Health: An ear for patients' complaints: To victims of hospital bungling they are allies, to some staff they are spies. Lynn Eaton meets a new NHS breed

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An elderly patient had a letter notifying him of his next appointment with the consultant. He went along to the out-patients' department, where he had been seen previously, to be told the consultant was not there. Eventually it was discovered, too late, that the patient should have been in the operating theatre for minor surgery instead.

The man dropped a note into a 'comment box' at the hospital, apologising for going to the wrong place, although the mix-up was the hospital's fault.

June Leat, the patient representative at Frenchay Hospital, Bristol, says: 'The letter this patient was sent didn't even use the word surgery. There was no mention of what the appointment was for, nor of where the patient should go when he got to the hospital. All it said was, we have made an appointment with this consultant, come on this day at such and such a time.' As a result the hospital had wasted staff time and money, and caused the patient anxiety and a further delay in surgery.

The missed operation is just one of several problems that have come to light since Ms Leat started work as a patient representative, employed directly by the hospital, just over a year ago. The hospital created this experimental post, based on an American model, soon after it became a trust in 1992.

Her role is not just to deal with complaints: she welcomes comments on any aspect of a patient's visit, and tries to eliminate shortcomings in the service offered. Unlike many nurses, she has time to listen. 'It's about being the human face of the NHS bureaucracy,' says Ms Leat. 'If patients want to talk about any aspect of their stay, we want to listen. We are catalysts for change.'

A hospital stay can be an alienating experience. A patient may be anxious or in pain, but reluctant to make a fuss, for fear of upsetting staff. And the health service bureaucracy has never made it easy to complain. Instead of viewing complaints positively, as a measure of how satisfied people are with the service, hospital managers have been inclined to see them as a threat.

Patient representatives, however, actually go in search of comments, flyposting the hospital with posters bearing their photograph, and leaving leaflets in wards and out-patient clinics.

Mixed-sex wards are one of Ms Leat's most recent concerns. After numerous complaints, mainly from women, she discovered that the hospital was not keeping to its policy on mixed-sex wards. Patients were often not told before admission that they would be on a mixed-sex ward; there were no partitions between beds; and no separate lavatories for the different sexes.

'Nobody had gone back and reviewed that policy with a proper audit process,' Ms Leat says, admitting that the discovery has made her unpopular with some hospital staff.

Bec Hanley was, until recently, the patient representative for the five hospitals run by Brighton Healthcare NHS Trust. Among her achievements are improved signposting (patients were getting lost and arriving late for appointments) and the inclusion of halal and kosher meals on the menu cards. The alternative food had always been available, but because it was not specifically itemised on the menu Muslim and Jewish patients assumed - hardly surprisingly - that it was not.

The service provided is confidential. If a patient does not want a complaint taken further, the representative abides by that. But if several patients make the same complaint, against a particular doctor for example, a report, protecting patients' identities, will go to the chief executive.

Only a handful of hospitals have made similar appointments and the titles and roles differ widely. Hospital staff, says Ms Hanley, were at first suspicious of having a potential 'spy' in their camp. But not all the news is bad: many patients use the comment boxes to say what wonderful care they have received, which, when passed on to staff, can give a much-needed boost to morale.

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