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Mr. Oliver Letwin (West Dorset): I have been listening with fascination to the hon. Gentleman's remarks. As I have the impression that he may be intending to continue for some time, and I know from experience that his energy is almost inexhaustible, could he give us an estimate of how long he intends to continue wittering?
Mr. Deputy Speaker: Order. It is not for the hon. Gentleman to concern himself about how long another hon. Member speaks. As long as he is in order, he is entitled to speak.
Mr. Dismore: I am grateful to you for your protection, Mr. Deputy Speaker. I was talking about the attitude of doctors to complaints and the tricks that they sometimes try to avoid liability.
Mr. Hammond: As the hon. Gentleman is making a point about doctors' attitudes, does he think that doctors are different in that respect from other professionals, particularly lawyers?
Mr. Dismore: I think that there are good and bad in both professions. I would be out of order if I digressed about the way in which the Law Society is, or is not, trying to clean up its act. Reputable legal practices--including, I hope, my own--have proper complaints procedures, as required by the Law Society. They view complaints in the correct light--not as something to be frightened of, but an opportunity to work out what went wrong, put it right, learn from experience and improve the processes. Some doctors, however, do not regard complaints in that light, although the ombudsman made it clear in his report that he thought that the British Medical Association--the profession--viewed complaints more constructively.
I should like to answer the hon. Gentleman's question by quoting something from the magazine Pulse. It was said by the chair of the local medical committee in the constituency of the right hon. Member for Wealden and is revealing about his attitude towards complaints. Dr. Ted King was commenting on the Bill and I think that he was having a bit of a pot at the right hon. Member for Wealden, quite unfairly. Dr. King said, in opposing the Bill, that the mood was more about revenge than justice. He said that serious complaints could still be pursued by patients through the civil courts, so patients would mainly use the new law to pursue trivial grievances. Dr. King said:
Mr. Deputy Speaker:
Order. I think that the hon. Gentleman is going wide of the debate before us. He cites cases of neglect or possible neglect, but the Bill deals specifically with doctors who seek to retire after a charge is made against them. That makes it a very narrow matter indeed.
Mr. Dismore:
Thank you, Mr. Deputy Speaker. I referred to that quote because it shows the right hon. Member for Wealden's own local medical committee having a go at the Bill and, presumably, indirectly having a pot at him. I am sure that he is far too clever a politician to have a go at the doctors in his constituency, but I do not see why I cannot at least answer on his behalf.
Sir Geoffrey Johnson Smith:
I am surprised that anyone should wish to have a poke at me on this subject. I have always enjoyed very close and friendly relationships with the medical profession in my
Mr. Dismore:
I assume from what the right hon. Gentleman says that neither of them are close to retirement.
My point goes back to what I was saying regarding the Medical Defence Union. If the ombudsman's service is to operate effectively and people are not to avoid liability by using the loopholes that exist and those identified by hon. Members, there will have to be a sea change in the way in which some--not all--doctors, approach complaints.
Mr. Hopkins:
A propos the recent comments made by Conservative Members, may I say that I am finding my hon. Friend's speech particularly interesting and illuminating? Within the scope of the debate, I hope that he will make every point that he has at his disposal, because I am learning a lot from listening to him.
Mr. Dismore:
I am grateful to my hon. Friend. If I stray too widely from the matter before us, Mr. Deputy Speaker, I am sure that you will bring me back to order. Perhaps I will be able to fill in the gaps for my hon. Friend in the Tea Room afterwards. The Bill raises important points, and I have striven to put it in context. We cannot look at the health service ombudsman without looking at how complaints first arise.
The BMA's efforts in continuing education and re-evaluation are important in this context. If I may refer to the recent intervention of the hon. Member for Runnymede and Weybridge (Mr. Hammond), my profession is concerned to ensure that lawyers have continuing education and keep themselves up to date. We have put in place all sorts of measures to achieve that. I am pleased that the BMA has recognised the need for re-evaluation of doctors.
Mr. Deputy Speaker:
Order. The hon. Gentleman is again straying from the scope of the Bill.
Mr. Dismore:
Doctors who will be retiring because they are coming to the end of their life in practice are the most likely to require re-evaluation and retraining. That is why I think that what the BMA said is important.
You have told me clearly, Mr. Deputy Speaker, that you are not minded to allow me to deal with some of the wider issues that have been raised in the debate by other hon. Members. I had hoped to be able to say something about the problems of private medicine. Other hon. Members managed to get away with it, but I get the impression that I will not.
I turn to the important issue of sanctions. The ombudsman's service, as presently constituted, does not have the powers that it needs to deal effectively with cases. We heard earlier that it was pretty much a toothless tiger: all it can do is name and shame. If a GP retires and is not in practice, naming and shaming will not make much difference to him. I hope that, if the Bill proceeds to Committee, one of the issues that we shall discuss is the sanctions that can be imposed.
Ms Bridget Prentice (Lewisham, East):
The sanctions that the commissioner can impose are important to the
Mr. Deputy Speaker:
Order. The provision of sanctions is not raised by the Bill.
Mr. Dismore:
That is a very serious omission, but I shall not try your patience, Mr. Deputy Speaker, further.
Sanctions are not just a question of securing an apology or an ex gratia payment. They are important for doctors who, by retiring, try to avoid the liabilities that might attach to them. That point is addressed in paragraph 4.6 of the ombudsman's report.
Mr. Jenkins:
My hon. Friend mentioned the length of time that it takes for an internal inquiry to happen and trigger the point at which the ombudsman is brought in. That time might allow the GP to come to arrangements regarding his retirement decision. If my hon. Friend is lucky enough to serve on the Committee considering the Bill--I doubt whether he will be--will he press the Minister to ensure that the ombudsman is brought in much earlier? People do not think that they will get justice if a doctor judges a doctor who judges another doctor and the process is made to drag on until the ombudsman, whom the public regard as their champion, is introduced.
Mr. Deputy Speaker:
I shall certainly not be taking part in the Committee.
Mr. Dismore:
My hon. Friend makes a valuable point about the way in which medical complaints are investigated. However, I get the feeling from your previous remarks, Mr. Deputy Speaker, that you will not permit me to go down that route. Perhaps that is unfortunate.
The health service commissioner's report makes an important point about when an investigation is kicked off but he does not follow it through. This is one of the ills that the Bill aims to address. In paragraph 4.6 of his report, the commissioner says:
The ombudsman adds:
Most complaints are not serious--there is a large revenge element which occurs when patients don't get what they want.
Those comments were made directly about the Bill.
During 1998-99 there were other occasions in which complaints to me raised issues which I thought appropriate to pass to the regulatory authority concerned, because there was a possible risk to the health or safety of patients.
That is one of the points with which the Bill deals. He adds:
However, the effect of the wording of the legislation governing my role is to restrict the circumstances in which I can pass such information to another organisation, such as the GMC or the Commission for Health Improvement. For example, I cannot disclose information to another organisation if I decide not to investigate the complaint, or if the matter of concern falls to be disclosed in one of my reports.
The Bill deals with doctors who retire, and that relates to the circumstances that the commissioner has described when his investigation cannot continue.
As a result, paradoxically, I have less scope to bring concerns to the GMC, for example, than a private citizen has. And my medical and nursing advisers are in a potentially invidious position if they consider that they have a professional duty to act on concerns arising from their scrutiny of a complaint to me.
3 Mar 2000 : Column 687
That is a particular ill with which the Bill seeks to deal in relation to GPs who retire, but only in so far as the investigation can continue. If the ombudsman decides for some reason that, after starting to investigate a complaint, he will not continue with it, he might not refer that information on to the General Medical Council or the Commission for Health Improvement.
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