NHS COMPLAINTS

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NHS COMPLAINTS Powered By Docstoc
					 NHS COMPLAINTS
Who cares? Who can
 make it better?

  A survey of members and their
 experience of the NHS Complaints
              System


        October 2008




    PATIENTS ASSOCIATION,
 PO BOX 935, HARROW, MIDDLESEX,
              HA1 3YJ
        0208 423 9111
    HELPLINE: 0845 608 4455
FOREWORD BY THE PRESIDENT




When you are ill, the last thing you want to have to do is make a
complaint. What you really need is quick, safe and effective care
to get you back on your feet. But there are times when patients
are so distressed or, frankly, furious about what has gone on that
making a complaint is the only option.

This is snapshot survey of our members experiences and makes
salutary reading for those in charge of Complaints in the NHS.

At the Patients Association we can only truly represent patients
when we know what they think. This report shows beyond doubt
that a radical overhaul of a cumbersome failure is what is
needed, and now.




                   CLAIRE RAYNER




                           2
                            INTRODUCTION

Each of us thinks we know best about the NHS. As individual patients we
think we know what works, what does not, and why. On a daily basis, when
things go wrong, we judge other organisations by their complaints system.
We remember organisations which have failed us by the way in which they
seek to right their wrongs.

We also understand that human beings are not automata, and that things
will go wrong. The test of any organisation is that, when they do get it
wrong, a quick and efficient complaints system puts things right. That is the
only approach to making things better. Above all, the system must fit the
complainant, not the other way round.

In the NHS there will inevitably be complaints across a broad range of
subjects, and it needs to be able to respond in a way appropriate to each
patient concerned. Other – genuinely customer focussed - organisations do
not expect their customers to conform to a strict format for complaints; the
single letter to the customer service department or even the chief
executive will start the resolution process.

Many staff in the NHS, many people bridle at the word “customer” when
applied to patients. At the Patients Association we too get criticised when
using this word, but we do so in order to alter the balance of the
relationship. Being treated as a customer – who can exercise a choice - is
about the NHS attitude to its patients and nothing more. When it comes to
complaints, surely we can agree that ‘customer focus’ is what matters?

The NHS has a plethora of organisations designed to offer a ‘customer
focus’, to ‘put patients at the centre of the service’ and to ‘empower’ them.
What this survey reveals however is that however well-intentioned these
organisations may be, they are not sufficiently independent or empowered
to offer the right service from the patient’s perspective. There is a lack of
transparency in procedures and overlaying it all there is the perception that
they exist to protect the NHS rather than help patients. Above all, the
system fails to allow for


                                      3
a simple apology to a ‘customer’, which often is all that is really
wanted.

The complaints process has suffered repeatedly from the effects
of NHS reorganisation. Much ‘reorganisation’ is just tinkering at
the edges, but the constantly changing titles of NHS bodies
causes confusion. Ultimately that confusion becomes cynicism
about the genuine desire of the NHS and its staff to resolve
patients’ concerns. With each name change or reorganisation,
the strength of the patient’s voice in the system becomes
diminished. Then, just when the public have become used to the
new system, new change comes along e.g the demise of
Healthcare Commission.

As with other parts of the NHS, the postcode lottery is with us.
Patients have to deal not just with a vast array of different
organisations but also with the fact that the standard of
response to patients will vary. There is no reason for this and the
fact that it happens shows that, on the crucial subject of
complaints, the NHS cannot provide the same service.

The changes due to come into force from April 2009 when the
Healthcare Commission merges into the Care Quality
Commission are further cause for concern. There is uncertainty
about how patients will find their way through the complaints
maze. What we can be certain about is that the calls to our
Helpline from desperate patients, who have been sent all round
the system, will increase.

Underlying all these problems for patients attempting to
complain is their strong perception, revealed in this Report, that
there is a lack of commitment to any complaints system, and an
inability by staff to view complaints positively rather than
negatively, and to see an opportunity to improve the service.
Explanations must be heartfelt and this attitude must be
embedded at the outset of the process. These weaknesses are


                            4
caused by weak management and should be critical to staff appraisals.

We urge those responsible for a compassionate complaints system to see
what patients are saying to us in this survey and to take action. This Report
reveals that dealing with low level complaints in a positive, sensitive and
individual way would go a long way to reducing the number of formal
complaints.

The waste in funding a complaints system which does not meet the needs
of patients for whatever reason should not be allowed to continue. Dealing
with complaints is a central element in future improvement and efficient
use of the service.

Research Methodology

The questionnaire was sent to a random selection of 1500 people from our
database via post and email. We received 484 responses given that the
questionnaire was only open for two weeks in August 2008.

The report is based on these responses.

Statistical analysis of quantitative results was achieved through the use of
data analysis software. Respondents were also prompted to provide any
additional comments they felt were relevant to the NHS Complaints
systems with answers subjected to corresponding qualitative informative
study.



EXECUTIVE SUMMARY

    The problems identified in the Healthcare Commission’s report ‘Is
     Anyone Listening’ a year ago (October 2007) still exist
    70% of our respondents wanted to make a complaint but only 56.4%
     actually did so
    Because patients fear retribution
    The process takes too long and complex


                                      5
 Patients believe the point of complaints is to ensure proper learning
  and a ‘never again’ approach
 But 68% regard complaints as ’pointless’ and so
 The purpose of complaints - the ‘never again’ intention - is lost
 The postcode lottery applies to the complaints system as much as to
  clinical care, with little sharing of best practice
 Clinicians practice ‘defensive medicine’ and staff are discouraged
  from adopting an open, no-blame, approach to errors
 75.1% of respondents believe trust in doctors and nurses has
  decreased in the last 5 years, but the criminal activities of some (e.g.
  Shipman) is not responsible for this
 Patients are more active in their questioning of clinicians in direct
  contact with them




                                   6
       CALL TO ACTION


 Staff appraisals must include positive
  commitment to taking complaints seriously
 Trust Boards must be publicly accountable for
  the open, transparent and timely resolution of
  complaints
 A national audit of complaints must ensure
  consistency and best practice and in turn
  reassure patients that it is an educational tool
  for staff
 NHS Management has a duty to eliminate the
  current postcode lottery for complaints
 The crossover between professional
  regulation, fitness to practice and individual
  Trust complaints must be streamlined for
  patients.



                 Every complaint matters.
     Ignoring complaints results in wasted resources,
 frustrated patients and the spread of cynicism about the
                   system and its staff.

     Patients are the reason for the health service, not
                     interruptions to it.
                    7
                Patients’ Complaints Questionnaire



Q.1. During the past five years, have you wanted to complain about NHS healthcare
you were receiving?




               No                                    31.2 %




                                                                                  68.8 %


              Yes



                        0   10   20        30        40            50   60       70




Nearly 70% of those responding felt there was something to complain about. 31% were
content with the health service they received.


Q.2. If yes, did you actually complain about what happened to you?




                                                                        43.6 %
               No




              Yes                                                                      56.4 %




                    0       10        20        30            40        50        60




                                                     8
       Interestingly, out of the 70% above, only 56.4% felt able to take action. 43.6% wanted to
       but did not do so for some reason. Some of the comments we received lead us to
       conclude there are two main causes: the complexity and length of the process itself, and a
       fear of retribution or compromised care. There is a widespread view that NHS staff
       protect each other against the individual patient. It is important that staff accept
       complaints as an opportunity to improve the processes and systems as well as individual
       practice. The complaints system itself discourages patients from complaining. It is not
       surprising that patients fail to complain at a time when they are sick and vulnerable.
       Patients may also have difficulty with terminology and lack the energy required to pursue
       a complaint. Staff should not take advantage of this state of affairs. Even those who felt
       able, educated and articulate enough to pursue a complaint, found they were treated with
       a lack of respect.

       Q.3. Looking back at the complaints process, would you say it was:




 Totally Pointless                                                                               28.9 %


        Pointless                                                           20.5 %


Slightly Pointless                                                       18.7 %


  Slightly Useful                                                16.3 %


          Useful                                        13.2 %


     Very Useful             2.4 %


                     0         5           10          15           20            25        30



       The NHS speaks much about “putting patients first” but for 68.1% of our respondents to
       regard the complaints system as “pointless” to any degree is an indictment of what should
       be a main route for service improvement. Of the remainder, just over one third, 31.9%,
       found the system useful. The Department of Health lays great emphasis on the complaints
       process. These figures show that it is despised by the majority of patients responding.
       Lost complaints, delays, and lack of outcomes were examples of the failure of the process
       given to us by patients.




                                                   9
            Q.4. In your opinion, what is the purpose of the complaints process? Please tick one
            or more boxes:




                        Other
                                                   15.1 %
   To mask what went wrong                 6.6 %
 To change clinical behaviour                                                          50.9 %

        To limit the power of                   12.1 %
              healthcare staff
        To receive an apology                                                40.4 %
    To defend patient’s rights                                                         51.1 %
 To ensure patient’s views are                                                                   60.3 %
               heard in future
    To punish those who have               7.3%
               made a mistake
To get financial compensation              7.1 %                                                           78.3 %
       To make sure everyone
      learns from the mistake

           To ensure it never                                                                                75.1 %
       happens to anyone else
                                 0        10        20        30        40        50        60        70      80




            While patients placed different emphasis on the purpose of complaints there was
            agreement that the overall intention was to ensure improvements in the various categories
            above. This idealism should, at the very least, be rewarded by staff and those dealing with
            complaints quickly, appropriately and effectively.




                                                         10
      Q.5. In your view how long should it take to resolve a serious complaint?




More Than a Year          1.9 %


       One Year         0.5 %


                             3.5 %
     6-12 Months


      3-6 Months                                       17.9 %
                                                                                              44.5 %

      1-3 Months


  Under a Month                                                               31.8 %


                    0       5        10      15        20       25    30       35       40         45




      These percentages confirm that patients expect rapid action to deal with their complaints.
      This includes dealing with every aspect of care which may be queried while the patient is
      undergoing treatment. Unfortunately the comments we received point to too many cases
      of rapid acknowledgement followed by lengthy delay.




                                                  11
         Q.6. To what extent do patients’ complaints improve the quality of healthcare? Do
         you think that they:




 Completely Reduce the
                                 2.9 %
  Quality of Healthcare

  Reduce the Quality of           2.9 %
            Healthcare
   Slightly Reduce the             4.6 %
  Quality of Healthcare

   Slightly Improve the                                                                                 56.5 %
  Quality of Healthcare

 Improve the Quality of                                              30.2 %
            Healthcare
Completely Improve the           2.9 %
  Quality of Healthcare
                          0           10           20           30            40         50             60




         Once again, patients remain optimistic about the effect their complaints will have on
         healthcare quality. This is despite the accompanying criticisms about delay and
         inadequacy. One can only guess at what improvements in healthcare might be achieved if
         the complaints system reflected patients‟ needs and if patients really were at the centre of
         the service.




                                                        12
     Q.7. Do you think doctors request test and/or investigations in order to protect
     themselves rather than the interests of their patients?




No, Not At All                   7.3 %


       Rarely
                                                 15.9 %


 Occasionally                                13.6 %



   Sometimes                                                                                 38.6 %


        Often                                         18 %


      Always                     6.6 %


                 0        5        10       15        20       25        30       35        40




     The practice of so-called “defensive medicine” is something regarded as common in
     other countries, such as the United States of America, but not generally in the NHS. It is
     interesting that respondents think this also happens from time to time in this country as
     shown above. Altogether, some 63.2% believe this happens at least some of the time.




                                                 13
     Q.8.Do you think healthcare staff are learning from their past mistakes?




                                       7.9 %
6. No, Never

           5                                              16.2 %


           4                                                              24.8 %
                                                                                          34.8 %

           3


           2                                10.5 %


1. Yes, Always
                               5.7 %


                 0        5            10        15          20      25            30      35




     Our respondents are almost evenly divided on this subject. There are difficulties in
     ensuring patients receive follow up information on decisions, and as the comments at the
     end reveal, many patients believe staff cover up for one another. Patients also believe the
     culture of too many clinicians assumes they have nothing to learn from complaints.




                                                     14
   Q.9. Do you think the process for investigating healthcare staff allows them to learn
   from any past errors?




6. No, Never                       8%


           5                                        14.6 %



           4                                                              24.8 %


           3                                                                             32.6 %



           2                                12.2 %


1. Yes, Always                     7.8 %


                 0        5         10         15            20      25            30      35




   The scale above of 1-6 shows that patients believe that there is a positive learning effect
   from errors for staff. From the additional comments we receive, whether or not this
   actually happens is another part of the postcode lottery. The reaction of individual
   clinicians to complaints about their care will determine if they are willing to listen and
   thus change. The job of management is critical. The dissemination of best practice is too
   often regarded as an add-on. The comments from respondents, about their depersonalised
   treatment call into question the whole matter of „vocation‟ and should make the clinicians
   concerned ashamed. The continuing campaign by the Patients Association and others for
   basic dignity and courtesy for patients is as necessary as ever.



                                               15
  Q.10.Whom do you hold responsible for MRSA and other healthcare acquired
  infections?




                                                15.6 %
Cleaning Staff


       Doctors                         9.6 %


 Nursing Staff                                  15.8 %


The NHS Trust                                                                                46.5 %
     Managers

    The NHS                                         16.5 %
  Trust Board

                                                         20.9 %
The Government

                   0       5      10     15         20       25   30   35      40     45     50




  This multiple choice question enabled our respondents to select more than one group as
  responsible for healthcare acquired infections. They stated that the main responsibility
  falls to NHS management to manage the situation in the round, including the other
  groups listed. Patients and visitors were also cited by respondents in the general
  comments, thus endorsing the Patients Association‟s long term campaign that safety is
  everyone‟s responsibility.




                                               16
   Q.11. In your opinion are healthcare staff encouraged to be open about their own
   mistakes?




                                                                                         35.7 %
6. Not at All


           5                                                               28.1 %


           4                                           16.7 %



           3                                  12.9 %


           2                  3.6 %


1. Yes, Totally               3.1 %


                  0       5           10     15        20       25       30         35      40




   These results echo those of question 9. 80.5% of respondents say they do not think
   healthcare staff are encouraged to be open about their mistakes. While patients will
   always accept that errors will occur in any health service, what they will not accept is the
   fact that staff are not open about admitting such errors occur. This in turn has an adverse
   effect on the relationship between staff and patient, leading to patients‟ belief that staff
   cover up mistakes and the complaints process is not genuine. Such a negative attitude
   will persist as long as there is no real encouragement to be open and therefore improve.
   Staff adopting a short term approach to complaints are in reality setting up long term
   barriers to patient-staff relationships.




                                                  17
         Q.12. Compared to 5 years ago, do you think patients’ trust in doctors and nurses
         has decreased?




6. Considerably                                           14.5 %
     Decreased
  5. Decreased
                                                                                          28.6 %

     4. Slightly
     Decreased                                                                                     32 %


     3. Slightly                                                   17.7 %
     Increased

   2. Increased                        6.3 %


 1. Considerably          1%
       Increased

                   0           5         10         15             20       25       30            35




         These results should made salutary reading for any clinician. Three quarters (75.1%) of
         our respondents believe trust in doctors and nurses has decreased. This is a depressing
         statistic when compared with the medical advances made in the same period from which
         it might be assumed the reputation of clinical staff would benefit.

         In the light of the responses to our earlier questions, however, it is perhaps not surprising.
         These responses state time and again that patients believe their clinicians regard them as
         equals, contrary to the repeated mantra of the NHS that patients are at the centre of the
         service and that patients can be of critical assistance in helping clinicians to provide
         effective and efficient care.




                                                         18
       Q.13. Has the criminal behaviour of some healthcare staff (e.g. Harold Shipman)
       affected your trust in doctors and nurses?




6. No, Not at All                                                                                 38.4 %


               5.
                                                             16.8 %



               4.                                   13.3 %



               3.                                  12.6 %



               2.                            10.2 %



 1. Yes, Totally                           8.8 %



                    0         5       10           15         20      25   30       35       40




       Doctors, and nurses, may take comfort from the fact that patients retain trust, despite
       appalling examples of criminal behaviour and these results reinforce the earlier comment
       that genuine errors are accepted by patients. It makes all the more compelling, however,
       the need to take more seriously the complaints that patients do make and to deal with
       them in a vigorous and constructive way. For a patient to make a complaint may be a
       reaction of last resort to events that should have been avoided.




                                                        19
           Q.14. Compared to 5 years ago, do you think patients question the actions of doctors
           or nurses more or less?




  6. Considerably Less         0.7 %
   Than They Used To
   5. Less Than They
                                 2.1 %
             Used To
4. Slightly Less Than
        They Used To            1.7 %


    3. Slightly More                                                             30.6 %
 Than They Used To

  2. More Than They                                                                                      43.4 %
            Used To
1. Considerably More                                              21.6 %
  Than They Used To

                         0       5       10      15         20    25       30     35       40      45




           These results are unsurprising and may be due to a combination of causes: informed and
           educated patients willing to challenge clinicians, but also frustration at a cumbersome and
           bureaucratic system. Given the dissatisfaction with the complaints system, and the
           results shown in other questions above, the main recourse for patients is to be alert to
           their own care in more direct ways. There may also be personal fear of individual
           clinicians who continue to work, unchecked by the system. The catalogue of fitness to
           practice cases at the GMC in recent years, which led to an overhaul of their system,
           showed that it was common for staff to know of poor practice by other staff members but
           to keep silent, until a serious disaster occurred. The approach of reporting “Near Misses”
           in the airline industry should be adopted in the NHS and there are bodies established to
           make this happen. From a patient‟s viewpoint there is still much to be done in this regard.




                                                       20
 15. Additional comments from our Questionnaire respondents.
 Patients had the opportunity to add their own remarks on this or other health topics.
 We have selected the most relevant to this survey and hope to quote from others in
 our future work. Several comments were for former doctors and nurses and we are
 grateful for their comparisons.

1. ‘Health care staff and more importantly managers need to welcome complaints as an
opportunity to improve their processes and systems as well as individual practice. My
experience as a patient is that there is no encouragement to make a complaint or
express a concern. As a patient under treatment (in or out-patient) one feels very
vulnerable and reluctant to rock the boat for fear of adverse repercussions. The fear may
be groundless but it is there. (…)’

2.‘The complaint went to the HCC and the whole process took 3 years with a great deal
of distress, to achieve nothing - nothing changed and no apology’.

3. ‘In the past 5 years I would have liked to complain about incidents in dentistry and
psychiatry. I think you should know why patients do not complain. Reasons for not
making a complaint: 1) It would be very unlikely to produce any improvement in future
behaviour; 2) the investigation would make me suffer all over again because it would be
focused on: a) dismissing my complaints; b) covering up mistakes; c) making me feel as
uncomfortable as possible; 3) My complaint would harm me in the future because I
would be regarded as a difficult patient just for having had the temerity to complain.’

4. ‘My main grouse against most healthcare staff is their attitude of belittling patients'
feelings and experience.’

5. ‘I think many people are "in awe" of the medical profession and afraid to ask too
many questions. I also feel some medical staff have a very poor attitude to patients who
may be very frightened and vulnerable at these times.’

6 .‘There are too many titles floating around. It is very frustrating. (…). There is too much
negligence and other factors due to too many titles and not enough front line staff with
relevant answers.’

7. ‘I feel that a complaint made while in hospital may cause some staff to lose interest in
the patient to some degree, by taking it personally.’

8. ‘(…) Restore dragon-type matrons with real (not pretend) powers; Cut out needless
managers and bureaucratic; Restore clinical precisions (?) to doctors and their medical
back-up and nursing teams; Do not allow staff to travel in their work uniforms but
change on site. Ensure best medication is always available on basis of need, not budgets.
Above all, STOP Targets: these are surely inappropriate in this context.’



                                             21
9 .‘Training nurses off the ward and contracting out cleaning are the 2 worst things that
have affected patients care.’


10. ‘(…) the process of complaining is too long, complicated and frustrating. One receives
an anonym initial acknowledgement and then waits and waits and the final response
doesn't give much confidence that things will change. I think the patient feels helpless to
take on the right of the NHS. The PALS scheme helps being (...) but I am not sure that is
very effective. (…).’

11. ‘It seems to me that nursing has changed from a dedicated profession to just a job.’

12. ‘As an 81 year old woman, with all the associated hang ups, yet still prepared to
stand up and be counted, I find it very difficult to argue/debate/discuss with doctors
when I have reason to complain strongly after I have been badly treated (I have the
scans to show). It would be helpful if an advocated, without the expense of a lawyer
where compensation is not sought, could be available for the patient. It is my experience
that surgeons in particular, are very defensive about their actions and those of their
teams.’

13. ‘(…) I have seen many visitors (when I have been visiting) walk in and out without
using the hand disinfectant provided. Also nurses travel on public transport with their
uniforms, which cannot be hygienic.’

14. Trusts take no responsibility to the patients: they are "untouchable". (…).’

15. ‘I believe medical staff just cover up for each other and do not care about patients.’

16. Nursing staff are badly stretched in many hospitals putting patients themselves at
risk. NHS Trusts underestimate this problem which isn't addressed by agency staff
although it may look better from the purely financial point of view.(…)’

17, The privatisation of the cleaning of the NHS has been disastrous. (…)

18. ‘I and close relatives have been in hospital several times and I am appalled at the
lack of attention to basic issues. Beside trolleys moved out of reach /forgetting requests
for help with feeding/toileting/pain relieve/nurse call buzzers left out of reach, etc.. I
raised this as a general issue asking what the hospital was doing to address these issues.
The reply said they could not deal with the issues raised as the incidents I used as
examples had happened some time ago and has not been complained about at the time.
No one seems to care about these basic things which can cause a great deal of distress
and would be easy to rectify.’



                                            22
19.NB: ‘Lewisham hospital staff in ward I went into has sodium low in the blood. I am a
disabled wheelchair user and yet they kept jeering me saying I was putting on an act. Yet
they never managed to get me into bed and made me sit in my wheelchair all the 3 and
half weeks I was there. I got pensioners forum to help me put in a complaint in writing.
They were also rude to other patients in the ward. Eventually apologies.. I am terrified if I
ever have to go there again.’

20.NB: ‘The fundamental change in nurse training in the last 15-20 years has resulted in
poorer care due to poor training, lack of knowledge. I am an ex-nurse and latterly a
complaints officer and investigate in a large acute NHS Trust and have excellent
knowledge of the changes that have affected hospital care. I have also been a patient
recently for major surgery so also have this experience to rely on

21.‘Compared to my experience from 1948, aged 21, treatment in NHS hospitals, from
the general to the personal, has got worse as time has passed. To be brief, taking back
Matrons and Ward Sisters and PUT THEM IN CHARGE. Cleaning should be brought "back
in-house" and ward-sisters put in charge of them too. All staff from the so-called "top" to
the bottom should be given, at least, monthly health checks. (…).’

22. ‘I was told by a doctor that they did not have time to wash hands. (…)’

23.‘I placed a query 3 years ago and never got an answer’

24. ‘Medical and nursing staff stick together always to try to protect each other against
the patient's complaint and this affects the outcome of the investigation
25.‘I would like to say that it is everyone's responsibility for cleanliness, including
patients and public. Some behaviours such as sneezing and coughing over people and
using toilets and not washing hands after are commonplace and there is no excuse in our
society when all facilities are provided’

26.‘On the whole I believe patients still do not question their doctors and nurses more
but I know that after my own experiences I certainly do. Patients I speak with still seem
to accept whatever happens without raising their concerns formally or seeking further
explanation’

27. ‘Government spending in the NHS has not risen sufficiently to allow for better
provision of medicines & operations as well as updating facilities and increasing the
number of personal to allow for better quality care. There needs to be more incentive to
recruit & keep good quality staff who are compassionate and understand the need for
good customer care.’

28.NB: ‘I am a health care professional. The complaint to which I refer concerns a critical
incident that I witnessed and reported. It has not been properly dealt with and more



                                             23
than a year later I am still trying to discover in what way my complaint might have led to
better treatment of the brain injured patient concerned.’

29.‘Patients are an inconvenience, too much useless paperwork and targets instead of
patient care, nurses rushed off their feet with no time to do the job they trained for.’

30.NB: ‘My problems are with nurses’ attitude to patients. I heard one nurse say she
would not go to a patient when she was buzzing for a bedpan, because she needed a
break, she then left the patient waiting for 20 minutes. This is awful! I won’t complain to
staff because they will treat me badly when I am re-admitted. Some senior staff have
attitude problems, they are not there to care, they are only in it for the money. I learned
my lesson at Stepping Hill hospital Stockport, when I was constantly ignored, discharged
early or outlaid to other wards for complaining. I was so ill that it was such a relief to get
away from that hospital, and be taken on by another consultant at Wythenshawe. Now I
keep quiet about staff who have upset me! (…) If you are a regular hospital patient, it
doesn't pay you to complain as the gang up against you when you are re-admitted. This
is my experience of hospital admissions.’

31.‘Health care staff are often impeded in their work by bureaucratic rules’

32.‘(…)Having been in hospital 3 times for the same operation, even 3 times into theatre
and coming out again without having the operation done I am still waiting 9 months
later and I still do not have an appointment. So much for the government’s targets.’

33.‘I complained lack of basic nursing care to my late father. 3 years later at another
hospital, I am complaining about the lack of care to my late husband. Part of my
complaint is that both were victims of pressure areas. Nursing care is far worse than it
was approx 5 years ago. I am an RGN with over 25 years experience. I am now ashamed
of the so called care provided by many nursing staff.’

34. ‘From my discussions with a Trustee, doctors, and nurses management is too
interested in their own empires and are slow in responding to short-comings. This results
in technical staff of all sorts suffering increasing difficulties not of their making. Patients
now seem more than ever to be a number -a statistic on a computer programme.’

35.‘The provision of mental health services is appalling and difficult cases are pushed out
of the system. This helps meet targets both financial and clinical. Many doctors show
massive prejudice against mental health patients.’

36.‘Responses I have had to complaints, apart from on one occasion have only resulted
in having responses that, at best, have been excuses, and at worst, have been comments
aimed at trying to get the staff off the hook by giving an irrelevant answer similar to that
sometimes given by politicians.’



                                              24
37.‘I believe in many cases, decisions are based on financial circumstances and not
clinical need. A huge amount of money is spent on administration, when it would be
better spent on nursing care. Nursing care seems to have been downgraded. Doctors and
nurses seem more and more only interested in treating acute cases. This is one reason
for the decline in basic hygiene. Nurses seem to spend most of their time "dealing” with
notes. Patients seem to be an inconvenience, especially if they are elderly and have
dementia. If a patient is unable to express their needs, they are deemed not to have any.’

38.‘Waiting times for first appointments to see Consultants are lengthening yet again’

39.‘All of us who work in the NHS are accountable for being vigilant about MRSA. So all
the boxes should be ticked for that question. There was a marked deterioration in the
standards of cleaning when it went to private companies years ago. The cleaners were
transient and not part of the team, the senior nurses lost control over the cleaning of
their area. The cleaners’ ownership and pride for their area was lost and so was the
standard for keeping toilets, bathrooms and clinical areas clean.’

40.‘The threat of litigation has made the work of the staff very difficult. Their hands are
often tied when a bit of risk taking might be beneficial. The rot set in when contract
cleaning was introduced in the 1980s. Cleaners were dedicated to wards and
departments and took pride in keeping them clean. They were treated as equals in
patient care. As an Ex Ward Sister, I always maintained that until the environment was
clean I could not start to nurse my patients.’

41.‘Staff will get away with atrocious behaviour if they can and some are simply abusers
of helpless patients unable to help themselves’

42. ‘SOME DOCTORS PLAY GOD WITH YOUR TREATMENT, IGNORE YOUR VIEWS AND
END UP MAKING YOU FEEL ILLER DUE TO THEIR APATHY, DISINTEREST AND SOMETIMES
SPITEFUL NATURES’

43.‘(…) I have had a number of situations which have needed complaining about, purely
down to egotistical consultants who cannot be bothered to do their jobs, and put
unqualified medical staff in their place. Patients tend to think they should not complain
on the NHS, but do complain when they go private. They fail to understand they have
paid for all the NHS care they receive. (…)The Complaints system within any NHS Trust is
purely a paper exercise, and they do not sit up and take notice until they think it will go
further. Some people do not have the vocabulary, energy or confidence to chase these
people and that is what the Trusts rely on’

44.‘My wish would be that medical staff and nurses were more sensitive to the fact that
they are dealing with vulnerable people and often people in need of understanding,
guidance and leadership. Instead, they often treat patients as animals, and, sadly,
sometimes, even worse than how you would treat an animal. Why do they work in the


                                            25
medical industry then? Why don't they work somewhere else where they don't need to
care for people needs and vulnerabilities?’

45.‘Get rid of two thirds of management and insist that those like RG in Maidstone etc
never work in any capacity again. Ensure cleanliness by making the cleaners part of a
team on a ward, etc.. Pay peanuts you will get monkeys. The cleaning staff should be
part of a team. A hierarchical structure in a ward is vital, not empire building between
different departments. Nurses are there to care for patients in all their needs not sit
around with degree courses it is a VOCATION NOT A JOBSWORTH’

46.‘It is often claimed in the NHS that patients who complain about treatment or staff
attitudes are not treated different, well they are, and very much so. Often complaints
result in the patient being labelled as difficult and are less likely to be taken seriously in
the future.’

47.‘I think that all the NHS is interested in doing is covering its own back! I was nearly
killed by the actions of an incompetent psychiatrist in 2003, and fought for 18 months to
get an apology and explanation out of the hospital in question. It quickly became clear
that all they had in place was NUMEROUS staff who took turns to respond to letters,
with the aim of causing as much confusion as possible and hopefully putting the patient
off continuing with their complaint! They know that most of us do not qualify for Legal
Aid, and medical negligence cases are notoriously extremely expensive to bring to court,
and extremely difficult to win. It was an absolute farce, very hurtful, and it was plain to
me that there wasn't an OUNCE of remorse or concern for what had been done to me.
(…)’

48.‘Communication between doctors, nurses & patients needs to be improved. Doctors
are not God, they need to LISTEN!! (…) Having student nurses not on the ward from the
start of their training means they miss out on some vital skills.’

49.‘I have experienced so many medical mistakes that could have been catastrophic,
(one of them was). That I have zero trust in medical profession, and feel that patients are
treated either as imbeciles or an inconvenience. I feel that I have to know nearly as much
as they are supposed to so that I can ensure that I can get the best treatment /outcome.’

50.‘Many decisions taken by doctors collectively are based on money or rather the lack
of money. As one manager of a surgery put it "this is a business"!!!’

51. ‘(…) If people don't complain things will never improve!’

52. ‘Doctors often object to being questioned about diagnosis and medication and treat
patients with disrespect rather than involve them in their own care’




                                             26
53.‘(…)As a Nurse who qualified in 1970 and worked in hospitals as a ward sister and
later the community and now in a private complementary capacity, I am appalled at the
way in which patients are cared for now (in a general sense), as compared to then. Now
it is too goal orientated and not patient focussed. My opinion only.(…)’

54. ‘We may question more, but the sinister NHS has beefed up its useless management
very substantially so that you're always held up in a thick fog of bureaucratic cover-ups
and lies. Also, by complaining, you assure yourself of even worse treatment: NEVER
believe that this doesn't happen. It's happening all the time to many thousands. Some of
which are now setting up a patient campaign group. I suspect that you're too dependent
on gvt in one way or another. Or maybe you really cannot see or believe the obscene
devastation that the NHS wreaks in good peoples' live on a daily basis. Whichever, wake
up!’

55. ‘Each new generation of doctors/nurses learn only from their own mistakes. Hence
same or similar mistakes get repeated. Some Doctors remain arrogant and consider
patients too stupid to be able to present their symptoms and ignore what they are told
about the condition which patients are living with (and hence have some detailed
knowledge of). Some doctors have a take it or leave it attitude and will only act
'properly' if pressed. (…) Complaints which should be welcomed as a means of
improvement are considered an unwelcome interference by the patient who should
rather be acknowledging and grateful for the Doctors collective wisdom. I'm not bitter
just disappointed with the change in attitude of medical profession in general.’

56. ‘If you’re seen as a troublemaker complainer, staff gang together against you and
service provision suffers. BOTH THE HEALTHCARE COMMISSION AND THE OMBUDSMAN
ARE USELESS AND INEFFICIENT IN DEALING WITH PATIENTS’ COMPLAINTS. I BELIEVE
THAT IF FINES OR COMPENSATION WAS PAID TO PATIENTS ISSUES AND STAFF
BEHAVIOUR WOULD SOON SHOW A PROFESSIONAL DEMEANOUR. CARE
PROFESSIONALS GET AWAY WITH TOO MUCH DANGEROUS PRACTICE THAT AFFECTS
PATIENTS. LET’S FACE IT THERE ARE TOO MANY OF US AND I’TS EASY TO DUMP
PATIENTS THAT ARE SEEN AS TROUBLESOME OR NEAR TO DEATH LIKE MYSELF.’

57. ‘(…) The medical profession still has a very patronising attitude to the "untrained"
general public. And older people are definitely discriminated against with the attitude
"oh they're going to die anyway". They don't always get the care they need: help with
feeding, proper preparation of hospital discharge papers, discussion with relatives
present, etc..’

58. ‘Complaining is often seen as a waste of time. We complained about the appalling
care that my Grandmother was receiving whilst she was in a mental health care unit, but
we were clearly not listened to. Some families may make a nuisance of themselves, but
those with genuine complaints are often brushed off as trouble makers or attention
seekers. Being educated and able to articulate your complaint does not seem to make a


                                           27
difference, you are still treated with a lack of respect. This leads to a concern that
complaining may actually have an adverse effect on the care that your family member
receives. The "God Complex" is still far too prevalent in the higher ranked medical
professionals.’

59.‘(…) Unlike any other country I know of, staff wear the same clothes in and out of
hospital. It seems so obvious that staff should change into cleanly laundered clothes on
entering the hospital, only they don't in this country. (…)’

60.‘Why is it that having made a considered complaint I have little hope that I
will succeed because of the way the system works? It's so dispiriting.’

61.NB: ‘The term complaint is not always appropriate. Patients are sometimes reluctant
to complain and staff can become defensive. Other terms such as patient feedback or
patient observation are better in all but the most serious cases. I have never wanted to
complain but regularly feel that feedback based on specific instances would be of benefit
to the NHS. Often this would be about, what appear to be, very minor issues, but serious
problems can eventually be the result of failing to address such issues. (I am a retired
NHS/DOH employee).’

62. ‘Many auxiliary staff in hospital do badly tasks that should be performed by trained
nurses. A considerable amount of nurses are less compassionate, caring and for all their
training don't do their jobs very well as they should. Some doctors act like demi-gods,
treating patients with disdain.(…)’

63.‘I think that the medical profession should be accountable to their patients. For too
long mistakes have been covered up. I also believe that nurses are born and not
moulded. Not everyone has the ability or personality to be a carer. There is in my
experience a lack of understanding. (…)’

64.‘Most say "What's the point, nothing changes!"

65.‘I did lodge a complaint, about the maltreatment of my late mother. I was simply
fobbed off. People lied. It was clear (from my experience and the experiences of others)
the hospital personnel knew they could behave badly with almost total immunity from
blame, and the Trust would cover up.’

66.‘There never seems to be anyone in charge on a ward’

67.‘The combination of traditional medical secrecy with the bureaucratic desire to bury
bad news makes a nonsense of a procedure entirely "in house" as at present. (…)
Information about what went wrong is withheld for "patient confidentiality”;” we do not
comment on individual cases" makes it impossible to discover the scale of the problem.
The PCT was not impressed by the Healthcare Commission's upholding my complaint, so


                                           28
I now await the Ombudsman. The most the PCT is offering after two years is a meeting
to "discuss my concerns."’

68.NB: ‘Having had 2 major operations in the last 18 months, one in the NHS and one
private. The NHS is far superior to the private hospital and I do not think private
hospitals should be allowed to operate as they do eg. minimal staff in theatre, no
doctors after 8 pm until 8 am and junior healthcare assistants monitoring after
operations which resulted in me going into respiratory arrest and almost dying. NHS is
far superior.’

69. ‘Healthcare professionals are getting away with murder. I don't even believe some of
the things that have been done to me and I was there. There is no point complaining
about GP's as the complaints process in this instance is useless as the only person you
can complain to is the person who harmed you.’

70.‘It seems to me that cleanliness in the wards is of paramount importance - when then
do doctors NOT wear white coats anymore? Why are nurses allowed to wear their
uniforms to and from work on public transport? Nurses need to be more "hands on" with
patients instead of leaving it to the auxiliary staff’

71. ‘The traditional arrogance of doctors has been heightened by their latest pay
increase which allows GPs to work effectively part-time for an enormous salary and
benefits. However, patients have to be very careful how they challenge doctors or risk
being labelled a trouble-maker and thrown off the GP list.’

72. ‘(…) the biggest issues that affect patients are the attitude of the health care
profession, the lack of training, the multicultural change in the health care profession
and the issues that this brings to patient and which is not addressed. (…)’

73.‘Complaints procedure is long arduous, complicated and designed to prevent
complaints. Little seems to be learnt’

74.‘There is still a fear that making a complaint will affect - if not the quality of care,
then certainly the attitude and relationship of the healthcare professional to the patient,
which prevents patients making a stand, even when they know they have real cause for
complaint. I do not see how this can be rectified, but until it is, there will always be
potential for lack of trust. Lack of choice is also an issue - why complain when you cannot
go elsewhere, for instance? "Don't rock the boat"’

75. ‘I'm a retired nurse and my experience over the last two years has been horrific. I am
still trying to get to the truth over what happened to me despite complaints to the
hospital and the Health Care Commission. I think the only way to find out the truth now
is to go to law’



                                            29
76. ‘I do not think Patients are encouraged nor informed properly as to how to make a
complaint. Little is known and few patients are aware of the PALS service, something I
would not have known about myself, had I not had access to the internet looking for the
complaints procedure. It is important that patients are made aware that this service is
available to them should they have a complaint.’

77. ‘If patients' complaints are never addressed - how can they effect changes in
behaviour?’

78. ‘Having complained and then being told that the complaint gets lost and that the
"complaints procedure" is Not scheduled to be reported back to me on, I have NO
confidence in complaining’

79. ‘The Internet has produced the "expert patient" and many doctors/nurses seem to
feel challenged by this. I think that the patient should be made even more of an
"informed partner" than has been the case where possible. (…)’

80. ‘They all cover for each other as employees of a Trust’

 81. ‘Patients are scared to question the action of Doctors, and Nurses in case there own
treatment is severely jeopardised.’




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