Column

Why has it taken so long to achieve so little?

The need for effective procedures for complaint has been present since the birth of the NHS. Charles Webster asks why the new system is weaker than one proposed over 20 years ago

Lesley Wratten’s helpful assessment of the new complaints system in the last issue of healthmatters reminds us that it has taken the NHS 50 years to evolve minimally adequate procedures for handling complaints, and there is little sign that the much-heralded new system will prove capable of commanding confidence. Why has it taken so long to achieve so little? It was the intention to establish a system for inspection and complaints at the beginning of the NHS, but this went by default owing difficult relations with the medical profession. Patients were accordingly exposed to risks of abuse at the hands of a powerful institutional system, without recourse to effective protection or redress for the victim, their families, or concerned staff.

The worst problems were likely to occur in long-stay institutions, but the risks were present throughout the health service. A small but potent reminder of these dangers is provided by a letter sent by a former Voluntary Aid Detachment nurse, published here in a slightly abbreviated and edited form:

‘I was sent for a period during 1940 to the S...Hospital for Women to work as a VAD. There was a staff nurse on the ward to which I was directed. Amongst emptying and swilling and all the usual things, my duty was to sit by patients. (I think that they mostly suffered from afflictions of the womb, including cancer.) They were mostly Jewish, and I still think that this particular nurse had a Hitler complex about them. This nurse said to me: “These are very hysterical people, and this is how you are to deal with them. When you see them beginning to regain consciousness, you are to slap each side of their face hard, yes, that prevents them from having hysteria.” She showed me how. Our patient’s eyes flew open as though she had had a severe shock. It was against everything that I had ever been told, either at home or abroad, about post-operative treatment. There was one patient to whom this nurse was always horrible — withholding bed-pans and that sort of mini-cruelty. One day when I and another turned up for work, the staff nurse said: “Now nurses. You can be very kind to Mrs X today because she is dying!” After those words I gave in my notice, in tears, and left the hospital with the immensely stout matron shaking an arm like a huge roly-poly at me. I was conscripted to factory work, which I preferred.’

The above memories were provoked in the course of the new wave of concern about abuse of hospital patients after the Ely Hospital report published in 1969. It was only then that the issue attracted the attention it deserved. Under Richard Crossman, there was a determined attempt to evolve a comprehensive system for handling complaints. After the Ely scandal, complaints made on behalf of patients by staff or other advocates were given particular attention, and complaints procedures were regarded as inseparable from a system for inspection, itself intended to assist representations by what later came to be called ‘whistle-blowers’.

The main outcome of the 1969 hospital complaints initiative was the 1973 Davies report, which now lies gathering dust, but which was considerably in advance of the 1996 complaints procedure in its thinking. The parallel inspection proposal was watered down into the Health Advisory Service, considerably less ambitious in its remit than originally intended. The Davies report and the more radical proposals for a health service inspectorate were quietly interred by the combined efforts of NHS authorities and medical politicians, giving rise to frustrations of the kind described in Virginia Beardshaw’s Conscientious objectors at work(1981), which echoed the anxieties expressed in 1940 by the VAD nurse.

Despite the undercurrent of concern, the same confederation of interests prevented this issue resurfacing until the 1990s, and they have determined that the new procedures will not give anything like the level of protection to complainants, including concerned staff, that was intended by Richard Crossman’s post-Ely policy working party in 1969.