Information problems highlighted in complaints review

A quarter of second-stage complaints in the English NHS related to information, according to the Healthcare Commission’s report on 16,000 complaints between July 2004 and July 2006.

The report identified ten common themes that came up regularly from second-stage complaints. Information problems were cited as a cause for complaint with regards to safety, care surrounding a death and record keeping.

Three per cent of the complaints raised were due to complainants raising concerns about record keeping alongside with six per cent of GP-related complaints connected to this.

The Healthcare Commission says that many patients have complained about poor record keeping, leading to confusion when they are being treated by different physicians.

The report says: "In many cases, poor records, particularly about what had been communicated to the patient and their family, made it difficult for us to resolve cases. From our perspective, if something has not been recorded there is no evidence that it occurred. We recommend regularly that trusts carry out an audit of compliance with policies on record keeping at a local level. We have, on occasion, also recommended that clinicians who are particularly poor at keeping patient records be referred to their relevant professional bodies.

The Healthcare Commission states: "Where a patient or family member objected to the comments made by a clinician in their record, the simple addition of a note acknowledging this objection was often enough to resolve the complaint. Where comments have caused unintended offence, an apology by a clinician has also helped to resolve the complaint. However, it is disappointing that apologies are not being offered earlier, before a case reaches the Healthcare Commission."

The report also found that there were problems with the transfer of records between GP surgeries, with many being misplaced. This also applied to issues with the archiving of records of deceased patients.

Safety was also an information-related issue with 22% of complaints related to the theme. One incident reported identified a mix up involving patients of the same surname during an immunisation clinic in a general practice resulted in a child being given the wrong injection.

Another theme that generated a lot of complaints (54%) was care surrounding a death. Families felt misinformed about their loved ones, and the report urges hospitals to ensure they avoid giving contradictory information.

The report says: "In many cases, families have received contradictory or confusing information from the different staff caring for their relative. Or, when they have compared the information they have received following a death, they have found discrepancies in what they have been told.

"Reviewing cases where basic clinical records, such as weight charts, fluid balance or nutrition charts, have not been kept and clinical observations not recorded has been particularly difficult. To family members, this lack of information suggests that their relative was not monitored, fed or cared for appropriately."

The commission recommends that healthcare providers review and audit their policies relating to record keeping and make sure that they are being implemented and adhered to by staff. Agreeing one point of contact with family members may also help to prevent such concerns, they say.

They also noted that patients often kept detailed diaries of their experiences in hospital. This could prove useful when the NHS releases a new website letting patients rate their hospital and leave comments on their experiences.

In the report’s foreword, Professor Sir Ian Kennedy, chair of the Healthcare Commission and Anna Walker, the chief executive said: "The concerns of many patients have focused on the basic elements of healthcare, including communication between clinical staff and patients and their families, standards of care and safety, inefficient or ineffective non-clinical practices, such as administration, booking of appointments and transport, and the attitudes of staff.

"Unfortunately, these themes have been a reason for complaint against the NHS for a number of years. We have therefore included recommended actions and guidance in this report to help trusts to achieve the improvements needed…We therefore call on senior staff within NHS organisations to focus on improving the way they learn from complaints to ensure that the themes highlighted in this report do not continue to cause concern for patients and their families. Complainants want their complaints dealt with as quickly and effectively as possible, not to have to complain again to another body."

Clinical care and treatment, including delays in referrals or diagnosis from GPs was the most complained about theme with 66% of the total tally.