By John Tingle
Today consumerism is an essential part of the fabric of British society and complaint systems are heralded in many retail and professional environments. The British public have got used to complaining over the years and this attitude has seeped into the provision of health care services.
Records levels of complaints about the National Health Service (NHS) can be seen to be made every year but the NHS just does not seem to be able to get to grips with developing a good patient complaints handling system.
The Health Service Ombudsman (HSO) lies at the top of the NHS complaints structure and makes the final decisions on complaints that have not be resolved by the NHS in England. The HSO has looked into the quality of NHS complaint investigations where serious or avoidable harm has been alleged.Systemic failings in complaint, patient safety investigations were revealed. Failures which unsurprisingly have appeared in numerous complaints reports over the years before.
For the report, the HSO reviewed 150 NHS complaint investigations where avoidable harm or death was alleged. The HSO also spoke to six different trusts and surveyed over 170 NHS complaint managers to gain insights. An advisory group was later convened by the HSO to test findings.
The HSO found that the process of investigating is not consistent, reliable or good enough. Forty per cent of investigations were not adequate to find out what happened. Serious incidents are also not being reliably identified by trusts. There is wide variation between and within trusts in terms of how patient safety incidents are investigated. In 41% of cases, complainants were given inadequate explanations for what went wrong and why. Twenty five per cent of complaint managers were unsure that sufficient processes existed to prevent a recurrence of an incident, and a further 10% believed sufficient processes were not in place. This is an age old problem seen whenever the NHS complaints system is discussed.
Learning is made more difficult according to the report because divisions within hospitals often work in isolation from each other:
“…learning from investigations appears to be trapped in high level meetings; and learning across organisations often relies on goodwill and personalities rather than any established processes or mechanisms. Our advisory group reported that cross organisational learning tends to be led by the willing few rather than something that is a widespread practice across the NHS.”(p.8)
The report discusses the role of the new Independent Patient Safety Investigation Service (IPSIS) which was established on 1st April 2016 and makes a number of recommendations including that IPSIS should develop and champion broad principles of a good investigation with the emphasis being on building local capability and capacity. Flexibility and proportionality need to be built into this. IPSIS and NHS England should consider how the role of NHS complaints managers and investigators can be better recognised and supported. The NHS can and should do much better in resolving patient complaint.
John Tingle, Reader in Health Law, Nottingham Law School, Nottingham Trent University, UK