A quarter of people in England experienced poor NHS care over the last year but fewer than one in 10 of them complained about it, a report by the patient watchdog has revealed.
When people did complain, more than half were not satisfied with either the process involved or the outcome, Healthwatch England said. Complaints take many months to resolve.
It found a widespread lack of public confidence in the health service’s handling of complaints, and “little evidence” that it was discharging its duty to use complaints to improve care.
Louise Ansari, the watchdog’s chief executive, accused the NHS of doing too little to take complaints more seriously and urged it to adopt “a culture of listening and learning” from them so that patients’ concerns would start to carry more weight.
The NHS has not responded properly to repeated concerns about the way it deals with complaints raised by official bodies and inquiries, and appears to be stuck in “a cycle of repeating the same mistakes”, the report said.
Ansari said: “We flagged failings with the NHS over a decade ago, following the patient safety scandal at Mid Staffordshire hospital. Ten years on, our research shows that the public still lack confidence in the NHS complaints system.”
The health service has not heeded its call for an overhaul and demonstrates persistent “serious failings in how NHS organisations listen and respond to patient feedback”, the watchdog said.
In October, YouGov surveyed for Healthwatch a representative sample of 2,042 adults in England about their experiences of NHS care, and a second group, of 2,650 adults, who had had a bad experience of NHS care in the preceding 12 months. They found that:
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24% of patients had received poor care in that time – the equivalent of 10.7 million people in England.
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56% took no action – and only 9% made a complaint.
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20% were scared that complaining would affect their treatment.
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34% did not trust the NHS to use a complaint they made to improve services.
The NHS constitution for England makes clear that patients have a right to complain and obliges the service to learn from them.
Complaints against the NHS rose to an all-time high of 241,922 in 2023-24 – up 5.4% from the 229,458 in the year before and up 38% compared with the 174,872 received in 2013-14.
The report, titled A Pain to Complain, said: “What we found should concern NHS leaders, government and regulators. Low public confidence is preventing people from taking any action after experiencing poor care, meaning that current complaints numbers could be just the tip of the iceberg.
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“There is little evidence complaints are being systematically used to improve care. The NHS does not consistently welcome, handle, respond or learn from complaints in a patient-centred manner.”
While the rise could suggest that patients are increasingly confident about speaking up, it “may also have been driven by poorer quality of care caused by pressures on the NHS, especially since the pandemic”.
NHS integrated care boards (ICBs) take between 18 and 114 working days – and an average of 54 working days – to respond to complaints. The Department of Health and Social Care should end that variation by setting mandatory response times, Healthwatch said, adding that ICBs should also measure how satisfied patients are with the complaints process and the outcomes it yields.
NHS England said staff were working tirelessly to respond to the growing demand for care. Primary care services, such as GP surgeries, and hospitals treated record numbers of patients in 2024.
A spokesperson said: “The NHS takes patient experience very seriously and we are committed to listening to patients and rolling out initiatives like Martha’s rule, which is already having a transformative effect in some cases.”
The findings come amid the lowest ever public satisfaction with the NHS in the 40 years since records began. Just 24% of people in Great Britain are satisfied with how it works.
