Complaint Form - Patient

Information:

If you are acting on behalf of a patient who wants to complain about their NHS care, please complete the patient representative form instead.

To enable NHS Cheshire and Merseyside ICB to progress your complaint, please provide the following information.

 

Including postcode
You can enter up to 250 characters

We also need this information to identify if you have approached the correct ICB

Enter the 10-digit number without spaces

If you have a preferred method or special need for communication, please state what that is.

 

Note: Raising a complaint with the use of AI

We want to hear about your complaint in your own words. We know some people find Artificial Intelligence (AI) tools such as ChatGPT helpful when completing forms. Please be aware that AI-generated text can sometimes make complaints too complicated or include legal references that are not relevant. This may increase the time it takes us to review your complaint, or we may need to ask you to resubmit it. We follow the Parliamentary Health Service Ombudsman – Good Complaint Handling standards. Information about using AI to raise a complaint has been taken from their guidance.

When you bring a complaint to us, we need to understand your personal experience and how the issues have affected you. Simple, clear language that explains what happened to you will always be more helpful than complicated, formal writing.

We know some people find AI tools useful to support with their writing. It is important to remember the risks of sharing your information with AI tools. Providers of these tools may use it to train their AI systems and may process it in different countries. Avoid entering sensitive personal information unless you are confident about how it will be used and protected.

Here are some suggestions to get the best results from AI tools while making sure it still sounds like you and your complaint:

  • Keep your prompts focused on your experience and how it made you feel. A prompt is a question or instruction that you type into an AI tool to tell it what you want help with. You can use these examples (from the PHSO website) of useful AI prompts to help with your complaint. 
  • Do not ask AI to add legal arguments, use formal legal language or reference laws to try and make your complaint sound more ‘official’.
  • It is important to check any AI-generated text to make sure it reflects your own personal experience and contains accurate facts.

 

You can enter up to 2000 characters

If you wish to add any attachments, such as copies of correspondence, please do so here. However we ask that you do not send any photographs of bodily parts.

Supported file types: .pdf, .docx, .xlsx, .txt, .png and .jpg

 

Consent

If your complaint is not about the services directly provided by the ICB, then we will need consent from you to share your concerns and any information you have provided, with the NHS organisation which you are complaining about.

Important note: Should the ICB not receive your consent, we will be unable to progress further.

I hereby authorise NHS Cheshire and Merseyside ICB to investigate my complaint under the NHS complaints procedure.

I understand that NHS Cheshire and Merseyside ICB will contact the NHS provider I am complaining about and share all the information I have provided, to enable an investigation into my concerns to take place.

I also understand that this may necessitate the divulging of personal information, medical notes and records of my treatment to NHS staff (clinical and non-clinical) involved in the management of my complaint case, and I hereby consent to that disclosure.

I also understand that this information might be used for other purposes, such as monitoring the complaints process and/or improving service quality, but that only anonymised information will be used. If identifiable data is needed for other purposes, then my consent will need to be obtained separately.

Note: If you wish to withdraw your consent at any stage of the complaint process, please contact your complaint case handler, once details of this have been provided to you.

 

Once you have completed the necessary fields above, press the button below to submit your complaint.