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)
| 
