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The NHS needs to ensure that it consistently acts on and learns from complaints by patients, the Healthcare Commission says today (Monday 8 October 2007).

Publishing the first audit of how well the NHS handles complaints, the watchdog says it has found considerable variation in performance across the country. 

The Commission says trusts should do more to make it easier for people to raise a complaint. They should ensure that the care of those raising complaints is not adversely affected as a result. And they should strengthen procedures for investigating problems and improving services in the light of the lessons learned.

The Commission launched the audit after becoming increasingly concerned about how patients’ complaints are handled locally.

It has responsibility in England for reviewing 8,000 complaints a year in which a patient is dissatisfied with the response of the trust. It sends nearly a third of these back to trusts for further work.

In a report on the audit, the Commission concludes: “Processes can be fragmented and applied inconsistently within individual trusts and across the NHS. While basic processes for responding to complaints were evident, the emphasis remains on the process rather than seeking to find resolution for the person raising a complaint.”

There is also little evidence that trusts are systematically learning from complaints to improve their services.

Anna Walker, the Commission’s Chief Executive, said: "Given that the NHS provides 380 million treatments a year, the number of complaints (140,000) is relatively small.

“But when someone does complain, trusts need to respond well. Patients want complaints resolved quickly and locally. Trusts need to show they can respond to the individual’s concern and learn as an organisation. If they do not, it could seriously damage people’s faith in the NHS.

“The best organisations clearly value feedback from the people they serve, but the NHS is some way from doing this consistently.”

The Commission chose 42 trusts for inspection against the Government’s core standard on complaints handling.

Thirty two of these were chosen because of concerns that they may not be meeting the basic standard for managing complaints. An extra 10 were selected* because they handled complaints well, to get an understanding of good practice and to share the learning.

The core standard requires trusts to: make complaints procedures accessible; ensure that complainants are not discriminated against; act on concerns and make changes where appropriate.

The report highlights the following issues:

• trusts are not doing enough to make the complaints systems open and accessible. This is particularly true for groups such as people with learning disabilities and minority ethnic communities
• people who complain should be confident that their care will not suffer, but nine of the audited trusts had a significant lapse on this aspect of the standard, and none had comprehensive arrangements. The main concern was an absence of systems to monitor whether care had changed in any way as a result of a complaint
• few of the trusts appeared to approach learning in a systematic way. Trusts should use complaints data to inform decision-making, acting on information as well as collecting it
• there is no one-size-fits-all approach to investigating complaints. But a common approach would improve risk management of complaints and manage the expectations of complainants
• there are no nationally available standard tools and resources such as case studies, checklists and training aids for staff. At trusts where these were available, staff felt better able to manage complaints

Of the 32 trusts in which concerns had been raised, the Commission:

• found that two trusts met all aspects of the standard
• notified 12 trusts of significant lapses in one or more parts of the standard, saying this would affect the organisation’s rating in the Healthcare Commission’s annual health check
• warned six trusts of evidence to suggest the standard was not being met, urging them to consider this carefully before making their declaration for this year’s health check
• told the remaining 12 trusts to make improvements ranging from improving access to complaints systems for people with disabilities to improving communication of the outcome of a complaint.

The Commission highlights improvements that trusts can make. These are in part drawn from observations of the best performing trusts. It recommends that trusts should:

• do more to open complaints systems and make them accessible, especially for groups with special needs and people from minority ethnic communities
• communicate their commitment to staff and patients that, should people make a complaint, they will not be discriminated against
• provide education and training for frontline staff specifically covering discrimination
• use audits, patient surveys and focus groups to systematically monitor  whether care has changed or been altered as a result of a patient or carer making a complaint.

The Commission urges primary care trusts to:

• develop systems where complaints data informs decision-making when commissioning services, particularly the services of independent contractors
• ensure monitoring complaints is an integral component of performance and risk management and clinical governance systems, and that trust boards receive a regular flow of information about complaints handling as part of their governance system.
  The Commission urges strategic health authorities to ensure they have a flow of information about complaints handling from each of their trusts. It wants them to use this as part of their regular monitoring and performance management.

The Commission welcomes the Government’s proposals for trusts to resolve more complaints locally as research shows this is what patients want. 

But the watchdog says its audit raises questions about whether trusts have the capacity and capability to take this on. Trusts would need additional staff, skills, and clinical and investigative expertise. 

Ms Walker said: “We fully support moves to ensure patients and the public get quicker and local resolution to complaints – that is what they tell us they want. But there are serious questions about whether trusts are in a position to ramp up their systems in time to provide the necessary standard of service.”

The Commission will continue to advocate for change in the way the NHS handles complaints and drive improvement. As a result of the audit’s findings, the Commission has toughened its assessment of how well trusts resolve issues for complainants and make service improvements in response to the issues people raise.

The Commission will also be working on a toolkit for complaints managers and will make it widely available in the New Year. This will guide managers on the most effective methods to resolve and use complaints for wider learning and service planning. The toolkit draws on the Commission’s knowledge of good complaints practice and will be distributed with the Commission’s second complaints annual report early next year.

More information about the NHS complaints audit

Notes to editors

*The following trusts were among those identified as the better performing organisations on complaints, and were randomly selected for a visit as part of the audit:

• Haringey Teaching Primary Care Trust
• Scarborough and North East Yorkshire Health Care NHS Trust
• Guys and St Thomas NHS Foundation Trust
• East Kent NHS and Social Care Partnership Trust
• Gloucestershire Partnership NHS Foundation Trust
• Heart Of Birmingham Teaching Primary Care Trust
• North East Ambulance Service NHS Trust
• East Lancashire Hospitals NHS Trust
• Central Manchester Primary Care Trust
• Plymouth Hospitals NHS Trust

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centered assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions   in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality   Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

For further information contact Janine Maher on 0207 448 9313, or on 0777 999 0845 after hours.