After completing the local Complaints process with the NHS Trust, and if you are still not satisfied that your complaint has been resolved to your satisfaction, the next step in the Parliamentary and Health Service Ombudsman (PHSO). In this section we explore the process and the ins and outs of the PHSO. We look at the current system and powers that it holds, as well as the issues that have been identified through our lived-experiences. We question whether the PHSO really achieves what it supposed to do.



  • The PHSO is the next stage for a patient to refer their complaint, should they not be satisfied with the outcome and response from the NHS Trust to whom they have to complain first.
  • The PHSO also has a time limit of 12 months for you to make a complaint to them. However, as the NHS Trust can take up to 12 months, the patient has to make a strong case as to the actual timeframe, in their initial submission to the Ombudsman if  it's beyond their arbitrary 12-month deadline.
  • One must remember that patients raising complaints may still be suffering or struggling from the ailments that brought them into contact with the NHS in the first place.
  • It takes time to compile and submit the initial complaint to the Trust, which may have to be completed in a short time frame, with their 12-month submission deadline.
  • The Trust are then at liberty to take as long as they wish to respond to the patient. The patient then has to go through the ordeal of reading this response, and find the wherewithal to take the matter further, should they not be satisfied with the response.
  • Only then would they make the steps necessary to submit their complaint to the Ombudsman.
  • The statistics from the PHSO over the cases they handle are of serious concern. Having been through the original process with the NHS Trust, the patient has made a difficult decision to escalate it to the PHSO, yet at Stage 1, the initial cursory review, the PHSO rejects around 75% (estimated) of all complaints submitted to them.
  • The PHSO have stated themselves that they “don’t even possess the authority or powers to elicit an apology, even when they conclude there has been wrong-doing”.
  • Their £44M annual budget, covering parliament and the NHS, amongst others, is clearly insufficient, when so few cases make it to Stage 2, which is no more than a desktop study of easily available information; primarily 2 documents, the original complaint, and the response by the Trust. From our experience, the way the response letters are written, it could almost be said to be aimed at the Ombudsman, knowing their procedures, and that Stage 2, if the complaint makes it that far, undertakes no checks and balances, no investigations, but simply a read through and comparison of the 2 key documents. Whatever is included by the Trust, in investigating itself, and judging itself, is taken at face value, and accepted as fact. This may well be acceptable in theory, but in practice, as noted in previous sections, the reality is the response is heavily diluted and written to persuade the Ombudsman they do not need to look into them any further.
  • We can present many examples of response letters containing intentionally misleading “facts”, that the patient will instantly identify as being false, yet to a third party, these intentionally misleading statements, make the Trust sound diligent and ethical. There is simply no check or corroboration of the facts presented by the Trust in their response letters, during a Stage 2 review. It would appear that the Trusts are fully aware of this and write their response accordingly.
  • How can this third-party, in the PHSO, have any influence or resolve over the actions of the NHS Trusts it is meant to be overseeing, when no actual check or investigations are undertaken until Stage 3 is reached? By Stage 3, there are only a few percent of all cases that make it this, and are actually investigated.
  • Even once a complaint reaches Stage 3 and the PHSO “investigates”, PHSO have stated that they are unlikely, if ever, to attend the NHS Trust in question or re-interview any of the staff mentioned within the Complaint. How they review, investigate and conclude what is appropriate seems to be kept secret.
  • At the conclusion of Stage 3, even if the PHSO does find in favour of the Complainant, and provides recommendations to the Trust, these are just that “recommendations”. The Trust has no legal duty or obligation to act on these recommendations, implement any changes nor follow any guidance. As noted above, the powers held by the PHSO are non-existent, and as they themselves have pointed out, they do not even possess the power to insist on an apology.
  • Is there any wonder that each NHS Trust feels at ease providing intentionally misleading and dismissive responses to complaints, when they know that even in the 1 in 100 chance that a complaint reaches Stage 3 with the ombudsman, they still do not have to act on the recommendations that may be forthcoming?