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10.15 am

Mr. Kelvin Hopkins (Luton, North): It gives me great pleasure to support what is a small but important Bill. I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on introducing it. I am one of those who remember him in his previous job as a

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television presenter on the excellent "Tonight" programme some years ago. I was rather surprised to find how long ago the programme was put on.

Sir Peter Emery: Do not remind us.

Mr. Hopkins: Indeed; it reminds me of how old I am, too.

At that time, I had no aspiration to become an hon. Member, but it gives me great pleasure to debate this important issue with the right hon. Member for Wealden and, indeed, to be on the same side.

The ombudsman concept is Scandinavian in origin. It is an important concept and institution in our constitutional arrangements. It is typical that it came from that civilising region--so many of its ideas have been initiated, adopted and imitated elsewhere. As a member of the British-Swedish all-party group, I take a great interest in Scandinavian affairs.

It is important for our constituents to have the right to take complaints to an ombudsman. They are known as ombudsmen rather than commissioners. I do not know about other Members' constituents, but mine refer to them as ombudsmen, ombudspersons or whatever, rather than commissioners, even though in law they are known as commissioners, I think. It is a vital backstop for constituents to pursue their complaints.

I want to follow up the comments of my hon. Friend the Member for Burton (Mrs. Dean). Many constituents become somewhat obsessed with their problems, particularly if they are medical. They come to me, or even go to the community health council, but they do not meet medical experts who can help them. If they have the right to pursue the matter through to the ombudsman, at least they will have the benefit of professional advice and comment. Neither they nor I possess such knowledge.

Importantly, the Bill eliminates certain loopholes. As we have heard, family health service providers can go into bankruptcy or liquidation. I do not suggest that they do that deliberately--but, who knows, if they are in serious difficulty with a patient and can get away with it, they might do that. If a practitioner were of a certain age, he could choose judiciously to retire just before a problem arose, if he realised that he had made a mistake but no complaint had yet been made. He could retire before the complaint came forward, perhaps even before the patient realised that he should complain. Some professionals are clever enough to be able to use such a ruse to escape being pursued by someone who has been wronged by them. Sometimes, it is a question of incompetence or lack of effort, rather than a medical misjudgment. Nevertheless, they can avoid being pursued.

I address my remarks specifically to general practitioners. They could apply equally to dentists, opticians and pharmacists, but I am most concerned about GPs because they face the whole range of human ailments. I understand their difficulty. If one is faced with the possibility of every type of illness and condition, to make a judgment in a 10-minute consultation is difficult. I do not underestimate that difficulty and I also understand that to keep up to date with medical practice and new discoveries is difficult. Nevertheless, sometimes they still have to be brought to account for mistakes.

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General practitioners work under great pressure, partly because Britain's ratio of GPs to patients is not good. We have to improve it. The Government foresee a future when the ratio is better, so that our aspiration to be the best in the world is realised--but we are some way from that goal. I am concerned about the ratio, as are many other hon. Members.

I talk about my local GPs because that is my experience. Generally, I have a very good relationship with them; they are very good GPs. I speak with them occasionally. I also have a good relationship with the members of the new primary care group. We have meetings and, occasionally, we even have dinner together--including groups of GPs--so that we can keep up to date and in touch with one another.

Nevertheless, one hears--sometimes through the community health council, but sometimes through cases brought to me personally; I am sure that other hon. Members have the same experience--of cases in which patients have not been treated appropriately. In such cases, it is very difficult for patients first, to make a judgment, and secondly, to challenge a GP. In asking a difficult question, one may put at risk one's good relationship with the GP. We all appreciate those difficulties. Those patients are able to go to their CHC or to me, as their Member of Parliament. Ultimately, however, they have to be able to go to an ombudsman.

I should like to digress slightly to deal with one point, although I think that it is legitimately within the ambit of this debate. I believe that group practices are better than single GP practices in avoiding a patient's need to visit an ombudsman. I ask my hon. Friend the Minister and her colleagues to try to persuade as many single GP practitioners as possible to join together in group practices. Group practices are a way of avoiding problems, as doctors within the group are mutually supportive and are able to consult one another if there is doubt about a patient's case.

Recently, I had a case where a patient complained about one member of a group practice, went to another member, was diagnosed with a serious condition and referred to hospital. Previously, the patient had been prescribed analgesics and told to go home to bed. A second opinion can be important, and it is quite easy to obtain one within a group practice. Moreover, within such practices there are collective pressures on doctors to ensure that care standards remain high.

Although I have no statistics to support the contention, I suspect that group practices have fewer problems than single member practices have. I am not saying that single GP practices do not do a very good job in most cases. However, there are GPs who perhaps belonged to a group practice, did not have a happy experience there, chose to go out on their own and, subsequently, have had difficulties with certain patients. Those patients need to be able to go to an ombudsman.

I suspect that it is precisely those GPs, especially if they are older, who would be able to take retirement as a way out of facing a difficult situation--to avoid dealing with the complaint of a patient who has been misdiagnosed and treated wrongly in one way or another. Mistakes are possible in the best of worlds. However, I think that group practices are better at preventing most mistakes from occurring initially, and at dealing with them if they do occur.

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I have a personal experience that demonstrates that there are differences between individual members of the community. Some constituents are professionals. Some, like me, may have a scientific and even quasi-medical background. Some years ago, I went to my GP and told him that I had an umbilical hernia and needed an operation. He was slightly affronted by my presumption and said, "I'll examine you and decide what's wrong with you." He examined me and said, "You have an umbilical hernia and need an operation." In such situations, my wife calls me "clever clogs". I hasten to add that I would not presume to make a self-diagnosis in every case.

Most members of the population are not capable of making a self-diagnosis, but have to rely absolutely on their GP's word for what is wrong with them. If one is given an analgesic for a malign tumour, for example, it is a serious mistake. Pressure on GPs must be maintained. Even good professionals must be kept up to the mark and know that there is a complaints procedure that really works. They must know that there are no loopholes that will enable them to escape their responsibilities.

As I said, most members of the population--most of my constituents--are not as pompous as I am and therefore do not think that they know what is wrong with them. They depend on their GP. It is absolutely vital that, when they go to their GP, they know that they are talking to a professional who is up to the job and who will do his or her very best to ensure that they are diagnosed and treated correctly. The Bill will help to ensure that every GP behaves appropriately and professionally towards their patients.

10.26 am

Mr. Brian Jenkins (Tamworth): I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on coming fourth in the lottery for private Member's Bills. I aspire to obtaining such a slot, but suspect that I shall have to serve in the House for another 40 years before I do so. I may not make it. The right hon. Gentleman--who has made it--has chosen to address a very sensitive issue. Although I understand why he chose it, I should like to raise a few related issues, on which I invite interventions--particularly by the Minister--if I need to be put right.

I am what is known as a cynical individual. I thought that, originally, our national health service was based on the concept that our doctors are not employees, but contractors, and that we pay them as contractors. Under that contract, complaints are dealt with on an almost commercial basis. We are able to investigate complaints about the performance of specific aspects of the contract, but only on those specific aspects. Under the contract, the patient is less a traditional consumer--a consumer is able to choose a service and decide whether to pay for it--and more a recipient of the service. The health service commissioners look after patients' rights and welfare under the contract, to ensure that we are getting a good deal. That is one of the problems.

Let us suppose, as an analogy, that a garage down the road is selling Fords, Rovers and Mercedes, that someone bought a Ford from it, and that the car turned out to have a problem. How would we feel if, when the person complained, the garage owner said, "I no longer sell Fords", and that person had no contractual right to complain directly? Patients are in that type of ball game.

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I have no problem with the Bill, which starts to address that issue, but I want to know why we are not going further in amending the legislation. Like the hon. Member for Runnymede and Weybridge (Mr. Hammond), I think that regulation of the private sector should be tightened up. I am not against a nanny state, because we have a duty to protect our citizens from those who do not provide a good level of service, in whichever sphere it is provided.

Like my hon. Friend the Member for Luton, North (Mr. Hopkins), who focused in his speech on single general practitioner practices, I should like to try to put the situation in the health service in perspective. I have frequent contact with the medical profession and I see my doctor regularly. At his surgery, we often spend five minutes on my case and 10 minutes on his, as he describes problems in the health service. What are some of those problems?

When my doctor joined his practice, there had been 1,200 applicants for the post. A few years ago there was another opening for a partner, but there were two only applicants. If we are to maintain high service levels, there will have to be competition in the profession. Britain is not, however, churning out enough well-qualified, good doctors to meet our needs. We therefore have many single member practices, located primarily--although this is not written in gospel--in the poorest inner-city areas. Many capable, good doctors decide to join a group practice in the leafy suburbs and shires of England. We shall end up with a different strata of service. How can an ombudsman, or commissioner, say that the level of service is not good enough?


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