NHS Complaints: Which Route and Who to Complain To

Complaints about NHS care in England run under the Local Authority Social Services and NHS Complaints (England) Regulations 2009. Two features surprise people. It is a single-stage procedure — there is no internal appeal to a higher NHS tier, so the provider's written response is the end of the NHS stage. And you choose one body to complain to: the provider that gave the care, or the organisation that commissioned it. You cannot run the same complaint through both.

The procedure covers essentially everything the NHS does:

• Clinical treatment — diagnosis, surgical outcomes, medication errors, delays in referral or treatment.
• GP, dental, pharmacy, and optometry services — access, prescriptions, removal from a patient list.
• Hospital care — nursing, ward conditions, discharge arrangements, cancelled operations.
• Mental health services — community care, inpatient treatment, and detention under the Mental Health Act.
• Ambulance response times and paramedic decisions.
• Communication, attitude, record-keeping, and how a previous complaint was handled.

Making a complaint cannot lawfully affect the care you receive, and the regulations require organisations to handle complaints in a way that keeps that separation.

You can complain if you are a patient, or someone affected by the service. You can also complain on behalf of someone else — with their written consent; as the parent of a child; as an attorney or deputy where they lack capacity; or as a representative of someone who has died. Where you complain for an adult with capacity, the organisation will normally want their signed authority before releasing clinical detail.

The time limit is 12 months from the date of the event, or from the date you became aware of it. The organisation has discretion to accept a later complaint where you had good reason for the delay and it is still possible to investigate fairly — bereavement, serious illness, or only discovering the problem later are the usual grounds. Ask expressly and explain the delay rather than hoping it goes unnoticed.

Two things fall outside the procedure. Complaints about a clinician's fitness to practise go to their regulator — the GMC for doctors, the NMC for nurses and midwives, the GDC for dentists. And where the concern is about the safety of a service rather than your own care, the Care Quality Commission wants to know, even though it will not investigate your individual complaint.

Five processes can follow an NHS failure. They are not alternatives you choose between once: several can run in parallel, and one of them has a deadline that keeps running whatever else you do.

• NHS complaint. Delivers an explanation, an apology, a corrected record, and a commitment to change practice. It cannot award compensation for injury. Deadline: 12 months from the event or from when you became aware of it. This is the right starting point for almost everyone.
• Clinical negligence claim. Delivers damages, but only where you can prove both that the care fell below a reasonable standard and that the failure caused you injury or loss. Deadline: 3 years from the negligence or from your date of knowledge, with no time limit for children until they turn 18 and no limit at all for people who lack capacity. This clock runs regardless of how long the complaint takes, which is why a complaint should never be allowed to eat the limitation period.
• Professional regulator. Delivers a fitness-to-practise investigation into an individual clinician — the GMC for doctors, the NMC for nurses and midwives, the GDC for dentists, the HCPC for other registered professions. It cannot compensate you and will not resolve your complaint about the organisation. Use it where an individual's conduct or competence puts patients at risk.
• Care Quality Commission. Delivers regulatory action against a service. The CQC does not investigate individual complaints, but it uses what you tell it to target inspections, and reporting a serious safety concern to it is worthwhile alongside a complaint rather than instead of one.
• Coroner's inquest. Where a death was violent, unnatural, of unknown cause, or occurred in state detention, the coroner must investigate. An inquest establishes who died and how, and a Prevention of Future Deaths report can compel change — but it does not determine blame or award damages.

How to sequence them

If injury or a death is involved, take legal advice on limitation early and run the complaint alongside. If you only want answers and an apology, the complaint alone is usually the fastest and least punishing route. If a specific clinician appears dangerous, refer to their regulator without waiting for the complaint to conclude. And do not let an organisation tell you it cannot investigate your complaint because a claim is contemplated — it can, and NHS Resolution guidance encourages it to.

The organisation reviews the clinical records, takes statements from the staff involved, and usually obtains a view from a senior clinician who was not part of your care. You may be offered a meeting; these are worth attending, ideally with an advocate, and you should ask for the notes afterwards.

The regulations require a written response signed by the responsible person (in practice the chief executive or practice partner) that explains how the complaint was considered, sets out the conclusions reached, says whether any remedial action is needed, and confirms that it has been or will be taken. The organisation should respond within the timescale agreed with you, and must keep you informed if it will take longer.

What the NHS stage can produce: a full explanation, an apology, correction of your records, a fresh appointment or second opinion, staff training or a policy change, and occasionally a modest payment for out-of-pocket expenses. What it cannot produce: compensation for injury, disciplinary action against an individual (that is a matter for the employer or regulator), or a finding of negligence.

If the response leaves questions unanswered, write once identifying exactly which of your numbered questions were not addressed and ask the organisation to complete its response. That single letter often improves the outcome — and, if it does not, it demonstrates to the Ombudsman that the NHS stage was properly exhausted.

Once the NHS stage is complete, the Parliamentary and Health Service Ombudsman is the final independent step. Unlike complaints about government departments, health complaints do not need an MP referral. Refer within 12 months of becoming aware of the problem, sending the original complaint, the NHS response, your chronology, and a clear statement of the injustice that remains unremedied.

The PHSO applies established standards of good administrative and clinical practice, obtains the records, and usually takes independent clinical advice. It looks for a failing and an unremedied injustice caused by it. It can recommend an apology, an explanation, financial redress for quantifiable loss and for distress, and organisational change; it publishes case summaries and lays reports before Parliament. It cannot award clinical negligence damages, discipline staff, or overturn a clinical judgement that was within the range of reasonable practice.

If the PHSO declines or does not uphold your complaint, ask for a review of the decision, identifying the specific evidence or argument that was not addressed — reviews succeed on new points, not on repetition. Beyond that, judicial review of the Ombudsman is possible but only for unlawfulness or irrationality, within three months.

Where the real issue is harm rather than process, the complaints route is the wrong one. A clinical negligence claim has a limitation period of three years from the date of injury or knowledge (with different rules for children and those lacking capacity), and it runs while you are complaining. Take advice from a clinical negligence solicitor early — many offer free initial assessments — and consider the coroner's inquest route where a death is involved.