Originally published 23 February 2011. This article is retained from the tCI archive. Law, policy or practice may have changed since publication.
When Ann Abraham, the Parliamentary & Health Ombudsman introduced her latest Report last week, the media gave it massive exposure. And rightly so; it detailed how ten older patients suffered unnecessary pain, indignity and distress while in the care of the NHS. On the same day, she gave evidence to the Health Select Committee and, for anyone interested in the subject, the two hour dialogue with anxious MPs should be compulsory viewing.
What emerges is this: • 15,579 complaints came to the Ombudsman in 2009-2010 • Many complainants are uncertain of procedures, but can be assisted by an advocacy function. • The Department of Health says it has a focus on the patient experience; complaints are only one facet. • Forming an accurate nationwide picture of complaints is difficult; for example 1 in 7 Foundation Trusts failed to send in their complaints data to the Department of Health; in an attempt to lift the burden of bureaucracy, they were not chased.
Clearly this is complex matter, and many thousands of dedicated staff in the NHS must have felt affronted by the media’s assumption that every single complaint was justified and that lessons are never learnt. But it does raise interesting questions about the relative roles of complaints and consultation and the influence they have on the performance of our public services. For this issue is not, of course, confined to health and social care. Every service performed by Government – central and local - and a growing host of other providers, will be subject to customer feedback or complaint.
Few organisations have found it necessary to establish such elaborate mechanisms to handle large volumes, though note that the Local Government Ombudsman for England processed 18,000 and the Independent Police Complaints Commission (England and Wales) over 31,000. But every one of these cost money to investigate, and alongside the parallel processes of public involvement and consultation, this represents a huge investment in public engagement.
What both processes have in common is that they should be influencing the policy and operational performance. The Department of Health, in giving evidence to the MPs, are clear that there are two aims for the complaints procedure. One is to seek maximum satisfaction and, where appropriate, restitution for the complainant; the other is to understand what causes problems and to learn how to put them right and avoid future complaints. Quite rightly, the emphasis today is on storytelling; they are direct and credible evidence and make compelling case studies.
Consultation output is subtly different. Whereas complaints are normally individual cases, consultation can yield a mixture of individual and collective perceptions. They can also vary in relevance and may also be based upon different levels of understanding. After all, they are perceptions, and are naturally affected by the information made available, by hearsay and of course by the media.
The profile of respondents can be influenced by so many factors. How the consultation was organised? What questions have been asked - and how? Often, there are permanent processes designed to gather collective views from the users of particular services. In the NHS context, we have Local Involvement Networks – or LINks – soon to become HealthWatch. There are also dozens of condition-specific groups and charities who gather a range of informed opinions and present them collectively.
If these do their jobs well - taking account of those who have complained as well as those that haven’t - the main themes from individual experiences, the positive as well as the negative, can be synthesised into an authoritative message for Managers and policymakers. Sadly this does not always happen; witness the appalling situation at the Mid-Staffordshire despite seemingly adequate public involvement mechanisms.
So to present decision-makers with a balanced account of the necessary evidence we need an effective consultation mechanism alongside efficient complaints processes. Although the relevant skills differ, there is a case for bringing these functions close, if not quite totally together. Fragmentation of process leads to confused messages and blurred accountability. What is needed is an integrated way of bringing both strands of evidence to those who need to take action.
The Ombudsman’s report shows the need for better responses. Maybe those in charge of consultation – in all services share the responsibility for bringing hard truths and personal experiences to decision-makers. Let’s not leave it to those who complain.
Trigger points
- The Ombudsman’s Reports are available from their website - click here
- How closely do the consultation staff in your organisation work with those who manage complaints?
- Do issues and problems identified through your complaints process form the agenda for wider consultation?
- Have you considered the need to gather user perceptions through front-line staff? This issue is covered in the Institute’s new course Effective Public engagement at the Front-line, currently available for in-house delivery. Contact Martin Roach for details
This is the 181st Tuesday Topic; a full list of subjects covered is available for Institute members and is a valuable resource covering so many aspects of consultation and engagement