NHS complaints

First: what kind of NHS problem are you dealing with?

Choosing the right route at the start matters. Some problems need immediate action rather than a lengthy complaint investigation; others need a formal record because you may later need an independent review.

PALS or a formal complaint?

PALS - the Patient Advice and Liaison Service - can be extremely useful, especially in hospitals. It can help with urgent practical concerns, communication failures, appointments, ward problems, access to information and navigating the complaints process. It can often get somebody involved quickly without requiring a formal investigation.

But PALS contact is not automatically the same thing as a formal complaint. If you want a documented investigation, a written final response and a clear route to PHSO, state that you are making a formal complaint under the NHS complaints procedure. If you first use PALS and the issue is not resolved, ask for the matter to be logged or transferred as a formal complaint rather than assuming that has happened automatically.

Who can make an NHS complaint?

You can complain if you have received or are receiving NHS care, or if you are affected or likely to be affected by an NHS body's action, omission or decision. Complaints can also be made by representatives.

If you complain for another adult who can decide for themselves, the organisation will normally need their consent before discussing confidential information. If the person has died, lacks capacity, or is a child who cannot reasonably make the complaint themselves, a representative may still be able to complain. The organisation can consider whether the representative is suitable and whether disclosure is appropriate.

Do not let a consent issue obscure the underlying safety concern. An organisation may be unable to disclose confidential details to you, but it can still receive information about a potential risk, safeguarding issue or service failure.

Provider or commissioner, who should receive the complaint?

For most NHS services in England, you can complain either to the organisation that provided the care or to the organisation that commissioned - planned and paid for - the service. For the same complaint, the NHS says you cannot complain to both at the same time.

Complaining to the provider is often sensible where the dispute depends heavily on its own staff, clinical records, local procedure or immediate remedial action. Complaining to the commissioner may be useful where you do not feel able to complain directly to the provider, or where the issue concerns how a commissioned service is being delivered.

NHS structures can change. If you are unsure who commissions a service, use the current NHS England/ICB contact information rather than relying on an old complaint address.

If several NHS organisations are involved

A patient should not have to run three disconnected complaint investigations simply because their care crossed organisational boundaries. NHS England states that where a complaint involves more than one organisation - for example a GP, hospital and ambulance service - the organisations must work together to provide a co-ordinated response.

When making the complaint, identify every organisation involved and ask who will act as the lead. List the cross-organisational questions explicitly, who sent the referral, who received it, what information was transferred, who was responsible for follow-up, and where the handover failed. This prevents each body from answering only its own narrow part while the central problem falls into the gap between them.

What can you complain about?

The NHS complaints procedure is broad. It is not limited to clinical negligence or serious harm.

Complaining about clinical judgement is not the same as proving negligence

You do not have to prove clinical negligence before you can complain. A complaint can ask whether care followed relevant guidance, whether the clinician considered the right information, whether communication was adequate and whether the organisation has learned from what happened.

Equally, a disappointing outcome does not automatically prove that care was negligent. Where the dispute turns on clinical judgement, ask the organisation to explain the reasoning, the evidence and any relevant guidance or accepted practice. If independent clinical advice was obtained during the investigation, ask how it informed the conclusion.

Immediate safety and safeguarding concerns should not wait for the complaints process

A formal complaint is retrospective: it investigates what happened and what should change. It is not a substitute for urgent action where somebody currently faces a serious clinical or safeguarding risk.

If the patient is in immediate danger or needs urgent medical attention, use the appropriate emergency or urgent-care route. If the concern involves abuse, neglect or a person at risk, raise the safeguarding concern through the relevant provider/local safeguarding route. A complaint can still follow, but protecting the person comes first.

The 12-month time limit - and when a late complaint can still be accepted

Under the NHS complaints framework in England, a complaint should normally be made within 12 months of the event or, if later, within 12 months of the matter first coming to your attention.

That is not an absolute bar. The 2009 Complaints Regulations allow a late complaint where the responsible body is satisfied that there were good reasons for the delay and that it remains possible to investigate the complaint effectively and fairly.

If you are outside 12 months, do not merely apologise for lateness. Explain why you could not reasonably complain sooner - for example illness, bereavement, ongoing treatment, delayed discovery of the facts or lack of capacity - and explain why the records and witnesses still allow a fair investigation.

How to make the complaint

An NHS complaint can be made orally, in writing or electronically. If a complaint is made orally and is not simply resolved as a very short informal matter, the organisation should make a written record and provide a copy to the complainant.

For anything complex, written form is usually safer because it fixes the scope and creates an evidence trail. A good complaint does not need legalistic language. It needs an accurate chronology, clearly separated issues, the evidence that matters and realistic outcomes.

What should happen within three working days?

The NHS Constitution and the 2009 Complaints Regulations require complaints to be acknowledged within three working days. NHS guidance also says you should be offered a discussion about how the complaint will be handled.

This is not just an administrative receipt. The early discussion is an opportunity to agree the complaint scope, clarify the outcomes you seek, identify whether records or other organisations are needed, and establish the period within which the organisation expects to complete its investigation and send the response.

If the acknowledgement silently narrows your complaint, correct it immediately. A later final response will often follow the scope recorded at the beginning.

There is no universal 28-day final-response deadline

England does not have a universal rule requiring every NHS complaint to receive a final response within 20, 25 or 28 working days. The response period should be discussed and will depend on complexity.

That does not give an organisation permission to leave the complaint open indefinitely. You have the right to know the expected period for the investigation, to be kept informed of progress and to know the outcome. If the agreed date cannot be met, ask for a revised date, the reason for the delay, what work remains outstanding and when the next update will be provided.

England does not use Scotland's universal Stage 1 / Stage 2 timetable

Do not import complaint deadlines from guidance written for NHS Scotland. Scotland uses a different complaints procedure with defined early-resolution and investigation stages. The English NHS complaints framework is different: it centres on local resolution under the 2009 Regulations, an agreed investigation timescale and then external escalation to PHSO where the local process has ended or is unreasonably stalled.

An English NHS organisation may have local escalation, review or resolution steps in its own policy, but there is no universal England-wide "Stage 1 in five days / Stage 2 in 20 days" rule.

What a proper investigation should do

A complaint investigation should address the actual complaint rather than simply ask the staff involved whether they remember doing anything wrong. Depending on the issue, relevant material may include clinical records, referral and appointment systems, prescribing records, incident reports, correspondence, call logs, policies, staff accounts and audit trails.

For a clinical issue, the organisation should distinguish factual questions from questions requiring clinical judgement. For an administrative issue, the electronic trail can be decisive. If the response says "there is no evidence", ask what systems and records were actually checked.

The PHSO NHS Complaint Standards expect organisations to understand the complaint and desired outcome, explain what they investigated and how, identify what went wrong, understand the impact, provide an appropriate remedy and explain what happens next.

What the final response should contain

A proper final response should let an independent reader understand the complaint, the investigation and the reasons for the outcome. Under the NHS complaints framework, the written response should explain how the complaint was considered, the conclusions reached and any action taken or proposed.

If the response does not answer your complaint

Do not simply send the entire complaint again. Turn the final response into an audit.

Create a short failure-to-answer schedule with columns for: complaint issue, evidence supplied, what the response says, what remains unanswered, and what you want the organisation to do next. This is particularly useful where the response changes the chronology, answers a different question, relies on an unidentified policy or ignores a document that contradicts its conclusion.

If the organisation offers a local review or further response, use the schedule to narrow the remaining issues. If it says the local process is complete, the same schedule can form part of a PHSO complaint.

What outcomes can you realistically ask for?

Think about remedy before writing the complaint. Possible outcomes include an explanation, apology, correction of an administrative error, review of care, a new appointment or assessment where clinically appropriate, reimbursement of an evidenced direct loss, improvement to a process, staff learning, policy change or confirmation of action taken to reduce recurrence.

A complaint can also result in a financial remedy for avoidable injustice in appropriate cases, and PHSO can recommend financial payments. But the complaints process is not a court and does not determine legal liability for clinical negligence. If you are seeking damages for injury caused by negligent treatment, that is a separate legal route.

Duty of candour, when something serious has gone wrong

The statutory duty of candour is separate from the complaints procedure. Providers regulated by CQC must act openly and transparently. Where a qualifying notifiable safety incident has occurred, Regulation 20 requires specific steps including notifying the relevant person, providing a truthful account of the known facts, explaining further enquiries, offering an apology and following up in writing.

Not every complaint or adverse outcome automatically meets the legal definition of a notifiable safety incident. If you believe the threshold may be met, ask whether the incident was considered under the duty of candour and, if not, why not. CQC regulates compliance with the statutory duty.

Records, SARs and correcting factual errors

An NHS complaint and a data-protection request solve different problems. A complaint asks the organisation to investigate care or service. A subject access request can help you obtain personal data such as records, correspondence and some administrative material. Article 16 rectification can be relevant where personal data is factually inaccurate.

But clinical records require care. A patient can challenge a wrong date, wrong medication, wrong address, incorrect statement that a referral was never received or another objectively inaccurate fact. That is different from demanding deletion of a clinician's genuinely held professional opinion merely because you disagree with it. Where the record contains disputed opinion, an appropriate annotation or supplementary statement may be more realistic than erasure.

CQC: important, but usually not your individual complaint decision-maker

The Care Quality Commission regulates health and social care services in England. It wants information about poor care because that intelligence can influence monitoring, inspection and regulatory action. But CQC says it does not generally take forward individual complaints on a patient's behalf or decide the personal remedy due.

That means "I told CQC" is not a substitute for making the NHS complaint if you want a response to your own case. It can be sensible to do both where the facts reveal wider safety or quality concerns.

There is an important exception: CQC has a specific statutory role in complaints about how Mental Health Act powers and duties have been used, including care while detained, on guardianship or under a community treatment order.

Professional regulators: a different question from an NHS complaint

Professional regulators such as the General Medical Council, Nursing and Midwifery Council, General Dental Council, General Pharmaceutical Council and Health and Care Professions Council protect the public and regulate professional standards. They are not substitute customer-service complaint bodies.

If the concern is serious professional misconduct, dishonesty, persistent unsafe practice, boundary violations or impairment of fitness to practise, a regulator may be relevant. But a regulator will not normally exist to secure your appointment, refund a cost, rewrite an NHS complaint response or compensate you. The NHS employer/provider complaint and the professional-regulation route can address different questions and may run in parallel.

Clinical negligence and legal action are separate - watch the time limit

If treatment fell below the legally required standard and caused injury, you may have a clinical-negligence claim. The complaint process can help establish facts and obtain explanations, but it does not determine legal liability and it should not be assumed to stop a court limitation period.

The usual limitation period for a clinical-negligence personal-injury claim is three years from the date of the alleged negligence or a later date of knowledge, subject to important exceptions and the court's discretion. Children and people lacking litigation capacity can be subject to different rules. If compensation for injury may be significant, obtain specialist legal advice early rather than waiting for the complaint and PHSO process to finish.

Do you need an MP to complain to PHSO?

No - not for an NHS complaint in England.

PHSO has two different statutory jurisdictions, and this causes persistent confusion. Complaints about UK government departments and certain other public organisations generally have to be referred to PHSO by an MP. Complaints about the NHS in England can be made to PHSO directly, or through an MP if you choose.

PHSO has announced that from 1 October 2026 it will use the name Public Service Ombudsman. It says its role and service will remain the same.

When can you go to PHSO?

PHSO is normally the final stage after the NHS organisation has had a proper opportunity to deal with the complaint. If you have a final complaint response and remain dissatisfied, you can use PHSO's complaint checker and submit the complaint directly.

You do not necessarily have to tolerate endless local delay. PHSO's current NHS guidance says that if your complaint has not been dealt with after six months, you can complain to it; it also asks people to contact it where an organisation does not reply in the time promised or where the PHSO time limit is becoming a concern.

PHSO's own time limit is separate from the NHS body's 12-month local complaint limit. For NHS complaints, PHSO says you should complain to it within one year of when you became aware of the problem. It has some discretion in appropriate circumstances, but do not assume that a lengthy local process automatically protects your external deadline.

What PHSO can look at

PHSO can consider whether an NHS organisation acted properly and fairly, whether there was service failure or maladministration, and whether unresolved injustice resulted. In clinical cases it can obtain clinical advice and consider whether care fell below the relevant standards for the purpose of the ombudsman complaint.

It can recommend explanations, apologies, service improvements, practical remedies and, where appropriate, financial remedy for injustice. It is not a court and does not decide civil liability for negligence or award damages in the same way a court does.

Build the PHSO complaint around the remaining unresolved issues. Identify what the NHS body concluded, why you say that conclusion is unsupported or procedurally defective, the evidence that matters, the injustice caused and the remedy you seek.

Healthwatch and independent NHS complaints advocacy

Local Healthwatch can help you understand complaint routes and find local support. It is also a route for sharing patient experience and concerns about local services.

Free independent NHS complaints advocacy is available in England. An advocate can help organise the complaint, draft correspondence, understand the process and attend meetings. NHS England says advocacy can be used at any stage. If you do not know who provides it locally, your Healthwatch or local authority can help identify the service.

An advocate supports your complaint; they do not decide it, provide clinical opinions or replace legal advice.

Evidence worth keeping