Health and Disability Commissioner Annual Report
Health and Disability Commissioner Annual Report 2005
Monday 7 November
Early resolution of complaints
The 2004/05 Annual Report of the Health and Disability Commissioner underscores the shift to earlier resolution of patients' complaints enabled by law changes in September 2004. New options include referring the matter to the provider for resolution, or calling a mediation conference, without the need for formal investigation.
Commissioner Ron Paterson says that "the new legislation strikes a sensible balance between early resolution for individuals, and protection of the public in cases where notification to relevant authorities or full investigation is necessary".
The Commissioner commends most District Health Boards for their commitment to early resolution of complaints and their recognition of the importance of open disclosure following an adverse event, and greater willingness to acknowledge shortcomings, apologise where appropriate, and take steps to remedy the situation.
Mr Paterson comments that "the recent changes to ACC's coverage of adverse medical events (with the move to a genuine 'no fault' system from 1 July 2005, covering any 'treatment injury'), combined with HDC's track record of fair processes and credible decisions, have contributed to a constructive medico-legal environment where providers have no legitimate reason to resort to defensive medicine or obstructive responses to complaints".
- Slight drop in all complaints to HDC: 1,124 in 2004/05 from 1,142 in 2003/04 - GPs dominate complaints about individual providers (33%) - Public hospitals dominate complaints about group providers (61%) - Record low number of open HDC files: 313 at 30 June 2005 § 82% of 4,448 complaints received by Nationwide Advocacy Service partly or fully resolved, 91% within three months - 79% of all complaints to HDC closed within six months - 15% of all complaints proceeded to formal investigation of alleged individual or systemic failures § 111 cases under investigation (compared with 500 in 2000) - 172 investigations completed, with 41% resulting in a finding of breach of the Code of Health and Disability Services' Consumers' Rights.
Most breaches of the Code related to deficiencies in assessment and treatment, lack of care co-ordination, poor communication and inadequate record-keeping. Major shortcomings in care or communication, or unethical practice are referred to the Director of Proceedings for consideration of further proceedings. In 2004/05 there was a decline in referrals to the Director of Proceedings to 14 (compared with 18 in 2003/04).
The Tauranga Hospitals Inquiry was the most significant inquiry in 2004/05. The Commissioner's report emphasises the legal obligation of employers to monitor and maintain the competence of their employees, to protect patients: "Employers of health practitioners need to have effective processes in place to enable them to respond decisively to any concerns about an employee's practice, in a co-operative and co-ordinated manner. Patient safety must be the paramount consideration."
A survey of 1,500 members of the public in November 2004 found that 72% were aware that health and disability services consumers have rights. This figure suggests an increasing awareness of consumer rights amongst the general public - in the last survey (in 1998) only 35% of service users knew they had rights.
Efforts are being made to target groups identified as having low awareness of the Health and Disability Commissioner and the Code of Health and Disability Services Consumers' Rights, including people of Maori and Asian ethnicity, older people, and people receiving mental health services. Educational initiatives are also being developed in the disability sector as part of HDC's response to the New Zealand Disability Strategy.
The Code of Health and Disability Services Consumers' Rights is a regulation under the Health and Disability Commissioner Act 1994. It confers a number of rights on all consumers of health and disability services in New Zealand, and places corresponding obligations on the providers of those services, including hospitals.
The Annual Report 2004/05 is available on the Health and Disability Commissioner website at www.hdc.org.nz.