New powers for the health service commissioner to investigate clinical complaints could mean fewer legal actions against the NHS, his annual report suggests today.

Immediately before his powers were extended in 1996, nearly one-third of rejected complaints were excluded because they involved clinical judgement, says the commissioner, Michael Buckley.

The 26 cases in this category now being investigated include some 'very serious' allegations where court action for negligence could have been considered.

They include a complaint that care at birth caused brain damage to a baby and that a cancelled ultrasound scan would have led to earlier discovery of a fatal cancer.

In another case it is alleged that there were unacceptable delays in arranging admission to hospital of a patient who later died of meningitis.

None of the clinical complaints has yet been completed, but they are expected to be the biggest source of complaints in future.

Deputy commissioner Isabel Nisbet told HSJ that most people were seeking an apology, an explanation of what exactly had happened, and reassurance that action was being taken to prevent the same thing happening again.

She welcomed the government's forthcoming legislation on quality as adding to good practice.

'If the ombudsman can work himself out of a job because lessons are being learned, he will be delighted, ' she said.

The report criticises trusts that have been faced with complaints under the new NHS procedure for failing to tell dissatisfied people that they have a right to take their complaint to an independent review panel and - ultimately - to the commissioner.

During 1997-98, a complaint was upheld against Preston Acute Hospitals trust for undermining the credibility of the system by taking issue with the findings of an independent review panel.

The trust chief executive wrote to the parents of a baby who died at Sharoe Green Hospital telling them that he did not accept some of the recommendations.

The commissioner said this destroyed the purpose of the panel process.

The trust has since apologised to the parents.

Mr Buckley's report also looks at the first completed investigations into complaints against GPs, who are criticised for removing patients from their lists too readily and without explanation.

In one case, a pregnant woman was excluded because she wanted a home birth, while three separate but related households were struck off because one of them complained.

The commissioner received 2,600 complaints during the year, an increase of 20 per cent on figures for the previous year and the highest number ever received in a single year.

He investigated only 4 per cent, mainly because the NHS complaints procedure had not been tried or exhausted first in the remaining cases.

The Health Service Commissioner for England, Scotland and Wales Annual Report 1997-98 , Stationery Office,£7.25. Also available on the Internet at