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11.31 am

Mr. Alan Williams (Swansea, West): I shall be brief. I am one of the Bill's supporters and I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on introducing it.

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Having served with him in Committee and during late-night sittings in the Chamber, I have great admiration for the hon. Member for West Dorset (Mr. Letwin). I admire his assiduity and the breadth of his parliamentary interests, but I seem to recollect that the length of his speeches is subject to a singular elasticity. If longevity becomes a punishable offence, he will face a lifetime ban from the House.

The subject of the Bill mirrors the frustration experienced by members of the Public Accounts Committee on numerous occasions when we have dealt with the national health service. I do not say that there is anything wrong with the trust structure of the NHS, but because of that structure incompetent, inefficient senior administrators who have failed need not leave the health service. All they have to do is leave one trust and move to another, picking up their severance pay on the way. Thus, they escape any penalty and avoid any risk of dismissal from the health service.

The target for which the right hon. Member for Wealden aims is a modest one, but it needs to be hit. The practice of using retirement as a means of evading accountability is well understood in this country's police forces, nowhere better than in the Metropolitan police, as the PAC discovered. The problem is greater in other spheres than the health service, but it must be addressed wherever it exists.

The issue of unfairness has been debated, and I shall not repeat points on which we all agree. One of the trends exacerbated by the problem is the greater use of litigation. I am not one of those who deplores the use of litigation in connection with the health service. I have sat through numerous inquiries into failures of the health service, although I should add that it has also had many successes. Nevertheless, the fact that litigation has become an appropriate response has to be deplored.

Many people are driven to the law because of the inefficiency and ineffectiveness of the current systems, both in the NHS and the medical profession generally. Because the NHS has failed and the profession refuses to address the problem correctly, we have been forced down the American route, whereby litigation has in many cases become the sole outlet for the dissatisfaction and frustration felt by many of our constituents. We in south Wales have recently had the experience of a local man--not a constituent of mine--dying in a Swansea hospital after the wrong kidney was removed. That should not have happened. When such things happen, there must be accountability. There has to be justice for the family.

I am sorry that my hon. Friend the Member for Hendon (Mr. Dismore) has left the Chamber, because I wanted to issue a caution to him in connection with private Members' Bills. Mr. Deputy Speaker, you know that I would never challenge your judgment on debate in the Chamber. However, as we are always told when we attempt to raise Committee matters on the Floor of the House, certain matters are for the Committee to deal with. The Chairman of the Committee might use his discretion to allow a far wider debate of the matter in hand. I caution my hon. Friend against attempting to exploit that in terms of amendments to the Bill.

All my experience as a Member of Parliament leads me to believe that the wider a private Member's Bill's scope, the less chance it has of reaching the statute book. In my 36 years in the House, I have never drawn number one in

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the ballot. We all dream of getting a great private Member's Bill passed, but only a few such Bills--four or five--are passed in the lifetime of a Parliament, and those only get through when the Government provide extra time. A private Member's Bill that goes the normal parliamentary route stands a far greater chance of reaching the statute book if it is well focused and kept within the minimum scope necessary to achieve its intended objectives.

If my hon. Friend becomes a member of the Committee, I encourage him to use whatever breadth the Chairman allows to air broader issues relating to the commissioner, but he should not attempt to insert extra provisions in the Bill that would make it far harder to get through Report, which is extremely limited and easily sabotaged.

11.36 am

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I welcome the opportunity to debate the important issues raised by the Bill introduced by the right hon. Member for Wealden (Sir G. Johnson Smith). The role of the health service commissioner is extremely important. Although the national health service has procedures for dealing with complaints, there are inevitably some cases that even its best endeavours cannot resolve to the complainant's satisfaction. When that happens, the commissioner provides an essential additional option for complainants, who might otherwise be left without the assurance that their complaint has been taken seriously and thoroughly investigated.

We have heard several useful contributions this morning; I shall refer briefly to some of them. My hon. Friend the Member for Basildon (Angela Smith) expressed doubt about the wisdom of congratulating those who draw numbers high up in the private Members' ballot on their achievement. I am reminded of Napoleon's response on being told about the abilities of one of his generals: he asked, "But is he lucky?" We all know that both ability and an element of luck are needed for success in politics. I therefore congratulate the right hon. Member for Wealden on his luck and join my hon. Friend the Member for Basildon in congratulating him on his choice of Bill.

My hon. Friend is a supporter of the Bill, as are many eminent right hon. and hon. Members on both sides of the House and some outside organisations. My hon. Friend raised the question of the review of the complaints procedure as a whole. That takes us outside the remit of the Bill.

With great charm, the right hon. Member for East Devon (Sir P. Emery) offered a caution about civil servants who might advise Ministers that, although the Bill is worthy, more can be done at a later stage, so it is best to do nothing now. That is the civil service rephrasing of "God, make me virtuous, but not yet." I hope that my colleagues and I will be able to resist temptation. The right hon. Gentleman also reminded the House of a previous achievement of the right hon. Member for Wealden. His contribution may be regarded as small, but he helped many older people and NHS patients by broadening access to meals on wheels. Today's Bill follows in a good tradition.

My hon. Friend the Member for Burton (Mrs. Dean) raised the important issue of time limits, to which I shall return later. In that context, she raised the question of

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clinical standards in the NHS and in the private sector. It is important to realise that the NHS is a managed service, whereas the private sector is regulated. Thorough regulatory powers introduced in the Care Standards Bill will ensure, using various methods, that proper clinical standards are observed.

My hon. Friend the Member for Luton, North (Mr. Hopkins) paid tribute to the ombudsmen and reminded us of some of the other enlightened developments from the Scandinavian countries. He was correct to point out that we have among the lowest general practitioner complements in Europe, and we therefore need to train more doctors. I am delighted that he intends to support the Government in that, rather than suggesting that we should all follow his example by diagnosing our own illnesses.

My hon. Friend the Member for Tamworth (Mr. Jenkins) questioned whether control and regulations could be taken wider. I tend to agree with other hon. Members who have commented that the fact that this is a small measure should not be allowed to detract from its contribution to ensuring better services. The Bill should be seen in a wider context.

I am delighted that my hon. Friend the Member for Hendon (Mr. Dismore) is now using his considerable legal skills to support the House and the Government, rather than pursuing medical negligence cases. Even though that will deprive some members of the public of his skills, I believe he does a much better job in this place. He raised the issue of sanctions and raised one concern which I shall take the opportunity to put right.

The commissioner has in the past expressed concern about his inability to pass information to other bodies. That problem was resolved in the Health Act 1999, which amends the Health Service Commissioners Act 1993. Since October 1999, the commissioner has been able to pass on information when he considers it necessary in the interests of patients' health, safety and welfare.

Finally, I express my thanks to my right hon. Friend the Member for Swansea, West (Mr. Williams) for sharing his considerable experience of how to ensure the success of private Members' Bills. I congratulate him on being a sponsor of the Bill.

On the issue of other professionals, my right hon. Friend may be interested to know that, with regard to possible disciplinary action against police officers following retirement, the Home Office is taking the matter forward in the light of recommendations made in the report on the Stephen Lawrence inquiry. I hope that we not only aspire to being a joined-up Government, but will show that that can be achieved.

Returning to the substantive matter of the Bill, may I take the opportunity to put on record the Government's admiration of, and gratitude for, the work of the commissioner and his office? Many of the speakers this morning confirmed my experience as a constituency Member. We are often faced with distressed or desperate constituents who come to see us as their last chance of getting their problem, whatever it may be, sorted out.We all know that it can take all our reserves of tact and sensitivity to deal with such situations, yet the commissioner's officers face them every day, and it is important to acknowledge the effort and commitment that that demands.

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It may be useful to give a little background to the present situation. Until April 1996, the health service commissioner could not investigate complaints about family health services practitioners--that is, general practitioners, family dentists, pharmacists and opticians. They were explicitly excluded from his jurisdiction. Nor could he consider complaints about matters of clinical judgment, and the extent to which he could look at complaints about independent providers of health care to NHS patients was limited.

That changed in 1996, when the current NHS complaints procedures came into force. In parallel with those reforms, and in order to provide a consistent system for all NHS patients, the Health Service Commissioners (Amendment) Act 1996 extended the jurisdiction of the commissioner to bring family health services providers, and complaints involving clinical judgment, within his remit. It also removed the limitations on his capacity to investigate independent providers.

The widening of the commissioner's remit represented the biggest change to his jurisdiction since the role was originally established. For the first time he was, and is, able to investigate complaints about any aspect of NHS treatment and services, regardless of where or how it was delivered. No one should underestimate the importance of that.

Nevertheless, as the right hon. Member for Wealden explained, there is a loophole in the wording of the 1996 Act. Sections 2A and 2B have been interpreted as requiring that the individual or organisation being complained about must still be providing NHS services at the time of the commissioner's investigation. If they are not, they are outside his jurisdiction. I understand from the commissioner's office that there have been a few cases where he has felt obliged to accept legal advice that he could not investigate a particular complaint because the practitioner involved had ceased to provide NHS services.

The right hon. Member for Wealden seeks in his Bill to plug that loophole by amending the wording of the 1996 Act so that, for example, retired GPs, or independent providers who have sold up, will remain subject to investigation by the commissioner.

I have considerable sympathy with the right hon. Gentleman's view on that. I also know that the commissioner himself has expressed concerns about the situation. Not only has he written to officials in the Department of Health, but he raised it in his annual report for 1998-99. I agree that it seems intrinsically unfair that complainants should not be able to pursue their concerns simply because the person about whom they wish to complain has retired. I understand also that it could be seen as a way for recalcitrant practitioners to avoid facing up to their responsibilities.

I should like to believe that the vast majority of practitioners would never behave in such an unprofessional manner, but I suppose the reality is that some will, given the opportunity offered by the loophole. Moreover, there is a further element of unfairness in that it is not a problem in the hospital sector, because it is the hospital trust as an organisation which is the subject of the complaint, not a particular individual in it. Thus the commissioner can investigate even if the clinician involved has retired, left the country, or whatever. It does not seem right that a complaint involving a retired hospital doctor can be pursued while one about a retired GP

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cannot, so I understand and sympathise with what the right hon. Member for Wealden is trying to achieve in his Bill.

Opponents of the Bill may argue that, even if it were enacted, it would still not be possible to make GPs or private nursing home owners co-operate with the commissioner's investigations. That is not true. The commissioner has the same powers as a judge when it comes to obtaining evidence, papers and so on. I am certain that he would not hesitate to use those powers if he considered it necessary. However, they are useless if the individual involved is not within his jurisdiction in the first place. The key point is to get those ex-practitioners within his jurisdiction, as the Bill seeks to do.

I must also consider these issues from the perspective of accountability and trust. We take the accountability of GPs very seriously indeed. As my right hon. Friend the Secretary of State told hon. Members on 1 February, the relationship between individual doctor and individual patient is built on trust. For that relationship of trust to work, GPs must be accountable for what they do. My right hon. Friend was speaking in a very different context on a very sombre occasion, following the sentencing of a GP for a series of crimes which Mr. Justice Forbes, the judge presiding in the trial, described as a calculating and cold-blooded perversion of his medical skills.

The independent inquiry that we have announced, chaired by Lord Laming of Tewin, will examine all aspects of that case and make recommendations to protect patients in the future. The inquiry will consider all the circumstances and it would be wrong of me to pre-empt that by dwelling on the case today.

However, there are two reasons why I have referred to it. The first concerns loopholes. As the right hon. Member for Wealden explained, there is a perceived loophole in the wording of the 1996 Act. We are not afraid to close loopholes where that is necessary. In the case to which I referred, we found that the way in which the NHS tribunal works meant that the NHS would continue to pay a person convicted of most serious crimes for about another month following the conviction. That was inconceivable, and we took action immediately to make sure that it did not happen.

We also found that there was nothing to require a doctor to disclose to prospective partners or to a health authority a past criminal conviction or a previous professional censure. In the case to which I referred, the doctor had a past conviction for obtaining and misusing a controlled drug and he had a record with the General Medical Council, but in the past that appeared to count for nothing. That, too, must change. There was also no requirement for GPs to report deaths in their surgeries or other serious incidents to health authorities. That, too, needs to change.

The case also put the existing powers and processes of the General Medical Council under the spotlight. We have said that the GMC's involvement in that case will be examined by the inquiry, so that lessons are learned and recommendations for reform made. However, we are also acting quickly to give the GMC the powers that it says it needs. They include: interim suspension, to enable the GMC to take action in the public interest; a new committee to consider interim suspension, with much greater lay involvement; and an ability to strike off for

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life except in the most exceptional circumstances. I repeat that we are not afraid to close loopholes when necessary in the interests of patients.

The second reason why I mention the case is the need for greater accountability of clinicians for the benefit of their patients. For a relationship built on trust to work as it should, it is important that patients can be assured that they can complain if they have a problem, that their complaint will be taken seriously and dealt with properly, and that if something has gone wrong, it will be put right.

The Government and the medical profession are taking action to modernise regulatory structures and to identify and deal with poor performance because of the need for better accountability of clinicians. That is why the GMC is developing proposals for assessment and revalidation at five-yearly intervals of all doctors' licences to practise. We are urging the GMC to keep up the momentum of developing those proposals.

To strengthen and underpin that work, the chief medical officer produced recommendations, which were published in November 1999, in his report "Supporting Doctors, Protecting Patients". His recommendations are comprehensive, and form part of a modernisation programme designed to prevent, identify and deal with the small minority of doctors whose performance gives cause for concern, and to take quick action to remedy that. For example, the chief medical officer proposes that there should be an annual appraisal of all doctors. That is a key proposal.

Appraisal will cover all aspects of a doctor's performance, including compliance with contractual requirements. The chief medical officer proposes that health authorities should be able to suspend a GP when the circumstances suggest that patients may be at risk. Until now, health authorities have been unable to do that. He further proposes that GPs' participation in external clinical audit should in future be mandatory. At present, it is not.

Consultation on the chief medical officer's proposals finished at the end of February. The GMC's proposals for assessment and revalidation will need to tie in with them. We shall now consider the responses as a matter of urgency, but we shall press ahead as quickly as possible with measures that benefit and ensure the safety of patients.

The need for true accountability means that we shall also apply the system of clinical governance to all doctors. That will promote high standards of care and ensure accountability in a way that has not existed before. It will place quality at the heart of health care by ensuring access to effective, prompt, high-standard care whenever a patient is treated in the NHS. Clinical governance provides NHS organisations and individual doctors with a framework for quality improvement.

Too often, we hear of incidents that occur in the NHS that should have been avoidable if the lessons of past experience had been properly learned. That is why we asked the chief medical officer to convene an expert group to examine the mechanisms whereby the NHS currently analyses and learns from adverse health incidents, and to make recommendations for improvements.

The main components of clinical governance are clear lines of responsibility and accountability for the overall quality of clinical care; a comprehensive programme of quality improvement activities; clear policies aimed at

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managing risk; and procedures through which all professional groups can identify and remedy poor performance. It is about a positive, demonstrable change of culture to one of learning, so that quality infuses all aspects of the NHS's work. Our aim is a coherent framework for clinical quality improvement, on the basis of best activity and practice, and with the highest standards.

All those steps, which will improve the accountability of doctors without preventing them from getting on with their job of treating and caring for their patients, are essential and will be established. They will provide assurance and reassurance for patients. We have a responsibility for that.

However, we also have a responsibility to ensure that we are scrupulously fair to the practitioners and providers who could be affected by the proposals in the Bill. The right hon. Member for Wealden expressed the hope that the measure would not be perceived as providing for a witch hunt.

One of the key elements of any complaints process must be that it is fair to all parties. The proposals in the Bill would potentially leave the practitioners and providers involved susceptible to investigation by the commissioner indefinitely. To me, that seems just as unfair to those individuals as the current system--as perceived by those who object to it--is unfair to complainants. Speaking as a lawyer, may I say that even the legal system recognises the unfairness of indefinite liability in civil cases, and sets limitation periods. I therefore believe that if the extension to the commissioner's jurisdiction were introduced, it should not be an indefinite power, but should be appropriately time limited. That would remove the permanent sword of Damocles that would hang over the heads of those individuals--most of whom, we must remember, will have been committed hard-working people with no reason to suppose that they might be complained about. It will also deal with the perceived risk that I mentioned earlier of less scrupulous practitioners retiring or resigning simply to avoid investigation.

However, determining an appropriate time limit is not easy. The commissioner has a time limit within which complaints must be submitted to him. It is generally not more than one year after the complainant becomes aware of the events being complained about. However, I appreciate that the commissioner has discretion to waive the time limit in special circumstances.

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