More to do on NHS and Social Care Complaints

One of the most powerful yet challenging ways to improve the quality of health and social care services is for the public to be able to feedback when the service is going well and when it is not.

Here’s a recent example of this in action where a complaint contributed to an improvement.  Healthwatch Nottinghamshire received a couple of comments from patients who were unhappy with the delay in making GP appointments and with the booking system. In response to this, and other feedback the practice had received, the practice extended the online service to enable cancellation of appointments and to order repeat prescriptions.

It’s not always so positive. Services responding to complaints may get defensive or sometimes focus down too much on the individual concerned. They then risk missing the feedback on how the wider health and social care system might be improved.

According to a recent Parliamentary report from the Health Committee, there’s not enough of this sort of learning from complaints happening in the NHS.  It recommended that the NHS moves “to a culture which welcomes complaints as a way of improving services”.

The problem that’s been identified by almost everybody who looks into this, is that services very easily become defensive when a complaint is made.  It’s then difficult for the service to listen to, and then learn from, the complaint. It becomes a vicious circle, with service users then feeling vulnerable and not able to complain. The word itself, “complaint”, has a negative ring to it.  Perhaps another phrase is needed.

Healthwatch England’s survey on complaints in health and social care services draws two conclusions: either the whole complaints system in England should be restructured, or the current system requires much improvement.

Going down the improvement route, it recommends that it should be made easier to complain for the patient or service user and also for the “worried bystander” as well. Advice and advocacy help should be more readily available.  Staff should encourage feedback, and respond positively when they get it.  The response to complaints should be compassionate and timely, acknowledging the person’s experience, outlining the next steps and, where appropriate, giving an apology.  Complaints can be stressful for staff too and they also need supporting.

Concerns and complaints are an important source of information for improving services. They should not be wasted.

Healthwatch England’s Annual Report: Implications for Healthwatch Nottinghamshire

Healthwatch England’s first Annual Report to Parliament 

What are its key points; what are the implications for Healthwatch Nottinghamshire

1    What does the report cover

Healthwatch England (HWE) presents an overview of the current state of health and social care in England. To do this it commissioned research which included a survey of 2000+ people and a face to face deliberative event.  The aim was to dig a bit deeper into what people really felt about the care they receive and how things actually are on the ground.

The weaknesses and failures in care identified here and elsewhere have led HWE to conclude that what is needed is a consumer rights approach to improving social and health care. It identifies 8 consumer rights it considers as key to ensuring that improvements happens (see below).

The report also covers the budget cuts facing social care services and future budget pressures within the NHS.

It celebrates the progress made in developing Local Healthwatch as a “network speaking with one voice”.

2   What did the HWE/MORI research identify

• 1 in 3 of us report experiencing or knowing someone who has experienced abuse, neglect or malpractice whilst being care for.
• More than half of us experienced poor care in the last three years but didn’t report it because we didn’t trust the system to act.
• An overwhelming 94 per cent of us think the nation’s health and social care service need improvement.
• There is something of a contradiction in this particular finding because, at the same time as they are saying the above, 72% of the public surveyed are saying they get good quality care. The report concludes that despite the apparent high satisfaction levels, this is not supported by the more in-depth comments of consumers of services, describing this finding as a “paper veneer of satisfaction”.
• 23% say that professionals aren’t really interested in what they have to say or do not actively listen to their views of those of their loved ones.
• 61% did not feel they had a clear way of providing feedback on a service.  Where concerns are raised, many people are not confident that action would be taken.

3     The Health and Social Care Funding Challenge

The report describes the financial pressures facing health and social care. Local Authorities responsible for social care have had their budgets reduced by 30% between 2010 and 2014. For the NHS, it has been suggested that due to an increasing dependent population and increased cost of treatment, around £20 billion of efficiency savings are needed between 2011 and 2014 to make healthcare sustainable in the future.  This has been described as the future “budget–hole” in the HHS.

4     Taking a Consumer Rights Approach

Anna Bradley, Chair of HWE, describes this approach as:

“Just seeing ourselves as having rights changes the game.  It gets us thinking differently, asking different types of questions and helps us demand the standard of treatment and care we deserve”.

“We all need to stop acting like grateful patients and care users, and start to see ourselves as savvy consumers, insisting on our right to safe, dignified and high quality care”

Accordingly HWE has been working with the public to develop a new framework of rights for health and social care.  These are based on widely established UN consumer rights.

5   HWE’s Proposed Eight Core Consumer Rights

HWE is seeking to develop the thinking on these rights. (I’ve given some illustrative practice examples from the report.) :

·   The right to essential services: we all have the right to a set of basic and essential treatment and care services at a defined standard.

e.g  If you are a resident in a care home, you have a right to be adequately fed and given help with eating at mealtimes;

·   The right to access: we all have the right to access services on an equal basis with others, when we need them and in a way that works for us and our families.

e.g  If you need to use a health service the health professional should not deny you access, provide you with a lower quality service or discriminate against you because you are disabled or because of your age, religion, ethnicity, sexuality or gender;

·   The right to a safe, dignified and quality service: we all have the right to high quality, safe services that treat us all with dignity, compassion and respect.

e.g  If you have a learning disability and are undergoing surgery, you should expect the specialist to talk to you (if you want them to) about it.  They should tell you what the benefits might be and any possible side effects.  They should do this using language you will understand.  They should not withhold any information if you want to know more.

 ·   The right to information and education: we all have the right to information and education about how to take care of ourselves and what we are entitled to within the health and social care system.

e.g  If the NHS collects any confidential information about you, it should be kept safe and secure.  You should be told how information about you might be used and you should be able to request that your confidential information is not used beyond your own care and treatment.

 ·   The right to choose: we all have the right to choose from a range of high quality services, products and providers within health and social care.

e.g  If your council has said that you are eligible for social care, you should be given the option of choosing different ways of being supported in your own home, rather than being pressured to go into a residential care home.

The right to be listened to: we all have the right to have our concerns and views listened to and acted upon. We have the right to be supported in taking action if we are not satisfied with the service we have received.

e.g  If you suspect someone is being mistreated in a residential home where your sister lives, you should be able to register your concerns and have them investigated appropriately.  You should not have to worry that your sister’s care will in any way altered as a result of yur complaint.

 ·   The right to be involved: we are equal partners in determining our own health and wellbeing. We have the right to be involved in decisions that affect our lives and those affecting services in our local community.

e.g  If you are at the end of your life, your family and your doctors should listen to your wishes and make sure you have the support and care you need to die at home if you want to.

 ·   The right to live in a healthy environment: we all have the right to live in an environment that promotes positive health and wellbeing.

e.g   If you are a child carer, your council should make sure you have the opportunities to have a break from your caring responsibilities, have fun and socialise with other children of your own age.

 

Some implications for Healthwatch Nottinghamshire

There are a lot of sets of “rights” out there.

The citizen “Rights” area may be becoming a crowded place. This is acknowledged on p. 32 of the HWE report. I have summarised below some of the other sets of “rights” and/or standards that may be competing for “space”.

Adult Social Care – works to the DOH nationally prescribed Outcomes Framework with 4    categories:

• Enhance the quality of life for people with care and support needs
• Delay and reduce the need for care and support
• Ensure that people have a positive experience of care and support
• Safeguard adults whose circumstances make them vulnerable and protect them from avoidable harm

Each of these categories have specific outcomes.

Think Local, Act Personal (2011 – Social Care Sector, LGA, CQC, Vol sector, DH etc agreement on personalisation) contains 6 principles regarded as essential for “personalisation” of services.

The NHS Constitution – has some 29 rights under the 7 headings of:

• Access to services
• Quality of care and environment
• Nationally approved treatments, drugs and programmes
• Respect, consent and confidentiality
• Informed choice
• Involvement in your healthcare and in the NHS
• Complaints and redress

2013 CQC Inspection regime – now has 5 main questions or “expected standards” designed to be complementary to the DOH’s Outcomes Frameworks for the NHS, social care and public health. The 5 expected standards are:

1. Are they (services) safe?  – People are protected from physical, psychological, or emotional harm

2. Are they doing the things they should be doing? – people’s needs are being met and their care is in line with nationally recognised guidelines and quality standards.

3. Are they caring? – people are treated with compassion, respect and dignity and care is tailored to their needs.

4. Do they change to meet people’s needs – people get the treatment and care at the right time, without excessive delay, and that they are listened to in a way that responds to their needs and concerns.

5. Are they well led? – There is effective leadership and governance. Open, fair and transparent culture.

In addition the government is committed to drawing up a set of “fundamental standards of care” that will sit within the legal requirements of providers of health and social care, focusing on the very basics of care

So what are the Issues for Us:

Taken as a whole, the DH social care outcomes framework, the NHS Constitution and CQC standards, and others, almost certainly cover the proposed HWE eight core consumer rights

Is there a danger that the HWE core consumer rights model might replicate what already exists in different statutory bodies?  How are we to avoid an overlap with parallel approaches being operated by health and social care commissioners and providers?

Some may question the idea of there being a “right” to a choice of services in health and social care analogous to a choice of goods in the consumer market place.

Also – can you have “Rights” without “Responsibilities”? The HWE annual report acknowledges that people using health and social care services also have “responsibilities” (as an accompaniment of “rights”) acting as good citizens. So should it be, for example, a responsibility of the citizen to safeguard their own health as far as possible? Should it be one of the roles of Healthwatch to develop a complementary set of responsibilities sitting alongside the set of rights?

Healthwatch Nottinghamshire is going to need to maintain a watching brief on how HWE proceeds with the further development of practice with the consumer rights approach, perhaps monitoring our local issues recording and practice in the light of it.