Andy Jaeger big thinking for a small world

Why don’t people complain?

At work recently, we've been thinking a lot about why people don't complain about the care they receive, in hospitals and elsewhere, when something goes wrong. Working for an organisation that exists to make sure people are safe when nurses and midwives care for them, it's important to us to understand the barriers that prevent people getting the care they deserve. In truth, it's important to me.

I've been surprised in thinking about this subject how little academic research has been carried out in this area. There are some interesting studies, but they tend to have been sited in mental health services - where the subject of service user advocacy is well established - but if you are interested in the experience of older people, and why they might not complain if they are receiving poor care, there is a big gap. In reality, we don't know why older people don't complain, whether they're complaining as much as they should, or too much, or even really what about.

As a result, we're left with a lot of anecdotal information, much of it aired in local newspapers. There are two interesting and contrasting articles this week which focus on the role that newspapers can play in the process of airing complaints. They take significantly contrasting views.

The first that caught my eye was an editorial in the South Wales Evening Post. It appears that one of the Community Health Councils in Wales drew attention to an "epidemic of bedsores" among patients in Swansea, and the Evening Post has been championing their cause. This seems to have drawn a large degree of criticism from readers of the paper, unhappy that the paper has reported on the complaints before they have been investigated, and suggesting that reporting of complaints in this way somehow discredits the NHS. The second is from Monday's Guardian, suggesting that high profile commentary on poor quality care can prompt a flood of letters to newspapers, almost all of which should really be directed at the NHS where they can be dealt with appropriately.

I think we tend to take our health services for granted, precisely because the majority of the time, we are well cared for. It's when we're poorly cared for, or even put in danger by our health services, that the problems start. Having been cared for in an environement that personalised and individual, we come up against an apparently monolithic and bureaucratic complaints system that seems both confused and confusing. In those circumstances, it's hardly surprising that people will want to air their grievance where they think they will be heard. And for many people, particularly of an older generation, that means writing to a newspaper.

So how can the media deal with healthcare complaints effectively? The South Wales Evening Post seems to have got it in the neck for champions patients in its area, while the Guardian suggests they shouldn't be getting the letters at all. Instinctively, I side with the Evening Post. However annoying it is for hospitals to be constantly nagged at by their local paper, the media can play an important role in voicing concerns, and shining a spotlight on poor practice. For as long as they do that, patients with complaints will go to them. Ultimately however, until that constant nagging brings about real change and improvement, those complaints will go unresolved.