HC Deb 23 November 1965 vol 721 cc473-80

2.45 a.m.

Motion made, and Question proposed, That this House do now adjourn.—[Mrs. Harriet Slater.]

Mr. Robert Edwards (Bilston)

apologise for keeping you, Mr. Deputy Speaker, and the staff out of bed for another half an hour so early in the morning, but I have a duty to perform on behalf of my constituency. It is a duty relating to the difficulty of registering legitimate complaints against the Health Service. In particular, my purpose is to ventilate the tragic case of the death of a boy of five years of age.

I always dislike criticising dedicated people, and far be it for me to criticise the medical profession. They are dedicated people, overworked, harassed and, I think, underpaid. Nevertheless, in our democracy, we cannot allow them, as we often do, to live in ivory towers, above criticism and often above public accountability.

The case I want to draw the attention of the Ministry of Health to is the case of Thomas Gripton, a boy aged five, who died on 10th January, this year. This boy was the only child of Mr. and Mrs. Thomas Gripton, constituents of mine.

The boy felt ill on 14th December and a doctor was called in and the boy was treated for constipation. Later, the boy was worse and another doctor from the same practice came and treated him for tonsilitis. The boy was in great pain and so the father frantically went to the doctor's surgery and brought the doctor to his home. The boy was immediately taken to hospital and operated on. On 10th January, this little boy, who had lived for so few years, died from peritonitis. It is not for me to criticise what went wrong. I want to express no opinion. But you can imagine the dreadful nightmare of emotion which the parents went through. The husband, Mr. Thomas Gripton, was off work for five weeks in a state of nervous collapse. Ultimately, the parents thought that some investigation into the circumstances of their only child's death should be undertaken.

Mr. Gripton wrote to the clerk of the Staffordshire Executive Committee of the Ministry of Health on 12th February asking that the case should be investigated. That was one month and two days after the death of his son. He received a letter from the clerk on 25th March which stated that the committee noted that the complaint was more than two months out of date and found itself unable to accept as reasonable the grounds given by Mr. Gripton for delay. That was in reply to a very friendly letter, a pathetically friendly letter, from the father who just wanted his son's case investigated. The committee was there to see that justice was done in cases of this nature.

The committee gauged the time from the first visit of the doctor on 14th December rather than from 10th January when the boy died. Apparently it was within its rights according to the regulations, which state that complaints must be made within six weeks of the visit of the doctor. These seem to me to be fantastic regulations. How can one make a complaint if the person concerned is sick for many weeks and dies after the time for making a complaint has expired? It is clear that the regulations need amending.

Mr. Gripton came to see me and I wrote to the Minister. Unfortunately, I got the reply that one usually gets from Ministers. The Department did not want to go over the head of the committee. The Minister stated that the regulations laid down that there could be only six weeks' delay in reporting a complaint, and that nothing could be done. However, looking at the regulations I observed that, although complaints should be made within six weeks, the committee has the right to extend the period if the person complaining has been ill. The father was ill for five weeks, receiving medical attention and also sickness benefit based on medical certificates issued by the National Health Service. Yet the committee clerk did not bother to lift the telephone and inquire whether the complainant was ill. Had this been done, the case could have been investigated within the regulations.

One can make a complaint six months after receiving attention from a dentist, but in the case of the medical profession it is only six weeks. I tried to get this matter debated last session.

but I was not fortunate. Meanwhile, although I advised him to the contrary, my constituent still wanted this matter investigated.

These are good people, and Mr. Gripton is a skilled craftsman and hardworking man. But he felt that unless there was some machinery for complaints what had happened to his son could happen to others. Therefore, he wanted the matter pursued and even took legal action. The case was lost, and it is not for me to discuss the decision of the learned judges in the divisional court. However, it is monstrous that a workman should have to spend his hard-earned money going to law to get the death of his son, which occurred in very exceptional circumstances, investigated when there is machinery established for this purpose. So we are discussing the matter now. It is not a case of wanting to, and I am sure Mr. Gripton did not want to pursue this course. Doctors are human beings and, like everyone else, they make mistakes. It may be difficult to discover whether peritonitis, constipation and tonsilitis are related. I do not want to pass judgment, but there is a necessity for machinery to investigate the complaints which occasionally arise.

In my constituency, Councillor Wagstaff dared to criticise a doctor whose surgery was closed for four days over Whitsun. He did it legitimately and democratically in the local council and did not mention the name of the doctor or the place of the surgery. The doctor removed the councillor and his family from his panel. In another case a lady was involved in a car accident with the doctor's car. Unwillingly she was dragged into court to give evidence against her doctor and she was removed from the panel. There are a minority of doctors who seem to imagine they are above criticism and are not publicly accountable as are most public servants.

Therefore, I beg my hon. Friend to look at the case of Mr. Gripton's son very seriously. It is a human case of great tragedy. The boy cannot be brought back to life, but at least we can guarantee to the citizens whom we represent that if they feel aggrieved, as these parents do, there is some safety valve.

There is a maxim which says that justice must not only be done but must be seen to be done. In this case the parents, their neighbours and Mr. Gripton's workmates, feel that not only has justice not been seen to be done but that there has been no justice and no means of investigating a very serious charge which involved this good family in such a dreadful tragedy. I hope my hon. Friend will have a new look at the regulations so that cases of this description will never occur again.

3.0 a.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)

I am grateful to my hon. Friend the Member for Bilston (Mr. Robert Edwards) for raising tonight the question of the application of the time limits in the case of the complaint by Mr. Gripton about the treatment provided for his son. We had a debate on another medical service committee case about a fortnight ago, when my right hon. Friend said that the events leading up to the complaint against a general practitioner were often of a distressing character. The death of a young and only child is especially sad, and I can well appreciate the emotion with which my hon. Friend has been faced in presenting the case this morning. I should like to take the opportunity to express my deep sympathy with Mr. and Mrs. Gripton.

As my hon. Friend has said, the main facts of the case are clear. Mr. Gripton wrote to the Staffordshire Executive Council on 26th February saying that his son had been taken ill on 14th December and that when the doctor called Mrs. Gripton told him that she feared that the boy had appendicitis but that the doctor thought that it was no more than constipation. Mr. Gripton also said that another doctor, the partner of the first, called on 17th December and, as my hon. Friend rightly said, diagnosed septic tonsils. The second doctor had to be called again on 19th December when she obtained the boy's admission to hospital for an emergency operation for peritonitis, but, unfortunately, the little boy died on 10th January.

The executive council wrote to Mr. Gripton on 1st March explaining that the complaint had been made later than the six weeks allowed by the regulations for making complaints and that his complaint could riot be considered unless he could show reasonable cause for the delay. He replied saying that he had been ill for five weeks and had still been suffering from shock after that and that his wife had still not recovered from the shock. The correspondence was then put before the medical service committee of the Staffordshire Executive Council and, on 23rd March, the clerk wrote again to Mr. Gripton saying that the committee noted that the complaint was more than two months out of date—though strictly that should have read more than two months after the event—and that the committee found itself unable to accept as reasonable the ground which he gave for the delay. Mr. Gripton then consulted a solicitor who also corresponded with the executive council. I will deal with that matter later.

The service committee procedure is domestic to the National Health Service, but it can result in a practitioner being judged to be in breach of his terms of service, that is, of having failed to comply with his contract with the executive council and, in some cases, in withholdings being made from his remuneration. Because of this, it is necessary that there should be rules governing the way in which matters are referred to and dealt with by the committee to ensure that justice is done and seen to be done. The rules are laid down in the National Health Service (Service Committees and Tribunal) Regulations.

A doctor cannot be held to be at fault solely by virtue of his failing to come to the right conclusion about the nature of a disorder or right treatment to prescribe, as he is no more infallible than other men.

At the other extreme nobody could possibly accept incompetent or negligent care as a satisfactory standard of treatment under the National Health Service. What can be expected of a doctor is that he should maintain the standards which n ordinary, reasonable practitioner could be expected to maintain. This is the standard that is expected in the National Health Service, and it is the criterion by which the services committee is guided when it is investigating a complaint that a doctor is in breach of his terms of service.

The first purpose of the service committee procedure is to investigate the allegations made by the complainant so as to establish the facts on which a decision can be made. The longer the delay between the event and the investigation, the more difficult it becomes to establish the facts. It is easier for the complainant to remember the facts, as it is his own case, than for the practitioner, who is treating many people every day. There must also be some limit to the time during which a practitioner can be asked to account for his actions on a particular occasion. There must, therefore, be some limit after which the complaint cannot be investigated. Under the regulations, the normal time for a complaint against a general practitioner is six weeks after the event which gave rise to the complaint. There are times when, with the best will in the world, a person is unable to make a complaint within this period, and it would not be right to make an absolute bar at this point.

The Regulations also provide that the service committee may investigate a complaint if it is satisfied that the delay in lodging it is due to illness or other reasonable cause, provided it is made within two months after the event or, if it is later still, it may so decide only if the consent of the general practitioner or the Minister's consent is obtained in addition. My hon. Friend will notice that the decision whether a complaint that is made after more than six weeks should be investigated is for the service committee to make, and that there is no appeal to the Minister from its decision. He is only asked for his consent to the service committee investigating the case if it is satisfied that there was reasonable cause, and, in practice, only when the complaint is made more than two months after the event and the practitioner has not given his consent to the investigation.

When the Staffordshire Medical Service Committee came to consider Mr. Gripton's complaint, it decided that the events which gave rise to the complaint were the visits of the general practitioners between 14th and 19th December. On this view Mr. Gripton's complaint was made more than six weeks after the event and could therefore only be investigated by the service committee if it was satisfied that there was reasonable cause for the delay. As I said earlier, the decision whether there was reasonable cause was a matter solely for the service committee. I should explain here that some of the members of the committee are laymen and some are doctors. I would not wish to enter into a discussion whether the Staffordshire Medical Service Committee came to the right conclusion in this case, as the service committee procedure is the statutory method of investigating complaints and the regulations governing the procedure leave the matter to the opinion of the committee and give my right hon. Friend no part in it.

When my right hon. Friend wrote to the Minister I know that he may have been disappointed by the reply he received. I can assure him that my Minister gave a reply in the terms of the regulations, and I feel sure that my hon. Friend will accept that he is a very sympathetic and understanding person. The reason for the disappointing reply was solely that he had no power to go outside the regulations. I will only say that the composition of the committee is specifically designed to ensure that the body which considers these difficult questions combines the viewpoint of persons outside the profession with the specialised knowledge which is only available within it.

The solicitor whom Mr. Gripton consulted challenged the decision of the medical services committee on two points: the first was the date of the event which gave rise to the complaint which the Committee had taken to be some time in the middle of December when the general practitioner visited Mr. Gripton's son—and the second was whether it had considered the case in the manner required by the regulations. Following this correspondence, an application was made on behalf of Mr. Gripton to the High Court directed to requiring the service committee to consider the complaint. The application was heard last week and was refused.

The question might be asked whether the normal period of six weeks for making complaints is long enough. I am aware that this question causes concern to many people, and my right hon. Friend is, in fact, in the course of examining the time limit, together with other aspects of the service committee procedure, with the representatives of the medical profession as part of the negotiations that are now taking place on the Doctors' Charter. My hon. Friend will, I am sure, not wish to press me to say more than that at this stage.

If I may, I will for a moment touch on the other matter raised by my hon. Friend, the removal of a patient's name from a doctor's list. I have had a number of these cases, and they are very difficult, particularly when the doctor not merely strikes off the individual concerned but, in one case that was cited, strikes off the family, too. It is a problem, and an executive council has no discretion in this matter. The right of a doctor to remove a patient from his list is, of course, complementary to the patient's right to change his doctor. If a doctor applies to have a patient's name removed from his list the executive council must comply with his request, and no other arrangement would work because confidence and good will on both sides are essential to the relations between doctor and patient. The executive council will, if there is need, arrange for another practitioner to take the patient on to his list.

My hon. Friend wrote to the Minister about Mr. Gripton's complaint and some of what I have said tonight was explained to him then. But I am sure that the debate tonight has been valuable. It comes at a time when a lot of thought is being given to the general practitioner service. I shall tell my right hon. Friend about the points that my hon. Friend made in his speech, and I am sure he will consider them further with other aspects of the procedure.

I am very grateful to my hon. Friend for raising this matter. I think it is right that it should have been raised. I noticed that he apologised in the first part of his speech. If he intended part of that apology for me, I can tell him that he has no need to apologise at all.

Question put and agreed to.

Adjourned accordingly at fourteen minutes past Three o'clock a.m.