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

Introduction

Despite being the most frequent users of health care services, older people1 are among those least likely to complain about poor care when they receive it. This is because they often lack the support or confidence needed to complain, they worry about what will happen to them if they raise concerns, and they are unsure that complaining will make any difference. 

We are the organisation responsible for making final decisions on complaints that have not been resolved by the NHS in England.  We have seen evidence of the particular barriers older people and their carers face when they want to raise concerns about poor care. We are sharing this so that action can be taken to help these complaints be heard. 

Not all older people struggle to use the complaints system. In our casework we see many examples of older people who have raised concerns about the care that they or a loved one have received. However, the fact remains that there are a number of issues that particularly affect the ability of some older people to complain effectively. Too few older people make complaints when things go wrong. Older people also say they are left frustrated by a process that can feel like it just isn’t worth the hassle. They can worry about making a fuss but, crucially, the fewer complaints that get made, the more missed opportunities we see for health care services to learn from mistakes. 

Using information collected from a national survey2, focus groups with older people and their carers, and case studies, we provide a number of broad recommendations in this report aimed at policy makers and organisations that provide health care. If implemented these have the potential to improve older peoples’ experiences of the complaints system.

As the size of the older population continues to grow, it is crucial that health care services can demonstrate a culture that welcomes complaints from the population they serve the most. There also needs to be adequate systems in place to gather feedback, and learn from complaints when people raise them. 

The Health Select Committee, the Public Administration and Constitutional Affairs Committee (PACAC) and the Department of Health have all recommended a number of far-reaching changes to the complaints system in recent months. The Hard Truths3 report, published by the Government in response to the Mid Staffordshire Public Inquiry, specifically mentioned how vulnerable people find the complaints system complicated and hard to navigate. The report made a number of recommendations about making it easier for people to use the complaints services. It also emphasised the need for far greater attention to be given to learning from complaints at all levels across the healthcare sector. 

Progress is being made. In response to the Hard Truths report, in partnership with the Local Government Ombudsman (LGO) and Healthwatch England, we published My expectations4, which sets out what people expect from health and social care providers when they make a complaint. My expectations provides a framework that can be used by organisations that provide services across health and social care to measure people’s experience of making complaints about the care they provide.

The Care Quality Commission has started to provide a toolkit to its inspectors, based on My expectations, to identify key lines of enquiry when looking to understand the effectiveness of complaint handling among organisations that provide health and social care. This is a positive step which should further encourage organisations that provide and commission services to use My expectations to shape the way they interact with complaints. 

Finally, the Government is now examining options for people to have their complaints investigated through a new, streamlined public ombudsman service, which will incorporate the services currently provided by ourselves and the LGO. This should significantly simplify the complaints system and reduce the instances of people falling through the gaps of the separate health and social care complaints systems, an issue which can be particularly problematic for older people.

Until then we will continue to conduct joint investigations with the LGO into complaints that involve both health and social care which haven’t been resolved locally. We now offer a single investigation process that reduces the complexity for complainants who bring their complaints about health and social care to us. 

We would like to thank all the older people and their carers who took their time to share their views.
We would also like to thank Independent Age for their support in arranging and delivering the focus groups we held with older people and their carers.


1 Throughout the report we loosely refer to “older people” as people of state pension age or older, but as many studies have shown, chronological age isn’t always the best guide to how an individual ages. In some sections, we focus on statistics for people aged 75 and older, who are considered the group most likely to make use of health care services. 
2 What people think about complaining, online survey commissioned by the Parliamentary and Health Service Ombudsman and carried out by YouGov Plc. Total sample size was 4,263 adults. Fieldwork was undertaken between 1-7 April 2015.
3 Hard Truths: The Journey to Putting Patients First (Department of Health, 2014).
4 My expectations for raising concerns and complaints (Parliamentary and Health Service Ombudsman, Local Government Ombudsman and Healthwatch England, 2014).