PHSO: The Final Stage of an NHS Complaint

The Parliamentary and Health Service Ombudsman investigates complaints about:

• NHS services in England — GPs, hospitals (acute trusts), mental health trusts, ambulance trusts, dentistry, optometry, pharmacy, community health.
• UK government departments and most non-NHS public bodies (the "Parliamentary" side — DWP, HMRC, Home Office, etc. — accessed via an MP referral).

It does NOT cover:

• Social care (use the Local Government and Social Care Ombudsman).
• Private healthcare (use the relevant regulator — GMC for doctors, NMC for nurses, GDC for dentists — or court).
• Wales, Scotland, Northern Ireland (use the equivalent national ombudsman).
• Decisions that are subject to litigation or have been adjudicated by a court or tribunal.
• Employment matters within the NHS.

The PHSO operates under the Health Service Commissioners Act 1993 and the Parliamentary Commissioner Act 1967. It is independent of government, accountable to Parliament.

Three stages:

1. Local NHS complaint first — write to the provider (PALS team for hospitals, practice manager for GPs). The provider must respond within 6 months under the Local Authority Social Services and NHS Complaints (England) Regulations 2009. The response is your "final response" letter.
2. Refer to PHSO — submit at ombudsman.org.uk within 12 months of becoming aware of the issue (and within 12 months of the final response in most cases). Include your final response letter and supporting evidence.
3. Initial assessment — PHSO screens for jurisdiction. About 60% of referrals are not taken forward (lack of evidence, not within remit, would not benefit from investigation). The decision letter explains why.
4. Investigation — investigator requests medical records, expert clinical advice (often), service records, witness statements.
5. Draft decision — both parties have 4 weeks to comment.
6. Final decision — published anonymised on ombudsman.org.uk decisions database.

Typical timeline: 9-18 months from referral to decision. Complex cases involving clinical expert evidence can take longer. The PHSO has a casework charter committing to specific timeframes for each stage.

The PHSO investigation considers:

• Medical records — the PHSO obtains your full clinical notes from the provider.
• Service records — correspondence, complaints history, internal incident reports.
• Your evidence — your own account, supporting witnesses, the impact on you.
• Clinical advice — for clinical complaints, the PHSO commissions independent expert opinion from a clinician in the relevant specialty. This is the central evidence in most clinical cases.
• Service standards — what NHS standards apply (NICE guidelines, GMC standards, professional codes).

The PHSO applies the "Service Failure" test — was the service materially below the standard a reasonable patient should expect? And the "Injustice" test — what was the impact on you? Both must be satisfied for a finding of maladministration.

The PHSO's remedies reflect their "Principles of Good Administration" and "Principles of Remedy". Available remedies:

• Apology — formal written apology from a senior officer, acknowledging the failing and its impact.
• Financial remedy — typically £100-£500 for moderate distress, £500-£2,500 for significant impact, £2,500-£10,000 for serious sustained failures. Up to £100,000+ in cases of catastrophic clinical failure with lasting harm.
• Reimbursement — for out-of-pocket costs (private treatment you had to pay for because NHS failed, additional care costs, travel).
• Specific corrective action — re-do a procedure, conduct a fresh assessment, correct records.
• Service improvement — change policies, training, governance. The PHSO requires the provider to confirm in writing what has changed.
• Apology to families in cases involving death — though clinical compensation for death itself is usually pursued separately through clinical negligence litigation.

If the provider refuses to comply, the PHSO can lay a Special Report before Parliament — used rarely but powerfully.

The PHSO route runs alongside other complaint and compensation routes:

• Clinical negligence claims — for compensation for harm caused by clinical failures, especially where the impact is serious. Time limit 3 years from injury or knowledge. PHSO and clinical negligence are not mutually exclusive — many people pursue both.
• GMC, NMC, GDC, HCPC complaints — regulator-led investigations into individual practitioners. These can lead to professional sanctions but not financial compensation to you.
• CQC concerns — for systemic safety issues at NHS providers. Not for individual cases but useful for flagging patterns.
• NHS Patient Safety Investigation — internal NHS investigation for serious incidents. The Patient Safety Incident Response Framework (PSIRF) replaced the Serious Incident Framework in 2023.

For serious harm, take legal advice early. Clinical negligence solicitors offer free initial assessment and most work on conditional fee agreements ("no win no fee").