The NHS Complaints Process: A Step-by-Step Guide to Making Your Voice Heard

When a Complaint Is Warranted, and What It Can Achieve

An NHS complaint is not about confrontation, it is a formal mechanism for accountability and improvement. The NHS received over 234,000 written complaints in 2024/25, covering issues from delayed diagnosis and communication failures to clinical negligence and care standards. A well-constructed complaint can achieve several outcomes: a formal apology, a review of clinical decisions, changes to hospital protocols, staff retraining, and, in serious cases, referral to professional regulators. It also creates a documented paper trail that is essential if you later pursue legal action or a negligence claim. The most effective complaints are specific, evidence-based, and focused on outcomes rather than emotion.

Stage 1: Local Resolution with the Trust

Every NHS trust has a Patient Advice and Liaison Service (PALS) as the first point of contact. For straightforward issues, a rude receptionist, a missed appointment, a communication failure, PALS can often resolve the matter informally within days. For more serious concerns, you need to submit a formal written complaint to the trust's Complaints Manager. You must do this within 12 months of the incident (or 12 months from when you became aware of the issue). The trust is legally required to acknowledge your complaint within 3 working days and provide a full written response within a 'reasonable timeframe', guidance suggests 25–40 working days, though complex cases may take longer. Address your complaint to the Chief Executive by name, this is public information available on the trust's website.

How to Write an Effective Complaint Letter

Structure your complaint chronologically. Begin with the dates and locations of care, name the staff involved (if known), describe what happened, explain the impact on you or your family member, state what you believe should have happened, and specify what outcome you are seeking. Avoid emotional language, factual statements carry more weight in formal processes. Include your NHS number, date of birth, and contact details. If the complaint involves a deceased relative, state your relationship and provide evidence of your authority to complain on their behalf (next of kin status or power of attorney documentation). Send the letter by recorded delivery and keep copies of everything.

Stage 2: The Parliamentary and Health Service Ombudsman

If you are dissatisfied with the trust's response, you can escalate to the Parliamentary and Health Service Ombudsman (PHSO). The PHSO is an independent body that investigates complaints about NHS services in England. You must submit your complaint to the PHSO within 12 months of receiving the trust's final response. The PHSO will first assess whether your case meets their criteria, they receive approximately 25,000 complaints annually but investigate only a fraction. If they take your case, they will conduct an independent review, potentially commissioning clinical advice from independent consultants. Investigations take 6–12 months on average. The PHSO can recommend financial remedies, apologies, and systemic changes.

When to Involve a Solicitor or the CQC

If your complaint involves potential clinical negligence, a misdiagnosis, a surgical error, a delayed cancer diagnosis resulting in harm, you should consider consulting a clinical negligence solicitor alongside the formal complaints process. Most solicitors offer a free initial assessment and work on a no-win-no-fee basis. Separately, if you believe there are systemic patient safety concerns (rather than an individual incident), report them to the Care Quality Commission (CQC). The CQC cannot investigate individual complaints, but they use patient reports to inform their inspection priorities. You can also report concerns about individual practitioners to the General Medical Council (GMC) or the Nursing and Midwifery Council (NMC).

Keeping Records: Your Most Important Tool

Throughout any medical journey, but especially during a complaints process, keep meticulous records. Request copies of your medical notes (your legal right under GDPR, trusts must respond within 30 days). Keep a chronological diary of all interactions with healthcare staff, including dates, times, names, and what was said. Save all letters and emails. Record phone calls where legally permitted (in England, you can record calls you participate in for personal use). Photograph any relevant physical evidence. If attending meetings with the trust, bring a companion and take written notes that both parties sign. This documentation is invaluable whether your case stays within the complaints system or progresses to legal proceedings.