In a three year period before 2008, between 400 and 1,200 more patients died at Mid Staffordshire NHS Foundation Trust than would have been expected.
The first indication something was not came in the summer of 2007, when monitoring unit Dr Foster alerted the Healthcare Commission to the trust’s high mortality ratio.
The trust argued that the alarming figures might be down to recording problems, rather than care problems. But this didn’t stand up through subsequent inquiries into what became a scandal.
First, the Healthcare Commission found there had been a “shocking” level of care provided to patients in a number of wards and to those admitted through A&E.
Then, an independent, inquiry led by Robert Francis QC, confirmed the Commission’s conclusions.
One of Francis’ most significant observations was that the trust did not have an effective way of dealing with the high level of patient complaints that it was receiving.
“Replies to complaints were often provided too slowly and did not always address all the issues raised. There was a formulaic approach which appeared to value process over substance,” Francis’ 2010 report concluded.
“A particularly disturbing feature of the complaints process was that the trust often did not apply effective remedial action.”
Francis was also concerned that the trust’s chief executive and board were not aware of the scale and nature of the complaints, because of the bland way they were presented in reports.
When the present, coalition government came to power, new health secretary Andrew Lansley ordered a new, public inquiry into Mid Staffs.
This inquiry, which is also being chaired by Francis, is now investigating the role of commissioning, supervisory and regulatory bodies and systems in detecting and correcting deficiencies – such as the ineffective complaints processes.
It is holding a number of public seminars to discuss issues and ideas. At one of these seminars this week, social media was proposed as a way for patients to deliver rapid feedback to organisations on their experiences, and to overcome some of the problems of the notoriously slow and confrontational NHS complaints process.
The chief executive of Patient Opinion, Paul Hodgkin, said embracing social media would give the NHS an extremely powerful tool to process complaints – because it is virtually free and easy to use for both patients and organisations.
“That is a massive free resource that the NHS has never really learnt how to tackle,” he said. “Everybody having a voice - be it on Facebook, Twitter, Patient Opinion, or blogging - alters the dynamic.
“We’ve never been able to access your desire to have great care previously because it’s always been too expensive; now we can.”
Collecting Patient Opinion
Patient Opinion is a not for profit organisation which allows the public to tell ‘stories’ about their hospital and GP care – whether they be good or bad.
To date, more than 33,000 people have submitted comments about a trust. All the comments are openly published, although Patient Opinion offers services to direct them to trust managers and others with an interest in the NHS, such as commissioners and MPs.
Trusts are encouraged to respond, and make changes if needed. It’s all a long way from the situation at Mid Staffs, where Francis said he knew of family members being bundled into broom cupboards to ‘resolve’ complaints.
“It is great if you can get it right, and it will help stuff like mid staffs less likely to happen in the future,” Hodgkin told eHealth Insider.
About 120 NHS trust have become involved with the site, which has led to nearly 200 changes within trusts as a result of the comments posted online.
However, not all trusts have chosen to respond. University Hospitals of Leicester NHS Trust, to take just one example, has had about 70 comments posted, but hasn’t offered a single response.
One observer at the seminar said it was all very well enabling people to post comments online, and even having them respond, but getting further action taken was more difficult. “It is very easy for someone in the PALS (patient advice and liaison service) to make a response, but quite often nothing happens,” they said.
Hodgkin concedes that there is still work to be done. “There’s a way to go yet, and in my view that’s understandable because this is scary stuff, and [trusts] have got other things to do, but we will get there.”
Patient Opinion is working on a way to publicly rank trusts in regards to their rate of response. Seminar participants expressed concern that this would ‘seal-club’ smaller trusts. On the other hand, they agreed it would make trusts more likely to contribute to the open complaints process.
Learning from retail – or not
The seminar also heard from University Hospitals of South Manchester NHS Foundation Trust, which has worked to rejuvenate its staff culture when it comes to complaints, and is using its Hospedia bedside patient information systems to capture instant feedback.
Although it is not currently involved with Patient Opinion, its chief executive Julian Hartley, said he was enthusiastic about changing that after seeing Hodgkin’s presentation.
“We use NHS Choices a lot and we’re looking into what more we can use in terms of feedback from patients,” he told EHI. “I think it’s really helpful to try to find methods to get patients’ feedback in real-time, quickly, and use the technology that’s available right now to do that.”
Retail experts from John Lewis were also called on to give evidence about the partnership’s dedication to effectively resolving complaints.
One of its executives told the seminar that because all its staff are partners in the firm, they all take responsibility for maintaining the image of the business and resolving complaints.
Many of those attending the seminar felt this was not relevant to the NHS. But Francis disagreed. “If only the health service paid as much attention to complaints then we might be in a better place than we are,” he said.
Francis concluded by saying the NHS needs to be open to new ways of capturing and using patient feedback.
“I want to know how complaints can be used better than what they are at the moment.
"I would like to know how to ensure that patients and the public’s views can be made to have more of an impact – how is it that we keep the thoughts and experiences in front all those people who make the decisions that actually end up with the results?”
Francis’ report detailing lessons learned from the second inquiry, and recommendations for the government, should be published next year.