§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Berry.]
2.41 pm§ Mr. Les Huckfield (Nuneaton)The Government Whip who moved the Adjournment of the House, the hon. Member for Southgate (Mr. Berry), and myself have been up all night on the Transport Bill in Committee. I must confess that I am not looking quite as bright-eyed and bushy-tailed as the Under-Secretary of State, who, I hope, will give me a favourable reply.
I am grateful for the opportunity of raising the subject of the dental treatment that I think should have been given to my constituent, Mrs. Vince. I do so in no spirit of vindictiveness or in any kind of personal, accusative way. I merely raise my constituent's case, and I am grateful for the opportunity of doing so on behalf of many of my constituents and others who have procedurally, as far as they are concerned, proceeded correctly only to come up against something of a brick wall.
I wish to praise particularly the advice and help given by the secretary of the North Warwickshire community health council, Mr. Len Murray, whom I have always found to be helpful in these matters, as I know has Mrs. Vince. Though my constituent has taken her complaint through the procedural channels open to her, with the advice of the community health council, she has, unfortunately, not got very far. Having followed most of the procedures open to her, she seem to have been given what I can only describe as the run-around. She seems to have encountered a fair amount of buck-passing.
As is natural in these cases, my constituent has perhaps shown some diffidence about complaining. She did not want to undermine the relationship with the practitioners who were looking after her, although from the beginning, since May 1977, she complained to the dentists who were treating her. She has complained on a number of occasions and through a number of channels but unfortunately the position still remains the same.
My constituent first came to see me in May 1981. She had first approached the community health council in May 1978. After my attempts to raise the matter with the Minister's predecessor and with the Health Service commissioner, I am raising it now as a matter of last resort. I shall quote the submission that Mrs. Vince made to the commissioner in March 1981:
I still wear the original dentures and the pain has also affected the other side of my face. I am very worried about what will happen when extractions become necessary, and what I will do if the pain becomes worse. I am very dissatisfied that I went from reasonable dental health to being in constant pain and no one seems able to put the error right, nor has any action been taken about my original complaint. Since the problem first arose, following my dentist's treatment in May 1977, I have been continually in pain, and yet I am expected to live with it.That was the submission that my constituent made to the commissioner in March 1981. I spoke to her on the telephone on Wednesday evening and she confirmed that that is still substantially the position.It was in May 1978 that my constituent first complained to the family practitioner committee. Unfortunately she did not hear the result of her complaint until December 1153 1978. The result was that the committee did not feel able to consider her complaint because it adjudged it to be out of time.
It was explained to my constituent that she had a right of appeal to the Secretary of State. I fully understand why she preferred not to pursue that right of appeal, as she was being sent to see the consultant at the Birmingham dental hospital for the first time. I am sure that the Minister will understand that, having just been sent to the Birmingham dental hospital and hoping that the treatment would mean an improvement, my constituent thought that that was not the most appropriate time to appeal to the Secretary of State because she did not want to prejudice her treatment at the Birmingham dental hospital.
Before that my constituent's dentist had referred her to the consultant at the Coventry and Warwickshire hospital. She was so worried that she had lost 1 stone in weight. So concerned was the secretary at the community health council in Nuneaton that a telephone call was made to the consultant's secretary at the Coventry and Warwickshire hospital. When my constituent was sent for treatment at the Birmingham dental hospital sufficient concern had already been expressed on her behalf.
My constituent then spent about two and a half years from December 1978 being treated at the Birmingham dental hospital. She came to see me only in May 1981 after she had raised the matter with the Health Service commissioner. She finished her treatment at the Birmingham dental hospital, but not because she wanted to finish it. She did not refuse treatment there, but she and some of the people at the Birmingham dental hospital felt that little more progress could be made since, as she has said, most of the treatment seemed to consist of her dentures being filed down about every three months.
My constituent approached me first on 2 May 1981. She showed me the reply that she had received from the Health Service commissioner on 24 April. He said that he could not intervene in her complaint to the family practitioner committee about her original treatment from her original dentist because that was not within his remit. He could not intervene in a complaint about the Coventry and Warwickshire hospital because at that time she had not complained specifically about that hospital. He could not intervene in anything appertaining to treatment at the Birmingham dental hospital because that matter involved a clinical judgment. Therefore, the reply that she received from the Health Service commissioner was not helpful. That is why she came to see me.
I took up the matter with the Minister's predecessor, now the Under-Secretary of State for the Environment, the hon. Member for Ealing, Acton (Sir G. Young). On 30 June, after a long explanation of the procedures, he said that he was not prepared to treat my letter to him as a late appeal to the Secretary of State because he felt that an investigation of the original dental treatment would have been oppressive of the dentist concerned. I was concerned—and still am—about the whole matter being oppressive of my constituent.
On 18 July 1981 I wrote again to the Minister's predecessor. I corrected some of the factual errors in his letter. I explained that my constituent had not resisted any treatment that she was offered from the Coventry and Warwickshire hospital. At one time she had been sitting in the dentist's chair at that hospital awaiting extractions. 1154 My constituent did not resist treatment at the Birmingham dental hospital. She was told there that not much more could be done. Certain travelling distances were also involved.
Personally I can speak only with high regard for the Birmingham dental hospital, having come across other constituency cases that were handled there. However, my constituent has suffered from procedural difficulties in being referred to that hospital. Advice was given to my constituent in a letter on 9 September to me from the Minister's predecessor. He said again that he thought that investigating the original complaint would have been oppressive of the original dentist. He advised my constituent to consult again the superintendent at the Birmingham dental hospital.
My constituent followed the Minister's predecessor's advice. She came to see me on 5 November last year and told me that the superintendent at the Birmingham dental hospital, whom she had been advised to see by the Minister's predecessor, had been surprised to see her and told her that she could not be treated there as dental ethics dictated that she had to be referred there by her dental practitioner. Although the dentist she was then seeing was in practice—and, I understand, in partnership—with her original dentist, he was adjudged by the dental superintendent and by the then Minister to be "another dentist". As my constituent certainly understood that he was in partnership with her original dentist, it is difficult to understand the previous Minster's view of the dental ethics of the matter.
At the beginning of this year, the Minister's predecessor again suggested that my constituent's current dentist should refer her to the Birmingham dental hospital. On 20 February, my constituent said that, having been all the way round the procedural rigmarole, she felt that she was back where she had started. I wrote to the Minister's predecessor on 20 February as follows:
Indeed, she is led to wonder whether as a result of all this treatment and mistakes, it might be better to have all her teeth extracted, though I think you will agree that this would hardly be a satisfactory outcome".I am glad to say that the Under-Secretary of State agreed with me. Having assumed his current post, he wrote to me on 7 April. explaining again that as my constituent had changed her dentist the ethics of the profession necessitated that she be referred again to the Birmingham dental hospital. I do not know whether that is still the case. I hope that the Minister will clarify it today.In brief, that seems still to be the position of my constituent. Regrettably, she is still in great pain, especially with the onset of the cold weather. She is visiting her own dentist in the constituency for regular check-ups, but he has explained that he cannot do much for her. He is in some doubt, however, about referring her again to the Birmingham dental hospital and there is, of course, some doubt as to whether that hospital could do much for her, although that may be the procedure that the Minister wishes to suggest.
On 17 June, I again referred the whole matter to the Health Service ombudsman. Unfortunately, he replied that he could not do anything. In desperation, I cast around the research division of the Library and other informative sources in August and they suggested that the last resort might be to contact the Patients Association. That association is an admirable body, but it is mainly concerned with patients in hospital. As a result of further 1155 consultation, including discussion with my constituent, I decided as a final resort to seek an Adjournment debate in the House, which I have been trying to do since the House resumed after the Summer Recess.
To sum up, I believe that my constituent has followed the procedure to the best of her ability. I have certainly tried to assist her in that over the past two years. The Minister may say that she should have gone to the Nuneaton community health council earlier, but a certain diffidence on her part is understandable as her dentist was referring her to the Coventry and Warwick hospital and then to the Birmingham dental hospital. Although my constituent might, strictly speaking, have been very slightly out of time, that is entirely understandable because she was being referred for further treatment and did not wish to prejudice her chances of obtaining it.
I still believe that it would have been within the capability and constitutional rights of my constituent to have her case adjudicated by the Secretary of State as a late appeal. I still hope that he or the Under-Secretary of State will find some way to re-examine the case.
I do not approach the case in any spirit of personal vindictiveness. I have not mentioned the dentist's name, the name of the consultant at the Coventry and Warwickshire hospital, or the name of the consultant at the Birmingham dental hospital. I have mentioned only the name of my constituent. I still feel that she has done her best. She knows and I know that the National Health Service can do better than this.
I can speak only with volumes of praise on behalf of many constituents and testify to the great satisfaction they have gained from the National Health Service. I hope that the Minister will show my constituent a way forward out of the maze. She is, I am afraid, in the same position as she was in when she came to see me almost two years ago. I want to be able to offer her a way forward. I hope that the Minister will be able to offer me and my constituent a way forward this afternoon.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)The hon. Member for Nuneaton (Mr. Huckfield) has been both sitting and rising for 14½ hours, but there was nothing lethargic about his presentation of his constituent's case. I know that that view will be echoed by my hon. Friend the Member for Southgate (Mr. Berry), with his usual silent eloquence.
I am glad to have the opportunity to set out the facts and to give an idea which may be of some help to Mrs. Vince in future. As the hon. Gentleman will know, he and I corresponded, and that correspondence terminated eight months ago. Mrs. Vince's original complaint related to a course of dental treatment which ended in September 1977. Essentially, her complaint is that she suffered considerable pain following the treatment she received and that she was dissatisfied with the treatment. When I looked at the papers, I was very sorry to learn of the difficulties and distress suffered by that lady, and I offer my sincere regret that events turned out for her as they did.
The complaint first came to light when it was lodged with the local family practitioner committee in May 1978, about nine months after the completion of her course of treatment. Unfortunately, as the hon. Gentleman has said, the complaint was received outside the relevant time limit for making complaints, although complaints received 1156 outside the time limit can still be considered by the committee if it feels that the delay in submitting the complaint is due to a reasonable cause.
On 28 November 1978, the dental service committee of the family practitioner committee considered the reasons put forward by Mrs. Vince for the delay in submitting her complaint. It decided that the delay was not due to a reasonable cause and that therefore it should not seek the consent of the dentist concerned, or of the Secretary of State, to an investigation. The decision was notified to Mrs. Vince by letter on 20 December, and she was advised of her right under the regulations to appeal to the Secretary of State within 14 days of the receipt of that decision. She did not exercise that right of appeal. The hon. Gentleman has told us why she did not exercise it. Instead, she wrote to the FPC complaining of the delay in arranging for the dental service committee to consider the matter and about the delay in notifying her of its decision. However, it is clear from Mrs. Vince's letter of 3 January 1979 to the FPC that she fully understood that the only way she could take her complaint forward was by exercising her right of appeal to the Secretary of State.
It appears that Mrs. Vince took no further action until 2 March 1981—two years after the last event—when she wrote to the Health Service commissioner complaining not only about the original treatment she had received from her general dental practitioner but about the dental treatment she had received subsequently at the Coventry and Warwickshire hospital and the Birmingham dental hospital. However, the Health Service commissioner was not empowered to consider the complaint about the treatment provided by the general dental practitioner, and he declined to exercise his powers to investigate the complaints about the hospital staff because of the practical difficulties of investigating actions which had taken place so long ago, and because Mrs. Vince had not pursued her complaints against the hospital staff through the appropriate channels—which at that time were the relevant area health authorities.
On 2 May 1981 the hon. Member for Nuneaton wrote to the then Secretary of State expressing his anxiety about the case and requesting an in-depth examination. That letter was the Department's first involvement in this whole affair.
On receipt of the hon. Member's letter the Department made detailed inquiries of the local family practitioner committee and of the two area health authorities involved. The inquiries revealed the position I have just described and confirmed that the only way in which Mrs. Vince's complaint against the general dental practitioner could be taken any further would be by means of a late appeal.
The question that then had to be determined was whether the Secretary of State should admit a late appeal for consideration some two and a half years after the decision of the service committee that the delay in submitting the appeal to it was not due to a reasonable cause. If I may remind the House, the original treatment which was the subject of the complaint ended in September 1977—almost four years earlier.
In deciding whether to accept a late appeal to the Secretary of State against the dental service committee's decision, my hon. Friend, the then Under-Secretary of State, considered the point made by Mrs. Vince in her letter that, as she was receiving treatment from a 1157 consultant at the time and did not want to prejudice her chances of receiving the correct treatment, she did not appeal against the decision of the service committee.
My hon. Friend the Under-Secretary of State did not accept that Mrs. Vince's treatment, which by then was being undertaken in a hospital and by a consultant, could reasonably be held to be at risk of being prejudiced had she pursued an appeal. My hon. Friend also had to take account of the position of the general dental practitioner in this matter: he concluded that it would be oppressive on him if an investigation were to take place at such a late stage into events which had taken place almost four years earlier.
My hon. Friend decided to recommend that he should not accept the letter from the hon. Member for Nuneaton, of 2 May 1981 as a late appeal on behalf of Mrs. Vince to the Secretary of State against the decision of the dental service committee. The then Secretary of State accepted that recommendation and the decision not to allow a late appeal was communicated to the hon. Member on 30 June 1981.
Mrs. Vince also complained in her letter to the health service commissioner about the treatment she had received from dental consultants at the Coventry and Warwickshire hospital and the Birmingham dental hospital. The burden of these complaints was that Mrs. Vince was unhappy about the way she was treated by the consultants concerned and that the treatment she received failed to alleviate the pain.
Mrs. Vince was referred by her general dental practitioner to a consultant oral and dental surgeon at the Coventry and Warwickshire hospital, and she saw him in December 1977—about three months after her original course of treatment had ended. After examination, the consultant concluded that the pain was caused by a condition normally treated by a bite-raising splint and such a splint was fitted. However, Mrs. Vince did not feel able to wear it and told the consultant who then made her some new dentures with a raised bite. Unfortunately, Mrs. Vince could not wear the dentures as they caused her discomfort and her condition made it extremely difficult to get them to fit properly.
The consultant then discussed with Mrs. Vince the possibility of extracting one or two teeth to make a denture which would fit better. Mrs. Vince would not, however, agree to this and when next she visited the hospital she took her husband with her who apparently told the consultant that he was dissatisfied with the treatment given to his wife. The consultant then concluded that his patient no longer had sufficient confidence in his treatment, that no further benefit would be gained by his continuing to treat her and that the best course would be to arrange an urgent appointment with another consultant.
Mrs. Vince was referred to the Birmingham dental hospital. The consultant concerned suggested that Mrs. Vince's dental problems be left whilst her family doctor obtained an ear, nose and throat opinion. Later, in May 1980, Mrs. Vince again attended the consultant's clinic when treatment was offered in the form of an appliance—a bite plate—designed to minimise the muscle tension that she was experiencing.
However, Mrs. Vince was unwilling at the time to have such an appliance. Later, in November 1980, Mrs. Vince wrote to the hospital saying: 1158
After giving the matter serious consideration and in view of the continued pain I am suffering, I feel now that I should have accepted the treatment offered to me by Dr. … "—the consultant concerned—and asking for an appointment to have the treatment carried out. However, the consultant felt unwilling to see Mrs. Vince again in view of his earlier difficulties with her, and referred her to the dental superintendent at the hospital.The dental superintendent examined Mrs. Vince on 3 December 1980 and concluded that she needed an appliance—a bite plate—accompanied by a course of medicine for the muscle pain. He wrote immediately to her family doctor recommending the course of medicine. However, it appears that Mrs. Vince experienced considerable difficulty and discomfort in wearing the bite plate and complained of nausea. Eventually, in April 1981, the dental superintendent advised Mrs. Vince that for the time being she should stop trying to wear the bite plate and should return to see him when her nausea had abated and when she was ready to persevere with the treatment.
As he said, the above information was communicated to the hon. Gentleman on 30 June 1981. In July 1981 the hon. Gentleman wrote and asked that the possibility of accepting a late appeal against the dental service committee's decision be reconsidered. In September 1981 my hon. Friend replied that, having looked again very carefully at the circumstances of the case, it would be unreasonable if the general dental practitioner were to be called on to answer the allegations against him so very long after the events occurred.
The hon. Gentleman wrote saying that his constituent had visited the Birmingham dental hospital and saw the dental superintendent. Apparently he was surprised to see her and said that he could do nothing for her. However, as I explained to the hon. Gentleman in my letter of 18 January 1982, Mrs. Vince had attended the hospital of her own accord and while she was obtaining treatment from a general dental practitioner. For ethical reasons, as I explained, the policy of the hospital is not to treat patients who are already under the care of a general practitioner unless they are referred.
The hon. Gentleman would like to know whether there is a way forward. Mrs. Vince has sought the help of several dentists in the NHS without having received relief. I understand that she is at present receiving NHS services from a general dental practitioner. If she feels that she is receiving satisfactory treatment, I believe she should continue in his care and persevere with whatever treatment he provides. I am sure that if he feels that specialist advice is needed, he will discuss it with Mrs. Vince and make a referral to a dental hospital. In that case I can tell the hon. Gentleman that the dental superintendent at the Birmingham dental hospital has already said that he would be willing to treat Mrs. Vince if a proper referral is made. I should also emphasise that Mrs. Vince herself can ask her general dental practitioner for a referral to a hospital consultant. It rests with his clinical judgment whether he makes such a referral, but, given the history of this case, I feel the general dental practitioner would not resent such a request if Mrs. Vince was to discuss the matter with him frankly. What she should not do is try to obtain treatment from one dentist without the knowledge and consent of the other. That would be both unfair to the dentists and possibly harmful to her health. 1159 This is an unfortunate case in which all the available safeguards under the Act were not used. Mrs. Vince wrote to the Health Service commissioner and bypassed the normal channel that allows local administrations to investigate the matter first. For that reason, and because of the clinical nature of much of her complaint, the commissioner was unable to consider her case.
I hope that the hon. Gentleman will feel that my suggestion is the only practicable way to help his unfortunate constituent. But I would not like it to remain 1160 on the record that the complaint system should be blamed for Mrs. Vince's dissatisfaction. Had she used the system in the way that Parliament intended, the case could have been looked at differently and a different result might have occurred several years ago. As it is, I can only hope that future treatment will relieve her unpleasant and horrible experience.
§ Question put and agreed to.
§ Adjourned accordingly at eight minutes past Three o'clock.