The right response

Dr Ian Reeves and Gráinne Byrne of the Scottish Public Services Ombudsman discuss why patients complain and how an effective response can often prevent complaints from escalating

  • Date: 01 January 2014

“DELAY, deny and defend” is how the NHS approach to complaints handling was described in a recent report. An independent governmentcommissioned inquiry led by Labour MP Ann Clwyd also highlighted “deep dissatisfaction” with a system (in England) in which people often did not bother to complain about poor care because the process was either too confusing or they feared for their future care or that of a loved one.

Complaints are usually reviewed negatively by the recipient, both at an individual and organisational level. Criticism is hard to take and the subsequent response is often ineffective as noted in the Francis report into deaths at Mid Staffs hospital.

The report stated: “A complaints system that does not respond flexibly, promptly and effectively to the justifiable concerns of complainants not only allows unacceptable practice to persist, it aggravates the grievance and suffering of the patient and those associated with the complaint, and undermines the public’s trust in the service.”

Better complaints handling

Given these reports, it seems that complaints handling could and should be high on organisations’ agendas. The Scottish Government’s detailed guidance on the NHS complaints handling procedure is outlined in the document Can I Help You? It emphasises the importance of learning from complaints, which is also a key focus of the work of the Scottish Public Services Ombudsman’s (SPSO) Complaints Standards Authority (CSA), which strives to improve complaints handling across the public sector. The SPSO is the final stage for complaints about public services in Scotland. (Similar organisations exist in England, Wales and NI).

Another crucial focus of the CSA is ensuring that complaints are handled effectively and, if possible, resolved at the first point of contact. The CSA provides advice and guidance for all complaints, not just those that reach the SPSO, including how to make an apology more meaningful and specific.

Apologies offered in response to a complaint need to show that the reason for the complaint has been understood, and that action will be taken to prevent a recurrence. It is also appropriate to acknowledge that the complainant is ‘right’ and their complaint is justified.

The CSA offers training courses on complaint handling which involve analysing the aspects of a complaint, and how to investigate and respond. This is applicable to all those involved in complaint handling, such as practice managers. With NHS Education for Scotland, the CSA has also developed e-learning modules to support frontline staff and complaints handlers.

SPSO investigations

The SPSO will only investigate complaints after the local organisation has concluded their response, and if the complainant remains dissatisfied.

A significant proportion of problems from the complaint process arise from delays in dealing with complaints. Dissatisfaction with the content of the complaint response usually arises where the organisation decides to “defend” the service provided, rather than offer an apology. It is also more likely if the apology is ineffective.

Errors in the complaint response, such as getting names/dates/clinical details wrong undermine the confidence of the recipient in the complaint process, so diligent factchecking and proofreading are essential.

After a dissatisfied complainant refers the complaint to the SPSO it is handled by an SPSO complaints reviewer who requests the relevant notes and, where appropriate, seeks clinical advice from a relevant independent professional. In the case of GP complaints, this is usually a GP working in Scotland who is familiar with current standards of GP care.

The outcome of the SPSO process is communicated to the complainant and the relevant service in the form of a letter to both parties. Some investigations are laid before parliament as an investigation report if there is a specific public interest.

The SPSO may make recommendations to provide redress for the complainant, and to ask the service to make changes to ensure any system errors are corrected. Individuals involved are usually asked to reflect on the complaint and SPSO findings as part of their annual appraisal.


  • Complaints should be valued by organisations and individuals, not feared.
  • The SPSO process is not punitive but provides an independent evaluation of the complaint process.
  • Following CSA guidance and training can help turn complaints into a positive experience.
  • Following complaint handling advice from organisations such as the CSA and SPSO will help ensure complaints are resolved satisfactorily while also improving the quality of the organisation’s services.


Dr Ian Reeves is a professional adviser to the SPSO and Gráinne Byrne is an SPSO communications officer

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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