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The NHS Complaints System: Wither the Toxic Cocktail Image?

The National Health Service in England has been trying for many years to get its complaints system right, but it has never succeeded. A great number of reports have been published on the system over the years, some dating back for at least a quarter of a century.

The Care Quality Commission (CQC ) the independent regulator of health and social care in England have just published a report launching a “Declare Your Care” campaign, which raises several important issues about the NHS complaints system.

The Parliamentary and Health Service Ombudsman (PHSO) also recently published a report, “Complaints about the NHS in England: Quarter 2,2018-2019.” This report presents statistics on complaints about the NHS in England and identifies trends.

It’s important for contextual purposes before discussing these recent reports to  reflect on progress made to date in establishing a good and effective NHS Complaints system. When many past reports on NHS complaint handling are looked at a poor picture sadly emerges. The NHS complaints system can be seen to have a long way to go before it can be regarded as good and effective.

The Toxic Cocktail

Clyde and Hart in a 2013 report discuss evidence given to them by the PHSO. The evidence presented characterizes well some of the central problems facing the NHS in the way it handles complaints

 “The PHSO told the Review: “At its worst there is a toxic cocktail that prevents concerns and complaints being heard and addressed. This is a combination of reluctance on the part of patients, families and carers to express their concerns or complaints and a defensiveness on the part of hospitals and their staff to hear and address concerns. As a result, opportunities to learn and improve care are lost.”

CQC Declare Your Care Campaign

The CQC have launched their campaign to encourage people to share their experiences of care with them. This will help to support the CQC care standards improvement efforts. The report states that almost 7 million people in England, who have accessed health or social care services, in the last five years have had concerns about their care, but never raised them. The reasons for this will come as no surprise again when other reports in the past on NHS complaints are read. Patients lacking knowledge of the complaints system was one key issue:

“The most common reasons for not raising a concern were not knowing how (20%) or who (33%) to raise it with, not wanting to be a ‘troublemaker’ (33%) and worries about not being taken seriously (28%). Over a third of people (37%) felt that nothing would change as a result. 

What is promising is the finding that when people did raise concerns or complaints, the majority (66 per cent) found their issue was resolved quickly. Over a fifth of those who were surveyed  raised concerns or wanted to raise concerns over communication failures between health and care services.

Complaints about the NHS in England: Quarter 2, 2018-2019

The PHSO represent the final stage in the NHS complaints process in England.The report presents statistics on complaints about the NHS in England from July to September 2018, Quarter 2, 2018-2019.Data is included about the complaints received, assessed and investigated and trends identified. The report provides an excellent insight into the scope and scale of PHSO activities.The area in which the PHSO saw the most complaints about healthcare provision in Quarter 2 was in hospital and community health services. The complaint issues covered included:

Access to treatment or drugs, communication, failure to diagnose, delay in diagnosis, clinical treatment-surgical:

“Communication issues could include how clinical decisions have been explained and whether the implications were made sufficiently clear.” 

The report also contains two case studies which provide useful insights into the complaints process.

These findings have been seen regularly and consistently in other reports on NHS complaint handling.Unfortunately, the NHS does seem to learn from its errors of the past and fails to change practices accordingly.


It is hard to be upbeat and positive about the NHS complaints system, there is a quarter of a century of reports pointing to repeated chronic problems and unlearnt lessons. The reports discussed show the mammoth task that faces the NHS in discarding the toxic cocktail NHS complaints culture image.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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