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NHS and adult social care services complaints - deciding what outcomes you want to achieve

Before you make a complaint about health or adult social care services, it will be helpful for you to work out what outcomes you want to achieve. This page explains your options.

You want to get the service you need

In some cases, you may have to make a complaint just to get the service that you needed in the first place. For example, you could use the complaints procedure if:

  • you’ve been denied a service that you have a right to, and
  • you’ve already spoken to the person who should provide the service, and
  • you’re not happy with their response.

You want procedures to improve

You may want a commitment that procedures will be improved so that other people don’t have the same experience you had. This could mean, for example, that a healthcare professional or social worker gets more training or that new procedures are brought in. These outcomes can usually be achieved by using the complaints procedure. You could also report the problem to:

  • the Care Quality Commission
  • the clinical commissioning group (if the problem is about a hospital)
  • NHS England (if the problem is about a GP)
  • the local authority (who are responsible for adult social care services and some health services)
  • the NHS Choices website. For example, you can look up the details of hospitals in your area, and use the ‘Comment on a hospital option’ to record your own opinions about the treatment you received in a hospital. This could result in improvements
  • local Healthwatch.

You want an explanation of what went wrong and an apology

If things go wrong, it can be very distressing if you aren't told that a mistake was made and no one says sorry.

It is a NHS pledge under the NHS Constitution that when mistakes happen or if you are harmed when receiving healthcare, you get an appropriate explanation and apology, delivered with sensitivity and recognition of the trauma you've experienced.

Doctors are bound by their professional code of conduct to give you an explanation of what happened during your treatment and, if appropriate, an apology. This code of conduct is called 'regulation 20: duty of candour'. You can read the full regulation and guidance on the Care Quality Commission (CQC) website.

The NHS Litigation Authority clearly states that ‘Saying sorry is not an admission of liability and it is the right thing to do’.

Any apology should be sincere and tactful and the explanation given in a way that you understand.

Using the complaints procedure can result in an apology or explanation. However in some cases, you won’t be given detailed explanation about the actions taken against someone who did something wrong. This is because it could be a breach of staff confidentiality.

You want someone to be disciplined or prosecuted

In some cases, you may want a health or adult social care professional to be disciplined or prosecuted because of what they have or have not done for you. Using the complaints procedure will not necessarily mean that the professional is disciplined. This is because the complaints procedure and disciplinary procedures are quite separate. However, in some cases if your complaint is upheld, disciplinary procedures may follow.

In serious cases of professional misconduct, or if the professional isn’t fit to practise, you could report the problem to their regulatory body who will investigate and take action against the professional.

If you believe that the actions of a health or care professional amount to a criminal offence, for example, assault, you should also contact the police. In an emergency, call 999, or in less urgent situations, call 101.

Compensation

The complaints procedure is not specifically designed to award compensation, but NHS bodies and the local authority do have the discretion to make one-off payments (called ex-gratia payments). There is no harm in asking for this.

Example

If your fertility has been affected by treatment, you could ask the hospital for a guarantee that they will carry out fertility treatment or pay for the treatment to be carried out somewhere else.

However, if you're asking for a large amount of money, it may be more appropriate to take legal action.

If you’re offered an ex-gratia payment, get advice from a solicitor or specialist organisation about whether to accept it. If you accept it, it usually means that you can’t take legal action later on.

If they refuse to pay compensation and your complaint is referred to an Ombudsman, the Ombudsman could order compensation. But this is usually less than the court would award if you took legal action, for example, for clinical negligence or discrimination.

Get help

You might find it helpful to talk through these options with a specialist organisation such as local Healthwatch or an independent complaints and advocacy service before you decide what to do next.

Next steps

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