treatment had taken place. If it had taken place in a hospital then the procedure
under Health Circular /81) 5 applied. This could lead to an `independent'
professionalreviewbyconsultants fromoutsidetheregioninwhichthecarehad
takenplace.Whilstthatprocedurewasdescribedasindependent,patientsdidnot
seeitassuch.Althoughtheconsultantscarryingoutthereviewwerefromoutside
theregion,neverthelesstheywereseenaspartofthehealthserviceandtherefore
likely to support their colleagues. A further problem was that if there was an
allegation of negligence which might have been the subject of litigation, then the
complaint could not proceed.
Ontheotherhand,wherethecarecomplainedofhadtakenplaceinaGeneral
Practitioner's surgery then the complaint had to be made to the Family Health
Services Authority where the procedure was totally different. Here, unlike with
hospital complaints, even if the complaint involved an allegation of negligence it
would still be dealt with.
Secondly there was yet another distinction between types of complaint. If the
complaint was about administration then it could be made to the Health Service
Commissioner±butnotifitrelatedtoprimarycareservicesinrespectofwhichthe
Commissioner had no jurisdiction.
Thirdly,ifthecomplaintrelatedtotheconductofaclinician,itmightamountto
professional misconduct and would therefore have to be made to the General
MedicalCouncilortheUKCCwherethedoctorornursecouldbedisciplined.The
burden of proof of professional misconduct was, however, so heavy for the
complainant that the vast majority of such complaints were rejectedout of hand.
ButthatwasnottheonlywayinwhichahospitaldoctorworkingintheNHScould
be disciplined. His or her employer, the hospital Trust, could itself implement
disciplinary proceedings the result of which could lead to dismissal but not to
removalfrom theregisterwhichwas thepurviewofthe General Medical Council
alone.
Finally, if the complaint concerned damage to the patient who consequently
wished for compensation, then the only recourse was to the courts.
Itcanbeseen,therefore,thatanypatientwishingtocomplainwasfacedwitha
bewilderingarrayofproceduresanyorallofwhichweremutuallyexclusive.Any
oneofthemcouldinvolveaprocessofsuchlengthandcomplicationthatpatients
often did not have the stamina either to commence it, or once they had
commenced, to last the course.
Now,however,thereisanawarenessonthepartoftheprovidersthatthereare
twoethicalaspectstothequestionofcomplaints.Firstlythereisarecognitionthat
howacomplaintisdealtwithcanhaveanimportanteffectonapatientandhisor
herfamily.Itcanbeseenaspartofthecareofapatientandassuchtheobligation
todealwithitproperlycomeswithinthedutyofcareofallhealthcareproviders.
The Chief Medical Officer recognised this in his seminal report on learning from
adverse events in the NHSAn organisation with a memory[2]:
`The processes of dealing with adverse events whichlead to litigation areoften
themselves perceived by patients as further elements of poor care.'
Althoughthisrecognitionisnotyetuniversal,certainlyamongtheleadersinthe
professions the concept, if not its consequences, is a reality and is accepted as
The Complaints Dimension: Patient Complaints in Health Care Provision 49