Hospitals should learn to say 'sorry'Healthcare Commission finds rise in safety concern

07 April 2008

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Hospitals should learn to say sorry more often when things go wrong with patient care, the health watchdog said today.

A report on more than 10,000 complaints revealed a rise in the number of concerns about safety, complaint handling and communication.

GPs and nurses with a 'brisk' attitude formed some of the complaints, alongside poor standards of hygiene, nutrition and maternity care.

Complaints

Roughly a quarter (24%) of the complaints were about safety and effectiveness, a 2% rise on the previous year.

Complaints about communication and the information patients received accounted for 17% of the total, up 1% on the previous year.

The third most common complaint was about how the NHS responded to grievances, accounting for 16% of the total, up 11% on the 5% of the previous year.

Healthcare Commission

The Healthcare Commission, which compiled the report, said it was seeing improvements in the way trusts handled complaints and learned from mistakes.

But it pointed to key areas for progress, including offering patients a simple apology.

The Spotlight on Complaints report covers more than 10,000 complaints independently reviewed by the Commission between August 2006 and July 2007. Each year, the NHS delivers 380 million treatments and receives around 140,000 complaints.

GPs

The watchdog reviews those complaints where patients are dissatisfied with how the NHS trust responded to their original grievance.

The study found that 43% of the complaints about GP services involved patients who felt their examination was too brief, sometimes with limited discussion about different treatments.

A further 23% felt their GP had failed to diagnose a condition or delayed diagnosis, usually with regard to cancer.

Attitude

A fifth of the GP complaints involved concerns about a doctor's attitude.

Others involved patients not being told about drug side effects, possibly because GPs assume patients cannot understand complex information, the report said.

The most common complaint about dental practices (34%) concerned the standard or quality of clinical treatment.

Standard of care

Meanwhile, 36% of complaints about hospitals were about the standard of clinical care.

Around 30% of these complaints were about the 'fundamentals' of nursing care, such as hygiene, communication, privacy, dignity and nutrition.

Some complaints involved elderly patients unable to reach call bells, or patients being left in soiled bedding and clothing.

In complaints about maternity services, there were examples of women being left alone during labour and mothers not feeling listened to.

Apology

The commission estimates it recommends an apology in some 23% of cases it reviews.

Only 18% of complainants want action taken against staff, compensation or reimbursement of any fees.

The study said: 'In almost one in ten of the cases referred to us, the person making the complaint was simply seeking an apology, or an acknowledgement that care could have been improved.

'We are frequently told by the trusts concerned that they had not apologised for fear of admitting legal liability.

'However, the medical defence organisations and the NHS Litigation Authority have consistently made it clear that apologies can be given to try to resolve matters without admitting liability.'

Resolved locally

The commission said more complaints could be resolved at a local level if trusts offered clear, evidence-based explanations and apologies where appropriate.

But they must also demonstrate that improvements to services were being made as a result of complaints.

Health Minister Ann Keen said healthcare in the UK was as safe as in the US, Australia, New Zealand or Denmark.

But she said patients deserved an apology when mistakes happen.

Sorry

She added: 'I am disappointed to hear that many trusts refrain from saying sorry for fear of admitting liability.

'This culture of fear must change, particularly as the NHS Litigation Authority has consistently said trusts can apologise to patients to try to resolve matters without admitting liability.'

From next year there will be a new system for resolving NHS complaints, currently being drafted by the government.

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