1 Introduction
1. In 2011 the Committee held an inquiry into Complaints
and Litigation, and looked in some detail at the working of the
NHS complaints system. In its report, it said that
There are unwarranted variations in how the complaints
system works across England, some elements of the system are ineffective,
and the cultures that exist often do not support effective resolution
and redress. The Committee's objective is to look at how the complaints
system can be further strengthened to give good and timely outcomes
for patients, contain the costs of litigation and ensure that
the NHS learns from complaints; it is a key objective that the
experience derived from proper consideration of complaints should
lead to changes and improvements in the care available to other
patients.[2]
2. It recommended that the Government undertake a
review of the NHS complaints system. It also made recommendations
about the roles of the Ombudsman, advice and advocacy services,
providers and commissioners, and about the co-ordination and monitoring
of complaints handling across the NHS. In its response to the
Committee's report, the Government accepted that "whilst
some NHS organisations respond quickly and effectively to complaints,
others are not so effective", and agreed that "the NHS
can do more to improve complaints handling."
3. The period since the publication of the Committee's
report into Complaints and Litigation has seen the implementation
of the Health and Social Care Act 2012; the publication of the
Francis report; and, in October 2013, the publication of the Clwyd-Hart
Review of the NHS Hospitals Complaints System. The Government
provided its formal response to the Francis report in November
2013.
4. As well as complaints and concerns made by patients
and members of the public, the Francis report also highlighted
the related issue of the way in which complaints and concerns
raised by staff within health and care organisations were handled.
This is an issue that has featured in much of the Committee's
work this Parliament and we considered it important to examine
it in this inquiry as another indicator of patient safety concerns
alongside complaints.
5. The current inquiry followed up relevant recommendations
made in the Committee's 2011 report on Complaints and Litigation,
and the commitments made in the Government response. It also examined
the treatment of staff who raise concerns about NHS services,
and the procedures in place to encourage NHS staff to raise concerns
without fear of detriment. Specific issues on which the Committee
asked for evidence were:
· Handling
of complaints made by patients and families about care received
in the health and care sectors, including both primary and secondary
care providers;
· Handling
of concerns raised by staff about care given in the health and
care sectors;
· The
extent to which the findings of recent inquiries have been incorporated
into the complaints process;
· Support
for patients, the public and staff who wish to make complaints
or raise concerns;
· The
consequences of complaints for care providers and of raising concerns
for the employment prospects of staff;
· Openness
about complaints and concerns, and accessibility of information;
· The
role of commissioners, system regulators and professional regulators
with regard to complaints and concerns;
· The
operation of the Public Interest Disclosure Act 1998 in relation
to health and social care;
· Future
plans for improvements in this area.
We received 120 written submissions. We are grateful
to all those who have contributed to the inquiry.
Developments since the Committee's
2011 report
6. Since our 2011 report, there have been significant
developments in the form of the second Francis report and actions
which flowed from it-the Government's formal responses and the
commissioning of the Clwyd/Hart review of acute provider complaints.
7. The Department of Health has set up its cross-service
Complaints Programme Board in response to Francis and Clwyd/Hart,
the aim being to complete as much of the work as possible by March
2015. This activity appears to have displaced the review of the
complaints system which the Government undertook to conduct in
response to this Committee's earlier report.
8. We have also seen the October 2014 publication
of Healthwatch England's review of the complaints system and the
publication by PHSO, the Local Government Ombudsman and Healthwatch
England in November 2014 of a service user-led vision for complaints
handling,[3] with support
from NHS England, Monitor, the Trust Development Authority and
the Foundation Trust Network. This work is one of the major items
in the Department's Complaints Programme.
9. Changes aimed at improving the culture of complaint
handling within providers and across the health and care system
are welcome, but they take time to have an effect and are difficult
to measure. Meanwhile, the volume of complaints continues to rise.
This may reflect increased awareness of complaints procedures
and an increased willingness to remark on poor standards of service.
While the headline figure may indicate service deterioration,
it may also indicate an organisation which welcomes complaints
as a means of improving performance. HSCIC data now also indicate
(on an experimental basis) the number of complaints upheld: in
2013/14 just over 50% of complaints about all NHS services were
upheld, though this figure is subject to significant caveats.
10. There is no doubt that the landscape has changed
significantly since our earlier inquiry. Patient safety and the
treatment of complaints and concerns have become high profile
issues. There is equally no doubt that we are only at the beginning
of a process of change with significant scope for further improvement.
11. Despite the work undertaken to change the culture
of complaints handling across the NHS system, the Committee has
received ample evidence from individuals and patient representative
organisations of a system which has not responded adequately to
address individual complaints. For example, in oral evidence the
Foundation Trust Network referred to a CQC in-patient survey where
7 per cent of those surveyed gave a 0 or 1 ranking for the overall
quality of their care:[4]
this level of assessment of is unacceptable.
12. We understand that many of the issues raised
with the Committee had their origins in incidents which occurred
before the second Francis report was published. That does not
mean that they can be discounted. Ann Clwyd was concerned that
many of her recommendations were not being acted upon, and it
is important that the health and care system should, through its
operations, demonstrate a clear commitment to improving the quality
of complaint handling.
13. There have been a number of significant reviews
of the complaint system which have urged a change in the culture
of the NHS in responding to complaints. There is little firm evidence
to date of the moves to change culture having a wholesale positive
effect either on the behaviour of NHS providers which give rise
to complaints or on the satisfaction of service users about how
their complaints have been handled.
14. We recommend that the Government publish a
detailed evaluation of the progress achieved, and work remaining
to be undertaken, by the Complaints Programme, in order for the
public and our successor Committee in the next Parliament to be
able to monitor progress. The Department should also include an
evaluation of the operation of the complaints system across the
health sector in the light of the post-Francis changes. A review
was promised for 2014 but has not been undertaken.
15. The rest of this report provides an overview
of the issues raised with us concerning complaint handling, the
role of the Ombudsman, professional regulators and the treatment
of staff raising concerns. It is a snapshot of where the complaints
system stands now, the progress that has been made and the areas
where change is still required.
16. We consider that our analysis in our previous
report remains relevant and we are not attempting to re-examine
all the issues that we addressed then. While there have been
some improvements there are still too many individual cases which
are mishandled, from instances of poor communication to those
which end in a complete breakdown in trust between patients, their
families and NHS institutions.
17. As the Committee said in 2011, the issue lies
in
…the individual cases where complainants
did not feel the NHS was sufficiently responsive to their concerns.
It is in this variable individual experience, rather than in movements
in the headline totals, that the Committee feels that there is
a real issue which the NHS needs to address[5].
18. Reform of the complaints processes in health
and social care and the inculcation of a culture of openness and
responsiveness is a continuing process and one that needs to be
regularly monitored. We recommend that our successors on the
Health Committee in the next Parliament continue this work of
monitoring improvement in the complaints process.
2 Health Committee, Sixth Report of Session 2010-12,
Complaints and Litigation, HC 786-I, para 4 Back
3
My expectations for raising concerns and complaints, PHSO, November
2014, Back
4
Q 407 Back
5
Health Committee, Complaints and Litigation, para 25 Back
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