Gareth Thomas looks at what happens when things go wrong in the NHS - from the patients' perspective

before the end of the year, the government plans to introduce proposals for the reform of the procedures for dealing with NHS complaints and clinical negligence. This is much needed.

Currently the complaints system is slow, difficult to access and an obstacle course. When it comes to seeking redress for clinical negligence in court, all of this is multiplied and, for smaller claims, the final award is often outweighed by any legal costs. At the same time the majority of those trying to battle with these systems are also having to deal with living with the outcome of the medical error or accident. What most people want in addition to good care and support is an apology, explanation and reassurance that errors will not happen again.

At a recent parliamentary seminar that I chaired - and organised in conjunction with Action for Victims of Medical Accidents (AVMA), Consumers' Association and Leigh Day and Co - I was very struck by the experiences of one woman who fought for over 12 years to prove medical negligence during the birth of her son. She was finally successful and is now able to provide all the specialist education, support and care that her son needs.

For someone on the receiving end of something that has gone wrong with their care or treatment, the current system is full of cracks and no single bit of it works well. Consumers' Association research shows that up to two thirds of consumers are dissatisfied with this. Many, particularly the most vulnerable, are completely excluded. Those who do complain face frustration and anxiety.

While litigation can work for larger or complex claims, it is often an inappropriate route for claims that are smaller and less complex. Taking a case to court can be lengthy and slow and the system is certainly weighted against the patient. One way to help prevent repeat mistakes would be to use the vast amount of information gathered through legal investigation of a case to help change practice.

The government has instructed the Chief Medical Officer to review the current system. It has been suggested that the introduction of a no-fault compensation scheme is the right way forward. However the reality demonstrates otherwise. Schemes in New Zealand, Finland and Sweden still require the claimant to prove causation, many patients are inadequately compensated and the procedures are extremely costly. Legal experts and patient and consumer groups alike do not believe this would be a desirable way to go forward. Instead they stress the value of other options to speed up resolution, reduce costs and minimise the adversarial process - such as increased used of mediation and reversing the burden of proof.

A key message that the government seems to have accepted is that court action should not be seen in isolation. If we get complaints right, many problems wouldn't go to court. The DoH produced a document last year on reform of the complaints system. The 600 or so responses to this overwhelmingly called for a simpler, more responsive system that enabled complaints to be resolved more quickly and independently. A reformed complaints system should be consumer-focused, accessible, transparent, fair, speedy and inquisitorial - so it is aimed at unearthing the facts, making it easier for patients to get information about what happened.

Reforms should build on the new Patient Advice and Liaison Services that are based in trusts, and embrace independent advocacy services for those who can't represent themselves. Crucially they should also cover private sector patients. This would be consistent with the proposed new Commission for Health Audit and Inspection (CHAI), which will cover both NHS and private services.

There should be monitoring of complaints to feed back into clinical governance procedures so that lessons are learnt and practice improves. It should also be possible to award compensation through the complaints system for sums up to £15,000. An effective, speedy service is only possible with these changes.

There is an opportunity here to embrace a patient-centred approach. It's about the service listening to patients and learning from any mistakes it makes. It's about the service being better in the future. And, most importantly, it's about giving people their lives back.