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Experiences from the frontline

Rob Behrens talks to staff on the frontline at the Walton Centre NHS Trust
Parliamentary and Health Service Ombudsman

Understanding what it's like 'on the ground'

In my first blog, I said it was critical that we keep listening both to the people who use our service and the organisations we investigate. Since taking up post I’ve been keen to get out and about and meet stakeholders, whether they are complainants, advocacy groups or organisations that we investigate.

To get to grips with what it’s like responding to patient feedback ‘on the ground’, I recently visited some NHS trusts where I met senior leaders, complaints teams, frontline staff and patients. I was quite frank at the start of each visit: as well as gaining an insight into the organisations, I wanted to know what they thought about us and our work.

My first visit took me to the specialist Walton Centre NHS Foundation Trust in Liverpool. Rated ‘Outstanding’ by the Care Quality Commission I was eager to understand how they’d achieved this and what made the organisation ‘tick’.

The Walton Centre’s strong commitment to patient experience was particularly evident; the senior leadership, the complaints teams and frontline staff I spoke to were committed to continuous improvement and saw responding to patient feedback and complaints as central to this. The Trust had also focused on staff health and wellbeing as they saw a link between mistakes and staff feeling stressed and unable to cope.

Supporting the NHS to 'get it right first time'

I was interested to hear complaint handlers say they would benefit from more skills development and more detailed national guidance on what good local complaint handling and investigations look like. This might help to ensure the NHS works in a consistent way on complaints.

On starting my role I’ve been keen to understand what guidance and standards currently exists relating to what ‘good looks like’, to see what more we and others can do to strengthen this. While our role is to make final, impartial decisions on complaints that come to us, we should support the NHS as much as possible to ‘get it right first time’ for the public. We will look at how we can build on ‘My expectations for raising concerns and complaints’ and the Ombudsman’s Principles.

I was pleased to hear that our communication had improved, including keeping organisations better updated and sharing our ‘emerging thinking’ during investigations – part and parcel of our Service Charter commitments.

Practical challenges

I got a sense of the practical challenges complaint teams face in their day-to-day work, whether it’s chasing clinicians for responses or dealing with emotionally-challenging situations. I heard that complaint handlers are not necessarily expected to complete, or offered, professional training or qualifications.

As a result, the experience and knowledge required differs between organisations and staff grades and numbers in a team can vary significantly. A key theme emerging is that complaint managers need to be given the status and respect they deserve, as a significant part of their role is challenging colleagues and acting as the experts in investigating and responding to complaints.

I also recently visited two NHS trusts in and around Nottingham where I spoke to dedicated staff who told me about their work in responding to patient feedback. Both trusts are involved in the local Sustainability and Transformation Plan (STP). Billed as local areas’ plans for joined-up health and care services, I was keen to understand the challenges and opportunities for STPs in improving user experience and services.

My abiding memory from meeting staff, doctors and nurses in Nottingham is of professional, committed and hard-working colleagues working with determination and skill, and keeping patients at the centre of their concerns and processes. I will be drawing on contacts made in both Nottingham and Liverpool to develop the necessary dialogue an Ombudsman service must have to ensure it remains relevant, informed and user friendly. 

Celebrating the work of carers

Finally, as it is Carers Week, I want to reflect on the visit I made to a truly inspirational carer in Nottingham, who welcomed me into her home to discuss the challenges and joys of looking after a severely disabled son. Carers are the unheralded foundation of our health and social care system. Their support for vulnerable people, who are sometimes unable themselves to complain when things go wrong, is a key feature of altruism in practice.

My visits so far have been hugely helpful and I look forward to getting out and about even more over the coming months and sharing with you the insights I gain as a result.