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Selected Investigations Completed April 2001July 2001 > Foreword II
This volume contains reports on investigations completed by my office between 1 December 2000 and 31 March 2001. Part one comprises reports of 96 investigations completed during that period, 29 of which appear in the form of a short report. Of those, 12 appear in full text format in part two of the volume. Reports of all other investigations appear in part one, in the form of summaries. All the material is published on the office's recently re-designed website: www.ombudsman.org.uk. I intend to continue to develop and improve my publications, and will welcome further comments and suggestions from readers about changes they might find helpful.
Themes from cases
In similar volumes published during 2000-01, I drew attention to a number of important issues: the support and supervision of doctors in training; communications between professionals and with patients and their relatives; and aspects of nursing care. This volume contains reports of investigations in which those issues were again sources of concern (for example, E1212/99-00, which was to do with support for doctors in training, and E2220/99-00 (in Part I), to do with nursing care). However, I would like to draw attention to other matters raised by this group of reports. They are to do with effective management of limited resources; co-ordination of care between professionals; communication with patients and their families; and removal of patients from the lists of general medical practitioners.
Effective management of limited resources
I am often asked if the shortcomings I find are the direct result of a shortage of resources. When that is the case, I say so. however, the fact that resources are limited does not automatically exonerate the body concerned from responsibility for poor service or treatment. It is not enough to say, for example, that the ward of clinic was exceptionally busy, if no effective steps had been taken to manage care appropriately in admittedly difficult circumstances. In one case (E.1347/99-00) a failure to administer drugs had serious consequences for a patient. My investigation showed that the ward was indeed very busy; it had recently changed from a ward providing rehabilitative care to one providing general acute care, with no change in staffing levels. This created risks, which needed to be take account of by the ward manager and those responsible for supporting the staff involved. Pressure on resources was a feature of another case (E1212/99-00). Although money had been made available to open additional beds on the ward, staff had not yet been recruited to all the vacant posts. The beds had, nevertheless, been added to the ward complement. The result was that, although medical and nursing staff did their best to care for all those in their charge, there were serious shortcomings in the care of one patient. The same issues arose in a third case (E.2069/99-00); the report of that case also highlights the importance of effective cover for medical staff at weekends at all times, and particularly when services are hard pressed.
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Co-ordination of care between professionals
Two reports in this volume illustrate the importance of co-ordination between different teams of professionals and between members of the same professional team. In the first (E.2266/99-00 in Part I), failures in communication and effective co-operation between the general medical, oncology, and haematology teams led to delay in diagnosis and treatment. in the other (E.1777/99-00), lack of co-ordination between medical and nursing staff led to delay in providing treatment, and to severe discomfort for the patient.
Communication with patients and their families
A number of investigations, reported here in summary form only, were about care that I found satisfactory, but communication with patients and relatives, and explanations about care that were not (E.126/00-01, E.1705/99-00, E.2299/99-00, E.2528/99-00 and E.263/00-01, all in Part I). I have commented before on the importance of effective explanation and communication: poor communications can undermine even the best clinical care and lead to protracted exchanges throughout the complaints process.
Removal of patients from the list of general medical practitioners
Although the proportion of patients removed from the lists of general medical pracitioners remains very low, I am concerned by some of the complaints I receive on this matter. I report five cases in this volume: I upheld complaints in four of them. In three of the cases (E.32/00-01, E.1228/00-01, and E.1934/99-00, all in Part I) practitioners removed patients without discussion with them, and without explanation. Most GPs have accepted the guidance of their professional organisations about good practice in dealing with this sensitive matter. But it seems that some others have not. Members of the public place a high value on their entitlement to primary care services. they are often very distressed when the care to which they are accustomed is withdrawn; and the possibility that it may be withdrawn may deter them from raising legitimate concerns about their care. Removing one patient from a list may have consequences beyond the care of that particular person.
Michael Buckley
Health Service Commissioner for England
(Ombudsman)
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