By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist and Maha Yassaie NHS whistleblower and former chief pharmacist, 2 November 2016
The Department of Health (DH) has been telling everyone for years what good complaints handling looks like. The Mid Staffs Public Inquiry reinforced the importance of good complaints governance to patient safety and crucially, the need for organisations to learn from complaints and to transparently disseminate the learning. The DH accepted this. [1] However, there is little evidence that the DH has applied these complaints handling standards to itself. The DH has admitted via FOI that it has not categorised or analysed complaints, and has not measured complainants’ experience. The DH seems to have paid little attention to the narrative of complaints (Recommendation 40 Mid Staffs Public Inquiry). FOI data from the Parliamentary and Health Service Ombudsman (PHSO) shows that an increasing number of complaints against the DH have been investigated, but few are upheld. The lack of good role modelling and accountability by the DH is damaging to culture, and surely sends a message to the rest of the NHS that rhetoric about good complaints handling is more display than action.
In its first response to the Mid Staffs Public Inquiry report, the DH stated:
“2.53 The system must learn and improve from general feedback and from any complaints and concerns raised by patients, service users, families and carers. Complaints can be an early symptom of a problem within an organisation.” [1]
In its subsequent report Hard Truths, the DH drew up a long shopping list of things that NHS boards should do when handling complaints. This placed an emphasis on understanding and analysing the content of complaints:
“We want Boards to see regular data about complaints which means the ‘narrative and not just the numbers’, so they can identify themes and recurring problems, and take action.”[2]
The DH has also signed up to the PHSO’s good practice principles for complaints handling, which included tracking complainants’ experience for specific outcomes:
“…they [complainants] feel confident in the system, that it worked for them and would for others too, and that they would feel willing and able to voice their concerns again”. [3]
However, the DH’s occasional reports about its complaints performance since 2010 are dry affairs, all about numbers and whether response times are compliant. [4] Neither does there appear to be a full set published – no such reports are evident after 2013, despite the public show of intensified interest in complaints from 2013 onwards. The numbers given also seem rather low – no more than 32 complaints a year. Of note, these DH reports have disclosed only what the DH calls “formal” complaints. This may obscure a proportion of the complaints that have been made. The reports contain nothing about the nature of the complaints nor the experience of the people who made them.
However, there seem to be quite a few unhappy people who went on to complain to the PHSO about the DH. FOI data from PHSO reveals that it received a total of 914 enquiries about the DH from 2010/11 onwards, of which, only five (0.5%) complaints were upheld and seven (0.7%) complaints were partly upheld. [5]
The DH itself has been coy about these complaints to the PHSO. The DH has reported very little complaints data in its annual reports, giving full figures on PHSO complaints for only one year and no data at all in some years:
Interestingly, PHSO’s data on the number of complaints about the DH that were investigated shows a significant rise in 2015/16:
The DH’s annual reports give absolutely nothing away about why people have complained to PHSO. PHSO’s data shows that the majority of the complaints investigated related to ‘regulation’ or ‘inspection’:
There appears to be no learning by the DH from complaints. An enquiry about the DH’s complaints governance resulted in a woefully threadbare reply. [6] The DH admitted in this response that:
- The DH has not categorised complaints
- The DH has not undertaken any central analysis of the complaints that it has received since 2010
- The DH has not evaluated the experience of complainants and has not surveyed complainants to this end.
One of the authors of this article, Maha Yassaie, was advised to complain to the PHSO about the DH. This was because the DH mishandled her whistleblowing case and subsequently refused to account. The potted background is thus:
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Maha Yassaie raised concerns about patient safety, the improper handling of controlled drugs and issues of probity. She subsequently experienced serious detriment, including counter-allegations and an investigation in which the trust’s appointed investigator was later discovered to have coached the witnesses against her. [7] She made a claim to the Employment Tribunal (ET) against her former employer, which was eventually settled at a very high sum of £375K. In the process, she received a letter of apology from the DH on behalf of the NHS. However, she has since been blacklisted [8] and was also put through a gruelling Fitness To Practice process on the basis of her former employer’s original allegations. [9] Despite the DH’s prior acknowledgment that she was unfairly treated, the DH – and specifically Jeremy Hunt – were impervious to her appeals for protection from this further detriment. [10] The DH has also since claimed that it does not hold some of the key documents containing her personal data, even though it was previously the source of disclosed documents for her ET case. The DH has also refused to help correct misleading records that contribute to her blacklisting. Due to these difficulties of progressing various issues with the DH, Maha Yassaie was advised to complain to the PHSO about the DH. |
What do readers think of Maha’s chances if she complains, as advised?
Over two years ago, the DH told NHS boards:
“We want to see Trust Chief Executives and Boards taking personal responsibility for complaints handling.” [2]
So, is Mr Hunt ultimately responsible for the DH’s lack lustre complaints performance? Mr Hunt has made much capital of Mid Staffs, but he does not seem to have paid much heed to Recommendation 40 of the Mid Staffs public inquiry:
“It is important that greater attention is paid to the narrative contained in, for instance, complaints data, as well as to the numbers.”
RELATED ITEMS
https://minhalexander.com/2016/10/02/do-complaints-matter-to-cqc/
REFERENCES
[1] Patients First and Foremost. Initial government response to the Mid Staffs Public Inquiry. DH March 2013
“Complaints, their source, their handling and their outcome provide an insight into the effectiveness of an organisation’s ability to uphold both the fundamental standards and the culture of caring. They are a source of information that has hitherto been undervalued as a source of accountability and a basis for improvement. Learning from complaints must be effectively identified, disseminated and implemented, and it must be made known to the complainant and the public, subject to suitable anonymisation.”
[2] Hard Truths. The Journey to Putting Patients First. DH January 2014
[3] My expectations for raising concerns and complaints. PHSO November 2014
http://www.ombudsman.org.uk/__data/assets/pdf_file/0007/28816/Vision_report.pdf
[4] DH complaints performance reports
[5] FOI disclosure 1 November 2016 by PHSO on complaints to PHSO about the DH
foi-disclosure-by-the-phso-about-complaints-against-dh-1-november-2016
foi-disclosure-by-phso-1-nov-2016-data-on-dh-complaints-investigated-fdn-271744
[6] FOI disclosure 31 October 2016 by DH on its complaints governance
dh-foi-disclosure-31-october-2016-complaints-governance-foi-1053421-reply
[7] Whistleblower told she was ‘too honest’ to work for the health service, Lyndsey Telford et al, Telegraph 3 April 2016
This is the relevant correspondence by the trust’s appointed investigator from Capsticks. In this correspondence it was proposed that witnesses should focus on why Maha Yassaie “cannot return to work” and speak always of “trust and confidence”. This correspondence also refers to arranging meetings in which the witnesses could “rehearse” their evidence:
[8] Whistleblowers being ‘blacklisted by NHS’ as staff records state they were dismissed despite even after being cleared after tribunal, Camilla Turner 20 August 2016
[9] Press statement by Maha Yassaie 15 October 2016
http://mahayassaie.weebly.com/
[10] From a letter by the DH of 18 February 2015 to the General Pharmaceutical Council, refuting that witness evidence against Maha Yassaie was ever found to be unreliable:
This is despite the fact that the DH had been in possession of a statement which noted that some of the witness evidence against Maha Yassaie had been excluded due to a problems with a witness:
Jeremy Hunt wrote a letter on 16 December 2015 denying that the DH had got it wrong about Maha Yassaie. It ended with a note that he remained committed to creating a culture in which NHS staff would feel able to speak up, which was not much comfort to Maha Yassaie as she contemplated the Fitness to Practice hearing ahead of her:
Alexander's Excavations 
Piggies fed and ready foir take off is the only comment I can consider! DH Complaints handling pffff!,,,,useless!!
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Given the uphold figures at PHSO your whistleblower stands a less than 1% chance of an uphold against the Department of Health. She will be forced to relive her trauma, provide all the evidence, drive the process and correct the errors as PHSO drag out their investigation. Then she may receive a partial uphold. Nothing significant like uphold for poor communication maybe and be sent on her way. You may be interested to know that PHSO have only a 12-month data retention policy. After that time most of the evidence is destroyed. Just how PHSO monitor themes and identify recurring problems is beyond me with no data base to rely on. Well clearly they don’t as the same old complaints turn up time and again. The whole system is run on hot air.
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I must agree. The air is thin at the top. It doesn’t seem to sustain all faculties, including common decency and fairness.
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Terrible culture of ‘complaint mishandling’, just to ensure the system is not held to account fro anything!
What a disgrace and a farce!
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