Sorry Is The Hardest Word
In April 2008 the Healthcare Commission (HC) produced their report on second stage complaints about the NHS in England titled “Spotlight on Complaints”. As a result of the report, it would seem to conclude that the HC are urging NHS Trusts to say sorry after review of more than 10,000 NHS complaints.
The report found that 52% of complainants simply want an apology, a better explanation or recognition of the event. 21% wanted improvements to services or for the same thing not to happen to other patients. Only 18% were looking for action to be taken against staff, compensation or reimbursement of fees. It would therefore seem that when clients do come to solicitors for advice and their overwhelming instructions are “I just want an explanation or an apology”, they are actually telling the truth.
The Healthcare Commission is an organisation which reviews complaints made by patients or their representatives about NHS services. The report in question “Spotlight on Complaints” covers the 7,500 requests for independent review that the Healthcare Commission received and the 10,000 reviews that they completed between August 2006 and July 2007. The report also highlights trends and lessons that the Healthcare Commission has learnt.
There are many millions episodes of treatment which are carried out across the NHS every year. The report confirms that just 140,000 of these episodes were the subject of complaint and of those only 7,500 were referred to the HC for independent review in the last twelve months. If a complaint cannot be resolved at the local trust level then the patient or their representative can ask the HC to independently review the way that the trust investigated and responded to the complaint. This is known as the second stage of the NHS complaints process which was introduced by the Department of Health in 2004. The third stage is when the patient or their representative takes their complaint to the Parliamentary and Healthcare Ombudsman.
The report highlights the concerns of the patient in respect of their unresolved complaint and these tend to centre on the basic elements of healthcare. For example, communication between clinical staff, the attitude of staff, standards of care and safety, and fundamental aspects of nursing care such as nutrition, privacy and dignity. The report focuses on these key clinical areas highlighting the areas of good and poor practice that the HC has seen in handling complaints and in delivering services. The report sets out its key findings and explains the most common themes and complaints surrounding various services including GP services, dental practices and hospital care. On a general theme the issues relating to communication were common throughout all clinical areas. The report found that open clear communication from trusts and better involvement of patients and relatives in key decisions about clinical care can often prevent complaints.
In the South West, the top five issues raised as a result of independent reviews were:
- Safe and effective practice;
- Complaints handling;
- Communication/information to patients;
- Patient experience; and
- Clinical treatment.
It is interesting that only 8% of the independent reviews carried out on the South West related to clinical treatment. The vast majority of reviews related to a safe and effective practice (37%), closely followed by the way in which the complaint was handled (23%).
The HC highlighted in the report the improvements that the trusts have made in the last twelve months in responding to complaints. The HC now return fewer complaints to the trusts, 26% compared with 33% in the first report. They also have encouragingly found that the trusts are learning more from these complaints.
Despite this the report highlights other areas where progress continues to be implemented. The emphasis in the report concentrates on providers apologising to patients and their families when something has gone wrong. The HC confirm that of one in ten of the complaints referred to them, the person making the complaint is simply seeking an apology or an acknowledgement that care could have been improved. Why then are these apologies not made to the patient or their family members?
It would seem as though the Hospital Trusts are very concerned that by apologising they are admitting legal liability. The medical defence organisations and the NHS Litigation Authority have consistently made it clear that apologies can be given to try to resolve matters without admitting liability and the report from the HC confirms that they would like to see more organisations and healthcare providers prepared to apologise when errors have been made and it is appropriate to do so. It surely must follow that if more patients receive a clear and full explanation followed by an apology if appropriate, and indeed, if errors have been made then it is likely that more patients will be satisfied and will not pursue litigation.
Anna Walker, the Commission’s Chief Executive said “It is often a distressing and frustrating time for patients who feel they have not received the care they deserve. It is striking that so many people simply want an apology and steps taken to ensure the problem is not repeated.” It does therefore seem to be that the trusts and the healthcare practitioners need to know that sorry should not necessarily be the hardest word and by apologising in an honest, full and heartfelt way, many of the complainants would be satisfied and protracted complaint correspondence or indeed the next stage namely litigation could well be avoided.
Solicitors in the Medical Negligence team are happy to deal with complaints including both the second stage, namely independent review to the HC and the third stage where the complaint is taken to the Health Service Ombudsman on behalf of patients who fell unable to deal with the complaint themselves. We also assist patients in considering whether a claim for compensation should be made. A complaint and a claim for compensation cannot run in conjunction with each other, they are exclusive avenues. Many patients look at bringing a complaint in the first instance, and then decide if their questions remain unanswered or adequate explanations have not been received that a claim is the only route.
We are here to help with those difficult decisions and we will strive to ensure that even if a compensation claim is the only answer, an apology, explanation and a change in procedure is part of the compensation package. More advice can be obtained from any of the solicitors within the medical negligence team.
Published 12/05/2008. The author of this article is Michelle Biddulph
