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Mr. Tony McWalter (Hemel Hempstead): I am bit concerned by my hon. Friend's use of the word "retire". A doctor aged 30 could easily retreat into the private sector while the heat was on. After the inquiry has been dropped, there is no reason why he should not return to the health service. I do not want my hon. Friend to give the impression that the provisions apply only to elderly doctors who have begun to get slack.
Mr. Dismore: I am grateful to my hon. Friend. I would have liked the opportunity to comment on private medicine, but given the views that you, Mr. Deputy Speaker, have expressed, I suspect that you will not allow me to go down that route. However, other Members have raised that point.
We need to consider what people expect from the complaints procedure against a GP who has retired or one who has gone into private medicine, and the Bill will deal with cases involving GPs who retire. People expect to have their complaints properly and promptly investigated. They want to know what happened and they want to be sure that it will not happen to anyone else. Many of the problems that result in claims for medical negligence would disappear if we could create a system in which complaints are investigated and the doctors concerned apologise.
I can give an example from my own experience. I was a victim of medical negligence myself. I had to have an injection in a shoulder for a tendon problem. When I see a doctor in hospital I have always made it clear what I do for a living just to keep him on his toes. However, we became so involved in discussing that issue that the doctor injected the wrong shoulder--a classic example of getting the wrong limb. He immediately explained what had happened, what the effects would be, said that he was sorry and that was the end of the story. I have suffered no long-term ill effects--as far as I know anyway. The approach taken by that doctor is what we are trying to achieve by having a more effective complaints procedure in which the ombudsman is the pinnacle of the process.
The Bill may have implications for resources. We know from the ombudsman's report that the number of cases that he investigates is not that great compared with the total number of complaints that he receives. In 1998-99, he received 2,869 complaints, of which 119 were investigated. Of the 119, roughly half the complaints--62--were about clinical matters. His report suggests that two or three of those complaints would have been caught by the Bill, so quite a few complaints could be investigated under it.
I am concerned about the principle of quis custodiet custodes and making the ombudsman system work effectively. His report illustrates graphically the length of time that he takes to deal with complaints. I am concerned that the Bill may increase his work load to such a degree that he cannot deal with complaints effectively.
The end of the report deals with the number of cases and investigations that the ombudsman has handled. It takes up to a year--three or four years ago, it took even longer than that--to deal with a complaint and that simply undermines the whole system. If the Bill adds to his work load--he investigates only a small proportion of the total cases involved--even by only 10 or 20 cases and the resources are not there to enable him to do his job effectively, it will have a knock-on effect on other cases and the undesirable consequences that I described earlier. The complaints process will take longer, people will become unsatisfied and they will resort to law as the only recourse left open to them.
We need to ensure that the public have confidence in the complaints procedure. To do that we have to ensure that it is timely and effective. You, Mr. Deputy Speaker, have prevented me from describing the ways in which the present system is not effective because it has no teeth. There are gaping loopholes in the Bill in relation to private medicine and Members on both sides of the House have referred to that. There are also many other problems, such as the lack of co-ordination between social services and the NHS.
Although the Bill deals with one small loophole, we should take the opportunity to address the wider issues. I am pleased that in response to the request from the health service ombudsman, the Government set up a wide-ranging review of public sector ombudsmen. That was done in March 1999, following the submission of a paper to the Government--
Mr. Deputy Speaker:
Order. I cannot allow the hon. Gentleman to continue that point. I remind him that Standing Orders of the House give the Chairman powers to prevent him from continuing in this manner, and he is getting close to the point at which I will invoke them.
Mr. Dismore:
I am grateful to you, Mr. Deputy Speaker. I was just about to conclude my remarks, which may cause relief to many.
I say to the right hon. Member for Wealden that although I welcome and support his Bill, it will not solve the problems of the ombudsman. The real answer to those problems is the conclusion of the review that the Government have set up to deal with all the problems of ombudsmen generally, including co-ordination.
Sir Geoffrey Johnson Smith:
Whatever the truth of that, the hon. Gentleman will agree that in the meantime we might as well take what is on offer and pass the Bill, and the Government can deal with the wider scheme much later. The Bill will not upset the Government's programme and does not contravene anything that they have proposed. I hope that if he cares to serve in Committee, the Bill will receive his support there.
Mr. Dismore:
I said at the beginning of my speech that I have no objection to the Bill. It is worthy, but it is very little, and although its title is ambitious, the Bill will not fulfil those ambitions. I wish the Bill good luck in its remaining stages, but we will eventually have to address the other issues. I would be satisfied if the Minister, in her response to the debate, indicated that the Government will introduce much broader proposals very soon. If that process is going to take a long time, the right hon. Gentleman has a valid point.
Mr. Philip Hammond (Runnymede and Weybridge):
I shall be brief. Listening to the hon. Member for Hendon (Mr. Dismore), I often have the impression that no one has told him that in this place, unlike in his previous profession, there is no meter ticking and he is not being paid by the hour.
I congratulate my right hon. Friend the Member for Wealden (Sir G. Johnson Smith) on securing his place in the ballot and introducing this small but important Bill. We are dealing with a simple solution to a narrow problem. The hon. Member for Hendon suggested that the work load of the health service commissioner might explode as a result of the Bill, but he was being disingenuous. Very few cases are affected by the loophole that my right hon. Friend has identified. The hon. Member for Luton, North (Mr. Hopkins) described the health service commissioner as a backstop provision, after other mechanisms for dealing with complaints in the health service have failed. The Bill will therefore affect only a few people.
Mr. Jenkins:
Although I accept that the Bill will affect only a few people, my concern is that the commissioner's existing work load is such that those few cases will lengthen the time in which cases are dealt with, as my hon. Friend the Member for Hendon said. We need to put in extra resources to ensure that that does not happen.
Mr. Hammond:
I suggest that on resourcing the hon. Gentleman addresses the Minister.
To return to my point, although only a small number of people will be affected, at the moment those people are deprived, through the loophole, of the pursuit of justice. My right hon. Friend has introduced the Bill to remove that sense of injustice.
As hon. Members on both sides of the House have noted during the debate, this issue is, in broader terms, gaining increasing public awareness. There is the question of police officers who retire and avoid being pursued by the proper mechanisms for dealing with maladministration or misconduct. We amended the Protection of Children Act 1999, during its passage through the House, to ensure that it dealt not only with those whose misconduct was detected while they were employed, but with those whose crimes or misdemeanours were detected after their employment ceased. This Bill is riding a tide of public awareness.
The health service commissioner himself has drawn attention to the loophole, as the hon. Member for Hendon explained at some length by quoting from the commissioner's report. The problem arises because, unlike the secondary health care service--our hospitals--where the institutions are enduring and do not depend on the presence of individuals, most of our primary care services are provided by independent contractors, as the hon. Member for Tamworth (Mr. Jenkins) pointed out. Although primary care is publicly funded, the services are effectively privately provided. That means that when providers of general medical, optical and dental services retire or cease to offer those services to the NHS, they cannot be pursued by administrative mechanisms.
One of the objections to the Bill which has been mentioned by more than one hon. Member is relevance. It is suggested that because the health service
commissioner has relatively blunt teeth, it is not conceivable that doctors would retire deliberately to avoid sanctions that are not very onerous. That misses the point. My right hon. Friend the Member for Wealden is suggesting not that doctors will retire for the explicit purpose of avoiding justice at the hands of the health service commissioner, but simply that when doctors retire or move out of the NHS, perhaps for reasons unrelated to complaints, those who are pursuing complaints may feel that they have been denied natural justice. Closing the loophole will address that.
There is a wider issue of the effectiveness of the health service complaints procedure and the question of whether the commissioner needs stronger powers. As my right hon. Friend the Member for East Devon (Sir P. Emery) said, those concerns, legitimate though they are, are no excuse for inaction when in this private Member's Bill we have the opportunity for action without any cost to the Government's legislative time.
My right hon. Friend the Member for Wealden and other hon. Members have drawn attention to questions about the role of the General Medical Council and the possible extension to the private sector of procedures for dealing with complaints and medical malpractice issues. Although we cannot debate that this morning, clearly there is a need for properly regulated mechanisms in the independent sector to ensure that patients are treated safely and properly, whether they choose to get medical treatment in the NHS or the private sector. It is the Government's primary responsibility to ensure a safe framework within which patients may make that choice.
I hope that the Government will in time recognise that and examine the health sector with the same evenhandedness with which they now propose to examine the residential and nursing care sector in the Care Standards Bill. Under that Bill, regulation of local authority and private sector provision will, for the first time, be placed on an even basis.
11.22 am
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