Examination of Witness (Questions 40-59)
Thursday 15 May 2003
MR DAVID
LAMMY MP
Q40 Dr Naysmith: You may be glad
to hear that we are leaving the subject we have been on for the
last 55 minutes and moving to another area.
Mr Lammy: I was enjoying it.
Q41 Dr Naysmith: As you know, our
Government's programme for the National Health Service involves
more choice for patients in a number of different areas and promises
more for the future, and rightly, I believe. Central to the concept
of making choices the patient needs to be equipped and the patient's
GP, also, needs to be equipped with proper information about how
to make these choices. Although there is a lot more information
available, are you satisfied that there is now enough information
available for people to make informed choices about their treatment.
Mr Lammy: I do not think it is
controversial to suggest that whilst I am proud of the NHS and
proud that people can get treatment free at the point of delivery,
the NHS—like a number of bodies across Britain—to
some extent was a top down one; it has been guilty of a bit of
elitism and in that sense the ordinary man—Joe Bloggs, as
it were—at the bottom has not been able to get his voice
heard and sometimes has not been able to be streamed through.
One has had a situation in which clinicians know best sometimes.
In terms of us changing that, we are only at the very beginning
of that journey. The baby is still an infant. I think the prospectus
that people had dropped through their doors around Christmas last
year guiding them through what NHS services are available in their
area is a key part of that. I think that the Patients' Forum providing
that advice will be a key part of that. I think a whole number
of things taking place are a key component of that. I think people
are increasingly better informed.
Q42 Dr Naysmith: What I am also getting
at is the quality of the information. There have recently been
one or two questions about the star system and whether it does,
in fact, deliver a complete picture to such an extent that people
can use it to make judgments. Would you agree with that?
Mr Lammy: No performance system
can be perfect and any performance system will have both quantitive
and qualitative determination which means that it could be changed
or moved in a different way. That is a fact of any system. I think
it is clearly preferably than what we had before and I think measures
things like how clean a hospital is, measures a hospital's performance
in terms of the waiting times in A&E; those sorts of things
are important, the management decisions that bear down on people's
experience. They go through those hospital doors and experience
a first star or two star or three star experience.
Q43 Dr Naysmith: We both agree that
there is a lot more information about. Possibly we agree, because
you said there was a long way to go, that more better quality
information is needed. What is going to happen over the next four
or five years in order to make better information available to
people?
Mr Lammy: I think the growth and
experience of NHS Direct is very important in this area. More
and more people are phoning NHS Direct. If one looks at the demographics
of the people phoning NHS Direct, for example, many people under
35 know the number and are ringing it; young mums are ringing
it. Presumably that then bleeds into their families as we move
through. We expect to see more information available on-line and
people are using the on-line service, particularly for areas where
people want to be private and confidential and do not want to
ask what might be embarrassing questions of a pharmacist or whatever.
They want to be able to go on-line and find out about certain
things and e-mail someone anonymously.
Q44 Dr Naysmith: I thought people
were to be encouraged to ask questions of pharmacists.
Mr Lammy: What we want is people
to get access to the right advice and the right information in
the way that they require it and which suits their needs. I think
that is important. When I was growing up it was the pharmacist
that provided that role and still provides that role. For some
people it is sitting behind a desk during a work break, it is
e-mailing on-line and it is enquiring about things privately depending
on the health needs that you have. I know, for example, that sexual
health has been something that the on-line service has been able
to major on. Also, we are developing that digitally on television
as well. So information is coming through different portals in
a modern way, but also information in the old fashioned way, on
a leaflet, at people's doorstep. Also, very importantly, you cannot
just flood people with information. You have also got to have
people to channel through that information and I think that PALS,
Patients' Forums, patient advisors, things like the self-care
agenda, the increasing role of the pharmacist, they are all a
key part of that.
Q45 Dr Naysmith: Is there any kind
of monitoring of these GP's prospectuses? I do not mean bureaucratic
monitoring but anybody looking at them, picking out best practice
and making sure it is circulated. Does that sort of thing happen?
Mr Lammy: That is happening; it
is happening from the strategic health authorities and it is happening
at the Department. No doubt the new Commission will take an interest
in that area as well.
Q46 Dr Naysmith: The other kind of
information that this Committee has taken an interest in before
is the question of when things go wrong and we get adverse incidents
occurring. A previous report to the Committee recommended the
setting up of a National Patient Safety Agency. Something very
similar to what we recommended has been set up. What progress
has been made by the NPSA?
Mr Lammy: I should say that I
do not have direct responsibility for the National Patient Safety
Agency, but I do know that we are now about 18 months—perhaps
a little longer—into the life of the Agency. It will role
out nationally in July. There have been a number of pilots informing
those adverse events, and one of the ways in which we can get
better is that the NHS has not been as good as it could have been
at having a memory and learning from mistakes that happen, the
adverse things that go on within an individual Trust and spreading
the best practice. People are reporting adversely. I think the
vast majority of those tend to be the minor things, but the serious
incidents are being reported as well. In a sense we are going
to be in a much better position than we have ever been to learn
from that, for commissions to learn from that.
Q47 Dr Naysmith: So the database
is building up, is it? Do you know of any difficulties in getting
information?
Mr Lammy: It is not my direct
responsibility, but I can make sure that we write to the Committee
and keep you up-dated on that point.
Q48 Dr Naysmith: And also is there
is any evidence of any improvement. I realise it has really only
been going for 18 months, but that would be useful too, if you
could write and tell us that.
Mr Lammy: Of course.
Q49 Dr Taylor: On that, could I ask
for a specific written answer. One of the most important ways
of avoiding adverse incidents is the yellow card system of reporting
suspected adverse drug reactions. Could we know if the numbers
of cards that have been filled up is still as low as it was a
few years ago, or if doctors are being better at filling those
in? It would be useful to have the numbers of cards filled in
for the last few years to see if they are increasing.
Mr Lammy: I will get my colleague
responsible for that to write to you.
Q50 Dr Taylor: The complaints procedure
is, quite rightly, being reformed. CHAI and CSCI will take over
the complaints process. Are you confident that they will be able
to do this? Can we have your thoughts about the process they will
engage in?
Mr Lammy: I have a serious amount
of professional respect for Sir Ian Kennedy and all the work that
he has done. I think that the new inspectorate CHAI are very well-placed
to do this work. I say this for a number of reasons. This goes
beyond being the minister responsible, it goes back to being a
lawyer and doing some work in the clinical negligence area and
knowing that one of the problems with complaints in the past is
that the problem the patient might experience, once they have
pursued the inquiry, it could go on for ages, years. They could
be coming up against brick walls and there was a perception that
there was no independence in the system, that people were investigating
themselves. Bringing that independence in through CHAI is fundamentally
important. Not just CHAI, but also having the board of the individual
Trust and those non-executive members that we were talking about
take ownership of this issue as important, so I do believe that
they will be well placed. Of course, the new CHAI will be coming
across the existing inspectorate and people will moving to ensure
that they can complete that role.
Q51 Dr Taylor: Were you surprised
by the resignation of Peter Homa and the loss of his experience?
Mr Lammy: I am not sure it is—
Q52 Chairman: This is probably a
more appropriate question for the Bill Committee next door, but
I was speaking this week at a conference at the BMA on intermediate
care and one or two people raised a concern that the new proposed
system would have problems addressing the kind of service interface
between health and social care, such as intermediate care. How
do you feel it will work in practice, where you have something
which is not entirely health and not entirely social care, but
a mix of both?
Mr Lammy: I think that is something
for the Bill and for my colleagues. What I would say is that there
is a requirement for the two bodies to work together and that
may be one of the areas which should be key and should be flagged
up within that.
Q53 Mr Amess: Just a point of information
on this complaints procedure and it is perhaps something you might
write to me about. Neither you nor I are bereavement counsellors
and I think we are in correspondence with a number of constituents
whereby they keep coming back to see me and they are just not
happy with the outcome. Indeed, there is one which I have mentioned
in the House on a number of occasions concerning my own relative
in Redbridge where it has gone on and on and on. With these new
procedures, when they are in place, will they be able to look
at old cases?
Mr Lammy: No, they will not be
retrospective.
Q54 Mr Amess: Is there some answer
to this situation whereby the relatives are totally unsatisfied
with what has gone one. The Ombudsman will not consider it. It
just seems to be that the answer is always to take independent
legal action.
Mr Lammy: I do not want to comment
on the specifics of the case.
Q55 Mr Amess: No, but we have reached
stalemate on a number of these cases.
Mr Lammy: Have you written to
the Department on this?
Q56 Mr Amess: Yes.
Mr Lammy: I do not want to comment
on the specifics, but we hope that it does not reach that point.
I was really pleased that the early signs are that having PALS
in place is bringing down complaints because people are being
assisted right at the coal face, instantly. We are getting past
the old system. The new complaints regime that we are putting
in place, I think, will fundamentally alter what has gone before,
bringing in the independent level if things are not satisfied
at local level.
Q57 Mr Amess: Even if the constituent
is still dissatisfied with what is going on when this new procedure
comes into place.
Mr Lammy: I suspect it may depend
on the circumstances, but it was not my understanding. Perhaps
you could write to me and then I could give you a bit of clarification.
Q58 Mr Amess: It is just that it
would give people a bit of hope.
Mr Lammy: Do write and I will
look into it.
Q59 Dr Taylor: Moving on to clinical
negligence which is right up your street because I think you were
in that field as a lawyer.
Mr Lammy: Representing doctors,
I might add.
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