Monday, 14 April 2014

How should we handle complaints?

Woke up to the today program on BBC this morning with discussion about the failings of the complaints system for public services, - with predictable references to Stafford.  In some ways this is useful - Francis himself was pretty clear that what we were dealing with here is an incoherent complaints system. When I listened to the 9 months of evidence it was clear that different people wanted different things out of a complaints system, and that what we had was not well suited to the unique mix of personalities that we had here.  It is also useful that the problems here are now being seen in the context of the much wider problems of complaints systems throughout the country and throughout our services.

Dame Julie Mellor is right in saying that it is a common human response to something difficult happening to you, that you want to ensure that this does not happen to other people.  To satisfy that very understandable desire then there has to be a way to ensure that "lessons are learned" and then applied. Maybe being in learning mode always means not feeling threatened.

For some people the desire goes further - they would like compensation for their suffering - and that is problematic - because as soon as you have a situation where there is litigation costs and lawyers involved then it is inevitable that a public service will become much more guarded in its response.

What I would really like to see is the introduction of the kind of no fault compensation system that exists in New Zealand, which is focused on meeting the needs of the people who may have suffered some kind of harm, rather than having to try and first establish that someone was culpable. 

For some people it goes even further - with the desire for "accountability" which sometimes starts to look like the attribution of blame.   If that could be separated from the issue of compensation then I think that this would become a rather more pure exercise.

Accusations against individuals really do need to meet the requirements of justice - which would require careful timely balanced investigation of claims with all parties involved being able to give their view of what happened and why.  This of course never happened here.  It is not a feature of the complaints system as it stands.

Many people, including Don Berwick see  the whole notion of "blame" as being counterproductive in bringing the best out of the people working in our services. I tend to agree with that. Certainly in Stafford when you start to look at the complex set of circumstances that led to conditions where sub-optimal service was likely to occur then it seems very difficult to me to be able to attribute blame to anyone.  Who for instance do you blame for Geography, which is such a key feature of the issues here.

What is certain is, as Dame Julie Mellor indicates, that there are some people who are deeply damaged by their experiences of the complaints systems, and there does need to be a very much better way of supporting such individuals.

I find it hard to say exactly what is required to create a perfect complaints system. It is so often going to boil down to the chemistry between the person making a complaint, who will often be in a distressed state, and the person receiving the complaint who may often be defensive on behalf of their organisation.  This is seldom the best kind of situation for a rational discussion of what actually happened and why.

Dame Julie Mellor is I think right in saying that people are reluctant to make a fuss.  I think that this may well explain a lot of things about problems at Stafford. Most people saw staff under pressure and did not want to add to their burdens. We may have been too polite.  It seems to me that help is required firstly to help people raise concerns and be given support before it reaches the complaint stage. The options being offered by organisations like patient opinion may well be part of the answer, and one of the initiatives piloted at Stafford, the hourly comfort checks, must be helping to deal with issues at the earliest possible stage and may help to explain the very high levels of patient satisfaction that now exist here.

When complaints do occur they may often become difficult very quickly. I feel strongly that there needs to be the back up of professional mediators to assist when a complaint appears to be becoming a source of conflict. 

If a complaint does have features that may lead to "accountability" issues, then of course in the interests of natural justice to all concerned then there does need to be a credible process to establish the facts at the earliest possible opportunity.

Making a complaints system work is an intractable problem. Many of the things that are being attempted are welcome Only time will tell if they will do the job.

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