Chapter 4
The Complaints Dimension:
Patient Complaints in Health
Care Provision
Arnold Simanowitz
Therehasprobablybeenmorefundamentalchangeintheareaofcomplaintssince
thischapterwaswrittenforthefirsteditionofthisbooksixyearsago,thaninany
other aspect of the ethical side of health care provision. This change has affected
the legal side to some extent as well.
Onthefaceofitthatmightappeartobeanextravagantclaim.Therehavebeen
majordevelopments,ifnotadvances,onallfrontsintheethicalandlegalspheres
of health care, as the other chapters of this book demonstrate, some of an extre-
mely far-reachingnature.Inthose areas,however,the developments have related
tospecificareasorspecificissuessuchasthecriticallyillpatientanddecliningand
withdrawing treatment.
Insofar as complaints are concerned, however, the change has been of a more
fundamental kind. Indeed, whilst the issue of complaints was quite properly
includedinabookaboutlawandethics,whenthefirsteditionwaswritten,atthat
timecomplaintswerenotreallyseenasanethicalmatteratallandhadverylittle
impact on or involvement with the law. With regard to ethics, on the one hand
complaints were simply regarded by health care providers as an attack on the
institution or individual involved, to be rejected if possible or diverted if not; on
the other hand, patients believed, partly because of that very attitude of the
providers,thatiftheycomplained,theyweredoingsomethingsomewhatfrowned
uponbysocietyandpossiblyharmfultotheNHS.Asaresultcomplaintswerenot
seen as an ethical issue at all.
It was because of this that the original steps taken to introduce procedures to
enable patients to complain, satisfied neither patients nor health carers. On the
providers side they were introduced grudgingly as a minimum that might satisfy
the`difficult'patient;ontheothertheydidnotbegintosatisfythefirstprincipleof
acomplaintsprocedurewhichistolookattheproblemfromthepatient'spointof
view.Ifsomeoneofnegativeintenthadsatdowntocreateasystemforpatientsto
complain about health care they wouldhave beenunlikely to have come up with
anything as unhelpful as the system that operated before the changes brought in
following the Wilson enquiry in 1994 [1].
Firstly there was an entirely different procedure depending on where the