WIREDGOV

New research by the Health Service Ombudsman out yesterday (13 August) shows a ‘toxic cocktail’ within some NHS hospitals which combines a  reluctance by patients, carers and families to complain with a defensiveness by  hospitals and staff to hear and address concerns. The research sets out  ideas which could help make  a step change in complaint handling from the  ward to the Board.

Improvements  suggested by the research include:

• Moving  towards an open culture of feedback and improvement;
• A  fresh focus on putting things right on the ward; and
• Replacing  deference and hierarchy in hospitals with a new culture of collaboration  between leaders and staff to listen to concerns and improve services.

The  ideas are based on the views of patients, families, carers and NHS staff who  attended a workshop held by the Ombudsman Service in London  recently. Feedback from patients and staff included: “The whole  complaints system is dated and unclear”, “They closed ranks”, “I  went to a Patient Advice and Liaison Service department for help, but when I  got there, the gentleman barely looked at me and dismissed me with a leaflet”,  “More compassion and empathy is needed so people aren’t too scared to  complain”, “Too many standards, lists and targets.”

Complainants and patients highlighted poor  communication as a key issue and a defensive culture once a complaint was made.

• One  carer’s complaint went back and forth for two weeks – but, as soon as she  threatened to raise the bar by involving the CEO or the press, her complaint  was dealt with within the hour.
• One patient  felt “trusts should learn from individual cases by sharing more information  and cross communication so they’re not working in their own little world.”

Key issues raised by staff included a fear of being  blamed rather than acknowledged for listening and putting things right, a  confusing variation in complaints procedure between hospitals, too much  deference to senior colleagues on wards, and a need for more training on  responding to complaints.

• One staff member said: “When I’ve  done statements on certain complaints all I get is the complaint letter and the  case notes, and I write my paragraph and send it off. I’ve not had a single  response and I haven’t learnt anything.”

The  Health Service Ombudsman, Julie Mellor, said:

“There  has been much said about what is wrong since Mid Staffs. But, we have now  identified what can be done to make things better. This research – the first of  its kind – brings together patients, carers and frontline staff in designing a  new model that works for everyone. The strong message was the need for a step  change in the culture from defensiveness to welcoming and seeking feedback,  including concerns and complaints, to deliver continuous improvement and the  best possible patient care.

The  key themes that come up again and again - those of openness, leadership and  culture change – all start with the board and end at the point of delivery on  the ward. There is a toxic cocktail of reluctance by patients to complain  and defensiveness by hospitals in handling complaints. This means  concerns and complaints are going unheard or unaddressed. Only strong leadership from boards will deliver the  culture change and improvement on wards that we all agree the NHS needs.”

Expert panelists at the event included Professor  Tricia Hart, joint  lead of the Clwyd/Hart review into hospital complaints and Chief Exec of South  Tees Hospital NHS Foundation Trust, Ciarán  Devane, CEO, Macmillan Cancer Support and Non-Executive Director of NHS  England, and Sally Brearley, Patient Representative at The National Quality  Board.

Professor  Tricia Hart said:

“Patient  power is growing – month by month, day by day. Do not underestimate how a  patient voice and a patient opinion can change the way NHS works, not just now  but in the future.”

Ciarán Devane also commented:

“The  atmosphere is changing. There’s a long way to go and a lot of resistance  is built in, but people of goodwill are out there and the partnership between  clinicians, staff and managers will make it happen. Not everywhere at once, but  it will happen.”