“Patients and their families need to be
empowered, encouraged and enabled to have their say. When they
speak up, they need to be listened to and what they say should be
Abraham to the Mid Staffordshire Public Inquiry
Dealing with complaints effectively throughout the NHS is
fundamental to maintaining the confidence of patients in relation
to its performance, efficiency, quality and safety of care.
Despite numerous independent inquiries and changes to the NHS
complaints system, the Parliamentary Health Service Ombudsman has
described the progress in improving complaints processes as “patchy
In December 2011 the Mid Staffordshire Inquiry finished hearing
the evidence into poor standards of care at Stafford Hospital
between 2005 and 2009, and the Inquiry will provide its
recommendations to the Health Minister in October 2012.
This article by Claire Bentley and Nadia Persaud provides a
checklist to consider when managing complaints.
Recommendations to the Inquiry
The Counsel to the Inquiry has proposed a series of
recommendations regarding effective complaint handling, which are
- Complaints must be embraced by trusts (and supervisory bodies)
as a particularly valuable source of feedback
- Complaints must be investigated quickly, efficiently and
objectively – if necessary with the use of independent expert or
- Clinicians must commit to using complaints to learn
- Complaints processes must be based on principles of candour,
full disclosure of information about treatment provided and an
acceptance of the value of complaints
- Dealing with complaints must be viewed as (a) a fundamental
part of the hospital’s function in caring for patients and respect
for their loved-ones, and (b) an opportunity to improve performance
and prevent future harm
- National guidance and standards on complaints handling should
be drawn up as a priority (probably by the CQC). The complaints
system needs to be clearer, transparent and homogenous through the
- Management and Boards must receive information on the detail of
complaints to enable them to know realistically the experience of
patients in their organisations
- The availability of independent impartial advice is crucial to
assist patients who are unable to find satisfaction in the internal
hospital complaints process, and should be widely publicised
- It is critical that the regulator has access to sufficient
information about complaints to allow them to be able to identify
trends, which may indicate poor standards of care
- CQC should have as open access to core complaints material as
- More information should be made publicly available (and
available to those overseeing quality within the NHS) in relation
- Consideration should be given to whether the statutory role of
the PHSO should be widened or better resourced to enable formal
investigation into a greater proportion of complaints
- Patients and the public must be informed of how to raise
concerns outside their hospital’s own structures. Ideally, there
should be a single point of contact, such as the CQC or
Checklist for Complaints Departments
The Inquiry’s actual recommendations in relation to the handling
of complaints will not be known until the Inquiry reports in the
autumn. We will have to wait and see whether the Inquiry
recommends significant structural changes to existing complaints
However, in the meantime, all NHS organisations should revisit
the effectiveness of their complaints processes in the light of one
fundamental question - Are complaints being investigated because
they have to be, or because of a passion and desire to improve the
organisation and the patient experience?
A consideration of the themes emerging in the evidence to the
Inquiry highlights a number of practical points for complaints
departments to consider:
Are complaints given a sufficiently high
- Do those staff responsible for the management of complaints
have sufficient status and authority to get responses from clinical
Is your complaints management process fit for
- Is your PALs service properly resourced and does it have
sufficient training and skills to be able to function
- How do you prioritise which complaints are dealt with
- Do you identify and document a complainant’s expectations at an
- Do you have a system for checking that reports are complete and
all relevant documentation is attached?
- Are your clinicians allocated sufficient time to respond to
- Do you challenge where clinicians are not providing quality and
timely responses to complaints?
How do you ensure that the voice of the patient is
embedded in the system?
- Do you have a range of approaches to obtain feedback from
- Are complainants always offered a face to face meeting?
Is impartial advice readily available to your
- Have you identified a straightforward way of explaining to
patients how to make a complaint and how it will be progressed and
- How do you make patients aware of the role of PALs, ICAS and
- How do you support frail, vulnerable and disabled people in the
complaints handling process?
How do you promote public confidence in the merit of
- Do you make comprehensive, relevant and meaningful information
about complaints publicly available?
- What steps do you take to reassure complainants that a
complaint will not adversely affect the care that they or a
- Do you publicise the changes made as a result of
Does the culture of your organisation positively
- How do you ensure that your clinicians take the time to assist
in the preparation of investigative reports into complaints?
- Do your senior executives lead the way in valuing and learning
- Do your staff acknowledge mistakes and apologise in a personal
and compassionate way?
Do your staff understand the importance of an
effective complaints process?
- Do your clinicians take ownership of complaints?
- How do you support staff who are the subject of a
- What active steps are you taking to establish an open,
positive, sensitive and constructive complaints handling
- Do you welcome any issues staff may raise as causes for concern
as demonstrating a desire for improvement?
Are your staff well trained?
- What training do you provide to complaints managers and front
line staff to improve their skills and attitudes to
- Do staff have sufficient guidance to enable them to follow
NHSLA guidance when responding to complaints?
- Do staff understand the role of PALs, ICAS and AvMA?
- Are staff aware that advocacy services are available for people
- Do staff have sufficient knowledge of other services to assist
patients, such as signers, interpreters, access to Language Line,
and medicolegal advice to explain terms or concepts?
How well do you monitor the resolution of
- Have you established a tracking system setting out time scales,
costs incurred, any action taken and if appropriate, any changes to
services as a result of complaints?
How accountable is your complaints
- Do you make sure that you identify the author of investigation
reports on the report?
- How do you hold staff to account for the quality of their
reports and responses?
How well do you learn from your
- Do you have central co-ordination of all complaints to
facilitate learning and themes?
- Does every investigative report explain what steps have been
taken to ensure that mistakes are not repeated?
- Is the implementation of action plans following complaints
- Do complaints files remain open until the action plan has been
implemented, and is failure to implement escalated?
- How do you evaluate risks to quality and safety? Do you analyse
patterns of complaints alongside information from incidents?
- How do you ensure that identified learning points are actioned
throughout your organisation?
- How regularly do management and the Board receive reports on
- Do the reports contain a summary of trends in complaints,
breakdowns by division, number and theme and details of particular
complaints to illustrate problems?
How can we help?
We understand that the management of complaints can be very
sensitive and time consuming. It is important, however, for
organisations to handle complaints efficiently in order to maximise
the opportunities complaints provide for learning and improvement
of the quality of care. Our experienced team of specialists
at Bevan Brittan can help with training your staff to address
complaints effectively and can provide assistance with complex