NATIONAL HEALTH SERVICE (REVEREND BRIAN BROWN) (Hansard, 7 December 1967)

§ Mr. Robert Edwards (Bilston)

I am grateful for the opportunity to raise an issue which I consider is one of very grave social injustice. It affects a very good family in my constituency, the Reverend Brian Brown, B.A., his wife and his two small daughters. His daughter, aged 5, was ill in May this year and his general practitioner said that the child had tonsilitis and should have an immediate operation.

Arrangements were made for the family and the child to see a consultant at the Royal Hospital, Wolverhampton, but the meeting did not take place until a month after the child had been seen by the family doctor. The consultant indicated that the child was very young and that although an operation was needed no accommodation could be found for her for this simple operation until March of next year.

The child was ill, the illness recurred and the parents were emotionally strained because the welfare of their child was at stake. The child was visited by another doctor of the practice and he again indicated that an operation was required. Again, the family visited the 1827 Royal Hospital and on that occasion the assistant consultant said that the child was only suffering from catarrh and that no operation was needed.

The parents called in their doctor again and he said that the child needed an immediate operation, but that, as they could not get a bed under the National Health Service, if Mr. Brown was willing to pay a fee of £80 an operation could be guaranteed immediately and a bed would be found for the child.

This family believes in the Health Service. Mr. Brown and his wife are not rich. They are a cultured family, but they have not a big income. However, they could have paid the £80, but they decided that a big principle was involved here and they wrote to the hospital management committee and asked for an explanation. The committee, through its chairman, sent back what was, in my opinion, a rather evasive letter and suggested that Mr. Brown and his doctors should have a friendly discussion to solve the difficulty that had arisen between them.

My constituents offered to talk this over with their three doctors in the practice, but Mr. Brown received a letter stating that they had informed the Dudley Executive Committee of the Health Service that he and his family had been removed from their panel.

It seems a very serious business that patients—a cultured family—cannot protest against what they consider is a grave injustice without being removed in the most arbitrary way, without any discussion at all, from the doctor's panel. This good family, this man and wife, had to trudge around Sedgley from surgery to surgery interviewing doctor after doctor. It took them a fortnight before they found a doctor who, rather reluctantly was willing to take them on to his panel. Indeed, one doctor with whom they discussed their problem said he had vacancies on his panel, but was unwilling to take them because he did not want any more patients from their area.

A serious problem arises which should be debated here and considered by my right hon. Friend. I appreciate his coming here at this late hour even though he is overwhelmed with work, to deal with a matter that concerns only 1828 one family. He is a man of great understanding, patience and a great feeling of justice, and that is why he is here.

I should like to read two brief extracts from letters written by the two doctors concerned to the Clerk of the Dudley Executive Council of the National Health Service. They were asked to explain why they had treated these good people in this arbitrary manner. Dr. Thompson replied: All I did was to point out that the only way to get round a situation which was to her"— Mrs. Brown— evidently objectionable was to have a private consultation. That meant that he was suggesting that a £80 fee should be paid. The comments concerning my political beliefs which are attributed to me are not reported accurately and in any case are not, I submit, a matter for consideration by your council's service committee. The political objection that the family took to their doctor was that he denigrated the whole Health Service, said that it had no future and that the only way one could get real medical treatment was to become a fee-paying patient. Yet in the letter the doctor suggests that his political views, which were frequently expressed in an attempt to undermine the Health Service, were not subject to consideration by the committee.

The other doctor on the panel also replied to the clerk, concluding his letter as follows: I cannot, however, refrain from pointing out that it is precisely the sort of selfish, hysterical and unreasonable attitude adopted by Mr. Brown (which, in passing, ill-befits his calling) which is undermining the National Health Service and persuading so many practitioners to seek employment in other countries. That seems a very arrogant way for two doctors who earn their living from our Health Service to deal with a genuine complaint by my constituent. It calls for investigation into their conduct. Far be it for me to condemn the medical profession of this country. The overwhelming majority of its members are over-worked and under-paid. But from time to time there is a minority in every profession who think that they can sit in their ivory towers, because they have specialised skill and there is a lack of competition, and that the citizen has no rights.

1829 I conclude by reading two extracts from the most recent letter I have received from Mr. Brown, who has been suffering emotional upset and social indignities. He says: Our sole reason for raising this issue is not a personal matter between us and our former doctors. We are protesting on behalf of the countless others who have given in to the same moral blackmail that we feel has been applied to us, or who for financial reasons do not get the chance to receive privileged treatment. If the unpleasant experience we have gone through will serve to assist in preventing what appears to be a rowing abuse of hospital and medical services under the National Health Service, it will have served some use. I assure you, Mr. Deputy Speaker, that I know this family personally. Mr. Brown is a lecturer as well as a Bachelor of Divinity and a Bachelor of Art, a man of great culture. His wife is a school teacher. They are good, honest citizens who do not make frivolous complaints and they are not the kind of people to create difficulties. But their lives have been upset and the unity and happiness of the family have been made difficult because of the conflict with the three doctors concerned.

I am certain that this is not a frivolous complaint, but a serious indictment of a growing content of our national institutions, this growing tendency by some professional people to feel that they have exceptional privileges in our society. I hope that my right hon. Friend will agree that this case should be thoroughly investigated, even if only to prevent situations like this from developing in other parts of the country.

§ The Minister of Health (Mr. Kenneth Robinson)

We debated earlier today legislation which I have put before the House and which is designed to improve in various ways the powers available to me for providing health and welfare services. it is in a way disappointing to end the day discussing someone's dissatisfaction with the services which he has received, but, after all, the touchstone of success of any general provisions is their effect on the individual, and I am, therefore, grateful to my hon. Friend the Member for Bilston (Mr. Robert Edwards) for raising this personal case.

My hon. Friend has given us an account of the dissatisfaction of the Reverend Brian Brown with both the 1830 general practitioner and the hospital services. I am in a little difficulty in replying to the debate as regards the general practitioners, for Mr. Brown has made a formal complaint to the executive council and I cannot discuss the merits of this aspect of the case. I must emphasis that the account given tonight represents Mr. Brown's account and we must remember that we have yet to hear the doctors' version.

The procedure to be followed in the investigation of a complaint against a general practitioner is governed by regulations. The first stage is to clarify the issues as far as possible by correspondence. I understand that this stage has now been completed in the investigation of Mr. Brown's complaint. The next stage is for the committee concerned to prepare a report on the complaint, and for this it may need the help of a hearing, for submission to the executive council for its decision.

Any party who considers himself aggrieved by the decision of the council has the right to appeal to me, and it is because of this that it would be wrong for me to venture an opinion tonight on what my hon. Friend has said about the general practitioner aspect of this case.

I ought to comment that what the executive council can investigate is whether the practitioner is in breach of the terms of service which form part of his contract with the council. It cannot deal with other matters. In particular, provided that the committee is satisfied that a doctor has exercised the care and skill to be expected of a professional man, it has no power to question his clinical judgment and there are certainly no powers to require a doctor to provide one form of treatment rather than or in addition to another.

Other aspects of the conduct of his practice also lie outside the terms of service and if a patient loses confidence in the advice given by a doctor or objects to his manner or for other reasons ceases to find the doctor satisfactory, his proper course is to seek the advice of another doctor.

I cannot, of course, comment on the general observations about the Health Service alleged by my hon. Friend to have been made by the general practitioners, save to say that if they were made in those terms I profoundly disagree 1831 with and deplore them. Mutual confidence is the basis of the relationship between the patient and the doctor. The Health Service has always provided therefore that a patient has a free choice of doctor and that a doctor is free to accept or to refuse a patient who applies to him for acceptance on his list. Similarly, a patient is free to change his doctor at any time without giving reasons and a general practitioner is free to ask the executive council to remove any patient or patients from his list.

My hon. Friend has mentioned that their family doctor asked the executive council to remove from his list the names of Mr. Brown and of his family. As I have explained, the doctor had a right to do so and this is not a matter which can form part of the investigation by the executive council. I understand that Mr. Brown afterwards sought acceptance from other doctors and asked the clerk of the executive council for the names and addresses of other doctors practising within a reasonable distance of his home. I am pleased to know that Mr. Brown and his family were accepted by another doctor on 25th November.

I will now turn to the hospital side of the matter. Two criticisms have been made: first, that it was detrimental to the child's health to have to wait until spring next year for a tonsils operation; second, that it is wrong that such a wait could be avoided by paying for the operation to be done privately.

I will give the facts as I have them, and I think my hon. Friend must agree with the conclusions to be drawn from them—that they indicate little cause for complaint, at any rate of the hospital.

In the Wolverhampton group of hospitals ear, nose and throat operations for children are done both at the Wolverhampton Royal Hospital and at New Cross Hospital. Alison Brown is on the list of a consultant ear, nose and throat surgeon, Mr. Clark, and the waiting time on his list for the operation of tonsils and adenoids is six months. There are two other consultants who do these operations, the waiting time for one of whom is considerably shorter.

Alison was referred by her family doctor and the consultant saw her on 27th June. He entered her on his list for removal of tonsils and adenoids, 1832 having observed significant inflammation in the ears. He made a note, however, that in his opinion the case was in no way urgent. He told the parents that it was likely to be the spring before the child was sent for, at the same time reassuring them that, as the child was so young, this would in no way be disadvantageous. The child's parents also understood that if the condition deteriorated the position on the waiting list would be reviewed. In fact, if a patient's condition deteriorates to the point where urgent action is called for, the patient does not have to wait at all.

On 29th September, the family doctor, at the request of the parents, wrote to the consultant asking that Alison be seen again. His reason for this—as he made clear in his letter—was not to ask for the operation to be expedited, but to raise the question whether her troubles were due to chronic sinus infection rather than to tonsils. The child was accordingly seen on 10th October, not by the consultant but by his assistant. He found that her nose was perfectly clear and he also considered that there was no medical reason for altering the child's position on the waiting list for operation. The child's condition seemed to have improved, in fact, since he noted that there was no evidence of any inflammation in the ear, such as the consultant had seen in June. Later, therefore, when the consultant studied the case notes he concluded that, in the spring he ought first to see her as an out-patient to review her condition before calling the child for operation.

On 19th October the Rev. Brian Brown wrote a letter to the Wolverhampton Hospital Management Committee setting out the facts substantially as I have given them. However, he was under the impression that the family doctor considered that there was an urgent need for an operation. He went on to express dissatisfaction that this should be possible only by admission as a private patient and ended by asking … that an early date be fixed for the operation". The group secretary acknowledged the letter on 23rd October and wrote on 1st November with a full explanation of the position—the salient facts being that neither the family doctor who had referred the child nor the hospital doctors who had examined her on the two 1833 occasions considered her condition to necessitate operation at an early date; in fact, there was less certainty after the second consultation on 10th October that an operation would turn out to be necessary at all.

How, then, did it come about that the Rev. Brian Brown had the impression, when he wrote to the hospital management committee on 19th October, that the family doctor thought the child needed an early operation? One cannot, of course, be certain, but I note that by that time no letter had been sent from the hospital to the family doctor reporting the outcome of the examination on 10th October. This was an unfortunate omission which was made good on 25th October when the consultant wrote a full report to the family doctor.

Naturally, the Rev. Brian Brown and Mrs. Brown were anxious during this time, but I should have thought that, thereafter, their minds ought to have been set at rest—and certainly after receipt of the group secretary's letter of 1st November.

I turn briefly to the allegation that the operation would have been undertaken immediately if the parents had been willing to pay £80 for private treatment. In the first place—and simply to put the record straight and this is not very important—I am told that £50, not £80, would have been the total outlay, inclu- 1834 sive of the hospital charges for a tonsil operation by the consultant who has seen this child.

But the point is that only if the operation had been considered by a consultant to be necessary on medical grounds, would it have been undertaken at all. The consultant had come to no firm conclusion that an operation would turn out to be necessary; and it is for this reason that he has arranged to see the child again as an out-patient in the spring on 5th March, 1968, to review her medical condition.

I regret that I have felt precluded tonight from discussing the matters raised by my hon. Friend in relation to the general practitioner as freely as I would wish to do, but he can rest assured that Mr. Brown's complaint will be thoroughly examined and what he says considered with great care. When the investigation under the service committee regulations has been completed, I shall let him know the final decision which has been reached on the complaint. Until then, I hope he will forgive my not commenting further on the matter than I have tonight. I also hope that he feels, as I do, that he was entirely right to have ventilated this case tonight.