The report was commissioned by the Prime Minister and Secretary of State for Health, Jeremy Hunt, after the failings at Mid Staffordshire NHS Trust were highlighted by Robert Francis earlier this year. Robert Francis QC highlighted that complaints are a warning sign of problems in a hospital.
The review received 2,500 responses describing poor care and a lack of compassion and deep dissatisfaction with the way in which their complaints had been handled. The review panel also heard from people who had not complained because they felt the process was too confusing or they feared for their future care. Many were also concerned about the lack of independence in the current system.
The recommendations aim to improve the quality of care, address the causes of complaints, improve access and responsiveness of the complaints system, and ensure that hospitals adopt an entirely new attitude to complaints – as well as whistleblowing.
The review reflects on a “decade of failure” to reform the way in which complaints are handled, and demands urgent action in the next 12 months. To ensure there is real change as a result of the review, the review has taken the unusual step of securing undertakings from key health organisations to ensure that action will be taken within the next year.
The three main drivers for change will be:
Consumer power – Consumer and patient bodies have agreed to work together locally and nationally to oversee and monitor implementation of the recommendations.
Championing complaints reform – Mike Richards, the Chief Inspector of Hospitals, is making complaints a central part of CQC inspections of hospitals. He will develop standards for the handling of complaints by NHS organisations, ensure inspectors’ judgements are fully informed by what people say about the quality of care in a hospital, and publish his findings on complaints across hospitals in a year’s time.
Concrete commitments from major NHS players – 12 organisations including the Royal College of Nursing, Health Education England, the General Medical Council, Monitor, CQC and NHS England have together signed up to nearly 30 actions to help improve the complaints culture across the NHS. For example, new guidance for nurses and reviewing training and education on complaints handling.
Ann Clwyd MP said:
When I made public the circumstances of my own husband’s death last year, I was shocked by the deluge of correspondence from people whose experience of hospitals was heart-breaking. It made me determined to do my best to get change in the system.
We have given patients and their families a voice in this report, and their message to the NHS on complaints is clear. The days of delay, deny, and defend must end, and hospitals must become open, learning organisations. Our proposals put patients firmly into the driving seat at every level as never before, and we now expect to see progress within 12 months’ time.
Tricia Hart, Chief Executive of South Tees Hospitals NHS Foundation Trust said:
I’ve heard first-hand how the NHS has let people down, and some of the stories I’ve heard have been the most harrowing of my career.
We need a fundamental change in culture and we need transparency so that when things go wrong improvements are made to make sure it doesn’t happen again. But most of all we need action – and that is what sets today’s report apart. Leaders from across the NHS have signed up to concrete actions to start to do better on complaints.
The end goal has to be that the NHS provides better, safer, kinder care so that fewer patients feel like they want to complain. Listening to and acting on complaints now is essential to making that a reality.
Secretary of State for Health, Jeremy Hunt said:
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.
I pay tribute to the great courage and zeal with which Ann Clwyd has championed this cause following her own personal tragedy last year, and am grateful to Tricia Hart for the leadership and frontline insight she has provided.
Key recommendations include:
Board level responsibility - Chief Executives need to take responsibility forsigning off complaints. The Trust Board should also scrutinise all complaints and evaluate what action has been taken. A board member with responsibility for whistleblowing should also be accessible to staff on a regular basis.
Transparency – Trusts must publish an annual complaints report in plain English which should state complaints made and changes that have taken place.
More information on the wards - Trusts should ensure that there is a range of basic information and support on the ward for patients, such as a description of who is who on the ward and what time visiting and meals take place.
Trust complaints scrutiny- Patients and communities should be involved in designing and monitoring the complaints system in hospitals.
Easier ways to communicate – Trusts should provide patients with a way of feeding back comments and concerns about their care on a ward, including by putting a pen and paper by the bedside and making sure patients know who they can speak to, to raise a concern.
Patient services and independent advice – the Patient Advice and Liaison Service should be rebranded and reviewed so its offer to patients is clearer and it should be adequately resourced in every hospital. The Independent Advocacy Services should also be rebranded and reorganised.
The Government will now consider this report and respond in full later this autumn.
The report which gives recommendations on how to make improvements focuses on four key areas of change including:
- making improvements in the quality of care in NHS hospitals so fewer people have to complain;
- making improvements in the way complaints are handled;
- giving the complaints process independence; and
- avoiding the need for whistle-blowing in the future, and protection for those who speak out.
- A dedicated postal and email address enabled people to send accounts of their experiences with the complaints system and make suggestions for improvements.
- Letters from patients, relatives, friends and carers received before the start of the review were also included in the evidence.
- In all, more than 2,500 letters and emails were received. The Department of Health took responsibility for the analysis of this data.
- Seven public engagement events were held in which oral evidence was taken from patients, relatives, friends and carers. These allowed the Review Team to understand how the complaints process is perceived and why people may be discouraged from complaining.
- Eight individual meetings were held with people the co-chairs considered to have particular expertise with the complaints process.
- Helped by advisers with experience of patient representation, the review team visited nine NHS hospitals and one hospice, meeting complaints managers, frontline staff and board members.
- Meetings were held with 20 leading organisations in the health and social care sector.
- Discussions were held with leaders of key organisations in the sector to secure pledges of support for the recommendations of the Review.
- In all the meetings, notes and minutes were analysed by the DH and discussed by the team.