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Health watchdog calls for NHS complaints revamp

System failing due to 'toxic cocktail' of patients too fearful to complain and defensive staff

Mark Gould

Tuesday, 13 August 2013

The NHS Ombudsman for England has called for major changes to the complaints systemt to address what she describes as a '"toxic cocktail" of patients fearful to complain, and defensiveness among hospitals and staff to hear and deal with concerns.

She says this combination means that concerns and complaints are going unheard or unaddressed. "Only strong leadership from boards will deliver the culture change and improvement on wards that we all agree the NHS needs," she said.

Publishing new research exposing flaws in the complaints system, the Ombudsman Julie Mellor calls for a step change in dealing with complaint handling "from ward to the Board".

Improvements suggested include:

  • Moving towards an open culture of feedback and improvement;
  • A fresh focus on putting things right on the ward; and
  • Replacing deference and hierarchy in hospitals with a new culture of collaboration between leaders and staff to listen to concerns and improve services.

Commenting on the research which involved interviews with patients, families, carers and staff, Ms Mellor said: “What we found was that there is toxic cocktail - patients felt reluctant to complain, because they can fear it will affect the care they get - and that if they do, they are met with a culture of defensiveness, where they don’t get the explanations they need, and the opportunity is lost to learn really powerful insights, which could improve the NHS.”

Feedback from patients and staff included: “The whole complaints system is dated and unclear”, “They closed ranks”, “I went to a Patient Advice and Liaison Service department for help, but when I got there, the gentleman barely looked at me and dismissed me with a leaflet”, “More compassion and empathy is needed so people aren’t too scared to complain”, “Too many standards, lists and targets.”

Complainants and patients highlighted poor communication as a key issue and a defensive culture once a complaint was made.

The report says one carer’s complaint went back and forth for two weeks. "But, as soon as she threatened to raise the bar by involving the CEO or the press, her complaint was dealt with within the hour."

One patient felt “trusts should learn from individual cases by sharing more information and cross communication so they’re not working in their own little world.”

Key issues raised by staff included a fear of being blamed rather than acknowledged for listening and putting things right, a confusing variation in complaints procedure between hospitals, too much deference to senior colleagues on wards, and a need for more training on responding to complaints.

One staff member said: “When I’ve done statements on certain complaints all I get is the complaint letter and the case notes, and I write my paragraph and send it off. I’ve not had a single response and I haven’t learnt anything.”

Ms Mellor, said much has been said about what is wrong since Mid Staffs, but her report has identified what can be done to make things better. "This research – the first of its kind – brings together patients, carers and frontline staff in designing a new model that works for everyone. The strong message was the need for a step change in the culture from defensiveness to welcoming and seeking feedback, including concerns and complaints, to deliver continuous improvement and the best possible patient care."

She said the key themes come up again and again - those of openness, leadership and culture change – all start with the board and end at the point of delivery on the ward.

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