Recommendation 6a: Communicating complaint escalation
From Report of the Independent Inquiry into the Issues raised by Paterson, published 4 February 2020.
Recommendation
We recommend that information about the means to escalate a complaint to an independent body is communicated more effectively in both the NHS and independent sector.
In brief (written by this site)
The Inquiry recommended more effective communication on escalating healthcare complaints to independent bodies. In commentary of September 2024, published in February 2026, the Department of Health and Social Care and NHS England stated that the Parliamentary and Health Service Ombudsman had rolled out standards requiring complaint escalation routes to be communicated across NHS services, while the Independent Sector Complaints Adjudication Service incorporated these standards for private providers (DHSC and NHS England, Feb 2026). In May 2024, the Thirlwall Inquiry legal team found that the Care Quality Commission had strengthened guidance expecting patients to have access to independent resolution (The Thirlwall Inquiry legal team, May 2024).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 12 Oct 2026. The record below is the sources' own words.
About this summary
This recommendation applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accept
The PHSO is currently piloting the NHS Complaint Standards, which set out in one place the ways in which the NHS should handle complaints, including the need for organisations to ensure people know how to escalate to the Ombudsman. These have been developed with ISCAS, who have included it in their code of practice. We will continue to work closely with key organisations involved to ensure that standards are reinforced.
The government accepts this recommendation in full and agrees the means to escalate a complaint to an independent body should be clearly communicated in both the NHS and the independent sector. We have split out the recommendation into 2 parts in the interests of the coherence of our response.
Delivery
DHSC and NHS England say in progress (27 February 2026)
CQC assesses all registered healthcare providers against the fundamental standard of ‘complaints’ (Regulation 16: receiving and acting on complaints) including ensuring information is available and accessible on how to complain.
For organisations providing NHS-funded care Services (NHS and independent) The NHS Complaint Standards, model complaint handling procedure and good complaint handling guides set out how organisations providing NHS services should approach complaint handling. They apply to all NHS organisations in England and independent healthcare providers who deliver NHS-funded care. This is a contractual requirement via the NHS Standard Contract (Service Condition 16).
In December 2022, the Parliamentary and Health Service Ombudsman (PHSO) issued NHS Complaints Standards which include expectations on how providers and commissioners will handle complaints, together with a model complaint handling procedure and detailed guidance on how the Complaint Standards can be applied in practice. PHSO has been rolling out supporting materials for the NHS Complaints Standards across the NHS from end March 2023. This is to improve how providers meet patient expectations when they make a complaint, including increasing awareness of independent resolution across the NHS.
All providers and commissioners of NHS services are subject to a statutory duty to handle complaints in accordance with the requirements of the 2009 Complaints Regulations. This includes primary care providers and independent sector providers.
Information on how to complain will be available through:
• The NHS website
• The provider and local PALs service
• The Parliamentary and Health Service Ombudsman
Patient advice and liaison
If complainants need assistance in making a complaint, patients and their carers should also have access to a Patient Advice and Liaison Service (PALS) operated within the provider organisation. This is intended to offer confidential advice, support and information on health-related matters and should be available as a point of contact.
Additionally, assistance can also be provided by the Independent NHS Complaints Advocacy Service. This supports people who wish to make a complaint about their NHS care or treatment. If a complainant decides they need some support, it’s never too late to ask for help. People can also contact their local Healthwatch to find out who provides NHS complaints advocacy in their area.
Independent sector only
The Independent Sector Complaints Adjudication Service (ISCAS) is a voluntary subscriber scheme for independent healthcare providers. ISCAS has incorporated the NHS Complaint Standards into its Code of Practice for Complaints Management and engaged independent providers in taking them up. All ISCAS subscribers were reminded of their responsibilities to incorporate the Complaint Standard Framework on renewal of their annual subscription in April 2023.
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 29.2 No. P4 / Action 4.1, PDF page 742-743.
DHSC states no delivery position (15 May 2024)
Action 4.1
This recommendation has been implemented. CQC assesses all registered healthcare providers against the fundamental standard of ‘complaints’ (Regulation 16: receiving and acting on complaints) including ensuring information is available and accessible on how to complain.
PHSO has been rolling out supporting materials for the NHS Complaints Standards across the NHS from end March 2023 - to improve how providers meet patient expectations when they make a complaint, including increasing awareness of independent resolution across the NHS.
The Independent Sector Complaints Adjudication Service (ISCAS) incorporated the Complaint Standards into its Code of Practice for Complaints Management and engaged independent providers in taking them up. All ISCAS subscribers were reminded of their responsibilities to incorporate the Complaint Standard Framework on renewal of their annual subscription in April 2023.
From: The Thirlwall Inquiry: Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024), The Department of Health and Social Care
Site note: DHSC's own comments on progress, supplied to the Thirlwall Inquiry in February 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). They are not a finding of the Inquiry. Table row: section 26.2 No. P4 / Action 4.1, PDF page 739-740.
Department of Health and Social Care says in progress (15 December 2022)
CQC assesses all registered healthcare providers against the fundamental standard of ‘complaints’ (see Regulation 16: receiving and acting on complaints) – including ensuring information is available and accessible on how to complain.
The PHSO has piloted the NHS Complaint Standards to improve how providers meet patient expectations when they make a complaint – including increasing awareness of independent resolution.
ISCAS has incorporated the Complaint Standards into its Code of Practice for Complaints Management and engaged independent providers in taking them up.
The government has appointed the first ever Patient Safety Commissioner for England, who will ensure that patient voices are heard across both NHS and privately delivered healthcare.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
Action 4.1:
Accepted by the government / accepted in principle so far as mandatory independent resolution for private patients.
The Parliamentary and Health Service Ombudsman is piloting NHS Complaint standards, which set out in one place the ways in which the NHS should handle complaints, including the need for organisations to ensure people know how to escalate to the Ombudsman.
The standards are included in the code of practice for independent providers, as developed by the Independent Sector Complaints Adjudication Service.
The government has conducted a review of the data which confirmed that 94% of recorded patient episodes by the Private Health Information Network, were at providers who subscribed to the Independent Sector Complaints Adjudication Service.
The Care Quality Commission has strengthened its guidance on this issue to clarify that there is an expectation that patients should have access to independent resolution, and that providers who do not provide such a mechanism must be able to show that patients are not disadvantaged by this.
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 26.2 No. P4 / Action 4.1, PDF page 739-740.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - DHSC
Delivery statement - Thirlwall Inquiry legal team
Finding