Search the hub

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’.[1] Too often, processes are variable in their quality and are insensitive and adversarial, frustrating patients further and causing additional harm. Review findings 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”.[2] 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.[3] 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”.[4] 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”.[5] 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.[6] 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.[7] 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”.[8] 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.[9] 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.[10] 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”.[11] 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 [12]. 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. References 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 3. Ibid. 4. Ibid. 5. Ibid. 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 10. Ibid. 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

This version of the Framework is for: All NHS staff, including all clinical and non-clinical staff and senior leaders, to: provide a clear vision of how to approach feedback and complaints effectively set out how they should approach learning from complaints to improve services. Everyone who provides feedback or makes a complaint about the NHS, and the people who support, advise or advocate for them. It sets out what they can expect to see and experience when doing so. NHS staff who are being complained about. It will make sure they are supported and that the complaint is seen as a learning opportunity rather than a finger-pointing exercise. The Framework is built on the following four principles: Promoting and learning and improvement culture. Positively seeking feedback. Being thorough and fair. Giving fair and accountable decisions.

In a blog in the Patient Safety Movement newsletter, James Titcombe talks about his son's death and how speaking out can save lives.

The complaints included in the report are not thematic or related to a specific incident or body. Instead, these new annual Ombudsman Casework Reports will share some of the most significant findings from cases completed over the year, including complaints against: NHS in England Mental Health Care. The report offers valuable lessons about the importance of good complaint handling and how complaints can be used to drive improvements.

Key findings Local reporting on complaints is inconsistent and inaccessible. Staff are not empowered to communicate with the public on complaints. Reporting focuses on counting complaints, not demonstrating learning.

Key findings from report Local reporting on complaints is inconsistent and inaccessible All hospital trusts are reporting to NHS Digital on the numbers of complaints they receive; however, only a minority of trusts report any more meaningful data at a local level. Analysis shows just 1 in 8 hospitals trusts (12%) are demonstrating that they are compliant with the statutory regulations when it comes reporting on complaints. Staff are not empowered to communicate with the public on complaints: All hospitals must produce an annual statutory complaints report but they are only required to make it available to people upon request. Yet we found that hospital complaints staff were often not aware of the reports or who could access them. Reporting focuses on counting complaints and not demonstrating learning: Only 38% of trusts make public any information on the changes they’ve made in response to complaints. Much of this reporting is still only high-level, telling us little detail about what has changed and only stating that “improvements were made”.

Advocacy is a free and confidential service. Advocates are independent to the NHS. The NHS Complaints Advocacy service is there to: Give you information about different NHS complaints processes. Help you understand the different options you have in raising your concerns. Offer you support to help you think about your complaint and what you want to get from making your complaint. Help you make your complaint if you want us to. If you would like an advocate to assist you now or would like to talk to someone about advocacy, please contact the Helpline on 0300 330 5454. You can complain about any aspect of NHS care and services but might include: poor treatment or care the attitude of staff poor communication waiting times lack of information failure of diagnose a condition. NHS Complaints Advocacy can only support you if your complaint is about NHS funded healthcare. There are some limits on what can be achieved using the NHS Complaints Procedure. Where the outcome you are looking for is more likely to be achieved through another route, we can explain this and give you information about who best to contact instead. We can support you to make this contact, where required.