COMPLAINTS, REMEDIES AND THE HEALTH SERVICE COMMISSIONER
| Published date | 01 September 1993 |
| DOI | http://doi.org/10.1111/j.1467-9299.1993.tb00980.x |
| Date | 01 September 1993 |
| Author | PHILIP GIDDIES |
COMPLAINTS, REMEDIES AND THE HEALTH
SERVICE COMMISSIONER
PHILIPGIDDIES
The Government’s Citizen’s and Patient’s Charters see the Health Service Commissioner
scheme playing an important part in
securing
effective remedies for complaints about
administration in the
NHS.
The scheme
is
assessed against the background of the frag-
mented nature of the
NHS
complaints systems. Because of jurisdictional limitations the
Commissioner can only deal with
a
small proportion
of
NHS
complaints.
An
analysis of
HSC
cases between
1986
and
1991
shows that it is those about complaint-handling itself
which have been most frequently upheld. The most frequent remedy achieved is an
HSC-
delivered apology, which is not always found satisfactory, but the
HSC
places equal
emphasis on providing a ‘quality audit’ and feedback mechanism for health authorities.
If
the
HSC
is to play the role implied by the charters,
it
will be necessary to consider
removing the limitations on his jurisdiction which exclude clinical judgement and the
work of family practitioners.
An
important principle enunciated in the government’s Citizens’ Charter (Cm. 1599,
mw,
July 1991) is that ’every citizen is entitled to expect that public services should
have a well-publicized and readily available complaints procedure’. The section
of
the charter dealing with ’Complaints and Redress‘ cites as an example the com-
plaints procedures of the National Health Service
(NHS).
It points out that the Health
Service Commissioner
(m)
is available as a back-up for complaints of a non-
clinical nature, implying that the
HSc
fulfils the requirement for an independent,
external route for complainants who are dissatisfied with the way in which their
grievance has been dealt with internally. Subsequently, the
W’s
Patient’s Charter
(Department of Health
1991)
has underlined the importance of effective complaints
mechanisms by including their availability as one of
three
‘new Charter rights’
introduced from
1
April 1992.
In
elucidation of this new right, the Patient’s Charter
states (p.
11)
that
’If
you are
.
. .
unhappy with the way your complaint about the
administration of an
NHS
service has been handled, you have the right to take the
matter up with the Health Service Commissioner‘. Furthermore, regional and dis-
trict health authorities are required by the Patient’s Charter to make available
Philip Giddings
is
Lecturer
in Politics, University
of
Reading.
Public Administration
Vol.
71
Autumn
1993 (377-394)
0
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1993,108
Cowley Road, Oxford
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USA.
378
PHILIP GIDDINGS
information about how to complain about
NHS
services. Given the importance
attached to the
HSC
scheme in both the Citizen’s and Patient’s Charter, the time
is
apposite for an assessment of how effectively the scheme has provided complain-
ants with a remedy for their grievances.
When the
I+%
scheme was introduced in
1974
it was modelled on the Parliamen-
tary Commissioner for Administration
(PCA),
itself a variant on the Scandinavian
concept of an
ombudsman.
The British adaptation of that concept has, in the case of
the
KA,
been firmly rooted in parliamentary mechanisms with his status as an
Officer of the House of Commons, with
MPs
as the route through which cases come
to
him
and a Select Committee established to oversee the workings of the scheme
(Gregory and Hutchesson
1975).
Nevertheless, both the
PCA
and the
HSC
retain the
character of an ombudsman as a non-partisan official, independent of government,
with power to investigate specific cases
of
alleged administrative injustice, able to
criticize the administrative action(s) and propose remedies for the injustice suffered,
but not able directly to enforce
his
recommendations.
COMPLAINTS PROCEDURES IN THE HEALTH SERVICE
Before we examine the
HSC
scheme in detail, as it
is
only one of several complaints
procedures operating in the health service, we must first set the context for the
Hsc
by describing
in
outline the other parts of the complaints ’system’ of the
NHS.
This
will be considered under three headings
-
family health services; hospital and
community health services; and professional conduct. Even though there are signifi-
cant differences applying in Wales, Scotland and Northern Ireland, for simplicity’s
sake the arrangements will be described as operated in England, since the purpose
is
to set the context for the
HSC
scheme, not to gve
an
exhaustive account
of
the
different varieties of complaints procedures.
For
family
health
service
complaints
one must distinguish between formal and
informal procedures. The formal procedure for dealing with complaints
is
governed
by the
NHS
(Service Committees and Tribunal) Regulations
1974
and centres on
whether the terms of service of the contract have been complied with.
FHSAs
(Family
Health Service Associations) are required to set up service committees covering the
different disciplines to investigate what are in essence allegations of breach of
contract. The service committee makes recommendations on appropriate action on
the allegation to the
%HA.
The
most serious cases may be referred on to the relevant
professional disciplinary
body
or to the
NHS
Tribunal. Appeals can ultimately
be
made to the secretary of state.
Before those formal procedures come into operation,
FHSAs
are required to
operate an informal procedure involving a lay conciliator appointed by the author-
ity.
This
is designed to consider both
less
serious allegations of breaches of the terms
of service/contract and matters not covered by the contract (e.g. rudeness).
This
procedure can only be used if both complainant and practitioner agree.
If
they do
not, or if the informal procedure fails to produce a mutually satisfactory outcome,
the formal procedure comes into operation.
The importance of this distinction between formal and informal procedures is that
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1993
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