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7.32 pm
Ms Ann Coffey (Stockport): I am taking the opportunity of this debate to bring to the House's attention the circumstances in which a young boy died, because it illustrates some of the problems with the current complaints procedure.
On Thursday 7 December--last week--Nicholas Geldard, aged 10, collapsed at home. His mother found him lying on his bedroom floor. She took him into her bedroom and gave him the kiss of life and an ambulance was called. It took 20 minutes to arrive. Nicholas was admitted to the accident and emergency department at Stockport infirmary at 4 o'clock, where he was seen by a nurse. Arrangements were made to transfer him to one of the children's wards at Stepping Hill hospital. That transfer took an hour to arrange. The registrar decided to admit him to the children's ward, but not to arrange for a scan. By that time, he was conscious.
Later that night, Nicholas had a fit. It was decided that a scan was necessary. The scanner at Stepping Hill hospital, bought with £1 million of public subscriptions, was not available as it was staffed only from 9 am to 5 pm. He was anaesthetised and transferred to Hope hospital for a scan at 12.30 am. His parents were informed that he had a brain haemorrhage, a slow bleed at the side of his head, and the blood needed draining. The consultant at Hope hospital told the parents that Nicholas had a fighting chance, but no intensive care beds were available in the whole of Greater Manchester and he was taken to Leeds infirmary. He arrived at 4 am, 12 hours after he was first admitted to the accident and emergency unit.
Nicholas's distraught parents were informed that he was brain dead. The funeral takes place this Friday. I spoke to his parents last night. They had contacted the local paper, the Stockport Express, which in turn contacted me. His parents were shocked and distraught but, more than anything else, extremely angry. They want to know why the scanner was not available for use at Stepping Hill hospital and why no intensive care beds were available in the whole of Greater Manchester. They feel that lack of resources when they were needed killed their child and that the NHS let them down.
Questions must be answered. Why did the Greater Manchester ambulance service, which has just received its charter mark, take 20 minutes to arrive? I shall ask the chief executive. I shall ask the chief executive of the community care trust about the clinical decision not to refer Nicholas for a scan on admission to the children's ward. I shall ask the chief executive of the Stockport health commission why he funds the scanner's operation only from 9 am to 5 pm. And I shall ask the chief executive of the acute services trust why there has been a delay in discussing funding the scanner outside those hours. Part of the problem these days is that there are many questions to ask and many people to answer them.
I have also tabled a parliamentary question to ask the Minister to launch an inquiry into the circumstances of Nicholas's death. The Minister will no doubt respond by saying that those are operational matters. If they are, they are the consequences of the fragmentation of the NHS and a market-driven delivery of health care, in which each hospital and purchaser protects its own budget. I hope that I shall not get that response, as last week the Minister ordered a cut in management costs, which was also an operational decision. If he is willing to intervene on management costs in the health market, he should intervene in the case of a child's death.
Nicholas's parents can consult a solicitor, provided that they can afford to do so; I can refer the matter to the parliamentary ombudsman; and the parents can take up the clinical aspect through the complaints procedure. The Bill is to be welcomed as it extends the ombudsman's power to deal with clinical complaints, but it will not help in enabling constituents to challenge policy decisions locally. My constituents feel that those decisions contributed to their son's death. Policy is made by unelected boards. The NHS failed that child. It failed to provide the resources to enable him to have the best possible chance of life. The subsequent inquiry will no doubt come up with a number of explanations and that well-known person--nobody-- will again take the final responsibility.
Mr. Kevin Barron (Rother Valley):
Whatever the circumstances of the case that my hon. Friend the Member for Stockport (Ms Coffey) has just described, the whole House will wish to offer its commiserations to my hon. Friend's constituents who tragically lost their son last week.
When we consider how the health service has operated for many years and the complaints that we have heard at our constituency surgeries, many of us could remark on the number of times we have wished that circumstances had been different. The hon. Member for Batley and Spen (Mrs. Peacock) told us of the circumstances in her constituency. We could all recount cases that have been brought to us, involving not just people who have suffered tragedy but people who feel that the mechanism within the NHS has not provided answers to the questions that they or members of their families have posed. We all agree that that complaint needs to be sorted out. As has been said, Opposition Members support the basis of the new system, in which the investigation of complaints is separated from the punishment of offenders; we support the division of complaints from the disciplinary procedures in the national health service.
We also welcome extending the scope of the complaints procedure to family health practitioners and the so-called "independent" providers. My hon. Friend the Member for Fife, Central (Mr. McLeish) asked the Minister whether he would say exactly how widely that extends in terms of the growing private sector in health care, and exactly whom the commissioner would inquire into.
I am pleased that clinical complaints will now be part of the commissioner's remit. The hon. Member for Chislehurst (Mr. Sims) said that that was not very clearly defined in the Bill, and it is probably not very clearly defined in all our minds. I hope that the commissioners will have clearly defined exactly what "clinical complaint" and "clinical judgment" mean. I am sure that many people outside the House will examine that closely.
The timetable is very ambitious because it does not stand on its own. The Bill is, if not an integral part, an important part of the change in the new complaints procedure that will come into being in April 1996. In general, we agree with that. The Patients Association believes that the details need to be clarified, and we would agree.
Specifically, as my hon. Friend the Member for Cannock and Burntwood (Dr. Wright) said, we require more information about the status of the lay panel at stage 2. There is a contradiction between the contents of an earlier Health Select Committee report and what is in the Bill. We want to know about the panel's independence from the person or organisation being complained about, and we are interested to know the Minister's opinion on the automatic right of access to stage 2 for those patients who want it.
It would be nice to know more about the type of professional clinical advice available to the panel and about the type and number of clinical advisers to be
included in the 130 new posts in the ombudsman's department which are planned under the provisions of the Bill.
We wish to know what measures are in place, and what further measures are planned, to improve staff training in the new procedures. My hon. Friend the Member for Pembroke (Mr. Ainger) mentioned that issue. Training will be crucial if we are to do effectively what my hon. Friend the Member for Cannock and Burntwood said that we should do--I hope that the profession will consider it--and to change the culture which has existed in the national health service and the wider areas in which we provide health cover. Changing that culture is crucial to the events of the next few months. In my opinion, if it is not comprehensive, and if it does not answer the questions that hang over it at the moment in its present early form, the Bill will fail to do that.
I shall briefly mention several matters. We shall return to these subjects in Committee, but it may help to move the Committee on a bit if we consider them now. One is the issue of the difference between the way in which fundholders and other purchasers are treated in the Bill.
On some of the specifics of the Bill, I should be grateful for clarification from the Minister about the meaning of clause 2(2)(1B), as there appears to be confusion in medical circles about the Government's intention. Will patients be able to complain about the way in which GP fundholders allocate their budgets? If that is the case, will the Minister tell the House whether complaints about decisions made by purchasing authorities will also be included in the procedures?
The Department of Health publication, "Being Heard", maintained that
Another issue was mentioned by my hon. Friend the Member for Fife, Central and a couple of other hon. Members who have contributed to the debate. It will be useful to consider that. Will the Minister enlighten the House about the provisions of clause 2 as compared to clause 6 of the Bill?
Another discrepancy appears in the Bill. Apparently, the commissioner cannot investigate the merits of all decisions complained against. As I read it, under the terms of the Bill, the commissioner would be able to consider the mechanics of the procedure that resulted in a decision on a complaint, but not the decision itself, unless such a decision came about as a result of maladministration. That is reinforced in clause 2(2)(1C) yet that provision does not apply to clinical decisions, in respect of which, if we are to believe it, clause 6(2) amends the commissioner's remit to allow him to investigate the merits of the decision as well as the procedure adopted.
The Minister intervened on my hon. Friend the Member for Fife, Central when he made his contribution at the start of the debate, and said that we would have to read
the consensus paper to examine the detail of what the commissioner would say in that area. That paper has become available only as the debate has proceeded. The glance that I have taken at it shows that that paper is to be sent out for general comment, which should be made on it by the end of January 1996. It is not definitive, and it may leave a gap in the Bill. I want the Minister's comments on that.
Although clause 10 relates to previous legislation which I confess that I have not yet read, it speaks about providing the final report to people who are involved, but it does not say whether the final reports considered by the commissioner are made available to complainants, as they are to the other people involved.
"there should be no change in the commissioner's current jurisdiction over complaints about purchasing."
It seems to me that, as the Bill stands, complaints about non-fundholder purchasing and allocation decisions are specifically excluded from consideration. If that is true, will the Minister amend the Bill to bring the procedures for complaints about non-fundholders' decisions into line with those planned for fundholders?
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