Managing Complaints

Jon Wigmore Head of Complaints Resolution & Litigation Guy’s and St Thomas’ NHS Foundation Trust

Guy’s Hospital
  • Foundation Trust since 2004
  • 900 year history
  • Three hospitals on two separate sites
  • 750,000 patient contacts per year
  • Annual Budget approx. £700m
  • 9,000 staff
Categories of Complaints at Guys

Complaints hurt

“It’s my belief we developed language because of our deep inner need to complain”. Lily Tomlin

“He who avoids complaint invites happiness”. Abu Bakr

“The usual fortune of complaint is to excite contempt more than pity”. Samuel Johnson

Improving services

Are we doing what we say we are doing?

Improve individual practice, systems, services, environment – Most complainants say they want this

Key area for inspection & audit

External Monitoring

  • Standards for Better Health
  • NHS Litigation Authority
  • Healthcare Commission, Ombudsman
  • Impact on GMC, NMC and legal processes
  • Department of Health
  • Monitor

Why complain?

  • To understand what happened
  • Accountability
  • To help others
  • For us to fix things
  • Control vs powerlessness
  • ‘Resolution’

Complaint triggers

  • Attitude
  • Communication
  • Worried about vulnerable person (carers)
  • Lack of ‘join’
  • Media reportage

What you get from complaining

  • Written explanation
  • Fixes
  • Undertakings
  • Action plans
  • Meetings
  • ‘Resolution’
Satisfaction with the outcome of complaint
Reasons for not Complaining

Reasons for dissatisfaction

  • NHS account does not resemble experience
  • Questions not answered
  • Complaint handling has amplified anger
  • Defensive attitudes
  • No sense that anything has changed


17,000 NHS staff lost Sept 2005-6 (ICHSC)

34,250 junior doctors are chasing 18,500 UK posts

59,000 physical assaults on NHS staff in 2005-06 (UNISON)

8,500 public sector targets since 1998


How learning is lost

  • The complaint (not the service failure) becomes the issue
  • Service-led thinking
  • Protective approach to staff
  • ‘Ownership’
  • Turnover

How learning occurs

  • Experience
  • Reflection
  • Investigation, audit
  • Teamwork
  • Training & education
  • Leadership

Clinical Governance

A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.’

Successful approaches

  • Be open, early on
  • Give weight to the complainant’s evidence
  • Take on board patient’s total experience
  • Involve the complainant in implementation

Complaints handling

Knowing the name of the person dealing with the complaint

Active contact & engagement

Checking understanding of issues / desired outcomes

Trying again

Horses for courses:

  • Fixes
  • Information, understanding
  • Face to face and/or written answers
  • Vindication, retraction, apologies
  • Commemoration
  • Collaboration

Case study:


Ward environment in children’s hospital, age mix and bed management inappropriate. Limited parents’ facilities – kitchen, toilets, bathroom. Children screaming – no rest for parents or children. East Grinstead Hospital invites parents in pre-admission


Busy 42 bed medical / surgical ward, Maximising bed usage means patients and carers can be inconvenienced, ‘We are sorry if you found the facilities unsatisfactory’, ‘We hope you will raise issues at the time next time’


Notification of HCC review. In the meantime, the Children’s Hospital improved parents’ facilities & information and put into practice the visiting suggestion. The complainant was invited back to see the improvements and to see how her aim of improving the service had been realised. She then asked HCC to close the case

A duty to collaborate

  • Give weight to the complainant’s evidence
  • Try and understand what people want
  • Keep people informed
  • Involve people in implementation

Jon Wigmore