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Listening To Patient Complaints Can Change NHS Culture

Doctor speaking to patient
30th October 2013

Exactly one year ago, in her forward to the ‘Listening and Learning Report 2012’ - a review of complaint handling by the NHS in England - Julie Mellor, DBE, Health Service Ombudsman wrote, 

“Time and again, poor communication with patients and their families is at the core of what goes wrong. Last year, we received 50 per cent more complaints from people who felt that the NHS had not acknowledged mistakes in care. We received more complaints from people who felt they had not received a clear or adequate explanation in response to their complaints, and more complaints about inadequate remedies, including apologies.”

One year on and the health ombudsman is now calling for a 24-hour advice service to help “unhappy patients”...who do  not have the confidence to raise a concern on a hospital ward ..." and provide  access so that “ every patient, carer and relative would have the opportunity to raise an issue in person, by email or over the phone”.

Better understanding of the underlying cause

While the NHS is by no means alone in being urged to engage more transparently and radically improve its complaints procedures, there is no doubt that the institution is going through one of the most challenging and demanding times in its 65 year history.  The need for ‘culture change’ seems to repeatedly appear in reviews and reports, which  try to gain a better understanding of the underlying causes for ‘delay and denial’ over NHS complaints.

In our own recently commissioned  British Health Report, 35 per cent of respondents said they experienced “poor care” from medical professionals. The prognosis from practitioners was not optimistic with 44 per cent of doctors believing that patient care and its scope of services will decline in the next five years and 28 per cent of doctors saying they “cannot see a future” for the NHS.

Increasing pressures of ward closures, cutbacks, additional workloads, reduced staffing and restricted budgets are all pointed to as contributing to a culture, which ultimately impacts on patient care and further undermines NHS staff morale.

Ushering in a new era of patient-centred care

It ‘s not only the Health Ombudsman who feels that if the NHS could just make the necessary changes  and begin truly “listening to patients”, then a new era of patient-centred care would be ushered in.

A government-commissioned inquiry, led by Welsh Labour MP Ann Clwyd, reports that too many patients found the current approach “unresponsive and confusing”, and urges hospitals to become “open, learning organisations.”  The review has signed up key organisations to a series of pledges, including:

  • The Nursing and Midwifery Council -  new duties over complaints handling in its code of conduct. 
  • Health Education England -  develop an e-learning course to improve training. 
  • NHS England -  work with local managers to hold hospitals and other providers to account.
  • The Care Quality Commission  -  place a strong focus on complaints in its new hospital inspection regime.

Hospitals will also be expected to publish annual reports in "plain English" on complaints.

Health Secretary Jeremy Hunt has welcomed the report saying that he wants to see “a complete transformation in hospitals' approach to complaints so that they become valued as vital learning tools."

Reaction has been mixed with some patient groups suggesting that the process of “candour” would only be applied to the most serious cases of harm and that the pledges do not go far enough.

What is becoming abundantly clear, however, is that a total transformation in complaints handling will only be possible by actually listening to patients and learning directly from their experiences.

For this to happen, the complaints process itself must be accessible to examination, diagnosis and treatment.