Andrew Medlock, Assistant Director of Customer Services reflects on our first conference for advocacy providers.
'You can't leave, dear', hospital staff repeatedly told an elderly lady, despite her having the right to discharge herself from hospital. With the exception of patients detained under the Mental Health Act, everyone has the right to decide when they want to leave hospital and to refuse treatment, including medication.
Poor communication from the NHS and issues around hospital discharge are just some of the problems that advocates told us their service users (clients) face when we met with them at our first conference for NHS advocacy providers, held in October 2015.
Advocates play an important role in helping people to understand and negotiate the often confusing NHS complaints system. They also help clients to communicate more effectively with us. This support is clearly valuable: typically 49% of people using our service for the first time, and who have used an advocate to bring their complaint to us, see it go on to be investigated by us.
During the conference we ran workshops with advocates to get a better understanding of the top issues that their clients complained about, and what worked and did not work in the local NHS complaints process. The increase in the number of cases we now investigate gives us greater insight into the issues concerning people about the NHS. The feedback and discussions that we had at the conference made it clear that there are real benefits in sharing key insights gained from our casework, to help us identify and look into these problems.
The issue that advocates raised the most was mental health. This resonates with our own casework. In 2014-15 the number of investigations we completed into mental health, social care and learning disability trusts increased by 14%. At the conference we learnt that people experienced delays in accessing mental health services, particularly child and adolescent mental health services. Advocates also mentioned misuse of 'sectioning' under the Mental Health Act. One attendee told us about a phenomenon he called 'voluntary sectioning'. This is where patients are told they cannot leave a setting despite not having been sectioned under the Mental Health Act.
In one of our own investigations, Ms C experienced a delay of several weeks after her GP referred her for an urgent assessment by a community mental health team. Read the full summary here.
Communication was another top issue, the 'bedrock' of good complaint handling in the words of one advocate. Advocates highlighted poor communication between their clients and the NHS, and a lack of reasonable adjustments such as interpreting services for Deaf people at GP surgeries, as key reasons for complaints.
This is something we see in our casework too. One of our investigations found that a Deaf patient did not have access to a British Sign Language (BSL) interpreter during GP appointments for three years. You can read more here.
Defensiveness of staff stood out as another key area for improvement – one advocate said 'trusts can try their hardest to avoid apologising'. This was particularly interesting because in our recent report on acute trust complaints, we found that people often come to us because they feel they have not had an adequate apology.
Advocates also raised specific concerns about unfair removal from GP patient lists and GP complaint handling. We are already leading work with the Care Quality Commission (CQC), NHS England and Healthwatch England to improve GP complaint handling across the NHS. Our publication My expectations for raising concerns and complaints is a user-led vision for good complaint handling. The CQC is now using this framework in its inspection regime.
Advocates said that where the NHS had dedicated complaint investigators, their clients felt listened to, regardless of the outcome. However, organisations that lacked such teams might have competing priorities and see complaints 'as a pain'. Early local resolution meetings also worked well, because they avoided the frustrating 'ping pong with letters'.
As the final stage of the NHS complaints process, we see around 1 in 10 of the complaints made to the NHS. Therefore, we want to strengthen our engagement with advocates so that people who need support to bring a complaint to us get that support. We also want to give advocates' clients a better service. Understanding how we and advocacy organisations go about our work is key to this. Our service charter, which we will soon be consulting on, will help by setting out what people can expect when they bring a complaint to us.