Unstable foundations: the complaint system and the duty of candour

How well we deal with being open and transparent with patients and their complaints is a fundamental prerequisite for attaining the development of a proper NHS patient safety culture. These are bedrock, foundational matters and if we fail on them then such a culture is beyond reach.

Unfortunately, the NHS has had long-standing problems with both complaint handling and the statutory duty of candour. These persistent issues have been the subjects of major criticism and intense debate in some recent publications, which will be discussed in this column.

Disquiet with the NHS complaints system goes back a long time. A good place to look for some historical context on the NHS complaints system is the review by Clyde and Hart (2013). Many of the issues they identified are still major problems today and the authors' analysis of them is still relevant. They laid out a complaints reform timeline, discussing prior official reports and recommendations, although ‘unfortunately, many of these recommendations have not been fully implemented (Clyde and Hart, 2013: 9). The authors pulled out major themes and findings, including: