Fighting the System: NHS Complaints Procedures

The first feature article I wrote for Mensa’s monthly glossy magazine was about medical and dental negligence and the uselessness, cruelty and bias of the NHS Complaints Procedures, and was entitled ‘Fighting the System’. In the years since then there will have been changes to the Complaints Procedure, but I am confident that it still harms complainants rather than helping them or reforming the system.
This is a slightly shortened version of the article:

Fighting the System

An abscess flared up on one of my front teeth. Talking was difficult and sleep impossible. My dentist said there was nothing wrong. So I went to the Dental Hospital. The pain – sudden, acute, accompanied by swelling, most severe when biting – was exactly characteristic of an acute abscess. But the pain was discounted and the abscess not treated.

When you have toothache you chew in strange ways to avoid exacerbating it. This puts unnatural pressures on teeth and it is easy to crack them. This happened to me. A cracked cusp, a separate agony, went untreated. Tooth-brushing was an ordeal and could not be as thorough as before the pain. Decay started, causing further severe toothache. This also went untreated. It was almost a year before the abscess was treated. It was over two years before I obtained treatment for all the dental disorders causing the toothache!

If consulted by a man with an abscess and weeping in agony, surely the most negligent dentist would take note of the signs and symptoms and would treat the abscess in its acute phase, ending the pain. In a full year of many attendances at the Sheffield Dental Hospital I was constantly insulted and left in agony. One consultant called me ‘You Fat Depressives’, plural, instead of using my name. It was clear that he habitually addressed suffering women in this way.

I eventually found a dentist brave enough to try to put things right. He dealt with the gross infections, etc but tragically much of the pain had by this time become chronic, which often happens when the cause is not dealt with promptly.

I heard from other women who had had their pain derided or been told that it was ‘nerves’ or ‘all in the mind’. One Rotherham woman had endured agony from trigeminal neuralgia for 13 years before someone (a neurosurgeon in private practice) took her pain seriously and operated. The pain then stopped. Trigeminal neuralgia mainly attacks women and its only symptom is pain. It is not uncommon for people to kill themselves because of severe toothache or because of trigeminal neuralgia, so intense is the pain.

Thirteen years of needless agony. Why does such cruelty flourish? The answer is many-faceted, of course. It includes ignorance and arrogance. Pre-eminent, however, is the health professional’s demeaning attitude towards women, coupled with the scandalous fact that in this country doctors and dentists are accountable to no-one, not to the patient, not to the hospital, not to the NHS.

Women are sub-human, second-class citizens whose voice need not be heeded. Everyone knows, don’t they, that whatever a woman complains of, the ‘real’ cause is usually psychological, and instead of investigation and treatment all she needs is a brusque injunction to pull herself together and a prescription for tranquillisers and anti-depressants. That’ll settle her!

In my desperate efforts to obtain the treatment I needed I turned to every health agency. All pretended that negligence does not occur. No-one insisted that my teeth be examined and my agonising toothache dealt with. The health agencies and the people to whom complainants must address complaints are financed by the DHSS or the NHS and by definition not impartial. The Complaints Procedure routinely adds to the difficulties of complainants rather than dealing with their complaints of negligence.

Why are the legislators not moved to effective remedial legislation? There are many reasons, I suppose; laziness, fear, the myth of medical infallibility, the desire to keep in with medics and their retinues, the fact that most MPs use private medicine rather than the NHS and that when they do use the NHS they get preferential treatment. Surely, also, a lack of imagination – failure to comprehend the scale of the suffering, the profound and terrible difficulties of damaged victims – trapped in pain and distress and worry, trapped in misunderstanding, trapped in bewilderment that those to whom they turn for help and from whom they have been led to believe they will receive it, adopt a confrontational stance. There is no-one in the entire edifice of the Health Service from whom victims of medical negligence can be assured of receiving help. They do not know where to turn.

In the Sheffield Star of August 20th 1986, the Administrator of the Sheffield Family Practitioner Committee is quoted as saying of complaints that most of them ‘were dealt with amicably, although in some cases the patient was struck off’. Dealing with complaints is clearly thought of as a matter of smoothing ruffled feathers or of placating/punishing the complainant, rather than of examining faults that need to be put right. If you made a complaint about trains, you would not consider it resolved by being forbidden to travel by train any more, would you? Why should a complaint about a doctor be considered resolved by crossing the complainant off his list?

When in the press someone criticises the medical profession, another person is certain to write in to protest that they themselves received wonderful treatment. e.g. the dreadful way that Sue Arnold was treated at the Moorfields Eye Clinic in London, reported a few months ago in her column in the Observer magazine. The following week someone wrote about their wonderful treatment there. If you publicised finding a dead mouse in a loaf, no-one would dream of writing to say that they had had a loaf from the same shop and it hadn’t had a dead mouse in it! Officials aver that the public makes few complaints about the Health Service. Like saying that most of our loaves don’t contain dead mice.

The official claim disregards the justifiable fears many people have about making a complaint. You risk being struck off a doctor’s list (and often the family of the complainant is also struck off) and may find it difficult to get a doctor at all.

The main reason for outraged complaint is being treated as sub-human. As I was. Callously left in agony which could easily have been treated and which I clearly could not treat myself. Agony for which it was impossible to get relief without the treatment that was being denied me. Abscesses and caries cannot ‘get better’. There has to be professional intervention.

By allowing medics to insult people under the guise of diagnosing them, by allowing honourable people to be treated in this appalling way, humanity is defiled. By categorising the person who then complains as a nuisance who must be pacified if possible and quelled if not, no-one is safe from such defilement.

There are moves to tinker with the Complaints Procedure. The Primary Health Care leaflet, with the Government’s proposals for discussion on health services outside hospital, suggests that there should be informal conciliation procedures to settle less serious complaints quickly and effectively. Again the ruffled feathers syndrome. Complainants do not want conciliation, they want remedial action taken about the complaint. Officially, negligence does not occur. So nothing is done about it.

It would be salutary to cause to be published a sample of the complaints of the last year and what the Complaints Procedure did about them. This would show it up for the charade it is. One only hears of anything being done if the matter is given publicity, which seldom helps.

That suffering, ill, exhausted people damaged by the medical profession have the right to redress in the civil courts is no right at all. Only 3% or 4% of cases get to court and they take a minimum of 4 years to get there. Everything is weighted against the victim, especially the hostile attitude of the Health Authorities. In any case, action in the civil courts has only individual relevance. General reform cannot result.

What victims most need is remedial treatment. There is no provision for this. What can be more important than the right to urgent remedial treatment when you have been harmed by hospital personnel? Gross medical negligence is compounded by the implacable unhelpfulness of the Health Authorities.

The NHS should be accountable to the consumer – i.e. the patient. Medical and dental staff have absolute power to give or to withhold necessary investigation and treatment to patients, to treat them with insolence, to defame their characters in privileged communications, etc. provided only that they call this the exercise of ‘clinical judgment’. (Compare this with, in recent times in Parliament, the ritual incantation that a matter is one of ‘national security’ and as such no-one has the right to question it.) Such power is clearly dangerous, is open to abuse and is clearly being abused. Terrible suffering like mine would be totally prevented if medical and dental staff were accountable.

Negligence

There can be nothing in this country more heinously unjust than the lack of help for the suffering victims of medical negligence. Patients have no protection whatsoever from the ignorance, incompetence, negligence and sometimes sheer malice of doctors and dentists. People who are not victims of the system are unaware of the situation. That negligent doctors and dentists incur neither censure nor sanction from the system ensures that negligence flourishes.

It is a moral imperative for caring people to do what they can to bring a speedy end to this cruelty.

The Complaints Procedure needs to be scrapped and replaced by a system providing immediate help for the victim of negligence (I don’t mean money; I mean remedial treatment and support) and an independent inquiry into the negligence with the purpose of apportioning responsibility and instituting reform to protect potential future victims. I stress that I am not interested in legal redress. I am asking for legislative action to remedy a national scandal.

The Health Ombudsman defines instances of medical negligence as matters of clinical judgment, and matters of clinical judgment, conveniently for negligent doctors and dentists, are outside his terms of reference. So he does not help. His reply to my letter made clear that he had given scant attention to my arduously compiled material. My evidence was ignored.

This state of affairs is independent of who the individuals are who become victims, being only dependent on the deficiencies of a system which allows the magic phrase ‘clinical judgment’ to override reason, humanity and justice. Clinical judgment cannot, by definition, obtain, where clinical diagnostic procedures have been waived. To pretend otherwise is an abuse of language, an abuse of trust, effectively an abuse of power and in practice a physical and psychological abuse of individual victims.

These abuses are systemic and must be rooted out. The powerless and suffering need protection from such cruelty.

There was a public inquiry about Wendy Savage, a doctor neither negligent nor incompetent, and about whom no patients had lodged complaints. There are no inquiries into real cases of negligence, initiated by the victims. Health professionals would be much more careful if their actions were to be subjected to public scrutiny.

Margaret Wilde