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12LEGAL MEDICOMAGAZINESponsored by:The Parliamentary and Health Service Ombudsman (PHSO) makes final decisions on unresolved complaints about the NHS in England, UK government departments and other UK public organisations. We do this independently and impartially. We are not part of government or the NHS in England, nor are we a consumer champion. We look into complaints where an individual believes there has been injustice or hardship because an organisation has not acted properly, or has given a poor service and not put things right. We normally expect people to complain to the organisation in question first so that it has a chance to put things right. If, after an organisation has responded, an individual believes there is still a dispute about their complaint, they can ask us to look into it. We share findings from our casework to help Parliament scrutinise public service providers and more widely to help public services improve. Examples of our reports and publications that have supported policy change and service improvements nationally include our Time to Act report on sepsis, our Midwifery Supervision and Regulation report, and more recently a report on how complaints are handled in Primary Care.How the Ombudsman investigates complaintsThere are a number of issues that we consider when deciding whether we are able to investigate a complaint. These include:• whether there are signs that the organisation potentially got things wrong that have had a negative effect on the complainant and that haven't been put right;• whether the complainant has the option of taking legal action instead and would prefer this; • whether they complained to us within a year of knowing about the issue – there are some exceptions to this.Once we have decided to investigate the case, it will be passed to a caseworker. If it is a health service complaint, they may seek clinical advice appropriate to the case. For example, if the complaint is about GP care they approach a GP Adviser such as myself and if it is a nursing issue the caseworker will go to the nursing advisers.What is the role of clinical advisers?The Ombudsman's clinical advisers all work in the NHS and provide advice for their area of expertise. We provide clear, impartial and timely advice, based on professional standards and clinical guidelines which applied at the time of the events complained about. We have a robust Quality Assurance programme in place which uses a peer-based approach to ensure the accuracy of the clinical advice we give to our caseworkers.When assessing the standard of care, we do not use the Bolam/Bolitho principle which refers to the ‘reasonable body of clinical opinion’. This is because these are tests used in the courts in relation to medical negligence and we make determinations about maladministration and service failure. Where there is an absence of recognisable guidance or standards, the benchmark used is one of ‘established good clinical practice’.Clinical advice is just one part of the evidence reviewed in the investigation of a case and the final decision about whether or not to uphold a complaint lies with the caseworker/investigator.Good complaint handling in the NHSThe cornerstone of good complaint handling is to accept that there is always room for improvement. Encouraging patients to speak up when things have gone wrong could prevent problems from escalating, save money by avoiding formal complaints and identify areas in need of improvement quicker. One Senior Clinician we know encourages his staff to actively seek out feedback from patients, carers and ABOUT THE PARLIAMENTARYAND HEALTH SERVICE OMBUDSMANBy Dr Paul Gray, GP and Clinical Adviser for PHSO