Let’s talk about handling complaints in health and social care – a Q&A

Q. Why did the Professional Standards Authority commission this research?

A. 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. 

Q. What are the most common barriers to making a complaint to a professional regulator for Healthcare professionals?

A. Healthcare professionals 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.

Q. And what about the barriers for service-users and/or patients?

A. 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.

Also for both these groups – the complaints process can seem “hostile” and means that they will be put off complaining because they worry about the potential repercussions of complaining and how it will affect them.

Q. What motivates both service users and professionals to make a complaint?

A. 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.

Q. What role does workplace culture play in discouraging complaints among professionals?

A. Workplace culture can affect the decisions of healthcare professionals and poor cultures 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 healthcare professionals to seek to raise issues with trusted senior colleagues, which have sometimes failed to result in action. Many healthcare professionals 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.

Healthcare professionals 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 some healthcare professionals reported strong ‘blame’ cultures in the workplace.

Q. How do people feel after they’ve made a complaint – what are the typical outcomes and experiences?

A. For both healthcare professionals and service users, the complaints process can be 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. They often find the regulators unempathetic and find the process re-traumatising which reinforces the social barriers of low trust in the system and uncertainty about the seriousness of their complaint.

Whilst healthcare professionals 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 healthcare professionals also reported a disruption to the workplace and feeling ostracised. Those whose complaints end in the dismissal of a colleague 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 service users feeling that their experiences are not significant enough. 

Q. What practical changes could regulators and Accredited Registers make to improve the complaints process?

A. The report suggests practical ways regulators and Accredited Registers 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 and 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.

Q. What kinds of support do people need to navigate the complaints process more easily?

A. 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 with evidence collection and navigating the complaints 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.

Q.How might this research influence future policy or standards for regulators?

A. 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 healthcare professionals.

Q. How will you use the findings?

A. We have already used the findings to inform the development of our new Standards for Regulators and Accredited Registers. The new Standards, which come into effect on 1 July 2026, include strengthened requirements for regulators and Accredited Registers around the support they provide to complainants, witnesses and registrants. Under the new Standards, regulators and ARs will need to ensure that all those involved in a complaint receive the support they need throughout the case and are kept informed about case progression in a sensitive and timely way. The Standards also say that complainants, witnesses and registrants should be treated with dignity, respect and sensitivity and that the process should seek to minimise further harm to their health and wellbeing. Our revised single set of Standards for Regulators and Accredited Registers  support practical improvements that strengthen public protection, accessibility and trust.