Select committee inquiry
Complaints and Litigation
Closed
What the inquiry looked at
“It is vital the NHS addresses complaints in a way which satisfies patients and their families in order to maintain confidence in the service. Complaints can also be an early warning of systemic problems. The Chair of the public inquiry into Mid Staffordshire NHS Foundation Trust said that “The Trust failed to listen to patients' concerns, the Board did not review the substance of complaints and incident reports were not given the necessary attention.””
The committee's words, from the inquiry page on parliament.uk ↗.
What the government said
6th Report - Complaints and Litigation - Volume III
No government response is linked to this report.
6th Report - Complaints and Litigation - Volume I (Report, together with Formal Minutes)
The government responded on 15 September 2011.
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 4 November 2010 to its close on 1 April 2012.
- Report 2 reports
- Government response 15 Sep 2011
What it recommended 6 recommendations · 50 conclusions
1The Committee welcomes the improving level of satisfaction with the local resolution process for complaints,...
Concluded (the committee's words)
The Committee welcomes the improving level of satisfaction with the local resolution process for complaints, but finds that the Government can still do more to improve patient experience of the complaints system.
2The Committee is clear that the current two-stage model of the complaints system has the...
Concluded (the committee's words)
The Committee is clear that the current two-stage model of the complaints system has the potential to give speedy resolution of, and earlier learning from, complaints. However, there is still a considerable amount of work to do in order to fully implement the system throughout England.
3The Committee takes the view that the two year period since implementation of the new...
Concluded (the committee's words)
The Committee takes the view that the two year period since implementation of the new system should give the Government sufficient data to undertake a review and to make improvements. The Committee endeavours to support this process with this report.
4The NHS complaints statistics show an increase of 13.4% in complaints between 2008–09 and 2009–10.
Concluded (the committee's words)
The NHS complaints statistics show an increase of 13.4% in complaints between 2008–09 and 2009–10. This is comparison of data between two distinct complaints systems is unreliable. Furthermore, the growing number of people treated by the NHS, the stricter reporting arrangements, more information about how to complain and a general improvement in consumer rights awareness may have added to the volume of complaints that the NHS receives.
5In particular we are concerned about the number of individual cases where complainants did not...
Concluded (the committee's words)
In particular we are concerned about the number of individual cases where complainants did not feel the NHS was sufficiently responsive to their concerns. It is in this variable individual experience, rather than in movements in the headline totals, that the Committee feels that there is a real issue which the NHS needs to address.
6Customer service complaints often can and should be resolved immediately by the person receiving the...
Concluded (the committee's words)
Customer service complaints often can and should be resolved immediately by the person receiving the complaint apologising and rectifying the issue, be they a clinician, a PALS officer or any other employee of the NHS. Due to the nature of these types of complaints, admitting that there was a problem, dealing with it and apologising will save time and resources that can be diverted to prompt and effective investigation and resolution of more serious and complex cases.
7It will always be difficult for a single complaints system to manage complaints about the...
Recommended (the committee's words)
It will always be difficult for a single complaints system to manage complaints about the great diversity of issues that occur on a daily basis. In its review of the complaints system in England, the Government should consider carefully the development of separate systems for investigation and resolution of customer care complaints and more serious complaints about clinical issues. A stratified set of standards relating to each part of the system should also be considered.
8The Committee recommends that in all cases where serious untoward incidents are being investigated, whether...
Concluded (the committee's words)
The Committee recommends that in all cases where serious untoward incidents are being investigated, whether or not a complaint has been made, those directly affected should always be included as full participants in the process.
9We recommend that the Ombudsman urgently reviews the manner in which data on complaint handling...
Recommended (the committee's words)
We recommend that the Ombudsman urgently reviews the manner in which data on complaint handling by her office is communicated to the public as she appears to be significantly more actively engaged in reviewing NHS complaints than is obvious from the published data.
10The terminology “no worthwhile outcome” which arises from the Health Service Commissioners Act is being...
Concluded (the committee's words)
The terminology “no worthwhile outcome” which arises from the Health Service Commissioners Act is being used in communication with complainants. Several have told us that their complaints were rejected because “no worthwhile outcome” could be achieved. The Committee recommends that the Ombudsman urgently reviews the use of this terminology in correspondence as it appears significantly to undermine public confidence in the complaints handling process.
11Many people see the role of the Ombudsman as a general appeals process for the...
Recommended (the committee's words)
Many people see the role of the Ombudsman as a general appeals process for the complaints system, but the remit under the Health Service Commissioners Act is much narrower than that. The Committee is of the view that a complainant whose complaint is rejected by the service provider should be able to seek independent review. The legal and operational framework of the Ombudsman’s office should be reviewed to make it effective for this wider purpose.
12Patient advice and liaison services are crucial, as the first line of contact for many...
Concluded (the committee's words)
Patient advice and liaison services are crucial, as the first line of contact for many complainants and as teams that can resolve complaints, sometimes on the spot. The Government needs to explore how PALS can have a highly visible presence in hospital receptions and GP surgeries and be well signposted throughout larger NHS buildings.
13In considering the future of PALS the Committee has had to balance its core role...
Concluded (the committee's words)
In considering the future of PALS the Committee has had to balance its core role i.e. the speedy resolution of complaints, with the independence that some witnesses have called for. On balance, the Committee finds that PALS should remain a part of the workforce of the organisation being complained about. This “insider” position offers PALS the opportunity to access and influence clinicians and managers that may otherwise be more difficult to achieve.
14The Committee does not seek to set a minimum grade for PALS officers in the...
Concluded (the committee's words)
The Committee does not seek to set a minimum grade for PALS officers in the NHS, but does recommend that the Government commissions a framework that sets out the capabilities required to deliver patient advice and liaison roles. This framework should then be used to support, train and develop PALS officers, as well as to ascertain their current skills and benchmark grades across similar organisations.
15The Committee finds that one single point of access for the entire local resolution of...
Concluded (the committee's words)
The Committee finds that one single point of access for the entire local resolution of a complaint is valuable and that integration of complaints and advice teams can provide this. The Committee finds that Local Involvement Networks (soon to become Local Healthwatch organisations), as the local voice of patients, should drive forward the improvement of patient advice and complaints services and feed into the commissioning process.
16It is a significant anomaly that complaints to a professional regulator cannot be supported by...
Concluded (the committee's words)
It is a significant anomaly that complaints to a professional regulator cannot be supported by ICAS, even when this forms part of a complaint that is being made to Complaints and Litigation 49 the NHS. The Committee recommends that Government removes this restriction as part of its review of the complaints system.
17Where advocacy is used, advocates play a valuable role at supporting complainants in making effective...
Concluded (the committee's words)
Where advocacy is used, advocates play a valuable role at supporting complainants in making effective complaints. The Committee finds that there may well be a business case for further support for ICAS in order to reduce the number of premature complaints received by the Ombudsman. The Committee recommends that Government reviews this proposal as part of its review of the complaints system.
18The Committee is concerned that some complainants who would benefit from support from ICAS are...
Concluded (the committee's words)
The Committee is concerned that some complainants who would benefit from support from ICAS are simply not aware of its existence.
19The Committee recommends that NHS management is tasked to deliver a significant improvement in patient...
Concluded (the committee's words)
The Committee recommends that NHS management is tasked to deliver a significant improvement in patient awareness of and access to the services provided by ICAS. It also recommends that PALS should be expected to refer serious cases to ICAS speedily in order to reduce delays in the process.
20The Committee notes that the NHS complaints system has only been in place for a...
Concluded (the committee's words)
The Committee notes that the NHS complaints system has only been in place for a little over two years. Whilst we are not proposing a lengthy and disruptive reorganisation at this point, the Committee believes that commissioning authorities (as outlined in our earlier report Commissioning: further issues)should be the engines that drive improvement in complaints handling, in the analysis of data and in leading change within the NHS.
21The Committee welcomes the Governments announcement that it will introduce a contractual duty of candour.
Concluded (the committee's words)
The Committee welcomes the Governments announcement that it will introduce a contractual duty of candour. The Committee does not think that placing further statutory duties on the NHS will produce the shift in culture that is required to ensure that patients get full disclosure of information when things go wrong. The emphasis on the importance of culture change described later in this report may have more impact than further statutory change.
22However, the Committee believes that service agreements between NHS commissioners and their providers should include...
Concluded (the committee's words)
However, the Committee believes that service agreements between NHS commissioners and their providers should include a contractual duty of candour to the commissioner. A duty of candour to patients from providers should also be part of the terms of authorisation from Monitor, and of licence by the Care Quality Commission.
23When commissioning authorities are being authorised by the NHS Commissioning Board they should also be...
Concluded (the committee's words)
When commissioning authorities are being authorised by the NHS Commissioning Board they should also be placed under a contractual duty of candour to their populations and to their local Healthwatch organisations.
24The Committee finds that in the absence of clear national standards for complaints handling, and...
Concluded (the committee's words)
The Committee finds that in the absence of clear national standards for complaints handling, and with no one organisation taking the lead on assessment of performance, it is extremely difficult to ascertain which organisations are performing well on complaints. There is significant potential for duplication by different regulators and for failing organisations to be overlooked.
25The Committee strongly advocates that one organisation should be responsible for maintaining an overview of...
Concluded (the committee's words)
The Committee strongly advocates that one organisation should be responsible for maintaining an overview of complaints handling in the NHS, setting and monitoring standards, supporting change, and analysis of complaints handling data “in the round” from all sources. The Committee recommends that this responsibility should rest with Healthwatch England in conjunction with local Healthwatch organisations and that it should be resourced at a level which reflects the importance placed in this issue by patients and taxpayers.
26The Committee thinks that commissioners need to have a much greater focus on complaints handling...
Concluded (the committee's words)
The Committee thinks that commissioners need to have a much greater focus on complaints handling and on complaints data. We would like to establish the principle that providers must account to their commissioner on complaints handling, and that the commissioner in turn must account to the public and local Healthwatch for the performance of their providers.
27The Committee recommends that the model commissioning contracts that will be developed by the NHS...
Concluded (the committee's words)
The Committee recommends that the model commissioning contracts that will be developed by the NHS Commissioning Board must mandate access to comparable complaints data from their provider organisations by commissioners.
28The Committee recommends that providers of NHS care and treatment should be under a contractual...
Concluded (the committee's words)
The Committee recommends that providers of NHS care and treatment should be under a contractual duty to report comparable complaints data to their commissioners at a frequency specified by them. Commissioners should in turn share this data with other commissioners, the relevant Healthwatches, and the NHS Information Centre who can in turn share their concerns with Healthwatch England.
29Action plans that arise from complaints are a vital part of organisational learning, but they...
Concluded (the committee's words)
Action plans that arise from complaints are a vital part of organisational learning, but they are only of value if they are followed through to implementation.
30The Committee recommends that providers of NHS care and treatment be put under a contractual...
Concluded (the committee's words)
The Committee recommends that providers of NHS care and treatment be put under a contractual duty to report their complaints action plans, and progress against implementing them to their commissioners, and to the complainant. Commissioners, as the focal point for local analysis of complaints, should then share action plans and progress updates with their local Healthwatch.
31Local Healthwatch should also share complaints action plans and any concerns they have about implementation...
Concluded (the committee's words)
Local Healthwatch should also share complaints action plans and any concerns they have about implementation with Healthwatch England.
32The Committee welcomes the provisions in the Health and Social Care Bill that support information...
Concluded (the committee's words)
The Committee welcomes the provisions in the Health and Social Care Bill that support information sharing between organisations but would like to see the proposals strengthened in a number of areas relating to the complaints system.
33From the evidence presented to it the Committee finds that people who use complaints advocacy...
Concluded (the committee's words)
From the evidence presented to it the Committee finds that people who use complaints advocacy services see a demonstrable benefit from it. However, existing commissioning arrangements have led to coverage that is neither complete nor consistent.
34The Committee supports the Government’s proposal for Local Authority commissioning of complaints advocacy.
Concluded (the committee's words)
The Committee supports the Government’s proposal for Local Authority commissioning of complaints advocacy. Local Authorities should use their considerable experience in this area to improve consistency of advocacy services across England. Commissioning statutory advocacy services for complaints, mental health and mental capacity could create opportunities to make service improvements and to reduce costs that should be explored by Local Authorities and the Department of Health against the background of a shared commitment to provide an effective advocacy service.
35In the Committee’s second report on commissioning, it expressed concern that the Governments proposals for...
Concluded (the committee's words)
In the Committee’s second report on commissioning, it expressed concern that the Governments proposals for commissioning primary care through the NHS Commissioning Board needed to be reconsidered. Commissioning complaints systems through the Board nationally presents similar difficulties. The Government needs to bring forward effective proposals for local commissioning of primary care, of which complaints form a key part.
36The Committee finds it striking that the Government did not mention complaints in the Information...
Concluded (the committee's words)
The Committee finds it striking that the Government did not mention complaints in the Information Revolution consultation and is surprised it does not see how complaints information can help people to “see what is going on within the NHS”.
37Complaints data can and should be used to support informed decision-making by patients and commissioners,...
Recommended (the committee's words)
Complaints data can and should be used to support informed decision-making by patients and commissioners, and to drive up the quality of care in the NHS. In its forthcoming report on the Information Revolution the Government should consider how complaints data can help patients to make informed choices about their care.
38The Committee welcomes the joint agreement on complaints information between the Department of Health, the...
Concluded (the committee's words)
The Committee welcomes the joint agreement on complaints information between the Department of Health, the Ombudsman and others, and would like to see clear plans in place for its implementation.
39However, the Committee remains very concerned that participation in the agreed protocol by Foundation Trusts...
Concluded (the committee's words)
However, the Committee remains very concerned that participation in the agreed protocol by Foundation Trusts remains voluntary. The Committee believes this communicates an unacceptable message about the prevailing culture towards complaints, and in particular towards the duty of candour which we believe that all providers of NHS care should respect towards their commissioners and the wider public. We propose that participation in the agreed reporting protocol for complaints should be a condition of the award of any NHS service contract to either public or private sector provider.
40The withholding of NHS complaints reports from the public until they are specifically requested runs...
Recommended (the committee's words)
The withholding of NHS complaints reports from the public until they are specifically requested runs counter to the principles of the Information Revolution. The Government must take action on this and ensure that complaints reports and serious untoward incident reports are automatically returned to commissioners who can then publish a rounded view on NHS-funded providers. These reports must also be automatically published by local Healthwatch organisations.
41There are significant cultural barriers to complaining about healthcare in England, not least because of...
Concluded (the committee's words)
There are significant cultural barriers to complaining about healthcare in England, not least because of the position that the NHS has within the national psyche. Added to this are fears that complaints will prejudice future care and that the complaints system will prove to be ineffective at resolving complaints to their satisfaction.
42The Committee strongly supports the use of tools that allow patients to give feedback anonymously...
Concluded (the committee's words)
The Committee strongly supports the use of tools that allow patients to give feedback anonymously and that can demonstrate that changes have been made to service provision based on feedback received.
43The Committee urges the Government to pilot how “real-time” feedback can be captured by using...
Concluded (the committee's words)
The Committee urges the Government to pilot how “real-time” feedback can be captured by using existing technology, for example patient bedside technology, that can capture immediate customer care issues, lead to an immediate response and be fed into analyses of broader complaints trends.
44The Committee endorses the view that the NHS workforce is skilled and capable of delivering...
Concluded (the committee's words)
The Committee endorses the view that the NHS workforce is skilled and capable of delivering world-class healthcare. As with any workforce, however, performance issues will from time to time arise and must be dealt with.
45There remains some way to go before a culture is created throughout the NHS that...
Concluded (the committee's words)
There remains some way to go before a culture is created throughout the NHS that is open to complaints, sees these in the light of systemic weaknesses and supports staff. Providers of NHS care and treatment must have clear policies for how they draw the line between system faults, practitioner faults and issues that will be referred to professional regulators.
46The Committee recommends that NHS organisations offer patient or user satisfaction training that includes basic...
Concluded (the committee's words)
The Committee recommends that NHS organisations offer patient or user satisfaction training that includes basic “customer care”, patient safety and how complaints should be responded to when received by front line staff. Complaints data should be fed back to teams and individual practitioners to support learning, appraisal and changes in practice.
47The Committee takes the view that NHS staff should fully support complaints investigations and local...
Concluded (the committee's words)
The Committee takes the view that NHS staff should fully support complaints investigations and local resolution, even when they have left the organisation concerned. The Committee recommends that the Government explore the potential for placing staff under a duty to supply information and attend local resolution meetings, even if they have left the organisation concerned.
48The Committee finds that Foundation Trust Boards meeting in private runs counter to the creation...
Concluded (the committee's words)
The Committee finds that Foundation Trust Boards meeting in private runs counter to the creation of an open culture within the NHS. We very much welcome the Governments announcement that it will end Foundation Trust secrecy by ensuring that the Boards of these organisations will meet in public. The Committee urges the Government to work with the Foundation Trust regulator Monitor to ensure that open meetings are the default position for all matters where confidentiality or commercial sensitivity are not at stake, and that resolutions to meet in private are used judiciously and sparingly.
49The Committee supports an annual “open culture-check” by NHS organisations.
Concluded (the committee's words)
The Committee supports an annual “open culture-check” by NHS organisations. This could utilise existing data from staff surveys, patient feedback and complaints Complaints and Litigation 53 data and cross-references these data with an external peer review by a similar but independent organisation.
50The Committee believes that the existing clinical negligence framework based on qualifying liability in tort...
Concluded (the committee's words)
The Committee believes that the existing clinical negligence framework based on qualifying liability in tort offers patients the best opportunity possible for establishing the facts of their case, apportioning responsibility for errors, and being appropriately compensated.
51Although the pre-action protocol for clinical disputes has been amended over time, the Committee takes...
Concluded (the committee's words)
Although the pre-action protocol for clinical disputes has been amended over time, the Committee takes the view that it is now time for this to be revised, with a view to reducing costs and duplication within the process.
52The Committee believes that the Government is in possession of the industry review report of...
Concluded (the committee's words)
The Committee believes that the Government is in possession of the industry review report of the NHS Litigation Authority. In order to prevent further uncertainty the Committee suggests that it complete the review process and make its conclusions known as soon as possible.
53The Committee is concerned about the activities of Claims Management Companies or “claims farmers”; in...
Concluded (the committee's words)
The Committee is concerned about the activities of Claims Management Companies or “claims farmers”; in particular it is concerned that they encourage people to go straight to litigation rather than use the complaints resolution mechanisms, that the bidding process may not lead to the cases being passed to the advisers best able to resolve the claim, and that they unduly contribute to the rising costs of litigation to the NHS. The Committee therefore proposes that the Government review the regulatory structure within which these businesses operate in order to ensure that patient and taxpayer interests are properly safeguarded.
54The Committee notes that the Government supports the recoverability of “after the event” insurance premia...
Concluded (the committee's words)
The Committee notes that the Government supports the recoverability of “after the event” insurance premia in clinical negligence case to mitigate against the high costs incurred in the early stages of such cases. The proposal to end the recoverability of success fees from the defendant, in this case from the NHS, remains in place. The Committee is concerned that this could impact negatively on some of the most seriously injured or disabled claimants, both by reducing the value of final settlements (after erosion by fees) and by undermining access to justice.
55The Committee considers that preservation of access to justice will be the yardstick by which...
Recommended (the committee's words)
The Committee considers that preservation of access to justice will be the yardstick by which these proposals will be judged by the public and that the Government must take care to gauge its proposals against this measure.
56The Committee welcomes the development of a rapid resolution process for lower value clinical negligence...
Concluded (the committee's words)
The Committee welcomes the development of a rapid resolution process for lower value clinical negligence claims against the NHS, as this will speed up admissions of liability and access to redress for patients, and reduce costs for the NHS. The Committee would like to see evidence of how the complexity of low monetary value claims will be managed whilst costs are reduced.