Improving how the NHS deals with complaints
In February and March 2007, we assessed how NHS trusts dealt with complaints from patients and their representatives. This page explains why and how we carried out the audit.
Why we audited NHS complaints handling
Our role as the health watchdog in England includes independently reviewing patients’ complaints against NHS trusts if the trusts have not resolved them locally.
When people make a complaint we know that they want it to be resolved as close in time and place as possible to the event, and that some action is taken to ensure that the same problem will not happen again to someone else. To achieve this, there needs to be an effective and efficient complaints handling system where the emphasis is on resolving complaints locally. We were concerned about the large number of complaints that we were being asked to review because the NHS trusts involved were unable to resolve them.
From the number of second stage complaints we receive (around 8,000 requests a year), just under a third of these need to be referred back to trusts for further investigation. This shows inadequacies in the way that some trusts deal with complaints. With the full support of the Department of Health, we have taken action to help ensure that the handling of complaints is as effective as possible.
We have published two reports on second-stage complaints about the NHS. “Spotlight on complaints: A report on second-stage complaints about the NHS in England” looks at the requests for independent review that we receive and highlights recurring themes raised by complainants, such as the safety of clinical practices and poor communication by providers.
Our reports on NHS complaints handling
To find out why so many trusts are not dealing with complaints effectively, we carried out the first ever audit of NHS complaints handling in England.
This in-depth audit of the local handling of complaints in the NHS represents our first move towards in-year risk assessment of trusts’ performance in relation to national standards. It is also an important part of our mission to drive improvement in trusts. The audit was not a ‘tick box’ exercise; rather it was about checking that trusts were using regulations and guidance tools from the NHS and Department of Health. Our inspectors were looking for evidence that trusts are genuinely learning from complaints, listening to patients and the public, and that their complaints processes are fully accessible.
How we conducted the audit
We wanted to look at performance across all types of healthcare organisations in the NHS, including acute, mental health, ambulance and primary care trusts. The audit focused on trusts’ systems for handling complaints and not on individual cases and looked at how trusts perform against the Department of Health’s core standard in this area (core standard C14).
Choosing which trusts to audit
We used a range of data on complaints handling to benchmark the performance of all trusts. This included:
- Department of Health data on written complaints
- comments from third parties
- trusts’ core standards status (taken from the 2005/2006 annual health check)
- trusts’ inspection status (whether we had inspected them and the outcome)
- number of second-stage complaints received and closed about the trust
The annual health check requires trusts to declare each year whether they are compliant with core standards; standard C14 is used to assess trusts’ performance on complaints handling.
More information on the data set
Complaints flowchart diagram (xls 30kb) (opens new window)
NHS and Department of Health regulation and guidance tools (opens new window)
Healthcare Commission inspection guides
This risk assessment of all NHS trusts highlighted the 10% of trusts (32) that were most at risk of not meeting core standard C14 and therefore requiring a visit by our inspectors in the audit. The visits to the 32 poor performing trusts focused on the operation of their arrangements for the handling of complaints on the day of the visit. The assessment team examined these arrangements with reference to The NHS (Complaints) Regulations 2004 and its associated guidance and the three parts of core standard C14.
Using the findings of the risk assessment of all trusts, we also identified the trusts that appeared to be least at risk. We selected and visited 10 of these better performing trusts at random in order to gain a better understanding of the factors that make them work well. Examples of their good practice are shown in the report of the audit.
What the audit found
During the audit, we visited a total of 42 trusts (32 poor performing and 10 better performing). The findings all 42 visits highlighting both good and poor practice, are detailed in the full report.
We found that complaints handling differs markedly across the country, and processes can be fragmented and applied inconsistently within trusts and across the NHS. While the basic elements of a complaints handling system were evident, the emphasis remains on the process rather than focusing on the outcome.
It is the outcome that counts for patients. Our audit showed that NHS trusts need to improve the following key areas relating to core standard C14:
The report highlighted the following issues:
- trusts were not doing enough to make the complaints systems open and accessible. This is particularly true for groups such as people with learning disabilities and minority ethnic communities
- people who complain should be confident that their care will not suffer, but nine of the audited trusts had a significant lapse on this aspect of the standard, and none had comprehensive arrangements. The main concern was an absence of systems to monitor whether care had changed in any way as a result of a complaint
- few of the trusts appeared to approach learning in a systematic way. Trusts should use complaints data to inform decision-making, acting on information as well as collecting it
- there is no one-size-fits-all approach to investigating complaints. But a common approach would improve risk management of complaints and manage the expectations of complainants
- there are no nationally available standard tools and resources such as case studies, checklists and training aids for staff. At trusts where these were available, staff felt better able to manage complaints
Of the 32 trusts in which concerns had been raised, we:
- found that two trusts met all aspects of the standard
- notified 12 trusts of significant lapses in one or more parts of the standard, saying this would affect the organisation’s rating in the Healthcare Commission’s annual health check
- warned six trusts of evidence to suggest the standard was not being met, urging them to consider this carefully before making their declaration for this year’s health check
- told the remaining 12 trusts to make improvements ranging from improving access to complaints systems for people with disabilities to improving communication of the outcome of a complaint
Read the press release, published 8 October 2007
Most reports on this site are PDF files, to view any PDF file you will need Adobe Acrobat Reader.