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Breaking down the barriers: Older people and complaints about health care

‘I would need support’

Among those older people who have complained about the NHS or another public service in the past 12 months, only around a quarter (28%) could recall being offered support to make their complaint.

Like many, older people will not always feel confident about how to go about making a complaint. Some older people will need support with the process, especially where it requires gathering documentary evidence or filling in a long form. Where an older person has undergone a stressful experience or they are still receiving the care they have concerns about, they may need additional support and encouragement to make a complaint.

Older people who are receiving care in a hospital setting, or indeed from a GP, may feel reluctant to complain and will not always go on to make a complaint without the intervention of a family member, friend or advocacy group. 

For potentially vulnerable older people, who may lack the social support networks to help them complain, an absence of offered support can have a particularly detrimental impact on their ability to make a complaint.'

What have we seen?

The national survey shows how a significant number of older people would not feel confident about making a complaint. Among those aged 65 and over who had not complained about the NHS or another public service organisation, 14% indicated they would lack the confidence to do so. 

For potentially vulnerable older people, who may lack the social support networks to help them complain, an absence of offered support can have a particularly detrimental impact on their ability to make a complaint.

The focus group discussions with older people highlighted how many vulnerable older people were strongly reliant on support from friends, family and advocacy or advice groups when it came to complaining, particularly if they were suffering from long term health problems. Working with advocacy and advice groups to share information on complaining was seen to be a worthwhile approach. 

‘How about if Age UK and Independent Age, if they both correspond with you [the Ombudsman]…those are the sort of people who would give us notices…’ (Poole focus group participant, older person)

‘Leaflets would be really useful. They would keep people to the facts [when they make a complaint]. We tend to go into the story but they [health and care services managing complaints] are just interested in the facts.’ (Poole focus group participant, older person).

The fact that complaining was seen to be a complex, drawn out process, added to the feeling that, without the support of friends, family or an advocate, many older people would not consider complaining.

‘My mum wouldn’t be able to do it, she’s in her nineties, she has dementia, without support there would be no chance.’ (London focus group participant, carer).

‘I think if someone has got a family or something, someone like a daughter who will say ‘oh come on, let’s push on with this, let us get this sorted’. If you are on your own it’s quite different, you do feel more vulnerable.’ (London focus group participant, older person).

A number of individuals also mentioned the value of support they had received from within the hospital, from the Patients Advice and Liaison Service (PALS), as well as the value of having access to complaints services:

‘I have been into PALS, with a couple of things. There are a couple of ladies who in there who are absolutely fantastic. As long as you are clear and to the point and don’t go rambling off on your little stories. [With my problem] they have been absolutely really, really fabulous.’ (Poole focus group participant, older person).

Unfortunately in the end, a consistent theme throughout the focus groups remained the bureaucratic hurdles many older people feel they have to overcome to pursue a complaint. The following case summary is about a man who made a complaint to us on behalf of his father, Mr H. Without his son’s support there was little chance that Mr H would have raised concerns about the care he received.

Mr H’s story

Multiple failures in nursing care of older patient

Mr H’s son complained about the poor nursing care his elderly father suffered during a three-week stay in hospital.

What happened

Mr H spent three weeks in hospital with suspected pneumonia. While he was there he ate and drank very little and developed a pressure ulcer. Despite tests showing he had MRSA, nothing was done about this for almost two weeks. Mr H’s son, Mr J, who is a nurse, visited him in hospital and witnessed a nurse giving his father medicine without first checking his identity, and handling his tablets without gloves or first washing her hands.

As Mr H was unable to give consent and would not understand proceedings, Mr J, who had power of attorney, complained on his behalf about the failures in service. He said his father ‘had trust in the health service and would not have complained’ but as a healthcare professional, Mr J was upset and distressed by the poor care his father received. Mr J also complained that the Trust’s complaint handling was poor, with no one at the Trust motivated to investigate his concerns. He said that the Trust had not fully addressed his complaint, and not responded when it said it would. 

What we found

Nurses did not monitor Mr H’s eating and drinking properly or give him the support he needed. His pressure ulcer became worse during his time in hospital, and nurses did not seek specialist help with this when they should have done. Staff repeatedly failed to check Mr H’s MRSA test results and a nurse did not follow proper procedure when administering his tablets.

The Trust’s formal response to Mr J’s complaint did not address all of his concerns, was significantly delayed, and was only prompted by our repeated intervention.

Putting it right

The Trust acknowledged and apologised for its failings and put together an action plan to show how it will prevent these failings happening again. Mr J also received £1,000 compensation in recognition of the service failure and poor complaint handling.