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Feeding back? Learning from complaints handling in health and social care

A report out today by the National Audit Office found that navigating complaints systems is not straightforward, particularly for health service users, and handling some complaints takes too long. There is little sharing of lessons from complaints or evidence that services are improving as a result.

Some 133,600 NHS and 17,100 social care complaints were received in 2006–07. In a representative survey of adults in England, around one in seven people using NHS and social care services in the past three years have in some way been dissatisfied with their experience.  But only five per cent of those who were dissatisfied with the NHS and 32 per cent who were dissatisfied with social care went on to make a formal complaint.

Two thirds of complainants were not offered help navigating the system. A national advocacy service is available to help NHS complainants, but awareness of it is low. For adult social care, complainants do not have an entitlement to advocacy support, and local authorities make their own advocacy arrangements.

There is a lack of systematic learning from complaints to improve services.  Neither the NHS nor social care have any formal means of capturing learning from complaints.  Monitoring and implementation of recommendations arising from complaints need to be improved.

Handling some complaints takes too long. Around 95 per cent of complaints are concluded locally and three quarters of these are concluded within 20-25 working days.  NHS complaints that progress to the second, independent review stage by the Healthcare Commission took an average of 171 working days and social care took an average of 63 working days.

Recognising the failings in the existing complaints systems, in 2006 the Department of Health announced it would introduce a single complaints system across health and social care in England by 2009. Until now, there has, however, been no detailed evaluation of the effectiveness of the existing systems. The NAO report identifies the strengths and weaknesses of the current arrangements and the issues that need to be addressed if the Department’s ambition for a single comprehensive NHS and social care complaints system is to be realized.

“The complaints systems for health and social care are not yet as accessible and responsive as they could be. There is a lack of learning from complaints, and providers are not making clear to users that services are being improved as result. Adequate staff training; proper tackling of complaints; and evidence of improvements in response to complaints are key pointers for the planned introduction of a new comprehensive complaints system across health and social care next year.”

Tim Burr, head of the National Audit Office

Notes for Editors


  1. Today’s report examines the performance, capability and capacity of current systems for complaints handling in health and adult social care, and identifies the issues that need to be addressed in the introduction of the single comprehensive NHS and social care complaints system.
  2. There are currently two separate statutory processes for handling complaints about health and social care.  For both services, there is a first, local resolution stage.  For complaints that progress to a second stage, the Healthcare Commission is responsible for NHS independent review and for social care, local authorities carry out a Stage 2 investigation.  The ultimate reviewers of complaints, for those complainants who continue to be unhappy, are the Health Service Ombudsman and the Local Government Ombudsmen.  The new arrangements to be introduced in April 2009 were described in Making Experiences Count published by the Department in 2007.
  3. Press notices and reports are available from the date of publication on the NAO website, which is at  Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  4. The Comptroller and Auditor General, Tim Burr, is the head of the National Audit Office which employs some 850 staff.  He and the NAO are totally independent of Government.  He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

PN: 40/08