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Written complaints in the NHS reached a record high in 2024. With public satisfaction with the NHS at record low levels, the way the NHS handles, responds and learns from complaints is vital. A high quality, responsive NHS complaints process not only provides a key way for services to learn and improve care, it also shows patients that the NHS values their feedback. When Healthwatch first reviewed the NHS complaints process over a decade ago, they found major failings and called for reform. To establish if people’s confidence or experience has improved, Health Watch conducted new research between September and December 2024. What they found should concern NHS leaders, government and regulators. Low public confidence is preventing people from taking any action after experiencing poor care, meaning that current complaints numbers could just be the tip of the iceberg. There is little evidence that complaints are being systematically used to improve care.  Key findings Very few patients complain: Almost a quarter (24%) told us they had experienced poor NHS care in the past year. Yet more than half (56%) of people who experienced poor care took no action, and fewer than one in ten (9%) made a formal complaint. This is a significant drop from the four in ten (39%) who said they made a formal complaint when asked a similar question in 2014. Low confidence stops people acting: Of those who didn’t make a complaint after poor care, 34% believed that the NHS wouldn’t use their complaint to improve services, 33% thought organisations wouldn’t respond effectively, and 30% felt the NHS wouldn’t see their concern as ‘serious enough’. A poor complaint experience is common: Over half (56%) of people who made a formal complaint were dissatisfied with both the process and the outcome of their complaint. Falling investment in support for people complaining: The budget allocated to councils to arrange statutory NHS complaints advocacy for local people has declined by more than 20% over the last decade People experience long waits for responses. On average, Integrated Care Boards (ICBs) took 54 working days to respond to complaints they handled as commissioners of NHS services. Response times ranged from between 18 and 114 working days. The NHS is not effectively learning lessons: NHS organisations do not effectively capture the right data about who makes complaints, do not welcome complaints or fail to fully demonstrate learning from complaints. There is little national oversight and accountability over the complaints process. Key recommendations The findings show that the NHS does not consistently welcome, handle, respond or learn from complaints in a patient-centred manner. Action is needed to: Make the complaints process easier for patients and their families to navigate NHS England (NHSE) should require NHS bodies to collect wider data about complainants, such as gender, ethnicity and disability, so that we know who does and does not submit complaints . The Department of Health and Social Care (DHSC) should set detailed and mandatory standards on NHS ‘front-door’ information - including on the NHS App - about how people can navigate the complaints process. DHSC should commission a comprehensive review of statutory NHS complaints advocacy services. Monitor and improve the performance of organisations that handle complaints DHSC should set mandatory response times for complaints following a baseline exercise on current average response times at all providers and ICBs. NHS organisations should survey patients after complaint cases are closed to monitor their satisfaction with the process and outcomes. o NHSE should require all NHS bodies to report on new performance indicators of complaint handling, including the number of re-opened complaints, and the number of complaints referred to the Parliamentary and Health Services Ombudsman (PHSO). NHSE should carry out a performance audit on ICB compliance with the 2009 complaints handling regulations. Develop a culture of listening to and learning from complaints DHSC should strengthen regulations to require NHS bodies to publish their annual complaints reports, rather than ‘on request’ as currently required. DHSC should require providers to better demonstrate learning from complaints through more detailed annual complaints reports. DHSC should make the PHSO’s NHS Complaints Standards mandatory and clarify which body should lead in monitoring and enforcing them. o NHSE should assess ICBs’ complaints handling in ICB annual assessments. The Care Quality Commission (CQC) should improve the regulation of providers’ complaints’ handling responsibilities by checking this at every new and full assessment. Related reading on the hub: How to make a complaint How do I make a complaint: Sources of help and advice

The Saudi Patient Safety Center (SPSC) is mandated to establish a mechanism for reporting sentinel events. This policy outlines the ground rules for the healthcare facilities across the Kingdom of Saudi Arabia with a standardised framework to ensure robust reporting and analysing sentinel events, including a detailed list of reportable sentinel events to assure consistency and accountability to improve patient safety. 

Healthcare staff adapt to challenges faced when delivering healthcare by using workarounds. Sometimes, safety standards, the very things used to routinely mitigate risk in healthcare, are the obstacles that staff work around. While workarounds have negative connotations, there is an argument that, in some circumstances, they contribute to the delivery of safe care. This scoping review explores the circumstances and perceived implications of safety standard workarounds (SSWAs) conducted in the delivery of frontline care. It found that SSWAs are used frequently during the delivery of everyday care, particularly during medication-related processes. These workarounds are often used to balance different risks and, in some circumstances, to achieve safe care.

Standard Operating Procedures (SOPs) are an essential part of any business operations. They provide a clear and concise set of instructions for employees to follow, ensuring efficiency, consistency, and quality control. However, writing SOPs can be a daunting task, and many companies struggle with creating effective processes and procedures. Too often, common mistakes are made in the creation of these critical documents, resulting in poorly written procedures that fail to achieve their intended purpose. The challenge lies in creating comprehensive yet user-friendly SOPs that foster a streamlined, productive working environment while reducing errors and enhancing overall performance. This blog looks at the common mistakes when writing SOPs and how to avoid them.

Project proposal to improve equality and reduce health inequalities. This NHS guidance is to assist organisations to develop a Standard Operating Process (SOP) for managing Covid-19 risk assessments.

The organisation Medical Protection are calling on NHS Trusts across England to correctly follow national guidelines, to ensure doctors are treated fairly during disciplinary proceedings. Failure to conduct disciplinary processes swiftly and fairly can also perpetuate a culture of fear amongst doctors in the NHS. This also works against improving patient safety. Openness and learning in the NHS relies on doctors having confidence in senior management and their commitment to due process, which further underlines why it is so important to get this right. A recent survey of a group of Medical Protection members who have experienced a disciplinary during the past seven years found: 53% said that the disciplinary investigation against them lasted over 1 year - 22% said the process was over 2 years. 80% said the disciplinary investigation had a detrimental impact on their mental health. 44% said that they experienced suicidal thoughts during the investigation. 72% said it affected their personal lives. 75% said the length of the investigation affected their mental health. 81% said feeling 'guilty until proven innocent' affected their mental health. 85% said the malicious nature of the allegation significantly impacted their mental health. 18% either chose to retire early or had no choice but to retire early. 24% either left the Trust, or had no choice but to leave the Trust. 13% considered leaving the medical profession due to their experience. The report identifies four themes for ensuring a ‘good’ disciplinary process. Within each of these themes, specific areas are identified where changes should be made. Theme 1: Efficient Proportionate - Trusts must consider whether a matter may be dealt with in a less formal manner before proceeding to an MHPS investigation. Any move to exclude the doctor from their duties must also be proportionate to the nature of the investigation. Timely - When a doctor is put through a disciplinary process, it should begin and conclude in a timely manner. Theme 2: Fair Fair treatment for all parties The doctor and their representatives should receive fair treatment during proceedings, with due process followed and all necessary disclosures made. NHS staff involved in carrying out the disciplinary processes should also receive adequate, specialised training; Trusts should not be relying on competence or experience. Dedicated time should be ring-fenced for those involved in an investigation to ensure that MHPS deadlines can be met. Free from bias and discrimination Steps must be taken to ensure discrimination and bias are not factors that can initiate a disciplinary investigation. Information about the importance of defence organisation and union membership should be highlighted at each induction to maximise the chances of a doctor being able to access appropriate support during an investigation. Theme 3: Compassionate Considerate - The wellbeing of the doctor subject to investigation should be considered at all times, and active steps taken to offer support and mentorship. Well communicated - The disciplinary process should be communicated clearly and in plain language at the outset, and frequent communication should continue throughout, so doctors are aware of the status of the investigation and any delays. Theme 4: Accountable Accountability of employers - When a Trust or another employer is found to have behaved in a seriously wrong way during proceedings, a clear method needs to be established to hold them to account. Scrutiny - Senior managers and Trust Boards should have greater knowledge and scrutiny of disciplinary processes. Standardised reporting and data collection, such as the inclusion of disciplinary processes in governance audits, should be rolled out.

A hospital-acquired pressure ulcer (HAPU) is a localised lesion or injury to the underlying tissue (wound) that happens while a patient is staying in hospital. It occurs when standardised nursing care is not correctly followed in the presence of friction and shear, leading to skin or underlying tissue breakdown. Unfortunately, inadequate knowledge of nurses to assess and provide standardised care for pressure ulcers or manage HAPUs results in patient harm. This study shared lessons from a reported HAPU incident and aimed to address the knowledge gap in patient safety risk assessment, identification and wound management at Nyaho Medical Centre (Accra, Ghana). A review of HAPU incidents was conducted using quality improvement tools such as cause-and-effect analyses to identify contributing factors and root causes. Subsequently, plan-do-study-act (PDSA) cycles were used to test interventions to improve pressure ulcer assessments and wound management. A run chart was used to analyse and evaluate the interventions over time. Development of policies, SOPs and training for assessing and managing pressure ulcers and wounds reduced the number of HAPUs during the project period. This project demonstrated that the combined use of quality methods and tools can be suitable for improving processes and outcomes for patients at risk for HAPUs.

The overall objective of a patient recall is to limit or mitigate the harm to patients and provide a clear focus for their ongoing care. Patient safety is the priority concern for all recall processes. The purpose of the national recall framework is to provide guidance on the arrangement of a recall of patients. This guidance is for patients who need to be called back by a healthcare provider for further consultation, review and/or clinical management because a potential or actual problem has been identified. There is a need to: understand if and how patients may have been affected and/or provide any further information, treatment and support needed.  The National Patient Recall Framework contains principles for conducting a patient recall in the interests of safety for providers of secondary care. It includes key elements which should be considered in order to conduct a recall process which is rigorous and patient-centred. Although this is for use in secondary care, the principles outlined may also be useful for recalls taking place in other settings.

The regulation of health practitioners is an essential strategy to minimise instances of patient harm in health services by enabling access to practitioners who meet minimum criteria for patient safety. Although the models of regulation vary, regulatory functions include the following: defining and enforcing education standards; defining the minimum levels for competence and conduct of health practitioners; investigating complaints and enforcing discipline; and informing the public about regulated practitioners. Health practitioner regulation also has the potential to advance other health system priorities and objectives, such as workforce availability, equitable distribution and improved performance. This World Health Organization (WHO) guidance aims to inform the design, reform and implementation of health practitioner regulation and to strengthen regulatory systems and institutions. It highlights the contemporary issues in health practitioner regulation, discusses challenges in implementing regulatory policies and articulates policy considerations for the design, reform and implementation of regulation. Finally, it highlights evidence gaps and identifies a research agenda.

The Duty of Candour for Wales statutory guidance. From April 2023 the Duty of Candour is a legal requirement for all NHS organisations in Wales. This duty builds on the Putting Things Right process which has been in place since 2011.

This report by Healthcare Inspectorate Wales (HIW) relates to vascular services provided by Betsi Cadwaladr University Health Board following the de-escalation of these services as a Service Requiring Significant Improvement (SRSI). The review outlines that while progress has been made against all nine recommendations made by the Royal College of Surgeons, the health board still has improvements to make. Review recommendations The health board must consider its responsibilities in line with the NHS Wales Putting Things Right process. This is to establish whether timelier responses could have been given following the two formal complaints it received, and whether it is assured that updates were given appropriately throughout the course of the complaint investigation. The health board should set out what action will be taken to ensure that in future, people are communicated with in a timely manner when raising concerns. The health board must maintain the record keeping audit process, to assure itself that the standards expected for record keeping, are consistent and are being maintained in the immediate and long term. Particularly within its vascular services, but also across the health board. This includes record keeping for all members of the MDT. The health board must explore the reasons for reported inconsistencies in the implementation of the Diabetic Foot Pathway across its three acute sites. The health board must consider and address the issues reported to us regarding the lack of clinical areas at YG, to review patients pre and post operatively. The health board must consider the comments and findings in this report regarding staff culture and the perceptions of different teams. This is to establish whether there is learning, or development required to improve the working relationships across all teams, to support a positive working culture. The health board must consider the comments made by staff regarding the ongoing issues following the implementation of new pathways. This is to establish whether the pathways need to be revised, or further action is required for compliance with the pathways as appropriately. The health board must ensure that all staff are completing all aspects of the consent process as applicable and are documenting this within the relevant clinical records. In addition, further consent process audits must be undertaken and continue on a regular basis, with feedback provided to all staff and actions implemented as applicable. The health board must ensure that: a) All clinical record entries are filed in chronological order; b) Surgical operation records are filled promptly after the surgical procedure. The health board must address the issue where we found examples of misfiling an incorrect patient clinical record, in a different person’s record. The health board must ensure that clinical documentation entries are signed with the clinician’s name legibly printed for identification of the author. The health board must ensure a process is in place to evaluate the sustainability of its vascular service support from UHNM to determine what arrangements will be in place once current agreements end in 2024.

These templates were developed by Liverpool Heart and Chest Hospital for use in After Action Review, SWARM and Rapid Review toolkit responses.

Failure to be aware of and to follow clinical guidelines and protocols could constitute clinical negligence, but not in all cases, and much will depend on the facts of each case. John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses aspects of the law on clinical guidelines and other care management tools.

This is the phase 1 report by the independent inquiry into the issues raised by the David Fuller case. The inquiry has been established to investigate how David Fuller was able to carry out inappropriate and unlawful actions in the mortuary of Maidstone and Tunbridge Wells NHS Trust and why they went apparently unnoticed, for so long. A phase 2 report, looking at the broader national picture and the practices and procedures in place to protect the deceased in the NHS and other settings, is planned for publication at a later date.