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Money & Rights

Health care in later life

Sally Bundock advises on how to make the most of NHS treatment, and how to complain if things go wrong

While there is much more about our lives we cannot control, when it comes to our health there's a lot we can do to help ourselves.

A recent Australian study reinforced a growing body of evidence that a many cancers can be prevented. Studying cancer risk factors such as smoking, diet and physical activity, researchers estimated that nearly 40 percent of cancer deaths annually in Australia were preventable.

In the UK we are fortunate to have one of the best health care systems in the world. In July, it will be 70 years old but regrettably it cannot claim to be in the best of health with current pressures on it, including cuts to budgets for social care, staff shortages and an ageing population.

Figures published in December indicated that nearly a tenth of NHS posts were vacant, and ten million GP appointments are wasted annually across England by patients who do not attend. We certainly need o nurture our NHS and use its resources wisely for the greater good. 

The NHS Constitution explains the rights individuals have  NHS patient. These include being involved being involved in decisions about treatment and being treated with kindness, dignity and respect.

People have the right to complain if they feel it is justified. You have the right to choose your GP practice, unless there are reasonable grounds for refusal.

If difficulties arise, NHS England or your local Clinical Commissioning Group (CCG) must find a practice for you. If your GP recommends an outpatient appointment at a hospital you have the right to choose which hospital, provided it offers the required service.

In some circumstances, you do not have the choice, such as an urgent referral for suspected cancer. 

The waiting time to start consultant-led treatment varies in different parts of the UK.In England and Scotland, the maximum wait should be 18 weeks. If a GP makes and urgent referral for suspected cancer, the patient should be seen by a specialist within 2 weeks. NHS Choices (www.nhs.uk) offers a wealth of information, including he opportunity to search for hospitals in a given area offering various specialisms and able to carry out specific procedures. Waiting times form referral and number of procedures carried out are also shown.

Staying in control

To achieve the best outcome, both the patient and the medical practitioner have an important role to plat. The patient should try to give a clear picture of their current health concerns. 

Three questions that patient can ask of any new proposed intervention or drug are: What are my options?What are the benefits and harms to me? And what happens if I do nothing?? Carefully weighing up the answers can give the patient a feeling of control.

A patient, if able, must give their consent for any type of medical treatment, test or examination. The principle of consent is an important part of medical ethics and must be done based on an explanation by a clinician.

For consent or a refusal to be valid, it must be involuntary, informed and the person consenting must have the capacity to make the decision. In England and Wales, the Mental Capacity Act applies when a person is judged, after an assessment, to lack the capacity to make a particular decision.

In this situation and other given exceptions- for example, where the person is unconscious- health care professionals must act in the best interests of their patient. They must, however, take reasonable steps to seek advice from the patient's friends or relatives before making decisions.

Many people arrange for a family member or close friend to have Lasting Power of Attorney to make health decisions for them should the need arise. similarly, an Advance Statement about personal wished can be made. This can cover any aspect concerning future health or social care but it is no legally binding. However, anyone making decisions about care must take it into account. 

An Advance Decision (living Will) is a legal document which must be signed and witnessed. his document lets family, friends and health professional know your wished about refusing treatment if you are unable to make or communicate those decisions yourself. 

for instance, you may in given circumstances not wish to be given CPR (cardiopulmonary resuscitation). Both Advance Statements and Advance Decisions need to be kept safe and accessible.

When someone does not have friends or family to consult about decisions relating to their health or care, an Independent Mental Capacity Advocate, an independent Mental Capacity Advocate, and independent person with relevant experience and training, can be appointed.

The advocate will help the individual to express their wishes, work in their best interests and challenge decisions if appropriate. For information oon this Local Authority funded service, see the NHS Choices website.

Going into hospital can be daunting. On admission, certain procedures must be followed and information collated on each patient. In some cases a social worker will be appointed. For those who will have few or no visitors, volunteers work on the wards in most hospitals, speaking to patients and offer moral support. People representing different faiths are also usually available and patients may request a visit. 

On discharge from hospital, in all cases a plan mus be drawn up which ensures the patient is going to a safe environment with all continuing health needs recognised and catered for.

In  most cases, patient' experiences of NHS treatment are positive ones. Being aware of what to expect beforehand helps them have realistic expectations and, equally, to be aware when things do not go as they should, in which case i may be appropriate to make a complain.

How to make a complaint

Patients have the right to complain about nay aspect of NHS care, treatment or services on behalf of themselves or another. In the first instance, raise concerns informally with the staff involved or the manager of the team. The complaint may be made in person, by phone, letter or email and should be acknowledged within three days. In many cases this will provide a speedy resolution. If you feel that the complain has not been satisfactorily resolved, you can make a formal complaint. All NHS organisations must have a complaints procedure explaining who to contact, how he issue will be investigated and how they will respond.

You will also be advised what further action you can take if you are still unhappy, and how to access the NHS Complaints Advocacy Service. This is a free, independent, confidential service that can help you make a complaint about NHS services. This might simply be by giving you information so you can make a complaint yourself, or it can offer you the support of an experiences advocate who can support you. Contact: www.nhscomplaintsadvocacy.org.

If you do not feel happy complaining to a staff member or the organisation providing the service, you can take your complaint to the NHS organisation that commissioned that service. this is NHS England for primary care services- your GP practice, dentist, optometrist or pharmacist. for secondary or out-of-hours services such as ambulances and NHS hospital services, you need to complain to the local CCG.

If you remain unhappy with the outcome of your complaint, you may ask the Parliamentary and Health Service Ombusdsman (PHSO) to consider the issue, tel: 03450154033. It will take the complaint further if it feels it is appropriate. You can also raise your concerns with regulatory bodies such as the Care Quality Commission. Ideally, complaints need to be made within 12 months of the incident taking place or of your first being aware of it.

Complaints about adult social care services for self-funders may be raised informally or formally with the service provider. For care that is funded or arranged via the local authority, a complaint may also be directed to them. All unresolved complaints can be referred to the Local Government Ombudsman. Several organisations scan offer help and advice with making a complaint. If the patient is in hospital, the Patient Advice and Liason Services (PALS) may be able to facilitate a speedy resolution. Age UK offers some very useful leaflets, tel: 0800 055 6112, www.ageuk.org.uk. NHS Choices, Helathwatch and the Citizen's Advice Bureau are also useful resources. The Patient's Association has a national helpline offering free confidential advice, information and support on health and social care issues, tel: 020 8423 8999.

Deciding whether or not to make a complaint can be difficult. Often there is the nagging worry that it may make things worse. the PHSO sees far fewer complaints from and concerning older people than would be anticipated given their high usage of NHS services. A 2017 survey of more than 600 Gransnet www.gransnet.com members reinforced these findings and highlighted very real concerns about help with personal care, being treated with dignity and respect and poor communications with patients and families.

The survey also revealed that of those who were concerned about the treatment of their older relative, only just over half complained. Two-thirds of those who did complain were not convinced it would make a difference. Department of Health and PHSO systems are under review but we all have or part to play, including raising issues where appropriate and perhaps taking part in the NHS Friends and Family feedback scheme. 

As we grow older and perhaps live away from friends and family, there may not be anyone to complain on our behalf. This could indeed be a problem for many more people in the future as a greater proportion of women choose not to have children. Data shows that around a quarter of women born in the Seventies are childless. Ageing without Children www.awoc.org is researching into this issue. for those on their own, it is very important to plan ahead, such as considering making an Advance Decision.

Increased life expectancy has been accomplanied for some people by an extended period of poor health, it is important for everyone to do their best to look after their physicla and mental health.

What do you think? Do you have anything to share? 

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