Health Service Ombudsman
This page contains information about the Health Service Ombudsman, including:
What it does
Advantages and disadvantages
Which complaints are eligible?
Which complaints are not eligible?
Complaints about health care in prisons
Cost
Timescale
Making the complaint
Getting information about the NHS
Procedure
Outcomes
What it does
The Health Service Ombudsman investigates complaints about the National Health Service (NHS) in England. The Health Service Ombudsman covers NHS hospitals, trusts and health authorities, GPs, dentists, opticians, pharmacists and other providers (including private health care) where the service is paid for by the NHS.
Complaints about NHS provision in Wales are dealt with by the Public Services Ombudsman for Wales, and in Scotland by the Scottish Public Services Ombudsman. Complaints about health services or about the Department of Health and Social Services in Northern Ireland are considered by the Northern Ireland Ombudsman.
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Advantages
- it is independent of the NHS
- it aims to treat everyone fairly and impartially, whatever their background or circumstances
- it is confidential for individual complainants
- it is free
- a complaint can be fully investigated
- it is a good way to get an investigation into common problems that affect a wide range of people
- it can lead to improvements in complaints handling and other procedures within the NHS
Disadvantages
- it can take a long time to investigate a complaint
- you have to complain to your local health provider first
- you won’t get the same level of damages or compensation that you would in court
It is important to remember that the ombudsman will not act as the "patient's champion", any more than she will serve as defender of NHS staff. She is independent, and until she has investigated and reached a conclusion on the complaint, she does not take either party's side.
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Which complaints are eligible?
The ombudsman can consider complaints about care, treatment and other services provided or paid for by the NHS. This will include:
- the wrong treatment
- poor treatment
- errors in diagnosis or treatment
- significant mistakes over appointments to see a doctor or go to hospital
- failure to provide or pay for a service such as continuing care
- delay that could have been avoided
- faulty procedures, or failing to follow correct procedures
- unfairness, bias or prejudice
- giving advice which is misleading, or inadequate
- rudeness, and not apologizing for mistakes
- not putting things right when something has gone wrong
The Health Service Ombudsman can’t look at complaints about private health care in non-NHS hospitals or nursing homes. Nor can she investigate complaints about staff matters such as pay or recruitment. Also, the Ombudsman is not allowed to investigate a complaint if you have taken – or intend to take – legal action.
Most of the complaints received involve clinical matters. Of these, two of the largest categories are complaints about in-patient hospital treatment and treatment by GPs. The ombudsman can also consider complaints about being struck off a GP's list. Recently, the Ombudsman has dealt with a lot of complaints about payment for continuing care in nursing homes. There is a very helpful guide on the Health Service Ombudsman website about this issue.
From April 2009 there are two stages to making a complaint about NHS health care.
- The first stage is to complain to the service provider – your doctor, dentist or hospital. If you don’t want to complain to them directly, you can complain to you local Primary Care Trust instead.
- If your complaint is not resolved at local level, you can go to the Health Service Ombudsman.
You can get help and advice with how to make a complaint about the NHS from the Patient Advice and Liaison Service PALS.
Complaints should usually go to the ombudsman within a year of when you became aware of the problem. The time limit can be extended in special circumstances, such as where the local complaints procedure took longer than it should have done.
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Which complaints are not eligible?
A lot of people go to the Health Service Ombudsman too early in the complaints process. Last year, fewer than half of complaints were taken on by the scheme. This is for a range of reasons, including:
- The complaint has come to the wrong ombudsman
- It hasn’t gone through the local complaints procedure yet
- There are court proceedings about the same complaint
- The complaint is about private, not NHS, treatment
From 1st August 2007, the three public sector ombudsmen in England have been able to take on joint investigations of complaints that cover two or more different ombudsmen. This is particularly relevant in cases of continuing care, where the NHS and the local authority are often both involved in the decision about funding. You can approach either the Health Service Ombudsman or the Local Government Ombudsman with your complaint, and they will ask for your permission to involve another ombudsman service if they think it will help with the investigation.
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Complaints about health care in prisons
Complaints about healthcare in public prisons in England should follow the local complaints procedure for the Primary Care Trust. If you are not happy with the way the complaint is dealt with at a local level, you can go to the Health service Ombudsman. Where complaints include problems with health and other issues in a prison, you can call the ombudsman helpline on 0345 015 4033 to check which ombudsman you should take your complaint to.
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Cost
The scheme is free. But if you pay for legal advice or representation to help with the complaint, you can’t claim back the costs.
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Timescale
In 2007-08, 53% of complaints were dealt with within six months, and 92% within twelve months. Figures from 2008-09 are not comparable becasue of the change in the NHS complaints procedure over the last year.
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Making the complaint
The best way to make a complaint is to call the ombudsman’s helpline on 0345 015 4033 to talk to someone about whether the complaint is suitable. If you like, the helpline staff will take the details over the phone and complete the application form for you to sign.
If you prefer, you can apply using the form on the Health Service Ombudsman website.
You can get help and advice with how to make a complaint about the NHS from the Patient Advice and Liaison Service PALS.
If you decide to go ahead with making a complaint, you can get independent advice from the Independent Complaints Advocacy Service (ICAS). The helpline numbers for different areas in England can be obtained from the ICAS map on the Department of Health website.
Note: The complaints form includes a question about whether you intend to take legal action. The ombudsman is not allowed to take on complaints where a claim is being taken through the courts. If you take your complaint to the ombudsman and you are not happy with the outcome, you can still consider legal action afterwards.
It is a good idea to get independent legal advice before you choose which route to go down – ombudsman or court. The ombudsman cannot award large amounts of compensation or damages in cases of clinical negligence, but the court can. So if it is important to get enough money to pay for ongoing care, then it is likely to be better to take court action.
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Getting information about the NHS
The Freedom of Information Act 2000 gives individuals a right to ask for any information that public bodies hold. It also requires public authorities to have publication schemes that make it clear what information is publicly available.
Complaints about refusal to provide information can be taken to the Information Commissioner.
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Procedure
Early resolution
If your complaint is accepted by the Health Service Ombudsman, the first stage will be to try to resolve the complaint informally. The ombudsman may advise you that the response you already have – an apology or an explanation – is appropriate, and you would not get anything different after an ombudsman investigation. Or the ombudsman may advise the local NHS provider to offer a particular remedy, and they agree to do so.
Investigation
If you can’t reach an agreed solution with help from the ombudsman’s office, then the ombudsman may decide to investigate the matter further. A caseworker from the ombudsman office will talk to you about what has happened, and what you would like to achieve. Your complaint will be sent to the body you are complaining about, and they will be invited to respond to what you have said.
All documents, including medical records, are kept confidential.
The investigation officer allocated to the case will keep in close touch with you throughout the investigation. He or she will ask to see all the relevant files, and may interview you and anyone else involved who can help with evidence. Although these interviews are informal, the ombudsman has the same power as the courts to obtain evidence. This means that even if witnesses are reluctant to be interviewed, they can be required to do so.
The ombudsman also has independent clinical experts to offer advice about the case.
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Outcomes
When the investigation has been completed, the ombudsman writes a report which is sent to you and to the NHS provider you have complained about. If the ombudsman has found the complaint to be justified, the report will state what remedies the ombudsman is recommending. The ombudsman's recommendations are based on reasonableness, equity and common sense, not on strictly legal criteria.
In the year 2008-2009, 40% of complaints were upheld in full, and 8% in part: 52% of complaints were not upheld. This is very little different from the previous year. However the vast majority of complaints have been about the Healthcare Commission (79.8%) or Strategic Health Authorities (9.5%). The new two-tier complaints system will mean that the 2009-10 results will look very different, as complaints will be about doctors, dentists, hospitals or primary care trusts.
Remedies
Remedies may include:
- an apology
- an explanation of what went wrong
- getting a decision changed
- repaying costs incurred by the complainant as a result of the mistake/mishandling
- changes in procedure
- improvements in facilities
- consolatory payments in respect of distress or inconvenience
The ombudsman will check that recommendations have been complied with.
There is no appeal against the ombudsman's recommendation, but you can take your case to court if you are still unhappy with the outcome. If new information comes to light after the report has been issued, the ombudsman can decide to re-open the investigation, but this is rare.
Ombudsman reports
The ombudsman publishes annual reports which give an overview of the cases handled during the year, details of the time taken to deal with complaints, and some examples of the types of cases which have been investigated. The reports name health authorities and trusts involved in the complaints reported on. The reports do not name general practitioners but identify their practices as being in a particular geographical area.
The only time an individual practitioner is identified by name is when he or she has failed to apologise for a shortcoming found by the ombudsman or has failed to implement a recommendation.
Special reports
The ombudsman also publishes special reports which highlight a particular issue which appears to be of widespread concern. For example, in February 2003 the ombudsman published a special report on NHS funding for long-term care for the elderly. This followed a cluster of complaints about the ways in which health authorities applied their eligibility criteria for full NHS funding for the long-term care of older and disabled people. For her investigation the ombudsman used four test cases. She concluded that mistakes were made and that the Department of Health guidance had not been clear. As well as recommending compensation and apologies in these cases, the report also recommended action for strategic health authorities and the NHS to improve their guidelines. The Health Service Ombudsman website gives information about making local complaints about funding for continuing care, and details of how to take a complaint about this to the ombudsman if it is not resolved. Over the last year 85% of complaints on this subject were upheld in full or in part.
Advisers are particularly encouraged to put cases forward to the ombudsman where they represent a general problem which needs investigation.
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June 2009
Figures revised August 2009
