Older people could be suffering in silence because they are less likely to complain when standards slip, even though they use the NHS the most, Health Service Ombudsman Dame Julie Mellor has said.

Writing in the Daily Mail, Dame Julie said she feared the reluctance of older people to complain “coupled with their not knowing where to go to make a complaint could mean we are just seeing the tip of the iceberg of serious failings in the care of people who are 65 and over.”

She continued: “But my fear is that too many older people are suffering in silence. Almost 80 per cent of all the investigations we carry out are about NHS services.

“Even though nearly half of NHS care and services are given to older people, only a third of the health complaints we investigate are about the care of older people.”

She also highlighted common themes of complaints made including misdiagnosis, staff attitudes, poor communication with patients and families, substandard nutrition, and patients not being treated with dignity.

The ombudsman called for a change in attitudes as well as the process of making a complaint.

She said: “More needs to be done to tackle the toxic cocktail of reluctance by patients, carers and families to complain and a defensive response from the NHS, when they do.

“Making a complaint should be easy and transparent. And people should be supported to do so. Often older people fear negative repercussions when they make a complaint or they simply don’t like to ‘make a fuss’.”

She stressed that if people were not happy with the way the NHS handled a complaint, they should complain to the Parliamentary and Health Service Ombudsman.

The ombudsman’s role is to investigate complaints of unfair treatment or ways in which individuals have been poorly served by government departments and other public organisations and the NHS in England.