Feedback, of which complaints are an important part, is a strong indicator of patient experience, and serves to assist organisations to improve service delivery. It should be encouraged and welcomed as a matter of good practice.
The Review of the Handling of Complaints in NHS Hospitals and the inquiry showed that complaints should be dealt with fairly and lessons learned when things go wrong. The emphasis is rightly on hospital Boards and Chief Executives to correct their mistakes, explain to patients what went wrong, and show how they will put it right. The management of an effective system of complaints and patient feedback is a board level responsibility. An effective trust board will promote a culture of openness, recognise the value of patient comments and complaints, and make it easy for patients, their families and carers to give feedback. An effective trust board will also be open about and publish regular information about the complaints it receives and the action it is taking as a result.
The government wants to see every trust make clear to every patient from their first encounter with the hospital:
- how they can complain to the hospital when things go wrong
- who they can turn to for independent local support if they want it, and where to contact them
- that they have the right to go to the Ombudsman if they remain dissatisfied, and how to contact them; and
- details of how to contact their local HealthWatch.
A sign in every ward and clinical setting would be a simple means of achieving this and the Department will be discussing with Healthwatch England, the Care Quality Commission and NHS England the best means of ensuring this becomes standard practice in all NHS hospitals in England. We would expect these posters to set out how to complain about hospital, how to seek support from their local Healthwatch and how to refer their complaint to the Ombudsman.
It is important that local Healthwatch, as the patient and public champion for health and care services, should be as strong and effective as possible so that it can speak up for patients and provided independent support on complaints. The Department of Health supports Healthwatch England in their plans to coordinate a consumer-facing complaints campaign with their partners.This will help ensure there is better quality information for patients about how to raise a concern and the standards they should expect if they make a complaint.
The Review of the Handling of Complaints in NHS Hospitals recommends the following:
- trusts should actively encourage both positive and negative feedback about their services. Complaints should be seen as essential and helpful information, and welcomed as necessary for continuous service improvement.
- trusts should provide patients with a way of feeding back comments and concerns about their care on the ward, including simple steps such as putting pen and paper by the bedside, and making sure patients know who to speak to if they have a concern – this could be a nurse or a doctor, or a volunteer on the ward to help people.
- hospitals should actively encourage volunteers. Volunteers can help support patients who wish to express concerns or complaints. This is particularly important where patients are vulnerable or alone, when they might find it difficult to raise a concern. Volunteers should be trained.
As part of its new inspection regime, the Care Quality Commission will be including complaints handling in its assessment of trust performance, looking at how they have learnt lessons and what action they have taken as a result.
Sir Mike Richard’s thematic complaints report Complaints Matter was published in December 2014. It covers acute inspections, primary care, and social care and identifies trends and themes in complaints handling drawn from the inspections done by the Care Quality Commission.
Monitor is in the process of working to further align the well-led framework with the Care Quality Commission’s new inspection regime. The current well-led framework was published in May 2014 and includes a number of references to how boards should use complaints in reviewing their governance arrangements. The framework will be used by NHS Trusts, Foundation Trusts, Monitor, NHS Trust Development Authority and the Care Quality Commission to ensure consistent standards across the system of how well-led NHS organisations are.
The Department of Health is working with NHS England to strengthen the 15/16 NHS Standard contract so it includes the need to prominently display complaints information.
Looking at whether patients can leave feedback easily has been a component of the new the Care Quality Commission inspections since October 2014. Complaints is a key line of enquiry in the Care Quality Commission inspections, and this includes looking at a random sample of closed complaints to see how they were investigated, and to look at how the Trust learnt from the complaint and embedded the change in the organisation. The Care Quality Commission will also look at the ward environment. Within the inspections, the Care Quality Commission will look at whether the method of investigating the complaint is appropriate for the issue involved i.e. that in serious cases, independent investigation was conducted.