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10.12 pm

The Minister of State, Department of Health (Mr. John Hutton): I am grateful to the hon. Member for South-West Hertfordshire (Mr. Page) for raising his constituent's case tonight. He has done his constituent a signal service. Like all right hon. and hon. Members, I was sorry to hear about the health problems that Mrs. Brett has experienced and that her subsequent complaints to Watford general hospital were not dealt with to her satisfaction. The hon. Gentleman has asked me to respond to several specific concerns about Mrs. Brett's case, and I shall deal with each in turn shortly.

It is important that we bear in mind the fact that the national health service treats tens of thousands of patients every day. Last year, it treated more than 12 million patients in England, 43 million patients attended out-patient clinics and more than 14 million attended accident and emergency departments. Mount Vernon and Watford hospitals NHS trust treated more than 46,500 in-patients, 189,000 people were seen as out-patients and more than 63,000 attended accident and emergency.

As I am sure the hon. Gentleman acknowledges, medicine is, sadly, not always an exact science, so when things go wrong it is important that there is a simple, clear and transparent system for dealing with complaints and concerns which enables them to be dealt with quickly and

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effectively. Clearly, that did not happen in Mrs. Brett's case. We accept that although the complaints procedure works effectively for many patients, some, like Mrs. Brett, have had less positive experiences of the NHS's handling of complaints.

The complaints system was introduced in 1996. The objectives were to make it easier, simpler and quicker to complain and to be fairer to patients and staff, so that concerns were resolved as thoroughly and as openly as possible. The commitment was made by the previous Administration, who introduced the complaints procedure about which the hon. Gentleman has been complaining.

A commitment was given to evaluate the complaints procedure once it had had time to bed down to ascertain whether it was meeting its policy objectives. In 1999, therefore, the Department of Health commissioned an independent two-year UK-wide evaluation project to examine the complaints procedure.

The evaluation report, which was published last month, confirms that there is obviously room for improvement. It highlighted four key messages from patients who had experience of the complaints procedure: that complaints are often not handled well and take too long to resolve—I am sure that that is the opinion of the hon. Gentleman's constituent, Mrs. Brett; that communication between staff and patients and complainants is often poor; that the process is not always sufficiently independent and is perceived to be biased; and that there is no real system to learn from experiences and to make the necessary improvements in other places.

The report went on to make 27 suggestions about how the complaints procedure and arrangements for managing it could be improved. The hon. Gentleman will be glad to know that I shall not go through all 27 suggestions, as will everyone else who is listening. However, its recommendations fell into four broad categories. First, it identified the need to change the way in which the NHS deals with complaints. For example, there is a need to ensure that all staff receive appropriate training and support so that they can deal with patients' concerns more effectively as and when they arise.

Secondly, to ensure consistency across the NHS, there is a need to standardise procedures throughout the service and throughout the country, no matter what part of the NHS it is. Thirdly, increased independence of the procedure would ensure that the independent review is genuinely independent and perceived to be so by patients and staff. Fourthly, there is the need to strengthen monitoring and accountability within the procedures to give more responsibility to trust boards for monitoring the quality of complaints handling within their organisation and considering the role for other outside organisations.

We certainly need to find ways to ensure that complaints about services that cut across health and social care—although this was not such a case—can be dealt with as smoothly as possible, given that there are currently two separate stand-alone procedures. With joint provision of cases across health and social care increasing, and especially with the advent of the new care trusts, we are examining how the two complaints processes can be harmonised.

Alongside the evaluation report that was published on 3 September, we invited views from NHS staff, members of the public and patient representative groups about four key issues. We asked for views on the 27 suggestions

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made in the report, and in relation to a series of key questions. First, what impact would a reformed procedure have on people and organisations? Secondly, how should performance in handling complaints be monitored and managed? Thirdly, what limits should there be for making and dealing with complaints? Finally, how can the current procedure be reformed to make it genuinely independent?

Our objective is to implement the necessary reforms next year. It is not just about improving complaints procedures for individuals. At the same time, we need to ensure that patients and the public have a better opportunity to be involved at a strategic decision-making level as well. That is why we intend, subject to legislation and the agreement of the House and the other place, to replace community health councils with patients' forums for every NHS trust and primary care trust, with a new national body to set standards and ensure consistency, and with local participation agencies, to be known as local voices, to enable citizen involvement in wider health issues.

In addition, the Department of Health has already agreed to implement all the recommendations made in the "Organisation with a Memory" report. A new independent body, the National Patient Safety Agency, will run a new national reporting system to record adverse events and near misses in health care. That will ensure that lessons learned in one part of the NHS are properly shared with the whole of the NHS.

In addition, the new National Clinical Assessment Authority will provide a fast response to concerns about doctors' performance and will provide a central point of contact for the NHS where concerns about a doctor's performance arise.

Another obvious challenge—the hon. Gentleman was right to draw attention to this—is to improve overall quality in the NHS, and thereby reduce the number of complaints, by developing and improving external inspection of services throughout the NHS.

Clinical governance provides NHS organisation and health care professionals with a new framework for quality improvement which, over time will, I hope, develop into a single coherent local programme for assuring and improving the quality of clinical services. Additionally, one function of the Commission for Health Improvement is to help the NHS to identify and tackle serious or persistent clinical problems. Information about complaints handling is considered by the commission in the context of its clinical governance reviews of individual NHS organisations. We need to ensure that the system for dealing with and monitoring the management of complaints develops in harmony with all those wider developments so that complaints are dealt with as effectively as possible and individual organisations and the NHS as a whole can learn from mistakes.

As the hon. Gentleman can see, all those things demonstrate the ways in which we are committed to learning from mistakes and to introducing a truly patient-centred NHS, which is the cornerstone of the NHS plan. While we can never guarantee that experiences such as that of Mrs. Brett will never happen again, our aim is to introduce a new system which will be as robust and responsive as possible in future.

I want to deal with the specific issues relating to Mrs. Brett which the hon. Gentleman brought to the attention of the House. He set out in detail the background

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to her long-standing complaint. He asked in particular that the trust implements the recommendations in the Glick report by apologising to Mrs. Brett, paying her compensation for injury and upset and conducting a proper review of its ophthalmology department. Finally, he urged Ministers to intervene in the case and ask an independent assessor to consider a further round of conciliatory discussions. My advice is that, following the trust board consideration of the Glick report, Mr. Eames, then chief executive of the trust, wrote to Mrs. Brett on 19 July 1999 making a full and unconditional apology; establishing that an audit of the ophthalmology department would be carried out by the trust's clinical audit team; offering an ex-gratia payment for the distress caused to Mrs Brett; and offering a meeting to discuss the trust's response. I have a copy of that letter with me this evening and I am sure that the hon. Gentleman has seen it, too. I am advised that the meeting referred to in the letter on 19 July 1999 never took place and that Mrs. Brett was unhappy with the compensation that was offered and refused to accept payment.

The review suggested by Mr. Eames and recommended by the Glick report was conducted by the trust's medical director and concluded that glaucoma was managed in a manner equivalent to that in similar NHS units. Those conclusions were shared with Mrs. Brett. The hon. Gentleman rightly drew attention to the fact that Mrs. Brett appears to have exhausted the NHS complaints procedure, so he raised the need for a further specific review of her case. He is legitimately concerned for the welfare of his constituent and wants to ensure that every effort is made to resolve her continuing concerns following her treatment in 1989. I share those concerns, but I do not think that that is the right way forward.

The hon. Gentleman will be aware that, thanks to the changes we have made, the Commission for Health Improvement now conducts regular inspections and reviews of the performance of NHS hospitals and the quality of care that they provide. I think that the most sensible way I can respond positively to the hon. Gentleman's concerns is to bring them directly to the attention of the Commission for Health Improvement in advance of its visit to West Hertfordshire Hospitals NHS trust. My considered opinion—I assure the hon. Gentleman that I have looked at the evidence and the file on the case—is that the best course of action would be for Mrs. Brett to reconsider the meeting offered to her by the trust as part of the package offered following the Glick report. I shall ask the new chief executive of the trust, Mrs. Harrison, to offer Mrs. Brett a meeting to discuss a range of issues referred to by Mr. Eames in his letter of 19 July 1999. I hope that that will meet, at least in part, some of the hon. Gentleman's concerns.

I do not doubt, however, that in this particular instance the NHS complaints procedure left Mrs. Brett and her family feeling considerable anger and unhappiness about her treatment. Her direct experience and that of others like her of both patient participation in the NHS and the complaints procedure itself has had an adverse effect. I hope that the measures that I have set out this evening will ensure that Mrs. Brett's experience of complaining about NHS treatment will not be shared by others in future.

Question put and agreed to.

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