Department of Health

Website of the Department of Health

Please note that this website has a UK government access keys system.

You are here:

Good practice

Complaints managers can learn from experiences and good practice of their colleagues in different parts of the NHS. This section covers case studies, which include learning from mistakes. There are also examples of good written procedures to help guide the work, as well as guidance to staff about responding to complaints. Monitoring is key and there are examples of forms that you can use.

Case studies

The case studies included here show how a small general hospital situated on one site has successfully brought public and patient services together and how a major teaching hospital in London has learned from complaints. Other topics include dealing with a complaint covering more than one Trust and how to handle a complaint against a Trust that uses facilities on your site. All case studies are in Portable Document Format :

Procedures in place

Many Trusts have established written procedures to guide the work of the complaints manager and NHS staff involved in responding to patients. Here are some examples in Portable Document Format  :

How to respond

St George's, Tooting has put together a Resource Pack which goes through the stages of handling formal complaints. It includes a one-page guide to handling complaints, responding to complaints, guidance on writing statements, and guidance for clinicians, A presentation produced by University College Hospital, London, introduces new staff to complaints issues. UCH has also produced two response templates

Monitoring and learning

Complaints are an excellent resource in aiding an organisation to improve. To achieve this, organisations need to monitor complaints effectively so that there is information for benchmarking trends as well as for making changes. Following through the progress of complaints internally is important, and the University College Hospital Trust has developed templates to help check on this work.

An internal and external function

An internal and external function

The complaints function needs to encompass both an internal and external perspective. Within the organisation, the operational lead for monitoring complaints may well be the Complaints Manager/Officer and or their line manager. However, the Board has overarching responsibility for monitoring complaints and effecting change.

In addition, there are a number of external stakeholders who could also monitor complaints. These include:-

  • Healthcare Commission
  • ICAS
  • Local MPs - as they may have contacted the organisation about a complaint from a particular constituent
  • Patients' Forum

The internal data collection process needs to be sufficiently robust to be able to provide accurate information for completion of the regular statistical returns (ie. Korner) whilst at the same time ensuring that the data collection reflects wider information needs - i.e. diversity monitoring data. (See also the section on Confidentiality).

Collection of statistical data, though an important aspect, is only one element of the monitoring process. It is important to recognise the various routes, where information could be sourced in order to provide a wider perspective and aid the overall monitoring process. These include:-

  • Complaints Monitoring/Audit Committees - the membership of which could include Non-Executive Directors; Patient Advisory Liaison Officers, General Managers; members of Community Health Councils / ICAS and users
  • Clinical Governance Committees
  • Incident / Claims Committees
  • staff concerns - there may well be developed mechanisms within the organisation for acquiring information from staff - i.e. staff surveys / satisfaction forms/incident forms / complaints' surgeries etc.
  • soft information - which may come directly from users or user representative groups (e.g. Patients Forum) or from staff groups (e.g. PALS and other front-line staff, such as receptionists).

When collecting information for the purpose of monitoring, it is essential to be mindful of the issues of confidentiality, as health information is collected from patients in confidence and attracts a legal duty of confidence until it has been effectively anonymised. When monitoring complaints, it is however, crucial to create the right balance between anonymity and usefulness, to aid learning within the organisation.

Analysing and learning

Analysing and learning

Information/data once collected can only be useful to the organisation's processes if it is analysed and reported on. Good practice should ensure that Boards are regularly updated on:-

  • the information collected through the monitoring functions
  • analysis conducted
  • trends identified
  • any remedial actions taken ( e.g. to ensure more effective methods of working/changes in practices)

It is, however, essential that this information is viewed by Board members in the context of associated issues, such as clinical governance; risk management; and as such should be presented to them in a holistic manner. Many organisations will have identified a Board level member to 'champion' complaints on behalf of the organisation.

Having gathered the information/data and analysed it, consideration needs to given to the learning from this process and more importantly, the need to put this learning into action. The Complaints Manager should facilitate this process by identifying where improvements to services can be made and influencing change. This can be effectively achieved by close working relationships with:

  • the Board-level champion
  • service / other managers
  • policy advisors - internal and external

The Learning Mechanism

The mechanism for learning should be multi-faceted and a continuous process:-

  • Learning from individual complaints;
  • Anonymised Independent Review Panel reports
  • Trend analysis
  • Stakeholder discussions
  • Training (initial and on-going)
  • Care standards - complaints viewed as a resource
  • Through effective performance management.

Improvement systems should include various internal and external stakeholders. For example:-

  • complaints staff;
  • those complained against and associated service managers; and
  • user representation

Having identified the learning actions, it is important to recognise the need to make change at a local unit level but also, where appropriate, to ensure that the learning/change is cascaded through the various levels within the organisation.

The Ombudsman's view

Markers of success in good practice in complaints management (from the Health Service Ombudsman's Annual Report 2000-2001):

Complaints are more often dealt with successfully when NHS organisations:

  • train clinical staff to recognise potential complaints, and to deal with them
  • support clinical staff in that aspect of their work
  • choose an appropriate and proportionate approach to investigation
  • involve clinicians from the outset
  • provide training and support for staff who investigate complaints
  • assure sound communications with patients, relatives and complainants, during and after the investigation
  • link their work on complaints with other aspects of corporate and clinical governance
  • include information about the complaints system in induction for all staff, including those rotating between posts and organisations

Access keys