House of Commons Hansard Debates for 25 Apr 1995

Mr. Sam Galbraith (Strathkelvin and Bearsden): For five years in the late 1980s I was an elected member of the General Medical Council. I was an anti-establishment elected member. The British Medical Association used to run slates. I was not on that slate. I was the only non-slate, anti- establishment, pro-patient representative, as it was termed, from Scotland on that GMC elected body. Therefore I hope that my comments will be regarded in the light of the position that I achieved. I was not there to take part in a conspiracy, as has been suggested, or to be part of some coterie to protect other individuals. I was there to ensure the representation of the rights of patients against the establishment.

When we consider the General Medical Council, it is important to realise--I am not sure that we have quite grasped it yet--that it is not just a disciplinary or sanction body but the final disciplinary and sanction body. Other avenues are open to punish or deal with doctors, some of which the hon. Member for Wyre Forest (Mr. Coombs) read out, including the criminal courts, the civil courts and various disciplinary procedures. What is different about the GMC and therefore why there are many complaints about it, although they are not justified, is that it is the body which removes from a doctor the power to practise.

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The GMC removes the power to practise not only in the United Kingdom, whether in the national health service or private health care, but virtually everywhere else in the world. If one graduates from this country and wishes to practise elsewhere, even for a temporary period, one is asked for a certificate from the GMC confirming registration and good conduct. That power is a very important sanction. The GMC is not just some disciplinary body which tells one that one has been a naughty boy and not to do it again; it can finally erase one's name from the register and deny one's fitness to practise.

While I was on the General Medical Council, I did not serve on the professional conduct committee but on the ethical committee, which is totally different and concerned with such things as ethical positions, in vitro fertilisation, disclosure of information, and so on. I did not have much desire to sit in judgment over my peers and some of their naughty antics. It was, however, clear to me that there was a problem in dealing with clinical competence, within which I would also include the attitudes of doctors to patients: rude, offensive, unacceptable attitudes and bad practice over and over again. While a single instance would not often reach the charge of serious professional misconduct, repeated episodes certainly did and we needed a procedure for that.

When I came to the House I therefore co-sponsored the private Member's Bill of my hon. Friend the Member for Newham, South (Mr. Spearing), which sought to deal with such problems with a lesser charge. I have sponsored such proposals for some time and the House will appreciate that I make my comments against that background. The proposals in the Bill go some way to deal with the problem as I have perceived it over the years. It was a little demeaning of the Secretary of State to try to pretend that the Bill was all a function of and related to the recent changes. We have been seeking a solution to this problem for as long as I have been in medicine, certainly well before the present Government came to power and long before the current changes. Imperfect as it is, the Bill is probably the best answer available so far, but it is one on which we can improve, so a Bill such as that promoted by my hon. Friend the Member for Newham, South is no longer necessary.

This Bill is about good practice, and there are many ways in which we can ensure good practice. It starts off by the selection of medical students. Selection is difficult because it may be based on academic qualifications, interviews and, headmasters' reports. I do not know the exact answer to that problem and many people who will not make good doctors and who will be professionally incompetent will slip through, even with best practice. Good medical education and training is very important, but still people will slip through. Good advice is also important. Anyone can be a surgeon; with a little competence it is not hard. Just now and again, however, for reasons of personality, attitude or sometimes dexterity, the odd person who so wants to be a surgeon is not up to it. In the past, some such people were allowed to slip through, but that is no longer the case because strong advice must be taken. Doctors have a duty through training to advise people if they think that they are not up to becoming a surgeon, for example, and they are told to change their specialty. Despite all those

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attempts to ensure good practice, however, some slip through and some, in fact, were always bad. The Bill deals with those cases and that is why I welcome it.

Nevertheless, I have a number of worries about the Bill, some of which have already been raised. I therefore hope that the General Medical Council--I am sure that it will do this--will monitor the Bill and how it works and that it will report back to the House very soon. I shall now deal with my main concerns about the Bill.

It seems to be assumed that dealing with incompetent doctors is like dealing with sick doctors and therefore the first-rate health procedures in place are very similar. I am not sure that that is all that good a parallel. There are trivial differences to begin with. Most sick doctors at least were well at one time and became sick, whereas some doctors have always been incompetent. Although that may be a trivial difference, it has practical implications and therefore the method of dealing with a sick doctor is not necessarily the same.

Perhaps different grades of doctors should be taken into account. I would be happy if the Minister would explain in Committee who is referred to the various committees. Who is referred to the health committee? Is it drunken, alcoholic consultants or junior doctors? Will junior doctors be referred for incompetence or will it be consultants? Again, that will reflect on public confidence in what is happening and how we can manage the problem.

Another way in which the problem is different from dealing with sick doctors is that patients, health authorities and employers of various sorts are more sympathetic to sick doctors. If a doctor is shown to be sick and has to be sorted out, he or she is given time, help and consideration. But if doctors are just no good and incompetent, should the employer be understanding, retain them as employees and have them in the hospital? The decision will have serious implications for the doctor's contract, how they are dealt with and whether they are retrained. Again, the case is not quite the same as that of a sick doctor.

The hon. Member for Birmingham, Edgbaston (Dame J. Knight) mentioned referral, which also worries me. Contrary to what was said by the hon. Member for Chislehurst (Mr. Sims), who is also a member of the General Medical Council, anyone can refer a case; but again, there is a difference between sickness and incompetence.

If one's problem is alcoholism one might be referred to the GMC via a route that does not affect one's contractual obligations and the employing authority could not question that. For example, one might have been done for drunk driving for a second time--one drunk driving offence results in automatic referral--but one can be treated as a sick doctor without it involving one's contract with the employing authority. If one is an incompetent doctor, however, I see no secondary position. The case must be referred in relation to one's practice and it will be more likely that the contract will be terminated. A hospital has no obligation to retain an incompetent doctor.

There are important differences in the way in which we deal with sick doctors and incompetent doctors, for example, in relation to retraining and who pays for it and their future in the service. If a patient refers a doctor because of incompetence, the case goes to the GMC, but not to the employing authority. If the doctor is found to be incompetent, but is still employed, who will pay for

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retraining? If the hospital has found a doctor incompetent and sacks him, he is in a different position from a doctor whom a patient has alleged to be incompetent.

What do we mean by incompetence? I hope that the Minister of State will deal with that. One might be an incompetent orthopaedic surgeon, but not an incompetent doctor. One might make a good doctor in some other specialty. Will one be paid to retrain? What of the consultant orthopaedic surgeon who is found to be incompetent? Will he be retrained as a neurosurgeon, a physician or a radiologist? And who will pay? If one is incompetent in one specialty, must one's name be struck off? Or will one be registered for all practice except, for example, neurosurgery? That is an interesting development and it will be interesting for the GMC to consider whether there will have to be different types of registration, with registration of competence but only within certain specialties.

Those are some of my worries about the idea that dealing with incompetent doctors is similar to dealing with those suffering from ill health.

It is right that the method should not be directly related to audit, which the hon. Member for Wyre Forest mentioned. There can be an indirect link, but audit is a slightly different practice. In an audit, a doctor considers areas of practice in which it is not known how he or she is performing and if it is found that there are discrepancies, the matters are dealt with. One might not be good at one procedure, but be better at others. It might be a case of the numbers of such procedures with which one has dealt. If one is not good at something, it will be necessary to change one's practice. A case might come before the GMC if one was shown to be poor at a procedure but continued to practise in the same way. That would be grounds for referral and it is indirectly related to audit. I hope that the hon. Member for Wyre Forest sees the distinction. It is not that I do not think that audit is important. Its purpose is to detect poor performance, but the action that is taken following that procedure is what matters. If a doctor is bad at one procedure, that does not make him or her incompetent.

The area that worries me, which is in the blue book and is what professional competence is all about, is not competence in a specialty or one area of it, but how one relates to, treats and manages patients. Rude, offensive and bad behaviour must be a basis for referral to the GMC and for being considered under the procedures in the Bill. Such behaviour is bad enough to be considered professional misconduct. In other words, doctors must treat patients with respect and some sort of dignity. Patients must be able to have confidence. They must be able to expect proper clinical history taking, examination, the appropriate diagnostic tests and, if necessary, treatment. Taken as a whole, that is the area with which the Bill probably deals best, and that is why it is not appropriate to deal with it under the heading of serious professional misconduct.

I do not think that there is a conspiracy to protect doctors. That is why I am not worried about the initial stages taking place in private. Anyone who has served on any disciplinary body, as the hon. Member for Chislehurst and I have, will know that there is no attempt to cover up or to protect. Doctors are concerned, first and foremost, to protect patients; secondly, to protect the profession; and, thirdly, to protect the hospital in which they work.

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Although I have those reservations, which I hope that we shall be able to explore in Committee, I believe that the Bill is an important step forward. It in part solves a problem that we have been trying to solve for many years and I very much welcome it.

7.7 pm

Mr. David Congdon (Croydon, North-East): First, I thank the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) for his thoughtful speech. I have listened carefully to the debate. Before I came into the Chamber, I had no reservations about the Bill, but various contributions have highlighted some of my concerns. To put some of the issues in context, we heard from the hon. Member for Newcastle upon Tyne, East (Mr. Brown), the Opposition spokesman, and from my hon. Friend the Member for Chislehurst (Mr. Sims) about the vast range of cases that are referred to the General Medical Council and how few result in a decision of serious misconduct for a variety of understandable reasons.

The hon. Member for Newcastle upon Tyne, East also mentioned consistency between the procedures for dealing with doctors and those for other health professionals. I have some sympathy with that approach. The Standing Committee should bear it in mind.

We must also consider the Bill in relation to other complaints against doctors and the recent White Paper on the subject. I echo the concerns of my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), who reminded us of the number of complaints against doctors, which are leading to a rise in professional medical insurance. There is a danger that that will lead to doctors not only prescribing defensively, but practising medicine defensively, which is not always in the best interests of the patient.

I pay tribute to my hon. Friend the Member for Chislehurst (Mr. Sims) for his work on the General Medical Council. It is too easy to assume that, when a colleague is appointed to such a body, it involves just the odd meeting. He referred to occasions when he has been in the Library with volumes of reports. I have seen him burdened with those volumes of reports and appreciate his difficult role. He deserves our respect and support.

Whatever we might say about doctors who perform badly or do not deliver the right quality of medical service to their patients, they are in the minority. The majority of doctors do an excellent professional job and I hope that anything that I say subsequently will be put in that context. In discussing complaints, we are in danger of creating the impression that all doctors perform badly, which is not the case.

However, there is a problem with the GMC's current powers. My hon. Friend the Member for Chislehurst said that the cases highlighted in the press usually involve sexual matters and the public have the impression that those are the only cases that are investigated. That does a great disservice to the medical profession because such cases are only a small percentage of those that are investigated. I hope that the new powers will go some way towards changing that perception.

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As the powers currently available to the GMC enable it to deal only with serious professional misconduct, the Bill limits the sort of cases that it can investigate. Earlier this afternoon, we had an interesting exchange of views about exactly what are the powers in the Bill. I confess that that aspect worried me as I listened to the debate and I decided to take a further look at the Bill. Frankly, it does not tell me a great deal. I realise that a lot of work has gone on behind the scenes to bring forward these proposals and I do not dispute the work that the GMC and others have done, but I am not sure exactly what the Bill, to which the House is being asked to give a Second Reading, really means. That does not stop me supporting it in principle because there are clearly gaps in the current legislation, but I hope that the Committee will examine the Bill in detail and try to deal with some of the concerns that have been raised today. As my hon. Friend the Member for Chislehurst explained excellently, the gap in the current provision means that, although the GMC may be concerned about a doctor's performance, that performance falls short of serious professional misconduct. At the same time, it may be aware of a pattern of similar occasions on which the doctor has been deficient. As matters stand, the GMC does not have the power to deal with such a case because it can deal only with a single act. I understand that the Bill is designed to deal with that problem. The interesting exchange this afternoon was about whether the Bill, in addition to giving the GMC the power to deal with serious deficiency based on a pattern of behaviour, provides the power to deal with a single act. The Bill is not clear in that respect. I was struck by the Library research paper, which said that the hon. Member for Newham, South (Mr. Spearing) had introduced a private Member's Bill in six different Sessions of Parliament to try to deal with that specific issue. He said that a child in his constituency died of meningitis after his GP had said that he could not be bothered to examine him. I have difficulty with such a case because, while the doctor had clearly not performed to the standard that we would expect of him, the question is: how adequately would the Bill deal with such a case? Could the GMC take action only if there were other examples of similar behaviour by that doctor?

I hope that the Committee deals with that issue because in many cases in the health service doctors might not perform at the level that we would expect of them. Some cases will be comparatively trivial but others will be serious and fall within the GMC's current powers. There will be other examples where action should be taken and I urge that the matter be considered carefully, because it might be a single act that falls short of serious professional misconduct, as evidenced by the hon. Member for Newham, South in a previous debate. No one is in the business of trying to hound doctors and make them behave more defensively than they are sometimes forced to behave now. Rather, it is a question of having procedures in place to deal with a variety of under-performance, whether it is a serious act under the current powers or a less serious act, so that those matters can be dealt with.

It is not entirely clear, particularly as a result of proposals that the Government recently brought forward, what the relationship will be in terms of powers of complaint to family health services authorities and, conversely, powers of complaint to the GMC. I appreciate

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that the FHSA case is more akin to the employer-employee relationship because it is not direct, whereas the GMC is much more concerned with the professional aspect and has the ability to deregister. I agree with my hon. Friend the Member for Chislehurst that that is crucial, particularly in relation to local doctors. It is no good someone saying that a doctor is not up to standard if that doctor is merrily practising as a locum all over the place and employers are pleased to get shot of him or her. It is important to deal with that issue, too.

Despite what I have said, I support the principles of the Bill because it fills a gap in current legislation. My only concern is whether it goes far enough. If the Minister cannot expand on his earlier intervention when he said that the Bill could deal also with single acts where a doctor fell short of professional performance, I hope that that matter will be dealt with properly in Committee. 7.17 pm

Dr. Tony Wright (Cannock and Burntwood): Although all hon. Members who have spoken so far support the Bill in principle, it is interesting that a critique has developed during the course of the debate about some of the problems and deficiencies in the Bill. The Bill deals with "serious deficiency of performance" yet the issue that we are all trying to address, and think that the Bill should address, is what we might call "consistent incompetence". Although we may think that the Bill is designed to deal with consistent incompetence, if it is concerned only with serious deficiency of performance, as defined in normal GMC criteria, we shall ultimately find that it has not solved the problem which we thought we had set out to solve in the first place. That is the heart of the problem with the measure before us.

As Members of Parliament, we must proceed a little gingerly in the realm of self-regulatory activity as we can hardly offer other professions a shining example of how they should conduct themselves. A little humility might even be in order. Although I agree with other hon. Members that the majority of medical practitioners are exemplary in their skill and their commitment, we know that we have a problem that must be addressed. If we do not get it right this time, we will make things worse, not better, because we will have pretended to solve the problem.

One of our initial difficulties is even deciding the scale of the problem involved. The Secretary of State used the same words as the president of the GMC when she spoke about a small number of consistently poorly performing doctors. What on earth is "a small number"? We do not know because it has never been investigated, but it is a crucial question.

On 4 December 1994, the health correspondent of The Observer wrote an article with the headline:

"Medical Mafia covers up Errors".

He reported that a study of poorly performing doctors was about to be published by the Open University Press in a book entitled, "The Incompetent Doctor". That study revealed that of the 95,000 doctors in practice in the United Kingdom, up to 10 per cent. were estimated by some of those interviewed to be a potential danger to their patients. One professor of surgery said:

"In Britain we tend to turn our backs on these things. It is not easy to recall where people were willing to confront incompetence."

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The study also quoted the manager of a family health services authority who estimated that 10 per cent. of local GPs were "impaired". He confided:

"It is almost impossible to force a resignation. It just has to be horrendous for anything to happen."

Mr. Malone: Before we embark on a route of what I might describe as overestimation, it might be sensible to point out that the GMC has had a certain amount of correspondence about the people likely to be subject to the new rules. Based on its knowledge of the matter, it has estimated that perhaps some 150 or so cases might come before it each year, of which 50 may proceed to further stages. The hon. Gentleman should put that estimate in the context of what we expect from the Bill, which is clearly distinct from the exciting pieces of literature to which he is referring, and which offer estimates of a considerably greater number.

Dr. Wright: I am bound to say that I was about to make the same point to reach a different conclusion.

One of the consistent problems highlighted in the responses to the consultation exercise from some of the interested organisations was that they did not know the numbers involved. The Open university study--the figures may be too large--reveals that we have a serious problem that may affect one in 10 doctors. If that is so, we are talking about nearly 10,000 doctors. That is a rather alarming prospect. Let us hope that it is not true, but there is a huge mismatch--the point of the Minister's intervention--between the scale of that problem and the figure of between 100 and 150 cases that the GMC says might come before it as a result of the new procedures. We should take some care to investigate as far as we can the scale of the problem. We know, however, that we have a problem that has not been addressed. Everyone who knows about it has sought for a long time for something to be done, but response has been consistent inaction. The BMA, in a masterly understatement, has said that the Bill is a long overdue measure. It is, because the problem of poorly performing doctors has been with us for a long time. We all know that the system has not managed to deal with it.

I endorse many of the plaudits bestowed on the GMC, but we should ask why, over the years, the GMC machinery has not managed to bring within its definition of serious professional misconduct all those things that normal people would consider to be serious professional incompetence. That indictment of the system should be put alongside any plaudits and congratulations that might be offered to the GMC today.

The way in which people try to raise queries about the performance of doctors or try to complain as patients or the relatives of patients is a profoundly unsatisfactory business. One of the matters about which I feel consistently most dissatisfied is how constituents who try to raise questions and make complaints about the service they have received from the health service are treated. I am sure that other hon. Members share that feeling. Those constituents are left totally dissatisfied by the outcome of any inquiries made. That is part of the problem that we must address now.

I should like to give four examples of the type of behaviour that I am talking about. Two of them came to my attention simply from my work on the Parliamentary Commissioner for Administration Select Committee, which deals with the health service ombudsman. That

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Committee has heard evidence from a succession of health service personnel, including doctors, who have come before it because they have been judged deficient in some way by the health service commissioner.

One case from 1992, which was referred to the Committee, involved a consultant at the Royal Free hospital at Hampstead, who behaved quite improperly in a case of child abuse. In fact, it was not a case of child abuse, but he told the mother that he thought that it was. His behaviour was contrary to the guidelines that the Government had just issued in the wake of the Butler-Sloss inquiry following the Cleveland affair. It was a most alarming case and the Select Committee stated:

"We consider it extraordinary that a consultant charged with revising the procedures in connection with child abuse should disagree with management on the nature of those guidelines." The consultant told the Committee that he did not feel that the guidelines issued by the Department applied to him because, as a consultant, he knew better. We should ask what happened to that consultant. The answer is that he is still consulting away. I am sure that the GMC has not actively intervened in the matter.

The second case before the Committee was even more appalling and involved a consultant at the Manor hospital in Walsall, which deals with many of my constituents. Not only did the consultant fail to tell the relatives of a patient that he was suffering from cancer, but he just happened never to get round to telling that patient the diagnosis. Such behaviour is unbelievable. When the patient's family subsequently complained, the consultant said that he never answered letters from patients and certainly never answered those from solicitors. The Select Committee of the House stated:

"It was the consultant's responsibility to ensure that effective communication of suspected diagnosis took place; something he signally failed to do on this occasion, not, it appears, for the first time."

In other words, that consultant's behaviour followed a consistent pattern, confirmed by the chief executive of the trust. The Committee also said of that case:

"We see the need for a culture change in the minds of many of the consultants who appear before us."

Whatever the GMC and the new proposed procedures may do, they will not bring about a culture change on the part of such consultants. Another case involves my constituent, Mrs. Ashley, who died leaving her husband in despair at his inability to get her condition taken seriously. His wife suffered from ever-worsening back pain and he had taken her on a number of occasions to the accident and emergency departments, which could not help. When we finally obtained an independent clinical review, the general practitioners did not even deign to give evidence. The consultant to whom my constituent wrote in despair at his wife's condition did not even bother to answer his letter. The independent clinical review said that that was indefensible. Has such a case been near the GMC? Of course not. My final example is a case involving one of the consultants that I have already mentioned, at the Manor hospital in Walsall. He treated a case as constipation when it turned out to be cancer. One might say that that was simply a misdiagnosis, but the independent clinical review concluded that it was not; it was poor clinical

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performance, because the man never carried out the obvious tests that would have established what the condition was. So there was never any proper terminal care for the person involved--who therefore lived and died in agony--or any proper care for the family. Indeed, the independent clinical review said that there should be a surgical audit of all the procedures carried out by that consultant at that hospital. Yet, has that case been near the GMC? Of course it has not. I had a letter from the chief executive of the trust, who told me that Mr. So-and -So, the consultant--I shall not give the man's name--"acted properly". That was written before the independent clinical review.

Rightly, the family has written to tell me that the consultant is still practising on my constituents, and to ask what is to be done about him. The answer is that nothing has been done, and the chances are that nothing will be done. Whatever the numbers may be, whether small or large, that man should certainly be counted as one of them, and on behalf of my constituents I want something done about that. I hope that we all do.

We all hope that the Bill will produce improvements but I, like other hon. Members, have some worries. I am worried about the definition of what is serious and what is not serious, and about the inconsistency of definition in that area as opposed to other professional areas, such as that governed by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. I think that the general rubric of professional misconduct could well be extended to include the kind of routine incompetence that has been discussed today.

I am also worried about the resolute way in which the GMC tells us that it will get into the business of being proactive. It will do nothing to initiate any investigation into whether people are performing properly, but will wait for cases to come to it. No doubt that explains why it says that it expects to deal with so few cases. In many ways that is the key issue-- the general lack of effective clinical monitoring within the system. Somehow we seem to expect the Bill to solve that larger problem, but I do not think that it will. Indeed, I feel rather sorry for the GMC in that respect, because if the GMC cannot play that role, who will? Which part of the system will carry out consistent clinical monitoring?

Another example of a particular worry concerns the clinical performance of many single-handed general practitioners--a worry endorsed by much of the research that has been carried out. Having recently discovered that in my part of the world there are many single-handed practitioners who carry large lists and seem to refer people to hospital at a high rate, I asked my family health services authority what it intended to do about the indicators that suggested that we had a problem with the quality of primary care. The answer was that it could do nothing.

All that the FHSA was doing was to examine prescribing patterns, because that is an initiative designed, quite properly, to cut costs and to achieve uniformity in prescribing. But it does not address the issues of quality and of clinical performance. It should do so, and I worry about that.

The Secretary of State said earlier that doctors had a duty under the internal guidance in the blue books to let it be known if they thought that any colleague was

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professionally incompetent. Yet clearly that is not happening. If it were, the figures and the evidence that we have discussed would not be there.

I should like there to be a requirement in the Bill to ensure that, as a matter of professional conduct, if a medical practitioner comes across professional misconduct and consistently poor performance he or she has a duty as a doctor to inform the professional body concerned.

Although there is a broad consensus that something needs to be done, worries have been expressed, not only in the House but by the Patients Association, by the Association of Community Health Councils for England and Wales and by consumer groups, about whether the Bill has got it right yet or whether there are areas that still need to be tightened.

I was alarmed to see in yesterday's edition of The Independent an article about the Bill that said:

"The Bill has been introduced only on condition that the Opposition will facilitate its passage and not try to alter it". I am all in favour of facilitating its passage, but--

Mr. Nicholas Brown: Before that idea gets going I shall kill it stone dead here and now. Nobody has said anything about not trying to alter the Bill; we merely said that we would facilitate its passage. Of course we can still try to amend the Bill, but we shall do so crisply.

Dr. Wright: I expected my hon. Friend to respond if I gave him a cue, and he did so admirably. Obviously it is the duty of the House to consider measures that come before it critically--and, I hope with a measure such as this, in a bipartisan way. I know that the Opposition will help in that process.

Finally, as several hon. Members have said before, the Bill must be seen in the context of a whole range of measures designed to improve matters in general. The new national health service complaints system, the attempts by the royal colleges to think about recertification and re-accreditation, and the clinical performance initiative are all most important.

I do not want to get distracted, but if only the Government had not been so crazed in their determination to make organisational changes in the health service and to set up a quasi-market for their own ideological reasons, but had simply devoted themselves to the quality agenda all those years, we could have made serious progress on the fronts that impact directly upon the quality of care that patients receive.

We are talking about the oversight of a profession, and one of the arguments that has emerged from the debate, concerning the inconsistency between how things are done in this area and in other areas, might even suggest that the time has come for one body to have oversight of all the professions, so as to ensure consistency. Having listened to the debate I am more persuaded of that case than I was before.

We have come to the end of a road. In another context concerning self- regulation, we were once told that it was last-chance saloon time. Perhaps it is now last-chance surgery time. We must get the balance between professional interests and the public interest right now. I am not yet persuaded that the Bill does that, and we must ensure that it does.

Finally, I shall mention the procedural point. In a motion on the Order Paper some of us have suggested that it would be entirely appropriate for the Bill to go to a

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Special Standing Committee. The more I have heard of the critique that has developed during the day, the more I have felt that to be right.

It is essential that we spend some time exploring the rationale for the Bill in a bipartisan way, teasing out some of the issues, before we start the usual, line by line, ministerial defence of the Bill that is the disabling feature of so much legislation that is created in this place.

Few measures have passed through the Special Standing Committee procedure since it started in 1980--the Mental Health (Amendment) Bill in the 1981-82 Session, the Matrimonial and Family Proceedings Bill in the 1983-84 Session and now the Children (Scotland) Bill. Those are similar measures to the one before us, in that they needed thorough, bipartisan scrutiny.

I shall conclude by quoting what the distinguished then Leader of the House, Norman St. John Stevas, said when introducing that raft of procedural changes, including the Special Standing Committee arrangements. Speaking about Special Standing Committees, he said that

"Government Bills which raise substantial issues, not of acute party controversy".--[ Official Report , 30 October 1980; Vol. 991, c. 725.]

should be subject to that type of arrangement.

The case for that has been made in today's debate. We need a few sessions in which Members who are interested in all that can explore further the aspects that we have begun to discuss today, before we start the usual progress of the Bill. It will be appropriate and helpful if, when the Minister replies, he brings us good news on that front.

7.40 pm

Mr. Nigel Evans (Ribble Valley): I am grateful for the opportunity to make a contribution to the debate.

I believe that all of us, as Members of Parliament, are interested in the health service, especially the national health service. We wish to ensure that the high standards that have been reached in the national health service are maintained and improved. The Bill will help to do exactly that.

Many sectors make up the health care industry, in both the private sector and the national health service. I use the national health service; I am a customer of the national health service, and I find it to be excellent.

There are many good news stories in the national health service, which do not receive the coverage that they deserve. My hon. Friend the Member for Croydon--

Mr. Congdon: North-East.

Mr. Evans: As my hon. Friend the Member for Croydon, North-East (Mr. Congdon) said, although some cases cause anxiety and improvements need to be made, that does not detract from the fact that the vast majority of people who work in the national health service at all levels do so to the highest possible standards. However, that fact does not prevent us from drawing attention to cases where they fall below those standards.

The bad news stories always catch the headlines. I have appeared on "Kilroy" a couple of times when the national health service has been mentioned, and the programme makers appear to be able to pack an audience full of people who have gripes about the national health service, when we know that the vast majority who use the national health service regard it highly.

Dr. Robert Spink (Castle Point): Is my hon. Friend aware that in my local hospital, the Southend Health Care

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NHS trust, the director has done a survey of the letters of thanks that he has received versus the letters of complaint, and that the letters of thanks, which generally go straight to the ward, are pinned on the notice board and are seen by the nurses and staff, far outnumber the letters of complaint that come in from time to time?

Mr. Evans: I am extremely grateful to my hon. Friend for making that argument. The vast majority of people--in excess of 90 per cent. of those who take part in polls and have used the national health service--speak highly of it. Yet a small number of those who use it and who find that the service falls below the standards that they expect, make the newspapers. My hon. Friend has just spoken about the letters of thanks. Would it not be wonderful if we could read some of those good news stories in our newspapers from time to time?

Mr. Cousins: I am puzzled about what happens to the letters of complaint. We have heard about what happens to the letters of thanks. What happens to the letters of complaint? Can the hon. Gentleman throw any light on that?

Mr. Evans: Those letters of complaint are investigated, in the main, but unfortunately most of them receive all the publicity, whereas letters that compliment the dedication of those who work in the national health service do not receive the airing that they deserve. Unfortunately, that is the case in many sectors, not only in the national health service.

I have anxieties about one aspect of the national health service--ageism. A constituent, Arthur Hornby of Janice drive in Fulwood, has a specific problem. For two years, we have been fighting that case in connection with the bad treatment that he received at Hull royal infirmary. We have not received satisfaction on that issue. My constituent's GP referred him to Hull royal infirmary. It was felt that he should have gone to a cardiac ward there, but he was placed on a general ward. Only after a further heart attack was he referred to the ward where he should have gone in the first place. We suspect that there has been a blatant case of ageism in that case. We have taken that complaint to several levels. We are still not receiving satisfaction and we shall continue to pursue that case until we can ensure that any examples of ageism are stamped out of the national health service.

Mr. Cousins: May I assume that that problem, which concerns the hon. Gentleman, has been handled modestly and without undue publicity?

Mr. Evans: Arthur Hornby has himself ensured that that case is receiving the right publicity. In some cases it is the publicity--

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. That is all very interesting, but the hon. Gentleman is straying from the subject of the debate. Will he get back to the debate, which is on the Medical (Professional Performance) Bill?

Mr. Evans: Thank you, Mr. Deputy Speaker. Mr. Arthur Hornby would wish me to mention the performance in that specific case. I know that it may fall outside the parameters of the specifics of this particular--

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