It’s not a new criticism, but a report co-authored by MP Ann Clwyd and former nurse-turned-NHS chief executive Tricia Hart confirms that NHS hospitals are bad at dealing with complaints. The report was commissioned following the inquiry into the failings at Mid Staffordshire hospital in response to the concern that this was not a one-off.
‘Defensiveness is a state of mind that will not be dislodged by policy and procedures’
In the case of Mid Staffordshire, the inquiry found that complaints about the care of patients had been dismissed, denied or ignored. They were either not properly investigated or were responded to by standard letters offering insincere apologies.
While senior management and the board had a clear understanding of the budget position, received regular financial updates and took a close interest in actions to address overspends, they did not show a similar interest in patient care, management information on complaints, lessons learnt and changes implemented.
The report characterises NHS trusts’ responses to complaints from patients and relatives as “delay, deny and defend”.
If past experience is anything to go by a comprehensive and complicated complaints system will be put in place that covers informal and formal complaints. No doubt there will be a requirement for every NHS trust to have a detailed set of procedures, which include how to complain and how complaints should be investigated and responded to.
It would include various escalating stages to appeal or take the complaint to a higher level, should the complainant not be satisfied with the outcome. It would be bureaucratic, off-putting, time consuming and ultimately not achieve the desired outcome.
This would be accompanied by a policy statement from the board that makes clear that all complaints should be treated seriously, investigated rigorously, that lessons learnt should inform changes and that the trust should be open and honest about failings.
But defensiveness is a state of mind that will not be dislodged by policy and procedures.
‘Apologising and putting it right straight away means dealing with a complaint informally’
You can’t defend a member of staff being rude; you can only apologise. You can’t defend staff leaving a patient in a soiled bed; the question to ask is, “Did someone do something about it when it was brought to their attention?”
Apologising and putting it right straight away means dealing with a complaint informally. As a senior manager I was tasked to get involved when situations had escalated because the initial response was considered unsatisfactory.
This would involve an independent investigation, a report that would be shared with the complainant and a meeting with me as a senior manager to receive our apology.
This might have involved explaining what action was being taken to ensure the issue didn’t arise again, whether that be instructions to staff or ensuring adequate cover for staff off sick.
Often the issue was further complicated by complaints arising out of the process such as complaining about the response of the person who they first raised the issue with; complaining about a perceived lack of independence of the investigating officer; or complaining about the length of time taken to conduct the investigation.
If the person complaining was still not satisfied they could take it to the ombudsman. If the ombudsman upheld the complaint in full or part, then the organisation would be required to make a formal written apology that would usually involve a commitment to actions to ensure the incident would not happen again.
The chief executive was required to present an annual report to the board that summarised all complaints received, broken down into informal, formal and ombudsmen stages. The nature of complaints were grouped and any actions taken as a result were identified; for example, this might include new guidance given to staff or issues to be covered in staff development.
The overall lesson to be learnt was that on almost every occasion, if the initial response had been to acknowledge the concern and do something to address it, patient and relative would have been satisfied.