The Health Select Committee’s 2011 inquiry into Complaints and Litigation recommended that the Government undertake a review of the NHS complaints system. It also made recommendations about the roles of the Ombudsman, advice and advocacy services, providers and commissioners, and about the co-ordination and monitoring of complaints handling across the NHS. In its response to the Committee’s report, the Government accepted that “whilst some NHS organisations respond quickly and effectively to complaints, others are not so effective”, and agreed that “the NHS can do more to improve complaints handling.”
The period since the publication of the Committee's report into Complaints and Litigation has seen the implementation of the Health and Social Care Act 2012; the publication of the Francis report; and, in October 2013, the publication of the Clwyd-Hart Review of the NHS Hospitals Complaints System. The Parliamentary and Health Services Ombudsman has also recently published research on NHS hospital complaints. The Government provided its formal response to the Francis report in November 2013.
As well as complaints and concerns made by patients and members of the public, the Francis report has also highlighted the related issue of the way in which complaints and concerns raised by staff within health and care organisations were handled.
Terms of Reference
With this in mind, the Committee has decided to review progress in improving the handling of complaints from patients and the public, and concerns raised by staff. Specifically, the inquiry will consider:
Handling of complaints made by patients and families about care received in the health and care sectors, including both primary and secondary care providers;
Handling of concerns raised by staff about care given in the health and care sectors;
The extent to which the findings of recent inquiries have been incorporated into the complaints process;
Support for patients, the public and staff who wish to make complaints or raise concerns;
The consequences of complaints for care providers and of raising concerns for the employment prospects of staff;
Openness about complaints and concerns, and accessibility of information;
The role of commissioners, system regulators and professional regulators with regard to complaints and concerns;
The operation of the Public Interest Disclosure Act 1998 in relation to health and social care;
Future plans for improvements in this area.
Royal College of Physicians of Edinburgh
Written submission to UK Parliament Health Committee: Complaints and raising concerns
The Royal College of Physicians of Edinburgh (“the College”) has 50% of its UK Fellows and members working in the NHS in England, and welcomes the opportunity to respond to this call by the Health Committee for written submissions on complaints and raising concerns.
Handling of complaints made by patients and families about care received in the health and care sectors, including both primary and secondary care providers
Fellows of the College have reported that complaints and feedback are increasingly welcomed by secondary care providers. There also appears to be an apparent rise in the number of complaints, which may be partly due to an increasing work load/ throughput in the NHS, and more awareness about the complaints procedure amongst patients and carers rather than a rising percentage of complaints due to poor care: good Trusts that actively seek feedback are more likely to receive it.
Fellows and members working in the NHS feel that the staff time and resource allocated to deal with complaints should be reviewed, as clinical staff are stretched and middle grade managers are scarcer. The College feels that aiming to promote a culture of compassion and transparency will assist in ultimately reducing the number of complaints, however many complaints are related to issues such as nursing numbers and old hospital estate which would need to be addressed on a wider basis.
Due to financial restrictions, managers in secondary care must make difficult decisions to find cost savings, and non-essential aspects of a patient’s care are more likely to be reviewed as a result. However, it is often these non-essential aspects of care, for example a hairdresser coming to an elderly care ward, which improve the quality of care and enhance a patient’s experience.
The role of commissioners, system regulators and professional regulators with regard to complaints and concerns
Complaints within the hospital sector must comply with national standards in terms of investigation and response. Some of these complaints require the Ombudsman to assess when the patient / family feel that their concerns have not been addressed. If a Trust had to report publically how many complaints it had received and how many had gone to the Ombudsman then it may encourage Trusts to look at a speedy resolution of the problem.
Openness about complaints and concerns, and accessibility of information
We are living in a litigatious society, where for example, there are regular radio adverts from lawyers looking to find clients who may have suffered a mishap in hospital. The legal route is tortuous, lengthy and expensive with perhaps the plaintiff not getting what they want in the first place: an apology. When a patient feels that they have suffered harm, they often threaten legal action. To avoid the growing threat of litigation, hospitals need to be more open even when threatened with legal action by the patient / family.
Handling of concerns raised by staff about care given in the health and care sectors; and the consequences of complaints for care providers and of raising concerns for the employment prospects of staff;
The reporting system of incidents in hospitals has been designed to capture vital demographic data; often a consultant may spend 10 – 15 minutes filling in an electronic form that is not user friendly for the medical staff. This discourages reporting of incidents apart from the most serious. Feedback of these incident reports are often not seen by the clinician who has reported them, which leads to a sense of frustration. Senior medical staff may also contact management, detailing their concerns; however medical staff can be reluctant to do this as they fear being labelled a trouble maker.
It would be helpful to have the obligations of raising concerns in professional codes being confirmed at interview, at induction and in appraisal, for all staff in order to raise confidence in the process of raising concerns. It would also be helpful for staff to have clear statements from Boards regarding their policy on whistleblowing.
Future plans for improvements in this area
The College feels that in order to see real improvements there needs to be cultural change in hospitals, to promote openness and transparency along the key principles of Francis and the NHS Constitution. This latter document also outlines the obligations upon patients, and the College feels it would be beneficial to both staff and patients if the level of care a patient can expect is clearly understood and acknowledged by all parties.