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7.46 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I believe that, when my hon. Friend the Minister for Health opened the debate, he felt that we were subject to some competition from "Gardener's Question Time". Uncharacteristically, he underplayed the point. We are actually subject to even worse competition by reason of the fact that today is the traditional annual Oxford and Cambridge rugby match, which is of considerable interest in medical and political circles, so we are under a double duress.
We should pay tribute to the diligence and virtue of all the hon. Members who attended the debate in the course of this afternoon because, in spite of the distractions, we concentrated on what is really important. The Bill is an important issue, whatever goes on outside the House.
I shall respond to some of the arguments that were made. I welcome the general Opposition support voiced by the hon. Member for Fife, Central (Mr. McLeish) in his opening remarks. If I remember rightly, he quoted the commissioner saying that we must translate hot air into performance; I certainly concur with that.
The hon. Gentleman will also be aware that the whole business of complaints procedures is something that the Government are tackling, not merely in the national health service, but throughout the range of public services. He will also know, as a student of those matters, that the Wilson committee was produced hand in hand with the Wilcox report of the committee chaired by Lady Judith Wilcox, which inquired into the issue of complaints procedures and evolved a model procedure for all public services.
We can assure the hon. Gentleman that the issue of complaints is being investigated, not merely deeply inside the national health service, but throughout the public services. It is an important matter. Very reasonably, the
hon. Gentleman said that, whatever procedures are established, they must gain the confidence of patients and professionals--I emphasise, professionals. He said that we had to proceed cautiously, given the huge sensitivities involved, and I accept that. It is very important, and we shall try to do that.
The hon. Gentleman asked whether NHS patients will be subject to the procedures whether their treatment was from a public or private source. The answer is yes. I assure the hon. Gentleman that the independent providers of medical services that may be involved will also be subject--in the larger package, of which the Bill is only a part--to stages 1 and 2. The hon. Gentleman and others raised the important issue of resources. We are contributing a substantial, 150 per cent. increase in the commissioner's resources. The 90 existing staff will be supplemented by 130 or 140 additional personnel-- a major change of focus of the commissioner's services, which is crucial to the exercise.
I doubt that we could proceed faster. When such a radical change is effected, there is always the danger of making the system worse by proceeding too fast. We must not overburden one commissioner by asking him to expand his services too rapidly. The hon. Member for Fife, Central mentioned regional variations. I would argue--I would, wouldn't I?--that we established the Wilson committee and are putting in place national procedures precisely because of regional variations.
The hon. Member for Greenock and Port Glasgow (Dr. Godman), in an intervention, asked a question of my hon. Friend the Minister for Health that, with the assistance of my hon. Friend the Minister of State, Scottish Office, I am happy to answer. That question related to medical records from Rankin hospital, Greenock. It is a matter of grave concern that sensitive personal health information came into the public domain, albeit as the result of vandals breaking into a closed building. The information that was taken comprised a computer printout detailing operation procedures between 1 January and 31 January 1985 of some former patients of the Rankin maternity unit. They were not individual case records but nevertheless contained sensitive personal information.
The Inverclyde Royal NHS trust much regrets any distress that the incident may have caused, and has set up a helpline so that former patients can speak to a senior midwife or, if necessary, a consultant about any concerns that they may have. Any members of the public finding printouts are asked to contact the trust, which will arrange collection. The trust has undertaken a full investigation and will provide the Scottish Office with a copy of its findings. Until those investigations are completed, neither I nor my hon. Friend the Minister of State, Scottish Office consider that it would be appropriate to comment further.
Dr. Godman:
I thank the Minister and the other Ministers concerned for their sympathetic response to a most distressing affair.
Mr. Horam:
I am grateful to the hon. Gentleman for his kind remarks.
My hon. Friend the Member for Rugby and Kenilworth (Mr. Pawsey) apologised for having to leave before the end of the debate--rugby seems to be invading this debate. I was grateful for my hon. Friend's remarks about the general value of the procedures that we are putting in
place. He paid tribute to the work of the Select Committee--he would, wouldn't he? My hon. Friend is the Committee's Chairman. However, his tribute was well merited because the Select Committee has made a major contribution to our work.
The hon. Member for Wakefield (Mr. Hinchliffe) strayed a little in his remarks--but as a former student of Silcoates school, Wakefield, I compliment the hon. Gentleman on his common sense. As a consequence of my school days, I have always been an aficionado of people from the area that the hon. Gentleman represents. He talked a lot of good Yorkshire common sense about the complexity of the present situation. We are presenting the total package of stages 1, 2 and 3--the ombudsman being stage 3--of which the Bill is part precisely because of that complexity, to take a clearer approach than currently obtains. If the hon. Gentleman serves on the Committee, he will--I hope--find that we have clarified matters in a direction, if not at the speed, that he can support.
My hon. Friend the Member for Batley and Spen (Mrs. Peacock), who has also left, mentioned the devastating effect of two particular cases. She eloquently indicated her support for the inclusion of clinical judgment in the ombudsman's clinical remit. The hon. Member for Southwark and Bermondsey (Mr. Hughes) declared himself to be not only a lawyer, which is interesting, but a critic of his own profession--which is rather more unusual. He made the point that medical negligence actions are profoundly unsatisfactory. They are--I have some personal experience of them, and they are the most inappropriate, time-consuming and costly way of pursuing difficult and heart-rending cases. If the procedures we propose can prevent such actions, we will do a great deal of good--even if the legal profession loses a certain amount of revenue. I am sure that neither the profession nor the hon. Gentleman would mind.
My hon. Friend the Member for Chislehurst (Mr. Sims) made a sound point about clinical judgment not being defined in the Bill. Neither is maladministration. We are establishing, by common sense and casework, a sensible approach. I draw my hon. Friend's attention to paragraph 42 of the commissioner's paper, which deals with his responsibilities and clearly shows his thinking. The essence of the concept is that clinical judgment is that which a health service professional makes by virtue of his or her particular skills, expertise and training, and that which a lay person could not make. That rough and ready definition is all that I can offer my hon. Friend for the moment.
The hon. Member for Pembroke (Mr. Ainger) made a telling speech about the case history of one of his constituents, Mrs. Rhoda Quigley, which we were all saddened to hear. He made an important point about hospital discharges, particularly of elderly patients. The commissioner can already examine discharge decisions, but the Bill will add clinical judgment--an important gain.
I am pleased to see my hon. Friend the Member for Southport (Mr. Banks) is in his place and that he has not disappeared. Neither would he, because he is a stout man and sits through everything. I was delighted to hear his trenchant remarks welcoming the Bill. Members of my family work in the medical profession in my hon. Friend's area, so I am particularly glad to have his support on this occasion.
The hon. Member for Cannock and Burntwood (Dr. Wright) congratulated the Government on their speed of action and ambition. I am sure that the hon. Gentleman will want to apply that verdict on a larger scale before the general election. It was well merited in this case. The hon. Gentleman regretted the absence of a general Bill incorporating all the measures in question, but we already have legislation that enables us to act on stages 1 and 2-- the internal NHS changes. I am sure that the hon. Gentleman would regard it as strange if the Government introduced new legislation when they are able to act under existing measures.
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