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Dr. Tony Wright (Cannock and Burntwood): The Minister says that the additional costs arising from the Bill in relation to the health service commissioner will be £5 million in the first year, rising to £6.5 million the following year. Taken as a whole, this change to the NHS complaints system will clearly have considerable costs across the system beyond those occasioned by the new role for the health service commissioner. Could the Minister say how large those costs will be and why they are going to be taken only from existing resources?
Mr. Malone: The hon. Gentleman will probably be aware from previous discussions in the House about the Wilson report that the view is that, once the Bill is implemented, it will, over time, be cost neutral. When it is implemented effectively, it will reduce the complexity of the diverse complaints systems in the health service. That will be very much a saving. He will understand that we have a whole family of complaints systems, which are frequently difficult to administer, take substantial time and often result in people taking complaints through all stages in the process because they do not get satisfaction. We are replacing that system with a more streamlined, single system which will serve the whole national health service.
I take this opportunity to set it on record that I hope that the Bill will result in far more complaints being resolved quickly within the body that is responsible for dealing with the complaint so that fewer complaints are passed up the system to the second tier and, eventually, to the ombudsman. That is the purpose of the Bill and the assessment is that, should the system be implemented in the way that we foresee, over time it will be cost neutral-- and a better system, too.
The Bill is part and parcel of our reforms to the way in which complaints are handled throughout the NHS. It will, as I have said, improve the efficiency of the way
in which we handle complaints and enable health care providers to learn valuable lessons from investigating complaints and so improve the efficiency and effectiveness of services generally.
Clauses 13 and 14 deal with repeals and commencement. Clauses 15 and 16 deal with the extent of the Bill and citation.
There are two schedules to the Bill. Schedule 1 deals with amendments to the 1993 Act, which are supplementary and consequential to the main provisions of the Bill on family health service and independent providers. Schedule 2 sets out the repeals to the 1993 Act provided for in the Bill.
I shall briefly outline the main provisions of schedule 1. Paragraph 2 enables the commissioner to investigate contractual or commercial transactions that relate to the purchase of services for NHS patients from independent providers by GP fundholders, who are newly brought under the commissioner's jurisdiction as family health service providers. That is simply a logical extension of the powers that the commissioner previously enjoyed in other areas. In addition, paragraph 2 excludes from the commissioner's jurisdiction complaints arising from disputes between family health service providers and health authorities or health boards about the arrangements made between them for the provision of family health services.
Paragraph 3 of schedule 1 provides for family health service or independent providers, or those working for them, to be given an opportunity to comment on any allegations in a complaint and ensures that family health service and independent providers are able to take action, such as disciplinary action, against a member of staff in relation to matters under investigation. In essence, it means that, when a complaint is made, other possible lines of redress will not close down while it is being dealt with.
Paragraph 4 extends the commissioner's powers to require information and documents to be supplied to cover the investigation of complaints about family health service and independent providers.
Paragraph 5 makes provision for reports about the investigation of complaints about family health service and independent providers closely following the existing provisions for complaints about health service bodies. Paragraph 7 adds family health service providers to the list of those who are ineligible for appointment as a commissioner.
I make no apology for going through the measures in the Bill in some technical detail because, although it is uncontroversial, it is fairly complex in its way. I have tried to give a thorough and businesslike review of the Bill's detailed provisions. It is an important measure and one which I have great pleasure in bringing to the House.
Mr. Henry McLeish (Fife, Central):
I acknowledge the
It is important to state at the outset that we welcome the Bill. We embrace its principles and support its ideas but we believe that it can be strengthened in Committee. We shall wait for it to go into Committee before discussing strengthening measures.
While I praise the health service commissioner, it is also important to quote his words from his third annual report, for 1994-95, in which he states:
It is also right to pinpoint the fact that this is all about complaints procedure and the rights of patients. It is also about a service that needs to be responsive, accessible and, as the Minister rightly said, accountable. It is important to stress that we owe it to the professionals in the service to have a fair system. Part of any complaints procedure is the worries, fears and concerns that professionals have, especially if investigations take place over a lengthy period. For all those reasons, this is an important debate.
The Bill builds on the Medical (Professional Performance) Act 1995 which, in its way, extended the competencies of the General Medical Council into new areas of performance. That is in the patient's interest. The Bill complements the 1995 Act and goes a great deal further in terms of complaints procedure.
I endorse the Minister's comments about the new procedures that will be implemented in April 1996. I share the concerns of some people that the timetable may be too tight, but we need ambitious timetables if we are to make progress. Obviously, the Government will want to implement the measures with sensitivity and take on board some of the criticisms made by some health groups. The two-stage process, which will be complemented by the new work of the health service commissioner, will help the whole process. There is nothing better than a set of procedures that gain the confidence of patients and professionals and, at the end of the day, improve what is now an important part of the changing face of the health service.
The Minister also pinpointed the important areas into which the jurisdiction of the commissioner has been extended. We welcome the measures on clinical judgment. That is an important development. From the comments so far by the commissioner and others, including the British Medical Association, that will have to be approached very cautiously indeed because while huge sensitivities govern the activities of professionals, there is a great number of complaints about clinical judgment.
We welcome the fact that the commissioner's jurisdiction has been extended to family health service practitioners, whether GPs, dentists, pharmacists or optometrists. That is important and brings consistency to the application of his work.
The fact that the commissioner's jurisdiction will be extended formally to independent providers is also important. As the amount of money flowing into the private sector increases, it is vital that NHS patients using private sector facilities are covered by the ombudsman. We shall look into that in much more detail in Committee and explore how it will work. The proposals build on the three-step complaints procedure, but the first two steps do not exist with private health care. If NHS patients are to be part of that process, we must ensure that we know what is happening in private hospitals. Vital public resources now go into those hospitals through the Government's reforms and it is crucial that we understand what is happening.
The Minister rightly pointed out that these proposals are built on some substantial reports, including those of the Select Committee on the Parliamentary Commissioner for Administration and the Wilson review, which started in 1993 and has come up with proposals for a two-stage complaints procedure to begin in 1996. That review flags up the new powers that have been given to the commissioner.
"aspirations about more effective complaints handling are hot air. They need now to be matched by performance."
While progress has been made, the Government would agree that we could make more progress. Clearly, the commissioner shares that aspiration.
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