Fundamental review of NHS complaints system

72. We accept this recommendation in principle and recognise that there are still challenges to overcome if we are to see improvements in the way complaints are handled in the NHS. However, we do not believe that another fundamental review will help. The issues are already well documented. 73. Complaints handling has been an important part of the Government's programme of work, particularly following the Inquiries into Mid Staffordshire NHS Foundation Trust. We are working to put in place a more open and transparent culture in which all forms of feedback – comments, concerns, compliments and complaints – are welcomed and acted upon. Over the last two years we have sought to achieve this by focusing on action in a number of areas. We have increased transparency by improving the quality and frequency of national complaints data in secondary care. The first quarterly data returns will be published in the summer and for the first time will have more granular detail on the issues being complained about. 74. We have sought to improve the information available locally for patients on how to complain, including by publishing a national advice guide, providing templates for posters on every hospital ward and, through Healthwatch England working with Citizen's Advice, ensured there is accurate information online about how to complain. 75. The Parliamentary and Health Service Ombudsman and Healthwatch developed a set of expectations which define what a "good" complaints experience feels like from the patient perspective. This provides a clear guide for Boards and Chief Executives to refer to when considering how to improve their complaint handling locally. We have added new commitments to the NHS Standard Contract on the importance of promoting information about how to complain and where to get advocacy support. New education and training tools have been produced by Health Education England and the Royal College of Nursing. The right to complain remains enshrined in the NHS Constitution. 76. To reinforce all of this, the Care Quality Commission inspection process now considers complaints as part of every inspection in primary, secondary and social care and takes a sample of complaints to look at how they have been handled in practice. The local scrutiny function performed by local Healthwatch is also very important as a check and balance on the action taken by the local NHS to handle complaints. 77. We also have ways to benchmark progress, using the annual Care Quality Commission inpatient survey to track whether information is available to people about how to complain, and the tracking survey capturing public perceptions of the NHS, including how people feel about complaining; the results of the winter 2014 tracking survey were published in January and showed around seven in ten people say they would feel comfortable making a complaint about a poor experience at an NHS hospital (71%)18. A full summary of the Government's work and progress to improve complaints handling across the board was set out in our "Culture Change in the NHS"19 progress report in February. 78. However, there is more to do. NHS England is taking forward a number of actions to improve complaints handling over the coming months. This includes developing a toolkit for commissioners to help commissioners deal with complaints more effectively and hold providers to account. NHS England are also working with the Parliamentary and Health Service Ombudsman to pilot ways of surveying patients about their experience of complaining, based on the statements set out in the Ombudsman/Healthwatch document My expectations for raising concerns and complaints20. We will consider what additional action could be taken to improve complaint handling; this includes looking at ways to improve collaboration across organisational boundaries and create a culture where lessons are learnt. 79. The Parliamentary and Health Service Ombudsman remains an important element of the complaints process and provides an independent view for individuals who are dissatisfied with the outcome of their complaint locally. However, we agree that improved local handling of complaints would reduce the proportion of complainants who remain dissatisfied and take their cases to the Ombudsman. 80. The Government are leading work to reform the Ombudsman landscape following on from the proposals set out in Robert Gordon's report. A consultation on these proposals, including the option of creating a single Public Services Ombudsman has just closed. Plans for a draft Bill were announced in the Queen's Speech and the Cabinet Office is working on the Bill which is due to be published later on in this Parliamentary session. As the Ombudsman is the final stage of the complaints process it is important that the infrastructure which surrounds them is as effective as possible and easy for people to use. 81. We continue to believe it important that improvement in the handling of complaints is linked to wider issues around hearing the patient voice, learning lessons and focussing on providing safe quality services. Delivering this requires the whole care system to play its part. In its role as steward of the system the Department will convene a new national partnership of organisations which looks at complaints improvement within a wider context, building on the work done to deliver commitments set out in "Hard Truths", and considering how to improve the culture around patient feedback, including complaints. 82. Finally, as discussed earlier in this document, the Government can now confirm that they accept the Public Administration Select Committee's recommendation to establish an independent patient safety investigation function (the Independent Patient Safety Investigation Service) for the NHS, and will be taking this forward in the coming months. As part of the work that is done to improve the investigation of patient safety incidents in the NHS, there will be consideration given to how local organisations can align their processes for handling complaints and investigations into serious incidents.

This recommendation was accepted in principle by the previous Government however, as set out in the response at the time, it was not felt that a further fundamental review would be helpful. The Government response set out a range of actions taken to improve complaints handling and put in place a more open and transparent culture in which all forms of feedback – comments, concerns, compliments and complaints – are welcomed and acted upon. Subsequently, the Department of Health and Social Care did not take forward a fundamental review of the complaints system and therefore this recommendation was not implemented.

In the intervening years the Parliamentary and Health Service Ombudsman (PHSO) published the NHS Complaint Standards in 2022. The standards set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care.

We are currently developing a national strategy which aims to drive improvements in how feedback and concerns from patients are dealt with by the National Health Service so that the NHS listens, learns and acts.

Department of Health response (July 2015):

“We accept this recommendation in principle and recognise that there are still challenges to overcome …. However, we do not believe that another fundamental review will help. The issues are already well documented.” (p. 84)

Department of Health outlines the issues in the complaints system and what they are doing in response, such as “posters on every hospital ward and, through Healthwatch England working with Citizen’s Advice, ensured there is accurate information online about how to complain.” (p. 83-4)