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Listening and responding to concerns and complaints

The Francis Inquiry Report focuses on the failings in patient care at Mid Staffordshire Foundation Trust that led to over 1,000 avoidable deaths amid appalling suffering and neglect.1 Poor standards of care were tolerated and complaints ignored as the Trust focused on achieving national targets, financial balance and foundation trust status. While the government continues to consider and respond to the implications of the report's 290 recommendations, there are important themes that impact on the work of everyone whether involved in primary or secondary care. The report calls for “caring, considerate and compassionate nursing” and the need to “foster a common culture shared by all in the service of putting the patient first”. This should involve listening to, and acting on, feedback from patients and their relatives or carers, including any concerns and complaints. 

In the current climate of financial constraint, amid transition and change in the NHS, listening to patients' concerns and learning from complaints is vital. Complaints are an important resource that can:

  • Provide early warning signs of falling standards or failings in treatment and care.
  • Highlight safety and performance issues.
  • Prevent ongoing mistakes.
  • Improve quality through learning the lessons from complaints.2

The year 2011-12 saw a rise in NHS complaints:

There were 162,100 complaints.

One in five complaints were made about nurses, midwives and health visitors.

54,900 written complaints related to GP practices and NHS dental services.

One third of these complaints were about clinical decisions, advice and treatment.3

There was also an increase in allegations against nurses to the Nursing and Midwifery Council (NMC) during this period.4 The majority of these related to misconduct and a lack of competence.  

Complaints can occur at any time and often when you are least expecting them. You may become involved in helping to resolve a patient's complaint because it is directed at you personally, or some aspect of the service that employs you. You may be asked to contribute to an investigation involving other members of staff, or you may need to provide support or advice for a colleague who is involved in the complaints process. In whatever capacity you are involved, you should support the aim of the NHS complaints procedure which is to achieve an effective resolution of the complaint at the earliest opportunity.5 This is known as 'local resolution', and allows for a flexible approach which may include independent clinical input and conciliation where appropriate.  It is critically important to engage actively in the resolution process by:

  • Acknowledging and apologising for mistakes or failings in care.
  • Participating in the investigation of complaints.
  • Offering clear and unambiguous explanations that are factually accurate.
  • Meeting with complainants and engaging in the conciliation/mediation process if requested.
  • Contributing to any actions and personal and/or organisational learning that results from the complaint.6

Good communication is key to maintaining an effective clinical relationship with patients and their families. It is also central to effective complaint handling, particularly as complaints are often generated as a result of misunderstandings. Poor or inadequate explanations frequently occur because no one has taken the time to listen carefully to the patient or their representative, and has therefore failed to discover the extent of their concerns and what they hope will be the outcome of the complaint. Unfortunately, too many of the complaints reaching the Parliamentary and Health Services Ombudsman, following the failure of local resolution, show evidence of poor complaints handling that compounds the original grievance.7

Responding positively to a complaint can be difficult if you feel personally criticised or unsure about how to admit to mistakes or failings. You will find that training in complaints handling that includes case studies and scenarios can be invaluable in encouraging you to think about the realities of responding to a patient or their relative in what may be very difficult circumstances. You should not underestimate the extent to which complaints can be stressful for all concerned, particularly when the initial handling of the issues exacerbates the situation.

Claims against nurses are also on the increase. A poorly handled complaint can lead to a claim especially if the complainant feels it is the only way of getting a full explanation. The risk of litigation faced by practice nurses reflects the increasing responsibilities of their role that requires them to make autonomous decisions for which they are accountable.8 The Royal College of Nursing estimates that claims against nurses amount to about £5 million each year. These claims mainly relate to:

  • Failure to refer a patient to a GP.
  • Failure to diagnose appropriately.
  • Poor treatment technique.
  • Medication error.

The likelihood of claims can be significantly reduced if nurses recognise the risks inherent in their role; for example, by taking steps to:

Ensure that they do not practice outside the limits of their professional competency.

Seek advice/second opinion when appropriate.

Maintain and increase their knowledge base and clinical skills through relevant education and training.

Openly admitting mistakes, apologising and seeking to ameliorate any damage or injury caused is vital in the context of any incident, whether it causes little or no harm, or relates to a catastrophic event that leads to serious injury or even death. Handling complaints in such circumstances requires particular sensitivity and nurses should regard this as a key skill and test of their professional competence. The issue is not whether a complaint is 'justified', but rather what can be done to address the complainant's concerns or distress. Patients and their relatives have a right to expect total honesty, and a defensive attitude or any attempt to deny or cover up mistakes is not only a breach of trust, but may have serious consequences for patient care. It is in this context that you have a duty to report on poor standards of patient care, including any neglect or abuse, using whistleblowing procedures if necessary (see Resources). 

Working closely with patients and their families gives nurses unique opportunities to pick up on issues of concern or complaint as soon as they arise. By listening carefully when things go wrong, and wherever possible acting speedily to put them right, you can ensure that patients' voices do not go unheard and that their healthcare experience is a positive one.

 

Resources 

Parliamentary and Health Services Ombudsman. Principles of good

complaint handling. London: Parliamentary and Health Services Ombu-

dsman; 2009.

Ward Platt A. Conciliation in Healthcare: managing and resolving complaints

and conflict. Oxford: Radcliffe Publishing; 2008. 

Whistleblowing in the NHS: England - NHS and Social Care Whistleblowing

helpline 08000 724725

Scotland - Healthcare Improvement Scotland 

0131 275 6000

 

References

1. Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013.

2. Ward Platt A. Handling complaints. BMJ 2010;340:98-99. 

3. Health and Social Care Information Centre. Data on Written Complaints in the NHS 2011-12. 

4. Nursing and Midwifery Council. Annual Fitness to Practise Report 2011-2012. London: The Stationery Office; 2012.

5. Statutory Instrument 2009 No. 309. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. 

6. Ward Platt A. Conciliation in Healthcare: managing and resolving complaints and conflict. Oxford: Radcliffe Publishing; 2008. 

7. Parliamentary and Health Service Ombudsman. Listening and Learning: the Ombudsman's review of complaint handling by the NHS in England 2011-12. London: The Stationery Office; 2012.

8. Stacey R. Nursing jeopardy. Your Practice 2011;5:6-7.