terms of service did amount to a vindication of the patient's complaint. Most
importantly, the patient had the opportunity of seeing the person whom they
considered responsible for the problem, being required to account for his or her
actions.
Howmuchofthedissatisfactionwiththeoldprocedurewassatisfactorilydealt
withbytheWilsonreforms?Underthe`Wilson'system,ifpatientsarenotsatisfied
withtheresultofLocalResolutiontheymakeawrittenrequestforanIndependent
Review.Thereisnoautomaticrighttosuchareview.Thedecisionastowhethera
reviewshouldtakeplaceistakenbytheconvenorwhoisusuallyanon-executive
directoroftherelevantHealthAuthorityorTrustBoard.Iftheconvenoragrees,a
review panel will be convened. Membership of the panel will comprise:
. an independent lay chair;
. the convenor;
. in the case of a Trust, a representative of the purchaser;
. in the case of a primary care complaint, for a health authority panel, another
independent lay person.
Thepanelwill,inthecaseofclinicalcomplaints,beadvisedbyatleasttwoclinical
assessors nominated by the regional office, from a list compiled on advice from
relevant professional bodies.
Theprocedureadoptedbythepanelisdecidedbythechaironanadhocbasis
and there is no obligation to hold a hearing. Indeed the thrust of inquiries is to
avoidaconfrontationbetweenthepatientandthosewhomightbethecauseofthe
complaint.
Itwillbeseenthatfromthepatient'spointofviewtheywillbeconfrontedbya
panelthat,apartfromthechair,isnotindependent,comprising,andbeingadvised
by, representatives of the very discipline about which they are complaining. The
problem of lack of independence was therefore, from the patient's point of view,
not satisfactorily addressed; the patient is still left without the right to hear the
evidenceoftheclinicianortotestit,althoughitiscommonforthechairtoagreeto
ahearingofsortsbutnolegalrepresentationisallowed;thereremainsnorightof
appeal; and the patient will never be informed as to what action has been taken
with regard to any practitioner who may have been found to have acted inap-
propriately.
Areport published by the Public Law Project [6] following extensive research
into the working of the new procedure concluded that:
`In the course of our analysis, certain key characteristics of panel hearings
emergedwhichraisedseriousquestionsabouttheirindependence,fairnessand
ability to achieve satisfactory outcomes for complainants.'4.2 The Health Service Commissioner Ombudsman)
TheroleoftheOmbudsman,too,haschangedconsiderably.Until1996hisremit
extended only to complaints about administrative matters and did not include
issues of clinical judgement. This often caused considerable frustration for both
The Complaints Dimension: Patient Complaints in Health Care Provision 53