Date Published: 1 February 2007

Watchdog urges NHS to learn from "raw feelings of patients" in report on 16,000 complaints

Commission to inspect local complaints handling in first national audit - UK

The Healthcare Commission is urging NHS trusts to do more to learn from patients' complaints and to handle the issues raised “quickly, efficiently and locally”.

It will today publish a report on the recurring themes in some 16,000 complaints sent to the Commission for independent review between July 2004 and July 2006.

The Commission has legal responsibility in England for reviewing complaints where a patient is dissatisfied with the response of a trust. This happens in about 8% of the 95,000 formal complaints made each year about the NHS, which annually provides 380 million treatments.

With poor complaints handling among the top issues patients raise, the watchdog will launch the first national audit of how NHS trusts deal with people's concerns.

It will look at good and poor practice, inspecting some 50 trusts after analysing performance indicators covering all trusts in the country.

Inspectors will check whether trusts give complaints handling sufficient priority and learn from the issues raised. They will consider whether complaints systems are accessible and understood by people using services. If trusts are not up to standard, this will be reflected in their annual performance rating.

The Commission’s report highlights the areas of concern most frequently raised by patients about NHS trusts, GPs and dentists (see note to editors). It then picks out ten common themes that came up regularly when inquiring into these complaints.

The themes were:

  • Safety - 22% of total. Often the most serious, issues included a mix up over names leading to a child having the wrong injection and a failure to properly manage when things went wrong after childbirth.
  • Care surrounding a death - 54% of complaints about hospitals. In many cases, families received contradictory or confusing information from different staff caring for a relative. In others, relatives felt that they were unprepared for the death or had no time to arrange for family members to be present.
  • Nursing - around 7% of total. Nurses provide a large proportion of patient care so the total number is unsurprising but the themes are concerning. Complaints about nutrition were most prevalent including low quality or inappropriate food and lack of help with eating. Common were complaints about staff attitudes and the dignity of patients.
  • Discharge from hospital and service coordination – around 5% of total. Some cases were about the lack of notice given to families prior to the discharge of a relative from hospital. More serious cases involved the discharge of vulnerable patients including children and the elderly without any support or at inappropriate times of the day.
  • Cleanliness and healthcare associated infection - around 5% of total. Patients often kept detailed diaries of their experiences in hospital. Issues highlighted included failure of staff to follow sign posted procedures or to challenge visitors who did not do so.
  • Removal of patients from GP lists – some 15% of complaints about GPs. This was a recurring theme despite clear requirements on the topic. Some GPs did not warn patients that certain behaviour could lead to them being taken off a list or explain to people why they had taken action.
  • Record keeping - 3% of all complaints. We frequently found poor record keeping in the cases we reviewed, despite detailed guidance from all professional bodies on what is expected. In a number of cases involving GPs, we found patients’ records had been misplaced. The transfer of records was frequently a source of problems.
  • Clinical care and treatment, including delays in referral or diagnosis - 66% of complaints about GPs. Concerns raised included alleged failures by GPs in making accurate or timely diagnoses. Patients often complained that they should have been referred sooner for specialist treatment or further investigation of their symptoms.
  • Disagreements on fees and charges - 30% of complaints about dentists. Many patients were concerned about the cost of treatments and the way in which fees were set by practices. Many believed they were being treated on the NHS but found they were charged private rates. Recent changes to the national dental contract may help make fees clearer.
  • Out-of-hours GP services – about 2.5% of total. In particular, concerns were raised about inadequate assessment and treatment and a failure to visit vulnerable patients. Poor handling of complaints about out-of-hours GP services was also an issue.

Anna Walker, the Commission’s Chief Executive, said:

Complaints represent the raw feelings of patients and the NHS must listen and learn from them. At the centre of each one is an individual who often has genuinely suffered. Too often, this was not just because of what went wrong but because of the way people were dealt with.

_ Many of people’s concerns are about the basic elements of healthcare, such as good communication. These are not things that cost a lot of money to solve. They are about management and staff working together to ensure they treat patients as they would like to be treated themselves.

The Commission referred 33% of complaints back to trusts that had not done enough to resolve the issue locally – in some trusts the figure was over 60%. The report names ten trusts with the highest percentage of complaints returned.

Ms Walker said:

Trusts must give priority to resolving complaints. We know patients want them resolved quickly, efficiently and locally by the trust concerned. Of the 500 to 800 we handle each month, we refer back about a third for further action.

_ This is too many and suggests serious inadequacies in how some trusts handle complaints. It’s important to recognise that there is good practice out there. But trusts consistently failing on this will feel the impact in their performance rating.

Looking at what complainants wanted, 33% said a better explanation of what went wrong, 23% service improvements, 10% an apology, 9% the event acknowledged, 8% action against staff, and 8% for the same thing not to happen again.

The Commission took over the role of reviewing NHS complaints in July 2004 because the public said reviews by NHS trusts were insufficiently independent.

Creation of the new system triggered a large rise in requests for review, which leapt from around 3,200 in a year to about 8,000 now. Over this period, the total number of formal complaints about the NHS remain broadly the same.

The unexpected rise in demand for reviews created a backlog to which the watchdog responded by increasing numbers of staff handling cases to over 150. Now the team accounts for 20% of the Commission’s staff and £10 million of its £80 million budget, up from £5 million originally.

The watchdog says it is still tackling the problem but now closes more cases than it receives. By the end of the summer 2007, it expects to meet routinely its self-imposed target of closing 95% of cases within 12 months.

Ms Walker said:

It’s well documented that rising demand has meant some people have waited too long for a review. This is really important so we have put resources into dealing with the problem. We have pushed that to the limit of what we can afford without compromising our wider responsibilities for issues like the safety of patients and the annual assessment of trusts.

She added:

We now have an important opportunity to look at the complaints system as a whole because the government has committed to a review of it. This would cover local trust handling, the independent appeals process and the final review stage by the Health Service Ombudsman.

_ Patients need the NHS to learn more from common complaints. They want issues dealt with quickly, efficiently and locally. They value an independent review mechanism and this must be resourced to deal with demand.

_ In redesigning this system, it will be crucial that all those involved learn the lessons of the past so we do better for patients in future.”

 

Source: Healthcare Commission (UK).

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