Previous SectionIndexHome Page

10.24 am

Mr. Henry McLeish (Fife, Central): I am pleased to participate in the debate and to echo the congratulations extended by other hon. Members to the hon. Member for Birmingham, Edgbaston (Dame J. Knight) on bringing the issue before the House. She graphically illustrated the

31 Jan 1996 : Column 927

problems that arise during suspension--including delay, the impact on the individual's career and the stress caused to the doctor and his or her family.

Major problems continue to arise, despite two measures having passed through the House over the past year--the Health Service Commissioners (Amendment) Bill and the Medical (Professional Performance) Act 1995--which strengthen health service complaints procedures. The inordinate time taken in some cases of suspension cannot be justified. If trusts look carefully at their procedures, they may reach the same conclusion.

To be fair to the Government, they have improved the procedures for processing complaints. The new three-tier system will operate from 1 April, and the monitoring powers of the General Medical Council has been strengthened. However, consideration of the matter must go beyond the structures and institutions in pinpointing why major problems continue.

Every trust has the ability to modify or change its procedures--the Minister will correct me if I am wrong. The hon. Member for Edgbaston said that national standards are needed. Fairness should apply not just in Birmingham or Glasgow but across the length and breadth of the country, and we are not seeing that. I repeat that the time taken to process some cases cannot be justified. What is going wrong?

One answer is that not enough priority is given to individual cases. The British Medical Association, among others, has pointed out that the issue is clearly one for the individual. On the other hand, there are implications for the hospital involved. The BMA points out that the suspended consultant may lose clinical skills, especially if the suspension lasts two, three or four years. A backlog of cases can be created when a specialist is lost to a hospital, and there is additional pressure on colleagues. That can be another problem in a health service that is already subject to strains and tensions.

The BMA also points to the lack of continuity of patient care. There can be nothing worse for a patient than to lose the services of his or her usual consultant. Of course, serious offences may be involved. No one is arguing that there is no case for the safeguard of suspension--but often it should be exercised as the course of last resort. Trusts may be opting for suspension rather than another course, which may not be best.

I agree with the hon. Member for Edgbaston that cases should be resolved more quickly. Obviously the issues are complex. [Interruption.] I do not know whether the Minister is mumbling in agreement or just mumbling to one of his hon. Friends behind him.

The Minister for Health (Mr. Gerald Malone): I was commenting to one of my hon. Friends.

Mr. McLeish: That is gratifying at this time of the morning, rather than being insulted--as I am usually.

Mr. Malone: Never.

Mr. McLeish: There is a mood of magnanimity this morning, at least in this debate.

Why do appeals and suspensions take so long? Trusts are not short of administrators, clerical employees and bureaucrats--people who want to do such work. Why

31 Jan 1996 : Column 928

should there not be a national standard and a time constraint? Some individuals will need to be suspended immediately and the cases will take a long time to resolve. The Minister could therefore aid the House in further discussions by painting a picture of what is happening nationally. We need more information.

In his winding-up speech, perhaps the Minister will be able to provide information on the number of complaints against hospital consultants and doctors being processed, the average length of the cases, and where they are occurring. I suspect that in some areas, that information would not be heartening. Clearly, in Birmingham and other areas, cases are arising routinely. The other issue that concerns me is the cost of the processes when we need to be spending as much as we can on the real business of hospitals.

Adjudication procedures concerning allegations of medical misconduct of hospital doctors is an excellent issue to discuss in the House. Although we clearly do not lack structures and institutions to cope with the problem, we must look to the trusts at the front end to improve matters. I am sure that the Minister will respond positively and I hope that he will seek information from each trust about what it is doing so that he can make a judgment on whether many of the delays are necessary. I am sure that an informed debate based on information from trusts will help to speed up the process, ease the misery of many doctors and consultants and ensure that the health service, through the trusts, is providing front-line patient care rather than dispensing of its energies or dissipating them through long suspensions.

10.31 am

The Minister for Health (Mr. Gerald Malone): I am grateful to have an opportunity, courtesy of my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), to address what the speeches of other hon. Members have shown is an extremely important subject. I am not sure whether I shall be able to go along entirely with the attempt of the hon. Member for Fife, Central (Mr. McLeish) to write part of my speech for me. I agree with him, however, and with my hon. Friend, that the matter is important not only for the medical profession but for patients--as my hon. Friend the Member for Chislehurst (Mr. Sims) said.

It is right that the House should debate a matter about which there is clear concern. Although I cannot go the whole way with my hon. Friend the Member for Edgbaston in some respects, some of the cases that she described seem to raise extremely serious issues, so I should be grateful if she would take them up in more detail--although that would not be appropriate in a debate on the Floor of the House. If what she is saying is borne out by evidence, I would be extremely concerned as it would be clear that the employing trust was not adhering to the very detailed guidelines on important matters.

The guidelines are constantly being reviewed and updated, as my hon. Friend said. She said that much progress has been made in recent years. The detail of the guidelines is such that I hope to be able to convince the House that the Government take the matter very seriously as a national responsibility, although that responsibility must be developed locally between employer and employee.

Dame Jill Knight: I am grateful to my hon. Friend for the receptive way in which he is replying to my remarks.

31 Jan 1996 : Column 929

There would be no problem whatever in furnishing him with more detailed information. As he rightly said, and as I judged, it would not be correct to go into great detail, giving names, places and so forth in this debate. Would he therefore agree to see a small deputation of people who have been studying the matter? They are all doctors and they could cite chapter and verse. It might help my hon. Friend to see them as a group--not a very large group--because they are knowledgeable and have spent a long time tabulating and examining cases.

Mr. Malone: I am grateful to my hon. Friend. If she would let me have details of what she is proposing, I shall--as always with any request that she makes--look on it very sympathetically.

It might benefit the House if I clear a little of the fog around the issue. It is important to understand the issue in its various components. There is the issue of suspension; the separate, but related, issue of disciplinary proceedings, which runs to a strict timetable; and paragraph 190 appeals should a medical practitioner employed by a hospital decide to exercise that right. When describing various cases, hon. Members have shown that, where separate procedures have been taken one after the other, there has been some muddying of the waters in understanding what rules apply to each procedure.

I do not wish to be defensive, but I am sure that the House will understand that where there is a need in the procedures to be fair to the interests of the public and the individual medical practitioner, there can be delays for a number of reasons. I do not want to refer to any particular case, but the Medical Defence Union--if it is representing a medical practitioner--or the British Medical Association may want to take a considered view of the matter, and take some time to investigate it fully, in order to present the case on behalf of their member. That is quite right, and in some cases it is an understandable reason for delay.

Illness of the medical practitioner is another reason why there might be delays, which on superficial examination might appear inordinately long, in the processes that we have set down. It is important to study each case to see whether it raises issues of unfairness. When it does, it is a matter about which nobody should be complacent.

My hon. Friend the Member for Edgbaston made much of suspension. It is important to see the matter in context. Evidence to the Public Accounts Committee revealed that only six cases of suspension had endured for more than six months. The six-month period is important because the system requires suspensions of more than six months to be reported to regional health authorities. That will continue after 1 April under the NHS executive because Ministers consider it vital to be informed of delays that go beyond the time limit set out in the guidance. It also encourages trusts to ensure that they comply with the guidelines which, as my hon. Friend said, are set out in HSG(94)49.

It is important to understand the aim of the guidance, which is to avoid unnecessary suspensions. We do not want to be suspending doctors for any reason. Employers are encouraged to consider suspension as something that might be necessary, but that should be avoided if at all possible. They are also told to ensure that, if practitioners are suspended, it should be for the minimum period necessary. I am sure that my hon. Friend was not suggesting that employers should not be entitled to use suspension--

Next Section

IndexHome Page