Complaints and Raising Concerns - Health Contents 1 Introduction 1. In 2011 the Committee held an inquiry into Complaints and Litigation, and looked in some detail at the working of the NHS complaints system. In its report, it said that There are unwarranted variations in how the complaints system works across England, some elements of the system are ineffective, and the cultures that exist often do not support effective resolution and redress. The Committees objective is to look at how the complaints system can be further strengthened to give good and timely outcomes for patients, contain the costs of litigation and ensure that the NHS learns from complaints; it is a key objective that the experience derived from proper consideration of complaints should lead to changes and improvements in the care available to other patients.[2] 2. It recommended that the Government undertake a review of the NHS complaints system. It also made recommendations about the roles of the Ombudsman, advice and advocacy services, providers and commissioners, and about the co-ordination and monitoring of complaints handling across the NHS. In its response to the Committees report, the Government accepted that whilst some NHS organisations respond quickly and effectively to complaints, others are not so effective, and agreed that the NHS can do more to improve complaints handling. 3. The period since the publication of the Committees report into Complaints and Litigation has seen the implementation of the Health and Social Care Act 2012; the publication of the Francis report; and, in October 2013, the publication of the Clwyd-Hart Review of the NHS Hospitals Complaints System. The Government provided its formal response to the Francis report in November 2013. 4. As well as complaints and concerns made by patients and members of the public, the Francis report also highlighted the related issue of the way in which complaints and concerns raised by staff within health and care organisations were handled. This is an issue that has featured in much of the Committees work this Parliament and we considered it important to examine it in this inquiry as another indicator of patient safety concerns alongside complaints. 5. The current inquiry followed up relevant recommendations made in the Committees 2011 report on Complaints and Litigation, and the commitments made in the Government response. It also examined the treatment of staff who raise concerns about NHS services, and the procedures in place to encourage NHS staff to raise concerns without fear of detriment. Specific issues on which the Committee asked for evidence were: · Handling of complaints made by patients and families about care received in the health and care sectors, including both primary and secondary care providers; · Handling of concerns raised by staff about care given in the health and care sectors; · The extent to which the findings of recent inquiries have been incorporated into the complaints process; · Support for patients, the public and staff who wish to make complaints or raise concerns; · The consequences of complaints for care providers and of raising concerns for the employment prospects of staff; · Openness about complaints and concerns, and accessibility of information; · The role of commissioners, system regulators and professional regulators with regard to complaints and concerns; · The operation of the Public Interest Disclosure Act 1998 in relation to health and social care; · Future plans for improvements in this area. We received 120 written submissions. We are grateful to all those who have contributed to the inquiry. Developments since the Committees 2011 report 6. Since our 2011 report, there have been significant developments in the form of the second Francis report and actions which flowed from it-the Governments formal responses and the commissioning of the Clwyd/Hart review of acute provider complaints. 7. The Department of Health has set up its cross-service Complaints Programme Board in response to Francis and Clwyd/Hart, the aim being to complete as much of the work as possible by March 2015. This activity appears to have displaced the review of the complaints system which the Government undertook to conduct in response to this Committees earlier report. 8. We have also seen the October 2014 publication of Healthwatch Englands review of the complaints system and the publication by PHSO, the Local Government Ombudsman and Healthwatch England in November 2014 of a service user-led vision for complaints handling,[3] with support from NHS England, Monitor, the Trust Development Authority and the Foundation Trust Network. This work is one of the major items in the Departments Complaints Programme. 9. Changes aimed at improving the culture of complaint handling within providers and across the health and care system are welcome, but they take time to have an effect and are difficult to measure. Meanwhile, the volume of complaints continues to rise. This may reflect increased awareness of complaints procedures and an increased willingness to remark on poor standards of service. While the headline figure may indicate service deterioration, it may also indicate an organisation which welcomes complaints as a means of improving performance. HSCIC data now also indicate (on an experimental basis) the number of complaints upheld: in 2013/14 just over 50% of complaints about all NHS services were upheld, though this figure is subject to significant caveats. 10. There is no doubt that the landscape has changed significantly since our earlier inquiry. Patient safety and the treatment of complaints and concerns have become high profile issues. There is equally no doubt that we are only at the beginning of a process of change with significant scope for further improvement. 11. Despite the work undertaken to change the culture of complaints handling across the NHS system, the Committee has received ample evidence from individuals and patient representative organisations of a system which has not responded adequately to address individual complaints. For example, in oral evidence the NHS Confederation referred to a CQC in-patient survey where 7 per cent of those surveyed gave a 0 or 1 ranking for the overall quality of their care:[4] this level of assessment of is unacceptable. 12. We understand that many of the issues raised with the Committee had their origins in incidents which occurred before the second Francis report was published. That does not mean that they can be discounted. Ann Clwyd was concerned that many of her recommendations were not being acted upon, and it is important that the health and care system should, through its operations, demonstrate a clear commitment to improving the quality of complaint handling. 13. There have been a number of significant reviews of the complaint system which have urged a change in the culture of the NHS in responding to complaints. There is little firm evidence to date of the moves to change culture having a wholesale positive effect either on the behaviour of NHS providers which give rise to complaints or on the satisfaction of service users about how their complaints have been handled. 14. We recommend that the Government publish a detailed evaluation of the progress achieved, and work remaining to be undertaken, by the Complaints Programme, in order for the public and our successor Committee in the next Parliament to be able to monitor progress. The Department should also include an evaluation of the operation of the complaints system across the health sector in the light of the post-Francis changes. A review was promised for 2014 but has not been undertaken. 15. The rest of this report provides an overview of the issues raised with us concerning complaint handling, the role of the Ombudsman, professional regulators and the treatment of staff raising concerns. It is a snapshot of where the complaints system stands now, the progress that has been made and the areas where change is still required. 16. We consider that our analysis in our previous report remains relevant and we are not attempting to re-examine all the issues that we addressed then. While there have been some improvements there are still too many individual cases which are mishandled, from instances of poor communication to those which end in a complete breakdown in trust between patients, their families and NHS institutions. 17. As the Committee said in 2011, the issue lies in …the individual cases where complainants did not feel the NHS was sufficiently responsive to their concerns. It is in this variable individual experience, rather than in movements in the headline totals, that the Committee feels that there is a real issue which the NHS needs to address[5]. 18. Reform of the complaints processes in health and social care and the inculcation of a culture of openness and responsiveness is a continuing process and one that needs to be regularly monitored. We recommend that our successors on the Health Committee in the next Parliament continue this work of monitoring improvement in the complaints process.
Posted on: Wed, 21 Jan 2015 07:34:23 +0000
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