NHS complaints: Advantages of a Service Design

Written September 2017

The NHS has had a lot of negative criticism over the last year for many things, from political reasons to general mess ups within the organisations. There has also been a lot of talk about the trusts not handling the complaints effectively, causing more aggravation. Due to this, we took a look at which trusts have been the most (and least) complained about, and what the implications of this may be for the way in which they design their services.

The NHS Trusts were asked to provide information on how many complaints they received from May 2016 to May 2017. Of the 156 contacted, 134 of the Trusts replied. The average amount of complaints UK NHS trusts received during the time period was 431.

The top ten most complained about trusts received over 1,000 complaints during the time period stated, whereas the ten least complained about trusts received less than 100 complaints.

Top ten most complained about NHS Trusts

1. Royal Free London NHS Foundation Trust — 1675 complaints
2. Sheffield Teaching Hospitals NHS Foundation Trust — 1621 complaints
3. South Western Ambulance Service NHS Foundation Trust — 1465 complaints
4. Lancashire Teaching Hospitals NHS Foundation Trust — 1386 complaints
5. Great Western Hospitals NHS Foundation Trust — 1359 complaints
6. Guy’s and St Thomas’ NHS Foundation Trust — 1223 complaints
7. Heart of England NHS Foundation Trust — 1126 complaints
8. Central Manchester University Hospitals NHS Foundation Trust -1100 complaints
9. King’s College Hospital NHS Foundation Trust — 1092 complaints
10. Nottinghamshire Healthcare NHS Foundation Trust — 1061 complaints

At the top of the list is the Royal Free London NHS Foundation trust, which serves around one million patients and employs more than 9,000 staff, making it one of the largest trusts in the UK. The second, Sheffield Teaching Hospitals NHS Foundation Trust, is the largest trust of the 156 questioned.

Top ten least complained about NHS Trusts

1. The Clatterbridge Cancer Centre NHS Foundation Trust — 27 complaints
2. Queen Victoria Hospital NHS Foundation Trust — 57 complaints
3. Papworth Hospital NHS Foundation Trust — 58 complaints
4. Liverpool Heart and Chest Hospital NHS Foundation Trust — 60 complaints
5. Alder Hey Children’s NHS Foundation Trust — 71 complaints
6. Airedale NHS Foundation Trust — 76 complaints
7. Bradford District Care NHS Foundation Trust — 81 complaints
8. Royal Brompton & Harefield NHS Foundation Trust — 85 complaints
9. The Christie NHS Foundation Trust — 89 complaints
10. Bridgewater Community Healthcare NHS Foundation Trust — 94 complaints

Of course, there are a variety of reasons for these complaints. In some ways, they’re inevitable, as the NHS is under a lot of strain. NHS Trusts have had budget cuts and are currently understaffed. On the technology side, there is no budget to strip out legacy systems and start from scratch, while new tech solutions will be costly and can date quickly.

One way to make sense of this complaint data and investigate its causes is to adopt a Service Design approach in order to improve the patient experience. Through Service Design, you can create solutions that require low investment but create high impact for both patients and Health Care Professionals (HCPs).

The NHS is ripe for change. They are currently a reactive organisation, soaking up resources to battle pressing emergencies rather than looking to the future with preventative care. Service design thinking, which emphasises preemptive investigation and co-creation, could help NHS trusts understand the roots of their problems and solve them proactively.

Service design is not about layering on top of an already flawed system. It is contextual, helping organisations stay “future-proof”. Organisations often take an incremental approach when it comes to change, introducing “shiny” new technologies into an already complex ecosystem to cover up the cracks. But where shiny band-aid solutions may solve one problem in the short term, they lack a comprehensive understanding of the relationship among the system flaws and often lead to swallowed budgets. Mapping relationships among stakeholders, customers and non-human actors is a key aspect of service design, used to uncover insights about the organisation and design for consistency across channels.

The key is to design for and with people, not technology. When you invite the people you are designing for into the process, you can reach high impact solutions with relatively low investment. Often these solutions end up being less digitally focussed, such as staff training guides or patient education plans. A great example of this is Better Conversations, an organisation that promotes patient health coaching among healthcare professionals. Based on data that more than half of people take their medications incorrectly, which puts major strain on the NHS and their staff, Better Conversations created a collaborative education plan to empower patients to take charge of their own healthcare. Other solutions can leverage low-investment tech, such as SMS, allowing services to be more quickly and easily accessible.

Ultimately, then, service design within healthcare and the NHS more specifically could be the right approach in order to adapt to changing healthcare trends. It is a human-centered approach to design, meaning that one focus, for example, could be on ways to relieve workload and stress from nurses and HCPs. As mentioned, it uses co-creation (with patients and HCPs) to get to solutions. It helps create frameworks for measuring “success”, patient happiness, and can arm stakeholders with the ability to adapt quickly.

Written by Hannah Steele

Graphics and Edited by Erin Peace