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Ombudsman to investigate more care failures

Hospitals and other health services are likely to face more investigations by the parliamentary and health services ombudsman after a review called for a change in its approach.

Ombudsman Dame Julie Mellor commissioned Baroness Fritchie to review how the ombudsman handled complaints about avoidable deaths in July. The review followed a critical report from the Commons health committee and complaints from members of the public including James Titcombe. Mr Titcombe’s baby son Joshua died at University Hospitals of Morecambe Bay Foundation Trust in 2008.

Mr Titcombe’s complaint − that the ombudsman had been wrong not to investigate his allegation that failure by NHS North West in its role as a local supervisory body for midwives had been a factor in Joshua’s death − was upheld in an internal review by the watchdog last year.

The findings of Baroness Fritchie’s review have been published today.

They include that in future the ombudsman should undertake to investigate complaints involving an allegation of avoidable deaths, even if the organisation involved has already acknowledged it is at fault.

Baroness Fritchie, who is chair of 2gether Mental Health Foundation Trust in Gloucestershire, also called for ombudsman staff investigating complaints to give more consideration to any wider patient safety issues raised by the case and to identifying not only what went wrong but why.

She warned the ombudsman’s current approach of viewing investigations as a last resort may not always provide maximum benefit to the complainant or the public.

At present the ombudsman carries out a detailed assessment of a complaint to determine whether there is a case to answer before proceeding to a full investigation. In future her office will refer to this whole process as an investigation.

Dame Julie, in an exclusive interview responding to the review, told HSJ: “We have accepted all of Baroness Fritchie’s recommendations… We will begin action quickly to conduct more investigations and improve when and how we share information and insight with the organisations responsible for the quality of NHS care and ensuring patient safety.”

Baroness Fritchie also supported plans for a complaints “hub”, first mooted by the ombudsman in July. Dame Julie said talks were ongoing about the potential for a central complaints handling system with other regulators. She said although there was “interest in principle” there was still “a lot of practical work to be done” before any formal plans could be proposed.

Readers' comments (1)

  • It would also help if the Ombudsman approach was more meaningful than a simple paper desk top exercise. Using the full facts may help them to come to more appropriate conclusions when they do investigate

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