The NHS complaints system is not working, says the Commons Health Committee. The Health Select Committee has found that the role of the Health Service Ombudsman needs a complete overhaul if it is to provide an effective appeals process for the complaints system.
It states that only 300 out of 100,000 complaints against the NHS last year were investigated by the Health Service Ombudsman.
The report’s other key finding is that there continues to be unacceptably wide variation in operation of complaints procedures within the NHS.
Launching the report of a recent inquiry into complaints and litigation against the NHS, Stephen Dorrell, chair of the committee said: “The legal and operational framework of the Health Service Ombudsman should be widened so that she can independently review any complaint which is referred to her following rejection by a service provider.
The ombudsman’s current terms of reference prevent her from launching a formal investigation unless she is satisfied in advance that there will be a ‘worthwhile outcome’.
Dorrell added: “We have concluded that this requirement represents a significant obstacle to the successful operation of the complaints system. Patients should be able to seek an independent review of the findings of internal reviews by care providers; the terms of reference under which the ombudsman works prevent her from properly fulfilling this role. This needs to be changed.”
The ombudsman’s 2005 report Making Things Better called for the establishment of clear national guidelines for the handling of complaints within the NHS.
However, the inquiry by the all party committee of MPs reveals that the NHS still has no national protocol for the classification and reporting of complaints, and reporting by foundation trusts remains voluntary.
Furthermore, the government’s recent consultation on information strategy in the context of the Health and Social Care Bill did not mention procedures for handling complaints. It remains unclear how patients’ complaints about services delivered by primary care will be handled following passage of the Health & Social Care Bill.
The inquiry suggests that NHS culture is too often defensive and the service remains to be persuaded to adopt a more open culture.
Dorrell said: “We welcome the government’s commitment to introduce a duty of candour within the NHS. We recommend that all providers of NHS care should in future owe a duty of candour to their commissioners under which they provide, among other things: timely reports, prepared to an agreed protocol, of all complaints made to them by NHS patients; in cases when complaints are upheld, complaints action plans to address the weaknesses which have been revealed; progress reports of the actions required under complaints action plans.
“We further recommend that commissioners should be under a duty of candour which requires them to publish this information on a regular basis.”
However, he said the inquiry believes that the “most fundamental change which is required” is a “change of culture”.
“We look to both the NHS National Commissioning Board and Healthwatch England to monitor progress in delivering this fundamental change in the direction of a less defensive and more open culture,” he commented.
The inquiry also examined the arrangements under which the NHS handles litigation by patients.
The committee concluded that the existing clinical negligence framework (based on qualifying liability in tort) offers patients the best opportunity possible to establish the facts of their case, apportion responsibility for errors, and secure appropriate compensation. It does not support a switch to no-fault compensation.
The government has issued proposals which will reduce access to legal aid for most clinical negligence cases. The committee warns ministers that the public will judge these proposals by how they alter access to justice. The government must take care to gauge its proposals against this yardstick.
The committee also recommends that ministers should review the regulatory framework that governs the activities of claims management companies. It believes that current practice hinders complaint resolution for patients and pushes up the cost of litigation.
In response, a Department of Health spokesperson said: “The revised plans we set out last week, in response to the independent Future Forum, will safeguard the future of the NHS and put patients at the heart of our health service.
“Under the plans, patients will have a stronger voice and the NHS will be more accountable for the quality of care it provides for patients. In addition, Local Healthwatch will champion the views and experiences of patients, helping to drive improvements in the quality of health and social care services.
“We will respond to the Health Select Committee in the normal way in due course. Its report brings together many voices and views on the system for handling NHS complaints. Together, they highlight some useful lessons for the NHS, the government and for us.”
The Health Service Ombudsman responded: “We have already begun to revise the way in which our data on complaint handling is presented to the public and a fuller picture of our work to resolve complaints will be available in our Annual Report.
“The feedback from the committee, and others, on the use of the phrase ‘no worthwhile outcome’ in our communications is valuable and we will learn from it as we work to improve the service we offer to everyone who contacts us.
However the ombudsman rejected a third recommendation by the inquiry for a review of our legal framework to enable every complainant whose complaint is rejected by the service provider to seek independent review. It said: “We already have the authority to review any complaint which is referred to her by a complainant following rejection by a service provider. We have informed the Committee of this error and hope that they will take steps to address the inaccuracy.
“The system for handling NHS complaints is a complex one. We welcome the report’s endorsement of the current system’s design and potential, its emphasis on listening to patients and support for advocacy and the committee’s call for a greater focus on complaints data and learning from complaints. We are committed to supporting further the implementation of the new system and to working with Parliament, the NHS, the Department of Health and patient advocates to achieve a speedy, and fair, resolution of patients’ complaints.”
Read the full inquiry.
Tags: Complaints
