In a survey undertaken last June, Healthwatch England, the national consumer champion in health and care, found that 49% of people have no confidence that formal complaints in health and social care are dealt with effectively. 38% of those who made a formal complaint or gave feedback said they did not find it easy to complain. 

Now, in mapping the complaints process, Healthwatch has discovered that there are a staggering 75 different types of organisations involved in the complaints process, making it “utterly bewildering” for patients and family members.

There are currently two stages to the NHS Complaints Procedure. The first is Local Resolution, where the complaint is made directly to the organisation, usually via the Complaints Manager. The NHS provider must investigate the complaint to resolve it 'speedily and efficiently' and must keep the complainant informed as to the progress of the investigation. The NHS provider must also prepare a written response within 6 months of the complaint. This response must contain an explanation of how it has been considered and the conclusions reached as well as confirmation of whether any action needed has been taken or is proposed.

The second stage comes into play where a patient is still unhappy with the outcome. This involves making a complaint to the Parliamentary and Health Service Ombudsman, an independent office set up to investigate patient complaints.

Complaints must be made within 12 months of the matter giving rise to the complaint occurring, or, the date that the complainant knew they had cause to complain. The time limit may be waived by the NHS provider if they are satisfied that the complainant had good reasons for not making the complaint within that time limit and it is possible for them to investigate the compliant 'effectively and fairly'.

This two stage system, which appears on paper to be relatively straightforward, came into effect in April 2009. So how has it gone wrong in such a short space of time?

Firstly, who to make a formal complaint to will depend on whether you are complaining about health care or social care, whether the care is paid for by the NHS or local authority. For example, if the complaint concerns a hospital the process would begin either with the hospital or clinical commissioning group. If the complaint concerns social care the process might involve the local care home provider, the local authority and ultimately the Local Government Ombudsman.

For patients who have already been let down, it is unsurprising that many are discouraged from navigating this bureaucratic minefield. The Healthwatch report found that 54% of people who had a problem with their health or social care service in the last three years did nothing to report it or give feedback, reflecting the silencing effect of this complex system.

In addition, there is lack of uniformity between Trusts at the investigative stage, with different processes followed in different Trusts. The quality of service and access therefore varies between Trusts.

As reported in Suzanne Farg’s blog post last October (Announcement of new NHS Guidance requiring Trusts to investigate patient complaints), another difficulty is the abandonment of investigation once there is an indication that legal action is being contemplated.

On a positive note, there is a commitment to change. Julie Mellor, Parliamentary and Health Service Ombudsman has said:

"We agree with Healthwatch that the current complaints system is too complex and we are working with the Department of Health, NHS England and regulators to help people better understand where they need to go when they want to raise a concern."

Jane Cummings, chief nursing officer for England, said NHS England was developing a new approach so that patients could have complaints resolved "simply and effectively", without having to negotiate a complex system.

What this approach would mean in reality and how easy it will be for people to understand where they need to go, raise concerns and give feedback remains to be seen. What is clear is that improvements must be made.

For further information on this topic, please see the links below.

NHS told to streamline 'complicated' complaints process - BBC News
Health and care complaints system is 'utterly bewildering' for people - Healthwatch

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