If your complaint cannot be resolved during Independent Review or you are unhappy with the Healthcare Commission’s decision not to grant an Independent Review, you have the right to appeal to the Health Service Ombudsman and ask her to review your case.

The Ombudsman is independent of the NHS and of the government.

The Ombudsman will not normally get involved unless you have already tried to resolve the problem using the NHS Complaints Procedure and you are still unhappy.

There could be several reasons for this, for example:

• it took too long to deal with the complaint locally
• you were unreasonably refused a review by the Healthcare Commission
• your complaint did not get a satisfactory answer at any stage.

You should submit a complaint no later than one year from the date of the event you are complaining about (or from when you first became aware of the matter).

In exceptional circumstances the Ombudsman may extend this time limit. An example of this may be if the local resolution process took longer than it should have done.

A member of the Ombudsman‘s staff will initially assess your case and decide whether or not further action will be taken. They may need to see medical records and papers involved in the case.

The Ombudsman will not usually investigate a complaint where:

• the NHS provider or practitioner has done all that they reasonably could to put things right
• you just do not agree with a decision made by your NHS provider and cannot offer any evidence as to why the decision is wrong.

They may also refer you back to the Local Resolution stage of the NHS Complaints Procedure if they think you applied to them too early.

However, if the Ombudsman thinks that your complaint may be valid they will make more enquiries. They will write to you to let you know of their decision.

The Ombudsman may write you a detailed letter offering an explanation of exactly what happened and why.

They may ask the NHS provider or practitioner to provide a suitable remedy, or the Ombudsman may decide to carry out an in-depth investigation resulting in a detailed report about the case.

This investigation will be very thorough and may last up to nine months. As a result of this investigation a detailed report showing any findings and recommendations will be sent to all parties involved and the Secretary of State for Health.

If you do not agree with the Ombudsman’s decision or findings you can ask for a review. The Ombudsman will consider your concerns and may look again at your complaint against the NHS.

The Ombudsman will write to you and let you know the outcome of their review of your concerns. If you are still not happy with this response, you can ask them to review your concerns again.

They will again consider your concerns but will not usually re-investigate or re-consider your complaint in depth.

Very rarely during either review process, the Ombudsman may find an error in the investigation and will re-open the whole complaint again or just a part of it.

There is no appeal after this second review, and the NHS Complaints Procedure comes to an end.