The NHS receives over 500 written complaints every day. When people complain about poor care, it can be a real opportunity for services to listen and change but how do we know this is happening?
Numbers leave questions unanswered
The latest figures published by NHS Digital about written complaints in hospital and community health services paint a blurry picture.
While the number of complaints made has remained relatively stable over the last four years, as has the distribution of complaints across service areas, there have been changes in complaints about particular issues.
For example, the number of complaints relating to communication has gone up by over 25% in four years. However, the data alone doesn’t tell us the reason behind this increase. It could be due to growing problems in the way services are communicating with patients, or it could be because people feel better able to speak up.
The data also tells us little about the people who have complained. We are told the age category of complainants, but with one age category spanning just eight years and another covering thirty, a useful comparison is impossible.
The only other facts we know about the people who complained are the region where they got the care and whether the complaint was made by the patient themselves or someone else on their behalf.
Since 2015, the NHS is publishing more detail about complaints data than it did before. However, improving the collection and national reporting of demographic details would be a big step forward in understanding whether or not there are certain groups who are not speaking up.
At Healthwatch, we have often made the case for improvements to the complaints system which would empower more people to share their experiences.
To drive improvement, complaints must be seen not as a measure of poor performance, but as an extremely important opportunity for learning.
Being open and honest about learning from complaints gives more people the confidence that the process will result in positive change.
In 2014, our report Suffering in Silence found that fewer than half of people who experience poor care report it, mostly because they don’t know how or don’t have confidence that their complaint would make a difference.
People told us that their main reason for complaining was a desire to make sure health and social care improves for the future, and most would be more likely to complain if they saw other people’s complaints having an impact.
We then worked with the Parliamentary and Health Service Ombudsman and Local Government Ombudsman to produce My Expectations and our Complaints Toolkit that is designed to help local Healthwatch scrutinise local complaints systems, make recommendations based on findings and follow through on the improvements they ask for.
Some improvements to the system have been made, but recent research suggests that many concerns are never raised in the first place.
According to the Care Quality Commission, three in ten people using health and social care have had concerns about their care but never raised them, for the familiar reasons of not knowing how and feeling that nothing would change. It’s clear that there are still improvements to be made.
Clarity, transparency, and consistency are fundamental to an effective complaints system. Currently, few services follow the same rules when it comes to showing how they are learning from complaints. Some produce detailed patient experience reports, while others only report the total number of complaints.
Since showing what you have learned from complaints is key to encouraging others to speak up, not doing so is a significant missed opportunity for further improvement.
Time to revisit the issue
We are looking at the quality of social care complaints reporting in councils, where there is no national oversight.
We are also analysing data on how hospitals deal with complaints by people who witness poor care but are not a patient, carer or family member, and how clear and open they are with their complaints reporting.
Over the coming months, we will be sharing our findings to help improve the way services learn from complaints, making sure more people’s stories lead to better support.