Two coruscating reports on complaints handling in the NHS appear to have sunk without trace. Healthwatch England published ‘Suffering in Silence’ in October 2014 and, in November, the Patients Association, ‘The People’s Ombudsman – how it failed us’.
IFF Research also published this year NHS Governance & Complaints Handling, which was less than complimentary about how complaints are handled, highlighting incompetence and a defensive culture.
These follow on from the Clwyd-Hart report and harrowing investigations into the shocking events in Mid Staffordshire and Morecambe Bay Trusts, and Winterbourne View Hospital, yet recommendations by Professor Don Berwick, Sir Bruce Keogh and Sir Robert Francis QC appear to fall on deaf ears. The ‘something must be done’ never happens.
Sir Robert, himself, said that “a health service that does not listen to complaints is unlikely to reflect its patients’ needs. One that does will be more likely to detect the early warning signs that something requires correction, to address such issues and to protect others from harmful treatment…”
According to Healthwatch, 174,872 complaints were registered in 2013/14, equivalent to 3,300 each week, yet they estimate that a further 250,000 cases are unreported because of the complexity of the system, and the ‘fear factor’. People don’t bother, or they give up, although millions of pounds is spent on compensation for those who do persist.
The Parliamentary and Health Service Ombudsman (PHSO) has the power and legislation to act on behalf of patients, yet the Patients Association condemns it for being “entrenched in outdated 1960s procedures, attitudes and investigative techniques…. Failing to change NHS accountability”.
As a result it “has no confidence in the PHSO to carry out independent, fair, open, robust investigation of complaints”. A traumatised patient said: “you may as well ask a poacher to investigate missing pheasants”.
Yet this service alone costs the taxpayer £40m p.a., although the financial and emotional cost to patients and their families is much greater – leaving them desperate for answers over many debilitating years. Just read the cases in these reports and you feel ashamed that, in this day and age, so many vulnerable people are let down by a complaints system and PHSO which “fails people at all levels”, with some cases not even investigated, or handled superficially without any clinical expertise.
So, isn’t it time that something was done? All unitaries and county councils have statutary Health & Wellbeing Boards, as well as health scrutiny committees and I suggest they grasp this nettle with a determination to put things right. No more reports, promises and recommendations; instead, a robust commitment to hold our health organisations to account and to implement the clear recommendations contained in all these – as well as other – carefully researched and well articulated reviews of appalling mistreatment.
Most complainants just want recognition that something went wrong and needs to be put right, they want someone sympathetic and understanding to listen to what they have to say, and to apologise if things did go wrong, to ensure that it doesn’t happen to someone else. But the far more serious cases should be dealt with carefully, following stringent procedures and timelines, which can be independently monitored – by the Health & Wellbeing Boards.
It was recently reported that the PHSO is reviewing 250 patient deaths, whilst acknowledging that some may be ‘victims of appalling failings’; how is the public to know the outcomes, unless their elected representatives, i.e. councillors and MPs are certain to hold those who did wrong to account? All too often, incompetence can be rewarded with a sideways move or early retirement.
At present, as these latest reports confirm, it is overwhelmingly evident that the system doesn’t work. Council leaders take note – and do something. You have a duty of care, and it is your duty to put procedures in place to challenge rather than just accept lists of ‘incidents’ which can be too easily dismissed as unimportant, as I discovered when a Hospital Governor.
Healthwatch has no teeth, you have! Use them, to appoint a senior councillor with sole responsibility for championing residents and helping them to get results. He/she to report back personally to every Health and Wellbeing Board and be fully accountable for ensuring all parties deliver. This doesn’t mean creating yet another layer of bureaucracy! The aim is to strip it out.
While you’re at it, ensure you have a Patients Association representative on your boards, not just Healthwatch and the public sector. It wouldn’t hurt to have a pharmacists’ representative either, given that they could relieve pressure on A & E’s, but that’s something for another day.