Examination of Witnesses (Questions 260-276)|
THURSDAY 24 JUNE 1999
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
(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.
(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.
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.
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 countriesall of Scandinavia
and Hollandhave 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 processsomeone said stonewallingand
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.
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.
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
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 brieflyplease very briefly because I do not want
to continue the session for much longeron 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
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.
(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