Welcome to UHB

Completing our secure complaint form will ensure we have the details we need to
register and investigate your complaint.

Before you complete the form, please read how our PALS service can offer
you support and advice on current issues that can be easily resolved.

PALS information

Are you complaining about something that happened in the last 12 months?

Yes
No

If you have not been able to complain to us within 12 months becoming aware of the problem, please tell us why you did not complain sooner:

Please confirm which hospital or service your complaint is about, including the ward or department:

Good Hope Hospital
Heartlands Hospital
Norman Power Centre
Queen Elizabeth Hospital Birmingham
Solihull Hospital and Community Services
Washwood Heath Community Diagnostic Centre
More than one of the places listed above

Please provide more information about which hospital/services your complaint is about.

Ward or department

Please note we can only deal with complaints that are about care and treatment provided by University Hospitals Birmingham.

Are you the patient?

Yes
No

Your details

Your hospital number or NHS number (if available)

Your first name

Your last name

Your date of birth

Your address

Your phone number

Your email address

Complainant details

What is your relationship to the patient?

Please explain why the patient cannot submit this complaint themselves:

Your first name

Your last name

Your phone number

Your email address

Please provide some information about the patient.

Patient's hospital number or NHS number (if available)

Patient's first name

Patient's last name

Patient's date of birth

Patient's address

Patient's phone number

How would you like us to contact you?

Email
Telephone
Other

Please tell us what your complaint is about

Assessment or diagnosis - this could be concerns around misdiagnosis, lack of assessment or delays in identifying the issue
Admission or access to care - this could be issues relating to getting an appointment, referral problems, or delays starting treatment
Care on the ward - this could be day-to-day care, treatment, monitoring and nursing during a hospital stay
A procedure, operation or treatment - this could be any clinical interventions, surgery or tests
Concerns around communication - this could be problems with information sharing, discharge planning, or inconsistent messages between teams
Discharge or transfer of care from hospital - this could be concerns related to discharge delays, unsafe discharge or poor coordination
Follow up or aftercare - this could be following discharge, including outpatient appointments, rehab, or ongoing treatment
Something else not listed above - please provide more information below

Please tell us what your complaint is about, if none of the above apply.

In order for us to fully understand and investigate your concerns, please give us more information about what you would like us to investigate for you.

You might find it helpful to read this guidance before making your complaint:

Tips on making a complaint to the NHS in England - Parliamentary and Health Service Ombudsman (PHSO)

Please ensure your complaint is as clear as possible and includes the following information:

What happened
Who was involved
When it happened
How it has affected you or someone else
What questions you would like answers to

What would you like us to investigate for you?

What are you hoping to achieve as an outcome of this complaint?

For example: an apology, an explanation or change in procedure. If we cannot achieve this, we will let you know.

In order to ensure we are treating people fairly and with dignity and respect, we monitor access to our complaints service and would like to use patient data we already hold on our records.

The protected characteristics are age, race, disability, religion or belief, sexual orientation, ethnicity, gender reassignment, sex, pregnancy and maternity and civil partership status.

Are you happy for us to use any existing data we hold to monitor access to our complaints service?

Yes
No