Bureaucracies should not treat complaints as a threat

In a briefing last week we looked at a variety of statistics around the NHS and concluded that they imply that the NHS is undoubtedly under sever duress but that they do not stack up the partisan explanations for the problems being put forward by various political parties.

Today we are presented with an NHS waiting list statistic that tells a different and equally concerning story – because it isn't about the wait for care but the wait for complaints about care to be addressed. It shows that there is a substantial backlog of cases which have gone well beyond the target 20-day response, some taking as long as nine months to be examined.

There are two aspects of this which are warning signs for the NHS. The first is that complaints provide both an outlet for patient unhappiness (which in the long run creates consent for the entire system) but also act as a feedback mechanism on care practice and performance.

An effective patient complaints system takes patient worries seriously but then filters them and identifies those where there are serious lessons to be learned for good practice – and we do not appear to have that system. Complaint teams are small and overwhelmed and do not seem to have the capability to enable complaint processes to play either of these roles.

Indeed it is questionable whether hospital managers see the complaints process in these terms at all. We have seen repeatedly in scandals that have broken out in Scotland's NHS where the NHS management structure has clearly treated them as reputation management issues. Rather than trying to get to the bottom of failures, Health Boards appear to have prioritised cover-ups.

The complaint process can unquestionably be vexatious and given that healthcare often takes place at periods of maximum vulnerability it is understandable that many complaints do not stand up.

But the instance of serious complaints being systematically ignored are too common – hundreds of patients were harmed by surgeon Sam Eljamel and some of them were harmed in the period between 2009 (when whistleblowers first raised concerns) and 2013 (when action was finally taken).

What should worry us all is not only that those whistleblowers were suppressed and ignored but that the recently-appointed Patient Safety Commissioner says she is “not confident” those whistleblowers would be listened to today.

The second aspect is more fundamental. Scotland seems at risk of drifting into 'Narrowly Avoid Prosecution' territory. This is a term used colloquially in the construction industry to indicate that the goal isn't to follow rules but to make sure that when you break them you do so to an extent that doesn't lead to action.

Increasingly in Scottish public life bureaucracies do not seem bound by the rules – on how quickly Freedom of Information requests should be handled, on appropriate transparency and behaviour on the part of senior staff, on whether legally-binding targets are met. We have even had malicious prosecutions.

What we have not had is any accountability for the above. This is usually addressed in terms of the effect on democracy, but the effect on individual citizens is every bit as important. If bureaucracies are unresponsive until they are pushed to the point where they risk action being taken against them, it is those with the capacity to push cases to that point who get more responsive public services.

The complaints process in public life is often more punishing for the complainer than those complained against, the latter having teams of lawyers they don't pay for. It means navigating the complaints process requires skill, perseverance and self-confidence. It is a system that favours educated professionals

Complaints should be a learning process for institutions, not a reputation management process. Common Weal has proposed a number of remedies to change the nature of this complaints process. Among them is a 'fixed tariff' scheme for compensation. Often it would be cheaper to simply pay a fixed compensation fee than it is to pay lawyers to fight the case.

As it stands, we risk losing a feedback mechanism that should help us improve services, increasingly lose public consent as a result and do so in a manner that heavily favours the educated middle classes over the rest. That is a patently bad complaints system.