Use of information about compliance by regulator from: Complaints

Accepted.
The new approach to inspection introduced by the Care Quality Commission places a stronger focus on how care is delivered in practice and how it is experienced, rather than only on compliance with regulations. In line with this, it is now making greater use of the information that it holds on complaints.
The Care Quality Commission already uses a range of information about complaints to inform the timing and focus of its inspections. The information ranges from aggregated numbers and patterns of complaints, to individuals who contact the Care Quality Commission and tell inspectors about their experience. The Care Quality Commission will review how it makes best use of the complaints that it receives directly from individuals, and the individual stories in complaints as well as the aggregated trends, in light of Rt Hon Ann Clwyd MP and Professor Tricia Hart’s Review of the Handling of Complaints in NHS Hospitals.

In 2022, the Parliamentary and Health Service Ombudsman (PHSO) published standards for NHS complaints handling. These include an expectation that organisations will routinely share learning from complaints with other organisation and emphasises the need to promote a learning culture.

The NHS Complaint Standards, model complaint handling procedure and good complaint handling guides 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. This is a contractual requirement as set out in the NHS Standard Contract.

Please see response to recommendations 38 above (on complaints) and 13 above (on supporting learning around quality surveillance).

The complaints data collection is the KO41 and is collected by NHS England. Section 18 of the The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 sets out the requirements for the completion of complaints annual reports which include narrative.

In addition, the Patient Safety Incident Response Framework includes as its first priority the compassionate and effective engagement of those affected by patient safety incidents in the learning response to those incidents. Those affected by incidents must be fully involved in patient safety incident s from the start and throughout as long as they wish to be involved. The Learn from Patient Safety Events (LFPSE) service is a national NHS system for the recording and analysis of patient safety events that occur in healthcare. This replaced the National Reporting and Learning System.

The new inspection process being developed by the Care Quality Commission, working with the Patients Association, is to build an approach based on listening and focus groups, and an interview with the complaints manager. It may also involve looking through complaints file; in other words, looking at the whole complaints process.

The Care Quality Commission provider handbooks were published in October 2014 and include mandatory key lines of enquiry for use in all inspections. For complaints this means the inspection finding evidence to answer the questions - How are people’s concerns and complaints listened and responded to and used to improve quality of care? For staff concerns, evidence will be gathered to answer the questions – Is the value of staff raising concerns recognised by both leaders and staff? Is appropriate action taken as a result of concerns raised?

Over the next six months, the Care Quality Commission plan to further strengthen this approach through:
• starting to design a set of training and support for inspection team members and other the Care Quality Commission staff that is likely to include issues such as understanding the legal framework, facilitating staff forums to ensure raising and acting on concerns is discussed, how to manage sensitivities in handling concerns such as confidentiality, use of inspection guidance and tool kits, identifying good and poor practice.
• In terms of complaints handling, the Care Quality Commission plan in hospitals and other care sectors to carry out an audit of a randomly selected (by the Care Quality Commission) sample of closed files to understand if these have been handled in a way that matches the good practice they expect to see.
• Interviews with senior management, including the Head of Human Resources or equivalent, will include questions about policies on and the practice of handling staff concerns.

There was a positive response when the Care Quality Commission engaged on their proposed approach with groups of people who have experience of making complaints, complaint advocacy services, staff who have raised concerns about services and national bodies. The Care Quality Commission have gathered, from their inspection activity, evidence of good and poor practice in the different sectors for a Chief Inspector of Hospitals report Complaints Matter, which was published in December 2014.

The Care Quality Commission is also undertaking a wide review of “customer experience” that will understand how they can improve the way they listen and respond to concerns and complaints and the providers they regulate. This will include looking at good practice in other service sectors. They are also carrying out a review of their own whistleblowing policies using external expertise.

The Care Quality Commission is building up the relationships it has with its strategic partners to reform the wider complaints system in order to align work on vision and standards, share good practice and consistency in messaging and on a joint vision for good complaints handling.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government said that the new inspection approach of the Care Quality Commission placed a stronger focus on how care was delivered in practice, and how it was experienced, rather than just compliance with regulations.

In the February 2015 Culture Change report, the Government referred to the Care Quality Commission using listening and focus groups, interviews with complaints managers and possible looking through the complaints file in order to look at the whole complaints process. The Government said that mandatory key line of inquiries in the October 2014 Care Quality Commission provider handbooks included asking how people’s concerns and complaints were listened and responded to and whether they were used to improve the quality of care.

The Government said that the Care Quality Commission planned to carry out an audit of randomly selected closed files to understand if they had been handled in a way that matches good practice.