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6.4 pm
Mrs. Elizabeth Peacock (Batley and Spen): As my hon. Friend the Minister for Health said, the Bill is pretty central to the Government's plans to reform the health service, particularly the complaints procedures. I suggest that many of the reforms are much better. In fact, one of the main changes that I welcome is that my local hospital rather than the regional office in Harrogate now holds the contracts for all the consultants who work within the area. That has brought much of the administration and supervision to a local level.
As we heard, the measures in the Bill will be implemented in April 1996. I welcome that. As hon. Members have commented, it is a tight schedule, but I am sure that my hon. Friend will get the Bill through by then and ensure that the necessary training is in place to enable it to proceed.
The Bill is most welcome. I suggest that it is overdue. It is a measure that I have long thought we should introduce, to enable constituents, such as my own in Batley and Spen, to have their clinical complaints investigated. I realise that it is a sensitive issue where professionals are concerned; nevertheless, there are times when that facility should be available. For the first time, patients and relatives will be able to complain to the health service ombudsman about all aspects of care and treatment provided by the national health service, and that must be a step forward. The bar which, until now, prevented the ombudsman from investigating complaints about clinical judgments and family health services provided by general practitioners and dentists will be removed. I welcome that, particularly the inclusion of GP and dental services.
We have heard from hon. Members on both sides of the House who have constituents who cannot afford to take the necessary legal action to instigate procedures against members of the medical profession when "accidents" occur and when surgical procedures leave the patient much worse after the surgery than before. In my 12 years in the House, I have had four or five cases where I felt completely helpless. Having exhausted all the procedures, I was not able to assist my constituents. They did not have the necessary finance to go to law to settle their grievances and they feel extremely let down-- understandably so--by the NHS.
There was a very sad case where a constituent's mother died unexpectedly after so-called keyhole surgery. My hon. Friend will be aware of the immense work that was done by the late Michael Silverman, who lost his wife through keyhole surgery a few years ago. Tragically, he has now died, but he spent a lot of time and money in the past two or three years raising the issue of keyhole surgery and the necessary training for it. In another case, a constituent of mine, a fit and very active 51-year-old, went into hospital for what appeared to be a straightforward procedure and came out in a wheelchair, with no hope of redress against the health service or the consultants, because there was insufficient money to take legal action. I am not sure precisely how that will be resolved by the Bill and by the commissioner's change of responsibilities, but I hope that it will make a considerable difference, because I have seen at first hand how those families were devastated and their lives changed beyond all recognition. I am sure that their lives were changed in a way that is not easy for us to imagine.
I referred both those cases to Mr. Reid, the parliamentary ombudsman. He is always exceptionally willing to examine cases where we feel as Members of Parliament that we do not have any other avenue to go down, but he could not take action as they were outside the remit of his work. I therefore have a special interest in the Bill, and have looked carefully at what Mr. Reid said in his report. In paragraph 21, he notes that
In paragraph 22, Mr. Reid goes on to say:
I understand that the health service ombudsman will continue to investigate complaints about the way in which services are provided--failures to provide service, for instance, and maladministration--and that is welcome. I must say that the majority of objections to the way in which a complaint has been handled are resolved after I have taken them to my local health trust, Dewsbury Healthcare NHS trust. Earlier, my hon. Friend the Member for Rugby and Kenilworth (Mr. Pawsey) spoke of a lack of communication; as with so much of our work--certainly mine--the problem here frequently relates to a blockage in the channels of communication that should make people understand exactly what is happening.
I note that the ombudsman will continue to be prevented from investigating complaints about disciplinary and other personnel matters. That is right: such matters should be resolved locally, in the shortest possible time. Consultants and other professionals should not be suspended on full pay for long periods when they are doing no work in the health service.
I believe that the national health service throughout the country takes complaints very seriously. The Dewsbury trust is excellent in that regard, but it cannot always resolve clinical complaints. The only option is for the patient or the family to take legal action, which--as I have said--is extremely expensive.
With respect to the General Medical Council, its various committees and the lay assistants who examine some of the cases, I must say that I am not convinced that the GMC has always had the necessary expertise to decide whether cases should proceed. That certainly applies to the cases that I have taken to the British Medical Association in the past. I feel that it is a bit of a closed shop, and that the Government should examine the position. In my experience, it is almost impossible to surmount the barrier: everyone closes ranks. That cannot be in the best interests of constituents with genuine cases against health authorities.
The latest six-monthly report from the health service commissioner shows that more than 8 million patients were treated in 1993-94, and 40 million were seen as out-patients. Only 1 per cent. registered complaints. Whatever I may say to my hon. Friend the Minister, I feel that we must see those figures in context. We are talking about a very small percentage--probably only a small percentage of that 1 per cent. of complaints represents serious cases in which no resolution could be found.
Mr. Simon Hughes (Southwark and Bermondsey):
There is clearly general agreement that the Bill is a good thing. I join other hon. Members in welcoming it.
In its first report on the national health service complaints system, the Select Committee on the Parliamentary Commissioner for Administration quotes from a document entitled "Complaints Do Matter", produced by the National Association of Health Authorities and Trusts. The document stated:
I have never understood the argument--or, rather, I have understood it but have never begun to support it-- that the ombudsman should not have the right to investigate complaints relating to clinical practice. If we allow the Police Complaints Authority to investigate the professional job done by the police, it is absurd to say that the core job that is done in the health service cannot also be investigated. It was possible to examine the paperwork, but not to look into whether someone had been seen in the right way or had received the right treatment.
It has taken a long time for us to reach this point-- although I note that things have moved quickly since the Select Committee made its recommendation in November 1993, and I pay tribute to it for that. In May 1994, the Wilson report was published. I commend that document: like others, it is very readable and hits the nail on the head. The Select Committee quickly picked up what the report said, and the Government presented proposals in March this year and legislated in November. Once the show was on the road, things moved rapidly. Throughout that time there was uncertainty about whether dealing with clinical complaints would feature in legislation, but we should be grateful that it has. I imagine that the profession felt rather defensive, and may still, but it serves as the servant of the public which must complain on the public's behalf. The purpose of the Bill is to give the lay public the right to make their health service serve them properly.
All of us--no matter how good the health service may be in our localities, and no matter how excellent our hospitals may be--present a succession of complaints
when things go wrong. Guy's hospital is in my constituency, and many of my constituents visit St. Thomas's and King's College hospitals. Those are excellent hospitals; they are probably among the best in the country. Nevertheless, things regularly happen that should not happen. The Wilson report sets out the reasons why people want to complain about such things.
Complainants are not normally vindictive; they simply want an acknowledgement that things have gone wrong. They often want an apology from the authorities, an explanation of how the problem can have come about and a report on what has been done so that the mistake does not occur again. Sometimes they want compensation or redress. Sometimes they want punishment, feeling that someone should not be allowed to get away with bad practice, bad supervision and bad management. Often they want to ensure that they are heard. All those are very good reasons.
Like the hon. Member for Batley and Spen (Mrs. Peacock), I think it highly unsatisfactory if the only recourse that people have is the extremely unhelpful process of law. I say that as a lawyer. Taking a medical negligence action through the courts is about the most unsatisfactory form of legal action there can be. If there can be a procedure that, in a known system, deals much more quickly with the matter and does not require people to spend money that they may not have, that is far better.
It is also vital--this will be the merit of the Bill--that everyone knows and can understand the system. The hon. Member for Wakefield (Mr. Hinchliffe) made the point that many people do not know the system at all. They do not know what the proper system is because, in large measure, there is not a proper system in the health service--it is very hit and miss. They may go to see their Member of Parliament, who may write to the chief executive of the trust or the health authority. Normally, something happens. There may or may not be a meeting. It may include only the people involved; but they may have left, so someone else comes. A person who has nothing to do with the incident may be involved. One gets the impression, however--let us not mince words on this--that people look after each other and defend their interests. Often, the reality is that people--if they do become involved--will not say anything about their colleague if that person has messed something up.
That is not the case all the time. The other day, I had occasion to complain about the treatment at St. Thomas's hospital of a relative of constituents of mine. The authorities whom we met said, "We apologise. We should not have behaved like this. The management on the ward was appalling. Various things should never have happened. Your relative was extremely badly looked after." Mercifully, that lady survived and is now being treated in another hospital, where the care and attention that she is given are much better. We must, however, have an impartial system, which is a good thing.
The hon. Member for Batley and Spen cited the past two half-yearly reports and gave examples of some of the ombudsman's cases. In those examples, it is clear that things often go wrong. From those reports--it happens that those were the ones mentioned--it seems that they go wrong in London more often than elsewhere: 18 of the 52 reports involve London-based complaints. There are, I think, still more complaints per head of the population in London than anywhere else. I am sure that Ministers are aware that those are some of the things that the health
service needs to sort out. If we have all these resources, it is bizarre that, in the capital city, things go so badly wrong so often.
It is clearly logical, therefore, that the ombudsman's powers will be extended, first, to deal with clinical matters and, secondly, to deal with other parts of the health service--things one's general practitioner, dentist or optician does or does not do. An unsatisfactory, very much "around the houses" system is still in place in relation to getting a GP. Shopping around for a GP, and trying to get another GP if one is struck off a GP's list, is still very hit and miss. That system needs to be reformed, but if we can have one that is fair, independent and speedy, which is important, so much the better.
The previous Chairman of the Select Committee on the Parliamentary Commissioner for Administration reiterated the trite, but true, saying that justice delayed is justice denied. I endorse what he said. It is no good having investigations stretching out over months or years. People want investigations to come to an end. Often they involve a bereavement; often someone has died. People want to be able to wrap up that portion of their experience, which is often extremely unpleasant to recollect and go through. They feel they have to and they want it done quickly.
In addition, I welcome the Bill's two Nolanesque powers of direct intervention. The first--which is in clause 5, I think--is that the ombudsman can shoot through the system: he can say, "I am going to investigate that, no matter where it has got to in the system." That is a good thing. The second is that he can lay reports directly before Parliament--they do not have to go around the health service's hierarchy. That is good, because the ombudsman system works on the strange equilibrium principle that an ombudsman investigates and makes recommendations and that his authority resides in the fact that Parliament will consider his report and, presumably, hit the health service over the head if it does not act properly in response to his report. That odd, inconclusive, historical, constitutional balance often appears in Britain, but, even so, in general terms, it is better--if it is cheaper and quicker--than going to law.
It is even more important that we get this right because we have an undemocratic health service. Yes, we have Ministers at the top, but no one pretends that the local health commission or local health trust are democratic bodies. I argue that they should be. As long as they are not, and as long as all the people who run them are appointed by the Secretary of State for Health, it is even more important that we have a proper complaints system that works. The public cannot sack the management, other than at a general election, which may be a bit of an overreaction if one is trying to deal just with a problem in the local hospital and if one does not necessarily think that the whole of the management should go. In my constituency, people think that the management should not have been there in the first place, but that is a separate issue--one clearly needs to be able to have the best possible form of complaint.
The system fails to do two other things. It does not-- this is not intended, but it is worth observing--provide a health service inspectorate. I strongly believe that we need a proper health service inspectorate, as we have in the education service through the Office for Standards in Education, in the Prison Service, and for the social services. There should be a body that can go in--the community health councils do this to an extent, but they
do not necessarily have the clout that a national inspectorate or a federation of community health councils would have. That is part of the missing link in an undemocratic health service.
The last, as it were, ambiguous thing that is left involves the ombudsman's ability to take up a matter where the complaint about the commissioning health authority is in terms of where, for example, it placed a contract and where a relative was treated. The ombudsman has the power to investigate such a matter if it causes, I think the phrase is, "harm to the individual". The individual still lacks the power to complain if a health authority asserts its right to treat the patient in a certain place or in a certain way. This is one of the failures of the present purchaser-provider system, which does not give the customer--the user--real power.
The new system will work if it has the resources. The hon. Member for Batley and Spen, the Chairman of the Select Committee--the hon. Member for Rugby and Kenilworth (Mr. Pawsey)--and the hon. Member for Warwick and Leamington (Sir D. Smith) made it clear that this will not work unless the money is put up front and enough people work for the commissioner to do the job. We do not want a system that results in a queue of cases, such as those waiting for asylum decisions, where a great pile is kept in an office corner because there are not the people to deal with it. That would be unacceptable.
"the vast majority of legal claims for medical injuries or negligence are settled out of court. Where in such cases a complainant receives damages there may be no admission of fault or explanation."
That is fine, but I must repeat that many people do not have the resources to reach that stage, given that each medical report that they may need costs £350 or £500. They need that amount to obtain information from the consultant, and another £300 or £400 to obtain, perhaps, X-rays. That is far beyond the means of many of my constituents.
"In considering whether to investigate in cases where there may be a remedy in the courts or a right to go to a tribunal, the Ombudsman expects ordinarily to have regard to the broad considerations in paragraph 21",
and specifically to one or two others. The ombudsman must also have regard to
"whether it is evident that his or her primary concern is to obtain damages (as distinct from an explanation, apology, or action taken to put matters right)".
A person may be seeking damages in extreme cases. People whose lives have been ruined and who, at a very young age, find that they cannot work any more may, if they have no other recourse, seek damages if it is felt-- and proved--that the consultant had a responsibility to avoid such an outcome. I hope that that aspect will be examined carefully in Committee.
"There is considerable dissatisfaction within the NHS, amongst the health professions and organisations representing patients and also amongst informed opinion, regarding the current arrangements for handling health service complaints. The arrangements are seen as being over-complex, failing to be user-friendly, taking too long, often over-defensive and often failing to give any satisfactory explanation of the conclusion reached."
The Select Committee concluded:
"The current complaints system in the National Health Service seems designed for the convenience of providers of the service rather than of complainants."
That, I think, was very much the general view.
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