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

'Where do I go?'

Arguably the biggest barrier preventing older people from making a complaint is knowing how to complain and who to complain to.

Data from the national survey shows how among those aged 65 and over, 1 in 10 said that they wouldn’t know where to go for information on how to raise a complaint about an organisation that provided a public service,  such as the NHS. Among those aged 75 and over, this figure rises to 18%. When it comes to taking the matter further, if they were not happy with how an organisation has dealt with a complaint, 15% of those aged 65 and over wouldn’t know where to go. This rises to 26% among the over 75s only. 

Specific rights on complaining about an NHS service are set out in The NHS Constitution, but awareness of these basic entitlements remains fairly low. Research by the Department of Health highlights how the majority (76%) of the general public are unaware of The NHS Constitution even among NHS staff, 31% are unaware of it.17

What have we seen?

The older people and carers we spoke to told us how their awareness of how to go about complaining was low, and how they are told by organisations that provide health and social care to use communication channels that are unfamiliar to them.

‘The problem is that when people have a problem they don’t know where to go; they are referred to a computer which they don’t have; they are referred to a library which is too far away to get to…[and] they wouldn’t know what to do anyway.’ (Manchester focus group participant, carer).

Organisations are increasingly providing information on how to raise concerns and complaints online, often in direct response to increasing expectations and demand among people who use public services.  In 2010-11 only 16% of complainants found out about our service via an internet search, by 2014-15 this figure had risen to over a quarter (26%). 

However, there are big disparities between the different age groups. Among those aged 75 and over, just 17% found out about our service online, compared to 27% among all other age groups. As organisations increasingly provide information and guidance to people who use their service online, there is a danger that some older people can be left behind.

‘They will say to you “email me” but older people don’t have a computer… I don’t want to use a computer.’ (Poole focus group participant)

The care that many people receive can often straddle the boundary between healthcare and social care and this can make it even more confusing for people to know where to direct their complaint, particularly if care is being delivered by lots of different people. The problem of knowing where to go is compounded for older people when it is not immediately clear who is responsible for the care they receive, and therefore for dealing with their complaint. In this context, people who are considering making a complaint need to feel confident that there is ‘no wrong door’ and that anyone they raise a concern with will take it seriously and act on it. 

One focus group participant’s story

The following example from the Poole focus group describes the difficulties faced by a daughter and mother looking to complain about the care received by their father and husband within his home following a stroke:

[After] having a big stroke my father was in the stroke unit at hospital. He was still compos mentis… [but] was experiencing some difficulties but wanted the rest of his life to be dignified [and spent at home]. The Trust arranged for him to have care at home delivered 24/7, and social services would specially adapt his bedroom including a hoist to get him in and out of bed. [At first] we were happy with this but then [things] started to go wrong. There were up to 80 different care workers coming in to look after my father. He was given painful treatments and you could hear him moaning. People came in and treated my father as if he were a vegetable. [On one occasion] he was left dangling by his legs. We found him in bed with no sheets just a blanket covering him. They said, “they couldn’t find any sheets…’

At this point they decided to complain:

‘We went to the hospital but they said it was the [organisation that provided the care] responsible. They said that the council was funding it but [the council] told us to go to the care provider directly. In the end we said we could go to the [local] press… but they didn’t like this. They threatened that they would withdraw the funding. They said he could end up in a care home that was “under investigation”. They said there were no other care providers who [would take him on]. My mother kept on at them and they said, “well, he was only supposed to live for a month”.’

17Report on the effects of The NHS Constitution (Department of Health, 2015).