NHS is told to improve hospital complaints system within a year

An independent review of the hospital complaints system in England has demanded urgent action within the next 12 months to improve the way in which patients’ complaints are handled, after a “decade of failure” to reform the process.1

The review was commissioned by the prime minister, David Cameron, and England’s health secretary, Jeremy Hunt, after Robert Francis’s report into failings at Mid Staffordshire NHS Foundation Trust concluded that problems there would have been spotted earlier if patients’ complaints had been listened to and acted on.

Francis emphasised that complaints were a warning sign of problems within hospitals. He called for a change in the NHS’s culture so that patients and staff did not fear raising issues about care and for the introduction of a duty of candour on health organisations and professionals to ensure that they were open and honest with patients and relatives when mistakes had been made.2

The final report of the review of the NHS hospitals complaints system, published on Monday 28 October, says that NHS staff need to be trained to listen to complaints and how to act on them and that senior managers must take ultimate responsibility for dealing with complaints.

The report says that hospital chief executives should have responsibility for signing off complaints; boards should scrutinise all complaints and evaluate what action has been taken; and one board member, who is easily accessible to staff, should be responsible for handling whistleblowing. Most importantly, it says, trusts should publish an annual report stating what complaints have been made and, where failings in care have occurred, what action had been taken to ensure that incidents weren’t repeated.

Asked at a press briefing whether this would be too onerous for chief executives, as the NHS received 3000 complaints a week, Tricia Hart, one of the review’s co-chairwomen and chief executive of South Tees Hospitals NHS Foundation Trust, said that she signed off all complaints at her trust and that the level of knowledge this gave her was invaluable, because it helped highlight trends and themes.

The report adds that trusts need to find simple ways for patients to feed back comments and concerns about their care on the ward, such as by hospital staff “putting a pen and paper by the bedside,” and that they need to ensure patients knew to whom they could speak if they wanted to raise a concern. In addition, the Patient Advice and Liaison Service should be rebranded and adequately resourced in every hospital.

Ann Clwyd, the review’s other co-chairwoman, a Labour MP who has said that the University Hospital of Wales treated her now deceased husband like “a battery hen” during his final hours, said that similar past reviews had simply been allowed to gather dust. Clwyd said that this would not be allowed to happen this time because the review team would be assessing progress in 12 months’ time.

Furthermore, a dozen health organisations, including NHS England, the General Medical Council, Health Education England, the Care Quality Commission, and Monitor, have already signed up to nearly 30 pledges to begin to improve the way complaints are handled. These include pledges to improve the education of junior doctors and trainee nurses in how to deal with complaints and a promise from the Care Quality Commission to focus on complaints handling in its new hospital inspection regime .

Hunt has pledged to respond to the review next month as part of his formal response to the Francis recommendations. “We saw in Mid Staffs how badly things go wrong when patients’ and families’ complaints aren’t taken seriously. I want to see a complete transformation in hospitals’ approach to complaints, so that they become valued as vital learning tools. There can be no place for closing ranks or covering backs when patient safety is at stake,” he said.

Peter Walsh, chief executive of the patient safety charity Action against Medical Accidents, said that many of the recommendations simply echoed similar ones that had been made in the past and not been implemented.

“We already have key recommendations from the Francis inquiry which the government has not signed up to, let alone implemented,” he said. For example, he said, so far the government has signalled that a duty of candour would apply only to organisations and not to individuals, and then only to the most severe incidents, such as those that have led to death or permanent disability.3 He added that this approach to a duty of candour “would, in effect, legitimise cover-ups of the vast majority of incidents which cause serious harm. It would kindle a culture of cover-up and denial.”

The NHS Confederation’s chairman, Michael O’Higgins, who was a member of the review’s external partnership panel, said, “A transparent, easy to use feedback and complaints system that is effective at identifying opportunities for improvements, both large and small scale, is a sign of a healthy organisation.”