recent investigation by the Parliamentary and Health Service Ombudsman has found that patients who complain about their care are being let down by "appalling" NHS investigations.

The investigation report forms part of a review of the complaints procedures of the NHS following the Francis report into the appalling care at Mid Staffordshire Hospital. It is an interim report from the Ombudsman with a more full and detailed report expected later.

Reviewing existing cases the Ombudsman’s office found over a third of investigations into deaths or serious harm  to be "inadequate". They reviewed some 150 cases where patients had died or suffered possible avoidable harm. Of these cases, 28 should have been investigated as a Serious Untoward Incident (SUI) but in most cases this was simply not done. In addition, there appeared to be a significant variation between areas and Trusts. Families who had undergone the complaints procedure reported feeling belittled and misled by hospital staff.

This would probably reflect the experience of most clinical negligence lawyers. For some time when legal aid was available, we had to encourage clients to follow the complaints procedure which was deemed almost a prerequisite to public funding. However, in the majority of cases the complaint was neither investigated properly nor resulted in anything of much use to any future legal claim. Now legal aid is essentially removed except for some very specific cases, the need to pursue complaints is reduced. The advice to clients now tends to place less emphasis on the complaints process because it is not essential for funding.

To be honest I have always found it to be a waste of time. I can probably count on one hand the number of cases where the investigation was thorough and favourable. Even when I had to advise clients to work through the system, it was rarely of use to them and generally appeared to cause more distress rather than less.         

But although legal claims no longer need to wait for the complaints process, for some clients it has a particular role. Many clients would not take action if an apology and explanation was provided at the outset. Some of those cases where there has been a full recovery and where perhaps the value of the claim is small, probably wouldn’t proceed at all if a full investigation was completed and a transparent attitude to the issues was available. Even in the larger claims there are still plenty of people who would rather not take a claim, but feel the need to hold people properly to account for what has happened.

The review of the NHS and its ability to deal with criticism will take some time. The Ombudsman’s report is interim and more will no doubt come. Robert Francis QC is continuing (with his team) further reviews of the NHS. There will be more reports and no doubt significant concerns about the service will be raised.

What is distressing is that the Francis report, which by any standards was a damning indictment of a trust and the care provided, appears to have been viewed in isolation by other trusts. Whilst they may have improved their care (although not in all cases), dealing with matters when things have gone wrong, remains poor, inconsistent and unsatisfactory.

The Ombudsman’s report suggests that the culture in the NHS remains less open and people centred than had been hoped or recommended. Clearly there is a very long way to go.