At the hands of 'haughty and stuffy' consultants, patients in some teaching hospitals are also made to feel more like educational aids than people. But the system for resolving complaints about shoddy or rude service in the NHS remains too cumbersome, locking some people into disputes that take years to settle, according to William Reid.
The ombudsman, who upheld 243 of the 442 grievances he investigated over 1991-92, said he had come across cases of health authorities attempting to cover-up bungles by doctoring or 'mislaying' records.
Mr Reid told the Independent that initiatives such as the Citizen's Charter had brought about some improvements in the handling of complaints. But NHS trusts and health authorities 'still have a long way to go' to bring their procedures up to the standard of the best. 'Any good organisation, like Marks & Spencer, deals with complaints sensibly and as quickly as possible, and I am sure that the best practice in the private sector should be emulated by the public sector. But the way health authorities deal with complaints is often a fertile source of complaint to us. Too often, the person whose job it is to deal with complaints has not been trained, and is at far too low a level within the organisation to carry any clout.
'You have to have clout to get these matters dealt with without unnecessary delay, to chase people up, to keep the complainant in the picture. I find sometimes letters that go out are so sloppy. Someone way down the line sends it to the general manager for signing, when the general manager doesn't even know anything about it. So these letters, they are forgeries because the complainant assumes the letter comes from the person at the top. It is a disgraceful practice.'
Mr Reid, a former senior civil servant, was appointed Parliamentary Commissioner for Administration and Health Service Commissioner for England, Wales and Scotland three years ago. On Wednesday, he will be the first to give evidence to a review launched by the Commons select committee on the Parliamentary Commissioner for Administration into the 'powers, jurisdiction and work' of the holder of his post.
Last month the National Association of Health Authorities and Trusts called for major changes to bring about more simple and speedy resolution of complaints. There are nine different channels for making complaints about the NHS. More complex cases may require the complainant to use several channels simultaneously, causing many to give up in despair and frustration at an early stage of correspondence.
The existing remit of the ombudsman (a Scandinavian word meaning 'grievance man') is fairly narrow, dealing mainly with alleged maladministration, and complaints about the handling of complaints. James Pawsey, the Tory chairman of the Commons select committee, recently described those that reached the ombudsman as 'the tip of the iceberg'. Many of those Mr Reid receives - and is forced to re-route to family health service authorities (FHSAs) - involve family doctors. But the tribunals appointed by FHSAs to investigate complaints have been much criticised both by professionals and complainants. 'Lay people feel they cannot make their case effectively, and that the proceedings are biased in favour of health professionals. I feel lay complainants are not treated as helpfully as they are in some other forms of tribunal. But professionals can feel they are biased against them too. It is obviously an area that is unsatisfactory.'
The health service ombudsman has no formal sanctions, but the office- holder's recommendations, which can involve payment of compensation, are 'almost invariably accepted and implemented', according to Mr Reid.
A high proportion of complaints arise from communications breakdowns, perhaps between mortuary attendants and grieving relatives, or among health care professionals. They can be 'tactless, or thoughtless remarks', he says.
Ignorance about the role of the ombudsman is widespread among public and health professionals alike. 'There have been times when I am doing an investigation, the response I get from managers is: 'Who the hell is this commisioner and why should I answer his questions'?'
In fact, Mr Reid has the powers of a high court judge to obtain information and documents and may certify that someone is in contempt of court.