NHS complaints procedure is a cause for grievance

Trust management had no culture of listening to patients. There were inadequate processes for dealing with complaints”

“Complaints… are a source of information that has hitherto been undervalued as a source of accountability and a basis for improvement”

While a complaints system should be consistent, it must never be applied in a formulistic or insensitive manner”

Extracts from the Mid Staffordshire NHS Foundation Trust Public Inquiry.

Sadly these observations can be applied to many other trusts and health boards in the UK. In my experience, complaints are not dealt with in the most appropriate manner and complaints departments are not recognised as a major frontline service.

‘Response letters are frequently insensitive in tone, condescending, superficial in content and defensive and terse’

A fundamental change in the NHS complaints process is needed. The current response is “complaint first, complainant second”, ignoring the human element behind the written complaint.

The first action should be to meet and listen to the complainants and their complaints. Face to face meetings with complainants at the start of the process will not only reveal their real concerns but provide them with an immediate and personal acknowledgment of their complaint. They can see someone has listened to their complaint. That action may even resolve the matter or lead to mediation.

Complaints develop because patients or family members become confused, frustrated, emotional, and following the death of a loved one, they may be in shock or delayed shock, reacting to the loss by seeking answers. 

Formal response

Currently, when a complaint is received, a rigid internal procedure begins, culminating in a formal response letter to the complainant. Throughout that process no one meets or talks to the complainant. The letters tend to follow a format that has to include standard paragraphs about the next stage in process, how to contact the Parliamentary and Health Service Ombudsman and a concluding statement.

Consequently, they become impersonal. They are frequently insensitive in tone, condescending, superficial in content and defensive and terse. Weak apologies are offered and many fail to provide convincing assurances that lessons have been learnt for future patients. No action plans are provided to assure the complainant that changes are taking place and that achieving promised improvements are being monitored.

‘A balance has to be struck between informality, understanding, compassion, respect, and the need to provide a robust answer’

Each response has to show empathy. The author of the letter has to recognise that complaints arise from emotional anxiety and a basic desire to understand what has, or has not, taken place in the care and treatment of a loved one. The letters should also avoid creating disrespect by failing to meet the response time deadline.

Furthermore, to wait many weeks (even many months) for a response that then fails to deal with all the concerns expressed in the original complaint is antagonistic. Frustration develops further, promoting total dissatisfaction with any subsequent response from the trust. So the complaint continues on towards the ombudsmand.

The tone and format of the response letter has become akin to a formal business letter. A balance has to be struck between informality, understanding, compassion, respect and the need to provide a robust answer regarding the care and treatment given. Whoever drafts the letter needs to demonstrate such skills.   

When members of staff receive notice of the complaint, many may have difficulty in recalling the patient and treatment given. Medical/nursing notes have to be studied and a response note submitted back to the complaints department. Resolution of a complaint can then hang over members of staff for a significant period of time and cause distress. Furthermore, staff may never see the final draft of the formal response letter and can be unaware of any subsequent developments in the complaint.

The way forward for trusts and health boards

There is a critical need to limit potential complaints developing at the bedside.

Trusts have to recognise their two main obligations:

• provide care and treatment to their patients; and
• maintain constant liaison with family members, particularly with regard to care and treatment being given to the very young, the elderly, and the terminally ill.

Staff need to be available to advise families on patients’ care plans and ensure both patients and family members have no concerns to avoid any misunderstandings or misconceptions developing into a complaint. What happened to the patient advice and liaison service?

If a formal complaint is made, meet the complainant as soon as possible and before any internal investigation into the complaint begins. Speed up responses from staff. Reply to the complainant in a manner that reflects compassion and consideration for the complainant’s concerns. Ensure that the response is robust and it covers all matters of concern. If an apology is required, offer a fulsome apology.

This will require a new approach to recruiting, training and the role of complaints officers and their teams.

For the future of our sometimes maligned NHS, with its host of conscientious, caring staff, the effective handling of complaints plays an underlying role in regaining loss of respect and trust in the NHS.

Neil Davies is an independent lay reviewer of NHS complaints