Complaints against health and community services

This section provides information about the scope and function of, and complaints to, the following:

  • Australian Health Practitioner Regulation Agency
  • Health and Community Services Complaints Commissioner
  • Aged Care Complaints Scheme

Australian Health Practitioner Regulation Agency

The Australian Health Practitioner Regulation Agency (AHPRA) is the organisation responsible for the registration and accreditation of 10 health professions across Australia.

AHPRA supports the 14 National Boards in implementing the National Registration and Accreditation Scheme.

National Boards

Each health profession that is part of the National Registration and Accreditation Scheme is represented by a National Board.

While the primary role of the Boards is to protect the public, the Boards are also responsible for registering practitioners and students, as well as other functions, for their professions.

The 14 National Boards are:

All Boards are supported by AHPRA.

Complaints to AHPRA

AHPRA can investigate complaints about the conduct, health and performance of a registered health practitioner.

Activities considered as breaches of professional conduct are categorised as professional misconduct, unprofessional conduct, and notifiable contact. Practitioners are health impaired if they have a physical or mental impairment, disability, condition or disorder that detrimentally affects, or is likely to detrimentally affect their capacity to practise their profession. The professional performance of a registered practitioner is defined to be unsatisfactory if it is below the standard reasonably expected of a practitioner of an equivalent level of training or experience.

Notifications (includes Complaints)

Members of the public may make a notification or complaint to AHPRA about the conduct, health or performance of a practitioner or the health of a student.

Practitioners, employers and education providers are all mandated by law to report notifiable conduct relating to a practitioner or student. Registered practitioners who fail to report notifiable conduct may face disciplinary action by their National Board.

AHPRA Complaints Process

AHPRA will assess all notifications/complaints to determine whether a Board must consider taking immediate action to protect public health or safety.

This may result in changing the registration status of a student or practitioner. If immediate action is not required, AHPRA will asses the notification thoroughly to enable the relevant Board to make an informed decision about it. Each investigation is tailored to the complaint received, and complex matters take more time. AHPRA aims to complete most investigations within six months. 

 

Stages of the Notification/Complaint Process

All notifications/complaints pass through stages 1-2, and depending on the outcome of the preliminary assessment may pass through any of the following stages, 3-5. 

 

Stage 1: Receipt of Notification/Complaint

AHPRA receives notification/complaint either by online form, hardcopy form (295 KB,PDF), letter or telephone. 

Stage 2: Preliminary Assessment

A preliminary assessment determines if the matter will be handled by AHPRA or referred to another health complaints entity.

Preliminary Assessment Outcome

The outcome of the preliminary assessment may be for the Board to:

  • take immediate action on the practitioner’s or student’s registration
  • investigate the notification
  • request a health assessment of the practitioner or student or a performance assessment of the practitioner
  • refer the matter to a health or performance panel hearing
  • refer the matter to a tribunal hearing
  • issue a caution
  • accept undertakings
  • impose conditions
  • take no further action

 Stage 3: Investigation

An investigation may need to be conducted to determine the appropriate course of action, which may be to:

  • take immediate action 
  • request a health or performance assessment
  • refer matter to a health or performance panel hearing
  • refer matter to a tribunal

A decision may be made to:

  • issue a caution
  • accept undertakings
  • impose conditions
  • refer all or part of the notification to another body
  • take no further action

Where an undertaking or condition applies, the registrant will be subject to monitoring to ensure compliance.

Stage 4: Panel Hearing

A panel hearing will be conducted to determine the appropriate course of action, which may be to:

  • refer to a tribunal

A decision may be made to:

  • issue a caution or reprimand (performance and professional standards panel only)
  • impose conditions
  • refer to another body
  • suspend (only by a Health Panel)
  • take no further action

Where an undertaking or condition applies, the registrant will be subject to monitoring to ensure compliance.

Panel hearing outcomes are published.

Stage 5: Tribunal Hearing

A tribunal hearing will be conducted to determine the appropriate course of action, which may be to:

  • issue a caution or reprimand
  • impose conditions
  • fine registrant
  • suspend registration
  • cancel registration
  • take no further action

Where an undertaking or condition applies, the registrant will be subject to monitoring to ensure compliance.

Tribunal hearing outcomes are made available to the public.

Telephone 1300 419 495 8am to 6pm (EST), Monday to Friday

Health and Community Services Complaints Commissioner (SA)

The Health and Community Services Complaints Commissioner (HCSCC) is an independent statutory authority established under the Health and Community Services Complaints Act 2004 (SA). The role of the HCSCC is to help people to resolve complaints about health and community services where a direct approach to the service provider is either unreasonable, or has not succeeded. It covers health and community services across the public, private and non-government sectors.

The HCSCC assists service users and carers who wish to complain about health and community services. In certain circumstances, it will also deal with complaints made on behalf of another person. The HCSCC also assists service providers to respond to complaints. The HCSCC is obliged by law to treat everyone involved in a complaint equally.

The HCSCC may be able to deal with complaints about:

  • any aspect of access, administration, behaviour, communication, individual rights or treatment
  • a community health centre, health clinic, hospital, nursing home, private clinic, supported accommodation, or any other place, or person providing a health or community service
  • health care and treatment received from all kinds of practitioners. Examples include registered health professionals, such as doctors, nurses and dentists, as well as unregistered health practitioners such as naturopaths, therapeutic masseurs, homeopaths, Reiki practitioners. (The HCSCC can investigate compliance with the Code of Conduct for Unregistered Health Practitioners and make orders imposing conditions upon, or prohibiting service, see above for futher information)
  • child protection services and investigations

HCSCC can help to resolve complaints:

  • about services sought, used or received from a community service, community service provider, health professional, health service or health service provider
  • that started within the last 2 years
  • made by almost anyone over 16
  • made orally or in writing.

HCSCC cannot handle complaints about :

  • incidents that happened over 2 years ago, unless an extension of time is granted
  • a matter that has commenced before a court
  • a matter that has already been determined by a court, tribunal, authority, or other person or body acting under a law
  • a decision of a court or a tribunal
  • a death once the Coroner has started an inquest
  • actions of government ministers or politicians
  • actions of private individuals
  • employment disputes

How to complain

The HCSCC recommends that it is often most effective to complain to the provider first. They provide some guidelines as to the suggested process for making a complaint to the provider. If the provider does not respond, or if the complainant feels that the response is unsatisfactory, they may contact the HCSCC by telephone or by completion of a complaint form. See more on their website: http://www.hcscc.sa.gov.au/making-a-complaint/.

The telephone enquiry service provides advice in relation to the complaints process. Interpreters are available. The HCSCC may require the complainant to provide further information or documents in relation to a complaint, or to verify the complaint by statutory declaration.

The HCSCC also provides guidelines to assist service providers to respond to a complaint.

How complaints are resolved

The HCSCC may use one or more of a broad range of alternative dispute resolution processes including informal mediation, investigation and conciliation. There is flexibility in adopting the most appropriate process for a particular matter. Any agreement reached in the course of a conciliation process may be made in a binding form.

Information disclosed in a conciliation process is confidential and cannot be used as a process of discovery for potential litigation.

If, after investigating a complaint, the HCSCC decides that the complaint is justified but appears to be incapable of being resolved, the HCSCC may recommend that the service provider take particular action to remedy the grievance. The complainant may be notified of the recommendation.

Code of Conduct for Unregistered Health Practitioners

Since 14 March 2013 health practitioners who provide a service which is not registrable through AHPRA must comply with the Code of Conduct for Unregistered Health Practitioners [Health and Community Services Complaints Regulations 2005 (SA) Sch 2]. Examples of unregistered practitioners include alternative health therapists, paramedics, disability support workers, counsellors and social workers.

These practitioners must display evidence of their qualifications, a copy of the "plain English" version of the Code and information about how clients can make a complaint to the Health and Community Services Complaints Commissioner [reg 5B].

What can the HCSCC do if the code is breached?

The Commissioner may commence an investigation upon receipt of a complaint or on his or her own motion [Health and Community Services Complaint Act 2004 (SA) s 43].

If the Commissioner has commenced an investigation and has a reasonable belief that the practitioner has breached the Code of Conduct (and it is necessary to protect the health or safety of members of the public) he or she may impose conditions on the practitioner's provision of service or prohibit the pracitioner's service for up to 12 weeks [s 56B].

If the Commissioner has completed an investigation and is satisfied that the practitioner has breached the Code of Conduct (and poses an unacceptable risk to the health or safety of members of the public), he or she may impose conditions on the practitioner's provision of service or prohibit the practitioner's service for a specified period or indefinitely [s 56C]. If such an order is made, the Commissioner must provide the practitioner (and any complainant) with a written statement outlining the Commissioner's findings, any material on which the findings were based and the reasons for the action [s 56D].

The Commissioner may publish a public statement identifying the practitioner and giving warnings or such other information the Commissioner considers appropriate. See, for example, the HCSCC's website here.

The Commissioner may at any time vary or revoke the orders made and/or statement published.

A practitioner may appeal orders made and/or any statement published to the Administrative and Disciplinary Division of the District Court [s 56E]. A time limit applies, but may be extended by the Court.

Aged Care Complaints Scheme

Complaints against aged care service providers (which are subsidised by the Australian Government) can be made to the Aged Care Complaints Scheme (the ACCS).

The ACCS can inform whether or not a particular provider is subsidised.

Aged care service providers subsidised by the Australian Government must:

  • be accredited by the Australian Aged Care Quality Agency; and
  • meet the responsibilities and standards of care set out in the Aged Care Act 1997 (Cth).

In 2011, the Complaints Investigation Scheme was renamed the Aged Care Complaints Scheme and a new complaints framework was created by the Complaints Principles 2011 (Cth).

Consumers (or their representatives) are encouraged to attempt to raise any concerns with the aged care service provider in the first instance. If they are unable to do this or the provider is unable to resolve their concern, they should then contact the Aged Care Complaints Scheme on 1800 550 552 or submit a complaint online. Complaints may be confidential and/or anonymous.

The ACCS can consider complaints relating to providers responsibilities under the Aged Care Act 1997 (Cth). Complaints may relate to care generally, communication, choice of activities, catering, accommodation and facilities or discirimination.

Complaints may be resolved using one or more of the following methods:

  • the provider's processes for complaint resolution
  • conciliation
  • mediation
  • investigation

Possible outcomes may include:

  • the circumstances giving rise to the complaint are addressed;
  • the ACCS issues a direction to the provider to demonstrate how they wil meet their responsibilities;
  • the ACCS refers the complaint to the Department of Health and Ageing Compliance Section for action;
  • no further action (this may occur if, for example, the circumstances are the subject of other legal proceedings).

If a consumer (or their representative) are not satisfied with the outcome of their complaint, they may request a review, stating the reasons for the request, within 28 days of receiving the decision letter from the ACCS.

If a consumer (or their representative) are not satisfied with the way their complaint has been handled by the ACCS or, after review, are still not satisfied with the outcome, they may then submit a complaint to the Aged Care Commissioner (time limits apply). For more information about submitting a complaint to the Aged Care Commissioner, see the Commissioner's website or telephone 1800 500 294.

Complaints are managed in accordance with the Aged Care Complaints Scheme Guidelines. For more information, see the FAQs and Resources pages of the ACCS website.

Medicare

Medicare is administered by the Commonwealth Government under the Health Insurance Act 1973 (Cth).

Complaints about Medicare and medical refunds can be made by telephoning the Department of Human Services Medicare and Centrelink Feedback and Complaints line on: 1800 132 468 or online at the Department of Human Services website: http://www.humanservices.gov.au/customer/information/feedback-complaints?utm_id=9

Australian Health Practitioner Regulation Agency  :  Last Revised: Fri Jan 22nd 2016
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