New ZealandHDC complaints · Writing your response
Responding to an HDC Complaint Letter: Structure, Tone and Evidence
A practical writing guide for registered practitioners who have just opened a letter from the Health and Disability Commissioner. What HDC is asking for and by when, what to do before you write a word, a section-by-section model outline, how to apologise, what to enclose, and what happens once you press send.
Reviewed October 2026 against the Health and Disability Commissioner Act 1994, the Code of Rights, HDC's guidance for providers and 2024/25 annual report, and the Medical Council of New Zealand's patient records statement
Short answer: When HDC writes to you about a complaint, it usually wants your account of events, copies of the relevant records and anything you have done since. Get advice from your indemnity provider or union first, keep the records exactly as they are, then write a factual, non-defensive response that answers each concern in turn, apologises sincerely for the person's experience, shows what you have reflected on and changed, and arrives by HDC's deadline. Most complaints close at the assessment stage, so this first letter often decides the outcome.
Key takeaways
- HDC must assess every complaint it receives (HDC Act s 33). Your response is the main evidence it has from your side when it decides whether to close the file, send the complaint back to you, refer it elsewhere or investigate.
- The deadline is the one in HDC's letter. If HDC has given notice of a formal investigation, the Act allows 15 working days for a written response, which the Commissioner can extend. Ask early if you need more time.
- Write for two readers. HDC shares your response with the complainant unless you say otherwise, so tone matters as much as clinical accuracy.
- Answer every concern in the complaint, in the same order, and anchor each answer to the record. Separate what the notes say, what you remember and what your usual practice is.
- HDC recommends a sincere apology and says an apology does not imply fault. Apologise for the person's experience and for any shortfall you accept, without speculating about others.
- Never alter the clinical record. Corrections or additions must be clearly identified, signed and dated, and the original entry left intact.
What the HDC letter is asking for, and by when
Our fitness to practise overview maps the whole route a complaint can take, from HDC to your responsible authority and the Tribunal. This guide zooms in on one moment in that route: the letter on your desk and the response you now have to write.
Under section 33 of the Health and Disability Commissioner Act 1994, the Commissioner must make a preliminary assessment of every complaint "as soon as reasonably practicable" and must tell both the complainant and the provider what it has decided. HDC's Complaints Assessment Team does that work. To assess the complaint fairly, it usually needs to hear from you. That is why most practitioners first hear about a complaint through a letter that encloses a copy of it and asks for a response.
Not every HDC letter asks for the same thing. Read yours carefully and work out which of these situations you are in, because the purpose of your reply changes with each one.
| What the letter says | What HDC wants from you | Timeframe |
|---|---|---|
| HDC is assessing a complaint and asks for your response | Your account of events, the relevant clinical records, and any steps you have already taken. HDC may also seek clinical advice on your care | The date set in the letter |
| The complaint is referred to you to resolve directly (s 34(1)(d)) | Resolve the complaint with the complainant, then report the outcome back to HDC. Your Right 10 complaint duties apply | Right 10 timeframes, plus any report-back date HDC sets |
| The complainant is referred to the Advocacy Service (s 37) | Engage with the advocate and the complainant to try to resolve the concerns by agreement | As agreed through the advocate |
| Notice of a formal investigation (s 41) | A written response to the complaint or subject matter, plus whatever records, policies, internal reports and names of other providers HDC requests | 15 working days, which the Commissioner may extend |
If the complaint has been referred back to you, the task is less a letter to HDC and more a conversation with the complainant, run within the Right 10 timeframes. Our guide to Right 10 complaint timeframes covers that practice-level process step by step. The rest of this guide focuses on the written response HDC asks for when it is assessing or investigating.
HDC is authorised by law to obtain the information it needs, and the Act gives the Commissioner power to require information and documents (s 62). HDC's provider guidance states that supplying what it asks for does not breach patient confidentiality or privacy. If you are unsure what is covered, ask HDC or your adviser rather than holding records back. Our Health Information Privacy Code guide explains the wider rules.
Why this first response carries so much weight
Only a small share of complaints ever reach formal investigation. HDC's 2024/25 annual report shows the large majority were closed after assessment, many by sending the concerns back to the provider or to the Advocacy Service so the parties could resolve them directly. That means the account you give at assessment is often the only account from your side that HDC weighs before it decides.
Health and Disability Commissioner annual report 2024/25 (year to 30 June 2025).
Table 1, Health and Disability Commissioner annual report 2024/25. Other closures included 113 outside jurisdiction, 102 withdrawn and 44 referred to another agency.
Who is writing these responses? HDC's figures by occupation show general practitioners were named most often in 2024/25, followed by midwives, nurses and dentists. The advice below applies whatever your profession, but the examples lean towards the situations those groups meet most.
| Occupation | Complaints, 2024/25 | Where to start |
|---|---|---|
| General practitioner | 314 | Medical Council complaint process |
| Midwife | 105 | Midwifery Council competence review |
| Nurse | 93 | Nursing Council complaint process |
| Dentist | 82 | Dental Council complaint process |
| Psychiatrist | 69 | Medical Council complaint process |
| Orthopaedic surgeon | 60 | Medical Council complaint process |
| Psychologist | 58 | Ethics courses for psychologists |
Before you write: six steps in the first week
The quality of the letter is mostly decided before you start drafting. Practitioners who write a reply the evening the letter arrives, from memory and while upset, tend to produce exactly the defensive response HDC's guidance warns against. Work through these steps first.
- Note the deadline and diarise it
Find the response date in HDC's letter and work backwards: allow time for records, advice and at least one cooling-off read before you send. If you cannot meet the date, HDC's guidance is to contact it immediately. Do not let the date pass and then apologise for lateness.
- Call your indemnity provider, union or professional body
HDC's own guidance suggests your professional association can advise you on responding, and gives the Medical Protection Society as an example for doctors. Nurses may have support through their union, and many midwives, dentists and allied health practitioners have indemnity cover or a professional association that offers it. Most advisers would rather see a draft early than repair a sent letter. Whether you also use a lawyer is your decision; HDC notes that some providers do and many do not.
- Secure the record, exactly as it is
Print or export the complete record for the period in question, including messages, results, letters and audit trails where your system keeps them. Do not tidy, complete or improve anything. The Medical Council's records statement says later corrections or additions must be clearly identified as such, initialled or signed and dated, and the earlier entry not changed or deleted, because doing so "might raise suspicion about covering up an error". Electronic systems often log every edit, so a quiet change is rarely quiet.
- Build a chronology before you build an argument
Lay out every contact in date and time order, with what the record says at each point. Then, in separate columns, add what you personally remember and what your usual practice was at the time. Keeping those three sources apart is what makes a response credible.
- Check who else is involved
If you work in a practice, a Health New Zealand service or another organisation, find out whether HDC has also written to your employer or colleagues. Coordinate so that accounts do not contradict each other, but write your own account of your own care. If there has been an internal review, find out its status, because HDC will want to know.
- Look after yourself
Being complained about is distressing. HDC's investigation guide suggests seeking collegial support, and a trusted colleague, supervisor, employee assistance programme or your own GP can help. Avoid discussing the complaint on social media or with the complainant's family outside any agreed process.
Changing a clinical record after you learn of a complaint can turn a defensible standard-of-care question into a conduct and honesty matter for your responsible authority. If something genuinely needs adding, write a new entry, clearly dated today, that says it is a retrospective note and why. If your notes are thin, our clinical record keeping course is a better long-term fix than any wording in your letter.
The response, section by section: an 8-part model outline
HDC does not prescribe a format, and it describes its tips as guidelines only. But its guidance lists what a good response covers: the key issues, detail on serious allegations, records and a timeline for complex matters, any prior contact with the complainant, any review under way, actions taken, accuracy and tone. The outline below puts those elements into an order that reads naturally for both HDC and the complainant.
Heading and reference
HDC's reference number, the complainant's name as HDC uses it, your name, registration and role, and the date. Address it to the person who signed HDC's letter.
Opening acknowledgement
Two or three sentences thanking HDC for the opportunity to respond, acknowledging the complainant's distress, and stating that you have reviewed the records before writing.
Your background
Qualifications, scope of practice, years in the role, and your relationship to the consumer: how often you saw them and in what setting. Keep it short and relevant.
Chronology
A dated account of each contact, drawn from the record. Quote the notes where they matter and say when you are relying on memory or usual practice instead.
Response to each concern
Number the complainant's concerns in the order they raised them and answer each one under its own heading. Give the most detail to the most serious allegation.
Apology
A specific, sincere apology for the person's experience and for any shortfall you accept. See the apology section below for wording.
Reflection and changes
What you have learned, what you have changed, and the evidence that the change is real: audit results, new templates, completed learning, team discussions.
Closing and enclosures
Any earlier contact with the complainant and attempts to resolve it, the status of any internal review, an offer to meet if appropriate, and a numbered list of enclosures.
How each part answers what HDC looks for
| HDC's guidance asks you to | Where it goes | Practical tip |
|---|---|---|
| Focus on the key issues, with detail on serious allegations | Part 5 | Use the complainant's own words as each sub-heading so no concern is missed |
| Include records and a timeline for complex matters | Part 4 and enclosures | Cross-refer each date to a page in your bundle ("Enclosure 2, p 4") |
| Say whether the complainant raised it with you first | Part 8 | State facts only: dates of contact, what was offered, what happened |
| Mention any internal or external review | Part 8 | If it is unfinished, say when results are expected and offer to send them |
| Describe education or changes arising from the complaint | Part 7 | Attach evidence rather than describing intentions |
| Check dates, times, names and details | Every part | Check every date against the record on a final read |
| Read it from the complainant's perspective | Every part | Ask a colleague outside the situation to read it as the patient would |
- Part 2
- "Thank you for the opportunity to respond to Ms A's complaint. I am very sorry that Ms A has been through such a worrying time. I have reviewed her clinical record in full before writing."
- Part 3
- "I am a registered nurse and have worked as a practice nurse at the Medical Centre since 2019. I saw Ms A on three occasions between March and June 2026."
- Part 4
- "On 4 March 2026 at 10.15 am I took a blood sample (Enclosure 1, p 2). The result was filed to the inbox of Dr B on 6 March. I have no record or memory of seeing it; my usual practice at that time was to check only results addressed to me."
- Part 5
- "Concern 1: 'Nobody told me my result was abnormal.' Ms A is right that she was not told until 2 May. The reasons are set out below..."
- Part 7
- "Since this complaint, the practice has introduced a shared tracking list for results needing recall, which I check twice a week. An audit of recall completion is attached (Enclosure 5)."
- Part 8
- "Ms A did not raise these concerns with the practice before contacting HDC. I would welcome the opportunity to meet her, with a support person if she wishes. Enclosures: 1 to 6, listed below."
Length is a judgement call. A focused complaint about one consultation might need two or three pages plus records; a complaint spanning months of care across several providers will need more. What matters is that every concern is answered and every factual claim can be traced to the record.
Tone: writing for HDC and the complainant at once
HDC's guidance is blunt that a defensive and dismissive response is unlikely to resolve anything. It also reminds providers that the complainant will receive a copy of the response unless you specify otherwise. In practice, write every sentence as if the complainant is reading it over HDC's shoulder, because they probably will be.
HDC's provider pages say that, most often, people want an acknowledgement of their experience, an assurance that preventative action has been taken, and an apology for any inadequacies in the care they received. The same page lists the need for an explanation of what happened among the reasons people complain. A response that delivers those things in a calm, plain voice gives HDC an obvious route to close the complaint or resolve it early.
Don't
- Question the complainant's motives, honesty or mental state
- Rely on jargon or a wall of clinical detail to sound authoritative
- Blame colleagues, the system or the patient without evidence
- Use sarcasm, exclamation marks or loaded words such as "allegedly" and "claims"
- Offer a conditional apology ("I am sorry if she felt...")
- Reargue the whole history when only one concern is serious
- Send the first draft you wrote while angry or upset
Do
- Use plain language and explain any clinical term the first time you use it
- Refer to the consumer respectfully and consistently, as HDC does in its letter
- Acknowledge the impact on the person and their whānau in concrete terms
- Concede points that are right, clearly and early
- Explain your reasoning at the time, including what you knew and did not know
- Mention resource or clinical constraints factually where they genuinely affected your care
- Keep sentences short and paragraphs focused on one point
Rewriting common sentences
| Defensive version | Better version | Why it works |
|---|---|---|
| "Mr C claims I was rude." | "Mr C has described me as dismissive during our appointment on 12 May. I am sorry he left feeling that way." | Restates the concern neutrally and acknowledges his experience before explaining |
| "The standard of care was entirely appropriate." | "I considered a cardiac cause and recorded my reasons for thinking it unlikely (Enclosure 1, p 3)." | Shows reasoning and evidence; leaves the judgement on standard of care to HDC |
| "We are extremely busy and cannot be expected to..." | "That afternoon I was the only nurse on duty for 14 patients. I explain below how that affected the timing of the observations." | Gives specific circumstances, which clause 3 of the Code allows HDC to weigh |
| "I am sorry if Mrs D was upset." | "I am sorry that Mrs D waited four hours without an update. That should not have happened." | Names the specific failing instead of making the apology conditional on her feelings |
Clause 3 of the Code of Rights says a provider is not in breach if it took reasonable actions in the circumstances, which include the consumer's clinical circumstances and the provider's resource constraints. The onus is on you to show that. HDC's provider FAQ confirms you can tell it if resource constraints or the consumer's clinical situation affected your actions. Our Code of Rights guide for practitioners explains how that defence works right by right. The point for your letter is that constraints should be described as facts, not used as excuses.
The apology: what to say and what it means legally
HDC's guidance for providers recommends a sincere apology for the person's experience and, where appropriate, for any distress, together with an acknowledgement of areas for improvement. HDC states that an apology does not imply fault; its purpose is to help resolve the issue. An apology for inadequacies in care is also one of the things HDC says complainants most often want, and it is one of the recommendations HDC can make at the end of a complaint. Offering it yourself, early and genuinely, is almost always better than being asked to.
What a meaningful apology contains
- The words "I am sorry" or "I apologise", said by you, not "the practice regrets"
- What you are sorry for, named specifically: the wait, the missed call-back, the way the news was given
- An acknowledgement of the effect on the person and, where relevant, their whānau
- Responsibility for your own part, without speculation about anyone else's
- What has changed or will change, so it is less likely to happen again
- An offer to meet or talk, if that would help and your adviser agrees
Weak apology
"I regret that Mr E perceived his care as inadequate. I followed all appropriate protocols, and I am sorry if he feels otherwise."
Stronger apology
"I am sorry that I did not explain the risks of the procedure clearly enough for Mr E to make an informed choice. I understand that he felt unprepared for the recovery he faced. I now use a written information sheet and check understanding before every consent discussion."
We could not find a New Zealand statute that gives apologies special legal protection in the way apology laws do in some other countries. The protection you can point to is HDC's own position that an apology does not imply fault, and the purpose of the process, which is resolution and learning. Treat that as reassurance rather than a legal shield: apologise freely for the person's experience and for shortcomings you genuinely accept, avoid making findings about other people's care, and ask your indemnity adviser to check the wording if the complaint is serious.
Where the complaint follows harm, the apology in your letter should be consistent with what was said in any earlier open disclosure conversation. If that conversation never happened, or went badly, our open disclosure training covers how to have it well next time.
Building the evidence bundle
A response is only as persuasive as the documents behind it. HDC can obtain records directly, and in an investigation it typically asks for clinical notes, internal reports, policies and procedures and the names of other providers involved. Sending a complete, organised bundle up front saves time, shows openness and lets the person assessing your care follow your account page by page.
Clinical record
- Complete notes for the relevant period, unaltered
- Results, imaging reports and the date each was received and actioned
- Referral letters, discharge summaries and correspondence
- Medication charts, prescriptions and dispensing records
- Phone, text, email and patient portal messages
- Appointment and booking logs, including missed appointments
Context and change
- Policies and protocols in force at the time, with their dates
- Staffing or roster information where workload is relevant
- Internal review or incident report, or when it will be ready
- Learning completed since, with certificates
- Audit results, new templates or checklists showing change
- Records of any earlier attempt to resolve the complaint
Presenting the bundle
- Number and index everything
Give each document an enclosure number and paginate the bundle. An index on the first page lets the reader find "Enclosure 3, p 7" in seconds.
- Send records, not summaries of records
A typed summary of your notes is useful as part of your chronology, but enclose the original entries too. Where handwriting is hard to read, add a typed transcript clearly labelled as such.
- Mark anything added later
If a retrospective entry exists, say so in the letter and point to its date. Being upfront about a late note is far better than having it found.
- Keep a copy of exactly what you sent
Keep the final letter, the full bundle and proof of the date you sent it.
Reflection and changes made
HDC's guidance asks you to describe any education, or changes to practices, systems or processes, arising from the complaint. This is where many otherwise careful responses fall flat, either because the reflection is generic or because it promises change without evidence. HDC follows up on the recommendations it makes, so concrete evidence of changes already made gives it a fuller picture of where things stand.
Generic reflection
"I have reflected deeply on this complaint and will strive to improve my communication in future. I take all complaints very seriously."
Credible reflection
"On reflection, I relied on Mrs F's daughter to pass on the discharge plan and did not check that Mrs F herself understood it. Since March I have used teach-back with every discharge, and recorded it in the notes. I discussed this complaint at our team meeting on 14 April and the ward has added a teach-back prompt to the discharge checklist (Enclosure 6)."
A useful test is whether a reader could check each claim. "I have completed learning on consent" is weaker than naming the learning, the date and how it changed a specific step in your practice. Where the complaint exposed a system issue, describe what you raised, with whom and when, even if the fix sits with someone else. If this complaint has shaken your confidence or your relationship with the patient or team, reflection on that is legitimate too.
Some practitioners choose structured learning that matches the theme of the complaint and enclose the certificate as part of their evidence of change. If you do, pick learning that fits your own development plan and the specific issue raised, and explain in your letter what you took from it. Our remediation course finder groups options by profession.
Common mistakes that make things worse
These are the patterns that most often turn a complaint that could have closed at assessment into one that runs longer than it needed to.
- Missing the deadline without asking for more time
- Answering the complaint you expected rather than the one actually made, so a concern goes unanswered
- Altering, completing or "tidying" notes after hearing about the complaint
- Writing from memory without checking the record, then being contradicted by it
- Presenting usual practice as if it were a recorded fact ("I would have told her" written as "I told her")
- Attacking the complainant's credibility, motives or family
- Blaming named colleagues instead of describing your own part
- A conditional or legalistic apology, or none at all
- Reflection that promises change but gives no evidence of it
- Contacting the complainant to pressure them to withdraw
- Sending a draft your adviser has not seen when the complaint is serious
Self-check: four tricky situations
Your notes for the consultation are brief. Can you add the missing detail now, since you clearly remember it?
The complainant has described events you are certain did not happen. Should you say they are lying?
Your clinic was badly short-staffed that day. Is it an excuse to mention it?
What happens after you respond
Once your response arrives, HDC completes its assessment. It may share your response with the complainant, ask for more information, or seek independent clinical advice from a practitioner in your field. Our guide to how HDC uses independent clinical advice explains what that adviser looks at. HDC then decides what to do, and must tell you and the complainant.
If HDC decides to take no further action, it must give you its reasons (s 38). If it closes the complaint with recommendations or educational comment, read them as carefully as you read the complaint, and act on them: HDC follows up on recommendations and reported that 91% of those it reviewed in 2024/25 had been complied with. If the complaint is referred to you or to the Advocacy Service, the focus shifts to resolving it with the complainant; where HDC refers it to you, you must report the outcome back to HDC (HDC Act s 35). If it is referred to your responsible authority, that body runs its own process; the hub page explains those pathways, and our guide to employer notifications about competence covers a related route into the same system.
If HDC opens a formal investigation, you will receive written notice and a fresh chance to respond, and much of this guide applies again. Investigations are thorough and slow: HDC says many take two to three years, although simpler ones can finish sooner. Our guides to responding to an HDC provisional opinion and referral to the Director of Proceedings cover the later stages. HDC's decisions cannot be appealed, but HDC can review its own decision, and the Ombudsman or the High Court can review how a complaint was handled.
Frequently asked questions
How long do I have to respond to an HDC complaint?
Use the date in HDC's letter. If HDC has given you notice of a formal investigation, section 41 of the HDC Act allows 15 working days for a written response, and the Commissioner can extend that. If you need more time at any stage, contact HDC as soon as you know, before the deadline.
Will the person who complained see my response?
Usually, yes. HDC's guidance says it shares the provider's response with the complainant, and that they will receive a copy unless you specify otherwise. Write it so that it is respectful and understandable to them as well as to HDC.
Does apologising mean I am admitting I was at fault?
HDC says an apology does not imply fault and that its purpose is to help resolve the issue. We could not find a New Zealand law giving apologies special legal protection, so apologise sincerely for the person's experience and for any shortfall you accept, and ask your indemnity adviser to check the wording if the complaint is serious.
Do I need a lawyer to respond to HDC?
It is your decision. HDC notes that some providers use lawyers and many do not. Many practitioners start with their indemnity provider, medical defence organisation, union or professional association, which can review a draft and advise whether legal input is needed.
Can I send HDC the patient's records without breaching privacy?
Yes. HDC is authorised by law to obtain information to assess complaints, and its guidance says supplying the information it requests does not breach patient confidentiality or privacy. Send what HDC asks for and keep a copy of exactly what you sent.
My employer is responding too. Should we send one joint letter?
Coordinate with your employer so the accounts are consistent and the records match, but write your own account of the care you personally provided. HDC can look at an organisation's systems and an individual's care separately, so it needs to hear what you did and why in your own words.
Should I contact the patient directly after receiving the HDC letter?
Take advice first. If HDC refers the complaint back to you to resolve, contact with the complainant becomes the point of the process. Otherwise, avoid approaching them about the complaint outside an agreed route, and never in a way that could feel like pressure to withdraw it. An offer to meet can be made in your response.
Does my responsible authority find out about the complaint?
Not automatically at assessment, but HDC can refer a complaint to your responsible authority if your competence, fitness to practise or conduct may be in doubt, and it must notify the authority promptly if it investigates a health practitioner. Final investigation reports usually go to the relevant registration body.
Primary sources
12 official documents
- Health and Disability Commissioner Act 1994 (sections 33, 34, 35, 37, 38, 41, 42, 62), version as at 10 July 2026
- HDC: Code of Health and Disability Services Consumers' Rights (clause 3 and Right 10)
- HDC: What if a complaint is made about me?
- HDC: Tips for complaints management, including guidelines for your HDC response
- HDC: Frequently asked questions for providers
- HDC: About the complaint process
- HDC: Formal investigations
- HDC: Guide for providers, HDC's investigation process
- HDC: Timeframes for responding to complaints under Right 10 of the Code (fact sheet)
- HDC: Annual report 2024/25
- HDC: Nationwide Health and Disability Advocacy Service
- Medical Council of New Zealand: Managing patient records statement (December 2020)
