Complaining to the NHS

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The issue of patient care is never far from the headlines and this was illustrated by a report from Dr Foster, the healthcare information company, which contained worrying reports of wards “full to bursting” and dangerous overcrowding which puts patient safety at risk.

What are your options if you feel that the care you received whilst at hospital was not adequate?

It’s worth pointing out, however obvious it is, that they have had complaints before and will have systems in place to deal with them, whatever the nature of the complaint you may have. This is the case whether it relates to a doctor, nurse or some other health professional.

The health service has a constitution which sets out a patient’s rights when wishing to complain. It says that patients have the right to have the matter they are unhappy about fully investigated and they should also receive a quick reply. They will also find that most healthcare providers have their own complaints managers who will hear the matter confidentially. This therefore means the patient, who is unhappy with his or her treatment does not, at least in the initial stages, have to confront the person they consider responsible but can raise the matter with someone who has a degree of independence.

  1. 1.      The complaint is made

So, the complaint should first be made, orally or in writing, to the NHS complaints manager with the process then seeing them receiving a prompt reply. If they feel this is not satisfactory and want to take the matter further they are able to do so by……

  1. 2.      Contacting the Parliamentary and Health Service Ombudsman.

This is a free service which looks into complaints where patients feel they have not been well treated. If after the ombudsman’s ruling, the complainant still feels the matter has not been properly addressed then they do have a final option……

  1. 3.      Taking the matter to a judicial review

 

However, this is fraught with difficulty and can be costly. Damages may be paid to the aggrieved party if the case does go down this route, but only if there is a recognised “private” law cause of action such as negligence.

Time limits – Those wanting to make a complaint should make it as soon as possible as there are time limits in place. They usually have 12 months from the date the event took place or 12 months from the date they first became aware of it.

Advice websites such as theclaimsconnection.co.uk will help answer any questions you may have regarding how to complain to the NHS.

CQC - Another option for those unhappy about their treatment and who want to raise concerns can do so through the Care Quality Commission which checks all hospitals in the country to ensure they are meeting national standards.

 

 

Do you share concerns over inadequate care from healthcare assistants?

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A new report has warned about the poor standards of care which are being given by unqualified healthcare assistants. Do you share this concern?

The Wills Commission says that more and more tasks which used to be performed by trained nurses are now given over to low paid and unregulated assistants because of budget cuts and nurses being needed in other areas. It has resulted in growing concern about public protection as, though the new assistants, thought to number about 50,000, have been brought in to perform simple tasks such as helping to keep patients fed and hydrated, they are not qualified to identify warning signs in a patient such as dehydration or a sudden change in their body temperature.

The report recommends that all healthcare assistants be trained to a minimum of NVQ level three which would go some way towards addressing growing concerns about their growing presence on hospital wards. It says the current level, which sees unregulated and unmonitored staff caring for vulnerable people is clearly unacceptable. The commission stresses that while there is no direct evidence of a decline in care, an all-graduate nursing profession is essential rather than merely desirable.

The Department of Health says however that there is no evidence that compulsory regulation would lead to higher standards as healthcare assistants were supervised by professionally qualified staff and often by experienced nurses. A spokesman said there was no substitute for “proper performance management, good leadership and day to day high quality patient care”.

Are you reassured by the statement from the Department of Health? Have you had concerns over treatment in hospitals either relating to your own stay in hospital or someone you know? Let me know your experiences.

 

NHS Complaints

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A new report by healthcare information firm Dr Foster paints a disturbing picture of care at some NHS hospitals with reports of wards being “full to bursting” and overcrowding at dangerous levels with a resulting effect on patient care.

If you feel that your care whilst in hospital was not adequate what option do you have?

Firstly, by way of reassurance it should be noted that all healthcare providers have systems in place to receive patient feedback, both positive and negative. Therefore, any patient unsatisfied with the care they received does have options in place to take the matter further. This is the same whoever the complaint relates to, whether it is against the service as a whole or a particular member of staff.

 

The NHS Constitution lays out the patient’s rights when wanting to make a complaint and states that when this occurs the person concerned has the right to have the matter fully investigated and they must receive a full and prompt reply. It is also worth recognising that many patients, who perhaps want to complain about a specific consultant for whatever reason, may feel intimidated into not doing so. For instance they may feel uncomfortable discussing the matter in front of that consultant or someone who works closely with him or her. The patient will not need to because…

 

The vast majority of NHS providers have official complaints managers, who are independent, and will hear the issues raised in private.

 

  • All NHS complaints should be made within 12 months of the date of the event the patient is referring to, though this time limit can be extended in some circumstances – as long as it is still possible for the matter to be investigated, such as in situations where it would have been difficult for the person to have reported the matter earlier, perhaps because they were badly injured, they were grieving or they had trauma of some kind.

 

  • Anyone wanting to make a complaint should therefore first talk to the relevant complaints manager, assuming there is one, and start the complaint, either verbally or in writing. The next stage in the procedure should see the complainant receiving a reply from the organisation in question. If this reply is not sufficient and the person is not satisfied or feels there is no prospect of it being adequately dealt with, they have the option of taking the matter further still by raising the complaint with the Parliamentary and Health Service Ombudsman.

 

The ombudsman is a free service whose role is to investigate NHS complaints where people feel they have been treated unfairly or have received poor service from government departments, other public organisations and also the NHS in England. If, after the ombudsman gives a ruling, the complainant is still not satisfied, the only course of action left open to them is to take court action referred to as a judicial review. This allows a court of law to review decisions made by public bodies. Damages may be paid to the person if they are successful going through court but only in limited circumstances; such as where there is a recognised “private” law cause of action, for example negligence or breach of a statutory duty.

Care for the elderly

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A survey conducted by the public sector union Unison has found that more of the elderly, in need of care, are becoming lonelier because carers are spending less time with them. It’s a concerning report which paints a picture of many of our elderly being increasingly lonely.

The survey questioned over 400 care workers and 79% of them said they have to leave clients sooner than they should because they have to cram in a certain number of visits every day. The report says the practice known as “call cramming”, whereby care workers spend only about a quarter of an hour at a pensioner’s home, is rife. Is it all to do with funding or are there other measures that can be taken to ensure that more time is spent with the elderly?

It is often only through general conversation that real concerns can be identified so it’s worrying that seemingly too many elderly people are left with an inadequate length of time spent with a carer. We’d like your feedback of course. Let us know what you think.

 

Another postcode lottery?

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The first national audit of epilepsy services for young people has found a “profoundly concerning” variability of care in the services provided in different parts of the country with England faring less well generally than other parts of the UK. Do you have any experience of epilepsy services in the UK? What’s your view?

Epilepsy is the most common serious neurological condition in the UK affecting about 60,000 youngsters, but the audit found that barely half of families had been offered the support of a qualified epilepsy nurse within 12 months of their child being diagnosed; a service which is recognised as vital in helping the children and their family in terms of their medication, schooling and general support.

Also, the audit established that England had the worst specialist nursing support in the UK with less than half of units offering this service compared to 77% in Wales, 73% in Scotland and 100% in Northern Ireland.

Why is it that standards of care vary according to which region of the country you are living in? Also, why does England have such a poor standard of specialist nursing support compared to the other countries of the British Isles? Let me know your views.

 

“Zero-hours” contracts

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The Labour party has called on the government to stop the spread of “zero hours” contracts which are increasingly being used for clinical staff within the NHS. Are they prevalent within the health service and, if so, are they necessarily a bad thing?

The shadow health secretary Andy Burnham said he wanted an end to the practice pending a review into the potential risks to continuity of care and patient safety. He added that the increasing use of the contracts was a “depressing symptom of the government’s drive to turn England’s health service into a full-blown market”.

The controversial contracts commit employees to on-call working but do not specify an exact number of hours or income earned, so as to meet the demands of the government’s market-driven changes in the health service. Though such contracts have been used before, mainly in the service sector, it is their use in key areas of the NHS such as cardiac and respiratory diagnostics which is proving so controversial and could, according to critics, ultimately lead to a “G4S-style” situation within a hospital in which key clinical staff are not available to work.

Oxford Radcliffe Hospital, which uses the contracts, says its advantage is that it allows the hospital to have a pool of experienced staff who are able to assist at times of greater demand, yet Unison, the public service union, says that it has received “worrying feedback” from many who are on the contracts. Its national officer Sara Gorton called it an unnecessary, untested experiment.

That charge was denied by a Department of Health spokesman, who said the NHS had always had to be flexible to meet demand and it was up to the providers to organise themselves to ensure that demand was met. So, what are your views on so-called “zero-hours” contracts? Let us know what you think.

 

Unjustified delays in ovarian cancer diagnosis?

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Research from the Medical Defence Union (MDU) has shown widespread delays and, in some cases total failure, to diagnose ovarian cancer. What are the reasons for this?

The MDU, which represents doctors who are accused of negligence, looked into 209 complaints made against doctors between 2002 and last year which involved the disease and in 84% of cases there had been a delay in diagnosis alleged. Those 209 complaints resulted in 71 claims against doctors and eight of these have been settled with compensation payouts ranging from £9,000 to £550,000.

Dr Rachel Sutcliffe, an MDU medico-legal advisor, said that in many cases the patient had eventually died as a result of ovarian cancer which affects 6,500 women in the UK every year. Early diagnosis is critical to a woman’s chances of living for more than five years after diagnosis.

The MDU said that this particular form of cancer does present a significant challenge to doctors in terms of diagnosis because many of the symptoms, such as stomach pain and bloating, are identical to those of some other conditions. However Sutcliffe said that ovarian cancer is potentially so serious that if a doctor considers it as a possible diagnosis, the patient involved should be referred for further assessment, treatment or tests as a matter of course. Surely she is right that, with survival rates from ovarian cancer being so low, doctors should have it in mind whenever any symptoms occur which could possibly indicate it. What do you think? Let me know.

 

What is the standard of care for dementia patients?

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A new report by the All-Party Parliamentary Group on Dementia has found that less than half of those suspected of having dementia have been formally diagnosed while people who have been seen have often been forced to wait weeks or even months. If you have any views on the care and treatment of patients with dementia we would like to hear from you.

The report says that the average wait for an appointment in a memory clinic, a key part of the process, is three months and adds that even when people are seen, doctors may not provide an accurate diagnosis.

Baroness Sally Greengross, chairman of the Parliamentary group, says that there are wide variations in standards throughout the country but a priority has to be a formal diagnosis as early as possible and, as well as doctors needing better training in identifying the signs of dementia, those who fear they may have it should go and see their GP as soon as possible and not delay it through a feeling that it is merely part of the ageing process.

The need for better diagnosis is highlighted by a figure in the report which states that almost 60% of the 800,000 who have dementia never actually receive a formal diagnosis. Greengross says that doctors should ask more questions to identify who may be suffering from it, though they should also have better screening methods at their disposal.

The Department of Health says that diagnosis rates have improved from 33% to 42% within the last three years and there has been a substantial amount invested in memory clinics. Care Services Minister Paul Burstow says that the aim is for the UK to be a world leader in dementia treatment. Is the UK now not a world leader in dementia treatment and if so, where does it fail? We would like to hear from you!

 

The “death pathway”

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Six doctors who specialise in care for the elderly have said that too many people are being placed on a “death pathway” and claim that many hospitals are using it to ease the strain on their resources. Are some doctors using it inappropriately?

The doctors put the allegations in a letter sent to the Daily Telegraph and which was written in conjunction with the Medical Ethics Alliance. They claim that thousands of patients every year are put on the Liverpool Care Pathway (LCP), which was set up in the 1990s to ensure that those patients close to death are not subjected to unnecessary interference by staff. Fluids and medication are withheld and patients can be put on sedation until they die.

However, the doctors say that natural deaths are preferable and are often less painful and stressful for both the patient and their loved ones. They also say that in up to half of cases, informed consent isn’t sought by doctors, and this has led to more patients deciding to carry cards which state that they do not want to be placed on the pathway in the event their condition deteriorates.

In the letter the doctors say there is no “scientific way of diagnosing imminent death” and so it is essentially guesswork. They also argue that other factors such as that hospital’s resources are also taken into account and so there is concern that it could be used by some as a sort of cost-cutting measure.

The Department of Health rejected the idea that the LCP is a way of saving money, saying that it was an established and respected approach which had overwhelming support from clinicians at home and abroad. If you have any experience of the pathway we would like to hear what you have to say and in particular it is being used as a money saving exercise.

Further evidence of privatisation of NHS?

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A private health company, which runs a large amount of outsourced services for both the government and local authorities, is being investigated amid claims that it has provided an “unsafe” out-of-hours GP service. Is this proof of the problems that can occur within our cherished NHS if privatisation is allowed “by the back door”?

The claims follow an unannounced inspection from the Care Quality Commission (CQC) earlier this year, which is believed to have found queues on its telephone helpline of up to 90 patients with the company also failing to meet its targets, blaming the delays on patients. Serco has admitted some other allegations, including that it adjusted waiting times and making calls to patients who had waited a long time for treatment, offering them a new date, but said that it always acted within the terms of its contract.

The complaints relate to Serco’s contract with the Cornwall NHS PCT which began in 2006 and which was renewed last year, which is valued at £6.4m a year. However, even before the involvement of the CQC, there had been allegations that shifts for doctors and nurses had often been left unfilled and target times were repeatedly missed. Staff shortages in the call centre, which logs all patient calls, have been blamed for many of the problems which have occurred.

The company also denied that it had just one or two GPs covering the whole of Cornwall at any one time and said that it employed a range of skills across the county to meet patient needs and the PCT requirements. It also said that it had consistently achieved the target times for home visits.

The coalition government has said that all 52 PCT clusters in England must identify a minimum of three of their services to be put out to competitive tender, which will result in greater involvement in the private sector within the NHS. Serco is expected to bid for many of these NHS contracts. What are your views on that issue, specifically on whether services should be put out to competitive tender? Perhaps claims about Serco’s service mask the underlying issue which is the creeping privatisation of the service as a whole. Any thoughts?