The NHS needs to make it easier for patients to complain

In 2014, Healthwatch England first flagged significant failings in the NHS’s handling of complaints, following the patient safety scandal at Mid Staffordshire Foundation Trust.

We called for a process that was “simple, compassionate and responsive to those making the complaints”. A decade later, our new research shows us little has changed.

More than half of the people (56 per cent) who had a poor experience of NHS healthcare last year told us, via YouGov polling, that they took no action at all to raise it with the NHS organisation. Fewer than one in 10 (9 per cent) made a formal complaint, down from almost four in 10 (39 per cent) in 2014. The rising number of complaints in recent years is, therefore, likely to be the tip of the iceberg of instances of poor care.

For those who did complain, more than half (56 per cent) said they were dissatisfied with the process and outcome.

How, then, can we improve the process for patients? Equally, with public satisfaction with the NHS at record-low levels, what changes could ensure crucial insights into NHS performance are captured and used to improve services?

Three key areas of reform are required.

Simplify NHS complaints for patients through consistent ‘front-door’ information

To start with, patients must feel equipped and empowered to understand and navigate the process. Detailed, mandatory standards are needed on the information that NHS organisations must provide at the “front door” on how to raise a complaint. This should include the named responsible staff member or department, contact details, and clear information on the difference between giving feedback, raising a concern with PALS, or lodging a formal complaint.

Likewise, people often need support to make a complaint. Providers and integrated care boards should give details of the local statutory NHS complaints advocacy service, ensuring people can get early information from an independent source about the scope and limits of the complaints process. This would help manage people’s expectations and signpost them to other bodies, such as professional regulators, if more appropriate.

Of course, for many, the NHS App is now the front door to the NHS. Information about the right to make a complaint and how to do this should be added to its home menu, in the same way that the recent 10-year Health Plan consultation was promoted on the platform.

Improving complaints handling

The second key area for reform is complaints handling, which people expect to be timely, fair, and compassionate.

To find out how quickly patients receive responses to complaints, we sent a Freedom of Information request to ICBs, which took on responsibility from NHS England for the devolved handling of primary care complaints in July 2023. It revealed that their average complaint response times varied widely, from 18 to 114 working days.

NHS organisations should offer post-complaint satisfaction surveys to understand what is and isn’t working, and for which demographic groups

Improving response times will require better-resourced complaints teams. Some steps would help to incentivise this. For example, benchmarking average complaint response times, setting clear national targets, and ensuring transparency on how organisations meet these.

In the meantime, NHS organisations should offer post-complaint satisfaction surveys to understand what is and isn’t working, and for which demographic groups.

Learning from complaints

Finally, we know the NHS needs to develop a stronger listening and learning culture. A first step would be to strengthen the regulations requiring NHS bodies to compile annual complaints reports to ensure they are published, with more thorough evidence of learning. This could include anonymised case studies, descriptions of changes to service delivery, staff training or policies, or escalations to national safety bodies.

Additionally, both regulators and national bodies need to step up monitoring of complaints handling.

Our polling showed that women, people out of work, and people with lower educational attainment were less likely to use the complaints process. Collecting better data on their characteristics would help us understand and tackle inequalities in who feels most able to raise their voice.

Finally, as the Care Quality Commission revises its single assessment framework, we urge the regulator to ensure that checks on complaints handling are built into all full inspections.

A call to action

In his investigation into the NHS, Lord Darzi argued “the patient voice is not loud enough”. If policymakers are looking for ideas on making NHS services genuinely responsive to the needs of patients, the complaints process would be a good place to start.