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Should patients feel free to make a complaint about medical treatment provided free if the treatment is not what they were entitled to expect? What impact does making a complaint have?
It was interesting to see that last week the Head of Healthwatch, Anna Bradley, was advising NHS users to see themselves as “consumers”. She said that: ”We know what good service looks and feels like and we complain if we don’t get it, even in Britain.” She went on to say that a reluctance to criticise health workers held people back from complaining, and that patients needed to “feel comfortable saying…this wasn’t good enough” in the NHS as they would in a shop.
This raises some fascinating issues. Is health care provided free at the point of access to be treated like a service or goods purchased commercially in a retail outlet? Are we in Britain too reticent generally about complaining? Are we imitating American culture? Will that result in a US style “compensation culture”? Are we afraid to complain because we believe that our own health care may suffer as a consequence?
Healthwatch was launched last week as part of the Government’s NHS reforms. Its remit is to insist that NHS bosses include the views of patients when making decisions. Anna Bradley herself, who was previously employed by Which? Magazine, has gone on record as stating that she wants to be seen as a consumer champion rather than as an advocate for patients.
From my experience, complaining about the NHS can be daunting for some. As a nation we remain reticent to complain. This is all the more so when a service is provided without charge at the point of delivery, although most of us are acutely aware that our NHS “rights” have been purchased by our tax payments. For the majority, standards have to slip pretty far before they are moved to complain.
Yet the events at the Mid-Staffordshire Trust demonstrate where a “slippery slope” can lead. When poor care has been received, holding back on making a complaint against the NHS may lead to others getting an equally raw deal in the future. As Anna Bradley says: “ There’s almost a sense of responsibility on all of us to make sure our own experience means that other people get something better.”
Certainly in my professional life I frequently come into contact with clients or potential clients who worry about the impact of their complaining, or worse still, intimating that they are considering a medical negligence claim for compensation, upon their future care. Anna Bradley suggests that a feeling of “vulnerability” may well render patients less likely to complain. She suggests that they need to get over that fear. But of course, often if patients are in need of ongoing care, the prospect of any retribution from those responsible for that care acts as a powerful deterrent against complaining.
Ultimately a change of attitude is needed from those within the NHS. It seems entirely repellent to think that a cancer patient who complains about a delay in diagnosis might receive less good care for their terminal condition because they have “rocked the boat.” I surmise that this would happen rarely, if at all, but the fact that patients fear that it might tells its own story. The NHS needs to act as if it is accountable, so that patients understand that it is.
The fear that we will end up in an American style culture are ill-founded. The systems of medical provision and law are fundamentally different on each side of the Atlantic. But we can learn from the American culture of expecting appropriate and good service in healthcare as well as in restaurants.
Many of my prospective clients say to me that their primary motivation for bringing a claim is to prevent someone else from having to go through what they have been through. I believe that in many cases this is genuinely so. Does complaining help? There are many reasons why a complaint may be justified but if ultimately it results in improved care then the case for complaining becomes unanswerable.