Patient Advice & Liaison Service Toolkit (PALS)

Legislative Requirements

Care Act 2014

PALS, as an NHS service, offers advice, information, and liaison for patients and families. It can guide individuals about accessing services, including how to navigate care and support systems. Section 3 of the Act lays a duty on local authorities to promote integration of care and support with health services, enabling better coordination across sectors like local government and the NHS. Local authorities are mandated under Section 4 of the Care Act to “provide people with the information and advice they need to make decisions about care and support." The toolkit supports accessible, respectful reporting of concerns and enables informal resolution and appropriate escalation.

Mental Capacity Act (2005)

Supports individuals to express views and access advocacy. It ensures actions reflect MCA principles and are properly documented.

Regulatory Guidance

CQC

Based on five key questions (KLOEs): safe, effective, caring, responsive, well-led. PALS events contribute to inspection evidence and governance.

Care Inspectorate (Scotland)

Based on Health and Social Care Standards: dignity, compassion, inclusion, wellbeing. PALS events show how services act on concerns and improve care.

Care Inspectorate (Wales)

Guided by National Minimum Standards and Regulation and Inspection Act. PALS events document rights-based concerns.

CQC Key Questions

Responsive and Well-led. This includes R3, which mandates that concerns and complaints are listened to and used to improve quality, and W3/W5, which focus on transparency and effective complaint management. PALS must demonstrate timely, respectful handling of concerns, clear documentation, and evidence of learning and service improvement.

CI Health and Social Care Standards

Dignity, compassion, inclusion, and responsiveness. Services must have a clear, accessible complaints procedure and show how feedback is used to improve care. PALS should ensure that individuals are supported to raise concerns safely and that complaints are handled fairly and promptly, with outcomes used to reduce variation and enhance person-centred care.

CIW National Minimum Standards

Regulation 34, which requires providers to have robust complaints procedures. These must be accessible in multiple formats, overseen by a designated person, and used to inform service development. PALS must ensure complaints are acknowledged and investigated within policy timelines, with documented learning outcomes and evidence of continuous improvement.

Statutory Guidance

• Duty of Candour – Encourage a culture of openness and continuous improvement.
• Safeguarding - Staff should be trained to recognise and escalate concerns appropriately.
• Listening, responding, and learning from feedback - Emphasise the importance of these actions.

HealthCare Guidance

Department Health Social Care

The DHSC supports a system where PALS (within NHS trusts) manages patient concerns at the local level. For direct feedback or complaints, patients are advised to approach PALS in their NHS trust. The toolkit aligns with DHSC guidance on transparency and responsiveness and supports multi-stage complaints.

Scottish Government Health & Social Care Directorate

Upholds Health and Social Care Standards: dignity, inclusion, responsive care.

H&S Service Group (Wales)

Meets Duty of Quality and People’s Experience Framework expectations. Enables experience sharing.

NICE England/Wales

Key Principles encouraged by NICE:

• Knowing the patient as an individual: Understand how their condition and circumstances affect care.
• Tailoring services: Personalised care plans, shared decision-making, and access to relevant services.
• Continuity and relationships: Support consistent care and communication.
• Participation: Enable patients to actively engage in their care and complaints processes.

Scottish Intercollegiate Guidelines

Promote evidence-based, person-centred care. PALS events should assess whether concerns align with SIGN principles and prompt a review of clinical practice or service delivery.

Joint NICE–SIGN Collaboration

This collaboration ensures UK-wide consistency in guideline development. For PALS:

• Use joint guidelines to benchmark care quality across regions.
• Reference shared standards in clinical audits, training, and complaint investigations.
• Ensure concerns are addressed using nationally agreed evidence-based practices.

Evidence-Based Practice

• Recognises when concerns relate to clinical standards or safety standards.
• Uses NICE and SIGN guidance to inform the review and resolution.
• Supports clinical governance, audit, and service improvement.

Clinical Governance and Safety (NHS)

• Recognises and escalates clinical safety concerns.
• Supports identification of high-risk individuals and patterns.
• Aligns with NHS safety frameworks and system-wide risk management.
• PALS data informs safety themes, risk profiles, and targeted interventions.

Patient Safety Incident Response Framework (PSIRF)

• PALS staff recognise when concerns relate to patient safety incidents.
• Supports compassionate engagement and signposting to PSIRF processes.
• Documents concerns that may trigger learning responses or thematic reviews.
• Contributes to system-wide safety learning and improvement.
• Aligns with NHS strategy to move from blame to a learning culture.

Value Proposition Ideas

• Toolkit meets all statutory, regulatory, legislation, and best practices.
• Captures if enquiry is standard or urgent.
• Captures if enquiry has been taken to the next stage as a complaint.
• Captures the likelihood of occurrence to support analysis of enquiries and drive improvements.
• Captures lessons learnt from PALS enquiries.

References

• Care Act 2014
• Mental Capacity Act 2005
• Health and Social Care Act 2012
• Equality Act 2010
• Data Protection Act 2018 & UK GDPR
• Local Authority Social Services and NHS Complaints (England) Regulations 2009
• Social Services Complaints Procedure (Wales) Regulations 2014
• Department of Health and Social Care (England)
• Scottish Government Health and Social Care Directorate
• Welsh Government Health and Social Services Group
• NICE Guidance CG138 – Patient Experience in Adult NHS Services
• SIGN Guidelines – Scottish NHS Model Complaints Handling Procedure
• Joint NICE–SIGN Collaboration Principles
• NHS Patient Safety Incident Response Framework (PSIRF)
• PSIRF Standards – NHS England
• CQC Key Lines of Enquiry (KLOEs)
• Care Inspectorate – Health and Social Care Standards (Scotland)
• Care Inspectorate Wales (CIW) – National Minimum Standards
• NHS England Complaints Handling Toolkit
• Local Government and Social Care Ombudsman – Complaint Handling Code
• Parliamentary and Health Service Ombudsman – Principles of Good Complaint Handling