What happens when the Ombudsman investigates an NHS complaint?

The Parliamentary and Health Service Ombudsman is the final independent stage for NHS complaints in England. You must complete the provider's own complaints procedure first and hold its final response, and you must refer within 12 months of becoming aware of the issue. NHS complaints can be sent directly; only the Ombudsman's non-NHS government work needs an MP referral.

The process

1. Initial assessment. The PHSO screens for jurisdiction and merit, and around 60% of referrals go no further — the decision letter explains why.
2. Investigation. The investigator obtains your full clinical notes, service records and internal incident reports, takes your account, and for clinical complaints commissions independent expert opinion from a clinician in the relevant specialty. That advice is usually the decisive evidence.
3. Draft decision, on which both sides have four weeks to comment.
4. Final decision, published anonymised on the PHSO's searchable database.

Two tests must both be met: service failure — was the service materially below what a reasonable patient should expect, judged against NICE guidance, professional codes and NHS standards — and injustice, meaning a real impact on you.

Remedies and the limits

The PHSO can recommend a formal written apology from a senior officer, reimbursement of out-of-pocket costs such as private treatment you had to buy, specific corrective action such as a fresh assessment or corrected records, and service improvements the provider must confirm in writing. Financial remedies are typically £100 to £500 for moderate distress and £500 to £2,500 for significant impact, rising into the thousands for serious sustained failures. Decisions are not legally binding but are followed in almost every case; refusal can trigger a special report to Parliament.

What it does not cover: social care, which goes to the Local Government and Social Care Ombudsman; private healthcare, which goes to the relevant regulator or the courts; Wales, Scotland and Northern Ireland, which have their own ombudsmen; NHS employment matters; and anything already decided by a court.

Parallel routes matter. Compensation for harm caused by clinical failure is a clinical negligence claim, with a three-year limitation period from injury or knowledge, and most solicitors work on a no-win no-fee basis. Concerns about an individual clinician go to the GMC, NMC, GDC or HCPC, which can impose professional sanctions but award you nothing. Pursuing the Ombudsman and a negligence claim together is common and usually sensible where the harm is serious.