An index finger rests on one yellow star while four other stars are shaded to the right, indicating a one star review.

Improving the Mindset on NHS Complaint Handling

By John Tingle

History has not served the NHS (National Health Service) complaints system well

History has not served the NHS complaints system well. There have been many reports about NHS complaints going back well over two and a half decades, saying the same or similar things about the system. Many have argued and continue to argue that the NHS complaints system needs to be much more responsive, simpler in operation and less defensive. It is fair comment to argue today that the NHS complaints system is still plagued with endemic and systemic problems. The NHS has never been able to gets its health care complaints system right.

Two contemporary reports, one published in 2018 and the other in 2020, give support to the view that the NHS needs to do much more to improve how patient complaints are handled.

NHS Resolution: BIT (Behavioural Insights Team)

The Behavioural Insights Team in association with NHS Resolution found in a complaints survey conducted for the report:

  • The majority (69-75%) rated the response to their complaint as ‘poor or very poor’ in terms of: – Accuracy – Empathy – Speed of the response – Level of detail of the response” (p 25).

The report also highlighted research interview findings:

  • Overall, complainants were not satisfied by the complaints handling process.
  • Interviewees described poor communication: the complaints process was opaque, impersonal and lacked compassion for some.
  • Interviewees reported lacking confidence that their complaints resulted in any meaningful outcomes. (p27)


Healthwatch is the independent national consumer champion for people who use health and social care services in England. They also provide a leadership and support role for the local Healthwatch network. Healthwatch recently identified some major problems with NHS hospital complaint handling in a report and made several key recommendations for change.


For the report, Healthwatch searched the websites of 149 NHS acute hospital trusts in England and looked for substantive reporting on complaints. They also looked for reporting of data on informal complaints and concerns handled by the hospital’s Patient Advice and Liaison Service (PALS) team. A 0-3 rating was then given to each trust for the level of transparency shown in their reporting and the quality of learning that they have evidenced from the documentation shown. The report made some key findings which include the following.

-Local reporting on complaints is inconsistent and inaccessible.

-Staff are not empowered to communicate with the public on complaints.

-Reporting focuses on counting complaints, not demonstrating learning.

Healthwatch found:

  • “Only 38% of trusts make public any information on the changes they’ve made in response to complaints.”
  • “Much of this reporting is still only high-level, telling us little detail about what has changed and only stating that ‘improvements were made'” (p5).

Not all doom and gloom

The report did highlight some positive examples of hospital trusts demonstrating learning taking place. The report is however not all doom and gloom, but it is clear hospital trusts should be doing much more to build public confidence in the complaints system. If NHS hospitals don’t publish the changes that they have made in the light of complaints being made, then the public will reasonably assume that complaining and giving feedback makes no difference.

The main hospital trust approach adopted to annual reports seems very perfunctory and generally not much is given away. It seems to me as if the complaints are treated as an embarrassment and the least said on them the better. I would agree with this statement in the report’s recommendation section:

  • “Feedback from patients should be seen as an opportunity to learn and demonstrate improvement rather than an adversarial process to be managed and minimised” (p15).

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.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.