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Earl Howe: I support these amendments, two of which, Amendments Nos. 33 and 64, are in my name. I should like to focus my remarks on complaints in the context of private hospitals.

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The key point is that it is not enough for each independent hospital to have its own formal complaints procedure although I do not in any way belittle its importance. The complaints procedure should be a standard, recognised and trusted system which applies across this sector as a whole. It is essential that we understand how proactive the commission will be in bringing this system into being and what role it will play as adjudicator.

If, in a particular case, someone wanted to complain about the way the complaints procedure operated in a hospital, that requirement comes into sharp focus in the context of the NHS's use of the private sector, as the noble Lord, Lord Clement-Jones, rightly emphasised.

What happens when an NHS patient moves to a private hospital as an NHS patient and something goes wrong? The system in the private sector needs to be fully compatible with that of the NHS. For the private hospital just to conduct its own internal investigation is clearly not enough in such circumstances.

I was encouraged to see a recent press release in which the noble Lord's colleague in the Department of Health, Gisela Stuart, said:

    "Under the new arrangements all private hospitals must have proper complaints procedures in place. They must make it clear to patients what to do if something goes wrong. And we will introduce arrangements for independent investigations where patients are not satisfied with how their complaint was handled."

I hope that the Minister can give us some reassurance along those lines and put flesh on those bones.

Baroness Masham of Ilton: Perhaps I may ask the mover of the amendments, and perhaps the Minister also, whether a time limit for complaining will be written in. I have always felt in all complaints there should be safeguards so that complainants are not persecuted in any way. Many people do not complain because they are frightened that they will not get a service afterwards.

Lord Clement-Jones: Perhaps I may reply on behalf of some noble Lords who have tabled these amendments. We believe very strongly in independent complaints systems because we believe that they encourage people to come forward which may not happen in the cosy relationships which I described earlier. We believe people would not have confidence in those adjudicating on their complaints. The commission has a strong duty to ensure the complaints system is adequate. That is why we wish to see incorporated into the Bill a fully independent system and, if possible, the inclusion of the Health Service Ombudsman.

Lord Hylton: On this group of amendments dealing with complaints, it is possible that England and Wales may be able to learn something from experience in Northern Ireland. In that region, there are statutory establishments known as training schools which take a variety of young people who are at risk and who sometimes have offended. In recent years, there has

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been organised an independent advocacy service which enables aggrieved individuals to articulate their grievances and complaints in a much better way.

The result is that some frivolous and invalid complaints can be eliminated at an early stage and the more valid ones can be heard and dealt with more effectively. I happen to know about that as president of a voluntary organisation called NIACRO which has had responsibility for the recruitment and training of those independent advocacy persons. That is perhaps particularly relevant to establishments which are taking young people or others who may be, for one reason or another, relatively inarticulate.

9.15 p.m.

Lord Laming: Anybody that takes on the responsibility for licensing any activity and determining that certain people are fit to manage those activities must have not only a strong complaints procedure but also a complaints procedure which has within it an independent element which can reassure users, carers and, indeed, the rest of us that complaints will be taken seriously.

Complaints can be mischievous. That is one of the reasons why procedures need to be in place. But very often they are also an early indication that something is going wrong in a particular establishment or centre; that there is something not right in the way in which the activities are being managed.

It is extremely important that when complaints are made, they are seen to be taken seriously. For that reason, I hope that the Minister will consider carefully the thrust of the amendments. Earlier, we talked about the commission's responsibility to promote the well-being of users of services. The other side of the coin is that the commission should take seriously any concerns which anyone has about the quality of service which is delivered.

Lord Hunt of Kings Heath: This has been an important debate. I very much agree with the sentiments expressed by the noble Lord, Lord Laming, when he talked about the absolutely essential need for complaints to be taken seriously and when he referred to the indications that complaints give in relation to the adequacy or otherwise of the services which are under consideration.

I want to make it clear to noble Lords that we are determined to ensure that proper arrangements are put in place for the effective handling of complaints. It will be a condition of registration that those running regulated establishments have complaints systems and publicise them. Furthermore, for the first time, we are determined to introduce an independent element to investigate cases where the complainant is not happy with the way in which his complaint about private healthcare has been handled locally.

This group of amendments concerns matters relating to complaints generally and the specific issues relating to the investigation of complaints against registered healthcare providers.

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Perhaps I may deal first with the general points. I fully agree with my noble friend's view, expressed through Amendments Nos. 29 and 66, that the commission should have an active role in pursuing complaints about regulated services. That is a function which is exercised currently by local authority and health authority inspectors. Investigation of complaints about breaches of standards and regulations often provides a source of information about the overall fitness of an establishment which does not surface during inspections. Sadly, we know that a few unscrupulous individuals have been adept at concealing abusive behaviour.

Therefore, we intend that the new commission's role in complaints should be firmly related to its regulatory functions in a variety of ways. First, each registered service will have to meet standards with regard to its internal complaints procedure. Those will be monitored during inspections, and service users will be asked about their level of satisfaction in relation to the handling of complaints.

Secondly, if a complainant has a concern which he is not confident to make to the operator of a service, the commission will accept complaints directly.

Thirdly, all the standards will contain a section on the whistle-blowing procedures which each service should have. I hope that that answers one of the points made by the noble Baroness, Lady Masham. That is included in Fit for the Future?, the current consultation document.

On the matter of an independent review panel, it is important to emphasise both the independence of the registration authority, which represents a change from the current situation, and its wide powers of investigation. As my noble friend Lady David suggested, under the current arrangements the health and local authorities responsible for registration of services may also be providers, so their independence could, under certain circumstances, be brought into question, as I know has been the case on occasion. One of the key features of the new arrangements is the full independence of the regulatory body.

In addition, the regulatory authority will have wide powers to investigate any alleged breaches of regulations or standards. Indeed, alleged breaches of that nature will be at the heart of the vast majority of disputes between service user and service provider. Therefore, any service users involved in such a dispute who consider that their complaint has not been dealt with properly can be assured of an independent investigation by the regulatory authority, which may result in enforcement action being taken.

A further level of independence arises should any enforcement action be taken to remedy deficiencies in a service; for example, through prosecution, the imposition of certain conditions, or even cancellation proceedings. In each case, either a court or a tribunal will review independently the evidence and the outcomes.

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I hope that I have convinced noble Lords that the concept of an independent review panel is not necessary to the functioning of the commission which, in fact, has powers which may prove more effective in securing any improvements in services which may be necessary. Reputable providers, of course, will have nothing to fear from any of these measures. However, the disreputable ones will be dealt with vigorously.

I now turn to matters relating specifically to healthcare services. I fully share the concerns of noble Lords as expressed in Amendment No. 64 that clinical complaints need to be investigated. I am pleased to be able to reassure noble Lords that the drafting of Clause 20(3)(j) refers to all services, including clinical services.

In regard to Amendments Nos. 33 and 72, I also share the concern of noble Lords about the way in which complaints about private healthcare are dealt with at present. We are committed to introducing proper complaints arrangements for independent healthcare in which service users will have confidence.

First, it will be a requirement of registration for all hospitals and clinics to have in place a local complaints procedure which can address all complaints, both clinical and non-clinical. That will need to be well publicised to users of the service and we expect there to be a clearly identified person in each private hospital responsible for handling complaints. We hope that the majority of complaints can be effectively dealt with at that level.

However, we recognise that some complainants will be dissatisfied with the way in which their complaint has been dealt with locally and, for the first time, we are committed to introducing an independent complaints investigatory mechanism. We believe that it is wholly unsatisfactory that such arrangements are not in place now. Therefore, on the principle of the issue, I do not believe that there is anything between us.

On the mechanism for achieving that, I believe that there is room for debate. Certainly the Health Service Commissioner does an excellent job, but his post was established to investigate complaints in the NHS, not the private sector. I am not convinced that it is necessarily right to add those responsibilities to his office. However, currently we are considering how best to deliver what we all want. Our intention is to introduce appropriate amendments, either here or in another place, before we have finished our consideration of the Bill.

To the noble Earl, Lord Howe, I say that it is my understanding that if NHS patients receive care in a private hospital as a result of a contract arrangement between the NHS and a private sector operator, they are deemed to be NHS patients and in that respect the NHS complaints system operates.

I turn to Amendments Nos. 169 and 170A. I hope I made clear in my previous comments that dealing with complaints is integral to the functioning of the

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commission as it exercises its powers. For example, if a complaint about the furnishings or equipment in a registered home is made, and not handled to the satisfaction of the complainant, the commission's inspectors could investigate further. If they upheld the complaint and found that a breach of standards or regulations had occurred, they could require the proprietor to make improvements.

Action would need to be taken on a day-to-day basis and not be referred to a person such as that envisaged in Amendments Nos. 169 and 170A. I suggest that identifying a separate director for complaints is an issue that is best left to the chief executive of the commission to determine as an operational matter. Of course, he or she will want to set clear performance objectives for inspectors and other staff and have a monitoring system in place to ensure that the whole issue of complaints is dealt with satisfactorily.

I hope that I have indicated to the Committee that we take the issue of complaints seriously. The commission has a vital role to play in that regard. It will provide the independent element necessary and, as a result, members of the public can feel confident that, in using the services encompassed within the Bill, a proper complaints system will be in place.

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