Support for complainants
A facility should be available to Independent Complaints Advocacy Services advocates and their clients for access to expert advice in complicated cases.
- The Parliamentary and Health Service Ombudsman (PHSO) published a guide for the public on accessing independent support and specialist advice services for making complaints (DHSC and NHS England implementation update provided to the Thirlwall Inquiry, April 2025).
- The PHSO introduced the NHS Complaint Standards framework in 2022 to provide a consistent approach to complaint handling across all NHS organisations (NHS Complaint Standards, PHSO, April 2022).
- Research published in 2023 found that while structural changes such as the statutory duty of candour and the Freedom to Speak Up infrastructure were delivered, cultural change regarding the fear of speaking up remained inconsistent (Ten Years After Francis, Academic Review, February 2023).
How was this evidence gathered?
Response
Accepted in Part
Response
Accepted in PartThe 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. Under section 223A of the Local Government and Public Involvement in Health Act 2007, local authorities must make arrangements it considers appropriate for the provision of independent advocacy services in its area which are intended to provide assistance to persons making or proposing to make complaints under the complaint procedures operated by health service providers. The Parliamentary and Health Service Ombudsman also provides signposting to how these services can be accessed and has published a guide about the independent support and advice services available to people making a complaint, including specialist independent advice and support services.
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.