Making experiences count: a new approach to responding to complaints
October 2007
The BMA welcomes the Department of Health’s recent consultation with the medical profession and patients on a new approach to responding to complaints to unify and reform the current arrangements for making complaints across health and social care. We recognise the wide variety of complaints about aspects of the care patients receive and the services they access in the NHS, our comments address the consultation largely from the perspective of medical professionals and thus complaints about doctors.
A key area we wish to highlight in responding to the consultation is the role of the General Medical Council. We seek assurances that the GMC’s role in the regulation and upholding of professional standards of medical professionals working in the NHS is recognised and that the complaints procedures remain separate and are not confused with the standards for professional regulation which are already in place.
On behalf of our members we wish to reaffirm our commitment to ensuring that complaints against the medical profession are dealt with appropriately. It is our belief that:
- only those complaints made within three months of the event and which are of a substantial and/or serious nature should be investigated;
- the time limit for acknowledging a complaints should be at least 15 working days;
- doctors should always be made aware of any complaint that has been made about them to their employer/ PCO and the doctor about whom a complaint has been made should be allowed an opportunity to comment upon and contribute to the written response of their employer/ PCO before it is sent to the complainant;
- if a complaint is referred to the Healthcare Commission or the Health Services Commissioner the employer/ PCO must state clearly why local resolution has been disregarded and the doctor must be given an opportunity to respond to the complaint before it is referred on;
- the membership of the independent lay panel considering a complaints should include a medical assessor.
We recognise that complaints provide an opportunity to learn and believe there should be structures in place to ensure that professionals and patients are dealt with appropriately and fairly. We recognise that systems need to be developed to ensure that complaints are dealt with and seek assurances that NHS time and resources are not wasted when explanation and apology may be all that is required to resolve a complaint.
We believe that the majority of complaints can be dealt with effectively at the local level and that patients are usually seeking an explanation of what happened, an apology if appropriate and reassurance that recurrences of the problem they have encountered will not occur again.
Our comments on the specific consultation question are set out below. We look forward to receiving a copy of the consultation outcome when it is available.
Sally Watson
1. What are the features of simple, efficient, timely complaints arrangements?
Timely and efficient complaints procedures should be locally based, that is at the practice, department or ward level.
We believe that local resolution to complaints can often be found. Where possible the complaints structure should ensure complaints are dealt with at the local organisational level leaving primary care trusts to develop complaints procedures for more complex cases which may be multiple provider based. We believe that retaining control of complaints at the local level will ensure that complaints can handled quickly and appropriately with satisfactory input from all those involved.
Any complaints procedure must adopt a whole system approach and should not seek to target the individual. The complaints procedure should not be seen as an alternative to the regulation and professional standards of the GMC which are already in place to regulate the medical profession. We are concerned that if the complaints procedure were to allocate blame at individual level rather than focusing on the system that this would not only de-motivate staff and other healthcare professionals but reduce the efficiency of the system. All those working in the NHS should be free to admit mistakes and the complaints procedure should address failings in the system and individuals but should also ensure that a blame culture does not develop.
We believe that any complaints system must be resourced and have adequate, appropriate and trained personnel to ensure that it is efficient, timely and simple.
2. What features must the new arrangements have in order to be accessible and fair to everyone involved in resolving a complaint?
In order for the new arrangements to be accessible and fair to everyone involved in a complaint we believe, as highlighted in our response to question one that complaints procedures should be locally based. We also believe the complaints structure should be managed and staffed at the local level to ensure not only the efficiencies described in our response to question one but also that complaints are resolved fairly.
We believe that those managing the complaints process should be trained and understand the system they are providing a service for. We believe that those managing the complaints system should also be able to provide accessible and professional support for all those involved.
It is our view that further work should be undertaken to explore areas of individual expertise which could be developed at the local level to support the complaints structure. It may not be efficient to develop specialists in all complaint areas however there should be specialist advice available centrally to ensure that complex cases are either referred from general advisers to those which expertise.
3. What are the hallmarks of an excellent complaint professional, and what qualifications, skills and/or expertise should they ideally have?
We believe that further work should be undertaken to determine the qualifications and skills required of similar professional groups in other sectors of the employment market.
We believe that there should be ownership of complaints by senior managers, such as trust chief executives and their equivalents across the NHS and also by senior clinicians and PEC chairs.
4. What key contributions must the following make to support the new arrangements?
a. Boards of service providers
Without the support of boards of service providers the new complaints procedures can not work effectively or efficiently. A non executive member of the board should have responsibility for oversight of the complaints process and should be accountable to the chairman of the board who in turn is responsible to a national structure. All board members should have complaints training and development in the role.
b. Senior health and social care managers
We believe that senior health and social care managers should have a genuine commitment to ensure rapid resolution of complaints and a commitment to uphold the principles of the complaints structure and the procedures as set out.
Senior health and social care managers should ensure that complaints are reviewed regularly and report on the nature and number of complaints received. This information should be feedback to boards of service providers regularly.
c. Service commissioners
See our response to b which applies also to service commissioners.
d. Regulator(s)
We are unclear about the term regulator used in the consultation and query if it is a reference to ‘a professional regulatory body’ or ‘a regulator of health services’.
We believe the role of healthcare regulators for the purposes of complaints should be an overseeing role with the exception of those complaints which require escalation due to the complexity of number of service providers involved. We also believe that the role of the regulator should be to review complaints where there has been unsatisfactory resolution or where further complaints have arisen during the complaints procedure. We would suggest that all complaints referred to the healthcare regulator should be published together with the outcome of the complaint to ensure that the process is seen as transparent, equitable and fair for all those involved.
We do not believe there should be any change in the role of the professional regulators without the appropriate consultation by those regulators.
e. The Ombudsmen
The ombudsmen should have a clearly defined role with a set of regulatory principles.
f. Central Government
We believe that there should be no involvement of central government in the complaints procedure other than to establish a fair and proper regulatory framework.
5. What arrangements need to be put in place to ensure vulnerable people know about and use the new arrangements?
We believe Patient Advice and Liaison Services (PALS) in each trust and primary care trust and Independent Complaints Advocacy Services are better able to respond to this question.
6. How can we ensure that local health and social care bodies own and are responsible for the complaints that they receive?
We reiterate our view that complaints structures should be locally based to ensure that complaints are dealt with timely and efficiently. We believe that local resolution to complaints can often be found often through the opportunity for the complaints voice to be heard and through explanation and apology on behalf of the service provider. Often by dealing with complaints in a timely way and ensuring apologies are made, where necessary, unsatisfactory and costly escalation of the complaints procedure can be avoided.
Our view is that if boards of service providers are accountable for the complaints procedures local accountability will follow.
7. How should health and social care bodies be held accountable for their complaints handling?
We believe that annual reporting to commissioners of care is the most effective way of ensuring health and social care bodies are accountable for their complaints handling. Reporting should include both numbers of complaints made, action taken to resolve the complaint and the outcome. Such reporting would also provide a way for other service providers to mitigate complaints.
8. Should there be monitoring and/or oversight of complaints received and responsiveness to them? If so, who should have this role?
We believe the role of monitoring and/or oversight of complaints received and responsiveness to them should be with boards of service providers as outlined in our response to question 4a.
9. What are the components essential to the complete handling of a complaint?
It is difficult to identify the components essential to complete handling of a complaint however we believe the complaints procedure should recognise differences in the complexity of complaints and ensure that it is able to respond to the different types of complaint.
Some complaints are less complex than others and this should be recognised. Any complaints procedure should include administrative processes to ensure deadlines are set and records of the complaint kept and the process is communicated to all those involved to ensure that expectations are appropriately managed.
Complaints staff should be equipped with the necessary skills to carry out their role effectively including investigating, communicating and resolving cases.
10. Do you feel that prescribed timescales are a useful component of good complaints handling?
Overall we do not believe that prescribed timescales are appropriate for good complaints handling however recognise that there is a need to ensure that complaints are dealt with appropriately and in a timely way and the timescale for the handling of the complaint communicated to all those involved when the complaint is made.
11. How can we ensure that learning from complaints benefits (different groups)?
It is vital that complaints a used as a learning tool to ensure that similar mistakes, where identified, are not made across the NHS. Equally examples of best practice should also be promoted.
The result of all complaints should be feedback to the complainant and all those involved in the complaint. Individual organisations should also identify complaints and resolutions and publish these to ensure the organisation ‘learns the lessons’. At the organisational level all complaints should be part of a continuous cycle of audit and service improvement.
12. What methods or techniques could be used at a local level to support the resolution of complaints?
Complaints resolution at the local level could be improved through timely and efficient management of complaints. By adopting a transparent approach to complaints where a whole system approach is adopted rather than targeting the individual we believe complaints could be resolved at the local level more effectively.
At a practical level and where a complaint is made from a patient about the medical care they received patient notes should be copied to all those involved, where appropriate, to ensure the timely resolution of the complaint. Medical professionals often complaint that accessing hard copies of notes adds considerably to the time taken to resolve cases.
13. Do you think that children’s social care services should be included as well as adult social care under these new complaints arrangements?
We have no view on this area of the consultation.
14. The Department of Health is currently drawing up a standard against which complaints handling would be measured. What would be the components of an effective standard?
We are aware that the Department of Health is currently developing a standard against which complaints standard. We await with interest the outcome of this work. It is our view that complaints can be quite different and the approach needed to deal with them can vary by case. We believe that an assessment of satisfaction with different aspects of the complaints procedure may be a way of assessing the process across the NHS.
We reassert the need to ensure that not only are lessons learnt from the handling of complaints but that examples of best practice are also communicated across the health service.