PHSO Complaints UK: How to Escalate to the Ombudsman

At a glance

• Two separate remits, one office-holder: NHS complaints in England under the Health Service Commissioners Act 1993, and UK government department/agency complaints under the Parliamentary Commissioner Act 1967.
• Time limit: normally 12 months from the day you first became aware of the problem, under both Acts — with discretion to extend in special circumstances.
• Local resolution first: you must complain to the NHS body or department and get its final response (or a reasonable time to respond) before the PHSO will normally investigate.
• MP filter — government complaints only: a complaint about a government department or listed public body must be referred to the PHSO by a member of the House of Commons (Parliamentary Commissioner Act 1967, s.5(1)).
• No MP needed for NHS complaints: you can complain to the PHSO about NHS care in England directly (Health Service Commissioners Act 1993, s.9).
• Free, and no solicitor required. The PHSO does not charge, and it is not a court.
• Legal-remedy exclusion: the PHSO normally will not investigate where you have, or had, a right to go to a tribunal or court, unless it is not reasonable to expect you to have used that route.
• Devolved services are out of scope: NHS and public services in Scotland, Wales and Northern Ireland have their own ombudsman schemes; English council and social care complaints go to the Local Government and Social Care Ombudsman.

What is the Parliamentary and Health Service Ombudsman?

The PHSO is one office held by one person, but it exercises two separate statutory jobs. As Parliamentary Commissioner for Administration, created by the Parliamentary Commissioner Act 1967, the Commissioner can investigate action taken by UK government departments and the other authorities listed in Schedule 2 to that Act — a list that covers departments such as HMRC, the Home Office, the DWP and their executive agencies. As Health Service Commissioner for England, created by the Health Service Commissioners Act 1993, the same person investigates complaints about NHS-funded care in England, including hospitals, GP practices, dentists, pharmacists and mental health services.

Both roles look for maladministration (poor administrative process — for example, unreasonable delay, failing to follow proper procedure, or giving misleading advice) or service failure that has caused an injustice to the person complaining. The PHSO is not a court and does not sit as an appeal tribunal: it cannot overturn a clinical decision or a legal judgment, and it does not decide questions of legal liability the way a judge would.

Where something has gone wrong, the PHSO can recommend remedies — an apology, a change in process, or in some cases a financial payment. Its findings are not legally binding in the way a court judgment is, but public bodies almost always follow its recommendations, and for government complaints there is a further backstop: under section 10(3) of the 1967 Act, if an injustice has not been, or will not be, remedied, the Commissioner may lay a special report before Parliament.

Two routes into the PHSO — and they are not interchangeable

Which set of rules applies depends entirely on who you are complaining about.

| | NHS complaint (England) | Government department / agency complaint | |---|---|---| | Governing Act | Health Service Commissioners Act 1993 | Parliamentary Commissioner Act 1967 | | Who can complain to the PHSO | You, or a suitable representative, directly | Only via a member of the House of Commons | | MP referral required? | No | Yes — s.5(1) | | Must the earlier complaints process be used first? | Yes — a statutory requirement under s.4(4)–(5) | Yes, as a matter of PHSO practice, before the case will normally be accepted | | Time limit | 12 months from awareness (s.9) | 12 months from awareness (s.6(3)) | | Excluded if a court/tribunal remedy exists? | Yes, unless unreasonable to expect it (s.4(1)) | Yes, unless unreasonable to expect it (s.5(2)) |

Confusing the two routes is one of the most common reasons a complaint stalls: sending a government-department complaint straight to the PHSO without an MP referral means it cannot be accepted, however strong the underlying case.

Step 1: complain to the organisation first

Before the PHSO will look at anything, you need to have raised your concern directly with the NHS body or government department and given it a fair opportunity to respond.

For an NHS complaint, this usually means using the service's own complaints procedure, or the local PALS (Patient Advice and Liaison Service) team where one exists. This is not just good practice — for NHS complaints it is a statutory precondition. Under section 4(4)–(5) of the Health Service Commissioners Act 1993, where a local complaints procedure exists, the Commissioner must not investigate unless satisfied that the procedure has been invoked and exhausted, or that it is not reasonable to expect that.

For a government department, you should use its own published complaints procedure and get a final response, or allow a reasonable time for one. This is the PHSO's consistent operational practice rather than a separate provision of the 1967 Act itself, but a complaint referred to the PHSO before the department has had a fair chance to respond is very unlikely to be accepted.

Whichever route applies, keep a clear paper trail: copies of your original complaint, the organisation's acknowledgement, any further correspondence, and — critically — the final response letter, which usually confirms you have exhausted the process and starts the clock running on how quickly you should act next.

Step 2: the MP filter for government department complaints

If your complaint is about a UK government department or a body listed in Schedule 2 to the 1967 Act, you cannot send it to the PHSO yourself. Section 5(1) of the Parliamentary Commissioner Act 1967 requires that:

• a written complaint is made to a member of the House of Commons by the person who claims to have suffered injustice through maladministration, and
• that MP refers the complaint to the Commissioner, with the complainant's consent.

In practice this does not have to be your own constituency MP, though that is the natural starting point — many MPs will also take up a case referred by a resident of a neighbouring constituency, or you can approach the Chair of the Public Administration and Constitutional Affairs Committee if you live outside the UK and have no constituency MP. You can find your MP's contact details through the UK Parliament's own website. Once the MP has your written complaint and your consent, they refer it on to the PHSO — you do not submit the case to the Ombudsman directly.

This MP filter has no equivalent in the Health Service Commissioners Act 1993. If your complaint is about NHS care in England, you can complain to the PHSO directly once you have exhausted the local process — no MP involvement is required at any stage.

Step 3: the 12-month time limit

Both Acts set the same headline time limit, though the exact wording differs slightly between them. Under section 6(3) of the 1967 Act, a complaint about a government department "shall not be entertained... unless it is made not later than twelve months from the day on which the person aggrieved first had notice of the matters alleged in the complaint" — though the Commissioner may still investigate a later complaint if satisfied there are special circumstances that make it proper to do so. Section 9 of the 1993 Act applies materially the same 12-month rule to NHS complaints, with the Commissioner able to accept a later complaint where it is reasonable to do so.

Worked example. Priya, a fictional complainant, receives a hospital's final response to her formal complaint on 3 March. She reads it, is dissatisfied, and puts it in a drawer while she considers what to do. If she does not bring her complaint to the PHSO until, say, 10 April the following year — more than 12 months after she first had notice of the matters complained of — she is at real risk of the PHSO declining to investigate unless she can show a genuine reason for the delay. Acting within weeks of the final response, rather than waiting close to the deadline, gives the most room for error if there are further delays finding an MP or gathering evidence.

The 12-month clock generally runs from when you first had notice of the matters you are complaining about — which is not always the same as the date of the final response letter, so keep a note of when you first became aware something had gone wrong, not just when the complaints process ended.

What the PHSO can and cannot investigate

Both Acts share the same basic shape: the Commissioner investigates maladministration or service failure that has caused an injustice, not the merits of a clinical or policy decision taken properly. Two exclusions apply in both roles:

• A legal-remedy exclusion. Under section 5(2) of the 1967 Act and section 4(1) of the 1993 Act, the Commissioner must not investigate where the person aggrieved has, or had, a right of appeal to a tribunal or a remedy by way of court proceedings — unless satisfied that in the particular circumstances it is not reasonable to expect them to have used that route. This is why the PHSO is often described as a route of last resort for cases that could otherwise go through litigation: it is available where court action would be disproportionate, unaffordable, or otherwise unreasonable to expect, but it does not simply sit alongside the courts as an alternative forum.
• Schedule exclusions. Certain categories of government action are excluded entirely from investigation under the 1967 Act, and certain NHS matters that are, or have been, the subject of a separate statutory inquiry are excluded under the 1993 Act.

If you are looking at significant financial losses — for example a serious clinical negligence claim — a solicitor-led claim through the courts, rather than a PHSO complaint, is usually the more appropriate route, precisely because the legal-remedy exclusion may apply.

What outcome can you actually expect?

If the PHSO upholds a complaint, the recommendations it can make include an apology, changes to the organisation's procedures so the same problem does not recur, and — in some cases — a financial payment reflecting the impact on you. These recommendations are not legally binding in the way a court judgment is, but organisations overwhelmingly comply with them.

For government-department complaints specifically, there is a further mechanism if compliance does not follow: section 10(3) of the 1967 Act allows the Commissioner, where an injustice has not been or will not be remedied, to lay a special report before both Houses of Parliament. This is the ultimate accountability lever behind the PHSO's recommendations — Parliamentary scrutiny, rather than a court order.

Scotland, Wales, Northern Ireland — and English councils

The Health Service Commissioners Act 1993 now covers NHS complaints in England only. NHS and other devolved public services in Scotland, Wales and Northern Ireland are the responsibility of their own national ombudsman schemes, not the PHSO. UK-wide government departments — HMRC, the DWP, the Passport Office, HM Courts and Tribunals Service and similar bodies — remain within the PHSO's remit wherever in the UK you live, subject to the same MP referral and 12-month rules.

If your complaint is about an English local council or an adult social care provider rather than the NHS or a central government department, the PHSO is the wrong body — that falls to the Local Government and Social Care Ombudsman instead.

How to submit your complaint

1. Complain to the organisation first and keep every piece of correspondence, especially the final response.
2. Work out which route applies — NHS in England (direct to the PHSO) or a government department/agency (via an MP).
3. If it's a government complaint, contact an MP with your written complaint and ask them to refer it to the PHSO with your consent.
4. Check the 12-month clock against the date you first had notice of the problem, not just the date of the final response.
5. Gather your evidence — a clear timeline, copies of correspondence, and a plain statement of the outcome you are seeking.
6. Submit the complaint using the PHSO's own complaint form or helpline once the earlier steps are complete, being concise and sticking to the facts.
7. Expect an initial assessment first. The PHSO decides whether a complaint meets its criteria before opening a full investigation — it does not investigate every case it receives.

If the PHSO decides not to investigate

The Ombudsman exercises discretion over which complaints to investigate, and not every complaint proceeds to a full investigation. If yours is turned away, the decision should explain why — commonly because the local complaints process has not been exhausted, the 12-month time limit has passed without special circumstances, or a court or tribunal remedy was reasonably available instead. Some PHSO decisions can be challenged by asking for an internal review; beyond that, judicial review of the Ombudsman's own decision-making is, in principle, available through the courts in appropriate cases, though that is a significant step that calls for its own legal advice.

This guide provides general information about complaining to the Parliamentary and Health Service Ombudsman in England. It is not legal advice and is not a substitute for advice tailored to your specific circumstances. The law described was accurate as at August 2026 and is subject to change — always check legislation.gov.uk for the current text of the Acts referred to above.

Last reviewed: August 2026 by a non-practising solicitor · Next review due: August 2027 or on legislative change.