A report by watchdog the Healthcare Commission - which has independently reviewed National Health Service complaints over the last four and a half years – indicates that some trusts “are still not responding to complaints effectively or learning lessons from them”.

The NHS receives around 135,000 complaints every year of which around 8,000 remain unresolved and so are passed to the Healthcare Commission to deal with.

This year, 8,949 cases regarding the NHS in England were sent to the organisation, which upheld 30% of these on the basis that the provider “could or should have done more to resolve the complaint locally”.

In addition, the organisation found that in a further 17% of cases the trust's response was inadequate, so all-in-all almost 50% of complaints passed on to the Commission required further work by the trust.

Commenting on the figures, Anna Walker, the Commission's Chief Executive, said that considering the NHS delivers millions of treatments each year it is “perhaps encouraging” that only 8,000 unresolved complaints are passed on each year. “However”, she stressed, “it is concerning that around half of complainants received an inadequate response from the trust when they first complained”.

According to the report, unresolved complaints are still largely centred on basic aspects of healthcare, but the proportions are changing. For example, the number of cases dealt with on NHS treatment standards leapt from 6% in 2006/07 to 11% this year, while those regarding delays in accessing healthcare doubled from 4% to 8%. On the flip side, it seems that some progress is being made in the area of communication, with complaints to the Commission falling from 17% to 12%.

Dealing with the problem
However, the way in which trusts handled grievances is still the number one theme of unresolved complaints, accounting for 19% (16% last year) of those reviewed by the Commission, which shows that patients and the public are just as concerned with how their complaints are being dealt with as with the issues behind them, the report states.

“We are told that the system is cumbersome, variable and takes far too long,” said Katherine Murphy, Director of the Patients Association. “If the NHS is to move into a more patient orientated, choice driven service then its staff and management need to become more open and more accepting of complaints and they need to respond constructively when something goes wrong,” she added, and concluded that the NHS still has “a long way to go in responding positively to criticism from its users.”

“Complaints are, of course, inherently negative feedback for organisations. However, the process of dealing with them should be viewed as a valuable and positive opportunity for the NHS to learn from mistakes and bring about real improvements in services,” the Commission said.

The report stresses that, although there is currently “much good practice” in resolving complaints, trusts need to do more to improve their responses, particularly as the current system will cease to exist later this year.
As of March 31, the three-tiered complaints structure will be replaced by a two-tiered process, under which unresolved complaints will be passed straight to the Parliamentary and Health Service Ombudsman.

In addition, the Healthcare Commission will be replaced by the Quality Care Commission, which will not review unresolved cases but play a key role making sure all healthcare organisations have appropriate arrangements for handling them.

Recommendations for better practice
In view of the incoming system, and to help improve the handling of NHS complaints, the Commission has drawn up 12 recommendations for trusts to follow, including: acknowledging a person's right to complain; ensuring response letters are clearly written and free from complex clinical terminology; keeping complainants informed of progress; and ensuring that any learnings are embedded into the system.

"Things are sometimes bound to go wrong given the amount of care the NHS provides. But we will have a stronger NHS if it can embrace complaints where justified and really learn from them rather than adopt a defensive approach,” the Commission concludes.

And Nigel Edwards, Policy Director at the NHS Confederation, agrees: "Although it is reassuring that only 0.002% of treatments in the NHS led to complaints, we agree with the Commission that learning from when things go wrong is a vital part of offering high quality, safe, compassionate healthcare.”