Mediation could help improve the NHS complaints system

14 Aug 19

Mediation consultant Terry Leigh explains how the NHS complaints system - often found to be long, frustrating and ineffective by users - could be improved. 

NHS nurses


The NHS complaints system has been underperforming for many years.

A comprehensive report by Dame Janet Smith, which was part of the Shipman Enquiry in 2004, highlighted numerous problems with the system. 

A House of Commons Health Committee report in 2011 said that “the NHS complaints system sometimes compounds and exacerbates the negative experiences of patients. In such situations, patients have little choice but to give up or turn to the legal system”.

The same report also noted “the motivation of complainants is often not to seek compensation for failures of care but rather to have their concerns listened to and acted upon”.

In 2018, Bernard Jenkin MP, the Chair of the Public Administration and Constitutional Affairs Committee highlighted in Public Finance the need for the government to ensure that the NHS complaints system gets better. 

These reports mirror my own experience of working as a mediator in the NHS. The people I work with (both complainants and NHS staff) often tell me that the complaints system is long, frustrating, stressful and ineffective.

The system continues to rely on emails, letter writing, phone calls and advocacy. Too many resolvable complaints go to the Ombudsman or litigation.

How can the NHS complaints system be improved?

Health mediation has long been cited as an effective tool to resolve complaints regarding NHS services

The process has a significant role in the healthcare complaints procedures of Australia, New Zealand, parts of the USA, Canada and Europe. Unfortunately it has been seriously under-utilised in the NHS and this has been mainly due to a lack of awareness and understanding of the concept.

External health mediation uniquely helps complainants and NHS staff to meet quickly, communicate effectively and find meaningful resolutions. Mediation works – it saves time, emotional energy and unnecessary costs.

Dominic Wilkinson (Professor of Medical Ethics at Oxford University and Neonatal Consultant at John Radcliffe Hospital) recently stated that “Looking forward, there is a real need to try to resolve disagreements between parents and doctors” and “in particular, formal mediation involving somebody independent of the hospital and the family who can sit down with both parties and try to help rebuild communication and help find common ground.”

Finally after so many years of underperformance, there is a real opportunity to improve the NHS complaints system. The introduction of health mediation as a recognised and key intervention during local NHS complaints handling should help to deliver the much needed changes called for by so many reports.

Mediation will save time, the emotional energy of those involved and money. The first step is to meaningfully raise awareness and understanding of health mediation throughout the NHS.

A case study 

Following treatment at a hospital, a patient raised a complaint regarding the treatment he had received. He felt very dissatisfied with the responses received from the hospital and felt that many questions remained unanswered.

I was contacted by the hospital to assist in the case and had an initial private meeting with the patient to explain how mediation works and discuss how he saw and felt about the situation. A way forward was agreed. I then had a similar meeting with hospital staff. 

Arrangements for a face-to-face meeting between the patient and hospital staff were agreed by all parties. I facilitated this meeting and ensured that everyone involved had the opportunity to speak and respond to the issues raised. 

I helped the patient and hospital staff to communicate with each other effectively. The patient felt that he had been heard and all his questions answered satisfactorily. He received a personal apology for things that had gone wrong. The meeting also provided an opportunity for hospital staff to explain to the patient how they would learn from the experience in order to implement changes in patient care.

  • Terry Leigh
    Terry Leigh

    mediation consultant specialising in health and workplace mediation. He is a provider of expert mediation guidance to national bodies

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