PALS Explained: How to Use Patient Advice and Liaison for a Long NHS Wait

What PALS actually is

PALS stands for Patient Advice and Liaison Service. Every NHS hospital trust in England has one. It exists for moments exactly like the one you might be in now: you've been referred, the wait feels too long, the letters have stopped, and you're not sure who to call.

PALS sits inside the trust but works on the patient's side of the conversation. The team is usually small — sometimes just one or two coordinators — and they spend their days translating between booking systems, clinical secretaries, service managers and patients. Their job is to make the system explain itself.

It's deliberately separate from the formal complaints process. Most issues — including waiting list questions, missing appointment letters, and confusion about your Referral to Treatment (RTT) pathway — are resolved informally through PALS, without ever needing to escalate.

What PALS can — and can't — do

What PALS can do

• Confirm where you are on the RTT pathway and what your current "clock start" date is.
• Chase your file with the booking team, clinical secretary or service manager.
• Flag administrative errors (missed letters, wrong contact details, paused clocks, lost referrals).
• Explain how patient choice works at your trust and how onward referral is handled locally.
• Help you understand consultant decisions or appointment letters in plain English.
• Pass on a clinical concern to the right team if your symptoms have changed.
• Signpost you to independent advocacy and the formal complaints route if needed.

What PALS can't do

• Override clinical priority — patients with urgent needs are seen first.
• Guarantee a specific appointment date.
• Make clinical decisions about your treatment.
• Force another trust to accept a referral.
• Speed up genuinely capacity-limited services on their own.
• Act as your legal representative or give legal advice.

When to contact PALS

There's no minimum threshold. PALS exists to be used. That said, the most useful moments to get in touch are usually:

• You've heard nothing for several weeks and your letter said you'd be contacted by a date that has passed.
• Your wait has crossed — or is about to cross — 18 weeks for non-urgent consultant-led treatment.
• You think there may be an admin error: a wrong address, a referral sent to the wrong service, a missed phone call.
• Your symptoms have changed and you'd like the clinical team to know without a full re-referral.
• You're considering patient choice or onward referral and want to know what's possible locally.
• You've left voicemails for a booking team and not had a call back.

If you're unsure whether your wait has passed the 18-week target, our free 18-week calculator gives you a clear answer in under a minute, which is useful information to bring into a PALS conversation.

PALS vs a formal complaint

Patients often confuse the two. They're related but very different in tone, formality and consequence:

• PALS is informal, fast, and aimed at resolution. There's no investigation file, no official process, and nothing to "win" or "lose". Most issues stop here.
• A formal complaint is a structured process with written timeframes, an investigation, and a formal written response from the trust's complaints team. It's the right route for serious concerns or where PALS hasn't resolved things.

A practical rule of thumb: start with PALS for anything you'd describe as "I'm trying to find out…" or "I'm trying to chase…". Move to a complaint for anything you'd describe as "something has gone wrong and I want it formally looked at." Our complaint template covers the formal route in detail.

How to find your PALS team

1. Search "PALS" plus the name of your hospital or trust on Google. Almost every trust has a dedicated page with a phone number and email address.
2. Check the back of any appointment letter you've received — PALS contact details are often printed there.
3. Ask at the main hospital reception. They'll point you to the office or give you the contact details.
4. If you've moved or been referred to a different trust, contact the PALS team at the trust holding the referral, not your local one.
5. If your trust's PALS office is closed or unstaffed, your GP practice manager or local Healthwatch can usually help you find the right contact.

What to prepare before you contact them

A two-minute prep list before you write or call makes a real difference to the response you get:

• Your full name, date of birth and NHS number (if known).
• The hospital, trust and speciality you were referred to.
• The date your GP referred you (your RTT clock usually starts here).
• Any reference numbers from referral letters or appointment letters.
• A short timeline of contact so far — calls, letters, appointments, no-shows from either side.
• A specific question or two. Vague is slow; specific is fast.

What to ask PALS

The clearer your ask, the faster the response. A vague "what's happening with my appointment?" is harder to action than a specific request. Useful things to ask for:

• Confirmation of your RTT clock start date and current waiting time in weeks.
• Whether your pathway is currently active, paused, or closed.
• The name of the service or speciality holding your referral.
• Whether there are any administrative reasons for the delay (lost letter, incorrect contact details, missed validation).
• What patient choice options exist locally, and how to be referred to another NHS or NHS-funded provider.
• Whether you can be added to any short-notice cancellation list.
• If your wait has passed 18 weeks: what the trust's process is for offering an alternative provider.

Suggested wording (email + phone)

You don't need to be formal or apologetic. Calm, specific and short is best. Two starting points:

If you'd like a longer template covering trust complaints and escalation, see our NHS waiting list complaint template.

What to realistically expect

• Within 2–3 working days: an acknowledgement that your message has been received, often with a reference number.
• Within 10 working days: a substantive response — usually confirming your status and any actions taken on your behalf.
• Where things take longer: if your case requires liaison with a clinical team, expect updates rather than instant answers.

A realistic outcome at this stage is information, not a date. Patients often expect PALS to come back with "you're now booked for X". Far more often, they come back with "your clock started on this date, you're at week X, the service has Y on the list ahead of you, and here are your options." That clarity is itself the win — most patients didn't have it before.

It's reasonable to send one polite follow-up after about ten working days if you've heard nothing.

What usually gets better responses from PALS

• One issue at a time. A single, focused query is easier to action than a multi-part one.
• Specific dates and references. Referral date, NHS number, letter dates and reference numbers cut hours of admin.
• Calm, polite tone. PALS coordinators read hundreds of messages a week. Calm ones get full, careful answers.
• A clear ask. "Please can you confirm X" is faster than "I'd like to know what's going on".
• Acknowledging the system. A line recognising service pressures isn't grovelling — it sets the tone of a working partnership.
• Written summaries after phone calls. A brief follow-up email recapping what was discussed creates a clear record on both sides.

What usually doesn't help

• Copying in the chief executive on the first email. It almost always gets routed back to PALS, with extra delay.
• Long, emotional narratives without a specific ask. Your story matters, but PALS needs an action they can take.
• Threatening legal action up front. It changes the conversation from informal to formal and slows everything down.
• Calling daily. A polite follow-up after the published response window is more effective than repeated calls.
• Sharing on social media first. Public posts rarely speed care; private, specific contact does.

What many patients don't realise

• PALS sits inside the trust but is structurally on your side. It's not a customer-service desk — it's a patient liaison function.
• PALS keeps records. Asking them to confirm something in writing creates a useful trail if you ever do need to escalate.
• Most trusts have separate PALS teams for different sites. Contacting the right one (the one holding your referral) speeds things up significantly.
• PALS can sometimes flag a clinical concern internally — for example, if your symptoms have changed since referral. They won't make a clinical decision, but they can make sure the right team hears it.
• PALS won't usually share your concerns with your consultant unless you've asked them to. Many patients worry about this and don't need to.
• You can ask PALS for a written summary of what they've done on your behalf. This is reasonable and routine.

Common misconceptions

• "Contacting PALS will mark my file." No. The NHS Constitution explicitly protects patients from being treated differently for raising concerns, and PALS is designed to be used.
• "PALS is for serious complaints only." The opposite. PALS is for the everyday questions, the chasing, the clarifications. Formal complaints come later, if at all.
• "PALS can book my operation." They can't make clinical decisions, but they can make sure the right people see your file.
• "Going to PALS means I've given up on my consultant." Not at all — most consultants never see a PALS contact unless you've specifically asked them to.

Escalating beyond PALS

Most waiting list queries are resolved at the PALS stage. If they're not, the next steps are:

1. Formal complaint to the trust. The trust's complaints team will respond within set NHS timeframes. Use our complaint template as a starting point.
2. Your Integrated Care Board (ICB). ICBs commission services and can investigate concerns about access and waiting times.
3. Healthwatch. Local Healthwatch teams can offer free, independent support and signpost you to advocacy services.
4. Parliamentary and Health Service Ombudsman. If you've been through the trust's complaints process and remain unhappy, the Ombudsman is the final independent step.

Common questions

See the FAQ section below for short answers to the questions most patients have when they're about to contact PALS for the first time.