Recommendation 133

Commissioners intervening in management of complaint

Accepted in principle
Commissioners should be entitled to intervene in the management of an individual complaint on behalf of a patient where it appears to them it is not being dealt with satisfactorily, while respecting the principle that it is the provider who has primary responsibility to process and respond to complaints about its services.

While we accept the spirit of this recommendation, we are concerned that it risks creating uncertainty over roles and responsibilities in the management of complaints. Clarity and consistency are critical for the patient.

The NHS complaints process is based upon the premise that complaints are best dealt with by the local organisation. If the complainant remains dissatisfied, they are able to seek an independent review through the Health Service Ombudsman.

We accept that in the cases of complaints of a serious nature, that may indicate a possible failure in care or a continued risk to patient safety, commissioners will want to be aware and take action where they believe a provider is in breach of their contract with regard to patient safety and service quality. The NHS standard contract requires providers to ‘implement lessons learned from complaints and demonstrate at review meetings the extent to which Service improvements have been made as a result’ – these review meetings take place between the provider and the commissioner. However, one of the lessons of the Mid Staffordshire Inquiry has been that this information needs to be meaningful – just noting the numbers of complaints received by an organisation is not effective. For 2014/15, NHS England are considering broadening the requirement on Lessons Learned to cover a wider spectrum of information, such as complaints, incidents and feedback from service users and staff, and the extent to which service improvements have been made as a result.

The Department of Health will ensure that each quarter every hospital publishes information on the complaints it has received. This will include:

  • the number of complaints received, as a percentage of patient interventions in that period
  • the number of complaints the hospital has been informed have subsequently been referred to the Ombudsman,
  • lessons learned and improvements made as a result of complaints

The Department of Health will work with NHS England and other key partners to determine the most effective mechanism through which to achieve these outcomes.

The standard contract also requires the povider to provide a complaints monitoring report. For 2014/15 NHS England are considering clarifying the expected content of the complaints report, to include meaningful information on complaints such as analysis of key themes in the content of complaints as well as the number of complaints received for each theme.

The NHS Standard Contract already provides commissioners with powers to intervene in certain circumstances, for example to require remedial action, to impose financial sanctions, to suspend services or to terminate a contract. However, we are examining whether these provisions should be strengthened for 2014/15, with a view to making more specific provision for commissioner intervention, to suspend a service or an element of it, where there are reasonable grounds for material concern about patient safety or outcomes.

However, enabling commissioning bodies to intervene in the management of an individual complaint would undermine the fundamental principle that local organisations themselves are, in the first instance, responsible for seeking to resolve a complaint. A commissioner could intervene if it considers an organisation’s general handling of complaints cases needs to be improved – but their intervention would not be about the specifics of an individual case.

The current complaints arrangements (laid out in regulations) are based on a two-stage model. The first stage is local resolution. At this local level, a complaint about service provision may be made to either the service provider or to the body commissioning the service (but not both). If the person making the complaint is not satisfied with the outcome at this local resolution stage, they have the right to ask the Health Service Ombudsman to investigate the case. The Ombudsman is independent of Government and the NHS, accountable to Parliament.

No update required. Please see response to the recommendation above