Suffering in Silence

This report highlights substandard care in England’s NHS, as revealed by Julie Mellor, The Parliamentary and Health Service Ombudsman. The Ombudsman is the final step for people who have been treated unfairly or received a poor service from the NHS in England, or a government department or agency.

By Julie Mellor, Parliamentary and Health Service Ombudsman

Our research shows that 25% of older people don’t know where to go to complain about the NHS, despite using the service more often than those under 65. Complaints are a gift to the NHS, as they drive improvements. Older people should be encouraged to voice concerns and taken seriously when they do.

Yet too many older people are suffering in silence. Almost 80% of all the investigations we carry out concern NHS services. Even though nearly half of NHS care is provided to those over 65, only a third of health complaints we investigate relate to their care.

Our role is to investigate complaints impartially and make recommendations to put things right. However, older people’s reluctance to complain—and their lack of knowledge about where to go—means we may see just the tip of the iceberg of serious failings in elder care.

Common themes in these complaints include:

• Misdiagnosis
• Poor staff attitudes
• Ineffective communication
• Substandard nutrition
• Lack of dignity in treatment

We believe a significant cultural shift is needed in how complaints are handled across health and social care. More must be done to tackle the toxic cocktail of patient reluctance and a defensive NHS response.

Making a complaint should be easy, transparent, and supported. Older people often fear repercussions or simply do not want to “make a fuss.” Yet complaints can lead to meaningful change—and often people complain because they don’t want others to suffer the same fate.

If someone is unhappy with how the NHS has handled their complaint, they can escalate it to the Parliamentary and Health Service Ombudsman.

Joint investigations with the Local Government Ombudsman—which examines complaints about local authorities and social care—highlight heart-breaking cases where older people fall through gaps between health and social care. In one case, an Alzheimer’s patient was denied his dying wish because five organisations failed to coordinate his care.

People need and deserve a joined-up complaints system covering both health and social services, so they only raise their concern once and have it managed by a single team. That’s why we’re calling for a single Public Ombudsman Service for England and the United Kingdom to handle all public service complaints under one roof.

Only with a significant change in attitudes towards complaints—and a drive to reform the system—will the NHS improve to ensure all older people receive the dignity and respect they deserve.

Elderly Reluctant to Complain about Healthcare, Says Ombudsman

Many older people are reluctant to complain about substandard health care—or don’t know how—and could be suffering in silence, according to a report by the Parliamentary and Health Service Ombudsman.

The research, based on a national survey of nearly 700 adults aged 65+, revealed:

• 56% had experienced a problem but did not complain due to fear of negative impact on future treatment.
• Almost 20% did not know how to raise a complaint.
• About a third felt complaining would make no difference.

One carer from Manchester noted: “When people have a problem they don’t know where to go; they are referred to a computer which they don’t have; to a library too far away… and they wouldn’t know what to do anyway.”

Julie Mellor stated: “Older people are some of the most frequent and vulnerable users of health and social care services but are the silent majority when it comes to complaining.” She warned that their silence could mean missed opportunities to improve services for others.

The report recommends:

• A proactive approach by NHS providers to ensure everyone knows how to complain without fear of repercussions.
• Use of the Ombudsman’s My Expectations guidelines to measure complaint-handling performance.
• Exploration of a streamlined public ombudsman service for all health and social care complaints.

With Britain’s ageing population—by 2030 one in ten UK residents will be 75 or over—a universal, independent complaints advocacy service is essential to protect vulnerable adults and ensure mistakes are never repeated.

Explore related insights in Suffering in Silence.