Chapter 4 - Recommendations
Jump to
108. The outcomes we seek to achieve from the complaints system are clear. The pause in the implementation of a revised complaints process, prompted, in particular, by the Shipman Inquiry, presents the opportunity for the Department of Health to take a lead and ensure that these outcomes are finally secured for complainants in a new health and social care complaints system.
109. The history of proposals for reform, described in Chapter 1 of this report, shows that there is remarkable consensus about what an effective complaints system should look like and what it needs to deliver. The Department of Health's publication, Making things right, echoed the recommendations that emerged from the 'listening exercise' and the Bristol Inquiry, and has been reinforced by the recommendations of the Ayling
, Neale and Shipman Inquiries. We do not dissent from that vision - indeed we have positively welcomed it.
110. The challenge, therefore, is not in determining the vision of an effective complaints system, but in avoiding the mistakes of the past and turning the aspirations of Making things right into a reality for patients and their families and NHS staff. Our recommendations are framed to that end.
111. A number of bodies need to work together to ensure that we now create the modern, responsive, patient-focused system to which we all aspire. In particular we see clear roles for the Department of Health, the Healthcare Commission and all providers of NHS healthcare.
Setting the national framework
112. The Department should set the framework and principles for the new complaints system. The core standards set by the Department of Health for all NHS bodies should set out the quality standards to which they should adhere. The standards should focus on outcomes and approach, not process.
113. We recommend that the Department of Health set core standards for the complaints system. This will ensure that key outcomes, clearly described in our principles, are secured. The outcomes we seek are:
- A simple, consistent approach across all health and appropriate social care providers, so that a complainant can use the same approach when complaining about any NHS care and is enabled to pursue a complaint which crosses organisational boundaries easily and to similar timescales.
- A complaints service accessible to all members of our diverse community, tailored to the needs of the complainant and the particular complaint and providing support for those who need it to pursue their complaint. Those handling the complaint should understand what the complaint is about and what the complainant would like to happen as a result of the complaint. The complainant should be clear how and to what timescales his/her complaint will be dealt with and be kept in touch with progress.
- Fit for purpose, thorough, rigorous and evidence based investigations of complaints with clear, well explained decisions. An approach which is fair to complainants and NHS staff and earns their confidence. Complaints handled by motivated, competent staff with the authority to secure the active participation of all relevant staff.
- A culture of openness and non-defensiveness which welcomes complaints as a way of remedying mistakes and improving service. Leadership by senior managers who live out this commitment and have in place systems to incorporate this learning through clinical governance and quality improvement.
- Provision for a full range of remedies for justified complaints at all levels of the complaints system to include explanations, apologies, specific actions or treatment and, where appropriate, financial compensation for loss, distress or inconvenience. This would need to include provision for the Healthcare Commission to recommend financial redress. Redress should be designed to put the complainant back in the position they would have been in had the service failure or maladministration not occurred; or, if that is not possible, to compensate them appropriately.
- Recommendations arising from the investigation of complaints should be implemented to ensure the mistakes do not recur. Systemic faults should be identified and addressed both in relation to individuals, organisations and across organisations to bring about continuous improvements in patient service.
114. We recommend that the Department of Health require these standards to be met by all providers of NHS care irrespective of whether that care is provided in an NHS Trust hospital, an NHS Foundation Trust, by independent contractors to the NHS such as family doctors and dentists, by contractors in the private sector or by any other service providers.
115. We recommend that the Department of Health take the lead in ensuring that the core standards and common approach to complaints are adopted across health and social care by co-ordinating discussions involving all the interested parties: specifically the Department for Education and Skills, the Healthcare Commission, the Commission for Social Care Inspection, the Local Government Ombudsmen and the Health Service Ombudsman.
116. We recommend that the Department of Health ensure that patients are able to complain direct to their Primary Care Trust about primary care providers such as their GP or dentist and be supported by the PCT in pursuing the complaint.
The Healthcare Commission
117. The Healthcare Commission plays two distinct roles in delivering the complaints system: the provider of the independent stage of the process and the Regulator and Inspector of healthcare.
118. As the deliverer of the independent second stage we recommend that the Healthcare Commission should ensure that both the local resolution stage and their own delivery meet the core standards set down by the Department of Health. In doing so they should review their own complaints process.
119. As Regulator and Inspector, we recommend that the Healthcare Commission:
- review their assessment proposals for complaint handling in the light of the adoption of a new core standard to ensure that local NHS bodies take real responsibility for handling their own complaints;
- develop best practice guidance in complaint handling as a developmental standard for NHS providers;
- capture and share learning from complaints and best practice across the health service.
Delivery by all NHS providers
120. NHS bodies will be at the forefront of delivering the core standards of the new NHS complaints system. To achieve this we recommend that each NHS body (including PCTs):
- develops and documents its own fit for purpose local procedure;
- ensures that its complaints system is accessible to all members of their local communities;
- provides appropriate support to enable patients or their representatives to make a complaint effectively;
- ensures that it has sufficient competent and influential staff to investigate and deal with complaints effectively;
- provides training in handling complaints to all staff to ensure the patient receives a quality service wherever they make their complaint;
- provides clear leadership so that complaints are welcomed and learning is secured;
- works collaboratively with all members of their local health and social care economy to enable a complainant to make a single complaint about cross organisational issues.
Introducing the new system
121. The new NHS complaints system which will follow from these core standards will only work in practice if it is implemented effectively.
122. We recommend that the Department of Health draw up and publish a clear project plan for the introduction of the new system which:
- provides comprehensive publicity for the new scheme for complainants and NHS staff;
- sets clear timescales for the delivery of each step of the implementation process;
- provides for the development and dissemination of clear guidance to support the new system;
- provides for the necessary training of staff.
