Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 260-276)

THURSDAY 24 JUNE 1999

MRS ANN DOWLING, MR JOHN ELDER, MS KARIN PAPPENHEIM, DR REG PEART, MR WILLIAM POWELL AND MR DAVID THROWER

  260. Okay. Breach of terms of service. Were you made aware of what that actually meant in terms of was this doctor going to be monitored for a period of time having been found in breach of service, having been found to be negligent to some extent. Was there going to be any monitoring of that person as a consequence of that finding on an on-going basis for a period of time?
  (Mr Powell) To answer your question, you have asked a few things. Firstly, all I wanted when my son died was the truth because nothing would bring him back.

  261. Sure.
  (Mr Powell) If they could have learned from the mistakes they made then the possibility was it would not happen again. I always feel that my son's life was important. All the parents who have lost children are treated with a staggering disregard and their children's lives are treated with contempt. We take exception to that. A doctor is paid with public money to take care of us and if he does not then he may have to be retrained. Not every doctor should be struck off when a mistake is made, I am not saying that for one minute, I would not want it. I would like to be perfect but I am not. I make mistakes in my life, I think everybody does. All the doctor has to do is admit it and if he needs retraining then have that retraining. If you are trying to deny the truth about the mistakes you have made how can you ever learn from it, you cannot. It is accepting that you are not just as clever as you think you are and have the training so that you become more knowledgeable so it does not happen again. That is what I would have wanted, that is all, the truth, to try to get on with my life, not take the next nine years still fighting for an inquiry into what I am led to believe it is my statutory right to have. If there is an inquiry into the death of my son it will expose the system for what it is, but I am never ever going to get it because nobody wants that. No disrespect to this Committee but the people involved do not want that. If there was one it would highlight it, we need the case to highlight exactly what was wrong behind the scenes.

  262. Thank you very much for that. Can I ask Mrs Dowling one question which I think is important. You made a very important point that colleagues of this doctor would have been aware over a period of time of the errors that he was making because they would have had to correct some of them and I am just wondering whether you feel there ought to be a system put in place, and this may apply to other people as well giving evidence, where we have decent statistical data which goes to some independent body which then demonstrates if there is a disproportionate pattern of things going wrong or things being strange. There does not seem to be any system to collect consistent data which may raise alarms. Would that have helped, do you think?
  (Mrs Dowling) Definitely. Mr Ledward and his colleagues they practised simultaneously in private hospitals and in the NHS so they obviously knew what was going on. So, yes, in answer to your question, there should be some sort of system where, if you like, they can name them and shame them at the end of the day when things are going wrong. are professional people and other professions are sacked or dismissed or whatever, why not doctors.

Mr Gunnell

  263. I wanted to ask Mr Elder whether he was satisfied with the general outline of the different sorts of patterns of regulation and complaints procedures which he saw as necessary. Obviously you have experience and have written extensively about it. Do you feel the pattern which you have put forward of a wholly independent complaints system is the right way to proceed or would you have any other observations on it?
  (Mr Elder) I think if we are going to have a credible complaints procedure it must be independent and it must be spearheaded by people who are qualified to do the job. For instance, in places like Denmark, Sweden, Norway and Finland, the complaints procedure has a very strong legal base with medico-legal components. In the case of Sweden and Denmark, the chairman of the complaints body, the Board of Health, is either a legally qualified judge or has the qualifications to be one. This is more or less the same in Scandinavia and also Austria as well. The other component parts also are more, I should say, qualified than the ones we have over here. We have chairmen and other people, conciliators and convenors, who have no identifiable credentials to deal with health care or the legal aspects of it.

Chairman

  264. I am a great believer in the role of the lay person in this process and we have several lay people here who have given very formidable evidence with a great deal of expertise, but you are ruling out the lay person's involvement. You are saying we need the experts.
  (Mr Elder) Yes, we need experts to chair these investigating panels. We need expert people but you have also got to have other people as well. If I may something else, the same should apply for the disciplinary mechanism. They should be independent and established by the state. All these countries—all of Scandinavia and Holland—have independent disciplinary authorities. In the case of an independent complaints mechanism, they are all one-stop procedures in the countries I have mentioned, and the process is much shorter and can take anything from six months to a year on average by comparison with the NHS complaints procedure which is a year to three years because it is phased and you have the stalling process—someone said stonewalling—and the whole thing is protracted. The effect is very, very weakening on the complainant who really has not got too much support. The other thing is compensation. For those who are seeking compensation, there should be state-run compensation procedures[5]. Denmark, Norway, Sweden, Finland have them and they are less costly and the time it takes to resolve a compensation claim can be between six months and 12 months, and another year or so for the assessment to be made. Over here, it can go on for years and it is very costly. Legal aid, for instance, in this country is only open to the very poorest in our country and those who have a few quid or have a home have to make a contribution, and it is jolly tough. That is roughly my view.

Mr Gunnell

  265. I would just say that obviously we have heard from all of you this morning and you have been extremely articulate and have been able to put your points very clearly, but there must be a great number of people who are much less articulate who also suffer similar outcomes. I would be concerned that we have to develop a system whereby people do not necessarily have to have that degree of intelligence, if you like, and ability to articulate their problems in order to get help. I wonder if you had any idea of the way in which the NHS should not only set up a system which will judge things independently but will make clear to patients in a simple way how the complaints system can be exercised and how you can initiate it. That of course implies that there must be some mechanism where people know that things have gone wrong and that it is as a result of their treatment. We ought to be able to devise a system which will help people in general to make complaints and to make sure those complaints come to some finality, that is what you are talking about, it takes a tremendous time. All the evidence we have taken this week testifies the length of time it takes to get things resolved. There is a need for some mechanism which will bring investigations to a conclusion and have judgments made.
  (Ms Pappenheim) I really wanted to put in a particular request and plea to this Committee because we have heard a lot very movingly from people where things have gone very obviously wrong with professional practice but in our instance this is continually referred to as "an incident of non negligent inadvertent harm" where it is not a question of looking for the negligence of a particular practitioner or group of practitioners, it is constantly referred to as "non negligent harm". Our real plea on behalf of our patient group to this Committee is to pay some very strong attention to what the mechanisms should be nationally and locally to address non negligent harm, be it some form of scheme of no fault compensation, to look abroad at what they do, for instance in Italy where there is a scheme for providing recompense where people have been, as it were, non negligently harmed by the treatment they have received. That is one of the major problems that our patient group has really to speak about today.

Chairman

  266. I want to conclude in a moment or two but I want to ask a very brief question. One or two of you have referred to the General Medical Council. I wondered what your thoughts were very briefly—please very briefly because I do not want to continue the session for much longer—on the current role of the GMC and possible thoughts on whether its role should remain similar or should be changed in future? Clearly one or two of you have implied perhaps the GMC should be scrapped completely.
  (Mr Elder) I agree.

  267. Very straight forward, Mr Elder.
  (Mr Elder) Absolutely.
  (Dr Peart) It is a totally inbred situation.

  268. Your concern is about the self-governance. Even though you recognise there are lay people on the GMC, you remain concerned that this is, as you say, an inbred situation?
  (Dr Peart) Very much so.

  269. Right. You would completely dismantle the General Medical Council?
  (Dr Peart) I am afraid so, yes. That is what should happen.

  270. Mr Thrower?
  (Mr Thrower) For regulation to be effective it has to be wholly independent and, taking John Gunnell's point, completely approachable to all the users, simple principles.

  271. Mr Powell?
  (Mr Powell) I would say scrap the GMC, start off afresh and get the legislation there to protect the patient not the doctor.

  272. Mr Elder, do you want to expand, briefly please, on your reaction?
  (Mr Elder) Yes. The GMC and the UKCC and all other parallel regulatory bodies should be scrapped really and state established as they have done with good effect in Scandinavia and also in Holland as well.

  273. Right.
  (Mr Elder) As I mentioned in my written evidence, recent warning sounds by the Government suggesting that the GMC could be replaced by a state disciplinary authority if strong sanctions for poor performance are not put in place may well be regarded as a positive step in the context of self regulation. But it could be seen as a convenient way of evading the prospect of independent jurisdiction. A remodelled GMC is unlikely to materially succeed in dispelling its poor public perception and its capacity to investigate complaints against doctors. The same will equally apply to the UKCC and, perhaps, to other parallel medical institutions.

  274. I think we have the very clear message.
  (Mr Elder) That is the point.

  275. Mrs Dowling, do you want to add anything on the GMC issue?
  (Mrs Dowling) I think I have just gone brain dead!

  276. Do any of my colleagues have any further questions? Are there any very quick, final points, and I mean quick, final points? I am sorry, I cannot take points from outside our panel of witnesses.
  (Dr Peart) I strongly support the suggestion of a drug or medical compensation scheme in lieu of legal practice.
  (Mr Thrower) There is one point I did not make earlier and that is that where there are very complex issues which may relate to syndromes of damage, then the system needs to be able to accept and recognise and live with uncertainty, and not assume that because parents cannot totally prove there is a problem it automatically follows there is not a problem.
  (Ms Pappenheim) The final point is that where we have very clear evidence, as was the case with haemophilia and contaminated blood, there must be an automatic national follow-up strategy to make sure that people struggling with the consequences of what has happened to them are actually informed, advised, counselled and, if need be, given appropriate treatment to cope with what has happened to them as a result of their treatment. So we would like to see a mechanism which would come into play more or less automatically without patients having to resort to campaigning for press and media publicity and to the courts to get something done to address their problems.
  (Mr Elder) I think, as you have said yourself, all hospital doctors should be employed by the NHS and give their full time to the NHS. I might even expand that to GPs as well in some form and that applies to nurses who are employed by GP practices. I think that would reduce the incidence of complaints against practitioners as well. That is about all.

  Chairman: There may be issues we wish to pursue further with you after this session when we have studied the transcript. If there are areas where you feel you want to qualify or add to points you have made, please feel free to add to them. On behalf of my colleagues, can I thank you all very much for what has been an extremely useful session. You have shared with us some very painful episodes which will be of great benefit to us in the course of this inquiry and we are most grateful to you all. Thank you very much indeed.





5   Note by witness: By "State-run", meaning established by government, but acting independently of it, and without cost to claimants. Back


 
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