Barriers and enablers to making a complaint to a health or social care professional regulator

For both healthcare professionals (HCPs) and service users there can be significant individual and social barriers to making a complaint. These include perceiving a complaints system that is almost ‘hostile’ as well as worrying about potential repercussions of complaining on themselves. 

HCPs in our study consistently reported pronounced social and cultural barriers. Hierarchy and team dynamics make speaking up feel risky; many worry about being labelled a troublemaker, harming relationships or careers, or contributing to a colleague’s loss of livelihood. They often delay external escalation until internal routes have failed, but even then, may be held back by uncertainty about seriousness thresholds, a fragmented regulatory landscape, lack of time, and the practical and emotional load of gathering evidence, sometimes compounded by mental health strain.

For service users, barriers can be more individual and informational. From the study, we found participants frequently lacked awareness of regulators and their independence, were unsure whether their case was “serious enough,” and feared consequences such as being removed from a GP list or not getting appointments. The wider context of an NHS under pressure can make some reluctant to complain if they think problems stem from system strain rather than individual conduct. The process itself can feel overwhelming and retraumatising, particularly for those with limited digital access or without support to navigate forms and evidence requirements.

Based on the findings, the strongest common driver that motivates both service users and professionals to make a complaint is the desire to prevent harm to others and ensure safe, high-quality care. Both groups have expressed wanting to see poor practice addressed and professionals held to account when standards are breached. Participants also tended to be driven by a sense of moral responsibility to act, even when the process seemed complicated or daunting.

HCPs and service users do seem to experience some differences in the complaints process. Health and care professionals typically raise concerns about a known colleague and must often keep working alongside them while matters are considered. That proximity, coupled with team dynamics and professional hierarchies, creates interpersonal and cultural pressure that shapes how and when they speak up. By contrast, service users usually have limited personal ties to the practitioner but are more likely to have experienced direct harm themselves, which frames their expectations of acknowledgement and redress. 

Although both groups are motivated by patient safety and public protection, their secondary drivers differ. HCPs place particular emphasis on upholding professional standards and codes and tend to escalate to a regulator after internal routes have failed. Meanwhile, service users often seek justice, explanation and accountability for what happened, and typically come to a regulator after trying exhausting local routes. In short, regulators are commonly treated as a last resort, but the path to that point and the outcomes sought are not the same.

The barriers that HCPs face are largely social and cultural, including workplace hierarchy and a fear of retaliation. Service users face more individual and informational barriers, including lower awareness of regulators and their independence, uncertainty about whether their concern is “serious enough,” and a risk of re-traumatisation.

Workplace culture can affect the decisions of healthcare professionals and act as a deterrent in numerous ways. Rigid hierarchies and strong seniority norms can make challenging a colleague feel risky, especially when the complainant must continue working alongside the individual concerned. It is also common for HCPs to seek raise issues with trusted senior colleagues, which have sometimes failed to result in action. Many HCPs also reported a fear of retaliation, career repercussions and a negative impact on social cohesion, due to the perceived negative impacts of ‘denouncing a colleague’. This highlights the perceived social cost of reporting, even when patient safety is a primary concern.

HCPs also highlighted low psychological safety during investigations, where they have felt unsettled due to receiving limited updates and unclear timelines. This is particularly difficult to manage as HCPs reported strong ‘blame’ cultures in the workplace.

For both HCPs and service users, the complaints process is unpleasant and often results in a negative experience. For many, their experience confirms the fears or expectations they had before starting the process. Service users find regulators difficult to identify and communicate with which enforces the individual barriers of regulator knowledge and confidence. In addition, they often find the regulators unempathetic and find the process re-traumatising which reinforces the social barriers of low trust in the system and personal belief in the seriousness of their complaint.

Whilst HCPs don’t tend to find the process difficult, they do experience friction, including feelings of uncertainty with the process and outcome as well as guilt and conflicted emotions. Some HCPs also reported a disruption to the workplace and feeling ostracised. Those whose complaints end in a dismissal also often feel conflicted. 

Service users reported finding the level of information required to place a complaint challenging. Uncertainty in the complaints process and slow communication often leaves services users feeling that their experiences are not significant enough. 

The report suggests practical ways regulators could improve their complaints process, including maintaining (or improving) different channels for complaining. It also recommended enhanced support for those who are less digitally confident, or who due to age or neurodiversity may struggle to engage with the complaints process on their own. 

Additionally, the report proposed setting clear expectations on what to expect from the complaints process and when; reducing the evidence burden; maintaining/strengthening anonymous routes for professionals to complain and publishing aggregated learning to show how complaints improve safety. 

An important finding from the report was the lack of awareness that some respondents had of the regulator’s role and function. Running visibility campaigns in healthcare settings (through distributing posters and leaflets) as well as via professional channels (through newsletters) could help mitigate this problem.

Reframing the narrative from ‘blame’ to ‘patient safety’ is crucial because it promotes earlier and more open reporting of risks by both healthcare professionals and service users. Coupling this shift with clear, consistent communication can also strengthen trust in the complaints process and reinforce confidence in regulators’ independence.

For healthcare professionals, this approach can enhance psychological safety, particularly in environments where individuals must continue working alongside colleagues they have reported.

For service users, positioning complaints as a means of learning and prevention helps close the loop on what many seek: acknowledgement, clear explanations, and visible improvements.

A recurring theme throughout the report was the perceived lack of communication from regulators and accredited registers during the complaints process. Several respondents described communication as so limited that they were uncertain whether any action was being taken on their complaint or what the eventual outcome was.

Improved communication and greater transparency would help set clear expectations from the outset, which is particularly important in what can already be a stressful experience. In addition, regulators can support people navigating the complaints process by:
- Proactive and regular updates
- Accessible multi-channel routes
- Trauma informed communication
- Practical help and resources with evidence and navigating the complains process
- Clear signposting that directs people to the correct body
- Clear explanations of decisions and published learning on how complaints have helped improve patient safety 

As the oversight body for health and social care professional regulators and Accredited Registers in the UK, we are committed to ensuring that our work protects patient safety. We want to encourage an environment where people can raise concerns easily, safely, and through the right routes. We commissioned this research to build a clearer, evidence-based picture of what helps and what hinders people when they consider making a complaint to a regulator or Accredited Register. The findings will inform our review of the Standards of Good Regulation and the Standards for Accredited Registers, and support practical improvements that strengthen public protection, accessibility and trust. 

The study brings together the voices of those who have complained and those who have chosen not to, across both the public and health and care professional spheres. By applying a behavioural science lens (the Individual, Social and Material – ISM – framework), it can help to understand the real-world motivations, barriers and enables that shape the decision to speak up. The research was aimed to generate tangible recommendations so that we can strengthen our standards for regulators and Accredited Registers and make sure people with serious concerns can navigate the process with confidence. 

We hope that this research will help inform how regulators improve their complaints processes in the future, including strengthening their communications channels and providing additional resources and support to complainants. Additionally, we hope that regulators will take this opportunity to increase awareness of their existence, role and remit, both to service users and HCPs.