applyingnotonlytothoseeventswhichleadtolitigationbuttothosewhichelicita
complaint as well.
Secondly,thereisarecognitionthatcomplaintshaveamajorroletoplayinthe
improvement of health care; that they are jewels to be treasured' ± they show, more than anything else, the shortfalls in the system. At the same time, patients have at last come to recognise that the provision of healthcareisaservicewhich,ifnotexactlythesameasanyotherservicesuchas theprovisionofelectricity,isneverthelesssomethingtheyareentitledtoreceiveat areasonablestandard.Ifthatstandardisnotattainedtheyarefarmoreprepared to complain without feeling that they are undermining the NHS. Insofarasthelawisconcernedthecomplaintsprocedurehasstartedtobecome an integral part of the legal process. It features both in the pre-action protocol /discussedinChapter5)whereitissomethingthatshouldbeconsideredbeforea claimant is advised to take legal action [3]; and it features strongly in the Legal ServiceCommission'sguidanceinclinicalnegligencecaseswherepublicfunding may not be granted if resort has not been made first to the NHS complaints procedure. There is little doubt that since the first edition of this book complaints have comecentrestageintheNationalHealthServiceandhaveevenbeguntomakean impact in the independent sector. It is not within the scope of this chapter to describeindetailallthereasonsforthis.Neverthelessitwouldnotbeappropriate to ignore entirely the three main causes. The first is the approach of the govern- ment. Itisgovernmentpolicytoinsistthatthecitizenisentitledtoexpectagood serviceinallpublicareasandtocomplainiftheydonotgetit.Itisthegovernment itselfthathasinsistedthattheHealthServiceshouldinthisrespectbetreatedlike any other service. The second is the high profile disasters that have received such prominent reportinginthemedia,abovealltheBristolRoyalInfirmarytragedy.Thatdisaster involved theavoidabledeaths ofabout 35babies and ledtoapublic inquirythat lasted more than two years. TheBMJeditorial in June 1998, commenting on the tragedy,startedwiththewordsAllchanged,changedutterly'.[4]Totheextentthat
thatbroughtrealisationtothewiderpublicthatdoctorscouldbechallenged,that
statement was absolutely correct and this has influenced attitudes towards
complaints ever since. It is an irony that, whilst Action for Victims of Medical
Accidents /AVMA) had by then dealt with over 25,000 adverse events, some
equally devastating for the families concerned and involving at least as bad
behaviour on the part of the doctors concerned, it was only after Bristol, which
involvedonly24incidents,albeitofthemostdistressingkind,thatthepublic,the
media, the healthcare providers and the government began to take the matter of
adverse incidents really seriously.
The third reason for the increased importance of complaints is the change in
approach that was recommended by the Wilson report. Whilst fundamental
problems remain with the way complaints are dealt with, nevertheless both the
underlying principles for a proper complaints procedure proposedby Wilson[1]
and the new procedure itself have led to changes in the way complaints are
perceived.
It will be seen below that the new procedures introduced as a result of the
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