This guide explains what to do if something goes wrong with your private healthcare treatment in the UK.
It looks at complaints about treatments you pay for directly or through private insurance. It also helps you know what to do if things do not go as expected.
Key points
The law and your right to complain
Under the Health and Social Care Act and the Consumer Rights Act , all patients can complain if their healthcare is not right.
Both NHS and private providers follow the same principles for handling complaints and must be honest with you (called the Duty of Candour).
Private or NHS
If your treatment was paid for by the NHS , use the NHS process for the country you live in:
Private hospitals have their own procedures, which can differ because doctors often work under different contracts, such as 'practising privileges' .
What do I do if I have a complaint about my private healthcare?
In the first instance, you should contact the hospital or consultant direct. Only once they have had the opportunity to resolve the complaint should you contact third party complaints services.
If you are thinking about private treatment, it is a good idea to ask some questions about how the hospital deals with complaints. Do this before you spend any money.
Who regulates healthcare complaints?
There are regulators for each of the four nations.
Care Quality Commission (CQC) (England)
The Care Quality Commission (CQC) is the national healthcare inspector in England. CQC Regulation 16 helps people make complaints about their care and treatment.
To meet this rule, providers must have a good and easy way to find, receive, manage, and respond to complaints from service users, their representatives, or other interested parties.
All complaints must be investigated thoroughly and any necessary action taken where failures have been identified.
When asked, providers must give CQC a summary of complaints, responses, and related information.
If a private healthcare provider does not use an outside review process, like ISCAS, for complaints, they may not get an unbiased final decision. This could lead to negative feedback during the next CQC inspection. As a result, they may face damage to their reputation, loss of market position, and possible penalties with their registration.
The result is that 97% of independent healthcare providers in England subscribe to ISCAS and use the Code.
The Government accepted in principle Recommendation 6b from the Paterson Inquiry which stated: “that all private patients should have the right to mandatory independent resolution of their complaint.”
The CQC promised to improve its guidelines. It wants to ensure that patients can easily find ways to resolve their complaints about independent service providers.
For more information see: https://www.cqc.org.uk/guidance-regulation/providers/regulations-service-providers-and-managers/health-social-care-act/regulation-16
Other national regulators
Independent Sector Complaints Adjudication Service (ISCAS)
Many companies provide complaint services for healthcare. But right now, only one, ISCAS, has a written agreement (Memorandum of Understanding) and can share data with all four national regulators.
ISCAS provides independent adjudication on complaints. It is a voluntary subscriber scheme and the vast majority of independent healthcare providers, including most PHIN members, have signed up to it.
ISCAS is a not-for-profit limited company, independent from the trade body and owned by the Centre for Effective Dispute Resolution (CEDR). ISCAS provides the services of external independent adjudication as the third stage of a three-stage process. ISCAS is impartial and does not take sides. Independent Adjudicators issue final decisions and no monetary compensation is awarded.
Following the conviction of disgraced surgeon Ian Paterson, there was an inquiry ( the Paterson Inquiry ) to review the circumstances surrounding his misconduct and consider other past and current practices in the NHS and the independent sector. The inquiry aimed to learn lessons from these and to make recommendations to improve the safety and quality of care provided to all patients.
In line with Recommendation 6a of the Inquiry, which stated that information about the means to escalate a complaint to an independent body should be communicated more effectively in both the NHS and the independent sector, the Parliamentary and Health Service Ombudsman (PHSO) developed the NHS Complaint Standards, which set out the ways in which the NHS should handle complaints, including the need for organisations to ensure that people know how to escalate to the PHSO.
The PHSO good complaints handling principles are fully incorporated into the ISCAS Code for Handling Patient Complaints.
Every individual private hospital publishes its own arrangements (incorporating the ISCAS Code) for locally resolving a complaint from a patient and will normally seek to satisfy the complainant on the spot.
If agreement cannot be found between the patient and hospital or the Group then ISCAS provides the route to independent, third-party adjudication ending in a final decision. Costs are absorbed by the healthcare provider, so this is free to the patient.
ISCAS does not address some types of complaints from private patients. Clinical negligence, clinical mistakes, financial complaints all have their own pathways,
For more information, see: Independent Sector Complaints Adjudication Service
Before choosing a private provider
Check the hospital’s complaints policy.
Ask if they are part of an external independent complaints service. If they are not, then you might want to consider finding a provider that is, so that you have peace of mind should something go wrong.
Understand who is responsible if something goes wrong and what insurance they have.
How to complain about private healthcare
Start by contacting the hospital or consultant directly.
Keep records of what happened and what you want (e.g., apology, refund).
If you’re not satisfied, you can escalate to independent bodies.
Extra tips
Read the small print in your contract.
Make sure you and your doctor agree on the expected outcome before treatment.
Be clear about what you want from the complaint process.
It's important to know that the complaints process usually does not offer money as a solution, but ISCAS can award a goodwill payment up to £5,000.
If you want compensation, this is usually handled in court. You should get legal advice for this approach.
Additional complaint adjudication services
Many companies provide services to handle complaints for hospitals. Hospitals can decide whether to sign up for these services and will let you know on their websites which one(s) they work with.
Some of these are identified below. If your consultant or hospital works with a complaints service it will give information on its website.
Complaints Handling, Investigation and Appeals Service (CHIAS)
CHIAS provides an independent complaints handling, investigations and appeals service to its members in the independent healthcare sector.
For more information, see: https://www.chias.org.uk/
Cosmetic Redress Scheme (CRS)
The Cosmetic Redress Scheme describes itself as a “straightforward and easy to use consumer redress (ombudsman) scheme”. It is an online system designed for cosmetic non-surgical treatments i.e. botulinum toxins/dermal fillers.
The main purposes of the CRS are to allow practitioners to comply with their legal requirement under the Alternative Dispute Regulation (ADR) for Consumer Disputes.
The ADR Regulations 2015 are designed to signpost consumers to a government authorised consumer redress scheme and to settle or resolve complaints made by consumers against its members.
It is authorised by the Chartered Trading Standards Institute under the ADR Regulations 2015 to offer an escalated complaints process to patients of CRS members.
For more information, see: https://www.cosmeticredress.co.uk/consumers/how-it-works
The Healthcare Sector Complaint Adjudication and Management Partners (HSCAMP)
HSCAMP aims to provide its Health and Social Care provider members with the tools and insights to turn dissatisfied patients into satisfied patients and to provide an independent adjudication service for patients who are not satisfied with the resolution proposed by the Health and Social Care providers’ internal complaint process.
For more information, see: https://hscamp.co.uk/
Patient complaint checklist
Thinking of making a complaint? Here’s a quick checklist so you’re prepared.
1. Gather details
- What happened?
- When and where?
- Who was involved?
- What outcome do you want (e.g., apology, refund, explanation)?
2. Check your paperwork
- Read your contract and hospital’s complaints policy.
- Confirm if they follow an independent scheme like ISCAS.
3. Start with the provider
- Contact the hospital or consultant directly.
- Explain clearly what went wrong and what you expect.
4. Keep records
- Save emails, letters, and notes from phone calls.
- Keep copies of any responses.
5. Escalate if needed
- If you’re not satisfied, go to:
? An external complaints adjudicator, e.g. ISCAS (Independent Sector Complaints Adjudication Service)
? Your Healthcare Regulator (eg CQC, HIS, HIW, RQIA) for serious concerns.
6. Stay clear and calm
- Be polite and factual.
- Focus on resolving the issue, not blame.
