Who is the Health Service Ombudsman, and how can they help?

Who is the Parliamentary and Health Service Ombudsman?

The Parliamentary and Health Service Ombudsman is a role set up by Parliament to investigate complaints where an individual believes there has been injustice or hardship because an organisation has not acted properly or fairly, or has given a poor service and not put things right. The current Ombudsman is Dame Julie Mellor. She makes final, and fair decision on complaints that remain unresolved by, for instance, the NHS and other government or public organisations.

How can the health service ombudsman help me?

If you have gone through the NHS complaints procedure, but you are dissatisfied with the outcome, you can refer the matter to the Ombudsman. The Health Service Ombudsman (also called the Health Service Commissioner) investigates complaints about the NHS and is independent of the NHS.

She investigates complaints where there is evidence that prejudice or hardship has been caused by failure to provide a service; failure in the service itself; or maladministration. Maladministration may include:

  • slow or unsatisfactory responses to letters
  • incorrect or misleading information and advice
  • refusal to give information
  • discrimination
  • rudeness or unhelpfulness
  • failure to follow reasonable rules in procedures and administration
  • poor health services, such as a long wait for treatment or an operation
  • failure to provide a disability aid
  • dirty wards at a hospital
  • unhelpful or inadequate staffing at a hospital
  • complaints about GPs, dentists, opticians and pharmacists working for the NHS, and
  • refusal to provide information to which you are entitled.

The Ombudsman does not have to take up every complaint. Out of more than 29,000 complaints received each year, just over 25% are considered. The Ombudsman will not investigate a case that has not been through the NHS complaints procedure. She will also not usually investigate a case that you could be expected to pursue in the court.

There is no right of appeal against the Ombudsman’s decision, and she will only establish a fresh examination into a grievance if new information is received which could not reasonably have been recognised earlier (this is highly unusual). However, the Ombudsman’s decision and any recommendations cannot be legally enforced.

What is the advantage of complaining to the Ombudsman?

Importantly, the Ombudsman is independent of the NHS and it is a free service. Everyone is treated fairly and impartially, whatever their background or circumstances. In addition, complaints are considered quickly: the Ombudsman aims to give a decision within 20 working days of receiving your complaint.

Complaining to the Ombudsman is an advantageous route where a direct complaint has been unfruitful, and you do not have a legal claim to compensation.

Making a Complaint

You should make your complaint to the Ombudsman within a year of the relevant incident or circumstances (or knowing about the issue/s). However, where more than a year has passed, your complaint may still be considered if, for instance, you were bereaved, or you were too ill to complain earlier; or it took the NHS a long time to consider your complaint.

How to complain?

Write to the Ombudsman explaining in detail why you are unhappy about how your original complaint was handled. You can also complain on behalf of someone else, but you must explain why the person cannot do so and that, if appropriate, you have their agreement. You may be making a complaint on behalf of a child.

What will happen?

The Ombudsman will carry out some initial checks and let you now if you she will take on your complaint. This takes around 5 days. If your complaint will be considered by the Ombudsman, a statement setting out the matters to be looked into will be sent to both the parties. Comments and relevant medical papers will be requested from the hospital, GP, dentist or other NHS service about which you are complaining. The Ombudsman may also want to interview you or other parties, and may ask for independent expert medical advice.

The Ombudsman will then write a detailed report and send a copy to both the parties. She may recommend that you receive an apology, that a decision be altered, that costs be returned to you, or that the service concerned introduces changes in the way it operates.

Cost

Having your complaint investigated by the Ombudsman is free. If you pay for legal help to assist with your complaint, you cannot claim the costs back.