Page last updated: 29-SEP-2009

Complaints

ONS kitemark Statistical Publication Notice

29 September 2009

NHS Complaints .

INTRODUCTION

The NHS Complaints system can be a powerful force for making things better, both for individual complainants and for the wider NHS, thus creating a culture of learning from mistakes and putting things right - a key objective for the NHS in Scotland.
 
Complaints about the NHS are a valuable way of identifying issues in the service where change is needed.  Acknowledging these issues and taking steps to rectify any problems is vital to create an open and honest NHS.  Complaints should be welcomed with a positive attitude and valued as feedback on service performance, driven by the search for improvement in the organisation and not the apportionment of blame.
 
The complaints system requires the whole organisation to value and take ownership of complaints received.  Front-line staff, managers and executive officers all need to have defined responsibilities in welcoming and learning from complaints, in order to make a complaints management process truly effective.  It is crucial that complaints intelligence feeds directly back into service improvements.
 
Patients or perhaps a relative on behalf of a patient can make a complaint if they feel dissatisfied with any aspect of their episode of care or other factors such as facilities or the place they are seen in.  There is an incredibly wide variation in the type of contacts that patients have with the NHS - such as treatment as an Inpatient, Outpatient, at A&E, the donation of blood or transportation by ambulance, to name but a few. 
 
Complaints received by the NHS are a relatively rare occurrence. In 2008/09, there were 6,904 complaints received about Hospital & Community Services.  For Family Health Services, there were an estimated 3,175 complaints received in 2008/09.
 
The independent review stage was removed from the procedure in 2005 to enable a faster process and to allow the introduction of independent scrutiny at an earlier point. Any individual who cannot get a complaint resolved on a local level can turn to the Scottish Public Service Ombudsman's

KEY POINTS

  • The number of complaints for Hospital and Community Services has continued to fall  in recent years, with 6,904 complaints received in 2008/09.
  • 68.4% of complaints were dealt with within the national target of 20 working days in 2008/09. 
  • In 2008/09, around 37% of all issues raised related to staffing issues, and 29% related to treatment.  Around 14% of issues raised related to environment and domestic issues.  The percentage of issues relating to waiting times was 10%.
  • The number of complaints for Family Health Services was estimated at 3,175 in 2008/09, and we expect to confirm a slight increase when compared against 2007/08 (3,073 complaints received). The totals for Family Health Services in NHS Highland are to be finalised, and as such an estimate based on the previous two-years data has been used in the interim and applied to the national total.

INTERPRETATION

In NHS organizations across Scotland, there was a lack of consistency when using codes to record complaints made against an NHS service. Each Complaints Office follows general guidance about complaint recording within the NHS, but may also use their own local set of categories to register the details, or have their own interpretation of how to complete the dataset. With the development of a new national dataset, ISD has built an NHS Complaints system containing revised codes and detailed definitions. These definitions and codes will be used nationally to ensure consistency with recording practices from Board to Board within the NHS.
 
Implementation of the new dataset for Hospital & Community Services commenced mid-way through the latest reporting year. The new data have been mapped to ensure we can provide consistent reporting measures for the full year in this release. System difficulties were encountered by a small number of suppliers, and they provided contingency extracts to ensure full submission for the year. The number of complaints has been signed-off locally and all data items have passed the validation process.
 
The statistics relating to GP and dental services are collated via an aggregated annual return of the total number of complaints made against Family Health Services in the previous financial year. ISD are in the process of confirming the return for NHS Highland and have presented an estimate based on the two previous year’s data as an interim measure. We have applied the estimate to the Scotland total as it constitutes such a small proportion (approx. 5%) of that figure.
 
Trend data for the Scottish Health Council, the Special Boards and National and Support organisations which are listed below, are only available from 2006/07. 
 
  • The National Waiting Times Centre (previously known as the Golden Jubilee National Hospital);
  • NHS Education for Scotland (NES);
  • NHS Health Scotland;
  • NHS Quality Improvement Scotland (QIS);
  • NHS National Services Scotland (NSS);
Interpreting the complaint numbers for Highland and Greater Glasgow and Clyde NHS Boards must be treated with caution when looking at data prior to 2005/06.   These Boards absorbed the complaints for Argyll and Clyde NHS Board, which was dissolved on the 1st April 2006.    
 
Revisions to the complaints process in 2005 were intended to remove some of the barriers which may have stopped some people complaining about the NHS in previous years.  For instance, if a complaint is being made regarding a General Practitioner (GP), then the complainant can now contact the NHS Board Complaints Officer, or go to the Independent Advice and Support Service instead of initially contacting their GP.
 
Citizens Advice Bureaux across Scotland are now funded by local NHS Boards to deliver the Independent Advice and Support Service (IASS).  IASS aims to support patients, their carers and relatives in their dealings with the NHS and in other matters affecting their health.

DETAILED FINDINGS

  • After a gradual rise in the number of complaints received about Hospital and Community Services from 1999/00, this number has continued to fall in recent years (7,387 in 2006/07; 7,290 in 2007/08 and 6,904 in 2008/09).
  • Of the 6,904 complaints made about Hospital & Community Health Services in 2008/09, 4,921 (71%) relate to the acute service area.
  • During 2008/09, 2,176 complaints about Hospital and Community Health Services related to Outpatient appointments. Currently in Scotland there are approximately 4.5m outpatient attendances per year.
  • The percentage of complaints acknowledged within the national target timescale of 3 working days from receipt was 94.4%. In 2007/08, 94.5% were acknowledged within 3 days.
  • The speed of dealing with these complaints within the national target of 20 working days has increased to 68.4%, when compared with 2007/08 (67.2%). This is the highest completion time for ten years (74.6% in 1998/99). Public holidays have been taken into account when response times have been calculated.
  • The median time taken to deal with complaints was 18 working days in 2008/09.  This figure has not changed since 2007/08.
  • Consultation has taken place with individual boards regarding variations in their 2007/08 and 2008/09 20-day response measures. Those showing the greatest drop have explained that this has been caused in the main by implementation of new complaints recording systems and staff shortages. All have reported positively that these problems have been addressed and this should be reflected in future statistics.
  • Over half the issues raised in 2008/09 concerned staff and treatment. Staffing accounts for 37% of all issues, and is the most common, with 29% of issues relating to treatment. During 2008/09, 10% of issues related to waiting times.
  • Within the broad category of ‘staff’ issues, the attitude/behaviour of staff (17%) and aspects of written and oral communication (16%) were the issues most commonly raised. 
  • In 2008/09, 27% of complaints were fully upheld, 33% were partially upheld and 38% were not upheld. In 2007/8 these were 24%, 36% and 39% respectively.
  • The number of complaints about Family Health Services in 2008/09 is estimated to be 3,175. If confirmed, this would indicate a 3% increase since 2007/08 (3,073 complaints).
  • The total number of complaints relating to the Special Health Boards; National & Support organizations and the Scottish Health Council has risen by 14% from 781 in 2007/08 to 888 in 2008/09. 
  • Complaints to the Scottish National Blood Transfusion Service (SNBTS) have increased from 197 in 2007/08 to 281 in 2008/09. Around 300,000 donors attend blood donation sessions in a single year, equating to a complaint incidence (% of attendances) of only 0.09%. The biggest rise in complaints is in relation to donor waiting times, with 84 complaints received in 2008/09 compared to 40 in 2007/08. SNBTS are trialing different approaches, including appointment and slot systems, to manage and reduce waiting times.
  • The number of complaints to NHS24 has again fallen. In 2008/09 there were 109 complaints compared to 149 in 2007/08; a 27% reduction.  
  • During 2008/09, 356 complaints were made to the Scottish Ambulance Service. Currently in Scotland there are over 2m ambulance transportations per year.
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MAIN CONTACTS:

Richard Dobbie
Principal Information Analyst
0131 275 7732
richard.dobbie@nhs.net

Frank Clarke 
Information Analyst
0131 275 6148
f.clarke2@nhs.net

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GLOSSARY:

Definition of 'complaint' In the NHS complaints procedure a complaint is defined :

"A complaint is an expression of dissatisfaction requiring a response."
Citizen's Charter Complaints Task Force

The data submitted to ISD includes all formal written complaints. Note however, that there is a variation in recording practice across Scotland and some NHS Boards / organisations include telephone and other formal oral complaints. Complaints which were initially made orally and subsequently made in writing are also included. Further investigation into the consistency of recording practices in the NHS Boards and organisations across Scotland will be undertaken in future months.

Complaints 'received' / complaints 'dealt with' Information is shown on all complaints received within financial years, from 1996/97 onwards.  In a small number of cases it is not possible to report on the response times or outcomes of complaints as the response is not known. Such complaints are classified as "response not known".

Issues raised For any one complaint a maximum of three different types of issue may be recorded for national returns and for this reason the total number of issues recorded may be greater than the total number of complaints.

Staff group For each complaint an associated staff group is attributed.  This does not imply, however, that a particular member of staff in that group was directly involved in the circumstances leading to the complaint.  For example, a complaint against a hospital for its lack of car parking facilities would be coded under "Division administrative staff/members".

Time taken to acknowledge The time taken to acknowledge a complaint is calculated using working days.  Analysis for 2005/06 onwards has been updated to exclude public holidays, however analysis prior to 2005/06 does not take into account any local or national public holidays.  Any investigation of a complaint completed within five days of receipt is notionally treated as if it had been acknowledged within three days, irrespective of whether a formal acknowledgement was actually made in that time.

Time taken to respond The time taken to respond is calculated over 20 working days (20 working days is the equivalent of 28 calendar days).  It should be noted that for analysis prior to 2005/06 public holidays are not taken into account when response times are calculated.  Analysis for 2005/06 onwards has been updated to take account of public holidays.

Median time taken to respond The median is a useful statistic for comparing response times between organisations.  The median number of days taken to respond to a complaint is such that half of all complaints received were responded to in less than this time, and half were responded to in more than this time.  Note that the median is used in preference to the mean (average) to ensure that complaints that took a long time to resolve do not skew the overall picture, which could present a misleading view of how long it takes to deal with complaints on the whole.

Calculation of times The time taken to acknowledge and respond to a complaint is calculated using the date of receipt of complaint at, and the date of despatch from, the Division or NHS Board.  This excludes any delivery time between the complainant and the Division/NHS Board.

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PRE-RELEASE ACCESS:

Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
NHS Board Chief Executives
NHS Board Communication leads
Complaints lead contacts at special boards and national organizations
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
 
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HISTORY OF THIS PUBLICATION:

Last Published: 30/09/2008
Next Due: September 2010
Data Available Since: First publication of 1995-1997 data in 1998

 


Main contact: Email Richard Dobbie