NHS reforms have made complaining more confusing for patients

BMJ 2014; 349 doi: (Published 11 July 2014) Cite this as: BMJ 2014;349:g4547
  1. Adrian O’Dowd
  1. 1London

Patients are more confused as to how to complain about problems they experience with the health service after NHS changes introduced last year, MPs have been told. The confusion was partly due to ignorance about NHS commissioning, witnesses told the parliamentary health committee during an evidence session on 8 July for its inquiry into complaints and raising concerns.

MPs asked whether patients got enough help in accessing and using the complaints system and whether they were confused by the “complexity of new commissioning arrangements” in the NHS.

Rob Webster, chief executive of the NHS Confederation, which represents most NHS organisations, giving evidence, said, “I don’t think there’s a widely held understanding of what the role of commissioners is or who commissions different bits of the services that patients receive. Without that understanding, it can be difficult for people to know to whom they should complain.

“It’s a fact that if you’ve got a child with multiple issues, then the organisations who commission services for that child’s health needs might include NHS England, local clinical commissioning groups, the local authority, and schools. If you have a complaint about one element of their treatment, then it will be confusing for you on the end of that.” However, the confederation was seeing a developing maturity around arrangements, he added, such that commissioners were working more closely together and services were more joined up.

A fellow witness was Chris Hopson, chief executive of the Foundation Trust Network, who said, “Part of the problem here is that we do have a fragmented health and care system in which responsibility for providing care is split across a number of different organisations . . . therefore it is not entirely surprising that it’s not clear who to complain to.” However, he argued that matters were improving, saying, “There are a number of trusts where we’ve seen a significant improvement over the last 18 months. What we see trusts doing these days is making a more significant investment in the quality of their complaints handling.”

MPs asked Daniel Poulter, health minister, about progress on planned reforms to the complaints system that are due to begin in March of next year. Poulter said that they were on track, adding, “There are a number of pieces of work which are nearing completion, in particular how to make patients much more aware about how to raise complaints.

“Historically this has been an area of complexity and we are looking at fairly soon publishing a sort of ‘bedside guide’ . . . We will add an addendum to the NHS Constitution about how we can help patients to better understand and navigate the system in a much simpler way.”

He said that the guide would make it clear which organisation a patient should complain to, emphasise that they should not feel afraid to complain, and explain how the process worked. Work was also taking place on making the complaints system more transparent and collecting complaints data to allow comparisons between different providers, he said.

Poulter acknowledged that the current system was not perfect, but he gave assurances that the reformed system was on track to begin next spring. He said, “When it comes to complaining and understanding how to raise concerns about how services are commissioned, there has been a lack of clarity and perhaps people not even being aware that there is a route or somebody to talk to, and that is something [for which] I hope this bedside guide will be helpful.”


Cite this as: BMJ 2014;349:g4547

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