5 The proposed health reforms |
103. A number of the Government's proposed reforms
will or could have a significant impact on the health and social
care complaints system. These include, among others, proposals
for the commissioning of complaints advocacy services by Local
Authorities, proposals for the handling of primary care by the
successor organisations of PCTs, and proposals for progressing
the Information Revolution consultation.
104. The only specific provisions relating to the
complaints system within the Health and Social Care Bill relate
to information-sharing. It is intended that the Ombudsman will
be able to share complaints reports with those she thinks appropriate,
such as professional regulators.
welcomes the provisions in the Health and Social Care Bill that
support information sharing between organisations but would like
to see the proposals strengthened in a number of areas relating
to the complaints system.
Complaints advocacy commissioning
105. Independent Complaints Advocacy Services or
ICAS are currently commissioned nationally by the Department of
Health in three block contracts. Each contract is provided by
a separate providerPOhWER (London, West Midlands and East
of England), The Carers Federation (North East, North West, Yorkshire
and Humberside and East Midlands) and SEAP (South East and South
106. The Committee notes that other statutory advocacy
services are also in existence. Independent Mental Health Advocates
(IMHAs) support people who are detained under the Mental Health
Act to understand and exercise their rights. Under Clause 35 of
the Health and Social Care Bill IMHA commissioning will pass from
PCTs to Local Authorities in 2013.
Independent Mental Capacity Advocates (IMCAs) support people who
lack capacity and are facing significant decisions. IMCA services
have been commissioned by Local Authorities since their inception.
107. The Government is proposing that local Healthwatch
organisations will evolve from the current Local Involvement Networks
(LINks) to represent the voice of patients to providers, regulators
and commissioners. Healthwatch will retain the powers that LINks
had to comment on service changes, to enter and view services
provided by or on behalf of the NHS and input people's views into
108. In the White Paper, the Government proposed
that local Healthwatch would be funded to provide complaints advocacy
services and would be able to refer concerns about services to
Healthwatch England which could in turn ask the Care Quality Commission
109. Following consultation on this, the Government
decided that Local Authorities should decide whether local Healthwatch
would provide complaints advocacy, or to commission this from
another body. In evidence to the Committee the Department of Health
told us that it will double the funding going to Healthwatch specifically
to enable it to support advocacy for complainants.
110. The Committee has heard evidence that the provision
of ICAS across England is inconsistent. Witnesses have told the
Committee that ICAS works in different ways in different parts
of the country
and others have told us that:
The recurring theme here is that the provision over
the whole of the country is inconsistent.
111. The Department of Health told the Committee
that where problems arise "we would expect Healthwatch England
perhaps to notify an individual local authority of those problems".
The Department went on to remind the Committee that Local Authorities
] are not subject to direction from the centre, either
within the Department of Health or, indeed, from HealthWatch England
the evidence presented to it the Committee finds that people who
use complaints advocacy services see a demonstrable benefit from
it. However, existing commissioning arrangements have led to coverage
that is neither complete nor consistent.
Committee supports the Government's proposal for Local Authority
commissioning of complaints advocacy. Local Authorities should
use their considerable experience in this area to improve consistency
of advocacy services across England. Commissioning statutory advocacy
services for complaints, mental health and mental capacity could
create opportunities to make service improvements and to reduce
costs that should be explored by Local Authorities and the Department
of Health against the background of a shared commitment to provide
an effective advocacy service.
Primary care complaints
114. GPs and other primary care practitioners provide
a significant proportion of the daily contacts that the NHS has
with the public. As such it is no surprise that complaints about
general practice comprised nearly 50% of all complaints about
the NHS in England in 2009-10.
Members of the public may have specific issues about complaining
about their GP, and the Committee heard evidence that this is
] there is a particular bond that you have
with your GP. He or she is your first point of call when you are
not well. The worry is that if you make a complaint you will be
treated differently. Anecdotally maybe, it has happened to a lot
of people where they are struck off after making a complaint and
people are worried that that is going to happen, especially if
it is a rural practice and they have nowhere else to go. Having
said that, there are other reasons why people do not complain.
115. The final report in the Shipman Inquiry supported
the then draft regulations that would allow patients to complain
either directly to their GP practice or to the relevant Primary
Care Trust (PCT).
The Department acknowledges that it may be difficult for people
to complain directly to their surgery about their GP and such
complaints about general practice may now also be made to the
PCT that commissions their practice.
116. As the Health and Social Care Bill stands at
the moment, including announcements made after the Governments
"pause" and "listening exercise", PCTs are
still due to be abolished in 2013. The Government has not made
a formal statement on which organisation will offer an alternative
to complaints directly to the GP practice once PCTs are abolished.
The Department of Health told the Committee that:
] there are occasions, particularly with complex
or sensitive cases, where someone wishing to make a complaint
may feel that it is appropriate to go to an organisation slightly
more distant than the organisation that provided the service.
That, therefore, means that, at the moment, the choice is to go
to the GP practice, the NHS trust, or, alternatively, to the commissioner
of that service. As the Minister has described, in the new framework,
if that principle holds, some complaints will go to the GP consortium
commissioning the care, if it is in the secondary sector, or,
if it is in the primary sector, the complaint will go to the NHS
117. In the Committee's second report
on commissioning, it expressed concern that the Governments proposals
for commissioning primary care through the NHS Commissioning Board
needed to be reconsidered.
Commissioning complaints systems through the Board nationally
presents similar difficulties. The Government needs to bring forward
effective proposals for local commissioning of primary care, of
which complaints form a key part.
Information and data sharing
118. The Government's White Paper on the NHS stated
that better information for patients can help to promote better
and safer care, improve outcomes and support people to be more
involved in decisions about their treatment and care.
The Government opened a formal consultation on the "Information
Revolution" in 2010, stating that:
Health and adult social care information will be
liberated from a closed, bureaucratic system in order to serve
patients and the public, and to help drive better care, improving
outcomes, innovation and the better use of resources.
119. It is notable that complaints are only mentioned
in the footnotes of the Information Revolution consultation.
The consultation closed
on 14 January 2011 and the Government's response is pending. When
questioned about this, the Minister of State for Health told the
Committee that the Information Revolution consultation was "fairly
comprehensive" but did acknowledge that complaints had not
When asked whether it should have, the Minister replied:
No, I don't. The complaints procedures are dealt
with through the measures introduced in April 2009 and if one
feels that there are failings or there are improvements that can
be made to the way in which complaints operate at present, then
that is the right area in which to look to seek to improve and
amend, if necessary, not through this. The focus of the Information
Revolution is to provide more information across the board so
that people can see what is going on within the NHS and within
health care in England.
Committee finds it striking that the Government did not mention
complaints in the Information Revolution consultation and is surprised
it does not see how complaints information can help people to
"see what is going on within the NHS".
data can and should be used to support informed decision-making
by patients and commissioners, and to drive up the quality of
care in the NHS. In its forthcoming report on the Information
Revolution the Government should consider how complaints data
can help patients to make informed choices about their care.
122. The Committee notes that there is also an issue
with how complaints data is collected nationally. All NHS Trusts
must return their complaints data to the NHS Information Centre
for inclusion in the annual report on NHS complaints, the so-called
KO41 central return. However Foundation Trusts do not have to
return this information and one in seven declined to supply this
information to the Information Centre in 2009-10.
123. The Department of Health and others query the
usefulness of the KO41 data return:
There is a true disagreement as to how effective
that information is. What I am arguing is that we need to look
to the future. We need to shift the situation with more meaningful
In response to this perceived lack
of usefulness, the Department of Health, the Ombudsman, the CQC,
and Monitor signed a joint statement on how to achieve meaningful,
comparable complaints information.
Committee welcomes the joint agreement on complaints information
between the Department of Health, the Ombudsman and others, and
would like to see clear plans in place for its implementation.
the Committee remains very concerned that participation in the
agreed protocol by Foundation Trusts remains voluntary. The Committee
believes this communicates an unacceptable message about the prevailing
culture towards complaints, and in particular towards the duty
of candour which we believe that all providers of NHS care should
respect towards their commissioners and the wider public. We propose
that participation in the agreed reporting protocol for complaints
should be a condition of the award of any NHS service contract
to either public or private sector provider.
126. Although Foundation Trusts are excluded from
mandatory returns of complaints data, all NHS providers are required
to produce an annual report on their complaint handling performance
and to make this available on request.
These reports must include numerical and subject data, the numbers
of complaints referred to the Ombudsman and actions taken to remedy
present there is no guidance on how organisations must present
their complaints reports, nor is it required that these reports
be published in print or online
making accessibility by the public difficult to achieve. In evidence
to the Committee, Cure the NHS told us:
But we have an ideal opportunity at the moment to
force foundation trusts to publish all their data. Now is the
time. Instead of allowing them to have closed board meetings,
we should force them to have all their evidence in public so that
they issue all the complaints, all the serious untoward incidents,
their infection rates, and their staffing levels. This is what
we should be doing. If all of that information was out in the
public arena, then the public would have a choice. They will know
if that hospital is safe.
withholding of NHS complaints reports from the public until they
are specifically requested runs counter to the principles of the
Information Revolution. The Government must take action on this
and ensure that complaints reports and serious untoward incident
reports are automatically returned to commissioners who can then
publish a rounded view on NHS-funded providers. These reports
must also be automatically published by local Healthwatch organisations.
103 Health and Social Care Bill Cl. 185 Back
"New ICAS contracts awarded to POhWER, Carers Federation
and SEAP", National PALS Network, February 2006, www.pals.nhs.uk Back
Health and Social Care Bill, Cl. 35 Back
Department of Health, Equity and Excellence: Liberating the
NHS, Cm 7881, July 2010, para. 2.26 Back
Q 82 Back
Q 19 Back
Q 386 Back
The Information Centre for Health and Social Care, Data on
written complaints in the NHS 2009- 10, August 2010 Back
Q 206 Back
The Shipman Inquiry, Fifth Report - Safeguarding Patients:
Lessons from the Past, Proposals for the Future, December
"GP Complaints", NHS Choices website, July 2009, www.nhs.uk Back
Q 379 Back
Health Committee, Fifth Report of Session 2010-2012, Commissioning:
further issues, HC 796-I, para. 79 Back
Department of Health, Equity and Excellence: Liberating the
NHS, Cm 7881, July 2010 Back
Department of Health, Liberating the NHS: An information revolution,
October 2010 Back
Q 381 to 382 Back
Q 383 Back
The Information Centre for Health and Social Care, Data on
written complaints in the NHS 2009-10, August 2010 Back
Q 373 Back
The Health Service Ombudsman, Driving improvement and learning
from NHS complaints information, March 2011 Back
Local Authority Social Services and National Health Service Complaints
(England) 2009 (SI 009/302) Back
Q 13 Back