Complaints about adult social care in England rose by 22% last year, according to the Local Government and Social Care Ombudsman's (LGSCO) Annual Review of Adult Social Care Complaints 2025-26, published today.

The LGSCO received 3,938 complaints and enquiries about adult social care in general in 2025-26, up from the previous year.

In the independent sector, complaints from people who fund their own care also rose by 10% to 368. The Ombudsman said this reflects a welcome increase in public awareness of the right to complain, though it remains concerned that too few people who fund their own care come forward given the scale of privately arranged care across the country.

Of the 904 cases investigated, 77% were upheld. The high rate of compliance with Ombudsman recommendations was maintained, with 99.8% of cases being completed to the Ombudsman’s satisfaction.

Positively, around a third (33%) of upheld complaints about private social care providers had already been suitably remedied by the organisation before the Ombudsman investigated, a 13-percentage-point rise on the previous year.

Amerdeep Clarke, Local Government and Social Care Ombudsman, said:

"We are seeing welcome signs of improvement in how councils and care providers handle complaints, but there is still more to be done. My message to the sector is simple: use the learning in this report to improve services now, rather than waiting for wider changes to the care system that are currently under discussion.

"Councils should ensure the care providers they commission have current policies in place that reflect best practice, including clear signposting to us as the final step in the complaints process.

“And for care providers, dealing with complaints properly isn't just the right thing to do, it i fundamental to fostering excellent relations with your clients, families, and the wider communities in which you operate. Handling a complaint well protects your reputation, and where you have already investigated and appropriately remedied an issue, this can mean a full Ombudsman investigation isn't needed.

"Behind every one of these numbers is a person, a family or a carer trying to get things back on track after something has gone wrong. Getting the fundamentals right: clear records, honest explanations and proper signposting to our service, protects everyone: the people who rely on care, and the organisations providing it."

The Ombudsman offers a free online toolkit for care providers (asctoolkit.lgo.org.uk) to help them become "complaints confident", alongside guidance and training for councils on managing complaints and reviews.

The report and associated data tables can be downloaded from the Ombudsman’s website at www.lgo.org.uk/ascreview

The Scottish Public Services Ombudsman has today published a report calling on NHS Lothian to urgently review their Significant Adverse Event Review (SAER) procedures.

The recommendation arose following a complaint from the family of a patient who died from a staphylococcus aureus bacterium (SAB) infection, a type of bloodstream infection, at the Royal Infirmary of Edinburgh.

The investigation found that the health board should have carried out a SAER following the patient's death. The Ombudsman said that the circumstances of the case met both national criteria and the Board's own criteria for a SAER. Despite this, no SAER was undertaken.

Instead, the Board commissioned a local review which was insufficient and completed by a member of staff without the relevant expertise. As a result, an important opportunity to fully examine the circumstances of the patient's death, identify learning and address potential systemic issues was missed.

This is the latest in a number of reports by the Ombudsman that has found substantive issues in the way SAERs are carried out across health boards in Scotland.

The investigation also found that the nursing care failed to meet the relevant standards for cannula care. This is significant given the SAB infection is presumed to have arisen from an infected cannula site in the patient’s forearm. 

The report is highly critical of the Board's failure to recognise the systemic nature of these failings. Similar shortcomings in nursing care have been identified in previous Ombudsman investigations into NHS Lothian, yet the Board did not acknowledge this case as part of a wider pattern of concern.  

The Ombudsman has recommended that that the board carry out audits of cannula care, record keeping and treatment of SABs in addition to reviews of staff training needs and their SAER procedures. 

Paul McFadden, Scottish Public Services Ombudsman, said;

“SAERs play a fundamental part in ensuring patient safety. They not only identify areas for improvement within the healthcare system but provide important answers to patients and their families around their care.

I have asked Lothian NHS Board to review their SAER procedures to ensure they are complying with the current Healthcare Improvement Scotland framework as a matter of urgency and will follow up on those recommendations.”

• New report highlights fragmented care and regional variation in access to services alongside a more than 200% rise in complaints about ADHD and autism.   
• Government must introduce national guidance and stronger regulation to tackle delays in diagnosis and treatment, improve access to care, and clarify patients’ right to choose a provider.  
• One Ombudsman investigation found a man was referred to a local ADHD service that had not yet opened. He paid almost £4,000 for private treatment.    

ADHD and autism services are failing too many people because of the way they are designed, commissioned, and delivered, England’s Health Ombudsman has said, as complaints about care continue to rise.  

To address these growing issues, Paula Sussex CBE, the Parliamentary and Health Service Ombudsman is calling on the Government to publish clear national guidance to improve access to care and clarify patients’ right to choose a provider.  

The Ombudsman is also calling for more support for Integrated Care Boards (ICB) to make consistent decisions about ADHD and autism services that meet the needs of their local communities.   

The Ombudsman also recommends that NHS-funded providers delivering ADHD and/or autism assessments, but not ongoing care, should be registered with the Care Quality Commission. Currently, these providers are neither inspected nor monitored, creating a regulatory gap that must be urgently addressed to make sure patients receive consistent, safe, high-quality care.    

In its new report, Improving ADHD and autism services: commissioning with confidence, the Ombudsman shared its findings based on 3,000 complaints. It found recurring issues including uncertainty about patients’ right to choose a provider, inconsistent recognition of diagnoses across NHS and independent providers, and lengthy waits for assessment and treatment.   

In one investigation, Rich, who has asked to only be referred to by his first name, was wrongly refused access to ADHD care with his chosen provider, despite this being a legal right. He was instead referred to a local service that had not yet opened.   

The Ombudsman has seen an almost 206% rise in complaints about ADHD and autism over the past five years, from 410 to 1,257.   

Ombudsman Paula Sussex CBE said:  

ADHD and autism services are under significant pressure, with demand outstripping capacity. While commissioning cannot solve these supply constraints, the way services are designed, commissioned and delivered can compound the pressure people experience and make it harder to make the best use of available resources.   

 

"When these decisions work well, people can access high-quality care wherever they live. Right now, the system is too complex and inconsistent, leaving too many patients falling through the gaps."  

The report shares several stories of the impact these failings have on people.   

In one case, Rich, 48, asked to be referred to Psychiatry UK for his ADHD treatment. Under Right to Choose legislation, patients in England can choose any NHS-funded provider offering a specialist service for their care.   

South East London ICB denied Rich’s request and wrongly insisted he be referred to a local ADHD service which was still being developed and had no opening date. The Ombudsman found his NHS treatment was delayed by five months. Rich felt he had no choice but to pay for private care amounting to almost £4,000.  

Rich, a student from South London, said, 

Trying to navigate such a complicated system was completely overwhelming. It is particularly challenging for an ADHD patient who, by definition, may find it difficult to manage and navigate needless complexity.  

 

“I had to do a lot of work and research into the system to get the care I was entitled to. I even provided my GP with the contact details of the person responsible for overseeing patient choice, but it made no difference. I was repeatedly told, without any reason being given, that I could not possibly access ADHD care via patient choice. I knew this was not true, which was extremely frustrating.   

 

“It felt like gaslighting. My ADHD diagnosis was a positive thing, as I’d found a framework for understanding myself better and accessing support. But my GP and the commissioners turned it into a punishing and abusive assault course as I tried to get the care I needed. It made me very anxious and I had terrible insomnia. I also worried that these symptoms, combined with my ADHD, would lead to a mental health misdiagnosis.”  

In another investigation, South London and Maudsley NHS Foundation Trust removed a woman from the ADHD medication titration (the process of adjusting medication to find the right balance) waiting list without warning or valid reason, leaving her without specialist monitoring support for around six months. This delay may have affected her symptoms and her ability to carry out everyday activities, causing frustration and distress.  

Ombudsman Paula Sussex CBE added:    

People should not have to fight their way through a confusing system to get ADHD and autism care. We have seen clear evidence that this has created a postcode lottery, with too many people’s access to care depending on where they live.  

 

“The way services are organised has real consequences for people. Patients are navigating confusing pathways, facing long waits, unclear decisions about their right to choose, and inconsistent access depending on where they live. Too many are left feeling they have no option but to pay privately. That is not what good public services should look like.  

 

“I welcome the Government’s commitment to improving support for people with ADHD and autism via an ongoing independent review. Local NHS bodies cannot solve these challenges on their own. The current approach has led to a postcode lottery in care. ICBs need clear national guidance, backed by practical support, to help them balance patient choice, local services and limited resources. Only then can we build ADHD and autism services that are fair, consistent and easier to navigate.”  

Henry Shelford, CEO of ADHD UK, said, "

We welcome the Ombudsman's intervention wholeheartedly. Every day we see a wild difference in care across the country: whether you are seen in months or left waiting for years depends almost entirely on where you live. That is not an accident of demand — it is the direct product of wide variance in how ADHD services are commissioned. Some ICBs commission well; others have failed for years - creating enormous local backlogs.  

 

"Behind every one of these 3,000 complaints is a person whose life is on hold. ADHD is not a trivial condition. Unsupported - it often costs people their education, their jobs, their health and sometimes their lives. When someone finally asks for help, the answer should not be a multi-year wait, a refusal of their legal right to choose, or a referral to a service that has not even opened.  

 

"The Ombudsman has diagnosed the system correctly, and we urge government to follow the Ombudsman's recommendations."