Please note that this guidance applies to England. There are some differences in the way the NHS complaints procedure operates elsewhere in the UK.
If someone isn't satisfied with the response to their complaint after the first stage of the NHS complaints procedure, they can refer their complaint to the Parliamentary and Health Service Ombudsman (PHSO) for investigation. This is stage two of the procedure.
- The ombudsman can also consider grievances about the administration of the complaints procedure itself.
- Complaints should normally be referred to the ombudsman within 12 months of when the complainant first knew about the issue. The ombudsman can decide whether to investigate complaints outside this time frame.
NB: For complaints relating to incidents from 1 April 2019 onwards, NHS Resolution asks that practices report any PHSO correspondence to them (and their medical defence organisation) within one week of receipt.
Screening process
- The ombudsman considers each case on its merits, and can decide whether or not to investigate a complaint.
- The ombudsman won't consider a referred complaint just because the complainant isn't satisfied with the initial response; there has to be an indication that there was a service failure.
- The ombudsman is required to consider complaints only when injustice or hardship arises from failure in a service, failure to provide a service, or maladministration.
If it decides not to investigate a complaint, the ombudsman's office will write to the complainant to explain why.
You can find more about the ombudsman's standards for complaint handling on the ombudsman's website.
Investigation
In the process of investigating a complaint, the ombudsman has access to all the paperwork from the local investigation, and can order the disclosure of documents and may interview witnesses.
It may also get independent professional advice, and is helped by specialist assessors for anything involving clinical judgement.
The ombudsman will share a confidential report containing provisional views with the complainant and doctor. It is seeking comments on:
- if we have explained our provisional views of the case clearly or if something needs more detail
- if we have got any of the facts wrong or have missed something
- if it has any new information that might make a difference to our investigation.
We encourage members to contact us for advice at any time they are contacted by the ombudsman.
You can't challenge the conclusions the ombudsman draws from the agreed facts of the case, but comments or objections can sometimes be made about the conclusions and recommendations.
The final report
The ombudsman's final report on the case is sent to the complainant, the organisation and any person complained about.
A case summary is sometimes published in an anonymised form on the ombudsman's website.
Recommendations
If individuals or organisations are found to be at fault, the ombudsman might recommend changes to working practices so that lessons can be learned. The ombudsman can recommend other actions, such as the offer of an apology or financial redress where appropriate.
Compliance with recommendations can't be enforced, but in practice doctors usually adopt recommendations that have been made.
This page was correct at publication on 03/02/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.