The Healthcare Commission's report has confirmed peoples' worst fears, that making a complaint can be bad for your health.

Which? found that although almost half of NHS patients are unhappy with an aspect of their care, the majority don't raise the issue with staff, because they don't feel it will make any difference or think it may be detrimental to the care they receive.

To commercial organisations, feedback and complaints handling provide a competitive advantage because of the insight into the customer experience that it can generate. For the NHS, effective complaint handling could put patients at the heart of their care and drive improvements. If the NHS continues to ignore its patients in this way, we won't see the improvements in the quality of care that politicians promise and patients deserve. We need a cultural shift that allows the NHS to listen and act on patients' concerns.

Nick Stace, Director of campaigns, Which?, Marylebone Road, London.