Health Service Focus


A time to complain?

Source: NHE May/Jun 17

A Freedom of Information (FoI) investigation by NHE has revealed that over the last five years ‘quality of care’ complaints have increased at mental health trusts in England. Josh Mines analyses the findings.

Improving mental health services has been a central talking point over the last few years. In NHS England’s ‘Next Steps on the Five Year Forward View’ document, it was announced that the government was finally recognising the sector’s desperate need for funding, as £1.4bn more was being spent in real terms on mental health than three years ago. On top of this, 120,000 extra patients received specialist mental health treatment this year compared to 2014, including 20,000 more children and young children. 

Despite this, obvious flaws can still be seen in the system. Much like acute and primary care, pressure on services due to high demand is currently more severe than ever. In a fact sheet released by NHS Confederation's Mental Health Network, it was revealed that referrals to community health teams had increased by 19% between 2010-11 and 2014-15. 

Unrelenting pressure on services 

It’s no wonder, then, that an FoI investigation conducted by NHE found that over a five-year period, complaints to mental health trusts had seen a sharp rise. Of the 55 trusts in England, 38 responded to the question of how many complaints had been registered due to ‘quality of care’ issues. It was revealed that the majority of trusts (60%) recorded more complaints in 2015-16 than in 2011-12. And nationally, the total number of complaints saw a year-on-year increase from 4,413 to 7,259 over the five-year period.

Interestingly, certain regions in the UK were found to have more complaints lodged against them than others. The Midlands was the only area where complaints went down over the five years, as 60% of trusts had fewer complaints. On the other side of the coin, 87% of south west trusts saw a rise, and in London and the south east complaints went up in 75% of trusts.

 Danielle Hamm, associate director for campaigns and policy at Rethink Mental Illness, told NHE the statistics represent something obvious to most healthcare professionals – the sector is struggling under the weight of high demand and stripped-back budgets. 

“Historic underfunding has left mental health services stretched and struggling to get by,” she said. “The impact of this is reflected in the experiences of people living with mental illness who continue to come up against barriers to accessing the quality of care they need and deserve.” 

In the shadow of the general election, it’s fairly predictable that rhetoric will dominate the headlines. But as Hamm warns, to bring mental health standards up to a sustainable level, reality must rise above rhetoric and be matched by sufficient cash: “The positive commitments to improve mental health services across the NHS are loud and clear. 

“But these figures should be a wake-up call that there is currently a mismatch between rhetoric and reality. The promised changes and investment urgently need to filter down to ensure that people’s expectations match the type of care and support that they receive.” 

Breaking down barriers for patients 

The reasons a patient may complain are wide and varied. One is that the patient feels the care they received was insufficient, and part of that can be put down to trusts struggling to cope with too many people coming through the doors. But as Alison Cobb, senior policy and campaigns officer at Mind, told NHE, it could also represent the fact that complaints are easier to make, and barriers are being broken that once stopped people blowing the whistle on poor care practices. 

“We know there’s been big increases in demand, cuts and increasing pressures, and so it is very likely that there is an increase in complaints because of decreasing quality,” said Cobb, adding that while improvements in the complaints systems are a step forward it is still “very concerning” when organisations see lot of complaints. 

To improve the care being given, it’s also key that patients feel they can make complaints about their care, and central to that is creating a “culture of openness” within the NHS, she added. 

“There are a lot of barriers that stop people with mental health problems making complaints, including knowing about how to lodge a complaint and feeling confident in their decision,” Cobb explained. 

“People may be worried about the consequences or repercussions or people may not think that it will make a difference, so there are various things happening where people can think, ‘what’s the point in complaining about this?’” 

But for health leaders, the important task is learning from mistakes rather than simply adding them up, Cobb was quick to state: “It’s concerning if things are getting worse or if the leadership of organisations don’t know what is going on, or if lessons aren’t being learnt from complaints. 

“Complaints need to be taken seriously and looked at, and there has to be a clear understanding of what’s gone wrong.” 

While Cobb is right to point out that lessons have to be learnt from complaints, and that a rise could indicate the NHS becoming a more transparent and reflective service, it appears that standards are slipping under high pressure. 

Whatever the colour of the next government, serious investment and long-term planning is desperately needed to prop up mental health. 

The positive political rhetoric around mental health is a good starting point, but it will have to be replaced by action very quickly if the NHS is to transform services and deliver the high-quality care needed, and demanded, for the many people who rely on them every day.

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