Written evidence submitted by The Parliamentary and Health Service Ombudsman (ICS0065)

1. About the Parliamentary and Health Service Ombudsman

1.1.   The Parliamentary and Health Service Ombudsman (PHSO) provides an independent and impartial complaint handling service for complaints that have not been resolved by the NHS in England and UK Government departments.

1.2.   We look into complaints where someone believes there has been injustice or hardship because an organisation has not acted properly, has given poor service and not put things right. We share findings from our casework to help Parliament scrutinise public services, and to help drive improvements in service delivery and complaint handling. We investigate complaints fairly and independently, and our service is free to use.

1.3.   When we look into complaints about the NHS in England, we do so under powers granted by the Health Service Commissioner Act 1993, which allows a member of the public to bring a complaint to PHSO directly if they are not satisfied with the final response they receive from the organisation they are complaining about.

1.4.   We are undertaking a programme of work to improve complaints-handling standards in the NHS, working in collaboration with complaints teams to improve practices. Underpinning this programme is the NHS Complaint Standards.

2. How best can a balance be struck between allowing ICSs the flexibility and autonomy they need to achieve their statutory duties, and holding them to account for doing so?

2.1.   The NHS Complaint Standards set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. The accompanying guidance/process was developed by PHSO and coproduced with the NHS itself.

2.2.   The Complaint Standards aim to support organisations in providing a quicker, simpler and more streamlined complaint-handling service, with a strong focus on early resolution by empowered and well-trained staff. They also place a strong emphasis on senior leaders regularly reviewing what learning can be taken from complaints, and how this should be used to improve services.

2.3.   By creating a just and learning culture, and better communication between providers and the public, the NHS Complaint Standards will promote better accountability and openness. The way an ICS looks at complaints is a key determinant of their attitude towards accountability.

2.4.   Pivotal to the NHS Complaint Standards are ‘My Expectations’. These set out what patients expect to see when organisations apply the Complaint Standards. This covers the complainant journey from initially considering bringing forward a complaint, the process for making a complaint, staying informed of progress, receiving outcomes to the willingness to raise a complaint again in future if felt to be necessary. The Standards and associated guidance modules describe how staff can meet those expectations. 

2.5.   The NHS Complaint Standards are supported by a model complaint-handling procedure and detailed guidance which will be used to develop professional skills training and support programmes for staff delivering NHS services. It is important that staff are supported with the skills and experience they need to be confident in handling complaints. As we have adopted a collaborative approach to their development, although the Complaint Standards are PHSO-led, they are owned by the NHS. 

2.6.   The NHS Complaint Standards are best practice guidance that offer ICSs flexibility in exactly how they are applied locally in each system and place. This means ICSs can tailor their adoption of the Complaint Standards to local circumstances, while demonstrating their commitment to improving both the quality of complaint-handling and their commitment to a just learning culture.

3. What can be learned from examples of existing good practice in established ICSs?

3.1.   Before their introduction across the NHS, the Complaint Standards, model complaint handling procedure and complaint handling guidance are all being tested in a series of pilot sites.

3.2.   Barts Health NHS Trust, in the North East London Health and Care Partnership ICS, has been one of several active pilot sites for the NHS Complaint Standards. Barts has used the pilot process to test a number of different ways of working resulting in improved systems for complaints. This includes an Annual Improvement Plan that changes emphasis for staff from performance monitoring to quality improvement. The Trust evaluates its performance over the year against the Standards and responds to its findings, encouraging a more proactive culture in complaints management.

3.3.   During the pilot phase we have also seen positive engagement with the Complaint Standards from the Sussex NHS CCG which transitioned to become an ICS in July 2022, as well as the Isle of Wight NHS Trust, already a part of an existing ICS. Further feedback from other pilot sites more broadly suggests that the focus on early resolution enables staff to accurately capture complaints and deliver more effective outcomes.

3.4.   In addition to the 11 NHS pilot sites, over 70 further NHS organisations have proactively requested to become early adopters of the Standards. This suggests that there is significant appetite within the NHS for learning from good practice with regards to complaints management as well as wider adoption of the Complaint Standards. We strongly encourage ICSs across England to learn from the existing good practice and embed the Complaint Standards in their processes, culture and leadership at both a system and place level.

4. How can it be ensured that quality and safety of care are at the heart of ICB priorities?

4.1.   As ICBs will now be taking responsibility for the management of primary care complaints within their own footprint, we face a very real risk of losing valuable national insight into primary care. Up until July 1 2022, NHS England took responsibility for maintaining oversight of complaints related to primary care in England where they were able to identify themes from both a national and regional level.

4.2.   The National NHS Complaint Managers Forum brings together complaint handling leads to share information and best practice. PHSO is supportive of the value that this group can bring and worked with members to gather feedback on the NHS Complaint Standards.  Given that the infrastructure of this essential forum is already set up and working well, it would be a missed opportunity to fail to adapt and maximise use of it as responsibility for complaints transfers to ICSs.

4.3.   An effective complaint-handling system creates an environment where staff feel supported and empowered to learn when things do not go as expected. By embedding the NHS Complaint Standards at an ICS level, it encourages the learning from safety issues and the quality improvement culture to be more widely adopted across a larger area. If ICSs were to ensure all providers in their footprint followed the NHS Complaint Standards guidance, it would reinforce a consistent, just culture of accountability, learning and improvement across the entire system – thus demonstrating their prioritisation of the quality and safety of care.

5. How best can this be done in a way that is consistent with how providers are inspected for safety and quality of care?

5.1.   The NHS Complaint Standards were developed in partnership with a number of organisations across the health sector in England including regulators, patient advocacy groups, professional bodies and statutory organisations.

5.2.   The Care Quality Commission (CQC) has been a key partner in both supporting and developing the NHS Complaint Standards, at both a working and senior stakeholder level, including being a member of the Complaint Standards Working Group. We will continue to work closely with CQC to ensure that the Standards are reflected as part of their new ‘Single Assessment Framework’ for inspections. This will apply to providers, local authorities and ICSs, ensuring that compliance with the Standards does not create any additional regulatory burden for providers.

5.3.   The Complaint Standards work alongside several other important requirements for NHS staff including the NHS Constitution, Duty of Candour, NHS England’s ‘Ask Listen Do’ pledge as well as aligning with the legal requirements arising from the existing NHS Complaint Regulations.

5.4.   The Complaint Standards pilot will end in Autumn 2022 and, from Spring 2023, PHSO will start to use the Complaint Standards in our own complaint-handling in relation to NHS organisations.  This means that when someone brings a complaint to us, we can consider whether the NHS looked at their complaint in accordance with the Complaint Standards.

Recommendations:

1)      NHS Complaint Standards should be embedded nationally and at an ICS level across the NHS. This will encourage the learning from safety issues and the quality improvement culture to be adopted more consistently.

2)      PHSO should be granted Complaint Standards Authority Powers so we can take more direct action to support organisations who are struggling to handle complaints effectively.

Aug 2022