Embrace complaints to improve

People could be being put off from making complaints about health and adult social care, which is leading to concerns not being identified and providers missing out on opportunities to improve their services.

In a report out on Monday 8 December, the Care Quality Commission has found that there is wide variation in the way complaints are handled across the NHS, primary care and adult social care services in England, with complainants being met too often with a defensive culture rather than one that listens and is willing to learn.

Although the regulator has found examples of good practice, more needs to be done to encourage people to come forward with their complaints, to keep them informed on the progress, to reassure them that action will be taken as a result, and to assess that whether they are satisfied with how it has been resolved. This in turn will lead to improvements in the quality of care.

Prof Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission, who has led the review said: “A service that is safe, responsive and well-led will treat every concern as an opportunity to improve, will encourage its staff to raise concerns without fear of reprisal, and will respond to complaints openly and honestly.

“Unfortunately this is not happening everywhere. While most providers have complaints systems in place, people’s experiences of these are not consistently good.

“We know from the thousands of people who contact CQC every year that many people do not even get as far as making a complaint as they are put off by the confusing system or worried about the impact that complaining might have on their or their loved one’s care.

“More needs to be done to encourage an open culture where concerns are welcomed and learned from.

“Through our inspections, we have a big role to play in supporting this change. We will continue to hold health and adult social care services to the high standards that people both expect and deserve.”

Over the last year, CQC has been developing how it considers complaints handling as part of its inspections of health and adult social care services in England, to make sure people receive care that is safe, effective, caring, responsive to their needs, and well-led.

As part of this, CQC has outlined how its inspection teams understand how well providers listen to people’s concerns and learn from them to improve their services.

This includes:

• Gathering information from partners such as the ombudsmen, Healthwatch England, local authorities and advocacy services before an inspection, as well as from providers
• Asking people who use services what they think about the way complaints and concerns are handled, often led by CQC’s Experts by Experience (trained members of the public who are part of the inspection teams)
• Reviewing a sample of complaints files to understand if these have been handled in a way that matches the good practice CQC expects
• Introducing a lead inspector for complaints and staff concerns on its larger inspections to draw together all of the evidence.
• Clearly explaining how providers handle complaints about their services in the inspection reports, the judgements of which contribute to overall ratings of Outstanding, Good, Requires Improvement and Inadequate to help people make informed choices about their care.

Health Secretary, Jeremy Hunt said: “One of the biggest lessons of the tragedy at Mid Staffs is the need to listen and act on all complaints.

“So as part of our drive to confront poor care we’re making sure people know how to complain and transforming complaints handling – now a crucial part of the CQC’s tough, independent inspection regime. Today’s report shows both that that progress has been made and that there’s still more to do.”

CQC has published its national report following a review of the NHS complaints system last November by the Rt Hon Ann Clywd MP and Professor Tricia Hart.

Rt Hon Ann Clwyd MP commenting on the review: “I welcome this report and in particular the CQC’s intention to develop a thorough inspection regime for complaints systems in hospitals. I want the many thousands of people who wrote to me in the course of my Review to know that change is expected as a result.”

Dr Katherine Rake, Chief Executive of Healthwatch England said: “It’s really encouraging to see the CQC recognising the huge importance of complaints and really starting to use people’s concerns to help guide the inspection of our hospitals, GP surgeries and care homes to ensure they’re up to scratch.

“But complaints handling cannot just be about driving improvement. Fundamentally complaints are stories about what happens when things go wrong and people are failed. First and foremost every case must be dealt with compassionately with those involved kept informed about how their complaint has made a difference.”

Parliamentary and Health Service Ombudsman, Julie Mellor said: “Today’s findings mirror our own research which shows there is significant variation in complaint handling in hospitals.

“Every complaint presents an opportunity to learn and improve services. We agree with the CQC that listening and learning when things go wrong needs to be embedded into an organisation’s culture.

“Our report, ‘My expectations for raising concerns and complaints’, sets out what good complaint handling looks like from patients and service users’ perspectives. We’re delighted the work has already been incorporated into the CQC’s new approach to inspections. We hope others will now use this to measure whether the actions they are taking are making a difference for the patient experience.”

The findings within CQC’s report are based on a sample of its inspections of NHS trusts, adult social care and primary medical services, published data including surveys, and feedback from its inspectors.

Within NHS trusts, CQC has found that:

• There is more evidence of good practice than of poor in how acute, community health and mental health NHS trusts respond to and treat people who make complaints. Most positive practice was found where NHS trusts learned lessons from complaints and demonstrated the actions they had taken in response.
• The timeliness of investigations and people feeling that their complaints had not been taken seriously enough or were adequately addressed were key areas of concern

Within adult social care and primary care, CQC’s early analysis suggests that:

• Many of providers report that they receive very few complaints; and so this suggests more could be done to encourage an open culture where concerns are welcomed.
• There are high levels of positive practice at all stages in the process of making a complaint and people have reported that they know how to raise concerns.
• As with the NHS, the timeliness of investigations and people feeling that their concerns are not being taken seriously or adequately addressed were key areas of concern.

These are early findings: as CQC inspects more services under its new regime, it will be able to comment more comprehensively on complaints handling at a national level in order to identify where health and adult social care services are performing well and where they need to improve.