Written Statement - A Review of Concerns (Complaints) Handling within NHS Wales –“Using the Gift of Complaints” – next steps

Using the Gift of Complaints, the independent review of the way NHS Wales handles concerns and complaints by Keith Evans, the former chief executive and managing director of Panasonic UK and Ireland, was published in July 2014.  The report, which was commissioned by the Welsh Government, made more than 100 recommendations about how the NHS could improve the way it deals with complaints. Following a period of engagement about the report’s key recommendations, I will now provide Members with an update about the Welsh Government’s plans to take this valuable work further.

Mr Evans’ review concluded that Putting Things Right, the NHS complaints system introduced in 2011 in Wales, is the right approach to managing complaints and concerns, but he highlighted variations in its implementation across Wales. The report’s findings fell into four general themes where he felt improvements could be made: in the responsiveness of the process; the infrastructure required, the ability to demonstrate learning and the overall culture.

He was keen to stress that the vast majority of patients receive good quality care from the NHS. However, there will be times when care will not be to the standards we expect and in a small number of cases things can, and do, go wrong. When this happens, the NHS must be open and honest about what has gone wrong; it must learn from its mistakes and share those lessons.  

Following the report’s publication, I gave NHS organisations, its staff and partners and members of the public the opportunity to comment on the recommendations and make further suggestions. I am grateful for these contributions and also for the feedback from the National Assembly’s Health and Social Care Committee following its subsequent inquiry.

Using the Gift of Complaints has been generally well received. Its conclusions and recommendations came as no surprise to many of the respondents and, for the most part, have been welcomed and supported. 
The Health and Social Care Committee took a wide range of evidence during its one-day inquiry in July. Its conclusions built on those of the Evans review and have also informed the Welsh Government’s response.  

Actions to take forward the recommendations have been grouped in three  ways:  those that can be addressed immediately by NHS organisations;  secondly some which require more detailed work and the development of proposals to consider changes to the existing arrangements, specifically aspects of the arrangements that could be undertaken on a national basis, and finally there are a small number which are for consideration in the longer term if the improvements set in train are not achieved. Some of these aspects could, depending on the detail of the proposals developed, also require new legislation.  

I am pleased to be able to report that health boards and trusts have already taken action in response to the Evans review.   They are looking at the resources and senior leadership that they have in place and making changes  to enable a more responsive and accountable service to be provided. This includes working to improve the timeliness of responses to complaints.    

Many organisations are looking at innovative ways to   improve the way they communicate with the public, so that patients and their families can clearly understand how to comment on any aspect of a service they may have received – whether good or bad. This is key to the theme throughout the Evans report around the need to deal with concerns as they arise rather than wait until they become more complex and serious. To support this principle and ensure the patient’s voice is central, Wrexham Maelor Hospital and the Princess of Wales Hospital, in Bridgend are piloting a new approach: iWantGreatCare in order to capture real-time patient and visitor feedback.  This will enable the organisations to deal effectively with issues more quickly.  It has been very encouraging to see the very positive comments coming through from the feedback so far.

The report also stressed the need for consistency across Wales. I am therefore pleased that the National Quality and Safety Forum has already started to ensure an all-Wales approach to help achieve this. They have already begun a number of pieces of work, including the development of a national complaints dataset to ensure all NHS organisations publish information in a consistent way, which is easy for the public to understand and allows for meaningful comparisons across Wales.  

It will also revise the Putting Things Right guidance and communication to eliminate variation in interpretation of the guidance and Regulations while making it simpler and more accessible for patients and families. A model for sustainable learning and sharing lessons from complaints is also being developed. A public engagement reference group will ensure the needs of patients are taken into account as this work develops.  

Mr Evans sets out a number of the recommendations which he feels would benefit from having a national approach. He feels this would help bring a greater level of independence in the process as well as the expertise needed for investigating the more serious concerns.

I want to consider further the potential for establishing a national expert team for dealing with serious concerns and shared learning.  This needs more detailed consideration and I have asked my officials to develop proposals over the coming months.

Community health councils (CHCs) have an important role to play in the NHS complaints process, particularly in relation to advocacy and escalating the intelligence from concerns to health boards and HIW. Work to strengthen the CHCs’ role is ongoing.   The current consultation on the proposed changes to CHCs should therefore be considered alongside this response

A number of recommendations may require changes to the existing regulations or indeed new legislation. This will need to be considered carefully as the work progresses.

I do not propose to take forward the recommendation to establish 
a national independent complaints regulator.  As Mr Evans says, this may be a consideration if the existing system cannot be improved. I want to give sufficient time for the NHS to demonstrate the improvements that it can make in its handling of concerns and to consider any potential changes at a national level.

Until these changes have had time to embed and improvements made, it would be premature to make any further decisions on the role of an independent regulator.  

The Evans review contains many practical recommendations, which will help the NHS in Wales to use complaints as an opportunity to improve the way it provides healthcare in the future. Many of the issues it identifies will require a change in culture, which will take time and effort at all levels of the NHS.

I intend to pursue the achievement of such cultural shift in the meetings I have with staff at all levels in the NHS so that we can act collectively to bring about a significant improvement in the way concerns are addressed.