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Report highlights that patients remain concerned about how trusts deal with their complaints, as well as the same basic aspects of healthcare

Some NHS trusts are still not responding to complaints effectively or learning lessons from them, says the Healthcare Commission in its report published today (Monday).

The way trusts handle complaints is still the number one issue raised by complainants, accounting for 19% of cases reviewed, up from 16% last year.

In almost half of complaints reviewed, the Commission either upheld the complaint or sent it back to the trust for further work because the trust’s initial response to the complainant was not good enough.

Patients and the public also continue to raise issues about the same basic aspects of healthcare such as: poor communication (12% of cases, down from 17% in 2006/07), standard of treatment (11% up from 6% in 2006/07), delay or failure to diagnosis a condition (9%), and delays in accessing care (8% up from 4% in 2006/07).

Each year the NHS delivers 380 million treatments and receives around 135,000 complaints. The Commission reviews cases where the patient is unhappy with the response from the trust. The report, the third of its kind, covers the 8,949 complaints reviewed in the year to 31 July 2008.

The Commission upheld 30% of the cases reviewed in this period, up from almost 20% last year. In a further 17% of cases (down from 26% in 2006/07), the Commission found the trust’s response to the complainant was not sufficient and it was sent back to the trust for further work.

This means almost half of complaints reviewed required further work by the trust.

Twenty-seven percent were out of the Commission’s jurisdiction, mostly because the complainant had not raised their concerns locally first. This is up from 24% last year, suggesting that some trusts are not making the complaints procedure clear enough for patients and the public or that people do not have faith in the independence of the local procedure.

Eighteen percent of cases were found in favour of the trust as it was found that the NHS had handled them appropriately. Most of the remaining cases were either withdrawn by the complainant or referred on to the Parliamentary and Health Service Ombudsman.

The report shows there were an equal number of complaints reviewed by the Commission about both primary and hospital care (both 43%). The remainder were about mental health trusts (10%), strategic health authorities (1%), ambulance trusts (0.9%), prisons (0.8%) and other trusts (2%).

Anna Walker, the Commission’s Chief Executive, said: “Considering that millions of treatments are delivered by the NHS each year it is perhaps encouraging that we only receive around 8,000 complaints a year.

However, it is concerning that around half of complainants received an inadequate response from the trust when they first complained and we required further work to be done on the complaint.

“It is also concerning that complaints raised with us continue to be about the same basic aspects of healthcare such as poor communication, inadequate treatment and failure to diagnose conditions.

“It is clear from our wider work on complaints that trusts are not always systematically learning from them and improving their services for the future as a result. They clearly need to do so.

“It is very important that people feel that they can complain about their NHS trust if they need to and that the trust will respond positively to their complaint and learn general lessons from it.

“We have made 12 key recommendations to all trusts to improve the way they handle complaints. These are basics which patients should be entitled to.

“Things are sometimes bound to go wrong given the amount of care the NHS provides. But we will have a stronger NHS if it can embrace complaints where justified and really learn from them rather than adopt a defensive approach.”

Analysis of the complaints reviewed by the Commission reveals the following themes:

· Hospitals (43% of total)
The majority of complaints about hospitals were concerning nursing care. Of these, 43.5% were about general care, highlighting issues such as nutrition, falls and observation of patients.

· GP practices (11% of total)
Complaints about GPs were the most common type of complaint about the primary care sector. Twenty-five percent of complaints about GPs were in relation to a delay or failure to diagnose a condition or illness.

· Dental surgeries (4% of total)
The majority of complaints about dental services related to treatment (36%). This included issues such as delays in accessing services and incorrect or unsuccessful treatment.

· Accident and emergency care (3% of total)
The main issues complained about were related to treatment (24%). There were concerns about ambulance response times and incorrect treatment.

· Maternity services (2% of total)
Thirty-one percent of complaints about maternity services were about treatment. These include complainants’ concerns about the standard and timeliness of treatment they received.

· Mental health services (5% of total)
The main concerns were in relation to general care (47%), such as the appropriateness of treatment, care review meetings and the use of control and restraint.

· Learning disabilities (0.3% of total)
These were not primarily complaints made about learning disability services, but healthcare services for those with learning disabilities. Recommendations to the trust were made in over half of cases.

The Commission has made 12 key recommendations to all NHS trusts to improve the way they resolve complaints in preparation for the new system.

It recommends trusts should: acknowledge the person’s right to complain, take statements and interview staff involved in events leading to the complaint, ensure any letters to the person are clearly written and free from complex clinical terminology, ensure that the person is kept informed of progress, offer an unequivocal apology where appropriate and ensure that general learning is taken from specific complaints and is embedded into the system.

From 1 April 2009, a new two-tier complaints handling system will replace the current three-tier procedure. If a person complains to a trust and they are unhappy with the trust’s response they will be able to request a review from the Parliamentary and Health Service Ombudsman.
The new system will put more emphasis on trusts resolving complaints at a local level. It is therefore even more important that they improve their initial handling of complaints to make sure patients are not disadvantaged.

The Commission emphasises that trusts need to learn from this report.


Notes to editors:

Complaints procedure
The current procedure for complaints is a three-tier process. If someone is unhappy with the treatment or service they have received from the NHS, they are entitled to make a complaint and receive a response from the trust. If the complainant is still not happy with the response, they can refer it to the Healthcare Commission to request an independent review. If, following a review, the complainant is still unhappy they may refer it to the Parliamentary and Health Service Ombudsman.

A new two-tier system will replace the current procedure from 1 April 2009. If a complainant is unhappy with a trust’s response they may refer it directly to the Parliamentary and Health Service Ombudsman to request a review.


When the Commission first took over responsibility for reviewing complaints in 2004, it faced a much higher than expected demand for its service that led to a build up of 5,000 open cases. The Commission cleared these cases and it now resolves 95% of complaints within six months, each taking two months on average. It has reviewed over 30,000 complaints and made 16,500 recommendations to trusts to resolve complaints and improve services for patients

Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

From 1 April 2009, the Care Quality Commission will bring together the work of the Commission for Social Care Inspection, the Healthcare Commission, and the Mental Health Act Commission. The new commission will regulate the quality of care in health and adult social care and look after the interests of people detained under the Mental Heath Act. This is the first time that independent regulation of health, mental heath and social care has been brought together in this way.

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