Complaints handling in Wales is governed by the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011, as amended, including by the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) (Amendment) Regulations 2025. The regulations use the term 'concern', which refers to complaints from patients, concerns about services or care, and patient safety incidents.

Since April 2026, the Welsh NHS complaints, incidents and redress process has been delivered through Listening to People, which replaced the Putting Things Right framework.

The process is intended to support early engagement, clear communication, proportionate investigation, learning and improvement. It also allows, if appropriate and the complainant agrees, a 10 working day early resolution period.

The complaints process in Wales also includes arrangements for consideration of financial redress. This is relevant where there is a 'qualifying liability', which can arise when there may have been a breach of duty in relation to patient diagnosis or treatment. Redress may include remedial treatment, other actions to put matters right, or financial compensation.

The statutory redress arrangements do not apply to primary care providers or independent providers treating NHS patients, although those providers remain subject to the concerns process and should investigate and respond appropriately.

If NHS patients are referred by a Welsh NHS body to an independent provider for NHS treatment, it is important to ask the contractor to clarify what indemnity arrangements will apply if something goes wrong.

Who can notify a concern?

Concerns can be notified by anyone who has used NHS services or facilities. A relative, friend or other representative may notify a concern on behalf of a patient, but practitioners should not assume that someone complaining on behalf of a patient has authority to do so. Investigating a concern does not override a patient’s right to confidentiality.

Adult patients with capacity should usually notify a concern themselves, although they can appoint a representative to act for them.
It might also be appropriate for a representative to bring a concern on behalf of a child. Where the patient lacks capacity, a representative may bring a concern on their behalf.
If there are concerns about whether the representative is appropriate, or whether they are acting in the patient’s interests, members should contact the MDU for advice.

If the issues raised are significant, it may still be appropriate to investigate the concern even if it is not appropriate to provide a full response to the person who raised it. In those circumstances, confidentiality and data protection issues will need careful consideration.

Staff members may also raise concerns about patient care, although employment or contractual matters are dealt with under separate processes.

Where a staff concern involves a patient who has suffered moderate or severe harm, or who has died, the patient or their representative would normally need to be notified under the relevant duty of candour. There may be circumstances where this is not in the best interests of the patient. If there are concerns that this is the case, members should contact the MDU for advice.

Time limits

Concerns should usually be notified within 12 months of the event giving rise to the concern, or within 12 months of the person becoming aware of the issue. The regulations allow the time limit to be waived where there is good reason for the delay, and it remains possible to investigate the concern.

Even where a concern is raised outside the formal time limits, it is often better to help patients resolve concerns where it is practicable and appropriate to do so. Members should seek advice where there are difficulties investigating an older concern – for example, if records are incomplete, staff have moved on or recollections are limited.

The procedure

The Listening to People process encourages organisations to engage with the person raising the concern at an early stage and to consider whether matters can be resolved promptly and proportionately. The MDU has extensive experience in assisting members with concerns and complaints, and members can contact us at any stage of the process.

Acknowledgement and initial handling

Concerns can be raised in writing, electronically or verbally. If a concern is raised verbally, a written record should be made and shared with the person raising the concern. The organisation should acknowledge receipt no later than five working days after the concern is received.

The acknowledgement should explain how the concern will be handled, identify how the person will be kept informed, and provide information about support and advocacy where appropriate.

See our quick guide on how to respond to complaints for more information.

The listening discussion

After a concern has been received, the organisation should offer the person raising the concern the opportunity to take part in a ‘listening discussion’. This may take place face to face, by video or by telephone, depending on what is appropriate and accessible for the person concerned.

The purpose of the listening discussion is to understand:
the issues being raised
what matters most to the person raising the concern
the outcome they are seeking.

It also provides an opportunity to identify any advocacy, accessibility, communication or language needs, including Welsh language needs, and to explain the options available under the process.

During the discussion, the organisation should seek to clarify:

the specific issues being raised
the outcome the person raising the concern is hoping for
whether the concern may be suitable for early resolution
whether consent is needed to access or share relevant clinical information
how and when updates will be provided
whether there are any support, advocacy, accessibility or language requirements
whether the concern includes allegations of harm or loss that may require consideration of qualifying liability and redress.

Members should ensure that appropriate records are kept from any listening discussion, including:

the issues discussed
the outcome sought
any support needs identified
the agreed next steps.

If the person raising the concern does not wish to take part in a listening discussion, the organisation should provide the relevant information in writing and ask how they would like the concern to be handled.

Stage 1: early resolution

The first stage of the process is early resolution. Organisations are expected to consider whether concerns can be addressed promptly and proportionately without the need for a detailed investigation. Early resolution may be appropriate when the issues can be understood quickly and resolved through explanation, apology, practical action or clarification.

Early resolution may involve:

checking records
obtaining factual information
answering questions
offering an apology where appropriate
agreeing practical steps to address the concern.
The focus should be on listening, understanding what has happened and resolving the concern where this can be done safely and fairly.

Early resolution should be completed within no more than ten working days from acknowledgement of the concern. The outcome should be confirmed and documented. As with all complaints correspondence, this should be stored within the complaints file and not in the clinical records. If the concern cannot be resolved satisfactorily, or if it is not suitable for early resolution, it should progress to stage 2.

If the early resolution successfully resolves the concerns, the organisation must provide written confirmation to the person who notified the concern that the matter has concluded and will not be further investigated.

The early resolution stage falls to the organisation providing care rather than the health board.

Stage 2: investigation, including consideration of redress

Where early resolution is not appropriate, has been declined or has not resolved the concern, the matter should proceed with a more detailed investigation. The investigation should be proportionate to the issues raised and should be carried out fairly, without bias and with reference to the available evidence.

The investigation may include:

reviewing relevant clinical and administrative records
obtaining accounts from staff involved
meeting the person raising the concern where appropriate
obtaining specialist or independent advice where required
considering any patient safety issues or learning points.

The organisation should explain the likely timescale for the investigation and provide updates if that timescale changes.

The final response should:

address the issues raised
explain the findings
apologise where appropriate
identify any learning
set out any actions that will be taken as a result.

Where personal injury, loss or harm has occurred or is alleged to have occurred, Welsh NHS bodies must consider whether there is a qualifying liability and whether redress should be offered. Where appropriate, this may include jointly instructed independent expert advice, remedial treatment, other action to put matters right or financial compensation. If redress is being considered, the person raising the concern should be signposted to funded legal support where this applies.

Primary care

GPs are contractually required to have a practice-based system for handling complaints, and practices must co-operate with the local health board where the board is involved in considering a concern. Concerns about primary care providers can be raised with the local health board, but the board must decide whether it would be more appropriate for the primary care provider to consider the concern.

Primary care providers should investigate concerns, respond appropriately and identify learning where relevant, but they cannot offer NHS redress under the statutory redress arrangements. If a concern raises complex clinical, indemnity, confidentiality or redress issues, members should contact the MDU for advice.

Redress

The regulations require Welsh NHS bodies investigating a concern to consider whether an offer of redress should be made where there may be a qualifying liability. This applies only to NHS trusts and local health boards, but not to primary care providers or independent providers treating NHS patients.

In essence, qualifying liability involves considering whether a patient suffered harm as a result of a breach of duty of care by an organisation or healthcare professional. Where a Welsh NHS body considers there may be a qualifying liability, it must inform the person raising the concern, provide relevant records and expert evidence where appropriate, and offer access to legal advice in accordance with the redress arrangements.

Outside Wales

Other NHS bodies (such as NHS trusts in England, Scotland and Northern Ireland) may need to be involved where a concern falls within the Welsh redress regulations. The statutory redress arrangements do not apply to primary care providers or independent providers of care to NHS patients.

Welsh NHS bodies may need to share expert evidence and provide access to legal advice when considering redress. Therefore, primary care providers and private practitioners treating NHS patients within or outside Wales may be contacted by a complainant who is pursuing a case against them. Members contacted in this way should get in touch with the MDU immediately.

If the complainant remains dissatisfied

If a complainant remains dissatisfied after the organisation has completed its investigation, they may ask the organisation for clarification or further explanation. They may also ask the Public Services Ombudsman for Wales to review the handling of the concern.

The ombudsman is independent of the NHS and can review how a concern was handled and whether the response was reasonable. The organisation’s final response should explain the complainant’s right to approach the ombudsman and provide the relevant contact details.

If the concern involves possible harm, injury or financial loss, the complainant may also wish to seek independent legal advice. If formal civil court proceedings are issued while a concern is being investigated, the Listening to People investigation must stop until those proceedings have concluded.

How can we help?

We have extensive experience helping members with complaints and concerns in Wales. We can advise on responding to concerns, confidentiality and representative issues, the interface with patient safety and duty of candour, redress, ombudsman referrals and related regulatory or legal risks.

For individual advice, call our 24-hour medico-legal helpline or email us.

Useful links

National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011

National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) (Amendment) Regulations 2025

Welsh Government: Listening to People

The NHS complaints process in Wales

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