Notes from the field of public involvement

Monday, 04 December 2006

Latest statistics on NHS complaints

The NHS Information Centre for Health and Social Care published its latest statistics on NHS complaints data on 15th November (2006).

Complaint data is always hard to interpret and understand and this latest bunch of statistics needs a lot more background before it can guide policy.

First off - is a rise from 88757 in 97/98 to 95047 in 05/06 a big deal? First we have no normalised figures that would put complaints in context of 'episodes' or encounters however defined or more narrowly what the escalation ratio has been - what proportion of complaints get to be written complaints?

Also think about what has been going on in the Health Service. A big complaint solicitation campaign has been running plus users are being given information about standards that allow them to see if they have been treated as promised. Complaints procedures have been published and new processes made available. All this and the increase just creeps up year on year.

This supports my belief that what underlines both a rise and a decline in complaint numbers is a public perception that some good will come of it. Witness the astonishing leap in complaints after the big privatisations of the 80's - BT is always the quoted example. There was a chance that you would jump the queue, get that replacement phone or the bill reduced. The decline comes when the new service compact between provider and user settles down and the number of things that cannot be sorted out at the time and on the spot declines. People have not yet decided that a NHS complaint is worth sticking with and escalating.

We need a picture of the iceberg - transaction numbers, problems encountered, problems voiced, problems not resolved that become formal complaints, fully escalated complaints. Only the last two categories - the final one being the Ombudsman - are fully counted in the health serrvice. The escalated tail is definitely wagging the dog and costing a fortune.

Easy / Difficult
So once escalated, which complaints are the most difficult to sort out? Look at the % not dealt with in 20 days and take those where 30%+ are left unresolved. Hospital acute services - no surprise there but what are services about the elderly and NHS Direct doing in these categories? The latter has 40% ( of a low number) left unresolved within target. What is going on there?

My take on the acute services falling outside the timetable is that the length of time does not necessarily much to do with the seriousness of the actual problem but more to do with the 'round the houses' investigation technique whereby Uncle T. Cobley and all are approached for their version of the story. Then because the accounts do not agree, they do it all again and then they have to wait because all are away on their holidays.

Doctors and Nurses
They are the most complained about group - are they all villains or heroes? Just the most visible and identifiable administering policies, potions and possets. (Have run out of P, nurse) Being complained about here is a mark of distinction and it is good to know someone in the NHS is standing up and being counted.

Solvable and Reducible
Can we really not do better on appointments? Hotel services are there to be improved - few escalated complaints but they may of course be the tip of the icecream. Staff Attitudes is the elephant in this statistical table. No wand to be waved here; no golden key to transform.

What is it that makes this such a persistent, large figure? OK as a proportion of staff employed, it may be low. I would argue that this is not the right basis for normalisation - it is a combination of encounters and the proportion of the staff dealing with patients. 

In thinking about solutions, what we do know is that the quality of service delivered by an organisation cannot be better than the readiness and willingness of staff to deliver it. If the staff are fed up, angry, frightened, then what follows is no service and lots of complaints. In research studies we and others have done, no other service characteristic matches staff attitude in its impact on satisfaction and readiness to recommend.

The M-A-C Partnership has a particular interest in complaint handling and how to measure and manage it. See our information MyOwn Anger Propelled Me (Observations driven by a study of patients' complaints) and Emotions in Decision Making.

Colin Adamson | (Problem occured connecting to database: The server requested authentication method unknown to the client