After six months in post, deputy health service ombudsman Hilary Scott reflects on her transition from the NHS to the civil service

I thought I had seen the best and worst of clinical notetaking during 20 years in the NHS. I was wrong. I'm seeing it now. In the six months since I started work as deputy health service ombudsman, I've been struck forcibly by the sameness of the problems - poor recordkeeping, poor communication and poor teamwork.

I've been struck, too, by the extraordinary lengths that health service staff go to in tailoring and explaining the care they provide, yet not satisfying people who complain about their work.

I've always been interested in how the NHS handles complaints and have often suggested that a complainant should take their case to the health service ombudsman because I realised that only a truly independent view would reassure them.

But I did not realise that a good portion of my work would be responding to people who are unhappy with our work. Sometimes we get it wrong, and we have the review procedures you might expect. Since the only appeal against our decision is to persuade a court to give leave for judicial review, we try hard not to get it wrong.

I can't imagine what I thought the investigation staff would be like, but when I heard our GP advisers congratulate them on their questioning and listening skills, I knew we had special people here.

Another surprise was the way it was decided whether we should investigate a complaint. The clear-cut criterion is to pose the question: is it to do with a failure in service, or a failure to provide service, and has the local complaints procedure been given a chance? The less clear criteria call for considerably greater powers of judgement: has an injury or injustice been done, has all reasonable action been taken locally to resolve the complaint, has there been maladministration (for example incompetent or perverse decision-making)? We are agreed that these need to be sorted out, for the sake of potential complainants and NHS staff who may feel, otherwise, that all our decision making is at best subjective and at worst arbitrary.

The real surprise was that so many of my NHS colleagues know so little about our work. On reflection, I can see why. The office is largely staffed by civil servants who do not seek a public profile. Another possibility is that before 1996, when jurisdiction changed and the ombudsman took on complaints about clinical matters, complaints he did handle - about maladministration - had little impact on most NHS users.

Clinical cases now make up more than 70 per cent of our caseload. Some are quite straightforward, but others are among the most complex, both in terms of clinical content and multi-agency activity, that I have come across.

The work can be stressful. Interviewing distressed complainants and staff, many of whom are already worn out by the complaints process, is hard. I had been at the office for only a few weeks before reading a file that moved me to tears.

There are some prejudices that should be laid to rest. The office employs 80 staff, more than two-thirds of whom are directly involved in investigations.

And yes, they do know what it's like to work in the NHS.

About 20 per cent of the investigation staff have worked in both hospital, community and family health services.

Several others, either recruited or on loan from government departments, have direct experience of health and social care policy making. Most of our professional advisers are in clinical practice, too.

Crossing the floor from the NHS to the civil service has been interesting. I was told that the reason I have five chairs in my office (rather than four - or only a leather sofa and coffee table) is to do with my grade. But I think someone may be having me on. There are lots of new acronyms to learn. But nothing will induce me to describe the ombudsman's office as my 'command', as some would have it. For years, HR meant human resources to me; now it means human rights.

About 3,000 people call us each year, but 40 per cent of them haven't raised their problem locally. They are happy to do so when we suggest it. There may be problems with getting access to us, but there is a bigger problem with accessing local complaints systems. If people can't tell us - you and me - what goes wrong, service improvement is made harder.

Hilary Scott is deputy health service ombudsman.

She was formerly chief executive of Tower Hamlets Healthcare trust.