The health service commissioner's first report covering clinical complaints has highlighted the office's potential role as an 'early warning system'.

About 70 per cent of the cases fully investigated between April and September involved clinical elements, said deputy commissioner Isabel Nisbet, who argued that the ombudsman was well placed to spot 'trends and worrying clusters of complaints'. She also suggested that the office could benefit from increased powers to alert other bodies 'at the earliest stages' of clinical investigations.

'At present the ombudsman's statutory powers to talk to other bodies about individual cases are quite limited because of strict confidentiality requirements. Perhaps he could have more discretion in the future,' said Ms Nisbet.

She said health service commissioner Michael Buckley was 'looking forward' to discussions with the National Institute for Clinical Excellence and the Commission for Health Improvement.

'It is going to be very important for us to have terms of agreement with these bodies,' Ms Nisbet said.

A record 1,575 complaints were received by the ombudsman's office between April and September. But just 33 full investigations were completed.

Ms Nisbet attributed the low figure to the complexity of clinical cases and the establishment of new working practices to deal with them. The ombudsman was given new powers in 1996 to investigate clinical complaints, as well as administrative failings.

While cases were 'very varied', questions about diagnoses, delays and shortcomings in direct patient care were common, said Ms Nisbet. The report is also the first to reflect new powers to investigate the actions of GPs and dentists. Ms Nisbet spoke of her 'disappointment' that two GPs criticised for striking patients off their lists 'unreasonably or precipitously' would not apologise for their actions.

In a case in the Calderdale and Kirklees area of Yorkshire, a GP removed the parents of a patient from his list after an argument between the patient and a partner at the practice. An Ayrshire GP struck off a patient after an argument following the GP's refusal of a request for antibiotics.

The Health Service Ombudsman: Investigations Completed April- September 1998. www.ombudsman.org.uk. See Comment, page 19.

Cases from the ombudsman's report

Mr Buckley upheld a complaint that staff at Southampton General Hospital failed to test the anti-coagulant status of a patient with a dislocated elbow, even though his wife warned he was taking Warfarin (an anti-coagulant) for a heart condition. The man had to undergo operations to relieve pressure caused by internal bleeding and was left with impaired use of his hand.

Central Nottinghamshire trust was criticised for 'inadequate arrangements for the care of a dead body' that was too large to fit in Mansfield Community Hospital's refrigeration unit. Mr Buckley upheld a complaint that relatives were unable to view the body because it deteriorated over 30 hours.

Two cases of poor complaint handling at Guy's and St Thomas' Hospital trust were reported to South Thames regional office. In one, a 98-year- old man attended an outpatient appointment and was told that his name was not on the list. The trust had changed the appointment, but it was 'not possible to tell' if the patient had been informed.

A draft response to the complainant, made in November 1996, was not prepared until April 1997. The complainant was still waiting for a response last month.