Complaints & Accountability (England)

Understanding NHS Complaints

An NHS complaint can be made if you are unhappy with:

• Medical treatment
• Delays in care
• Waiting times
• Poor communication
• Misdiagnosis
• Clinical decisions
• Staff behaviour
• Accessibility issues
• Lost records
• Medication errors
• Hospital discharge
• Appointment problems
• Consent issues
• Confidentiality breaches
• Equality or discrimination concerns
• Failure to make reasonable adjustments

You can complain about care provided by:

• GP surgeries
• Hospitals
• NHS dentists
• NHS pharmacies
• Mental health services
• Community services
• Ambulance services
• NHS 111
• Opticians providing NHS services
• Other NHS-funded healthcare providers

Official NHS guidance:

https://www.nhs.uk/contact-us/how-to-complain-to-the-nhs/

Your Rights Under the NHS Constitution

The NHS Constitution for England gives every patient the right to:

• Have complaints investigated properly.
• Receive an explanation.
• Receive an appropriate response.
• Be treated fairly.
• Receive information about the complaints process.
• Escalate unresolved complaints.

You should not be treated differently because you have made a complaint.

Official:

https://www.gov.uk/government/publications/the-nhs-constitution-for-england

How to Make an NHS Complaint

Most concerns can be resolved locally.

Step 1 — Speak to the Service

Speak with:

• Doctor
• Nurse
• Therapist
• Reception team
• Practice manager
• Ward manager
• Service manager

Sometimes concerns can be resolved immediately.

Step 2 — Make a Formal Complaint

If the concern cannot be resolved informally, submit a formal complaint to the NHS organisation responsible for your care.

Include:

• Your name
• NHS number (if known)
• Dates
• Location
• Staff involved
• What happened
• Evidence
• What outcome you want

Examples of outcomes:

• Explanation
• Apology
• Review of care
• Policy changes
• Further investigation
• Staff training
• Service improvements

Time Limits

Normally complaints should be made:

• Within 12 months of the incident, or
• Within 12 months of becoming aware of the problem.

However, NHS organisations may investigate complaints outside this period where it is reasonable to do so.

Patient Advice and Liaison Service (PALS)

PALS provides confidential advice, information and support for patients, families and carers using NHS hospital services.

PALS can:

• Explain NHS services.
• Help resolve concerns quickly.
• Improve communication.
• Assist with accessibility issues.
• Explain complaints procedures.
• Help people navigate hospital services.

PALS is not the same as the formal complaints process but may resolve issues before a formal complaint is needed.

Find your local PALS:

https://www.nhs.uk/service-search/other-health-services/patient-advice-and-liaison-services-pals/

Independent Advocacy

If you need help making a complaint, you may be entitled to independent NHS complaints advocacy.

Advocates can help you:

• Understand your rights.
• Prepare complaints.
• Attend meetings.
• Explain medical information.
• Organise evidence.
• Challenge decisions.
• Escalate complaints.

Other advocacy services include:

• Independent Mental Health Advocacy (IMHA)
• Independent Mental Capacity Advocacy (IMCA)
• Care Act Advocacy
• Children's Advocacy
• SEND Advocacy

Advocacy is independent from the NHS.

Parliamentary and Health Service Ombudsman (PHSO)

If you remain dissatisfied after completing the NHS complaints process, you may ask the Parliamentary and Health Service Ombudsman (PHSO) to investigate.

The Ombudsman is independent of the NHS and Government.

The PHSO may investigate:

• Maladministration
• Poor service
• Delays
• Failure to follow procedures
• Poor communication
• Clinical failings (where appropriate)
• Failure to investigate complaints properly

The Ombudsman cannot normally investigate until the NHS organisation has completed its own complaints process.

Official:

https://www.ombudsman.org.uk

Care Quality Commission (CQC)

The Care Quality Commission (CQC) is the independent regulator of health and adult social care services in England.

The CQC:

• Inspects services.
• Registers providers.
• Monitors quality.
• Publishes inspection reports.
• Takes enforcement action where necessary.

The CQC does not resolve individual complaints, but information from patients helps identify concerns and informs inspections.

You can share concerns about care with the CQC.

Official:

https://www.cqc.org.uk

Raising Concerns About Patient Safety

Raise concerns immediately if you believe there is:

• Unsafe care
• Medication errors
• Safeguarding concerns
• Abuse or neglect
• Serious communication failures
• Delayed diagnosis
• Incorrect treatment
• Failure to make reasonable adjustments
• Serious staffing concerns
• Infection control failures

If there is an immediate risk to life or safety, call 999.

For hospital concerns, ask to speak to:

• Ward manager
• Senior nurse
• Consultant
• Duty manager
• Patient Safety Team
• PALS

Evidence Standards

Keeping clear evidence helps NHS organisations understand what happened and investigate fairly.

Keep copies of:

• Appointment letters
• Referral letters
• Medical records
• Care plans
• Medication lists
• Test results
• Hospital discharge summaries
• Emails
• Letters
• Complaint correspondence
• Photographs (where relevant)
• Witness details
• Notes of telephone conversations
• Dates and times
• Names and job titles of staff

Ask for:

• Copies of your health records.
• Complaint acknowledgement.
• Investigation findings.
• Written explanations.
• Action plans.
• Learning outcomes where appropriate.

Children, Parents and Carers

Parents and carers may complain about NHS care received by a child where appropriate.

Useful evidence includes:

• School reports
• Attendance records
• Health visitor notes
• CAMHS reports
• Paediatric letters
• Therapy reports
• EHCP evidence
• Medication records
• Symptom diaries
• Hospital letters

Children and young people should be involved in decisions and complaints where appropriate, taking account of their age, understanding and wishes.

Legal Rights

Patients are protected by several important laws and standards, including:

• NHS Constitution for England
• Equality Act 2010
• Human Rights Act 1998
• Mental Capacity Act 2005
• Data Protection Act 2018
• UK GDPR
• Health and Social Care Act 2008
• Care Act 2014
• Children Act 1989
• Children and Families Act 2014
• Accessible Information Standard

These laws help ensure healthcare is safe, fair, accessible, accountable, and respectful of patients' rights.

Accessibility Support

You can request:

• Easy Read information
• Large print
• Braille
• Audio information
• British Sign Language (BSL) interpreter
• Spoken language interpreter
• Communication support
• Longer appointments
• Quiet meeting rooms
• Wheelchair access
• Home visits where appropriate
• Carer or advocate involvement

Reasonable adjustments should be recorded and shared where appropriate under the NHS Accessible Information Standard.

Practical Questions to Ask

• What happened?
• Why did this happen?
• What investigation has taken place?
• What evidence has been considered?
• What actions will be taken?
• How will future patients benefit?
• Can I receive a written response?
• How do I escalate my complaint?
• Can I have advocacy support?

Useful NHS & GOV.UK Resources

NHS Complaints

https://www.nhs.uk/contact-us/how-to-complain-to-the-nhs/

NHS Constitution

https://www.gov.uk/government/publications/the-nhs-constitution-for-england

Patient Advice and Liaison Service (PALS)

https://www.nhs.uk/service-search/other-health-services/patient-advice-and-liaison-services-pals/

Parliamentary and Health Service Ombudsman

https://www.ombudsman.org.uk

Care Quality Commission

https://www.cqc.org.uk

Accessible Information Standard

https://www.england.nhs.uk/accessible-information-standard/

Care Opinion

https://www.careopinion.org.uk

Independent Support Organisations

You may also find support from:

• Citizens Advice
• Local Healthwatch
• NHS Complaints Advocacy
• Disability Rights UK
• VoiceAbility
• POhWER
• Law Centres Network

These organisations can help explain your rights, prepare complaints, understand NHS procedures, and access independent advocacy.

Quick Checklist

✔ Raise concerns as soon as possible.
✔ Keep copies of all letters, emails, records, and appointment details.
✔ Ask for written explanations and investigation outcomes.
✔ Contact PALS to resolve concerns informally where appropriate.
✔ Request an independent advocate if you need support.
✔ Escalate unresolved complaints to the Parliamentary and Health Service Ombudsman after completing the NHS complaints process.
✔ Share wider concerns about healthcare quality with the Care Quality Commission (CQC).
✔ Request reasonable adjustments or accessible information if you need support communicating with NHS services.