How to Escalate an NHS Concern: Who to Contact, What to Ask For & What Happens Next

Start here: what do you think has gone wrong?

You do not need to know the correct regulator before you begin.

Start with the problem.

Open the situation that sounds closest to yours.

My NHS care or complaint was handled badly and the organisation has not put it right

Likely routes:

NHS complaints process → final response → Parliamentary and Health Service Ombudsman (PHSO).

If the issue also reveals unsafe care, discrimination, professional misconduct or systemic governance problems, another route may be relevant alongside the complaint.

What you might ask for: investigation of what happened, comparison against what should have happened, findings on failures, acknowledgement of impact, remedy, organisational learning and action to prevent recurrence.

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I think an ICB, NHS Board or senior leadership has failed

Likely routes:

Chair / Board governance structures → NHS England regional oversight → local health scrutiny where the matter concerns commissioning, policy or population impact.

If the concern involves the continuing suitability of an individual Board member, the Fit and Proper Person Test may also be relevant.

What you might ask for: governance review, examination of Board oversight, assessment of organisational controls, consideration under FPPT, clarification of accountability, or regional examination of organisational capability.

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I believe a senior NHS Board member may no longer be fit to hold their position

Likely route: Fit and Proper Person Test governance.

For concerns about a Chief Executive or non-executive director, the Chair is normally central to the FPPT process. Concerns about the Chair involve separate governance arrangements, including the Senior Independent Director or deputy chair. NHS England Regional Directors receive annual FPPT submissions and may also receive relevant information arising outside the annual cycle.

What you might ask: whether the new information has been considered under the FPPT framework, whether an ad-hoc reassessment is appropriate, who is responsible for that assessment, and what governance record exists of the conclusion.

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I think a healthcare service is unsafe or the same risk could affect many patients

Possible routes:

CQC for regulatory concerns about the quality and safety of a regulated provider.

HSSIB where the concern reveals a wider or systemic patient-safety issue that could generate national learning.

NHS England or commissioners may also be relevant where the concern reflects wider organisational or commissioning failure.

Important: HSSIB does not investigate individual complaints or determine personal blame.

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I believe an NHS policy or decision discriminates against a protected group

Possible routes:

NHS complaint → request equality evidence → Equality Advisory and Support Service → Equality and Human Rights Commission where the matter raises wider regulatory concerns → legal advice where an enforceable remedy is required.

Local health scrutiny may also be highly relevant where the discrimination arises from a commissioning policy affecting a local population.

What you might ask for: the Equality Impact Assessment or equivalent evidence, records showing how the Public Sector Equality Duty was discharged, the evidence considered, mitigation identified and decision-making record.

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I believe my consent, bodily autonomy or human rights were ignored

Possible routes:

NHS complaint → PHSO → CQC where regulated-care standards are engaged → equality/human-rights support → specialist legal advice where a legal remedy is needed.

The appropriate route depends heavily on whether the issue is poor administration, clinical consent, systemic policy, discrimination or an alleged legal violation.

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The NHS has ignored, delayed, refused or inadequately answered my Freedom of Information request

Likely route:

Public authority → Internal Review where appropriate → Information Commissioner's Office.

What you might challenge: missed statutory deadlines, exemptions, inadequate searches, claims that information is not held, excessive-cost refusals, inadequate Section 16 advice and assistance, redactions or poor Internal Review handling.

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I believe an individual doctor, nurse or healthcare professional has committed serious misconduct

Likely route: the relevant professional regulator.

Examples include the GMC for doctors, NMC for nurses and midwives and HCPC for many allied health professionals.

Professional regulators generally focus on serious concerns affecting patient safety, professional standards or public confidence rather than resolving ordinary complaints or awarding compensation.

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The problem is a local NHS policy, service restriction, postcode lottery or commissioning decision

Possible routes:

ICB complaint/governance structures → local authority health scrutiny → NHS England regional oversight → equality or legal routes where relevant.

What you might ask health scrutiny to do: place the issue on its work programme, request documents and evidence from the NHS body, invite responsible officers to answer questions publicly, examine population impact and issue recommendations.

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A death may reveal an NHS failure that could put other people at risk

Potential routes: coroner/inquest, regulatory routes, professional regulators and potentially a Prevention of Future Deaths process.

This is a specialist area and legal advice may be particularly valuable.

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I work for the NHS and am afraid to raise what I know internally

Possible routes: Freedom to Speak Up Guardian, appropriate regulator, professional regulator and specialist whistleblowing advice depending on the concern.

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I need the decision stopped, reversed, compensated or declared unlawful

You may need legal advice.

Ombudsmen, regulators and scrutiny committees have important powers, but they do not replace courts.

Depending on the facts, legal routes can potentially include judicial review, clinical negligence, Equality Act proceedings, Human Rights Act proceedings or other public-law claims.

Do not assume that pursuing a complaint pauses a legal deadline.

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What should you do before escalating an NHS concern?

The strongest escalation is usually not the longest one.

Before contacting another body, reduce the problem to five questions:

1. What happened?
2. What should have happened instead?
3. What evidence shows the difference?
4. Who had responsibility for it?
5. What do you want the organisation you are contacting to do?

The fifth question is especially important.

Do not simply tell a regulator:

“The NHS treated me terribly. Please investigate.”

Where possible, identify the issue within that body's remit:

The more clearly your request matches the recipient's legal or regulatory power, the harder it is for the issue to be dismissed simply because it has been sent to the wrong place.

Poor care, maladministration or a complaint that has not been resolved

Step 1: use the NHS complaints process

For most patient complaints, the NHS organisation should first have an opportunity to investigate what happened.

A good complaint should identify:

• what happened;
• what you believe went wrong;
• the evidence or standards you rely on;
• the impact on you;
• and what outcome you are seeking.

The NHS Complaint Standards expect organisations to understand what the complainant wants to achieve, investigate the issues fairly, examine evidence, explain whether something went wrong and identify what will happen as a result.

The final response should make clear that the organisation has completed its investigation and explain the right to approach the Ombudsman.

Step 2: escalate unresolved maladministration to PHSO

The Parliamentary and Health Service Ombudsman can independently examine unresolved complaints concerning the NHS in England.

Rather than merely resending everything you previously sent the NHS, make it easy to see:

Issue → evidence → relevant standard → NHS response → why that response does not resolve the issue → injustice caused.

What should you ask PHSO to investigate?

Depending on the case, this might include whether:

• the decision-making process was fair and evidence-based;
• relevant information was ignored;
• the organisation followed its own procedures;
• the complaint investigation was adequate;
• the reasons given were supported by evidence;
• avoidable delay occurred;
• identified failures were properly remedied;
• or organisational learning was required to prevent recurrence.

ICB governance, Board failure or senior leadership concerns

Sometimes the problem becomes bigger than the original complaint.

You may start with one policy, one patient or one administrative failure and gradually uncover:

• repeated breakdowns in controls;
• failure to implement external recommendations;
• senior leaders being informed but apparently failing to act;
• inadequate Board oversight;
• conflicting explanations;
• unresolved statutory breaches;
• or a pattern that appears to reveal organisational rather than isolated failure.

At that point, simply opening another patient complaint may not address the real question.

The issue may have become:

Is this organisation being governed properly?

What should you ask the NHS organisation itself?

You might ask:

You are not necessarily entitled to every internal document, particularly where exemptions or confidentiality apply.

But asking precise governance questions can reveal whether the organisation has actually considered the concern or merely answered correspondence.

When should you ask for Fit and Proper Person concerns to be considered?

The Fit and Proper Person Test applies to NHS Board members and examines whether they remain suitable to hold senior Board-level positions.

Relevant considerations include matters such as character, competence, qualifications and whether information exists concerning serious misconduct or serious mismanagement.

A member of the public does not personally “conduct” an FPPT and cannot require a predetermined result.

What you can do is place relevant evidence before the responsible governance body and ask whether it requires consideration under the FPPT framework.

What should you ask?

Who do you approach?

For a concern about a Chief Executive or non-executive director, the Chair is ordinarily central to the FPPT process.

The Chair's own FPPT involves separate oversight, normally involving the Senior Independent Director or deputy chair.

NHS England Regional Directors receive annual FPPT submissions, and the framework also provides for relevant information to arise and be submitted outside the annual cycle.

This means a separate question may eventually arise:

Has the organisation's own FPPT process dealt properly with the evidence?

When should you approach NHS England regional oversight?

NHS England's regional teams oversee ICBs and providers and can examine organisational performance and capability.

Regional escalation makes more sense where your evidence suggests:

• systemic governance failure;
• persistent problems rather than an isolated incident;
• serious weaknesses in commissioning;
• Board or leadership capability concerns;
• failure to address known risks;
• repeated non-compliance;
• or inadequate organisational response to external findings.

It makes less sense to approach regional oversight simply because you disagree with the outcome of one ordinary patient complaint.

What should you ask NHS England to do?

This distinction is useful because it makes clear that your concern is about the organisation's ability to govern itself, not simply dissatisfaction with the answer it gave you.

Unsafe care and systemic patient-safety concerns

When should you tell CQC?

CQC wants information about poor or unsafe care because patient experiences help inform its regulatory picture of a provider.

However, CQC generally cannot investigate and resolve an individual complaint on your behalf.

Think of the distinction this way:

When might HSSIB be relevant?

HSSIB looks for patient-safety issues from which wider healthcare learning could be generated.

It invites patients, families, carers and healthcare staff to submit safety concerns.

But it does not use that process to investigate your individual dispute or a complaint solely about one provider or member of staff.

The stronger HSSIB framing is therefore:

“This appears to reveal a systemic patient-safety risk that may extend beyond my individual case.”

Explain:

• what the risk is;
• why it might recur;
• who else may be exposed;
• what system conditions create the risk;
• and what evidence suggests it is not merely an isolated event.

Discrimination, inequality and the Public Sector Equality Duty

If the concern is about discrimination or unequal healthcare access, separate two questions:

Was I personally treated unlawfully?

and

Did the NHS body properly consider equality when designing or implementing the policy?

The second question can engage the Public Sector Equality Duty.

What evidence should you ask the NHS for?

Useful requests may include:

• the Equality Impact Assessment or equivalent equality analysis;
• records identifying affected protected groups;
• evidence considered;
• consultation or patient involvement;
• identified adverse impacts;
• mitigation;
• approval and sign-off;
• and evidence that equality implications were actually considered when the decision was made.

An Equality Impact Assessment is a useful tool, but the legal question is not merely whether somebody completed a document carrying that title.

The underlying question is whether the public authority actually discharged its equality duty.

Where can you escalate?

The Equality Advisory and Support Service can help individuals understand equality and human-rights issues.

The Equality and Human Rights Commission has significant statutory enforcement powers, including formal investigations, Public Sector Equality Duty assessments and compliance action.

EHRC uses those powers strategically and is not an ordinary complaints-resolution service for every individual case.

Legal action may therefore remain relevant where an individual enforceable remedy is required.

Read the dedicated guide: NHS Equality, Discrimination and the Public Sector Equality Duty.

Human rights, consent and bodily autonomy

There is no single organisation called the “NHS Human Rights Regulator”.

The appropriate route depends on what the alleged violation actually consists of.

For example:

• poor administration may belong with PHSO;
• unsafe or non-consensual regulated care may engage CQC standards;
• discrimination may engage equality law;
• professional misconduct may engage a professional regulator;
• and a legal Human Rights Act remedy ultimately belongs within the legal system.

Consent and bodily autonomy issues may also involve common-law principles and professional standards rather than only the Human Rights Act.

Read the dedicated guide: Human Rights, Consent, Bodily Autonomy and the NHS Constitution.

Freedom of Information and transparency failures

Freedom of Information has its own escalation structure.

If the NHS has not responded within the statutory period

Follow up with the public authority and preserve evidence of the original request and the date it was received.

If the authority remains non-compliant, the ICO can consider a complaint about the delay.

If you received a response but believe it is wrong

Ask for an Internal Review where that process is available and appropriate.

Be precise about what you dispute.

For example:

Then escalate to the ICO

The ICO will usually want the request, the authority's response, your Internal Review request where relevant and the Internal Review outcome.

If the authority has failed to complete the Internal Review despite substantial delay, the ICO can also consider how to proceed.

The ICO regulates information-law compliance.

It does not automatically investigate the separate question of whether a manager or executive should face internal accountability for causing or tolerating the failure.

That separate issue may potentially belong within governance or oversight routes.

Read the dedicated guide: How to Use Freedom of Information to Investigate NHS Decisions.

Concerns about an individual healthcare professional

If the central concern is about an individual's continued fitness to practise, identify their professional regulator.

For example:

• GMC — doctors and the other professions within its statutory remit;
• NMC — nurses, midwives and nursing associates;
• HCPC — many allied health professionals and practitioner psychologists;
• and the relevant regulator for dentistry, pharmacy, optical professions and other regulated healthcare professions.

Regulators focus particularly on concerns that may affect:

• public safety;
• professional standards;
• or public confidence in the profession.

They are not intended simply to punish every past mistake.

This distinction matters.

A poor experience with a doctor is not automatically a GMC case.

Serious dishonesty, significant misconduct, serious repeated failures or behaviour raising a continuing public-protection concern may be different.

What should you send?

Focus on:

the conduct → the evidence → the relevant professional standard → why the concern may remain relevant to current fitness to practise.

Avoid turning a professional-regulator referral into a general complaint about the entire NHS organisation.

Local NHS policy, commissioning and health scrutiny

Local authority health scrutiny can be extremely useful where the concern affects more than one individual and involves:

• commissioning;
• healthcare access;
• local health inequalities;
• service restrictions;
• policy;
• service changes;
• or population impact.

Health scrutiny has powers that ordinary correspondence does not.

Relevant NHS bodies can be required to provide information reasonably necessary for scrutiny, and certain NHS representatives can be required to attend and answer questions.

Scrutiny can also issue reports and recommendations and request a formal written response.

What should you ask the scrutiny body to do?

The strongest submission explains why this is a scrutiny issue affecting the community, rather than simply asking councillors to resolve your individual complaint.

What if NHS failures may have contributed to a death?

Where healthcare failures may have contributed to a death, additional legal and investigative routes can arise.

The coroner's role is distinct from the NHS complaints process.

Where an inquest reveals circumstances creating a risk that future deaths could occur, a coroner can issue a Regulation 28 Prevention of Future Deaths report.

The recipient must respond to that report explaining action taken or proposed, or why no action is proposed.

Professional regulation, CQC involvement, patient-safety investigation or legal claims may also arise depending on the circumstances.

Because inquests and deaths involve specialist procedural and legal issues, obtaining appropriate legal advice can be particularly important.

Routes for NHS staff and whistleblowers

People working inside the NHS may have information that patients could never obtain themselves.

If ordinary management routes do not feel safe or appropriate, NHS workers may be able to approach their organisation's Freedom to Speak Up Guardian.

The concern may also need to go to:

• CQC;
• NHS England;
• a professional regulator;
• another prescribed regulatory body;
• or a specialist whistleblowing adviser, depending on the circumstances.

Whistleblowing law is a specialist area. If employment consequences or retaliation are a concern, obtain appropriate advice rather than assuming every disclosure automatically receives legal protection.

When should you consider legal action?

Regulators and Ombudsmen can establish important facts, recommend change and exercise regulatory powers.

But sometimes the outcome you need is something they cannot provide.

You may need legal advice if you are seeking:

• a decision stopped urgently;
• a policy or decision declared unlawful;
• a public body required to reconsider a decision;
• damages for injury;
• an enforceable discrimination remedy;
• a Human Rights Act remedy;
• or another court-enforceable outcome.

Read the dedicated guide: Legal Routes for Challenging NHS Decisions, Negligence and Unlawful Care.

What evidence should you prepare before escalating?

You do not necessarily need hundreds of pages.

A useful accountability pack often has several layers.

1. A one-page summary

Explain:

what happened → what failed → why it matters → what you want investigated.

2. A chronology

Use dates.

Do not make the investigator reconstruct the order of events from dozens of emails.

3. The strongest evidence

This might include:

• policies;
• clinical records;
• complaint responses;
• Board papers;
• FOI disclosures;
• emails;
• external findings;
• Equality Impact Assessments;
• audit material;
• or contemporaneous notes.

4. The standard you believe applies

This could be:

• legislation;
• NHS policy;
• professional standards;
• regulatory requirements;
• clinical guidance;
• or the organisation's own published procedure.

5. A precise request

End by saying what you want the recipient to consider.

For example:

Can you use more than one NHS escalation route?

Yes — because one event can raise several separate questions.

But avoid asking every organisation to investigate everything.

Imagine an ICB introduces a policy that you believe discriminates against women, has poor supporting evidence and has been defended by senior leadership despite external findings.

The same evidence may therefore legitimately appear in several places.

The question you ask about that evidence should change according to the powers of the recipient.

What makes an NHS escalation weaker?

Several things can make a legitimate concern easier to dismiss.

• Sending everything to everybody without identifying why each recipient has jurisdiction.
• Making conclusions stronger than the evidence. Say what the records establish and separately identify what you believe they may indicate.
• Focusing entirely on motive. You often do not need to prove why somebody acted as they did to demonstrate that the process failed.
• Failing to say what outcome you want.
• Submitting hundreds of pages without a chronology or summary.
• Using the wrong regulator. CQC, PHSO, ICO, GMC and NHS England do fundamentally different jobs.
• Waiting too long where legal rights may expire.

Other Fighting Back guides

• Who Oversees the NHS? — regulators, Ombudsmen and accountability bodies
• FOI & Transparency — how to obtain the evidence behind NHS decisions
• NHS Equality — discrimination, the Public Sector Equality Duty and Equality Impact Assessments
• Human Rights & the NHS — consent, bodily autonomy and the NHS Constitution
• Advocacy & NGOs — reproductive-rights and patient-support organisations
• Legal Routes — judicial review, negligence, equality and human-rights claims

Official frameworks used for this guide

This guide has been prepared using current official material including:

• NHS England — NHS Oversight Framework 2026/27;
• NHS England — Fit and Proper Person Test Framework for Board Members;
• NHS England — FPPT guidance for Chairs and NHS organisations;
• Parliamentary and Health Service Ombudsman — NHS Complaint Standards;
• PHSO — Good Complaint Handling guidance;
• Information Commissioner's Office — FOI request-handling, Internal Review and complaint guidance;
• Care Quality Commission — information about raising concerns and regulatory enforcement;
• Health Services Safety Investigations Body — patient-safety concern and investigation guidance;
• Equality and Human Rights Commission — Public Sector Equality Duty and statutory enforcement guidance;
• Department of Health and Social Care — local authority health-scrutiny guidance;
• General Medical Council — fitness-to-practise guidance;
• Nursing and Midwifery Council — fitness-to-practise guidance;
• Health and Care Professions Council — raising fitness-to-practise concerns;
• and the statutory framework governing Prevention of Future Deaths reports.