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Selected Investigations Completed April - September 1997 > Foreword
This report contains a selection of 10 reports taken from the 45 reports of investigations completed between April and September 1997. I completed—and started—fewer full investigations in this period than in recent six-month periods. However, my office received more complaints in the first six months of 1997-98 (1172) than in any six-month period before. Many of those had already been considered under the new NHS complaints procedure, which was introduced in April 1996. In some cases, I considered that the most appropriate response from my office was an intervention which prompted the NHS body dealing with the complaint to take further action on it immediately, without the need for a full investigation by me. Between April and September 1997, over and above the 45 full investigations completed, there were 101 cases in which further action was taken locally on the complaint as a result of intervention by my office.
The new NHS complaints procedure encourages local resolution of complaints, but if that is not achieved it allows for a complainant to apply to a "convener" (usually a non-executive director of the NHS body concerned) for an independent review of the complaint by a panel. My last volume of Selected Investigations included four cases where I had found shortcomings in the way the convener arrived at his or her decision. In this volume I include two more such cases: in one (E.515/96-97) my investigation revealed such serious administrative problems and delays that I invited the NHS Executive to consider how the Trust concerned could be assisted to make sure that applications to the convener were dealt with expeditiously and appropriately.
Of the 101 cases in which further action was taken as a result of my office's intervention, the majority were complaints about decisions by conveners. The most common problem was failure by the convener to take appropriate clinical advice. In some of those cases, the complaint was clearly about clinical matters but the convener took no clinical advice; in others, clinical advice was not taken on the professional nursing issues involved, but only on the medical issues; in others, the person from whom clinical advice was sought had already been involved in handling the complaint. In most of the cases, when I drew the omission to the attention of the NHS body concerned they agreed to reconsider the decision. That did not always result in a panel being granted, but it did mean that the complainant knew that his or her request was fully and properly considered, involving an independent clinical view when appropriate. That in itself can be an important remedy.
I found some confusion about the purpose of clinical advice to conveners: it is to advise the convener whether the clinical aspects of the case have been fully and fairly assessed at the local resolution stage. It is not appropriate for either conveners or their clinical advisers to investigate or pass judgement themselves on the quality or adequacy of the clinical care of the patient. I have intervened in several cases where conveners or clinical advisers have become too deeply involved, in effect re-investigating the complaint, and thus have compromised their independence.
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In several cases, my intervention brought an end to delays by conveners in arriving at a decision; in others the NHS body agreed to provide the complainant with a much fuller explanation of the convener's decision, making sure that each point of concern was adequately answered. In one case, where the complainant had received inadequate replies both from a health authority (at the local resolution stage) and from the convener, the health authority agreed to look at the whole matter afresh.
I am encouraged by the willingness of NHS bodies to take action quickly in those cases. That can be a more satisfactory outcome for everyone concerned than a prolonged investigation. However, it is clear from the problems revealed by those cases—and from the two full reports in this volume about decisions by conveners—that there is still some uncertainty about the convening role. In my Annual Report for 1996-97 I identified lessons from the first complaints I had received which had been dealt with under the new NHS complaints procedure. I hope that my office's interventions in specific cases, and the publication of this report, can similarly help conveners, health authorities and NHS Trusts to learn lessons for the future, as the new system settles down.
This volume contains my first report (E.894/96-97) of an investigation of a complaint about an independent review, under the new procedure. I found that the review panel's efforts were nullified by their failure to take clinical advice on a clinical complaint. Another case (E.590/96-97) concerns a Trust's response to the report of an "independent professional review" under the previous clinical complaints procedure. I have included it—and a case about a Trust's handling of a report by an independent panel following a girl's death—because there are common underlying principles, whatever system is in force. It is important for citizens to have confidence that their complaint has been handled fairly, and for them to be told clearly, fully and objectively what has happened about their complaint, and why.
I do not find every complaint to be justified. In this volume I have included one case (E.826/96-97) where, on the basis of the clinical records and other evidence, I supported the account given by staff of the NHS Trust, and did not uphold the complaint. My report of an investigation does not include all the evidence obtained during an investigation. In deciding what to include I satisfy myself that no matter of significance has been overlooked, and reach my findings on the basis of what I consider to be relevant evidence gathered by an entirely independent investigation.
For the first time, this volume includes short summaries of all reports of investigations which I completed between April and September 1997 and which are not reproduced in full earlier in the volume. In 1996-97, I followed my predecessors' practice of including such summaries in my Annual Report. For 1997-98, I am publishing them together with my selection of full reports issued, in order to make them available sooner, and to enable all the investigations completed to be considered together.
The text of this report has been made available through the Internet (www.ombudsman.org.uk), where my office now has its own website. I hope that this will enable more people to study the texts of my reports and draw lessons from them.
Annex I gives a glossary of the most commonly used abbreviations; but it is not comprehensive. In many cases, longer descriptions of an individual or organisation are given in full when they are first referred to, and abbreviated thereafter.
Annex II gives the dates on which the investigations of each of the published cases began and finished.
In this report I have named the health authorities and NHS Trusts against whom the complaints were made. I have maintained the anonymity of those who put their complaints to me, and of individual members of staff.
MICHAEL BUCKLEY
Health Service Commissioner
December 1997 (Ombudsman)
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