There are both patients and practitioners who would like to see NHS complaints processes reformed. Things came to a head this week.
[Reader warning - this article contains content related to self-harm and suicide.]
Twitter has been on fire (again). Disabled and chronically ill patients’ stories of diagnostic overshadowing, minimisation, and medical disbelief have spilled out with considerable anger this week. Some defences have been similarly fiery. Hashtags created ranged from #DoctorsAreHuman and #DoctorIRespect to #PatientsAreD*ckheads and #DoctorsAreD*ckheads. The whole debate has felt like part of a bigger conversation about patients’ complaints and NHS clinicians’ power, which has been taking place via social and mainstream media all year.
A key figure in that conversation is Dr Clare Gerada, a senior GP who has held a number of national roles including Chair of the Royal College of GPs. She has commented several times that encouraging patients to make complaints is a direct contributing factor to the clearly catastrophic high rate of suicide among medics. The ensuing online debate has come painfully close to suggesting that patients complain for the sake of it; that we are instantly believed at the expense of NHS staff; that the complaints process is too easy. This is a far cry from my own experience.
I have been using mental health services for five years, and have been in and out of A&E, psychiatric and medical wards for that time. Here is an incomplete list of the formal complaints I did not have the strength to make:
- I did not complain about the A&E doctor who refused to use local anaesthetic when he sutured my wounds because they were self-inflicted.
- I did not complain about the member of the crisis team who called the police to have me removed from their office when I was curled up in a ball, dissociating, unable to move.
- I did not complain about the triage nurse who would not refer me onwards after a life threatening overdose until he had lectured me on precisely how painful it would be if I needed dialysis for the rest of my life, and told me I couldn’t “play” with medication like this.
- I did not complain any of the times I was illegally prevented from leaving A&E by placing a security guard on watch duty so that I stayed still, silent and terrified. It is less paperwork to do this than to detain someone under a short-term section of the Mental Health Act - and it removes all legal safeguards for the detainee.
- I did not complain when I was illegally detained on a psychiatric ward, because there were no beds to section me to.
- I did not complain about the nurse who refused me anxiety medication because I “wasn’t violent”.
- I did not complain when I was asked to write my own care plan at 9.30 pm, because the CQC were inspecting the ward the next day.
- I did not complain when none of the hospital staff remembered to order dressings, so I couldn’t cover my self harm injuries and developed cellulitis.
- I did not complain when they left another patient to bang on the office door until she bled.
- I didn’t complain about these things because I have tried making complaints before and all they achieved were denials, sorry-not-sorry apologies, and a bone-deep, exhausted hopelessness. Frankly, I also didn’t have the time.
On one occasion, I did write to raise concerns after A&E security staff - with doctors and nurses standing by - threatened to make me remove my bra to search me; said I was “playing games” with them; then restrained me while I was curled up, unmoving, pleading with them not to touch me. I received a response stating that the security guard “apologises that your perception was as described” but “does not recall” making the comments. In any case, the hospital said, “security staff would never ask a patient to remove their underwear”.
I wanted to take it further, but couldn’t find it in me to face down this kind of disbelief. So I let it drop, and I will never voluntarily walk into that hospital again. I had no interest in any staff being hung out to dry. I wanted an apology - a real one, one that said sorry for their actions, not for my perception - and I wanted safety.
My experiences are not unique. The service user whisper network is a constant chorus of #MeToo moments like this: suffering compounded by a complaints process concerned with institutional reputation management rather than bearing witness to failure and learning from it.
An adversarial complaints process which punishes individuals for system-wide problems is dangerous for everyone. But I’d ask doctors, nurses, and NHS staff of all stripes to work with us when we raise concerns, even in the difficult situations where that means challenging colleagues’ or employers’ practices. We will all be safer for it.