Complaining about health and social care
A brief legal guide to complaining about health and social care in England or Wales, including details of where you can go for further information or support.
If someone is unhappy with the service received from NHS or adult care services, there are a number of steps they can take. A brief explanation about taking legal proceedings for clinical negligence is set out in another briefing called Clinical Negligence, which outlines the legal process for making a legal claim for compensation because of a medical mistake.
Legal proceedings can be very costly and time-consuming. A more appropriate and effective way to get an apology or an explanation may be to use the complaints procedure.
Helpful tips when making a complaint
- Date the letter of complaint.
- Provide your name and address.
- Give a clear account of what happened and what went wrong.
- Include all the relevant facts such as dates and names but try to keep the letter concise.
- Attach copies of relevant documents or photographs and list the items enclosed in the letter.
- Explain what the solution should be e.g. apology, better service or explanation.
- Keep the tone polite.
- Identify the date by which a reply is expected.
- Keep a copy of the letter and of any enclosures.
- Send the letter by recorded delivery.
If someone has an urgent need for a health or social care service which has been refused or withdrawn, it is helpful to get legal advice about the best way to challenge this, in other words, whether to use the complaints process first, or whether it is possible to take immediate legal steps to access the service they need. If there is an urgent need for a service to be provided it is helpful to get community care legal advice.
Complaints procedures can also be used before starting legal proceedings. However, it is important to understand that there are time limits for bringing legal proceedings and using a complaints procedure does not extend the relevant time limit. So it is advisable to get specialist advice if someone is considering legal proceedings and wants to complain as well. Also a complaint will not usually be investigated once legal proceedings have started.
Bringing a legal claim
If someone has an urgent need for a service or treatment now from a public body, and it is not possible to wait until the complaints procedure is followed, it may sometimes be possible to use a legal procedure called judicial review to challenge the lawfulness of the decision to refuse or fail to supply that service. Time limits for this are short and a judicial review must be made promptly and at least within three months, so it is important to obtain advice from a community care solicitor as soon as possible.
Complaints procedure in England
Since April 2009 there has been a single complaints system for all health and adult social care services, and this is set out in the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009.
The system covers complaints against Local Authorities, NHS hospitals, Primary Care Trusts and independent providers. GP practices are included under Primary Care Trusts. These are known as “responsible bodies”.
Who can complain?
A person who has used health or social care services has the right to complain about their own experience. They might want to complain, for example, about delays, the quality of service or a refusal to provide a service. Carers or families of people receiving a service from the NHS or the local authority also have the right to complain if they are affected or likely to be affected by what has gone wrong. A complaint can be made by a person on behalf of the service user, who is known as a representative, if the service user:
- has asked the representative to act for them.
- is a child
- is unable to make the complaint themselves because of a physical incapacity or lack of capacity (see Mental Capacity Act 2005 Overview and key provisions).
- Has died.
What is the time limit for complaining?
Normally any complaint needs to be made within 12 months of the matters that are the subject of the complaint. This time limit does not apply if it can be shown that there were good reasons for not making the complaint earlier and it is still possible to investigate the complaint properly.
How does the complaints system work?
In many cases a problem can be dealt with quickly by speaking directly to the person involved in providing the medical treatment or care services, without the need to make a formal complaint. However, if the matter cannot be dealt with in this way then it will need to be investigated as a complaint.
Under the complaints procedure, each responsible body must make arrangements for dealing with complaints to ensure that:
- Complaints are dealt with efficiently
- Complaints are properly investigated
- Complainants are treated with respect and courtesy
- Complainants receive, as far as possible, assistance to help them understand the procedure and advice on where to get such assistance
- Complainants receive a timely and appropriate response
- Complainants are told the outcome of the investigation of their complaint and
- Action is taken if necessary.
Each responsible body must have a person who is responsible for ensuring the complaints procedure is followed. For a Local Authority or NHS body this will be the Chief Executive. The responsible body must also have a complaints manager who is responsible for managing the complaints procedure.
The Equality Act 2010 applies to the way complaints procedures are organised. If somebody has a disability which makes it very difficult for that person to use the complaints procedure, then the responsible body has a duty to make reasonable adjustments to the procedures to assist that person access the complaints service. A reasonable adjustment might be providing complaints information in larger font or identifying an advocate to support a complainant who has a mental health condition (See Disability discrimination under the Equality Act 2010).
If a complaint relates to services provided by more than one responsible body, the different organisations must co-operate with each other in handling the complaint to make sure that the complainant receives a co-ordinated response. Each body must provide the other with relevant information and attend at any meetings which are reasonably required.
How do you make a complaint?
A complaint can be made verbally, in writing or electronically. Where the complaint is made verbally, the responsible body must make a written record of the complaint and provide a copy to the complainant.
What happens after the complaint is received?
A complaint has to be acknowledged within 3 working days of receipt. The responsible body must offer to discuss with the complainant how the complaint is to be handled, and how long it will take to complete an investigation and provide a response. If the complainant does not wish to discuss this, the responsible body still has an obligation to reach a decision.
The responsible body must investigate the complaint as quickly and efficiently as possible and keep the complainant informed of progress. As soon as reasonably practicable after the end of the investigation, the responsible body must send the complainant a written response. This must include an explanation of how the complaint has been considered and the conclusions reached. The responsible body must also confirm that it is satisfied that action needed has been taken or will be taken. It must tell the complainant of their right to take the complaint to the Health Service Ombudsman and/or the Local Government Ombudsman if they are not satisfied with the outcome.
If the responsible body fails to send the complainant the response within 6 months of the date the complaint was made, it must explain why and send a response as soon as reasonably practicable thereafter.
The Parliamentary and Health Service Ombudsman in England
In England, if the complaints procedure does not resolve a complaint about health care, a complainant may ask the Health Service Ombudsman to investigate. If the complaint is also about social care then the Local Government Ombudsman will jointly review the case (see below). The Ombudsman is entirely independent of the NHS and of the Government. The Ombudsman is not obliged to investigate every complaint referred to him or her and will not generally take on a case until it has already been through the complaints procedure.
He or she will not investigate a complaint if it is subject to legal proceedings, and strict time limits apply. A complaint must be made within 12 months of the date of the relevant events unless there are special reasons for the delay.
The Ombudsman can investigate complaints about NHS organisations in England when they have not acted properly or fairly, or have provided a poor service.
If the Ombudsman does find a fault has occurred with a case then they can get the organisation to:
- Provide an explanation and acknowledgement of what went wrong, and
- Take action to put the matter right, including giving an apology.
Where the Ombudsman finds serious faults with the organisation they can also recommend that:
- Changes are made in the way the organisation works so that similar things don't happen again.
- Lessons are learnt from things that have gone wrong, and
- Compensation should be made for a financial loss or for the inconvenience or worry caused.
It is important to understand that the Ombudsman does not have any formal power to enforce their recommendations but they are almost always followed. The contact details for the Health Service Ombudsman are:
0345 015 4033
The Local Government Ombudsman
If the complaints procedure does not resolve a complaint about social care services, a complainant may ask the relevant Local Government Ombudsman to investigate. If the complaint also concerns health care then the Health Service Ombudsman will jointly review the case (see above).
There are two Local Government Ombudsmen for different regions in England and one for Wales. The Ombudsmen are entirely independent of the Local Authority and of the Government.
The Ombudsman is not obliged to investigate every complaint referred to him or her and will not generally take on cases unless they have been through the Local Authority complaints procedure. He or she will not investigate a complaint which is the subject of legal proceedings. Strict time limits apply. In particular, a complaint must be made within 12 months of the date of the relevant events unless there are special reasons for the delay.
The Ombudsman can investigate complaints that a council has not provided a service which it has a duty to provide, that there has been a failure in providing a service or that there has been maladministration connected with action taken by or on its behalf.
If the Ombudsman does find that something has gone wrong with a case then they can request that the council:
- Take action to put the matter right, including giving an apology
- Make a decision that should have been made before
- Improve its procedures so that similar problems do not happen again and
- Make payment for financial loss or for the inconvenience or worry caused.
Although the Ombudsman does not have any formal power to enforce recommendations they are almost always followed.
Contact details for the Local Government Ombudsman advice line are set out below. The advice line can provide a copy of the complaints procedure used by the LGO.
The Local Government Ombudsman
PO Box 4771
0300 061 0614 Advice Line / 0845 602 1983
Complains procedure in Wales
Social care complaints: Wales
In Wales the social care complaints process follows a three stage process.
- Stage 1: local resolution where the complainant raises concerns with the social services department which has ten days to try to resolve it.
- Stage 2: formal consideration where the complainant has the right to ask the social services to investigate usually using someone not involved with the service who provides a report.
- Stage 3: independent panel. If the complaint is not resolved the complainant has the right to go to a hearing by an independent panel.
NHS complaints: Wales
Under the NHS complaints procedure in Wales complaints are called concerns. A concern can be raised about any primary care provider that is providing services under arrangements with a Welsh NHS or with the local health board, or any matter relating to the way a Welsh NHS body exercises its functions. It also applies to independent providers of health services if the services are provided under arrangements with a Welsh NHS body.
The time limit for making a concern is 12 months from the date when the subject matter of the concern occurred. Investigations have to be completed within 30 working days and a detailed written report prepared.
Ombudsman for Wales
In Wales, if the complaints procedure fails to resolve the problem a complainant may ask the Public Service Ombudsman for Wales to investigate.
Public Services Ombudsman for Wales
1 Ffordd yr Hen Gae
01656 642150 / 0845 601 0987
Advocacy and regulation
Independent and private sector providers
All health and social care providers in England have to be registered with the Care Quality Commission (CQC) to meet essential quality standards. Anyone whose health or social care is arranged or funded by the NHS or the local authority can use the health and social care complaints procedure to complain, as well as using the internal complaints procedure provided by their particular care provider.
People who have arranged and funded their own social care are entitled to take their complaint to the local government ombudsman if they are not able to resolve the complaint directly with the care provider.
Advocacy for NHS complaints
Having an advocate can empower and inform a complainant. There are advocacy services to help with NHS complaints.
In England, Patient Advice and Liaison Services (PALS) is available in every Hospital Trust and Primary Care Trust. PALS provide information and on the spot options on how complaints can be resolved to patients, their friends, families and carers. PALS can take up complaints and help resolve them. If complaints require more detailed investigation, PALS can provide advice on access to other advocacy and advice services. PALS website at www.pals.nhs.uk provides information on local PALS services.
In England, there is also an Independent Complaints Advocacy Service (ICAS) to help patients take up formal complaints. Contact numbers for local ICAS offices are:
- North London: 0845 120 3784
- South London: 0845 337 3061
- South East: 0845 600 8616
- Bedfordshire and Hertfordshire: 0300 456 2370
- Cambridgeshire, Norfolk and Suffolk: 0300 456 2370
- Essex: 0300 456 2370
- South West: 0845 120 3782
- West Midlands: 0300 456 2370
- East Midlands: 0300 456 2370
- North East: 0300 456 8348
- North West: 0300 456 8350
- Yorkshire and Humberside: 0300 456 8349
In Wales, Community Health Councils provide support and advocacy for NHS complaints and there is one for each local health board.
Care Quality Commission (CQC)
As the independent regulator of health and adult social care in England, the Care Quality Commission (CQC) registers, monitors and routinely inspects all hospitals, care homes and home care agencies to ensure that they meet national standards of quality and safety.
All providers of health and social care have to be registered with the CQC. It publishes its inspection reports on the CQC website, so you can see whether a particular health or social care provider has met the required national standards.
The CQC does not investigate or resolve individual complaints, but you can contact them if you feel that you, or someone you know, have received poor care. Any information you provide is used to help the CQC decide when and where to inspect services.
If you would like to report poor care to the CQC, you can do so in the following ways:
- Via an online form – visit www.cqc.org.uk and click on ‘Your experience’
- By telephone – contact the National Customer Service Centre on 03000 616161 (Monday to Friday 8.30am to 5:30pm)
Regulators of health and social care professionals
Health and social care professionals who work in the UK must be registered with a regulator. All health and social care professionals must meet the standards given in the code of conduct or code of practice for their profession. They must have the right skills or care and act professionally and with integrity. A person may be mainly concerned that a health or social care professional providing them with a service acted in a way that was not in accordance with their professional standards of service, conduct or ethics of their profession.
If there are serious allegations of professional misconduct – this means if the concerns raised about the ability or behaviour of a health or social care professional are so serious that it puts in question that professional’s ability to provide safe treatment or care, then a complaint can be made to the relevant regulator responsible for that professional.
For doctors, the responsible body is the General Medical Council. The GMC has to ensure that its members, the doctors and consultants, comply with its rules and codes of conduct. It can discipline members if necessary; it does not award damages.
350 Euston Road London
0161 923 6602 (Mon- Fri 8am to 6pm & Sat 9am to 5pm)
Other professions have their own governing bodies, for example the Nursing and Midwifery Council for the nursing profession.
Nursing and Midwifery Council
23 Portland Place
020 7333 9333 / 020 7637 7181
They also regulate their professions and ensure that members keep to their codes of conduct. So their powers are essentially disciplinary.
The Health and Care Professions Council regulates a range of health and care professions including clinical psychologists and speech therapists. The contact details of some regulators are listed below.
Health and Care Professions Council
184 Kennington Park Road
020 7840 9814; Freephone (in the UK): 0800 328 4218 email@example.com
- By letter – write to CQC National Customer Service Centre, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA
Mental Health Act complaints
Mental Health Act Complaints
In England, the CQC has to keep the use of the Mental Health Act 1983 under review and check that it is used correctly. It employs Mental Health Act Commissioners to visit places where patients are detained under the Mental Health Act 1983 and meet with them in private. On request arrangements can be made to meet patients in the community who are subject to community treatment orders. The CQC appoints doctors to provide to provide second opinions (known as SOADs) in relation to compulsory treatment of patients detained in hospital and provides guidance for professionals working with the Mental Health Act. The CQC publishes an annual report about the use of the Mental Health Act in England.
It has a duty to investigate complaints made about the use of the Mental Health Act (MHA) by patients who are liable to be detained in hospital under the MHA or are living in the community but are subject to Community Treatment Orders. Complaints about the use of the MHA are made to the CQC Mental Health Act, Citygate, Gallowgate, Newcastle upon Tyne NE1 4PA. Tel 03000 616161 or email firstname.lastname@example.org.
For Wales responsibility for monitoring the use of the Mental Health Act is by Health Inspectorate Wales which also has a responsibility to investigate complaints by detained patients about the use of the Mental Health Act.
Caerphilly Business Park
Tel : 029 2092 8850
This legal briefing relates only to the law and procedure of England and Wales in force at the time of writing. It is a brief outline of the law and is not a substitute for detailed advice.
For further information about the work of Mind's Legal Unit, please see the Legal Unit page.
For more detailed advice on any of the issues discussed in this briefing you should take advice from a solicitor specialising in health and social care law - a community care lawyer. Details of where to seek specialist advice can be obtained from the Find a solicitor search on on the Law Society website, telephone 0870 606 2555; or Community Legal Advice, Legal Advice telephone service 0845 345 4345; Minicom: 0845 609 6677, Monday to Friday 9am to 8pm, Saturday 9am to 12.30pm. Alternatively, you could contact your local Law Centre or Citizens Advice Bureau, who may be able to help.
Mind Legal Unit, Granta House, 15-19, Broadway, Stratford, London, E15 4BQ.
Updated October 2012