Whose complaint is it anyway?

March 2007

Introduction

The Healthcare Commission has just released its report “Spotlight on Complaints” which reviews the first two years since the Commission took over the role of independent reviewer of complaints.

The report makes sobering reading for Trusts that are failing to deal with complaints in the “patient-centred” way which the Commission clearly wants. It also makes clear that the Commission will have no hesitation in coming down heavily on Trusts which it considers are not giving complainants the service they deserve by:-

	Carrying out detailed assessments and spot inspections of “failing” Trusts
	Feeding any adverse information into the Trust’s annual health check
	Naming and shaming the 10% of Trusts’ with the worst complaints record

In the light of the report senior management at Trusts need to consider now how their Trust performs in complaints handling and what improvements can be made to avoid the adverse consequences set out above.

What are the areas of concern?

The report sets out the top 10 issues raised in complaints which reach the Healthcare Commission. Unsurprisingly two particular types of complaint top the list producing almost 40% of all the complaints reaching the Commission. These are:-

	The safety of clinical practices; and
	Poor communication/lack of information

Whilst the report makes clear that the subject matter of the complaints themselves are of key importance, what is of particular concern to the Commission is how those complaints are responded to and dealt with.

What comes across very clearly from the report is the disappointingly high percentage of complaints that are referred back to Trusts for further attempts at local resolution. Over the course of the first 2 years of the Commission’s role 33% of the complaints it has reviewed have been sent back to Trusts for further local resolution.

The implication is clear. The Commission believes that many Trusts should be doing much better in responding to complaints in the first instance. Trusts that continually have a high percentage of claims returned to them for further local resolution can expect close inspection and assessment. Potentially, they may also be at real risk of adverse publicity and downgrading in their annual health check score.

What can your Trust do to avoid this?

There are a number of common themes that come out of the report emphasising what the Commission is looking for in first stage complaints handling. In particular:

	The Commission found that many Trusts are still not treating complaints as valid, that apologies are not given even where shortcomings are identified, and that no explanation is given as to the steps the Trust will take to prevent future recurrence of the same type of adverse event.
	Too often responses were found to contain jargon, either technical or medical, that the complainant could have difficulty understanding. Sometimes key staff were not involved in the investigation of the issue complained of.
	Often Trusts’ responses to complaints demonstrated that existing DOH guidance was not being followed. The Commission expects Trusts to benchmark services against accepted guidance and to test response letters against that existing guidance.
	The Commission indicates that the buck stops with Trust Chief Executives to satisfy themselves that there really is nothing more that can be done to resolve a complaint locally. Of the 33% of complaints which were referred back to Trusts from the Commission the overwhelming majority were resolved. Again the message is clear – local resolution is the priority and Chief Executives have to take ultimate responsibility to assure themselves that it is not achievable by any means.

The future

The report makes abundantly clear how the Commission intends for complaints to be dealt with in future and what it intends to do about it if they are not! Trusts are encouraged to:

	Approach complaints in a patient-centred and flexible way. Be open with complainants about the process and what it can achieve. Explain alternative options.
	Be creative in the remedies that are offered – to do this Trusts should actively involve the complainant to establish what it is they are seeking to achieve from the process.
	Improve systems to learn from complaints and respond to trends. Introduce more capacity into each Trust’s complaints team and ensure that staff are well supported and trained.
	Provide better support and training to clinical staff to enable them to respond better to complaints as they arise.

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Summary

The Commission has clearly had a difficult time in the course of the first 2 years of its stewardship of the independent review stage of the complaints process. It was inundated with requests for independent review even before its operation commenced. It is dealing with almost three times the annual volume of requests for independent review that Trusts dealt with themselves under the old system. It has had to substantially increase its capacity in order to respond to this demand.

However, it is now getting to grips with the situation and is likely in the coming years to significantly “up the bar”. The report makes clear that the status quo will not be good enough. Poorly performing Trusts will be identified, given the chance to improve their performance, but if they fail to take up that chance, penalised.

We strongly recommend that all Trusts urgently consider the following in the light of this report to ensure that they are not likely to be the subject of adverse publicity and criticism in their annual health check as a result of poor performance in complaints handling.

	Establish the proportion of your independent reviews that are being referred back to the Trust from the Commission for further attempts at local resolution. If your percentage is higher than the average of 33% take action to find out why, and to get that percentage down.
	Ensure that wherever possible your Trust is benchmarking services against national guidelines. Be prepared to demonstrate that the services you are offering are compliant with such guidelines. Examples quoted frequently in the report include compliance with Essence of Care launched by the Department of Health in February 2001, Discharge from Hospital; Pathway Process and Practice and When a Patient Dies: Advice About Developing Bereavement Services in the NHS.
	Audit the quality of record keeping. The Commission makes clear that so far as it is concerned if “something has not been recorded there is no evidence that it occurred”
	Be much more prepared to take a proactive stance on complaints rather than dealing with a complaint as a dress rehearsal for a claim. Be upfront and clear about what the complaints procedure is designed to achieve and what can be done to help resolve the complaint to the satisfaction of the complainant.

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Tim Hodgetts
Associate Solicitor
tim.hodgetts@bevanbrittan.com

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