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Reviews into handling complaints, quality of care and patient safety

In the wake of the publication of the Mid Staffordshire public inquiry, Prime Minister David Cameron asked for several reviews into patient safety and quality of care. These included reviews by Professor Sir Bruce Keogh, NHS Medical Director for England, Professor Don Berwick, and Ann Clwyd MP and Professor Tricia Hart.

Review by Professor Sir Bruce Keogh

The Prime Minister announced on 6 February that he had asked Sir Bruce to review the quality of care at trusts that were outliers on mortalities indicators. Fourteen trusts were investigated. After he published his review on 16 July 2013, 11 of the 14 trusts were placed into special measures by Monitor or the NHS Trust Development Authority.

Review by Professor Don Berwick

Professor Berwick published his report into patient safety in the NHS on 6 August 2013, highlighting areas for improvement and making the following recommendations:

  • the health system needed to recognise the need for wide, systematic change
  • the health system needed to abandon blame as a tool and trust the goodwill and good intentions of staff
  • quantitative targets should be used with caution – the primary goal should be better care
  • transparency was essential
  • responsibilities for functions relating to safety and improvement needed to be established clearly and simply
  • staff would require support to learn and master quality control and quality improvement methods.

Berwick highlighted that the primary responsibility for delivering safe care should rest with providers, but noted the complex and 'bewildering' system of regulation in England: 'Delivering safe care is first and foremost the responsibility of providers, but having no regulation is not an option. Regulation should make clear the expectations that providers must meet, detect failings early and take appropriate action when sub-standard care is found. The current NHS regulatory system is bewildering in its complexity and prone to both overlaps of remit and gaps between different agencies. It should be simplified.'

Review by Ann Clwyd MP and Professor Tricia Hart

The government also commissioned Ann Clwyd MP and Professor Tricia Hart to examine how complaints about care in NHS hospitals were listened to and acted upon. They published their report on 28 October 2013.

The review suggested that, too often, patients felt uncertain or confused about the complaints system and that there needed to be a change in the way hospital staff approached the handling of complaints. The review recommended that every chief executive should take personal responsibility for the complaints procedure, including signing off letters responding to complaints and that there should be board-level scrutiny of complaints.

Clywd and Hart expressed concern about the independence of complaints handling by hospital trusts. They suggested that hospitals should offer an independent investigation when dealing with serious incidents and that patient services and patient complaints support should remain separate.


Keogh B.
Review into the quality of care and treatment provided by 14 hospital trusts in England; overview report.
NHS England; 2013.

Berwick D.
A promise to learn - a commitment to act. Improving the safety of patients in England.
National Advisory Group on the Safety of Patients in England; 2013.

Clwyd A, Hart T.
A review of the NHS hospitals complaints system; putting patients back in the picture. Final report.
Department of Health and Social Care; 2013.