declined and this prompted an evaluation of the processes and tools for managing reviews. The evaluation demonstrated that the ‘one size fit all’ review model is not necessary or appropriate and that upfront assessment of each review request to tailor the review strategy would be both more efficient and more customer centric. Where the initial scoping of a review reveals robust assessment and the complainant has provided no new information to be considered, the review process is expected to be more focussed and faster. If it is found that the assessment process had shortcomings, such as a particular line of inquiry was not made or the complainant provides new information, the review process will be more intensive and can be expected to take longer.

Where a review involves consideration of a substantial amount of new material there may also be a need for additional independent expert opinion to be gathered. These are the cases where new executive oversight and monitoring arrangements now apply, to ensure that the process is both thorough and as timely as possible.

Resolution serviceChart 25 shows the outcome of resolution processes over the past five years.

Resolution results continue to be positive, with just over three quarters of complaints resolved or partially resolved (76.9%) in 2015-16 once the parties consent to participate in the process. This is in line with the previous two years’ results, although less than 2011-12 and 2012-13 (87.6% and 87.0% respectively). As has already been noted, whilst the Resolution Service is dealing with less complaints, it is now appropriately focusing on those that are more serious and complex. The reduction in the successful resolution rate may be attributable to this change in business focus and the more challenging nature of it. Further analysis of the resolution matters and outcomes will be undertaken in 2016-17 to inform forward planning and priority setting for the Resolution Service.

In 2015-16, 60 complaints (23.1%) were not resolved. Typically the reasons that complaints do not get resolved include irreconcilable disagreements over key facts central to the complaint; a breakdown in relations between the parties; and/or one or both parties withdraw from a meeting or the process entirely.



Chart 25 – Outcome of resolution processes 2011-12 to 2015-16

409

58

208

420

63

171

357

97

165

230

56

133

200

60

111

60.6%

8.6%

30.8%

64.2%

9.6%

26.1%

57.7%

15.7%

26.7%

54.9%

13.4%

31.7%

200

16.2%

31.9%

Fully/partially resolved

Not resolved

Process did not proceed

2012-13 2013-14 2014-15 2015-162011-12


Case study – Explanation and reassurance through assisted resolution

A woman made a complaint to the Commission about the treatment provided to her by a hospital and treating obstetrician during the birth of her son. She complained that they did not provide adequate and appropriate care or treatment during her pregnancy and this led to the death of her baby boy soon after the birth. She advised that due to this experience, she and her partner did not intend to have another baby.

A resolution meeting was held. In the course of the meeting the obstetrician and the hospital representatives provided explanations as to the treatment provided and the particular complications (thrombophealia) that were experienced. The hospital representatives acknowledged and apologised in relation to the complainants concerns regarding the attitudes of some staff members. The obstetrician indicated they would assist the complainant with the costs of further tests, such as a thrombophealia screening test.

At the conclusion of the resolution process the complainant advised she was satisfied and reassured and intended, as a result of the meeting, to reconsider their decisions about having a family in the future.

In 2015-16, of all complaints referred to the Resolution Service, nearly one in three (30.5%) did not proceed, which is broadly consistent with the results of previous years. Resolutions do not proceed largely due to one or both parties not consenting to participate in the process. For example, the complainant determines that the possible outcome cannot deliver what they want. They may have a change in their personal circumstances, or health or wellbeing issues preclude them from participating.

The detailed outcomes of resolution processes can be founded in Tables A.23 and A.24 in the Appendix of this report.

Resolution officers aim to resolve all complaints in a timely manner. This financial year has seen a significant improvement on previous years with almost 77.9% of complaints being resolved within four months including conciliation, as compared to the previous financial year 73.7%. The number of complaints closed within six months has also improved at 88.1%, as compared with 87.4% in the previous financial year.



Investigating complaints

The nature and purpose of investigations The Commission refers complaints for investigation where it is possible that there could be :

• a significant issue of public health or safety

• a significant question as to the appropriate care or treatment of a client by a health service provider,

• grounds for disciplinary action against a registered health practitioner if the complaint is substantiated.

In 2015-16, 350 complaints were referred for investigation. As shown in Chart 26, this represents a 33.6% increase on the 262 complaints referred in 2014-15. Since 2013-14, there has been an increase of 63.6% in complaints referred for investigation.

Although the increase is significant, in analysing these numbers it is important to recognise the complexity and diversity of the Commission’s jurisdiction and that there are many different contributors to the increase. Importantly, the investigations in 2015-16 relate to all types of health services.

They may be of individual practitioners (be they registered in one of the 14 registered professions or non-registered) or they may be about a health organisation (which may be one of many different types of organisations – a medical centre, an imaging service, a cosmetic surgery service, a public or private hospital etc).

As Chart 27 shows, there are fluctuations over time in the matters and services complained about. Some noteworthy features of the 2015-16 investigations data are:

• Individual registered practitioners are by far the most frequent focus of investigations.

• A small number of individual practitioners generated multiple investigations – nine individual practitioners generated 79 investigations (23.0% of all complaints referred for investigation) in 2015-16.

• Complaints relating to one particular private health facility and its practitioners generated 4.9% of all referrals (17 complaints).

• A campaign in NSW to focus on improving infection control in dental practices saw many more dental complaints referred for investigation.

• Complaints regarding illegal prescribing and compounding practices of pharmacists became more prevalent.

• There were fewer complaints about nurses and midwives within the individual practitioner category – a decrease of 32.2%

• There were fewer public hospitals referred for investigation (a decrease of 33.3%), but more private facilities.



2011-12 2012-13 2013-14 2014-15 2015-16

1,521(36.8%)

1,607(35.3%)

1,670(35.0%)

1,821(34.6%)

2,160(35.6%)

Chart 27 – Investigations received by health service provider 2011-12 to 2015-16

1311

175

17

18

179

819

187

813

241

13

27

310


Health organisation

Chart 26 – Investigations received 2011-12 to 2015-16

2014-15

262

2015-16

350

2013-14

214

2012-13

214

2011-12

199



A single investigation may also have considerable complexity, and this will in turn have an impact on the time taken to conduct the investigation. For example, a recent Commission investigation has involved the care and treatment of dozens of women, all of whom had undergone multiple surgeries conducted by several specialist practitioners that resulted in poor outcomes and at times irreversible life changing injuries. Such investigations involve gathering witness statements from relevant patients, examination of thousands of pages of medical records, x-rays and other radiological scans.

When investigating certain complaints, and in all clinical matters, the Commission engages an independent expert who is provided with all of the relevant investigation documents, on the basis of which a formal report with an opinion on the standard of care delivered or the particular professional conduct of the practitioner is provided. Independent expert opinions are instrumental in determining whether there has been a departure from relevant professional and clinical standards and the seriousness of any identified departure.

The Commission’s operating landscape is also changing and this is leading to changes in the types of issues and investigation techniques that are required. Investigations involving joint commercial enterprises between medical practitioners and compounding pharmacists in NSW are indicative. These involve

the prescribing, compounding and dispensing of medications such as peptides, injectable steroids, and ketamine, for non-recognised therapeutic purposes, generating significant profits and risking the health of clients. Such investigations are complex and can only be satisfactorily progressed through close collaboration with other regulatory bodies such as the Ministry of Health’s Pharmaceutical Regulatory Unit (PRU).

In relation to non-registered health practitioners, the Commission investigates complaints when a two-stage test is met. Firstly, the alleged conduct must breach the NSW Code of Conduct for non-registered health practitioner (the Code). Secondly, the practitioner may pose a risk to the health or safety of members of the public.

Unlike investigations into registered health practitioners, the Commission may decide to impose a prohibition order on the non-registered health practitioner. Such an order would be made where the Commission finds that the non-registered health practitioner poses a risk to the public. Prohibition orders may prevent a non-registered health practitioner from providing health service or specific health services for a period of time of permanently. The Commission may also cause a public statement to be issued and give warnings or information about the practitioner.

Case study – Personal and sexual relationship with a patient

The Commission received a complaint about the conduct of a registered psychologist. The complainant alleged that he became involved in a personal and sexual relationship with a patient who had a Dissociative Identity Disorder and complex presentation, including gender identity issues. The allegation was assessed to be serious enough that, if proven, it would warrant disciplinary action and there was some evidence supporting the allegation.

The investigation found more extensive evidence, including that:

• The psychologist had moved into the patient’s home and later moved together with the patient to another property in which they both lived.

• The patient presented as a male at the beginning of the therapeutic relationship, having been born a female and previously having undergone gender reassignment surgery.

• During the course of the therapeutic relationship the patient decided to transition back to being a female and shortly after the sexual relationship commenced, the practitioner took out a loan to pay for surgery to feminise her appearance.

• The practitioner failed to seek supervision from a professional colleague regarding his treatment of the patient.

• There was some indication that the practitioner may have destroyed the patient’s clinical records.

The investigation found that the conduct of the psychologist could amount to unsatisfactory professional conduct and professional misconduct and the complaint was referred to the Director of Proceedings for consideration of prosecution. The complaint was ultimately prosecuted in the NSW Civil and Administrative Tribunal with the practitioner found guilty of unsatisfactory professional conduct and professional misconduct.


INVESTIGATING COMPLAINTS

The Commission also conducts investigations into health organisations, including public and private hospitals, medical centres, and other treatment services. When investigating a health organisation, the focus for the Commission is on examining the systems and procures that are in place, and recommending improvements that will deliver improvements and remove risks for all patients.

Recommendations to a health organisation may cover a multitude of clinical scenarios. Some are of an educative nature, such as a requirement for a hospital to embark on activity aimed at increasing practitioner awareness in relation to a specific policy or treatment pathways. The Commission may also recommend that a hospital formulate new policy designed to strengthen current practices or to overcome and rectify identified flaws in the delivery of patient care.

When making recommendations, the Commission directs that the hospital provide it with documentation that provides evidence of the implementation of the Commission’s recommendations. The Commission monitors implementation and recommendations are not recorded as implemented until the Commission has received documentary evidence to substantiate compliance. Any delays in implementation or a failure to comply are reported to the Health Secretary.

In addition to making recommendations and comments, the Commission is also implementing a programme of follow up visits to public hospitals, to audit continued compliance with recommendations previously made. Commission audits are carried out by Commission staff and clinicians who have been trained by the NSW Clinical Excellence Commission. These audits also offer the Commission and LHD staff the opportunity to share ideas around best practice and drive systemic improvements. The Commission’s audit reports are provided to the Chief Executive team of the LHD and the Secretary of the Ministry of Health. This is a relatively new function for the Commission and is still evolving.

In an environment of ever increasing complexity and demand, the Commission must, more than ever, be innovative and agile in its approach to investigations. Resources will continue to be focussed on those investigations that go to the very heart of the integrity of the state’s health service, leveraging off the lessons learned from specific incidents and complaints to facilitate improvements to treatment quality, systems and procedures that will benefit all health consumers.

Case Study – Reducing risk to patients through investigative work and regulation

In 2015, the Commission received a number of complaints about a non-registered health facility that was delivering breast augmentation services. Medical complications had occurred following these procedures.

Specifically, this facility was allowing deep sedation during breast augmentation surgery, which posed risks to the health and safety of members of the public.

The Commission’s investigation involved close co-operation with the NSW Ministry of Health’s Private Health Care Unit (PHCU) and the collection of the anaesthetic records of a large sample of patients. The Commission also secured expert advice on the technical issues and use of local anaesthetic agents and vasoconstrictors, such as adrenaline.

Noting also that many patients were unhappy with the outcome of the surgery even where there were not complications arising from the techniques of sedation, the investigation also examined the consent processes that the facility had in place.

During the investigation, the facility elected to change its business model to ensure that breast augmentations would be conducted only at its licensed operation, so that deeper sedation or general anaesthetic could be used as necessary and with appropriate protection for patients.

The facility also agreed to a change to its consent procedures. Patients now benefit from a more thorough consent process, which specifically addresses in detail their acknowledgment and awareness of undergoing a breast augmentation where a breast lift is clinically indicated, and the associated risks and outcomes. The facility specifically recommends that patients in these circumstances consult with a plastic surgeon (and they provide a referral) before undergoing breast augmentation.

These improvements were formally acknowledged and captured in recommendations to the facility as the outcome of the investigation.

New legislation has now been passed by the NSW Government to define certain types of cosmetic procedures that must be conducted in licensed premises – this includes all breast augmentation surgery. This regulation will take effect from March 2017.



Investigation outcomes The Investigation Division finalised 244 investigations in 2015-16. This represents an increase of 25.8% compared to the previous year. Chart 28 shows the outcomes for the investigations finalised in 2015-16 compared to the previous four years.

It is important to note that not all investigations reveal serious issues. In 2015-16:

• 22.9% of all investigations finalised by the Commission in 2015-16 were not significantly serious enough to warrant disciplinary proceedings and they were referred to the relevant Council for management under their health, performance or conduct processes.

• 13.3% of investigations led to no further action being taken by either the Commission or a relevant professional Council, primarily because no allegations could be substantiated.

Outcome of investigations into registered health practitioners In 2015-16, there has been an increase in the number of investigations into registered health practitioners referred to the Director of Proceedings – 139 (63.8%) in 2015-16 compared to: 93 (53.4%) in 2014-15. Fewer investigations resulted in registered health practitioners being referred to a professional council for further action, with 13 investigations or 6.0% with this outcome (2014-15: 38, 21.8%).

Chart 28 – Outcomes of investigations 2011-12 to 2015-16


2013-142012-132011-12 2014-15 2015-16

131

5

32

36

7

9

2

85

14

30

45

8

16

3

110

20

31

33

10

14

7

1

93

19

19

38

6

9

7

3

139

37

25

13

11

9

8

2

Referred to Director of Proceedings

Referred to Council under s20A

No further action

Referred to Council

Public Statement / Prohibition Order

Make comment or recommendation

No further action - National Board informed

Make comments to the practitioner

Breach of Prohibition order, refer to Commissioner

59.0%

2.3%

14.4%

16.2%

3.2%

4.1%

0.9%

42.3%

7.0%

14.9%

22.4%

4.0%

8.0%

1.5%

48.7%

8.8%

13.7%

14.6%

4.4%

6.2%

3.1%

0.4%

47.9%

9.8%

9.8%

19.6%

3.1%

4.6%

3.6%

1.5%

57.0%

15.2%

10.2%

5.3%

4.5%

3.7%

3.3%

0.8%



If it becomes apparent during the investigation of complaints that the issues originally identified in the complaint are more suitable for management by the relevant professional council, the complaint is reassessed and referred to council after investigation under section 25B of the Health Care Complaints Act. 37 (17.0%) investigations were finalised this way (2014-15: 19, 10.9%)

Twenty one (9.6%) investigations were terminated with no further action being taken due to there being insufficient evidence to substantiate that the care and treatment delivered by the practitioner was below acceptable standards (2014-15: 16, 9.2%).

A further eight investigations (3.7%) were terminated due to the practitioner no longer being registered and having retired from practice (2014-15: 7, 4.0%). In these cases, the relevant national registration board was informed to ensure that the incident and issues raised in the assessment and initial investigation are actively considered by the relevant board in the event that the practitioner reapplies to be registered.

Outcome of investigations into non-registered health practitioners In relation to non-registered health practitioners, 11 investigations (64.7%) resulted in a prohibition order and public statement (2014-15: 6, 54.5%). In 2 investigations (11.8%) the Commission made comments to the non-registered health practitioner at the end of the investigation (2014-15: 2, 18.2%). Four investigations of non-registered health practitioners (23.5%) were finalised without any further action being taken (2014-15: 3, 27.3%).

Outcome of investigations into health organisations The focus when investigating a health organisation, is on examining the systems and procedures that are in place and identifying improvements that will deliver benefits for all patients.

Such recommendations may cover a multitude of clinical scenarios. Some are of an educative nature, such as a requirement for a hospital to embark on activity aimed at increasing practitioner awareness in relation to a specific policy or treatment pathways. The Commission may also recommend that a hospital to formulate new policy designed to strengthen current practices or to overcome and rectify identified flaws in the delivery of patient care.

The Commission finalised nine investigations into health organisations during the 2015-16 period. In all of these cases the Commission made comments to the organisation to improve service delivery (2014-15: 9, 100.0%). The Commission made a total number of 30 recommendations to improve the future provision of services in all of these matters.

In the latter part of 2015-16 the Commission progressed planning for a major audit of a health facility that has been the subject of recommendations, to enable it to undertake that audit early in 2016-17.

The Commission will continue to develop its program of auditing compliance with recommendations it has made to health organisations, given the importance of drawing lessons from individual investigations to drive system wide improvements.

Investigation timeliness The time taken to complete investigations for 2015-16 compared with previous years has increased. Excluding the time a Commission investigation may be suspended while the complaint is being investigated as part of a coronial inquest or where there are related criminal proceedings, investigations took an average of 275 days to complete. This compares with 230 days in the previous year.

The increase in the average number of days to complete an investigation is primarily attributable to the substantial increase in the overall numbers of complaints allocated for investigation, but other factors are also in play. Of note is the increasing number of complex complaints concerning practitioners across a range of specialties and often involving the care and treatment of a vast number of patients, coupled with an increase in the investigation of pharmacists involved in the large scale, inappropriate compounding of medication, such as peptides. Further resources have been allocated to the Investigation Division to address this.



Increased use of preventative techniques and partnerships To deliver better results in an environment of increasing complaints volumes and complexity, the Commission is placing particular emphasis on the use of a broader range of strategies to influence systemic improvements in health service delivery and on prevention of consumer exposure to identified risks.

The Commission must work closely with its co-regulatory partners- including the Ministry for Health’s Pharmaceutical Regulation Unit and Public health Units and NSW Police to ensure that operational intelligence is combined to gather evidence which ensures that there is the most efficient, effective and timely approach to protecting the health and safety of the public.

The ability to use public warnings about unsafe treatment or services, under s94A of the Act is one important feature of this work. Recent legislative change enables the Commission to make such warnings during its investigation, in cases where any further delay in issuing the statement poses a risk to an individual or to public health or safety. Such a warning was issued during a joint operation conducted by the Commission and the Ministry of Health’s Public Health Unit and NSW Police into a number of complaints concerning cosmetic services and procedures being offered by non-registered practitioners which were being advertised through various social media platforms.

The use of the public warning enabled the Commission to swiftly identify to the public at large the dangers of consulting with such practitioners and provided a rapid and effective tool for ensuring that the public are aware of the inherent dangers in not consulting with suitably registered health practitioners.

Case study – Public warning issued

During 2015-16 the Commission received an increasing number of complaints about cosmetic procedures being performed in residential premises and hotel rooms, by non-registered practitioners in NSW, particularly in the Sydney area.

The procedures involved a range of skin penetration procedures and administration of Schedule 4 prescription-only medication to ‘improve’ appearance. It is illegal for a non-registered health practitioner to undertake these procedures and because there is no validation of their qualifications and experience, there is a real risk to public health and safety. The procedures are being performed in facilities that have little, if any, infection control measures).

The medications used by the non-registered health practitioners are imported and not on the Australian Register of Therapeutic Goods (ARTG). The import and supply of medication that is not on the ARTG is unlawful and dangerous since there is no way of determining the efficacy and safety of the medicines.

As part of its investigation of this complaint the Commission executed a search warrant on the apartment where the double eyelid procedure was alleged to have been performed. The search warrant was executed in partnership with staff from the Pharmaceutical Regulatory Unit, the LHD’s Public Health Unit and with the assistance of the NSW Police Force. The search warrant uncovered significant evidence including medical equipment and scheduled medications at the apartment and revealed deficient infection control practices.

The Commission decided to make a public warning under s94A of the Act following this step in the investigation. In its public warning the Commission urged individuals seeking cosmetic surgical and medical procedures to be vigilant in their research prior to proceeding, and gave guidance to consumers on the factors that should be considered before committing to a cosmetic procedure, including:

• Is the practitioner appropriately qualified, experienced and accredited?

• Is the facility appropriately equipped?

• Am I appropriately informed?



The nature and purpose of prosecutionsThe Director of Proceedings makes determinations under the Health Care Complaints Act (‘the Act’) about whether a complaint against an individual registered health practitioner should be prosecuted and if so, in which forum.

Complaints referred for consideration of prosecution include allegations of impairment, lack of competence, criminal conviction, and not being a suitable person for registration, as well as unsatisfactory professional conduct and professional misconduct.

The forums available are a Medical Professional Standards Committee, a Nursing and Midwifery Professional Standards Committee or NSW Civil and Administrative Tribunal (NCAT).

Complaints about unsatisfactory professional conduct of nurses, midwives or medical practitioners will usually be prosecuted before a Professional Standards Committee, while complaints about professional misconduct will be prosecuted before the NSW Civil and Administrative Tribunal (NCAT), which also hears complaints about all other registered health professions.

If the Director of Proceedings decides not to prosecute a complaint, it is usually referred back to the Commissioner to consider other appropriate action.

In considering whether a complaint should be prosecuted, the Director of Proceedings acts independently from the Commissioner and is required to have regard the following criteria:

• the protection of the health and safety of the public

• the seriousness of the alleged conduct the subject of the complaint

• the likelihood of proving the alleged conduct

• any submissions made under section 40 of the act by the health practitioner concerned.

Prosecutions are disciplinary proceedings taken against individual practitioners, with the purpose of protecting public health and safety rather than punishing the practitioner. The NCAT can cancel or suspend the registration of a practitioner and may also issue a prohibition order that bans or limits the practitioner from practising in another area of health service. For example, a psychiatrist whose registration is cancelled can be banned from working as a counsellor.

Chart 29 – Complaints referred to Director of Proceedings


2011-12

131

2012-13

85

2013-14

110

2014-15

93

2015-16

139

Prosecuting complaints


Proceedings can be brought even if the practitioner is no longer registered at the time that the prosecution is brought.

2015-16 saw a 49.5% increase in the number of complaints referred from Investigations to the Legal Division, from 93 in 2014-15 to 139 in 2015-16. Despite this increase in referrals, the Director of Proceedings considered 93.5% of complaints within three months of receiving the referral from Investigations, compared to 90.5% in 2014-15.

In 2015-16, 63.8% of investigations into registered health practitioners resulted in referral to the Director of Proceedings for consideration of prosecution. This is significantly higher than the previous year, in which only 53.4% of such investigations were referred.

Case Study – Crossing professional boundaries

Ricardo Marcenaro Vega was a registered nurse employed at Nepean Hospital. It was alleged that he inappropriately touched an 89 year old female patient whilst caring for her during a night shift. The patient was seen crying some hours later and disclosed what had occurred to an enrolled nurse who was also on the night shift. Mr Marcenaro Vega was questioned and strongly denied the allegations. He claimed that the patient was confused at the time and may have been suffering from delirium. Mr Marcenaro Vega later contacted the enrolled nurse and sought to influence the information that she would provide to the Hospital in the subsequent investigation of the matter.

The Commission prosecuted Mr Marcenaro Vega before the NSW Civil and Administrative Tribunal. The patient passed away prior to the matter being heard by the Tribunal. Mr Marcenaro Vega contested the complaints and provided a report from a doctor in relation to the patient’s confusion at the time of the alleged assault. In evidence, the doctor acknowledged that she had not personally seen or assessed the patient, and that medical staff who had directly observed her were in the best position to assess her mental condition. Evidence was presented by the Commission from medical and other staff who had assessed and treated the patient to the effect that they had found her to be awake, alert and orientated.

The Tribunal considered the totality of the evidence, including CCTV footage from the Hospital. Although the patient was unable to be cross-examined, the Tribunal accepted her written statement as coherent and believable and accepted that she had been inappropriately touched by Mr Marcenaro Vega. The Tribunal found Mr Marcenaro Vega to be an unreliable witness. The Tribunal was also satisfied that the evidence established that Mr Marcenaro Vega had sought to influence the version of events to be given by the enrolled nurse in the Hospital investigation. In June 2015, the Tribunal found the complaints of unsatisfactory professional conduct and professional misconduct proved.

The Tribunal published its decision in relation to protective orders in April 2016. It was satisfied that the conduct constituted professional misconduct of the most serious kind. The Tribunal reprimanded Mr Marcenaro Vega in the strongest terms, and ordered that his registration as a nurse be cancelled for at least four years. The Tribunal also made a prohibition order that prohibits him from providing health services, either as public or private services, whilst the cancellation is in place.


PROSECUTING COMPLAINTS

Prosecution outcomesDuring the year, the Director of Proceedings made 140 determinations whether to prosecute a health practitioner before a disciplinary body. This compares to 98 determinations for the previous year. 93.5% of the determinations made in 2015-16 were made within three months of the complaint being referred to the Legal Division.

In four complaints, the Director of Proceedings decided not to prosecute the health practitioner. The reasons for this included that the practitioner had died or there was no reasonable prospect of a successful prosecution.

Timeliness was affected by the increased volume of complaints referred for consideration of prosecution. The percentage of matters referred for prosecution within 30 days of consultation with the relevant professional council fell from 84.7% to 78.9%, just under the target of 80%.

The Legal Division also finalised more matters, with the number of matters finalised increasing from 82 in 2014-15 to 94 this year, representing a 14.6% increase. The rate of successful prosecutions remained high, at 97.2%.

A matter may include multiple complaints against the same health practitioner. As shown in Chart 30, the 94 matters finalised included 50 matters before NCAT, 26 matters before a Professional Standards Committee, 10 appeals and other applications, and eight review and re-registration matters. The outcomes of these matters are detailed in Table 1.

In one further matter, the disciplinary body found the Commission’s complaint proven but protective orders were yet to be made.

Of all matters that were heard and finalised before NCAT or a Professional Standards Committee, 97.2% were found proved.

While there have been some fluctuations in the number of matters referred to the Director of Proceedings over the last four years, it is anticipated that the proportion of investigations referred will remain relatively consistent over the next year, noting the significant increases in both the total number of complaints received and the number referred for investigation.

Chart 30 – Legal matters �nalised 2011-12 to 2015-16*

Counted by matter* Excludes matters where the Diredtor of Proceedings determined not to proscecute* Excludes matters where disciplinary body made findings but not yet protective orders as at 30/06/16

2013-142012-132011-12 2014-15 2015-16

NCAT

4455

3941

50

Professional Standards Committee

301818

2426

Re-registration

7

55

10

8

Appeal

1310

107

10

46.8%62.5%54.9%50.0%53.2%

31.9%20.5%25.4%29.3%27.7%

7.4%

5.7%5.6%12.2%

8.5%

13.8%11.4%

14.1%8.5%

10.6%



Table 1 – Outcome of disciplinary proceedings

1. Professional Standards Committee No.

Medical Professional Standards Committee Not ProvedWithdrawnCaution and ConditionsCautionReprimand and ConditionsReprimand

1161

102

Nursing and Midwifery Professional Standards Committee Caution and ConditionsReprimand and Conditions

23

Total Professional Standards Committee 26

2. Tribunal

NSW Civil and Administrate Tribunal – Chiropractic Suspension and Conditions 1

NSW Civil and Administrate Tribunal – Dental CancellationConditions

21

NSW Civil and Administrate Tribunal – Medical Not ProvedWithdrawnCancellationDisqualifiedSuspension and ConditionsReprimand and ConditionsConditions

1391261

NSW Civil and Administrate Tribunal – Nursing and Midwifery

CancellationDisqualifiedConditions

341

NSW Civil and Administrate Tribunal – Osteopathy Cancellation 3

NSW Civil and Administrate Tribunal – Pharmacy DisqualifiedCancellationCancellation; DisqualifiedCancellation; ReprimandDisqualifiedReprimand and Conditions

111111

NSW Civil and Administrate Tribunal – Podiatry Suspension and Conditions 1

NSW Civil and Administrate Tribunal – Psychology CancellationDisqualified

32

Total Tribunal 50

3. Appeals/Applications

Court of Appeal Appeal by practitioner – Appeal dismissed 3

High Court of Australia Application by practitioner – Application dismissed 1

NSW Civil and Administrate Tribunal – Administrative & Equal Opportunity Division

Application by practitioner – Application withdrawnApplication by practitioner – Application dismissedApplication by practitioner – Application upheld

112

NSW Civil and Administrate Tribunal – Osteopathy Application by practitioner – Application dismissed 1

Supreme Court Appeal by practitioner – Withdrawn 1

Total Appeals/Applications 10

4. Re-registration

NSW Civil and Administrate Tribunal – Medical Referred to Council for consideration 1

NSW Civil and Administrate Tribunal – Nursing and Midwifery

WithdrawnReferred to Council for considerationRe-registered with conditions

131

NSW Civil and Administrate Tribunal – Pharmacy WithdrawnDismissed

11

Total Re-registrations 8

Total Legal matters finalised 94

Counted by matter



Legal policy and practiceThe Commission participated in the statutory review of the Health Practitioner Regulation National Law (NSW) (“the National Law”) conducted by the NSW Ministry of Health to consider the need for legislative amendments to the provisions of the National Law that apply specifically to NSW.

The Commission continued to be represented by the Director of Proceedings on the NCAT Liaison Group which is chaired by the President of NCAT and meets bi-annually. Representatives from the Legal Division also participate in periodic NCAT Occupational Division user group forums.

The Legal Division provided assistance in the drafting of the Commission’s Policy on Reporting Offences to Police. This policy was drafted subsequent to the hearing into Case Study 27 conducted by the Royal Commission into Institutional Responses to Child Sexual Abuse. The Legal Division also substantially redrafted its Facts Sheet for Witnesses relating to hearings, as well as updating the Legal Division Procedures Manual.

Case Study – Practicing alternative medicine whilst suspended

The Commission prosecuted Dr Nguyen-Phuoc, a general practitioner who practiced alternative and complementary medicine, before NCAT in 2015.

The complaint related to 52 of Dr Nguyen-Phuoc’s patients. Dr Nguyen-Phuoc’s registration was suspended in 2013. In early 2015 Dr Nguyen-Phuoc voluntarily surrendered his medical registration. In 2010 he appeared before the New South Wales Medical Tribunal (“Medical Tribunal”) in relation to inappropriately prescribing steroids, rivotril, pethidine, endone and human growth hormone. The Medical Tribunal imposed conditions on his registration.

NCAT found the majority of the complaint proven. It was found that in the absence of clinical indicators, Dr Nguyen-Phuoc diagnosed and treated hypothyroidism; administrated Myers’ cocktail infusions; and diagnosed and treated iron deficiency. It was also found that he failed to offer appropriate preventative health care and exhibited poor record-keeping. In addition the Tribunal was satisfied that Dr Nguyen-Phuoc issued prescriptions to patients during a period when his medical registration was suspended.

NCAT found professional misconduct proven and stated that Dr Nguyen-Phuoc was practicing medicine “in a manner inconsistent with that of his general practitioner peers, and in a manner which is potentially dangerous”. In relation to practicing during a period of suspension the Tribunal stated “[H]is actions were both disgraceful and dishonorable and inconsistent with the standards of conduct which are expected by the community of medical practitioners”.

On 14 September 2015 the NCAT ordered that Dr Nguyen-Phuoc be:

(1) disqualified from being registered as a medical practitioner for a period of three years from 14 September 2015; and

(2) prohibited from providing, on a public or private basis, alternative health services being naturopathy and/or intravenous vitamin therapy, unless and until he is re-registered as a medical practitioner.

The Tribunal found that Dr Nguyen-Phuoc had “learned little” from the 2010 Medical Tribunal decision and that his “powerful, deep-seated and unshakeable belief in the practice of complementary medicine is unlikely to be displaced, at least in the near future”.



Case Study – Inappropriate personal relationship

Mr Mike Siebe Greive (“the nurse”) was employed as a casual registered nurse at the Hornsby Hospital Adult Mental Health Unit (“the Mental Health Unit”). Patient A was admitted to the Mental Health Unit in September 2013 for treatment of a manic episode and was discharged approximately three weeks later. The nurse provided direct care to patient A on three occasions during her admission to the Mental Health Unit.

On one of these occasions, Patient A passed some notes to the nurse indicating that she would like to continue contact with him after her discharge. The nurse failed to advise his supervisor or another member of the treatment team that this had occurred and he failed to seek appropriate guidance about how to respond to her request. Instead, following her discharge from the Mental Health Unit, the nurse contacted Patient A and arranged to meet with her to return some keys that she had left behind. In the course of the meeting, the nurse revealed a number of personal details about himself, including that he was planning to travel to Cambodia for a holiday and the date of his departure.

Between October and late November, a friendship grew between Patient A and the nurse with frequent telephone contact and meetings, which then developed into a sexual relationship. On 25 November, Patient A flew to Cambodia with the nurse, travelled with him and shared accommodation. Whilst in Cambodia, it appears that Patient A’s mental health deteriorated and the nurse left her and returned to Australia alone on 2 December.

The Commission brought a complaint of professional misconduct against the nurse before the NSW Civil and Administrative Tribunal (the Tribunal), alleging that the nurse had failed to maintain proper professional boundaries with Patient A. Prior to the hearing, the nurse admitted the conduct, ceased practice as a registered nurse and had his name removed from the Register. He indicated that he did not wish to ever practice as a nurse again.

In his evidence to the Tribunal, the nurse stated that he initially contacted Patient A because he felt she would be hurt by him avoiding her and he needed

to return the keys she had left in the Mental Health Unit. He denied having invited her on the holiday but agreed that he had acquiesced in her decision to travel to Cambodia where access to health services would be limited. He contended that once in Cambodia, it was difficult to get away from Patient A as she had never been there before and he had. He pleaded her forceful personality and neediness as reason why he maintained the relationship in circumstances where he would have preferred not to.

The Tribunal adopted the observations of the Commission’s expert witness who stated “that to engage someone with Patient A’s psychiatric history in such a confusing relationship and then travel abroad to a country presumably where services either are not known or non-existent, represents a flagrant disregard for the safety of Patient A.”

The Tribunal found that the conduct amounted to professional misconduct. It was of the opinion that the nurse’s actions were “a gross breach of the [nurse’s] professional obligations to his patient and an example of inappropriate exploitation of a vulnerable individual who had been the subject of his professional care”. The Tribunal found that in forming the relationship with Patient A, and failing to disclose issues of concern to the treating team or seeking counsel from more experienced colleagues, the nurse had “ignored his obligations to maintain professional boundaries and displayed a lack of professional insight about the power imbalance and vulnerability of mental health patients, particularly in relation to their carers”.

The Tribunal stated that it would have cancelled the nurse’s registration had be still been registered. In this instance, it disqualified him for a period of 18 months. The Tribunal also prohibited him from providing the following health services on a public, private or volunteer basis:

• medical, hospital, nursing or midwifery services

• mental health services

• community health services

• health education services

• welfare services necessary to implement the above services.


Access and outreach

Inquiry ServiceThe Commission recognises that navigating the health sector can be a challenge for people, given the extensive services offered, and they may be unsure as to the next step – whether it be seeking additional information, referral to another service provider or lodging a complaint. Real time communication is valuable to consumers in these situations, and to this end, the Commission offers an Inquiry Service. Inquiry Officers are able to provide a range of advice and assistance including:

• information regarding health providers and services delivered in NSW

• assistance to bring the person’s concerns to the attention of a health provider or service

• advice on how to raise a complaint directly with a health provider or service

• assistance to lodge a complaint with the Commission.

Often the Inquiry Service can help resolve issues in the early stages without the need to escalate it to a point where a complaint is formally lodged.

In 2015-16 inquiries to the Commission rose 7.8%, with 11,197 inquiries received.

This increase comes after a fairly constant number of inquiries in the years 2011-12 to 2014-15.

Beyond its core complaints management function, the Commission is uniquely placed to contribute to the broader health system improvement agenda through:

• consumer and practitioner education

• early intervention where problems are emerging

• identification and communication of beneficial practice

• meaningful reporting on consumer experiences and complaints.

Provision of information to the public and working closely with our key partners is critical to gaining and maintaining confidence in the ability of the Commission to carry out its core function of protecting public health and safety and helping to maintain the integrity of the health system. The Commission achieves this primarily through: being accessible; raising awareness; working with others and being responsive to consumers.

Being accessibleOn its website, the Commission offers information about its functions, services and how to access these. The Commission also provides translated resources for the public to access. For example, the complaint form and key information fact sheets are available in 20 community languages.

When dealing with inquiries and complaints, bilingual Commission staff can assist clients in their native language. The Commission also regularly uses telephone, oral and written interpreter services in a broad range of languages.

The Commission’s information film, ‘What happens with health care complaints’, is available in the Australian sign language AUSLAN, as well as with Arabic and Chinese subtitles.

People with a hearing impairment can contact the Commission using the TTY number (02) 9219 7555 or through the National Relay Service on 133 677.

People with an intellectual disability and people with low literacy levels have access to a simple, illustrated fact sheet about how to make a complaint.

Chart 31 – Inquiries received 2011-12 to 2015-16

Counted by inquiry

2014-15

10,390

2015-16

11,197

2013-14

10,187

2012-13

10,934

2011-12

10,702


ACCESS AND OUTREACH

Method of contacting the CommissionTelephone access remains the most frequent way in which people access the service, with 95.1% of people contacting the service by phone.

In 2015-16 more people accessed the inquiry service via e-mail, with 419 email inquiries being received (3.7% of inquiries; 2014-15: 1.9%).

Inquiry outcomesDuring 2015-16 the Commission considered the best way of dealing with written inquiries where the person making the request or the provider or service is not able to be identified from the material provided, and there is therefore not sufficient information to progress the inquiry. Nevertheless there may be useful information which should not be lost in case related matters emerge in the future. The Commission therefore introduced the new outcome category of “no further action required” for the Inquiry Service, so that the information provided could be retrieved and used in the event that a related inquiry comes to the Commission at a later stage.

As with the last two years the provision of information remains the most significant outcome for 46.8% (5,237) of callers to the Inquiry Service (2014-15: 4,851, 46.7%).

In 2015-16, there was a slight increase in assisted referral with 11.1% (1,247) of inquiries treated this way compared to 2014-15 (10.9%, 1,132). This is a favourable result as it is consistent with the Commission’s objective providing maximum support at the first point of contact, so that consumers are connected with that part of the system that can deliver the most appropriate and immediate response as quickly as possible.

It is noted, however, that the proportion and number of callers referred to another organisation decreased in 2015-16 to 9.7% (1,089) – down from 12.4% (1.293) in 2014-15. It is also noted that the proportion of callers where strategies for resolution were discussed fell to 7.7% (866) in 2015-16 from 13.2% (1.373) in 2014-15. These trends have highlighted the need for increased focus on providing advice and support to callers to encourage them to attempt to resolve their concerns directly with the health provider or service and to make assisted referrals where appropriate.

Chart 32 – Outcome of inquiries 2011-12 to 2015-16

0.5%

0.3%

0.2%

0.3%

0.1%

57

30

19

30

16

0.5%

0.5%

0.7%

0.7%

0.6%

57

52

74

72

61

Counted by inquiry

2013-142012-132011-12 2014-15 2015-16

5,033

1,672

1,247

1,089

1,682

5,008

1,655

1,427

1,229

1,513

4,637

1,411

1,312

1,390

1,344

4,851

1,629

1,132

1,293

1,373

15.7%

13.8%

13.2%

13.2%

5,237

47.0%

45.8%

45.5%

46.7%

46.8%

2,237

15.6%

15.1%

13.9%

16.0%

20.0%

1,198

11.1%

13.0%

12.9%

10.9%

11.2%

1,040

9.7%

11.2%

13.6%

12.4%

9.7%

8667.7%

404

Information provided

Complaint form sent

Assisted referral

Referred to another body

Discussed strategiesfor resolution

No further action

Letter of complaintdrafted

Referred for assessment

3.6%


ACCESS AND OUTREACH

Raising awarenessCommission staff gave 32 presentations, workshops and information stalls in 2015-16 to health service providers and community groups in NSW. The presentations focused on the Commission’s role, functions and the services it provides, together with discussing case studies that demonstrated best practice. The overall number of presentations was fewer than 2014-15, as complaints management and support to individual complainants via the Inquiry Service took precedence in an environment of increasing number and complexity of complaints. Nevertheless, these presentations and outreach initiatives maintained a focus on particularly vulnerable health consumers and in building a connection with health practitioners in a way that would make the greatest difference.

Public statements and warningsUnder section 41A of the Act, the Commission may also make a public statement that identifies and gives warnings or information about a health practitioner and their health services. Typically these relate to non-registered health practitioners who have had prohibition orders made against them.

In 2015 the Commission was given a new power under section 94A(1) of the Health Care Complaints Act to issue a public warning about unsafe treatment that is detected during the course of an investigation. Previously the Commission could only issue a warning at the end of an investigation. This year the Commission utilised this power to issue a public warning in relation to it receiving an increasing number of complaints about cosmetic procedures being performed in residential premises and hotel rooms, by non-registered practitioners in NSW, particularly in the Sydney area.

Public statement extract: Mr Qing Cai (David) Wang

The NSW Health Care Complaints Commission conducted an investigation into the professional conduct of Mr Qing Cai (David) Wang, a massage therapist.

On 13 May 2015 Mr Qing Cai (David) Wang pleaded guilty to, and was convicted on, the following offences which he committed whilst providing massage therapy:

• Having sexual intercourse without consent with a female patient, Patient A, on 3 May 2014 (section 61I of the Crimes Act 1900).

• Indecently assaulting a female patient, Patient B, on 12 March 2014 and on 3 April 2014 (section 61L of the Crimes Act 1900).

The Commission investigation found that:

Mr Wang breached clause 3(1) of the Code of Conduct for non-registered health practitioners (made under Schedule 3 of the Public Health Regulation 2012), in that he did not provide health services in a safe and ethical manner, when:

• Between 11.30 a.m. and 12.30 p.m. on 3 May 2014 at Lane Cove, during massage sessions which Mr Wang conducted with Patient A he committed two offences of sexual intercourse without consent.

• Between 9.00 a.m. and 6.00 p.m. on 12 March 2014 at Lane Cove, Mr Wang committed the offence of assault with an act of indecency when he massaged Patient B’s left breast and nipple with his hands.

• Between 9.00 a.m. and 6.00 p.m. on 3 April 2014 at Lane Cove, Mr Wang committed the offence of assault with an act of indecency when he massaged Patient B’s left breast and nipple with his hands.

The Commission is satisfied that Mr Qing Cai (David) Wang poses a risk to the health or safety of members of the public.

Prohibition orderAs a consequence of the findings that Mr Qing Cai (David) Wang has breached the Code of Conduct and poses a risk to the health or safety of members of the public, the Commission makes the following prohibition order pursuant to section 41A(2)(a) of the Health Care Complaints Act 1993:

Mr Qing Cai (David) Wang is prohibited from providing any health services in either a paid or voluntary capacity for a period of seven years from the date of this order (7 October 2015).


ACCESS AND OUTREACH

Case study – Concerns about infection control

A caller was understandably concerned about the quality of the food and the infection control practices at the aged care facility where her father was in care.

The inquiry officer talked in greater depth with her about the concerns to ensure that there were no clinical issues that may warrant a complaint to the Commission. This established that the caller was satisfied with the quality of the care her father was receiving but not satisfied with overall hygiene and infection control e.g. how the facility left food trays in the corridors, the quality of the hand washing

facilities available to staff, etc. The possibility of raising these issues directly with the Director of Nursing were discussed with the caller who said that she had raised them with the registered nurses on the ward who had told her that the Director of Nursing was not likely to be sympathetic to her concerns. The inquiry officer then informed the caller about the Aged Care Complaints Scheme, explaining its role in looking at overall quality and car standards for aged care services including their inspection and accreditation function. The caller was helped in making contact with the Scheme to lodge her complaint regarding the aged care facility.

The Commission believed it was important to raise awareness of these practices due to the risk to public health and safety, and urged those individuals seeking cosmetic surgical and medical procedures to be vigilant in their research prior to proceeding.

In 2015-16 the Commission issued one public warning and 11 public statements.

Aboriginal OutreachThe Commission continued its outreach program with Aboriginal health services in regional and rural NSW. Commission staff travelled to towns such as Orange, Lismore and Broken Hill and, in addition to raising awareness about the Commission’s broader role and functions, there was guidance and advice provided on developing robust complaints mechanisms at the local level. Staff also attended information days held by Good Service Mob on the Central Coast. The Good Service Mob is a collaboration of NSW consumer organisations that seeks to ensure members of Aboriginal and Torres Strait Islander communities are aware of their rights as consumers and the services that are available to help them.

The Commission’s outreach work with Aboriginal community groups and service providers continues to build on previous work and incorporate findings learnt through this work. The information sessions to all ten of the Aboriginal health Services in the Bila Muuji group in western NSW in 2014-15 were particularly instructive for the Commission and enabled its work this year to be tailored further. The Commission recognises that poor management of health complaints is detrimental for those in rural NSW with limited access to health care, let alone culturally appropriate health care. Relationship breakdown between service providers and consumers due to poor complaint management

can have a much greater impact and result in people refusing to access health services; or conversely lead to them not making serious complaints for fear that they will limit future access for themselves or their children. It is also important that health complaints are well managed in these environments, because of compounding issues like isolation, small communities and staff attraction/retention issues.

The Commission is now more confident that Aboriginal communities in some of the most isolated areas of the state have a greater awareness of how and where to raise their health concerns. Also, service providers will be more aware of their obligations, particularly in terms of mandatory reporting, and also more confident in their management of complaints and how the Commission can assist in prompt resolution of complaints.

Focus on Mental HealthThe Commission also focussed more intensively on mental health in its outreach activities. The Commission deals with a number of complainants with mental health issues and it is important that mental health service providers are made aware of the sensitivities and challenges of dealing with such patients. In 2015-16 Commission staff concentrated on providing education and training to mental health service providers on the role and processes of the Commission, responding to complaints, managing complaints at a local level and how to help clients make complaints to the Commission.


ACCESS AND OUTREACH

It also strengthened its connection with mental health workers by presenting at four sessions of the Accredited Persons Training in Mental Health. This training is provided by the NSW Institute of Psychiatry and is funded by the Mental Health and Drug and Alcohol Office. These were held in Sydney, Newcastle and Wagga Wagga.

Other presentations in 2015-2016 included providing information to Mental Health Transition Nurses and Broken Hill Mental Health Workers.

Practitioner EducationThe Commission continued its commitment to presenting to health practitioner students at TAFE and universities in NSW (including across Sydney, Ballina and Dubbo). This is part of the Commission’s efforts to educate practitioners at the earliest stages of their careers about their mandatory reporting obligations and how to deal with complaints appropriately.

The Commission also maintained structured training sessions for expert advisers who assist the Commission’s investigations of health service providers and who may be called as expert witnesses in disciplinary proceedings.

MediaThe Commission continued to respond to media inquiries, and provide information where possible, noting s99A of the Health Care Complaints Act 1993 heavily restricts the disclosure of information relating to complaints. These media inquiries predominantly related to health professionals that the Commission had prosecuted before the NSW Civil and Administrative Tribunal, or complaints under investigation.

The Commission also published 86 media releases which related to decisions of disciplinary bodies, as required under its legislation. These releases are published on the Commission’s home page and subscribers to its media release mailing list are automatically notified of each new media release.

Brochure distributionThe Commission continued to have its key brochures “Concerned About Your Health Care?” and “Resolve Concerns About Your Health Care” distributed across medical practices and facilities in NSW. The content of these brochures will be reviewed in the coming year as they were last reviewed in October 2013 and June 2011 respectively.

Working together

Within NSWWhen dealing with complaints, the Commission regularly consults with the various professional councils, registration bodies, the Ministry of Health and the Local Health Districts (LHDs).

After an investigation, where the Commission had made recommendations to a health organisation to improve systems, it also provides a copy of these to the Clinical Excellence Commission to support its work on systemic improvement.

The Commission is committed to maintaining a very strong working partnership with the LHDs across the state, consistent with the view that health consumers will get the very best results if any problems and concerns can be identified and addressed at the time as far as this is possible. The LHDs and hospitals are also in possession of information that if provided quickly to consumers, can prevent problems from escalating. Staff gave a number of presentations to LHDs as well as hospitals on good complaints handling at the local level, including preventing complaints.

In particular, the Commissioner and senior staff have established a schedule of programmed visits to all LHDs across the state. This has provided the opportunity to understand the continuing improvements to governance and patient safety that are occurring under the National Safety and Quality Framework; discuss the LHD’s complaints trends and their performance comparative to other LHDs and/or regions; as well as to identify areas where the Commission’s processes and interactions with them could be improved.

Of particular value has been the opportunity to discuss a feedback mechanism in relation to complaints referred to an LHD for local resolution. One outcome of the Commission’s assessment of a complaint is that it may be referred to an LHD for local resolution. The Commission has discussed with LHDs that it would be valuable for there to be an “end –to-end” picture of the complaints process where complaints are referred on, as this would assist in understanding the experience of the complainant and the eventual outcome of the complaint from the consumer perspective. The feedback mechanism is now being established. This understanding will guide continuous improvements to the complaints management process.


ACCESS AND OUTREACH

Interjurisdictional collaborationThe Commission has continued to participate in a range of national and interjurisdictional fora that ensures it is involved in key decision-making related to the health complaints management environment.

This includes:

• The national working group on the development of a National Code of Conduct for non-registered health practitioners. NSW already has a state Code of Conduct for these practitioners and has taken a leadership role in this issue.

• The Commissioner attends the National Health Commissioners conferences which is an important forum for discussing matters that cross jurisdictional boundaries.

• The Commissioner is also a member of the Medical Board of Australia’s Consultative Committee on revalidation for medical practitioners.

Consumer responsiveness Understanding the concerns of health consumers and health service providers is very important for the Commission. It regularly reviews comments from people who lodged a complaint as well as health service providers who were involved in a complaint, about their experience with the Commission’s services. The Commission uses this feedback to train its staff. The results of its satisfaction surveys are included in the chapter, Assessing and Resolving Complaints.

Consumer Consultative CommitteeThe Commission has a Consumer Consultative Committee (CCC) which over recent years has provided health consumer organisations with the opportunity to raise current issues and provide valuable feedback on the Commission’s work.

In 2015-16 a review of the Committee was undertaken. The members of the Committee and the Commission have identified the need to revitalise the approach to consumer engagement so that there is the opportunity for a wider range of participants in the engagement process and identification of a new and innovative techniques for hearing from consumers and adopting more responsive business practices as a result.

The revitalisation of the approach to consumer engagement will be a priority in 2016-17.

Case study – Reluctance to access health services

The Commission received an extensive complaint from an Aboriginal family in a remote Western NSW town. Their complaint concerned the premature deaths of three of their five adult sons over the previous ten years from serious and complex health conditions. Their experiences with the health system had been so distressing that the family was reluctant to access health services, and the community was losing confidence in there services.

Through face to face meetings with the family in their home town the Resolution Service was able to identify and record all of the outstanding issues.

The Resolution Service then engaged multiple health service providers across the state and secured expert medical advice as required.

The process was complex and intensive, and allowed the family to get answers to their questions and to gain a better understanding about the sequence of events and the rationale for certain decisions that impacted on the treatments provided to their sons. The resolution process also provided an avenue for the family to hear about changes that had been made to change and improve services. This went some way to fostering a higher level of confidence in the health services.


ACCESS AND OUTREACH

Research projectsThe Commission continued its support of a five-part research project comparing complaint-handling in NSW to other Australian jurisdictions, through providing feedback on draft papers and participation in stakeholder meetings. This project is run by the University of Sydney in cooperation with the Commission, the Australian Health Practitioner Regulation Agency, the national boards and the NSW Health Professional Councils Authority. The project is due to finish in 2016-17

In addition, the Commission continues to provide on request ad-hoc advice and statistical data to smaller research projects.

Complaints about the CommissionIn 2015-16, the Commission was notified of nine formal complaints about its staff. Eight complaints concerned staff contact with people who had made a complaint and the management of their complaints. One was made by a Commission employee. Following investigation, the complaints resulted in counselling about measures required to improve professional behaviour. In all cases, they did not result in any formal disciplinary action against staff.

Complaints to the Ombudsman The NSW Ombudsman has advised that in 2015-16, it received 21 complaints about the Commission. This is the same number of complaints as the previous year.

Complaints to the Ombudsman generally related to alleged failures to respond to people and other delay, decisions made by the Commission and disputes over expert judgment.

Of those complaints received:

• 14 were declined at outset (because complaint was: premature, no jurisdiction, concurrent, no evidence of wrong conduct)

• Three were declined after inquiries were made with the Commission (no evidence of wrong conduct found)

• Two were resolved after inquiries were made with the Commission (issue raised by complainant resolved to the Ombudsman’s satisfaction).

• Two were still open.

In addition to the 21 complaints in 2015-16, the Ombudsman recorded 42 inquiries about the Commission.

PrivacyThe Commission has a privacy management plan developed in accordance with the Privacy and Personal Information Protection Act 1988

In 2015-16, the Commission received three requests for internal review under the Privacy and Personal Information Protection Act 1998. These were:

• Allegation of disclosure of private information The Commission conducted a review of the alleged conduct and found no evidence to support the allegations that private information had been disclosed. No further action was taken.

• Request for access to private information As the request was regarding the Commission’s related complaint information (which is deemed to be excluded information under the Government Information (Public Access) Act 2009 the Commission did not consent to the request in full. The Commission did release part of the information requested as this was information omitted in the Commission’s response to the complainant. No further action was taken.

• Request for access to private information As the request was regarding the Commission’s related complaint information (which is deemed to be excluded information under the Government Information (Public Access) Act 2009 the Commission did not consent to the request, and no further action was taken.

Complainant and provider feedbackThe Commission receives complaints and feedback from consumers about the complaint process or the outcome of their complaint. The Commission commits to address and resolve as quickly as possible dissatisfaction that is expressed by consumers or health service providers when it is raised in an attempt to resolve the problem as quickly as possible. Where such resolution is successful, no formal complaint is recorded.

The Health Care Complaints Act entitles complainants to a review of Commission decisions in relation to the assessment and investigation of complaints.

At the completion of each assessment process, both the health service provider and the complainant are invited via a questionnaire to provide feedback to the Commission. The information contained in the questionnaire assists the Commission to understand the experience of the parties in a complaint’s assessment process.

The rate of response from complainants was 8.6%. Of these, 87.5% stated they were satisfied with the Commission’s service. The rate of response from health service providers was 10.5% – of these 68.7% stated they were satisfied with the Commission’s service.


ACCESS AND OUTREACH

“Thank you for your recent feedback, I will certainly endeavour to implement this feedback in my future professional practice” – health service provider

“I wanted to send you a note to express my gratitude for all you did during the process. And particularly your support during the meeting with the Hospital and the suggestion of us having follow up with them. This has given us some relief.“ – complainant feedback

“I found (name of resolution officer) helpful and courteous. I had no idea what the function of the HCCC would be in a case like mine. I did not want to be embroiled in a legal battle that I would – in all likelihood – lose. Yet the treatment I had been subjected to was wrong and I wanted it on the record from my standpoint. The HCCC provided a very professional forum from whereby I could state my viewpoint and more importantly get an addendum placed on my medical records. The resolution officer’s patience and experience allowed him to give practical advice at an emotionally challenging time for me.” – complainant feedback

“Thank you for your professional assistance, I have been able to reconnect with my service in a more positive way and received the service that I wanted”. – complainant feedback

Your feedback


FOCUS AREA – MENTAL HEALTH COMPLAINTS

The Commission analyses its complaints data and trends and uses this to monitor the experiences of cohorts of health consumers that may be more vulnerable. The objective is to guide improvement in access and responsiveness for these cohorts.

For 2015-16 an area of focus was improving our handling of complaints raising mental health issues.

The analysis that has been undertaken indicates that complaints relating to consumers with mental health issues are a relatively small but nevertheless constant proportion of complaints. It highlights the importance of understanding the wide range of providers involved in this service area, the sensitive, complex and systemic nature of some of the issues and the need for a combination of strategies to identify and respond to service delivery issues.

Mental health complaints trendsEach year complaints relating to mental health make up around 12% of all complaints received by the Commission.

In 2015-16, there were 759 complaints in this category. This means that over the five years from 2011 to 2015-16 the Commission has received 3,051 complaints concerning mental health.

Who is complained about The diversity of providers across the mental health system is reflected in the spread of complaints across the range of categories of providers.

Complaints relating to mental health relate to both health organisations and individual health practitioners. The top eight health service providers are shown in chart 34. The majority of complaints are about medical practitioners and psychologists, but private and public health facilities are also a fairly consistent proportion.

Over the last five years the Commission received: 807 complaints about medical practitioners; 647 complaints about psychologists; 438 about mental health services in a public hospital and 299 about psychiatric hospitals; 302 about nurses; and, 220 about community health services. It is difficult to build a clear picture of complaints that relate to the non-registered service delivery area of counsellors and therapists as the numbers are small and this part of the service delivery system is unregulated.

What is complained about The differences between the issues raised in mental health complaints relative to those raised across all complaints are of note.

As Chart 35 shows, a smaller proportion of mental health complaints raised concerns about the treatment received, but a much larger proportion raised issues about communication and information, and consent to treatment. The proportion of complaints about medication are also marginally higher in complaints relating to mental health. Of particular note too are the number of complaints about medical records.

To a large extent, these issues reflect the often involuntary and complex circumstances in which services are being planned and provided, and they highlight the importance of identifying strategies that can help focus service planning and delivery on these issues- particularly in relation to communication with patients and their families.


Focus area – Mental Health complaints

Chart 33 – Mental health complaints received

2011-12 2012-13 2013-14 2014-15 2015-16

463

563

640 639

759





Psychologist Public Hospital


CommunityHealth Service

Nurse/midwife

Correction anddetention facility

Counsellor/therapist

2012-13 2013-14 2014-15 2015-162011-12

128

143

174175

189

87

125

138133

162

72

116107 107

3127 26

32

86

42 39 3744

53

39

53

6571 72

1710

26

1524

7 8 913 13

111

Chart 34 – Types of health service providers complained about

41.5%

13.5%

10.9%

6.6%

3.8%

3.4%

2.4%

2.3%

2.2%

2.1%

2.1%

1.1%

31.9%

21.0%

15.8%

7.9%

2.9%

2.8%

4.5%

1.0%

3.0%

1.6%

5.2%

2.4%

Treatment



Medication


Access


Fees/costs

Medical records

Grievance processes

Consent


Chart 35 – Issues raised in mental health complaints compared to all complaints 2011-12 to 2015-16

All complaints

Mental health complaints


44.0%

19.2%

10.4%

8.4%

6.4%

5.0%

2.8%

2.7%

1.2%

48.9%

17.2%

8.2%

5.3%

9.6%

4.8%

3.8%

1.2%

1.0%

Discontinue

Refer to Council

Resolution

Resolved during Assessment Process

Local Resolution (No RO)

Investigation

Withdrawn

Refer to Another body

Discontinue with comments

All compaints

Mental health complaints

Chart 36 – Issues raised by metropolitan and regional complainants



Improving our approachOur analysis has already started to drive improvements in the Commission’s practices. These include:

• Focussed and customised outreach.

• More effective management of inquiries relating to mental health issues

• Staff training in working with mental health issues

• New partnerships

• A continued focus on identifying and addressing any systems issues that may improve outcomes for those receiving mental health services.

Outreach strategiesThe Commission’s outreach program in respect of mental health services has concentrated on providing education and training to mental health service providers on: the role and processes of the Commission, responding to complaints, managing complaints at a local level and how to help clients make complaints to the Commission.

In 2015-16 the outreach team has strengthened its connection with mental health workers by presenting at the Accredited Persons Training in Mental Health. This training is provided by the NSW Institute of Psychiatry and is funded by the Mental Health and Drug and Alcohol Office. In 2015-16 the HCCC outreach team were part of four training courses throughout NSW.

Information sessions have also been delivered to Mental Health Transition Nurses and Broken Hill Mental Health Workers.

Case Study – Focus on systemic improvements through failure to carry out observations

The Commission investigated a complaint against a mental health inpatient unit in a regional public hospital. The key facts were that:

• Patient A was scheduled under the Mental Health Act 2007 (NSW) with a dual diagnosis of schizophrenia and alcohol abuse

• The patient was difficult to manage due to lack of insight, non-compliance with medication and high level aggression.

• The decision to co-locate the patient in a double room with Patient B – both unpredictable and potentially violent patients – without any a risk assessment.

• On a night shift, required observations either not carried out at all or were not carried out in the manner required, but staff signed off that all care level checks were completed

• Overnight Patient B was killed by Patient A.

The investigation found that care and treatment of Patient A was inadequate. His care plan was ineffective, rigid and failed to improve his condition. There were lost opportunities in terms of appropriate, alternative ways to manage and treat him. Furthermore, his safety and that of others was put at risk through the decision to co-locate him with patient B and because staff failed to carry out the required observations.

The Commission’s investigation carefully considered issues relating to observation practices and risk assessment. Patient observation practices were particularly important in this context as they identify and record signs of improvement or deterioration to inform clinical decision-making. They also provide a period of safety for people experiencing distress and who may be at risk of harm to themselves or others or both. It can be used to manage disturbed or violent behaviour and to prevent self-harm.

The Commission made a number of comments and recommendations to the LHD to:

• Provide further education to staff on policies regarding management of mental health patients.

• Develop a program of audits to monitor compliance with the LHD’s Observation Policy.

• Develop a risk assessment framework when a decision to co-locate patients on the unit and provide evidence of how it will ensures the risk assessments will be carried out.

• Implement a model of care for mental health nurses.

Implementation of these recommendations is being actively monitored by the Commission.



InquiriesThe Commission’s telephone Inquiry Service often receives calls about mental health services. These calls can include patients that are being detained under the Mental Health Act. In these circumstances inquiry officers will talk though the patient’s concerns and advise them where they can go for assistance and advice. If the person is unable to make calls themselves the inquiry officer can make inquiries on their behalf and try to connect them with someone who can assist them such as the Mental Health Advocacy Service. The inquiry service has information about Mental Health Services and helplines in NSW which they can provide to callers.

Staff training and new partnershipsA primary objective of additional training, supported by new partnerships, is to continue to build expertise in both assessing and resolving complaints.

The Commission has staff with experience of working in mental health services in NSW. Training has also been provided in relation to current legislation and policies by the NSW Mental Health Tribunal. These

trained staff are always available to provide advice to any officers when they are dealing with complaints relating to mental health care and treatment.

In the coming year the Resolution team plans to invite mental health services to come into the Commission to speak to staff about mental health services in NSW. This will further assist staff to provide complainants with other avenues of inquiry and help when the Commission may not be able to assist them.

Given the increased focus on mental health, the Commission is working to strengthen its partnership with the Mental Health Commission of NSW (MHC NSW). Within this, the focus will be on exchange of information, training support and access to advice. This will also include advising the MHC NSW of any systemic issues that are identified through the course of the Commission’s work.

The MHC NSW training on “Mental Health First Aid” will be offered for Commission staff in working at the interface of people with mental health issues. The Commission will also explore the option of having access to people nominated by the MHC NSW, who may be able to provide advice on complaints or investigations relating to mental health services.

Case study – Resolution processes driving change

A complaint was received by the Commission from a mother about the care and treatment her late son received while a client of an Early Access Team. There were four main areas of concern raised in the complaint. These related to the patient’s diagnosis; medication; communication with the family; and the lack of support provided by the service.

The complaint was referred to the Commission’s resolution service and following two resolution meetings between the family and the Mental Health Service the following outcomes were agreed to and implemented:

• Updated client transfer guidelines and procedures were adopted across the LHD’s mental health network.

• Orientation processes and material for new staff were updated.

• Monthly group supervision for staff was implemented utilising the expertise of a family therapist. Individual supervision now also occurs with the expertise of a psychologist.

• Funding was received from HETI received to conduct leadership training for staff.

• The Medical Director discussed the patient’s care, the complaint and the RCA with the hospital’s Psychiatric Consultants and Junior Medical Officers. It was also planned to discuss the same at a LHD Peer Review Meeting.

• The Service Manager agreed to develop a youth team’s complaint/feedback brochure – “where do I go if I have a problem?”

• The service received funding to work with families that have children at risk. This program is another indication of the service’s renewed focus on family inclusive practice.

• Monthly random audits on mandatory documentation is ongoing.

• The individuals involved in the patient’s care were supported and supervised in relation to their ongoing work.

• The service is now working with ‘Partners in Recovery’ in relation to employment programs for their consumers.

• The Service Manager offered the option for the complainant to talk to staff about her experience.


Organisation and governance

Legislative changeIn 2014 and 2015 the Commission was part of a working group convened by the Ministry of Health in connection with the statutory review of the Health Practitioner Regulation National Law (NSW). The review was an opportunity to make small changes identified as necessary or desirable by interested parties, as well as to consider broader proposals for reform of the legislation which regulates health practitioners in NSW.

As a result of the review process, the Health Practitioner National Law (NSW) Amendment Review Act 2016 was passed on 9 March 2016 (to commence on 1 July 2016). The main changes which directly impact on the work of the Commission are as follows:

• Mandatory self notification by practitioners under s130 of various events including being charged or convicted of offences or restriction of their rights to supply or prescribing medications are to be taken as a complaint under the legislation [s139(I)]

• Impaired Registrant Panels may continue to deal with a practitioner once it becomes aware that the Commission is investigating, if the Commission consents [s152F(2)]

• Both the relevant Council or the Commission may appear on an application by a practitioner to NCAT for a review of disciplinary orders [s163C(4)]

• The List Manager or legally qualified Member, NCAT, may exercise ancillary and interlocutory orders preliminary or consequential to a final decision in health disciplinary proceedings sitting alone [s165B(5A)]

• An extension of NCAT’s power to impose interim conditions during a disciplinary inquiry to include a power to suspend a practitioner after the complaint has been found proved [s165L(3)]

• A requirement that NCAT to publish a decision where the complaint is admitted in writing and the tribunal decides not to conduct an inquiry [s165M(5)]

• Amendments to the powers and procedures of Professional Standards Committees (PSCs) enabling the Chairperson to decide interlocutory matters and have the deciding vote if the Committee is split and to continue with three members if one of the members becomes unavailable [s170A, D & E]

• A requirement that PSC inquiries are recorded [s171G]

• NCAT may order that the amount of costs arising out of disciplinary proceedings be assessed under the Legal Profession Act 2014 [Schedule 5D]

Corporate structure


ORGANISATION AND GOVERNANCE

Commission staffThe Commission employed a total of 84 staff as at 30 June 2016.

Table 2 – Staff numbers by employment category 2012-13 to 2015-16 (as at 30 June)

Employment basis 2012-13 2013-14 2014-15 2015-16

Permanent full-time 50 54 52 59

Permanent part-time 7 8 7 3

Temporary full-time 14 8 10 9

Temporary part-time 8 5 4 4

Contract – Senior Executives 4 4 4 4

Contract non senior executive – – – –

Training positions – – – –

Retained staff – – – –

Casual 3 4 4 4

Total 86 83 81 84

Subtotals

Permanent 57 62 62 61

Temporary 22 13 15 16

Contract 4 4 4 3

Full-time 64 62 66 68

Part-time 15 13 15 7

Table 3 – Average full-time equivalent staffing 2012-13 to 2014-15

2012-13 2013-14 2014-15 2015-16

76.2 74.3 72.6 74.3

Public Service Senior ExecutivesPublic Service Senior Executives are employed under the Government Sector Employment Act 2013. The executive structure complies with the Senior Executive Implementation Plan prepared for the Public Service Commission in June 2015.

The Commissioner, Ms Sue Dawson commenced a five year terms on 7 December 2015. As shown on the organisational chart, the Commission has three operational divisions which require specialist skills and Senior Executive management to ensure strong analysis and effective resolution, investigation and prosecution of complaints. Each of these areas is headed by a Director. There is also an executive unit and a corporate services unit.

In 2015-16 the Commission had four Public Service Senior Executive roles:

• Commissioner, Senior Executive Band 3 – Sue Dawson, Bachelor of Laws (Hons 1) (LLB), Master of Urban Planning, Bachelor of Social Work (Hons 1), Executive Fellow, Australia New Zealand School of Government

• Director of Proceedings, Senior Executive Band 1 – Karen Mobbs, Bachelor of Arts (BA) and Bachelor of Laws (LLB)

• Director of Investigations, Senior Executive Band 1 – Tony Kofkin, Bachelor of Arts (BA), former Detective Chief Inspector at Kent Police (UK)

• Director of Assessment and Resolution, Senior Executive Band 1 – Ian Thurgood, Certificate in Orthopaedic Nursing, Certificate of General Nursing, accredited mediator.

In addition, the Commission was supported by the Director, Corporate Services, Independent Commission Against Corruption (ICAC), Andrew Koureas as a sitting member on the Executive, reflecting the shared corporate services agreement between the Commission and ICAC.



Table 4 – Senior Executive Service as at 30 June 2016

Band 2015 2016

Female Male Female Male

Band 3 (Commissioner) 1 0 1 0

Band 1 (Directors) 1 2 1 2

Totals 2 2 2 2

4 4

Table 5 – Remuneration of Senior Executive as at 30 June 2016

Band Range $ Average remuneration

2015 2016

Band 3 (Commissioner) $313,051 – $360,00 $305,401 $336,525

Band 1 (Directors) $204,300 – $219,100 $208,933 $214,167

11.2% of the Commission’s employee related expenditure in 2015-16 was related to senior executives, compared with the previously published 7.0% in 2014-15*.

*Note that on recalculation the percentage of the Commission’s employee related expenditure that related to senior executives salaries in 2014-2015 Annual Report was stated in error at 7% – it should have been 10.7%.

Staff changesIn 2015-16 twenty employees took leave or resigned as follows: one employee left for 12 months maternity leave, one employee retired, one employee went on leave without pay, three employees were seconded to other agencies, three ended fixed term contracts, eleven employees resigned, and one short term internship finished.

Conditions of employment and movement in salaries and allowancesEmployees of the Commission, including Senior Executives are appointed under the Government Sector Employment Act.

Employees under the Crown Employee (Public Service Conditions of Employment) Award received a 2.5% increase in salary and related allowances on 1 July 2015. The Commission employs medical and nursing advisers who are employed under the Crown Employees (Health Care Complaints Commission) Medical Advisers Award and they received a 2.5% annual increase from October 2015.

The Statutory and Other Officers Remuneration Tribunal (SOORT) determined a performance-based increase of 2.5% for the Commissioner and other Public Service Senior Executives in August 2015.

Personnel policies and practicesConditions of employment are principally set by the Government Sector Employment Act and, for the majority of employees, by the Crown Employees (Public Service Conditions of Employment) Award. Employees’ conditions and entitlements are managed in accordance with the guidelines, policies and directions set by the Public Service Commission of NSW and the Commission’s own workplace agreement and internal policies.

The Commission has a number of policies and procedures regarding conditions of employment, work health and safety, equity, security and other operational requirements.

Performance managementAll employees have a performance agreement that aligns individual job focus and performance expectations with the goals and priorities defined in the Commissions strategy, corporate and business plans. Each employees performance agreement also includes a development plan that incorporates development objectives to build capabilities required in their job or that is required to make the employee ready for an organisation need in the future or a personal career goal.

Going forward, the emphasis on training and development will be strengthened to ensure that managers and staff are equipped to work effectively in a changing complaints management landscape. Each of the employees who got a performance rating that identified a need for improvement will be provided with the necessary support and tools to assist in improving performance.



Staff development and trainingAll employees had personal development discussions and plans set as part of their Annual Performance Agreements. The key development themes across these plans have been identified and addressed.

The Commission continued its commitment to regular delivery of training designed to support staff in working in a challenging complaints management environment and in working in a customer centric fashion. The target of an average of greater than 2 days training per employee was exceeded.

This included continuation of the commitment to making resilience training available for all Commission staff, so that they are well equipped work in a sustainable and constructive way with aggrieved, distressed, angry or abusive clients and in working with a wide range of health consumers. Staff feedback is that the training was well planned and the interactive exercises gave them an opportunity to hone their skills in handling the more emotionally demanding side of complainant interactions.

The NSW Ombudsman’s Office training on the effective management of unreasonable complainants was also added to the training regime, to ensure that the Commission recognises that there are times when people will be unwilling to accept the outcome of the complaints process and persistent in their efforts to secure a different outcome. The training ensures that there are constructive, transparent and fair processes for working with these complainants while avoiding undue impact on staff and the organisation.

Support for the Continuing Legal Education responsibilities of our legal officers also continued.

In addition to formal training the commission also offers a range of other opportunities for the development of employees- these include performing higher duties, leadership or participation in projects, mentoring and coaching, and cross Divisional information sharing and teaching.

To support the objective of better equipping the Commission to work effectively in a changing

complaints management landscape, a manager training program will be implemented in 2016-17. This will support managers to build the leadership, project management, delegation and communication skills required to ensure good performance.

Staff wellbeingThe Commission supports staff wellbeing with a range of activities.

Grievance Officer

The Commission has appointed a Grievance Officer who is trained to provide staff with confidential information and support to address any work-related issues they may have. Issues may relate to allegations of discrimination, harassment, bullying or other workplace concerns.

Employee assistance program

The Commission has an established Employee Assistance Program and has engaged OPTUM to provide free confidential and professional counselling in relation to any work-related or personal concerns of an employee or their immediate family members.

Flexible work arrangements

Commission offers flexible work arrangements to allow its employees to balance their work with other commitments, including caring for children or elderly parents. In 2015-16, 14 staff had flexible work agreements, including part-time work, parental leave without pay and working from home.

Staying healthy

Every year, the Commission offers free influenza vaccinations for staff. Twenty two employees chose to have the vaccination in 2011-12, 28 in 2012-13, 30 in 2013-14, 35 in 2014-15 and 38 in 2015-16. Staff can also participate in lunch hour on-site Pilates classes, at their own expense.

Charitable work

The Commission gives staff the opportunity to raise funds for charitable projects in their own time. Staff

Table 6 – Training offered and attendees

Course name Number of attendees

Managing Unreasonable Complainant Conduct – Ombudsman’s Office 18

EEO Training – Anti Discrimination board 48

The Cost of Caring 33

Job applications and interview skills 2

Trauma Informed Practice to Promote Helper Resilience training 55

Presentation by NSW Office of the Public Guardian 8

Other training and conferences 25



participated in the Cancer Council Biggest Morning Tea and each year a Christmas fund raiser collects donations for a charity of choice. Staff also have the opportunity to celebrate and recognise national milestone events within the Commission, such as International Women’s Day, NAIDOC week and White Ribbon Day.

Industrial relations and the Workplace Consultative CommitteeThe divisional directors, nominated staff and the Public Service Association of NSW meet quarterly as members of the Workplace Consultative Committee to discuss issues relating to the conditions of employment and entitlements of staff, including recruitment, training, work health and safety (WHS) matters, and any new policies.

The Commission has a workplace agreement that provides for flexible working hours and conditions, and sets out dispute settlement procedures and avenues for consultation, if issues arise.

There were no industrial disputes involving the Commission in 2015-16.

Governance

Governance structures The Executive Management Group meetings have taken place monthly to set corporate direction and priorities, monitor financial and operation performance and strategic HR matters, and oversee major projects.

The Monthly Assessment Review Group (MARG) comprises the Commissioner, Director of Assessments and Resolution, Manager of Assessments, the three Assessment Team Leaders and the Executive Officer. Its purpose is to review the performance of the Assessment Division and a provides a focus on operational strategy and practice that identifies and delivers better business processes across all complaints assessment functions.

The Investigative Review Group (IRG – made up of the Commissioner, Director of Investigations and Investigation Managers) closely monitors the progress of investigations. All investigations identified as carrying significant risk to public health and safety were reviewed. In addition, the progress of all investigations that involved unexpected and catastrophic health outcomes for complainants and all investigations into non registered practitioners were reviewed and resources were allocated to ensure effective outcomes.

The ICT Steering Committee has met every two months as planned to manage the Commission’s ICT requirements and to decide on strategic ICT issues

such as migrating the Commission’s Data Centre to GovDC and the engagement of auditors to review the Commission’s core business process case management system (Casemate).

The Risk and Audit Committee has met quarterly to review the Commissions risk management framework, financial performance and internal controls and provide assurance to the commissioner on compliance with the relevant Treasury and statutory policies and directives.

The Work Health & Safety Committee has met every quarter to ensure identification and management of all WH&S issues across the Commission.

Staff Workplace Consultative Committee is made up of the divisional directors, nominated staff and the Public Service Association of NSW. The Committee meets quarterly to discuss issues relating to the conditions of employment and entitlements of staff, including recruitment, training, work health and safety (WHS) matters, and any new policies.

Each division has conducted monthly employee meetings to identify and address team performance, behaviour and cultural issues (in some cases weekly).

Cross divisional oversight groups have been formed for major projects and priorities, such as a Reform Group for Corporate Services migration and Case Review Group formed to review all child sexual abuse complaints files.

Risk management and insurance activities The Commission reviewed its business risks as part of the corporate planning process. The Commission’s Risk Register and Risk Policy were subsequently amended to reflect revised assessment, evaluation and treatment of risks.

The Commission has also reviewed its Business Continuity Plans, including its Information Technology and Management Disaster Recovery Plan and Crisis Management Plan. Work has also commenced on a review of the Commission’s Risk Management Framework.

The NSW Treasury Managed Fund provides the Commission with insurance cover for workers compensation, motor vehicles, public liability, property and other items. Workers compensation insurance is provided by QBE Ltd, with GIO General Ltd providing insurance for the remaining categories.

Workers compensation premiums decreased by $412 (1%) from the previous year and the remaining insurance categories also decreased by $405 (2.7%).



Internal Audit and Risk Management Attestation Statement for the 2015-16 Financial Year for the Health Care Complaints CommissionI, Sue Dawson, Commissioner of the Health Care Complaints Commission (the Commission), am of the opinion that the Commission has internal audit and risk management processes in place that are compliant with the eight (8) core requirements set out in the Internal Audit and Risk Management Policy for the NSW Public Sector, specifically:

Core Requirements Compliance Status

Risk Management Framework

1.1 The agency head is responsible and accountable for risk management in the agency

compliant

1.2 A risk management framework that is appropriate to the agency has been established and maintained and the framework is consistent with AS/NZS ISO 31000:2009

compliant

Internal Audit Function

2.1 An Internal Audit function has been established and maintained compliant

2.2 The operation of the internal audit function is consistent with the International Standards for the Professional Practice of Internal Auditing

compliant

2.3 The agency has an Internal Audit Charter that is consistent with the model of the “model charter’

compliant

Audit and Risk Committee

3.1 An independent Audit and Risk Committee with appropriate expertise has been established The chair and members of the Audit and Risk Committee are:

• Independent Chair – Mr Ray Petty appointed from 1 September 2012 to 31 August 2015, reappointed to 31 August 2016.

• Independent Member – Ms Claudia Bels appointed from 1 February 2013 to 31 January 2016, reappointed to 31 August 2016.

• Independent Member- Mr Norman Smith appointed from 18 May 2016 to 17 May 2018.

• Non Independent Member- Mr Tony Kofkin, Director of Investigations

compliant

3.2 The Audit and Risk Committee is an advisory committee providing assistance to the agency head on the agency’s governance processes, risk management and control frameworks, and its external accountability obligations

compliant

3.3 The Audit and Risk Committee has a Charter that is consistent with the con-tent of the ‘model charter’

compliant

Agency Contact Officer: Michael Doran A/ Director, Organisational Development [email protected]

Sue Dawson Commissioner Health Care Complaints Commission

22 September 2016



Audit Committee and internal auditThe Audit and Risk Committee oversees business risks and governance issues such as financial practices and internal management controls, including internal audits.

The Commission offered a two year appointment, as an independent member of the Committee, to Mr Norman Smith on the Audit and Risk Committee, raising the number of independent members to three in accordance with TPP15-03.

The internal auditors conducted a review of key financial controls. The objective of this review was to identify and test the design and operating effectiveness of key controls in place relating to core financial processes, and to identify improvement opportunities. Key recommendations included the definition of debt management processes which resulted in an update of the legal cost recoveries policy and transfer of outstanding debtors follow up activity to the Finance Unit.

A major audit of the Commission's case management system, Casemate also commenced in June 2016. A key objective of the audit was to identify opportunities for improving Casemate to effectively and efficiently meet current and near future business requirements, and also identify possible alternative systems to support the requirements identified.

The Commission received the formal Independent Auditors report from the NSW Auditor General on 23 September 2016.

Public interest disclosuresThe Public Interest Disclosures Act requires the Commission to report public interest disclosures made to it. The Commission reports that in 2015-16:

• No public officials made public interest disclosures in performing their day to day functions.

• No public interest disclosures were made that are not covered by the above that were made under a statutory or other legal obligation.

• No other public interest disclosures were made.

The Commission has a public interest disclosure policy that encourages and guides staff to report potential wrongdoing.

Government informationThe Commission has a range of information on its website that people can openly access. During the year, the Commision reviewed and updated its publicly available information.

In relation to its complaint-handling functions, the Commission is exempt from the Government Information (Public Access) Act (GIPA).

During the year, the Commission received 15 applications for the release of documents under the Government Information (Public Access) Act. All of these were applications for documents that related to the Commission’s complaint-handling functions and were therefore invalid applications. The tables in Appendix F summarise the applications received in 2015-16 as required under the Government Information (Public Access) Act.



Information and communications technology The Information and Communications Technology (ICT) Strategic Plan 2014–17 outlined relevant emerging technologies that offered the potential to improve the Commission’s operational efficiency.

Actions taken under this plan in 2015-16 are detailed below.

ICT infrastructure upgrade projectThe Commission continued its planned roadmap to adopt emerging technologies and improve operational systems efficiency. During this period the rollout of a new virtualised desktop infrastructure was completed as well as improvements to backup procedures. The Commission also conducted a feasibility analysis of migrating its ICT data centre to the GovDC site at Silverwater.

Implementation of a Digital Information Security Policy The Commission completed the implementation of the Digital Information Security Policy (DISP) to meet the NSW Government’s digital information security requirements for the public sector. Throughout the year ongoing monitoring was performed to ensure the new security classifications were being used correctly and staff awareness programs were provided to new staff.

Enhancements to the case management systemA number of enhancements to the Commission’s case management system (Casemate) were made during the financial year, including:

• improved system functionality reflecting divisional requirements

• improved reporting functionality

• improved system stability and performance

• introduction of electronic signature capability

• document collation capabilities

Records managementIn 2015-16, the Commission undertook a number of records-related projects, including:

• the ongoing identification and preparation of records for future transfer to the State Archives

• digitising approximately 4,000 paper-based case files, which significantly reduced offsite storage costs of paper files

• continued streamlining of the mail process and records filing procedures and practices in a further move towards an electronic records environment.

Internet and intranet website enhancements A number of enhancements were implemented during this period as part of the ongoing improvement of the Commission’s website. This included ensuring ongoing compliance with the WCAG 2.0 AA accessibility Standard, as required by the Premier’s Circular C2012-08.

The Commission commenced a comprehensive review and update of its intranet site, in consultation with a reference group consisting of nominated staff throughout the Commission. This project will continue during 2016-17.

ISO27001 Standard for Information SecurityThe Commission has actively operated and maintained its Information Security Management System (ISMS) since achieving accreditation to the ISO27001:2005 Standard for Information Security. It continues to take steps to maintain its accreditation, by regularly reviewing and updating relevant policies and procedures, ensuring a program of continual improvement for information security, and conducting regular internal and independent external audits.

The last independent annual external audit was successfully completed in August 2015. During this audit, the Commission met the requirements of the new ISO 27001:2013 Standard and subsequently gained accreditation. The next surveillance audit is due in September 2016.



Digital Information Security Annual Attestation Statement for the 2015/2016 Financial Year for the Health Care Complaints Commission

I, Sue Dawson, Commissioner am of the opinion that the Health Care Complaints Commission had an Information Security Management System in place during the financial year being reported on consistent with the Core Requirements set out in the Digital Information Security Policy for the NSW Public Sector.

I am of the opinion that the security controls in place to mitigate identified risks to the digital information and digital information systems of the Health Care Complaints Commission are adequate for the foreseeable future.

I am of the opinion that all Public Sector Agencies, or part thereof, under the control of the Health Care Complaints Commission with a risk profile sufficient to warrant an independent Information Security Management System have developed an Information Security Management System in accordance with the Core Requirements of the Digital Information Security Policy for the NSW Public Sector.

I am of the opinion that, where necessary in accordance with the Digital Information Security Policy for the NSW Public Sector, certified compliance with AS/NZS ISO/IEC 27001 Information technology – Security techniques – Information security management systems – Requirements had been maintained by all or part of the Health Care Complaints Commission and all or part of any Public Sector Agencies under its control.

Sue Dawson Commissioner Health Care Complaints Commission


Finance

TABLE OF CONTENTS

Preamble 70 Payment performance indicators 70

Health Care Complaints CommissionIndependent auditor’s report 71Statement by the Commissioner 73 Statement of comprehensive income for the year ended 30 June 2016 74Statement of financial position as at 30 June 2016 75Statement of changes in equity for the year ended 30 June 2016 76Statement of cash flow for the year ended 30 June 2016 77Notes to and forming part of the financial statement for the year ended 30 June 2016 78

Health Care Complaints Commission Staff AgencyIndependent auditor’s report 97Statement by the Commissioner 99 Statement of comprehensive income for the year ended 30 June 2016 100Statement of financial position as at 30 June 2016 101Statement of cash flow for the year ended 30 June 2016 102Statement of changes in equity for the year ended 30 June 2016 103Notes to and forming part of the financial statement for the year ended 30 June 2016 104


FINANCE

PreambleThe Commission’s Net Result was a deficit of $118,000 which was $111,000 lower than budgeted. The result was primarily due to higher than budget legal cost recoveries.

PAYMENT PERFORMANCE INDICATORS

Aged analysis at end of each quarter 2015-16

Current (i.e.) within due

date

Less than 30 days overdue

Between 30 and 60 days

overdue

Between 60 and 90 days

overdue

More than 90 days overdue

Quarter $’000 $’000 $’000 $’000 $’000

All suppliers

September 1,155 12 – – –

December 1,213 103 18 2 3

March 1,266 140 30 32 5

June 1,185 163 94 2 –

Small business suppliers

September 18 – – – –

December 20 – – – –

March 7 – – – –

June 6 – – – –

Accounts due or paid within each quarter

September December March June

All suppliers

Number of accounts due for payment 511 484 579 596

Number of accounts paid on time 487 362 423 456

Actual percentage of accounts due for payment 95.30% 74.79% 73.06% 76.51%

Dollar amount of accounts due for payment 1,166,731 1,339,075 1,472,788 1,443,598

Dollar amount of accounts paid on time 1,154,611 1,212,784 1,265,202 1,184,779

Actual percentage of accounts paid on time (based on $) 98.96% 90.57% 85.91% 82.00%

Number of payments for interest on overdue accounts – – – –

Interest paid on overdue accounts – – – –

Small business suppliers

Number of accounts due for payment 10 11 6 17

Number of accounts paid on time 10 11 6 17

Actual percentage of accounts due for payment 100% 100% 100% 100%

Dollar amount of accounts due for payment 18,266 20,243 7,010 5,837

Dollar amount of accounts paid on time 18,266 20,243 7,010 5,837

Actual percentage of accounts paid on time (based on $) 100% 100% 100% 100%

Number of payments for interest on overdue accounts – – – –

Interest paid on overdue accounts – – – –

The Commission did not make any interest payments for late payment of accounts. Where there were delays in the payment of accounts, the reasons can be attributed to inaccuracies/incompleteness of the original invoices and/or minor disputes requiring the adjustment of invoice details prior to eventual payment.

All small business number of accounts were paid on time during the current reporting period.


FINANCE


FINANCE

Start of financial statements


FINANCE


FINANCE

Start of financial statements


FINANCE


APPENDICES

Appendices

Appendix A – Complaint Statistics 111Appendix B – Performance in 2015-16 against key indicators 140Appendix C – List of expert advisors 145Appendix D – List of tables 147Appendix E – List of charts 148Appendix F – Access applications 149Appendix G – Index of legislative compliance 152


APPENDICES

Table A.1 – Complaints received by issue category 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Issue category No. % No. % No. % No. % No. %

Treatment 3,350 46.2% 3,340 40.0% 3,241 40.2% 3,519 39.4% 5,008 42.3%

Communication/information 1,096 15.1% 1,731 20.7% 1,328 16.5% 1,471 16.5% 2,035 17.2%

Professional conduct 795 11.0% 1,000 12.0% 1,150 14.3% 1,272 14.2% 1,763 14.9%

Medication 482 6.6% 647 7.8% 520 6.5% 577 6.5% 700 5.9%

Access 194 2.7% 269 3.2% 317 3.9% 282 3.2% 453 3.8%

Fees/costs 300 4.1% 301 3.6% 282 3.5% 317 3.5% 402 3.4%

Environment/management of facilities 304 4.2% 250 3.0% 374 4.6% 413 4.6% 348 2.9%

Medical records 130 1.8% 178 2.1% 163 2.0% 242 2.7% 260 2.2%

Reports/certificates 132 1.8% 207 2.5% 203 2.5% 255 2.9% 258 2.2%

Consent 133 1.8% 181 2.2% 134 1.7% 246 2.8% 237 2.0%

Grievance processes 221 3.0% 121 1.4% 202 2.5% 207 2.3% 191 1.6%

Discharge/transfer arrangements 116 1.6% 120 1.4% 147 1.8% 139 1.6% 187 1.6%

Total 7,253 100.0% 8,345 100.0% 8,061 100.0% 8,940 100.0% 11,842 100.0%

Counted by issue raised in complaint

Appendix A – Complaint statistics


APPENDICES

Table A.2 – Breakdown of complaints received 2015-16

Issue category and name No. %

Treatment

Inadequate treatment 1,742 14.7%

Unexpected treatment outcome/complications 732 6.2%

Diagnosis 587 5.0%

Inadequate care 579 4.9%

Delay in treatment 331 2.8%

Inadequate/inappropriate consultation 264 2.2%

Rough and painful treatment 167 1.4%

Coordination of treatment/results follow-up 146 1.2%

Wrong/inappropriate treatment 124 1.0%

No/inappropriate referral 100 0.8%

Excessive treatment 74 0.6%

Infection control 58 0.5%

Inadequate prosthetic equipment 34 0.3%

Attendance 34 0.3%

Withdrawal of treatment 18 0.2%

Experimental treatment 13 0.1%

Public/private election 5 0.0%

Treatment Total 5,008 42.3%


Attitude/manner 1,172 9.9%

Inadequate information provided 634 5.4%

Incorrect/misleading information provided 202 1.7%

Special needs not accommodated 27 0.2%

Communication/information Total 2,035 17.2%


Breach of guideline/law 337 2.8%

Competence 313 2.6%

Impairment 250 2.1%

Illegal practice 223 1.9%

Inappropriate disclosure of information 126 1.1%

Misrepresentation of qualifications 101 0.9%

Sexual misconduct 95 0.8%

Boundary violation 83 0.7%

Breach of condition 56 0.5%

Assault 55 0.5%

Annual declaration not lodged/incomplete/wrong or misleading 50 0.4%

Financial fraud 42 0.4%

Discriminatory conduct 27 0.2%

Emergency treatment not provided 2 0.0%

Scientific fraud 2 0.0%

Advertising 1 0.0%

Professional conduct Total 1,763 14.9%

Medication

Prescribing medication 416 3.5%

Dispensing medication 138 1.2%

Administering medication 113 1.0%

Supply/security/storage of medication 33 0.3%

Medication Total 700 5.9%


APPENDICES

Issue category and name No. %

Access

Refusal to admit or treat 234 2.0%

Service availability 109 0.9%

Waiting lists 99 0.8%

Access to facility 9 0.1%

Remoteness of service 2 0.0%

Access Total 453 3.8%

Fees/costs

Billing practices 304 2.6%

Cost of treatment 70 0.6%

Financial consent 28 0.2%

Fees/costs Total 402 3.4%


Physical environment of facility 127 1.1%

Administrative processes 90 0.8%

Cleanliness/hygiene of facility 82 0.7%

Staffing and rostering 39 0.3%

Statutory obligations/accreditation standards not met 10 0.1%

Environment/management of facilities Total 348 2.9%

Medical records

Record keeping 158 1.3%

Access to/transfer of records 92 0.8%

Records management 10 0.1%

Medical records Total 260 2.2%

Reports/certificates

Accuracy of report/certificate 176 1.5%

Refusal to provide report/certificate 42 0.4%

Timeliness of report/certificate 30 0.3%

Report written with inadequate or no consultation 8 0.1%

Cost of report/certificate 2 0.0%

Reports/certificates Total 258 2.2%

Consent

Consent not obtained or inadequate 107 0.9%

Involuntary admission or treatment 86 0.7%

Uninformed consent 44 0.4%

Consent Total 237 2.0%

Grievance processes

Inadequate/no response to complaint 181 1.5%

Information about complaints procedures not provided 6 0.1%

Reprisal/retaliation as result of complaint lodged 4 0.0%

Grievance processes Total 191 1.6%


Inadequate discharge 175 1.5%

Patient not reviewed 6 0.1%

Delay 3 0.0%

Mode of transport 3 0.0%

Discharge/transfer arrangements Total 187 1.6%

Grand Total 11,842 100.0%


Table A.2 – Breakdown of complaints received 2015-16 (continued)


APPENDICES

Table A.3 – Complaints received about health practitioners 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Health practitioner No. % No. % No. % No. % No. %


Medical practitioner 1,496 57.3% 1,622 55% 1,673 54.0% 1,939 56.3% 2,134 54.5%

Dental practitioner 482 18.5% 435 14.8% 363 11.7% 349 10.1% 542 13.8%

Nurse/midwife 226 8.7% 377 12.8% 480 15.5% 506 14.7% 501 12.8%

Pharmacist 103 3.9% 148 5.0% 167 5.4% 211 6.1% 197 5.0%

Psychologist 97 3.7% 137 4.6% 149 4.8% 149 4.3% 177 4.5%

Chiropractor 27 1.0% 20 0.7% 26 0.8% 36 1.0% 59 1.5%

Physiotherapist 19 0.7% 22 0.7% 26 0.8% 34 1.0% 33 0.8%

Chinese Medicine Practitioner 6 0.1% 15 0.5% 5 0.2% 13 0.4% 30 0.8%

Optometrist 27 1.0% 12 0.4% 24 0.8% 28 0.8% 24 0.6%

Occupational therapist 4 0.2% 7 0.2% 10 0.3% 12 0.3% 22 0.6%

Student Nurse 2 0.0% 1 0.0% 12 0.4% 16 0.5% 17 0.4%

Podiatrist 16 0.6% 12 0.4% 12 0.4% 17 0.5% 15 0.4%

Medical Radiation Practitioner 2 0.0% 4 0.1% 14 0.5% 10 0.3% 12 0.3%

Osteopath 8 0.3% 6 0.2% 4 0.1% 10 0.3% 12 0.3%

Student medical practitioner – 2 0.1% 4 0.1% 3 0.1% 5 0.1%

Student Osteopath – – 1 0.0% – –

Student Pharmacist 1 0.0% 1 0.0% – 2 0.1% –

Student Physiotherapist – – 1 0.0% – –

Total registered health practi-tioners

2,516 96.4% 2,821 95.7% 2,971 96.0% 3,335 96.8% 3,780 96.6%


Counsellor/therapist 10 0.4% 9 0.3% 14 0.5% 10 0.3% 17 0.4%

Assistant in nursing 9 0.3% 21 0.7% 23 0.7% 10 0.3% 13 0.3%

Alternative health provider 12 0.5% 19 0.6% 11 0.4% 9 0.3% 12 0.3%

Massage therapist 3 0.1% 6 0.2% 10 0.3% 8 0.2% 12 0.3%

Administration/clerical staff 12 0.5% 24 0.8% 10 0.3% 15 0.4% 9 0.2%

Social worker 11 0.4% 9 0.3% 11 0.4% 2 0.1% 9 0.2%

Cosmetic therapist 4 0.2% 3 0.1% 4 0.1% 1 0.0% 8 0.2%

Dietitian/nutritionist 1 0.0% 1 0.0% 3 0.1% 2 0.1% 7 0.2%

Ambulance personnel – 1 0.0% 1 0.0% – 3 0.1%

Naturopath 1 0.0% 6 0.2% 4 0.1% 2 0.1% 3 0.1%

Dental technician 1 0.0% 4 0.1% 4 0.1% 1 0.0% 2 0.1%

Personal care assistant – – – – 2 0.1%

Homeopath – 1 0.0% – 1 0.0% 1 0.0%

Hypnotherapist – 2 0.1% – 2 0.1% 1 0.0%

Psychotherapist 2 0.1% 3 0.1% 3 0.1% 1 0.0% 1 0.0%

Residential care worker 6 0.2% 2 0.1% 2 0.1% – 1 0.0%

Venopuncturist – – – – 1 0.0%

Audiologist 1 0.0% – – 1 0.0% –

Doula 1 0.0% – 1 0.0% 1 0.0% –

Kinesiologist – – 2 0.1% – –

Natural therapist – – 2 0.1% – –

Optical dispenser – 1 0.0% – – –

Speech pathologist 2 0.1% 2 0.1% 2 0.1% 1 0.0% –

Student Psychologist – – – 1 0.0% –

Total non-registered health prac-titioners

76 2.9% 114 3.9% 107 3.5% 68 2.0% 102 2.6%

Other/unknown health practitioner 17 0.7% 12 0.4% 18 0.6% 42 1.2% 33 0.8%

Grand total 2,609 100.0% 2,947 100.0% 3,096 100.0% 3,445 100.0% 3,915 100.0%


* Occupational therapist registered from 1 July 2012** Medical radiation practitioner registered from 1 July 2012*** Chinese medical practitioner registered from 1 July 2012*** All student practitioners are registered and are now reported under registered health practitioner except with psychology students who are not registered


APPENDICES

Table A.4 – Complaints received about medical practitioners by service area 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Service area No. % No. % No. % No. % No. %

General medicine 625 41.8% 708 43.6% 622 37.2% 702 36.2% 828 38.8%

Surgery 218 14.6% 214 13.2% 194 11.6% 276 14.2% 257 12.0%

Mental health 43 2.9% 74 4.6% 68 4.1% 71 3.7% 116 5.4%

Emergency medicine 56 3.7% 39 2.4% 71 4.2% 57 2.9% 94 4.4%

Psychiatry 85 5.7% 66 4.1% 104 6.2% 101 5.2% 73 3.4%

Medico-Legal 74 4.9% 81 5.0% 71 4.2% 70 3.6% 66 3.1%

Obstetrics 36 2.4% 35 2.2% 33 2.0% 52 2.7% 66 3.1%

Ophthalmology 28 1.9% 26 1.6% 32 1.9% 47 2.4% 62 2.9%

Other service areas 29 1.9% 42 2.6% 59 3.5% 77 4.0% 59 2.8%

Early childhood/Paediatric Medicine

23 1.5% 33 2.0% 36 2.2% 52 2.7% 55 2.6%

Oncology 12 0.8% 22 1.4% 19 1.1% 13 0.7% 51 2.4%

Gynaecology 29 1.9% 35 2.2% 29 1.7% 42 2.2% 48 2.2%

Cosmetic Services 44 2.9% 20 1.2% 24 1.4% 23 1.2% 45 2.1%

Anaesthesia 23 1.5% 32 2.0% 31 1.9% 35 1.8% 41 1.9%

Dermatology 28 1.9% 23 1.4% 41 2.5% 39 2.0% 38 1.8%

Neurology 17 1.1% 18 1.1% 27 1.6% 29 1.5% 33 1.5%

Radiology 15 1.0% 11 0.7% 23 1.4% 25 1.3% 28 1.3%

Administration/Non-health related

13 0.9% 23 1.4% 44 2.6% 40 2.1% 22 1.0%

Aged Care 15 1.0% 29 1.8% 18 1.1% 24 1.2% 20 0.9%

Gastroenterology 25 1.7% 22 1.4% 21 1.3% 28 1.4% 19 0.9%

Cardiology 18 1.2% 18 1.1% 27 1.6% 41 2.1% 16 0.7%

Drug and alcohol 8 0.5% 21 1.3% 19 1.1% 17 0.9% 15 0.7%

Geriatrics/Gerontology 7 0.5% 4 0.2% 16 1.0% 25 1.3% 15 0.7%

Rehabilitation medicine 3 0.2% 8 0.5% 7 0.4% 10 0.5% 14 0.7%

Pain Management 4 0.3% 3 0.2% 8 0.5% 12 0.6% 11 0.5%

Endocrinology 5 0.3% 5 0.3% 8 0.5% 11 0.6% 10 0.5%

Intensive care 0.0% 0.0% 2 0.1% 2 0.1% 9 0.4%

Rheumatology 6 0.4% 3 0.2% 4 0.2% 2 0.1% 9 0.4%

Palliative care 1 0.1% 3 0.2% 5 0.3% 10 0.5% 7 0.3%

Respiratory/Thoraric medicine 6 0.4% 4 0.2% 10 0.6% 6 0.3% 7 0.3%

Total 1,496 100.0% 1,622 100.0% 1,673 100.0% 1,939 100.0% 2,134 100.0%



APPENDICES

Table A.5 – Complaints received about health practitioners by issue category 2015-16

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Health practitioner No. No. No. No. No. No. No. No. No. No. No. No. No. %


Medical practitioner 2,137 542 772 260 109 180 80 75 84 39 37 35 4,350 60.6% 33,236

Dental practitioner 445 235 105 11 103 1 32 21 8 22 15 998 13.9% 6,580

Nurse/midwife 226 348 149 50 2 1 17 14 3 8 8 5 831 11.6% 104,721

Psychologist 69 121 62 11 25 9 6 3 1 3 – 310 4.3% 11,236

Pharmacist – 127 26 124 6 1 3 1 1 8 – – 297 4.1% 9,171

Chiropractor 16 51 12 1 7 1 7 1 – 1 1 – 98 1.4% 1,736

Physiotherapist 19 15 11 5 5 3 1 – 1 2 – 62 0.9% 8,408

Chinese Medicine Practitioner

10 26 5 2 5 – 2 2 – 5 2 – 59 0.8% 1,953

Optometrist 17 11 8 – 6 – 1 – – – – – 43 0.6% 1,743

Occupational therapist

2 14 10 – 3 2 1 4 1 2 – – 39 0.5% 5,167

Podiatrist 11 4 4 – 2 – 6 – – – – – 27 0.4% 1,268

Osteopath 5 11 – 3 2 – – – 3 – – 24 0.3% 572

Student Nurse – 20 1 – – – – – – – – – 21 0.3%

Medical Radiation Practitioner

7 7 – – – – 3 – – – – – 17 0.2% 5,089

Student Medical practitioner

– 5 – – – – – – – – – – 5 0.1%

Total registered health practitioners

2,964 1,537 1,165 448 262 218 164 125 100 90 68 40 7,181 100.0%

Non registered health practitioner

Unknown health practitioner

7 17 7 – – 1 1 – – – – – 33 14.8%

Counsellor/therapist 2 11 6 – 1 1 1 4 – – – 2 28 12.6%

Massage therapist 2 14 2 – 2 – – – – 1 – – 21 9.4%

Dietitian/nutritionist 3 11 5 – 1 – – – – – – – 20 9.0%

Alternative health provider

3 12 3 – 1 1 – – – – – – 20 9.0%

Other health prac-titioner

3 15 1 – – – – – – – – – 19 8.5%

Assistant in nursing 2 10 2 4 – – – – – – – – 18 8.1%

Cosmetic therapist 6 8 – – – – – 1 – – – – 15 6.7%

Social worker 2 1 6 – – 2 – 1 – 1 – 1 14 6.3%

Administration/cleri-cal staff

– 4 4 – 1 – – 1 – – 1 – 11 4.9%

Ambulance per-sonnel

1 2 3 – – – – 1 – – – – 7 3.1%

Naturopath 1 2 1 – – – – – – – – – 4 1.8%

Dental technician 2 1 – – – – – – – – – – 3 1.3%

Hypnotherapist 1 – – – 1 – – – – – 1 – 3 1.3%

Personal care assistant

– 2 – – – – – – – – – – 2 0.9%

Residential care worker

– 1 – 1 – – – – – – – – 2 0.9%

Venopuncturist 1 – – – – – – – – – – – 1 0.4%

Psychotherapist – 1 – – – – – – – – – – 1 0.4%

Homeopath 1 1 0.4%

Total Non registered health practitioners

36 113 40 5 7 5 2 8 – 2 2 3 223 100.0%

Grand Total 3,000 1,650 1,205 453 269 223 166 133 100 92 70 43 7,404 100.0%



APPENDICES

Table A.5 – Complaints received about health practitioners by issue category 2015-16

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Health practitioner No. No. No. No. No. No. No. No. No. No. No. No. No. %


Medical practitioner 2,137 542 772 260 109 180 80 75 84 39 37 35 4,350 60.6% 33,236

Dental practitioner 445 235 105 11 103 1 32 21 8 22 15 998 13.9% 6,580

Nurse/midwife 226 348 149 50 2 1 17 14 3 8 8 5 831 11.6% 104,721

Psychologist 69 121 62 11 25 9 6 3 1 3 – 310 4.3% 11,236

Pharmacist – 127 26 124 6 1 3 1 1 8 – – 297 4.1% 9,171

Chiropractor 16 51 12 1 7 1 7 1 – 1 1 – 98 1.4% 1,736

Physiotherapist 19 15 11 5 5 3 1 – 1 2 – 62 0.9% 8,408

Chinese Medicine Practitioner

10 26 5 2 5 – 2 2 – 5 2 – 59 0.8% 1,953

Optometrist 17 11 8 – 6 – 1 – – – – – 43 0.6% 1,743

Occupational therapist

2 14 10 – 3 2 1 4 1 2 – – 39 0.5% 5,167

Podiatrist 11 4 4 – 2 – 6 – – – – – 27 0.4% 1,268

Osteopath 5 11 – 3 2 – – – 3 – – 24 0.3% 572

Student Nurse – 20 1 – – – – – – – – – 21 0.3%

Medical Radiation Practitioner

7 7 – – – – 3 – – – – – 17 0.2% 5,089

Student Medical practitioner

– 5 – – – – – – – – – – 5 0.1%

Total registered health practitioners

2,964 1,537 1,165 448 262 218 164 125 100 90 68 40 7,181 100.0%

Non registered health practitioner

Unknown health practitioner

7 17 7 – – 1 1 – – – – – 33 14.8%

Counsellor/therapist 2 11 6 – 1 1 1 4 – – – 2 28 12.6%

Massage therapist 2 14 2 – 2 – – – – 1 – – 21 9.4%

Dietitian/nutritionist 3 11 5 – 1 – – – – – – – 20 9.0%

Alternative health provider

3 12 3 – 1 1 – – – – – – 20 9.0%

Other health prac-titioner

3 15 1 – – – – – – – – – 19 8.5%

Assistant in nursing 2 10 2 4 – – – – – – – – 18 8.1%

Cosmetic therapist 6 8 – – – – – 1 – – – – 15 6.7%

Social worker 2 1 6 – – 2 – 1 – 1 – 1 14 6.3%

Administration/cleri-cal staff

– 4 4 – 1 – – 1 – – 1 – 11 4.9%

Ambulance per-sonnel

1 2 3 – – – – 1 – – – – 7 3.1%

Naturopath 1 2 1 – – – – – – – – – 4 1.8%

Dental technician 2 1 – – – – – – – – – – 3 1.3%

Hypnotherapist 1 – – – 1 – – – – – 1 – 3 1.3%

Personal care assistant

– 2 – – – – – – – – – – 2 0.9%

Residential care worker

– 1 – 1 – – – – – – – – 2 0.9%

Venopuncturist 1 – – – – – – – – – – – 1 0.4%

Psychotherapist – 1 – – – – – – – – – – 1 0.4%

Homeopath 1 1 0.4%

Total Non registered health practitioners

36 113 40 5 7 5 2 8 – 2 2 3 223 100.0%

Grand Total 3,000 1,650 1,205 453 269 223 166 133 100 92 70 43 7,404 100.0%


Table A.6 – Complaints received about health organisations 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Health organisation No. % No. % No. % No. % No. %

Public Hospital 698 45.9% 763 47.5% 761 45.6% 868 47.7% 926 42.9%

Correction and detention facility 171 11.2% 187 11.6% 249 14.9% 192 10.5% 301 13.9%

Medical centre 97 6.4% 99 6.2% 96 5.7% 98 5.4% 189 8.8%

Private Hospital 82 5.4% 81 5.0% 82 4.9% 100 5.5% 113 5.2%

Psychiatric hospital/unit 32 2.1% 32 2.0% 31 1.9% 41 2.3% 88 4.1%

Community Health Service 60 3.9% 53 3.3% 54 3.2% 64 3.5% 74 3.4%

Pharmacy 60 3.9% 61 3.8% 28 1.7% 40 2.2% 67 3.1%

Dental facility 51 3.4% 62 3.9% 61 3.7% 33 1.8% 64 3.0%

Aged care facility 49 3.2% 47 2.9% 70 4.2% 75 4.1% 61 2.8%

Ambulance service 21 1.4% 28 1.7% 27 1.6% 43 2.4% 47 2.2%

Cosmetic health facility – – – – 39 1.8%

Pathology centres/labs 17 1.1% 20 1.2% 18 1.1% 28 1.5% 31 1.4%

Radiology facility 28 1.8% 37 2.3% 31 1.9% 33 1.8% 29 1.3%

Specialist medical practice – – – – 23 1.1%

Local Health District/Speciality network 23 1.5% 18 1.1% 20 1.2% 18 1.0% 19 0.9%

Alternative health facility 9 0.6% 15 0.9% 26 1.6% 31 1.7% 13 0.6%

Drug and alcohol service 5 0.3% 6 0.4% 6 0.4% 9 0.5% 12 0.6%

Day procedure centre 6 0.4% 8 0.5% 15 0.9% 9 0.5% 11 0.5%

Aboriginal health centre 9 0.6% 7 0.4% 1 0.1% 9 0.5% 10 0.5%

Other/unknown health organi-sations 21 1.4% 9 0.5% 5 0.3% 14 0.8% 7 0.3%

Rehabilitation facility 2 0.1% 2 0.1% 2 0.1% 2 0.1% 6 0.3%

Optometrist facility 5 0.3% – 4 0.2% 5 0.3% 5 0.2%

Physiotherapy facility 1 0.1% 1 0.1% 6 0.4% 3 0.2% 5 0.2%

Psychology facility 2 0.1% 1 0.1% 6 0.4% – 5 0.2%

Multi purpose service 1 0.1% 4 0.2% 4 0.2% 6 0.3% 4 0.2%

Supported accommodation services (not aged care) 3 0.2% 2 0.1% 6 0.4% 1 0.1% 4 0.2%

Government Department 23 1.5% 5 0.3% 5 0.3% 7 0.4% 3 0.1%

Chiropractic facility – 2 0.1% 1 0.1% 4 0.2% 2 0.1%

Health fund 8 0.5% – – – 1 0.0%

Respite Service – – – 2 0.1% 1 0.0%

Blood Bank 1 0.1% 1 0.1% – – –

Boarding house – 1 0.1% – – –

Medical practice 31 2.0% 53 3.3% 49 2.9% 83 4.6% –

Nursing agency 2 0.1% – – 2 0.1% –

Optical Laboratory – – – 1 0.1% –

Osteopathy facility – – 3 0.2% – –

Podiatry practice 3 0.2% 1 0.1% 2 0.1% – –

Sexual Assault Service – 1 0.1% 1 0.1% – –

Grand Total 1,521 100.0% 1,607 100.0% 1,670 100.0% 1,821 100.0% 2,160 100.0%



APPENDICES

Table A.7 – Complaints received about public and private hospitals by service areas 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Service area No. % No. % No. % No. % No. %

Public hospital



Mental health 66 9.5% 111 14.5% 77 10.1% 89 10.3% 101 10.9%

Surgery 134 19.2% 122 16.0% 92 12.1% 132 15.2% 93 10.0%

Obstetrics 33 4.7% 52 6.8% 52 6.8% 61 7.0% 62 6.7%

Early childhood/Paediatric Medicine 15 2.1% 15 2.0% 25 3.3% 42 4.8% 47 5.1%

Other service area 53 7.6% 59 7.7% 39 5.1% 53 6.1% 39 4.2%


Administration/Non-health related 28 4.0% 21 2.8% 27 3.5% 15 1.7% 27 2.9%

Oncology 11 1.6% 19 2.5% 14 1.8% 10 1.2% 26 2.8%

Cardiology 17 2.4% 13 1.7% 18 2.4% 33 3.8% 20 2.2%

Gynaecology 13 1.9% 15 2.0% 8 1.1% 10 1.2% 16 1.7%

Neurology 9 1.3% 14 1.8% 10 1.3% 9 1.0% 13 1.4%

Palliative care 20 2.9% 9 1.2% 16 2.1% 13 1.5% 13 1.4%



Renal medicine 6 0.9% 4 0.5% 8 1.1% 7 0.8% 9 1.0%

Aged Care 9 1.3% 8 1.0% 3 0.4% 6 0.7% 8 0.9%

Drug and alcohol 3 0.4% 5 0.7% 4 0.5% 5 0.6% 5 0.5%

Endocrinology – – 2 0.3% 4 0.5% 5 0.5%

Intensive care 4 0.6% 8 1.0% 4 0.5% 7 0.8% 5 0.5%

Midwifery 14 2.0% 10 1.3% 13 1.7% 14 1.6% 5 0.5%

Psychiatry 5 0.7% 4 0.5% 29 3.8% 22 2.5% 5 0.5%

Optometry – – – – 4 0.4%

Public hospital total 698 100.0% 763 100.0% 761 100.0% 868 100.0% 926 100.0%

Private hospital

Surgery 30 36.6% 32 39.5% 28 34.1% 25 25.0% 40 35.4%


Mental health 5 6.1% 8 9.9% 1 1.2% 8 8.0% 13 11.5%

Obstetrics 2 2.4% 2 2.5% 5 6.1% 6 6.0% 7 6.2%




Oncology – 1 1.2% 1 1.2% 1 1.0% 3 2.7%

Cardiology – 1 1.2% 3 3.0% 2 1.8%

Geriatrics/Gerontology – 2 2.5% 1 1.2% 3 3.0% 2 1.8%

Gynaecology 1 1.2% 2 2.5% 1 1.2% – 2 1.8%

Cosmetic Services – – – – 1 0.9%

Endocrinology – – – 1 1.0% 1 0.9%

Infectious diseases – – – – 1 0.9%

Intensive care – 1 1.2% 1 1.2% – 1 0.9%

Medico-Legal – – – – 1 0.9%

Palliative care 2 2.4% 1 1.2% 1 1.2% 2 2.0% 1 0.9%

Pharmacy/Pharmacology – – – – 1 0.9%

Physiotherapy – – 1 1.2% 1 1.0% 1 0.9%

Psychiatry – 1 1.2% 3 3.7% 3 3.0% 1 0.9%

Other service area 20 24.4% 13 16.0% 12 14.6% 15 15.0% –

Private hospital total 82 100.0% 81 100.0% 82 100.0% 100 100.0% 113 100.0%

Total 780 100.0% 844 100.0% 843 100.0% 968 100.0% 1039 100.0%



APPENDICES

Table A.8 – Complaints received about public hospitals by Local Health District in 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Num

ber

of e

mer

gen

cy

dep

artm

ent

atte

ndan

ces

Num

ber

of d

isch

arg

es

fro

m h

osp

ital

Num

ber

of o

utp

atie

nt

serv

ices

Local Heath District No. % No. % No. % No. % No. %

Hunter New England

107 15.3% 110 14.4% 105 13.8% 111 12.8% 161 17.4% 396,110 220,496 2,188,908

South Western Sydney

83 11.9% 84 11.0% 76 10.0% 97 11.2% 83 9.0% 267,185 234,555 1,154,274

Western Sydney 58 8.3% 77 10.1% 85 11.2% 84 9.7% 81 8.7% 176,196 179,966 1,148,374

South Eastern Sydney

61 8.7% 64 8.4% 57 7.5% 80 9.2% 77 8.3% 223,245 173,813 1,251,045

Sydney 43 6.2% 48 6.3% 58 7.6% 78 9.0% 67 7.2% 156,064 164,883 1,272,426

Northern Sydney 57 8.2% 55 7.2% 63 8.3% 68 7.8% 57 6.2% 202,739 149,587 1,021,386

Nepean Blue Mountains

44 6.3% 38 5.0% 37 4.9% 39 4.5% 54 5.8% 119,545 83,270 645,649

Central Coast 33 4.7% 41 5.4% 49 6.4% 50 5.8% 53 5.7% 128,234 90,028 627,228

Northern NSW 35 5.0% 36 4.7% 34 4.5% 46 5.3% 52 5.6% 194,618 107,163 485,365

Illawarra Shoalhaven

31 4.4% 41 5.4% 51 6.7% 58 6.7% 49 5.3% 152,228 95,725 727,531

Western NSW 41 5.9% 38 5.0% 33 4.3% 46 5.3% 47 5.1% 189,319 80,015 711,741

Mid North Coast 22 3.2% 34 4.5% 18 2.4% 24 2.8% 39 4.2% 116,362 75,083 435,080

Southern NSW 17 2.4% 34 4.5% 18 2.4% 20 2.3% 25 2.7% 102,438 54,521 358,397

St Vincent’s Health Network

11 1.6% 19 2.5% 23 3.0% 16 1.8% 23 2.5% 48,397 47,490 347,806

Murrumbidgee 31 4.4% 27 3.5% 29 3.8% 17 2.0% 20 2.2% 139,202 70,526 530,527

Sydney Children’s Hospital Network

12 1.7% 11 1.4% 14 1.8% 14 1.6% 20 2.2% 95,632 50,544 462,664

Albury Wodonga Health (network with Victoria)***

6 0.7% 15 1.6% n/a n/a n/a

Far West 6 0.9% 3 0.4% 6 0.8% 12 1.4% 3 0.3% 26,339 8,248 110,045

Other/Unknown public hospital

6 0.9% 3 0.4% 5 0.7% – – n/a n/a n/a

Total 698 100.0% 763 100.0% 761 100.0% 868 100.0% 926 100.0% 2,733,853 1,885,913 13,478,446


* Excludes psychiatric hospitals/units**Albury/Wodonga LHD is unique in that it spans NSW and Victoria. The statistics represent complaints for facilities in NSW only.***Previously complaints about facilities in Albury were processed in the Murrumbidgee LHD. These complaints are now processed by Albury Wodonga Health


APPENDICES

Table A.9 – Issues raised in all complaints received about health organisations by organisation type 2015-16

Issue category

Tre

atm

ent

Co

mm

unic

atio

n/in

form

atio

n

Acc

ess

Env

iro

nmen

t/m

anag

emen

t o

f fac

ilitie

s

Med

icat

ion

Dis

char

ge/

tran

sfer

ar

rang

emen

ts

Fee

s/co

sts

Gri

evan

ce p

roce

sses

Pro

fess

iona

l co

nduc

t

Co

nsen

t

Med

ical

rec

ord

s

Rep

ort

s/ce

rtifi

cate

s

Total

Organisation type No. No. No. No. No. No. No. No. No. No. No. No. No. %

Public Hospital 1,193 447 79 132 72 113 15 60 23 48 36 11 2,229 50.2%

Correction and detention facility 217 30 150 7 85 – – 2 3 2 2 2 500 11.3%

Medical centre 77 71 40 19 10 – 18 14 10 1 35 7 302 6.8%

Private Hospital 99 49 3 22 11 10 22 9 3 2 2 – 232 5.2%

Psychiatric hospital/unit 64 24 10 17 10 13 3 5 5 28 2 4 185 4.2%

Community health service 60 35 12 9 7 3 – 6 8 16 4 1 161 3.6%

Aged care facility 60 28 4 21 7 – 5 2 2 – – – 129 2.9%

Dental Facility 45 25 15 6 – – 16 6 4 1 – – 118 2.7%

Pharmacy 6 15 8 2 34 – 9 1 16 1 5 – 97 2.2%

Ambulance service 40 22 11 1 1 2 5 2 5 1 – – 90 2.0%

Cosmetic health facility 37 13 – 3 3 1 5 5 14 1 – – 82 1.8%

Pathology centres/labs 21 11 1 1 – – 7 2 3 1 – 1 48 1.1%

Radiology facility 17 11 4 2 – – 6 1 3 – 1 3 48 1.1%

Specialist medical practice 11 17 1 2 2 – 11 1 2 – – 1 48 1.1%

Local Health District 12 1 6 2 1 – – 1 1 – 2 – 26 0.6%

Drug and alcohol service 6 4 1 4 1 1 – 1 – 1 – – 19 0.4%

Alternative health facility 6 1 – – 2 – 2 – 5 – 1 1 18 0.4%

Day procedure centre 4 3 – 4 – 1 2 – 1 – – 1 16 0.4%

Aboriginal health centre 7 4 2 – – – – – – – 1 – 14 0.3%

Multi purpose service 7 2 – 1 – – – – 1 – – – 11 0.2%

Other organisations 2 2 2 – – – 1 – 3 1 – – 11 0.2%

Rehabilitation facility 3 2 2 – – – 1 1 – – – 2 11 0.2%

Psychology facility 3 2 1 – – – – 2 – – – – 8 0.2%

Supported accommodation services (not aged care) 4 1 – 1 1 – 1 – – – – – 8 0.2%

Optometrist facility 2 2 – – – – 3 – – – – – 7 0.2%

Physiotherapy facility 2 3 – – – – – – 1 – – 1 7 0.2%

Government Department 2 2 1 – – – – – – – – – 5 0.1%

Chiropractic facility – 1 – – – – 1 – – – 1 – 3 0.1%

Respite Service 1 2 – – – – – – – – – – 3 0.1%

Health fund – – – – – – – – – – 2 – 2 0.0%

Grand Total 2,008 830 353 256 247 144 133 121 113 104 94 35 4,438 100.0%



APPENDICES

Table A.10 – Issues raised in all complaints received by service area 2015-16

Issue category

Tre

atm

ent

Co

mm

unic

atio

n/in

form

atio

n

Pro

fess

iona

l co

nduc

t

Med

icat

ion

Acc

ess

Fees

/co

sts

Env

iro

nmen

t/m

anag

emen

t o

f fac

ilitie

s

Med

ical

rec

ord

s

Rep

ort

s/ce

rtifi

cate

s

Co

nsen

t

Gri

evan

ce p

roce

sses

Dis

char

ge/

tran

sfer

ar

rang

emen

ts

Total

Service Area No. No. No. No. No. No. No. No. No. No. No. No. No. %

General medicine 1,225 525 392 235 183 57 94 84 72 21 48 19 2,955 25.0%

Dentistry 519 133 252 13 39 120 27 32 1 23 21 1 1,181 10.0%

Mental health 367 173 100 67 39 7 32 22 17 92 19 47 982 8.3%

Surgery 534 169 58 19 18 39 26 8 6 24 20 23 944 8.0%

Emergency medicine 444 123 21 17 26 5 18 10 1 4 13 39 721 6.1%

Pharmacy/Pharmacology

5 42 141 156 8 17 9 8 1 2 1 – 390 3.3%

Aged Care 131 61 61 32 6 6 22 4 1 1 4 2 331 2.8%

Obstetrics 196 79 17 2 2 4 4 1 1 6 5 5 322 2.7%

Early childhood/Paediatric Medicine

154 53 33 19 5 4 9 5 7 4 1 5 299 2.5%

Psychology 67 57 111 2 3 11 2 8 21 6 4 – 292 2.5%

Oncology 134 39 15 10 2 – 8 4 – 3 3 6 224 1.9%

Administration/Non-health related

7 40 79 – 5 12 26 19 2 1 2 – 193 1.6%

Psychiatry 64 39 18 18 6 6 3 4 18 4 2 2 184 1.6%

Cosmetic Services 92 11 48 8 8 6 – – 1 5 – 179 1.5%

Gynaecology 99 32 15 2 5 3 1 1 – 2 2 5 167 1.4%

Drug and alcohol 25 19 22 21 44 – 6 2 – 1 3 5 148 1.2%

Ophthalmology 84 24 8 – 1 8 4 1 3 3 3 1 140 1.2%

Geriatrics/Gerontology 69 30 4 6 2 – 3 2 2 4 3 9 134 1.1%

Medico-Legal 26 35 14 – 1 – – – 45 1 – – 122 1.0%

Neurology 68 24 4 8 7 3 – 2 1 – 1 3 121 1.0%

Radiology 46 15 15 – 5 7 4 1 16 1 1 – 111 0.9%

Chiropractice 16 13 51 1 – 8 1 8 1 1 1 – 101 0.9%

Cardiology 58 20 2 – 4 4 1 1 6 2 – 1 99 0.8%

Ambulance Service 41 25 7 1 11 4 1 – – 2 2 2 96 0.8%

Dermatology 50 14 4 4 3 3 3 – – 2 2 – 85 0.7%

Gastroenterology 54 12 3 2 1 2 – 1 – – 5 2 82 0.7%

Rehabilitation medicine 36 19 4 3 8 1 2 – 3 – 3 3 82 0.7%

Anaesthesia 37 14 15 3 1 8 – 1 – 1 – 1 81 0.7%

Alternative health 10 10 40 9 – 5 2 – 1 – 1 – 78 0.7%

Palliative care 38 16 5 4 1 – 5 3 1 2 – 1 76 0.6%

Pain Management 28 10 3 18 6 1 – 1 4 2 – – 73 0.6%

Physiotherapy 22 15 15 – 1 5 1 4 6 1 2 – 72 0.6%

Midwifery 27 15 15 – – – 2 2 – 4 1 – 66 0.6%

Optometry 23 13 11 – – 10 1 1 – – 1 – 60 0.5%

Other service areas 2 – 55 – 2 – – – – – – – 59 0.5%

Pathology 19 11 3 1 1 8 1 4 1 2 – 51 0.4%

Traditional Chinese medicine

11 5 13 – – 4 4 2 2 2 2 – 45 0.4%

Renal medicine 20 11 1 3 1 1 3 – – – 1 2 43 0.4%

Endocrinology 13 12 – 2 2 – 1 1 2 5 1 39 0.3%

Intensive care 22 7 5 2 – – – – – 2 1 – 39 0.3%

Occupational therapy 2 8 13 – 2 3 3 – 2 4 – – 37 0.3%

Podiatry 14 6 6 – – 2 – 6 – 1 – – 35 0.3%

Immunology 6 5 4 4 – 1 2 7 – – 1 – 30 0.3%


APPENDICES

Issue category

Tre

atm

ent

Co

mm

unic

atio

n/in

form

atio

n

Pro

fess

iona

l co

nduc

t

Med

icat

ion

Acc

ess

Fees

/co

sts

Env

iro

nmen

t/m

anag

emen

t o

f fac

ilitie

s

Med

ical

rec

ord

s

Rep

ort

s/ce

rtifi

cate

s

Co

nsen

t

Gri

evan

ce p

roce

sses

Dis

char

ge/

tran

sfer

ar

rang

emen

ts

Total

Service Area No. No. No. No. No. No. No. No. No. No. No. No. No. %

Rheumatology 14 6 – 3 – 1 2 2 – – 28 0.2%

Counselling 5 8 8 – – 1 1 1 2 – – 26 0.2%

Osteopathy 6 – 11 – – 3 3 – 2 – – – 25 0.2%

Respiratory/Thoraric medicine

15 6 1 – – 1 1 – 1 – – – 25 0.2%

Infectious diseases 13 4 – 1 – – 2 – – – – 2 22 0.2%

Haematology 13 3 2 1 1 – – – 1 – – – 21 0.2%

Reproductive medicine 10 5 1 – – 2 3 – – – – – 21 0.2%

Massage therapy 4 1 12 – – 2 1 – – – – – 20 0.2%

Sleep medicine 4 3 – – – 5 – – 1 – – – 13 0.1%

Unknown – 1 8 – – – – – – – – – 9 0.1%

Developmental disability

2 3 – 1 – – 1 – – 1 – – 8 0.1%

Health education/information

– 3 4 – – – 1 – – – – – 8 0.1%

Occupational health 2 – 1 – 1 – – 1 1 1 – – 7 0.1%

Family planning 2 3 1 – – – – – – – – – 6 0.1%

Sport medicine 2 1 2 – – – – – 1 – – – 6 0.1%

Nephrology 1 2 – 2 – – – – – – – – 5 0.0%

Sexual assault service 4 – – – – – – – 1 – – – 5 0.0%

Autopsy 1 – 1 – – – – – 1 – – – 3 0.0%

Hypnotherapy 2 – 1 – – – – – – – – – 3 0.0%

Medical Radiation Practice

– – 3 – – – – – – – – – 3 0.0%

Nutrition and dietetics 1 1 1 – – – – – – – – – 3 0.0%

Acupuncture – – 2 – – – – – – – – – 2 0.0%

Personal care 2 – – – – – – – – – – – 2 0.0%

Natural therapy – 1 – – – – – – – – – – 1 0.0%

Psychotherapy – – 1 – – – – – – – – – 1 0.0%

Grand Total 5,008 2,035 1,763 700 453 402 348 260 258 237 191 187 11,842 100.0%


Table A.10 – Issues raised in all complaints received by service area 2015-16 (continued)


APPENDICES

Table A.11 – Complaints received by service area 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Row Labels No. % No. % No. % No. % No. %

General medicine 950 23.0% 1,178 25.9% 1,015 21.3% 1,142 21.7% 1,533 25.2%

Dentistry 528 12.8% 522 11.5% 430 9.0% 394 7.5% 648 10.7%

Mental health 258 6.2% 344 7.6% 310 6.5% 341 6.5% 492 8.1%

Surgery 413 10.0% 390 8.6% 347 7.3% 487 9.3% 432 7.1%


Pharmacy/Pharmacology 170 4.1% 230 5.1% 199 4.2% 253 4.8% 260 4.3%

Aged Care 135 3.3% 169 3.7% 196 4.1% 215 4.1% 179 2.9%

Psychology 89 2.2% 118 2.6% 134 2.8% 135 2.6% 166 2.7%


Obstetrics 74 1.8% 103 2.3% 103 2.2% 123 2.3% 145 2.4%

Paediatric Medicine/Early childhood 51 1.2% 60 1.3% 79 1.7% 124 2.4% 125 2.1%

Drug and alcohol 45 1.1% 63 1.4% 92 1.9% 93 1.8% 101 1.7%

Oncology 25 0.6% 47 1.0% 40 0.8% 30 0.6% 100 1.6%

Cosmetic Services 61 1.5% 30 0.7% 88 1.8% 43 0.8% 94 1.5%

Other service areas 89 2.2% 67 1.5% 65 1.4% 141 2.7% 90 1.5%

Psychiatry 103 2.5% 82 1.8% 167 3.5% 148 2.8% 85 1.4%

Medico-Legal 87 2.1% 92 2.0% 78 1.6% 78 1.5% 73 1.2%

Radiology 54 1.3% 70 1.5% 75 1.6% 83 1.6% 71 1.2%

Gynaecology 46 1.1% 55 1.2% 42 0.9% 52 1.0% 68 1.1%

Ophthalmology 42 1.0% 36 0.8% 42 0.9% 55 1.0% 68 1.1%

Chiropractice 28 0.7% 22 0.5% 24 0.5% 40 0.8% 61 1.0%


Neurology 27 0.7% 32 0.7% 40 0.8% 42 0.8% 51 0.8%

Ambulance Service 21 0.5% 27 0.6% 23 0.5% 47 0.9% 49 0.8%

Anaesthesia 25 0.6% 35 0.8% 36 0.8% 39 0.7% 49 0.8%

Dermatology 34 0.8% 32 0.7% 48 1.0% 45 0.9% 43 0.7%

Alternative health 15 0.4% 32 0.7% 33 0.7% 49 0.9% 40 0.7%

Physiotherapy 19 0.5% 24 0.5% 39 0.8% 43 0.8% 40 0.7%


Cardiology 37 0.9% 32 0.7% 60 1.3% 89 1.7% 38 0.6%


Optometry 29 0.7% 18 0.4% 30 0.6% 39 0.7% 35 0.6%

Pain Management 6 0.1% 8 0.2% 38 0.8% 31 0.6% 35 0.6%

Pathology 28 0.7% 29 0.6% 26 0.5% 30 0.6% 34 0.6%

Midwifery 26 0.6% 36 0.8% 39 0.8% 56 1.1% 32 0.5%

Palliative care 28 0.7% 21 0.5% 28 0.6% 27 0.5% 32 0.5%

Occupational therapy 2 0.0% 4 0.1% 9 0.2% 13 0.2% 21 0.3%

Traditional Chinese medicine 1 0.0% 5 0.1% – 0.0% 3 0.1% 20 0.3%

Intensive care 4 0.1% 12 0.3% 10 0.2% 15 0.3% 18 0.3%

Podiatry 19 0.5% 13 0.3% 16 0.3% 17 0.3% 18 0.3%

Endocrinology 5 0.1% 5 0.1% 10 0.2% 18 0.3% 17 0.3%

Immunology 8 0.2% 15 0.3% 20 0.4% 17 0.3% 17 0.3%

Counselling 9 0.2% 17 0.4% 24 0.5% 13 0.2% 16 0.3%

Renal medicine 10 0.2% 6 0.1% 13 0.3% 10 0.2% 16 0.3%

Osteopathy 9 0.2% 5 0.1% 8 0.2% 9 0.2% 13 0.2%

Massage therapy 4 0.1% 9 0.2% 13 0.3% 9 0.2% 12 0.2%

Rheumatology 7 0.2% 4 0.1% 5 0.1% 2 0.0% 11 0.2%

Infectious diseases 2 0.0% 3 0.1% 7 0.1% 12 0.2% 10 0.2%

Respiratory/Thoraric medicine 27 0.7% 14 0.3% 17 0.4% 12 0.2% 10 0.2%

Reproductive medicine 9 0.2% 7 0.2% 15 0.3% 17 0.3% 9 0.1%

Grand Total 4,130 100.0% 4,554 100.0% 4,766 100.0% 5,264 100.0% 6,075 100.0%



APPENDICES

Table A.12 – Source of complaints 2011-12 to 2015-16

2011-12 2012-13* 2013-14* 2014-15* 2015-16*

Source No. % No. % No. % No. % No. %

Consumer 1,999 56.2% 2,403 63.4% 2,289 57.1% 2,374 49.9% 3,182 51.4%

Family or friend 737 20.7% 800 21.1% 969 24.2% 1049 22.0% 1,561 25.2%

Unknown/other source (including mem-bers of the public) 14 0.4% 22 0.6% 143 3.6% 451 9.5% 600 9.7%

Health care provider 55 1.5% 194 5.1% 301 7.5% 400 8.4% 357 5.8%

Professional council/association and regulatory authority 646 18.2% 118 3.1% 127 3.2% 189 4.0% 201 3.2%

Government department 23 0.6% 49 1.3% 66 1.6% 139 2.9% 49 0.8%

Department of Health (State and Com-monwealth) 20 0.6% 135 3.6% 56 1.4% 82 1.7% 37 0.6%

Consumer organisation/advocate/carer/employer 21 0.6% 18 0.5% 32 0.8% 48 1.0% 169 2.7%

Member of Parliament/Minister 14 0.4% 6 0.2% 2 0.0% 11 0.2% –

Court 8 0.2% 12 0.3% 6 0.1% 7 0.1% 15 0.2%

Legal representative 16 0.5% 27 0.7% 8 0.2% 7 0.1% 13 0.2%

College 2 0.1% 4 0.1% 9 0.2% 3 0.1% 2 0.0%

Total 3,555 100.0% 3,788 100.0% 4,008 100.0% 4,760 100.0% 6,186 100.0%

Counted by Complainant and this take into consideration multiple subjects

* The Commission reviewed its categorisation of case sources in 2012-13 which resulted in data from 2012-13 onwards not being directly comparable with prior years.

Table A.13 – Location of complainants 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

No. % No. % No. % No. % No. %

Metropolitan 2,601 61.2% 2,725 58.8% 2,807 57.8% 3,089 57.7% 3,243 52.4%

Regional 1,125 26.5% 1,203 25.9% 1,214 25.0% 1,361 25.4% 1,823 29.5%

Interstate 138 3.2% 166 3.6% 190 3.9% 252 4.7% 296 4.8%

International 13 0.3% 19 0.4% 20 0.4% 17 0.3% 13 0.2%

Address Not Coded 371 8.7% 523 11.3% 623 12.8% 639 11.9% 811 13.1%

Grand Total 4,248 100% 4,636 100% 4,854 100% 5,358 100% 6,186 100%

Counted by Complainant

Table A.14 – Location of health service provider 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

No. % No. % No. % No. % No. %

Metropolitan 2,689 65.1% 2,860 62.8% 3,124 65.5% 3,607 68.5% 4,147 68.3%

Non-Metro 898 21.7% 926 20.3% 1,178 24.7% 1,296 24.6% 1,569 25.8%

Interstate 108 2.6% 121 2.7% 134 2.8% 140 2.7% 184 3.0%

International 7 0.2% 7 0.2% 5 0.1% 5 0.1% 4 0.1%

Address Not Coded 428 10.4% 640 14.1% 326 6.8% 218 4.1% 171 2.8%

Grand Total 4,130 100.0% 4,554 100.0% 4,767 100.0% 5,266 100.0% 6,075 100.0%

Counted by Provider identified in complaint


APPENDICES

Table A.15 – Issues raised in all complaints received by complainant location

Metropolitan

NSWRegional NSW

Address Not

CodedInterstate International Total

Issue category No. % No. % No. % No. % No. % No. %

Treatment 2,658 42.0% 1,615 45.0% 555 36.2% 290 46.7% 15 50.0% 5,133 42.4%

Communication/information 1,046 16.5% 601 16.8% 339 22.1% 95 15.3% 5 16.7% 2,086 17.2%

Professional conduct 950 15.0% 514 14.3% 241 15.7% 85 13.7% 5 16.7% 1,795 14.8%

Medication 424 6.7% 187 5.2% 71 4.6% 31 5.0% –

713 5.9%

Access 241 3.8% 163 4.5% 46 3.0% 5 0.8% 2 6.7% 457 3.8%

Fees/costs 248 3.9% 77 2.1% 63 4.1% 18 2.9% –

406 3.4%

Environment/management of facilities 154 2.4% 97 2.7% 81 5.3% 21 3.4% 1 3.3% 354 2.9%

Medical records 152 2.4% 68 1.9% 24 1.6% 18 2.9% 1 3.3% 263 2.2%

Reports/certificates 141 2.2% 65 1.8% 29 1.9% 25 4.0% –

260 2.1%

Consent 141 2.2% 64 1.8% 36 2.3% 7 1.1%–

248 2.0%

Grievance processes 99 1.6% 64 1.8% 15 1.0% 17 2.7% 1 3.3% 196 1.6%

Discharge/transfer arrangements 80 1.3% 71 2.0% 35 2.3% 9 1.4%

–195 1.6%

Grand Total 6,334 100.0% 3,586 100.0% 1,535 100.0% 621 100.0% 30 100.0% 12,106 100.0%


Table A.16 – Outcome of assessment of complaints 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Assessment decision No. % No. % No. % No. % No. %

Discontinued 2,017 49.2% 2,148 47.3% 2,483 52.4% 2,334 46.7% 2,338 40.3%

Referred to professional council 753 18.4% 887 19.5% 842 17.8% 942 18.8% 1,211 20.9%

Resolved during assessment 180 4.4% 240 5.3% 260 5.5% 662 13.2% 692 11.9%

Referred for local resolution 239 5.8% 252 5.5% 384 8.1% 262 5.2% 411 7.1%

Investigation by Commission 194 4.7% 209 4.6% 206 4.3% 250 5.0% 344 5.9%

Referred to the Commission’s Reso-lution Service

615 15.0% 714 15.7% 442 9.3% 409 8.2% 329 5.7%

Discontinued with comments – – – – 288 5.0%

Referred to another body or person 105 2.6% 94 2.1% 125 2.6% 143 2.9% 192 3.3%

Total 4,103 100.0% 4,544 100.0% 4,742 100.0% 5,002 100.0% 5,805 100.0%



APPENDICES

Table A.17 – Outcome of assessment of complaints by issues identified in complaint 2015-16

Outcome

Issue category and name Dis

cont

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d

Ref

erre

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Ref

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d t

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Co

mm

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on’

s R

eso

lutio

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ervi

ce

Ref

erre

d fo

r lo

cal

reso

lutio

n

Inve

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atio

n b

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om

mis

sio

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Dis

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Total %

Treatment No. No. No. No. No. No. No. No.

Inadequate treatment 773 244 148 186 113 68 80 23 1,635 15.1%

Unexpected treatment outcome/com-plications 306 106 57 88 20 46 34 30 687 6.4%

Diagnosis 270 84 57 52 16 10 26 8 523 4.8%

Inadequate care 203 50 74 86 49 18 23 16 519 4.8%

Delay in treatment 104 12 54 36 51 6 12 7 282 2.6%

Inadequate/inappropriate consultation 111 30 33 3 3 2 22 4 208 1.9%

Rough and painful treatment 71 15 16 7 3 2 16 8 138 1.3%

Wrong/inappropriate treatment 55 39 9 14 1 7 4 2 131 1.2%

Coordination of treatment/results follow-up 45 15 20 17 5 4 7 1 114 1.1%

No/inappropriate referral 40 13 9 2 3 – 7 – 74 0.7%

Excessive treatment 31 11 8 – – 10 – – 63 0.6%

Infection control 24 15 4 3 2 4 3 2 57 0.5%

Inadequate prosthetic equipment 15 8 5 – 3 – – – 31 0.3%

Attendance 10 – 16 – 1 1 2 – 30 0.3%

Withdrawal of treatment 13 – 3 1 2 – 1 – 20 0.2%

Experimental treatment 3 1 – – – 4 1 2 11 0.1%

Public/private election 2 1 – 1 1 – 1 – 6 0.1%

Treatment Total 2,076 644 513 496 273 182 242 103 4,529 41.9%


Attitude/manner 503 111 172 62 68 17 81 14 1,028 9.5%

Inadequate information provided 241 54 77 84 39 10 40 10 555 5.1%

Incorrect/misleading information provided 87 23 21 14 7 11 14 10 187 1.7%

Special needs not accommodated 8 1 5 3 6 – – – 23 0.2%

Communication/information Total 839 189 275 163 120 38 135 34 1,793 16.6%


Breach of guideline/law 36 195 2 1 – 38 10 20 302 2.8%

Competence 58 120 9 1 – 64 12 5 269 2.5%

Impairment 17 175 3 – – 42 – 4 241 2.2%

Illegal practice 51 74 8 – – 49 4 36 222 2.1%

Sexual misconduct 32 14 2 – – 49 5 14 116 1.1%

Inappropriate disclosure of information 50 24 10 2 5 6 9 7 113 1.0%

Misrepresentation of qualifications 20 16 5 – – 12 4 29 86 0.8%

Boundary violation 18 20 – – – 32 6 2 78 0.7%

Breach of condition 19 15 2 – – 20 2 1 59 0.5%

Assault 23 16 3 – – 11 3 1 57 0.5%

Annual declaration not lodged/incom-plete/wrong or misleading 2 52 – – – 1 – – 55 0.5%

Financial fraud 11 17 2 – – 7 1 3 41 0.4%

Discriminatory conduct 14 1 2 – 4 8 – – 29 0.3%

Scientific fraud 1 1 – – – – 1 – 3 0.0%

Emergency treatment not provided – 1 – – – – 1 – 2 0.0%

Advertising – 1 – – – – – – 1 0.0%

Professional conduct Total 352 742 48 4 9 339 58 122 1,674 15.5%


APPENDICES

Outcome


cont

inue

d

Ref

erre

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o

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Res

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asse

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ent

Ref

erre

d t

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he

Co

mm

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on’

s R

eso

lutio

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ervi

ce

Ref

erre

d fo

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cal

reso

lutio

n

Inve

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atio

n b

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om

mis

sio

n

Dis

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Total %

Medication No. No. No. No. No. No. No. No. No.

Prescribing medication 159 53 26 27 49 33 25 13 385 3.6%

Dispensing medication 20 83 6 3 14 1 127 1.2%

Administering medication 25 42 5 8 7 9 4 4 104 1.0%

Supply/security/storage of medication 8 9 5 1 6 2 1 32 0.3%

Medication Total 212 187 42 35 60 62 31 19 648 6.0%

Access

Refusal to admit or treat 113 6 45 8 22 15 209 1.9%

Service availability 26 1 17 1 52 1 3 101 0.9%

Waiting lists 19 20 2 55 1 97 0.9%

Access to facility 3 4 3 10 0.1%

Remoteness of service 2 1 3 0.0%

Access Total 163 7 86 11 132 17 4 420 3.9%

Fees/costs

Billing practices 124 38 78 1 6 7 11 13 278 2.6%

Cost of treatment 27 11 20 2 1 1 62 0.6%

Financial consent 6 2 12 1 1 1 23 0.2%

Fees/costs Total 157 51 110 3 8 7 13 14 363 3.4%


Administrative processes 62 6 21 7 6 3 3 2 110 1.0%

Physical environment of facility 39 6 24 7 22 3 5 106 1.0%

Cleanliness/hygiene of facility 25 15 14 7 7 11 2 2 83 0.8%

Staffing and rostering 14 1 4 2 2 1 3 27 0.2%

Statutory obligations/accreditation standards not met 3 1 1 2 7 0.1%

Environment/management of facilities Total 143 28 63 24 38 17 8 12 333 3.1%

Reports/certificates

Accuracy of report/certificate 125 22 18 2 2 2 16 2 189 1.7%

Refusal to provide report/certificate 18 4 7 1 3 33 0.3%

Timeliness of report/certificate 8 2 9 1 20 0.2%

Report written with inadequate or no consultation 4 4 1 9 0.1%

Cost of report/certificate 2 2 0.0%

Reports/certificates Total 155 32 37 3 2 3 19 2 253 2.3%

Medical records

Record keeping 51 53 8 12 2 16 7 1 150 1.4%

Access to/transfer of records 35 4 25 5 5 2 4 2 82 0.8%

Records management 2 2 1 1 2 8 0.1%

Medical records Total 88 57 35 18 7 18 12 5 240 2.2%

Table A.17 – Outcome of assessment of complaints by issues identified in complaint 2015-16 (continued)


APPENDICES

Outcome


cont

inue

d

Ref

erre

d t

o

pro

fess

iona

l co

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Res

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urin

g

asse

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ent

Ref

erre

d t

o t

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Co

mm

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on’

s R

eso

lutio

n S

ervi

ce

Ref

erre

d fo

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cal

reso

lutio

n

Inve

stig

atio

n b

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om

mis

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Dis

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Total %

Consent No. No. No. No. No. No. No. No. No.

Consent not obtained or inadequate 53 17 13 7 6 4 8 4 112 1.0%

Involuntary admission or treatment 62 3 8 4 1 2 80 0.7%

Uninformed consent 20 7 2 3 1 1 7 2 43 0.4%

Consent Total 135 24 18 18 11 6 17 6 235 2.2%

Grievance processes

Inadequate/no response to complaint 72 15 24 21 15 9 5 161 1.5%

Information about complaints proce-dures not provided 3 2 2 7 0.1%

Reprisal/retaliation as result of com-plaint lodged 1 1 0.0%

Grievance processes Total 76 15 26 23 15 9 5 169 1.6%


Inadequate discharge 70 6 21 28 16 1 8 2 152 1.4%

Patient not reviewed 2 1 3 0.0%

Mode of transport 1 1 2 0.0%

Discharge/transfer arrangements Total 72 6 22 29 17 1 8 2 157 1.5%

Grand Total 4,468 1,982 1,275 827 692 673 569 328 10,814 100.0%


Table A.17 – Outcome of assessment of complaints by issues identified in complaint 2015-16 (continued)


APPENDICES

Table A.18 – Outcome of assessment of complaints by most common service area 2015-16

Outcome

Dis

cont

inue

d

Ref

erre

d to

pr

ofes

sion

al

coun

cil

Res

olve

d du

ring

asse

ssm

ent

Ref

erre

d fo

r lo

cal

reso

lutio

n

Inve

stig

atio

n by

C

omm

issi

on

Ref

erre

d to

the

Com

mis

sion

’s

Res

olut

ion

Ser

vice

Dis

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inue

d w

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Ref

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on

Service area No. No. No. No. No. No. No. No. Total %

General medicine 552 228 229 137 68 49 94 24 1,381 23.8%

Dentistry 167 299 58 25 26 3 15 10 603 10.4%

Mental health 226 46 40 55 23 46 12 7 455 7.8%

Surgery 221 54 48 18 22 50 15 6 434 7.5%

Emergency medicine 115 27 47 28 11 32 16 – 276 4.8%

Pharmacy/Pharmacology 60 130 24 – 23 – 6 6 249 4.3%

Aged Care 69 39 16 2 11 8 9 29 183 3.2%

Administration/Non-health related 59 35 19 8 9 1 3 15 149 2.6%

Obstetrics 51 13 17 11 5 28 7 15 147 2.5%

Psychology 55 52 7 – 17 1 8 4 144 2.5%

Early childhood/Paediatric Medicine 41 26 17 9 4 7 12 2 118 2.0%

Drug and alcohol 34 7 6 50 4 – – 2 103 1.8%

Gynaecology 25 4 9 3 8 7 3 34 93 1.6%

Oncology 36 19 6 2 9 16 3 91 1.6%

Psychiatry 59 11 3 3 4 2 6 1 89 1.5%

Cosmetic Services 33 8 3 – 18 – 7 14 83 1.4%

Radiology 48 7 17 – 1 1 3 1 78 1.3%

Medico-Legal 50 6 5 – – – 8 – 69 1.2%

Ophthalmology 33 9 13 2 6 – 3 – 66 1.1%

Other 12 40 1 – 12 – – – 65 1.1%

Chiropractice 14 27 – – 10 – 9 2 62 1.1%

Geriatrics/Gerontology 25 5 7 4 17 1 – 59 1.0%

Gastroenterology 20 11 5 4 3 9 2 – 54 0.9%

Anaesthesia 21 11 4 – 10 – 4 1 51 0.9%

Physiotherapy 21 11 4 – 3 2 4 – 45 0.8%

Ambulance Service 17 – 11 14 – 3 – – 45 0.8%

Neurology 20 5 6 3 – 5 4 – 43 0.7%

Cardiology 15 3 6 5 1 11 – – 41 0.7%

Dermatology 20 4 7 1 1 – 7 – 40 0.7%

Alternative health 9 4 1 – 14 – 4 7 39 0.7%

Optometry 12 11 6 2 – 1 2 2 36 0.6%

Pain Management 17 1 2 15 – 1 – – 36 0.6%

Midwifery 12 17 2 – – 2 2 – 35 0.6%

Palliative care 14 4 3 1 1 8 – 1 32 0.6%

Rehabilitation medicine 14 2 4 2 3 6 – 31 0.5%

Pathology 13 – 9 1 – – 5 1 29 0.5%

Occupational therapy 13 4 2 – – – 1 – 20 0.3%

Podiatry 11 5 2 – 1 – – – 19 0.3%

Endocrinology 11 – 2 – – 3 3 – 19 0.3%

Intensive care 12 1 – 1 1 2 2 – 19 0.3%

Counselling 9 1 1 – 2 1 1 1 16 0.3%

Traditional Chinese medicine 3 8 1 – 1 – – 2 15 0.3%

Massage therapy 6 – 2 – 4 – 2 – 14 0.2%


APPENDICES

Outcome

Dis

cont

inue

d

Ref

erre

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pr

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coun

cil

Res

olve

d du

ring

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ent

Ref

erre

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cal

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n

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atio

n by

C

omm

issi

on

Ref

erre

d to

the

Com

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’s

Res

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ion

Ser

vice

Dis

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on

Service area No. No. No. No. No. No. No. No. Total %

Renal medicine 3 – 3 1 – 5 – – 12 0.2%

Immunology 3 1 5 1 – 1 1 – 12 0.2%

Reproductive medicine 7 – 3 – – – 2 – 12 0.2%

Osteopathy 6 4 – – 2 – – – 12 0.2%

Infectious diseases 5 2 1 1 1 1 1 – 12 0.2%

Respiratory/Thoraric medicine 8 – 1 – – – – – 9 0.2%

Rheumatology 5 – 2 – – – – – 7 0.1%

Haematology 3 1 1 1 – – – – 6 0.1%

Nuclear medicine 4 – 1 – – – – – 5 0.1%

Developmental disability 2 – – – – – – 2 4 0.1%

Nephrology 3 1 – – – – – 4 0.1%

Health education/information 2 2 – – – – – 4 0.1%

Unknown 0 2 1 – – – – 1 4 0.1%

Sleep medicine 3 1 – – – – 4 0.1%

Sexual assault service 2 1 – – – – 3 0.1%

Occupational health 2 – – – – – 1 3 0.1%

Hypnotherapy 2 – – – – – – – 2 0.0%

Nutrition and dietetics 0 – – 1 1 – – – 2 0.0%

Medical Radiation Practice 0 – – – 2 – – – 2 0.0%

Family planning 1 – 1 – – – – – 2 0.0%

Acupuncture 0 1 – – 1 – – – 2 0.0%

Psychotherapy 0 – – – – – – 1 1 0.0%

Autopsy 0 – – – – – – 1 1 0.0%

Personal care 0 1 – – – – – – 1 0.0%

Speech therapy 1 – – – – – – – 1 0.0%

Sport medicine – – – – 1 – – – 1 0.0%

Natural therapy 1 – – – – – – – 1 0.0%

Total 2338 1211 692 411 344 329 288 192 5,805 100.0%


Table A.18 – Outcome of assessment of complaints by most common service area 2015-16 (continued)


APPENDICES

Table A.19 – Outcome of assessment of complaints by type of health service provider 2015-16

Outcome

Health service provider type Dis

cont

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d

Ref

erre

d t

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pro

fess

iona

l co

unci

l

Res

olv

ed d

urin

g

asse

ssm

ent

Ref

erre

d fo

r lo

cal

reso

lutio

n

Inve

stig

atio

n b

y C

om

mis

sio

n

Ref

erre

d t

o t

he

Co

mm

issi

on’

s R

eso

lutio

n S

ervi

ce

Dis

cont

inue

with

co

mm

ents

Ref

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d t

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ther

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per

son

Grand Total %

Health practitioner No. No. No. No. No. No. No. No.

Medical practitioner 1,027 339 219 n/a 176 49 173 88 2,071 35.7%

Dental practitioner 137 299 32 n/a 26 – 11 5 510 8.8%

Nurse/midwife 131 269 20 n/a 42 2 9 11 484 8.3%

Pharmacist 33 118 4 n/a 24 – 2 3 184 3.2%

Psychologist 62 65 5 n/a 18 1 8 3 162 2.8%

Chiropractor 14 27 – n/a 10 – 8 1 60 1.0%

Physiotherapist 16 11 2 n/a 3 1 4 – 37 0.6%

Optometrist 8 11 2 n/a – – 2 1 24 0.4%

Chinese Medicine Practitioner 3 14 – n/a 2 – 1 2 22 0.4%

Occupational therapist 13 5 2 n/a – – 1 – 21 0.4%

Counsellor/therapist 12 – – n/a 1 1 2 2 18 0.3%

Podiatrist 9 5 1 n/a 2 – – – 17 0.3%

Student Nurse 1 16 – n/a – – – – 17 0.3%

Assistant in nursing 9 – – n/a 2 – 4 1 16 0.3%

Alternative health provider 3 – – n/a 3 – 4 4 14 0.2%

Massage therapist 5 – 2 n/a 5 – 1 – 13 0.2%

Osteopath 6 4 – n/a 2 – – – 12 0.2%

Unknown 5 – 2 n/a – – – 5 12 0.2%

Administration/clerical staff 7 – 2 n/a – – – 2 11 0.2%

Other 4 – 1 n/a 1 – 1 4 11 0.2%

Medical Radiation Practitioner 2 5 1 n/a 1 – – – 9 0.2%

Social worker 6 – – n/a – – 1 – 7 0.1%

Cosmetic therapist – – – n/a 5 – – 2 7 0.1%

Dietitian/nutritionist – – – n/a 7 – – – 7 0.1%

Student Medical practitioner – 6 – n/a – – – – 6 0.1%

Naturopath 3 – – n/a 1 – – – 4 0.1%

Ambulance personnel 2 – – n/a – – – – 2 0.0%

Hypnotherapist 1 – – n/a – – – 1 2 0.0%

Personal care assistant – – – n/a 2 – – – 2 0.0%

Homeopath 1 – – n/a – – – – 1 0.0%

Dental technician – – – n/a – – – 1 1 0.0%

Psychotherapist – – – n/a – – – 1 1 0.0%

Residential care worker – – 1 n/a – – – – 1 0.0%

Health practitioner Total 1,520 1,194 296 333 54 232 137 3,766 64.9%


APPENDICES

Outcome

Health service provider type Dis

cont

inue

d

Ref

erre

d t

o

pro

fess

iona

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unci

l

Res

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urin

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asse

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ent

Ref

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d fo

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cal

reso

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n

Inve

stig

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n b

y C

om

mis

sio

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Ref

erre

d t

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Co

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on’

s R

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lutio

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ce

Dis

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with

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Grand Total %

Health organisation No. No. No. No. No. No. No. No.

Public Hospital 333 – 158 150 4 212 18 5 880 15.2%

Correction and detention facility 54 – 22 196 – 4 – – 276 4.8%

Medical centre 94 – 64 – – 1 13 1 173 3.0%

Private Hospital 53 – 23 – 1 16 4 4 101 1.7%

Psychiatric hospital/unit 45 – 10 15 1 14 2 1 88 1.5%

Community health service 31 – 9 14 11 2 1 68 1.2%

Pharmacy 24 17 18 – – – 4 3 66 1.1%

Aged care facility 23 – 7 – – 3 – 26 59 1.0%

Dental Facility 25 – 18 8 – 2 3 2 58 1.0%

Ambulance service 15 – 11 14 – 3 – – 43 0.7%

Radiology facility 22 – 12 – – 1 – 1 36 0.6%

Cosmetic health facility 22 – 1 – 3 – 1 4 31 0.5%

Pathology centres/labs 11 – 9 1 – – 5 – 26 0.4%

Specialist medical practice 12 – 11 – – – 2 1 26 0.4%

Local Health District 7 – 2 7 – 3 – 1 20 0.3%

Alternative health facility 7 – 5 – 1 – – 3 16 0.3%

Drug and alcohol service 7 – 2 1 – 1 – – 11 0.2%

Day procedure centre 7 – – 1 1 – 1 – 10 0.2%

Aboriginal health centre 3 – 3 1 – 1 – – 8 0.1%

Other health organisation 4 – 3 – – – – – 7 0.1%

Optometrist facility 3 – 3 – – – – – 6 0.1%

Physiotherapy facility 5 – 1 – – – – – 6 0.1%

Rehabilitation facility 2 – – 1 2 – 5 0.1%

Multi purpose service – – 1 2 1 – 4 0.1%

Psychology facility 2 – 2 – – – – – 4 0.1%

Government Department 2 – 1 – – – – – 3 0.1%

Supported accommodation services (not aged care) 2 – – – – – – 1 3 0.1%

Chiropractic facility – – – – – – 1 1 2 0.0%

Health fund 1 – – – – – – – 1 0.0%

Nursing agency 1 – – – – – – – 1 0.0%

Unknown health organisation 1 – – – – – – – 1 0.0%

Health organisation Total 818 17 396 411 11 275 56 55 2,039 35.1%

Grand Total 2,338 1,211 692 411 344 329 288 192 5,805 100.0%


Table A.19 – Outcome of assessment of complaints by type of health service provider 2015-16 (continued)


APPENDICES

Table A.20 – Time taken to assess complaints 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Percentage of complaints assessed within 60 days

88.1% 94.5% 94.2% 92.7% 85.8%

Average days to assess complaints 43 40 38 40 47


Table A.21 – Requests for review of assessment decision 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Requests for review of assessment decision

292 389 320 274 307

Percentage of all Assessments finalised

7.1% 8.6% 6.7% 5.5% 5.3%


Table A.23 – Outcome of complaints referred to the Commission’s Resolution Service 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Outcome No. % No. % No. % No. % No. %

Resolution did proceed

Resolved 239 36.6% 283 44.5% 223 36.7% 127 31.3% 111 31.7%

Partially resolved 152 23.3% 123 19.3% 127 20.9% 90 22.2% 70 20.0%

Not resolved 54 8.3% 59 9.3% 94 15.5% 56 13.8% 58 16.6%

Resolution did proceed total 445 68.1% 465 73.1% 444 73.0% 273 67.2% 239 68.3%

Resolution did not proceed

Resolution did not proceed total 208 31.9% 171 26.9% 164 27.0% 133 32.8% 111 31.7%

Grand total 653 100.0% 636 100.0% 608 100.0% 406 100.0% 350 100.0%


Table A.22 – Outcome of reviews of assessment decision 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Review result No. % No. % No. % No. % No. %

Original assessment decision confirmed

267 88.7% 344 93.2% 279 91.5% 255 92.4% 270 91.2%

Assessment decision varied 34 11.3% 25 6.8% 26 8.5% 21 7.6% 26 8.8%

Total 301 100.0% 369 100.0% 305 100.0% 276 100.0% 296 100.0%


2 reviews were withdrawn






APPENDICES

Table A.24 – Outcome of conciliations initiated by the Commission’s Resolution Service 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Outcome No % No % No % No % No %

Conciliation process did proceed

Agreement reached 18 81.8% 14 77.8% 7 63.6% 13 100.0% 19 90.5%

Consent withdrawn 2 9.1% 4 22.2% - – - – - –

The conciliation was helpful in clarifying concerns

- – - – 1 9.1% - – - –

No agreement reached 2 9.1% - – 2 18.2% - – 2 9.5%

Conciliation process did proceed total 22 100.0% 18 100.0% 10 90.9% 13 100.0% 21 100.0%

Conciliation process did not proceed

Conciliation process did not proceed total

- – - – 1 9.1% - – - –

Grand total 22 100.0% 18 100.0% 11 100.0% 13 100.0% 21 100.0%


Table A.25 – Time taken to complete complaints referred to the Commission’s Resolution Service 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Time taken to complete No. % No. % No. % No. % No. %

0-1 month 143 21.2% 116 17.7% 83 13.4% 69 16.5% 49 13.2%

1-2 months 123 18.2% 133 20.3% 87 14.1% 85 20.3% 75 20.2%

2-3 months 122 18.1% 96 14.7% 74 12.0% 72 17.2% 63 17.0%

3-4 months 83 12.3% 77 11.8% 78 12.6% 82 19.6% 90 24.3%

4-5 months 52 7.7% 62 9.5% 45 7.3% 38 9.1% 32 8.6%

5-6 months 50 7.4% 48 7.3% 52 8.4% 20 4.8% 18 4.9%

6-7 months 28 4.1% 34 5.2% 41 6.6% 15 3.6% 17 4.6%

7-8 months 21 3.1% 25 3.8% 34 5.5% 16 3.8% 8 2.2%

8-9 months 21 3.1% 18 2.8% 31 5.0% 6 1.4% 3 0.8%

9-10 months 7 1.0% 12 1.8% 27 4.4% 6 1.4% 4 1.1%

10-11 months 11 1.6% 10 1.5% 21 3.4% 4 1.0% 3 0.8%

11-12 months 4 0.6% 6 0.9% 18 2.9% – –

>12 months 10 1.5% 17 2.6% 28 4.5% 6 1.4% 9 2.4%

Total 675 100.0% 654 100.0% 619 100.0% 419 100.0% 371 100.0%



APPENDICES

Table A.26 – Outcome of investigations 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Investigation outcome No % No % No % No % No %


Referred to Director Proceedings 131 66.8% 85 51.2% 110 57.9% 93 53.4% 139 63.8%

Referred to Council under s20A 5 2.6% 13 7.8% 20 10.5% 19 10.9% 37 17.0%

No further action 24 12.2% 22 13.3% 27 14.2% 16 9.2% 21 9.6%

Referred to Council 36 18.4% 45 27.1% 32 16.8% 38 21.8% 13 6.0%

No further action – National Board informed

– – – 7 4.0% 8 3.7%

Make comments to the practitioner – 1 0.6% 1 0.5% 1 0.6% –

Total registered health practitioner 196 100.0% 166 100.0% 190 100.0% 174 100.0% 218 100.0%


Public Statement / Prohibition Order 7 46.7% 8 50.0% 10 45.5% 6 54.5% 11 64.7%

No further action 6 40.0% 5 31.3% 4 18.2% 3 27.3% 4 23.5%

Make comments to the practitioner 2 13.3% 2 12.5% 6 27.3% 2 18.2% 2 11.8%

Breach of Prohibition order, refer to Commissioner

– – 1 4.5% – –

Referred to Council – – 1 4.5% – –

Referred to Council under s20A – 1 6.3% – – –

Referred to Director of Proceedings – – – – –

Total non-registered health practitioner

15 100.0% 16 100.0% 22 100.0% 11 100.0% 17 100.0%

Health Organisation

Make comment or recommendation 9 81.8% 16 84.2% 14 100.0% 9 100.0% 9 100.0%

No further action 2 18.2% 3 15.8% – – –

Total Health Organisation 11 100.0% 19 100.0% 14 100.0% 9 100.0% 9 100.0%

Grand Total 222 100.0% 201 100.0% 226 100.0% 194 100.0% 244 100.0%



APPENDICES

Table A.27 – Investigations into health organisations and health practitioners finalised 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Health service provider No. % No. % No. % No. % No. %


Medical practitioner 124 58.8% 91 50.0% 112 52.8% 71 38.4% 121 51.5%

Nurse/midwife 47 22.3% 31 17.0% 55 25.9% 53 28.6% 42 17.9%

Dental practitioner 6 2.8% 21 11.5% 8 3.8% 15 8.1% 25 10.6%

Pharmacist 9 4.3% 8 4.4% 4 1.9% 21 11.4% 13 5.5%

Chiropractor 3 1.4% 2 1.1% 3 1.4% 4 2.2% 5 2.1%

Psychologist 5 2.4% 3 1.6% 6 2.8% 9 4.9% 5 2.1%

Chinese Medicine Practitioner 1 0.5% 1 0.5% 1 0.5% - 2 0.9%

Physiotherapist - - 1 0.5% - 2 0.9%

Osteopath 1 0.5% 7 3.8% 5 2.4% 3 1.6% 2 0.9%

Podiatrist 1 0.5% 3 1.6% - - - –

Student Nurse - - - - 1 0.4%

Total Registered health practitioner 197 93.4% 167 91.8% 195 92.0% 176 95.1% 218 92.8%


Alternative health provider 2 0.9% 2 1.1% - 1 0.5% 8 3.4%

Massage therapist 1 0.5% 4 2.2% 5 2.4% 1 0.5% 4 1.7%

Personal care assistant - - - - 2 0.9%

Assistant in nursing 3 1.4% 6 3.3% 6 2.8% 3 1.6% 1 0.4%

Doula - - - - 1 0.4%

Other - - 2 0.9% - 1 0.4%

Administration/clerical staff 3 1.4% - - - - –

Counsellor/therapist - - - 1 0.5% - –

Dental technician 1 0.5% 1 0.5% - - - –

Hypnotherapist 1 0.5% - - - - –

Natural therapist - - - 1 0.5% - –

Naturopath 2 0.9% - 2 0.9% 1 0.5% - –

Psychotherapist - - 2 0.9% - - –

Residential care worker 1 0.5% 2 1.1% - - - –

Social worker - - - 1 0.5% - –

Total Non-registered health practitioner 14 6.6% 15 8.2% 17 8.0% 9 4.9% 17 7.2%

Total health practitioner 211 100.0% 182 100.0% 212 100.0% 185 100.0% 235 100.0%

Health organisation

Cosmetic health facility - – - – - – - – 4 44.4%

Public hospital 8 72.7% 11 57.9% 4 28.6% 6 66.7% 3 33.3%

Local Health District - – - – - – - – 1 11.1%

Day procedure centre - – - – - – - – 1 11.1%

Aged care facility - – - – 6 42.9% 1 11.1% - –

Alternative health facility - – - – 3 21.4% - – - –

Ambulance Service - – - – - – 1 11.1% - –

Dental facility - – 4 21.1% - – - – - –

Drug and alcohol service - – 2 10.5% - – - – - –

Multi purpose service - – - – - – 1 11.1% - –

Other health organisation 2 18.2% - – 1 7.1% - – - –

Private hospital 1 9.1% 2 10.5% - – - – - –

Total health organisation 11 100.0% 19 100.0% 14 100.0% 9 100.0% 9 100.0%

Grand total 222 100.0% 201 100.0% 226 100.0% 194 100.0% 244 100.0%



APPENDICES

Table A.28 – Investigations finalised by issue category 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Issue category No. % No. % No. % No. % No. %

Professional conduct 208 56.8% 138 39.3% 193 50.1% 154 48.1% 198 44.9%

Treatment 106 29.0% 136 38.7% 91 23.6% 88 27.5% 139 31.5%

Medication 26 7.1% 24 6.8% 50 13.0% 41 12.8% 36 8.2%

Medical records 5 1.4% 10 2.8% 15 3.9% 17 5.3% 22 5.0%

Communication/information 7 1.9% 13 3.7% 22 5.7% 7 2.2% 16 3.6%

Environment/management of facilities 3 0.8% 5 1.4% 3 0.8% 3 0.9% 13 2.9%

Fees/costs 4 1.1% 1 0.3% 1 0.3% 4 1.3% 7 1.6%

Consent 1 0.3% 19 5.4% 8 2.1% 2 0.6% 5 1.1%

Discharge/transfer arrangements 4 1.1% 2 0.6% 1 0.3% 1 0.3% 3 0.7%

Grievance processes – – 2 0.6% 1 0.3% 3 0.9% 1 0.2%

Reports/certificates 1 0.3% - – - – - – 1 0.2%

Access 1 0.3% 1 0.3% - – - – - –

Total 366 100.0% 351 100.0% 385 100.0% 320 100.0% 441 100.0%


Table A.29 – Outcome of investigations finalised by profession and organisation type 2015-16

Health service provider Co

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No. No. No. No. No. No. No. No. No.


Medical practitioner – 16 5 – – 7 11 82 121 55.5%

Nurse/midwife – 3 1 – – 1 3 34 42 19.3%

Dental Practitioner – – – – – 3 17 5 25 11.5%

Pharmacist – – 1 – – – 4 8 13 6.0%

Chiropractor – – – – – 1 – 4 5 2.3%

Psychologist – – – – – – 1 4 5 2.3%

Chinese medicine practitioner – – – – – – 1 1 2 0.9%

Osteopath – – – – – 1 – 1 2 0.9%

Physiotherapist – 2 – – – – – – 2 0.9%

Student Nurse – – 1 – – – – – 1 0.5%

Registered health practitioner Total – 21 8 2 – 13 37 139 218 100.0%


Alternative health provider – – – 5 – – – – 5 29.4%

Massage therapist – – – 4 – – – – 4 23.5%

Cosmetic therapist – 3 – – – – – – 3 17.6%

Personal care assistant 1 – – 1 – – – – 2 11.8%

Assistant in nursing 1 – – – – – – – 1 5.9%

Doula – 1 – – – – – – 1 5.9%

Other – – – 1 – – – – 1 5.9%

Non-registered practitioner Total 2 4 – 9 – – – – 17 100.0%

Total health practitioner 2 25 8 11 0 13 37 139 235 100.0%

Health organisation

Cosmetic health facility – – – – 4 – – – 4 44.4%

Public Hospital – – – – 3 – – – 3 33.3%

Day procedure centre – – – – 1 – – – 1 11.1%

Local Health District – – – – 1 – – – 1 11.1%

Health organisation Total – – – – 9 – – – 9 100.0%

Grand Total 2 25 8 11 9 13 37 139 244



APPENDICES

Table A.30 – Request for review of investigation decision 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Request for review of investigation decision

4 5 5 2 1

Percentage of all investigations finalised 1.8% 2.5% 2.2% 1.0% 0.4%


Table A.31 – Outcome of reviews of investigation decision 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Outcome No. % No. % No. % No. % No. %

Original investigation decision confirmed 2 66.7% 6 100.0% 5 100.0% 1 100.0% – 0.0%

Re-opened for investigation 1 33.3% – – – 1 100.0%

Total 3 100.0% 6 100.0% 5 100.0% 1 100.0% 1 100.0%


Table A.32 – Time taken to complete investigations 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Time taken No. % No. % No. % No. % No. %

0-1 months 2 0.9% 2 1.0% 6 2.7% 1 0.5% –

1-2 months 6 2.7% 11 5.5% 5 2.2% 7 3.6% 6 2.5%

2-3 months 20 9.0% 8 4.0% 16 7.1% 6 3.1% 14 5.7%

3-4 months 22 9.9% 10 5.0% 27 11.9% 12 6.2% 4 1.6%

4-5 months 17 7.7% 19 9.5% 22 9.7% 17 8.8% 16 6.6%

5-6 months 23 10.4% 13 6.5% 26 11.5% 18 9.3% 17 7.0%

6-7 months 19 8.6% 16 8.0% 18 8.0% 20 10.3% 23 9.4%

7-8 months 32 14.4% 24 11.9% 22 9.7% 22 11.3% 19 7.8%

8-9 months 22 9.9% 21 10.4% 24 10.6% 34 17.5% 16 6.6%

9-10 months 11 5.0% 22 10.9% 14 6.2% 20 10.3% 27 11.1%

10-11 months 12 5.4% 19 9.5% 17 7.5% 11 5.7% 25 10.2%

11-12 months 16 7.2% 15 7.5% 18 8.0% 19 9.8% 35 14.3%

12-18 months 19 8.6% 14 7.0% 10 4.4% – – 36 14.8%

18-24 months 1 0.5% 7 3.5% 1 0.4% 7 3.6% 6 2.5%

Total 222 100.0% 201 100.0% 226 100.0% 194 100.0% 244 100.0%

Average days 222 244 209 230 275


* Excludes time when investigation was paused


APPENDICES

Table A.33 – Legal matters finalised 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

No. % No. % No. % No. % No. %

NSW Civil Administrative Tribunal

Proved 39 41.5% 53 60.2% 34 47.9% 34 41.5% 46 48.9%

Withdrawn 4 4.3% 2 2.3% 4 5.6% 6 7.3% 3 3.2%

Not proved 1 1.1% – 1 1.4% – 1 1.1%

Dismissed – – – 1 1.2% –

Total NSW Civil Administrative Tribunal 44 46.8% 55 62.5% 39 54.9% 41 50.0% 50 53.2%

Professional Standards Committee

Proved 25 26.6% 13 14.8% 16 22.5% 20 24.4% 24 25.5%

Not proved 3 3.2% 3 3.4% 2 2.8% 1 1.2% 1 1.1%

Withdrawn – 2 2.3% – 2 2.4% 1 1.1%

Terminated and referred to Tribunal 2 2.1% – – 1 1.2% –

Total Professional Standards Committee 30 31.9% 18 20.5% 18 25.4% 24 29.3% 26 27.7%

Appeal 13 13.8% 10 11.4% 10 14.1% 7 8.5% 10 10.6%

Re-registration 7 7.4% 5 5.7% 4 5.6% 10 12.2% 8 8.5%

Grand total 94 100.0% 88 100.0% 71 100.0% 82 100.0% 94 100.0%

Counted by matter

Table A.34 – Open complaints as at 30 June

2011-12 2012-13 2013-14 2014-15 2015-16

Open process No. % No. % No. % No. % No. %

Assessment 609 49.5% 667 51.4% 685 58.7% 895 65.3% 1,326 65.8%

Legal processes 257 20.9% 160 12.3% 169 14.5% 105 7.7% 215 10.7%

Investigation process 148 12.0% 161 12.4% 149 12.8% 217 15.8% 323 16.0%

Resolution process 172 14.0% 250 19.3% 96 8.2% 92 6.7% 88 4.4%

Review of assessment 25 2.0% 37 2.9% 50 4.3% 45 3.3% 51 2.5%

Brief preparation 14 1.1% 17 1.3% 13 1.1% 5 0.4% 9 0.4%

Conciliation 4 0.3% 5 0.4% 5 0.4% 11 0.8% 3 0.1%

Review of investigation 1 0.1% – – 1 0.1% 1 0.0%

Total 1,230 100.0% 1,297 100.0% 1,167 100.0% 1,371 100.0% 2,016 100.0%


Table A.35 – Number of complaints finalised from 2011-12 to 2015-16

2011-12 2012-13 2013-14 2014-15 2015-16

Complaints finalised No. % No. % No. % No. % No. %

Assessment Process 3,294 78.7% 3,621 81.0% 4,094 83.1% 4,343 87.7% 5,132 89.4%

Resolution Process 645 15.4% 632 14.1% 598 12.1% 402 8.1% 342 6.0%

Investigation Process 222 5.3% 201 4.5% 226 4.6% 194 3.9% 244 4.3%

Conciliation Process 22 0.5% 18 0.4% 11 0.2% 13 0.3% 21 0.4%

Grand Total 4,183 100.0% 4,472 100.0% 4,929 100.0% 4,952 100.0% 5,739 100.0%



APPENDICES

Appendix B – Performance in 2015-16 against key indicators

GOAL 1. COMPREHENSIVE AND RESPONSIVE COMPLAINT HANDLINGObjective: Efficient and timely processing, assessment and resolution of complaints and review processes

Strategy

Employ best practice complaint handling processes by: - improving assessment and review processes and guidelines - maximising opportunity for less serious complaints to be mutually resolved - timely communication of assessment processes and outcomes

16.1% more complaints assessed

The Commission assessed 5,805 complaints in 2015-16 – an increase of 16.1% on the 5,002 complaints assessed in 2014-15.

85.8% of complaints assessed within 60 days (Statutory timeframe – target 100%). During the year the Commission assessed 85.8% of complaints within the statutory 60-day timeframe. This compares to 92.7% in 2014-15 and the reduced timeliness is attributable to the dramatic increase in the number of complaints received. On average complaints were assessed within 47 days (2014-15: 40 days).

11.9% were successfully resolved during the assessment of the complaint Single issue and minor complaints can be more straightforward the commission has introduced early resolution processes that aim to resolve these quickly and informally during the assessment process. Further development of capability in this area will continue to be a focus.

90.1% of complaints not assessed within 60 days where extension approved (Target 100%). An extension was approved in 90.1% of cases where the complaint could not be assessed within 60 days, generally because: a considerable amount of information is required from different sources; the complaint requires input from the Commission’s internal experts; and/or where a provider is unable or unavailable to respond within the specified timeframe.

5.3% of complaints assessed were subject to a request for a review (Target <10%). In 2015-16, the Commission received 307 requests for a review of an assessment decision; this represents 5.3% of all complaints assessed which compares favourably with 5.5% in 2014-15 and 6.7% in 2013-14. Of the complaints reviewed, in 91.2% of cases the decision remained unchanged.

9.8% of reviews completed within 4 weeks (Target 90%). The timeliness in the completion of reviews has been significantly below expectation with 9.8% being completed within four weeks. It should be noted, however, that in previous years, the target completion time for reviews was within 6 weeks. Performance monitoring resulted in changes to the review business processes to address the delays that were occurring.

88.7% of decision letters sent within 14 days (Statutory timeframe – target 100%). When the assessment of the complaint has been finalised the Commission is required to inform all parties to a complaint. During the year 88.7% of decision letters were sent within 14 days of the decision being made (201415: 97.7%). This fall in timeliness is due to the increase in complaint numbers.

87.5% of complaint assessment clients who completed a survey were satisfied with service (Target 80%). At the completion of each assessment process, both the health service provider and the complainant are invited via a questionnaire to provide feedback to the Commission. The rate of response from complainants was 8.6%. Of these, 87.5% stated they were satisfied with the Commission’s service. The rate of response from health service providers was 10.5% – of these 68.7% stated they were satisfied with the Commission’s service

Strategy: Quality file management

50.0% of complaints were acknowledged within seven days of receipt (Target 90%). When the Commission receives a complaint, it sends out an acknowledgment letter to the complainant confirming receipt. In this acknowledgement letter they are advised of the assessment officer’s name and the file number to quote when contacting the Commission. In 2015-16 the Commission acknowledged 50.0% of complaints within 7 days, a significant decline in 2014-15 performance where 94.0% of complaints were acknowledged in 7 days. This is due to the required adjustments to administrative processes not keeping pace with the rate of increase in complaint numbers.


APPENDICES

88.4% of 21 day file audits returned a satisfactory result (Target 90%). Each assessment file is subject to an audit process to ensure the effective management of the file. An audit occurs on day 21. This audit is to ensure that all activities for the collection of information have been actioned. In 2015-16, 88.4% of 21 day audits were satisfactory (2014-15: 90.8%).

Strategy: Improve resolution/conciliation management processes & systems

95.4% of complaints where the resolution officer contacts the parties within 14 days. In 95.4% of complaints referred to the Resolution Service, a Resolution Officer contacted the parties within 14 days to introduce themselves, explain the resolution process, and answer any questions regarding the assessment of the complaint. (Target 90%).

77.9% of resolutions completed within 4 months. The Resolution Service closed 77.9% of matters within four months (which exceeded the target of 70%).

76.9% of complaints that proceeded to resolution were resolved or partially resolved (Target 80%). The resolution processes delivered full or at least partial resolution for the complainant in 76.9% of cases. In cases where a complaint remains unresolved, it is common that the complainant has negotiated the vast majority of what they were seeking to resolve the complaint, but the provider’s refusal to provide an apology may remain an unresolved issue- and this often leads to the complainant advising that without the apology the matter is not resolved.

95.3% of complaint resolution/conciliation clients satisfied with service (Target 80%). At the completion of each resolution process both the complainant and the provider receive a satisfaction survey. During this year the response rate to the survey was 24.5% from complainants and 25.7% from providers. Both expressed a high level of satisfaction with the service with 95.3% of complainants stating they were satisfied with the service and 86.0% of providers expressing their satisfaction.

GOAL 2. INVESTIGATE SERIOUS COMPLAINTSObjective: Ensure a best practice approach for the conduct of all investigations

Strategy: Ensure the expeditious and comprehensive investigation of complaints

82.8 % of investigations finalised within 12 months (Target 90%). The Commission finalised 82.8% of investigations within 12 months in 2015-16 (2014-15: 96.4%). Investigations took an average of 275 days to complete (2014-15: 230 days). The increase in time taken to conduct investigations reflects the significant increase in the number of complaints referred for investigation, and the pattern of diversity and complexity in complaints generally. Matters are carefully prioritised within investigations, and this includes ensuring that investigations where the subject of the complaint is seriously ill are expedited.

96.9% of investigation plans completed within 14 days (Target 100%).

The Investigation Division completed 96.9% of investigation plans within 14 days of receiving the complaint from the Assessment Division in 2015-16, compared with 100% the previous year. The planning process is central to good investigative practice, as it is the point to identify critical sources of information and significant witnesses that need to be pursued to ensure that effective and timely progress is made. The slight reduction in timeliness is attributable to the increased number of matters referred for investigation.

Strategy: Monitor investigations to ensure statutory compliance, timeliness, and the reassessment of issues, including status reports to Investigation Reporting Group

85.7% of investigations reviewed on time (Target 90%). The Commission keeps all investigations and associated risks under active review. As an investigation unfolds additional allegations, issues or respondents may be identified and these may need to be formally added to the investigation. The information gathered will also often lead to additional sources of evidence. Throughout the investigation review process, the Commission actively considers that material and information is provided to the relevant professional council, so that they can conduct their own risk assessments.

97.6 % of investigation reviews showed satisfactory progress (Target 90%). Investigation practice continues to be very strong. To be assessed as satisfactory progress the investigation plan must be followed, evidence needs to be obtained within identified timeframes and the investigation is keeping on track.

0.4 % of requests for review of investigation outcome (Target <5%). Only one review of an investigation outcome was requested during the reporting period. This is testimony to the quality of the Commission’s investigations and the commitment to ensuring careful and sensitive communication about the findings and outcomes. Where a decision relates to a situation where there has been a particularly poor outcome for a patient, an Investigation Officer makes direct contact with the complainant, in person or by phone, to explain the decision and any next steps that may be relevant.


APPENDICES

Strategy: Sound brief of evidence handling processes and systems in place

96.4% of matters referred to Director of Proceedings that were not referred back for further information (Target 90%). Well-structured investigation plans, strong investigative review processes and effective supervision at all stages of the investigation process, ensured that comprehensive briefs of evidence are provided to the Director of Proceedings and in only a very small number of cases is additional work required before a determination about legal action can be taken.

71.2 % of briefs of evidence prepared within 28 days (Target 80%). During 2015-16, 111 briefs of evidence were prepared and 71.1% prepared within 28 days compared to 2014-15 where of the 93 briefs of evidence 76.3% were completed in 28 days. The reduction is timeliness is directly related to the increased number of investigations finalised. Additional resources and efficiency gains from the electronic compilation of briefs of evidence are expected to improve performance in this area.

Objective: Support improvements to patient care in health care delivery through recommendations arising from investigations

Strategy: Sound processes for the creation of recommendations

41.7% of recommendations implemented (Target 90%). The Commission monitors the implementation of recommendations made to health organisations and reports on the outcomes in the year after they were made. In 2014-15 the Commission made 24 recommendations arising out of investigations. As of 30 June 2016, 10 of these recommendations had not yet been fully implemented by the relevant health organisations. The Commission has an audit and follow up programme, through which it has subsequently confirmed that implementation has now been finalised.

No audits held. The Commission did not hold any audits of compliance with recommendations to health organisations in 2015-16, however advanced planning has been completed into audits for 2016-17

GOAL 3. PROSECUTE SERIOUS COMPLAINTSObjective: Independent and timely prosecutions

Strategy: Timely determinations made to prosecute

93.5% of complaints considered by the Director of Proceedings on time (Target 80%). The Director of Proceedings considered 93.5% of complaints within three months of referral to determine whether or not to prosecute the complaint before a disciplinary body. This is an improvement from last year where 90.5% of complaints were considered within three months of referral.

78.9% of matters referred within 30 days (Target 80%). The Director of Proceedings referred 78.9% (2013-14: 84.7%) of matters to be prosecuted within 30 days of consulting with the relevant professional council.

Objective: Professional and competent prosecutions of serious complaints in the public interest

Strategy: Conduct professional and competent prosecutions

97.2% success rate in prosecutions (Target 90%). 97.2% of matters prosecuted by the Commission, that were heard and finalised before the NSW Civil and Administrative Tribunal (NCAT) or a Professional Standards Committee during the reporting report were found proven. This compares to 98.2% in the previous year.

Strategy: Ensure compliance with timeframes imposed by Professional Standard Committees, Tribunals, and courts

93.4% compliance with deadlines (Target 80%). The Commission complied with timeframes imposed by Professional Standards Committees, NCAT and courts in 93.4% of cases. This compares to 96.2% in the previous year.

Strategy: Recover legal costs

90.5% of bills of costs prepared on time (Target 75%). 90.5% of bills of legal costs were prepared internally or sent to a costs consultant within 120 days of a costs order in favour of the Commission having been made. This is an improvement on 76.5% in the previous year.

Quarterly reporting on recovery of legal costs to Executive (Target: quarterly reporting). Monthly reports on the recovery of legal costs were provided to the Executive


APPENDICES

GOAL 4. ACCOUNTABILITYObjective: Provide timely, accurate and relevant reporting to the Minister and the

Parliamentary Joint Committee

Strategy: Quarterly reporting on performance to Minister and Parliamentary Joint Committee (JPC) on the Health Care Complaints Commission

Responsive quarterly reporting on performance. The Commission provided quarterly reports on its complaint-handling performance to the Minister for Health, the Assistant Minister for Health and the Joint Parliamentary Committee on the Health Care Complaints Commission in July 2015, October 2015, January 2016 and April 2016.

Strategy: Develop and maintain open and meaningful communication with the Minister and JPC on issues as they arise

Responses to Minister within 15.5 days on average. The Commission provided 57 responses to correspondence received by the Minister during the year. On average, the requested information was provided within 15.5 days and those matters that were classified as urgent (due within 1 week) or priority (due within two weeks) were produced within those tighter timeframes in the vast majority of cases.

Timely responses to Joint Parliamentary Committee. The Joint Parliamentary Committee’s annual review occurred on 11 March 2016. The Commissioner and Directors appeared at the public hearing before the Committee and provided responses to questions asked by the Committee as well as responses to questions taken on notice within the specified timeframe. The Committee’s report was handed down on 23 June 2016. No formal recommendations were made.

Objective: Promote and publicly report about the work of the Commission

Strategy: The Commission’s Annual Report reflects the key business and operational results for the year and fully complies with legislative requirements

Annual Report on time and fully compliant. The Commission’s Annual Report for 2014-15 was tabled in the Legislative Council of NSW Parliament on 17 November 2015. It was fully compliant with the Treasury’s annual report checklist.

Audited financial statements. Unqualified audit certificates for the financial statements of both the Health Care Complaints Commission and the Office of the Health Care Complaints Commission were received on 23rd September 2016

Increased accessibility via the website. The Commission continues to experience a very high visitation rate to its website – in 2015-16 there were 366,241 visitors, over 1 million page views (2014-15: 947,786) and over 12 million hits. This exceeded the target of 250,000 visitors and 7,000,000 hits.

Education on effective complaints management and the role of the Commission. The Commission’s staff gave 32 presentations and workshops to community and health professional groups across NSW which was below the target of 60. The focus this year was on Aboriginal health workers, Local Health District and Specialty Network staff, mental health workers, and TAFE and university students studying to become health practitioners.

100% compliant with requirement to publish disciplinary decisions. The Commission was fully compliant in relation to publication of decisions about the outcomes of disciplinary proceedings – 86 media releases relating to decisions of disciplinary bodies were posted. In addition, the Commission issued 12 public statements and warnings about risks posed by particular health services.

GOAL 5. OUR ORGANISATIONObjective: Continue to develop as a learning organisation that embraces a culture of continuous

improvement, sharing of knowledge and promotes a productive, safe and satisfying workplace

Strategy: Develop the organisation’s skills capability to meet expected performance requirements

Provide staff training (target more than 2 days per staff member). In 2015-16, on average, each full time equivalent staff member attended more than 2 days of training.

Strategy: Develop and maintain an organisational culture which promotes equity, diversity and safety

Development and reporting of WHS, Diversity Plan, Multicultural Plan, and Disability Action Plans comply with relevant agency timeframes (Target 100% – achieved). WH&S, Diversity, Multicultural and Disability plans were developed as five year plans in June 2014 and have been tracked and monitored to ensure we have realised the targets set and that the actions have been implemented. The plan for 2015-16 has been implemented and the targets set for the period have all been achieved.


APPENDICES

Strategy: Promote internal communication throughout the organisation.

Monthly general staff briefings on events, outcomes, activities, changes, significant organisational changes. The Commission has held monthly staff meetings where the Commissioner and divisional directors have informed employees about business events, updates, and significant changes that have occurred – or are planned – that impact on the work or functioning of the Commission. These all staff meetings are in addition to Divisional, team and project based collaboration.

Percentage of key corporate documents distributed to all staff and/or included on the intranet. All relevant corporate documents were distributed to staff and/or were placed on the Commission’s intranet site for all employees and managers to access.

Objective: Monitor performance to ensure work quality, organisational development, good governance and effective resource management

Strategy: Internal management groups plan, review and monitor performance

Governance and accountability structures and processes in operation. The Commission’s governance and accountability structures and processes in operation include:

• Executive Management Group – monthly monitoring of financial position, HR and operational performance and oversight of major projects

• Monthly Assessment Reporting Group – monthly review of complaint assessment data and performance

• Investigations Review Group – monthly monitoring and strategy for investigation cases ICT Steering Committee

• Audit and Risk Committee

• WHS Committee

• Staff Workplace Consultative Committee

• Divisional meetings

• Team and project level meetings

Strategy: Ensure security of IT systems

Compliance with information security standard ISO 27001 – 2013. Independent audits have been conducted by accredited ICT auditors and the Commission has continued to maintain compliance certification to the updated ISO 27001 Standard requirements.

Strategy: Conduct strategic planning process that integrates all planning activities, budget preparation and regular performance reporting

Complete planning processes for corporate and divisional levels according to the Commission’s Corporate Governance Framework Document. The Commission held strategic planning workshops with the Executive Management Group and implemented plans to integrate the strategies and goals into Divisional plans. Key priorities are considered when setting and managing the Commission’s budget and corporate functions.

Strategy: Monitor and report on key performance measures

Monthly financial management and staffing reports showing performance against budget. Monthly Financial and Human Resources performance reports are tabled and reviewed at the monthly Executive Management Group meetings and any necessary corrective actions are agreed, actioned and followed up.

Quarterly reports to Executive on complaint handling performance against KPIs. A monthly dashboard tracking and reporting on the KPIs set by the Commission is a standing item at the Executive Management Group monthly meetings

Strategy: Monitor staff performance management system, including staff learning and development plans that address technical and management skills

100% of performance agreements developed and reviewed for staff (Target 100%). All employees that are employed for greater than three months have performance agreements and performance reviews.

82% of staff rated competent or better at performance review (Target 95%). The nature of the work of the Commission is changing as the volume and complexity of complaints increases and as we continue to strengthen customer focus. The Commission is therefore developing a capability building agenda that will support staff in developing the new skills that are required to adapt to this changing environment.


APPENDICES

Dr. Richard Abbott

Dr. Ion Alexander

Dr. Roger Allan

Dr. Bruce Allen

Dr. Stephen Allnutt

Mr. Mark Apolinario

Ms. Deborah Armitage

Dr Mark Arnold

Dr. Bruce Ashford

Mr. John Baker

Dr. Michael Baldwin

Dr Jonathan Ball

Mrs. Susan Banks

Dr. Simon Banting

Prof. David Barnes

Mrs. Jeanne Barr

Ms. Robyn Barrett-Roydhouse

A/Prof James Bell

Dr. Warwick Benson

Dr. Hani Bittar

Mr Michael Blair

Dr Peter Bland

Dr. Elie Bokey

Mr. Sam Borenstein

Dr. David Bowers

Dr. David Brazier

Prof. Bruce Brew

Dr Geoffrey Brodie

Dr. Andrew Brooks

Ms. Julie Burgess

Mr. Paul Butterworth

Dr Andrew Byrne

Mrs. Janice Caldwell

Dr. Eric Carter

Prof. John Carter

Prof Jonathan Carter

Dr Betty Chaar

Dr. Daniel Challis

A/Prof Richard Chard

Miss Kate Chellew

Dr Andrew Child

Prof. Peter Choong

Dr. Louis Christie

Dr Jeremy Christley

Dr. Anne Clark

Mr. Edward Clark

Mr. Peter Cleasby

Prof. Geoffrey Cleghorn

Ms. Vanessa Clements

Dr Suzanne Cochrane

Prof. Paul Colditz

Mr. Albert Coleiro

Dr. Peter Coles

Mrs. Christine Coombs

Dr Rosalba Courtney

Ms. Nerida Croker

Dr. Gregory Crosland

Dr John Crozier

Ms. Allison Cummins

Dr. John Curotta

Dr. Paul Curtis

Mr Mark Dalton

Mr. Eric Daniels

Prof. David Davies

A/Prof Llewelyn Davies

Dr. Robert Day

Dr. Gary Deed

Mr. Christopher Derkenne

Prof Helen Dewey

Prof. Hugh Dickson

Dr. Glenys Dore

Mrs Helen Dowling

Prof Olaf Drummer

Dr. Geraldine Duncan

Dr. Iain Dunlop

Dr Paul D’Urso

Ms. Maureen Edgtton-Winn

Dr. Frederick Ehrlich

Dr. David Eisinger

Dr. Jeannie Ellis

Dr John England

Prof. Nicholas Evans

Dr. Gregory Falk

Dr. David Farlow

Dr. Diana Farlow

Prof. Glen Farrow

Prof Jennifer Fenwick

Mr. John Ferguson

Dr. Dean Fisher

Prof. John Fletcher

Dr Andrew Foote

Ms Elaine Ford

Dr. Robert Ford

Dr. Alan Forrester

Dr. Abra Fransch

Dr. Anthony Freeman

Ms. Julianne Friendship

Dr. Peter Frost

Prof. Gordian Fulde

Dr. Richard Gallagher

Dr. Jonathan Gani

Prof Paul Gatenby

Dr. Paul Gaudry

Dr. Margaret Gibbons

Dr. Michael Giblin

Prof. Lyn Gilbert

Dr. Jonathan Gillis

Mrs. Greta Goldberg

Dr Michael Golding

A/Prof Peter Gonski

Mrs. Alison Goodfellow

Ms. Maxine Goodman

Ms. Amanda Gordon

Dr Sandra Grace

Ms Kathryn Grant

Prof. James Greenwood

Mrs. Sue Greig

Ms. Kathrine Grover

Dr. Graham Gumley

Dr. Mina Gurgius

Dr. Seyed Hamidi

Dr. John Harkness

Dr. Stephen Harlamb

Ms. Rachel Harris

Ms. Bethne Hart

Dr. Keith Hartman

Dr. Lawrence Hayden

Dr. Raymond Hayek

Mr. Antony Heath

Dr. Paul Hendel

Dr. Illana Hepner

Dr. Ralph Higgins

Dr. Gary Hoffman

A/Prof Anna Holdgate

Dr. Herbert Hooi

Dr. George Hopkins

Dr. Craig Hore

Dr. Stephen Howle

A/Prof Francis Hoyal

Mr. Allan Hudson

Dr Melissa Hughes

Dr. Carole Hungerford

Mrs. Sarah Hunstead

Ms. Lee-Ann Jackson

Prof Michael Jelinek

Dr. Peter Johnson

Ms. Andrea Jordan

Mrs. Tracey Jubb

Dr. Stephen Jurd

Mrs Blanche Kairies

Dr. Jeffrey Keir

Dr Adrian Keller

Mrs. Jacqueline Kelly

Dr Bernard Kelly, AM

Dr. Dan Kennedy

Prof. Dianna Kenny

Dr. Timothy Keogh

Dr Emery Kertesz

Dr Suresh Khatri

Mr. Raymond Khoury

Mr. David Kitching

Prof. Leon Kleinman

Dr. Peter Klug

Ms. Diana Knagge

Mr. Alex Knopman

Prof Paul Komesaroff

Dr Edward Korbel

Dr. Andrew Korda

Dr. Beth Kotze

Dr. Geraldine Lake

Appendix C – Expert Reviewer ListThe Commission uses a panel of experts from which to draw expert opinion. It should be noted that all reviewers listed may not have been used in 2015–16


APPENDICES

Dr. Mary Langcake

Dr Pauline Langeluddecke

Dr Bruce Latham

Ms. Janine Learmont

Mr. Jack Leigh

Dr. Vinoo Lele

Dr Michael Levitt

Dr. Danforn Lim

Dr. Peter Liu

Dr Jane Lonie

Dr. Edward Loughman

Mr Ashton Lucas

Dr. Sara Lucas

Dr. Peter Lye

Mr. Stiofan Mac Suibhne

Dr. Kenneth Mackey

Dr Andrew MacQueen

Prof. Guy Maddern

Dr. Linda Mann

Dr Peter Mansour

Dr Elizabeth Marles

Ms. Carol Martin

Dr. Hugh Martin

Ms. Kerri Masters

Ms. Toni McCallum Pardey

Dr. Sallyann McCarthy

Prof. William McCarthy

Dr. Martin McGee-Collett

Ms. Marrianne McGhee

Dr. Michael McGlynn

Mr. John McGuire

Prof. Peter McMinn

Mr. Bernard McNair

Dr Dimitra Mersinia

Ms. Rebekkah Middleton

Dr. Geoffrey Mifsud

Dr. Antony Milch

Ms. Helen Miller

Dr. Janelle Miller

Dr. Peter Morse

Dr. Ahman Moubayed

Dr. Muniswami Mudaliar

Ms. Christine Muller

Dr. Raymond Mullins

Ms Donna Muscardin

Mr. Vaneshkumar Nayak

Dr. Gregory Nelson

Dr. Harry Nespolon

Ms. Robin Norton

Prof. Lynne Oliver

Mr. Brendan O’Loughlin

Dr. Matthew O’Meara

Dr Jannifer Orman

Dr. Jitendra Parikh

Ms. Michelle Parker

Dr. Julian Parmegiani

Dr Martyn Patfield

Dr. Gordon Patrick

Dr Andrew Paul

Ms. Jennifer Paull

Dr. Christopher Pearson

Dr Neil Peppitt

Dr. John Percy

Dr. Lian Pfitzner

Dr. Sharron Phillipson

Dr. Jeffrey Post

Ms. Tracey Powell

Dr. Kinga Price

Prof. Joseph Proietto

Dr. Jennifer Prowse

Prof. Carolyn Quadrio

Dr. John Quinn

Dr. Geoffrey Ramin

A/Prof Rohan Rasiah

Dr. Dennis Raymond

Mr. Scott Read

Dr Ian Relf

Ms. Patricia Reynolds

Dr. Adam Rish

Dr. Wendy Roberts

Dr. Patricia (Patsy) Robertson

Dr. Tuly Rosenfeld

Mrs. Kim Rosevear

Ms. Nadime Roumieh

Dr. Michael Rowland

Ms. Robyn Rudner

Prof. Richard Ruffin

Dr Anthony Samuels

Prof. John Saunders

Ms. Dana Scott

Mrs. Julie Scott

Dr. Diana Semmonds

Mr. Stephen Seymour

Dr. Gabriel Shannon

Dr. Nadine Sharples

Mrs. Jennifer Shaw

Ms. Nerralie Shaw

Mr. Warren Shaw

Dr. John Sippe

Dr. George Skowronski

Dr. John Slaughter

Dr. Grahame Smith

Dr Graydon Smith

Ms. Marion Solomon

Dr. Robert Spark

Ms. Lisa Spencer

Dr. Gautam Sridhar

Dr. Oscar Stanley

Dr Brian Stein

Dr. Michael Steiner

Mr. David Stelfox

Ms. Helen Stevens

Dr. Janine Stevenson

Dr Ruth Stewart

Ms. Caroline Stone

Dr. Neil Street

Dr Michael Suranyi

Dr. Joanna Sutherland

Ms. Sally Sutherland-Fraser

Dr Martin Suthers

Dr. Michael Talbot

Dr. Deniz Tek

Mr. Jack Tillotson

Dr. Derrick Tin

Dr. Kenneth Tiver

Dr. David Townend

Dr. Tom Tseng

Dr. Adrian van der Rijt

Mr. Andrew Van Essen

Dr. Hein Vandenbergh

Dr. Vincent Varjavandi

Dr. Christopher Vickers

Dr Kim Vu

Ms Katrina Vukovic

Dr Shane Waddell

Dr. Andrew Walker

Dr. Martine Walker

Dr Norman Walsh

Dr. James Walter

Mr. Jonathan Wardle

Prof. Bruce Waxman

Mr. Athol Webb

Ms. Elvina Weissel

Mr. Adam Whitby

Mr Lawrence Whitman

Prof. Ian Wilcox

Prof James Wilkinson

Dr. Cholmondeley Williams

Mr. Michael Williamson

Dr. Alexander Wodak

Dr. Melanie Woollam

Dr. John Wright

Dr. Deborah Yates

Dr. Simon Young

Dr. Rasiah Yuvarajan

Prof. Chris Zaslawski

Mr. Shijing Zhang

Dr Zhen Zheng


APPENDICES

Appendix D – List of tables

List of tables Page No

Table 1 – Outcome of disciplinary proceedings 45

Table 2 – Staff numbers by employment category 2012-13 to 2015-16 (as at 30 June) 61

Table 3 – Average full-time equivalent staffing 2011-12 to 2014-15 61

Table 4 – Senior Executive Service as at 30 June 2016 62

Table 5 – Remuneration of Senior Executive as at 30 June 2016 62

Table 6 – Training offered and attendees 63

Table A.1 – Complaints received by issue category 2011-12 to 2015-16 113

Table A.2 – Breakdown of complaints received 2015-16 114

Table A.3 – Complaints received about health practitioners 2011-12 to 2015-16 116

Table A.4 – Complaints received about medical practitioners by service area 2011-12 to 2015-16 117

Table A.5 – Complaints received about health practitioners by issue category 2015-16 118

Table A.6 – Complaints received about health organisations 2011-12 to 2015-16 119

Table A.7 – Complaints received about public and private hospitals by service areas 2011-12 to 2015-16 120

Table A.8 – Complaints received about public hospitals by Local Health District in 2011-12 to 2015-16 121

Table A.9 – Issues raised in all complaints received about health organisations by organisation type 2015-16 122

Table A.10 – Issues raised in all complaints received by service area 2015-16 123

Table A.11 – Complaints received by service area 2011-12 to 2015-16 125

Table A.12 – Source of complaints 2011-12 to 2015-16 126

Table A.13 – Location of complainants 2011-12 to 2015-16 126

Table A.14 – Location of health service provider 2011-12 to 2015-16 126

Table A.15 – Issues raised in all complaints received by complainant location 127

Table A.16 – Outcome of assessment of complaints 2011-12 to 2015-16 127

Table A.17 – Outcome of assessment of complaints by issues identified in complaint 2015-16 128

Table A.18 – Outcome of assessment of complaints by most common service area 2015-16 131

Table A.19 – Outcome of assessment of complaints by type of health service provider 2015-16 133

Table A.20 – Time taken to assess complaints 2011-12 to 2015-16 135

Table A.21 – Requests for review of assessment decision 2011-12 to 2015-16 135

Table A.22 – Outcome of reviews of assessment decision 2011-12 to 2015-16 135

Table A.23 – Outcome of complaints referred to the Commission’s Resolution Service 2011-12 to 2015-16 135

Table A.24 – Outcome of conciliations initiated by the Commission’s Resolution Service 2011-12 to 2015-16 136

Table A.25 – Time taken to complete complaints referred to the Commission’s Resolution Service 2011-12 to 2015-16 136

Table A.26 – Outcome of investigations 2011-12 to 2015-16 137

Table A.27 – Investigations into health organisations and health practitioners finalised 2011-12 to 2015-16 138

Table A.28 – Investigations finalised by issue category 2011-12 to 2015-16 139

Table A.29 – Outcome of investigations finalised by profession and organisation type 2015-16 139

Table A.30 – Request for review of investigation decision 2011-12 to 2015-16 140

Table A.31 – Outcome of reviews of investigation decision 2011-12 to 2015-16 140

Table A.32 – Time taken to complete investigations 2011-12 to 2015-16 140

Table A.33 – Legal matters finalised 2011-12 to 2015-16 141

Table A.34 – Open complaints as at 30 June 141

Table A.35 – Number of complaints finalised from 2011-12 to 2015-16 141

Table A.36 – Number of applications by type of applicant and outcome 151

Table A.37 – Number of applications by type of application and outcome 151

Table A.38 – Invalid applications 152

Table A.39 – Conclusive presumption of overriding public interest against disclosure: matters listed in Schedule 1 to Act 152

Table A.40 – Other public interest considerations against disclosure: matters listed in table to section 14 of Act 152

Table A.41 – Timeliness 153

Table A.42 – Number of applications reviewed under Part 5 of the Act (by type of review and outcome) 153

Table A.43 – Applications for review under Part 5 of the Act (by type of applicant) 153


APPENDICES

Appendix E – List of charts

List of Charts Page No.

Chart 1 – Number of complaints received from 2011-12 to 2015-16 10

Chart 2 – Number of assessments finalised from 2011-12 to 2015-16 11

Chart 3 – Number of investigations finalised from 2011-12 to 2015-16 12

Chart 4 – Number of legal matters finalised from 2011-12 to 2015-16 13

Chart 5 – Complaints received 2011-12 to 2015-16 by type of health service provider 14

Chart 6 – Complaints received about health practitioners 2011-12 to 2015-16 16

Chart 7 – Most complained about areas of practice for medical practitioners, 2015-16 17

Chart 8 – Complaints received about health organisations 2011-12 to 2015-16 18

Chart 9 – Most complained about service area in public hospitals, 2015-16 19

Chart 10 – Issues raised in all complaints received 2011-12 to 2015-16 [editing note – please change chart title in body to be 2011-12 not 2010-11] 20

Chart 11 – Most common treatment issues raised in complaints received, 2015-16 21

Chart 12 – Most common communication or information issues raised in complaints received, 2015-16 21

Chart 13 – Most common professional conduct issues raised in complaints received, 2015-16 21

Chart 14 – Issues raised in all complaints received about health practitioners, 2015-16 21

Chart 15 – Issues raised in complaints received about health organisations, 2015-16 21

Chart 16 – Location of complainants 22

Chart 17 – Issues raised by metropolitan and regional complainants, 2015-16 23

Chart 18 – Location of providers 24

Chart 19 – Assessments finalised from 2011-12 to 2015-16 24

Chart 20 – Outcome of assessment of complaints 2011-12 to 2015-16 25

Chart 21 – Outcome of assessment of complaints by health practitioner 28

Chart 22 – Outcome of assessment by health organisation 29

Chart 23 – Outcome of assessment of complaints by most common service area 2015-16 30

Chart 24 – Outcome of assessment of complaints by issues raised 2015-16 31

Chart 25 – Outcome of resolution processes 2011-12 to 2015-16 32

Chart 26 – Investigations received 2011-12 to 2015-16 33

Chart 27 – Investigations received by health service provider 2011-12 to 2015-16 35

Chart 28 – Outcomes of investigations 2011-12 to 2015-16 36

Chart 29 – Complaints referred to Director of Proceedings 36

Chart 30 – Legal matters finalised 2011-12 to 2015-16* 39

Chart 31 – Inquiries received 2011-12 to 2015-16 42

Chart 32 – Outcome of inquiries 2011-12 to 2015-16 44

Chart 33 – Mental health complaints received 48

Chart 34 – Types of health service providers complained about 49

Chart 35 – Issues raised in mental health complaints compared to all complaints 2011-12 to 2015-16 56


APPENDICES

Table A36 – Number of applications by type of applicant and outcome

A

cces

s g

rant

ed in

full

Acc

ess

gra

nted

in p

art

Acc

ess

refu

sed

in fu

ll

Info

rmat

ion

not

held

Info

rmat

ion

alre

ady

avai

lab

le

Ref

use

to d

eal w

ith a

pp

licat

ion

Ref

use

to c

onfi

rm/d

eny

whe

ther

info

rmat

ion

is h

eld

Ap

plic

atio

n w

ithd

raw

n

Media – – – – – – – –

Members of Parliament – – – – – – – –

Private sector business – – – – – – – –

Not for profit organisations or community groups

– – – – – – – –

Members of the public (application by legal representative)

– – – – – – – –

Members of the public (other) _ – – – – – – –

Table A37 – Number of applications by type of application and outcome

Acc

ess

gra

nted

in fu

ll

Acc

ess

gra

nted

in p

art

Acc

ess

refu

sed

in fu

ll

Info

rmat

ion

not

held

Info

rmat

ion

alre

ady

avai

lab

le

Ref

use

to d

eal w

ith a

pp

licat

ion

Ref

use

to c

onfi

rm/d

eny

whe

ther

in

form

atio

n is

hel

d

Ap

plic

atio

n w

ithd

raw

n

Personal information applications – – – – – – – –

Access applications (other than personal information applications)

– – – – – – – –

Access applications that are partly personal information applications and partly other

– – – – – – – –

Appendix F – Access applications received under the Government Information (Public Access) Act


APPENDICES

Table A38 – Invalid applications

Reason for invalidity No of applications

Application does not comply with formal requirements (section 41 of the Act) –

Application is for excluded information of the agency (section 43 of the Act) 15

Application contravenes restraint order (section 110 of the Act) –

Total number of invalid applications received 15

Invalid applications that subsequently became valid applications –

Table A39 – Conclusive presumption of overriding public interest against disclosure: matters listed in Schedule 1 to Act

Number of times consideration used

Overriding secrecy laws –

Cabinet information –

Executive Council information –

Contempt –

Legal professional privilege –

Excluded information –

Documents affecting law enforcement and public safety –

Transport safety –

Adoption –

Care and protection of children –

Ministerial code of conduct –

Aboriginal and environmental heritage –

Table A40 – Other public interest considerations against disclosure: matters listed in table to section 14 of Act

Number of occasions when application not successful

Responsible and effective government –

Law enforcement and security –

Individual rights, judicial processes and natural justice –

Business interests of agencies and other persons –

Environment, culture, economy and general matters –

Secrecy provisions –

Exempt documents under interstate Freedom of Information legislation –


APPENDICES

Table A41 – Timeliness

Number of applications

Decided within the statutory timeframe (20 days plus any extensions) –

Decided after 35 days (by agreement with applicant) –

Not decided within time (deemed refusal) –

Total –

Table A42 – Number of applications reviewed under Part 5 of the Act (by type of review and outcome)

Decision varied Decision upheld Total

Internal review – – –

Review by Information Commissioner* – – –

Internal review following recommendation under section 93 of Act

– – –

Review by Administrative Decision Tribunal – – –

Total – – – * The Information Commissioner does not have the authority to vary decisions, but can make recommendations to the original decision-maker. The data in this case indicates that a recommendation to vary or uphold the original decision has been made by the Information Commissioner.

Table A43 – Applications for review under Part 5 of the Act (by type of applicant)

Number of applications or review

Applications by access applicants -

Applications by persons to whom information the subject of access application relates –


APPENDICES

Page numberAnnual Reports (Statutory Bodies) Act 1984 and Annual Reports (Statutory Bodies) Regulation 2010Letter of submission 02Charter 03Aims and objectives 03Access Inside front coverManagement and structure 60-62Summary review of operations 08-13Funds granted to non-government community organisations The Commission does not allocate funds.Legal change 60Factors affecting achievement of operational objectives 04-05, 08-13Management and activities 30, 06-07, 66, 140-144 Research and development 54Human resources 61-64

Consultants In 2015-16 the Commission engaged consultants on 247 occasions to provide specialist clinical advice to support

assessment and investigation functions (Category - Legal). The total cost for all engagements was $211,096 with all

engagements less than $50,000.Workforce Diversity The Commission reports triennially with the next report due in

2016-17.Disability Inclusion Action Plans The Commission reports triennially with the next report due in

2016-17.Land Disposal The Commission does not own any land.Promotion No overseas visits by employees in 2015-16Consumer response 54-55Payment of accounts 70Time for payment of accounts 70Risk management and insurance activities 64Internal audit and risk management policy attestation 65Disclosure of controlled entities 97-109Multicultural Policies and Services Program The Commission reports triennially with the next report due in

2016-17.Agreements with Multicultural NSW The Commission does not have any agreement with the

Multicultural NSW.Work Health and Safety (WHS) The Commission reports triennially with the next report due in

2016-17.Budgets 76, 102Financial Statements 71-109After balance date events having a significant effect in succeeding year 94,109Annual report external production costs – typesetting of prepared material

$10,000

Annual report availability Electronic copies of this report are available on the Commission’s website www.hccc.nsw.gov.au.

Investment performance The Commission does not have surplus funds to invest.Liability management performance The Commission does not have debts greater than $20m.Exemptions from Reporting Provisions The Commission reports on a triannual basis about Workforce

Diversity, Work Health and Safety, Multicultural Policies and Services Program, and Disability Plans, with detailed reports to

be include in the 2016-17 Annual Report

Appendix G – Index of legislative compliance


APPENDICES

Page numberNumbers and remuneration of senior executives 62Disability Inclusion Act 2014Disability Inclusion Action Plans The Commission reports triennially with the next report due in

2016-17.

Government Information (Public Access) Act 2010 (GIPA)Annual report of GIPA operations 66, 149-151

Health Care Complaints Act 1993The number and types of complaints made during the year 10, 14-25, 111-139The sources of those complaints 24-25, 124The number and types of complaints assessed by the Commission during the year

11, 28-33

The number and type of complaints referred for conciliation during the year

125-132

The results of conciliations 134The number and type of complaints investigated by the Commission during the year

135-137

The results of investigations 135,137Summary of the results of prosecutions completed during the year arising from complaints

44-45

The number and details of complaints not finally dealt with at the end of the year

139

The time intervals involved in the complaints process 133, 134, 138The number and type of complaints referred to the Director-General during the year

There were no complaints referred under section 25

Any report made to the Minister under section 44 (2) No report was made to the Minister under section 44(2)Any notification and request made to the Director-General under section 60.

There were no notifications or requests made to the Director-General under section 60.

Privacy and Personal Information Protection Act 1998 Privacy 54

Public Interest Disclosure Act 1994 and Public Interest Disclosure Regulation 2011 Public interest disclosures 66

Other requirements Digital information security annual attestation statement 68Credit card certification In accordance with Treasurers’ Direction 205.01, it is certified

that the credit card usage by officers of the Commission has complied with Government requirements

Health Care Complaints Commission Annual Report 2015-16

Published by the Health Care Complaints Commission 2016

ISBN 978-0-9808155-5-9

HEALTH CARE COMPLAINTS COMMISSION Annual Report 2015-16

Documents

Transcript of HEALTH CARE COMPLAINTS COMMISSION Annual Report 2015-16