Chaired by Baroness Julia Cumberlege, the Independent Medicines and Medical Devices Safety Review, First Do No Harm, examines how the healthcare system in England responds to reports about the harmful side effects from medicines and medical devices.
In this blog, Patient Safety Learning reflects on one of the key patient safety themes featured in the Review – patient complaints.
In our recent blog Analysing the Cumberlege Review; Who should join the dots for patient safety? we identified a number of key patient safety issues which were reflected in the Review’s findings. One theme running throughout the Review was a lack of support for patients after incidents of unsafe care, particularly around patient complaints.
Why are complaints important for patient safety?
Complaint processes are often viewed in a negative light, with patients and families not being recognised as playing a ‘primary source of learning for safety’. Too often, processes are variable in their quality and are insensitive and adversarial, frustrating patients further and causing additional harm.
The Review reflects on the complexity of the complaints system in health acting as a significant barrier to patients raising concerns, highlighting issues around:
1) Difficulties navigating the system – the Review notes that they have heard from many patients who “have expressed their frustration at the lack of a clear pathway for them to make a complaint or raise concerns about aspects of their care”. They note that the length of time this can take, all while patients are living with complications from their original complaint, results in some patients describing themselves as being “broken” by this experience.
2) Failure to listen – another issue cited was dissatisfaction with the complaints system itself. The Review notes that complainants feel that they are being treated unfairly during the process. It expressed concerns that this could discourage patients from making complaints again, reinforcing a “culture of denial and resistance to acknowledging mistakes”.
3) Time limits – the Review raises the issue that “where there is a pattern of complaints relating to an individual doctor that spans years, these restrictions mean older complaints are not investigated by the GMC”. Investigations into clinical matters by the GMC are limited to the event taking place within five years of the allegation. The Review notes that this may risk prevent exposing “a pattern of poor practice” where complaints relating to an individual doctor may span a number of years.
There is a significant amount of literature on complaints in healthcare. Earlier this year, Healthwatch published a report looking at complaints processes in the NHS, finding inconsistent local reporting and a focus on counting complaints rather than demonstrating learning. The Paterson Inquiry in February also highlighted concerns about this, noting that “while there were differences in the way patients complained in the NHS and the independent sector and how they escalated their complaints, the response was inadequate in both sectors”.
What needs to be done to improve complaints processes?
The Cumberlege Review suggests some specific recommendations around complaints processes, including:
- Patients across the NHS and private sector must have a clear, well-publicised route to raise their concerns about aspects of their experiences in the healthcare system.
- All organisations who take complaints from the public should designate a non-executive member of the board to oversee the complaint-handling processes and outcomes, and ensure that appropriate action is taken.
The Parliamentary and Health Service Ombudsman (PHSO) are currently working to develop a Complaints Standards Framework to provide a “shared vision for NHS complaint handling”. In their proposals for public consultation, they suggest an effective complaint handling system is one that:
- promotes a learning and improvement culture
- positively seeks feedback
- is thorough and fair
- gives a fair and accountable decision .
At Patient Safety Learning, we concur with these points and think it is vital that we have systems where harm is properly investigated and where learning is applied to prevent future harm. Further to the PHSO’s suggestions, we believe that it is important that learning from complaints processes is shared widely and feeds directly into the actions taken. Organisations should be able to demonstrate how complaints have been acted on, and resulted in, improvements.
What are your thoughts on this issue? Are you a patient or member of staff who has had a negative or positive experience of the complaints process. Do you have examples of good practice that we can share? Let us know in the comments below.
1. Patient Safety Learning, The Patient-Safe Future: A Blueprint For Action, 2019. https://s3-eu-west-1.amazonaws.com/ddme-psl/content/A-Blueprint-for-Action-240619.pdf?mtime=20190701143409
2. The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf
6. The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf
7. Healthwatch, Shifting the mindset: A closer look at hospital complaints, January 2020. https://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/20191126%20-%20Shifting%20the%20mindset%20-%20NHS%20complaints%20.pdf
8. The Right Reverend Graham Jones, Report of the Independent Inquiry into the Issues raised by Paterson, 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/863211/issues -raised-by-paterson-independent-inquiry-report-web-accessible.pdf
9. The Independent Medicines and Medical Devices Safety Review, First Do No Harm, 8 July 2020. https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf
11. PHSO, Have your say in shaping the future of NHS complaint handing, Last Accessed 17 July 2020. https://www.ombudsman.org.uk/csf
12. PHSO, Complaint Standards Framework: Summary of core expectations for NHS organisations and staff, Last Accessed 17 July 2020. https://www.ombudsman.org.uk/sites/default/files/Complaint_Standards_Framework-Summary_of_core_expectations%20.pdf