End the culture of patient deference towards NHS professionals

http://www.theguardian.com/society/2014/oct/29/nhs-complaints-open-transparent-response

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The 126 detailed examples of poor healthcare and inadequate complaint-handling by NHS organisations published today by the NHS ombudsman make for very troubling reading. They are a detailed dossier of what can, and does, sometimes go wrong with treatment of the sick, occasionally with disastrous consequences: cancerous tumours undetected; patients unsafely discharged from hospital; tests not done; a baby left with permanent brain damage after a nurse and two doctors made terrible mistakes during a blood transfusion.

Some of the 126 complaints received over a three-month period this year involve one error. Many involve a series of errors at different stages of the care pathway. Some had less serious consequences; others proved fatal. Some involved one individual. Others involved entire teams of health professionals. Almost the full range of NHS services are mentioned – GPs, hospitals, surgery, ambulance trusts, providers of mental healthcare.

The easy option is to recall the huge numbers of patient interactions with the NHS and view the 126 as very rare one-offs that do not indicate widespread failings in care. Quality of care, as NHS England chief executive Simon Stevens rightly stresses, has improved immeasurably over the last 10-15 years. It has survived austerity-era flat budgets in the NHS, as well as the “Nicholson challenge” to make £20bn of efficiency savings, and increased understaffing remarkably well. And while ministers may demand “zero harm”, occasional human error makes that unrealistic.

But to deny that this particular litany of failings is significant is to add insult to the injury already caused. A patient’s poor experience of care is far too often compounded by the NHS’s failure to take an ensuing complaint seriously, thus compounding the pain, frustration and grief. This recurring inadequacy, vouchsafed in painful detail in recent years by compelling reports from the Patients Association and Healthwatch, is so familiar as to now be above dispute. Too often patients affected by poor care encounter a closed, self-serving system that is neither responsive nor effective.

Healthwatch reported recently that 61% of people had not complained about the poor care they experienced or witnessed, and that almost two-thirds of those who do complain feel they are not taken seriously, with some describing the experience as a “nightmare” and a “waste of time”. Fewer than half ever receive an apology.

Jeremy Hunt, the health secretary, is finalising a report called “Hard truths: one year on”, which aims to help usher in a new, more meaningful complaints system. Through the “duty of candour”, highlighting of “never events” and harsh exposure of lapses in care and safety, allegedly costing up to £2.5bn a year, he has made clear that the NHS needs to raise its game. Healthwatch suggest a 72-hour maximum response time for all complaints, with complainants told what improvements have been instigated, and every complainant to have a named case handler.

These are helpful ideas. But greater changes are needed to end the culture of deference to health professionals – consultants but also nurses and midwives – by patients and their families, that means dissatisfaction often doesn’t rear its head. Until then, the open and transparent NHS that the response to the Mid Staffs scandal was meant to encourage will be a distant dream.