Complaints and Raising Concerns - Health Contents

Conclusions and recommendations

Developments since the Committee's 2011 report

1.  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. (Paragraph 10)

2.  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. (Paragraph 14)

3.  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. (Paragraph 16)

4.  We recommend that our successors on the Health Committee in the next Parliament continue this work of monitoring improvement in the complaints process. (Paragraph 18)

What should good complaint handling look like?

5.  We recommend that Trusts be required to publish at least quarterly, in anonymised summary form, details of complaints made against the Trust, how the complaints have been handled and what the Trust has learnt from them. (Paragraph 27)

Complaint handling by providers

6.  We agree that the onus should be on the system to help a complainant. People should not be forced to search out the most appropriate way to raise concerns. We recommend that the complaints system be simplified and streamlined by establishing a single 'branded' complaints gateway across all NHS providers. This should be available online, but not exclusively so. There should be adequate resourcing to enable complaints to be examined, identified, and directed speedily to the appropriate channel. (Paragraph 31)

7.  The relationship between the provider and the commissioner is, in our view, key to determining the day-to-day quality of services provided under NHS contracts. It is the commissioner which is best placed to work constructively with the provider on delivering improvements. We do, however, expect the CQC to examine the culture of complaints handling by providers. (Paragraph 42)

Role of commissioners in complaints, and handling of complaints by commissioners

8.  We recommend that the system for service users to make complaints to commissioners about NHS services should be integrated into a single complaints system. Commissioners need to take a far greater role in holding providers to account for delivering a well-functioning complaints system. (Paragraph 47)

Complaints handling in primary care

9.  The Committee is concerned about the effects of centralising complaint handling in primary care by NHS England. We do not believe that primary care complaints should be investigated in a different region. This has led to fragmentation and disconnection from local knowledge and impaired the ability to deliver a timely response and learn from complaints. We recommend NHS England reports on progress on providing a primary care complaints system that is responsive to patients in a timely manner and which results in local learning and improvement. (Paragraph 52)

Complaint handling in social care

10.  On the evidence we have heard there is a strong case for working towards the integration of social care complaints into a single complaints system. As a first step we consider there should be a single health and social care ombudsman. (Paragraph 55)

Complaint advocacy services

11.  We recommend that there should be clear commissioning and consistent branding of PALS and NHS Advocacy services to make them as visible and effective as possible to any patient seeking assistance through the complaints process. Current arrangements are variable and too often unsatisfactory. (Paragraph 66)

12.  In its written evidence the Department of Health said that it would begin a review of PALS services in 2014 and would also review the commissioning arrangements for independent advocacy services. In responding to this report, we ask the Department to set out what progress has been made in reviewing the commissioning arrangements for advocacy services. (Paragraph 67)

13.  We recommend that the Government provide a progress report on the functioning, funding and budgets of local Healthwatch organisations, in order that the information be available to our successor Committee. (Paragraph 72)

The second stage: the Health Service Ombudsman

14.  We welcome the work that has been done to produce what is essentially a best practice guide to first-tier complaints handling. There can be no excuse now for any health or care organisation not to have an appropriate mechanism in place to deal with concerns and complaints. It represents an important first step towards an over-arching, single access-point complaints system. (Paragraph 79)

15.  The serious criticisms of the Ombudsman from the Patients Association are of grave concern. We recommend that an external audit mechanism be established to benchmark and assure the quality of Ombudsman investigations. In her response to this report we ask the Ombudsman to set out how her organisation is seeking to address problems with its processes, and a timetable for improvements. (Paragraph 91)

Professional regulators and complaints

16.  While we agree with the GMC that people wishing to give information about poor practice should be able to do so anonymously, we consider that medical professionals raising concerns about poor practice via a confidential helpline are under a professional duty to provide as much information as possible to enable the matter to be investigated and to put patients first. (Paragraph 98)

17.  We welcome the willingness of the GMC to review its practices and investigations to ensure that they adequately support registrants who genuinely raise patient safety concerns in the public interest, and protect them from retaliatory action. Such a review must have as its primary purpose the establishment of an open reporting culture. (Paragraph 103)

18.  The Committee welcomes the GMC initiative in establishing the Hooper Review to examine how it deals with doctors who raise concerns, and looks forward to examining its conclusions. (Paragraph 104)

19.  Linking together professional regulation, system regulation and the complaints system is essential. Progress towards this goal is another issue that our successor Committee will need to monitor in the next Parliament. (Paragraph 105)

Treatment of staff raising concerns

20.  The failure to deal appropriately with the consequences of cases where staff have sought protection as whistleblowers has caused people to suffer detriment, such as losing their job and in some cases being unable to find similar employment. This has undermined trust in the system's ability to treat whistleblowers with fairness. This lack of confidence about the consequences of raising concerns has implications for patient safety. (Paragraph 114)

21.  We expect the NHS to respond in a timely, honest and open manner to patients, and we must expect the same for staff. We recommend that there should be a programme to identify whistleblowers who have suffered serious harm and whose actions are proven to have been vindicated, and provide them with an apology and practical redress. (Paragraph 115)

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Prepared 23 January 2015