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Do you wish to make a: Required
Hospital: Required
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Your details

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Address: Required
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Made on behalf of: Required

Service user details (if different from above):

Address:
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Please be aware your complaint/concern will not be reviewed until it reaches the central Complaints department. If you need to speak to someone more urgently, then please inform a member of staff or call our crisis team on NHS 111 (selecting option 2).

Equality and Diversity Monitoring Form

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (the Trust) has a public duty to promote race equality, disability equality and gender equality. The Equality Act 2010 extends equality legislation to fully cover the following issues.

Race
Age
Disability (including reasonable adjustments)
Sexual Orientation
Sex
Religion or Belief
Maternity and Pregnancy
Marriage and Civil Partnership
Gender Reassignment, expression and identity


The Trust as a responsive service provider wishes to monitor equality and diversity information provided by those making complaints. All the information we receive will be used and treated with the strictest confidence. Any information released will be anonymous with all names removed.

There is no obligation to complete this section, but any information that you can provide will help us to provide a better service.

A.  Disability

The Equality Act 2010 protects disabled people. The Act sets out the circumstances in which a person is ‘disabled’. It says you are disabled if you have:

A mental or physical impairment that has an adverse effect on your ability to carry out normal day-to-day activities (meaning it has lasted 12 months, or is likely to last for 12 months or more)

There are some special provisions, for example:

If your disability has badly affected your ability to carry out normal day-to-day activities, but it doesn’t anymore, it will still be counted as having that effect if it is likely to do so again.

If you have a progressive condition and it will badly affect your ability to carry out normal day-to-day activities in the future, it will be treated as having a bad effect on you now.

Cancer, HIV infections, and multiple sclerosis are covered effectively from the point of diagnosis. Past disabilities are covered.

C

Taking this into consideration, do you consider yourself to have a disability?
Are there any reasonable adjustments that you would like us to consider in order to improve and support communications?

B. Ethnicity

Please note we are not asking about citizenship or nationality, but about the ethnic group to which you feel you belong. If you feel you are descended from more than one group, please tick the one you feel you most belong to, or choose the ‘Any other ethnic group’ option.

Please tick:
C. Sex
D. Sexual Orientation
E. Religious Belief
F. Marriage or Civil Partnership
Required

Consent Guidance

A patient’s health information is personal and can often be very sensitive, both about them and sometimes about other people, including family members and carers.  It is therefore important that information is protected and kept confidential and only disclosed to other people when the patient has agreed they are happy for this to happen.

A patient can give their consent for another person to act on their behalf in respect of a complaint (if they have the mental capacity to make this decision).

It is best practice for consent for the complaint to be dealt with by another person, on behalf of a patient, to be obtained in writing.  In this respect, the complaints department will write to the person who is making the complaint to ask if they are happy for a copy of their complaint letter to be sent to the patient.

If the complainant is not agreeable to this, where possible the complaint, or parts of the complaint, will be responded to in general terms, i.e. without providing specific details from the health records about the patient’s care and treatment. 

If the complainant is agreeable to this, a copy of the complaint letter and a consent form for the patient to sign will be sent from the complaints department.   On receipt of the signed consent form, the complaints department will arrange for the investigation into the concerns raised to commence.  The investigation therefore cannot start until the patient has returned the consent form which will increase the length of time required in which to provide a response.

If the patient refuses to give consent or does not return the consent form, where possible the complaint, or parts of the complaint, will be responded to in general terms, i.e. without providing specific details from the health records about the patient’s care and treatment.

Complaints on behalf of young people (aged 13 years of age and over)

Once children reach the age of 13, under Data Protection Act 2018, they are presumed in Law to be competent in relation to providing consent to information sharing for the purpose of investigating and responding to a complaint. Therefore, the complaint can only be managed by another person if the young person has given their consent for this. Where there is concern regarding the capacity of a young person over the age of 13, consent may be provided by an individual with parental responsibility.

Where a service user is over the age of 16, consent cannot be given by an individual with parental responsibility. If there is concern regarding capacity, this would be dealt with under the provisions of the Mental Capacity Act 2005.

Complaints on behalf of children (aged 12 years or under)

With regard to children aged 12 years or younger, their competence to deal with a complaint themselves needs to be assessed. Unlike adults, there is no presumption with regard to competence and a judgement must be made by the clinical team on a case-by-case basis.

If the outcome of this assessment is that the child is competent  to consent to information sharing for the purpose of investigating and responding to their complaint, then the complaint can only be managed by another person (including someone with parental responsibility) if the child has given their consent for this.