“Complaints about NHS not acknowledging mistakes ‘up by 50%’,” The Independent reports, while The Daily Telegraph says doctors have been “careless and insincere” while talking to patients.
The papers have been covering the latest annual report on how the NHS handles complaints. The report was produced by the Parliamentary and Health Service Ombudsman, an independent body.
As the headlines suggest, the report shows a sharp rise in the number of people complaining that individuals or institutions in the NHS have failed to acknowledge mistakes in care. This is up by 50% on last year.
There has been a 42% rise in complaints about ‘inadequate remedies’ being offered by the NHS, including a lack of apologies.
People have also complained more about being unfairly struck off general practice lists after disputes or disagreements.
The report features a number of shocking stories about some patients left dissatisfied with how the NHS dealt with their original complaints. They include a man accused of being a “baby” by a surgeon when he expressed anxiety about having a general anaesthetic. The report also highlights a letter from the NHS to a bereaved daughter which said, “death is rarely an ideal situation for anyone”.
The Ombudsman, Dame Julia Mellor, commented: “A poor response to a complaint can add to the problems of someone who is unwell, struggling to take care of others, or grieving. The NHS needs to get better at listening to patients and their families and responding to their concerns.”
The report goes on to argue that handling complaints well needs to be embedded within the heart of the NHS.
When is an apology not an apology?
The Ombudsman’s report highlights how many complaints are met with the politicians’ favourite, the ‘non-apology apology’.
This is the response “I’m sorry you feel that way”, which does not acknowledge any failure on the part of the person or organisation giving the ‘apology’.
The report identifies these ‘false apologies’ as one of the main ways in which NHS organisations get complaints handling wrong.
Who produced the report?
The report is by the Parliamentary and Health Service Ombudsman.
This is an independent body whose role is to consider complaints from the public that government departments, a range of other public bodies in the UK, and the NHS in England have not acted properly or fairly, or have provided a poor service.
Anyone who is unhappy about how a complaint about the NHS in England has been dealt with can take their complaint to the Ombudsman.
What were the main findings?
The report says that during 2011-2012 the Ombudsman received 16,337 complaints from the public about the NHS or NHS-funded services. This was an 8% increase on the previous year.
Of the 16,333 complaints received, 4,399 were formal written complaints. The Ombudsman looked closely at these written complaints (the rest were not formal complaints, or were seeking advice on a complaint). Of the 4,399 written complaints that the Ombudsman dealt with:
- in 2,400 there was considered to be no case for the NHS to answer
- in 950 they found things had gone wrong but the NHS had put them right
- in 649 they were able to put things right quickly without the need for a formal investigation
- the Ombudsman agreed to formally investigate 400 (compared to 351 the year before)
In particular, the report says it received more complaints about the quality of NHS complaint handling. There were:
- 50% more complaints about the NHS not acknowledging mistakes in care (1,523 compared to 1,014 last year) – 78% of these were upheld by the Ombudsman
- 13% more complaints about the NHS providing inadequate response to complaints (1,542 compared to 1,362)
- 42% more complaints about inadequate remedies, including apologies being offered (1,655 compared to 1,163)
- 61% more complaints about independent providers (272 compared to 169)
- 16% more complaints about unfair removal from GP lists (91 compared to 84)
The Ombudsman’s report says that common pitfalls in how the NHS handles complaints include:
- equivocal language and sitting on the fence over care decisions that had been made
- getting key facts wrong
- using technical language without appropriate explanations
- false or insincere apologies
One case quoted in the report describes a male patient whose skin cancer (a malignant melanoma) was misdiagnosed by his GP practice on six different occasions over a period of 10 months. He was unable to get the practice to acknowledge its failings when he complained.
Complaints about unfair removal from GP lists have continued to rise, despite a warning about this practice from the Ombudsman last year. Concerns about how GP practices are handling complaints needs to be addressed as a priority, the report argues. The Ombudsman also says it expects to receive more complaints about independent providers as more healthcare organisations enter the market.
How can complaints handling be improved?
The Ombudsman’s report points out that when a patient complains, the first question that should be asked is “how can this be put right?”. It says that in some cases this might be as simple as acknowledging that something went wrong and apologising as quickly as possible, adding that investigating complaints means listening to the patient and focusing on the key issues raised.
The Ombudsman says that where something has gone wrong, any apology should be frank and unqualified, and should include an explanation of what went wrong and how it happened.
The report also argues that it is vital that while the NHS is being reformed people at every level of the organisation need to ensure that they take patient complaints seriously and act on them appropriately. It goes on to say that although staff and institutions may come under extra pressure, this is no excuse to ignore patient complaints. As the report says, if anything the need to listen and learn from complaints has never been greater.
How should GP practices deal with people they want to remove from their patient lists?
The Ombudsman says that:
- The patient must be warned that their behaviour is putting them at risk of removal from the practice’s patient list.
- The patient should be given a clear explanation about why their behaviour is putting them at risk (such as frequently not attending appointments without cancelling in advance).
- The patient must be told exactly what they must do to avoid being removed from the list.
How do I make a complaint?
You can complain either to the service that you’re unhappy with or to the local primary care trust (PCT) that commissioned the service. Complaints should normally be made within 12 months of the date of the event that you’re complaining about, or as soon as the matter first came to your attention.
Ask your hospital or trust for a copy of its complaints procedure, which will explain how to proceed. The first step is normally to raise the matter with the practitioner in writing or by speaking to them; with their organisation, which will have a complaints manager; or your local primary care trust. This is called ‘local resolution’ and most cases are resolved at this stage.
If you’re still unhappy, you can refer the matter to the Parliamentary and Health Service Ombudsman, which is independent of the NHS and government. However, the Ombudsman will only deal with complaints that have first been through the local resolution process.
- Parliamentary and Health Service Ombudsman. Listening and Learning: The Ombudsman’s review of complaint handling by the NHS in England 2011-12 (PDF 15.9MB). Published online Novemebr 9 2012