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Mr. McLeish: The Minister nods. We may want to see whether the commissioner's responsibilities could be extended fairly and squarely to administration and clinical judgment.
Mr. Malone: I am grateful to the hon. Gentleman for his support for the Bill, on which there is cross-party unity in principle.
On the hon. Gentleman's specific point, he will be interested to read the paper published by the commissioner, which runs to some 70 paragraphs and sets out in detail how he proposes to tackle those matters. That paper will form part of the debate in Committee, as it sets out most of the commissioner's thinking.
Mr. McLeish:
The Minister makes a fair point. We shall read the paper with interest, and will make a stab at reading it all before Committee stage. There must be consistency in any extension of jurisdiction and I shall read the commissioner's comments.
May I deal with the first two stages of the complaints procedure? Stage 2 of the new procedure has an interface with the commissioner's role. The public, as patients and family representatives, are concerned about impartiality. At stage 2 of the complaints procedure, a non-executive director of a trust, for example, will be instrumental in screening a complaint to decide whether a panel should be set up to investigate it further. Although the commissioner will expect normal procedures to have been exhausted before he enters the frame, he has the ability to override those and enter the complaints procedure at an
earlier stage. The Minister can ensure that public fears about partiality are allayed by going beyond having a non-executive director of a trust, for instance, as the key person who screens a complaint and decides whether it should go further. He must clear up any confusion that might arise if the commissioner decides to enter early into the complaints procedure rather than wait until all normal procedures have been exhausted. Clarity is the issue and I hope that the Minister who winds up will deal with that point.
The private sector's inclusion in the complaints procedure is an interesting development. We agree that there should be fairness throughout the system in relation to NHS patients. I imagine that, apart from a tiny minority of people, complainants will be NHS patients. Are we to believe, then, that the commissioner will have jurisdiction over those NHS patients? Whether they are treated in a private hospital through private health care insurance or because they have been referred by a fundholder or district health authority, they should be covered by the health service commissioner's extended jurisdiction. It would be a fundamental change if everyone were included in that extension. I hope that the Minister, who is writing feverishly, is responding at least mentally to my comments.
The complaints procedure in the NHS is a three-step process but, in private provision, two of those steps do not exist. In Committee, we shall seek to find out how complaints are processed in the private sector. There is an important interface between private sector patients and patients referred to private hospitals by the national health service. If the Minister's assurance that NHS patients will be covered by this measure is to be taken at face value, will he assure us that virtually everyone in Britain with access to independent provision will be covered? Will the Minister clarify that point when he winds up?
We must ensure that there is no confusion in terms of the patients charter and targets for accident and emergency and ambulance provision. Some people say that the new system should clarify current procedures, be effective and provide quality and fairness. Given the interface between the new procedures, we must avoid problems with existing Government targets and standards.
Professionals in any walk of life find change difficult to accept. Those in the national health service are no different. Any complaints procedure must generate trust and confidence and, at this stage in the development of the NHS, transparency is vital. Constituents who complain to me about the health service are often as concerned about the process and how they are treated as they are about the issue about which they wish to complain. That shows that, within any organisation, the culture is crucial. As the Government move towards implementing the new proposals, including extending the commissioner's jurisdiction, the issues of trust, confidence, transparency and accountability will become front-line issues for the public. We want to avoid confusion and delay, and the commissioner is concerned about the time that inquiries take. It is therefore important that we look closely at that matter.
As we have argued before, any procedure must be about quality. People will never be 100 per cent. satisfied and the rising volume of complaints within the NHS shows that we shall not satisfy huge numbers of people. Ultimately, the system must be not only fair in its application but seen to be fair.
The commissioner, Mr. Reid, made a vital comment when he said, in an important paragraph:
That paragraph contains several thoughts. First, Mr. Reid wants problems to be dealt with locally and effectively solved. That is what we should like. Secondly, he emphasises the crucial fact that, in a complaints procedure, people should be treated with civility and politeness. Far too often, the way in which people are treated is what generates aggravation, and that is often unnecessary.
I know that the Government and the Opposition cannot build that consideration into the culture of the NHS from the centre. Professionals owe it to patients to act with their best judgment, but it requires a commitment from Government to ensure that the complaints procedure is properly resourced and is applied consistently throughout the country. That will inform the confidence of professionals, which in turn will help the patient.
Last year, 90,000 people decided to write about their treatment in the national health service. Complaints to the commissioner have increased by nearly 28 per cent. in one year, to 1,782. Unfortunately, we are on a rising curve of complaints in the service. As the commissioner said, that does not necessarily mean that there are more problems in the national health service; it may mean that more people are aware that they can complain. That strikes at the heart of another consideration--the size of the NHS, and the need, in such a large organisation, for access points so that people may use the service complaints procedure.
The system should be simple for people to use. People need to know that their concerns will be treated sensibly by the professionals involved. However, one of the problems that the Government's reforms in procedures might involve is the issue of how the managers police the professionals in the NHS.
I return to the stage 2 process, identified earlier. I hope that the Minister accepts that it cannot be right to leave it entirely to a non-executive director of the NHS, in the instance that I quoted, to decide whether someone's complaint goes further than it currently does. Independent observers, community health councils and consumer councils are aware of the sensitivities in the NHS, but they want their fears allayed. The concerns of patients must be treated with the utmost seriousness. I hope that the Minister, when he replies, will be able to tell us that in Committee we may consider widening that stage 2 process, because it interfaces directly with the commissioner's role.
That leads me to the question of what role the community health councils will play in the procedure. In a system that will have been significantly changed, we shall need organisations with an advocacy role; organisations that are able to advise independently and, at
each local level, organisations that can monitor objectively and feed that information back into the system for the benefit of all.
A readily accessible, understanding system is required. Without mentioning the community health councils, it seems to me that the Government have a vehicle that might be substantially improved in relation to the patient complaints procedure. I hope that, in Committee, we shall be able to consider ways in which those organisations might be better deployed in the process.
I have mentioned the perception of fairness. We all have a heavy responsibility to ensure that people consider the system to be fair. I believe that, in Committee, we must carefully consider ways in which to achieve a balance. I reiterate that we want to protect professionals, but the system must be transparent and accountable. It is crucial for patients to be able to obtain redress if the treatment is not what they believe that it should be.
"The best way to deal with a complaint is to handle it quickly, politely and effectively at local level."
The Minister said that earlier, and I endorse that. Mr. Reid continued:
"I would be the first to applaud if the new complaints procedures reduced the number of complaints which had to come to my office. The effective involvement of lay persons as well as professionals in complaints arrangements locally should generate greater confidence in the objectivity and rigour of an internal investigation. It will help if staff in all professions look upon complaints not as a personal affront but as a valuable contribution to audit and to the improvement of service."
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