NHS logo on the side of a building

Testing the Temperature of Patient Safety in the NHS

In terms of transparency and accountability the National Health Service ( NHS) in England is excellent at producing insightful, well-produced reports on health quality and patient safety. It does this on a regular basis and one of the great difficulties faced by NHS nurses and doctors today is the sheer volume of reports published. It’s an impossible task for nurses and doctors to keep up to date with all the reports published and to maintain heavy workloads in resource constrained environments. It’s also hard for health care staff to know which reports to prioritize and which are authoritative.

There is an urgent need for the NHS to create a one stop, patient safety information hub which collects reports from all NHS sites and other important global sites, putting everything into one accessible place. Some recent reports on written patient complaints have been published which are helpful in assessing, testing patient safety and health quality in the NHS.

NHS complaints

Patient complaints are a good barometer of patient safety and health quality and should be analysed for trends, themes. Complaints should also be viewed as a valuable source of patient feedback. Many retailers view complaints from customers positively as constituting useful marketing feedback which can inform new products and services development. Unfortunately the NHS experience with complaints is not that positive and defensive attitudes prevail as the House of Commons Committee of Public Accounts in 2017 stated, “There seems to be a prevailing attitude of defensiveness in the NHS when things go wrong, and a reluctance to admit mistakes, which is likely to be leading to more clinical negligence claims.”

NHS Digital Complaints Reports

NHS digital produce regular data reports on written complaints in the NHS. NHS Digital in 2018 provided data in a report on written complaints in the NHS -2017-2018. “The total number of all reported written complaints in 2017-18 was 208,626. This is the equivalent to 4,012 written complaints a week or 572 complaints per day…The total number of all reported Primary Care written complaints has increased by 4,058 (4.5 per cent) from 90,579 in 2016-17 to 94,637 in 2017-18,” said the report.

An interesting takeaway point from the above quote is the figure of 572 written complaints a day.

More recent figures

More recent figures have been produced by NHS Digital in a 2019 report. This is quarterly collection count of written complaints made by or on behalf of patients about NHS Hospital and Community Health Services (HCHS) in England. The report states that for the period  1 January – 31 March 2019 (Q4) there were 29,507 new HCHS written complaints compared to 28,019 in Q3.  Over the period, the report states, 27,054 complaints were resolved, of these 8,684 (32.1 percent) were upheld, 8,453 (31.2 percent) were partially upheld and 9,917 (36.7 percent) were not upheld.

The report breaks down the 29,507 new complaints made into discrete areas, service, subject and profession. There were 38,417 complaints by service area, the largest proportion being attributable to inpatient services with 33.2 percent (12,748) followed by outpatient services at 22.0 percent (8,465). The report states that there were 48,886 complaints by subject area, of which 27.0 percent (13,210) were complaints about clinical treatment:

“The largest proportion by all subject areas were about communication with 15.6% (7,620) then patient care including nutrition/hydration at 12.5 percent (6,115).

There were 42,648 complaints by profession, with the largest proportion being attributable to medical with 41.4% (17,651) followed by nursing at 23.3 percent (9,929).

The NHS does need to reappraise how it deals with complaints and must view them more positively and less defensively.

John Tingle

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I am also a Patient Safety Specialist at ECRI Institute. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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