Complaints and Litigation - Health Committee Contents

Written evidence from Anne Ward Platt (CAL 24)

1.  My name is Anne Ward Platt. I am director of AWP Associates and of WP Medical and Professional Services Ltd., and I am a Non-Executive Director of Northumberland, Tyne and Wear NHS Foundation Trust. I am author of "Conciliation in Healthcare: managing and resolving complaints and conflict", foreword by Sir Liam Donaldson, former Chief Medical Officer (Radcliffe Publishing 2008). I have been involved in healthcare conciliation since 1997 and I have experience as a conciliator in relation to both primary and secondary healthcare.

2.  I make this response to the Health Committee Inquiry in a personal capacity.

3.  The headings under which I am submitting evidence are:

——  The effectiveness of the constituent parts of the complaints system

—  Encouraging the use of mediation before litigation is instigated.

4.  To this submission I append the following articles I have written,[18] which highlight best practice in complaints handling, including the use of conciliation:

Ward Platt A. Handling complaints. British Medical Journal 2010;340:98-9.

Ward Platt A. Say you want a resolution: conciliation in general practice. Management In Practice 2008;14 (with permission from Campden Publishing).

Ward Platt A. The new complaints procedure in general practice. Management In Practice Web Exclusive. 20 April 2009 (with permission from Campden Publishing).


5.  The Ombudsman's office is now receiving more than twice the number of complaints compared to the period before April 2009, which suggests that problems remain with resolving complaints at a local level. I would like to suggest that wider use of independent conciliation could be instrumental in preventing the escalation of complaints to the Ombudsman. The current NHS complaints arrangements remove the need for a rigid timetable to be applied to handling complaints, and in principle this greater flexibility should also enable the wider use of conciliation.

6.  The potential value of using conciliation within both primary and secondary healthcare is not sufficiently recognised in the UK. However, conciliation is already used extensively in relation to healthcare complaints in a number of other countries; I have highlighted examples of best practice in "Conciliation in Healthcare: Managing and resolving complaints and conflict".

7.  Complaints often originate from situations that are distressing for all concerned. Where these occur following the death of a patient, an adverse event, a side-effect or reaction arising from clinical treatment, or where mistakes have been made, conciliation offers an opportunity for the issues to be addressed in a way that is supportive for both the complainant and the clinician. The process can enable more effective communication between the parties, which may in turn facilitate resolution of the complaint.

8.  Conciliation can provide a supportive process for staff as well as for those making a complaint. Complaints can have a deleterious effect on a health professional's clinical practice, particularly if they are engaged in a long and protracted complaints process. If not properly managed, seemingly minor issues can escalate and have far reaching consequences. Some doctors practise more defensively and others lose their enjoyment of work, and these effects can still be evident in the long term, with consequent damage to patient care.

9.  Key aspects of conciliation are:

  1. 9.1  It is undertaken by a neutral intermediary who is independent of the parties concerned.
  2. 9.2  It is a voluntary process, and the parties can withdraw at any time.
  3. 9.3  It is a confidential process (so conciliators need to comply with the relevant NHS guidance).
  4. 9.4  It allows for apologies to be made.
  5. 9.5  Further explanations or information can be provided, which may include independent clinical advice.
  6. 9.6  It can be used in relation to complex clinical complaints as well as complaints involving the attitude and manner of healthcare staff.
  7. 9.7  It is not essential for the parties involved in the complaint to meet together during the conciliation process unless a desired outcome is a restoration of the relationship between them.
  8. 9.8  Where appropriate, redress may be agreed.
  9. 9.9  Service improvements can be identified or other actions can be taken as a direct result of the complaint.
  10. 9.10  It is cost effective, as expensive litigation is often avoided.


10.  Where appropriate, the use of mediation/conciliation in relation to claims can be invaluable. It is worth bearing in mind that some claims have their origins in a poorly handled complaints process; some claimants pursue litigation because they have not received satisfactory explanations, particularly where there has been an adverse clinical outcome.

11.  Although there are some variations in the models used in different contexts, conciliation and mediation share these characteristics:

  1. 11.1  The use of a neutral intermediary who acts as an impartial and independent facilitator using specific skills aimed at bringing about a resolution of the dispute to the satisfaction of the parties concerned;
  2. 11.2  the process is based on an agreed framework or code of conduct;
  3. 11.3  any information that is disclosed during the process is "without prejudice", which means that it cannot normally be used in any subsequent court proceedings;
  4. 11.4  the parties agree to take part in the process voluntarily;
  5. 11.5  the parties can withdraw at any time;
  6. 11.6  the mediator or conciliator does not impose a solution on the parties;
  7. 11.7  the private sessions between the mediator or conciliator and each party are confidential (within certain limits), and only such information as is agreed is passed on to the other party;
  8. 11.8  there is opportunity for joint sessions involving both parties;
  9. 11.9  the process provides a "safe" environment in which the participants can express their feelings and emotions;
  10. 11.10  the outcome may include apologies; explanations; evidence of organisational change (for example, action plans); evidence of individual change (for example, learning or re-training); or restoration of relationships between parties; as well as financial settlements where provision is made for this; and
  11. 11.11  the outcome is not legally binding, but where the process is being used as an alternative to a court hearing, the parties may agree subsequently to a legally binding contract.


12.  I hope that the Committee's Inquiry will recognise that the potential benefits of conciliation are considerable, and that conciliation/mediation should be widely promoted as an effective means of resolving complaints and claims.


1.  Ward Platt A. Conciliation in Healthcare: Managing and resolving complaints and conflict. Oxford: Radcliffe, 2008. Foreword by the Chief Medical Officer, Sir Liam Donaldson.

2.  Ward Platt A. Say you want a resolution: conciliation in general practice. Management In Practice 2008;14.

3.  Ward Platt A. The new complaints procedure in general practice. Management In Practice Web Exclusive. 20 April 2009.

4.  Ward Platt A. Handling complaints. British Medical Journal 2010;340:98-9

December 2010

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Prepared 6 July 2011