Archive for the ‘Care’ Category

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.

Francis Report – a catalogue of shame

In 2013, Care, NHS on February 6, 2013 at 2:40 pm

The Report of the Inquiry into the Mid-Staffordshire Scandal was published today. In his statement, Robert Francis QC said ‘This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self interest and cost control ahead of patients and their safety. I have today made 290 recommendations designed to change this culture and make sure that patients come first.’

The scale of the failures in Patient Care had been exposed by the earlier Inquiry, the focus here is how it could be that the failures went unnoticed, unchallenged and unaddressed for so long. The Report makes it clear that there was a major failure of governance from the Trust board, whose members have already been removed from office. However, the problems are deeply rooted in a cultural malaise in which the quality of care for patients ceased to be the primary focus of the organisation. Too many people, not just managers and professionals, tolerated unacceptable standards of care. The systems designed to give voice to patient perspectives failed. Performance management lost sight of patient care in a focus on financial control and high level targets. Regulatory oversight was both fragmented and unco-ordinated.

This is a crisis of values and requires sober reflection, acceptance of responsibility and concerted action to create a common purpose around high quality patient care. As the Report says, a ‘culture of caring requires a displacement of a culture of fear with a culture of openness, honesty and transparency’ Para 1.180.

Robert Francis will be in Southampton on 4 March to reflect on the Report and its significance at the inaugural Hickman & Rose/Centre for Law, Ethics and Globalisation lecture. We look forward to exploring it with him.

Time for a ‘Silverline’?

In 2011, Care on December 5, 2011 at 7:30 am

In yesterday’s Sunday Times it was reported that Esther Rantzen has called for a ‘Silverline’ equivalent of Childline for ‘older people’ (often, but not exclusively, defined as persons aged 65 years and above, see EHRC FAQs). This call comes hot on the heels of two hard-hitting Reports in recent months, both critical of the quality of care received by older persons. In October, the Care Quality Commission reported their findings on Dignity and Nutrition for Older People and in November the Equality and Human Rights Commission published Close to Home: An inquiry into older people and human rights in home care.

The CQC inspected 100 hospitals to assess whether older people were i) treated with respect, and ii) got the food and drink fit for their needs. Of these hospitals, 20 failed to meet one or both standards. Further, the EHRC found that almost 500,000 older people receive care in their own homes, paid partly or wholly by the local authority, and while many received care that respected their human rights, it cautioned that this is not a ‘universal experience.’ Of those who gave evidence to the inquiry around 50% expressed satisfaction with the home care provided, but many examples were given that breached the human rights of the recipients.

Calls too are being made for the government to follow in the steps of the Welsh Assembly (and Northern Ireland) and to establish their equivalent of the Older People’s Commissioner for Wales. Whether by ‘Silverline’ or by Minister, or both, the demand for action to protect vulnerable older people is gathering pace – almost 6 years since one of its neighbours deemed older people important enough to have a minister of their own (Wales, February 2006).