Changes to NHS complaints system

Hi everyone I just got a basic copy of the meeting in London concerning the proposed future changes to the NHS complaints procedure. The Delegates summed up the faults under the old system to a tee. But IT does not look like new procedures will be coming into force for a long time yet. A comment was that the morning delegates for change came across as merely going through the motions I am informed. So don't hold your breath on this subject of change.

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  • The trouble with change is it is entirely possible to change everything within department or procedure or whatever, such that all that happens is the old way of doing things is swapped for a new way that has just as many faults as the old system but with the vital difference that people doing the work knew how to handle the old system and its faults but haven't a clue what they are doing with the new system.

    What I prefer is to study the existing system for particular bottlenecks and other failings on a small scale and tackle those problems that are found rather than just making a new set of problems that nobody understands.

    And beware the "seagull manager" who swoops into the department changing things almost on a whim. He continues to fly about leaving behind the sort of mess, that birds do leave behind and then swoops off leaving the mess for every one else to clear up afterwards. Such mangers may be detected as they seem to be of the ambitious type who generally seem to stay in one job for no more than about 2 years.

  • Oh so true, your approach sounds more plausible i.e check the bottlenecks in the old system. In the old days we would have change the fault raised not the whole system at a great cost along with the new faults to iron out months down the line.

  • The basic problem as I see it is the patients' submissive attitude. The NHS is defensive and will procrastinate rather than risk change.

    Always give feedback both positive and negative then you get used to commenting and gain confidence.

    Also if you want a reply email every fortnight until you get one, be polite eg Can you give me a date by when I can expect a reply.

    Escalate to the Chief Ex/Chair if all else fails .

    And don't forgot who is paying the bill - YOU!!!!

  • To some degree I do agree with you that many patients are submissive or fear making a comment, just like any other consumer issue. Having been through the very old complaints system where even legal redress often failed, and also the new system plus the feedback comment system I see some apparent changes but not when it comes to believing the complainant or speedy conclusion. In fact the system at the moment is more complex in order to allow more fairness to all parties concerned and still is a case of colleagues investigating colleagues often at a massive cost to the tax payer, money that some would feel should be spent on care instead. Thanks for the reply.

  • The Chief Exec is on the golf course allowing a PA to pretend she is him, on a remit - no discretion- just like the MPs .I know having attempted to point of cardiac arrest .Ask for a Manager and Security arrives .In cardiology too forcing you out when just been revived x3 knowing there is noone at home & no assistance in place.Now suffering because of low priority policy with SAB not contactable & LA s SS saying don't deal with the medical when have classic symptoms needing tele health/care .If you have chronic conditions there negligence is making you acute reducing your lifespan.

    It feels as if the National Front have taken control.

  • And, if a new system is being developed (let's say a new bit of software) and work starts to get behind schedule it is normal to put more people to work on that system being developed to help speed up things.

    Now some , perhaps more enlightened managers, think the thing that makes a project go faster is to reduce the project headcount and thereby increase efficiency of the remaining team.

  • Sounds a plausible idea, however as we all know reducing the head count can result in less efficiency as there is only so much one person can do in a set time. Haste makes waste has the saying goes. Rushing to do two mens work can result in mistakes and in medicine mistakes cost lives.

  • I guess it depends upon the type of work under consideration. But also the skill level of your staff is particularly relevant. If you assume that all staff are presented equally then you're likely to come unstuck when you find that 2 badly or irrelevantly trained people have been put into help the one truly experienced and knowledgeable person and the extra 2 people just get in the way, perhaps even undoing some good work done by the one good one.

    In short, if you must increase your headcount to make things look like they are under better control then don't put them on your critical path.

    And while we're on about plans, if a project is running late there is a pretty good chance that project is running along at the right speed it’s just that the plans are rubbish.

    Manager: How long will it take you to complete that job

    Me: oh about 8 weeks

    Manager: right well you've got 8 days.

    Hmm, nobody believes a plan like that so they just ignore it. Sure enough about 8 weeks later I've nearly done. And don't say that a job extends to fill the time available as that really only applies when things are

    a) resources including people are badly managed with

    b) unbelievable plans and

    c) extra features are being added to the workload without updating the plan to reflect the extra workload and costs.

    d) your own estimates of workload fall short with unforeseen problems only coming to light as things move forward and things suddenly become revealed.

    I remember working for a chap who, when asked how long it would take to make the simplest imaginable change to a system, he would reply 6 months. He was always about right,

    When it is demanded those extra features are to be included such demands should be resisted. Instead extra features should be collected on a list of extra's to be done at a later time when current workload has come to the right point and plans may be redrawn and costs re-calculated etc. That will stop costs escalating and help the project to look as though it is being managed properly. Right I expect most people in this community have seen / experienced this type of thing already and know all about it. To prevent more reader tedium I'll shut up now.

  • Thanks Pete1 you are obviously used to working on the Technical sides of things, in a nutshell correctly trained staff with experience are more important than numbers. However staff do need training too and the shop floor is where you get that and grievances of services users need to be addressed at shop floor level where they receive the service. Good examples are the backbone of good service . I wont bore you with my simplistic views but good service including changes come from good practices being set and used to start with.

  • Can that be shortened, at least in part, to " you lead by example" or is that not quite appropriate?

    Training required? Absolutely and on-the-job training, great. So often though on-the-job training ends up being on-the-job "finding out for yourself" or so it often seemed to be.

  • Totally agree, you've heard the one about thrown in at the deep end. Lead by example is fine if the example is good. But there does have to be back up some where or a catch all net, peoples ability to learn for themselves varies some have to be taught or have good leadership.

  • "We trained very hard but it seemed that every time we were beginning to form up into teams we would be reorganised.

    I was to learn later in life that we tend to meet any new situation by reorganising and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralisation."

    This could have been written by almost anyone working in health and social care in the last few years. It was said by Caius Petronius in AD66. Problems with change management go back a long way!

    Using clinical models may not be the best method to solve psycho-social or socio-political issues. NHS management and leadership is progressing in some areas, with the help of patient involvement, to lead in better structured change. We can all help that process by becoming involved locally to influence the system

  • That is what appears to be happening on the surface elewasal, more local involvement including patients and carers but in practice so far we are making very little progress. Just have to accept that some progress is better than none. I find some in the medical profession do wholeheartedly accept the need for change in all areas and accept that some of the methods suggested don't constitute progress only confusion, inefficiency and costly bills resulting in staff and consumer demoralisation as you point out.

  • Yes I agree. I am fortunate that the London Clinical Senate has shown exceptional leadership in encouraging clinical networks to include patient and public views and facilitate active co-production, and my local healthwatch in Kingston is also well facilitated and in general recognised by clinical services as essential and desirable for future developments. Our Patient and Public advisory group has therefore had exceptional access to and influence on developments. However, I am aware of areas where these standards of inclusion are not so widely upheld and in some cases actively resisted or merely diverted by check box exercises that may not be an efficient use of resources and may indeed add to confusion instead of solving problems. I am also fortunate that some of my group's work has been integrated in the London Health Commission's recommendations. I hope the implementation of its recommendations touches base with the groups and networks that are already making meangingful progress. There is a risk that this could all be swept aside by yet another reorganisation of the strategic frameworks that are just starting to make progress or that in London a new health commissioner will try to start with a blank canvas rather than connecting to what is already in progress

  • I think there is a good analogy here => Doing spring cleaning at home.

    First you get the room empty then you clean the room then the things going back in the room and unwanted stuff is dumped outside somewhere.

    This is where the analogy comes in. It takes ages to get to this point and everything is still in an ‘orible mess. It looks like you’re getting nowhere and ‘er indoors is going to wonder what you’ve been doing all day.

    BUT all of a sudden the job gets to a point where in just a few minutes time everything is going to be put back together all neat and tidy.

    Before those few minutes at the end are just like the planned job that looks like its in trouble. But hold your nerve all is well. It just looks bad so people start to panic about how much time is left and there’s still such a lot to do.

    The managers start to put more people on the job which slows it down as the new people don’t know enough of the job so inefficiencies add to the dismal appearance of work still to do according to the plans. So don’t start getting in the way Mr. Middle Manager just provide whatever is really needed. But DON’T PANIC.

    I hope you can see what I am trying to say only I don’t feel I have expressed my point here very well and I’m bored with my post on this analogy so TTFN

  • The problem is that while you are emptying the room, cleaning it and changing things around people need the space to do some essential activities, they need the equipment that you have removed to continue functioning and they need to keep track of where everything is. In the NHS some of the items you moved out of the room and got rid of as unwanted turn out to be essential and you then had to trawl around the second hand shops to find and retrieve them. Then everyone complained that you spent money getting rid of them to save on space and cost and clean things up and then spent more money to buy them back. The 'orrible mess was also disliked by all your customers who complained and the media made a great fuss

    I have worked in public services for a few years now, and prior to that I had a substantial career in industry, managing large complex projects. It was during my work in the criminal justice system under the labour govt at the time that I realised that most of the reorganisations we were asked to implement were experiments with live social systems. We were being asked to carry out changes to tasks based on a conceptual description rather than a working specification which described what tasks were required, what they should achieve, what skills should be deployed and how the tasks connected with other work and how to manage delivery within timescale. Some of the concepts might have actually worked if proper change management processes had been introduced to secure support for how to accomplish the changes using the skills, knowledge and understanding of the staff who actually know about such services and want their service to be successful for the sake of their clients as well as their professional careers. Usually it ended in a bodged system, over-reliant on bureaucracy, with confused aims, unintended effects, and wasted resources.

    Such changes are usually driven by political ideology as well as by socio-economic drivers. There is a certain amount of arrogance about how the current administration thinks they own the best or only view of the big picture and from that privileged position impose change without sufficient consultation, another thing that the last gov also did.

    In a recent example of this arrogant thinking, literally thousands of people under the leadership of Lord Darzi have been working on the London Health Commission review of how to improve health and wellbeing for Londoners. An excellent report was produced with a lot in it to like, whatever your stripe. An important part of the report was about encouraging smoking cessation. At its presentation to the great and good in health and social care at City Hall Lord Darzi and The Mayor stood side by side. Lord Darzi gave a nice presentation. Then the Mayor made a speech in his usual affable style. The Mayor is supposed to support the report. but he said he would not be further restricting smoking in public spaces because he liked that he could smoke a cigar in the park on a special occasion and did not see why he shouldn't. Well sure, a likeable comment, if given by from the butcher, baker or candlestick maker but the Mayor's position is different. Is it too much to expect him to show some leadership and express some regret for a habit that has huge social consequences?

    In this fashion, we often see carefully evolved recommendations which have some good chance of successful implementation for the greater good of our society being compromised by political ideology.

    make no mistake - at great public cost and using the resources of our most talented health professionals your "room" and a thousand like it are being refurbished and made good for the future. Detailed planning is being evolved to accomplish a comprehensive spring clean of health services while maintaining or improving them.

    The present ideology is well on its way to ensure that when it is fully functioning it will become an attractive object for privatisation, not of the whole, but part by blessed part. I hope it does not come to that but "I think we're going to find it hard"

  • Hi elewasal,

    Well that's quite a post, regarding the criminal justice system work, it makes me wonder what inputs you had and what outputs you had to produce in response.

    Well is it really true or only a conspiracy theory that leads to the conviction that the NHS is being "tarted up" in preparation for sale to the highest private bider? Aren't improvements just part of the drive for an improved NHS an efficient NHS, one that people will complain about much less?

    If my room was very large I'd hire a bunch of porta-cabins for temporary storage and a temporary work place

    When you say

    "We were being asked to carry out changes to tasks based on a conceptual description rather than a working specification which described what tasks were required, what they should achieve, "

    I guess this bit of your post quoted above already answers my next question regarding your source of

    information but only in part.

    I wonder what did you take as input for your starting point. Did everything start with a few peoples imagination and with no reference to the old existing system.

    That conceptual description, was there anything,a document perhaps quite a detailed specification that someone could take as a starting point or was the conceptual description little more than a vague wish list given in very simplistic terms. Just wondered?

    I feel we could go on forever here if we're not careful. It could be that I will be running out of steam fairly soon too.

  • Your second paragraph hit the nail on the head, however I am not sure we are getting there. To make things so patient friendly that there are no complaints, pipe dream, things will go wrong this is not an ideal world. And if a practice is wrong , to get back to the original post, we need a complaints system that is open, fast , efficient and prepared to accept change. People also need to be encouraged to state their case not victimised into submission and given an explanation if the particular thing cannot be changed.

  • On a different tack I was just wondering to myself how a complaint from a member of staff might be handled. Differently or exactly the same?

  • From what I know of the past staff get the same treatment in respect of whistle blowing no matter what their employment status level. Many staff like patients feel disinclined to report bad practice for fear of reprisal including loss of job. How to get rid of that fear I do not know. It has taken me years to stop the fear of being punished for speaking up and I am sure there are many others the same.

  • Thanks for comments and questions. Referring to the example I gave in criminal justice (which in this case also refers to health) what we had was a desire on the part of politicians to set a direction in drug policy related to crime reduction. They were prepared to spend quite a lot to demonstrate reducing crime by treating drug problems. But rather than build on existing systems for assessment and treatment, (already an effective and efficient electronic database for probation and prisons beginning to be linked in) they decided to introduce a paper based system. The assessment and care planning was 24 pages and the action and onward referrals was another form of 8 pages (page counts for both were increased in version B). As a conceptual description the idea of reducing crime by reducing drug dependency through effective treatment is obvious. But the Drug Intervention Programme (DIP) project was introduced as if no records of assessment, care planning, treatment interventions or onward referral were done prior to the project. In fact, the laborious bureaucracy was justified by saying " if I give extra funding of xxx millions then I want a record of what it is being spent on" without looking at what is actually already on record. A lot of the extra funding went on extra admin. The forms were clumsy, non standard size, with tear off strips for regional health centre analysis and were cumbersome to transmit by copy or fax to achieve inter-agency liaison. If an actual functional specification for the work had been developed and compared to what was actually already being done, then the extra funding could have been used more effectively for increasing capacity and conducting effective research and development.

    But look at the private v public outcomes in probation: large contracts have been let to private industry at ever inflating prices for tagging and transport services: tagging is notoriously ineffective compared to public probation service, notoriously overspent, and notoriously lax. Instead of widening the rehabilitative work done by public probation services (reasonably effective and efficient) and rehabilitation programmes in prison for longer sentences, extensive privatisation has recently taken place on grounds that re-offending for people on short sentences is too high (ignoring that those on short sentences do not get rehab work in prison and are not on probation afterwards!)

    Look at the work programme where billions were given to large contractors, who did very little and yet got paid for the work mainly done by charities and public services to get people back on their feet again

    Of course we all want our health services to improve efficiency and effectiveness. Efforts towards that do not automatically mean "conspiracy". But any observer of developments in public services must draw parallels between what has already happened in privatising large chunks of the public ector and what might happen in health. The creation of a myriad of trusts each controlling a manageable section of NHS services leads one to think ahead to what might happen if the trusts' members were given a "fat cat" opportunity to draw in private capital investment

  • Excellent. Not heard that one for longer than I would like to remember.

  • This broth tastes a bit funny, been a bit spoiled! lol

  • the trouble with complaining is it often depends on the surgeons, doctors, nurses being honest, the stories you see in the papers show you they can be very dishonest, plus my own experiences of doctors.

  • Yes abused, complaints are dependent on open and honest reporting which we know often does not occur. Hence the reason for looking more closely at openness without redress both for the patient and the medics concerned. We all make mistakes and should be accountable sadly it is a fact of life that people often cover up their mistakes rather than admit to them, more so if the mistake has caused others grieve. Even criminals lie that's why we have witnesses in court . However in the case of medical complaints it becomes patient verses the NHS staff and even when a patient has witnesses their side of the story is not even asked for let alone recorded. Computer records can be altered at the push of a button if someone's career is at stake.

  • It is essential that a "no blame culture" is vigorously and genuinely encouraged. Can't have people waving the white flag only to be shot upon surrender.

  • agreed

  • 'No blame culture' doesn't of course no accountability.

    People should still be accountable for their actions or lack of action otherwise standards will drop.

    The root cause of many incidents will usually be the management system in its widest form eg lack of training, ways of working etc and these should be identified and addressed. The vast majority of people go to work to a good job - NHS is no different in this to any other organisation - if that good job doesn't materialise the root causes need to be identified and not the easy option of blaming the individual.

  • BLAME CULTURE:-

    Mgr: So Fred what's going on here

    Fred: oh its Jo. He's a hopeless case but we can't sack him for all sorts of reasons. not least because of his union membership

    Mgr: well we'll just have to make him uncomfortable such that he gets dischuffed enough to leave "voluntarily"

    Result:

    The manager doesn' t really find out what the problems are.

    He gets to be disliked by all normal non-game playing members of staff

    The main problem is that because the Manager is such an unpleasant individual nobody tells him anything and sure enough he complains about all his staff keeping things from him and even people from other departments avoid passing on messages to him because they know that as messengers thy are liable to be shot.

    and incredulously he is completely perplexed regarding the reasons for the communication failure

    "NO BLAME"

    Hello Fred, how are things. Well I think Jo is probably in the best position to shed light on things

    Mgr: Morning Jo, can I tear you away from what you're doing for a few mins.

    Jo: sure, in your office?

    Mgr: Mmm yes please.

    Mgr: I gather there's a bit of a problem with the whatsit. Any ideas?

    Jo: oh that's probably me. I haven't had to do one of those thingy's that are integral with the whatsit before so my attempt at that was a dismal failure.

    Mgr: right Jo so In this instance I've picked the wrong bloke for the job. Jo I'll get you on one of these 1 day courses, if there's one that is appropriate but for now I'l get Denis to give you a bit of an introduction to that topic, very quickly though as I think Denis should do that job as it turns out that he is our expert with the thingy whatsits and as that job is on the critical path.

    Jo: Thank you. Would you like me to do that other stuff now only I Know a fair bit about other stuff and should be able to make some headway.

    Results:

    The manager is genuinely keen to see staff become the best they can be. Staff realise this and also they realise that if a manager is to stand any chance of keeping on schedule then he needs to know about problems in advance of their becoming significant. He needs as much advance warning as possible so that he has time to fix the problem.

    This manager has the correct focus and a constructive team who have no fear of being ill-treated, They know they won't get into trouble just for being the messenger.

    A no-blame culture is nothing to do with discipline - if someone has their hand in the till then there is a fair chance that being turfed out is the only next thing.

    However, having communications that are fluid and a real no-blame culture installed. Then work can be regularly reviewed and compared with the grand (well written and thought out) plan that most staff believe in. Any problems will be seen in those meetings will stand out because it will be seen that a problem is regularly mentioned without any progress to report against the plans.

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