Responding to Complaints

Authors: Charlotte Davies, Steve Walters, Eimear Jones / Editor: Elizabeth Herrieven / Reviewer: Rebecca Smoker / Codes: / Published: 30/07/2019 / Reviewed: 10/03/2026

Answering complaints is an important role of the Emergency Department (ED) Consultant and its now part of the RCEM management portfolio. Weve made a few suggestions about how to answer complaints but everyone will have their own tips, so feel free to leave a comment or two.

Statutory underpinning

The NHS Constitution sets out rights for patients, public and staff. It outlines NHS commitments to patients and staff, and the responsibilities that the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. This is readily available to the public, and though complaints procedures vary by Trust, there are standard expectations that patients have the right to an open and transparent relationship with the organisation providing their care, and that complaints are responded to in a timely way. The GMC also is very clear that every health and care professional must be open and honest with patients and people in their care when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress which is otherwise called a Duty of Candour.

The process around answering complaints is regulated and governed by:

A complaint should be made within 12 months of the incident that is the subject of the complaint or 12 months from the date the complainant became aware of the matter that is the subject of the complaint. If it would have been unreasonable for the complaint to be made earlier and where it is still possible to investigate the facts of the case effectively, then discretion may be used.

Complaints procedures vary by Trust so read your local policy and speak to the people who answer complaints regularly. Here, however, are a few tips and tricks that weve picked up along the way.

Front Line Response

Remember of course, that the ED is where patients and relatives first come into a hospital. It is often the place where they are most worried, most unsure about what is causing the problem, or concerned that they are being discharged to face a later scenario alone which they wont have the skills for. There may be a context to why they are animated, short tempered, or unable to take in what is being said. They have also likely waited a long time to see you, and are tired, hungry and missing the comforts of home. This is not their normal environment, even if it is yours.
Most complaints are not about care, but the communication of it. Good communication is something which can be lost when there is an increased pressure to see patients. Think first, have I explained this properly, why are they anxious/unhappy? Often complaints can be headed off on the shop floor just by listening, understanding the concerns, adjusting a plan or trying to offer a different solution. Listen to what the complainant is actually saying not what you think they are saying! Stay calm and give them chance to express their concerns. If you cant solve the problem maybe someone else can often the senior nurse will be most adept at de-escalating complaints. Have a re-read of our communication blog.

If a patient or relative is angry, particularly If something has gone wrong, it can quickly be dispelled by offering an apology. Even if you dont think their complaint is justified, their experience has been negative. Never say that something is nothing to do with you or not your department. Say that you will try to help and put the patient in contact with the appropriate person.

If the details of PALS or the complaints department are requested, then give them. It is important to be transparent. However, do your best to do everything possible to resolve the concern and then that complaint, in the light of day, may not be written.

PALS

All Trusts must have a Patient Advice and Liaison Service. Not every Trust will have a face-to-face service, or full-time hours, so familiarise yourself with how your Trust operates. The details will be available on the website, and your department should have a leaflet available. The PALS team must acknowledge the concern within 3 working days. The PALS team will triage the patients concern and, depending on the nature of the concern and wishes of the patient, may attempt to agree an informal resolution. By triaging the complaint, PALS are able to identify the key issues and the preferred action of the patient if all the patient wants is another appointment its easier for everyone if they can make that happen rather than going through a full investigation and a formal written response. You may be asked to respond to query or call the patient/relative. Remember, 3 days is a long day to wait for a response if you are worried, so dont delay here and make contact as soon as possible.

If a PALS concern is not a simple single quick fix, and is judged to require a formal considered response. PALS can register the issue as a formal complaint (going formal) which is usually by passing the case to a separate Complaints Department, who can also be contacted directly rather than via PALS.

Trusts vary in how they process complaints. Usually, the content of the complaint will be first reviewed by the complaints team. The complaint is logged and a formal tracking process commences. It is assessed who needs to respond, and whether the correct consents are present. If the person writing the complaint is not the person affected (e.g. daughter of a mother with dementia who was the patient), the Complaints or PALS department will make sure appropriate consent from the patient has been sought. If the patient is deceased and the complainant has sufficient interest the complaint will proceed. It may be necessary to seek permissions from the listed Next of Kin. This can be complicated and take time to work through, particularly in cases of family disputes. A complaint may be made by a representative acting on behalf of a child, but consent will be requested for any child over the age of 13 with Gillick competency, and children over 16 should normally be consented unless directed otherwise by a clinician. Children can complain, although they are encouraged to involve an adult in their complaint.

Complaints should be accepted in any language and the Trust should facilitate a translator. Sometimes MPs complain on the behalf of their constituents it is assumed by most Trusts that the MP has gained consent to do so and there will be an email trail/letter to support this. The complaints team may still need to formally request consent.

Once the complaints team are assured they have the right permissions to proceed, the complaint is distributed to the various teams who need to respond your input may be part of a larger complaint across multiple teams. They will help form an agreement with the local complaints officers/governance leads as to who should lead the response and will likely be the final review of an outgoing response letter to check the language is appropriate. They may also help co-ordinate local resolutions meetings. The regulations require that an appropriate timescale to receive a written response is agreed with the patient and the patient should be kept informed of any delays. It varies within Trusts who keeps the complainant informed, but it is not expected that it is you.

There are usually three options for a response: a verbal resolution, a written response, or a local resolution meeting (face to face, or virtual e.g. MS Teams). Or a combination of these.

PALS are also able to see if the complainant has raised similar concerns before and offer advice on how to proceed. Patients who persistently complain may need a specific code of conduct plan your Trust will have advice on who needs this, and how to create it. Patients who frequently complain often have a single point of contact. A high frequency of complaints should not be assumed to be vexatious many patients have complex needs and repeated complaints reflect the incapacity of EDs to cater for these, or that a team has not fully learned and made the relevant changes/reasonable adjustments.

If a complaint reveals that there has been a patient safety incident, this needs to be escalated via your local governance leads, and a separate clinical incident (Datix/Ulysses etc) should be logged. The incident should then be managed according to the local Patient Safety Incident Response Framework (PSIRF) plan, and it may be that the proportionate response is just to continue the complaint investigation and response.

Ongoing Care

Making a complaint should not alter the quality of care the patient receives. It is recognised that making a complaint sometimes causes the relationship between the doctor and patient to break down and continuing treatment would not be in either party’s best interest. If possible, the patient’s care should be transferred to another clinician, including in another NHS trust if appropriate. Because care should not alter, details of complaints should not be documented in the patient’s file.

Concluding Complaints

Once a response has been sent, if the patient is still not satisfied they can approach the Trust for further resolution. If the patient is still not satisfied or if the Trust is not able to offer any further resolution the complainant has the right to approach the Parliamentary and Health Service Ombudsman (PHSO). The PHSO will review a Trusts entire response to a complaint and efforts to resolve the dispute. This may take a year or more to do. They aim to put the complainant back in the position they were in before the issue occurred, so have the power to make Trusts pay financial compensation. They may equally agree that the Trust has answered the complaint and there is no further action.

Answering a Formal Complaint Procedure

When (not if) you receive a complaint, try not to take it personally or think that your colleagues think less of you. They are an opportunity to take stock and reflect openly on your practice. They will highlight your own blindspots and stimulate you to improve.

It is important to remember that a complaint response should be taken as a formal statement, and treated as such. They may be requested as part of a claim, inquest or investigation. The overall complaint is released as a document which can be shared within the public sphere. Dont rattle off an angry email, take time to think, sit with it and then respond. If complaint is complicated, consider legal / MPS / MDU review of your response.

As mentioned, it is not usually that your practice is at fault, but the communication of it, which itself should be reflected on. Where there has been a mistake made, it is important to recognise that and learn from it.

The email from your complaints lead should contain the information you need to review and respond to the complaint. Consent should have already been gained. Complaints received from other channels should be sent first to the complaints team before responding, unless it is a direct GP/colleague query. Take advice from your governance team here.

Answering a Complaint Structure

You will be given the complaint in the original form, which will give you a sense of where the weight of the issue is for the complainant. One way is to treat it like a comprehension print out the complaint and highlight the questions and concerns you need to respond to. You can extract and use these as headings. For example:

  • My mother did not receive any pain killers for 6 hours. Respond to lack of analgesia
  • We didnt know what the hell was happening, Respond to lack of communication. Assure with what was actually happening in this time.

The general rules for writing a response are not surprising: be professional, measured, sensitive, and avoid jargon and medical abbreviations. Explain practices which may be unfamiliar and provide context which might help the complainant understand why you did what you did. (If that was the wrong thing to do in hindsight, then be humble and say so.) You can also try and mirror the language used in the complaint, though a poorly written letter does not imply a low level of intelligence.

Each Trust will be different, but you are likely to be writing your response letter to the Complaints Coordinator. The response should be typed on headed paper, with the date written, and the complaint number documented. Write in the first person if you were involved.

If the complaint relates to a deceased person, give condolences at the outset: I was so sorry to hear of the death of your..please accept my deepest condolences at this time. A useful phrase then to start is Thank you for asking me to respond to the concerns raised by and I would like to respond to the points raised below. Get your apologies in early. You could say In response to the concerns raised by firstly, on behalf of the department, I would like to apologise, and hope that this report will answer some of the questions and concerns raised. Apologies are not the same as admitting liability/negligence.

Do not assume the person reading your response has any background knowledge of the case, so your first paragraph should start with a factual account of what happened. This should be objective but contain relevant information to the complaint e.g. There had been 12 emergency calls, instead of our expected 5 rather than we had too many blue calls, and we couldnt cope. In ED, it is often useful to highlight the timeline e.g. you were booked in at 1959, triaged at 2010, and seen by a doctor at 2059 an hour after arrival. However, this timeline should be a skeleton to hang the issues on and should not just read like a list of activities, as the complainant may feel like their issues are being swamped or obfuscated.

Incorporate the issues which you have already highlighted and worked through into the timeline. As you go, specify what your account is based on is it memory, contemporaneous notes, statements or usual working practice. (You may also like to say at the outset that I have made this report based on the contemporaneous notes made at the time, and statements made by the doctors who looked after). As required, apologise and reflect on any change to practice or learning undertaken. Comment only on the performance of your own department though, and let other departments respond regarding their own issues.

Some people find it easier to structure an apology using The 3Rs:

Regret acknowledge that something has gone wrong, even if you are not at fault.
Reason provide a reason for the mistake, if there is one.
Remedy ask the complainant what they would like to happen, or highlight the steps you have already taken.

Fig. 1 – RCEMLearning image generated with Google Gemini

You should never, however, apologise that a patient felt the need to complain or that they felt you were rude. This is seen as a non-apology as it is not apologising for the specific event, just for bad feeling. Avoid also saying you understand their situation; no one shares the same lived experience, and this can come across as silencing rather than listening. Rather apologise if the experience caused any frustration, or distress etc. You are reaching out with some empathy, but you are not assuming the narrative. You can of course say you are sorry to hear about your poor experience or that you are sorry for the sad outcome without saying the complaint was justified.

Finish off with a repeated apology and a summary of the bottom line, together with suggested learning outcomes.

The Complaints Coordinator, or equivalent will generally then pull all responses together into a formal response to the patient from the Chief Executive. This may be then put into the 3rd person. If there is anything in the response which is not clear or left unanswered then the complaints coordinator will come back to you for clarity. If you have identified a clinical risk or incident, this should be raised within the department and logged. Breaches of confidentiality should be raised as IG incidents according to your Trust protocol. If at any point you think that you cannot proceed with the complaint as it has identified a significant incident that needs to be immediately escalated, halt the complaint and discuss with your governance lead.

A note on AI

AI is an amazing bit of kit that we are all rapidly gaining access to. Its ability and our use of it is accelerating at apparent breakneck speed. It would be wrong not to expect you to wonder how you can use this in completing a complaint response!

Your own Trust should by now have or be drafting its own AI policy, and first of all you should follow that. However, if used, please consider the below:

  • AI has its uses in picking out concerns in a complaint that you should respond to, but be mindful of doing that, as you lose a direct connection with the complainant and lose a feel for where they want you to spend your efforts and what they most want you to understand. You also need to walk through with the AI software, it doesnt always get the right end of the stick as it has never been to an ED.
  • At the end, it can be effective at putting the pieces together and it can be useful for looking for a kinder way of saying something, or helping you with the wording of an apology. However, the language is no longer yours, and the public may spot that. A suspected fake complaint response will land like a bag of wet sick.
  • What should definitely be discouraged is plugging the complaint in and letting it write your response. There is no place for this in reflective practice, and does both you and the complainant a huge disservice.
  • It is extremely useful by helping you reflect on a certain scenario. It can tease out why you followed a course of actions cheaper than any therapist can. This can be effective for real learning and improvement without judgement.

We hope this has provided you with some useful tips for answering complaints. We’d love to hear your suggestions and if you have any “stock” phrases or complaint templates. Managing a complaint is a mandatory component of the RCEM management portfolio so is something you, or your supervisees, will have to do.

For further reviewing, this is a great review of the Complaints System – Putting Patients Back in the Picture.

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START Complaining about Complaints SBA

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