The NHS’s internal system of handling patients’ complaints is broken, argues a new government report published by a commission headed by Labour MP Ann Clwyd. Patients who file a complaint about matters such as staff rudeness, neglect, poor quality of care etc. often find that their concerns are delayed, played down, met with defensiveness or denial, and ultimately remain inconsequential. This represents a major failure because if complaints from patients and carers had been taken seriously, the calamities of Mid Staffordshire might have been prevented, and so would many other less well-known cases of collapses in care standards.
The report calls for a change in culture in the NHS. Healthcare providers should stop treating complaints as an attack to be fended off, and start treating them as an opportunity to learn about where things are going wrong. They should stop seeing the people who file those complaints as vicious troublemakers, and see them as people with legitimate concerns. More tangibly, the report also calls for a series of ‘pledges’ by NHS organisations, and a simplification of the complaints procedure.
Well-intentioned though those recommendations are, it would be surprising if this report led to substantial improvements in the quality of care. The focus on the procedures of the complaints process is ultimately wrongheaded.
Complaints procedures are normally a way of dealing with information asymmetries. Many business owners fail to retain customers and have no idea why. They do not spot any mistakes, but neither can they keep an eye on every one of the company’s activities all the time, nor can they easily see their own business from a consumer’s perspective. That is why well-run businesses deliberately seek out customer feedback. Many supermarkets, restaurants and pub chains have straightforward feedback forms on their website, and some of them incentivise customers to use them. (Wetherspoon’s, for example, gives you a voucher for a free coffee if you leave a review of your last visit.)
Nobody enjoys receiving negative feedback, but in some cases we accept it because we like the alternative even less. It is no good if customers pretend to be satisfied, but then never come back again, or tell other people how awful the product is. That is why actors in competitive markets often seek feedback, even though no review by a government commission has ever told them to do so. It is in their own best interest.
And that is the big difference compared with the NHS. If an organisation has no real interest in taking criticism on board, no amount of fiddling with the complaints procedures will make much of a difference. And if an organisation has a real interest in taking criticism on board, they would sort out procedural problems themselves, without the advice of a government commission.
We have to make it a lot easier for NHS hospitals to go bankrupt, and we have to make it a lot easier for independent sector providers, including for-profit providers, to step in and take over. Forget the Clwyd review. Let’s have a series of hospital bankruptcies - and I bet the remaining ones would suddenly learn very quickly how to take patients’ complaints seriously.