NHS building

When Will the NHS Get Its Complaints System Right?

By John Tingle

The National Health Service (NHS) in England has been trying to get an effective, fit-for-purpose complaints system for at least 28 years, and it has still not succeeded.

This has been one of the NHS’s perpetual and intractable problems. History has not served the NHS well here, despite the publication of countless reports on patient safety and NHS complaint handling, and several major crises happening, such as Mid Staffordshire.

More often than not, the reports into patient safety crises and NHS complaints system reform all say the same (or similar) thing, and point to the same issues.

Researcher Margaret Mayberry gives a sense of the history of this NHS complaints system reform discussion:

“The NHS Complaints Procedure was set up in response to “Being Heard.” This followed the report of a review committee, which had been chaired by Professor Alan Wilson in 1993. Its purpose had been to review how complaints were dealt with in the face of growing criticism of outdated procedures.” 

New Complaint Guidance

The Health Service Ombudsman (HSO) has recently published several documents relating to NHS Complaint handling.

The NHS Complaint Standards set out how organizations providing NHS services should approach complaint handling. They apply to NHS organizations in England and independent healthcare providers who deliver NHS-funded care. These standards, the HSO states, are being tested in pilot sites in 2021, and will be refined and introduced across the NHS in 2022.

Also published is a draft model complaint handling procedure and complaint handling guidance, along with examples of good practice in complaint handling.

The draft complaint handling guidance contains thirteen modules; in each there is a detailed discussion of relevant issues.

The HSO discusses the benefits of having NHS complaint standards, and provides a single vision for staff, NHS service users, and the people who support them of what to expect when a complaint is raised. The complaint standards are stated as follows:

  • Welcoming complaints in a positive way
  • Being thorough and fair when looking into complaints
  • Giving fair and accountable responses.
  • Promoting a just and learning culture

Implementation Challenges Ahead

All these HSO complaint handling system materials have the potential to make demonstrably good and sustainable change in a vexed area of NHS practice. There is, however, a lot of material here for health care providers and others to digest. The seminal Care Quality Commission (CQC) report, “Opening the door to change,” warned about busy NHS staff being overloaded with patient safety information. Meanwhile, many of the individual modules of the draft complaint handling guidance are over 10 pages in length.

I do wonder how all of this recently published HSO complaints handling material will be effectively distilled and implemented in a very busy NHS that is also dealing with the COVID-19 pandemic.

Shorter, more condensed NHS complaints policy advice may be more readily received and acted upon. As the adage goes, “less can be more.” In reading the HSO complaint handling materials you also cannot escape a feeling of déjà vu. We have all been down this complaints reform road before. We need to ask why steps to develop an effective NHS complaints system have faltered over the years, and why we have yet to see effective implementation.

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 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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