Recommendation 117

Access to advice for Complaints Advocacy Services

Accepted in part
A facility should be available to Independent Complaints Advocacy Services advocates and their clients for access to expert advice in complicated cases.

We agree that expert advice should be provided in appropriate cases, and in appropriate cases, the providers of NHS complaints advocacy would obtain advice from an independent clinical expert. However complaints advocacy services are no longer commissioned nationally. From April 2013, local authorities have been responsible for commissioning NHS complaints advocacy services, and are able to determine the appropriate model of delivery for these services for their local community.

We consider that the need for expert clinical advice ought not to be determined by how complicated a case might be, but whether it is appropriate in the individual case. In those cases, the trust should offer that advice, along with independent investigation.

The Review of the Handling of Complaints in NHS Hospitals recommends:

  • When trusts have a conversation with patients at the start of the complaints process they must ensure the true independence of the clinical and lay advice and advocacy support offered to the complainant.

The Department of Health will work with Healthwatch England and the Local Government Association to develop a set of ‘good practice’ standards for NHS complaints advocacy services; these standards may be expected to include access to clinical advice in appropriate cases.


The Department of Health, with key partners, will consider different aspects of Patient Advice and Liaison Services and identify if there are any areas where more substantial work may need to be commissioned to gain a better understanding. Work on this project has started, and it is envisaged the initial review and identification of areas for more detailed consideration, will be complete by Spring 2015.

The Health and Social Care Act 2012 gave responsibility for commissioning NHS complaints advocacy to individual Local Authorities from April 2013. The Clwyd/Hart Review of the handling of NHS complaints recommended that “the independent NHS Complaints Advocacy Service should be re-branded, better resourced and publicised. It should also be developed to embrace greater independence and support to those who complain. Funding should be protected and the service attached to local Healthwatch organisations.” The Government accepted that a review of NHS complaints advocacy services should be conducted to measure the effectiveness of the provision of advocacy services to the public. This review is expected to be complete by Spring 2015.

Healthwatch England have also developed a set of national standards for complaints advocacy services, generated from workshops and interviews with people who use advocacy services.