A pain to complain: Why it’s time to fix the NHS complaints process.
Context
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 we first reviewed the NHS complaints process over a decade ago, we found major failings and called for reform. To establish if people’s confidence or experience has improved, we conducted new research between September and December 2024.
What we 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.
Download our report
Key findings in our research
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 10 (9%) made a formal complaint.
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 complaints 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 to help people complain.
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
Our 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.
- 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.
- 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.
- 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.
Methodology
We adopted a mixed-method approach to our research, consisting of:
Polling
YouGov conducted polling for us in two parts.
- Part one: A nationally representative sample of 2,042 adults living in England, between 17-22 October 2024. This asked people if they’d experienced poor NHS care since October 2023 and their general confidence in making complaints.
- Part two: A boosted sample, made up of 2,650 adults who had experienced poor NHS care since October 2023, polled 17–29 October 2024, about whether they took any action and experience of the complaints process.
- Where relevant, we compared results with the 2014 polling we conducted on the topic.
Freedom of Information requests
We sought data that we believed was held by health and care organisations, but which was not in the public domain. We did this via Freedom of Information requests sent in September 2024. We submitted these to:
- 206 NHS hospital, mental health or community trusts, asking about their budget for Patient Advice and Liaison Services (PALS) and total staff in PALS and complaints teams. We received responses from 166.
- All 42 integrated care boards (ICBs), asking about resourcing of complaints handling, response times and if they delegated the remit to another ICB. All but one responded.
- 151 upper-tier local authorities, about how much they spent on statutory NHS complaint advocacy services. We received 114 responses.
Roundtables with Healthwatch
In November 2024, we held two roundtables with more than 20 staff from approximately 17 local Healthwatch services. These focused on patient feedback on complaints, local complaints processes, and their role in providing NHS complaints advocacy if their organisation also delivered this service.
An analysis of Healthwatch feedback on complaints
In October 2024, we analysed over 200 pieces of feedback on people’s experiences of the NHS complaints process shared by local Healthwatch services. We use some of these stories in this report.
Download our report
If you need this report in a different format, please email enquiries@healthwatch.co.uk or call 030000 68 3000.
