Notes from the field of public involvement

Friday, 13 August 2004

NHS Complaints - failings encountered 'time and time again'

Ann Abraham does both sorrow and anger very well. I remember meeting Ann fairly early in her time at the Ombudsman Office, fresh from her stint at the Legal Services Ombudsman. Her Annual Reports from the LSO were a good rehearsal for the ones she produces now – at least she could report that the Office of Supervision of Solicitors was trying – spending money and time on better service. So sorrow – efforts recognised but ineffectual. Anger that so many consumers of legal services were still receiving such poor service.

Now it is the NHS’s turn and believe me, she is just warming up. She has spotted her point of entry into the NHS complaint process – poor process. Her Annual Report 2003/4 as the Health Service Ombudsman identified poor complaint handling as a common theme in many of the cases her Office saw.

"serious shortcomings of NHS complaint handling"

Delay, poor communication and inadequate record keeping were the most common of those themes. The bare statistics show 172 cases were investigated out of the 1028 judged to be investigable. The 4 case histories put a human face on the numbers.

In careful unemotional prose, Ann Abraham’s report nails what she calls the ‘serious shortcomings’ of NHS complaint handling.

“The convenor failed to take clinical advice from a suitable person and that provided was of questionable value since the adviser did not consult Mrs T’s medical records”.

In another IRP case, both the Chief Executive and the Complaints Manager tried to influence the lay chair – both were criticised. Requests by complainants for Independent Review seemed to be treated as a reason to re-open local proceedings and sometimes not even that as time passed without any action by the Trust even after the Ombudsman’s Office had already been in touch asking about an IRP. We will have to see how much better the Healthcare Commission manages.

Ex-gratia payments for service-related blunders - the future?

The one the Health Service has to watch is the note that a Trust continued to handle complaints poorly “despite the fact that we had made recommendations to the Trust about complaint handling as a result of previous investigations.” Health service managers should take a look at Ann’s previous Ombudsman work as Legal Services Ombudsman where she was unrelenting about continued problems at the Office for the Supervision of Solicitors. At the end she was recommending that the responsibility for complaint handling be removed completely from the Law Society – a view the Lord Chancellor’s Department (as was) took increasingly seriously culminating in recommendations to establish Legal Commissioners to do the job.

But NHS complaint handlers will not have to wait for Government or Agency action. My bet is that the Ombudsman will be naming Trusts within three years if for example, the same Trust crops up as the source of an investigable case in three successive years for similar reasons. Anyone take my money?

If AA gets on your case, get out of the way – if the new NHS complaint handling system does not work at any stage of the process, Ann will be gunning for improvements. What might this be? Again there is a short term development which receives the Ombuds imprimatur – ex-gratia payments.

Ann makes the point that “there is a wide margin between apologies for service failures and claims for clinical negligence that involve large sums of money”. Set up the budget heading now – ex-gratia payments for service-related blunders. It may indeed pay for its itself if it stops the complaint escalating with all the extra time and resource that that entails.

Colin Adamson | Send feedback