In last year’s report, Listening and Learning: the Ombudsman’s review of complaint handling by the NHS in England 2009-10, I concluded that the NHS needed to ‘listen harder and learn more’ from complaints. The volume and types of complaints we have received in the last twelve months reveal that progress towards achieving this across the NHS in England is patchy and slow.

This report shows how, at a local level, the NHS is still not dealing adequately with the most straightforward matters. As the stories included here illustrate, minor disputes over unanswered telephones or mix-ups over appointments can end up with the Ombudsman because of knee-jerk responses by NHS staff and poor complaint handling. While these matters may seem insignificant alongside complex clinical judgments and treatment, they contribute to a patient’s overall experience of NHS care. What is more, the escalation of such small, everyday incidents represents a hidden cost, adding to the burden on clinical practitioners and taking up time for health service managers, while causing added difficulty for people struggling with illness or caring responsibilities.

In the most extreme example of the last year, a dentist from Staffordshire refused to apologise to a patient following a dispute, which led to Parliament being alerted to his non-compliance with our recommendations. The dentist apologised shortly afterwards and the case is now closed, but it is a clear example of how poor complaint handling at local level can make significant, and needless, demands on national resources.

Two particular themes stand out from my work this year. Poor communication – one of the most common reasons for complaints to us in the last year – can have a serious, direct impact on patients’ care and can unnecessarily exclude their families from a full awareness of the patient’s condition or prognosis. Secondly, in a small but increasing number of cases, a failure to resolve disagreements between patients and their GP has led to their removal from the GP’s patient list – often without the required warning or the opportunity for both sides to talk about what happened. As GPs prepare to take on greater responsibility for commissioning patient services, this report provides an early warning that some are failing to handle even the most basic complaints appropriately.

As we work to improve local complaint handling with health bodies across England, we welcome the increased national scrutiny of the NHS complaints system. In June, Parliament’s Health Committee reported on its Inquiry into complaints and litigation in the NHS, reinforcing the value of complaints information. The Health Committee concluded that there is a need for a change in the culture of complaint handling in the NHS, with clear guidance for staff and regular feedback on complaints about them and their teams. The ongoing Public Inquiry into Mid Staffordshire NHS Foundation Trust is also examining the mechanisms in place for listening to patients and learning from the feedback they present. The Inquiry’s report is expected to be published next year.

The reformed NHS complaints system is now in its third year of operation. A direct relationship between the Ombudsman and health bodies is embedded within the complaints system’s structure and the past year has shown how constructive engagement between the Ombudsman and the NHS can generate positive results for patients. Where health bodies have engaged directly with the Ombudsman, using our data and theirs to identify areas for improvement, we have seen complaint figures drop. As the story of Mr T, illustrates, when the NHS listens to patients and takes action on what they say, it can make a direct and immediate difference to the care and treatment that patients experience.

Alongside this local engagement, there has been an encouraging response from NHS leaders, regulators, professional bodies and the Government to some of our gravest concerns about healthcare in England. In October 2010 the Department of Health published a report on progress made to improve the care and treatment of people with learning disabilities, following the recommendations in Six Lives: the provision of public services to people with learning disabilities, published jointly by my Office and the Local Government Ombudsman in March 2009. There is still much more work to do, but the progress report confirmed that all NHS bodies have carried out a local review of services offered to people with learning disabilities. In February 2011 Care and compassion? Report of the Health Service Ombudsman on ten investigations into NHS care of older people, called for a transformation in the experience of older people in hospital and under the care of their GP. The consequences of this report are being considered at national and local level by NHS leaders, practitioners and policy makers. On both these issues there needs to be clear and consistent action across the NHS in England, with patient feedback and complaints information collated and monitored as an indicator of the progress of change.

This is my last review of NHS complaint handling before I retire later this year. Nine years ago, when I was appointed as Health Service Ombudsman, I saw a complaints system that was long-winded and slow, focused on process not patients, with learning from complaints an occasional afterthought. Now, there is a growing recognition that patient feedback is a valuable resource for the NHS at a time of uncertainty and change. It is directly and swiftly available, covering all aspects of service, care and treatment. But when feedback is ignored and becomes a complaint, it risks changing from being an asset to a cost. As this report illustrates in the statistics section, last year we secured nearly £500,000 for patients to help remedy injustice caused by poor care and poor complaint handling.

I hope that this report, and the growing body of complaint information now available throughout the NHS, will be a valued resource for frontline staff and complaints managers, NHS boards and leaders, as well as the general public. Complaints have an important role to play in shaping the future of the NHS: helping health bodies prioritise areas for improvement, and enhancing patients’ capacity to make informed choices about their healthcare. The NHS still needs to ‘listen harder and learn more’ from the complaints that it receives.

Ann Abraham
Health Service Ombudsman for England
October 2011