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This Parliamentary and Health Service Ombudsman (PHSO) short paper shares insights from senior leaders at NHS trusts across England on how they handle complaints, what complaints reveal and how they use that learning to make improvements.  It draws on conversations with NHS trust leaders and covers themes including:  leadership and complaints culture  rising complaint volumes and the patient-clinician relationship  defensive culture and its impact on behaviour  the role of regulation in supporting improvement  prioritising patient experience  digital transformation and patient-centred design.  The findings highlight good practice and persistent challenges, with a shared message that patient experience must remain central to improvement in care and patient safety across the NHS. 

Patients, service users, their loved ones and carers have the right to raise concerns about the care they receive under the NHS in Wales. This can be done through the Listening to People NHS Wales Complaints, Incidents, and Redress process. Raising a concern can be difficult and distressing. People often come forward because something has had a real impact on them or their loved ones. This guidance explains what support you can expect and what will happen when you raise a concern. A concern can include a complaint, patient-safety incident or any other issue relating to an organisation’s health services. Responsible bodies, which are organisations that are legally responsible for your care, have a duty to listen to, act on, investigate and respond to concerns, and to learn from them to improve care and reduce the risk of harm re-occurring in the future. Responsible bodies can be an NHS organisation, a GP practice, dental practice or an Independent Provider delivering NHS funded care. Raising a concern often follows upsetting or traumatic experiences and NHS organisations in Wales aim to respond in ways that are compassionate, respectful and sensitive to the impact on you and your loved ones.  Further reading on the hub: How to make a complaint

The Parliamentary and Health Service Ombudsman (PHSO) five-year strategy marks an exciting new chapter for the organisation.  It's built around three priorities: driving public service improvement improving user experience  raising awareness and trust. The new strategy sets out how PHSO will take a more active role in using complaints data and evidence to identify risks, prevent harm and strengthen accountability across the NHS and government. The strategy has two big ideas: To make sure mistakes stop happening. To make public services better for everyone. Goals: Goal 1 is to make an impact on public services. Goal 2 is to make sure people who use the service have a good experience. Goal 3 is to raise awareness of PHSO.

Prioritising patient safety is a blog series from the Parliamentary and Health Service Ombudsman (PHSO). Each month, PHSO publish between 70 to 100 of their casework decisions as a way to share learning that will help organisations improve their service and prevent mistakes happening again. This blog shares two cases involving patients with disabilities and the improvements one Trust has made, highlights key themes emerging from PHSO casework and provide updates on patient safety work from NHS Resolution, the Freedom to Speak Up Guardian and the Health Services Safety Investigations Body (HSSIB). 

The General Medical Council (GMC) may decide to investigate a concern about a doctor, physician associate (PA) or anaesthesia associate (AA) registered with them. Their website contains information about the support available as we know this can be a difficult and stressful time. It also explains their investigation processes and the actions they may take. Fitness to practise explained How we investigate concerns about doctors Doctors under investigation - Find out what support is available for doctors. And find out how the GMC investigation process works. Physician associates or anaesthesia associates under investigation - Find out what support is available for PAs or AAs. And find out how the GMC investigation process works. Hearings and decisions - Find the latest results of hearings and decisions by GMC and the Investigation Committee. Help for witnesses - Guide for witnesses helping the GMC with an investigation. It sets out how you can help, what to expect and the support available.

For a registered professional, being called before their professional regulator, such as the General Medical Council, is known to be very challenging, and is even associated with suicide. But what about patients and colleagues who have experienced harm and raised a concern about a registered professional with their regulator? Employers and regulators should support patients and colleagues who give evidence against registered professionals and embed lessons learnt, writes Emerita Professor Louise Wallace and Dr Annie Sorbie in this HSJ article.

This report from the Northern Ireland Public Services Ombudsman relates to the care and treatment the Northern Health and Social Care Trust provided to a patient in the Emergency Department of Antrim Area Hospital. The investigation found the Trust’s decision to act to prevent the complainant leaving the hospital grounds for her own safety was reasonable and appropriate and that the actions it took to restrain the patient and prevent her leaving were disproportionate and contrary to relevant standards. The investigation also identified maladministration in the Trust’s handling of the complaint. In particular, the Trust failed to conduct a sufficiently robust and comprehensive investigation into the complaint in a fair impartial manner. It placed too much emphasis on the Nurse in Charge’s statement about the incident, without taking steps to gather other potentially relevant evidence to corroborate or refute her statement. As a result, the Trust failed to give sufficient consideration to the complainant’s account of events, and failed to provide an appropriate response.

This report from the Northern Ireland Public Services Ombudsman relates to the care and treatment the Belfast Health and Social Care Trust provided to a patient during the period of 7 February to 21 September 2022. The complainant believed the Trust misdiagnosed her Temporomandibular Joint Dysfunction1 as muscular, rather than Disc Displacement without Reduction2 and consequently did not provide appropriate treatment. The investigation identified the Trust failed to carry out appropriate radiological investigations in diagnosing the complainant’s condition and clearly communicate the diagnosis in accordance with relevant standards.

This report from the Northern Ireland Public Services Ombudsman relates to the care and treatment the Northern Health and Social Care Trust provided to a patient. The patient, who was 85 years old at the time, has now sadly passed away. The complainant is the patient’s son. He said the Trust provided his father with substandard care, causing him severe bed sores. He found his father in a wet state on several occasions, indicating staff did not meet his toileting needs for extended periods of time.   The investigation founding several failings in pressure damage care and treatment in this case. This included a failure to reassess the patient’s pressure ulcer risk appropriately; a failure to reposition the patient appropriately on several occasions; and a failure to develop an appropriate care plan for managing the patient’s incontinence. Its recommendation is that the Trust apologises to the complainant for the failures and injustice identified and that it provides refresher training on certain aspects of pressure damage care and treatment to relevant staff and reviews its protocol for managing patients’ incontinence.

Clinical negligence is a breach of a legal duty of care which directly caused harm to the patient. If clinical negligence has occurred, a patient or their representative may claim for damages against the clinicians or their employers. NHS services are legally liable for any clinical negligence and must pay compensation to the claimant and cover their legal fees if the claim is proven. The vast majority of patient safety incidents are not associated with a clinical negligence claim. This investigation sets out: long-term changes in the government’s liability for clinical negligence and the amounts needed to settle claims the drivers of claims volume and costs the factors that could affect the future cost of clinical negligence, including systemic pressures. This report only considers the cost of clinical negligence in England. We have not set out to evaluate the performance of the public bodies involved, nor reviewed NHS patient safety, which is the subject of other inquiries and reviews.

The organisation Medical Protection are calling on NHS Trusts across England to correctly follow national guidelines, to ensure doctors are treated fairly during disciplinary proceedings. Failure to conduct disciplinary processes swiftly and fairly can also perpetuate a culture of fear amongst doctors in the NHS. This also works against improving patient safety. Openness and learning in the NHS relies on doctors having confidence in senior management and their commitment to due process, which further underlines why it is so important to get this right. A recent survey of a group of Medical Protection members who have experienced a disciplinary during the past seven years found: 53% said that the disciplinary investigation against them lasted over 1 year - 22% said the process was over 2 years. 80% said the disciplinary investigation had a detrimental impact on their mental health. 44% said that they experienced suicidal thoughts during the investigation. 72% said it affected their personal lives. 75% said the length of the investigation affected their mental health. 81% said feeling 'guilty until proven innocent' affected their mental health. 85% said the malicious nature of the allegation significantly impacted their mental health. 18% either chose to retire early or had no choice but to retire early. 24% either left the Trust, or had no choice but to leave the Trust. 13% considered leaving the medical profession due to their experience. The report identifies four themes for ensuring a ‘good’ disciplinary process. Within each of these themes, specific areas are identified where changes should be made. Theme 1: Efficient Proportionate - Trusts must consider whether a matter may be dealt with in a less formal manner before proceeding to an MHPS investigation. Any move to exclude the doctor from their duties must also be proportionate to the nature of the investigation. Timely - When a doctor is put through a disciplinary process, it should begin and conclude in a timely manner. Theme 2: Fair Fair treatment for all parties The doctor and their representatives should receive fair treatment during proceedings, with due process followed and all necessary disclosures made. NHS staff involved in carrying out the disciplinary processes should also receive adequate, specialised training; Trusts should not be relying on competence or experience. Dedicated time should be ring-fenced for those involved in an investigation to ensure that MHPS deadlines can be met. Free from bias and discrimination Steps must be taken to ensure discrimination and bias are not factors that can initiate a disciplinary investigation. Information about the importance of defence organisation and union membership should be highlighted at each induction to maximise the chances of a doctor being able to access appropriate support during an investigation. Theme 3: Compassionate Considerate - The wellbeing of the doctor subject to investigation should be considered at all times, and active steps taken to offer support and mentorship. Well communicated - The disciplinary process should be communicated clearly and in plain language at the outset, and frequent communication should continue throughout, so doctors are aware of the status of the investigation and any delays. Theme 4: Accountable Accountability of employers - When a Trust or another employer is found to have behaved in a seriously wrong way during proceedings, a clear method needs to be established to hold them to account. Scrutiny - Senior managers and Trust Boards should have greater knowledge and scrutiny of disciplinary processes. Standardised reporting and data collection, such as the inclusion of disciplinary processes in governance audits, should be rolled out.

At Patient Safety Learning we often get asked by patients and families who have received poor healthcare what they need to do to make a complaint. Although we cannot get directly involved in individual cases, we have put together a simple guides on the steps you can take if you need to make a complaint about your private healthcare. We also have the following guides: How do I make a complaint about my NHS care in England: a simple guide for patients and families How do I make a complaint about my NHS care Northern Ireland: a simple guide for patients and families How do I make a complaint about my NHS care in Scotland: a simple guide for patients and families How do I make a complaint about my NHS care in Wales: a simple guide for patients and families How do I make a complaint: Sources of help and advice By law, the Parliamentary Health Service Ombudsman (PHSO) cannot look into complaints about privately funded healthcare services. This includes care provided by Private Patient Units within NHS Trusts. However, they will look at complaints about healthcare services provided in a private hospital if the NHS paid for it. They will also look at complaints about NHS-funded healthcare services which privately funded patients get in an NHS hospital. See our ‘Making a complaint about your NHS care' guides above if this applies to you. If you are unhappy about treatment you have received in a private hospital or clinic, it is your right to: Make a complaint. Have the matter investigated. Receive a full and prompt response to your complaint. If you are concerned with the outcome of your treatment, then you should first talk to your treating consultant in order to obtain an explanation and advice. If your consultant is unhelpful or unresponsive, and you believe you are in need of further treatment, you should talk to your GP about your concerns and possible treatment options. This may include obtaining a referral for a second opinion. Making a formal complaint to the hospital or clinic If you are unhappy with the response, you can make a complaint using the Independent Sector Complaints Adjudication service (ISCAS) who have a code of practice for handling patients’ complaints. However this will only apply to private healthcare providers who are ISCAS subscribers or to patients treated by an Independent Doctors Federation Member ISCAS is one of the recognised independent adjudication services of complaints for the private healthcare sector. ISCAS has produced a patients’ guide with input from the Patients Association which explains how to make a complaint about using the ISCAS Complaints Code of Practice. Here are the stages to take if you would like to make a complaint about private care you received. More information on each step is given below. See the full Patients’ Guide to the ISCAS Code for more information. Stage 1: Complaint raised directly with the clinic or hospital where care was provided Complaining can be stressful, so the aim should always be to try and sort out any problems as quickly and informally as possible. If your complaint is responded to effectively when you first raise your concerns, then it is unlikely that matters will need to be escalated through stages 2 and 3. Before you make a formal complaint, ask the provider for a copy of their complaints procedure. If you do not wish to speak to a member of ‘frontline’ staff, or if you are unhappy with how they have responded, you can take your complaint to someone more senior within the organisation, such as the unit Manager or Hospital Manager. You should normally make your complaint within six months. The provider may be willing to investigate complaints after this time where there is a realistic opportunity of conducting a fair and effective investigation, and if you have a good reason why you could not act sooner (for example, if you were unaware of the matter, if you were unwell or grieving). If you are not satisfied with the outcome, you can escalate your complaint to stage 2. Stage 2: Internal review of complaint by someone who was not involved at stage 1 If you wish to escalate your complaint to stage 2, you should do so in writing, within 6 months of the final response at stage 1. Normally the complaint review at stage 2 will be conducted by a senior member of staff who has not been involved in the handling of the complaint up to that point and is not involved in the daily operation of the hospital/clinic. The person conducting the complaint review is expected to send you a full, written response on the outcome of the review within 20 working days. Where the investigation is still in progress, you should receive a letter explaining the reasons for the delay. The aim is to complete the review at stage 2, in most cases within 3 months. Stage 3: External review If you are not satisfied with the complaint review at stage 2, you have the right to refer the matter to stage 3 independent external adjudication through ISCAS (for subscribing providers). Please see the providers who are covered. You need to do this within 6 months of receiving the final response at stage 2 and ISCAS aims to complete its adjudications within 3-6 months. The person making a complaint does not pay for the complaints process. Stage 3 adjudication will not consider ‘new’ issues that have not previously been raised with the provider, with the exception of concerns raised about the way the private healthcare provider has handled the complaint, which may not surface until after a response has been made at stage 2. If you wish to escalate your complaint to ISCAS at stage 3, you should do this in writing. Your letter should include the information in the Patients’ Guide to the ISCAS Code, which also provides more information on prompts to help you think through what you want to achieve, and whether it is achievable under the ISCAS Code. The Independent Adjudicator will decide to uphold or not uphold each aspect of your complaint. They have the discretion to award a goodwill payment up to a limit of £5,000, in accordance with the ISCAS Goodwill Payments Guide. There is no appeal to Stage 3 adjudication and the Independent Adjudicator’s decision is final. However you can seek legal action at any point during or after the ISCAS complaints process and your statutory rights are not affected. If you are not satisfied with the way ISCAS has managed the stage 3 process you are entitled to make a complaint about ISCAS. AvMA (Action against Medical Accidents) have a number of self-help guides that provide clear and straightforward explanations of the procedure and guide you through making a complaint about your treatment. Unlike PHSO for the NHS, ISCAS cannot deal with complaints related to clinical negligence (e.g. injuries caused by poor hospital hygiene or failure to follow proper procedures). Clinical negligence complaints should go straight to the relevant professional regulator, or patients should seek accredited legal advice. Patients with private medical insurance can take their financial (but not clinical) complaints directly to their insurer, and escalate to the Financial Ombudsman Service. These routes to resolution should always result in satisfying a patient’s reasonable demands without needing to resort to the civil courts. Complain to the Care Quality Commission Under the Health and Social Care (Community Health and Standards) Act (2003), the Care Quality Commission (CQC) is now responsible for regulating and inspecting independent healthcare in England. If for any reason you are unable to get the private health provider to respond to a complaint, or if you are unhappy with their response, you can make a complaint to the CQC (or the equivalent body in Scotland Northern Ireland and Wales). England: Care Quality Commission; Telephone: 03000 616161 Northern Ireland: The Regulation and Quality Improvement Authority; Telephone: 028 9051 7500, Email: [email protected] Scotland: Healthcare Improvement Scotland; Telephone: 0131 623 4300, Email: [email protected] Wales: Healthcare Inspectorate Wales; Telephone: 0300 062 8163, Email: [email protected] It is a statutory duty on providers registered with the CQC to have a complaints system in place that is brought to the attention of service users, which provides complainants with support where necessary and which should ensure that the complaint is fully investigated to satisfy the service user as far as reasonably practicable. Complain to the professional regulating body If the issue is about an individual health professional’s fitness to practise, make a complaint to the relevant professional regulating body, such as the General Medical Council (for doctors) or Nursing and Midwifery Council. AvMa has a self-help guide. Complaint about private dental care If your complaint is about privately funded dental care, contact the Dental Complaints Service. Complaint about private eye treatment If your complaint is about privately funded eye treatment, contact the Optical Consumer Complaints Service.

At Patient Safety Learning we often get asked by patients and families who have received poor healthcare what they need to do to make a complaint. Although we cannot get directly involved in individual cases, we have put together a list of sources of help and advice. We also have the following guides: How do I make a complaint about my NHS care in England: a simple guide for patients and families How do I make a complaint about my NHS care Northern Ireland: a simple guide for patients and families How do I make a complaint about my NHS care in Scotland: a simple guide for patients and families How do I make a complaint about my NHS care in Wales: a simple guide for patients and families How do I make a complaint about my private care: a simple guide for patients and families If you are a healthcare professional looking at these pages, the NHS Complaint Standards, model complaint handling procedure and good complaint handling guides set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. Sources of help and advice Academy of Healthcare Science (AHCS) investigates any concerns you have about an AHCS registrant. The Academy for Healthcare Science is the single overarching body for the entire UK Healthcare Science (HCS) workforce, working alongside the healthcare science professional bodies, and also professionals from the Life Science Industry and Clinical Research Practitioners AvMA provide free independent advice and support to people affected by medical accidents through their specialist helpline, written casework and inquest support services. They can also refer you to accredited clinical negligence solicitors and have a wide range of self-help guides available on their website. Care Quality Commission (CQC) In general the CQC does not have the legal powers to investigate complaints about GP or hospital services, but they do invite feedback from the public and they can use that information when investigating and regulating individual services. Independent Sector Complaints Adjudication Service (ISCAS) is one of the recognised independent adjudication services of complaints for the private healthcare sector. ISCAS is a not-for-profit limited company, independent from the trade body and owned by the Centre for Effective Dispute Resolution (CEDR). ISCAS provides the services of independent adjudication as the third stage of a three-stage process. Private Healthcare Information Network An independent, government-mandated organisation publishing performance and fees information about private consultants and hospitals. The Law Society provides a list of lawyers who specialise in medical matters. Tel: 020 7320 5650. Llais is a Welsh independent body which provides free and confidential complaints advocacy and support. Tel: 029 2023 5558; Email: [email protected]. Rethink Advocacy will be able to put you in touch with a local contact to provide assistance at all levels of the NHS complaints procedure. Northern Ireland Public Services Ombudsman Helpline: 0345 015 4033 (Choose option 3); email: [email protected]. Northern Ireland healthcare gateway Provide advice and guidance to healthcare staff, GP Practices and members of the public on patient entitlement to access publicly funded health and social care in Northern Ireland. Tel: 02895 363893; Email: [email protected]. Healthwatch is an independent statutory body that helps make sure your feedback is listened to. The services and support they provide vary regionally. Email: [email protected]. Parliamentary and Health Service Ombudsman (UK) Email: [email protected] Patient Advice and Liaison Service (PALS) Each NHS trust has a PALS team who can give general information on NHS complaints and may be able to help resolve less serious complaints informally. Contact your local hospital trust for more information on PALS. Patient Advice and Support Service (PASS) can help you with your complaint in Scotland. The service is delivered by the Scottish Citizens Advice Bureau and provides free, accessible and confidential information, advice and support to patients, their carers and families about NHS healthcare. Tel: 0800 917 2127. Patient and Client Council Complaints in Northern Ireland will listen to your experiences and offer the advice or support that you need. Helpline: 0800 917 0222; Email: [email protected]. Patients Association is an independent charity with a direct line to patients living with any health condition. This gives us a unique insight into patients' experience and a holistic view of the health and care system from their perspective. We talk to thousands of patients each year – including through our helpline – and therefore are experts in representing patient voice exactly as we hear it. You can call our freephone helpline on 0800 345 7115 or send an email to: [email protected] Public Services Ombudsman for Wales Tel: 0845 601 0987. Scottish Public Services Ombudsman Tel: 0800 377 7330 or 0131 225 5300. VoiceAbility offers free information and support to help you use the NHS complaints process. Professional bodies The following professional bodies can help if you believe someone is: putting patient safety at risk. not meeting professional standards. General Medical Council The General Medical Council (GMC) will investigate complaints about doctors for up to five years after the event. It can: stop or limit a doctor’s licence to work in the UK post a warning on a doctor’s record for up to five years. It cannot: pay compensation or make a doctor pay a fine force a doctor to apologise or give you the treatment you want. Telephone: 0161 923 6602. Nursing and Midwifery Council The Nursing and Midwifery Council (NMC) investigates complaints about nurses and midwives without a time limit. It can: issue a one-year caution which future employers can see suspend a nurse or midwife remove someone from the professional register. Telephone: 020 7637 7181. Health and Care Professions Council The Health and Care Professions Council Investigates complaints about a wide range of professionals, including: Arts therapists Biomedical scientists Chiropodists / podiatrists Clinical scientists Dietitians Hearing aid dispensers Occupational therapists Operating department practitioners Orthoptists Paramedics Physiotherapists Practitioner psychologists Prosthetists / orthotists Radiographers Speech and language therapists Telephone: 0300 500 6184.

At Patient Safety Learning we often get asked by patients and families who have received poor healthcare what they need to do to make a complaint. Although we cannot get directly involved in individual cases, we have put together a simple guide on the steps you can take if you need to make a complaint about NHS care in Northern Ireland. We also have the following guides: How do I make a complaint about my NHS care in England: a simple guide for patients and families How do I make a complaint about my NHS care in Scotland: a simple guide for patients and families How do I make a complaint about my NHS care in Wales: a simple guide for patients and families How do I make a complaint about my private care: a simple guide for patients and families How do I make a complaint: Sources of help and advice If you are a healthcare professional looking at these pages, the NHS Complaint Standards, model complaint handling procedure and good complaint handling guides set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. If you are unhappy with the care and treatment you have received from health or social care services in Northern Ireland, you have the right to make a complaint. Your concerns could be about any aspect of your care. Step 1: Make a complaint to the practitioner or institution concerned You can speak directly to a member of staff involved in your care about your complaint and ask for a copy of the complaints procedure. If your complaint relates to services provided by a GP, dentist, pharmacist or optician you can contact the Health and Social Care Board’s complaints office. They will then act as a go-between and offer an ‘honest broker’ service. They may also offer conciliation services if appropriate. If the complaint is about a nursing or residential home, you should contact the home directly, addressing your complaint to the home manager. There are six health and social care trusts in Northern Ireland. Details are available on the Northern Ireland healthcare gateway. If the NHS organisation thinks that your complaint has been fully investigated, they should send you a full written response. They should also tell you what to do next if you are not satisfied. If you remain unhappy, you can refer your complaint to the Northern Ireland Commissioner for Complaints (the Ombudsman). The Ombudsman will then consider whether this is a matter they can investigate—see Step 2. Step 2: Northern Ireland Commissioner for Complaints The Ombudsman can investigate: All complaints about health and social care services including hospitals, GPs and dentists. Private sector complaints where health and social care are funding the care or service. Cases of unfair treatment or poor service where the complaint has not been resolved to your satisfaction. Complaints relating to professional judgement of clinical decisions in a healthcare setting, as well as how your complaint has been handled. The Ombudsman cannot investigate. Private medical care. Complaints relating to access to information and the Data Protection Act. If more than six months have passed since the completion of the public body’s consideration of your complaint then the Ombudsman may not be able to investigate. However, they may be prepared to extend the time frame and you should ask for any special circumstances, such as ill health, to be taken in to account You should make a complaint in writing or by using the forms available on the Ombudsman’s website. The Ombudsman can make recommendations about what should be done to make matters right including changes in practice. They cannot award compensation or take disciplinary action against individual members of staff. If you need help to raise your concerns, you can contact the Patient and Client Council’s complaint support officers by telephone, email, letter or through their website. They will listen to your experiences and offer the advice or support that you need. Step 3: Judicial review In some cases, it may be appropriate to use the judicial review procedure, particularly if you need to urgently challenge a decision made by an NHS organisation, for example, a decision not to provide certain treatment. Judicial review is a remedy of last resort and will only rarely be applicable to NHS complaints. You will need a solicitor to offer you specialised advice about whether there are grounds to make an application for judicial review. They will also offer you advice on whether it is worthwhile becoming involved in what can be an expensive and complex legal procedure. The Law Society provides a list of lawyers who specialise in medical matters.

At Patient Safety Learning we often get asked by patients and families who have received poor healthcare what they need to do to make a complaint. Although we cannot get directly involved in individual cases, we have put together a simple guides on the step you can take if you need to make a complaint about NHS care in Scotland. We also have the following guides: How do I make a complaint about my NHS care in England: a simple guide for patients and families How do I make a complaint about my NHS care Northern Ireland: a simple guide for patients and families How do I make a complaint about my NHS care in Wales: a simple guide for patients and families How do I make a complaint about my private care: a simple guide for patients and families How do I make a complaint: Sources of help and advice If you are a healthcare professional looking at these pages, the NHS Complaint Standards, model complaint handling procedure and good complaint handling guides set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. In Scotland, your right to complaint is covered by the Charter of Patient Rights and Responsibilities. The Charter explains your rights to: Give feedback, make comments or raise concerns or complaints about the healthcare you receive. Be told the outcome of any investigation into your concerns or complaints. Have independent advice and support when providing feedback. Take your complaint to the Scottish Public Services Ombudsman (Ombudsman). Step 1: Frontline resolution Since April 2017, the NHS in Scotland aims to deal with more straightforward complaints within five days. This is known as frontline resolution. If you have a concern about health or social care issues, you can complain to any member of staff or ask to speak to the Feedback and Complaints Officer for the NHS organisation involved. If you are still at the place where you have received care, you can raise your concerns with the GP, nurse or other health professional you are dealing with. They may be able to resolve the complaint immediately and offer an apology. You can complain directly to the provider (GP practice, NHS dentist or hospital). If you do not wish to deal directly with the provider or if your complaint involves more than one NHS provider (such as a GP and a hospital or more than one hospital) the NHS Board can enable a co-ordinated investigation and response. Find your local NHS Board. Specific contact details for complaints can be found at NHS Inform. The provider will consider if the matter is a complaint and whether the issues are relatively straightforward and can be resolved with little or no investigation. If so, your case will be dealt with under frontline resolution. If your complaint is not resolved, see Step 2: Investigation. Step 2: Investigation This is the complaints handling process for cases which have not been resolved at the frontline stage or where the complaint is complex, serious or ‘high risk’. When will stage 2 be triggered? If frontline resolution has been attempted but you remain dissatisfied and request an investigation; this may happen immediately after the frontline stage decision or sometime later. If you refuse to take part in frontline resolution. If the issues raised are complex and require detailed investigation. If the complaint relates to serious, high-risk or high-profile issues. AvMA (Action against Medical Accidents) has a number of self-help guides that provide clear and straightforward explanations of the procedure and guide you through making a complaint, including a helpful template letter. The investigating officer may wish to contact you to discuss the scope of their investigation and to see whether the resolution you are seeking is achievable and realistic. They may ask you for additional information needed to investigate the complaint and should explain if they are going to seek such additional information. At this point they may offer you a meeting or telephone call to discuss the complaint. You do not have to agree to this. You should receive a full response to your complaint, by your preferred method of communication, within 20 working days. If you are not satisfied with the outcome but think that the provider could still put things right, you should respond setting out what you are unhappy with and how you think it could be resolved. If you do not think your concerns can be settled by the provider, you can contact the Scottish Public Services Ombudsman—see Step 3. Mediation is a service where independent mediators help the relevant parties to reach an agreement. You can request, or health boards may offer, to provide this service. Both parties must agree to take part before this can go ahead. You can get help finding mediation services in your area by asking the Feedback and Complaints Officer at your local health board. Step 3: Scottish Public Services Ombudsman If you are dissatisfied with the response you have received then you can contact the Scottish Public Services Ombudsman. Before you approach the Ombudsman, you must have completed the local resolution complaints process above. You will need to put your complaint in writing and include copies of all correspondence from the local resolution stage of your complaint. You should make your complaint to the Ombudsman within 12 months of the events or incident in question, or within 12 months of you becoming aware that there were grounds for complaint. Step 4: Judicial review In some cases, it may be appropriate to use the judicial review procedure, particularly if you urgently need to challenge the way in which the NHS has made a decision which affects you (for example, not to provide certain treatment). The Court of Session in Edinburgh can: Look at how the decision was made on a procedural basis. This is not an appeals process and cannot change or reverse the actual decision. Check that the NHS did not abuse its powers. Check that the NHS acted properly and lawfully. Judicial review is a remedy of last resort and is only very rarely applicable to NHS complaints. You will need specialised advice from a solicitor on whether there are grounds to apply for judicial review. The Law Society provides a list of lawyers who specialise in medical matters.

At Patient Safety Learning we often get asked by patients and families who have received poor healthcare what they need to do to make a complaint. Although we cannot get directly involved in individual cases, we have put together a simple guides on the steps you can take if you need to make a complaint about NHS care in England. We also have the following guides: How do I make a complaint about my NHS care Northern Ireland: a simple guide for patients and families How do I make a complaint about my NHS care in Scotland: a simple guide for patients and families How do I make a complaint about my NHS care in Wales: a simple guide for patients and families How do I make a complaint about my private care: a simple guide for patients and families How do I make a complaint: Sources of help and advice If you are a healthcare professional looking at these pages, the NHS Complaint Standards, model complaint handling procedure and good complaint handling guides set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. You have the right to make a complaint about any aspect of NHS care, treatment or service. Every organisation that provides an NHS service in England must have their own complaints procedure. You can usually find information about how to complain in waiting rooms, at reception, on the organisation’s website or by asking a member of staff. Here are the steps to take if you would like to make a complaint. More information on each step is given below. Step 1: Informal complaint Many issues can be resolved quickly by speaking directly to the staff at the place where you received care or accessed a service. You are under no obligation to make a complaint informally before you make a formal complaint. However, if you believe something has gone wrong with the healthcare provided to you or a loved one, it is almost always best to discuss your concerns with the medical staff as soon as possible, especially if your main concern is to have something urgently put right. Talk to the staff concerned or a manager and explain why you are unhappy. If you prefer, you can contact the Patient Advice and Liaison Service (PALS) at the organisation and ask them to investigate the matter. Contact your local hospital trust for contact details of their PALS. If your complaint is about a family health service (such as a GP, dentist, optician or pharmacist) you can contact the practice complaints manager. They may be able to settle your complaint straight away. If you are not satisfied with their response, however, you can submit a formal complaint through local resolution procedures—see Step 2. Step 2: Local resolution procedures If you would like your complaint to be dealt with more formally, you should use the NHS complaints procedure. The first stage is local resolution, where the NHS is required to investigate and respond to your complaint. You should make your complaint as soon as possible so that your memory of events is fresh. Your complaint must be made: no later than 12 months after the event(s), or no later than 12 months from when you first became aware of the issues. NHS organisations may consider complaints outside these time limits—for example, if you have a long-term illness or condition. A complaint can be made verbally, in writing or electronically. You can complain: Directly to the provider (such as a the hospital or GP surgery). To your local integrated care board (ICB) for complaints about primary care services (GPs, dentists, opticians or pharmacists) and secondary care (such as hospital care, mental health services, out-of-hours services, NHS 111 and community services like district nursing). Each ICB has its own complaints procedure, which is often displayed on its website. Find your local integrated care board. AvMA (Action against Medical Accidents) has a number of self-help guides that provide clear and straightforward explanations of the procedure and guide you through making a complaint, including a helpful template letter. Under the NHS complaints procedure, you can get: An explanation for what happened. An apology or other statement of regret. Steps to review procedures to avoid similar incidents happening in future. In general, the NHS complaints procedure will not: Offer financial compensation. Address issues of staff discipline, for instance by sacking someone or having them struck off a professional register. If you are not satisfied with the final response to your complaint, you have the right to request an independent review of your complaint by the Parliamentary and Health Service Ombudsman—see Step 3. Step 3: Parliamentary and Health Service Ombudsman If you have tried local resolution and are not happy with the result, or if the investigation has taken over six months, you can ask for an independent review by the Parliamentary and Health Service Ombudsman (the Ombudsman). You must go through the NHS Complaint (local resolution) stage first—the Ombudsman will not consider your complaint until you do. Although you have a right to request an independent review of your complaint, the Ombudsman is unlikely to agree to a review if it thinks that more should be done to resolve the complaint at local resolution stage. You should try to request a review within 12 months of the incident occurring or when you first became aware that something had gone wrong. If this is not possible, you can ask the Ombudsman to consider your request, particularly if you have a good reason for the delay such as trying to obtain other advice. You can use the Ombudsman’s own forms to submit your complaint if you wish. AvMA also provides further guidance on making a complaint to the Ombudsman. Once the Ombudsman has confirmed its decision, this is the end of the NHS complaints procedure. If you still strongly disagree with the Ombudsman’s decision the only way to challenge it is via judicial review. Step 4: Judicial review Although the NHS complaints procedure finishes with a final decision by the Ombudsman, you may be able to challenge the Ombudsman’s decision by seeking a judicial review. You will need to take legal advice to see if you are eligible. Judicial review is a legal process in which the courts assess whether a public body—in this case the Ombudsman—has reached or failed to reach a decision fairly. The grounds for this can include: There has been an unfair or biased process. This could be that the public body has failed to review evidence presented by one side or hasn’t given a fair hearing on the basis of the written information. The decision is irrational. The most important point about judicial review is that it must be sought very quickly after the decision has been made. You should seek legal advice as quickly as possible if you are considering this route. An application for judicial review should be made as soon as possible and no later than three months after the public body’s decision has been made. The Law Society provides a list of lawyers who specialise in medical matters.

On 13 September, our Safety and Learning team, in collaboration with Health Services Safety Investigations Body and NHS England, hosted a virtual forum on the benefits of implementing safety science in primary care, responding to patient safety incidents and the support available to staff working in primary care. The recording of the forum is now available.