01Principles and purposeThe professional or clinical skill and the decisions it supports.
A skilled response begins before a formal letter. Give the person time to describe what happened, reflect the main concern, ask what would help and acknowledge distress. Some want an explanation or apology; others seek correction, practical care, assurance of learning or redress. Do not promise the requested outcome, but make the process and decision criteria transparent. Separate the clinical question—what care is needed today—from the governance question—how the prior care will be examined.
A fair response is evidence-based and proportionate. Secure the unaltered clinical record, identify relevant staff and policies, and reconcile discrepancies without coaching accounts. Address each issue, state findings in plain language, apologise where appropriate and explain learning or why an action is not accepted. Confidentiality still applies: a relative cannot automatically receive the patient’s information, and a complainant about another person’s care may need consent or other authority. Patients should not have to use technical labels; a concern may simultaneously trigger candour, safeguarding, patient-safety review or professional investigation, each with its own purpose and safeguards.
Jurisdiction must be explicit. In England, organisations should apply the NHS Complaint Standards and signpost the Parliamentary and Health Service Ombudsman after local resolution. Scotland has a two-stage NHS complaints procedure and Scottish Public Services Ombudsman route. Wales’s Listening to People process applies to concerns raised on or after 1 April 2026, integrating complaints, incidents and redress; older concerns can fall under transitional arrangements. Northern Ireland’s HSC Model Complaints Handling Procedure went live in January 2026, with NIPSO as the final stage. Local procedures supply current time limits and named contacts; do not memorise and export one nation’s deadlines as UK law.
Key points
- Listen without defensiveness, acknowledge the person’s experience and clarify the outcome sought. A complaint is information about care, not evidence that the therapeutic relationship has failed.
- Identify urgent clinical harm or ongoing risk immediately. Complaint timescales must not delay treatment, safeguarding, candour or incident action.
- Explain how the concern will be handled, who owns it, expected timescale and escalation route. Offer accessible communication, advocacy and a reasonable adjustment.
- Investigate proportionately: preserve records, obtain relevant accounts, distinguish fact from opinion, address every material point and give reasons supported by evidence.
- Do not retaliate, remove care or discriminate because someone complained. If boundaries or safety require a change of clinician, make it objectively and preserve continuity.
- Routes differ: England uses the NHS Complaint Standards and ombudsman pathway; Wales replaced Putting Things Right with Listening to People for concerns raised from 1 April 2026; Scotland and Northern Ireland have their own current procedures.
02Situations and prioritiesThe context, relevant information and actions that matter most.
A message about “not being listened to” may disclose deterioration, a missed result or unsafe medicine use. Triage clinical content immediately and arrange care independently of the complaint investigation.
If the concern reveals that care caused or might have caused harm, begin professional and organisational candour. Do not wait for the complaint response to provide an apology or needed explanation.
Alleged abuse, coercion, harassment or discriminatory denial of care needs protective and equality action alongside complaint handling. Do not reframe a safety concern as mere communication difficulty.
Persistence, distress, disability or repeated contact does not itself make behaviour unreasonable. Use proportionate communication boundaries only for objectively problematic conduct and keep a route for new clinical information.
Clarify the patient’s wishes, capacity and the representative’s authority. You can listen to information from anyone, but what you disclose remains governed by confidentiality and the patient’s interests.
03Assessment and interpretationHow to gather information, assess the situation and recognise uncertainty.
Consider the information, its meaning and its limitations before deciding what follows.
- 01
Immediate clinical and safety triage - Why
- Separate time-critical care from administrative response.
- Interpretation and limitations
- Arrange urgent assessment, safeguarding or incident action now; tell the complaint handler what has been done without making access to care dependent on withdrawal of the complaint.
- 02
Desired-outcome and communication check - Why
- Understand the concern and make participation accessible.
- Interpretation and limitations
- Confirm scope in the person’s words, preferred contact, interpreter or advocate and desired resolution. Avoid narrowing the complaint so that material issues disappear.
- 03
Contemporaneous evidence review - Why
- Establish a fair chronology and explain differences.
- Interpretation and limitations
- Preserve records and audit trails, examine relevant results, policies and accounts, and distinguish contemporaneous evidence from later recollection. Never retrospectively improve the original note.
- 04
Procedure and jurisdiction check - Why
- Apply the correct current stages, timeframes and escalation route.
- Interpretation and limitations
- Use the nation and organisation’s policy, including Wales and Northern Ireland changes in 2026. Explain any delay and agree an updated response date.
- 05
Learning and remedy assessment - Why
- Match action to findings and reduce recurrence.
- Interpretation and limitations
- Possible remedies include explanation, apology, corrected information, restored access, staff support or system redesign. Identify an owner and measurement rather than promising vague learning.
04Worked approachesCases with ordered reasoning, an action and a check of the outcome.
01Worked caseComplaint reveals an unreviewed resultA patient complains that repeated messages about worsening symptoms were ignored. During triage, the clinician finds an abnormal result with no documented action.+
- 1Contact the patient promptly, assess current symptoms and arrange clinically appropriate review. Preserve the record and alert a senior; the urgent care response does not wait for formal complaint allocation.
- 2Acknowledge the complaint and clarify the patient’s concerns and desired outcome with communication support. Explain that a clinical issue has been identified and activate candour and incident processes without prejudging causation.
- 3Use the correct national complaint procedure to appoint an owner, define scope, secure evidence and provide a realistic response date. Keep confidentiality and staff fairness while addressing every material issue.
- 4Final action: provide a reasoned response with apology where appropriate, explanation, current care plan, findings, remedy and independent escalation route. Do not condition treatment on acceptance of the response.
- 5Verification: confirm the patient received and understood the response, ensure clinical follow-up occurred, and audit whether the specific system action prevents another unreviewed result.
02Practical approachRelative complains without clear authorityAn adult patient’s sibling demands the full record and an explanation, while the patient has capacity and has not consented.+
- 1Listen and record any information the sibling offers; receiving a concern does not breach confidentiality.
- 2Contact the patient privately where safe, clarify wishes and seek authority for what may be shared.
- 3Explain the process and give general information without confirming confidential facts beyond authority.
- 4Investigate any safety issue regardless of disclosure limits and provide a response consistent with the patient’s consent and law.
03Escalation approachRepeated hostile contactA complainant uses abusive language but also sends new information suggesting ongoing clinical risk.+
- 1Triage the new clinical information and act on risk.
- 2Use a senior-approved proportionate contact plan addressing specific behaviour, not the fact of complaining.
- 3Offer an accessible single point of contact and preserve emergency and new-evidence routes.
- 4Document review, communicate the restriction and appeal route, and avoid punitive removal from necessary care.
05Feedback, follow-up and evidenceReview outcomes, seek feedback and identify what to improve.
- Track acknowledgement, agreed response date, extensions, ownership and escalation information; proactively explain delays rather than allowing silence.
- Confirm urgent clinical actions, candour conversations and safeguarding referrals independently of administrative closure.
- Check whether the response addresses every agreed issue, uses accessible language and distinguishes findings from unresolved uncertainty.
- Assign learning actions to named owners with completion evidence and outcome or balancing measures; “staff reminded” is rarely sufficient alone.
- For WPBA, reflect on listening, confidentiality, defensiveness and system learning, anonymising the case and not using the patient’s complaint as evidence of difficult character.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
A complaint can be diagnostically useful
The patient often sees handoffs and communication failures invisible to one clinician. Treat the narrative as safety intelligence while still testing facts fairly.
Apology and finding are not identical
You can apologise for distress, delay or poor communication while an investigation remains open. Later findings should specify what is and is not substantiated.
Receiving differs from disclosing
Anyone can provide information about risk. Confidentiality limits what you tell them back; it does not require you to ignore a credible concern.
Parallel routes need coordination
Complaint, incident, candour, safeguarding and employment processes answer different questions. Coordinate evidence and communication without allowing one to suspend necessary action in another.
Jurisdiction changed in 2026
For current practice, Wales uses Listening to People for new concerns from 1 April and Northern Ireland uses its HSC model procedure from January. Historic teaching labels can now misdirect escalation.
07Common pitfallsFrequent interpretation and management errors.
- 01
Treating the complaint as administrative correspondence while an urgent clinical problem remains unassessed.
- 02
Being defensive, blaming the patient or making continued care conditional on withdrawing the concern.
- 03
Disclosing confidential information to a relative merely because that person submitted the complaint.
- 04
Altering the original record, coordinating retrospective accounts or presenting disputed interpretation as fact.
- 05
Using obsolete or wrong-nation procedures, especially Putting Things Right for a new Welsh concern after 31 March 2026.