More complaints please! - Public Administration Committee Contents

3  Valuing complaints

The importance of leadership

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.[40] 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 that:

    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.[41]

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".[42] 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.[43]

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".[44] 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.[45]

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 consumers—our customers and clients—should be able better to report complaints.[46]

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."[47]

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.[48]

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 NHS—which found that of 94 Trusts, only 20% reviewed learning from complaints and took resulting action to improve service—we 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 and behaviour

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 opposite—a sense of resistance to complaints as if this was something to be avoided and deterred.[49]

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."[50]

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.[51]

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.[52] Another suggested that the approach to a complaint made to an NHS Trust was "defensive".[53] 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.[54]

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.[55] 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.[56]

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.[57]

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".[58] 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".[59]

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.[60]

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.[61]

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".[62] 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.[63]

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 handling".[64] One witness, however, said "its lack of public profile has to say something about its ability to have an impact".[65]

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.[66] 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 Government Departments.[67]

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".[68]

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 of transparency.

40   Parliamentary and Health Service Ombudsman (COM 16), para 7 Back

41   Q78 Back

42   Q305 Back

43   As above [Claire Murdoch] Back

44   Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, HC (2012-13) 898-I Back

45   Parliamentary and Health Service Ombudsman, NHS Governance of Complaints Handling (June 2013) p12 Back

46   Q93 Back

47   Q403 Back

48   Q412 Back

49   Q2 Back

50   Q305 Back

51   Q196 Back

52   Jan Middleton (COM 34) para 28 Back

53   Margaret and Janet Brooks (COM 33) Back

54   Q141 Back

55   Q234 Back

56   Q236 Back

57   Q275 Back

58   Q327 Back

59   Q330 Back

60   Q307 Back

61   Health Select Committee, Complaints and raising concerns, February 2014 Back

62   Public Administration Select Committee (PASC), Eighth Report of Session 2013-14, Truth to power: how Civil Service reform can succeed, HC74, p26 Back

63   Q162 Back

64   Parliamentary and Health Service Ombudsman (COM 16) para 30 Back

65   Q90 Back

66   Public Administration Select Committee (PASC), When Citizens Complain, para 96 Back

67   Q78 Back

68   Q114 Back

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Prepared 14 April 2014