For many people the care and attention they receive in hospital is high quality and their treatment successful.
But going into hospital can be a daunting and emotional time for any patient no matter how old or how serious the illness. Preparation and knowing what to expect can help overcome any fears.
So what care can you and your relatives expect? What are your rights? And if things do go wrong what can you do?
Help the Aged and Age Concern have provided Panorama with some advice and information to some common questions.
I am concerned about my own care
I have to go into hospital and I am concerned about not being treated well there. What can I expect?
You have a legal right to a reasonable standard of care and treatment from hospital staff. The definition of 'reasonable' is decided by what other members of the same profession would do in similar circumstances. There are also some basic standards which NHS hospitals are required to meet. These include:
- respect for privacy, dignity and religious and cultural beliefs;
- respect for confidentiality;
- a clean and safe hospital environment;
- a named nurse in charge of your care; and
- name badges to be worn by all staff.
If there are problems in the care I receive or if there were problems in the care I have received in the past, how can I complain?
Your stay in hospital should be as comfortable as possible. However, if you do have any complaints about the way you have been treated, it is your right to have it investigated and to be given a full and prompt written reply.
If you have any concerns about your standard of care raise them with the staff involved or the nurse in charge of the ward in the first instance. Some hospitals also have 'modern matrons' who cover a number of wards - one of their roles is to arrange practical solutions to problems so that patient care is improved.
If you feel unable to raise your problem or concern in this way, you or a relative or carer could contact the hospital Patient Advice and Liaison Service (PALS). One of their roles is to try and help resolve patient concerns before they become major issues. They are often located in the reception or entrance to the hospital.
If the situation doesn't improve, use the official process to make a formal complaint.
All NHS hospitals have a complaints procedure - as a first step ask to see a copy. This procedure will explain how to make a complaint, and who to make it to. Usually, the first person to speak to is the person you hold responsible for what has happened.
If you're uncertain who is responsible, or feel unable to talk to them, contact the hospital complaints manager. As with all complaints, remember to keep copies of all correspondence
As a last resort, contact a health service ombudsman. Before doing so you must give the NHS a chance to investigate the matter. An ombudsman will look at complaints concerning faulty services or administration, such as unhygienic ward conditions or a long wait for treatment. The ombudsman can also investigate complaints about matters involving a doctor's clinical judgement.
Contact the ombudsman's office for advice on making your complaint; you can check whether the ombudsman will be able to look at your complaint, and get advice on what information you need to provide them with. Usually, you should write to him/her (see contacts), giving details of:
- your name and address;
- the name and address of the offending organisation;
- the nature of your complaint;
- any financial loss, injustice, or hardship suffered;
- what, in your opinion, could be done to put it right;
- details of all previous action taken and;
- copies of all relevant correspondence.
If they feel it is appropriate, the ombudsman can conduct an investigation into the complaint, and will write a report. A copy of it will be sent to the relevant authority, with recommendations on rectifying the situation. The ombudsman can't enforce these recommendations, but they are usually accepted.
If you are thinking about taking any legal action against a hospital or health authority, it is a good idea to first seek advice from an organisation with expertise in this area, such as a Citizens Advice Bureau, a specialist lawyer or an independent advice centre.
I am worried that they will not let me come back to my own home after I have been in hospital. How can I ensure that my feelings are taken into account?
If a hospital believes you're no longer in need of treatment, it is entitled to discharge you. It is the hospital's responsibility to ensure you don't leave hospital unless adequate arrangements for your support in the community have been made.
You should not feel pressured into making hasty decisions about going home (or perhaps into a care home). This particularly applies if you aren't sure whether you can cope at home or whether you need residential or nursing home care. Hospital staff should appreciate that finding a suitable solution takes time.
If you are returning home, then it is important to make sure well in advance that you'll receive the help and facilities you will. The hospital should arrange for your local authority to assess your need for assistance at home.
If you are unhappy with the arrangements being made or if you have any concerns about being discharged from hospital, talk to a member of the hospital staff and explain your feelings.
I know that I should try and walk about more on my own - but am scared of falling over, hurting myself and ending up in hospital. What should I do?
Although falls are a major cause of disability for older people, fear of falling can have a significant impact on your quality of life.
If you are concerned about falling and there have been occasions when you felt in danger of falling you should discuss this with your GP. Exercises that can improve your balance and the strength of your muscles are helpful in minimising your risk of a fall. There may be Pilates or Tai Chi or other specialist class that your GP could suggest you join.
There are many factors that can influence a person's confidence and the likelihood of them falling. If your GP feels it appropriate, he / she may wish to refer you to a local falls prevention service.
I am concerned about someone else's care
I am worried that an older person I know who is in hospital is not getting the care they deserve. What can I do to help?
If you have specific concerns you should raise them, as a concerned friend, with the nurse in charge as soon as possible - with the patient's knowledge and approval as appropriate. Your concerns should be taken seriously and addressed quickly and satisfactorily. You should receive feedback and where appropriate a commitment that changes will be made.
If you would find this difficult, you could raise your concerns with the hospital Patient Advice and Liaison Service (PALS) instead. One of their roles is to try and help resolve patient / carer concerns or problems with treatment or care before they become major issues. PALS are often situated in a prominent place in the hospital such as the main entrance or you may find details on how to contact them on posters around the hospital. NHS Direct - the confidential NHS helpline on 0845 4647 - should also have contact details.
If you remain dissatisfied after following either of these routes, PALS can explain the formal NHS complaints procedure to you. This is explained in Age Concern factsheet 44 NHS Services.
I am worried that an older person who I know is losing weight rapidly because they are not eating. Is there anything I can do to help, short of monitoring every meal?
If they are in hospital
One of the Standards for Better Health that all hospitals must reach relates to helping patients who need help with eating and drinking. As part of their admission assessment, many hospitals now record a patient's weight and give them a 'nutritional risk' score based on their current nutritional status. If they are at risk, their weight and other indicators of any decline should be monitored regularly. You may like to ask the nurse in charge if this happens on your friend's ward and how they are monitoring any changes.
If this has not happened, you should raise your concerns about your friend's weight loss with the nurse in charge. If you know there are foods / meals the older person usually enjoys, flag these up with the staff. Food and drink is available from the ward kitchen outside mealtimes and so small snacks in between meals may be appropriate. There may be a nutrition nurse or dietitian who could be asked to assess your friend and make recommendations which may include providing nutrition supplements.
If they are at home
It can be difficult to raise concerns like this. If you feel weight loss may be because of difficulties in shopping and preparing food, you might suggest seeing if it would be possible for your friend to receive meals on wheels. Your local authority's social services department can explain what is available and how to access the service. They could also tell you about other help such as luncheon clubs that may operate locally. See Age Concern Fact sheet 6 Finding help at home. Some local Age Concerns run luncheon clubs but may not be able to accept an older person without a referral from social services. You could contact your local Age Concern to see what services they offer (contact details in the phone book or by calling Age Concern Information Line on 0800 00 99 66 [freephone]).
The weight loss may have a medical reason so if your friend has not been to see their GP recently, it would be worth trying to persuade them to make an appointment for a general check up during which they could mention their recent weight loss.
I am worried about the declining health of an older person - but they are refusing to let me get help for them. I want to respect their wishes but am worried that others perhaps health and social services should be involved. What should I do?
Social services and NHS staff are unable to force a person to see them, so it important to try and persuade the older person to take action and visit / ask for a visit from their GP or allow you to contact Social Services on their behalf.
Despite a rejection when you first approach the subject, try again at an opportune moment and see if you can find out what concerns they might have about speaking to their GP. Addressing these concerns may be the first step in persuading them to take action.
If the older person has a good friend you may like to see if they have noticed any change/deterioration. A suggestion from a close friend or perhaps a favourite relative may be more persuasive.
If you know the patient's GP you may like to raise your concerns with them. For reasons of patient confidentiality a GP cannot discuss a patient with a third party but they may have had a good relationship with the patient in the past and feel able visit unannounced. If the person is currently taking medication, it may be possible to invite them for a medication review as a way in to discuss wider health issues.
If you are concerned about the safety of an older person, you may like to contact Social Services and ask to speak to the duty officer for the adult team and explain your concerns. They may suggest how you might proceed.
I am worried that an older person I know is very depressed. Are there any counselling services or emotional support services specifically for older people?
Again it is important to try and persuade the older person to visit their GP who can make a diagnosis and decide on appropriate treatment. Counselling is one option and is not appropriate for everyone. Unfortunately there are usually long waiting lists when a GP makes a referral for any NHS patient to see a counsellor. Although the counsellor may have experience of working with older people, there is currently no specific NHS counselling service for older people.
I am a nurse/doctor and am concerned about standards on a ward where I work
I think there are problems on my ward but am nervous about blowing the whistle on my colleagues. Where can I go for help?
Procedures should be in place within every hospital to allow for concerns to be raised
"sensibly and responsibly without fear of victimisation." Staff should have access to local guidance to enable them to raise concerns which includes telling them who to bring concerns to.
Public Concern at Work is an independent authority on whistleblowing. If you have trouble finding local guidance it may be worth contacting their confidential helpline for people who are concerned about wrongdoing at work but not sure how to raise the concern.