Final Report > Chapter 23: Respect and Honesty > The need for openness and honesty within the hospital > The future of the NHS complaints systems

The future of the NHS complaints systems

55 It will be clear from what we have said that an NHS which has respect for and honesty towards patients is not one which hides mistakes or waits for patients to complain. It is for this reason that we advocate openness when things go wrong and an active approach to seeking feedback and comments from patients. The more that difficulties can be addressed early on, by, for example, being open about error, by helping to resolve patients' concerns at an early stage and by the effective use of patients' feedback, the more it should be possible to reduce the extent to which the great variety of patients' concerns and questions coalesce into a generalised notion of `a complaint'.

56 Of course, there will be times when a patient wishes to complain, or is justified in doing so. Thus, there also needs to be an open and easily accessible system for the patient or carer to follow in such circumstances. Currently, the complaints system operated in trusts is widely acknowledged to be cumbersome and bureaucratic. Despite efforts to reform it in the mid-1990s the system has too many layers and lacks a sufficient element of independence. The Government has committed itself to further reform of the system. The decision to establish Patient Advocacy and Liaison Services within trusts is a first and important component of a broader system to identify and respond to problems as early as possible. While we make no comment on the detailed operation of any new system, we offer the following observations. There should be a clear system in the form of a `one-stop shop' in every trust, for addressing the concerns of a patient about the care provided by, or the conduct of, a healthcare professional. The Patient Advocacy and Liaison Service should be part of this system. The system must be kept as simple as possible. It must follow a well-established principle in handling complaints, that a complaint is best resolved as close as possible to the time and place it arose. The system must be easy to use and accessible. It must be integrated with other policies and systems (such as feedback from patients) and not be off to one side, so to speak, of the mainstream of the hospital's activity. It must also be understood to be part of a pattern of exchanges between healthcare professionals and their patients, and between the trust and patients. When serious complaints arise, which are not easily resolved, they should be dealt with swiftly and thoroughly, keeping the patient (and carer) informed along the way. There should be a strong independent element, not part of the trust's management or board, in any body considering serious complaints which require formal investigation. For this category of complaints, we support the Government's proposal to establish an independent advocacy service to assist patients (and carers).

57 Patients, for the most part, as we heard in our seminars, do not want to complain. Often they feel forced to because their concern has been ignored or not properly addressed. The message is clear: improve communication generally, be more open with patients, and complaints will go down. For the complaints which remain, the system in place must be open, minimally bureaucratic, receptive, and appropriately independent.