The NHS’s internal system of handling patients’ complaints is broken, argues a new government report published by a commission headed by Labour MP Ann Clwyd. Patients who file a complaint about matters such as staff rudeness, neglect, poor quality of care etc. often find that their concerns are delayed, played down, met with defensiveness or denial, and ultimately remain inconsequential. This represents a major failure because if complaints from patients and carers had been taken seriously, the calamities of Mid Staffordshire might have been prevented, and so would many other less well-known cases of collapses in care standards.

The report calls for a change in culture in the NHS. Healthcare providers should stop treating complaints as an attack to be fended off, and start treating them as an opportunity to learn about where things are going wrong. They should stop seeing the people who file those complaints as vicious troublemakers, and see them as people with legitimate concerns. More tangibly, the report also calls for a series of ‘pledges’ by NHS organisations, and a simplification of the complaints procedure.

Well-intentioned though those recommendations are, it would be surprising if this report led to substantial improvements in the quality of care. The focus on the procedures of the complaints process is ultimately wrongheaded.

Complaints procedures are normally a way of dealing with information asymmetries. Many business owners fail to retain customers and have no idea why. They do not spot any mistakes, but neither can they keep an eye on every one of the company’s activities all the time, nor can they easily see their own business from a consumer’s perspective. That is why well-run businesses deliberately seek out customer feedback. Many supermarkets, restaurants and pub chains have straightforward feedback forms on their website, and some of them incentivise customers to use them. (Wetherspoon’s, for example, gives you a voucher for a free coffee if you leave a review of your last visit.)

Nobody enjoys receiving negative feedback, but in some cases we accept it because we like the alternative even less. It is no good if customers pretend to be satisfied, but then never come back again, or tell other people how awful the product is. That is why actors in competitive markets often seek feedback, even though no review by a government commission has ever told them to do so. It is in their own best interest.

And that is the big difference compared with the NHS. If an organisation has no real interest in taking criticism on board, no amount of fiddling with the complaints procedures will make much of a difference. And if an organisation has a real interest in taking criticism on board, they would sort out procedural problems themselves, without the advice of a government commission.

We have to make it a lot easier for NHS hospitals to go bankrupt, and we have to make it a lot easier for independent sector providers, including for-profit providers, to step in and take over. Forget the Clwyd review. Let’s have a series of hospital bankruptcies – and I bet the remaining ones would suddenly learn very quickly how to take patients’ complaints seriously.


Head of Health and Welfare

Dr Kristian Niemietz joined the IEA in 2008 as Poverty Research Fellow, becoming its Senior Research Fellow in 2013 and Head of Health and Welfare in 2015. Kristian is also a Fellow of the Age Endeavour Fellowship. He studied Economics at the Humboldt Universität zu Berlin and the Universidad de Salamanca, graduating in 2007 as Diplom-Volkswirt (≈MSc in Economics). During his studies, he interned at the Central Bank of Bolivia (2004), the National Statistics Office of Paraguay (2005), and at the IEA (2006). In 2013, he completed a PhD in Political Economy at King’s College London. Kristian previously worked as a Research Fellow at the Berlin-based Institute for Free Enterprise (IUF), and at King's College London, where he taught Economics throughout his postgraduate studies. He is a regular contributor to various journals in the UK, Germany and Switzerland.

5 thoughts on “We need more hospital bankruptcies, not procedural changes”

  1. Posted 02/11/2013 at 16:51 | Permalink

    I suspect the problem with NHS Trusts is that they constantly have in mind the downside of political interference and are keen to resist it. Meet all targets set, ensure no serious patient criticism and communicating good news to the Minister all remain top priorities.

    Unfortunately letting Trusts go bankrupt is not the answer because the bad ones remaining within budget will continue to provide a substandard service.

    PRIVATISE THE LOT. Three dirty words, I know but, not as dirty as NATIONAL HEALTH SERVICE, and thats for sure

  2. Posted 04/11/2013 at 17:52 | Permalink

    Better still, terminate state-funding for hospitals and schools. People want health and education, and will find the money for it. The market will find ways to satisfy people’s needs.

  3. Posted 09/11/2013 at 13:44 | Permalink

    One step at the time, though.

  4. Posted 10/11/2013 at 08:34 | Permalink

    Kris writes “one step at a time” and I agree in the sense that one doesn’t necessarily do this sort of thing overnight (unless state-bankruptcy forces you to). However, we’ve been waiting for more than half a century for government to deliver world-class public services to rival private provision. There comes a time when our patience is exhausted, we stop giving the unionised sector second and third chances, and we say “enough is enough”. The income from taxation must stop. If you can privatise Royal Mail in a few weeks, you can do that with health, education and all the rest. You can close the departments of business, culture, farming, aid, transport, environment and energy overnight. Education, pensions and health will take a bit longer. We need a royal commission on privatising the army and police. Justice needs must more competition (abolish the DPP/CPS).

  5. Posted 14/11/2013 at 12:55 | Permalink

    I completely agree that errors and issues should be used as learning curves rather than fought off defensively. If the NHS makes a mistake they should apologise – maybe they wouldn’t have as many negligence cases to pay off if they learnt how to say sorry.

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