Complaints vs. care

Complaints are a gift to the NHS in the drive to improve standards - or so it has been argued. But do we need to rethink our approach? We are all rightly concerned with improving levels of care and patient safety, but how should we determine our priorities? Although our approach is currently informed by adverse incident reporting, and complaint analysis, and to a lesser extent claims reviews, there is no objective evidence that these very different measures provide a coherent and consistent picture.

Consultant neurologist Dr Paul Goldsmith set out to discover whether there was any overlap between the cases captured by these different systems at his own hospital trust by checking internal databases to see how many complaints and claims had also been the subject of a previously reported adverse incident1. He also hoped to determine whether the resources allocated to reviewing clinical incidents, responding to complaints and dealing with claims were proportionate to the information they provided.

'It all started because of a conversation with an economist friend about whether complaints improve standards,' he recalls. 'A now retired neurologist once spoke about having one filing cabinet for complaints and one for patient safety incidents, with little overlap between the two. It struck me that now we record this data electronically, it was possible to find out whether his perception was right.'

Newcastle is a large NHS Foundation Trust which sees around 1.5 million patients each year. In 2013/14, staff reported 13,266 patient-related incidents, which were graded into catastrophic, major, moderate, low or insignificant according to national criteria from the National Reporting and Learning System. The vast majority (96.5%) were classified as minor or insignificant.

During the same period, the Patient Advice and Liaison Service (PALS) was contacted by 2,597 patients, including 50 compliments and 868 concerns while  the trust Patient Relations Department (PRD) handled around 30,000 calls. More than 90% were addressed within 24 hours but the PRD investigated 702 formal complaints, taking statements from the staff involved to answer each issue raised and reviewing the draft response. In most cases, there was no further contact but 29 dissatisfied complainants went to the Ombudsman where just three complaints were upheld.

Finally, there were 191 claims opened in 2013/14, over half (56%) within a year of the event. The civil litigation process can last many years, so it was not possible to know the ultimate outcomes in these cases. However, it's safe to assume many will be defended successfully because more than 46% of clinical claims concluded by the NHS Litigation Authority (NHSLA) in 2014/15 were resolved with no damages payment2 and in 2014, the MDU successfully defended nearly 80% of claims brought against its members.

Significantly, Dr Goldsmith and his team found that while incident reporting was high, only a small proportion of recorded complaints (less than 5%) and claims related to a previously reported clinical incident.

For Dr Goldsmith, the study confirms the value of incident reporting by clinicians in highlighting potential weaknesses. 'The number of incident reports we found, especially as so many were about apparently minor things, shows that staff are prepared to speak out at an early stage and makes it easier to see patterns and system vulnerabilities before there is a major problem.'