NHS building

The Long and Winding Road of NHS Complaints System Reform

By John Tingle

Sadly, the NHS (National Health Service) has not been able to get its complaint system right, even after decades of trying.

Despite several reports published over two and half decades detailing the challenges the complaint system faces, as well as potential solutions, it still is not fit for purpose. Most recently, the Parliamentary Health Service Ombudsman (PHSO) has produced a report on complaint handling with a focus on the NHS. It is a good, hard-hitting report, which spells out clearly the problems, difficulties, and opportunities to put things right with NHS complaints.

It is, however, another good NHS complaint system reform report in a long line of others. The other reports failed to change adequately the NHS complaints culture and there is little evidence to suggest that this one will succeed where the others have failed.

In a post-COVID-19 NHS focused care environment, it is also questionable whether there is government and NHS appetite for root and branch reform of the NHS complaints system. There are other, arguably more pressing, matters of concern which include dealing with the aftermath of the pandemic, waiting lists, and chronic staff shortages.

The Report

Research for the report unearthed a broad consensus that there is a need to reform the complaints system.

In section 1 of the report, there is discussion of promoting a learning and improvement culture in the NHS. The importance of leadership from the top is essential to this.

The report identifies a culture of defensiveness in the NHS when it comes to handling complaints. Defensiveness in NHS complaint handling has plagued the system for decades and is seemingly an intractable, systemic problem.

There are also other systemic problems such as a prevailing NHS blame culture when mistakes are made. This inhibits reporting of errors and fosters negative staff attitudes toward complaints when they are made. The Department of Health and Social Care has tried to deal with this issue by focusing on what is termed a
“Just Culture.” There is also the perpetual problem in the NHS of failing to learn the lessons from past adverse health care treatment, care events, and complaints.

Other findings

The most common theme found in the review of investigation reports was delays in responding to complaints. Poor handling of investigations into complaints contributed to delays.

The report found that staff do not always get protected time to investigate complaints properly. Complaints are, in some cases, seen as an add-on to a person’s other responsibilities. The report expresses concerns that complaints teams are not appropriately resourced.

Further, the report notes, NHS organizations are not sufficiently publicizing the insight and learning they have taken from complaints.

A way forward

Section 2 of the report focuses on positively seeking feedback. When organizations proactively seek feedback from service users and resolve concerns promptly, this can prevent matters from spiraling into formal protracted complaints. It also discusses the need for hospitals and other organizations to adopt a more personalized approach to complaint resolution.

In section 3, there is a discussion of being thorough and fair in complaint handling. Complaints should be resolved through an open, transparent, and responsive process.

The report highlights the importance of organisations giving people fair and accountable decisions:

“When things do go wrong, it is important that organisations encourage staff to identify suitable ways to put things right for those raising feedback and complaints. This should always include providing meaningful apologies and showing why learning can be taken from the complaint…”

A Complaints Standard Framework is introduced to provide consistency in complaint handling. There is currently a public consultation on the framework.

The report concludes with several issues for Parliament to consider.


It would be good to see this report break the mould of previous NHS complaint system reports and lead to positive and sustainable changes. The nagging question and doubt that remains is that we have all been here before, many times. Nothing much has changed over two and half decades of complaints reports being published, and there is little reason to expect things will go differently this time.

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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