Ombudsman plans to locate blame in complaints cases

When the British health ombudsman begins investigating complaints about the clinical judgment of NHS doctors this year he intends to consider questions of fault. This is in contrast with the trend in litigation, where most medical negligence claims are settled out of court with no admission of fault or explanation.

In a paper describing his new powers the ombudsman, Mr William Reid, states that legal proceedings, even when damages are paid, provide no assurance to the complainant that any action has been taken to prevent recurrence of the matter complained about. His experience is that securing such action is often a matter of great concern to complainants.

Mr Reid says that it is a “natural and proper concern” of patients to know whether anyone was at fault, and he says that his investigations will address that issue. But he also recognises that clinical decisions responsibly taken can occasionally lead to unintended and harmful consequences for patients, and in his conclusions he will be seeking to be fair to all concerned.

“Without seeking in any way to encourage or promote a ‘blame culture' it is the ombudsman's responsibility to criticise where in his view the patient does not receive the service he is reasonably entitled to expect,” the paper states.

In 20 pages Mr Reid describes how he envisages his wider powers under the Health Service Commissioners (Amendment) Bill now before parliament (9 December 1995, p 1526). He will be empowered to hear complaints against family doctors as well as about the exercise of clinical judgment. Advice on medical, nursing, and midwifery matters will be provided by professional advisers both on the ombudsman's staff and appointed case by case. The ombudsman and his advisers will assess whether the actions complained of were based on “a reasonable and responsible exercise of clinical judgment of a standard which the patient could be reasonably entitled to expect in the circumstances in question.”

They will also consider whether acceptable standards of delegation, accountability, supervision, and support had been shown. The final decision will be the responsibility of the ombudsman.

For his new jurisdiction on family health services Mr Reid has still to decide whether to identify providers, as he already does with health authorities and hospitals. He says that he is disposed to maintain consistency, which would mean that “a measure of identification would emerge.”—JOHN WARDEN, parliamentary correspondent, BMJ