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Under the NHS Constitution for England, individuals have a right to make a complaint about any aspect of their NHS care and treatment in England.

Most complaints can be made using the standard NHS complaints procedure. Other options include medical negligence claims and complaints to professional regulators, such as the General Medical Council (GMC) and Nursing and Midwifery Council (NMC). Complaints about the use of the Mental Health Act where someone is detained in hospital, or on a guardianship or community treatment order, can also be made to the Care Quality Commission (CQC).

The standard NHS complaints procedure

The standard NHS complaints procedure can be used to complain about primary care, community health or hospital services. There are two-stages:

  1. Local resolution: an individual should first complain to the service or commissioner of the service they wish to complain about (either the local integrated care board or NHS England).
  2. If they are not happy with the outcome of the complaint, an individual can then complain to the Parliamentary and Health Service Ombudsman.

The NHS website provides further information. It also notes that anyone can make a complaint although family members, carers, friends, or local MPs, should seek an individual’s consent to make a complaint on their behalf.

The Ombudsman is the final stage for unresolved complaints about the NHS in England. If an individual is unhappy with the Ombudsman’s outcome, they may be able to raise their concern with the person who handled their case within a month of the Ombudsman’s decision. Following this, the Ombudsman website explains that if they remain unhappy, they have the option of seeking independent legal advice about their options to challenge the decision through the court system. Information on sources of legal advice can be found in the Library briefing Legal help: where to go and how to pay.

Local resolution (first stage)

For the first stage of complaints, often called ‘local resolution’, complaints can be made to the organisation providing the NHS service (such as a GP, dental practice or hospital) or to the body responsible for the service (the local integrated care board for most NHS services, or NHS England for certain specialised services).

The NHS website states that individuals should contact their local integrated care board (ICB) if their complaint is about:

  • a GP surgery
  • an NHS dentist
  • an NHS optician
  • a pharmacy
  • hospital care
  • mental health services
  • out-of-hours services
  • community services, such as district nursing
  • NHS 111

And to contact NHS England if their complaint is about:

  • healthcare in prison
  • military healthcare
  • specialised services that support people with a range of rare and complex conditions

Parliamentary and Health Service Ombudsman (second stage)

If the individual has complained to the organisation and are not satisfied with the outcome, they may be able to take their complaint to the Parliamentary and Health Service Ombudsman (PHSO).

On 23 May 2023 the Ombudsman confirmed a change to the way they handle complaints about the NHS. Having reviewed the approach they took during the pandemic and decided to embed that into their casework process they now only look further into the more serious cases (see PHSO service update).

Further information is available on the PHSO website, including Information for MPs.

Rights and pledges covering NHS complaints and redress

The NHS Constitution sets out the following patient rights and pledges relating to NHS complaints and redress:

Your rights.

You have the right to have any complaint you make about NHS services acknowledged within three working days and to have it properly investigated.

You have the right to discuss the manner in which the complaint is to be handled, and to know the period within which the investigation is likely to be completed and the response sent.

You have the right to be kept informed of progress and to know the outcome of any investigation into your complaint, including an explanation of the conclusions and confirmation that any action needed in consequence of the complaint has been taken or is proposed to be taken.

You have the right to take your complaint to the independent Parliamentary and Health Service Ombudsman or Local Government Ombudsman, if you are not satisfied with the way your complaint has been dealt with by the NHS.

You have the right to make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body or local authority.

You have the right to compensation where you have been harmed by negligent treatment.

NHS pledges

The NHS also pledges to:

  • ensure that you are treated with courtesy and you receive appropriate support throughout the handling of a complaint; and that the fact that you have complained will not adversely affect your future treatment

  • ensure that when mistakes happen or if you are harmed while receiving health care you receive an appropriate explanation and apology, delivered with sensitivity and recognition of the trauma you have experienced, and know that lessons will be learned to help avoid a similar incident occurring again

  • ensure that the organisation learns lessons from complaints and claims and uses these to improve NHS services

The Handbook to the NHS Constitution provides further detail on the legal basis for these rights, and notes that the pledges are consistent with the Principles of Good Administration, Principles of Good Complaint Handling and Principles for Remedy, available on the Parliamentary and Health Service Ombudsman’s website.

Medical negligence

In cases where someone believes they have been harmed due to medical negligence they could consider making a claim for damages. Where legal action is being considered, professional legal advice should be sought and this is not something the House of Commons Library can provide. Information on sources of legal advice can be found in the Library briefing Legal help: where to go and how to pay.

Negligence claims made against NHS bodies in England are handled by NHS Resolution. The NHS Resolution website provides advice for claimants and notes that most negligence claims are resolved outside of court, through negotiation or dispute resolution between parties.

Action against Medical Accidents (AvMA) is an independent charity. It can help patients to consider the options that may be open to them after suffering a medical accident, including providing contacts for specialist solicitors. AvMA have a helpline: 0845 123 2352 (open Monday to Friday, 10am to 3.30pm).

Complaints about individual healthcare professionals

If an individual is concerned that the behaviour of a doctor, or other regulated healthcare professional, may call into question their fitness to practice, a complaint can be made to the relevant professional regulator.

For example, for a doctor this would be the General Medical Council (GMC), or in the case of a nurse, the Nursing and Midwifery Council (NMC). The Professional Standards Authority for Health and Social Care (PSA) provides a list of statutory bodies that currently regulate health and care professionals in the UK.

Organisations that can help

There are several organisations that can help individual patients resolve issues with the NHS. Local patient advice and liaison services (PALS) offer confidential advice, support and information on health-related matters. Charities like the Patients Association or Action Against Medical Accidents (AvMA) have helplines for patients.

Other organisations that can provide help and advice to individuals who want to complain about NHS services include:

  • Local NHS complaints advocacy services can provide free, confidential and independent advice to help patients make a formal complaint about NHS services.
    • Individuals can find their local NHS complaints advocacy services by searching online for “NHS complaints advocacy” and the name of their area. Individuals could also contact their local council or local Healthwatch to find out about complaints advocacy services in their area.
  • Independent Mental Health Advocates (IMHAs): IMHAs can help and support patients detained under the Mental Health Act to understand and exercise their legal rights.

Constituents can also seek help from Citizens Advice in making complaints about healthcare.

The CQC has no role in investigating individual complaints about services except for certain complaints made in relation to the Mental Health Act 1983. However, the CQC highlights that it is keen to hear from the public about their experience of care to help inform when and how it regulates and inspects health and care services (CQC, give feedback on care).

Complaints about non-NHS services

While the NHS complaints procedure can be used to complain about all NHS-funded services, whether provided by an NHS or non-NHS organisation, it cannot be used for complaints about privately funded healthcare.

Complaints about privately funded healthcare services need to be made to the healthcare provider directly in the first instance. Complainants may then have the option of referring the complaint for independent external adjudication by the Independent Sector Complaints Adjudication Service (ISCAS), which represents some independent healthcare providers. There is further information about ISCAS on their website, including information about which organisations are members.

Complaints about social care should also be raised with the service providers in the first instance. Where care is funded or arranged by a local council, complaints can also be raised with the local authority social services department. Further information is available from the Local Government and Social Care Ombudsman website.

Further information

Information on whistleblowing procedures for NHS staff to raise concerns can be found on the NHS England website.

Information for complaint procedures in the rest of the UK is published by the NHS and health services in:

About the author: Devyani Gajjar is a researcher specialising in health policy at the House of Commons Library.                                                                                           

Disclaimer

The Commons Library does not intend the information in this article to address the specific circumstances of any particular individual. We have published it to support the work of MPs. You should not rely upon it as legal or professional advice, or as a substitute for it. We do not accept any liability whatsoever for any errors, omissions or misstatements contained herein. You should consult a suitably qualified professional if you require specific advice or information. Read our briefing for information about sources of legal advice and help.

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