A pain to complain: Why it’s time to fix the NHS complaints process (Healthwatch, 27 January 2025)

Summary

Written complaints in the NHS reached a record high in 2024. With public satisfaction with the NHS at record low levels, the way the NHS handles, responds and learns from complaints is vital. A high quality, responsive NHS complaints process not only provides a key way for services to learn and improve care, it also shows patients that the NHS values their feedback.

When Healthwatch first reviewed the NHS complaints process over a decade ago, they found major failings and called for reform. To establish if people’s confidence or experience has improved, Health Watch conducted new research between September and December 2024. What they found should concern NHS leaders, government and regulators. Low public confidence is preventing people from taking any action after experiencing poor care, meaning that current complaints numbers could just be the tip of the iceberg. There is little evidence that complaints are being systematically used to improve care. 

Content

Key findings

• Very few patients complain: Almost a quarter (24%) told us they had experienced poor NHS care in the past year. Yet more than half (56%) of people who experienced poor care took no action, and fewer than one in ten (9%) made a formal complaint. This is a significant drop from the four in ten (39%) who said they made a formal complaint when asked a similar question in 2014.
• Low confidence stops people acting: Of those who didn’t make a complaint after poor care, 34% believed that the NHS wouldn’t use their complaint to improve services, 33% thought organisations wouldn’t respond effectively, and 30% felt the NHS wouldn’t see their concern as ‘serious enough’.
• A poor complaint experience is common: Over half (56%) of people who made a formal complaint were dissatisfied with both the process and the outcome of their complaint.
• Falling investment in support for people complaining: The budget allocated to councils to arrange statutory NHS complaints advocacy for local people has declined by more than 20% over the last decade People experience long waits for responses. On average, Integrated Care Boards (ICBs) took 54 working days to respond to complaints they handled as commissioners of NHS services. Response times ranged from between 18 and 114 working days.
• The NHS is not effectively learning lessons: NHS organisations do not effectively capture the right data about who makes complaints, do not welcome complaints or fail to fully demonstrate learning from complaints. There is little national oversight and accountability over the complaints process.

Key recommendations

The findings show that the NHS does not consistently welcome, handle, respond or learn from complaints in a patient-centred manner. Action is needed to:

Make the complaints process easier for patients and their families to navigate

• NHS England (NHSE) should require NHS bodies to collect wider data about complainants, such as gender, ethnicity and disability, so that we know who does and does not submit complaints .
• The Department of Health and Social Care (DHSC) should set detailed and mandatory standards on NHS ‘front-door’ information - including on the NHS App - about how people can navigate the complaints process.
• DHSC should commission a comprehensive review of statutory NHS complaints advocacy services.

Monitor and improve the performance of organisations that handle complaints

• DHSC should set mandatory response times for complaints following a baseline exercise on current average response times at all providers and ICBs.
• NHS organisations should survey patients after complaint cases are closed to monitor their satisfaction with the process and outcomes. o NHSE should require all NHS bodies to report on new performance indicators of complaint handling, including the number of re-opened complaints, and the number of complaints referred to the Parliamentary and Health Services Ombudsman (PHSO).
• NHSE should carry out a performance audit on ICB compliance with the 2009 complaints handling regulations.

Develop a culture of listening to and learning from complaints

• DHSC should strengthen regulations to require NHS bodies to publish their annual complaints reports, rather than ‘on request’ as currently required.
• DHSC should require providers to better demonstrate learning from complaints through more detailed annual complaints reports.
• DHSC should make the PHSO’s NHS Complaints Standards mandatory and clarify which body should lead in monitoring and enforcing them. o NHSE should assess ICBs’ complaints handling in ICB annual assessments.
• The Care Quality Commission (CQC) should improve the regulation of providers’ complaints’ handling responsibilities by checking this at every new and full assessment. 

Related reading on the hub:

• How to make a complaint
• How do I make a complaint: Sources of help and advice