Care of dying patients and safety dominate report on NHS complaints

Complaints about the care of dying patients and patient safety dominate a report published last week that reviewed complaints referred to the Healthcare Commission, the NHS watchdog in England.

The report analysed 16 000 complaints sent to the commission for independent review between July 2004 and July 2006. More than half (54%) of complaints about hospitals were about care surrounding a death. In many cases, families complained that they had received contradictory or confusing information from different staff caring for a relative. In other cases, relatives felt that they were unprepared for the death or had no time to arrange for family members to be present.

Nearly one quarter (22%) of total complaints were about patient safety. One of the most serious incidents was a mix up over names leading to a child having the wrong injection.

In relation to primary care, the biggest concern was about misdiagnosis or delays in referring patients, accounting for 66% of complaints. Patients often complained that they should have been referred sooner for specialist treatment or further investigation of their symptoms.

The commission urged NHS trusts to do more to learn from patients' complaints and to handle the issues raised “quickly, efficiently and locally.”

Anna Walker, the commission's chief executive, said, “Complaints represent the raw feelings of patients and the NHS must listen and learn from them. At the centre of each one is an individual who often has genuinely suffered. Too often, this was not just because of what went wrong but because of the way people were dealt with.”

Thirty three per cent of complainants wanted a better explanation of what went wrong, 23% service improvements, 10% an apology, 9% the event acknowledged, 8% action against staff, and 8% for the same thing not to happen again.

Gill Morgan, chief executive of the NHS Confederation, which represents most NHS trusts, said, “Over 90% of complaints are handled at a local level, so most trusts have good systems in place to respond to patients and their families quickly and appropriately.”

She noted that figures from the National Council for Palliative Care showed that more than 50% of terminally ill patients would prefer to die at home but only 20% currently do so. And only 11% of people want to die in hospital, but that's where 56% spend their final hours. “It is therefore essential that the golden opportunity provided by the out of hospital white paper to improve end of life care is seized.”

Lancashire Teaching Hospitals NHS Trust—one of those named in the report as a poor performer—“categorically refuted” the commission's figures. A spokesperson said, “The Healthcare Commission has inaccurately tried to portray us in a bad light at resolving such issues locally.”

The commission has legal responsibility in England for reviewing complaints in which a patient is dissatisfied with the response of a trust. This happens in about 8% of the 95 000 formal complaints made each year about the NHS, which annually provides 380 million treatments. The commission deals with about 8000 unresolved complaints a year. Just under 70% of these were upheld in favour of the patient.

As a result of the findings, the commission is planning the first national audit of how NHS trusts deal with patients' concerns. It will look at good and poor practice, inspecting 50 trusts after analysing performance indicators covering all trusts in the country. Inspectors will check whether trusts give high enough priority to handling complaints and whether they learn from the issues raised. They will consider whether complaints systems are accessible and understood by people using services. If trusts are not up to standard, this will be reflected in their annual performance rating.