Health: Patients need justice

WHAT HAS become of the health service ombudsman? The ultimate court of appeal for those dissatisfied with their treatment by the NHS - short of going to law - is itself generating an unprecedented volume of complaints.

Six consumer organisations have expressed their discontent with the office of Michael Buckley, the current holder of the post. The National Consumer Council, the Consumers Association and the Association for Improvements in Maternity Services all believe that the interests of patients are being overlooked in the drive for administrative efficiency.

The charge is that, at a time when complaints are rising to record levels, the number being investigated has fallen. In 1995-6 there were 229 investigations completed, in 1996-7 there were 238; but in 1997-8 the total dropped to 120. This fall has occurred just as the ombudsman's remit has been extended into two new areas - clinical complaints and GPs.

The findings show the NHS under extreme pressure. Hospitals are operating so close to the limit of their capacity that when a clutch of emergencies occur at once they can find themselves unable to cope. One man dangerously ill with Legionnaire's disease waited six hours to be transferred to the intensive care unit of a neighbouring hospital, because no anaesthetist was free to insert a tube into his lungs so that he could be ventilated on the journey. However, the anaesthetists escaped criticism because all three on duty were dealing with even sicker patients.

In a second case, a woman with liver cancer was denied an ultrasound test by her surgeon because he did not think anything could be done to save her. The ombudsman criticised the decision because it meant that the woman had been denied the chance of knowing the cause of her illness.

These cases should lead to improved NHS care - but only if they are investigated and publicised. The ombudsman's office says the apparent drop in its case load conceals extra work being done behind the scenes. More complaints are being settled informally with, in some cases, a simple phone call to the hospital involved, an apology and a promise to do better next time.

The argument is that a full formal investigation is neither necessary nor appropriate in every case. Often it is clear what happened, but the complainant has never had it explained in language they can understand. Settling complaints informally is a sensible use of people's time and speeds things up. Setting up a full investigation in every case would be "stupid and wasteful".

Sensible as this sounds, the ombudsman is appointed not only to ensure that justice is done, but to ensure that it is seen to be done. His responsibility does not end with satisfying the complainant; it includes ensuring that the lessons are learnt and errors are not repeated. Visibility is as important as impartiality.

An informal procedure can work only if steps are taken to ensure that those beyond the immediate case learn from the mistakes. The ombudsman must ensure that the work of his office is open and transparent, and his findings are widely circulated.