Healthcare Complaint Management in England & Wales — What's Coming and Why It Matters
A Harbour Governance Sector Insight · July 2026
Category: Regulatory Updates
Complaint management is one of the most under-governed areas in independent healthcare. Most providers have a complaints policy.
Far fewer have a complaints system — one that identifies patterns, drives learning, closes the loop with patients, and gives the board genuine assurance.
That gap matters more now than at any point in the last decade. Because the regulatory and legislative landscape around complaint handling in England and Wales is changing — faster, and more significantly, than most providers realise.
This briefing sets out where things stand, what good looks like right now, and what is coming in the next twelve to eighteen months.
The current landscape — in brief
In England, the legal framework for complaint handling is the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. These establish a two-stage process: local resolution by the provider, followed by referral to the Parliamentary and Health Service Ombudsman (PHSO) for complaints that remain unresolved.
The PHSO has developed NHS Complaint Standards that set out how organisations providing NHS services should approach complaint handling. These place a strong emphasis on early resolution, compassionate engagement and fair, accountable responses.
For independent providers — here is where it gets complicated.
The PHSO has no jurisdiction over privately funded care. If a patient receives privately funded treatment and remains dissatisfied following the provider's local complaints process, their options are limited. ISCAS (the Independent Sector Complaints Adjudication Service) provides independent adjudication — but membership is voluntary. If your organisation is not registered with ISCAS, a dissatisfied private patient currently has no independent route of appeal.
This is a significant governance and reputational gap. And it is one that is increasingly on Parliament's radar.
In Wales, the most significant complaints reform in fifteen years has just come into force. The new Listening to People framework replaced Putting Things Right on 1 April 2026, introducing a two-stage process — Early Resolution and Formal Investigation — with financial redress of up to £50,000 in eligible cases. For independent providers regulated by Healthcare Inspectorate Wales, the expectation that complaint governance aligns with these four core principles is increasingly being applied in HIW inspections.
What good complaint management looks like in 2026
Drawing from PHSO standards and CQC's Well-Led expectations, there are eight defining characteristics of good complaint management right now. The four that independent providers most consistently get wrong are:
Agreed — not imposed — timescales The 2009 Regulations do not set a mandatory response deadline. Good practice requires agreeing a timescale with the complainant at the acknowledgement stage. Not telling them when you will respond. Agreeing it. The distinction matters both to patients and to inspectors.
Any open door - The NHS (and therefore the CQC) doesn't have a formal "open door" policy, but it lives by a "no wrong door" principle. That means complaints can be raised anytime, anywhere—by phone, email, or in person—and staff are trained to catch concerns even if you never use the word "complaint." Issues are fixed informally on the spot if possible, and if not, the door simply opens onto the next stage, all the way up to the independent Ombudsman. In short: the system is designed so you never have to fight to be heard—you just have to walk in.
A coordinated response when multiple providers are involved Where a patient's complaint spans more than one provider, those providers are required to give a coordinated response. This is one of the most frequently cited complaint handling failures in CQC inspection reports — particularly in independent providers who share patients with NHS services.
Genuine learning — not just resolution Modern complaint governance is not about closing cases. It is about triangulating complaint themes with incident data, patient feedback and audit findings to identify where systems are failing. PSIRF expects this. CQC's Well-Led framework expects this. The PHSO expects this. Resolving individual complaints without analysing the patterns is compliance theatre.
The horizon — what's coming in the next 12-18 months
The following section provides a summary of the key developments on the horizon. Our full horizon scan — covering all five developments in detail, with governance action points for each — is available to Harbour and Deep Water subscribers.
The 10 Year Health Plan — complaint reform commitment The government has committed to reforming the NHS complaints process through the 10 Year Health Plan — setting clear standards for both timeliness and quality of responses, and introducing a new National Director of Patient Experience. The most significant proposal is the introduction of patient power payments — allowing patients to withhold a portion of payment for their care if dissatisfied. If enacted, this would be the most significant shift in complaint leverage for patients in a generation.
PHSO jurisdiction — the independent sector gap Parliamentary attention on the absence of a mandatory independent complaints route for privately funded patients is growing. The most likely development is a tightening of CQC registration expectations — requiring all independent providers to belong to an approved independent adjudication scheme such as ISCAS. This is not yet confirmed, but providers who are not currently ISCAS members should be reviewing that position now.
Healthwatch England abolished Healthwatch England is being abolished, with patient voice functions moving to the Department of Health and Social Care. For independent providers, this removes one patient advocacy route and may increase the volume of complaints that escalate directly to CQC.
For the full analysis — including the Wales Listening to People framework in detail, the CQC/HSSIB merger implications for complaint governance, and our recommended governance action plan for independent providers — see our full Complaints Horizon Scan, available to Harbour and Deep Water subscribers.
Three questions to ask about your complaints governance today
Before the landscape changes further, here are the three questions every governance lead and board member in independent healthcare should be able to answer:
1. If a private patient exhausts your internal complaints process and remains dissatisfied — where do they go? If the answer is "I'm not sure" or "there isn't anywhere," that is a governance gap and a reputational risk. The answer should be: to ISCAS, or to an equivalent approved adjudication scheme.
2. Can you show your board a complaints themes analysis from the last twelve months — not just a case count? A board that only sees how many complaints were received, and how many were resolved within timescale, is not being given the governance information it needs. Themes, learning, and evidence of service change are the markers of a mature complaints system.
3. Does your complaints process meet the Accessible Information Standard? If patients cannot access your complaints process in a format that meets their communication needs — large print, BSL interpretation, easy read — your complaint handling is failing before it has started. This is a compliance gap that CQC is increasingly focused on.
How Harbour Governance can help
Our Complaints, Compliments and Feedback policy — included in all subscription tiers — is aligned to current PHSO standards and CQC expectations, and will be updated as the landscape changes.
Our full Complaints Horizon Scan — covering all five horizon developments in detail with governance action points — is available to Harbour and Deep Water subscribers.
If you are a governance lead or board member who wants to understand your complaints position before the landscape shifts further, book a conversation with our founder here — available to Deep Water subscribers.
Harbour Governance publishes regular regulatory analysis and practical governance guidance for independent and private healthcare providers in England and Wales. Subscribe to receive updates directly.
