First, the fear to put aside

The biggest reason people swallow a bad experience in A&E is worry: that complaining marks their card, that future care will suffer, or that hard-pressed staff do not need the grief. Let us deal with that directly. The NHS Constitution gives you an explicit right to raise concerns, and an equally explicit guarantee that doing so cannot be held against you or affect your treatment. Complaints are also, bluntly, how the system learns — trusts are required to analyse them, act on them and show regulators what changed. Staying silent protects nobody, including the next patient.

This guide maps every route, from a two-minute conversation to an independent national investigation — and covers saying thank you as well, because that matters too.

While you are still in the department

Problems raised on the spot are the ones most likely to be fixed on the spot.

  • About your own care? Talk to the clinician treating you. You are entitled to an explanation of any decision, to ask for a second opinion, and to decline treatment you do not want — our guide to your rights in A&E sets these out fully.
  • About the department itself? Waits stretching on with no updates, a confused elderly patient left struggling, an unpleasant interaction with a staff member — ask any nurse to point you to the nurse in charge of the shift. This is a normal, everyday request, and the coordinator has real authority to sort operational problems there and then. (Worth knowing: the four-hour standard you may have heard about is measured, published and trackable — see how waits are measured and our statistics pages for context on what departments are actually achieving.)
  • Want someone outside the clinical team? Ask for PALS — the Patient Advice and Liaison Service. Most hospitals have an office on site, typically open weekday office hours, staffed by people whose entire job is untangling patient concerns.

After you are home: the informal route

PALS remains your best first port of call after the event, reachable by phone, email or letter — contact details live on each trust's website, and our hospital directory links to every trust. PALS can pull your notes, speak to the staff involved, get you an explanation or an apology, arrange a sit-down with a senior clinician, and feed problems into the department's improvement work. A large share of concerns end satisfactorily here, usually within days rather than months, and using PALS never stops you escalating later if the answer disappoints.

You will probably also receive a Friends and Family Test text asking about your visit. Answer it honestly — the scores are collated and watched — but understand its limits: it is a thermometer, not a complaints process. Nobody investigates an individual survey response.

Making it formal

When the issue is serious — a missed diagnosis, a safeguarding worry, treatment that felt unsafe, or an informal answer that did not hold water — the formal NHS complaints procedure exists for you.

The ground rules

  • Deadline: complaints should normally be lodged within 12 months of the event or of your realising something was wrong; trusts can and do waive this for good reason, so a late complaint is still worth making
  • Who can complain: you, or someone acting for you with consent — and relatives can complain on behalf of children, people who lack capacity, or someone who has died
  • Free help exists: every area of England has an independent NHS complaints advocacy service that will help you draft, submit and pursue a complaint at no cost — search your council's name plus "NHS complaints advocacy," or ask PALS to point you to it

Writing a complaint that gets results

Address it to the trust's complaints team (every trust website has a complaints page) and build it like this:

  1. Your details, plus the date, rough time and department of the visit
  2. A timeline of what happened — times, names or descriptions of staff, what was said and done, in order. Specifics are what investigators can check against records; "the nurse at about 3 am who refused to reposition my father, despite three requests over two hours" can be investigated, whereas "the staff didn't care" cannot
  3. Facts first, feelings second — say how it affected you, but anchor everything to events
  4. What you want: an apology, an explanation, evidence of changed practice, a corrected record. Naming the outcome makes it far easier to deliver
  5. Keep copies of everything, and consider requesting your medical records too — your rights guide explains how

What the trust must then do

Acknowledge your complaint within three working days; investigate it properly (records review, staff statements); agree a response timescale with you — commonly in the range of 25 to 60 working days for anything complex — and send a written response answering each point, owning any failures, and setting out actions taken. If the deadline slips, they should tell you why and give a new one. Chase silence; do not absorb it.

Not satisfied? Escalate

You can ask the trust for a resolution meeting — sitting down with senior staff often unlocks what letters cannot. If local resolution is exhausted and you remain unhappy, take the complaint to the Parliamentary and Health Service Ombudsman (PHSO), the independent final tier for NHS complaints in England. The Ombudsman is free, does not act for the NHS, and can uphold complaints, order fresh action and require remedies. (Scotland, Wales and Northern Ireland each have their own public services ombudsman playing the same role.)

Two clarifications people often need:

  • Complaints and compensation are separate tracks. The complaints process delivers explanations, apologies and change — not damages. If poor care caused you real harm, a clinical negligence solicitor is the route to compensation, and pursuing one track never blocks the other.
  • Complaints do not discipline individuals. Staff conduct is handled through separate professional and HR processes — though a complaint can be what triggers them, and serious patient-safety incidents spark their own formal investigations with published learning.

When the care was brilliant

The feedback system runs both ways, and positive feedback is scandalously under-supplied. A card naming the nurse who calmed your frightened child, an email to the department manager, a glowing Friends and Family response, a review on the NHS website — these get read out at handovers and pinned to staffroom walls, and in a service under strain they land harder than you would guess. If someone made your worst night easier, tell their department so.

The short version

  • Raise problems in the moment where possible — the nurse in charge and PALS can often fix things same-day
  • PALS handles most concerns informally after the event; it costs nothing to start there
  • Formal complaints: within 12 months, in writing, built on a specific timeline, ending with the outcome you want — acknowledgement due in three working days
  • Free independent advocacy services exist to help you through it
  • Final stop: the Parliamentary and Health Service Ombudsman
  • Complaining is a protected right that cannot affect your care — and compliments deserve sending just as much