Recommendation F117: Support for complainants
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
A facility should be available to Independent Complaints Advocacy Services advocates and their clients for access to expert advice in complicated cases.
In brief (written by this site)
In September 2024, the Department of Health and Social Care and NHS England reported that local authorities are legally required to arrange independent advocacy services, adding that the Parliamentary and Health Service Ombudsman signposts complainants to specialist independent advice and support (DHSC and NHS England, Feb 2026). In an implementation review published in February 2026, the Thirlwall Inquiry legal team noted that the government had accepted the recommendation only in part, maintaining that advocacy commissioning was a local authority responsibility and that access to clinical advice should depend on individual circumstances (The Thirlwall Inquiry legal team, Feb 2026).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
Government response
Accepted in part.
We agree that expert advice should be provided in appropriate cases, and in appropriate cases, the providers of NHS complaints advocacy would obtain advice from an independent clinical expert. However complaints advocacy services are no longer commissioned nationally. From April 2013, Local Authorities have been responsible for commissioning NHS complaints advocacy services, and are able to determine the appropriate model of delivery for these services for their local community.
We consider that the need for expert clinical advice ought not to be determined by how complicated a case might be, but whether it is appropriate in the individual case. In those cases, the trust should offer that advice, along with independent investigation.
The Review of the Handling of Complaints in NHS Hospitals recommends:
• When Trusts have a conversation with patients at the start of the complaints process they must ensure the true independence of the clinical and lay advice and advocacy support offered to the complainant.
The Department of Health will work with Healthwatch England and the Local Government Association to develop a set of ‘good practice’ standards for NHS Complaints advocacy services; these standards may be expected to include access to clinical advice in appropriate cases.
How this response relates to the recommendation
Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.
Delivery
DHSC and NHS England say in progress (27 February 2026)
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.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented - Ongoing”. Table row: section 18.2 No. 117, PDF page 480.
Department of Health and Social Care says in progress (11 February 2015)
The Department of Health, with key partners, will consider different aspects of PALS and identify if there are any areas where more substantial work may need to be commissioned to gain a better understanding. Work on this project has started, and it is envisaged the initial review and identification of areas for more detailed consideration, will be complete by Spring 2015.
The Health and Social Care Act 2012 gave responsibility for commissioning NHS complaints advocacy to individual Local Authorities from April 2013. The Clwyd/Hart Review of the handling of NHS complaints recommended that “the independent NHS Complaints Advocacy Service should be re-branded, better resourced and publicised. It should also be developed to embrace greater independence and support to those who complain. Funding should be protected and the service attached to local Healthwatch organisations.” The Government accepted that a review of NHS complaints advocacy services should be conducted to measure the effectiveness of the provision of advocacy services to the public. This review is expected to be complete by Spring 2015.
Healthwatch England have also developed a set of national standards for complaints advocacy services, generated from workshops and interviews with people who use advocacy services.
Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (27 February 2026)
This recommendation was accepted in part by the Government.
In the January 2014 Hard Truths report, As complaints advocacy services had been the responsibility of local authorities since April 2013, the Government considered this was a matter for local authorities. The Government expressed its view that the need for expert clinical advice ought not to be determined by how complicated a case might be, but whether it was appropriate in the individual case.
In the February 2015 Culture Change report, the Government said that the Department of Health would consider different aspects of Patient Advice and Liaison Services and identify any areas where substantial work might be commission ed to gain a better understanding.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 18.2 No. 117, PDF page 480.
Earlier findings (1)
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted in part by the Government.
In the January 2014 Hard Truths report, as complaints advocacy services had been the responsibility of local authorities since April 2013, the Government considered this was a matter for local authorities. The Government expressed its view that the need for expert clinical advice ought not to be determined by how complicated a case might be, but whether it was appropriate in the individual case.
In the February 2015 Culture Change report, the Government said that the Department of Health would consider different aspects of Patient Advice and Liaison Services and identify any areas where substantial work might be commission ed to gain a better understanding.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 117, PDF page 446-447.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding