Last year the Government consulted on reforming the current complaints processes for users of publicly funded health and social care in England. A two stage model for complaints handling across health and social care is proposed: first, local resolution and, second, the Health Service Ombudsman, bringing to an end the Healthcare Commission's second stage for NHS complaints. This mirrors a commitment in Our Health, Our Care, Our Say (January 2006) for implementation by 2009, and is intended to bring in a single set of complaints arrangements that can cover as many providers and commissioners as possible.

The key objectives proposed for service providers and commissioners are to:

• deliver a simple, consistent, unified approach across health and social care
• generate a culture within organisations of openness and fairness when dealing with complaints
• emphasise local handling and early and effective local resolution
• make available investigation that is fair and proportionate to circumstances and seriousness
• take account issues of patient/user safety, protection of vulnerable people, and complexity
• facilitate a complaints process at local level and through investigations that is a lever and support for organisations improving quality and safety of services
  
  

Criteria proposed for the new arrangements:

• Open and easy to access - flexible about the ways people can complain and with effective information and support for people wishing to do so, including specialist advocacy as appropriate
• Fair - emphasising early resolution and minimising the strain and distress for all those involved
• Responsive - providing appropriate and proportionate response and redress
• Providing an opportunity for learning and developing - ensuring complaints are treated as a positive opportunity to learn from service users' experiences and views; to drive continual improvement in services; and make this demonstrable
  
  

What do the changes mean in practice?

• Trusts will be encouraged to better respond to cases through measurable national standards, which are focused on local resolution.
• Boards will have a clear legal responsibility for responding effectively to complaints and ensuring that lessons are learned from them.
• Increased focus on patient outcomes.
• Commissioners contracts will need to clearly set out the expectations for the trust's performance. Complaints handling by trusts will also be expected to inform commissioning decisions.
  
  

NHS Redress Act 2006

Principles in this act are equally applicable to complaints system: when things go wrong the response should be honest and open; people should have a say in how the case is handled; and people should be reassured the organisation learns from their experience.

Regulator

It is proposed that the regulator will no longer have a role in processing individual health complaints. The regulator's role would be to check that all organisations (public and independent sector) have appropriate complaints systems in place, look at outcomes of complaints, focus on standards of complaints handling and implementation of learning.

Ombudsman

The role of the Ombudsman would remain unchanged. That is, if the service provider or commissioner doesn't put things right through local arrangements, the Ombudsman would still investigate and provide the ultimate independent view of what happened.

Making experiences count: Early Adopter sites

An early adopter (EA) programme has been established to assist in developing arrangements for more effective timely local resolution and to identify and solve issues linked to transferring to a two stage complaints system. A number of organisations across health and social care economies and in each SHA region are currently taking part in the EA programme and are trialling the unified approach proposed for 2009 alongside the existing complaints system. Best practice and learning from these sites will inform the development of a tool kit and ensure that the new system is fit for purpose.

The NHS Confederation is keen to ensure that the system is designed for effective local resolution that limits a potential growth in the volume of Ombudsman cases. We are keen to hear ongoing feedback and concerns from organisations involved in the EA sites. Please forward any comments to Claire.mallett@nhsconfed.org