In this article...

In October 2008 the National Audit Office (”NAO”) published "Feeding back? Learning from complaints in health and social care". This is an independent evaluation of existing performance, capability, capacity, and costs of complaints handling in both health and adult social care. Claire Bentley and Matthew Trinder review the main findings of the report with respect to NHS Trusts, and highlight what NHS Trusts can do to improve complaints handling.

The process for handling complaints about NHS services

The current system
Currently there are separate complaints procedures for health and adult social care. This has made it complicated for those patients who use both services to make a complaint. At the moment, the procedure for making a complaint about the NHS is a 3 stage process, and is as follows:- 

  • Local resolution - If a patient is not satisfied with a service provided by the NHS they can make a written or verbal complaint to the NHS body or primary care contractor that provided the service.
  • Independent review - If the patient is unhappy with the outcome of the local resolution they can request a second stage independent review by the Healthcare Commission. 
  • Ombudsman - If the patient remains unhappy with the independent review they can refer their complaint to the Parliamentary and Health Service Ombudsman. 

The system as from April 2009
In April 2009 a new, combined and comprehensive complaints system for health and social care will be rolled out nationally. This will be a two stage system and will have an increased focus on local resolution. If the complainant is not satisfied with the outcome of the first stage local resolution the matter can be referred to the Health Ombudsman, who will act as the second stage in the complaints process. The Healthcare Commission will no longer exist and will no longer act as the second stage independent reviewer of complaints. It is hoped that these reforms will:- 

  • reduce delays. 
  • promote a more timely, responsive and effective outcome. 
  • achieve greater alignment and integration between the NHS and the social care system. 

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What are the main findings for the NHS?

There have been a number of changes made to the NHS complaints system. However, this report and other independent evaluations and inquiries indicate that there are still significant issues for the NHS when handling complaints, as follows:-

  • Complaints handling is not being taken as seriously as it should be.
  • The culture and attitudes of the organisation often acts as a barrier to responsive complaints handling. 
  • Navigating the complaints system is not straightforward and can take too long.
  • Only a small percentage of NHS complainants are aware of, or receive, national advocacy support.
  • Where people are dissatisfied with their experience, there is a low propensity for them to go on to make a formal complaint. This was often because people did not feel that anything would be done as a result. In addition a considerable amount of time and effort is required to pursue a complaint.
  • Monitoring and implementing any findings from complaints need to be improved.

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Action to improve complaints handling

All NHS Trusts should consider the following points to ensure that they are not likely to be the subject of adverse criticism and publicity as a result of poor performance in complaints handling:-

  • Culture - Establish an open, positive, sensitive and constructive complaints handling culture. 
  • Training - Provide appropriate training to complaints managers and front line staff to improve staff confidence, knowledge and attitudes to complaints. Clinicians do need to be aware that their "confidential" comments will be disclosed in any subsequent compensation claim. This should not inhibit frank factual analysis when something has gone wrong but must avoid sniping between colleagues, prejudicial comments about the complainant or opinions about the legal position. Remember that the informal stage can be the most effective point to resolve complaints amicably and a lot of compensation claims represent a missed opportunity. 
  • Support - Provide support to staff members who are the subject of the complaint.
  • Process - Identify a straightforward way of explaining to service users how to make a complaint and how it will be progressed and handled. Provide regular updates to complainant.
  • Expectations - Identify and document a complainant’s expectations at an early stage and track any changes to improve the opportunity of resolving complaints quickly. 
  • Monitor - Establish a tracking system which sets out time scales, costs incurred, action taken and, if appropriate, any changes to services as a result of complaints. Evaluate risks to quality and safety by analysing patterns of complaints alongside information from incidents.
  • Feedback - Establish a range of approaches to obtain feedback from complainants.
  • Knowledge Sharing - Improve learning and sharing of ideas on complaints regionally and nationally. 
  • Publicity - Promote public confidence in the merit of complaining by publicising the changes made as a result of complaints.

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Driving the improvement of the local resolution of complaints will require focused leaders within each NHS organisation who are determined to use the complaints process to improve services. Effective complaint systems are integral to quality improvement, efficiency, risk management and patient confidence.

The new comprehensive complaints system is an ambitious project and there will be a number of organisational challenges in achieving the efficient running of the new system in April 2009. It remains to be seen how smoothly the new system will operate. Inevitably the new procedure will mean that there will be an increase in the number of complaints that the Ombudsman will receive. However the Health Ombudsman hopes that this will be a short term issue, and that in the longer term they will need to deal with less complaints as a direct result of better complaint resolution locally. This Autumn the Ombudsman will publish "Principles of Good Complaint Handling", the purpose of which is to ensure that NHS bodies and individuals understand how complaints should be handled and how the Ombudsman will consider cases.

Complaints handling can be very sensitive, complex work. Well known firms of Claimant solicitors have been known to use the complaints process as a fishing expedition, hoping that Trusts will make errors or injudicious internal comments when dealing with the complaint, which can then form the basis for a subsequent compensation claim. The Legal Services Commission may require a complaint to be made before committing to fund a claim. Developing a feel for the cases that require more attention or liaison between complaints and legal teams at an early stage comes with experience, and Bevan Brittan can help if you need us. The NHSLA will also assist. We would be pleased to discuss the implications of this report with any Trusts that recognise that they need to take urgent action to address the issues which the report raises.

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