AVMA: Making the NHS complaints process fit for purpose (October 2026)

Summary

The NHS complaints system should provide answers, accountability, learning and resolution to all areas of service concern, including when care goes wrong. Avma supports people affected by avoidable medical harm and sees first-hand how an effective complaint response can meet patients’ needs and, in some cases, reduce the call for alternative, more complex and costly routes such as litigation. Too often, however, patients and families encounter delay, fragmentation, defensiveness, poor communication and complaint responses that do not answer their questions or show what has changed. The purpose of this paper is to use Avma’s unique insights to help improve complaints handling in support of those who are avoidably harmed. In summary, AVMA are calling for a remodified NHS complaints system based on eight key principles.

Content

What principles should govern a redesigned complaint system?

1. Patient-centred and with advocacy support: The patient should not have to understand NHS processes and organisations to obtain an answer and should be provided with independent advocacy support where required.

2. Prioritise resolution before defence: Early candour, explanation, apology and remedy should be normal responses to harm without prejudicing legitimate legal rights.

3. Proportionate independence: Local investigation in less serious cases should remain available, but independence must increase with seriousness, conflict and integrity risk.

4. Relational and humane incorporating the principles of the Harmed Patient Pathway: The process should incorporate the restorative practices of the Harmed Patient Pathway and must recognise illness, bereavement, trauma, disability, language and other circumstances affecting participation.

5. Evidence-led and transparent processes throughout: Findings and conclusions must be traceable to evidence; missing evidence and uncertainty must be acknowledged.

6. Professionally investigated: Investigation is skilled work that requires training and should be resourced and accredited accordingly.

7. Closed-loop learning: A complaint is not resolved when a letter is sent; significant recommended actions must be implemented and tested.

8. Accountable and with human-experience-led measures: Boards and external bodies should be able to see whether the system is timely, fair, candid and effective with a human-experience test for complaint handling. Boards should appoint a person responsible for the oversight, quality and integrity of complaint handling.