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Complaints need to be taken more seriously says CQC

Complaints about health and social care need to be taken more seriously, according to the CQC.

In a report out today the regulator said that there is wide variation in the way complaints are handled across the NHS, primary care and adult social care services in England. Too often complainants are being met with a ‘defensive culture’ rather than one that listens and is willing to learn, the report says.

The report is based on a sample of CQC inspections of NHS trusts, adult social care and primary medical services as well as surveys, and feedback from its inspectors.

Although the CQC found examples of good practice, it says that more needs to be done to encourage people to come forward with their complaints, to keep them informed on the progress, to reassure them that action will be taken as a result, and to assess that whether they are satisfied with how it has been resolved. The report argues that this in turn will lead to improvements in the quality of care.

Key areas of concern that were highlighted in the report include investigations taking place in a timely manner and complainants feeling that they had not been taken seriously enough.

Prof Sir Mike Richards, chief Inspector of hospitals and leader the review, said: "A service that is safe, responsive and well-led will treat every concern as an opportunity to improve, will encourage its staff to raise concerns without fear of reprisal, and will respond to complaints openly and honestly.

"Unfortunately this is not happening everywhere. While most providers have complaints systems in place, people’s experiences of these are not consistently good.

"We know from the thousands of people who contact CQC every year that many people do not even get as far as making a complaint as they are put off by the confusing system or worried about the impact that complaining might have on their or their loved one’s care.

"More needs to be done to encourage an open culture where concerns are welcomed and learned from.

"Through our inspections, we have a big role to play in supporting this change. We will continue to hold health and adult social care services to the high standards that people both expect and deserve."

As part of the report the CQC has also issued guidance to its inspection teams on how they should investigate and assess the handling of complaints.

This includes:

  • Gathering information from partners such as the ombudsmen, Healthwatch England, local authorities and advocacy services before an inspection, as well as from providers
  • Asking people who use services what they think about the way complaints and concerns are handled, often led by CQC’s Experts by Experience (trained members of the public who are part of the inspection teams)
  • Reviewing a sample of complaints files to understand if these have been handled in a way that matches the good practice CQC expects.
  • Introducing a lead inspector for complaints and staff concerns on its larger inspections to draw together all of the evidence.
  • Clearly explaining how providers handle complaints about their services in the inspection reports, the judgements of which contribute to overall ratings of Outstanding, Good, Requires Improvement and Inadequate to help people make informed choices about their care.

The CQC published its report after a review of the NHS complaints system a year ago by the MP Ann Clywd and nursing expert Professor Tricia Hart, interviewed by NHE at the time.

Commenting on the new report Clywd said: "I welcome this report and in particular the CQC's intention to develop a thorough inspection regime for complaints systems in hospitals. I want the many thousands of people who wrote to me in the course of my review to know that change is expected as a result."

Dr Katherine Rake, chief executive of Healthwatch England said: "It's really encouraging to see the CQC recognising the huge importance of complaints and really starting to use people's concerns to help guide the inspection of our hospitals, GP surgeries and care homes to ensure they're up to scratch.

"But complaints handling cannot just be about driving improvement. Fundamentally complaints are stories about what happens when things go wrong and people are failed. First and foremost every case must be dealt with compassionately with those involved kept informed about how their complaint has made a difference."

In our July/August 2014 edition, NHE examined the complexity, fragmentation, inconsistency and defensiveness of complaints systems in the NHS and social care, and what is being done to improve the situation, including an interview with Healthwatch England’s director of policy and intelligence, Dr Marc Bush.

Parliamentary and Health Service Ombudsman, Julie Mellor said that the CQC’s findings mirrored the research of the Ombudsmen that found significant variation in complaint handling in hospitals.

“Every complaint presents an opportunity to learn and improve services. We agree with the CQC that listening and learning when things go wrong needs to be embedded into an organisation’s culture,” she said. “Our report, ‘My expectations for raising concerns and complaints’, sets out what good complaint handling looks like from patients and service users’ perspectives. We’re delighted the work has already been incorporated into the CQC’s new approach to inspections. We hope others will now use this to measure whether the actions they are taking are making a difference for the patient experience.”

Health secretary Jeremy Hunt MP said: "One of the biggest lessons of the tragedy at Mid Staffs is the need to listen and act on all complaints.

"So as part of our drive to confront poor care we’re making sure people know how to complain and transforming complaints handling – now a crucial part of the CQC’s tough, independent inspection regime. Today’s report shows both that that progress has been made and that there’s still more to do."

(Image: c Joe Logon)

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