A report commissioned by the Scottish Health Council highlighted poor communication and staff attitude as the most persistent problems, but found “significant” barriers to making a complaint.

In all, almost one-third of patients had encountered a problem with the NHS, but 53% of that group did not complain about the service they received, with many saying that it “wouldn’t make any difference”.

The report said: “People perceive many disincentives to complain even when things have gone quite seriously wrong for them in their contact with the NHS in Scotland. People’s experiences and relationships with the NHS in Scotland are often complex and most people just want to move on from them.

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“Fundamentally, people in Scotland just do not want to complain about the NHS.”

The Making It Better report was based on a survey of almost 2000 people, including 257 who had complained to the Scottish Public Services Ombudsman, and responses from health boards and complaints-handling staff.

About 35 formal complaints are made for every 100,000 patient contacts, but the report warned that this “cannot be assumed to be a mark of patient satisfaction” as people have “low expectations” and many do not give any feedback about their treatment.

The majority (69%) of people said they were satisfied with their experience of the NHS in Scotland, but 31% had encountered a problem.

However, only 18% of those who had experienced a problem said they had made a formal complaint and almost two-thirds (64%) of those who did not take any further action said it was because they thought it “wouldn’t make any difference”.

A further 27% said that they had expressed concern or given feedback to staff, but the report warned that data on issues mentioned informally may “not be captured, meaning that trends are going unrecognised”.

Other concerns were that the patient might be “branded a troublemaker” and this could affect their future treatment, that they were too busy coping with their illness or caring for someone to follow up their complaint and that they did not know how to complain. Other people expressed a “fear of being thought to be motivated by financial gain”.

The report said that people can feel “disempowered and disadvantaged” in the healthcare system.

But it added: “We found this is often unwarranted. Some NHS Boards are actively encouraging feedback from patients and have made important changes following patient complaints.

“We also found a high proportion of GP practices surveyed had changed systems and practices in light of patient complaints and feedback. The NHS has in many instances been responsive to patients.”

Statutory response times for dealing with complaints are “not being met consistently across Scotland” and the report recommended action to enable health boards and GP practices to deal with complaints in shorter timescales.

A Scottish Government spokeswoman said: “Most people are satisfied with the treatment and contact they have with the NHS. But for those who are not, it is important that they are able to raise these issues and have them dealt with appropriately.”

“There is a need for alternatives for people who have concerns about the NHS to be able to raise these and have them dealt with by means other than the NHS complaints procedure, when they choose to.

“This is why we commissioned the report. We are now considering its recommendations and how best to implement them.”