NHS Complaints – Step Three – The Health Service Ombudsman

Who is the Health Service Ombudsman?

The Health Service Ombudsman (sometimes known as the Health Service Commissioner) acts as a "final arbiter", to resolve complaints that are not settled at a local level. There are separate Ombudsmen for England, Scotland, Northern Ireland, and Wales (though, at present, the Ombudsman for Wales is the same person who has responsibility for England). Full contact details for each Office are given below. Each Ombudsman is independent of the NHS and the government: he or she is appointed by the Queen, and reports to Parliament.

What cases will the Ombudsman consider?

Except in very unusual circumstances, the Ombudsman will only look at cases once all other avenues (i.e. the other steps listed in this guide) have been exhausted. This means that he or she is only likely to investigate complaints of three types:

• Where you have been denied the opportunity to pursue your complaint locally, for instance if your request for an Independent Review has been turned down
• Where you have followed the NHS Complaints Procedure through Local Resolution and Independent Review, and you still believe that your concerns remain unaddressed
• Where you have been let down by the Complaints Procedure itself: perhaps you have good evidence that the investigation of your complaint is not proceeding in the way - or at the speed - that it is supposed to

The Ombudsman will normally only consider complaints that are referred to him or her within one year of the events that are the subject of complaint. Under certain circumstances, however, the Ombudsman can look at older cases. One example would be where the delay is the result of local investigation of a complaint taking longer than it should.

How do I apply to the Ombudsman to review my case?

The Ombudsman can only consider requests that are made in writing. You can either do this by setting out details of your complaint in a letter, or by filling in a form. Forms are available from each of the Ombudsmen's offices, and you can download them from the relevant website (see contact details, below). Even if you decide to set your case out in your own way, it is worth taking a look at the forms, to see what information you are expected to provide. This will include:

• Your name, address, and any other contact details
• An outline of your concerns: the events that gave rise to your complaint, the way you have been affected, and what your particular concerns are
• Details of the Complaints Procedures you have previously followed, with an explanation of why you consider the outcome to be unsatisfactory

The Ombudsman will also want to receive copies of any relevant documentation you have. This might include:

• Letters you have written to the NHS organisation about which you are complaining
• Responses you have received from the organisation
• Other correspondence and documentation, including the report of any Independent Review Panel that has looked at your complaint

When you have put this information together, send it to the relevant Ombudsman (see contact details, below).

How does an Ombudsman's investigation work?

It is up to the Ombudsman to decide whether to investigate any particular complaint. If, having considered your complaint, he or she decides not to approve your case for full investigation, you should receive a letter setting out the reasons for rejecting your case.

If your case is accepted, the Ombudsman will investigate your complaints in detail. The investigative processes of the Ombudsman are confidential in nature, although anonymised summaries of his or her investigations are published at the conclusion of a case (see below).

Although each Ombudsman has slightly different procedures, he or she will usually start by providing you and the organisation about whom you are complaining with a formal "statement of complaint". This is a document that sets out what the complaint is, and what the Ombudsman will be looking into. The NHS body in question will be asked to respond to the statement of complaint, and to provide relevant documentation (this might include your medical records).

Next, the Ombudsman will want to interview you, and all other relevant parties. These interviews will be held in private, and will be separate (you will not be asked to give evidence to the Ombudsman at the same time as the clinician(s) about whom you have complained). The Ombudsman may also seek advice from experts in the particular field in which you received treatment.  If so, independent experts from outside your area will be chosen.

Once all the necessary evidence has been gathered, the Ombudsman will produce a report, detailing his or her findings and recommendations. You will be sent a copy of this report, as will the organisation about whom you are complaining. If the Ombudsman concludes that your complaint was wholly or partly justified, he or she can recommend that the organisation in question should provide a remedy. This may be a simple apology, or it may be an undertaking to sort something out. The remedy may also extend to a small financial payment, but any amount will be nominal, and certainly will not be equal to the kind of compensation that can be obtained through litigation (suing for negligence).

If the Ombudsman upholds your complaint, he or she will often also recommend steps that should be taken to avoid any repetition of what has happened to you. The Ombudsman has no power to enforce such recommendations, but it is usual for them to be accepted. If the organisation about which you complained tells the Ombudsman that it will make changes, the Ombudsman is entitled to check that they have done so.

Whatever the outcome of your complaint, a summary of the Ombudsman's investigation will be published in the Ombudsman's Annual Report, or in a separate document. This summary will not mention you by name, but will discuss the nature of your complaint, the Ombudsman's findings, and any remedy ordered.

There are no fixed time limits for Ombudsman's investigations, and the procedure can take a long time. As a rule, investigations should be completed within a year, but you should be aware that they can - and sometimes do - last longer. At the least, you should be kept informed of the progress of your case.

What if I disagree with the Ombudsman's findings?

A complaint to the Ombudsman is the last stage in the NHS Complaints Procedure, which means that the Ombudsman's decision is final, and you do not have the right to contest his or her findings. If you remain unhappy about the way your complaint has been handled, you may choose to raise the matter with your MP. In very exceptional circumstances, you might be able to have the Ombudsman's decision reviewed by the High Court.

See also: