Effective complaints handling

Accepted.
Feedback of any kind, but particularly concerns and complaints, are important; they enable things to be put right for the complainant and drive the improvement of hospital services. But there is evidence that not everyone who would wish to make a complaint does so. This can be for a number of reasons, of which ease of access to the complaints arrangements is an important one.
The overall framework for complaints handling is laid down in regulation and it is important that the overall process is consistent across the NHS and clear to patients.
The Government wants to see every Trust make clear to every patient from their first encounter with the hospital:
• How they can complain to the hospital when things go wrong
• Who they can turn to for independent local support if they want it, and where to contact them
• That they have the right to go to the Ombudsman if they remain dissatisfied, and how to contact them; and
• Details of how to contact their local HealthWatch.
A sign in every ward and clinical setting would be a simple means of achieving this and the Department will be discussing with Healthwatch England, Care Quality Commission and NHS England the best means of ensuring this becomes standard practice in all NHS hospitals in England. We would expect these posters to set out how to complain about hospital, how to seek support from their local Healthwatch and how to refer their complaint to the Ombudsman.
It is important that local Healthwatch, as the patient and public champion for health and care services, should be as strong and effective as possible so that it can speak up for patients and provided independent support on complaints. The Department of Health supports Healthwatch England in their plans to coordinate a consumer-facing complaints campaign with their partners. This will help ensure there is better quality information for patients about how to raise a concern and the standards they should expect if they make a complaint.
The Department of Health wants to see patient advice and liaison services well-sign posted, funded and staffed in every hospital so patients can go and share a concern with someone else in the hospital if they do not feel confident talking to their nurse or doctor on the ward. The Department agrees it is appropriate to review the patient advice and liaison services, and will undertake to begin that work in 2014.
Furthermore Rt Hon Ann Clwyd MP and Professor Tricia Hart’s Review of the Handling of Complaints in NHS Hospitals makes two recommendations on good practice to support patients who have some dissatisfaction with their healthcare that would assist in the delivery of this recommendation:
• Trusts should provide patients with a way of feeding back comments and concerns about their care on the ward, including simple steps such as putting pen and paper by the bedside, and making sure patients know who to speak to if they have a concern – this could be a nurse or a doctor, or a volunteer on the ward;
• Hospitals should actively encourage and use volunteers to support patients in expressing concerns or complaints. This is particularly important where patients are vulnerable or alone, when they might find it difficult to raise concerns at the time the problem arises: volunteers should be regularly refreshed.
As part of its new inspection regime, the Care Quality Commission will be including complaints handling in its assessment of Trust performance which includes how Trusts have learnt from complaints.

Local Authority Social Service Complaints (England) Regulations in England require local authorities, NHS bodies, primary care providers and others to publicise their complaints process. Adherence to this requirement can be assessed by the CQC during an investigation under the Health and Social Care Act 2012. In December 2022, the Parliamentary and Health Service Ombudsman issued Complaints Standards which include expectations on how providers and commissioners will handle complaints, together with a model complaint handling procedure and detailed guidance on how the Complaint Standards can be applied in practice

The Department of Health made a complaints poster template available to the NHS at the end of November 2014.

The Parliamentary and Health Service Ombudsman working with Healthwatch England and the Local Government Ombudsman published universal expectations for raising concerns and complaints to support improvements in complaint handling. The user led vision and expectations represent a comprehensive guide to how a good experience of raising a concern or complaint should look and feel.

For the person who has raised a concern or complaint, the ultimate vision is for them to be able to describe their experience as: “I felt confident to speak up and making my complaint was simple. I felt listened to and understood. I felt that my complaint made a difference.” The expectations provide a tangible way to measure the extent to which the expectations of users of health and social care services are being met through the complaints arrangements. .

The Department of Health and NHS England together are issuing an accessible feedback and complaints guide for patients who wish to give feedback or that are dissatisfied with the service they have received from the NHS. The guide will provide information on how to raise a concern or to make a complaint. This will support the NHS Constitution which sets out patients’ right to complain about their NHS care, should they wish, and will be published on the NHS Constitution page of the Gov.uk website.

Creating an environment whereby complaints are encouraged across the NHS will take time, but the Government and its national partners are seeing substantial progress being made in a variety of areas. One example of progress in the patient’s access to complain is the Lancashire Teaching Hospitals NHS Foundation Trust. Information and awareness of how to provide feedback/make a complaint is emphasised in the Trust through installation of a suite of posters widely displayed in public areas; information leaflets that are available in all areas; and information on the Trust’s websites, both internally and externally facing. In addition, satisfaction questionnaires included with each complaint response in which the complainant is asked to provide feedback on the complaints process, the quality of the response letter, and whether it satisfactorily answers their queries and concerns ensures that the Trust maintains a certain level of quality in its complaints processes. While these methods of patient complaint are not nationwide as of yet, Lancashire Teaching Hospitals NHS Foundation Trust testifies that a positive cultural change, which welcomes negative feedback, is beginning to take place within the nation’s healthcare environments.

Complaints are a key line of inquiry for the Care Quality Commission in all health and social care inspections as part of the “responsive” domain.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government said the Department of Health woud discuss with Healthwatch England, the Care Quality Commission and NHS England putting up signs in every ward and clinical setting giving information about how patients could complain to the hospital, who they could turn to for independent support, their right to go to the Ombudsman and details of how to contact their local Healthwatch.

In the February 2015 Culture Change report, the Government said the Department of Health had made a complaints poster template available to the NHS at the end of November 2014; and the Parliamentary and Health Service Ombudsman had published with Healthwatch England and the Local Government Ombudsman universal expectations for raising concerns and complaints. It also stated that the Department of Health and NHS England were issuing an assessable feedback and complaints guide for patients.

DH and NHS England issued guide for patients on complaining and poster made available.