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Selected Investigations Completed April and September 1998 > Foreword
This report contains a selection of 11 reports from the 33 investigations completed between April and September 1998. It also contains one report which was completed very shortly after the end of September 1998, and which I have included now rather than holding it back for publication till my next report.
In each of my last two reports I said that my office had received more complaints than in any 6-monthly period before. The first half of 1998-99 established another record - 1,575 complaints compared with 1,488 in the second half of 1997-98. Many of those writing to me had not first made their complaint through the NHS complaints procedure; and my office sent a quick reply encouraging them to do so. Of the others, many matters could be resolved by means short of a full investigation; and if the NHS body concerned agreed to take immediate action to put matters right, I left matters there. In some cases, my clinical staff assisted by providing a fuller explanation of the clinical events than the complainant had received before, and that was enough to resolve matters. I started 64 full investigations during the six-month period, and at the end of September I had 103 investigations in progress - a higher figure than for some time. The majority of those are investigations of clinical matters, which came within my jurisdiction from 1 April 1996. The number of investigations completed was lower than in previous half-years. This is largely because the first group of clinical investigations have taken longer to complete than investigations of alleged maladministration, since they were breaking new ground and required my office to establish new working procedures. Many of them are still in progress. I hope to complete most of them in the second half of 1998-99. It is already clear, however, that many of the investigations my office is now carrying out are a good deal more complex - and require more expert advice - than those that were typical in past years.
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This volume includes, for the first time, reports of investigations about clinical matters in hospitals. Of the four such reports which I have selected, one involved serious failures in medical and nursing care; in another failure to carry out diagnostic tests meant that a patient was not able to have hospice care before she died.
In all investigations about the exercise of clinical judgement - whether by hospital staff or by family health service practitioners - I appoint independent clinical assessors to advise me on the clinical aspects of the complaint. Their reports are included in my final investigation report. I am grateful to all assessors who have helped my office in this way. I should emphasise, however, that the final decision on all aspects of a complaint is made by me, or by one of my senior staff acting on my behalf.
I do not find every complaint to be justified. In this report I have included one case in which, after receiving independent clinical advice, I did not uphold a complaint about diagnosis of a patient's abdominal pain and whether an endoscopy should have been undertaken. In other cases I have rejected criticisms of the diagnosis made by clinicians at a hospital, although I have upheld other aspects of the complaint.
In arriving at my findings on complaints about clinical care in hospitals my concern is to establish whether what happened was within the bounds of reasonable care in the circumstances prevailing at the time. I do not view complaints from an ivory tower oblivious of shortages of resources and the stress under which many hospital staff work. In one case I described as unacceptable a delay in providing anaesthetist attention to a patient, but I did not criticise the staff involved for giving priority to other patients with still more urgent needs.
My last report contained several accounts of investigations against general medical practitioners (GPs); and there are three more such cases in this volume. Two concern the removal of patients from GPs' lists. In my last report I set out the principles which I bring to such cases. I emphasised that my role is not to judge whether a GP contravened his or her statutory terms of service, but whether unreasonable action by the GP caused hardship or injustice. In two cases the GP concerned did not agree to apologise for all the matters which I criticised.
April 1996 saw the introduction of new procedures for handling complaints in the NHS. My office has devoted much time and effort since then to feeding back lessons from complaints to me about the operation of the procedure. I have been encouraged to see those lessons reflected in training and networking events. The Chief Executive of the NHS Executive in England has encouraged me to contact the Executive's regional offices at an early stage if I perceive a worrying trend of similar complaints about a particular health authority or NHS Trust. In this volume, I have included two reports about serious failings in complaint-handling in one London Trust. The Regional Director of the South Thames Regional Office of the NHS Executive has undertaken to monitor this aspect of the Trust's performance. I hope that that will be more effective in bringing about speedy improvements than the production of a special report by me, although if I consider that a particular complaint to me warrants investigation - or the issue of a special report - I shall take that action.
Since 1996, I have had powers to investigate complaints by NHS staff about the operation of the NHS complaints procedure. In this volume I have included one case in which I upheld a complaint by a GP that an independent review panel did not give her a fair hearing in a case where their report criticised her although the complaint was against a colleague.
This volume also contains the first report of an investigation of a complaint about the actions of a general dental practitioner. I hope to include a wider selection of such cases in my next publication.
As in previous reports, I have named health authorities, health boards and NHS Trusts against whom complaints were made. In the case of complaints against GPs or general dental practitioners, I have continued the practice in my previous volume of identifying the health authority (or health board) area in which the practitioner worked, but not naming the individual GP or dentist. However, I reserve the right to name individuals in future if the circumstances warrant it.
In this volume I have continued my recent practice of including short summaries of all investigations which I completed during the period and which are not reproduced earlier in the volume.
The text of this report has again been made available through the Internet (www.ombudsman.org.uk). I hope that this will enable more people to study the texts of my reports and learn from them.
The Annex gives the dates on which the investigations of each of the cases selected for publication in full began and finished.
M S BUCKLEY
Health Service Commissioner
(Ombudsman)
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