The role of the Health Service Ombudsman needs a complete overhaul if it is to provide an effective appeals process for the NHS complaints system, says a committee of MPs. 

The legal and operational framework of the Ombudsman, Ann Abraham, "should be widened so that she can independently review any complaint which is referred to her following rejection by a service provider," said Stephen Dorrell MP, launching the report of an inquiry by the House of Commons Health Committee into complaints and litigation against the NHS today.

The Ombudsman's current terms of reference prevent her from launching a formal investigation unless she is satisfied in advance that there will be a "worthwhile outcome," but the MPs' inquiry has concluded that this requirement represents a significant obstacle to the successful operation of the complaints system, added Mr Dorrell, who chairs the Health Committee and is Conservative MP for Charnwood.

Patients should be able to seek an independent review of the findings of internal reviews by care providers, but the terms of reference under which the Ombudsman works prevent her from properly fulfilling this role, and this needs to be changed, says the Committee.

The other key finding of the MPs' report is a continuing and unacceptably wide variation in operation of complaints procedures within the NHS. The Ombudsman's 2005 report, entitled Making Things Better, had called for the establishment of clear national guidelines for the handling of complaints within the NHS, but the Health Committee enquiry has found a number of problems.

For example, the MPs say that regulations governing the classification and reporting of complaints are inadequate, and that reporting by Foundation Trusts remain voluntary. They also note that the government's recent consultation on the "information revolution" in the context of the Health and Social Care Bill did not mention procedures for handling complaints, and it remains unclear how the alternative route for patient complaints about services delivered by primary care will be handled following passage of the Bill.

Moreover, too often the culture within the NHS is "defensive," they say, and the Service "remains to be persuaded to adopt a more open culture.”

The MPs welcome the government's commitment to introduce "a duty of candour" within the NHS, and recommend that all providers of NHS care should in future owe a duty of candour to their commissioners under which they will provide, among other things: - timely reports, prepared to an agreed protocol, of all complaints made to them by NHS patients; - Complaint Action Plans to address the weaknesses which have been revealed in cases where complaints are upheld; - and progress reports on the actions required under Complaints Action Plans.

Commissions should also be under a duty of candour which requires them to publish this information on a regular basis, they add.

Nevertheless, the MPs believe that the most fundamental change needed is a change of culture within the NHS, and say they "look to both the NHS National Commissioning Board and Healthwatch England to monitor progress in delivering this fundamental change in the direction of a less defensive and more open culture."

Commenting on the report's findings, the NHS Confederation said policies such as the creation of a duty of candour may help if introduced sensitively, but pointed out that well-run complaints regimes already operate on principles of openness. " Working to encourage that way of working may well be as effective a way of generating a more transparent system," the Confederation suggests.