How can the NHS treat complaints?

When was the last time you were so angry at the service you received that you took the time to write in a formal complaint? Chances are that for every time you did so there were dozens of times were services fell far short of what you would expect, but you were just too busy, exhausted or cynical about the likely outcome to bother.

But how many people would an organisation have to be letting down, disappointing or generally messing about to receive no less than 305,264 written complaints?

NHS England has just released data which shows that a population equivalent to a city larger than Salford submitted written complaints in the past year. This is the highest total in the organisation’s history and exposes the remarkable scale of popular dissatisfaction with the UK’s largest public service.

Written complaints have jumped by 18.9% in the past year. In Hospital and Community and Community Health Services the increase is even higher at 22.4 per cent — meaning that those providers have seen complaints increase by almost a quarter in a year! These are the kind of increases which would ring alarm bells in any large company, suggesting a risk of a mass exodus of customers to competitors.

This is obviously not the case in the NHS. As Policy Exchange has argued in The NHS: A Suitable Case for Treatment, patients in the NHS benefit from very limited choice and competition. This means that the system within which many good and dedicated people operate will always mitigate against genuinely empowering patients and prioritising what they are most concerned about. With funding decisions made at a system level rather than being in the hands of patients as consumers, time, attention, care, effort and focus needed for excellent service is always more likely to be lacking. When it is present it will be because of individual dedication from staff, not as a result of a system designed to empower patients.

The long-idealised and venerated NHS has become a totem to producer capture, a manifestation of unresponsive, bureaucratic top-down direction in which the views of patients seem to matter rarely and for very little.

Many attempts have been made to enshrine the rights and voices of patients within the NHS over the years, including the Patients Charter (1991), The NHS Constitution (2012), the NHS Choice Framework (2016) and “You and Your General Practice” (2026) as well as broader initiatives such as the Citizens Charter (1991) While laudable in principle these documents often do not survive contact with reality when there is no mechanism for patients to enforce  them, and insufficient competition to compel providers to respond.

Building on earlier evidence of poor satisfaction levels with the NHS Policy Exchange’s report About Managing demonstrated how management in the health service lacks the capability to enhance performance and how very few managers are fired for poor performance.

As a further illustration of how insulated and unproductive NHS operations are Policy Exchange’s NHS Heal Thyself showed how sickness absence policies within the NHS are costing taxpayers billions of pounds a year, denying patients millions of days of clinician time and losing trusts the services of many highly trained clinicians over time as they go off long-term sick.

Once again, it is hard to imagine such systemic inefficiency surviving if organisations had to respond to genuine competitive threats.

It is telling that so many of the new complaints came in relation to communications, patient care and values and behaviours — this is in addition to the entirely expected very large percentage increases in complaints about waiting times. These are highly concerning areas to be falling down on and speak to a culture in which parts of the NHS see the patient as a burden and an imposition, rather than as a valued customer.

There is also an increase in complaints related to clinical practice, with areas with the most new complaints (surgery and obstetrics and gynaecology) and the largest percentage increases (paediatrics, dental and surgery) being notable for the likely relatively high levels of vulnerability or anxiety of patients seeking care in these areas.

That some of the people needing the most compassion and humane care are increasingly likely to complain about their treatment throws into stark relief the scale of the problems with the health service. Problems which we are doing no one any favours by hiding or excusing.

There is always going to be a case for additional funding for healthcare but the UK spends more as a percentage of GDP on healthcare than some of the best performing healthcare systems around the world, such as the Netherlands. In addition, the same 12 month period in which this increase in complaints was observed saw substantial real-terms increases in health budgets of over 2.7 per cent. Patients accordingly are paying a higher price tag for a service and finding more problems with it at the same time.

The forthcoming budget is projected to increase NHS spending by 3 per cent in the next year, yet while the Health Secretary has recently been condemning some of the symptoms of a broken system such as “corridor care,” she has so far shown no appetite to tackle the structural failings at the root of them.

People are naturally wary when it comes to proposals for structural reform and many people’s gut reaction is to “let the doctors get on with doing their jobs.”  But while it is the job of doctors is to make sick people better, it is the job of politicians to make sure that our public services are delivering in line with public priorities and that public money is well spent. That includes making decisions about how services are delivered and held to account.

It is admittedly hard to imagine a Government half way through a Parliament setting out a radical new future for the NHS (anyone brave enough will need to do a lot of preparation, starting by reading our step-by-step guide: How to Save the NHS in 1000 Days). It surely is not too much to hope though that the Government will make further increases in NHS funding contingent on improved productivity, better management, and on tackling the immediate issues which caused 305,264 people to put pen to paper (or 305,265 if you count this plea for action!)