Engaging with health services can be a trying time for patients and their families. Inevitably, sometimes, things will go wrong and when that happens, it’s essential that people should have easy access to explanations and redress. Patients and their families will want an explanation of what happened and, if possible, they’ll want to see it put right.
A recent article by Dr Jacky Jones in The Irish Times Health + Family supplement de scribed the difficulties experienced by an experienced professional in complaining on behalf of a family member.
If that was her experience, how daunting must it be for ordinary members of the public?
The health service in Ireland is very complex, with its mixture of public, private and voluntary provision and complex funding arrangements including medical cards and insurance, all of which makes it hard for citizens to know what to expect.
It also means that complaining, or simply getting an explanation, can be very hard to do. Recent evidence suggests that up to 900 people are involved in handling health complaints across the HSE.
Considering complaints
My office has been considering complaints about health services for nearly 30 years. People can complain to me when they have not got a satisfactory response from their health provider.
Although I can’t currently look at issues of “clinical judgment” (ie the judgment used to diagnose a condition or decide a course of treatment), in practice I am able to consider the majority of complaints and determine whether the individual has suffered an injustice as a result of a failure by the service.
Even where this has not been the case, my office is often able to offer a full explanation of what happened, as we find that poor communication often underlies dissatisfaction.
Complaints are very important to healthcare. As well as dealing with individual concerns, properly managed, they are a vital source of intelligence about failings in the health service.
A cluster of complaints about similar issues in a particular service can be a vital early warning sign of serious systemic failures.
Ignoring them, as was the case identified by Robert Francis QC in his report into the failings in the Mid-Staffordshire Health Trust in England, can lead to poor practice persisting and lives being lost.
I want to make the learning from cases considered by my office much more widely available and will be doing so by publishing a regular digest later this year. This will include a specific section on health complaints.
Those leading health provider organisations need to use the learning from complaints, alongside information about failures from other sources, to inform their planning and management.
It is also a vital tool for regulators such as Hiqa and the HSE in monitoring health provision.
I am concerned that the volume of health complaints to my office is relatively low compared to ombudsman offices in other jurisdictions.
I believe that this may in part be due to the failure of some health bodies to inform complainants of their right to come to my office if they are not satisfied with the response they receive.
It may also be because some complainants are worn down by the difficulties they experience in making their initial complaints, and by the protracted process which often follows. I am also aware that many complaints I receive show evidence of poor complaint handling, which exacerbates the original concerns.
Public views sought
For all of these reasons, I am planning to launch an investigation into the handling of complaints by some HSE services. I am interested in hearing from members of the public about their experience of complaining, good and bad.
My office has been engaged in a productive dialogue with the Department of Health and the HSE looking at individual complaints, but also looking at improvements to the health complaints system.
I will want to continue to work closely with them in undertaking the investigation and in implementing the findings.
I believe that a single, streamlined process for dealing with all complaints about the public service would help to ensure that service users know how to complain and what to expect when they do so.
An effective complaints process would first of all provide an opportunity for the frontline member of staff – a nurse, GP or social worker, for example – to put things right as soon as they happened, or to provide a proper explanation.
Where this doesn’t resolve the complaint, there should be a proper investigation designed to establish the facts and to determine what, if anything, went wrong and what is required to put things right.
This might be an apology, an explanation or compensation, depending on the circumstances. Any complaints not resolved at this stage should then have access to independent consideration by my office.
For this to work effectively, all frontline staff need to be properly trained in how to respond when a complaint arises. Investigations need to be conducted by staff who are trained in this work, and there needs to be effective processes in place.
The number of individuals currently involved seems much too large, and this will be one of the issues we will be considering.
For many people, their reason for complaining is to stop what happened to them or their loved one happening to anyone else.
We need to be sure that we are making it easy for people to complain and that we are learning the lessons that they teach us. Good healthcare requires learning organisations and that is what my office aims to promote.
Peter Tyndall is the Ombudsman. The Office of the Ombudsman examines complaints from the public about most public sector organisations. ombudsman.ie.
For information on making a complaint in the health sector: visit healthcomplaints.ie .
