It is not easy to complain about care. Poor care has been a taboo subject for many years, within and around the care (nursing ) profession, for many reasons such as professional and poilitical.
Despite some excellent care, here are some examples of care- in whatever country;
A patient is shouted at for wetting the bed.
A patient is given a dose of pain killers, 2 hours after he needed them.
A patient dies unexpectedly- baby, teenager, old person–.
A patient receives the wrong medication.
Staff work with 3 in total- not 6, due to staff absences or staff needed at the Doctors surgery (in care home) .
Where these situations occur, is not be the issue for this article ; whether they were in private, charity or NHS owned establishments. Although there may well be cultural differences regarding what is acceptable or not.
The issue is poor care; care that is below the expectations of the patient or the nurse/carer/other professional. We may also include relatives and inspection bodies and politicians here.
Poor care may arise on a continuum from errors (drugs/clinical), to sheer abuse (physical or verbal etc).
Not all incidents of poor care are due to short staffing. Short staffing may well contrbute towards omited aspects of care such as baths but not abuse.
Since 1973 the Parliamentary Healthcare ombudsman in England has existed. Prior to that, there were several patients groups such as the Patents Association, as described by Mold (2010), and the Community Health Councils. The combudsman is described as being “independent”, yet the representative at least, is selected by the government and is responsible to the government.
The PHSO will address issues regarding health of NHS funded patients, or those within NHS owned establishments- as long as they meet the criteria eg approached every lower agency first. Hence the majority of PHSO complaints are rejected. Social care issues may be addressed by the Local Ombudsman. The difficulty is defining what are health or social issues, or indeed, nursing issues. Donnelly (2014) states that ” it fully investigated less than 400 of 16,000 patient complaints made last year”. Professor B Jarman commented “complaints should be treated like gold dust” due to lessons to be learned from them. Is the ombudsman indeed, a means to hiding problems? (see Newsome 2013). “Professions effectively regulate themselves” (ibid), with the government abdicating responsibility for independent bodies. Ombudsman within other countries such as USA or Australia, do have similar problems (Dimon 2013). This further indicates the political secrecy which is now a factor within all societies, based upon neoliberalistic intentions, where individuals are responsible for themselves and the focus upon money-making businesses.
Issue is- who does the PHSO serve?
These are the equivalent agencies in the 4 regions of the UK;
England – Health Ombudsman/Local Government Ombudsman.
Northern Ireland Ombudsman. The Northern Ireland Ombudsman can deal with complaints about: a government department or agency, local councils, health services, education services
In Scotland, Complaints may finally be raised with the Scottish Public health Service Ombudsman regarding NHS and Councils, for example but not private care services.
The Public Services Ombudsman in Wales, will investigate some complaints regarding NHS patients in hospitals or NHS funded patients in private hospitals and nursing homes. but similar to England, there are criteria to meet. Private paying patients in hospital or care home, are expected to seek the advice of solicitors which may be expensive and stressful for many.
Despite the Ombudsman, there are differences in other agencies within the 4 regions. For example all healthcare in Wales; private or NHS, is inspected by the Healthcare Inspectorate Wales. There are 7 local health boards who plan and deliver services . Community Health Councils still exist in Wales. CHCs aim to improve and monitor quality in NHS services. They are described as being independent- some are council members or are known to the council (wales.nhs.uk/siteplus).
This influences the whole complaints procedure within the NHS or private sectors.
How one complains, also depends on who funds their care (Dimon 2013). In many cases, it may only be staff who witness, or are aware of any type of poor care.Since the Francis report, which focusses on the NHS, there has been a campaign to encourage staff to do this. There are many reasons why this may not be done by staff (Dimon 2013). Such prescribed procedures and channels, may well aim to prevent individuals from approaching the police or the press. However, there have been fabricated cases, especially of staff or managers, about other staff (Dimon 2013).
One postive example is California which offers an example complaints form, and a step by step outline of the process.In all 4 regions of the UK, as in other countries, it appears that complaining especially about the private sector, is a difficult process. One issue may be that there is no alternative for care provision. Yet complaints can be dealt with and could be used by the establishment as a positive indicator if well resolved . When care- or people- are commodities, numbers are the aim of the game.
Dimon C (2013) The Commodity of Care Cloister House Press
Donnelly L (2013) NHS Watchdog accused of throwing away complaints The Telegraph 3.2
Mold B (2010) Patient Groups and the description of patient- consumer in Britain: An Historical Overview Journal of Social Policy October 39 (4) 505-512
Newsome B (2013) National Healthcare: How Not to manage it (part2/2) 26.9 fairobserver.com