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Mr. Andrew Dismore (Hendon): I follow what my hon. Friend is saying, but as a London Member I am concerned that he does not recognise the excellent work of dedicated general practitioners in group practices on housing estates, who carry out forward-looking work and are in the forefront of developing the NHS. I suspect that some of the practitioners to whom my hon. Friend is referring may be a little behind the game.
Mr. Jenkins: I did put in the caveat that I was not speaking specifically. Of course, the more challenging work needs to be done where health needs are greatest--in poor, deprived, inner-city areas. I am well aware that emphasis should be placed on urban areas. It all may look fine on paper, but if we ask the commissioner to hound down the bad doctors, he may say, "If we get rid of the bad doctors, who will take their place?" We do not have enough doctors to go round. The statistics show that the worst covered areas are in deprived inner cities. Doctors will not want to work in those areas because the work is hard and the rewards are not sufficiently good. They would rather have an easy life.
In considering the legislation, we must ensure that the commissioner is in a position not only to name and shame, but to question the Government.
Mr. Hammond:
Before the hon. Gentleman moves on from single-handed practices, I remind him that single-handed practitioners bring value to the system in sparsely populated rural areas. I am sure that he will agree that in pressing the case for group practices, for all the valid reasons that he and the hon. Member for Luton, North (Mr. Hopkins) have outlined, he would not want
Mr. Deputy Speaker (Mr. Michael J. Martin):
Order. We must be careful that we do not go wide of the Bill and get into a general health service debate.
Mr. Jenkins:
Thank you, Mr. Deputy Speaker. You jumped in just in time to stop me responding to that intervention. However, I totally agree with the hon. Member for Runnymede and Weybridge (Mr. Hammond) about the problems in sparsely populated areas.
I am trying to set the legislation in the context of what is possible in the real world. It is no good passing laws that are unenforceable. Not only must we close the loopholes, we must discuss the role of the commissioner and how the providers of health care should be brought into line. That includes the role of the British Medical Association and the General Medical Council.
We should ask why it is so difficult to investigate the work of a doctor. I hate to refer to specific cases, so I shall speak hypothetically of a case in which a doctor who had been culpable of the death of a young child continued to practice for more than 20 years before his right to practice was withdrawn. Why are we not getting such people out of the system? Why are they not retrained?
I am very lucky in that the GPs in my local practice have worked together closely for the past three or four years. When they become a trust, one of the doctors will have the role of a mentor. One of his functions will be to draw up the standards of his colleagues. I welcome that, but who will drive up his standards? Who will watch the watchers? The health authorities will lose power when the cash goes directly to the trusts, and when that happens who will control them? I worry that if we do not have an independent commissioner to act on behalf of the patient rather than the purchaser, we shall force people to go to the law. However, lawyers will only take a case that is winnable.
As the hon. Member for Burton (Mrs. Dean) said, we should also recognise that, on retirement, a GP should not be hounded until his dying day. There must be a reasonable time limit for investigations. However, a GP must not be placed in the position where he cannot work for the health authority or the NHS, but can continue to practice in the private sector in a practice that was purchased and built up using public moneys.
My local GP practice, as a former fundholder, was expanded using money that was not spent on patient care. The receptionist is employed by the practice. He is a contractor who gives me a ticket. I then go to a private shop where a pharmacist gives me drugs produced by a private company. The only time I meet an employee of the health service is when I go to hospital. Yet we speak as though we had a publicly run service staffed by public employees. It is not; it has always been a publicly funded private service. We must maintain safe scrutiny on behalf of the patients. At the end of the day, the commissioner must be the patients' champion.
Mr. Andrew Dismore (Hendon):
I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on securing his place in the ballot and selecting such an important subject for his private Member's Bill. Its long title goes beyond the specific matters in the legislation and raises wider issues.
Perhaps I should declare a sort of interest. Although I have never been an ombudsman, in my practice as a personal injury lawyer, I have taken a few pounds off the NHS in respect of medical negligence claims. Obviously, I have not done so since I was elected as I would not dream of pursuing my own party on such issues. Nor do I have the time to practise and be a Member of Parliament. However, my experience and that of my law firm in dealing with medical negligence cases against the NHS and the private sector provide a certain insight into how the NHS deals with complaints and how the ombudsman service works.
The reason why the Bill is so important is set out in the health service ombudsman's annual report on the health service commissioner for England, Scotland and Wales 1998-99 at paragraph 4.13 which states:
The words of the health service commissioner are important, because he raises the issue in detail, but the issue goes further. The right hon. Member for Wealden mentioned a case that was referred to by the Consumers Association in Which?, and the facts of that case support what he is trying to achieve. The facts bear restating, because they concern a reader, Mr. Peter Smith, who contacted Which? after the investigation into his wife's GP was dropped. Which? states:
I also contacted the local medical committee in my local health service area of Barnet and it also supports the Bill. The BMA also supports the Bill, and has said:
It was inevitable that the experience of the first few years of my extended jurisdiction would raise problems caused by the wording of the legislation which governs my role . . . A further issue on which I have expressed my concerns to the Department of Health is my inability to investigate complaints against GPs who retire or cease NHS work after the events complained of--or even during my investigation.
He stated that he was advised by his lawyers that the wording of the 1993 Act
precludes me from investigating such a complaint if the GP has left NHS work since the event complained of, and requires me to discontinue my investigation if the GP retires before or during my investigation. That occurred in two cases in 1998-99. In my view this is a clear injustice. It is unfair to complainants, and has the effect of giving GPs--and, by the same token, other FHS practitioners--immunity from investigation by me after they retire, which is not shared by clinicians employed by Health Authorities and Trusts: I may investigate their actions after they retire, in the context of a complaint against their employing organisation.
He also expresses the hope that there will be an early legislative opportunity to deal with the problem.
Peter's wife, Dorothy, a retired headteacher, died from leukaemia, and Peter complained to the ombudsman that Dorothy's GP hadn't diagnosed it.
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In the months before her death, Dorothy had visited her GP several times. But she was diagnosed only after she'd paid for private tests and another GP had acted on the results. Sadly, she died three months after this.
Peter had complained to the Health Service Commissioner, but the Commissioner dropped his investigation on legal advice when he discovered that Dorothy's GP had retired from his practice.
That is a scandal and clearly reveals a loophole. The Consumers Association, in its briefing on the Bill, said that it
and most importantly--
means that . . . complaints, which have been deemed as worthy of investigation by the Health Service Commissioner's Office are not seen through to their logical conclusion . . . Important information about a practitioner's performance may never come to light while the individual practitioner can continue to treat other patients . . . Practitioners who are concerned about the outcome of the Health Service Ombudsman's investigation can simply retire from NHS practice as a means of avoiding having to answer for their actions--
Patients are denied their right to have their complaint thoroughly considered and investigated.
The right hon. Member for Wealden referred to the actions that have been taken by the Home Office to deal with that loophole in relation to the police service, in the wake of the Stephen Lawrence inquiry. I shall not pursue that point, save to say that if it is important for police officers, it is equally important--if not doubly so--for doctors. In that context, Nick Stace, the senior public affairs officer at the Consumers Association, has said:
GPs should not be allowed to get away with avoiding complaints by simply retiring. If GPs have got something to hide, there is even more reason for the public to know. Consumers want fair treatment. This Bill is an obvious first step in achieving this.
I also contacted Action for Victims of Medical Accidents and it also supports the Bill. It said:
We welcome this Bill, which is intended to close a loophole that allows doctors to avoid investigation by the Ombudsman by retiring.
I shall give some of the statistics on that later--
The Ombudsman does not lightly undertake an investigation--
If a doctor has behaved in such a way that the Ombudsman has decided that his behaviour should be investigated it is important from the point of view of the patient or the patient's relatives that the investigation takes place. For the doctor to be able to escape being investigated simply by retiring is not only unjust but leaves the impression that doctors are not accountable.
I echo those comments.
Lack of accountability has been the major issue for patients for years . . . It is only recently that the Ombudsman has been allowed to investigate matters of clinical judgment . . . That was a major source of frustration to patients.
To those, however, who find themselves in the position where the Ombudsman actually is able to investigate, and agrees to investigate, only to have the doctor escape investigation by simply retiring, it seems a travesty of justice.
Retiring from the NHS does not prevent the GP to continue to practise as a locum--a temporary stand-in doctor--or to practise privately.
That is an important point when one considers the role that locums play in the NHS, especially in the inner cities--as my hon. Friend the Member for Tamworth (Mr. Jenkins) pointed out--in covering overnight care. GPs are run off their feet during the day and house calls at night are often done by locums or contracting services brought in by the GPs. Often, locums see patients in great distress, at times when they might not be entirely clear in their descriptions of their symptoms. The locums also do not know the patients' histories, and one of the great strengths of our family doctor service is the continuity that comes from the same practice looking after the same family for generation
after generation. That can break down if a locum is called out to cover for illness or holiday, or to provide overnight care. There is, therefore, a greater risk that problems may arise with locums.
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