NHS Complaints & PALS: How Complainants Are Really Treated

Introduction

Many patients who experience poor care or abuse within the NHS believe that making a complaint will bring change. Yet for many, the reality is – a service that is hard to navigate, slow to respond, lacks transparency, and may even produce unintended retaliation.Drawing on the whistle-blowing and institutional-cover-up themes in John England’s NHS Dirty Secrets, this article explores how complainants are treated by the NHS’s PALS system and complaints departments, identifies systemic failings, and offers guidance for survivors of mental-health abuse and negligence.

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1. What is PALS and the NHS Complaints System?

The Patient Advice and Liaison Service (PALS) is intended as a first-point of contact for patients who have concerns or wish to complain about NHS services. Its role includes:

• Giving information and resolving issues informally.

• Advising on formal complaint routes.

• Acting as a bridge between patient and service.

The formal complaints route follows the NHS Complaints Regulations: patients write to the Trust, the case is acknowledged, investigated, and a response issued.In theory, this system is meant to provide responsive, fair redress. In practice many complainants report a very different experience.

2. Insights from NHS Dirty Secrets on Cover-ups and Complaint Culture

John England’s book gives a compelling view of how institutional culture in the NHS can undermine complaints and whistle-blowing. Key findings include:

• A culture of fear and self-protection: staff and institutions prioritise protecting their reputation over addressing patient harm. Patient Safety Learning - the hub+1

• Complainants and whistle-blowers often face detriment or ostracisation from colleagues or services. Patient Safety Learning - the hub

• The systems for investigation can be opaque, with limited external scrutiny and delays in releasing full findings or records. Patient Safety Learning - the hub

These characteristics mean that when a mental health patient or relative uses PALS or the complaints process, they may be entering a system that is structurally biased in favour of the service rather than the complainant.

3. How Complainants Are Often Treated: The Patient Experience

From academic research and patient reports, several recurring patterns emerge:

3.1 Delayed or Non-responsive Acknowledgement

Many patients report long delays before their complaint is acknowledged by the Trust, or they receive only minimal response.

3.2 Defensive Investigations

Investigations often appear to protect the institution rather than ask “what went wrong”. They focus on whether policies were followed rather than whether the outcome was safe.

3.3 Limited Transparency

Complainants are frequently denied full access to investigation reports, internal audit findings or original records.

3.4 Fear of Retaliation or ‘Being a Difficult Patient’

Some avoid complaining because they fear it may negatively affect their on-going treatment or relationship with clinicians. Research found: “20% didn’t believe complaining would be safe for their future care.” Healthwatch+1

3.5 Settlement or Silence Instead of Learning

Even when complaints are upheld, the outcomes may involve – a generic apology, procedural “learning”, but little visible change.

3.6 Poor Follow-up for Mental Health Complainants

Patients in mental-health settings report particular vulnerability: issues with detention, coercion, medication or records may be harder to justify in complaints terms.

4. Where PALS Fits (and Where It Falls Short)

PALS can provide timely informal resolution, but it has major limitations:

• PALS is not empowered to make binding decisions or demand systemic change.

• Many issues raised to PALS are redirected into the formal complaints process anyway, causing confusion and delay.

• PALS staff may lack independent status – operating within the same Trust they are required to challenge.

• For complex mental-health or abuse-related matters (e.g., medication harm, restraint, falsified records) PALS may not have sufficient scope to fully investigate.

In essence, while PALS promises approachable contact, the deeper issues often still require formal complaints, legal advice, or regulator escalation.

5. What Complainants Should Know Before They Raise a Complaint

• Document everything now: dates, names, what happened, copies of records, PALS contacts.

• Request full records (see our guide How to Access Your Full Medical Records in the UK).

• Decide whether to raise via PALS (informal) first or go straight to formal complaint.

• Expect delays and hold the Trust to timelines: an acknowledgment within 3 working days, full response usually within 30–40 days (or longer if investigation complex).

• Keep copies of all correspondence and log every call/meeting.

• Be aware of escalation routes: Parliamentary & Health Service Ombudsman (PHSO), Care Quality Commission (CQC), etc.

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6. Reform Proposals to Make the Complaints System Work

Building upon themes from NHS Dirty Secrets, meaningful reform would include:

• Independent oversight of complaints investigations, ensuring Trusts cannot self-investigate without accountability.

• Mandatory publishing of complaint outcomes and institutional learning.

• Stronger protection for complainants and whistle-blowers in mental health settings.

• Fast-track routes for mental-health abuse complaints, recognising the unique vulnerabilities involved.

• Transparent data on how many complaints relate to restraint, medication, record-falsification in psychiatric units.

Only by shifting from a culture of protection to one of learning can the system begin to trust patient feedback.

Conclusion

Making a complaint within the NHS — especially in mental-health or abuse-related contexts — can feel like climbing a wall of bureaucracy, defensive culture, and institutional inertia. The themes uncovered in John England’s NHS Dirty Secrets remind us how far the system still has to go.But armed with knowledge, records, perseverance and the right support, patients and families can navigate the PALS and formal complaints process with greater confidence.Visit our Homepage to explore more survivor-resources or learn about our mission on the About Us page.