1 Introduction
1. If a member of the public wishes to complain about
a public service, he or she has the right to have their complaint
respected, for their concerns to be addressed, and for any wrongdoing
to be put right with fair redress and without undue delay. Those
delivering the service should ensure that lessons are learnt from
complaints to identify what needs to be improved. Our inquiry
examined the extent to which this was an accurate representation
of complaints handling in public services.
2. Members of Parliament are often the last resort
for constituents who have a complaint about a public service,
or other issue. We are frequently confronted by people in deep
distress, suffering intense pain or loss, and who may be at the
end of their tether. Many who complain do so for the most altruistic
reasons; not to punish, or to gain something for themselves, but
to try to ensure that the same experience they have suffered should
not be inflicted on others. They want the system, and the people
within it and who lead it, to learn and to benefit from their
experience.
3. So often, as MPs, we find that complaints handling
is more about understanding and empathy than process and outcome,
and public services often fail to recognise this. All too frequently,
complaints are greeted by a management who are defensive, even
legalistic, and who see complaints as a hostile criticism, rather
than as an opportunity to learn from failure. Even if a complaint
is not upheld, there is always the opportunity to learn about
why the complainant has complained, and a need to understand the
motives and feelings of the complainant. To embrace this is both
a challenge and an opportunity for every organisation that serves
the public, but particularly in public services.
4. The shocking collapse of care at Mid Staffordshire
Hospital, and the exposure of the failure of the Mid Staffordshire
NHS Foundation Trust and NHS leadership to hear both the complaints
of patients and their families, and the complaints of their own
staff, led to the unspeakable disaster at that hospital. The Francis
Report gave no comfort that a culture of denial did not exist
across the NHS as a whole.[1]
A subsequent review of complaints handling by the Rt Hon Ann Clwyd
MP and Professor Tricia Hart similarly found that the public "were
unaware how to raise concerns or make complaints, either for themselves
or on behalf of friends or relatives" and that delays in
resolving complaints were "a huge source of frustration".[2]
Complaints handling in the NHS was described by Dame Julie Mellor,
the Parliamentary and Health Service Ombudsman (PHSO), as a "toxic
cocktail":
This is a combination of reluctance on the part
of patients, families and carers to express their concerns or
complaints and a defensiveness on the part of hospitals and their
staff to hear and address concerns. As a result opportunities
to learn and improve care are lost.[3]
The changing nature of complaints
and complaints handling
5. The nature of complaints and complaints handling
is changing. The number of complaints made by citizens is rising
across sectors. The Financial Ombudsman Service reported a 92%
increase in the number of new cases in 2012/13, compared with
the previous year.[4] In
2012 the General Medical Council witnessed an 18% increase in
the number of concerns raised about doctors' fitness to practice.[5]
6. Observers of complaints handling practices note
that this general rise in complaints does not always indicate
that the quality of services is diminishing, but "reflects
in part rising expectations and new technologies making it easier
to complain".[6] Many
of today's citizens have a higher level of confidence, are more
aware of their rights, and expect an increasingly effective service
from all parts of the public and private sectors. At the same
time there are those who will require support and advocacy in
order to enjoy equal access to complaints procedures.
Our inquiry
7. In 2005, the National Audit Office's report, Citizen
Redress: What citizens can do if things go wrong with public services,
concluded that members of the public saw complaints and appeals
processes as complex, slow-moving, expensive and time-consuming.[7]
PASC examined the issue of complaints handling in 2008. The then
Committee considered how easy it was for citizens to complain,
what made for good practice in complaints handling and how complaints
could be used to identify and address problems. The Report, When
Citizens Complain, concluded, amongst other things,
that there was a systemic problem with "first-tier complaint
handling"; that complaints systems were difficult to navigate;
and that government organisations should have an active strategy
for monitoring and learning from complaints.[8]
8. This inquiry built on previous work and was very
much influenced by the findings and the implications of the Francis
Report with regard to how complaints are handled not just for
the NHS, but for the whole of public service. We have examined
the approach to complaints handling by government departments
and agencies to determine how well it complies with best practice
in complaints handling; how it has adapted to the changing nature
of complaints; and the extent to which complaints made to government
departments and agencies meet the needs and aims of those who
complain. We also conducted a parallel inquiry into the performance
and effectiveness of the Parliamentary and Health Service Ombudsman
(PHSO), and we are reporting separately.
9. We have received, as PASC does as a matter of
course, a number of individual complaints about public services
and other matters, including complaints about the office of PHSO.
PASC does not have the capacity, nor is it within its remit, to
adjudicate on individual cases. We recognise that this can be
very frustrating for individuals. Nevertheless we are grateful
for the insight such cases have added to our understanding of
how complaints can be handled or mishandled.
10. As part of our investigations we visited the
Netherlands to learn about the operation of the National Ombudsman
of the Netherlands, and the relationship between that office,
the Dutch Government and the Dutch Parliament. We wish to thank
all those who contributed to this inquiry, with special thanks
to Dr Nick O'Brien for his support as a Specialist Adviser on
this piece of work.[9]
1 Report of the Mid Staffordshire NHS Foundation Trust
Public Inquiry, HC (2012-13) 898-I Back
2
Rt Hon Ann Clwyd MP and Professor Tricia Hart, A review of the NHS Hospitals Complaints System Putting Patients back in the Picture
(October 2013), p22 Back
3
Parliamentary and Health Service Ombudsman, Submission by the Health Service Ombudsman for England to the Review of the NHS Complaints System
(June 2013), p4 Back
4
The Financial Ombudsman Service, Annual review of consumer complaints about: insurance, credit, banking, savings and investments financial year 2012-2013
(May 2013), p33 Back
5
General Medical Council, Annual Report 2012 (July 2013), p8 Back
6
NESTA, Grumbles, Gripes and Grievances. The role of complaints in transforming public service
(April 2013), p7 Back
7
National Audit Office, Citizen Redress: What citizens can do
if things go wrong with public services, HC (2004-05) 21,
p13 Back
8
Public Administration Select Committee (PASC), Fifth Report of
Session 2007-8, When Citizens Complain, HC 409 Back
9
Dr Nick O'Brien was appointed as a Specialist Adviser for this
inquiry on 11 June 2013. The following interests were declared:
an Honorary Research Fellow at Liverpool University; employed
as a fee-paid judge in the Mental Health Review Tribunal; held
various paid advisory and employed part-time posts at the Office
of the UK Parliamentary Ombudsman and Health Service Ombudsman
between 2007-2012; contracted to prepare a policy position paper
in April 2013 and facilitate a roundtable of academics for the
Ombudsman in May 2013 in respect of the forthcoming inquiry; contributing
to a project jointly for the Parliamentary Ombudsman, the Financial
Ombudsman Service and the Legal Ombudsman on options for future
shared approaches to redress; paid advisor to the Northern Ireland
Ombudsman on a project relating to the investigation of complaints. Back
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