Lowering barriers
Patient feedback which is not in the form of a complaint but which suggests cause for concern should be the subject of investigation and response of the same quality as a formal complaint, whether or not the informant has indicated a desire to have the matter dealt with as such.
- NHS England stated in April 2025 that clinical concerns raised in complaints are followed up through the Patient Safety Incident Response Framework (PSIRF) and the Learn from Patient Safety Events (LFPSE) service (DHSC/NHS England implementation update to the Thirlwall Inquiry, April 2025).
- NHS England published a report in 2023 following a discovery phase on how patients and families can share concerns about unsafe care (Patient Safety Discovery Report, NHS England, 2023).
- The Learn from Patient Safety Events (LFPSE) service allows patients and families to share concerns about unsafe care via an online form (LFPSE service, NHS England, 2024).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented - Ongoing. The PHSO NHS Complaint Standards provides a wide definition of “complaint” as an expression of dissatisfaction – either spoken or written – that requires a response. NHS England worked together with the PHSO and other stakeholders to create the standards. Clinical concerns included in complaints are followed up and can link with Patient Safety Incident Response Framework (PSIRF) and Learn from Patient Safety Events (LFPSE)NHS England recognises how important it is for patients and families to be able to share their concerns about unsafe care. To support this we undertook a Discovery Phase in Autumn 2023, and published a report with proposed next steps. Patients and families can share concerns about unsafe care using an eForm.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
PHSO developed NHS Complaint Standards framework providing consistent approach to complaint handling across NHS. Piloted 2021-2022, introduced across NHS from 2022. Applies to all NHS organisations and independent healthcare providers delivering NHS-funded care.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.
Ann Clwyd MP and Professor Tricia Hart published review of NHS hospital complaints handling on 28 October 2013. Key recommendations: Chief Executives must sign off complaint responses; Trust Boards must scrutinise complaints; trusts must publish annual complaints reports in plain English.