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Written on 6th August 2020 by Richard Money-Kyrle

The Parliamentary and Health Service Ombudsman (PHSO) has reported to Parliament that the NHS complaints system is in urgent need of investment and reform. The PHSO’s research found that NHS complaints handling is inconsistent, often carried out by unsupported, undervalued and inadequately trained staff in defensive organisations. The healthcare system is therefore missing a vital opportunity to learn from patients’ complaints. 

After the government’s repeated failure to give the PHSO powers to deliver a statutory complaints standards framework, the PHSO has joined with key organisations, including NHS bodies, to create a draft voluntary complaints standards framework. PHSO believes the need for reform of NHS complaints now is vital and urgent, given the current healthcare crisis, and has launched a public consultation inviting everyone to have their say.

Who is the PHSO? 

The Parliamentary and Health Service Ombudsman (PHSO) is an independent, statutory service which makes final decisions and recommendations on complaints that have not been resolved by the NHS in England and government departments. PHSO is not part of the NHS or the government. Its service is free to the public but it is not a consumer champion or regulator. PHSO reports to Parliament to help Parliament scrutinise public service providers, and more widely to encourage improved public services and complaints handling. 

Why is the PHSO calling for NHS Complaints Standards Framework?

For three years, the current PHSO (or Ombudsman), Rob Behrens CBE, has been asking Parliament for statutory power to set up a complaints standards framework for the NHS in England. Scotland already has a system in which complaints about public services are handled to the same set of standards, with a strong emphasis on learning from complaints. 

PHSO’s recent report, Making Complaints Count: Supporting complaints handling in the NHS and UK Government Departments, was based on the first-hand experience of individuals, organisations and its own investigations into NHS complaints. The detailed report shows the PHSO’s insight into the many factors which prevent open, thorough and effective handling of patient complaints. It found three main areas needing change: 

  • Lack of consistency – there is no standard way that staff are expected to handle and resolve complaints.
  • Complaints staff lack training to support them - complaints handling should be recognised as a professional skill.
  • Public bodies view complaints negatively, instead of as an opportunity to learn and improve their service.

Given the COVID-19 healthcare crisis and in the light of the findings of the recent Cumberlege Review, PHSO believes that the need for NHS complaints reform is now urgent. PHSO is still waiting for statutory powers to set mandatory standards for NHS complaints in England but has worked with NHS and other organisations to draft a voluntary complaints standards framework which sets consistent standards and clear expectations for high quality handling of NHS complaints. 

What does the draft NHS Complaints Standards Framework say? 

The draft Complaints Standards Framework sets standards for NHS complaints handling to ensure that the complaints system meets patients’ needs. It says that from the patient’s point of view, this means: 

  • Patients feel confident to speak up: 
    • They know they have a right to complain;
    • They are made aware of how to complain, right from the start; 
    • They understand that they can be supported in making a complaint; 
    • They are certain that their care will not be compromised by making a complaint.
  • Patients feel that making their complaint is simple:
    • They feel they can raise their concerns with any of the staff they deal with; 
    • They are offered support to help make their complaint;
    • They are able to communicate their concerns in the way that they want;
    • They know that their concerns are taken seriously the first time they raise them;
    • They are able to make a complaint at a time that suits them.
  • Patients feel listened to and understood:
    • They always know what is happening in their case;
    • They feel that responses are personal to them and the specific nature of their complaint;
    • They are offered the choice to keep the details of their complaint anonymous and confidential; 
    • They feel that the staff handling their complaint are also empowered to resolve it.
  • Patients feel that their complaint made a difference:
    • Their complaint is resolved in a time period that is relevant to their particular case and complaint;
    • They are told the outcome of their complaint in an appropriate way, in an appropriate place, by an appropriate person;
    • They feel that the outcomes directly address their complaint;
    • They feel that their views on the appropriate outcome are taken into account.
  • Patients know that they would feel confident making a complaint in the future:
    • They would complain again, if they felt they needed to;
    • They feel that their complaint has been handled fairly;
    • They would happily advise and encourage others to make a complaint if they felt they needed to;
    • They understand how complaints help to improve services.

The Complaints Standards Framework sets expectations for NHS organisations and staff. It says that an effective NHS complaints handling system: 

  • Promotes a learning and improvement culture:
    • The organisation demonstrates its commitment to promoting a just and learning culture that is open and accountable when mistakes occur.
    • Supports the whole organisation to view complaints as an opportunity to develop and improve services and staff. 
    • Sets clear expectations to create an open, non-defensive approach to learning from feedback. 
    • Senior staff review information from complaints and are accountable for acting on learning to improve services. 
    • Shares learning from feedback with managers, leaders, other organisations and the public.
    • Gives staff regular support and training to handle feedback according to best practise. 
    • Ensures that every member of staff knows their role in promoting a ‘learning from complaints’ culture. 
  • Positively seeks feedback:
    • Recognises complaints as a positive way to improve services. 
    • Welcomes feedback and makes it easy for people to make a complaint. 
    • Resolves complaints at the earliest opportunity.
    • Gives staff the freedom and training to resolve issues quickly and to everyone’s satisfaction.
    • People know how to complain, can do so in a way that suits them and without fear of their care being affected.
    • People have confidence that their complaint will be taken seriously, handled with empathy and answered quickly.
    • Staff who are being complained about are made aware of the complaint and can access advice and support.
    • Staff identify and can signpost patients appropriately when their complaint should be addressed by another route, such as legal claims for serious injury which cannot be answered through the complaints system.
    • Staff consistently respond to complaints quickly within clearly set out and appropriate timeframes.
  • Is thorough and fair:
    • Complaints are answered openly, honestly and impartially, based on the facts, as quickly as possible.
    • Staff listen and demonstrate clear understanding of patients’ concerns and the outcomes they seek.
    • Everyone involved in the complaint knows how the complaint will be handled and is updated regularly.
    • The organisation takes full accountability for mistakes.
    • Staff have appropriate training, experience, authority, resources, support and time to look into complaints thoroughly.
    • The organisation publishes its complaints procedure which meets framework standards and sets out expectations for how staff will handle complaints. 
    • Staff are free to look for ways to resolve complaints at the earliest opportunity. 
    • Everyone involved in a complaint has the opportunity to give their views and respond to new information, and their views are taken into account. 
    • In complaints involving multiple organisations, roles are clear between the lead and other organisations to provide a coordinated investigation and holistic response.
  • Gives a fair and accountable decision about what happened and whether mistakes occurred or not. 
    • The decision recognises everybody’s experience to ensure a culture of learning and accountability. 
    • Staff are free and have confidence offer remedies and take action to ensure learning is identified and acted on to improve services.
    • Staff give a clear, balanced, factual account of what happened, compared with what should have happened, with reference to relevant standards, policies or guidance. 
    • Staff allow everybody involved in a complaint to respond to initial views, taking this into account in the final decision.
    • Staff have confidence to be open and honest when things have gone wrong or where improvements can be made. There is the right balance between accountability, identifying learning and action to improve services and support staff.
    • Where possible, staff explain why things went wrong and identify ways to put things right after mistakes have occurred. Apologies and explanations should be meaningful, sincere, and openly reflect the mistake’s impact. 
    • Organisations guide, resource and empower staff to identify ways to put things right for those raising complaints. 
    • For complaints that involve multiple organisations, the lead organisation’s response includes issues, conclusions and actions to be taken by the other organisations.
    • People are kept involved about how the learning from their complaint is being used to make improvements.
    • Final written responses to complaints include advice about the right to complain to the Ombudsman. 

Will the Complaints Standards Framework improve patients’ experience of NHS complaints? - Have your say

The PHSO’s report into NHS complaints handling is the latest amongst many reviews and inquiries to demonstrate that the NHS is too defensive, inconsistent, incapable of learning and under-resourced to respond properly to patients’ complaints. 

The draft Complaints Standards Framework offers a much-needed benchmark for high quality NHS complaints handling. However, without statutory backing, individual NHS organisations can decide whether, or to what extent, they are willing to commit to its values and are able to use it. 

The Parliamentary and Health Service Ombudsman (PHSO) has launched a public consultation and invited everyone to have their say on the draft Complaints Standards Framework before the final version is prepared. You can have your say here. The original deadline of 18/9/20 has now been extended to 18/10/20.