NHS Complaints Process

Let's start off by looking at the current Complaints process that is used with the NHS. Here we explain how the current system works, and identifies where the system could be substantially improved.

• An internal market for healthcare operates within the NHS. Services are bought on behalf of patients by commissioners (Integrated Care Boards - abbreviated as ICBs) from providers. Whilst providers can be in the private sector, most services are purchased from within the NHS (typically from NHS Trusts). Together the Trusts and the ICB within a local health economy form an Integrated Care System (ICS) which is responsible to NHS England at a national level. 
• When it comes to procedures and policies, each NHS Trust can formulate and write their own, though most follow the templated guidelines and policies, laid out by NHS England, for their own ease, of both cost and compliance.
• With regards to the Complaints Process, each Trust has their own policy, but in general they follow the same process.
• The Complaints Process is the sole responsibility of the Trust and is undertaken and instigated by their own Complaints Department.
• When an investigation is started, it is usual practice to call on the services of existing staff members, of appropriate seniority, to undertake the “investigation”, which would involve talking with the staff and departments about whom the complaint is concerned.
• This does not mean that the individual tasked with the investigation has any medical knowledge of that particular area of the complaint. For example, a pharmacist could be commissioned to undertake an investigation into Mental Health or psychiatry.
• The investigator works for, is paid by and answerable to the same management team, who oversee the staff and department the department or staff they are “investigating”.
• It should be noted that the NHS Trust has the Complaints department as well as any investigators seconded in from their day-job, under contract and will be paying these staff members directly. This inherently creates an unconscious bias.
• It also should be noted that any staff seconded to undertake an investigation as part of a complaint, have been taken away from the usual role – which may lead to an impact on the provision medical services to other patients. The investigators are meant to have undertaken a short course to qualify them to take on this role. However, it is clear to any observer that a pharmacist, or consultant have studied and chosen a career as per their job title, and not sought to be a police officer or detective. The secondment is essentially not in their skillset or career aspirations. The question could be asked about their conscientiousness, determination or pride in undertaking this task to the best of their abilities. Taking into account the next few points, the role of the investigator may raise some significant questions.
• They may well know or have dealt with these members of staff during their career.
• The investigator will certainly be fully aware that those being investigated are colleagues, work for the same Trust and potentially could be investigating them in the future, should a complaint be raised that involved them.
• The investigator, even with the best intentions, cannot therefore be completely independent. It would be a near impossibility with the factors above to remain totally independent.
• The investigator, once concluded their interviews and made their notes accordingly, then pass these notes back to the Complaints Department. Here, the administrative staff compile the formal response, and can amend, change, edit and word this response however they see fit. Or how their managers and directors above them see fit.
• The formulation of the complaint response, will inevitably be written and worded to ensure the Trust itself is painted in as much of a positive light as possible. It is NOT in their interest to be honest, supportive of the patient or uphold any aspect of the complaint, if they can possibly dismiss it.
• Once drafted, the response letter is vetted by several levels of management and director level staff. Each further removed from the frontline, from the patients, and closer to the board level, and the ethos of protecting the reputation of the Trust. Their own jobs and livelihoods depend on this reputation, so again, it is in their own interests to dilute down and gloss over anything and everything they can, in order to protect their reputation.
• The final resolution letter is signed off by the Chief Executive Officer (CEO) of the Trust. The person most removed from the frontline, the patients and the reasons for the complaint being raised.
• The response letter has only one signature. That of the CEO. The many hands who have moulded the response are not signatories. There is no transparency, other than the name of the investigator – who is identified by name only – and not by job title, experience or seniority. No mention is made within the response letter of the administrator's or Complaints department's role, who actually draft the letter.
• The Trust only permit a complaint to be made within a set time-limit, usually 12 months from the incident, or from the time the patient became aware of the incident that is being complained about.
• The Trust, however, are able to take as long as they wish to look into the complaint. They can drag it out as long as they wish. It seems that this is common practice.
• Once completed and issued back to the patient, the Trust are then able and have the right to then cut off all further correspondence regarding the complaint. They are at liberty to state they have looked into the complaint, aren’t willing to do anything further, and direct you to the PHSO (Ombudsman) if you are not satisfied with the outcome.
• As a patient, having waited up to a year to receive the response to your complaint, the Trust are fully able to brush it aside, in the knowledge that the only further option for an unhappy patient is to go to the PHSO.
• The PHSO, is, in our lived-experiences and from the data available, not a friend of the patient. We cover their process in our next section – What about the PHSO?