New NHS Complaints Procedure
Subtle evolution or radical reform?
Written by: Dr Sara Watkin, Medicology Ltd. Published: 3rd June 2010
The new shared complaints procedure for both health and socialcare; ‘Listen, Respond, Improve’ came into force on 1st April 2009.The premise for the change was to make the procedures morepersonal and flexible whilst ensuring that all those involved in anactual complaint learned appropriate lessons that could be used toimprove service provision. We examine the new procedure and invitethe rhetorical question – does the revised version represent a subtleevolution or a radical reform.
Introducing the procedure
The new complaints procedure represents a significant attemptto improve the management of patient, carer and public concernsin a complainant-centred manner. Each healthcare organisationwill, of course, need to develop its own policy and guidelinesbased closely on the guidance within the new procedure and it istherefore essential that this is both addressed in a timely manner andappropriately migrated down through the chain to the clinical coalface.
Certainly extended from the procedure it replaced, the newerversion marries formal complaint handling with the importantprinciple of ongoing feedback, recommending that all organisationsproviding healthcare develop a variety of mechanisms for receivingfeedback on their services, for example 24 hour phone lines,postal questionnaires and feedback stations throughout theirorganisation. By combining these two principles, the new procedureprovides some basis for organisational performance management& improvement through patient & public involvement, as long asprovider organisations themselves appreciate the benefits of notonly viewing complaints an standalone incidents.
Why was there a need for a change in policy?
It is well recognised that when complaints are dealt with in aneffective manner there is a reduction in legal recourse. Many patientshowever still do not feel their complaints are adequately addressedor that “it is not even worth bothering as no one will listen”.When people complain, the majority want one or both of two things:
- An apology
- Reassurance that lessons will be learnt and the same thing willnot happen again i.e. that they have not complained in vane
Despite the need for an apology, which was prominent in theexisting guidance too, a significant proportion of the medicalprofession remain convinced that we should not apologise topatients because this could increase the likelihood of subsequentlitigation. However, in both guidance and in law, apologising doesnot in itself mean admission of a mistake. We can all apologise forthe distress caused or the feelings endured, for example “I regretthe discomfort experienced ..........” or “I apologise for the anxiety thisincident has caused to you and your family”.
The new procedure seeks to reassert these principles and ensure thatan appropriate apology is forthcoming as early as possible in thecomplaint time course.
The NHS Constitution – the basis for the principles
The new NHS Constitution (published January 09) states thatevery patient and carer has:
- The right to have any complaint they make about NHS servicesdealt with efficiently and to have it properly investigated
- The right to know the outcome of any investigationinto their complaint
- The right to take their complaint to the independent HealthService Ombudsman, if they are not satisfied with the way theircomplaint has been dealt with by the NHS
- The right to make a claim for judicial review if they think theyhave been directly affected by an unlawful act or decisionby an NHS body
- The right to compensation where they have beenharmed by negligent treatment
The NHS constitution also commits to a number of other principlesor rights, including that complainants are treated with courtesy andreceive appropriate support throughout the handling of a complaint,as well as that making a complaint will not adversely affect futuretreatment. It also reinforces the two main wishes of the majority ofcomplainants:
- When mistakes happen, to acknowledge them, apologise,explain what went wrong and put things right quickly andeffectively
- To ensure that the organisation learns lessons from complaintsand claims and uses these to improve NHS services
How does the new procedure differ from the old procedure?
The new procedure differs from the one it replaces in both directand subtle ways, including:
- Patients now have 12 months from the event happeningor becoming aware of the event to complain (previously 6months). This time period can be extended if it is still possible toinvestigate the complaint. Reasons for extending the timescaleswould include such things as the complainant undergoinggrieving or other traumas e.g. severe anxiety as a resultof the complaint
- There are now only 2 stages to the complaints procedure; localresolution and recourse to the parliamentary and health serviceombudsman. The Healthcare Commission (now the Care QualityCommission) no longer plays a role, although providers willobviously need to consider that complaints in their own rightcould precipitate the Care Quality Commission ‘taking interest’in a provider, as Mid Staffs was evidence of
- Complainants should have initial contact within 3 working daysof complaining. At this initial contact it should be acknowledgedthe complaint has been received. Ideally at that point oran agreed future point the complainant should have theircomplaint fully listened to, should be asked what they wish tosee happen as a result of their complaint, should be asked howthey would like their complaint dealt with e.g. face to face or inwriting and they should be informed of the plan for and likelytime scales involved in reviewing the complaint.
- The new system allows increased flexibility e.g. to meet with thecomplainant and/or have a meeting with all parties concernedwith the complaint
- Complainants should be made aware of both the organisation’sPatient Advice and Liaison Services (PALS) and the IndependentComplaints Advisory Service (ICAS)
- PALS advise complainants on how to take theircomplaint forward or resolve it informally. Theydo not take up the complaint on behalf of thecomplainant
- ICAS is a free, confidential and independent servicewhich helps parents and carers make a formalcomplaint about NHS services.
- Serious complaints need to continue to be brought to theCEOs attention and so local policies and education processesneed to have clear guidance on what constitutes a complaintthat is sufficiently serious as to want this escalation
- Ideally the investigation report should be reviewed by boththe complainant and the staff concerned prior to its finalpublication. In the past, the complainant received a letter orreport but did not have the opportunity to actively contributeto this, increasing the likelihood that complainants could feelnot listened to or unfairly judged, which in itself could lead tofurther escalation
- The time scale of 25 days for a written response from theCEO has been removed. However it is envisaged that regularcontact is maintained with the complainant and all complaintsas investigated thoroughly in a timely manner. Wheredelays beyond 6 months occur, the reasons for this must becommunicated to the complainant
- Lessons should be learnt from all complaints and these shouldbe disseminated through the organisation as appropriate andan annual report produced
This guidance does represent a significant departure from theprevious procedure in that it introduces more flexibility underthe premise that providers will work collaboratively and openlywith complainants, who in turn can escalate complaints to theombudsman if that is not happening. This does remove some ofthe rigid formality which in itself could lead to complainants feelingthat services are cold and hard, rather than warm and conciliatory.
What should I be doing as a front line clinical staff member?
It is envisaged that NHS organisations will develop their customerservice roles specifically to deal with complaints in the newmanner. All front line teams should be encouraged to think interms of ‘customer service’ anyway, as greater emphasis is placedon the importance of public and patient opinion in everything fromoutcome measures to assessment of quality to funding and patientchoice.
When receiving a formal complaint it is essential you follow your localprocedure by liaising with your complaints officer or department.However, what simple advice can front line staff heed now, takendirectly from Listen, Respond, Improve?
- Ask the person how they would like to be addressed – as Mr,Mrs, Ms or by their first name
- If someone has phoned you, offer to call them back and givethem the chance to meet face to face to discuss the issue
- Ask them how they wish to be kept informed about theircomplaint and how it is being dealt with – by phone, letter, emailor through a third party such as an advocacy or support service
- If they say by phone, ask them for times when it isconvenient to call and check that they are happy formessages to be left on their answer phone
- If they say by post, make sure that they are happy toreceive correspondence at the address given
- Check if the person has any disabilities or circumstances youneed to take account of (for example, do they require wheelchairaccess, or are they on medication that can make them drowsy?)
- Offer to meet the person at a location convenient to them
- Make the person aware that they can request an advocate tosupport them throughout the complaints process, including atthe first meeting
- Systematically go through the reasons for the complaint withthe person who is unhappy – it is important that you understandwhy they are dissatisfied
- Ask them what they would like to happen as a result of thecomplaint (for example, an apology, new appointment,reimbursement for costs or loss of personal belongings or anexplanation). Tell them at the outset if their expectations are notfeasible or realistic
- Agree a plan of action, including when and how the personcomplaining will hear back from your organisation
- If you think you can resolve the matter quickly without furtherinvestigation do so as long as the person complaining is happywith that and there is no risk to other service users
- For any complaint, remember to check if consent is needed toaccess someone’s personal records, and let the complainantknow the name and contact details of the manager who willinvestigate their complaint
In Conclusion
In conclusion, the new procedure is sufficiently different in thedirection of open collaboration to make a significant difference to theway patients & public feel in complaint situations. However, the truedifference is always in the interpretation and implementation of theprocedure. In that, only time will tell whether this quiet revolution isdelivering the benefit it is designed to deliver.
Further information
Further information can be found on the DH website where you cansearch directly for the following publications:-
DH_095439
DH_095445
DH_095447
DH_095448
DH_095450
Author: Dr Sara Watkin
Medical Director, Medicology Ltd
