Recommendation 116

Advocates available to all complainants

Where meetings are held between complainants and trust representatives or investigators as part of the complaints process, advocates and advice should be readily available to all complainants who want those forms of support.

People making complaints can feel isolated and intimidated when in meetings with complaints managers and trust representatives. Some patients, relatives or friends remain deeply affected by their experiences. It is right that support is available, particularly where there may have been a serious failing in care, not only to help them navigate through the process but also for someone to be there to speak for them.

Local authorities are responsible for commissioning NHS complaints advocacy services, and are able to determine the appropriate model of delivery for these services for their local community. The Department of Health considers the recommendations above to be best practice and the best local advocacy services will provide support that complainants can access easily, and that meets their needs.

NHS trusts, and particularly the Patient Advice and Liaison Services within those trusts, will be aware of the NHS complaints advocacy providers within their areas. It is right that they publicise these arrangements for people who have made a complaint or who are thinking of making one. The Department of Health wants to see patient advice and liaison services (PALS) well-sign posted, funded and staffed in every hospital so patients can go and share a concern with someone else in the hospital if they do not feel confident talking to their nurse or doctor on the ward. The Department agrees it is appropriate to review the PALS service, and will undertake to begin that work in 2014.

The government wants to see every trust make clear to every patient from their first encounter with the hospital:

  • how they can complain to the hospital when things go wrong
  • who they can turn to for independent local support if they want it, and where to contact them
  • that they have the right to go to the Ombudsman if they remain dissatisfied, and how to contact them; and
  • details of how to contact their local HealthWatch.

A sign in every ward and clinical setting would be a simple means of achieving this and the Department will be discussing with Healthwatch England, CQC and NHS England the best means of ensuring this becomes standard practice in all NHS hospitals in England. We would expect these posters to set out how to complain about hospital, how to seek support from their local Healthwatch and how to refer their complaint to the Ombudsman.

The Review of the Handling of Complaints in NHS Hospitals made the following recommendations:

  • when trusts have a conversation with patients at the start of the complaints process on a serious failing in care they should immediately offer truly independent clinical and lay advice and independent advocacy support to the complainant, and
  • hospitals should actively encourage volunteers. Volunteers can help support patients who wish to express concerns or complaints. This is particularly important where patients are vulnerable or alone, when they might find it difficult to raise a concern. Volunteers should be trained.


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.