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Defensiveness is often implicated in systemic organisational failures to explain why early warning signs were ignored and organisational resilience was compromised. But how does an organisation become defensive? The authors of this study propose that defensiveness can arise as a response to contradictory work demands. The research focuses on UK hospital staff tasked with responding to criticism online (herein complaint handlers). It examines these responses to criticism using a mixed methods explanatory sequential design. Six defensive tactics were reliably identified: redirecting patients to other channels, evading issues, psychologising concerns, invalidating concerns as incomplete, closing the feedback episode, and individualising concerns with bespoke workarounds. These defensive tactics were generally associated with less organisational learning and were sometimes viewed as unhelpful. To explain these results, the authors introduce the complaint handler’s bind: staff are tasked with responding to complaints without a viable pathway for organisational learning and an implicit injunction against voicing this dilemma. This demand-control double bind unwittingly gives staff little alternative but to be defensive. Future research, the authors conclude, needs to conceptualise defensiveness as sometimes a symptom rather than a cause of problems in organisational learning.

Prioritising patient safety is a quarterly blog series from the Parliamentary and Health Service Ombudsman (PHSO). Each month, PHSO publishes 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 highlights how the PHSO is working with NHS England to improve NHS imaging services and looks at cases that show how organisations are making complaints count by listening, learning and putting things right.

In this Health Services Safety Investigation Body (HSSIB) blog, Professor Shin Ushiro talks through the no-fault compensation system for birth injury in Japan, in particular how they worked with patients and families to launch the system and the resultant reduction in harm. Professor Shin Ushiro is Executive Board Member, Japan Council for Quality Health Care (JQ), and Deputy Director and Professor of Patient Safety – Kyushu University Hospital.

Prioritising patient safety is a new quarterly blog series from the Parliamentary Health and Service Ombudsman (PHSO). Each month, PHSO publishes 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. Through these blog, Tony Dysart, Senior Lead Clinician, will be highlighting some of the cases PHSO publish to share good practice and findings from the casework more widely. This first blog focuses on two cases PHSO have looked into about maternity care and imaging. 

In healthcare environments, staff members can become exposed to substances hazardous to health as part of their day-to-day work that can lead to adverse outcomes to health. By sharing our claims data as a catalyst for learning, we aim to encourage improvements in reducing harm and improving staff safety. This resource outlines risks associated with these exposures, and illustrates learning from claims through illustrative case stories and an analysis of recurring themes in settled claims. NHS Resolution received 371 claims for harm caused by exposure to substances hazardous to health from incidents occurring between 1 April 2013 and 31 March 2023. The total cost for closed claims was £5,989,451. Of these 371 claims, there were 165 that were settled with damages paid. The total cost of damages paid was £2,471,880, excluding defence and claimant costs. 58 of the 371 claims are still open, they have been excluded from this analysis. These claims could go on to settle with or without damages.

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.  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

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.

Keeping the NHS Honest is a campaign group calling for an Independent NHS Complaints Service (INCS) to be established, to undertake patient complaints in a truly open, honest and independent way. Find out more about their work via the link below.

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.

The Northern Ireland Public Services Ombudsman has released its Ombudsman Report for 2023-24. Commenting on its release, Ombudsman Margaret Kelly said: “Resolving complaints as early as possible is much more effective and less costly than an elongated complaints process. In this report I am reflecting on the importance of improving and building public trust through robust investigation and meaningful learning from complaints. This has included the critical role of complaints as an early warning system in improving patient safety, the vital importance of complaints and engagement with local communities on the environment, and the importance of listening to complaints from some of the most vulnerable in our society, particularly those who may be experiencing housing difficulties. More broadly this year we have also focused on introducing statutory complaints standards for public bodies. This is fundamental to improving trust in our public services. Mistakes and errors are unfortunately a part of life and can never be fully eradicated. However, together we must move from a culture which is sometimes defensive with a lack of openness towards a culture which values complaints as an opportunity to learn and prevent future harm.”

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 Wales. 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 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. Since April 2011, the NHS Complaints Procedure in Wales has been replaced by a new system called Putting Things Right. A complaint under this new system is defined as a ‘concern’. This is when you feel unhappy about any service provided and funded by the NHS, which includes treatment funded by the NHS in Wales, even if this is provided in England. This may result in you having your concerns investigated, the offer of an apology or improvement of services. Step 1: Raising a concern If you feel able to do so, in the first instance you should try and speak to the staff who were involved in providing your care. This may enable your concerns to be resolved immediately. If this does not resolve your concerns or you do not feel able to speak to the staff, then you can contact a member of the concerns team at the NHS trust or your local health board. If your concern relates to primary care (a GP, dentist, pharmacist or optician), you can either raise your concern with the primary healthcare provider directly or contact your local health board to investigate your concerns. You should raise your concern within 12 months of the incident happening, but ideally as soon after the event as possible, so that the details are still fresh in your mind. Even if more than 12 months have passed, if there are valid reasons for the delay, such as coping with a bereavement or illness, the organisation may still agree to investigate your concerns. If you need assistance with raising your concern, you can contact Llais. Llais is an independent body which provides free and confidential complaints advocacy and support. Step 2: Public Services Ombudsman for Wales If you are not satisfied with the outcome of the investigation, you have the right to take your complaint to the Public Services Ombudsman. The Public Services Ombudsman for Wales has legal powers to look into complaints about public services in Wales, which include health boards, NHS trusts and GP services. The Ombudsman can investigate concerns where you feel you have been treated unfairly or have received an unsatisfactory service due to a failure on the part of a public service provider. You will normally be expected to make a complaint within 12 months of becoming aware of the problem. However, the Ombudsman will consider how much time the healthcare provider in question has spent dealing with your initial concern. If you feel that you have experienced medical harm, further investigations may need to be undertaken as part of NHS Redress arrangements. Step 3: Redress and compensation Redress relates to situations where you may have experienced harm as a result of your treatment. Redress is made up of either one or a combination of all of the following: An explanation. A written apology. A report on the action which has or will be taken to prevent similar incidents happening in future. An offer of financial compensation and/or remedial treatment (remedial treatment refers to medical treatment which is offered to you to try and restore you— as near as possible—to the position you would have been in had the medical harm not occurred.). Financial redress can only be considered if it is proven that the NHS organisation has failed in its duty of care and that that failure has caused the harm. This is also the case for pursuing a civil claim for negligence. Payment of financial redress will only be considered when both these tests are satisfied. Financial compensation is offered on the condition that you will not seek to pursue the same redress through further civil proceedings. In accordance with the redress regulations, you will be able to access free legal advice, but this can only be sought from solicitors with known expertise in clinical negligence who are accredited by the Law Society or AvMA.