Recommendation 109

Multiple gateways for registering complaints

Methods of registering a comment or complaint must be readily accessible and easily understood. Multiple gateways need to be provided to patients, both during their treatment and after its conclusion, although all such methods should trigger a uniform process, generally led by the provider trust.

Feedback of any kind, but particularly concerns and complaints, are important; they enable things to be put right for the complainant and drive the improvement of hospital services. But there is evidence that not everyone who would wish to make a complaint does so. This can be for a number of reasons, of which ease of access to the complaints arrangements is an important one.

The overall framework for complaints handling is laid down in regulation and it is important that the overall process is consistent across the NHS and clear to patients.

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 of Health will be discussing with Healthwatch England, the Care Quality Commission 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.

It is important that local Healthwatch, as the patient and public champion for health and care services, should be as strong and effective as possible so that it can speak up for patients and provided independent support on complaints. The Department of Health supports Healthwatch England in their plans to coordinate a consumer-facing complaints campaign with their partners.This will help ensure there is better quality information for patients about how to raise a concern and the standards they should expect if they make a complaint.

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.

Furthermore Rt Hon Ann Clwyd MP and Professor Tricia Hart’s Review of the Handling of Complaints in NHS Hospitals makes two recommendations on good practice to support patients who have some dissatisfaction with their healthcare that would assist in the delivery of this recommendation:

  • trusts should provide patients with a way of feeding back comments  and concerns about their care on the ward, including simple steps such as putting pen and paper by the bedside, and making sure patients  know who to speak to if they have a concern – this could be a nurse or a doctor, or a volunteer on the ward;
  • hospitals should actively encourage and use volunteers to support patients in expressing concerns or complaints. This is particularly important where patients are vulnerable or alone, when they might find it difficult to raise concerns at the time the problem arises: volunteers should be regularly refreshed.

As part of its new inspection regime, the Care Quality Commission will be including complaints handling in its assessment of trust performance which includes how trusts have learnt from complaints.


The Department of Health made a complaints poster template available to the NHS at the end of November 2014.

The Parliamentary and Health Service Ombudsman working with Healthwatch England and the Local Government Ombudsman published universal expectations for raising concerns and complaints to support improvements in complaint handling. The user led vision and expectations represent a comprehensive guide to how a good experience of raising a concern or complaint should look and feel.

For the person who has raised a concern or complaint, the ultimate vision is for them to be able to describe their experience as: “I felt confident to speak up and making my complaint was simple. I felt listened to and understood. I felt that my complaint made a difference.” The expectations provide a tangible way to measure the extent to which the expectations of users of health and social care services are being met through the complaints arrangements.

The Department of Health and NHS England together are issuing an accessible feedback and complaints guide for patients who wish to give feedback or that are dissatisfied with the service they have received from the NHS.  The guide will provide information on how to raise a concern or to make a complaint.  This will support the NHS Constitution which sets out patients’ right to complain about their NHS care, should they wish, and will be published on the NHS Constitution page of the website.

Creating an environment whereby complaints are encouraged across the NHS will take time, but the Government and its national partners are seeing substantial progress being made in a variety of areas. One example of progress in the patient’s access to complain is the Lancashire Teaching Hospitals NHS Foundation Trust. Information and awareness of how to provide feedback/make a complaint is emphasised in the Trust through installation of a suite of posters widely displayed in public areas; information leaflets that are available in all areas; and information on the Trust’s websites, both internally and externally facing. In addition, satisfaction questionnaires included with each complaint response in which the complainant is asked to provide feedback on the complaints process, the quality of the response letter, and whether it satisfactorily answers their queries and concerns ensures that the Trust maintains a certain level of quality in its complaints processes. While these methods of patient complaint are not nationwide as of yet, Lancashire Teaching Hospitals NHS Foundation Trust testifies that a positive cultural change, which welcomes negative feedback, is beginning to take place within the nation’s healthcare environments.

Complaints are a key line of inquiry for the Care Quality Commission in all health and social care inspections as part of the “responsive” domain.