Ombudsman will rule on clinical complaints

BMJ 1995; 310 doi: (Published 01 April 1995) Cite this as: BMJ 1995;310:824

A move towards patient power took place in Britain last week when the government announced that all NHS doctors and their clinical actions are to be brought within the jurisdiction of the health service ombudsman, who will adjudicate on complaints by patients and their relatives about their treatment.

At present the actions of family doctors, as well as matters of clinical judgment, are outside the ombudsman's scrutiny, which is confined to looking at administrative complaints.

The decision by the health secretary, Virginia Bottomley, to bring all these complaints within a revamped NHS complaints system took most doctors by surprise, and the BMA expressed its concern at crucial points of detail still to be agreed.

The inclusion of general practitioners and clinical complaints within the ombudsman's ambit will be the most radical extension to the office since its inception 23 years ago and will require legislation to bring it into effect.

The ombudsman, health service commissioner William Reid, estimates that he will have to handle an extra 1000 complaints a year, almost doubling his workload.

New “simplified and fairer” NHS complaints procedures are detailed in a booklet, Acting on Complaints. They combine recommendations by Professor Alan Wilson of Leeds University and the Commons select committee on the ombudsman.

Introducing the changes Mrs Bottomley declared the NHS to be no longer a “like or lump it” service. Patients had to be in the driving seat and know how to go about making a complaint.

The new system is due to come into effect on 1 April next year. A two stage process will apply to all complaints about NHS treatment.

Stage one will provide a quick and informal conciliation on the spot in the hospital or surgery or by written explanation within four weeks, with hospitals' responses signed by the chief executive. Detailed complaints procedures for general practice have still to be decided.

Stage two is for complaints that cannot be resolved by the providers of services. It entails a further review by an investigating panel, with a lay chairperson and a majority of members independent of the provider. The decision to convene a panel will be made by the health authority or trust. Independent clinical assessors will advise when needed.

The ombudsman remains at the apex of the system, after the internal NHS procedures have been exhausted. It is proposed to extend the ombudsman's jurisdiction to cover clinical complaints against all NHS staff and against family health service practitioners—namely, family doctors, dentists, opticians, and pharmacists. It will end the present situation, in which all complaints against family doctors are treated as disciplinary matters.

Mrs Bottomley said: “This will make life much better for GPs, whose present system has added to their stress.” Dr John Chisholm, joint deputy chairman of the BMA's general practitioners' committee, broadly welcomed the changes but said that he would have preferred to see a doctor as one of the members of the stage two panel considering complaints in primary care. He viewed the involvement of the ombudsman in matters of clinical judgment “with some concern.”

Overall, the new complaints procedure will be concerned only with resolving complaints and not with discipline. Complainants will have a time limit of one year in which to complain.

Mr James Johnson, chairman of the BMA's consultants' committee, said that he regretted that the government seemed to be moving towards a “more legalistic process.”

“The new proposals appear to contain little to safeguard them from being used to rehearse possible future court action,” he said. He argued that giving NHS trusts the responsibility for organising complaints panels was further evidence of the break up of a “national” health service.

While recognising the need for lay involvement, Mr Johnson said: “Ultimately it is only the independent clinical assessors who can make judgments about clinical decisions taken by other doctors.”—JOHN WARDEN, parliamentary correspondent, BMJ

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