Health Service Ombudsman
The Health Service Ombudsman is the final stage for the complainant in the NHS complaints process.
If the complainant is still dissatisfied after going through the local resolution stage and Healthcare Commission independent review, they can write to the Health Service Ombudsman and ask for a further investigation.
The Health Service Ombudsman looks into complaints made by or on behalf of people who have suffered because of unsatisfactory treatment or service by the NHS. The Ombudsman also looks into complaints against private health providers, but only if the treatment was funded by the NHS. She can also investigate complaints about other services provided on behalf of the NHS.
The Ombudsman reports to the Select Committee for Health. Any health body who refuses to accept the Ombudsman’s findings and implement her recommendations may be called before the Select Committee.
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Website for the Health Service Ombudsman (external link)
Both posts of the Parliamentary Ombudsman and the Health Service Ombudsman are held by Ann Abraham (external link)
She is completely independent of the NHS and the government. Her services are free.
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Unhappiness about the outcome of the complaints process is not sufficient reason for the Ombudsman to investigate: the complainant needs to provide reasons why they are still dissatisfied and believe that they have suffered hardship or injustice. Practitioners may also complain to the Ombudsman about the NHS Complaints Procedure if they feel that they have been treated unfairly.
Examples of where the Ombudsman could become involved:
- it took too long to deal with the complaint locally
- the complainant was unreasonably refused a panel review
- the complainant did not get a satisfactory answer to their complaint.
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What is the public’s perception of the Ombudsman’s role?
in 2003 the Ombudsman commissioned from MORI, jointly with the Commission for Local Administration in England, a public awareness survey and a survey of advisory organisations. The aim was to find out more about their customers and those whom they do not reach.
The principal findings were:
- a quarter of the members of the public questioned had made a complaint to one of the organisations within the Ombudsmen’s jurisdiction. Of those, 48% were dissatisfied with the final outcome, but only 2% of those subsequently contacted an Ombudsman;
- a further quarter had wanted to complain but could not be bothered, were put off by complaining unsuccessfully in the past, or feared that complaining would make little difference or even affect the standard of service they receive.
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Who can complain to the Ombudsman?
The Ombudsman can consider complaints from
- a patient
- a close member of the family, partner or representative, if the patient is unable to act for themselves
- someone who has suffered injustice or hardship as a result of the actions of the NHS.
If the complaint is made on behalf of a patient, they must explain why the patient is not doing so, and that they have their permission to complain on their behalf.
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Time Limits
The complaint must be sent to the Ombudsman no later than a year from the date when the complainant became aware of the events which are the subject of complaint. However, the Ombudsman is aware that in some cases it can take longer than a year to go through stages one and two of the complaints’ procedure. Even if it has been more than a year, it is worth appealing to the Ombudsman, as her office has the discretion to waive the time limit, especially where local investigation took a particularly long time.
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What the Ombudsman can and can’t investigate
The Ombudsman can investigate complaints against hospitals or community health services which are about
- a poor service: complaints about the care and treatment provided by a doctor, nurse or other trained professional
- failure to purchase or provide a service a person is entitled to receive
- poor administration: such things as administrative failure such as
- avoidable delay
- not following proper procedures
- rudeness or discourtesy
- not explaining decisions, not answering complaints fully or promptly
- significant mistakes over appointments to see a doctor or go to hospital
- poor complaint handling
- misleading advice
- refusal to give you information to which you are entitled.
The Ombudsman can also consider complaints about being struck off a GP's list: in 2002-03 all of these complaints that were investigated were upheld.
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Complaints about long term care
Applying for funding for long term care has been a lengthy hit and miss process and has given rise to an unprecedented number of complaints to the Ombudsman. The Ombudsman received 4,000 complaints since the publication of the Ombudsman’s first report in February 2003. The Ombudsman found when investigating these complaints that mistakes were made and that the Department of Health guidance has not been clear.
On 16 December 2004, the Health Service Ombudsman published a report (NHS funding for long term care: follow up report (HC 144 (2004-2005)(external link) )
The report highlights the need for clear and consistent national guidelines about who is eligible for funding. The Department of Health responded by saying that it will commission ‘the development of a national consistent approach to assessment for fully funded NHS continuing care’
The Parliamentary Health Committee is currently undertaking an inquiry into NHS continuing care. (external link) |
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The Ombudsman cannot look into
- complaints which can be taken to court - unless the Ombudsman does not think it would be reasonable to do so. If the complainant is seeking damages for what happened, only the courts can decide that. The Ombudsman cannot take a complaint at all if the complainant has already started legal action
- personnel issues such as appointments of staff, pay or discipline. The Ombudsman can look into complaints from staff about the way in which a complaint about them by or on behalf of a patient has been handled by a NHS or Trust or other body
- commercial or contractual matters, unless they relate to services for patients provided under a NHS contract
- services in a non-NHS hospital or nursing home, unless they are paid for by the NHS
The Ombudsman does not have to investigate the complaint. It is up to the Ombudsman to decide whether to take up any particular complaint. If the complaint is not to be investigated, clear reasons will be given why.
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In 2003-4 the Ombudsman received a record 4,703 new complaints – an increase of 18% on the previous year, which had itself seen a huge rise in new complaints, many relating to continuing care.
Most (about 90%) of the complaints involved clinical matters. The two largest categories were complaints about in-patient hospital treatment and treatment by GPs. |
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What won't the Ombudsman usually investigate?
There are certain other things that the Ombudsman may not investigate. She will consider whether her intervention would be helpful and whether it would be likely to achieve anything for the complainant. She has discretion whether to investigate a complaint, and exercises her judgment in the particular circumstances of each case.
She will not usually take action if the organisation or practitioner complained against has done all that could reasonably be expected to put things right.
The Ombudsman will not consider a complaint about properly made decisions which an NHS authority or other body or individual providing NHS services has a right to make, even if the complainant does not agree with the decision
She will require some evidence that the decision was wrongly taken - for example that a relevant fact was not taken into account.
Costs
Complainants are not expected to incur any costs in making a complaint to the Ombudsman. The Ombudsman can, however, recommend financial recompense for expenses the complainant has incurred because of faults by the NHS body concerned.
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Complaints about access to information
The Freedom of Information (FOI) Act was passed on 30 November 2000. It gives a general right of access to all types of recorded information held by public authorities, with full access granted from January 2005. There are exemptions to that right and places certain obligations on public authorities.
Under the Data Protection Act (external link) patients have the right to access their medical records and other personal information held about them.
If the complainant has been refused access to their medical records they should complain to The Information Commissioner (external link)
Information Line: 01625 545 745
If they have been wrongly refused access to the medical records of a person who has died, they should put their complaint to the Ombudsman. |
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First steps - local investigation must be completed
Anybody wishing to complain to the Ombudsman must first have put their complaint to the NHS organisation or practitioner concerned, such as the hospital trust, Health Authority, the GP or the dentist.
Many complaints received by the Ombudsman are premature: that is they have not been through the NHS complaints procedure locally at all. In 2002-3, 1665 complaints were premature. The Ombudsman will refer these complaints back for consideration by the NHS organisation or practitioner concerned.
Making the Complaint: Checklist
The complainant should if possible use the form provided on the Ombudsman’s website link to or write a letter.
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Complaints, by law, cannot be made electronically. The complaints form must be printed off.
Health Service Ombudsman leaflets are available in pdf format Arabic, Cantonese, Bengali, Gujerati, Hindi, Punjabi, Urdu, Greek, Turkish and Vietnamese (external link) . There is also a symbol version of the leaflet (external link) and form (external link) compiled by Mencap and a large print version of the leaflet, complaint flowchart and form (external link). English, Braille, cassette and symbol versions of the leaflet are also available from the Ombudsman’s office. |
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The form sets out what information the Ombudsman will need to know. The complainant should make sure to
- describe what happened, when, where and (if possible) who was involved
- say why this is the basis for complaint. This means demonstrating that there has already been hardship or injustice
- provide all the evidence available. Send all letters and any background papers. If originals are sent, photocopies will be taken (at no cost) and the originals will be returned promptly
- if possible, include a daytime contact telephone number.
Ombudsman’s checklist
http://www.ombudsman.org.uk/hse/england/contacts.html (external link)
Is the complaint about an NHS service? |
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Yes |
No |
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No |
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Yes |
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Have you complained to the organisation or practitioner involved? |
No |
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Write to them, detailing your complaint |
Yes |
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Have you requested an independent review of your complaint? |
No |
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Write to the Trust or Health Authority involved, asking for an Independent Review |
Yes |
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Was the review wrongly refused or badly run? |
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Yes |
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Fill in the form (external link) or write us a letter about your complaint. we may be able to help you. |
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First stage: the decision to investigate
When the complaint is received by the Ombudsman, a decision will be made on whether or not an investigation will be carried out.
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The Ombudsman will usually acknowledge receipt of a complaint within two working days. Whilst they aim to respond to most correspondence within 18 days, a letter with the decision on how they are going to deal with the complaint may take up to two months. This will depend on the complexity of the complaint. |
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The letter will be passed to one of the Ombudsman's staff, who will look at the complaint in detail and decide whether or not they can take it further. In order to make that decision, the Ombudsman may need to see the medical records and other papers surrounding the complaint. All information will be kept strictly confidential. If the complaint is about clinical care, one of the Ombudsman’s clinical advisers will look at the complaint.
If the Ombudsman cannot look into the complaint or decides not to, you will be told why.
There are three ways that the Ombudsman resolves complaints, depending on the circumstances of each case:
- detailed letter: as a result of their analysis of the evidence and the clinical advice they receive, they could send a detailed letter explaining exactly what happened and why
- a request for the NHS to take further action: the Ombudsman may ask the NHS organisation or practitioner concerned to take some further action to resolve matters. The complainant is told about this and invited to return to the ombudsman if the matter is not resolved to their satisfaction.
 The complainant must return to the ombudsman within a year
- a formal investigation
How will the Ombudsman investigate the complaint?
If the complaint is accepted for investigation, the Ombudsman will send a statement of complaint which will set out which matters the Ombudsman will look into. A caseworker will be appointed to investigate the case.
The caseworker may ask to interview
- the complainant
- NHS staff
- any other relevant witnesses
at a convenient time and place. The complainant can have a friend of their choice with them. The Ombudsman's investigator may then interview others concerned.
If the complaint is about treatment provided by doctors, nurses or other professionals, independent clinical advisers will be available to help the Ombudsman with the investigation. They will look at all the relevant records, and may informally interview some or all of those concerned. Interviews are carried out in private. They are usually informal, although the Ombudsman has the same power as the civil courts to obtain evidence. This means that even if witnesses do not want to be interviewed, they can be required to attend.
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Be prepared for a long wait!
Investigations by the Ombudsman are very thorough and detailed, and this can be a lengthy process, often taking up to a year from start to finish. The investigation is likely to take at least nine months. Some cases have been known to take even longer. If the complainant is suffering from a life limiting illness, you need to ensure that the Ombudsman is aware of this fact when the complaint is referred to her office so they can “fast track” the complaint. |
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The report: findings and recommendations
At the end of the investigation the complainant will be sent the Ombudsman's report. A copy is also sent to the NHS or other body responsible for the matters complained about. If the complaint is found to be justified, the Ombudsman will seek an apology for the complainant or another remedy. Sometimes that may include getting a decision changed, or repayment of unnecessary costs to patients or their families. The Ombudsman does not recommend damages.
The Ombudsman may also call for changes to be made so that what has gone wrong does not happen again. Where the body complained about tells the Ombudsman that it will make such changes, the Ombudsman checks that they have done so.
Learning from complaints
NHS bodies are expected to feed the results of the Ombudsman’s investigations into their improvement processes, and so reduce the risk that the same problems will happen again. Any NHS body who refuses to accept the Ombudsman’s findings and implement her recommendations may be called before the Health Select Committee, and this can be a daunting prospect. The Health Select Committee can ask GPs to attend a public hearing and question him or her about their conduct.
In terms of complaints handling, however, experience from the Ombudsman indicates that her recommendations may not change things immediately.
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“Time and again, I have seen examples of poor complaint handling by NHS bodies. Moreover, some health bodies have accepted my recommendations for improvement but continued to handle complaints badly. Where we have seen pockets of bad practice a common feature of the organisations involved is the lack of leadership and attention given to these important matters by chief executives and the senior management. This cannot continue and my Office will be working closely with the Department of Health and the NHS to ensure that the lessons we have uncovered are embedded in changes in behaviour.”
Extract from Health Service Ombudsman 2004 report (external link)
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Where the Ombudsman investigates a complaint, this will be reported in her regular (anonymised) reports to Parliament.
Is there any appeal against the Ombudsman's decisions?
No. A complaint to the Ombudsman is the final stage in the procedure for pursuing a complaint. The Ombudsman's decision on a complaint is final. If completely new information comes to light which could not reasonably have been known about before, the Ombudsman may start a new investigation. That is extremely rare.
Next: Supported closure
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