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Mr. Hargreaves: I, too, have noticed a huge increase in the NHS work load that results from my mailbag. I am sure that other hon. Members have shared the same experience.
I return to the difficulties that were experienced by the hon. Gentleman's constituent as a result of a mammogram. A close member of my family went through the same experience slightly more than a year and a half ago. There were exactly the same problems. It is my impression, however, that the Bill will enable the commissioner to examine the sequence of events from beginning to end, and to investigate it thoroughly and properly.
Mr. Deputy Speaker (Sir Geoffrey Lofthouse):
Order. We are moving away from the Bill. The hon. Member for Wakefield (Mr. Hinchliffe) should confine his remarks to the Bill.
Mr. Hinchliffe:
In a sense, Mr. Deputy Speaker, I do not disagree with the hon. Member for Birmingham, Hall Green (Mr. Hargreaves). I am concerned that the Bill will not unravel the earlier stages of complaints. It seems that we are tackling the problem backwards rather than forwards.
If the Government were to consider establishing a one-shot, one-stop, complaints system as a first stage, as opposed to continuing with the various elements of the present complaints system, the huge increase in demand for the ombudsman's involvement might be reduced. In a sense, if complaints reach the ombudsman, the system has failed. If people are still aggrieved at that stage, it would seem that the system has failed. The system should allow people to receive satisfaction earlier, especially when serious complaints are made of the sort that I have described, as the result of local investigation.
I am concerned about self-investigation. I hear complaints about the police investigating themselves. Surely it is reasonable for people to think that it is wrong that a hospital trust should effectively investigate itself. The same applies to a health authority. I should like to see complaints procedures tied in much more to local level, and simplified at that level. If my hon. Friend the Member for Fife, Central (Mr. McLeish), the Opposition spokesman, wishes in some ways to reduce expenditure on the health service, tidying the complaints procedure would lead to a more effective use of scarce resources within the NHS.
One of the consequences of the 1990 Act is an increase in buck-passing when there are complaints within the NHS. There is a "not me, guv" attitude. It seems to be,
"It is somebody else's responsibility, not mine." I have noted the attitude on several occasions in several areas.
I travel by train from Wakefield to King's Cross every week. Since the privatisation of the railways began, the "not me" mentality has developed within the railway system. Instead of an apology for the train being late and acceptance of responsibility by the provider of the service, the company which runs the service from Leeds to King's Cross blames Railtrack. In effect, it says, "Blame Railtrack, it isn't our fault, guv. It's somebody else's fault." That is happening with the NHS.
I am concerned that the Government have not taken account of the way in which various organisations are blaming one another. As I have said, I have seen the process developing within the NHS. The purchaser blames the provider, and the provider says that the purchaser has not provided enough money. There is argument about responsibility.
I do not wish to knock good officials in the local NHS area I represent, but I have received some difficult representations from general practitioners. Some GPs feel that their patients are not receiving proper treatment, because of the two-tier system that has arisen because of fundholding. I am sorry that the Minister has left the Chamber, because my argument relates directly to the commissioner's role in responding to complaints. My constituents' GPs, and some hospital consultants, feel that they are being badly let down by a two-tier system that gives priority treatment to fundholders in various ways.
Behind the scenes, off the record and privately, people say, "That is true. It is not our fault. It is their fault. It is not the hospital's fault, it is the health authority's fault." Or they might say, "It is not the health authority's fault,
it is the hospital's fault." The buck is being passed. Perhaps I am not surprised that the Minister has left the Chamber, bearing in mind the fact that it is the fourth time that I have raised the issue. Indeed, it is the fourth time that he has avoided responding to a serious issue.
The commissioner should have the power to carry out detailed examinations in penetrating bureaucratic responses, which lead to agencies within the internal market blaming one another. There is a lack of response, of which I am becoming tired. Serious issues are raised, and my constituents are not receiving the responses they deserve.
Many of the problems that arise in the complaints procedure stem from the fragmentation of the service, and that has arisen with the implementation of the 1990 Act. The Bill does not meet patients' concerns and grievances.
The commissioner's role will remain far too limited. Despite the extension of that role, the commissioner will not be able to deal with certain issues. I shall localise my argument by referring to my constituency.
Until the internal market was introduced--I am not sure what the connection is between deterioration in service and the introduction of that market--the primary complaints that I used to receive about the health service in Wakefield turned on the quality of hospital food. It may be that people have become more willing or more prepared to complain since the introduction of the internal market. Unfortunately, we had a serious problem with the quality of hospital food, arising from the cook-chill system, and I have raised that issue several times.
The complaints that I receive about the health service in Wakefield are about basic caring provision at ward level. The picture I get is not of uncaring nurses, as I know many nurses personally; I have neighbours who are nurses, and they are decent people and well motivated. But they are so stretched at ward level that things are going badly wrong. They are under-resourced on the basics, and complaints arise through patients not receiving basic treatment that they have a right to expect.
The reason for that may well be underfunding. I query what the role of the ombudsman can be in the Bill where a complaint is about the allocation of resources, because, as you well know, Mr. Deputy Speaker, from representing an adjacent area to my own and one that is within the same health authority area, my area has a major problem arising from the revised resource allocation formula introduced by the Government to allocate resources to individual health authorities.
Percentage-wise, my area has lost more resources than any other health authority in the Yorkshire and northern region. I am conscious that some of the complaints that will end up with the commissioner relate to simple facts about under-resourcing of services at the local level. The commissioner has a role to play in that context. I can see my hon. Friend the Member for Stockport (Ms Coffey), the Whip, looking at me to say that it is about time I sat down--I used to like her.
I shall finish on a key issue for my constituents. The market forces factor introduced in the new resource allocation formula assumes that an area of lower property prices will have cheaper staff. That is nonsense. It assumes that the purchaser will drive down the wages paid by the provider. That is fundamentally wrong.
The other issue of which the commissioner should be aware, and which should be considered in the Bill, is the way in which the standard mortality rate, which is used in
the allocation funding formula, penalises the areas where people tend to die younger. The area that you and I represent, Mr. Deputy Speaker, has a history of mining and heavy industry, where people tend not to live as long as those who have not worked quite as hard in other areas or under such difficult working conditions.
We are penalised because we have fewer older people, despite the fact that hospital interventions are precisely the same as they would be with people dying later--
Mr. Deputy Speaker:
Order. The hon. Gentleman has tried hard to keep within the confines of the Bill. He has not always succeeded, and he is straying from it now.
Mr. Hinchliffe:
You have been very patient, Mr. Deputy Speaker, and I respect that.
I conclude with a point that needs to be explored, and it relates to the complaints procedures. We should contrast the way in which the Government introduced the Bill, on the role of the commissioner, with the manner in which they treat community health councils--supposedly the patients' voice. My hon. Friend the Member for Fife, Central touched on that issue. In my area, community health councils are denied observer status at the board meetings of the community trust and the hospital trust, which I think is wrong. To the credit of the health authority, they can attend the health authority meetings.
Another point that I wish to raise is the current consultation document issued by the Department of Health on the membership of community health councils. We are in danger of undermining some of the strengths of community health councils by removing from their membership some very good people: experienced members, who have had a role to play in dealing with issues and complaints, which did not then have to go to the health service commissioner, whose role is examined in the Bill.
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