Examination of Witnesses (Questions 40-59)
ROSIE WINTERTON
MP
26 JANUARY 2006
Q40 Charlotte Atkins: Minister, your
departmental report 2005 claims that you are on course with the
public service agreement on enhancing patient accountability and
experience. How exactly is that measured?
Ms Rosie Winterton: Through the
section 11 duty on the NHS, we have said they have to show they
are consulting with the public, with patients. The Healthcare
Commission then monitors the way that has been carried out. The
evidence so far is that that will involve seeking wherever possible
the views of patient forums, probably overview and scrutiny committees,
about how involved they feel they have been at local level.[3]
Q41 Charlotte Atkins: Good. Where you
have an individual patient who has a complaint against a trust,
when they receive what they would consider to be a report which
is effectively a whitewash of something that has gone wrong, how
can that be accountable to patients who use the NHS and are aggrieved?
Ms Rosie Winterton: As I am sure
members of the Committee are aware, the NHS Redress Bill is looking
at how, in a sense, to improve the system of complaints at the
moment and at how information can be shared with patients more
when we look at the complaints system itself. Very often people
will make a complaint but what they often want to know is that
it is not going to happen to somebody else. They are not always
looking for monetary redress; very often they are looking for
an acknowledgment that something has taken place which should
not have taken place and they want to know that steps have been
put in place to address the issues that they have raised. I certainly
know that from the letters I get which are passed through Members
of Parliament, that very often it is a question of a bit more
openness about what has happened and how you can address that.
That is the system we are looking at through that Bill. I think
there is more scope—and this is something I do want to look
at—as to whether we can improve the liaison between perhaps
what PALS receive in terms of complaints about, say, a trust,
what ICAS might receive, and whether there could be greater powers—and
this is on a wider basis than obviously the individual—if
there are trends, for whatever system you have for patient and
public involvement to get that information as of right, and to
look at what a trust might have done to put right what seems to
be a trend. That is an area that I think we should look at a bit
more closely and I want to look at whether we could strengthen
that.
Q42 Charlotte Atkins: The key issue
is that, if the patient's experience is a bad one, that leaves
them with a view of the NHS that it is not delivering, and, if
they get a whitewash report on their particular complaint, then
they do not get any follow up to indicate that that is not going
to happen to another patient. The impression they get is that
it happens every day to people. If you look at the press, that
will be reinforced in the press as well. The clear issue here
is to make trusts far more accountable to individual patient complaints—direct
complaint, not through PALS—to get them more accountable,
so that patients understand that it really will not happen in
the future.
Ms Rosie Winterton: As I am saying,
that is part of what is being looked at in terms of the Bill.
At the same time, if there is a trend and patients think this
is happening all the time because people they talk to say, "Ah,
that happened to me as well," is there a way we can improve
the system of getting that information out there and therefore
giving the ability for patient and public involvement bodies to
take an overall look at what they consider to be a trend in terms
of complaints procedures. You have to be careful because there
can be issues about patient confidentiality and things like that.
Q43 Charlotte Atkins: Absolutely.
But do they not need to know that, if they do not get it right,
heads will roll?
Ms Rosie Winterton: There are
two issues there. It is quite an interesting way to look at how
you deal with that. One of the things we are looking at particularly
is how to give NHS staff more confidence, in terms of, if you
like, reporting incidents if they think that there is going to
be a fair system, whereby if something is a genuine mistake and
can be put right that it is not necessarily a heads-rolling scenario
all the time. Because that is what can prevent people coming forward.
In some circumstances, where they are working in very close teams,
you have to make sure you are getting the balance right between
saying "This is not a blame culture; this is about learning
from mistakes." But, to learn from mistakes, everybody has
to be very honest about what has happened. I think it is a balance
between the two. If you put too much emphasis on "heads will
roll" the whole time, you might find that people close up,
and we want to have an open situation.
Q44 Charlotte Atkins: That is an
issue about making sure that managers know what is going on in
their own hospitals.
Ms Rosie Winterton: Exactly. That
is very much what is being looked at at the moment, how you make
sure there is that accountability but make sure you create an
atmosphere where people can say, "Look, this happened. This
was not deliberate. It happened and we have to be open and honest
about that." That is exactly the direction of travel that
we are going in.
Q45 Dr Taylor: Going back to overview
and scrutiny committees, Minister, I put in a parliamentary question
not that long ago to ask how many cases the Secretary of State
had referred to the Independent Reconfiguration Panel. The answer
I got at that time was one, and that there were three on her desk
waiting. I wonder if you could tell us if she has passed any more
than that one to the Independent Reconfiguration Panel, and how
many are waiting now.
Ms Rosie Winterton: I think the
figure is eight.
Q46 Dr Taylor: Eight which have been
passed to the panel?
Ms Rosie Winterton: I think so.
I will come back with a firm figure, but I think that is the latest
figure.
Q47 Dr Taylor: The other thing I
asked at the same time was what criteria she uses to decide on
the referral. The answer I got was really to the effect that it
depends what she feels like on the day it comes.
Ms Rosie Winterton: Right!
Q48 Dr Taylor: I wonder if she has
any criteria. It strikes me that it is absolutely crucial, The
Independent Reconfiguration Panel feels fairly strongly about
it because they have gone out separately and are now offering
a service of advice before it even gets to the Secretary of State,
because it has appeared, unless you are right and eight have been
referred, that she has been rather a block on the referral to
the IRP.
Ms Rosie Winterton: If we have
a system in place whereby we are talking about the buck and whether
people feel there is a process there that allows a proper scrutiny,
I think it is important that a very careful look is taken at each
individual referral to decide that it is appropriate or not. There
will be some areas where perhaps it is a grey area and the Secretary
of State with officials may say, "Let's get them to have
a second look at it." Some may be fairly clear: if the referral
is that proper consultation has not taken place, and when the
process is examined quite closely it is possible to say, "This
has been quite a good consultation process, it has followed good
practice, and in a sense therefore we do not agree that the consultation
has been inadequate." That may be fairly obvious in some
circumstances. But if it is a situation where it is perhaps in
the balance, and there are other issues whereby there may have
been representations that perhaps some of the financial implications
have not been looked at properly and there is uncertainty about
that, that should go to an independent panel for advice. I think
people have more confidence that there is a judgment being made,
it being looked at carefully, and not everything is referred to
an independent panel because, otherwise, you are not really getting
the personal look at it that people are asking for.
Q49 Dr Taylor: Surely the panel do
not only review it if the consultation has been inadequate. Surely
they are allowed to review it from the point of view of the decision
being wrong.
Ms Rosie Winterton: That is what
I said. I was saying that if the grounds for referral were purely
on the consultation and the Secretary of State looked at it and
thought, "Actually, in terms of what we know about the consultation
process, x, y, z has taken place," then it would be correct
not to refer it to the independent panel. But I am saying that
if there were other issues, whereby there was conflicting evidence
about whether the services could be provided adequately in the
light of the reconfiguration proposed, or the finances were not
considered to have been carefully thought out, then that may well
be something that it would be appropriate to refer on for an independent
look at what was being proposed. So it could be a mixture of the
two, as I have said.
Q50 Dr Taylor: And you will come
back to us with the number.
Ms Rosie Winterton: With the number,
unless my officials can hand me something immediately.[4]
Q51 Mr Amess: Come on, officials.
Ms Rosie Winterton: I am sorry,
it is still one. There have now been eight referrals to the Secretary
of State from OSCs overall. So overall there have been eight referrals
and one has been passed on.
Mike Penning: Could we see those, Chairman?
Q52 Mr Burstow: Could we have a note
of how many of those have gone to the Secretary of State; how
many she has decided herself; how many have gone to the referral
panel; and how many are still waiting for decisions of one sort
or another.
Ms Rosie Winterton: Of course.
Mike Penning: And who they are would
be very helpful, because you will see if there are clusters within
the country, I am sure.
Q53 Dr Taylor: What has the Centre
for Public Scrutiny done with the £2.25 million that it was
given to improve the work of overview and scrutiny committees?
Ms Rosie Winterton: It has done
an excellent job with the money.
Q54 Dr Taylor: What?
Ms Rosie Winterton: In terms of
the reports that have been produced, such as this, such as holding
a number of conferences, workshops, and going into individual
local authority areas. Sometimes Members of Parliament have been
to me and have said, "We are not entirely satisfied that
our overview and scrutiny committee is getting all the advice
it needs." It can go in to help people look at particular
ways they might conduct an inquiry. It pulls together a lot of
the good practice that has gone on in different areas and then
advises others and gives advice on how they can conduct similar
inquiries. It has really done a very good job, I think, in terms
of getting overview and scrutiny committees to carry out some
very good reports and to make sure that there is a consistency
in that across the country.
Q55 Dr Taylor: Going back to patient
forums, what do you plan will take over the sort of coordination
role, the national voice, after the Commission is abolished?
Ms Rosie Winterton: That is one
of the areas we are looking at in terms of the review. We will
have a centre of excellence—we have already made that commitment—which
will look at some of the roles which are currently being undertaken
by the commission, such as the drawing together of best practice.
A little bit in the way that the Centre for Public Scrutiny does
its work at the moment. We have already said we will do that.
I am not sure whether you are getting at whether there would be
a kind of national association of patient forums.
Q56 Dr Taylor: Yes, a national voice.
Something to coordinate their activities.
Ms Rosie Winterton: That depends,
in a sense, at how we look at a number of issues, including the
relationship, for example, between any patient and public involvement
bodies and overview and scrutiny committees—a whole series
of things that we need to look at once we have consulted with,
not least, the patient forums themselves, to look at what they
feel is going to be most appropriate. I think you are very right
to say there does need to be a forum in which they can exchange
information about what they are doing or what any patient in the
public involvement system is doing, but I think it would be wrong
to pre-empt that by saying there would be one body for one area
of it before we look at the totality.
Chairman: Could I bring David in very
briefly on this.
Q57 Mr Amess: Our Chairman, quite
rightly, wants us to get on to dentistry and he is annoyed I want
to say something. I very quickly want to congratulate the Minister
on successfully seducing the Committee this morning. Eyes are
glazing over.
Ms Rosie Winterton: Oh!
Mr Amess: We have been blinded by science.
Chairman: It is easier in some cases
than others.
Q58 Mr Amess: I have to say to the
Committee that we have the most charming selection of health ministers
we have ever had. It is very difficult to be tough and robust
with them, but I simply want to put to this Minister that the
charge could be made that we have heard a lot of hogwash this
morning. In essence, governments, particularly individual departments,
are about news management. There is no doubt at all that community
health councils were a focus for complaints. At the moment in
the media we are dealing with sex, Big Brother, a bit of
education, we are going to go on to Afghanistan, and the Health
Department is having quite a quiet time at the moment, but we
did have the Secretary of State slipping in about all the debt
that is building up and how trusts are running out of money. I
want the Minister to reassure the Committee that what we now have
is not to do with news management, and it is not blunting what
a number of colleagues have articulated this morning: the right
of our constituents to focus their genuine concerns and complaints—and
I am very pleased that the Department took the trouble to share
the information about Southend and I shall congratulate them on
how they are working closely with the Government.
Ms Rosie Winterton: It is not
in any sense trying to blunt, if you like, a local voice. Indeed,
the whole direction of travel is to look at how we can improve
that. As a minister, but also as a constituency MP, I believe
very strongly that we can only make some of those improvements
we want to see if we are able to strengthen the local voice. There
are always going to be debates about how money is used at local
level, how services are provided, whose needs they meet, and you
can only get satisfaction about that if people feel they have
an adequate means of putting in their views. That is where we
want to get to. I feel that Members of Parliament have a very
important role to play in this and that is why I have written
on two or three occasions to all MPs saying, "Please get
involved in your local forums. Give them encouragement, give us
advice on how they can be improved"—and it is the same
with overview and scrutiny committees. It is a very serious subject
and we do need to get it right.
Chairman: Could we now move on to dentistry,
Minister.
Q59 Mike Penning: Minister, I will
do a deal with you: I will ask a very short question if you give
me a very short answer.
Ms Rosie Winterton: If I give
a short answer. Right.
3 See Ev 21, supplementary memorandum from the
Minister. Back
4
See Ev 21, supplementary memorandum from the Minister. Back
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