Monday 07 Apr 2008 @ 09:49
Care Quality Commission
Care Quality Commission
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HEALTHCARE WATCHDOG CALLS ON NHS TO LEARN FROM PATIENTS’ COMPLAINTS
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were either out of the Commission’s jurisdiction (mostly because the concerns had not been raised locally first) or withdrawn by the complainant.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. Twenty one per cent 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 says 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 relatives
· 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.
Anna Walker, the Commission’s Chief Executive, said:
“When you consider that millions of treatments are delivered by the NHS each year, it is encouraging to see the overwhelming majority of patients are happy with the care and treatment they receive.
“However, it is clear from the complaints referred on to the Commission that trusts have some way to go before they are effectively resolving the complaints they do receive, and learning from the issues their patients raise.
“It is often a distressing and frustrating time for patients who feel they haven’t received the care they deserve. It is striking that so many people simply want an apology and steps taken to ensure the problem is not repeated.
“Trusts need to improve their own complaints handling and resolve complaints quickly and locally for patients. We still refer too many complaints back to trusts (one in four), for further action.
“The complaints we do review and uphold continue to show more attention is needed to the basics – standards of care and safety, communication between staff and with patients, and fundamental aspects of care such as nutrition and privacy and dignity.
“Our report shows some trusts handle patient complaints well consistently.
All trusts need to do so.”
Since August 2004, the Commission has received over 27,000 complaints, of which over 25,000 have been resolved. It is now meeting its target of resolving 95% of cases within a year.
From April 2009, the Commission will no longer review complaints about the NHS.
The Commission urges trusts to learn from this report and improve their complaints handling in order to manage this change successfully.
It has recently published guidance to help NHS trusts improve complaints handling. Called The Complaints Toolkit – Handling Complaints in NHS, the guidance provides advice to NHS bodies and primary care providers on best practice in handling complaints at a local level.
The Commission recommends that procedures should be:
· accessible to everyone and easy to use
· sympathetic to the concerns raised
· focused on resolving matters
· non-adversarial
· able to give a robust examination of the issues
· able to ensure an appropriate remedy is provided if a problem is found
· linked to the trust’s improvement agenda to help prevent complaints
being made about services in the future.
For further information contact Emma Reynolds in the press office on 0207 448 9237 or email emma.reynolds@healthcarecommission.org.uk Or call on 0777 999 0845 after hours.
Notes to editors:
The full report will go live on the Commission website at 00:01am on Monday 7 April. It is available at:
The NHS provides 380 million treatments a year. Around 140,000 complaints are made to the NHS each year.
If a patient believes that something has gone wrong during treatment or that something should have been done better, they can make a complaint to their local NHS provider. The provider then investigates and responds. In over 90% of cases this will resolve the issue. If this is not the case, the patient can refer the case to the Healthcare Commission for an independent review. This is the second stage within the NHS complaints process.
This is the second review of complaints dealt with by the Commission. The first, in Febraury 2007, is available at: http://www.healthcarecommission.org.uk/_db/_documents/spotlight_on_complaints.pdf
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-centred 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.
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. Twenty one per cent 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 says 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 relatives
· 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.
Anna Walker, the Commission’s Chief Executive, said:
“When you consider that millions of treatments are delivered by the NHS each year, it is encouraging to see the overwhelming majority of patients are happy with the care and treatment they receive.
“However, it is clear from the complaints referred on to the Commission that trusts have some way to go before they are effectively resolving the complaints they do receive, and learning from the issues their patients raise.
“It is often a distressing and frustrating time for patients who feel they haven’t received the care they deserve. It is striking that so many people simply want an apology and steps taken to ensure the problem is not repeated.
“Trusts need to improve their own complaints handling and resolve complaints quickly and locally for patients. We still refer too many complaints back to trusts (one in four), for further action.
“The complaints we do review and uphold continue to show more attention is needed to the basics – standards of care and safety, communication between staff and with patients, and fundamental aspects of care such as nutrition and privacy and dignity.
“Our report shows some trusts handle patient complaints well consistently.
All trusts need to do so.”
Since August 2004, the Commission has received over 27,000 complaints, of which over 25,000 have been resolved. It is now meeting its target of resolving 95% of cases within a year.
From April 2009, the Commission will no longer review complaints about the NHS.
The Commission urges trusts to learn from this report and improve their complaints handling in order to manage this change successfully.
It has recently published guidance to help NHS trusts improve complaints handling. Called The Complaints Toolkit – Handling Complaints in NHS, the guidance provides advice to NHS bodies and primary care providers on best practice in handling complaints at a local level.
The Commission recommends that procedures should be:
· accessible to everyone and easy to use
· sympathetic to the concerns raised
· focused on resolving matters
· non-adversarial
· able to give a robust examination of the issues
· able to ensure an appropriate remedy is provided if a problem is found
· linked to the trust’s improvement agenda to help prevent complaints
being made about services in the future.
For further information contact Emma Reynolds in the press office on 0207 448 9237 or email emma.reynolds@healthcarecommission.org.uk Or call on 0777 999 0845 after hours.
Notes to editors:
The full report will go live on the Commission website at 00:01am on Monday 7 April. It is available at:
http://www.healthcarecommission.org.uk/_db/_documents/Spotlight_on_complaints_08.pdf
The NHS provides 380 million treatments a year. Around 140,000 complaints are made to the NHS each year.
If a patient believes that something has gone wrong during treatment or that something should have been done better, they can make a complaint to their local NHS provider. The provider then investigates and responds. In over 90% of cases this will resolve the issue. If this is not the case, the patient can refer the case to the Healthcare Commission for an independent review. This is the second stage within the NHS complaints process.
This is the second review of complaints dealt with by the Commission. The first, in Febraury 2007, is available at: http://www.healthcarecommission.org.uk/_db/_documents/spotlight_on_complaints.pdf
In October 2007 the Commission published the first audit on how well the NHS handles complaints. This is available at:
http://www.healthcarecommission.org.uk/_db/_documents/HC_Complaints_Handling_tagged.pdf
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-centred 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.
