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NHS complaint-handling policies could do more to support learning from concerns raised

The current design of national policies for complaint handling in NHS hospitals in England means there is too much focus on assessing a complaint’s validity and not enough on learning from the concerns raised, according to a new study published by the Journal of the Royal Society of Medicine.

The researchers say the process for raising formal complaints can be unclear for patients and relatives, with NHS complaints teams forced to focus on decisions over whether to uphold a complaint or not, rather than listening to the concerns and issues that have been raised by the complaint to see how to learn from it, in order to reach targets set within national policy.

Lead researcher Dr Jackie van Dael, of the NIHR Imperial Patient Safety Translational Research Centre at Imperial College London’s Institute of Global Health Innovation, said: “The complex nature of the NHS complaints system is often cited as an obstacle to effective complaint handling. However, a detailed examination of how national rules, regulations and infrastructure influence complaint handling, investigation and monitoring within hospitals has remained relatively unexplored.”

The researchers interviewed staff and analysed complaints documentation at a multi-site acute hospital trust in London. Four areas were identified where the design of national rules and policies were reported to undermine a patient-centric and improvement-focused approach to complaints. These relate to: access to the complaints process, the conduct of investigations, data collection systems and administrative performance targets.

A frequently mentioned issue among staff interviewed was confusion regarding the routes for raising concerns. Central to this was a lack of awareness, among both patients and frontline staff, about the different roles of the formal complaints team and the Patient Advice and Liaison Service (PALS). PALS is a point-of-contact within hospitals created to resolve lower-level concerns and queries directly on the ward. Dr van Dael said: “The visibility of PALS positions the service as a catch-all destination for patient concerns and queries and served to overshadow complaints departments in some cases.”

In addition to clarifying the roles of PALS and formal complaints processes to staff and patients alike, the researchers suggest reviewing national data collection systems, and re-considering the regulatory requirement for hospitals themselves to judge whether complaints are ‘well-founded’.

“All complaints are opportunities towards better understanding patients’ needs and their unique perspective on organisational safety,” commented Dr van Dael. “We recommend involving patients and families in complaints investigations as standard practice and creating opportunity for dialogue between involved staff and affected patients.”

Notes to editors

Do national policies for complaint handling in English hospitals support quality improvement? Lessons from a case study (DOI: 10.1177/01410768221098247) by J van Dael, T W Reader, A T Gillespie, L Freise, A Darzi and E K Mayer will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Wednesday 1 June 2022.

For further information or a copy of the paper please contact:

Rosalind Dewar

Media Office, Royal Society of Medicine

DL: +44 (0) 1580 764713

M: +44 (0) 7785 182732


The Journal of the Royal Society of Medicine (JRSM) is a leading voice in the UK and internationally for medicine and healthcare. Published continuously since 1809, JRSM features scholarly comment and clinical research. JRSM is editorially independent from the Royal Society of Medicine, and its editor is Dr Kamran Abbasi.

JRSM is a journal of the Royal Society of Medicine and it is published by SAGE Publishing.

Sara Miller McCune founded SAGE Publishing in 1965 to support the dissemination of usable knowledge and educate a global community. SAGE is a leading international provider of innovative, high-quality content publishing more than 1000 journals and over 800 new books each year, spanning a wide range of subject areas. A growing selection of library products includes archives, data, case studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company’s continued independence. Principal offices are located in Los Angeles, London, New Delhi, Singapore, Washington DC and Melbourne. 

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