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Selected Investigations Completed October 1999 and March 2000 > Foreword II
This volume contains reports on investigations completed by my office between 1st October 1999 and 31st March 2000. It contains only reports on English cases. I report on my work as Health Service Ombudsman for Scotland and as Health Service Ombudsman for Wales to the Scottish Parliament and the National Assembly for Wales respectively.
For the first time this volume of reports is being published in two parts. The first consists of single-page summaries (known as epitomes) of key cases, and briefer summaries of the rest. The contents page and an index classify cases by NHS sector and geographical area, and provide a quick reference to the matters investigated. The second part consists of the full, anonymised, texts of the reports outlined in the epitomes in the first part.
Part one is designed for easy and wide distribution. Part two will not be so widely distributed and is in a format intended to be easy to reproduce for educational purposes. Both parts are posted on the office's website www.ombudsman.org.uk
I hope that these changes will make the work of my office more accessible. Before making them I consulted widely among professional and community-based organisations. I am grateful for their positive and constructive response.
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Purpose of publication
In the foreword to my previous volume of Completed Investigations (HC 19, Session 1999-2000) I explained that I published reports for four main reasons:
- together with the Annual Report, to account for the work of my office;
- to provide material for use in education and training;
- to expose reports to public and professional scrutiny and discussion;
- to help promote good practice in the National Health Service.
Themes from cases
The cases reported here arose mainly from events during 1998-99, and cover many issues, including in-patient and out-patient hospital care; out of hours family health services; the work of NHS conveners; and the conduct of independent reviews. Some matters raised by the cases deserve particular attention.
Out-of-hours family health services
I report the outcome of three investigations into out-of-hours family health services (cases E.1329/98-99, E.1927/98-99 and E.616/99-00,). They criticise unacceptable delays in visiting people who had called for assistance; lack of training and support for telephone and administrative staff, and delays in assessing cases by a clinically qualified person. I am pleased that the recommendations arising from the investigations are being taken up by those concerned, and that I am able to contribute our experience of these cases to the Department of Health's review of out-of-hours services.
Procedures that depart from sound principles
Two cases illustrate the need for care when devising local procedures that guide daily practice. The first (E.2041/98-99,) relates to charges for repairs to orthopaedic footwear. The Trust concerned mis-interpreted guidance that precludes charging for repairs arising from usual wear and tear and placed a patient at a considerable disadvantage. I am pleased that the Trust has compensated the complainant, and others like him, but am concerned that the Department of Health declined to write to NHS trusts reminding them of the need to conform with the principles that underlie the guidance on this issue.
The second (E.1450/98-99) relates to action following a 'stick' injury. This is an injury sustained when a needle, scalpel or other contaminated object accidentally pierces the skin. The Trust's policy on such incidents was incomplete. It gave proper attention to the needs of staff, providing a reporting system and access to tests to identify any infection arising from the injury. It did not, however, cover the needs of patients in the same circumstances.
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Maternity services
I report the outcome of three investigations into maternity care in this publication (E.1520/98-00, E.2135/98-99 and E.27/99-00). The cases all raise different issues, but illustrate a trend that is beginning to emerge in my office's work: the proportion of complaints about maternity care is increasing, and these are often complex and difficult cases. With this in mind, I have recently appointed a clinical adviser in obstetrics and gynaecology and added a clinical midwifery manager on secondment to the office's team of advisers.
Removal from the list of a family health service practitioner
Four cases reported are about removals from the lists of family health service practitioners: for the first time, one of them is to do with removal from the list of a general dental practitioner (E.163/99-00,). Although guidance to general dental practitioners on this issue is framed in different terms from that to general medical practitioners, the tests I apply are the same for both. Had the practitioner taken positive steps to try and preserve the professional relationship; was the decision to remove the person from the list a reasonable one; had the practitioner explained his or her reasons to the patient; had the practitioner ensured that any current treatment was not compromised?
Lessons for conveners and the conduct of Independent Review Panels
Thirty-two cases are to do with the way complaints have been handled. As ever, I see examples of very good practice in complaints handling; but I see, too, some poor practice. I am pleased that I, and other members of the office's staff, have contributed to development sessions aimed at conveners, lay chairs, and complaints managers. I believe that my comments, drawn from real cases, about the need to secure appropriate clinical advice at all stages of the process; the need for sound support and training for all those involved; and the need for absolute clarity about (and compliance with) the Directions that govern the complaints procedure and the guidance that should shape processes, have been well received.
Finally, this volume contains a letter that invites readers to tell me whether they find the new format helpful, the use they plan to make of the publication, and how they think it might be improved. Comments and suggestions will be very welcome.
Michael Buckley
Health Service Ombudsman for England (Ombudsman)
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