Complaint Toolkit (NHS)

Legislative Requirements

Care Act 2014

Care providers must have an effective and accessible system for receiving, handling, and responding to complaints from residents and their representatives or other stakeholders. All complaints must be thoroughly investigated, and proportionate action taken to address them. If a complaint is not resolved satisfactorily, there must be an opportunity for further escalation. Complaints involving safeguarding or abuse must be reported to local authority safeguarding teams. Providers must maintain records of all complaints and responses and be able to provide complaint summaries to CQC within 28 days of request.

Mental Capacity Act 2005

Individuals have the right to complain about their care or the care of a loved one. They are encouraged to raise these concerns directly with the care provider.

Regulatory Guidance

CQC

Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ensures that people receiving care have the right to complain and that providers must respond appropriately. Providers must have a clear, effective, and accessible system for identifying, receiving, recording, handling, and responding to complaints. All complaints must be investigated, and actions taken to address them. Requests to see complaint summaries by CQC must be sent within 28 days.

Care Inspectorate (Scotland)

Registered adult social care services in Scotland must follow a complaints framework based on principles of accessibility, fairness, and responsiveness. Complaints procedures should be easy to understand and accessible to all service users. Complaints must be handled promptly, respectfully, and thoroughly. Services are expected to learn from complaints and use them to improve care quality.

Care Inspectorate (Wales)

Complaints procedures must be easy to understand and available in multiple formats. Providers must acknowledge complaints promptly and explain the investigation process. A designated person, such as a Registered Manager, should oversee complaint handling and be accountable. Complaints should be used to identify areas for service improvement through learning and development.

CQC Key Questions

Responsive: Concerns and complaints are listened to and acted upon. There is a clear, accessible complaints process, and complaints are used to improve care. People are supported to make complaints without fear of reprisal. This ensures that care providers have a transparent and effective complaints procedure that investigates complaints thoroughly and fairly, and learns from complaints to improve service delivery.

CI Health and Social Care Standards

Providers must have a clear complaints process. The CI scrutinizes how feedback and complaints are used to improve services. Following the Scottish Public Services Ombudsman’s guidance, it emphasizes accessibility, support, and fairness.

CIW National Minimum Standards

Standard 34: Complaints require providers to have robust complaints procedures and demonstrate how they use feedback to improve care.

Statutory Guidance

• Duty of Candour: Encourage a culture of openness and continuous improvement.
• Safeguarding: Staff should be trained to recognize and escalate concerns appropriately.
• Emphasize the importance of listening, responding, and learning from feedback.

HealthCare Guidance

Department Health Social Care

Individuals are advised to complain directly to the care provider and follow the care provider's complaints policy. If unresolved, escalate the complaint to the Local Government and Social Care Ombudsman. Poor care can also be reported to CQC.

Scottish Government Health & Social Care Directorate

Individuals have a clear right to raise complaints with the care provider, ensuring concerns are addressed fairly and promptly. If unresolved, complaints can be taken to the Scottish Public Services Ombudsman (SPSO) or Care Inspectorate (CI).

H&S Service Group (Wales)

Care providers in Wales are legally required to have a clear complaints procedure. Concerns should be raised directly with the care provider. If unresolved, complaints can be taken to the Local Government and Social Care Ombudsman. Poor care can also be reported to CIW.

NICE England/Wales

Key principles encouraged by NICE include:

• Transparency: Patients should be informed about their rights to make a complaint.
• Empowerment: Patients should be supported to raise concerns and complaints when care falls short.
• Improvement: Complaints should be used to identify barriers and improve service delivery.

Scottish Intercollegiate Guidelines

The guidelines refer to the Scottish NHS Model Complaints Handling Procedure, designed to be person-centered, streamlined, and focused on learning and improvement. Key principles include:

• Accessibility: Complaints can be made in person, by phone, email, or writing.
• Transparency: Clear communication and updates throughout the process.
• Learning: Complaints are used to identify areas for improvement.
• Accountability: Senior management is actively involved in oversight.

Evidence-Based Practice

The Local Government and Social Care Ombudsman (LGSCO) Good Practice Guide emphasizes accessible, proportionate, and timely complaint resolution. It encourages councils to:

• Promote early resolution and avoid unnecessary escalation.
• Ensure clear communication and transparency.
• Use complaints to drive service improvement.

The importance of protecting human rights and dignity in care settings is also highlighted. Under the Local Authority Social Services and NHS Complaints (England) Regulations 2009, complaints must:

• Acknowledge complaints promptly—ideally within 3 working days.
• Provide a full response within a reasonable timeframe, often within 20 working days for straightforward cases.

For more complex complaints, providers should:

• Inform the complainant of any delays.
• Provide regular updates.
• Aim to resolve the issue within 3 months, unless exceptional circumstances apply.

Best Practice Principles

• Accessibility: Complaints should be easy to make, in multiple formats.
• Transparency: Clear communication about process and outcomes.
• Timeliness: Prompt responses, with realistic timeframes.
• Learning Culture: Complaints should be used to improve care quality and safety.
• Fairness: Impartial investigations and respect for complainants.

Clinical Governance and Safety (NHS)

• Captures the format of the complaint, clear workflow steps with assignees, and timescales all in one place.
• Includes incident escalation processes, investigation workflow, learning capture, and feedback loops that align with PSIRF principles.
• Links related event steps to prompt users to connect events, where a PSIRF learning response may have taken place linked to the complaint.

Toolkit Statistics

Complaints within the NHS have been steadily rising:

• 2023–24: 241,922 complaints (up 5% on the previous year).
• Complaints have grown 37% since 2013–14.

Despite the increase, only 0.4% of NHS patient encounters result in a formal complaint, and just 9% of patients with poor experiences actually submit one. Clinical treatment concerns dominate in primary care. Communication issues remain the most common complaint in secondary care. Other frequent themes include delays in appointments, access to treatment, and administrative problems.

Value Proposition Ideas

• Toolkit meets all statutory, regulatory, legislation, and best practices.
• Improved efficiency for Ko41a reporting, less time spent on manual reporting.
• Includes Ombudsman signposting.
• External forms meet the required accessible information standards – WCAG AA.

References

• Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – CQC
• CQC Key Lines of Enquiry – KLOEs
• CI Health and Social Care Standards
• CIW National Minimum Standards
• Complaint Handling Code by the Local Government and Social Care Ombudsman
• Local Government and Social Care Ombudsman (LGSCO) Good Practice Guide
• Local Authority Model Complaints Handling Procedure (MCHP) by SPSO
• Social Services Complaints Procedure (Wales) Regulations 2014
• Statutory Guidance – Wales (2014)
• Care Act 2014
• Health and Social Care Act 2008
• Mental Capacity Act 2005
• Equality Act 2010
• Data Protection Act 2018 (GDPR)
• Department of Health and Social Care (DHSC)
• Scottish Government Health and Social Care Directorate
• Health and Social Service Group – Wales
• NICE guidelines (England/Wales)
• Scottish Intercollegiate Guidelines Network (SIGN)
• Local Authority Social Services and NHS Complaints (England) Regulations 2009
• Patient Safety Incident Response Framework (PSIRF) 2022
• Patient Safety Incident Response Framework (PSIRF) Standards 2022