HEAL UoS

Taking Complaints Seriously

In 2013, Care, NHS on February 7, 2013 at 10:11 am

The Francis Report carries a powerful chapter explaining how NHS complaints procedures developed over the past decade, and in some ways have moved backwards. It makes a series of recommendations for improvement, including the need for independent advocacy and arms-length investigations and the transparency of complaints data to commissioners and local authority scrutiny committees. These system reform should not detract from the crucial observations about failures in governance. Even without changes the NHS could, and should, have done better.

The Report quotes the Chair of the Trust as denying that complaints were her personal business – ‘A complaint that’s investigated properly and resolved is then put to bed and doesn’t need to come to the attention of the hierarchy in the organisation, actually’ (para 3.22). The Board appeared to receive statistical reports but not to have examined the substance of the complaints. Robert Francis points out that ‘such an approach completely ignored the value of complaints in informing the Board of what was going wrong, and what, if anything, was being done to put it right’ (para 3.33).

Patterns of complaints are an important barometer of difficulties, especially when patterns are monitored (which wards come up frequently, the substance of the complaint – all too often staff attitudes – and changes over time) and are correlated with other measures of stress (staff sickness, data from staff surveys showing lack of confidence in leadership or the quality of care). Plenty of other data sources exist to help organisations assess how safe they are, including the National Reporting and Learning System which generates organisational reports on the rate of reporting incidents. Staff surveys report on the perception of how likely they are to make reports. There is plenty of data to support organisations in picking up problems early if they are prepared to look for it. Many of these data are available to commissioners and the public – you can look up your local organisations’ profiles through the link.

These data enable problems to be identified, but do not tell you how your organisation responds. Boards should satisfy themselves that the responses are appropriate and expect reports to detail not just whether complaints were upheld but also what has changed as a result. Further, Board members are wise to see a sample of complaints responses if they wish to understand the culture of their organisation. I have seen resistance to giving a straight answer, defensive protection of staff, and an institutional reluctance to say sorry – all displayed in draft letters that needed correction before being sent. You learn a lot from seeing your organisation through the eyes of those it has failed to serve well. There is no substitute for meeting and listening to them.

Jonathan Montgomery reflects on his experience of serving on NHS Boards for two decades in the light of the Mid-Staffs Report.

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