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Ombudsman calls for health staff to listen more to patients

The Health Service Ombudsman has called on health professionals to improve the way they deal with complaints after more dissatisfied people referred their issues to her.

Listening and Learning is a report by the Ombudsman looking at the complaints received during 2011-12 about NHS services. It includes examples of responses people have received after making a complaint, including one grieving woman who was told “Truth be told your mother probably said her goodbyes long before the final moments”.

Ombudsman Julie Mellor said her report highlighted a need for those working for the NHS to make improvements to the way they listen to patients and their loved ones and deal with the issues they raise.

The report revealed issues with GPs removing patients from their practice lists as a result of disagreements. The Ombudsman had already expressed concern about this last year after patients contacted her claiming their doctor had behaved unfairly. But despite her raising the issue in the past, she received 16% more complaints about this during 2011-12.

Other examples cited in the report include a male patient who was called a “baby” when he told his surgeon he was worried about being given general anaesthetic and a man whose GP practice failed to spot he was suffering from skin cancer six times.

Another experience mentioned in the report is that of a couple who had to pay the care home bill themselves for several months while a primary care trust decided whether the husband met the criteria for funding even though another trust had already ruled he was eligible.

NHS Confederation chief executive Mike Farrar, said: “This is an important report from the Health Ombudsman and one whose findings all of us in the NHS should carefully consider. Listening to patients and their families is an essential part of providing dignified and compassionate care. It provides invaluable information about what’s working and where organisations need to do better.

“But we should not take these figures lightly, and where NHS organisations have a case to answer it is right that they help resolve the situation as quickly and effectively as possible.

“The new standards for board members and the proposed changes to the NHS Constitution place a significant emphasis on the importance of organisations being transparent when things go wrong. Leaders should act as good role models and actively seek feedback from people who use their services and encourage frontline staff to do the same.

“It is important to remember that a high number of complaints for an organisation does not necessarily equate to poor care. It may indicate the organisation has an open and accountable approach to handling complaints that actively encourages patients and their families to raise issues when they feel the right care has not been provided.

“We should encourage feedback from patients and families. Only by having a two way dialogue and seeing complaints as positive, can we change patient experience.”


Readers' comments (17)

  • communication can be poor, there are so many people involved in one patients care.

    genuine concerns need addressing, moans, groans and unfounded allegations also need addressing. It can be very disheartening sometimes.

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  • I agree, but in addition I find patient/carer expectation to be unrealistic and this contributes to their dissatisfaction. As a clinical nurse specialist it amazes me that in agreeing to be a partner in a person's care family members think it's okay for me to handle everything, 24/7. Most people are lovely, some are until they don't get what they want when they want even if it's contrary to patient well being.

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  • Florence

    I think we should all be more honest with Patients and relatives from the word go about what is realistic. So many complaints Ive listened to are due to unrealistic expectations. Often other Healthcare Professionals have been reluctant to stand up to people and be honest and we have had to pick up the pieces.
    I think we should give people more written information to back up any discussions too.
    In our Trust I think we should deal with complaints more quickly and I would welcome more structure for this too.
    Sometimes we do have to deal with complaints that we may class as trivial. However if it is important enough to the person making the complaint then we have to answer it.
    Ive made statements for complaints( not about me) which were totally unfounded and down right lies. I found out later the relatives had hoped to get compensation off the Trust.
    We still had to answer the complaint and I admire the professionalism of our Manager in the way she handled the matter.
    Sometimes we do get it wrong and thats where proper analysis of the problem and not blame has to be employed. And a proper apology with explanations of lessons learned has to be given.
    I still feel that even with the NHS stance of zero tolerance on abusive behaviour towards staff isnt having much impact.Who does stand up for us ? Ok we stand up for ourselves and if we are lucky we will have a good Manager who will support us too.
    But sometimes I still feel vunerable.
    I will end on a positive note though.
    A few years ago I had a chap shouting his head off at me as he was anxious about his Mums recovery. He wasnt complaining but he disagreed with some of the Doctors interventions.Although these had been previously explained to him.
    I asked to to stop shouting and tell me what his worries were.He was then able to express his worries and I was able to reassure him. But I mean this is just basic stuff we all do everyday.
    The following day he brought me a box of sweets and apologised for his behaviour. He acknowledged that he was allowing his anxiety to take over and he realised that he felt so worried as he felt helpless to help his Mum.His Mum had a long stay with us and we developed a good relationship with him and his Mum.
    I know that a box of sweets doesnt always make things right. And sometimes reasonable people behave in ways they wouldnt normally under stress.
    Like I said earlier I believe we do need to talk to Patients and families more. However we need the right staffing levels to enable this to happen.And if we had the right skill mix, staffing levels we would not have so many complaints in the first place ! Maybe more written information. Such as copies of notes taken at progress meetings and summaries of a discussion with a Doctor. And in our ward the more visible presence of our ward sisters to talk to people as we are busy with essential care tasks.
    I think its important that we dont get defensive about complaints. They can be used to effect change. Although some senior nurses sadly still tend to pass the buck and refuse to acknowledge that the root cause of a complaint is usually down to factors in their control. Poor staffing, and wrong skill mix.

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  • I have had experience as a patient, and family carer As a HCP what may seem the logical solution, or the best care plan, may be totally unworkable in the home environment, or go against dignity and respect. Too many assumptions are made through out the NHS. It is vital that patients are consulted about all their care, including the need for precise timing of medications for long term conditions and pain management in an inpatient setting.Too often patients are fobbed off with excuses, rather than find solutions, the number of times I have been told that that is the NHS you know. Times are tough financially, but it is vital that patients are given choices that put them in control of their own body and care. What may seem the cheapest option may not be if patients are expected to carry out their own care. Patients have a right to life, not a mere existence. Life is tough on both sides of the NHS, spending time making sure that individual needs are met will go along way to reducing the resources that are needed to deal with complaints. It must be remembered that many do not get reported in case it impacts further on a person's care. Patients are usually acutely aware that most nurses are trying their best, and that they are often understaffed. However it is vital that you put yourself in the position of the patient, and not be afraid to raise concerns on their behalf.

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  • michael stone

    Anonymous | 10-Nov-2012 10:13 am

    Yeah !

    The entire system is designed to ignore patients and relatives, especially relatives, once some sort of dispute has arisen - eventhe PHSO does that (I had a letter from an idiot at the PHSO, telling me that 'I can't know what happened at that meeting, because the PCT informs me it has not got any records of the meeting' - well, this was very odd: the CE of the PCT was a t tha tmeeting, and the PCT DID have records of every visit I made to its enquiry desk ! Anyway, pointing out to the writer of that letter 'I was at the meeting, and I can tell you what was said - how come you did not ask ME - are you biased ?' moved this up to the Ombudsman herself {although all I ended up with was 'there seesm to have been some confusion invovled}).


    Rant over - I get very annoyed, by this !

    Oh - and patients have a legal right to self-determination !

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  • I have received complaints made against staff for their 'attitude' simply because they asked a relative not to lie on the bed, asked a patient to turn their mobile phones onto silent, dare to suggest that an independent perfectly mobile patient walk out to the bathroom rather than use a commode overnight.

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  • michael stone

    Anonymous | 10-Nov-2012 11:17 am

    I don't think the Ombudsman is very bothered about that type of complaint !

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  • Florence

    Reading these comments reminded me of my recent experience as a Patient. I didnt feel listened to when I had more of concern than a complaint about a long term health condition I have.My concern was the medication I was recieving and the regularity with which it was reviewed.
    As a Nurse I get frustrated with the system and worn out dealing with complaints. And while it has left me sometimes feeling unsympathetic to others.I have never let this be translated into my practice. I know and am assured by my Manager that I deal with complaints and communicate well with patients and families.

    When the shoe was on the other foot for me I felt my GP treated me condescendingly and didnt listen. My GP simply didnt have the active listening skills to help me and help himself to resolve the situation.
    I gave up and switched GP practice. My current GP takes the time to listen and asks the right questions too.
    In a nutshell when I felt listened too. I began to feel empowered again and my anxiety lessend.

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  • Tiger Girl

    Florence | 10-Nov-2012 11:05 pm

    It is important, to (mentally) stand on both sides of a disagreement, as you have noticed - especially if the main reason for the disagreement, is that neither side properly understands where the other is 'coming from' !

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  • Communication has, and always will be, an ongoing issue. It is getting headlines and attention because of the number of complaints which, in itself, is on the rise. Where was the Ombudsman 20 years ago when communication issues were just as prevalent? Oh, that's right...they weren't interested as no-one complained as patients were more tolerant.
    The problem a lot of the time is nurses get complained about when, in reality, they are the face of the hospital to many patients and relatives. In my experience, it is the doctors who are seriously lacking in communication skills and the nurses who get the abuse for it.
    Personally, I always try and take the time to listen to a patient or a relative if they have a complaint or concern, no matter how trivial but then not only am I a very good listener but I also have a very good sense of empathy (I find it easy to "put myself in their shoes" and see the issue from both sides), which has been enhanced by experiencing being a patient (both in hospital and through GP) a lot over the last 10 years or so.
    I certainly blame a lot of it on time pressures and staffing levels as how is someone supposed to sit down and take the time to listen and respond to a patient's or family members concerns when that person doesn't even have the time to provide all the basics?
    As for patients being removed from GP Surgeries, I would be interested to see a breakdown of the figures to see if there is a correlation between higher figures and higher populations (such as London Boroughs). If a GP surgery is "over-subscribed" then I would imagine they are more likely to strike a patient off for less than at a, say, rural practice (I could be wrong but that is my feeling). I would imagine that a large number of the strike-offs are from worried patients having to wait days (or even weeks in some cases) for an appointment and then getting angry because of it and being struck-off because they were verbally aggressive. Certainly, despite my knowledge of the system and medicine, if I was deeply worried and couldn't get an appointment, I might well get angry and shout if I felt I wasn't being taken seriously.
    I guess it comes down to: Patients and relatives just want to know that they are being taken seriously and are being treated with respect. Most reasonable people will accept that staff are busy and will accept "I am really busy right now but will come and talk to you as soon as I can" rather than perceiving a health professional as not being interested and trying to fob them off. I have had this many times where a patient or relative has been very unhappy with something and I have been busy but were willing to wait till I was less busy as I had shown I was taking them seriously and was willing to listen at a time when I could.

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  • Ombudsman calls for health staff to listen more to patients


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  • I get very depressed going into work now knowing that a number of patients, relatives, ward staff and management will complain, it is very disheartening.

    I want to have the time and the appropriate number of staff to be able to help wash patients properly, take them to the loo, give everyone their meds on time,look after someone who has become acutely unwell, transfer patients to appropriate wards, escort patients to their procedures, update all the bedside documentation, make MDT referrals, provide a sandwich and a hot drink at any time, complete the admission documentation and take part in some audit, update the dreaded computer.

    I'd like to spend more than a few minutes talking to a patient or a relative,which usually only happens when I am doing another task or during visiting hours.

    I don't want to go to work knowing that I will just about scrape through a shift. I have 15 patients to look after, I have staff to look after, I have relatives to look after. I also have myself and my family to look after but day after day I don't get any break at all just so that I can get SOME (not all anymore) of my jobs done.

    I'd also like someone somewhere to take my concerns seriously, to deal with my complaints about the care patients, relatives and staff receive nowadays.

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  • The managers should come down to speak to patients and relatives when they have a complaint.

    Instead of a nurse having to constantly apologise why can't the CEO come and say that they are sorry the nurse was a bit rude but she is overworked and stressed out, sorry that your tablets are late but there is only one trained nurse on the ward, sorry you have to go home when you're not really ready but we need the bed, sorry you have a HAI but we don't have enough staff to look after you properly, sorry your sheets are still wet but so are others and the staff can't cope because I'm too mean to employ more nurses.

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  • Anonymous | 12-Nov-2012 10:16 am

    I almost agree with you. If the nurse was 'rude' because she was over-worked and stressed out, FIRST she should apologise, pointing out that she was stressed out and over-worked.

    THEN management should be asked to come down, by the patient and relatives, to explain why the nurses are stressed out and under-staffed.

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  • does anyone really think that nurses who spend years training and earning a pittance feel proud and satisfied with their days work.

    do the papers believe for one minute that we enjoy not being able to look after patients properly.

    do people seriously believe we like going home in tears, enjoy seeing our patients upset, enjoy upsetting relatives, enjoy seeing our colleagues in tears, enjoy being treated like imbeciles by management who constantly tell us 'just do your best', 'this is how it is now'.

    Does anyone really think we want our patients to be lying in a wet bed, have to wait for analgesia because there's no-one to double-check out a cd, fall because no-one is able to help them, develop pressure sores - I came into nursing to help people.

    For just once do you think that the media might actually try and help us to do our job by showing us support.

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  • someone has suggested that the ombudsman isn't bothered with some complaints which I presume others might feel trivial. these 'trivial' complaints are often the start of a cycle of events that lead to serious concerns. how many mistakes can truly be attributed to just one person?

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  • michael stone

    Anonymous | 12-Nov-2012 6:00 pm

    'these 'trivial' complaints are often the start of a cycle of events'

    There is a difference between a truly trivila issue, and a significan tissue which is onlt seen as trivial if a single (as opposed to multiple) perspective is being adopted.

    The genuinely 'trivial' (as in 'very minor') issues, should be addressed without getting anywhere near the PHSO - it is systemic fault, if those escalate !

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