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NHS complaints system ‘utterly bewildering and largely ineffective’

Most NHS patients who complain never get an apology, and 80% say they had to complain more than once before someone listened to them, according to a new investigation into complaints from Healthwatch England.

The healthcare consumer watchdog today published Suffering in Silence, a look into the “utterly bewildering and largely ineffective complaints system” of the NHS. It found that two-thirds of people who witnessed or experienced poor care did not complain, a quarter of these because they did not know who to complain too. Of those who did complain almost half found it difficult to find out how to do so.

Not even one person in 10 were provided with any formal support to make a complaint yet more than 80% said they would have made a complaint about some aspect of care if they thought it would make a difference.

The report says that making a complaint can be tough for unwell patients and those feeling vulnerable, with the survey showing that more than a quarter did not complain because they feared it might have negative repercussions on their care.

The report estimates that as many as 250,000 incidents of poor care went unreported last year.

It also found that 61% of complainers did not think they were taken seriously enough. Based on this the report finds that the NHS needs a “complaints system that above all deals with people compassionately, delivers a swift and professional resolution and demonstrates that lessons have been learned from complaints”.

One patient surveyed told the watchdog: “I received a written reply two months after the incident. No fault was admitted, no regret expressed and, as far as I know, their practice remains unchanged. My complaint remains completely unresolved as far as I am concerned.”

Anna Bradley, chair of Healthwatch England, stressed that professionals and policy makers cannot continue to look on complaints as raw data about performance, they need to be compassionate and supportive of those who feel they have been let down.

“There is already universal support for the need to improve complaints handling and the public has helped us highlight some quick wins for the system,” she said. “But having examined the experiences of thousands of patients, it is clear that the problem goes much deeper than a bit of tinkering with what we already have.

“We are calling for legislative time to be dedicated to this issue as soon as possible following the election, with the aim of creating a new, streamlined and genuinely responsive system that will give people what they want and ultimately provide the system with the insight to learn from its mistakes.”

The report makes several key recommendations to change complaints procedures now, however Healthwatch says that the problems go too deep to stop at minor adjustments, and is also calling for wholescale reform.

The changes it recommends are:

• Allow anonymous complaints and those by 'worried bystanders' who witness others suffering as a result of poor care
• Introduce a 72-hour maximum response time for all complaints
• Clearly display up-to-date information about where and how to complain in all appointment letters, on prescription notes, on waiting room walls etc.
• All councils to be required to send details of complaints about social care services to the Health and Social Care Information Centre to provide the same national oversight as for complaints about the NHS
• Prevent people being bounced around the complaints system by making health and social care staff responsible for ensuring complaints reach the right part of the system rather than leaving it to the patients
• Introduce a named case handler for every complaint so people have a consistent point of contact
• Replace fragmented complaints support services such as Patient Advice and Liaison Services and the Independent NHS Complaints Advocacy Service with one single offer of support open to all patients regardless of age, condition or service
• Scrap the one-year rule and give patients and care users the power to control the pace of their complaint, including the ability to register their intent to complain and then 'stop the clock' until they are emotionally and physically able to pursue it

Commenting on the report NHS Confederation chief executive Rob Webster said that many of the issues it raised reflect the complexity of service delivery, he also mentioned a “golden thread” to handling complaints well.

"It is vital that patients, their families and carers feel safe and able to feed back on their NHS care and treatment,” said Webster. “While both positive and negative feedback should be equally valued and encouraged, it is essential that we make every effort to learn from when things go wrong, and that NHS organisations deal with patients' concerns promptly, effectively and appropriately.

"There is a 'golden thread' to handling complaints well - apologising, explaining what happened, and describing why it won’t happen again. Healthcare is personal, and hearing “sorry” from someone who means it can be a major part of finding a successful resolution for patients and their families.”

A Department of Health spokesperson said: “Mid Staffs was a turning point for the NHS - it is now more transparent than ever before, but we know patient feedback is essential so mistakes are not repeated. We’ve already taken tough action to ensure patients are listened to, with the CQC now including complaints handling as part of their independent new inspection regime.”

NHE interviewed Healthwatch England’s director of policy and intelligence, Dr Marc Bush, about the failures of the complaints system in our July/August 2014 edition.

(Image: c. alexskopje)

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