NHS Patients Who Complain Risk Victimisation, Say Inspectors

NHS patients who complain about a poor standard of care are at risk of being victimised, health inspectors warn today after the first national audit of the complaints system in England.

The Healthcare Commission said it launched the review after becoming increasingly concerned about how hospitals and primary care trusts respond when patients criticise the behaviour of staff or conditions in hospitals or GP surgeries.

After a risk assessment of all trusts, it identified 32 hospitals, ambulance services and primary care trusts which appeared to have the least satisfactory arrangements. Inspectors found none had comprehensive safeguards to ensure that people who complained could be confident their care would not suffer as a result. They identified “significant lapses” at nine of the audited trusts. “The main concern was an absence of systems to monitor whether care had changed in any way as a result of a complaint,” the commission said.

Few trusts were using complaints to learn how to improve the service. The commission named 12 trusts where it found “significant lapses” in one or more of the national standards for managing NHS complaints. It said this would affect their marks in the annual performance tables. Another six were given formal warnings and 12 were told to make improvements. Only two got a clean bill of health.

The commission investigates about 8,000 appeals a year from patients who have complained to a hospital or primary care trust and are dissatisfied with the response. Its report concluded: “Processes can be fragmented and applied inconsistently within individual trusts and across the NHS … the emphasis remains on the process rather than seeking to find resolution for the person raising a complaint.”

It criticised trusts for doing little to help people from ethnic minority communities or patients with learning difficulties. Anna Walker, the commission’s chief executive, said: “Given that the NHS provides 380m treatments a year, the number of complaints – 140,000 – is relatively small. But when someone does complain, trusts need to respond well. Patients want complaints resolved quickly and locally.”

The report praised one of the largest and busiest acute hospitals in the north-west for learning from a complaint about a patient who died after an MRSA infection. Relatives expressed concern about staff wearing uniforms outside the hospital, risking contamination. The trust devised a new dress code and invested in facilities for staff to change clothes.

Peter Walsh, chief executive of Action against Medical Accidents, said: “This audit is further evidence, as if we needed it, that the way many NHS organisations handle complaints adds insult to injury and there is an urgent need for improvement.” Nigel Edwards, policy director of the NHS Confederation, representing trust managers, said: “NHS organisations consider any feedback from patients invaluable as a means to raise standards of care.” He denied that trusts might victimise complainants. A spokeswoman for the Department of Health said the NHS received a “tiny number” of complaints in relation to the number of treatments.

“But when patients do complain, their complaint should be handled quickly and effectively.”

Failing the test

The dozen NHS organisations failing the complaints standard

Hospitals

Queen Mary’s Sidcup NHS Trust

Pennine Acute Hospitals Trust

North Cumbria Acute NHS Trust

Northern Devon NHS Trust

Ambulance services

East of England, North West

Primary care trusts

Devon, Eastern and Coastal Kent, Lambeth, Plymouth Teaching, Suffolk West, Telford and Wrekin