The report covers complaints received between April and September.

The ombudsman, Michael Buckley, said he had received a record number of complaints during the period - just under 1,600 came into his office.

Mr Buckley completed 33 investigations into complaints, including, for the first time, those about clinical matters in hospitals.

The ombudsman's powers were widened in 1996 to allow him to look into the clinical treatment of patients and the actions of GPs and dentists as well as just administrative problems.

Dislodged drip

Eleven of the investigations are outlined in detail in his report.

They include:

• a complaint about a man whose drop became dislodged and was not replaced for two hours. He was left with blood-stained pyjamas and bedding.

  The man, who subsequently died from Legionnaire's Disease, had had a blood test which showed abnormalities, but no action was taken by doctors.

• a complaint about a woman who died of liver cancer. She was not given an ultrasound test because her doctor thought it would not help to save her.

  The ombudsman said the test could have given her the chance to know what caused her illness and allowed her to benefit from hospice care in her last days.

• a complaint about a woman whose corpse was left unrefrigerated in a mortuary for more than 30 hours and decomposed so badly that her family could not identify it.

Unreasonable

Two of the complaints in the report concern GPs who have struck people off their lists.

The two GPs, from Yorkshire and Ayrshire and Arran respectively, both refused to apologise to the patients despite a request from the ombudsman.

The Yorkshire GP struck off the parents of a woman who asked to be removed from his partner's list.

The parents lived at a different address to the woman and had been on the GP's list for many years.

"I am disappointed that a few GPs are taking such a negative attitude," said Mr Buckley.

Legally, doctors have the right to strike any patient off their list, but the ombudsman argues that, in the two cases concerned, the decision was "unreasonable" and not in the interests of good practice.

Other complaints concern delays in replying to patients' complaints. One London trust - Guy's and St Thomas' - took over 11 months to reply to a complaint.

Mr Buckley said he investigated fewer cases in 1998 than he had in past years because the cases were becoming more complex.

He said clinical cases were particularly complicated.

He stressed that he had attempted to be fair and independent and had taken into account circumstances such as lack of resources.

The report fails to name and shame individual doctors, but Mr Buckley said he would not hesitate to do so if a case was serious enough to warrant such treatment.

Small number of cases

The Institute of Health Services Management welcomed the report.

Director Karen Caines said: "Although the ombudsman's report shows an increase in the number of complaints investigated over the last six months, the figure is still small when compared to the increasing number of patients treated."

She said over 11.5m inpatients were treated in 1997/98 along with over 41.6m outpatients.

"In the past, clinical matters in hospitals and general practice eluded the long arm of the Health Service Commissioner. This report shows these areas are now covered and that there are many lessons still to be learnt by clinicians and managers alike," said Ms Caines.

The government has pledged to drive up clinical standards by publishing a league table of hospital performance.

It says public confidence has been undermined by a series of cases, most notably that of the deaths of 29 babies after heart surgery at Bristol Royal Infirmary.

The NHS complaints procedure is to be evaluated by a government-appointed team.

Alasdair Liddell, the NHS Executive's Director of Planning, said: "The aims of the research are to provide an evaluation of how the new complaints procedure is operating across all parts of the NHS - hospital, community and family health services - based as far as possible on the actual experiences of complainants and NHS staff.