3 Valuing complaints |
26. Many witnesses emphasised the importance of leadership
in determining the quality of complaints handling throughout a
service. PHSO said that those at the very top of an organisation
should "take the lead" in ensuring good complaints handling
in terms of both process and the way in which complaints are valued.
The Ombudsman for Amsterdam told us on our visit to the Netherlands
that officials need to have the backing of politicians and high-level
managers to enable them to change an organisation. Jo Causon,
Chief Executive of the Institute of Customer Service, told us
If [a complaint] is visible and it is being measured,
there is a general chance that something is more likely to happen
as a result.
27. Others echoed this, particularly in respect of
the NHS. Brenda Hennessy, then Director of Patient Experience
at Cambridge University Hospitals, said that the role of an NHS
Trust Board was "absolutely key to the success or not of
a good complaints system".
Claire Murdoch, Chief Executive of the Central and North West
London NHS Foundation Trust, said that:
It is the job of the Trust Board to know very
clearly what the quality of care is that you are providing. I
do think that, in this hugely complex landscape of commissioning
and regulators, and in our case providers, it is helpful to all
if we are clear, both as boards and as the public, that the people
most accountable for the quality of patient care are boards of
provider organisations and the clinicians working for them.
28. The evidence of a failure of leadership to value
complaints and to take them into account is all too clear. The
Francis Report highlighted serious failures with the complaints
process and the performance of the Mid Staffordshire Hospital
Trust Board, saying that the Board "did not listen sufficiently
to its patients or its staff or ensure the correction of deficiencies
brought to the Trust's attention".
A review of NHS governance of complaints handling by PHSO in 2013
found that of 94 Trusts, only 20% reviewed learning from complaints
and took resulting action to improve service, and fewer than two-thirds
used a consistent approach to reviewing complaints data.
29. We heard that clearer responsibility and accountability
for complaints handling within Government would be welcomed. Richard
Lloyd, Executive Director of the organisation Which?, told us
that a central responsible minister for complaints could be useful:
It seems to me that this is a classic ministerial
job. There are quite a few ministers in the Cabinet Office these
days, and one of them should be responsible for looking across
Whitehall at how data from complaints could be aggregated and
collected more systematically and acted on more efficiently, and
how consumersour customers and clientsshould be
able better to report complaints.
30. When questioned about the issue of leadership
and responsibility we found the Rt Hon Oliver Letwin MP, Minister
for Government Policy, to be candid about shortcomings in this
area. He suggested that complaints handling had "not been
a matter of policy [...] for any Government in recent recorded
history" and that: "Until very recently, there had not
for many decades been any very serious attention paid to the question
of how we use complaints to improve service delivery."
31. The Minister conceded that more work needed to
be done, and that he would carry out a review of complaints handling
as a result of the issue being drawn to his attention by PASC:
I want to create a culture within which, through
services, and ideally right at the ground level, complaints are
welcomed and used so that they do not have to be run from somewhere
on top. However, whatever system, or systems, we set up for doing
that then has to be invigilated and monitored to see whether it
is working, where it is and is not working, and that is the role
I envisage for me and the Cabinet Office.
32. Valuing complaints and supporting people who
feel the need to complain should be at the heart of the values
which drive public services. The importance of leadership cannot
be overstated. Complaints must be valued from the very top of
an organisation and seen as something to be welcomed. Good leadership
will appreciate that an increase in the volume of complaints about
a particular department or agency may not indicate that the quality
of service has diminished. It could indicate an improved public
awareness of the right to complain, better complaints handling
processes, an increased call on services or success in obtaining
more honest feedback on the quality of the service.
33. Since the Parliamentary and Health Service
Ombudsman's research on the governance of complaints in the NHSwhich
found that of 94 Trusts, only 20% reviewed learning from complaints
and took resulting action to improve servicewe believe
that practice is already changing at Trust Board level throughout
the NHS. We welcome the renewed focus on complaints handling more
widely from the Minister for Government Policy, and his agreement
to carry out a review.
34. There should be a single minister for government
policy on complaints handling. In our report on the Parliamentary
and Health Service Ombudsman, we will recommend that there should
be a minister for government policy in respect of the Parliamentary
and Health Service Ombudsman. These two responsibilities should
form part of a dual role.
35. We recommend that the Cabinet Office work
with high performing public and private sector companies in complaints
handling to identify best practice and how to apply it to the
departments and agencies, taking relevant differences into account.
36. We recommend that the Cabinet Office audit
departmental complaints systems to identify good and bad practice
as well as identify where lessons have been learned. This audit
should result in recommendations for improvement in complaints
handling across departments and agencies.
The impact of leadership on attitudes
37. Richard Lloyd told the Committee that:
There is a sense in the public sector, relative
to the best practice in private markets, that there isn't a culture
of looking at complaints as a great source of feedback about how
you improve what you do for people. It is sometimes quite the
oppositea sense of resistance to complaints as if this
was something to be avoided and deterred.
38. Some suggested to us that the lack of leadership
and focus on complaints handling had led to the kind of poor complaints
handling culture which was so frequently referred to. Brenda Hennessy
told us: "If that leadership is not demonstrated at the top
by the board, then it is not going to filter into the culture
of the organisation."
39. Mark Mullen, the then Chief Executive Officer
of First Direct Bank, explained to us the link he believed existed
between leadership and staff, and staff and customers, and how
the former influences the latter:
There is a relationship between how you treat
your people and how you ask or expect or want your people to treat
their customers. In my experience, in the service sector it is
virtually impossible to create a positive outcome with customers
unless you have created a positive relationship with your own
employees. So culture begins within and you have to treat people
with the same degree of care and respect irrespective of whether
they work for you or whether they are your customers.
40. Dr Alex Brenninkmeijer, the National Ombudsman
of the Netherlands, told us during our visit to the Netherlands
of the need to take an interest-based approach in people making
a complaint and to try to solve the problem faced by each individual,
rather than behaving like a court or tribunal. He explained how
the concept of "fairness" was very important for citizens
and he stressed four elements of this:
· personal contact;
· fair treatment;
· equal footing; and
· trust in citizens (most citizens were
honest and should be treated as such).
He told us that he applies principles of fairness
and empathy in his approach, and that personal contact and asking
the citizen how best they can serve them was important. He also
emphasised the importance of training in good customer service
for those who deal with complaints.
41. Individuals who said that those dealing with
complaints need a sympathetic approach echoed this ideal. However,
some individuals told us that they experienced a negative response
when pursuing their complaint. One individual said in complaining
about the way she had been dealt with by a member of staff, she
received a "rude and dismissive" response.
Another suggested that the approach to a complaint made to an
NHS Trust was "defensive".
Sarah Rapson, the then Interim Director General, UK Visas and
Immigration (UKVI), now Director General, UKVI, Home Office, gave
us an example of poor practice that she had identified and was
tackling within UKVI:
The organisation has not had customer service
at the top of its priorities. 'It will take as long as it will
take to make the right decision' is part of the culture, as opposed
to, 'We need to make the right decision, but we also need to do
it in a timely way'. That is something that has been recognised.
42. As part of our inquiry we took evidence from
Sir David Nicholson, the then Chief Executive of NHS England,
and Chris Bostock, Policy Lead for NHS Complaints at the Department
of Health. Sir David accepted that the "toxic cocktail"
exists within the NHS: a reluctance on the part of citizens "to
express their concerns or complaints" and a defensiveness
on the part of services "to hear and address concerns",
and he said that there is a "real issue" about defensiveness
and a lack of transparency.
Sir David said that the need for openness is not always recognised
in the NHS and went on to say that, while more data is being published,
and more people are connecting with NHS services and each other
about their experiences through social media, the leadership within
the NHS is "having difficulty coming to terms with that"
and is "slightly" behind. He accepted that it comes
down to leadership and culture:
Undoubtedly, in broad terms, the NHS leadership
is not equipped to handle some of the big issues that are coming
forward, so we need to tackle that leadership. We need to work
really hard on the culture of the system overall, because as you
are going through that transition the importance of setting the
right tone from top to bottom of the organisation is increasingly
important. You need to make sure that you are learning the lessons
and getting innovation from the system as a whole.
43. Sir David also explained how the NHS Leadership
Academy, which aims to develop outstanding leadership in health
in order to improve people's health and their experiences of the
NHS, is focussed on addressing some of these cultural issues:
One of the things we found in the NHS was that
there is a particular type of leadership, which in the jargon
is described as 'pace-setting'. It is about getting stuff done,
setting targets, hitting them and then getting the next one and
driving the organisation forward. If you look at NHS management,
it is predominantly pace-setting, when in fact, to deal with the
world that we are talking about in the future, being responsive
to patients, engaging with local populations and creating services
around individual patients, there are different styles that you
need. We have got a major task to shift NHS leadership from the
predominantly pace-setting to something else. That is a really
important precondition for making this happen, and we have set
up a leadership academy to enable us to do that.
44. Dr Johnny Marshall, Director of Policy at the
NHS Confederation, told us that in his experience of having been
on an NHS Leadership Academy course, he had felt it understands
"the task in hand" and made sure he looked across "the
whole range of leadership skills, not just the pace-setting style,
which is perhaps the natural style within the NHS".
Brenda Hennessy, however, said she doubts whether it would "reach
down" to people such as ward managers "who will typically
manage about 60 or 70 nurses delivering front line care".
45. In respect of the NHS, we heard some examples
of how behaviour and attitude towards complaints handling and
customer service is being addressed. Claire Murdoch told us that:
A few years ago [...] we were scrutinising complaints
and felt that there were too many about staff attitude, a lack
of care, a lack of compassion. We looked at a range of data and
decided, yes, there was a problem with, for example, our band
five staff nurses. What we did then, five years ago, was change
the recruitment process for staff nurses. They now go through,
and have done for five years in my trust, a daylong assessment
centre process, where we test the numeracy and literacy before
coffee. If those newly qualified nurses pass their numeracy and
literacy tests, we keep them on for the rest of the day, where
patients and experienced staff will test them for, even then,
compassion, aptitude, attitude and motivation.
46. Sir David Nicholson acknowledged shortcomings
in NHS attitudes and behaviour in respect of complaints. He adopted
encouraging language, but we are far from convinced that the NHS
leadership knows how to change attitude and behaviour throughout
the NHS. This is a huge challenge for the NHS leadership. We look
forward to the Health Select Committee's findings on the question
of leadership, attitudes and behaviour in its inquiry into the
handling of complaints and concerns in the NHS.
47. An attitude that welcomes complaints is important.
This means challenging defensive behaviour to create relationships
that are open and collaborative. Strong and positive leadership
is essential to achieve this, which includes removing the fear
of blame and increasing the confidence of those handling complaints.
If staff are to listen to complaints with attention and compassion,
and to handle them with intelligence and sensitivity, they must
be trusted to use their judgement and respected when they do so.
This is the way to help the organisation to learn.
48. We recommend that the NHS Leadership Academy
acts now on the need to rectify shortcoming in NHS attitudes and
behaviour in respect of complaints handling. This is urgent so
it can address one of the main findings of the Francis Report.
49. We recommend that the primary objective of
the Cabinet Office review of complaints handling should be to
change attitudes and behaviour in public administration at all
levels in respect of complaints handling. The review should also
aim to help senior leaders to use complaints as a valuable source
of information and learning; to raise expectations of complainants
that they will be respected and treated in a straightforward manner;
and to encourage citizens to complain in order to put things right.
Openness, and sharing learning
50. In our Report, Truth to power: how Civil Service
reform can succeed, we concluded that a "failure to learn
from failure" is a major obstacle to more effective Government.
Lord Browne of Madingley, Government Lead Non-Executive Director
and Lead Non-Executive Director at the Cabinet Office, told us
that this failure to learn was "the biggest single obstacle
to progress in government".
Applying this conclusion to complaints handling, we explored the
extent to which information and learning from complaints is visible
across different departments and services.
51. We heard about the cross-government complaints
handling forum, which was established in 2006 as a self-organised
network comprising complaints managers from organisations within
the jurisdiction of the PHSO, including Health, the Department
for Work and Pensions, Transport, the Home Office, HM Revenue
and Customs, and the NHS. The network aims to promote the effective
management of, and learning from, complaints and customer feedback
by encouraging the exchange of good practice. It is overseen by
Robert Devereux, Permanent Secretary in the Department for Work
and Pensions, who told us that:
The mandate, in the sense of 'Does Robert Devereux
have the authority, in some sense, to make it happen in DEFRA?'
the answer is no. Is this forum set up in such a way so as to
get people to think about it in a common way? The answer is yes
[...] I am using this forum as a methodology so that, if it looks
as if Department A or B is not playing the game, I can, on behalf
of the Permanent Secretaries collectively, have a word and say,
'This is not where we want to be. You need to improve'. It is
not a mandate, but it is a leadership role, if you wish.
52. We heard mixed evidence on the success of the
forum. PHSO suggested that "the forum has generated new high
level standards and a complaint resolution framework that will
increase transparency, accountability and consistency in complaint
witness, however, said "its lack of public profile has to
say something about its ability to have an impact".
53. In respect of openness more broadly, several
past reports have highlighted the need for clear reporting of
complaints data. PASC's 2008 inquiry into complaints handling
recommended that departments should be required to publish in
their annual reports information on the number of complaints they
received; the number reviewed by the Ombudsman; and the number
that were upheld.
A similar recommendation was made in the more recent NESTA report,
Grumbles, Gripes and Grievances, which Carol Brennan, Director,
Consumer Insight Centre, Queen Margaret University, Edinburgh,
told us advocated:
statutory reporting of complaint data from Government
Departments and bodies, so that there is a clear view of what
the position is and what is being done in relation to those complaints.
I think that would be a great help; also, more learning across
We were told by PHSO that annual reporting has not
addressed these recommendations fully, and that reporting is "mainly
about how many come to us and whether we uphold them".
54. The new Cabinet Office minister for government
policy on complaints handling should examine the purpose, powers
and structure of the cross-government complaints handling forum
and put in place measures to improve the profile and influence
it has across departments. The minister should chair the forum.
55. Each Government department should publish
information on the complaints it has handled in its annual report,
including the numbers received and resolved, and the learning
has been taken from those complaints. The aim is not to create
bureaucracy or a tick box exercise, but to achieve a greater level
40 Parliamentary and Health Service Ombudsman (COM 16),
para 7 Back
As above [Claire Murdoch] Back
Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry,
HC (2012-13) 898-I Back
Parliamentary and Health Service Ombudsman, NHS Governance of Complaints Handling
(June 2013) p12 Back
Jan Middleton (COM 34) para 28 Back
Margaret and Janet Brooks (COM 33) Back
Health Select Committee, Complaints and raising concerns, February
Public Administration Select Committee (PASC), Eighth Report of
Session 2013-14, Truth to power: how Civil Service reform can succeed,
HC74, p26 Back
Parliamentary and Health Service Ombudsman (COM 16) para 30 Back
Public Administration Select Committee (PASC), When Citizens Complain,
para 96 Back