Our position on complaints in the NHS and social care
Our position
It’s important that service providers or commissioners manage public complaints well and lessons are learnt to improve services for current and future generations.
Getting this right requires a mix of local action and national leadership.
What we want to see
Better management of complaints
We support a single national framework for complaints standards to give staff a set of guidelines for how they should manage complaints.
Understanding who is and is not complaining is essential to making complaint processes as accessible as possible for everyone, including those with additional communication needs.
Yet official data about NHS complaints collected by NHS Digital currently tracks only the age of the person making the complaint and no other demographic characteristic. To address health inequalities, services need to collect more robust demographic data, including age – as currently mandated -and gender, ethnicity, and disability at a minimum.
We advocate for the importance of analysing thematic and regional trends in complaints to identify wider learning for the entire health system. In recent years, NHS England regional teams have done much of this work, but the transition to Integrated Care Systems (ICSs) has shifted all responsibility for complaints management to them. It is important to preserve and generalise the processes for national learning from regional complaints and to feed this into a national system for learning from complaints.
Learning from complaints
As part of managing complaints, health and care services should communicate to patients how they have learned from past complaints, including by publishing regular complaints reports as required by statutory regulations. However, services should also work to communicate learning from complaints in more accessible ways, including leaflets or physical display boards in hospitals.
We support a single national organisation being empowered to act as a complaints standards authority, responsible for developing national good practice, training, monitoring, reporting and learning from complaints.
We have advocated for a national review of advocacy services and commissioning arrangements for complaints advocacy to streamline expectations for advocacy provision. We have suggested that the Department of Health investigate a single national commissioning model for complaints advocacy.
Our evidence
Why do people complain?
We know that most people who complain don’t do it in search of compensation or retribution. They are motivated by a desire to improve care for others in the future. Seeing evidence of how past complaints have led to change and improvement makes people more likely to speak up for themselves in the future, and this is where we focus much of our advocacy on complaints.
People need guidance
We also know that only some people want to make a formal complaint. When services focus on encouraging and acting on informal feedback, this can empower patients to speak up through informal routes, avoiding the complexity of a formal process while giving services the same opportunity to learn and improve.
We know that many people would like to share feedback with services on how they could improve, but only a small proportion do. The most common reason for this is that people don’t know how to share concerns.
Inaccessible processes
When it comes to formal complaints, the barriers to navigating an often complex and lengthy process are even higher. Through feedback collected as part of our Your Care, Your Way campaign, we know that people with sensory impairments and disabilities and those who speak little or no English often find complaint processes inaccessible.
Gaps in advocacy support
Through our past work on complaints, we have heard about gaps in providing advocacy support nationally. There needs to be more clarity on what advocacy providers can assist with, and criteria vary by region and provider. There are also areas that advocacy support does not cover, such as fitness to practice complaints made to the General Medical Council.
People have told us that advocacy support helps them to feel much more empowered throughout the whole experience of making and pursuing a complaint which can sometimes take years.
Complaints backlog
The Covid-19 pandemic led to a significant backlog of complaints across the system due to a national “pause” in complaints processing, followed by ongoing pressures due to staff redeployment and lack of clinical capacity to respond to investigations.
The Parliamentary and Health Service Ombudsman (PHSO) – the arbitrator of last resort if people feel that complaints have not been dealt with fairly at the service level – also changed their criteria for consideration, only investigating the most severe cases.
As a result, we started hearing more concerns from the public and local Healthwatch about long timescales for responses to complaints and PHSO not accepting people’s cases for consideration.
Our work so far
Our work on complaints in health and social care dates back to 2014 when we published our ‘Suffering in Silence’ report and My Expectations, a vision for good complaint handling across both health and social care. This document is widely used across the sector and recognised as a guide to good practice which puts patients first.
Over the years, we've worked, often in partnership, to improve complaint processes and to highlight the need of learning from complaints:
- In 2018, we committed to Quality Matters, a sector-wide initiative to improve social care, and published a toolkit to improve social care complaints handling.
- In 2019 we analysed how local authorities report on complaints and found that councils are not making the most of opportunities to demonstrate how responsive they are to feedback; we also investigated how well hospital trusts are demonstrating learning and improvement in response to complaints, finding that hospitals are not making the most of learning from complaints.
- Throughout 2019 and 2020, we worked with the Parliamentary and Health Service Ombudsman (PHSO) and other health and social care regulators and advocacy groups to help design a Complaint Standards Framework, which provides detailed system-wide guidance for best practices in handling concerns and complaints. This framework was tested in pilot sites in 2021 and rolled out across the NHS in 2022.
- Through our Your Care, Your Way campaign, we have emphasised the importance of improving the accessibility of complaint processes and ensuring that health services proactively seek feedback from those less likely to speak up. This has resulted in changes to the Accessible Information Standard, including additional responsibilities for ICSs and providers to ensure complaints processes are accessible.
