Alternatives to Litigation: Patient Advocacy: PALS, ICAS, etc.

PALS: Patient Advice and Liaison Service

What Is PALS?

Every NHS Trust is now required to provide a Patient Advice and Liaison Service (PALS).  PALSs are intended to provide friendly, on-the-spot help where a patient needs information, or has developed concerns about his or her treatment.

The role of PALS staff is, wherever possible, to seek speedy resolutions to any problems that are brought to them.  Trusts recognise that many patients' problems escalate into complicated and unpleasant disputes when they could have been sorted out at an early stage.  PALS officers are employed to make this kind of early resolution possible, by listening to patients' concerns, and helping to find a solution.

It is important to understand that PALSs are not independent, and are not meant to be.  PALSs are paid for, managed by, and answerable to the NHS organisations with which they deal.  They are expected to resolve problems before they turn into out-and-out conflicts and, to this extent, they benefit Trusts by reducing the number of formal complaints they have to deal with, and the number of legal claims they face.  This is not to say that PALSs are there to handle patient concerns by "sweeping them under the carpet": an efficient PALS will work hard to resolve what problems it can, and has a responsibility to refer patients on to other sources of support, if their concerns cannot be sorted out quickly and easily (see below).

What Kind of Problems Can PALS Help With?

Although PALSs can be a good starting point for any kind of patient concern, it is probably fair to say that PALSs are at their most useful when dealing with relatively minor problems.  Circumstances under which you might consider approaching your local PALS include where:

  • You are unhappy about an aspect of your treatment, but you don't want to make a fuss;
  • You feel "in the dark" about your treatment: you have questions, but you don't know where to get the answers;
  • You want to have your feelings heard, but would feel uncomfortable about complaining directly to those who are treating you; or
  • You want to give general feedback (good or bad).  Perhaps you might want to make a suggestion about how your experiences could be learned from to improve other people's experience of healthcare in your area.

PALSs' lack of independence can be a positive benefit.  It makes them ideal for some situations, because they know all about the way in which healthcare is delivered in your area.  As colleagues, PALS staff are likely to be listened to by clinicians, managers, and other staff in the Trust for which they work.  They may well already have a working relationship with the clinician(s) about whom you are unhappy, which means that they can put your point of view across without any fuss and without causing undue ill-feeling.  Trusts are also keen to use their PALSs as an "early warning system", so that they get to hear of the kind of issues patients are raising, and can take steps to address any problems that are resulting in multiple complaints.

What If PALS Cannot Solve my Problem?

Sometimes, it will be clear that your concerns need to be addressed by someone who is not answerable to the organisation about which you are unhappy.  It is part of a PALS's job to direct patients to sources of independent advice and support (they are said to provide a "gateway").  This means that, if it becomes clear that your problems are not going to be solved by PALS, they should help you to get in contact with someone who can help you to take things further.  The most appropriate source of further support will vary from case to case, but one direction in which you might be pointed is that of your local Independent Complaints Advocacy Service (ICAS - see our guidance).

Where Can I Find PALS?

PALSs are supposed to be as easy to find as they are simple to use.  Because each PALS is associated with an NHS Trust, the first thing you need to know is which Trust your treatment was provided under:

  • Hospital treatment: you can find out which Trust oversees the hospital at which you have received treatment on the NHS's website (see the links section at the end of this page).
  • GP / Community treatment: Every GP, NHS dentist, and community healthcare practitioner (health visitors, etc.) is responsible to a regional Primary Care Trust (PCT).  You can find out which PCT oversees your area on the NHS's website (see the links section at the end of this page).

Having identified the appropriate Trust, you can telephone the main switchboard, and ask to be put through to the PALS department.  You may be able to find specific contact details, and other information, by exploring the website of the Trust in question; you should see a link to the Trust's site if you look it up on the central NHS website, using the methods above.

You may also choose to make contact with your PALS in person.  In big hospital Trusts, the PALS office will often be based in the main hospital, and there will be signs up showing you where to go.  In PCTs, it might take a moment longer to find out where to contact the service, but it should be straightforward enough: ask any member of staff (perhaps a receptionist), and they should be able to provide details.