Memorandum from the Department of Health
1. Please could you indicate the four most
significant (in terms of size) services your department provides
to individual citizens, either directly or through its agencies
— How many people receive each service
(to the nearest 50,000)?
— What is the cost of each service
to the public purse? For each of those services.
As stated above, we do not operate any services
for the public, as a Department. However, in practical terms,
we fund two services through devolved delivery arms:
1. A health care system (NHS), which services
the entire population.
2. A social care system, which services up
to 1.5m people at any point in time.
2. What formal systems do you have for gathering
customer feedback?
| Yes/No | Cost pa
|
| Facility on Website | Yes |
Unknown |
| Response cards at offices | Yes
| Unknown |
| Focus Groups | Yes | Unknown
|
| User Surveys | Yes | Unknown
|
| Analysis of complaints | Yes
| Unknown |
| Other (please specify) | |
|
While "customer feedback" can be interpreted simply
as satisfaction surveys and complaints mechanisms, we are looking
broadly at how to gather insight about the users and the general
public—through their behaviours, usage patterns, attitudes,
satisfaction, complaints, etc—to build a holistic view of
the citizens we serve. The goal is to move beyond just directly
asking the public what they want, to building a rich and deep
understanding of what health, healthcare, and social care mean
in their lives and designing the service around them. In that
sense, the discipline of "customer insight"—which
we are endeavouring to embed throughout the Department—involves
many tools, cultures, and behaviours that extend beyond traditional
research methodologies. This can involve everything from visits
to the front lines and work shadowing, to customer segmentation,
attitudinal surveys, environmental studies, usage pattern analysis,
intermediary feedback, and observational techniques, to name a
few. It also extends beyond simply conducting the research and
obtaining feedback and information, to ensuring it is reaching
the right people in the right format on a regular basis so that
it is used optimally and has real influence over how we work.
In response to the five methodologies in your questionnaire,
we and the service organisations would conduct all of them, to
varying degrees:
1. Facility on website
DH level: We have used the Departmental website for gathering
feedback during recent consultations. There is also a contact
email for DH, and contact phone numbers, all of which go through
to the Customer Service Centre.
Service level: Local services may have websites and may
have facilities on their websites to collect feedback; however,
this is not centrally managed by DH.
2. Response cards at offices
DH level: Not applicable, as we do not have public offices.
Service level: Local services may choose to have response
cards; again, this is not centrally managed by DH.
3. Focus Groups
DH level: DH frequently conducts focus groups (with many
stakeholders including users and the general public) on an ad-hoc
basis, to explore a range of strategy, policy and communications
issues. These are organised by individual teams within the Department,
and we do not maintain a central record of costings for this.
Service level: Local services may choose to conduct focus
groups; there is no nationally coordinated programme for this.
4. User Surveys
DH level: DH frequently conducts quantitative research
on a range of strategic topics, coordinated by individual teams
within the Department. These are ad-hoc and usually to inform
a particular strand of work. DH would also feed into and utilise
the results from various national surveys such as the British
Social Attitudes Survey, the General Household Survey, and the
Health Survey for England. These are broader than "feedback
from users" but help to shape the overall picture.
NHS level: DH, along with the Healthcare Commission,
coordinates the National Patient Survey Programme. Details are
attached in Appendix A. We have also recently initiated another
major survey, General Practice Patient Survey, which may develop
further in the future. Information on this is located in Appendix
B. In addition, DH is indirectly involved in the Quality and Outcomes
Framework (QOF). The QOF is a voluntary incentive scheme for primary
medical care contractors that resources and rewards them for how
well they care for patients rather than simply how many they treat—this
includes carrying out and responding to patient surveys, as outlined
in Appendix C. Finally, local research may be done by local services
to supplement the findings from the aforementioned surveys; DH
would have little or no role in this.
Social Care level: On behalf of the Department of Health
and the Commission for Social Care Inspection (CSCI), the Information
Centre (IC) for health and social care carries out user experience
surveys on an annual basis to target areas of particular interest
within Social Services. There is a three-year rolling programme
of surveys to gain an understanding of service users' views. Previous
surveys include people aged 65 and over receiving home care, and
18-64 year olds with physical disabilities and sensory impairments.
Currently the IC is developing a user survey to gain the feedback
from people receiving equipment. Other than these, the Department
does not have involvement in survey work within the devolved delivery
organisations; however, local research may be commissioned by
Local Authorities or service organisations to inform their operations
and delivery.
5. Analysis of Complaints
DH level: The Department receives approximately 275,000
contacts a year, by phone, email, and post. Summary reports—including
complaints and comments on DH and its policies—are regularly
reported to senior officials and Ministers. Complaints related
to the service organisations are directed to those channels and
are not managed by DH.
NHS level: Complaints are handled by the immediately
relevant service organisation in the health system. "Local
Resolution" aims to resolve complaints quickly and as close
to the source of the complaint as possible, using the most appropriate
means. Analysis of complaints, therefore, would take place on
a local level, and would not be managed by DH. Please see Appendix
D for more detail on the complaints procedure and its future direction.
Social Care level: Local Authority social services departments
are required to have a complaints procedure. As with the NHS,
complaints are dealt with by the local organisations. Please see
Appendix E for more detail.
Please note that there is currently work underway to create
a single comprehensive complaints procedure across health and
social care by 2009, as outlined in the recent White Paper, "Our
Health Our Care Our Say: a new direction for community services."
3. Which systems are most effective?
We believe that it is only with a holistic analysis of all
methodologies on a regular basis that you get a true picture of
the needs of the citizens. Individually, each methodology only
tells part of the story. While collecting information is important,
what is equally relevant is that we must ensure that the research
and feedback gets appropriately reported throughout the organisation
to ensure it gets acted upon.
4. Can you identify any changes made as a result of gathering
user feedback?
At the Departmental level, feedback would regularly feed
into policy development, through a variety of mechanisms, including
consultations, qualitative and quantitative research. The recent
white paper, Our health, our care, our say: a new direction for
community services (published January 2006) is a good example
of this.
At an operational level within the devolved delivery organisations,
while there are undoubtedly examples of changes made as a result
of gathering feedback, the Department would not be involved or
have visibility into these.
5. If you undertake user surveys how often they repeated,
and how much is spent on each survey?
Please see Appendix A for information about the National
Patient Survey Programme and Appendix B for information about
the GPPS.
6. What targets for customer service, if any, are in place?
DH level: We have a target to reply to 90% of written
contacts from the public in 20 days, and all telephone calls to
be answered in 30 seconds. Performance in February was 98% against
target.
Service level: Again, with devolved operations and management,
decisions regarding targets are taken locally. However, the Department
does define the standard of service delivery that organisations
must operate—eg as set out in "National Standards,
Local Action". These standards are also incorporated into
the annual performance assessment of healthcare providers (the
Healthcare Commission's Annual Health Check), and in national
Public Service Agreement (PSA) targets. The following pages on
our website provide further information, and Appendices A and
B provide examples where the views of service users have been
used to construct metrics for measuring local performance against
targets/standards.
http://www.dh.gov.uk/AboutUs/HowDHWorks/ServiceStandardsAndCommitments/DHPublicServiceAgreement/PublicServiceAgreementArticle/fs/en?CONTENT_ID=4106188&chk=zYiEVM
http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT—ID=4086057&chk=ypFWoL
7. Do you have a complaint handling unit, or are complaints
handled where they are received?
Please see answer £2 on complaints, which outlines DH,
Social Care and NHS complaints procedures.
8. How many full time equivalents are involved in complaint
handling, and at what grades?
Please see answer £2 on complaints. Decisions about
FTEs and grades would be taken locally.
9. Do you have an internal review process for dealing
with complaints? If so, how does it operate?
Please see answer £2 on complaints.
10. Do you do any analysis of complaints to inform service
delivery and design?
Please see answer £2 on complaints.
Annexe A
THE NATIONAL PATIENT SURVEY PROGRAMME
The Programme was first announced by the Department of Health
(DH) in the National Plan (2000), and it was primarily designed
to provide robust structured patient feedback for the annual NHS
performance assessment system (initially star ratings, and now
the Healthcare Commission's Annual Health Check). On this basis,
the introduction of the Programme was an important milestone in
establishing the principle of collecting feedback of recent service
users at an organisation level.
Given this genesis, the survey the Programme was devised
in such a way that would provide annual data for performance assessment
of the different types of NHS organisation—eg to cover acute
trusts, PCTs, mental health trusts etc. In summary, it has the
following features:
— The architecture of the Programme is based on
a partially devolved centralised survey delivery model—eg:
— DH owns the policy on surveys.
— Healthcare Commission (HCC) are responsible for
the day-to-day administration of the Programme.
— Although HCC procure (via OJEU) the services of
an NHS Survey Advice Centre to develop and test all methodologies
and instruments, provide support/guidance to trusts, and coordinate
all of the final data ready for analysis and publication by HCC.
— Trusts are responsible for conducting and paying
for their own surveys—they can conduct them in-house (using
all of the materials developed by advice centre), although most
tend to commission a research supplier from a centrally approved
list.
— Surveys are setting-based—eg adult inpatients,
children/young inpatients, outpatients, emergency services, PCTs,
community mental health services, ambulance trusts, maternity
services.
— In order to minimise the financial and resource
demands on the NHS, the Programme is organised on a rolling-basis.
This means that not every setting/survey is conducted each year,
but that each organisation type has at least one set of patient-derived
survey data feeding into their annual assessment.
— The survey methodology and instruments for each
survey/setting are standardised—so all trusts must sample
patients from their records and conduct the survey in line with
guidance. This standardisation is critical for a number of reasons,
including the following:
— It provides highly robust organisation-level data—for
trusts/PCTs to use to plan and monitor their local improvement
activities.
— Trusts/PCTs can reliably benchmark their own performance
against other organisations—ie those within their region,
or comparable organisations elsewhere in the country.
— Results can be aggregated to SHA level—so
SHAs can compare their performance with others.
— Further, SHAs can compare the performance of organisations
within their area on each of the survey measures to identify variations
in performance.
— Results can also then be aggregated to produce
a national snapshot.
— By following the same methodology and using many
of the same survey questions, the Programme is able to track performance
over time—and so is able to provide an insight into the
changing experience of service users.
Further, by using a highly robust and "scientific"
methodology, results can also be used to in a number of ways that
ensure that DH and the NHS are accountable to patients, the public
and Parliament. The list of outputs is growing—but they
include the following:
— HCC—in their role of regulator they publish
survey results in their own right (see the web links above), eg
benchmark reports for each and every organisation, national summary
reports, and reports exploring variations by patient subgroups
(eg sex, age, ethnicity, disability, region etc).
— HCC—they also publish survey results in
their Annual Health Check.
— HCC—they also use the data in a number of
other publications—including State of the NHS, improvement
reviews etc.
— DSH/HCC + wider analytic community—analyse
survey data in a number of different ways, including in conjunction
with other survey or operations data (both nationally and at an
organisation level).
— DH—extends the HCC approach in the Annual
Health Check to construct metrics for measuring performance against
the patient experience PSA national target. [147]
— DH—uses the survey data in PEXIS. This is
a user-friendly IT tool that the E&I Group has developed for
the NHS to manage and monitor its performance in patient experience.
This is available via UNIFY.
— DH—has used survey data to produce information
sets for patients in order to help them in their Choice decisions.
Each survey goes through an extensive period of development
and testing—both in terms of the instrument, and the methodology.
So, over the years, the Programme has accumulated questionnaires
that have been fully evaluated—ensuring that they include
issues that are important to patients, are easily understood by
patients, and that they are able distinguish between organisations
in the quality of care provided.
Finally, it is also important to note that the surveys are
deliberately designed to collect actionable data. For example,
rather than asking questions to elicit high level feelings of
general satisfaction/dissatisfaction (which are difficult to interpret),
the surveys ask detailed factual questions about what patients
say they experienced. The range of issues that are covered are
very wide—and many are not covered by any other data-collection.
If you want to have a look at the instruments for secondary
care in more detail, then the following links will be of interest:
Adult inpatients (2006/07—fieldwork just finished)
http://www.nhssurveys.org/categories.asp?parent=239
Children/young patients (2004/05)
http://www.healthcarecommission.org.uk/—db/—documents/04006701.pdf
Outpatients (2004/05)
http://www.healthcarecommission.org.uk/—db/—documents/04011422.pdf
Emergency services (2004/05)
http://www.healthcarecommission.org.uk/—db/—documents/04011423.pdf
Annexe B
THE GENERAL PRACTICE PATIENT SURVEY
The GP patient survey: your doctor, your experience, your
say has been developed as a result of a commitment made in the
White Paper Our health, our care, our say: a new direction for
community services, which was published in January 2006. The Survey
has been developed to act as a nationally consistent tool for
eliciting patients' views on primary care services at practice
level. The Survey focuses on patients' experience of access: the
results will be used by primary care trusts (PCTs) to reward general
practices on the basis of their patients' experiences of consulting
a GP.
The Survey will give patients a greater say in how their
services are provided, and will enable PCTs to reward those practices
that are offering patients good access to services. Patients will
be asked questions on flexible booking, telephone access and opening
hours. The Survey should help drive improvements so that patients
are able to fit appointments with their GP around their daily
lives.
The aim of the Survey is to use patients' experiences to
help PCTs assess general practices' achievement against standards
set out in two one-year (April 2006—March 2007) Directed
Enhanced Services (DES) entitled the Improved Access Scheme and
Choice. The results of the initial 2006-07 Survey will support
PCTs in relation to the Improved Access Scheme. Separate arrangements
are being made for the Choice component of the Survey.
The Survey results will provide PCTs with information on
the extent to which patients consider that their GP practices
are:
— enabling patients to consult a GP within two working
days;
— enabling patients to book ahead for non-urgent
appointments;
— enabling patients to contact their practices by
telephone; and
— enabling patients to make an appointment with
a particular GP if that is their preference (even if this means
waiting longer).
The Survey includes some questions that are not linked to
the Improved Access Scheme, These questions are about practice
opening hours and are intended to provide PCTs with information
on the extent to which patients belonging to different practices
would like to see changes in their practice's opening hours.
Payments are linked to the percentage of positive responses
received from patients surveyed. For the questions on access to
the GP practice, payments are graded, so the higher the percentage
of scores, the more payment the practice will receive.
Annexe C
PATIENT EXPERIENCE DOMAIN OF THE QUALITY AND OUTCOMES
FRAMEWORK
The Quality and Outcomes Framework, a quality incentive scheme
for GP practices, contains a section ("domain") on patient
experience. This domain covers two areas: length of consultation
and patient surveys. Two patient surveys are accredited for use:
the General Practice Assessment Questionnaire (GPAQ) and the Improving
Practice Questionnaire (IPQ). 75 points are available for conducting,
analysing and acting upon the patient survey (worth £9345
for the average practice).
The results of the survey are owned and fed back to the practice
and do not go to the Department of Health in any format. QMAS,
the computer system which is used to calculate achievement for
the QOF, only records whether the survey has been conducted and
analysed, which is confirmed by the PCT during the verification
process. The data is collected from local patients for use locally.
However, some of the companies used for conducting and analysing
the survey may be at some distance from the practice.
Annexe D
NHS COMPLAINTS PROCEDURE
Responsibility for dissemination of information about complaints
at local level rests with the local NHS organisation. Under Regulation
20 of the National Health Service (Complaints) Regulations 2004,
each NHS body must ensure that there is effective publicity for
its complaints arrangements. These regulations require NHS bodies
to establish and operate complaints procedures with a view to
securing a speedy resolution at local level. Where complainants
are not satisfied with the result of an investigation at local
level, they may request the Healthcare Commission to consider
their complaint.
The Independent Complaints Advocacy Service (ICAS) was established
to support patients and the public wishing to make a complaint
about their NHS care or treatment. ICAS aims to ensure complainants
have access to the support they need to articulate their concerns
and navigate the complaints system, maximising the chances of
their complaint being resolved quickly and effectively.
PROCESS
The NHS complaints procedure covers complaints made by a
person about any matter connected with the provision of NHS services
by NHS organisations or primary care practitioners (GPs, dentists,
opticians and pharmacists). The procedure also covers services
provided overseas or by the private sector where the NHS has paid
for them.
Who can complain?
A complaint can be made by a patient or person affected or
likely to be affected by the actions or decisions of a NHS organisation
or primary care practitioner. A complaint can also be made by
someone acting on behalf of the patient or person, with their
consent.
Time limit for making a complaint
A complaint should normally be made within six months of
the event(s) concerned or within six months of becoming aware
that there is something to complain about. Primary care practitioners
and complaints managers in NHS organisations have discretion to
waive this time limit if there are good reasons why the complaint
could not have been made earlier.
To whom should the complainant make the complaint initially?
The first stage of the NHS complaints procedure is "Local
Resolution". The complaint should be made in the first instance
to the organisation or primary care practitioner providing the
service. Local resolution aims to resolve complaints quickly and
as close to the source of the complaint as possible using the
most appropriate means; for example, use of conciliation.
Concerns can also be raised immediately by speaking to a
member of staff (eg doctor, nurse, dentist, GP or practice manager)
or someone else, eg the Patient Advocacy Liaison Services (PALS).
They may be able to resolve the concerns without the need to make
a more formal complaint.
However, if the complainant wants to continue with the complaint,
this can be done orally or by writing (including e-mail) to the
primary care practitioner or the NHS organisation concerned. If
the complaint is made orally, a written record should be made
by the complaints manager.
The complainant should receive a response from a primary
care practitioner within 10 working days or from the Chief Executive
of the NHS organisation concerned within 25 working days, though
this deadline can be extended with the complainant's agreement.
NHS Foundation Trusts
NHS Foundation Trusts will have their own systems for the
internal handling of complaints, which may differ from the "local
resolution" process described above. If the complaint is
about an NHS Foundation Trust, the complainant should contact
it for advice on how to make the complaint. The "independent
review" stage carried out by the Healthcare Commission does
apply to NHS Foundation Trusts, which are also covered by the
Health Service Ombudsman.
Complaints about both healthcare and social care
If the complaint is about healthcare or social care, the
complainant can complain to either the local NHS or social care
organisation and they will ensure either that they respond to
the complaintant themselves or that it is sent to the right organisation
(with the complainant's permission). If the complaint covers both
NHS and social care, the organisations will work together to respond
to the concerns.
Independent Review
If the complainant is unhappy with the response to the complaint,
including a complaint about an NHS Foundation Trust, they can
ask the Healthcare Commission for an "Independent Review"
of the case. The Healthcare Commission is an independent body
established to promote improvements in healthcare.
The Health Service Ombudsman
If the complainant remains unhappy after local resolution
and independent review, they can complain to the Health Service
Ombudsman. The Ombudsman is completely independent of both the
NHS and Government.
FUTURE
It is accepted that the NHS needs to be better at handling
and learning from complaints, so that complaints lead to improvement
in services. It is imperative that information about complaints
and their causes is integrated into systems for ensuring the NHS
provides safe, high quality treatment and services.
The Department of Health is looking for ways to improve the
way the NHS handles complaints. Work has started to consider and
develop what a patient centred complaints procedure might look
like and how it would operate. From 1 September last year, interim
revised NHS Complaints regulations came into force to make the
system more responsive and also to give better links with the
arrangements for responding to Social Care complaints.
Last year, the White Paper "Our Health, our care, our
say: a new direction for community services", announced the
Department's commitment to developing a comprehensive single complaints
system across health and social care by 2009. In addition, the
Department will be reviewing the current arrangements for making
complaints and raising concerns and this will provide us with
the opportunity to reconsider the best means of independent review
in a new, reformed complaints system. Within the Department of
Health, we are working closely together across health and social
care, with input and involvement of key advisers such as the Healthcare
Commission, the Health and Local Government Ombudsman and the
National Patient Safety Association, to take forward an integrated
approach to complaints handling, ensuring greater consistency
between health and social care and a focus on resolving complaints
locally.
The complaints reforms will build on the existing procedures,
and wider initiatives, to introduce improvements that place the
focus on what patients want from the complaints procedures, rather
than on process and timescales.
Annexe E
Local Authority social services departments are required
to have a complaints procedure. The new regulations and guidance
for the social services complaints procedure for adults issued
by DH came into affect 1 September 2006.
DH was responsible for the regulations and guidance issued
under Section 7 of the Local Authority Social Services Act 1970
for local authority implementation.
The guidance and underpinning regulations are a foundation
for LAs to build on a culture of listening to, and learning from,
complaints in order to drive up improvements in service provision.
One of the requirements is for LAs to produce an annual report
that records complaints received and what action has been taken
to address the concerns.
If a complainant remains dissatisfied, they can approach
the local government ombudsman (the LGO will expect LAs to attempt
to resolve the issue in the first instance). Regarding self-funded
users of independent services (ie in care homes), it is for the
providers (care homes) to have their own complaints procedure
in place, with recourse to CSCI if the complainant remains dissatisfied.
There is currently underway a project to deliver a single
comprehensive complaints procedure across health and social care
by 2009 (White Paper commitment).
March 2007
147
SR 2004: "Secure sustained national improvements in NHS patient
experience by 2008, as measured by independently validated surveys
ensuring that individuals are fully involved in decisions about
their health care, including choice of provider". Back
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