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Content ArticleAction Against Medical Accidents (AvMA) have created a set of guides to help patients raise concerns about a healthcare worker. Health professionals fitness to practise Raising concerns about doctors Raising concerns about nurses, midwives and nursing associates Raising concerns about dental professionals. Follow the link below to find out more.
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Content ArticleAvMA’s self-help guides have been written by experts to help guide you through the process of taking action following a medical injury. In clear and straightforward language, they set out the procedures you will need to follow, and legal rights and obligations, and contain useful contact details for regulatory bodies, advice services and other organisations that may be of help.
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Content Article
Making a complaint to the NHS in England (AVMA)
PatientSafetyLearning Team posted an article in Complaints
If you are not happy with the treatment that you or a loved one has received from the NHS you are legally entitled to an investigation and full response by the NHS body that provided the treatment. This is known as the NHS complaints procedure. This self-help guide from Action Against Medical Accidents (AvMA) contains all the information you should need to make a complaint. If you have any further questions, please visit AvMA's website where you will find more advice and a range of specialised self-help guides, or call their helpline on 0845 123 2352. -
Content ArticleThis editorial in BMJ Quality & Safety suggests that individual doctors' conduct, performance and responsibility are important factors in improving patient safety. The authors argue that although a 'systems approach' is important, it is necessary to examine the role of individuals within those systems. They highlight recent research that points to small numbers of individual doctors who contribute repeatedly to patient dissatisfaction and harm, and to difficult working environments for other staff. They suggest that identifying and intervening with these individuals plays a role in the wider systems approach to patient safety. They also highlight an urgent need for further research into identifying and responding to problematic clinicians.
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Content ArticleA report on the investigation into the death of Elizabeth Dixon and a series of recommendations in respect of the failures in the care she received from the NHS.
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Content ArticleThe use of healthcare complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, developed by Alex Gillespie and Tom W. Reader was used to analyse a benchmark national data set, conceptualise a systematic analysis, and identify the added value of complaint data.
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Event
NHS Complaints Summit 2021
Patient Safety Learning posted an event in Community Calendar
This National Virtual Summit focuses on delivering a person-centred approach to complaints handling, investigation, resolution and learning. Through national updates, practical case studies and in depth expert sessions the conference aims to improve the effectiveness of complaints handling within your service, and ensure that complaints lead to change and improvements in patient care. The conference will reflect on the challenges and complaints that have resulted from the Covid-19 pandemic. The conference will also update delegates on the Complaint Standards Framework for the NHS which is in consultation and due to be published by the PHSO in early 2021, and will lead to a single developmental pathway for all complaints staff that rightly acknowledges complaint handling as a professional skill. Further information and to book your place or email kate@hc-uk.org.uk Follow the conversation on Twitter #NHSComplaints We are pleased to offer hub members a 10% discount. Email: info@pslhub.org for the code. -
Content ArticleIn this blog, Patient Safety Learning sets out its response to NHS England and NHS Improvement’s draft Framework for involving patients in patient safety. We commend the intention and share thoughts on our perspective on this important patient safety issue. We make proposals for how to strengthen patient engagement and co-production.
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Content ArticleDr Kathryn Leask outlines steps GPs can take to try and avoid patients coming to harm as a result of delayed referrals and provides advice on dealing with patient complaints on this issue. There are some steps GPs can take to try to avoid patients coming to harm while putting themselves in the best position to address the potential medico-legal ramifications. In their guidance on Delegation and referral the GMC says that you are not accountable for the actions or omissions of colleagues to whom you make referrals. However, you are accountable for your decisions to transfer care and the steps you have taken to make sure that patient safety is not compromised. If you are aware that there are delays for a particular service and your patient is likely to be affected by this, you should make this clear to them and manage their expectations from the outset. In this GP Online article, Kathryn gives practical tips for GPs and shares a case example.
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Content Article
HSIB: Submit a patient safety concern
PatientSafetyLearning Team posted an article in Investigations and complaints
The Healthcare Safety Investigation Branch (HSIB) has launched an online form for submitting a patient safety concern. The form should take around 20 minutes to complete. You can tell them about something that has happened or something that might happen. Something that has happened: this could be a one-off or a series of events where something potentially dangerous has happened, whether or not someone was actually harmed. Something that might happen: this could be a safety risk or an unsafe condition that, if not corrected, might lead to an incident which could cause harm. Follow the link below to find out more about the process, read their privacy notice or request the form in an alternative format. Note: HSIB can investigate events or risks that occurred within NHS-funded care in England after 1 April 2017. -
Content ArticleIn this blog, Patient Safety Learning look at why complaints are important to improving patient safety and sets out its response to the Parliamentary and Health Service Ombudsman (PHSO) consultation on a new Complaint Standards Framework for the NHS.
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Content ArticleSir Robert Francis, Chair of Healthwatch England, reflects on the mid-Staffordshire inquiry 10 years on and explains why speaking up is so vital, particularly in the context of COVID19. He also shares his support for the new Complaint Standards Framework and tells us why it’s important to listen to, learn from and be honest with the people you serve. Listen to the podcast or download the transcript.
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Content ArticleDo patients’ and families’ experiences with communication-and-resolution programmes suggest aspects of institutional responses to injury that could better promote reconciliation after medical injuries? This interview study of 40 patients, family members, and hospital staff in Australia found that patients have a strong need to be heard after medical injury that is often unmet. Although 18 of 30 patient and family participants (60%) reported positive experiences with communication-and-resolution programmes overall and continued to receive care at the hospital, they reported that hospitals rarely communicated information about efforts to prevent recurrences. Opportunities are available to provide institutional responses to medical injuries that are more patient centred.
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Content ArticleThe aim of this study from Bismark et al. was to identify characteristics of doctors in Victoria, Australia, who are repeated subjects of complaints by patients.
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Content ArticleChaired 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.
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Content ArticleThis report from the Parliamentary and Health Service Ombudsman, follows an invitation from the House of Commons Select Committee on Public Administration and Constitutional Affairs to explore the state of local complaints handling across the NHS and UK Government departments. It draws upon significant evidence taken from interviews carried out with a wide range of individuals and organisations who have first-hand experience of how the NHS and UK Government departments approach complaints. It also incorporates a review of a wide range of other research reports and over 300 of our own investigation reports documenting complainant experience. The report highlights three areas that need to change: There is no consistent way in which staff are expected to handle and resolve complaints. Staff do not get consistent access to training to support them in their complex role - complaint handling should be recognised as a professional skill. Public bodies too often see complaints negatively, not as a learning opportunity that can be used to improve their service.
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News Article
Have your say in shaping the future of NHS complaint handling
Patient Safety Learning posted a news article in News
The Parliament and Health Service Ombudsman (PHSO) been working with the NHS and other public service organisations, members of the public and advocacy groups to develop a shared vision for NHS complaint handling. We've called this the Complaint Standards Framework. Now they want to hear from you. Have your say in shaping the future of NHS complaint handling by taking part in their survey. Read the Complaint Standards Framework: Summary of core expectations for NHS organisations and staff -
Content ArticleThe Framework sets out a single set of standards for staff to follow and provides standards for leaders to help them capture and act on the learning from complaints. This is a draft Framework developed with partners across the health sector and PHSO are keen to hear people's views on the draft so they can improve it. The online survey can be found here.
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News Article
Coronavirus: Calls for government to plan public inquiry
Patient Safety Learning posted a news article in News
The government must set out plans for an inquiry into its handling of the coronavirus pandemic, the health service ombudsman has said. This was not about blaming staff but about "learning lessons", he said. Ombudsman Rob Behrens said patients were reporting concerns about cancelled cancer treatment and incorrect COVID-19 test results. Ministers have not committed to holding an inquiry, but have accepted there are lessons to be learned. The Parliamentary and Health Service Ombudsman (PHSO) stopped investigating complaints against the NHS on 26 March, to allow it to focus on tackling the COVID-19 outbreak. But people had continued to phone in with these concerns, Mr Behrens said. "Complaining when something has gone wrong should not be about criticising doctors, nurses or other front-line public servants, who have often been under extraordinary pressure dealing with the Covid-19 crisis," he said. "It is about identifying where things have gone wrong systematically and making sure lessons are learned so mistakes are not repeated." Read full story Source: BBC News, 1 July 2020 -
News Article
PHSO to restart their work on NHS complaints
Patient Safety Learning posted a news article in News
NHS England and Improvement have announced changes to the NHS’s complaints process during the coronavirus emergency. Individual NHS organisations are being told to ensure complaints are still taken, and monitored for patient safety issues. However, NHS organisations have been given latitude over whether they launch full investigation processes in the short term, and being advised to ‘manage expectations’ about investigations being launched. Complaints that are logged will remain open until further notice. The advice to NHS providers also says that where patients have been waiting over six months for a resolution to their complaint, consideration should be given now to making an effort to see if the complaint can be resolved. NHS England and Improvement have announced that they will be advising NHS bodies to end their 'pause' in complaints handling from 1 July onwards. Similarly, the Parliamentary and Health Service Ombudsman (PHSO) reduced its complaints-handling activity during the emergency period. It is not accepting new complaints, and its helpline is temporarily closed. PHSO has announced that it will recommence work on existing complaints, and begin accepting new ones from 1 July. Read full story Source: The Patients Association, 15 June 2020 -
Content ArticleInvestigation of a complaint against the Belfast Health and Social Care Trust A Trust’s failure to perform an examination of a patient on admission to hospital meant he was not assessed by medical staff against this baseline during his time on the ward.
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News Article
Isle of Wight patient sent home on first day of COVID-19 lockdown almost died
Patient Safety Learning posted a news article in News
A patient almost died after being misdiagnosed and sent home from hospital on the first day of the lockdown as the NHS curtailed many normal services to focus on COVID-19. The NHS trust involved has admitted that its failings led to the man suffering excruciating pain, developing life-threatening blood poisoning, and contracting the flesh-eating bug necrotising fasciitis. He needed eight operations to remedy the damage caused by his misdiagnosis. The man, his wife and his GP spent three weeks after his discharge trying to get him urgent medical care. However, St Mary’s hospital on the Isle of Wight rejected repeated pleas by them for doctors to help him, even though his health was deteriorating sharply. The man, who does not want to be named, said his experience of seeking NHS care for something other than COVID-19 during the pandemic had been “debilitating and exhausting” and that feeling the NHS “was not there” for him had been “very distressing” for him and his wife. Mary Smith, of the solicitors Novum Law, who are representing the man in his complaint against the trust, said his plight highlighted the growing number of cases that were emerging of people whose health had suffered because they could not access normal NHS care in recent months. Read full story Source: The Guardian, 16 June 2020 -
News Article
NHS staff 'not told when colleagues test positive for COVID-19'
Patient Safety Learning posted a news article in News
NHS staff at a hospital that has stopped taking new patients amid a COVID-19 spike have lodged a series of concerns, including that they are not routinely being informed of when colleagues test positive for the virus. The concerns were laid out in a letter from union representatives to management at Weston general hospital in Somerset, which is now testing all staff while carrying out a deep clean. Another concern raised by Unison was that priority for testing was not being given to BAME staff. University Hospitals Bristol and Weston NHS foundation trust said on Wednesday that as many as 40% of staff from a cohort tested after contact with infected patients were found to be positive. The trust’s chief executive, Robert Woolley, told the BBC the figure was from a sample testing last week and authorities were now attempting to understand the scale of the infection. More than 60 patients were found to be infected last weekend. Read full story Source: The Guardian, 28 May 2020 -
Content Article
The Patients Association: Report your care
Patient Safety Learning posted an article in Complaints
The Care Quality Commission (CQC) is an organisation that inspects and regulates health and social care services to make sure they meet fundamental standards of quality and safety. About seven million people who used NHS services in the past five years had concerns about their treatment but had never raised them, according to the Care Quality Commission. Of these, over half (58%) expressed regret about not doing so. However, when people did raise a concern or complaint, the majority (66%) found their issue was resolved quickly, it helped the service to improve and they were happy with the outcome. The Patients Association is here to help and can pass on the information you provide to the CQC. Whether this is a positive example of great health or social care you've received, or of a troubling experience you or your family have had. -
Content Article
What to do when complications occur (3 January 2018)
Patient Safety Learning posted an article in Processes
In this article, Cruikshanks and Bryden outline the process that should take place after an adverse event has occurred.- Posted
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