Barriers to complaints: what are they and how can we break them down?
06 Feb 2025
Why do complaints matter?
Health and social care services are the backbone of civil society, supporting our physical, mental and social wellbeing. The professionals working in those services, from physiotherapists to dentists, doctors to social workers, help us to manage our health and put our lives back on track when things go awry.
The people working in these professions are respected and often (rightly) celebrated. The vast majority are highly competent, compassionate, and hard working. They demonstrate their skills, values and integrity daily.
So why would anyone want to complain about a health or care service, or the professionals working within it? And why do those complaints matter?
Put simply, people complain when they have a concern about the care or service they’ve received. For the majority, the motivation for complaining is altruistic – they want to see the service improve for others in the future.
Complaints are (or should be) an important source of learning and improvement for health and care services, highlighting where things are going wrong and change may be needed. In the most serious cases, where there are concerns about the competence or conduct of a health or care professional, complaints are a vital part of the system that protects patients and service users. However, research shows that most people who have a concern about their care do not make a complaint.
If people feel unwilling or unable to complain, regulators may never know things are going wrong and won’t be able to take action to address concerns. This presents a clear risk to public protection - the overarching mission of all health and care regulators.
A year ago, our two organisations – the Professional Standards Authority for Health and Social Care (PSA) and the Parliamentary & Health Service Ombudsman (PHSO) hosted a joint seminar on tackling barriers to complaints in the health and care sector.
This blog sets out some of the learning from that event and tells you about the work we have done since, and plan to do, to improve the complaints landscape.
What do we mean by ‘barriers’ to complaints?
A barrier to making a complaint is anything that prevents or impedes someone who has a concern from taking the next step of making a complaint.
Barriers might be easy to identify and solve (for example, not being able to find information about how to complain) or more fundamental (such as the fear that making a complaint might impact on future care).
The aim of our joint seminar was not only to explore what barriers exist, but also to come together to find solutions. Both organisations have a strong focus on fixing issues and making things better for patients and the wider general public.
What are the main barriers to complaining about a health or care service or professional?
We were privileged to have a number of experts in the field present at the seminar, including from National Voices and Healthwatch England.
Speakers drew on existing evidence and reports (such as PHSO’s complaints research) to identify a wide variety of barriers to making a complaint, which we’ve grouped into several themes. There were too many barriers identified to include here, but some of the key categories identified during the seminar were:
Barriers to the process for making a complaint
- Lack of awareness of rights – people do not understand their rights in relation to complaints within health and care services
- Not knowing how or where to complain – people are often unclear where to direct complaints or don’t understand how the process works
- Length of process – people worry that making a complaint will be a protracted and time-consuming process
- Complexity of the process – some complainants find the process (e.g. the forms they are required to complete) too long and complicated.
Psychological/emotional barriers to making a complaint
- Fear of repercussions and guilt – fear of negative consequences or guilt for complaining about a hard-pressed public service or the individuals within it
- Information overload – overwhelming amount of information about the process, which may be especially challenging for those with communication needs or experiencing trauma
- Emotional impact of the process – the complaints process is often a psychological and emotional strain
- Perception that nothing will change – the belief that the complaint won’t make a difference or result in any meaningful action.
Language and physical barriers to making a complaint
- Language barriers – for example not enough support for those who do not speak English or the use of complex/legalistic terminology
- Physical barriers – for example problems accessing online platforms for web-based complaints or inaccessible buildings where complaints are received
- Format restrictions – for example requiring complaints to be submitted in a specific format.
The way forward: how can the barriers be overcome?
Identifying the barriers to making a complaint is just the first step on the journey to tackling them. What really matters is finding ways to overcome or break down those barriers, and taking decisive action to drive improvements in the system.
Our solutions-focused seminar sought to start that process, by identifying a wide range of potential actions and solutions. These included:
- Making complaints information more visible
- Harmonising complaints processes across different organisations where possible
- Making information clear and accessible, and using plain English
- Ensuring complaints processes are empathetic and that support is available
- Seeking feedback from people who have raised concerns
- Collecting data about individuals who raise concerns and using this to drive service improvements
- Sharing data between organisations
- Ensuring that people only need to tell their story once
- Establishing a central complaints hub.
Next steps for the PHSO and PSA
So now we know many of the barriers and potential solutions, what’s next for the PSA and PHSO?
The PHSO’s NHS Complaint Standards (launched in 2021) were designed to help the NHS develop an organisation-wide culture that openly welcomes complaints and is accountable when mistakes happen. PHSO have now published revised ‘Good complaint handling guides’ for senior leaders in the NHS that will help them reflect on their organisational culture around dealing with complaints. This will help them identify the barriers and challenges when it comes to delivering a good complaints service and identify goals and actions for the development of their complaint service, reporting and learning.
Over the 12 months since the joint seminar, PHSO has delivered training on the NHS Complaint Standards to over 700 front-line NHS complaint handling colleagues, and have also developed a workshop for senior leaders emphasising the value of complaints and developing a learning culture in their organisations.
At the PSA we’re very pleased to announce that we’ve commissioned research to explore in more detail the barriers and enablers to making a complaint that are specific to health and care professional regulators and accredited registers. This research will build on our 2022 report Safer care for all in which we noted that there are gaps in the evidence base in terms of understanding complaints to regulators.
We will use the findings of this research to support the regulators and registers we oversee to make tangible improvements to their complaints processes. We will do this by embedding the learning from the research into our Standards of Good Regulation and Standards for Accredited Registers both of which are currently under review. We will publish our updated standards later this year for implementation from 2026. And in September this year, we will attend the Council on Licensure, Enforcement and Regulation’s annual conference to share the findings of our research and our emerging thinking in this area.
Many of the solutions identified are beyond the control of either the PHSO or PSA. We hope that by highlighting them and continuing to work with partners across the health and care sector, we can encourage and support others to improve the culture around complaints and break down the barriers people face when making one. Complaints matter and it is incumbent on all of us to ensure that they are heard. Where possible, they should be resolved and lessons learned. Getting this right is crucial to making care better and safer and to protecting the public.