New NHS complaints handling procedure: first year review

1. Introduction and policy background

1.1 Introduction

This report is a review of the NHS Scotland's first year experience of the model Complaints Handling Procedure. Scotland has 14 territorial health boards, 7 special health boards and 1 public health body.

The findings and observations have been informed by:

• 22 feedback and complaints 2017/18 annual reports;
• visits to 12 NHS boards (10 territorial and 2 special Boards);
• visits to 4 stakeholders.

See Appendix 4.1 for a list of the NHS Boards and stakeholders visited.

1.2 Background and policy context

The Patient Rights Act (Scotland) 2011 was established to improve patient's experiences and involvement in their health and NHS services. The Act required NHS Boards to seek feedback, comments, concerns and complaints from all patients and to use the information to improve the services and the patient experience. Every patient has the right to give feedback or to raise concerns or complaints. Healthcare needs to be patient focused, with focus on the patient's needs and health and wellbeing.

The Scottish Health Council's 'Listening and Learning' report published in April 2014 found that while all Boards could demonstrate clear progress in terms of responding to the requirements of the Patient Rights (Scotland) Act 2011, there were significant learning points for NHS Scotland in terms of welcoming feedback, removing the 'fear factor' and demonstrating improvement. It also recommended a more standardised approach for complaints management to address the inconsistencies between health Boards in process, procedures and implementation.

The Scottish Government agreed with the report's observation that the Complaints Standards Authority (CSA) should work with NHS Boards to develop a revised NHS model complaints handing procedure and associated information materials for all NHS boards and providers.

1.2.1 New model Complaints Handling Procedure

The model CHP has been developed through a partnership approach, led by a steering group involving the Scottish Public Services Ombudsman (SPSO) and representatives from across NHS Scotland including territorial boards, the Scottish Health Council, NHS Education for Scotland, NHS National Services Scotland, the National Prisoner Healthcare Network, primary care and the NHS Complaints Personnel Association Scotland (NCPAS). The independent Patient Advice and Support Service (PASS) and Healthcare Improvement Scotland public partners were also actively involved.

Feedback and complaints are extremely important for NHS Scotland, and for patients and carers who access healthcare services. Not only do they provide a route for people's views to be heard, they also provide a rich source of information for Boards and healthcare staff to understand what needs to be considered to make improvements in healthcare delivery.

The revised procedure is intended to support a more consistently person-centred approach to complaints handling across NHS Scotland, and bring the NHS into line with other public service sectors by introducing a distinct, five working day stage one process for early, local resolution, ahead of the twenty working day stage two process for complaint investigations. It reflects the broader ambition for the NHS in Scotland to be an open, learning organisation that listens and acts when unintended harm is caused. The procedure complements the Duty of Candour provisions in the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act, and the development of a national approach to reviewing and learning from adverse events. It is also complemented by the Apologies (Scotland) Act 2016, which is intended to encourage apologies being made, by making it clear that apologising is not the same as admitting liability. The CHP has a strong emphasis on frontline resolution and on monitoring, reporting and learning from complaints.

The CHP was introduced across Scotland from 1 April 2017. The key aims are:

• to take a consistently person-centred approach to complaints handling across NHS Scotland;
• to implement a standard process;
• to ensure that NHS staff and people using NHS services have confidence in complaints handling;
• encourage NHS organisations to learn from complaints in order to continuously improve services.

The new CHP introduced nine key performance indicators (see Appendix 4.2 for full list of indicators) by which NHS Boards and their service providers should measure and report performance. These indicators, together with reports on actions taken to improve services as a result of feedback, comments and concerns provide valuable performance information about the effectiveness of the process, the quality of decision-making, learning opportunities and continuous improvement. NHS Boards are required to review and report internally on complaints handling information quarterly, including SPSO observations with a view to identifying areas of concern, agreeing remedial action and improving performance. Boards must then publish their complaints handling performance annually. Directions require that the annual complaints statistics must be submitted by Boards to the ISD at National Services Scotland, within three months of the year-end.

1.3 Project aim and objectives

The aim of this research project was to examine the experience of NHS Boards with regard to the first year of the new model CHP. The project was undertaken by an SGSSS intern over three months (October 2018 – January 2019). The internship project briefing is in Appendix 4.3.

Objectives:

• To review the NHS Boards' annual reports (particularly the qualitative indicators 1 to 3, Appendix 4.2);
• To meet with NHS Boards' key staff and stakeholders;
• To identify what difference the CHP has made and whether it has been embedded into the NHS culture;
• To explore how it has influenced learning and service improvements;
• To explore effectiveness of internal communication of complaints information;
• To identify how the CHP is working in prisons;
• To highlight examples of good practice;
• To identify challenges and areas of concern;
• To produce a report that sets out the findings of this research project and observations.

1.4 Method

Between November and December 2018, NHS Boards' complaints and feedback annual reports were reviewed. The intern arranged visits to ten NHS territorial Boards and two special Boards to gather more qualitative information about the experience of the new model CHP, identify the challenges and examples of good practice. The intern also spoke with stakeholders to get more information on their involvement in the CHP development, their work with NHS Boards, patients and the public, and their views on the first year of CHP within the NHS and areas for improvement.

All NHS Boards responded positively to the request for their involvement in the review process and indicated that they looked forward to receiving the findings and observations that will support their improvement as well as help address common challenges. Visits lasted 1.5 to 3 hours and involved the complaints manager or team lead and sometimes additional team members or other staff involved in quality improvement.

During the visits, their annual report was considered in more detail, with particular focus on KPIs 1, 2 and 3. We discussed their experience and challenges for stage 1 and stage 2 processes, the Boards' culture around complaints and their work with independent contractors and prisons. Appendix 4.4 provides the briefing email sent to NHS Boards regarding the visits and review and Appendix 4.5 provides the topic guide sent to NHS Boards ahead of the visit. There were several examples of good practice happening in all Boards and some are highlighted in this report.