Making a complaint

30 Jan

People are able to complain about the services that they have received from health service providers.

There are two main bodies that receive complaints about health services in Victoria. They are:

the Australian Health Practitioner Regulation Agency (Ahpra), which is responsible for the registration of 16 kinds of health professions in Australia; and
the Victorian Health Complaints Commissioner (HCC), which is responsible for maintaining standards in the health professions which are not registered by Ahpra; and seeking to resolve complaints about health service providers of all kinds.

Other specialised bodies can receive complaints about particular kinds of health service providers.

Further, some Victorian health service entities must follow the ‘statutory duty of candour’ process when some serious adverse patient safety events occur.

Ahpra provides support to 15 ‘national boards’ which regulate the following 16 professions across Australia:
- Aboriginal and Torres Strait Islander health practitioners;
- Chinese medicine practitioners;
- chiropractors;
- dental practitioners (including dentists, dental hygienists, dental prosthetists and dental therapists);
- medical practitioners;
- medical radiation practitioners;
- nurses and midwives;
- occupational therapists;
- optometrists;
- osteopaths;
- paramedics;
- pharmacists;
- physiotherapists;
- podiatrists; and
- psychologists.
The regulatory scheme is established by each state and territory passing similar (but not identical) legislation. Each board’s primary role is to protect the public by setting and enforcing standards and policies that all registered health practitioners must meet.
Ahpra supports the national boards in implementing the national scheme in accordance with the Health Practitioner Regulation National Law, including by receiving and investigating complaints – called ‘notifications’ – about health practitioners in the nationally regulated professions listed above.
Ahpra cannot receive complaints about other kinds of health practitioners. Nor can it receive complaints about health service organisations (such as hospitals or medical clinics).
The national boards may decide to take action against a registered practitioner if the national board is satisfied that the practitioner’s conduct is a departure from accepted standards or that the practitioner’s health might pose a risk to the public.
The notification process can result in a practitioner being cautioned or reprimanded, their registration being made subject to conditions (such as being required to undertake education) or – in the most serious cases – referred to VCAT – seeking cancellation or suspension of their registration.
Explanations, apologies, refunds or compensation, access to medical records or changes in policy are not available to complainants in the notifications process.
Ahpra has a range of resources available on its website that explain the kinds of notifications it does and does not receive, the process for handling notifications and the possible outcomes.
The HCC is an independent and impartial statutory body established under the Health Complaints Act 2016 (Vic) (‘HC Act’). The HCC:
- resolves complaints about health services and the handling of health information in Victoria;
- investigates providers who pose a serious risk to the health, safety or welfare of the public;
- monitors and reviews trends in complaints data;
- provides an accessible service that is a free alternative to legal proceedings; and
- educates consumers and providers about their rights and responsibilities.
A person may make a complaint to the HCC about the health services that they have (or have not) received. The HC Act establishes that health services should attempt to resolve matters in the first instance and that anyone can make a complaint to the HCC (e.g. a consumer, carer, or a third party).
A complaint can be made via telephone, the online complaint form, in writing, and in person.
The HCC may attempt to resolve a complaint by seeking a response from the health practitioner or engaging in other more formal processes, such as conciliation.
The HCC can also investigate complaints they reasonably believe should be investigated and:
- the complaint is not suitable for a complaints resolution process; or
- the complaints resolution process has not been successful; or
- the health service provider, without a reasonable excuse, does not participate in the complaints resolution process; or
- there has been a contravention of the General Code of Conduct for ‘general health service providers’ (providers who are not regulated by Ahpra and the national boards).
Further information about the HCC’s role can be found on the HCC’s website.
Other specialised bodies can receive complaints about particular kinds of health service providers. For example:
- the Victorian Mental Health and Wellbeing Commission may receive complaints from mental health and wellbeing service ‘consumers’ about a mental health and wellbeing service (www.mhwc.vic.gov.au) (See also Chapter 8.4: Mental illness);
- the Aged Care Quality and Safety Commission may receive complaints about the quality of Commonwealth funded aged care (www.agedcarequality.gov.au);
- the Quality and Safeguards Commission may receive complaints about providers of supports under the National Disability Insurance Scheme (www.ndiscommission.gov.au) (see also Chapter 8.2: Understanding the National Disability Insurance Scheme; and
- where there has been a significant problem with management of a public health service or a private hospital or day procedure centre, a complaint may be made to the Victorian Government Department of Health (see ‘Contacts’ at the end of this chapter).
Under the HS Act, some kinds of Victorian ‘health service entities’ (including public hospitals, denominational hospitals, private hospitals and day procedure centres) are subject to a ‘statutory duty of candour’ that requires them to provide a patient who has suffered a ‘serious adverse patient safety event’ (SAPSE) or the patient’s next-of-kin/carer with:
- a written account of the facts regarding the SAPSE;
- an apology for the harm suffered by the patient;
- a description of the health service entity’s response to the event; and
- the steps that the health service entity has taken to prevent re-occurrence of the event.
A SAPSE is defined in the Health Services (Quality and Safety) Regulations 2020 (Vic) as an event that occurred while the patient was receiving health services from a health service entity and that in the reasonable opinion of a registered health practitioner, has resulted in, or is likely to result in, unintended or unexpected moderate, severe or prolonged psychological harm to the patient.
A patient, or their next-of-kin/carer may opt out of the statutory duty of candour process.
Further information about the statutory duty of candour is available on Safer Care Victoria’s website (www.safercare.vic.gov.au).