Complaint process

The earlier a complaint is raised, the greater the chance of achieving a good resolution. If you would like to make a complaint about a health or disability service, we suggest that you consider the following options:

Assessment of your complaint

Your complaint to HDC will be assessed by complaints resolution staff, and a Complaints Assessor assigned to your complaint. Your Complaints Assessor will contact you if more details are needed, and will answer any questions about your complaint. 

Most contact about your complaint will be from your Complaints Assessor, but you may also be contacted by other members of the Commissioner's staff, for example another Complaints Assessor, an Administrative Assistant, or a Legal Advisor. You can also expect to receive correspondence from the Commissioner and/or one of the Deputy Commissioners. Generally, decisions that may be made by the Commissioner may also be made by the Deputy Commissioners.

Complaints assessment process

There are a number of steps involved in assessing a complaint, and the steps will vary depending on the circumstances. Usually we will do one (or more) of the following:

  • Assess your complaint to determine whether it is something that the Commissioner can look at (that is, whether the Commissioner has jurisdiction).

  • Send a copy of your complaint to the provider of the health or disability service (the person and/or organisation you are complaining about), and ask the provider for a response.

  • Ask you and/or other relevant people and/or organisations for additional information, for example we may ask the relevant District Health Board for a copy of your medical records. Sometimes a number of requests for additional information are necessary.

  • Ask an independent expert to review your care and advise the Commissioner about clinical aspects of the services you received.

The complaints assessment process may take anywhere from a few days to several months, depending on the complexity of your complaint (such as whether it is about several different providers) and the issues that arise during our assessment.

In most cases, this part of our process will be completed within six months. Your Complaints Assessor will keep you updated about progress in assessing your complaint, and you can expect to hear from us at least once every two months during this time.

Possible outcomes

At any time during the complaints assessment process, the Commissioner may decide to do a number of things. Most commonly, the Commissioner will do one (or more) of the following:

  • Send the complaint to an independent advocate to assist you with resolving your complaint directly with the provider of the service (the outcome of these referrals will be reported back to HDC).

  • Send the complaint to the provider of the health or disability service for resolution between yourself and the provider (the outcome of these referrals will be reported back to HDC).

  • Take an educational approach, and ask for an apology or recommend action.

  • Send the complaint to another agency, such as the Ministry of Health, a registration authority (such as the Medical Council of NZ), the Privacy Commissioner, or a Mental Health District Inspector.

  • Formally investigate your complaint.

  • Take no further action on your complaint (if, for example, the provider has already addressed the issues, the events occurred a long time ago, or someone else could deal with it better).

The Commissioner may also suggest to you other things you could do to try to resolve your complaint (for example, going to the Disputes Tribunal to recover money you may be owed).

You will receive a written explanation about any such decisions and actions taken by the Commissioner.

Case studies demonstrating the possible outcomes are available in our most recent Annual Report.

Financial compensation

The Commissioner does not have any power to award compensation or require a provider to give you a refund. However, some people who have suffered a personal injury as a result of their treatment may be entitled to ACC compensation. If you think you are entitled to accident compensation, please raise this directly with ACC.

Formal investigation

In a small number of cases, the Commissioner may decide to conduct a formal investigation.  

Before commencing an investigation, HDC will inform the consumer/complainant and the provider (ie. the person and/or the organisation you are complaining about) of the intention to investigate, and will advise the provider of the details of the complaint. HDC must also let the provider know of the right to submit a written response to the complaint.

If your complaint is to be investigated formally, it will be assigned to an Investigator, who will become your primary point of contact. The Investigator will identify the facts to be proved (such as what happened, when, where, and so on), collate relevant evidence, and present it to the Commissioner or Deputy Commissioner who has been delegated the investigation for his or her consideration.

During an investigation, HDC may consider oral evidence obtained during interviews with witnesses and parties, and documentary evidence such as correspondence, clinical notes, policy and practice manuals, and any other relevant evidence such as labelled medication containers.

Where the quality of care is an issue, HDC will obtain independent expert advice from a peer of the provider with knowledge of, and experience in, the matters under investigation.

After an investigation, the Commissioner or Deputy Commissioner forms an opinion on whether the provider has breached the Code of Rights, and notifies the parties of his or her provisional findings. If the provisional finding is adverse to any provider, the provider will be given an opportunity to make a written submission. The consumer/complainant will usually be given an opportunity to review and comment on the "information gathered" section of the provisional report.

The Commissioner or Deputy Commissioner forms and reports his or her final opinion after consideration of any responses to the provisional report and any further expert advice that has been obtained.

Learning from an investigation

While distribution of HDC's final opinion signifies the end of an investigation, the Act provides HDC with a range of options for using the report to promote change, both in respect of the conduct of individual providers and in the sector generally.

Recommendations may be made to the provider, the appropriate authority (for example, a registration body), the Director-General of Health (the Ministry of Health), or any other person or organisation HDC thinks fit, including professional colleges, district health boards, ACC, and consumer and provider groups. In cases where the Commissioner has found a breach of the Code, often an anonymised copy of the report is placed on the HDC website, for educational purposes.

Outcome of an investigation

Recommendations to providers vary from case to case, but may include a written apology to the consumer; undertaking specific training; and implementing and reviewing systems to prevent further breaches of the Code.

When any recommendations are made, HDC follows up to confirm that they have been implemented.

Where an investigation suggests that there may be concerns about the competence of a registered health practitioner, HDC may recommend to the registration authority (for example, the Medical Council for a doctor) that it consider whether a review of the practitioner's competence is warranted.

It is important to note that not all issues that are investigated lead to a finding that there has been a breach of the Code. Sometimes, even after an investigation, it is still not clear what happened, and no further action is taken.

Director of Proceedings

In a very small number of cases, the Commissioner or Deputy Commissioner may refer the matter to the Director of Proceedings, to consider whether to bring disciplinary and/or other proceedings.