The health service commissioner does not deal with staff whistleblowers, and only a fraction of complaints from the public concern clinical judgement. Could he really help prevent a recurrence of the Bristol tragedy? Mark Gould finds out

With health service quality issues high on the agenda, MPs might have been expected to turn up in droves for the health service commissioner's annual appearance before the Commons public administration committee.

Not so. Just three MPs turned up to quiz commissioner Michael Buckley, and despite their best efforts to inject a sense of urgency into proceedings by raising the Bristol baby deaths tragedy, the session lasted less than an hour.

Committee chair Rhodri Morgan asked why whistleblowers like anaesthetist Stephen Bolsin could not be referred to the commissioner to prevent such cases in future.

Mr Buckley replied that he could only deal with complaints that were received from patients or relatives.

Mr Morgan said he thought it had been maladministration on the part of hospital management not to take Dr Bolsin's concerns seriously and halt potentially lethal operations pending an inquiry.

Mr Buckley said that if such an issue was drawn to his attention he would inform the trust chief executive and the chief medical officer so that they could draw up a report.

As a result, he could bring the matter to the attention of regulatory bodies such as the General Medical Council.

But in the final analysis any inquiry would require hard evidence, he said.

'In my experience the medical profession, like many others, does close ranks. Whistleblowers are not held in high regard.

'It is a matter of the attitude of the profession.

'If a trust chief executive asks clinicians for written evidence which they could present to the GMC, in many cases the complainants back off.'

Mr Morgan wanted to know how Mr Buckley's office would interact with the Commission for Health Improvement 'to ensure a tragedy like that at Bristol Royal Infirmary never happened again'.

Mr Buckley said: 'These are questions for the professions and the NHS managers. We welcome the words in the white paper which envisage that the commission will not work without regard to bodies, including my own office. We are an ex post facto organisation. We come along at the end.'

Mr Buckley repeated earlier warnings that patients were not being informed of their full right of redress via local complaints procedures at trust, health authority or GP practice level.

And although he received a record 2,660 new complaints and 975 enquiries last year, only 120 cases included complaints about clinical judgement.

As a result his office is considering ways to raise public awareness about the service.

'It is my experience that a one-off campaign is of limited value. It would have to be more concerted, ' Mr Buckley told MPs.

He said complaints were not investigated for a number of reasons. 'One thousand complaints were sent back because they had not gone through the trust concerned and so there was no reason for the ombudsman to intervene at that stage.

'People have a complaint and they think 'ombudsman' too quickly. We are getting a significant number of complaints which we can't look at because they are premature .

'We have got to make it clear that they have got to go through local procedures before they come to us. When they come to us, they have to come with evidence.'

Mr Buckley told the committee that he had set up a unit to deal with inappropriate complaints which provides a fast response to 60 per cent of correspondence - sending it back, referring it elsewhere or offering guidance.

A quarter of all investigations were dealt with in under 36 weeks, and one third within 40 weeks. But some were taking 18 months and a small percentage up to two years.

Deputy commissioner Isabel Nisbet told the committee that it was crucial to involve community health councils in making sure the 'appropriate use' message was hammered home.

'The Association of Community Health Councils for England and Wales is a key body. We are going to their conference next week to ask for their help in this matter.'