Complaints mechanism fails older patients

News An independent study by the Public Law Project, a national legal charity, has identified serious failings in the NHS's complaints procedure and called for urgent reform. The procedure, introduced in April 1996 after an inquiry by the Department of Health, is a two stage process in which resolution at the local level is attempted initially. If the complainant is still dissatisfied, a convenor decides whether further action is needed: the complaint may be referred back for another attempt at local resolution or it may proceed to an independent review panel. With funding from the National Lottery Charities Board, researchers from the Public Law Project used a combination of qualitative and quantitative methods to assess the effectiveness of the procedure. The researchers surveyed community health councils throughout the United Kingdom , trust and health authority convenors, and chairs of independent review panels; they also conducted 72 in depth interviews with complainants, health service personnel, and health councils. Survey response rates ranged from 52% to 65%. According to the report, participants " generally felt that the principle of local resolution was sound " but that it was weakened by a lack of procedural rigour, an imbalance of power between health professional and patient, and a lack of both impartiality and external monitoring. In the survey of convenors, the researchers found that nearly half (47%) of all cases had been sent back for further attempts at local resolution, suggesting that " service level complaints handling is being inadequately conducted across all sectors of the health service. " Particular problems were identified in primary care, arising from the requirement that patients complain directly to the practitioners they are criti-cising. Complainants were daunted by this direct confrontation , fearful of retribution , and sceptical about whether they would receive an impartial explanation. The appropriateness of local resolution was questioned in complaints about professional performance, conduct, or competence. Examples examined in the study include an alleged lack of supervision leading to suicide in a psychiatry ward and a case of alleged profound neglect in nursing care. In such cases, complainants reported a lack of honesty in explanations and a tendency to believe the accounts of the staff involved rather than the complainant. The authors point out that since " the role of the convenor as gatekeeper to the second stage of the complaints procedure is pivotal, " the impartiality of the convenor is crucial to …