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10.41 pm
The Minister of State, Scottish Office (Lord James Douglas-Hamilton): I congratulate the hon. Member for Glasgow, Maryhill (Mrs. Fyfe) on raising some important matters and begin by making the obvious point that if the General Dental Council erases the name of a dentist from its register, that dentist cannot practise. Practising in those circumstances would be a criminal offence.
I should also mention that 50 to 80 per cent. of the gross earnings of many dentists relate to expenses. That may be the case with this individual.
The hon. Lady has asked me to look into various matters. Tomorrow, I shall study what she has said in great detail, because some of the matters are complex. I shall try to give a full explanation of what has happened and why, and of what is likely to happen in the future.
Happily, the occasions on which such complaints are made are few. The great majority of dentists are committed to their profession and to using their skills for the benefit of their patients. That is why it is important that there should be robust procedures to deal with dentists who fail to provide care to the high standards of skill and probity that we rightly expect.
The Scottish Office recognised that the previous procedures were unsatisfactory in a number of respects, and the hon. Lady has described some of them. We therefore instituted a review of the NHS complaints
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The events relating to the concerns expressed by the hon. Lady took place during 1993-94. It is a basic principle of our system that changes do not apply retrospectively. The handling of complaints about Mr. Duff must, therefore, be governed by the regulations in force at that time.
I have every sympathy with the hon. Lady's constituents. Indeed, as she mentioned, one of my constituents has also complained about Mr. Duff, so I know that it has been a very distressing experience, but the regulations in force at the time cannot be ignored.
I shall explain the regulations. Until 1 April of this year, complaints and questions of discipline about dentists and other family health service practitioners who provide treatment under the NHS were dealt with under the same system. It involved referral to statutory service committees where appropriate and, in the most serious cases, referral to an NHS tribunal.
The rules governing the time scale within which complaints had to be made were laid out in the NHS (Service Committees and Tribunal) (Scotland) Regulations 1992, which state that a complaint must be made within six months of the end of the treatment that gave rise to the complaint, or within 13 weeks of the cause for complaint becoming known to the complainer, whichever was the sooner.
Any complaint made more than six months after the date on which treatment ended was, by virtue of that fact, a late complaint, and for a late complaint to be investigated by a service committee the patient had to show, for each and every day, that there was good reason for the delay in submitting the complaint. The onus was on the patient to show that he or she could not have known earlier that there was cause for complaint, and that they made the complaint immediately they were so aware unless they could show good reason, such as bereavement or illness, for each day they delayed further.
It was, of course, open to patients to appeal to my right hon. Friend the Secretary of State for Scotland against a health board decision to dismiss a complaint on grounds of lateness. In such cases, the Secretary of State is precluded from considering the merits of the complaint. The only question that he can address is whether the lateness of the complaint was justified.
I have dwelt on those points in some detail because many of the issues that the hon. Lady has raised revolve around the question of lateness. In particular, she accused Greater Glasgow health board of inflexibility in its handling of cases relating to Mr. Duff. As I have explained, the health board must apply the regulations as they stood at the time, and they do not allow for much latitude.
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I shall now deal with the question of complaints against Mr. Duff. I understand from Greater Glasgow health board that it received many complaints about Mr. Duff from patients during 1993.
Mrs. Fyfe:
If the Minister will undertake to examine closely the cases to which I have referred, he will see that they are not generally time-barred because of individual circumstances. I did not have time to explain earlier, but if he studies the cases I think he will find that they should have been considered and have been wrongly rejected.
Lord James Douglas-Hamilton:
I will study what the hon. Lady has said very closely, but I must operate according to the same criteria for all constituents, regardless of the constituency from which they come. Whether a case is time-barred is a matter of legal interpretation, and I must follow the best advice that the Scottish Office lawyers give as objectively as possible. I will study what the hon. Lady has said very closely, but I act on the basis of the best information that we now have available. I shall deal with each case individually because, as the hon. Lady will appreciate, there are many cases of this kind.
The volume of complaints of a potentially serious nature was such that the board took the step of referring Mr. Duff directly to an NHS tribunal on 11 January 1994. The case was protracted, both because of the volume of evidence and because the proceedings were adjourned for a time when Mr. Duff was unwell. Mr. Duff ceased to practise in the summer of 1994. The tribunal, under the chairmanship of Mr. W. C. Galbraith QC, issued its report in February this year. It found that Mr. Duff had been in breach of his terms of service on many counts, and directed that his name be removed from the dental list of the health board. It also directed that Mr. Duff's name should not be included in the list of any other board.
I understand that, in addition to the cases that were covered by the tribunal, 18 subsequent complaints were looked into by Greater Glasgow health board's dental service committee. In 15 cases the complaint was late and against the criteria that I have explained this evening. The health board decided, on the ground of lateness, that those cases should not be investigated. In five of those cases, an appeal was made to the Secretary of State. One is awaiting determination, three have been dismissed, and one case was allowed. Three were dismissed because grounds for lateness were inadequate and did not meet the criteria. The one case that was allowed is now being investigated by Greater Glasgow health board. I have again gone into some detail because it is important to realise that these cases are complex. Each has to be considered on its merits and the outcome of each can be different, depending on the individual circumstances.
In three cases that were in time, the service committee held that the complaints had been made timeously, and these cases include those of the hon. Lady's constituents. In both cases the health board decided, on the recommendation of the dental service committee, that Mr. Duff was in breach of his terms of service on some counts but not on others. The complainants have appealed against the findings adverse to them, and Mr. Duff has done likewise. Appeals in these hybrid cases are complex and, as I have explained, they must be considered in terms of the regulations in force at the time.
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I regret that the appeals by the hon. Lady's two constituents, Miss O'Neill and Mrs. Russell, have not yet been determined. Appeals are dealt with as far as possible in the order in which they are submitted. The efforts required to put in place the new system for patient complaints and practitioner discipline meant that resources had to be diverted and, unfortunately, a backlog of appeal cases arose. Since the summer, that backlog has been substantially reduced. The cases in question are now being looked at urgently, and decisions will be taken shortly. The House will appreciate that I cannot give any indication now of the likely outcome, but I undertake to inform the hon. Lady as soon as decisions are made.
Mr. McMaster:
My request is simple. The Minister has undertaken to look in detail at the cases in Greater Glasgow health board. Will he also look at the case of Nicholas Gilmour in Argyll and Clyde health board and at cases in Ayrshire and Arran health board?
Lord James Douglas-Hamilton:
Yes, and I shall write to the hon. Gentleman in due course. I will not give a snap answer.
The hon. Lady has raised concerns about the freedom of dentists to continue to practise in the NHS while they are under investigation by a tribunal, and about their ability after disqualification to practise as assistants or deputies. I can reassure her on both counts. First, since Mr. Duff's failings came to light, the powers of the tribunal have been extended. By virtue of the National Health Service (Amendment) Act 1995, the tribunal has power to suspend a practitioner, if that is necessary for the protection of patients, pending full consideration of the case.
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