patients and the Ombudsman himself. The Ombudsman had built up an
impressivereputationforobjectiveandfairadjudicationoncomplaintsreferredto
him. Yet in the area in which the most distress was caused to patients, that of
clinicalcomplaints,hewasnotpermittedtointervene.Inlatteryearssuchwasthe
frustration of the Ombudsman with this state of affairs, and the pressure of
patients' representatives, that when the nature of a complaint, though relating to
clinical issues included even a hint of administrative matters as well, he would
often be prepared to consider it.
Now, following the Health Service Commissioner /Amendment) Act 1996, the
Ombudsmanisabletolookatthewholeofacomplaintincludingclinicalcare.His
remitisalsoextendedtocomplaintsaboutFamilyHealthServicesfromwhichhe
was previously excluded. A particularly helpful aspect of his role is that if the
convenor refuses or fails to set up an independent review the complainant can
complaintotheOmbudsmanwhocanthenrequirethatareviewbeimplemented.
There is major scope for the Ombudsman to perform a role that would come
close to the truly independent and objective system that patients require. Unfor-
tunatelythatroleisnotpermitted.Hedoesnotinvestigatecomplaintsunlessthey
have exhausted the rest of the complaints procedure and then only if he, in his
wisdom, considers that maladministration is involved. He is often seen as some-
one to whom an appeal lies in the case of dissatisfaction with the result of a
complaint.AlthoughapplicationtotheOmbudsmancansometimeshavetheeffect
of an appeal that is not his role. His role is still confined to ensuring that the
process takes place in accordance with the rules and spirit of the procedure.
As a result only a tiny number of patients who remain dissatisfied with the
results of the complaints procedure have their complaints further investigated.
Furthermorehisproceduresarenotregulatedinanywayand,whilstpainstaking,
theystillrelyonmedicalexpertswhodonotnecessarilyhavethetrustofpatients.
4.3 Complaints in the independent health care sector
Until recently, patients who were unhappy with any aspect of care within the
independent sector had no recourse to any formal complaints procedure. They
were left to take up their complaint with the hospital administration or the clin-
ician direct. Furthermore, there was no support system available to them as the
remitoftheCommunityHealthCouncilsdidnotextendtotheindependentsector.
The attitude of successive governments appeared to be that as they were not
responsible for treatment outside the National Health Service, problems within
that service were not their concern. This left patients with problems with no
redressandoftentheyweredriventolitigateastheonlywayinwhichtheycould
ensure that their complaint was taken seriously. The numerous problems that
arose with independent care and a number of high profile disasters within that
system led to aninquiry by the Health Select Committee.In its report in October
1999theCommitteestated,inter alia[7],`WeconsiderthatitisvitalthattheNHS
complaints procedureismade more open and transparent and thatthe system is
seen to be fair and independent'.
At last, in 2000 the Independent Healthcare Association introduced a pilot
54 Nursing Law and Ethics