Concerns about care or treatment in Wales are encouraged in the first instance to be resolved as soon as possible directly with the staff involved. Alternatively, patients complaints can be to the health board or trusts complaints team. The process for raising concerns or complaints in NHS Wales is called ‘Putting Things Right’, a procedure under which Public Health Wales manage and respond to ‘concerns’ with consideration of redress to meet the requirements of the NHS (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011. The management of complaints or ‘concerns’ regarding NHS Wales care or treatment is governed by The National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011. The process for raising concerns or complaints in NHS Wales is called Putting Things Right.

The term “concern” is used throughout the PTR process and means “any complaint, claim or reported patient safety incident (about NHS treatment or services) to be handled under these arrangements. It also includes concerns which may also trigger the candour procedure as set out in the Duty of Candour Procedure Regulations 2023”. 

The PTR process aims to address relatively minor complaints or concerns through to the most catastrophic (severe harm or death) under one process. The name ‘Putting Things Right’ has attracted much criticism and many complainants ask how can anything be ‘put right’ for a patient that experienced avoidable suffering and death due to NHS failures in care?

Following recent consultation, it appears the (rather unfortunate for some) name is here to stay, though work is in progress to redesign the PTR process, and the legislation and the guidance which governs it. The consultation responses included concerns around the quality of investigations undertaken and the quality of the training of those undertaking investigations, and have been confirmed as being part of the scope of the refresh and redesign work. Next steps to change the process in line with the feedback and ideas received is underway. It remains to be seen whether the changes will appropriately address current concerns, particularly those regarding the independence, training, and professional standards followed by investigators. As our campaigners believe to be the case across all UK nations, systems whereby NHS are largely expected to investigate their own failures, with insufficient accountability, are fundamentally flawed, with optimal learning often not being identified, monitored and maintained as a knock on effect, hence we see the same themes of repeated widespread failures.

Implementation and oversight of HR policies are outside the scope of Putting Things Right and remain the responsibility of CEOs. If a complainant is not satisfied with the health board or trust’s response, they can contact the Public Services Ombudsman for Wales.

Llais (meaning 'Voice' in Welsh) is an independent body which provides free and confidential complaints advocacy and support, aiming to provide a positive contribution to strengthening voices of people going through the internal NHS complaints process and helping to shape services. There are, however, limitations as to what advocacy agencies such as Llais can do, including limited scope in providing advice and being unable to support anyone who has legal representation. Many experience these limitations as a gap, as the primary aim of legal representation (e.g. medical negligence Solicitors) is proving both breach of duty and causation for a successful case ‘win’ but often, what harmed patients and/or bereaved families want goes much deeper than this. In cases where admission of liability is formally accepted, harmed patients and bereaved families often report experiencing secondary harm and being left with unanswered questions and a lack of confidence that meaningful learning has been identified and appropriately addressed.

Death investigations : Coronial Process and Medical Examiner Service 

A new statutory Medical Examiner Service has been rolled out across England and Wales to provide independent scrutiny of deaths, and to give bereaved people a voice. Whilst this is a positive introduction, some express concern that like scope is limited, along with the coronial process.

Coroners are required, by law, to investigate deaths which are suspected to have been violent or unnatural, where the cause of death is unknown, or where the person died while being detained by the state – for example, in prison, by the police, in immigration detention or in a mental health care facility. Coroners’ investigations are carried out to answer four questions: who died, how they died (including the medical cause of death), when they died, and where the death occurred. The final stage of some investigations is a fact-finding public hearing (an inquest.)

Jeremy Miles himself acknowledges limitations “A coroner’s inquest is a formal judicial inquiry into the case and circumstances of a death, and is a limited, fact-finding inquiry” and that “Coronial law and practice are the responsibility of the UK Government – that means only the UK Government can make changes to the system in Wales and England.”

Some of our Welsh campaigners have expressed concern with the limitations of the Coronial process within England and Wales. Providing an example of sepsis, dubbed ‘the biggest killer’, with over 48,000 individuals per year lose their lives to sepsis, often preventable with early detection and treatment, PHSO expressed recent concern that NHS are not learning from mistakes and a recent study of Coroner’s reports revealed 45% of Sepsis Prevention of Future Death Reports resulted in no response. Many others in Wales have raised concern that optimal learning is not happening across all nations. The following report touches upon this issue, and that of the inconsistencies with the service people receive depending on where they live:

Bereaved people are not yet at the heart of the coroner service

The duty of disclosure in coroners’ inquests is limited to the information requested by the coroner. These requests must be complied with under coronial law, but due to limited scope and potential for inconsistencies as highlighted above, if a coroner fails to request certain information deemed pertinent by the family, families can sometimes find themselves in the unfortunate situation of feeling the inquest has not provided them with full answers.