In the second of a series of three blogs on the importance of learning, Jill Mason explores the Parliamentary and Health Service Ombudsman's recent reports.
Their annual Casework report is only a small cross section of the cases they completed in 2019 but the reason they selected the cases featured is because they are typical of many of the complaints they see. The plan is that these new annual casework reports will share some of the PHSO’s most significant findings.
Almost 80 per cent of their work is made up of complaints about the NHS. They encourage public bodies to learn from the cases not just in terms of improving frontline services but also in terms of complaint handling – to learn from the mistakes of others.
Whilst they emphasise that they do NOT see all the good examples of public service they also feel strongly that complaints are a vital source of learning and should be looked at openly and honestly and be used to drive continuous improvement.
Cases cover GP practices, acute trusts and mental health trusts.
By April 2021 they will be publishing the majority of their decisions anonymously too.
Making Complaints Count followed an invitation from the House of Commons Select Committee on Public Administration and Constitutional Affairs to the PHSO to explore the state of local complaints handling. Interviews with a wide range of individuals and reviews of over 300 PHSO reports were drawn upon.
In his foreword, the ombudsman explains that what complaints staff tell him about their role and experience often provides a raw picture of a complaints system that is in urgent need of reform and investment. He notes how coronavirus will amplify pressures on an already fragile complaints system. He is of the view that more is needed to support and strengthen frontline complaints handling. One output is the Complaints Standards Framework referred to below. He seeks effective and inclusive leadership and is concerned to ensure senior leaders invest in their staff through access to better, more consistent training and professional development in complaints handling.
He also recognises that some of the expectations raised may also be relevant to how patient safety investigations are approached, particularly around training and capacity and the need for a more open and learning culture.
Issues that came up in their interviews include:
- Reusing the same standardised text from previous responses rather than providing a personalised response
- Mislabelling of complaints as concerns
- Dealing with the “top coat” of a complaint rather than the underlying issues
- NHS Resolution’s “Saying Sorry” and the statutory duty of candour do not always appear to be understood in terms of making apologies
- Lack of protected time to investigate complaints
- Real time feedback is critical to help identify potential fault lines in services and prevent these becoming longer term issues
- Lack of sufficient publication of insight and learning from complaints
- Need to proactively seek feedback and resolve concerns promptly to prevent issues escalating into a protracted complaints process
- Face to face early intervention meetings can avoid a long and frustrating process of communication by letter
- Delays
- Not responding to points raised, not acknowledging failings and not understanding what went wrong
There are also much wider issues covered such as abuse and intimidation, lack of a career path and support for staff complained about.
The report does however also set out case studies of positive steps taken by several Trusts, including Mersey Care and Nottinghamshire Healthcare NHS Foundation Trusts.
In terms of next steps they suggest a review of the 2009 Complaints Regulations and whether the PHSO will be granted statutory Complaints Standards Authority powers.
The draft Complaint Standards Framework is described as a summary of core expectations for NHS organisations and staff. It is a short nine page read which describes an effective complaint handling system as one which:
- Promotes a learning and improvement culture
- Positively seeking feedback
- Is thorough and fair
- Gives a fair and accountable decision
Particularly, with regard to the learning and improvement culture, it lists seven points, including every organisation has in place appropriate governance structures to ensure senior staff regularly review information arising from complaints and are held accountable for ensuring the learning is acted upon to improve services. There is emphasis on reporting on how new expectations are being met.
The PHSO hope to publish the final version of the Framework (along with next steps for how it will be embedded) in early 2021.
