You can forget all that ‘listening and learning’ stuff when it comes to the NHS. History shows that successive governments have deliberately diminished the voice of the patient when dealing with complaints about healthcare.

Let’s start with this reference to the ‘complaint monitoring panels’  (1999) who, according to this extract from the Mid Staffs review, would have been more able to prevent the national scandal from harming so many before the ‘Cure the NHS’ campaign brought it to light. Unfortunately, these panels were abolished in 2004 so unable to detect the horror of neglect which featured in the report from 2005 to 2009. Mid-Staffordshire-Trust-inquiry-how-the-care-scandal-unfolded.html

Here are the key points:

  • The system worked extremely well.

  • The panels reviewed every complaint

  • They reviewed action points from previous meetings to ensure change had taken place

When the Healthcare Commission took over in 2004 they were ‘overwhelmed by complaints and there was no follow up. This body was in turn abolished in 2009 with the bulk of the monitoring role going to CQC who have no powers to investigate individual complaints.

Community Health Councils  acted as effective, local complaint monitoring panels from 1974 to 2003. They were abolished by Tony Blair who declared ‘war’ on complainants who were bringing the NHS into disrepute.

Blair used the ‘full weight of the Government’s publicity machine’ to help hospitals rebut complaints whilst at the same time abolishing those bodies which effectively spoke out on the patient’s behalf.  Rhion Jones gives a warning as the Welsh government consider abolishing their Community Health Councils.  He accurately records the shambles which followed, leaving patients in England with no effective means of representation.

Insofar as the replacement body will cover both the NHS and social care, the change is very welcome, but if the ‘abolition of CHCs’ sounds familiar, it is because fifteen years ago, the English tried the same trick. Managers were fed up with those they saw as local interfering busybodies inspecting NHS facilities (unannounced – what affrontery!) and generally being unco-operative when it came to service changes, that the then Labour Government was persuaded to wind them up. What followed was a case study in how not to manage change. First they invented Public & Patient Forums, which were not Forums but Committees, only for them to be castrated in infancy and replaced by something called Local Involvement Networks – called LiNKS – which were Forums – but actually couldn’t be called that!

LiNKS was hobbled from the outset. Ministers decided not to specify how these new creations would work. Each one therefore spent about eighteen months trying to work it out, and some never managed it. In no time, they were gone – to be replaced by Healthwatch, which seven years later, are still just about finding their feet. For about five years, the NHS was not subject to effective public/patient (as opposed to Council) scrutiny. It is this mistake that the Welsh Government risk repeating. wales-to-abolish-community-health-councils-can-it-avoid-the-mistakes-made-in-england

Essentially, more democratic bodies with actual powers to deliver improvements are replaced by government quangos who have only ‘advisory’ powers.   Then they wonder why nothing ever improves in the NHS and hold a series of Health Safety conferences to get to the bottom of it.  Kelvin Hopkins MP and member of PACAC knows exactly why the staff at PHSO are having  difficulty improving first-tier complaint handling and took the time to inform Rob Behrens and Amanda Campbell at the last scrutiny meeting.  He believes that ‘private providers’ are behind the move, making it more difficult for anyone to hold them to account. Just as well he is standing down as an MP; dropping truth bombs like that can cause repercussions.

So there we have it. A simple formula. Take away all the bodies who have teeth and represent the people. Replace them with quangos who are starved of resources and powers. Then any harm caused by cuts to the NHS, inadequate staffing levels or lack of suitable drugs or resources can all be swept under the carpet.  Rob Behrens, Ombudsman accepts that he has the role of ‘igniting’ the momentum across the NHS to improve complaint handling.  His  apparent lack of enthusiasm for the task is no doubt due to his awareness that as he works to ignite, the government work to extinguish and so the wheels turn.