Are private patients in the NHS at a disadvantage when they complain? A blog by Vivienne Heckford

Summary

In this blog, Vivienne Heckford, NHS PPU Lead at ISCAS (the Independent Sector Complaints Adjudication Service), highlights how many NHS private patients are at a disadvantage if they wish to make a complaint about the healthcare they have received, and asks why only a small proportion of NHS Private Patient Units (PPUs) are signed up to external review systems.

Content

Patient and customer complaints in healthcare are not the most exciting issues to discuss or even address. We would all much rather respond to and publicise the compliments we receive. We like to believe we deliver expert care and that our patients receive the best outcomes and the highest standard of care.

However, we know that is not always the case. Unfortunately some patients and their friends and family are unhappy with the service they receive or their care outcomes despite best endeavours, and so they decide to complain. Complaints can indicate significant safety issues and have been mentioned in recent healthcare industry safety inquiries like the Paterson Inquiry.

Complaints are an excellent opportunity to learn and improve services.

If you can provide complainants with meaningful and satisfactory responses then they often become your best and most loyal supporters. However, if you cannot satisfy them there is the risk they become some of your biggest detractors; they will continue to complain through any medium they have access to, which may lead to a lot of media noise.

People understand that issues happen and incidents occur. What they want is honesty, openness and an acknowledgement that things will be put right and lessons will be learned.

The complaint process is vital to manage complaints fairly and effectively and achieve the best outcome for the patient. The process should be clearly defined for patient, clinician and care provider, so that each knows how it works and what to expect. For those services that are regulated, the Regulator requires compliance with specific regulations for example Regulation 16 of the Health and Social Care Act (Registered Activities) Regulations.

I think we all agree that patients should be treated equally and fairly, and we should be open and honest. This means they should have access to an independent review of their complaint if they wish. After all, they can request an independent review of care by asking for an independent second opinion, and serious incidents may require an independent review from outside the organisation, so why should all complainants not have access to an external review of their complaint if they remain dissatisfied.

Complainants should be able to have their complaint reviewed by someone who is not employed in that unit and is seen to be impartial regardless of how well they may conduct a complaint investigation.

All independent (private) hospitals have access to an external review system and all NHS patients have access to a third-party review by the Parliamentary and Health Service Ombudsman (PHSO); however, only 18% of NHS PPUs are signed up a known external review system. Is this fair? The NHS PPUs are based in NHS hospitals either in a dedicated unit or sometimes spread throughout the hospital in standard ward beds and they accept patients who pay for their services. This gives the patient more choice, improved hospital services and administrative staff to focus on their care. The private patient income can also be used to support the hospital.

NHS private patients do not have access to the services of the PHSO and are therefore disadvantaged compared to NHS patients and those cared for in the Independent Sector who have access to ISCAS. This also means that complaint themes are not shared openly in the sector and learning is not facilitated. How does that help patient safety?

One of the Paterson Inquiry recommendations (Recommendation 6) says, "We recommend that all private patients should have the right to mandatory independent resolution of their complaint." Would a review of complaints have supported Paterson patients better and enabled an earlier review? Possibly... This recommendation has not been implemented in all NHS PPUs and at all NHS hospitals. There are organisations that can support private patients and providers. They can help with policy development, offer support for staff managing complaints, and provide training resources and adjudication or mediation for difficult complaints. Why are they not being used? If units were to engage with not-for-profit organisations such as ISCAS (Independent Sector Complaints Adjudication Service) then the cost is minimal and they have access to expert support.

Isn’t it time private patients had the same service across all sectors?

Further reading on the hub:

• Ensuring private patients' voices are heard
• How do I make a complaint: Sources of help and advice

About the Author

Viv has extensive operational management, clinical, governance and regulatory experience in both the independent healthcare and NHS sectors.

A professionally qualified first level nurse, Viv started her career in the NHS working in the acute sector as first a Staff Nurse and then a Ward Sister in acute medicine and coronary care.

Viv changed career paths to train and work as a Community Nursing Sister before transferring back into the acute sector where she trained as a nurse teacher and developed a Staff Development function in an Acute District Hospital. Viv became a Directorate Manager for Medicine and Medical Specialties in the NHS, and Acting Director of Nursing Services before she left the NHS for the independent sector.

Viv has worked as Executive Clinical Director in a large national multi-site independent provider, and in other roles has worked as Group Clinical Director, Governance Director, Matron, and Hospital Director; managed commercial doctor engagement and has project managed the commissioning of a large new independent hospital. She also provides support to the CQC as a specialist advisor and advises on governance.

Viv has a portfolio of work, and also does some consultancy work. She is currently working with ISCAS leading on the ISCAS relationship with NHS PPUs.