NHS Complaints – Crying out for Mediation
Ann Clwyd MP was appalled by the treatment of her husband in hospital as he died. David Cameron, moved by her account, appointed her earlier this year to advise on NHS complaints handling in the wake of the Francis enquiry.
Her report, delivered this week, revisited several of the damning themes from Francis, referring to a “toxic cocktail” in the workings of the current system and describing how complainants can feel “out-gunned by a powerful monlithic organisation”. Welcoming the report, the Health Secretary said he wanted a complete transformation in hospitals’ approach to complaints.
The total number of written complaints about the NHS from April 2011 to March 2012 was 162,129, an increase of 8.3% over the previous year. Of these, a minority (45.8%) related to clinical treatment. In her forward to Listening and Learning, a review by her team of 16,337 NHS-related complaints in 2011-12, the Parliamentary and Health Service Ombudsman said:
“Time and again, poor communication with patients and their families is at the core of what goes wrong. Last year, we received 50% more complaints from people who felt that the NHS had not acknowledged mistakes in care. We received more complaints from people who felt they had not received a clear or adequate explanation in response to their complaints, and more complaints about inadequate remedies, including apologies ……. When patients go unheard the result is careless communication, insincere apologies and unclear explanations.”
A statutory Duty of Candour, long campaigned for by the pressure group Action Against Medical Accidents, was a central recommendation from Francis. The government has moved towards a weak-ish form of this in a recent amendment to the Care Bill currently before parliament. In whatever form it finally emerges, such a duty can never be more than a starting point. The NHS, wonderful in so many ways, too often induces powerful defensive spasms in those responding to problems. Mediation, with its combination of discipline, analysis, empathy and resolution, is a huge unrealised opportunity for the NHS, where clarity and confidence are so crucial but fear, confusion and shame so often deny complainants a satisfactory outcome. NHS procedures should draw out concerns and grievances at the earliest possible stage and establish a firm presumption of mediation to resolve them, for the benefit of everyone.