Kieran Mullan: The NHS must stop hiding behind complex bureaucracy

The NHS complaints system allows mistakes to slip through the cracks

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Organisations such as the Patients Association rely on brave individuals coming forward to share their experiences of healthcare in the UK. Their abiding concern is often not for themselves, but for the patients of the future. They do not want anyone else to suffer in the manner in which they have, either as patients or as relatives of those unable to speak for themselves.

Our most recent report, Patients Not Numbers, People not Statistics, featured 16 case studies of poor care in National Health Service hospitals which, many people have assumed, represented the worst of what we have been told and only a small number of people. In fact, according to the Care Quality Commission, the Government's watchdog, around 2 per cent of NHS hospital in-patients are dissatisfied with the care they receive. While that may not sound like many, over the last six years it amounts to more than one million people.

I would like to tell you the story of one of them, whom we shall call Patient B. We didn't include the case in our report, but her story shows how all healthcare professionals need to ensure they always put patient care as their first priority.

Patient B was admitted to a hospital after developing a serious infection that required treatment in intensive care. After making an initial recovery Patient B began experiencing weakness in her shoulder and then her legs and arms. Staff on the ward were unconcerned and took little action as the symptoms worsened. Eventually a physiotherapist was brought to assess her. Patient B told us how this allied healthcare professional didn't believe her symptoms were genuine. Patient B was told that she was being lazy as she asked for help with toileting, eating and drinking as her strength deteriorated. She was visited by a hospital consultant making a general round on the ward. He asked her how she was doing, at which point she explained she was practically paralysed. He asked her why she hadn't told anyone.

On examining her he was sufficiently worried to schedule an emergency X-ray. The infection she had been suffering from had moved into the bones in her neck. She needed emergency surgery and has been left with a life-long disability.

The NHS is full of systems and processes for addressing patient concerns but little can be done to redress this kind of experience. What should happen is that bad experiences should be recorded and reforms made to ensure they are not repeated. However, the complaints systems, the Care Quality Commission, the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) rarely act in concert. And that means mistakes and poorly performing professionals continue to slip through the cracks.

The Parliamentary Health Service Ombudsman offers a power of review for people whose complaints to NHS bodies have been unresolved. But this service is underfunded and needs to move beyond reviewing case notes and making recommendations in writing. It should become a vociferous patient champion, following up complaints through visits and always making sure poor care and poor carers never go unaddressed.

We have been asked over the last few days what has happened to any of the nurses that have done and said some of those things that featured in our report, but the simple answer is that we do not know. Even when a patient makes a complaint to the ombudsman and it is upheld, unless the patient themselves knows about the NMC and its role in ensuring the good practice of all nurses, no one else will necessarily make an additional complaint. The ombudsman must start taking that role – if it is hearing about poor care, as well as visiting the hospital concerned and ensuring change, they should refer legitimate complaints they come across to the GMC or NMC, or at the very least, advise complainants on how to do so.

We need a system of regulation and supervision that is working for the patient. It is not good enough for letters to be written from London making recommendations to NHS managers and chief executives. They are preoccupied with targets and budgets, perhaps rightly so, but because of this, we need to make sure there is always someone over their shoulder ensuring that these priorities never overshadow patient care.

Much of the comment generated by our report has focused on nursing but it seems clear that to get the best out of our hospitals the reform must be broader than that. It is largely for the Royal College of Nursing, Nursing and Midwifery Council and nurses themselves to address the concerns raised about their profession by the report. But nurses are not the only ones to come in for criticism. It is now all too obvious that patients can have bad experiences at the hands of any healthcare professionals in any setting.



Kieran Mullan is the Policy Director of the Patients Association

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