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

‘I don’t want to make a fuss and worry what will happen if I do’

Among those aged 65 and over who had experienced a problem with the NHS or another public service but not complained, over half (56%) indicated that they would be worried about the impact that complaining about an organisation might have on the way they were treated in the future.

Older people are sometimes stereotypically described as having a ‘mustn’t grumble’ mindset and approach to life. While this is a generalisation, we have seen that older people can under-report poor service or downplay the difficulties they experience in later life.

Although the general increase in complaints about health care services in England might suggest that people are more willing to challenge professionals, older people are one section of the population who can still sometimes be less confident and won’t always push for what they need18. More worrying still, there is evidence that older people can prove even more reluctant to complain when they believe they are going to need a service again19

What have we seen?

This is supported by the comments from a number of older people we spoke to directly, who described their concerns that complaining would see them singled out, especially if they were based in a care setting and relied on the organisation for ongoing care: 

‘If you complain in a ward it’s a case of the staff saying “that’s the one who complains over there in the corner.’

(Manchester focus group participant, carer).

This can also be an issue that we see in our casework. The following case summary is based on a joint investigation by us and the LGO. It concerns a complaint made by Mrs A about the care her father received. Mrs A highlighted her concerns about complaining about the organisation that provided the social care while her father was still in its care.

Mrs A’s story

Trust’s poor communication and council’s failure to make appropriate sick leave arrangements led to anxiety and distress.

Mrs A complained that her father, Mr B, suffered heart failure because he was not given enough of his medication. She also said that her father’s discharge from hospital after his readmission was delayed because of faults by the council.

What happened

Mr B went to hospital after he fell at home. During this time, his condition deteriorated. Mr B did not take his regular medication for fluid retention, which was restarted five days later at a lower dose than usual. Mr B developed fluid on the lungs as a result of his heart condition, and was treated for a chest infection. His condition improved and he was discharged home the following month. There was some confusion in how paperwork was sent from the Trust to a social worker, especially when the social worker was absent on sick leave. The next day he was readmitted to hospital where he suffered a heart attack. He was discharged home again the next month.

As Mr B was too unwell to complain, his daughter, Mrs A, complained to us on his behalf. Because the complaint concerned the actions of a local authority – which provided Mr B’s social care - as well as an NHS organisation, we asked whether the complaint could be shared with the Local Government Ombudsman (LGO). Mrs A was reluctant for the investigation to cover social services and initially asked us not to investigate its actions unless ‘absolutely necessary’, as her father was still under its care. We agreed to make the LGO aware of the complaint to see if a joint investigation was necessary. Sadly, Mr B died shortly afterwards.

What we found

We partly upheld Mrs A’s complaint, which we investigated jointly with the LGO. There was fault in the initial hospital care given to Mr B, but the Trust had put things right. We found fault in the Trust’s communication with Mr B’s family, which led to anxiety and distress, and also in the way the complaint was handled. The council failed to make sure alternative arrangements and contacts were in place when the social worker working on Mr B’s case was absent from work.

Putting it right

The Trust wrote to Mrs A to acknowledge and to apologise for the anxiety and distress it had caused. It also drew up plans to address the faults found and reassured Mrs A that it would use the lessons learned to improve its service for future patients. 

The council agreed to apologise to Mrs A for the delay responding to her original complaint and for not updating the absent social worker’s voicemail. It also agreed to make sure systems were in place to effectively manage the 
caseloads and telephone messages for absent social workers. 

If problems or concerns can be addressed without the need for a formal complaint then clearly this is a positive outcome.' 

There can be reluctance among older people to complain, particularly if they feel they may be getting an individual into trouble: 

[Older people] don’t want to cause trouble; they might be upset but they don’t want to cause a fuss. But if they could just talk to someone, if they had someone to share it with so it could just be put right. But to actually complain [formally] that is a big step.’ (Manchester focus group participant, carer).

‘Older people have been brought to feel that if it is a person in authority or someone with qualifications you don’t query it. The last thing that older people want to do is complain. It’s [not] in you, you haven’t been brought up like that.’ (Manchester focus group participant, older person).'

If problems or concerns can be addressed without the need for a formal complaint then clearly this is a positive outcome. Informally raising concerns to staff is often the easiest and quickest way to resolve issues. One older couple discussed the advantage of being able to talk through things informally with their doctor:

‘It’s just about who you get. When we speak to our doctor he is so good because he will listen and [be patient]… but if you are in the hospital well that’s not something that’s available.’
(London focus group participant, older person)

However, it is important that older people feel able to make a formal complaint if necessary:

To actually get as far as filling out [the formal] form…you would probably think, ‘well, perhaps it was just that nurse, perhaps she has just had a bad day.’ (Manchester focus group participant, older person).

I think [some of those delivering public services] rely on our age group not to complain, there is an [acceptance] among older people sometimes.’ (Poole focus group participant, older person).

This example from an older lady in the Poole focus group, highlights the reluctance to complain amongst certain older people, even when a problem is having an ongoing impact on their quality of life. She felt that little would change if she did complain and didn’t want to cause a fuss. As a result, she ultimately decided not to complain.

‘I went to a private clinic for an NHS cataracts operation… It went wrong and I lost the sight in my eye… It had quite a big impact on me; I don’t feel I can drive anymore so a bit of my [independence] has gone. I had to have lots of follow up at the hospital, they were shocked.'

‘I did request some of the notes from the operation but I didn’t complain… I just thought it would be too much hassle;  I didn’t want a fuss… I wasn’t expecting to get anything from it.’ 

18 Barriers to Choice: A review of public services (David Boyle, Cabinet Office). 
19 Waiting for Change (Charlotte Potter, Age UK, 2009).