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In March 2013
the parliamentary and Health Service Ombudsman led by Dame Julie Mellor
held a two-day collaborative workshop to support inform its forthcoming
contributions to the Clywd Hart review
into complaints handling in the NHS. The event brought together patients and
their carers or family members
as well as those with made a complaint previously and NHS professionals
and was observed over the course the two days by Professor Tricia Hart
who is leading the review alongside and Ann Clywd MP.
Based on their own knowledge and personal experience
as well as evidence from expert speakers, participants in the event was asked to
examine the way complaints are currently handled within the NHS
and develop a set of principles and standards that should govern the way
patient concerns and complaints are dealt with in future.
We are at a critical point with the Francis
report into what happened at Mid Staffordshire in the review into
complaint handling that's been set up
there is an energy and a momentum about listening to patients
so I hope where we'll get to you is that people will not feel powerless because
they'll see the change that has been
brought about because they have given feedback. Participants heard from a
number of different
expert speakers each introducing a different stage at the complaints
process
participants agreed that putting things right on the ward
before it becomes necessary to enter a formal complaints process
is by far the most preferable scenario. So we were looking at
dealing with issues in the ward we decided that our
primary objective is to create an atmosphere
in which and patients and everybody involved in their care
can communicate effectively and without repercussions.
In order to achieve this the objective should be
we basically all were pretty much in agreement that if you're going through an
ordeal whether it's yourself or a loved one
being in hospital and things weren't going well
by the time you or they are out you're so relieved the whole thing's over
you just want to move on
and not think 'oh god I've now got this
headache and mountain to climb of dealing with an official complaint so if it
can be dealt with there and then
if staff just treat patients with more compassion and empathy then
probably won't be as scared
to complain to them we also said and that is really important to educate
patients probably, and explain everything to them as soon as they get there
just to make them less anxious and less likely to complain
and feel overwhelmed. The nurse tells you
who to talk to and how to raise concerns and ask questions
there's a real open-door policy which works both ways
so any issues are resolved immediately. What might be normal and everyday tasks
for a nurse or a doctor
is probably a one-off for the patient
or the relative. Just seems like this too much work being done by too few people
which means that nobody's going anywhere
The staff aren't getting erm
they aren't able to do their jobs and patients aren't getting the care they need
which is leading to complaints I think if you start there
and perhaps things will get better. Participants were also asked to consider
access to the formal complaint system and how hospitals could
aim to improve it. In the end I think we've distilled it down to
one very clear and sensible objective
which is to ensure a fair an easy access to the complaints system for all
and that's any complainant whether it's
the patient, the carer, any family member. Participants felt that the system should be characterized
by
equal, fair and easy access for all who might wish to make a complaint
they felt that consistency was key to this aim
and that the introduction of common standards for handling complaints across
the NHS was crucial
in addition to this they felt non-clinical advocates for patients were
critical
in giving them a voice
every hospital has a website and there should be
clear guidelines on that website
these guidelines should include the what,
whom and the how as we described it. What the process is
who would be dealing with it and
how it would be dealt with. I believe the NHS could
overcome lots of barriers first of all
someone taking
ownership of the complaint secondly
a follow-up that complaint or you giving me a reference number
and thinking about it, a
timed schedule to return
the feedback of the complaint and
thirdly, basically to give you some reassurance
that it will be looked at and not to stuck on a shelf somewhere
Participants were asked to consider the nuts and bolts of the process once a
formal complaint has been made
and had strongly held views on how it should work.
Both the bodies, the complainant and hospital or the individual against whom
the complaint has been made
they should feel boat comfortable
satisfied and understood. After the initial complaint has been made
participants felt that regardless of its complexity and length
complaints handlers had a responsibility to ensure all parties
should feel informed and clear on what is happening with the case at every
stage
be involved in shaping the way it is handled and
be clear about what the complainant wants to achieve through the process.
Some items of good practice would be things like
involving the complainant in the actual complaint
resolution at the end of the day so giving them the option of what they
want to do
how they want have the complaint resolved, if they want a face to
face meeting
who do they want there, where do they want the meeting held
is it at their home our premises a neutral venue
all those sorts of things and trying to facilitate as much
assistance from the complainant as possible in
in resolving the issues. If I could change the system within my unit
of maternity I think that should be a supervisory person
that guides the complaints and we all have supervisors individually so maybe that person
my supervisor could sort of guide me through the complaint and give me feedback
debrief me on the notes as well
Participants felt the single most important outcome from a complaint
should be clear evidence the lessons have been learned
and best practice will be shared not just within hospitals and trusts
but across the NHS as a whole it is crucial
all parties feel they were listened to properly and regardless of whether a
complaint is upheld or not
the outcome is communicated clearly and sensitively
Some things we all agreed on was that the response should be sincere
clear, honest,
appropriate to the complaint, respectful
and illustrating concretely the next steps that being taken to ensure
it won't happen again
Across the four different areas scrutinized by participants
three clear calls for change emerged hospitals must move from a defensive
culture that discourages complaining
to an open one that welcomes feedback traditional deference between patients
and staff
and the most medical staff themselves must be replaced by collaborative
approach to care
where concerns can be raised freely and tackled together
and there should be a set of standardized steps common to every NHS
Trust's complaints system
Participants presented their final conclusions across
all the areas they had covered to an expert panel to offer their own responses
and thoughts. The things you've said
particularly about the expectations of nurses in terms of introducing people to
the ward taking time to talk to them
to find out what their experiences etcetera etcetera
most nurses almost overwhelmingly
you know, a majority nurses say that's exactly what they want to do
you know that's what they've really see as their job
that relationship with patients and with their carers and families but there
seem to be things in the system
that stop them doing that. Please do not underestimate
how a patient voice and a patient
opinion
to change the way our NHS would work. Not just now but there
into the future. The atmosphere is changing
at even in my time as chief executive macmillan
I can feel that people are much more receptive now
to the views of patients to patient experience
to making sure that the patient view is at the centre of planning
there is a long way to go and there is a lot of resistance built into the system
into let's call it culture of some institutions but they're enough people of
goodwill
out there who are trying to make a difference and
if the partnership between the clinicians the patients and the manager
is
that will will make it happen not everywhereat once but it will happen
I think what we got from
the mixture of public and people who made complaints and staff
was magic in that they expressed what a good standard
what would be happening on the ward would look like what they would expect
to see if things were working well
that was really concrete so we can take that now
and feed it into the Tricia Hart and Ann Clywd review into
hospital complaints and maybe what will happen
is that we will get the adoption of some core standards
across the country for all hospitals that all staff can sign up to that all
hospitals can sign up to you
and the potentially even that the Care Quality Commission could use
when they're inspecting hospitals to look at how that hospital how well the
hospital is dealing with concerns and complaints