Date Published: 7 April 2008

Healthcare watchdog calls on NHS to learn from patients' complaints (England)

Health News from the Royal College of Nursing (RCN).

Report highlights that patients have concerns about complaints handling, and want trusts to say sorry more often.

The Healthcare Commission is urging NHS trusts to learn from patients’ complaints and improve complaints handling, with key proposals including apologising more often when they do make mistakes.

A report published today shows that complaints about a lack of basic nursing care, poor communications, overly brisk GP consultations and a lack of help for mental health service users are among the key issues patients raise.

The Spotlight on Complaints report covers more than 10,000 complaints that were independently reviewed by the Commission between August 2006 and July 2007. Each year the NHS delivers 380 million treatments and receives around 140,000 complaints. The Commission reviews cases where the patient is unhappy with the response.

Today’s report, the second of its kind, looks at how complaints are handled and the common themes to enable trusts to learn lessons from them.

Of the cases reviewed in this period, the number of complaints the Commission returned to trusts for further action fell to 26% from 33% the previous year, suggesting that complaints are being handled better by trusts when they are first made.

The Commission upheld or partially upheld almost 20% in favour of the complainant. This was an increase from just 8% the previous year.

The Commission says that where it reviewed a complaint there were more cases where the trust’s response was not as accurate as it should be. Often, clinical advice found the care provided was not in line with established standards.

The Commission upheld 18% of complaints in favour of the NHS trust, compared to 19% in the same period the previous year.

Most of the remaining cases were either out of the Commission’s jurisdiction (mostly because the concerns had not been raised locally first) or withdrawn by the complainant.

The concerns of many complainants centred on the basic elements of healthcare. Examples include: communication between clinical staff, standards of care and safety and fundamental aspects of nursing care such as nutrition, and privacy and dignity.

Issues raised most commonly related to the safety and effectiveness of practices (24% of the 10,000, up from 22% in 2006). This was followed by complaints about communication and information given to patients (17%, compared to 16% last year).

The third most frequent issue raised was complaints handling, which accounted for 16% of the total, up significantly from 5% the previous year.

This suggests patients are increasingly concerned about the processes trusts follow, as well as the care itself.

In particular, the Commission highlights the need for trusts to acknowledge errors and say sorry where necessary. Trusts can and should express sorrow or regret where appropriate, at an outcome. The Commission estimates that it recommends an apology in some 23% of cases it reviews.

In addition, Commission research suggests that 52% of complainants simply want either an apology, a better explanation or recognition of the event. 21% want improvements to services or for the same thing not to happen to other patients. Only 18% are looking for action to be taken against staff, compensation or reimbursement of fees.

The report indicates that the largest number of complaints reviewed by the Commission related to primary care (38.4% of the total), followed by hospital trusts (34.5%), foundation trusts (17.9%), mental health trusts (7.3%) and ambulance trusts (0.7%).

Of the 10,000 complaints reviewed, 50% required clinical advice. Analysis based on a representative sample reveals the following clinical themes:

  • Hospitals – 30% deal with the fundamentals of nursing care, such as unmet personal hygiene needs, a lack of privacy when receiving intimate care, inadequate help with eating, and nurses being “abrupt” or “sharp”, making the patient feel they were a nuisance.
  • GP practices – 43% of complaints about GPs related to clinical treatment, with many patients saying their examination was of poor quality, often because it was so brief. A further 23% complained of failed or delayed diagnoses, with the condition involved usually cancer. Twenty percent were about GPs’ poor attitude to patients, including rudeness and neglecting to give full information about treatment because of fears that the patient “could not cope” .
  • Dental surgeries – 34% of complaints were about the quality of treatment. In many of these cases, inexperienced dentists underestimated the difficulty of the cases involved.

Other services highlighted in the report include:

  • Mental health services - a significant number of complaints related to the lack of help for people in crisis. Complaints included people not knowing who to contact in times of crisis, crisis resolution teams having a “poor attitude” and being reluctant to assess people in their homes and poor communication between staff, service users and their families about how to access services.
  • Palliative care – frequent issues complained about included families not being fully informed and the seriousness of an illness not being conveyed to patients or their relative.
  • Accident and emergency – frequent complaints related to the failure of staff to recognise or act on abnormal vital signs and the lack, or insufficient use, of pain relief.
  • Maternity services – common themes included women saying staff did not listen to them when they expressed their needs, women being left alone in labour without pain relief and midwives being too busy and having poor attitudes.


Source: The Healthcare Commission (England, UK).

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