Last reviewed March 2026 — LetterSure editorial team
The NHS has not resolved your complaint to your satisfaction. The Parliamentary and Health Service Ombudsman is your next step — here is exactly how to escalate and what to expect.
You can escalate to the Parliamentary and Health Service Ombudsman when the NHS organisation has completed its complaints process and you are unhappy with the outcome, or when they have not responded within the expected timeframe. You must normally have exhausted the NHS organisation's own complaints process first.
You must escalate within 12 months of receiving the NHS organisation's final response. The service is free and you do not need a solicitor. The Ombudsman covers NHS services in England — separate bodies cover Scotland, Wales, and Northern Ireland.
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Generate my NHS complaint letter — £6.99Investigate your complaint independently
The Ombudsman is completely independent of the NHS and will review your case impartially.
Recommend an apology
The Ombudsman can recommend that the NHS organisation issues a formal apology.
Recommend service improvements
The Ombudsman can recommend changes to NHS procedures to prevent the same thing happening to others.
Recommend financial compensation
In cases where you have suffered financial loss or significant distress the Ombudsman can recommend compensation.
Require explanations
The Ombudsman can require the NHS to provide a full explanation of what happened and why.
Your original complaint letter
A copy of what you sent to the NHS organisation.
The NHS organisation's response
The final response letter you received from the NHS.
Why you are unhappy with the response
Explain clearly and specifically what is missing or incorrect in the NHS response.
Relevant medical records
Any records that support your complaint — ask your GP or hospital for these if needed.
A clear account of what happened
Set out the timeline of events in plain English.
What outcome you are seeking
An apology, an explanation, compensation, or a change in procedure.
You can submit your complaint to the Parliamentary and Health Service Ombudsman online, by phone, or by post. The Ombudsman will first assess whether your complaint is eligible for investigation. Not all complaints are investigated — the Ombudsman prioritises cases where there is evidence of significant injustice or hardship.
If the Ombudsman decides to investigate, they will contact the NHS organisation for their side of the story and review all the evidence before reaching a conclusion. The process can take several months to over a year for complex cases. Keep copies of everything you send.
Step 1 — NHS complaint
Submit a formal complaint to the NHS organisation. They must respond within 25 working days.
Step 2 — Internal review
If unhappy with the response, request an internal review from the NHS organisation.
Step 3 — Ombudsman referral
If still unhappy, escalate to the Parliamentary and Health Service Ombudsman within 12 months of the final response.
Step 4 — Investigation
The Ombudsman assesses and if appropriate investigates your complaint, reviewing evidence from both sides.
Step 5 — Outcome
The Ombudsman issues their findings and any recommendations for the NHS organisation.
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When can I escalate to the Ombudsman?
When the NHS organisation has completed its complaints process and you are unhappy with the outcome, or when they have not responded within the expected timeframe. You must escalate within 12 months of the final response.
What does the Ombudsman do?
Independently investigates unresolved NHS complaints in England. Can recommend apologies, service improvements, and financial compensation. The service is free and you do not need a solicitor.
How long does the process take?
Several months to over a year depending on complexity. The Ombudsman first assesses eligibility, then investigates if appropriate, gathering evidence from both sides before reaching a conclusion.
Is it free to complain to the Ombudsman?
Yes. The Parliamentary and Health Service Ombudsman is completely free. You do not need a solicitor.
What evidence do I need?
Your original complaint letter, the NHS response, relevant medical records, a clear explanation of why you are unhappy, and what outcome you are seeking.
This guide is for general information only. LetterSure letters are personal correspondence drafts and do not constitute legal advice. For legal matters consult a qualified solicitor at solicitors.lawsociety.org.uk.