Improving the way the NHS deals with complaints
Good quality complaints handling is vital to ensuring continuous improvement in the quality and safety of care at NHS organisations. It provides a tangible and measurable reflection of the organisations commitment to an open and responsive safety culture. Numerous national reports (National Audit Office, Ombudsman, Health Select Committee etc.) have found that complaints are too often handled poorly by the NHS. The PHSO said “complacency in the system has meant that all too often patient complaints have been ignored”. The recent report stated “when patients make a complaint it is often responded to without compassion or apology, and Boards fail to monitor complaints and learn from mistakes”.
The Speaking UP project
As part of the Health Foundation funded Speaking Up project the Patients Association has developed tools aimed at improving the quality of complaints handling at Mid Staffordshire NHS Foundation and elsewhere. Three key partners worked with us on this two year project : Mid Staffordshire Hospitals Trust (MSHFT) NHS Foundation Trust, Pilgrim Projects and the National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD).
There were four key strands to the Speaking Up Project work – a Complainant Support Service, Digital Patient Stories, Peer Review Panel Process of external review and Complainant Survey. These are outlined below.
We provided a Complainant Support Service at MSHFT to support complainants during the process of making a complaint. Support was provided by Patient Champions, led by a Senior Nurse. They provided active support to complainants who often had complex complaints spanning several organisations and provided complainants with a clear judgement as to whether the complaint was handled appropriately or not. They supported the complainant until a satisfactory conclusion was reached. This service ceased at the end of May 2013.
In order to ensure that learning from complaints is harnessed and used to improve future care we developed a number of Digital Stories. These stories tell the tale of individual complaint cases from the perspective of the person making the complaint. These have been used in induction and ongoing staff training and are a really powerful way to ensure that the patient voice is clearly heard. The four stories which we developed can be viewed here.
We developed and piloted a Complainant Survey and a Peer Review process to provide qualitative and quantitative feedback on how Trusts were dealing with their complaints, highlighting areas of positive performance and areas for improvement using a set of good practice standards which were developed as part of this project. The programme was funded over two years until May 2013 by a grant from the Health Foundation. Legacy funding from the project is now being used to fund the post of National Project Lead, Jenny Treanor for nine months to sustain and spread this work across the NHS, following the end of the project.
The work and the Standards on Complaint Handling which we developed as part of this project were specifically recommended by Robert Francis, QC, in his recent Public Inquiry into the problems at Mid Staffordshire NHS FT (MSFT). Recommendation 113 states that “Trusts should consider the recommendations and standards developed by the Patients Association in its work with Mid Staffs Hospital…” This is a strong endorsement for our work. A copy of the standards can be found here. The Scorecard contains all the detailed sub standards.
Moving forward – the Peer Review programme
The Peer Review process is based on the methodology used by the National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD) to review the quality of clinical care across the NHS. We have developed, piloted and refined a scorecard which can be used to review the quality of individual complaints based on the case files. A sample of complaints from the organisation is reviewed to give an overall score and feedback on specific parts of the process the organisation could improve on. It looks at the quality of triage and risk assessment, investigations, decision making and response letters. This scorecard has been developed in partnership with clinicians, complaints managers from the NHS and elsewhere and lay people. The feedback it provides includes both specific process points and general areas for improvement. A copy of the report following the January 2013 peer review panel at Mid Staffs NHS FT can be found here.
We are currently seeking to form a partnership of 10 Clinical Commissioning Groups (CCGs) to invest in the further development of the Peer Review programmes which will enable CCGs to ensure one or more of their major provider organisations can take part in this unique work. Clinical Commissioning Groups are ideal partners in the development of this further activity due to a shared interest in improving governance and quality at their provider organisations. As the work represents a process of external review, these activities are a natural partner to the work of scrutiny that CCGs are expected to undertake. In addition CCGs may wish to consider submitting some of their own complaint cases for review. The independence generated by working with Commissioners rather than providers should also strengthen the credibility of the results of the programme. If you are interested in getting involved or would like to discuss this further, please contact Jenny Treanor (email@example.com).
Moving forward – the Complainant Survey
The Complainant Survey is currently being used at 10 acute NHS Trusts. It asks complainants to rate different aspects of the complaints process - were they kept informed, were they made to feel comfortable throughout the process, did the response answer all their questions, how overall did they rate the experience? It was piloted at Mid Staffordshire and at a smaller group of five Trusts for a year which has enabled us to improve the survey and the operating procedure for delivering it. We are now seeking to develop it further as evidence based tool for comparing the performance of organisations with the ambition of enabling commissioners to use it as part of Commissioning for Quality and Innovation target by 2014. Trusts who have been involved to date have found the work really valuable in enabling them to identify areas for improvement. As the survey is ongoing, they can then track results to see if results are more positive after improvements have been made.
In particular, the fact that they can benchmark their results against all other participating Trusts is seen as a bonus. Participating Trusts met up on a regular basis to share results and good practice suggestions
We are now opening the survey to any NHS Trusts who would like to be involved. Please contact us so that we can discuss the benefits and costs of signing up. In addition to regular reporting of results each Trust involved will get a free place at our annual Complaints Improvement Conference which will focus on making the best use of the information generated from the Survey to really improve Complaints Handling and subsequently patient care, within the NHS.. If you are interested in getting involved or would like to discuss this further, please contact Jenny Treanor (firstname.lastname@example.org).
We have now received the results from the surevys we conducted at the ten acute trusts. You can see the results here.
Moving forward - Training and Complaints review
As part of the project, the Patients Association is also developing a programme of support and training to enable providers to improve their complaints handling. This includes training days for matrons, clinical managers and other staff involved in investigating and preparing responses, the provision of best practice advice and templates for response letters and written tools to support senior managers in decision making. There is also the option of carrying out a complaints review which is currently being explored with some Trusts and can be developed according to need. Both the training and review will be available at an extra cost.