§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Patnick.]7.12 pm
§ Sir Antony Buck (Colchester, North)
I thank my right hon. Friend the Leader of the House for the fact that we are having this debate. I hope that it will become a regular feature of each Parliament. We are debating the work of the Parliamentary Commissioner for Administration. It is appropriate, therefore, that Parliament should scrutinise fairly regularly both his work and that of the Health Service Commissioners. Moreover, while he remains within our jurisdiction, we should also scrutinise fairly regularly the work of the Parliamentary Commissioner for Administration for Northern Ireland. All these matters are relevant to the debate.
We shall be considering in the debate what has come to be referred to as the work of the ombudsman. There is no difficulty about that person being referred to as the ombudsman. At one stage it was suggested by someone, who had better be nameless, that we should not be sexist—that we should refer to the "ombudsperson". I did not take kindly to that idea. The person who was in situ as ombudsman at that time was Lady Serota, a lady for whom I have the greatest admiration. I telephoned her and we talked about this. I suggested to her that the title should perhaps be ombudsperson. Her reaction was not couched in parliamentary language. She told me, in effect, "Don't be silly, Tony", but she used more abrupt terms than that. Therefore, we are entitled to continue to refer to the "ombudsman".
This is an interesting example of Britain taking over another country's democratic institution and adapting it for our own purposes so that we can provide a more efficient service for those whom we have the privilege to represent. The roots of the ombudsman go right back to Scandinavia. The original ombudsman was the people's man who spoke up at the court of the Vasa kings. He had a pretty tough and rugged role to play. People such as Charles XII and Gustavus Adolphus were very tough people indeed. The ombudsman had a perilous life in those early times.
The first constitutionalised ombudsman under the Swedish system was Mannerheim—a Finn and a relation of the great Marshal Mannerheim who so courageously led his nation against the assaults of the Russians. He was a great man.
The work of the ombudsman is relevant, as is the role of the Select Committee, of which I have the privilege to be Chairman. I was grateful, some while ago now when there was a change of Government, that, although a strong case could have been made that the post which I hold should be held by an Opposition Member, there was agreement on both sides that I should continue in office. I am very grateful for that because, as I think hon. Members who serve on the Committee will agree, the work that we do is conducted on a completely non-party political basis. Witnesses would have difficulty in deciding which of us were Tories, socialists, Liberal Democrats, or members of any other party.
The ombudsman system is an interesting example of our adopting the democratic institution of another 369 country and adapting it for our own ends in order o make our system more effective and more able to react to the genuine needs of our constituents.
It is important to ensure that democracy remains relatively efficient. If it does not do so, the electors are likely to turn, as a matter of expediency, to the extreme right or the extreme left. It was because democracy became so hopelessly incompetent that it failed in the cradle of democracy—Greece. There the Greek Government, under Mr. Canalopoulos—a man of great academic distinction—did not thrive. In political terms, he did not know his way round. I had the opportunity of meeting him on one occasion and found him to be a charming man. We are glad that democracy has once again been restored to that country, it having failed because the democratic system became so incompetent. Our system is effective. Democracy is a crazy system until one considers the alternatives, but it is important for us to ensure that our democratic system remains relatively efficient and reactive to those whom we have the privilege of representing.
It was with that in mind that the ombudsman system was introduced to this country. Among those who claim credit for it are Justice and the Society for Individual Freedom, organisations with different political orientations. The Government published a White Paper, Cmnd. 2767, which was followed by the introduction of the legislation which became the Parliamentary Commissioner Act 1967. That was a long time ago. I had the privilege of serving on the Standing Committee which considered the Bill.
Fears were expressed about the creation of an ombudsman. It was suggested by members of my party and of the Labour party that it might derogate from the role of the Member of Parliament. That has not happened. It was emphasised from the beginning that what was being provided was an additional bolt in the armoury of the Member of Parliament to help him the better to look after the legitimate interests of his constituents.
Since the establishment of the office of ombudsman in 1967, I have served on the Select Committee, save for the period when I was a Minister. The office of ombudsman came into being on 1 April 1967. There was comment about the fact that that was April fools' day but there was no significance in that. We are debating the subject on I May, Red Army day; again I do not think that there is any significance in the date, but there has been comment about it on the fringes of the press.
The first person to take up the office of ombudsman was Sir Edmund Compton. All who have been concerned with the affairs of the parliamentary commissioner agree that he set a very high standard which has been fully maintained by his successors. They have all been people of high calibre and great competence. The present ombudsman, Mr. Reid, carries on the high tradition and standards of his predecessors.
It was recommended by our Committee that the ombudsman should not always be an ex-civil servant. The Government of the day over-reacted and said that the next one would not be a civil servant. In the main the ombudsman has been an ex-civil servant. That does not matter, but occasionally to have someone who is not an ex-civil servant ensures that justice is not only done but is seen to be done. In fact, the former civil servants who have held the position and those who work in the office have been the harshest critics of their own profession.
370 The ombudsman system has been a success. The distinguishing feature of our system is the MP filter. A report 10 years after the establishment of the office emphasised that access to the ombudsman is a bolt in the armoury of a Member of Parliament. An interesting statistic which emerged from that investigation was that no fewer than 10,000 cases a year are taken up by Members of Parliament with Government Departments and agencies. No doubt the number is even greater now.
When a former Israeli ombudsman, Mr. Nebenzal, the doyen of ombudsmen, was giving evidence before us, he said that according to our system every hon. Member is an ombudsman. That is right. It is important that we continue so to be regarded. The parliamentary involvement distinguishes our system from those in other countries. Some academics have questioned the MP filter, but we should emphasise that our ombudsman is a parliamentary commissioner. It is right that he should adjudicate on abuses about which our constituents complain from time to time.
For the benefit of those outside the House who may not be as well versed as my colleagues, perhaps I should say how the system works. Like other hon. Members, I have regular surgeries in my constituency. A typical case will be that of a pensioner who thinks that he is not getting as much pension as his chum down the road. He goes along to the local pensions office where a clerk—no doubt a very nice person, but who may be having a difficult morning—does not explain the matter properly. The pensioner goes away and says, "I will go and see old Buck." He comes to my advice bureau, but probably I will not know the answer. I am like the original matches man. Like Lord Randolph Churchill, every time I see a decimal point I think of those damned dots.
If I cannot solve the problem, I take it up with the local office where it is solved in 90 per cent. of the cases. If I can understand the explanation, so will my constituent. From time to time, although rarely, the local office has made a mess of it and I am not satisfied with the result. In those cases I refer the matter to the ombudsman who goes through the books and checks every detail. He may ask why it took three weeks for an office to reply to a simple inquiry, why a person was wrongly categorised, and so forth. When he has sorted out the problem, the matter is referred back to the Member of Parliament.
The ombudsman has two aims: first, to ensure that procedures are tightened up so that there is a minimum chance of repetition; and, secondly, to ensure that there is redress for the complainant where that is appropriate. Therefore, the ombudsman has had a considerable sharpening-up effect on the whole Whitehall process and on the health service.
Over the years some of my colleagues have suggested that it is a bit much to drag down to London the boss of a regional health authority, the chief medical officer and so on. I do not agree. I think that it is salutary for the heads of Government Departments or for the holders of principal offices in the health service to have to answer to the Select Committee for things that have gone wrong. It is right that they should be subjected to the robust questioning of the hon. Member for Ashfield (Mr. Haynes) and of the rest of us on the Select Committee.
On the whole, it has been a success story. The parliamentary role distinguishes our system from others throughout the world. There are ombudsmen in all parts of the Commonwealth. One could say that it has been a 371 growth industry in Commonwealth countries. There is an ombudsman in every state in Australia—they also have federal and military ombudsmen. In Canada there are ombudsmen in every province. An ombudsman in Alberta obviously felt that ombudsmen's rule was okay, which in my view was a little over the top as Members of Parliament are jealous of their position as champions of the people.
I believe that we should retain the original system whereby the parliamentary commissioner enables Members of Parliament to provide a better service to those we have the privilege of representing. The parliamentary role distinguishes our ombudsmen from those in other parts of the world.
The work load of the parliamentary commissioner and the Health Service Commissioner has increased steadily but not dramatically. It is cyclic. Immediately after an election the work load increases because we have all been campaigning on doorsteps and have had even more contact with our constituents than usual. Although the work reaches a peak soon after an election, it has grown steadily over the years.
We have to consider for how long one man or woman is able to be both the parliamentary commissioner and the Health Service Commissioner. At present our hardworking commissioner scrutinises every file that reaches his office. That is important as it enables him to remain in close touch with what is happening in his office. There are advantages in having both offices under the same roof from the point of view of staffing and the expertise that crosses the divide between the two roles, but I am doubtful whether the ombudsman will retain that schizophrenic role as both parliamentary commissioner and Health Service Commissioner. Mr. Reid who does such a splendid job and has such a good staff may well be the last ombudsman to hold both positions. I am grateful to my hon. Friend the Under-Secretary of State for Health for attending the debate. It is entirely appropriate that he should be here and I should be grateful for his comments on that.
In the past there have been difficulties concerning clinical judgment. That is a difficult matter. However, from time to time, distinguished medical practitioners have pushed their luck as to what is clinical judgment. Hon. Members may recall a case involving a lady in her nineties. She was transferred from one hospital to another at midnight or even later on a frosty night and, not surprisingly, she caught a cold and died. The medical practitioners had the nerve to suggest that it was a matter of clinical judgment whether it was appropriate for a lady of great antiquity to be transferred from one hospital to another at the dead of night when, had they but known it, there was a room available for her in the first hospital.
Clinical judgment does not come under our wing, but what is clinical judgment can be fairly broadly interpreted. Any medical man who tried to suggest that a case such as the one I have just adumbrated was a matter of clinical judgment would get short shrift from the present Health Service Commissioner. I would be grateful to hear from my hon. Friend the Minister about the complaints procedure in the health service.
The Select Committee recommended that matters on the fringe of clinical judgment should be dealt with by the commissioner assisted by two assessors in the same way as the Admiralty division uses assessors. If a case involved 372 the possibility of maladministration in obstetrics or gynaecology, the commissioner would sit with an adviser from the Royal College of Obstetricians and Gynaecologists. A second opinion procedure for dealing with complaints in the health service has been introduced and I should be glad to hear from my hon. Friend, if not now then in writing, whether it is still regarded as working unsatisfactorily. I still take the view that it would be appropriate for matters involving some degree of clinical judgment but which are on the fringe should be dealt with by the commissioner, assisted by proper advisers from the appropriate medical discipline.
The Northern Ireland Parliamentary Commissioner for Administration also comes within our purview. I should like to pay tribute to the recently retired Northern Ireland commissioner, Dr. Maurice Hayes, who did a most excellent job in circumstances of greater difficulty than those on what is usually described as the mainland. He did a superb job. The Select Committee thought it appropriate not to be pompous and continually drag him over here, so we visited Northern Ireland on several occasions. It was great fun for us to have meetings at Stormont, and we are grateful for the lavish hospitality provided by both the ombudsman and my right hon. Friend the Secretary of State for Northern Ireland. I am glad to see the hon. Member for Ashfield nodding in agreement. I commend the work of Dr. Hayes and wish Mrs. McIvor, who has taken over from him, the best of good fortune. Dr. Hayes will be a difficult act to follow, but those of us who have met Mrs. McIvor have little doubt of her competence and ability to be a worthy successor to Dr. Hayes.
Publicity greatly concerns the commissioners here and in Northern Ireland. It is important that the work of the commissioners should be better known. The Central Office of Information has issued a series of pamphlets and there is also a video on the workings of the committee of the ombudsman and of the Select Committee of which I am Chairman. The video on the Select Committee of which I am Chairman makes the Chairman look exactly like Captain Mainwaring. The video is used in technical and educational institutes. A distinguished lady named Mrs. Whitehouse lives in my constituency, so I have to be sensitive about what I say about videos. It is a completely wholesome video and is a good example of the way in which we want to get the work of the ombudsman better known. The present parliamentary commissioner and the commissioner in Northern Ireland are anxious that their work be better known than it is. Those of us on the Select Committee agree with that. Opposition Members are nodding in agreement, so we have all-party agreement. Most of our work is not carried out on a party-political basis. I am glad of that; long may it continue.
The ombudsman story is one of limited success. Over the years we have brought into being an institution which enables us as Members of Parliament to give our constituents a better service. That is what it is all about. It is important that we provide a proper service to our constituents and that we make sure that our democratic system remains moderately effective. If we do not do so, people will be in danger of turning to the expediencies of the extreme left or of the extreme right. While there are robust hon. Members such as the hon. Member for Ashfield and some of my hon. Friends, that is a remote possibility. One of the barriers against anything unpleasant happening to our democracy is the existence of a healthy ombudsman system. I have considered only the 373 parliamentary commissioner and the Health Service Commissioner, but the same applies to the local government service, which does not come under the direct purview of the Select Committee.
I am grateful to my hon. Friend the Minister and the Opposition for allowing the debate to take place and to hon. Members for listening to me with such care and attention.
§ Ms. Harriet Harman (Peckham)
I thank the hon. Member for Colchester, North (Sir A. Buck) for the way that he has introduced the debate. He has made clear the broad range of work with which the ombudsman deals, and I join the hon. and learned Gentleman in his thanks to Mr. Reid and his staff for the work that they have done.
Since becoming a Member of Parliament, I have referred a number of cases to the ombudsman, particularly on social security matters. The cases have always been investigated thoroughly and to a high standard, and the conclusions have been fair and lucid. It is notable not only that the investigations satisfy my concerns that everything should be considered in the greatest detail, but that, by and large, the reports are not full of gobbledegook and I am able to send them to my constituents confident in the knowledge that they will be able to understand why the determination has been reached.
I welcome the opportunity for this debate, and congratulate the Select Committee on its proposal that the ombudsman's work should be debated regularly. I know that other hon. Members wish to speak because of the wide range of points involved, but I shall focus on the work of the ombudsman in the health service.
It is surpising that there are so few complaints about the health sevice to the ombudsman. In the annual report for 1989–90, the ombudsman recorded 794 complaints about the health service. In that year, in England alone, the health service dealt with over 7,477,000 in-patients. There are a number of reasons for the low level of complaints. First, by and large, people support the health service and there is not a culture of complaining about it. Too often, people tend to think that, although it did not go right for them and that there was something wrong, they will not complain because the NHS is a wonderful institution. It is a pity that there is not a culture of complaining because the organisation could learn and grow by examining mistakes and looking at where things go wrong.
The second reason for the low level of complaint is that people do not know who to complain to. They do not know whether they should complain to the same person whether the case involves their general practitioner, the receptionist, the hospital or the nurse. People do not know where to find that information.
Thirdly, people do not complain because they do not know what they can complain about. The hon. and learned Member for Colchester, North touched upon the difficult distinctions between clerical and administrative errors—something that has gone wrong because of a shortage of resources and just one of those things. Such distinctions make investigations in the health service more difficult than they are in some other Departments.
A significant number of complaints mentioned in the annual report showed that underfunding played a part in the problem. Paragraph 34 entitled "Charges for treatment" states: 374Sometimes patients write to me alleging that they have had to pay for private care out of anxiety after a long time on a NHS waiting list.If everyone who suffered pain and anxiety from being on a waiting list complained to the ombudsman, he would have an extremely full postbag.
Another source of complaint related to resources derives from discharge arrangements. In probably one of the understatements of the year, paragraph 18 states:Pressure on beds means that hospital doctors do not usually want to keep patients in hospital longer than is really necessary".The truth is that sometimes there is so much pressure on beds that the administrative arrangements which should be in place to deal with the care of patients on discharge go by the board. The shortage of resources does not make that acceptable, but it gives us an insight into why it happens.
§ Mr. Michael Lord (Suffolk, Central)
The hon. Lady opened her remarks by saying she was surprised how few complaints there were, given the millions of cases treated by the national health service. That is good news. She also heard my hon. and learned Friend the Member for Colchester, North (Sir A. Buck) say that this is not normally a party political matter. I hope that the hon. Lady will not turn this rare opportunity to debate these matters into a party political debate.
§ Ms. Harman
I am not seeking to do that. Since a Minister from the Department of Health is present, I am seeking to raise some issues that were mentioned in the Health Service Commissioner's annual report. I am not sure whether the hon. Member for Suffolk, Central (Mr. Lord) has read the annual report—
§ Ms. Harman
Then he will see that the issues that I have mentioned are raised by the ombudsman, and it is fair to include them in the debate.
Paragraph 11 deals with complaints arising from the amount of time that staff can devote to observing and supervising individual patients. Once again, that is a function not just of training, experience and organisation but of health service resources.
I predict that, next year, the work of the health service ombudsman will take a new turn, because there will be a new challenge with the internal market, which will lead to new areas of complaint. No doubt the ombudsman will receive complaints from people that they cannot go to the hospital of their choice, because that is not where the contract has been placed, or that there is no contract to purchase the sort of care they need, such as infertility treatment, sterilisation or treatment for varicose veins.
It will be interesting to see how the ombudsman responds to complaints that might, for the first time, arise from treatment undertaken overseas. Some of the extra contractual referrals in the internal market procedure will be to hospitals overseas. No doubt the Committee will want to look at how the ombudsman deals with complaints arising from treatment in French hospitals.
§ Ms. Harman
I shall not give way again, because I want to press on with my remarks about the annual report.
The ombudsman's work is essential not only to address individual grievances but to be part of setting standards 375 and of supervision within the NHS. We need a three-way approach to ensure good quality care in the NHS. First, we should have a national inspectorate setting standards and monitoring the outcome—an NHS quality commission. Secondly, we need local accountability. District health authorities should be rooted in the interests of the local community, making sure that the health services in their area serve the local community.
Thirdly—this is where the ombudsman's work comes in—there must be rights for individual patients. That is why we have published a charter for patients. We require patients to know whom to complain to, what they can complain about and how long it will be before they can expect to obtain a response. Also, an essential part of ensuring good standards and adequate redress will be a no-fault compensation scheme.
I want to take the opportunity of the debate to raise cases in which something terrible has gone wrong but people cannot obtain redress through the ombudsman or the courts. The cases have been raised by hon. Members from all political parties. They are of patients other than haemophiliacs who have been given blood transfusions and, tragically, thereby have been infected with HIV. Some are very ill; some have died; but none has received a penny in compensation.
Davey, a 26-year-old chef from Scotland, was given a transfusion after a bone marrow operation to treat leukaemia. The operation was a success, but he was infected with HIV. He said that he felt that he had been given another death sentence: he had been given another illness for which there was no treatment or cure. A young man had an operation after a road accident and had an infected blood transfusion that gave him HIV. A London woman had a transfusion after giving birth to her baby. The baby was fine, but she was infected with HIV and has since died from AIDS. A seven-year-old girl from the north-west had a hole-in-the-heart operation. She is now a teenager, but her blood transfusion infected her with HIV.
My hon. Friend the Member for Birmingham, Ladywood (Ms. Short) raised the case of a woman in her constituency, a lone parent, who was infected with HIV by a blood transfusion, but who is now dead. No compensation or redress can help her now, but she struggled with poverty as well as AIDS, and her four children were left with nothing.
When we have debated the issue, Health Ministers have denied compensation but have offered sympathy. We can all break our hearts about cases of men, women and children whose lives are overshadowed by the threat of AIDS, but they want not sympathy but justice. If there were any justice, they would get compensation. The Government were right to offer compensation to the haemophiliacs, but wrong to deny it to those who were not haemophiliacs but were infected with contaminated blood in exactly the same way. I hope that the Minister will announce that he will review those cases, but he must not delay because time is running out.
We must judge an organisation by what happens when things go wrong, as well as when things are going well. The annual report of the Health Service Commissioner says:The hallmark of a service which cares for its consumers is an open complaints system which provides courteous, critical and thorough investigation of grievances.376 That is important, but it must also be a comprehensive system. A system is not working properly if it provides redress for some people but not for others. Our system of redress will not be satisfactory or comprehensive until it includes a no-fault compensation scheme.
§ Sir Anthony Durant (Reading, West)
I am grateful for the opportunity to speak in the debate, because for a short time I was a member of the Select Committee on the Parliamentary Commissioner for Administration. Later, I joined the Whips Office, but I have now returned to the Select Committee. I am therefore a retread on the Committee.
On returning to the Select Committee, I was disappointed to find that some of the issues that I had raised before had not gone away. I wish to mention three, the first of which is literature. Some of the leaflets that the Government produce on people's rights or how to claim are written in gobbledegook. They have improved—they have some colour and some pictures and are looking better—but I used to lecture civil servants on the relationship between the Member of Parliament and the civil service. I used to take a leaflet from the nearest post office and read it to the civil servants. At the last lecture, I said, "This benefit leaflet is for an 80-year-old lady. Do you understand it, because I don't?"
If the literature is not right, it is not surprising that many people set off in the wrong direction in making their claim for benefit, and continue to go wrong. The Select Committee found that such problems occurred because people were given the wrong information. Improvements have been made, but this is one of my causes and I shall return to it again and again with the Select Committee until leaflets are produced that people can understand.
My second disappointment is that we are still arguing about the vexed question of clinical judgment, about which I remember the Select Committee arguing with the British Medical Association. The BMA said that, if a surgeon operates on someone and finds something unexpected, he must make a decision on the spot. People understand that things sometimes go wrong, but the BMA said that we must not allow clinical judgment to be examined. The Committee said that, if the BMA wanted to keep out of the courts and avoid moving to the American system—medical litigation is widespread in America—it should let the ombudsman investigate such cases. We felt that that would be a safety valve.
The Select Committee accepted that a surgeon had human life in his hands, but I pointed out that so does an aircraft pilot. He probably has 300 people behind him. If he makes a mistake, 300 people may be killed. A pilot may have to appear before inquiries, so why should not doctors? I am disappointed that we have progressed little on that vexed question.
My third disappointment is the delay between a Member of Parliament making an application to the parliamentary commissioner and a decision being made. The parliamentary commissioner is working hard to reduce the delay, but it is still far too long. Employees of the health service and of district health authorities were cross-examined by the Select Committee, but were able to dodge by saying, "It wasn't us; it was the previous people, who have left." That is not good enough. They read prepared briefs but cannot answer our questions and say, 377 "The people have left." Insufficient improvement has been made in reducing delays. I know that the ombudsman takes this seriously and is working hard to speed up the process. The average Member of Parliament does not want to put a case to an ombudsman, because it takes so long.
I shall continue to push for improvements in those three matters. On the whole, the system works well. We have been well served by parliamentary commissioners. They have always been of a high standard, have treated the Select Committee with respect and have used it to back up the problems they face. That is what is special about this country. In countries where the ombudsman has no Select Committee, he is on his own. The local government ombudsman does not have a Committee, although he might have a committee of councillors. However, they often have vested interests, so they are not as impartial as a Select Committee.
I welcome the debate as an excellent opportunity for us to discuss the work of the parliamentary commissioner. I wish him well in the future and I am sure that the Select Committee will back him and that we shall have satisfaction. I shall continue with my three issues—literature, clinical judgment and delay.
§ Mr. Mike Watson (Glasgow, Central)
Like my colleagues who serve on the Select Committee, I welcome the opportunity to participate in the debate. I have been a member of the Select Committee for a little more than a year and I have found it interesting and enjoyable. I am still on a learning curve with regard to the full range of activities of the Parliamentary Commissioners for Administration and for the Health Service. However, my experience of the past year has shown me that it is especially valuable to have a Select Committee that can call to account senior managment in health authorities in England and Wales and in health boards in Scotland. I particularly welcome the fact that Scotland comes within the jurisdiction of the commissioner on health service issues. It might be possible to widen that role in terms of his general responsibility, although that remains to be examined.
Of the complaints investigated by the commissioner last year, about 700 were new complaints, which must be initiated by Members of Parliament and, last year, 371 of my colleagues took the opportunity to initiate cases. That is commendable, although it represents only just over half the hon. Members who had the opportunity to do so. There may be a possibility of increasing that number in the future. Recently, the commissioner circulated to all Members an explanatory leaflet drawing attention to his role and to what can be achieved. He did so for the benefit of those who were unaware of his role. We can hope for an increase in the number of cases dealt with in the years to come.
The hon. and learned Member for Colchester, North (Sir A. Buck)—who was about to leave the Chamber, but who has had a rethink—said in his opening remarks that each Member of Parliament is himself or herself an ombudsman. It is important to underline that role because it is missing in other countries that have an ombudsman. I understand that last year the number of cases dealt with by the Parliamentary Commissioner for Administration was just over 1,000. If we compare that with other countries, the number is rather small.
378 In November last year members of the Select Committee had the opportunity to visit Denmark and Sweden to consider at close quarters the work of the ombudsman in those countries. It was interesting to learn that in 1989 in Denmark, for example, the ombudsman dealt with just over 2,000 cases from a population of 5 million. In Sweden, he dealt with 3,000 cases from a population of 8 million. Those figures seem out of kilter with the figures for the United Kingdom, at least for England and Wales, where there is a population of about 50 million.
It must be understood that here Members of Parliament filter many cases and take them up directly with the authorities so that there is no need to take them further. There is no such system in Denmark or Sweden, partly as a result of their proportional representation system, which means that in many cases the individual does not know who his or her Member of Parliament is. There are no individual constituency Members of Parliament, so that would make such a system difficult. I am an advocate of proportional representation and it is important that when—I use that word advisedly—we move to a more proportional system we retain in some form the link between the Member of Parliament and his or her constituency. There is clear value in that.
§ Mr. William Ross (Londonderry, East)
As the hon. Member for Glasgow, Central (Mr. Watson) is speaking from a theoretical rather than a practical knowledge of proportional representation, of which some of us have more experience, I advise him to stick to his strictly first-past-the-post system, which is far superior.
§ Mr. Watson
With respect, I reject the advice of the hon. Member for Londonderry, East (Mr. Ross). There are many examples of proportional representation producing a much more effective system of government than we have in this country.
§ Mr. Watson
I do not want to get into that debate. I am not advocating a single transferable vote. I regard that system as no fairer than the current system.
I shall return to our visit to Denmark and Sweden. There is an interesting aspect to the role of the ombudsman in both countries. He has the right to initiate cases as well as to receive them from various bodies. In practice, the numbers that the ombudsman initiated were fairly small—about 70 in Denmark and about 160 in Sweden. There is an open door which might be of value to our ombudsman if he had the opportunity to take up cases that came to his attention in some way other than through a Member of Parliament. I am not advocating the idea that an individual should be able to take a case to the ombudsman—I believe that the filter of the Member of Parliament should remain.
Although we are not dealing in detail with the role of the ombudsman for Northern Ireland, it is interesting to read his report. I have met Dr. Maurice Hayes a few times and I know that he chooses his words carefully. In his report he said that he "invited sponsorship" in some cases. That is constructive because in Northern Ireland Members of Parliament must also channel cases to him. However, there have been a number of cases in which he has contacted a Member of Parliament to say that a case might 379 be worthy of examination. There might be a similar role for the Parliamentary Commissioner for Administration in England and Wales in the future. It is an idea to which the Select Committee might wish to give some thought.
Another area—perhaps a controversial one—in which the ombudsman might develop his activity involves his ability to investigate the police. In Denmark and Sweden, that role falls within the ombudsman's remit. We have a Police Complaints Authority, but there is some disquiet about the way in which police forces tend to investigate each other when there are complaints. That is unsatisfactory. Perhaps there is a role for the commissioner to consider complaints made by members of the public about the behaviour of the police. I shall give a couple of examples that arose in our discussions with our Swedish and Danish counterparts.
Perhaps the most noteworthy case that was referred to the Swedish ombudsman in recent years involved the behaviour of the Swedish police following the tragic murder of Prime Minister Olof Palme in 1986. The way that the investigation was carried out was considered in detail by the commissioner and his recommendations were not kind to the police. There was also an interesting case which may open a door that would be difficult to close in this country. There were a number of complaints made in Stockholm following a Sweden-England football match when the Swedish police cordoned off areas of the city and denied access even to residents of those areas. One can imagine the fuss about that. It was within the remit of the ombudsman to investigate and he did so amid considerable publicity, which is no bad thing.
There was an even more remarkable case in Denmark. Largely as the result of an investigation of the way in which immigrants were treated while they were held in police custody pending consideration of their status, a Government Minister was forced to resign because of evidence that emerged against him. They may not be typical cases, but they show that there is a role for an independent investigator of cases referred to him relating to police activity. The Select Committee should consider discussing with the ombudsman and with other interested parties whether we should broaden his remit in such a way.
I shall also comment on the ombudsman's role as the Health Service Commissioner. In the year to March 1991, about 990 cases were received by the commissioner, which is a record. Only about 15 per cent. of them were found to be worthy of investigation, but it is pleasing to note, particularly in light of the remarks of my hon. Friend the Member for Peckham (Ms. Harman), that the numbers are increasing. That is partly due to the fact that the Government widely circulated leaflets about the national health service reforms over the past two years. Those leaflets appear to have brought to people's attention the fact that they have the right to complain through the commissioner.
The main issue to come to my attention in the Select Committee was the discharge arrangements that apply in hospitals. We heard about some pretty horrific cases and we subjected the health service managers whom we asked to appear before us to some fairly strong questioning and we did not by any means receive satisfactory answers to all those questions. It was part of the Select Committee's remit to demand that the health authorities and health 380 boards that we questioned should report back to us on how they had improved their procedures as a result of our suggestions. It is also important to note that more than 50 per cent. of the cases investigated were upheld.
The health service ombudsman can investigate the NHS trusts that are now subject to some controversy. I hope that my colleagues on the Conservative Benches will not think that I am trying to make political capital out of this. In the near future the trusts at Guy's hospital or at Bradford royal infirmary might be investigated in terms of maladministration. At Guy's there is certainly prima facie evidence that there may be maladministration in terms of the general manager's contract and conditions of service and with regard to the substantial loss of 600 or 700 jobs. It is at least comforting to know that the commissioner has a role in investigating the trusts and that the trusts remain accountable, albeit in a more remote sense than some of us would like.
I have directed my remarks to the way in which the commissioner's role may develop. The commissioner has a role to play in Scotland. The local health councils in Scotland, which are equivalent to community health councils in England and Wales, have recently been reorganised. Those local health councils have been the subject of controversy because they have been significantly decreased in number and in terms of the number of people who serve on them. I am not alone in believing that their effectiveness will be reduced. Their ability to criticise health boards will certainly be reduced.
The Scottish Home and Health Department believes that the local health councils should not come within the remit of the Health Service Commissioner. It is said that they are not involved in the provision of health services. That is true, but they provide advice and assistance to patients and they are now closely linked to the health boards in Scotland. The health boards appoint the local health councils. Previously they were representative of local communities, but that is no longer the case. They will be much less likely to criticise the health boards because they are appointed by them.
The Scottish Home and Health Department and the Government cannot have it both ways. They have severely reduced the independence of the local health councils, which are now virtually adjuncts of the Scottish health boards. Therefore, they should be subject to the scrutiny of the Health Service Commissioner. They must submit annual work programmes and reports. They are accountable to the health boards and, in the same way as the health boards themselves are accountable to the commissioner, the local health councils should also be accountable.
The average man or woman in the street does not know enough about the role of the ombudsman. I must be honest: when I became a Member of this place I had only the vaguest notion of the ombudsman's role and how, if I had to, I could contact him to make a complaint. Debates like this help to raise the ombudsman's profile, although not as an individual—I am sure that Mr. Reid would not want that. However, his role must become more widely known. The more publicity we can get for that the better. Since Mr. Reid took over his post, he has publicised his role among Members of Parliament and that publicity must now be widened. It is incumbent on all Members of Parliament to use the ombudsman with regard to constituents' complaints and we must ensure that our constituents are aware of the services that are available. I 381 welcome my role on the Select Committee and I look forward to continuing and developing that role in the years to come.
§ Mr. Michael Lord (Suffolk, Central)
Like the hon. Member for Glasgow, Central (Mr. Watson), I am a relatively new member of the Select Committee on the Parliamentary Commissioner for Administration. I welcome this debate and the opportunity to consider our Committee's work. It is far from being the most famous Select Committee, although the ombudsman's role is becoming more widely recognised. However, the Committee does an enormous amount of important and useful work and it is gratifying that this debate recognises that fact.
I commend to the House the work of the Parliamentary Commissioner, Mr. Reid, and his team. His job demands a mixture of qualities—a combination of administrative speed and legal precision that is not always easy to achieve. It includes concern for people combined with scrupulous fairness and the ability to produce accurate, concise and, as the hon. Member for Peckham (Ms. Harman) said, readable conclusions. That is absolutely crucial For the people who have made the complaints. From my experience on the Committee so far, all those things are achieved and it is no mean feat to pull together all those qualities.
The relationship between Members of Parliament and their constituents is unique. In a sense, we are all ombudsmen. We deal with a vast majority of problems in our constituencies and we involve the ombudsman only when we believe that we cannot take the matter any further. That gives hon. Members an enormous degree of job satisfaction and in the main it serves our constituents well.
The ombudsman's role has now become accepted as part of our democratic framework. The ombudsman played a crucial role in issues of national importance such as the Barlow Clowes affair. However, at the same time, the ombudsman regularly deals with hundreds of smaller problems which, although smaller in a national context, are no less important to the people concerned.
In other countries the ombudsman plays a much larger role in the nation's affairs and some would argue that he should do so here. The Select Committee recently visited Scandinavia and saw at first hand the work of the ombudsmen there; they have a much more comprehensive brief and a freer hand in many ways. The hon. Member for Glasgow, Central mentioned the sheer number of cases dealt with in Scandinavia as compared with the number of cases in this country.
Ombudsmen in Scandinavia are allowed to investigate more areas than our commissioners and they can initiate inquiries. That is something that we should consider here. In one of the countries that we visited, the ombudsman's office had a team whose job it was to scrutinise the papers daily to see whether there were issues that should be investigated. I am not sure whether that is the right approach, but perhaps we might at least consider giving our ombudsman a slightly freer hand.
I refer briefly to the question of people versus systems. The enormous value of the concept of the ombudsman is that it highlights the role and responsibility of the individual in the complex administrative frameworks that 382 we have created to run our country's life. At the end of the day, people make systems work. Systems may help or they may hinder, depending on how well they are designed, but people run them and are responsible for them. Too much reliance on systems and managerial frameworks rather than on personal responsibility can be disastrous.
The other factor that bedevils any system, and which has become one of my pet hates over the years, is jargon. It seems that some committees can hold entire conversations using only initials or titles that are meaningless to anyone outside that close professional circle. May I make a plea for plain speaking and simple language that everyone can understand?
I suppose that "The Parliamentary Commissioner for Administration" is rather a long title; perhaps, in comparison with the simple word ombudsman, it could even be termed jargon. Much dearer to my heart, however, is the word matron. Let me deal briefly with the matron, who comes within the ambit of the Health Service Commissioner. In days gone by, the title and role of matrons was clearly understood. With the 1960s and 1970s came changes in structures, job specifications and titles which I believe have not proved helpful in many cases. The position of matrons has become obscured. It is time to bring it back—not just back, but right into the foreground of nursing.
Some time ago, I tabled an early-day motion—which attracted more than 100 signatures—supporting that idea. Hon. Members may know that my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) has also been campaigning to reintroduce the matron. Since then, I have talked to colleagues and constituents, all of whom seem to agree with me.
I am sure that the Chairman of our Select Committee will bear me out when I say that, time after time, we ask witnesses whether, had one person been solely responsible for nursing care, the problem would have arisen; and, more often than not, the answer is no. The role, responsibility and title of matron were clearly understood. She was the person who could talk to consultants and doctors; she understood the needs of patients; and, as a trained nurse herself, she could manage her nurses with efficiency and understanding. Every nursing unit should have a matron in charge, and "matron" must be her title.
Let me quote from one of the various notes that I have received from the Department of Health. Advising hospitals about how to run their affairs, it states:The professional head of nursing for the whole of the Unit may be called a Director of Nursing Services or a Matron".I suggest to my hon. Friend the Minister that "may" is not good enough, and that these titles are confusing. My hon. Friend smiles and I understand why: in many ways the topic is amusing. None the less, it goes to the heart of many of the problems that we encounter in the Select Committee, notably the understanding of roles and responsibilities on the part of those who are responsible and of those whom they are serving. I repeat my plea: let us have our matron back.
I have been in correspondence with various nursing organisations and I received a letter from the Sheffield and North Trent college of nursing and midwifery, which agrees entirely with what I am saying. The principal writes:It may be of interest to note that in Sheffield the designation Matron has been retained by the Northern General Hospital, one of the first wave of NHS Trusts and has been introduced into the Doncaster Royal Infirmary 383 Montagu Hospital Trust. I would accept that the term has fallen into misuse over the years, but I do agree that it is readily understood by the public.Again, let me plead with my hon. Friend the Minister. Let us not have the word "may"; let us press all our hospitals, and all organisations where nursing takes place, to reintroduce the matron and give her that title.
Having, I think, made that point as strongly as I can, I turn briefly to the entirely different question of court administration. Some time ago, on behalf of one of my constituents, I had cause to write to the Lord Chancellor about a case that had been brought to my attention. A man was contesting a divorce case. The solicitors on both sides and the client all agreed that a certain length of time would need to be taken by the court. Unfortunately, the court disagreed, saying that it would not need that much time, and a shorter period was allocated. In the event, the case needed the amount of time that the two solicitors had said that it would need and the two clients suffered both inconvenience and considerable financial loss as a result.
When I sought redress for my constituent, I encountered all sorts of problems from the Lord Chancellor's Department. I had great difficulty establishing exactly whose responsibility it was to decide such matters. Following a considerable amount of correspondence I have now heard from the Lord Chancellor's Department, which tells me that the allocation of time for cases is seen as a judicial decision and cannot be challenged in any way. What can be challenged is the administration of those decisions—in other words, the way in which witnesses are dealt with, messengers are sent and paperwork is handled.
In some ways, that is a step forward, but I am still unhappy that the allocation of time for cases cannot be challenged, even when so much inconvenience is involved. Moreover—although the Lord Chancellor's Department has made changes that took effect from 1 January this year—our ombudsman, who is allowed to look into the administrative side of court listings, still cannot examine the position of tribunal staff and their workings or investigate the Scottish courts.
Let me return to my opening remarks about the power and influence of our ombudsman and the question of widening his remit. Conservative Members would, I think, argue that the best way in which to run organisations that are not profit-oriented—such as the health service and the civil service—is to use the private enterprise system, or what we might sometimes describe as enlightened self-interest. Opposition Members may say that such organisations can be run efficiently by means of a system of brotherly or sisterly concern; but perhaps the best safeguard for the interests of the general public is a healthy respect for the powers and sphere of influence of a well-established and well-known ombudsman.
Like other hon. Members who have spoken, I much enjoy participating in the work of the Committee, which I consider very valuable. In my experience, all our witnesses—whoever they may be—are robustly questioned; and not just questioned, but sent away to bring back answers and, if need be, to effect changes in their sphere of responsibility. As I said earlier, I am delighted that we are holding this debate, which has recognized the valuable work that the commissioner does.
§ Mr. William Ross (Londonderry, East)
We have before us a great many papers, which are listed on the Order Paper. Each of the four reports would merit its own debate, rather than their being knocked together for consideration in a debate lasting less than half a day—and such debates happen all too rarely at that.
We also have before us reports prepared by the ombudsman in his various guises in different parts of the United Kingdom, and the responses to them; and Select Committee reports. Currently serving on the Select Committee are the hon. and learned Member for Colchester, North (Sir A. Buck), the hon. Members for Blyth Valley (Mr. Campbell), for Southport (Mr. Fearn), for Ashfield (Mr. Haynes), for Ipswich (Mr. Irvine), for Rugby and Kenilworth (Mr. Pawsey), for Glasgow, Central (Mr. Watson), for Suffolk, Central (Mr. Lord) and for Reading, West (Sir A. Durant). The previous members, since the start of the current Parliament, have been the hon. Members for Leicestershire, North-West (Mr. Ashby), for Wansdyke (Mr. Aspinwall), for Stratford-on-Avon (Mr. Howarth) and for Richmond, Yorks (Mr. Hague).
All those people served as Members representing constituencies in Great Britain; not one was a Northern Ireland Member. They will understand—many are not simply political acquaintances, but personal friends of mine—that I am not criticising them when I say that they have been reared, and have lived both their parliamentary and their personal lives, in circumstances that are in many ways entirely different from ours, governed by entirely different administrative arrangements. Yet it is they who go to Northern Ireland to take evidence and to try to reach conclusions on what has been said.
No matter how worthy and hard-working Great Britain Members may be, I do not think that they really grasp the nuances of life in Northern Ireland, which means that, far too often, they do not ask the questions that we who represent the Province believe should be asked. We think that answers to those questions should be winkled out of the officials concerned, and even out of the ombudsman in his various guises, whether they like it or not. I would much have preferred to ask questions of an ombudsman who deals with affairs in Northern Ireland rather than to ask such questions of an ombudsman who also has to look after the affairs of the constituency of, for example, the hon. Member for Ashfield. I might not know very much about a mining community, but the hon. Gentleman would, and he would be better at asking such questions.
It is for that reason that I hope that the Government will look again at the question of establishing a Select Committee for Northern Ireland, which is vital and long overdue. In the absence of such a Committee, I hope that the Government will consider replacing Members from Great Britain—at least temporarily—with at least one Member from Northern Ireland whenever a Committee investigates matters relating to Northern Ireland. Frankly, the questions that need to be asked are not being asked, and we are not getting the answers we need. We will not do so without a Select Committee for Northern Ireland. At the very least, Members from Northern Ireland should serve on Committees that ask questions in or about the Province, or even of the Northern Ireland Office.
On page (iv) of the second report by the Select Committee for the Parliamentary Commissioner for 385 Administration for Northern Ireland, I particularly welcome the comment that the Committee intends to examine "in due course" the annual report of the ombudsman for Northern Ireland, which was published on 31 January this year. As it happens, the Committee was in Northern Ireland in January, looking at the previous reports. When the Committee examines the report which has been handed to us today, I hope that it will contain a Member from Northern Ireland who can ask the questions that need to be asked.
We read:more complaints were made about planning than any other matter",but we then read that the number of planning complaints was "remarkably few." This is the first point on which hon. Members from Great Britain got it wrong. Nobody in Northern Ireland complains about a planning application that is granted. Rows arise about the small percentage of applications that are refused and in those cases where the fellow goes ahead with the development anyway. Such people often drive not only a team of four through the application, but half a dozen teams of four, and gel. away with it.
The sooner that that nonsense is stopped and we make such people take down the buildings that they have erected, often at great expense, and try by blackmailing the Government to allow them to stay, the better. That transgression of the planning laws will not stop until the transgressors are dealt with harshly. Heaven help the first, but there will be no more transgressors after that, because one has to take action only once or twice for folk to get the idea.
We also read that Dr. Hayes is intent onresolving cases, where possible, without a formal investigation.I agree with that because, where there has been a slight misdemeanour. a quiet word will do more good than wielding the big stick. However, the commissioner in Northern Ireland sometimes seems to have been too willing to accept the assertions of officialdom instead of listening more carefully to the complainant.
In future, I hope that the complainant's word will be given considerably more weight and that, where there is a conflict of evidence or of understanding about what words actually mean, the person carrying out the investigation on behalf of the ombudsman's office will go back to check and, if necessary, will carry the matter forward into a formal investigation without any further ado. Officialdom sometimes gets away with things rather too easily.
I am also concerned about the long periods which sometimes elapse between start and end of an investigation. It is said that 11 months is now the average period for an investigation, but I can think of a few that have lasted rather longer and where I was still not all that happy about the conclusion. I hope that some effort will be made to deal with cases rather more speedily. Paragraph 9 refers to having "adequate legal advice". I hope that the ombudsman will try to get that, because the ombudsman's office in Northern Ireland needs good legal advice as soon as possible.
I am happy to note that the ombudsman will be able to spend rather more money in the future than has been the case in the past. Adequate resources are needed to carry out investigations into what are sometimes serious allegations.
386 I am concerned about the allegation in paragraph 15 that the ombudsman would like to be able to investigate a case that may be "just over the fence" from an investigation that he is carrying out. I am curious about the meaning of the phrase "just over the fence". I should have liked the ombudsman to set out his thinking rather more clearly and to know exactly what he was trying to say.
Was he saying that, if he is investigating a case and sees something associated with it but just beyond the scope of his current investigation, he cannot go into it unless there is a further complaint? If so, that would simply delay matters longer. I should like a clear explanation.
Paragraph 17 states:We recommended that the Government examine the possibility of establishing a separate Health Service Commissioner for Northern Ireland.We then read:Nevertheless, the Department of Health and Social Services pointed out to him that his powers were, in some ways, wider than those of the Health Service Commissioners".That may well be the case, but I suspect that the ombudsman's powers are very different from those of the Health Service Commissioners. I hope that the Select Committee will look into this again and adhere to its original recommendation that there should be a commissioner.
I could say a great deal more, but I hope that my hon. Friend the Member for Upper Bann (Mr. Trimble) will catch your eye later, Mr. Deputy Speaker, because I know that he has some complaints to make.
I should now like to draw the House's attention to the annual report for 1990. Two of the important cases to which it refers arose in my constituency and were brought to the commissioner's attention by me. Those two cases caused me some heartache. One relates to patent searches and to complaints about LEDU—the Local Enterprise Development Unit in Northern Ireland—and the ISD—the Industrial Science Laboratory in Northern Ireland. To some extent, the questions that were raised remain unanswered. I am exceedingly unhappy about these cases, and it is for that reason, as much as for any other, that I hope that, the next time round, an hon. Member from Northern Ireland will be present so that the right questions can be asked.
I am concerned about another case—No. PC 148/88, which relates to an individual who alleged that he had sustained an injustice as a result of maladministration by the Department of Agriculture in relation to the slaughter of cattle. The case led to considerable loss for my constituent. The account of it covers six pages of the report, from which one can see immediately that it was a fairly major, long-winded and detailed investigation. It ended with my constituent receiving a small amount of monetary compensation, but the amount fell far short of compensating him for the heartache and mental anguish that he has suffered since the allegation was made that he had administered illegal drugs to his cattle. In fact, he was one of the leading opponents in Northern Ireland of the administration of that drug. The fact that he was found not guilty of that practice in relation to his second group of cattle sent to the abattoir is some consolation to him, but not very much.
When one comes across cases such as the two that I have mentioned, one wonders where we should draw the line relating to the powers and responsibilities of the commissioner. We are now overdue in taking another 387 long, hard look at the powers of the commissioner and at his investigative authority. We should try to sort out once and for all a system that is more effective than the present system, without going so far into legalities that we become involved in endless legal wrangles. That is a difficult line to assess but we need to take another look at it.
§ Mr. William Cash (Stafford)
I was interested in the final point made by the hon. Member for Londonderry, East (Mr. Ross) about whether we should engage in ceaseless legal wrangling. I say that as a lawyer, and for this reason. When we are deciding whether people should have redress of grievance—fundamentally that is one of the most important aspects of the function of this House of Parliament—we should not be deprived of the opportunity to make complaints on behalf of our constituents simply because they fall on one side or other of a line that has been drawn as a matter of law. From reading the Committee's reports, it seems that the office of the ombudsman does a remarkably good job. However, even that office becomes a little precise in the way in which it adjudicates. I know that it does a good job and that it does its best. However, we should address ourselves to the intrinsic quality and efficacy of the case in question.
I have two cases in my constituency. One is that of a Mr. Gane. He has had what I regard as a thoroughly raw deal. He was court-martialled many years ago. He is a first-class constituent and a man for whom I have the greatest respect. He has persistently sought to have his case reviewed by the Ministry of Defence. I have had a series of replies from Ministers. There is a voluminous file of correspondence on the case. There are all sorts of reasons why Mr. Gane's case cannot be given the consideration that I feel that it deserves. At the bottom line, without going into all the details—they are all on file—Mr. Gane has had a raw deal. I should like to feel that this House and the officials who are responsible for examining cases such as his could give that bit of extra attention to it. I should like to feel that they would not simply go over the facts again and come up with much the same answer.
I look to the Minister and those who have influence with him to take yet another look at Mr. Gane's case. It is time that he obtained the discharge which he would like and which I would like on his behalf. One vote in a constituency will not make very much difference, but there are times when people come into one's surgery whom one knows have had a raw deal. I feel strongly that Mr. Gane deserves a little more justice.
The case of another of my constituents, Mr. Kent, is rather different. He is now a pensioner but was previously employed in east Africa. I have had a lot of correspondence with my hon. and learned Friend the Member for Colchester, North (Sir A. Buck) about the case. My constituent was employed before legislation was passed which would give him a larger pension than he receives now. The details of the case are well known to officials in the Foreign Office. Without going into all the details, let me say that Mr. Kent has not had a fair deal. There does not seem to be any reason why a pensioner who worked in colonial administration before certain Acts of Parliament were passed should not receive the justice which applies to civil servants now receiving pensions— 388 sometimes, dare I say it, inflated pensions. My constituent, who in his own time did exactly the same job as those who receive larger pensions, is living in reduced circumstances simply because a line was drawn
The case of Mr. Kent reminds me of the old Court of Requests. People would go to someone like Sir Thomas More and say, "I have had a raw deal. There has been inequity. Do you not think that I should be given extra consideration? The line of the law has been drawn, but I have a case and I want redress of grievance." One would go to either the Court of Requests or Parliament. One would probably obtain justice. It was perhaps a little rough, but none the less one obtained it.
At the bottom of all the reports, the voluminous correspondence that underpins them and the good work that the office does—I make no complaint about that—I sometimes wonder whether the reasonableness that lies at the heart of justice is overlooked because we look at the minutiae of the law. In my correspondence with my hon. and learned Friend the Member for Colchester, North, the Chairman of the Select Committee on the Parliamentary Commissioner for Administration, I have raised the case of Mr. Kent on several occasions. My hon. and learned Friend replied that, although he would have liked to help, unfortunately he could not because the law did not provide for him to do so. One then looks to the law and asks whether Parliament will pass a new Act. Parliament will not pass an Act to help Mr. Kent. I should like to think that it would, but it will not. So we should consider in the context of this annual report whether more discretion should be allowed in cases such as those I have mentioned. I have only two cases in my constituency which come to mind, but I suspect that there are many more in the United Kingdom where a little extra flexibility would help to produce the redress of grievance and justice that people deserve.
I have put the two cases from my constituency before the House. Officials in the relevant Departments know exactly what I am talking about. Each case deserves a debate in its own right. With regard to Mr. Kent, I was intrigued to see that under the heading "Foreign and Commonwealth Office" in appendix A the report says: "See under HO." I take that to mean the Home Office. I then looked at the appendix which deals with complaints. I have not the faintest idea whether the complaint that I have in mind appears in that convoluted appendix, but I do know that people such as my constituents deserve a little more attention than they have received.
I do not expect the Minister who is on duty this evening to deal in his reply with the cases that I have mentioned, but I do ask that those cases, which are well known to the relevant Departments, are properly investigated and that my constituents are given a fair deal.
§ Mr. Ronnie Fearn (Southport)
I have been a member of the Select Committee on the Parliamentary Commissioner for Administration for four years. I have also been a local councillor for 22 years. During those years I have written many times to the local ombudsman. I always regarded the parliamentary ombudsman as rather a mysterious person in a mysterious office. When I became a member of the Select Committee, I found that we had a hard-working, hard-hitting Committee and certainly one which was exciting at times. It is so exciting that the television 389 cameras should come in some time. Not only one aspect or item but a variety of events is often dealt with, especially when the health service is being considered. Broadcasters would find it interesting.
I do not want the cameras to come into the Committee because we crave for television. I want the public to see what really goes on in the ombudsman's office. The present Parliamentary Commissioner for Administration is excellent and previous commissioners were also excellent. They give us good answers, which everyone deserves to know about. At times, radio has picked up one or two items and the public have been grateful. The public are only just becoming aware of the work of the ombudsman and are beginning to use their Member of Parliament in the right way.
There is still confusion between the functions of the local ombudsman and those of the parliamentary ombudsman. Perhaps the problem can be cleared up in the future. The extent to which the services are being used is indicated by the figures. There are about 1,000 cases on the books. Of those, perhaps 500 will be rejected. The numbers vary. At a meeting of the Select Committee I asked what happened to cases that had been rejected. After all, the people concerned make sane and sensible complaints. The Parliamentary Commissioner said that complaints were not rejected out of hand, but were passed to others who could provide advice and help. The citizens advice bureaux take on board items that have been rejected by the parliamentary ombudsman. The Members of Parliament involved get the same sort of service through other organisations.
One third of all complaints concern social security. As other hon. Members have said, the main social security complaints arise from misleading forms and leaflets. In that respect, I think that the parliamentary commissioner is beginning to get the position rectified. Ordinary people are now much better able to understand the leaflets. Other matters about which large numbers of complaints are received concern the Inland Revenue, the environment, transport, trade and industry, and employment. I was very surprised to see in the latest report a reference to a complaint about the National Rivers Authority. As the NRA is a very new body, the complainant and the Member of Parliament were rather quick off the mark. Complaints are also received about defence and data protection. Indeed, the whole range of parliamentary business is covered.
Public awareness has been increased. At the request of the Select Committee, the commissioner has issued 150,000 leaflets, many of which are now to be found in libraries and in the premises of citizens advice bureaux and other organisations. They will help to remove some of the confusion and the veil of secrecy that people perceive to hang over the ombudsman's office. When we visited Canada, we found that the public there were aware of the system. It was not a joy trip by any means; we covered 11,000 miles in seven days. Indeed, at one time we lost the Chairman. He was talking to a group of people about the work of the ombudsman and missed the plane. However, he caught up at the next stop. The Canadian system is efficient. But, of course, so is ours. I missed the trip to Scandinavia—if one may call it a trip—but I understand that the same sort of efficiency is to be found there. Indeed, efficiency is to be found throughout the world. As ombudsmen meet internationally, albeit not on a formal 390 basis, we may see such systems develop throughout the world. It seems to me that there will soon be a Euro-ombudsman.
The Select Committee was aware of the efficiency of the office in respect of the Barlow Clowes case. Practically every Member of Parliament received letters about that affair. I received 27 complaints. The matter was resolved very satisfactorily. We are very grateful for the work that the commissioner's office did. Of the money that was lost, 90 per cent. has been paid back.
Health service complaints constitute one of the most interesting aspects of the commissioner's work. They cover a variety of items, including the procedures for the discharge of elderly people from hospital. The Committee heard from people about health authorities whose procedures were very wrong. In some instances, relatives brought complaints rather timidly but had their cases upheld. I am thinking, for instance, of situations in which people died within a few days of their discharge from hospital. Then there is the recording of falls or of untoward incidents. I recall the terrible case of a lady amputee being left to go to the toilet alone, falling off the toilet, and lying for quite some time before being found. That was one of many cases. Another matter that comes to our attention is the training of staff in the handling of bereavement. It is vital that hospital staff be given proper training. The matter has been highlighted by the office and by the Select Committee. Then there is the question of setting up local complaints procedures. We have community health councils and other bodies, but local complaints procedures need to be examined very closely.
One case that comes to mind concerns a mentally disturbed hospital patient whose money was used to buy seven pairs of trousers. We thought that that was amazing. An investigation revealed that the money had simply been used very carelessly. Clearly, the person concerned did not need seven pairs of trousers. One of the most important facts to have emerged during my four years on the Committee is that various hospitals hold £67.7 million of patients' money. The money is held in the patients' names, and relatives have the right to decide what should happen to it. Many of those patients are incapable of going out into the community, and the money should be—and is—used for their benefit. The Southport and Formby health authority does excellent work. A young man in Greaves Hall hospital was very keen on Elvis Presley—so keen, indeed, that it was his life. His money was used to send him to an Elvis convention in America, and he has never stopped thinking and talking about it. In my opinion, that was a good use of his money. The enormous sum of money that I have mentioned—£67.7 million—must be closely guarded. This is a matter that should come within the scope of the parliamentary commissioner.
There is still confusion about the titles of hospital staff—ward sisters, ward managers and matrons. Administrative posts, too, seem to vary from one place to another, even though the people concerned do the same jobs. Committee witnesses, as well as Committee members, seemed to be confused about the grading system. Perhaps pressure from the Committee and the commissioner will result in this problem being cleared up.
The loss of records is another serious problem that keeps cropping up. I believe that the system is being tightened, but there have been instances of junior doctors—they were and still are extremely overworked—taking home work. Once some records were found in a junior 391 doctor's car boot. Some such doctors have given up, and records have disappeared with them as they disappeared from the service. It is a great problem for hospitals, patients and their relatives to follow through those records. The parliamentary commissioner and the Select Committee now have their fingers on the pulse of that problem, and they will not let go.
I asked the commissioner whether prisoners had the right to use the ombudsman's office, and found out that they have as much right as anybody else. They do not use their right frequently, but there have been complaints from within the prison service that have been upheld. I was pleased to see that in the report for 1990.
All the items that I have described have come before us through the parliamentary commissioner and his excellent staff. We do our best in the Select Committee, and enjoy doing so. We have an excellent Chairman, too, but I would also like to thank the parliamentary commissioner and the workers in his office for all that they do. Until this debate their work was unsung.
§ 9 pm
§ Mr. Frank Haynes (Ashfield)
It is a great pleasure to talk about the office of the parliamentary commissioner. Like its Chairman, the hon. and learned Member for Colchester, North (Sir A. Buck), who is not in the Chamber, I have served on the Select Committee for some time. The trick is to know exactly what is going on.
It has been interesting over the years to observe the different parliamentary commissioners who have served the Select Committees and the House. Every one of them has been first class. They have all done a marvellous job. But one group has not yet been mentioned so I shall mention it now. The Select Committee could not manage without the Committee Clerks, who serve us in preparing reports and in providing information of all sorts. We have had different Clerks over the years, and they have all served us well.
Even if the general public do not know about the parliamentary commissioner, Government Departments do, and in no uncertain terms. Some of them have come in for a bit of rough treatment for the way in which they have served the community or individuals. Furthermore, people have been seconded from various Departments into the parliamentary commissioner's office. I wondered about that idea, and have questioned it from time to time, but at least it means that those who are seconded for a period and then return to their Departments can let those Departments know exactly where they stand with the parliamentary commissioner's office. The Departments are told that they must be on their toes and look over their shoulders because the parliamentary commissioner is watching them.
Another idea that worried me was that a Department such as the Treasury could have someone in the parliamentary commissioner's office. I thought, "Hello, hello. We have a spy in the camp." Someone who had been seconded could be tipping off his Department about what was going on. It works both ways. I have been a little worried about the secondment of people into the office, but in practice it works quite well. We have sometimes been to the parliamentary commissioner's office to talk to staff. That is how I found out about secondment—a 392 chappie was introduced to me as having come from the Treasury. I was a little worried, but I have overcome that problem now. The parliamentary commissioner has set my mind at rest.
As I said, the Clerks do a first-class job and the Committee could not work without them. The service that they provide for every member of the Committee helps us to know exactly what is going on.
I do not know for how long we banged on the door of the Administration to debate the issue of the parliamentary commissioner on the Floor of the House. At long last we are having that debate, which gives us an opportunity to publicise, through the cameras, the wonderful work of the parliamentary commissioner's department. As members of the Select Committee, we get to know all that department's business and the parliamentary commissioner feeds us well—there is no doubt about that.
Naturally, the parliamentary commissioner sometimes has to come to us and say, "I think you had better call this lot in and give them a going over". By God, that has been done many a time. Tory Members come into the Committee Room and get a rough ride. They should not be there, but come because they have stepped out of line and things have gone wrong.
I remember sitting in a dark corner of the Chamber when the Secretary of State for Trade and Industry was at the Dispatch Box at Question Time. My hon. Friend the Member for Southport (Mr. Fearn)—he is in another party, but we are all friends on the Committee—was present, and the questions to the Secretary of State were on Barlow Clowes. The Secretary of State wanted to know nothing about the matter, despite the fact that many people were taken for a ride. Two of my constituents were ex-miners who had taken redundancy settlements of £20,000 and £25,000. They had sunk every penny into Barlow Clowes and all their money went to Gibraltar. We may have problems here, but Gibraltar was even worse. The Secretary of State did not want to know, but the matter was referred to the parliamentary commissioner, which was the best move that has ever been made in this place. He sorted the job out and the Government had to change their minds. The Tory Administration and Secretary of State in office at that time—everyone knows who he is because he has just put his house on the market for £1 million—did not want to know but the parliamentary commissioner did his job and those people were paid. That clearly shows the importance of the office of the parliamentary commissioner, which does a first-class job. I must be a little careful because the matter is sub judice—the person responsible has yet to go to court and the inquiry is going on—so I shall say no more.
For Members with constituents involved in that business it was a nightmare, so it must have been a nightmare for the parliamentary commissioner and the wonderful staff who serve under him. We have been talking about the parliamentary commissioner, but we must not forget his deputies and his whole team who have done a first-class job. From time to time, we have been across to look at their department.
The hon. Member for Reading, West (Sir A. Durant) mentioned the courts. That issue bothered us. We realised that we had a problem because we were being denied the opportunity to ask the parliamentary commissioner to take action. So what did we do? We summoned the Lord 393 Chancellor to our Committee. At first he said, "I ain't coming"—he was an awkward beggar—but in the end he had to come.
I remember when the Lord Chancellor marched into the Committee Room. Before he came in, however, we had a little private discussion and the Chairman said to all of us, "Be careful what you say and what you ask. For God's sake don't upset him or we will not get anything." The Lord Chancellor came in with an army of officials. He sat down and spoke for 15 minutes and told us, straightforwardly, that we were not going to get what we were looking for. I then indicated to the Chairman that I wanted to say something. He did not like calling me because he knew that I was seething. I told the Lord Chancellor that I felt that I had been shot down by Dillinger—the House will remember Dillinger, that big American gangster.
When that Lord Chancellor was changed, the new one moved in the right direction. He allowed us to study the administration of the courts. Some bad things were going on and there had been some slip-ups as well as massive administrative delays. The parliamentary commissioner can now study all that, which is a step in the right direction.
I believe that the parliamentary commissioner needs to be given more teeth. I have always said so. He needs that extra power to take the right action because at present he only recommends—he does not make any decision. He should be able to make decisions, never mind recommendations.
One of the Health Ministers is here tonight. What about all the problems in the blooming health service? We are not getting what we should be having because the health service is not getting the proper resources—I shall prove that later. The Minister is pulling on his ear and making out that he is reading, but I hope that he is listening to all the problems that we have in the NHS.
My hon. Friend the Member for Southport mentioned a number of cases that the Committee and the Health Service Commissioner considered. The House should understand that that person wears two hats—he is the parliamentary commissioner and the Health Service Commissioner. He does a first-class job of both and he gets on with it. There is no doubt about that. My hon. Friend the Member for Southport referred to an elderly lady with one limb who sat on a commode and fell off the damn thing because no one was there to look after her. That was shocking.
The Committee has summoned various health authorities and has given them a real going over to put the wrongs right. Often they have put things right before they appear in the Committee because the people who made the mistakes have moved on. The new people have to deal with the problem and put it right. Sometimes, however, we get the people who made the mistakes. Then the Committee shows no mercy, it just gets stuck in and tells them quite clearly where they went wrong. We have also made it clear that some penalty should be imposed because of the serious mistakes that have been made from time to time.
§ Sir Antony Buck
The hon. Gentleman's impact on the Committee is considerable, as is his impact on the senior civil servants who come before us. The Committee values the wonderful work that he does with us. I should, however, correct one thing that he said. Lord Hailsham was keen to come before the Committee—it did not take 394 any dragging from the Woolsack to get him to the witness stand. In fact, Lord Hailsham volunteered to appear before the Committee. The Committee was literally after his staff, but, in fairness to Lord Hailsham, he insisted on coming to be subjected to strenuous cross-examination from the hon. Member and me, too.
§ Mr. Haynes
It took the Chairman of the Select Committee a bit of time to think about that. I mentioned it ages ago. I accept what he says. However, I am putting my point of view and how I felt about it at the time. The Lord Chancellor's comments blooming well upset me. I am not used to being talked to like that and I did not like it at all, so he had it coming to him and he got it. I had the final word, anyway. The result was that we did not get from him what we were looking for. We had to wait for the present Lord Chancellor, who is a real gentleman. We got what we were looking for from him, but we need to go even further as time goes on and I am sure that we will.
We have had the district or regional health authorities in on many occasions when there have been serious problems. I remember one occasion when a sister in a geriatric hospital was covering a number of wards throughout the night. Patients of that age need to be turned, but they were short of staff. We come back to resources again—to provide adequate staff to do the job properly. We should look into that. It amounts to maladministration if the right resources and number of bodies are not provided to give a proper service.
I remember well hearing about a geriatric lady who, having seen the consultant, was stuck in a wheelchair in the corridor all flipping day. She was incontinent and freezing cold and was not given a cup of tea or a bite to eat. Everybody walked past her in the corridor. The poor old dear was left there. That was one complaint that we heard about, but there are many similar complaints about the national health service. When those complaints are brought to our attention, it is our job to ask the parliamentary commissioner to look into them and do something about them. He should have more teeth. I hope that we shall soon be in a position to give him more teeth so that he can really get stuck into the job. I shall be right behind him.
§ Mr. Rhodri Morgan (Cardiff, West)
It is a great pleasure to follow my hon. Friend the Member for Ashfield (Mr. Haynes). He is one of the few Members who can communicate with his constituents from the Palace of Westminster without the medium of the telephone. It is also a great pleasure to be able to take part in the debate, although I am not a member for the Select Committee, for reasons that I shall explain.
I take particular comfort from the words used by the ombudsman when he refers to his health service functions. They are to be found in paragraph 57 of his annual report. No one else, I believe, has referred to them, so it is important to put them on the record. In paragraph 57 he says:By highlighting some of the problems which can arise, my purpose is to promote a better service for future patients who look to the NHS for health care.I think that we all agree with that. Tonight we are interested in whether the ombudsman has sufficient 395 resources and in whether his role is defined in the right way to permit him to carry out the mission that he has picked out.
All hon. Members who are here tonight do not, I believe, consider that the ombudsman has a wide enough role. He cannot look at NHS problems quickly enough to enable him to carry out his purpose, according to the words that I have just read. At the moment, he is a sort of grumbling appendix for the national health service. A patient, a Member of Parliament, a relative and, in some sad cases, the next of kin takes up a complaint about the administration of health care. Sometimes that complaint goes via the community health council. That is one of the advised ways of taking up a complaint. The community health council then takes up the complaint with the health authority. If the health authority rejects the complaint, or fails to answer, the Member of Parliament takes it up with the ombudsman—or the patient takes it up direct with the ombudsman. He then looks into the complaint and may make a recommendation. If the ombudsman thinks it is a really serious complaint, he brings it to the attention of the Committee chaired by the hon. and learned Member for Colchester, North (Sir A. Buck). If the Committee thinks that it is important, it will write it up in the annual report. A month later the House debates it. That whole process may take up to two years. During that period somewhere in the NHS someone has probably managed to get a cataract operation or even a hip replacement. It is a slow and tortuous process. It is shutting the stable door long after Shergar is in the next county or even in the next world.
We are reviewing the role of the ombudsman to find out what else he might need to do in future compared to the service—excellent though it is—that he has provided in the past. Can we speed up the process? If so, how can we do it? Should the ombudsman be able to adopt a fast-track approach in certain cases if he thinks that he should step in immediately rather than deal with the matter retrospectively? Should he have a challenge role whereby he can write to the health authority straight away? The ombudsman may comment not on the clinical aspects of treatment but on administrative aspects. He may suspect maladministration which he wants to investigate immediately. At the moment he cannot do that; all he can do is to take retrospective action.
The ombudsman has to steer a narrow channel. He may not look into clinical matters or resources and strategy. If a patient cannot get treatment in a hospital because it has closed, provided the closure was carried out properly, with authority from the Secretary of State for Health or from his territorial opposite number in Scotland, Wales or Northern Ireland, the ombudsman cannot challenge that. If the hospital has been closed properly, that is not maladministration.
If a patient cannot get treatment within the specified period and dies as a result, that is not maladministration either. That is a clinical matter which can be taken up by the person's next of kin who may seek compensation because the patient was neglected.
What is maladministration? I want to give an example of what I consider to be maladministration, which I have drawn to the attention of the ombudsman in Wales today.
396 It is an illustrative example of what I think that the ombudsman should be able to do by a fast-track, challenge method.
The children's ward in Rhydlafar orthopaedic hospital, Cardiff, the main orthopaedic hospital serving south Wales, is being closed. The procedure is being carried out properly. There is no challenge to that. The Minister's opposite number in Wales has authorised the closure and the reason for closure was explained last October. The authorisation was delayed because of the Gulf war. Permission has now been given by the Secretary of State and the ward is to be closed. The last admissions were yesterday and probably all the patients will be out by Friday. Is that maladministration?
When the in-patients were told that the hospital was to close, the consultant in whose care they were was not there. Let me explain the dates. The date on which the closure was announced to the patients still there was 11 April. The hospital administrator told the parents of the children in the ward that the last admissions would be on 30 April and that all the children were to be out by 3 May.
The consultant in whose care they are is on holiday for a fortnight and nine days of his holiday remain. He is a constituent of mine, Mr. John Hombal. As he was at home, the health authority tried to get hold of him that Friday but did not manage to do so. The hospital administrator had to ask the parents of the children who were continuing their in-patient treatment whether they would prefer their children to transfer to a children's ward at the Cardiff Royal infirmary or to an adult ward at the same hospital—the Prince of Wales orthopaedic hospital.
One of the patients is a nine-old child who would have to be transferred to a ward of women patients whose average age is 75. Another is a boy who had an accident and had to be readmitted to hospital as the pins in his legs had to be re-set. He would have to spend quite some time in hospital in a ward full of old men. The consultant has gone to Spain on holiday. He has every right to do that, but he is not due to return for another week. When he returns he will advise the patients to transfer to an adult ward in the same hospital and not to the children's ward at another hospital.
Is it maladministration to give parents the choice of whether their children should switch to another hospital in order to remain in a children's ward—it is sound paediatric practice that children should always be in hospital with other children—or to transfer to the adult ward in the same hospital for the sake of the continuity of nursing care when there is no doctor aroujd on whom they can rely for medical advice?
The parents told me that they felt completely at sea. They said, "How were we supposed to make such a choice when our doctor is not around to be consulted?". The children are not in the care of the hospital administrator; they are in the care of the consultant, Mr. Hombal, but the hospital administrator said to parents, "Here is your choice. Tell me by next week, if you possibly can"; and needs a decision before the consultant comes back.
It seemed to me, and the ombudsman has confirmed it prima facie, that that is a possible definition of maladministration. It certainly worries me. What worries me more is the fact that if the ombudsman were in a position to step in he might say that, had the consultant been around, he would have explained to the health authority that he recommended clinically that the children should not be transferred out of the hospital because he 397 wanted to continue their care in the same hospital even if the children's ward were closed and they had to transfer to an adult ward. Although it is not good practice that they should be in an adult ward, at least they will have the same nurses who know about the long-drawn-out process of leg lengthening.
When the consultant returned, he explained to me why he had recommended that the children should remain in the same hospital. He said, "Clinically, I would never advise that a child who is having leg lengthening gets one leg lengthened in one hospital and then transfers to another hospital to have the other leg lengthened." I cannot imagine anything worse than having one leg lengthened by three inches and the other by two inches as a result of changing from anaesthetists and nurses who were experienced in that procedure to those who were less experienced.
That is an illustration of what I would consider a good reason for the evolution of the role of the ombudsman into a challenge role whereby the ombudsman could say to the health authority, on a fast-track basis, "You had better stop what you are doing until we have had a chance to look at it, because it appears that you have broken the rules of medical ethics and procedure."
Consultants whom I have told about that case in which parents have to make a difficult choice without being able to consult a doctor tell me that it breaks all the rules of sound medical practice. It is not a matter that can be taken to the General Medical Council as a case of medical negligence because no doctor is involved. But that is precisely the point. No doctor is involved because the hospital administrator, through no fault of her own, was put in the impossible position of asking medical questions when the patients are not in her care but in the doctor's care, and the doctor happens to be away on holiday.
What on earth are we supposed to do? There is a role for the Member of Parliament and there is a role For the ombudsman, which I should like to think might not always be as retrospective as it is today. There is also the usual process of ringing up the chairman of the health authority and asking him what he is doing about the matter. I have done that, and it is quite clear that the chairman of the health authority was not even told by the unit general manager that the consultant was away on holiday so that the parents could not consult him before having to decide to which hospital their children should be transferred when the ward is closed halfway through their in-patient treatment. How are they supposed to operate when the chairman of that authority did not know that the decision was being pressed on to the parents while the consultant was away on a well-deserved holiday? In trying to steer a channel between being able to consider strategy and resource decisions, which are properly the province of the Minister; the execution of the decisions, which is properly the province of the health authority; and clinical decisions, which were not involved in this case because there was no doctor present, the ombudsman has a restricted and retrospective role.
If we are to move to a system similar to that of the Danes or the Swedes, the ombudsman must be able to challenge decisions halfway through their execution. He could bring enormous benefits to administration of the health service by acting as a check against abuses and the steamrollering of decisions while doctors are away. The ombudsman's role must be permitted to evolve to answer the new requirements of the more commercial health 398 service. Unfortunately, we are moving towards a more market-oriented system, and we shall need a stronger ombudsman if more patients are not to suffer.
I am grateful, Mr. Deputy Speaker, for having the opportunity to put my strong feelings on the record. I shall wait to see what the health commissioner in Wales makes of this case.
§ Mr. David Trimble (Upper Bann)
I am glad that the subject for debate includes the Northern Ireland Parliamentary Commissioner for Administration, particularly as I raised the issue during business questions last Thursday. Although it does not appear on the Order Paper, I hope that the debate also covers the Northern Ireland commissioner for complaints. I have his report here. The same person holds both posts and produces one report.
In recent years, complaints to the Northern Ireland Parliamentary Commissioner for Administration have followed a familiar pattern. Most of them relate to town and country planning issues and welfare benefits. In 1990, there were 35 complaints on each subject, out of a total of 164. To that total we should add the five complaints about the Northern Ireland Office and the court service that were made to the Parliamentary Commissioner for Administration for Great Britain.
I hope that the paucity of complaints about the Northern Ireland Office is not taken as suggesting that there is satisfaction with its work. It probably reflects ignorance of the fact that complaints about that Department go to the British commissioner. I hope that something can be done about that.
I should like to draw attention to the almost total absence of complaints to the Parliamentary Commissioner for Administration about alleged political or religious discrimination. That is significant, in view of the allegations that are regularly made about the administration of Northern Ireland. It is not something new, since it has also occurred in previous dispensations.
The spread of complaints to the commissioner for complaints is interesting. In 1990, out of 331 complaints, only 45 were against local bodies, mainly local authority bodies. Thirty-nine were against education boards, 82 were against health boards, and 114 were against the Northern Ireland Housing Executive. The pattern is not new. In recent years, more complaints have been made against the Northern Ireland Housing Executive than any other local body. If the number of complaints reflects consumer satisfaction, the Housing Executive has no grounds for complacency.
In view of the perception common in some places that there is something wrong or unusual about local democracy in Ulster—such as it is—there are comparatively few complaints against local authorities. Of those, only two were upheld. One related to delays in completing a compulsory purchase. The commissioner for complaints said that the local authoritydisplayed a clear lack of strategic thinking and this deficiency led to a lamentable failure to get to grips with the question of acquiring the complainants' land. I recognise the difficulties faced by the Council in terms of changing government attitude to grant-aid, the counter-proposals it received from the complainants and delays engendered by the public inquiry … Nevertheless, I am convinced that the development of a 399 clear strategy at the outset and less faith in its policy of acquisition by agreement would have resulted in a much more businesslike resolution".I do not complain about the result in that case, but of what local authority in England could not something similar be said?
The commissioner for complaints heard an allegation of discrimination on religious grounds about the failure of a person to be appointed to the post of principal at a nursery school. I am happy to say that, after a painstaking inquiry, in which the commissioner took evidence on oath from the parties—the case is notable for that precedent—the allegation was disproved. I am especially delighted that the commissioner heard that case, because appointments in schools are not fully covered by the fair employment legislation. Indeed, the unequal application of that legislation, and the privilege given to certain sectors in education to discriminate, is much resented in Ulster.
It is time to reconsider the range of remedies that are available to aggrieved citizens—not only the ombudsmen but the role of judicial review. That is especially pressing because judicial review has been extended in recent years.
I had a case in my constituency a few months ago, the subject of which is not important, on which the Department made an unsatisfactory decision. The Department appeared to have moved the goalposts, so I raised the case with it. Correspondence was exchanged, but not much progress was made. In the back of my mind was the possibility of referring the matter to the parliamentary commissioner, but my aggrieved constituent decided on a faster way of dealing with the matter, by making an application for judicial review.
I wished her luck with the proceedings and hoped that the financial risks would not be too high. A mere three weeks later, she came into my constituency office and happily reported that, shortly after proceedings were commenced, the Department threw in the towel and settled. It agreed not only to reopen the case but to procedures to deal with it. I had been trying for a long time to get the Department to agree such a course.
Hon. Members have not fully appreciated the way in which judicial review has changed such cases. It has one enormous advantage—any aggrieved person can apply. Whatever the original reason for a parliamentary filter on applications to the ombudsman, is there any point in retaining that obstacle, especially as it does not apply to the Northern Ireland commissioner for complaints, which does not seem to have caused a problem?
Judicial review has the advantage of access, but its disadvantage is that it has no power to award damages. The ombudsman has no power, but compensation is often paid by settlement. That is not good enough, because compensation by settlement rests on the grace and favour of the Department. It is unacceptable that a citizen who has been proved right should have to go as a supplicant to the Department that has been proved wrong. Sometimes payments are not made.
An example of that appears in paragraph 23 of the second report of the Select Committee. The problem arose from the construction of a police station. The commissioner concluded—the Select Committee agreed with him—that it was unfair that the complainant's home should be seriously devalued by the fortress that surrounded it, and that she lived in constant fear of 400 terrorist attack. The Select Committee recommended that the Department should reconsider the legal position. I sought to move an amendment to the Northern Ireland (Emergency Provisions) Bill that would have dealt with the matter. I am glad to have the somewhat belated support of the Select Committee. I hope that the Government will take the opportunity in another place to resolve the matter.
The solution to the problem of monetary compensation is to give a right to damages, for which there is a precedent. The Northern Ireland commissioner for complaints made findings that enabled the parties' damages to be assessed by the courts. That is unique to the Northern Ireland commissioner. The parliamentary commissioner for complaints does not have the same power to make a finding that can be followed up in the courts and damages assessed.
I am well aware of that procedure because, in one of the first major cases in Northern Ireland, a number of my colleagues in the local authority had to bear heavy financial bills. I shall not go into the details of the case, but they felt somewhat aggrieved—with reason—and thought that it had been unfair. They suffered from what was until then a novel and little-known procedure. It may now be a little better known in Northern Ireland, but should it be confined there?
Why should public bodies and some councillors have to carry a potential penalty that is not applied to people elsewhere in Great Britain? It should apply generally; there is nothing unique about the cases that arise in Northern Ireland and to which the procedure applies. Having read the report of the parliamentary commissioner for complaints, who can say that similar cases do not arise on this side of the water? On matters concerning the rights and remedies of the citizen, there should be no discrimination between one part of the kingdom and another.
I hope that, in the general review of grievance procedures which I have suggested, the rights of the citizens in Great Britain will at least achieve the level of those in Ulster. In addition, I hope that the remedies of all will be significantly enhanced.
We are grateful for the opportunity to contribute to the debate. I hope that debates on this subject will be more frequent, especially as long as we who represent Northern Ireland constituencies continue to be under-represented on Select Committees.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)
I begin by echoing the comments by hon. Members of all parties in thanking those who currently fill the offices of the Parliamentary Commissioner for Administration and the Parliamentary Commissioner for the Health Service—Mr. Reid—and Mrs. Mclvor, who combines the office of the Northern Ireland PCA with that of the Commissioner for Complaints. Tributes have been paid to their hard work and to the effectiveness of that work.
I also join the hon. Member for Ashfield (Mr. Haynes) in taking the opportunity to pay tribute to the previous holders of those offices who established a high standard of work, which the current holders undoubtedly continue. The standing of the various ombudsman posts has undoubtedly been enhanced by the people who have 401 previously occupied them. In his typically generous fashion, the hon. Gentleman wished to extend thanks to the people filling the offices of Clerk to the Select Committee.
Listening to the hon. Member for Ashfield talking about his work on the Select Committee, I began to wonder what he was like as a Committee man. The House is familiar with his style and delivery in the Chamber—
§ Mr. Dorrell
My hon. and learned Friend describes the hon. Gentleman as forceful, which is no surprise. The debate has centred on essentially administrative and relatively important but low-key issues, but the hon. Gentleman nevertheless managed to make the populist speech that we have come to expect from him. He is a one-man argument for delaying the general election so that we shall continue to have the pleasure of his presence in the House. He will forgive me if I observe that Dillinger was before my time. I have learnt something—indeed, quite a lot—this evening, not least from the hon. Gentleman's reference to Dillinger.
I begin my more serious comments by picking up on the speech of my hon. and learned Friend the Member for Colchester, North (Sir A. Buck) who rightly stressed that the importance of the ombudsman process is its function of ensuring that democracy not only works but is seen to work and that the citizen has an effective right of redress if the various organs of the state do not fulfil efficiently and effectively the task for which they have been established. I shall deal with my functions in a moment. My hon. and learned Friend is absolutely right that if the state is not seen to be effective and if there is not adequate machinery for redress if it is not effective, democracy gets a bad name and that is enough to put the concept itself under threat. I entirely agree with him. That establishes the importance of the work carried out by the ombudsman. There can be few more important responsibilities of this House than to ensure that democracy works effectively and that we are seen to be accountable to the people who elected us to this place.
My hon. and learned Friend the Member for Colchester, North was right to stress the importance of the accountability of the ombudsman to Parliament. The principle upon which our constitution is built is that civil servants are responsible to Ministers and Ministers are responsible to this House for everything that goes on in their Departments. No Minister should ever wish to avoid that responsibility. The accountability of Health Ministers for what happens in the health service, including the trusts, and the accountability of other Ministers for what happens in their Departments is to the House. It is the task of every hon. Member to try to enforce that accountability. That is why my hon. and learned Friend the Member for Colchester, North was right to describe the ombudsman as a bolt in the armoury of an hon. Member. The ombudsman is one of the machineries that enhance the effectiveness of individual Members in calling the bureaucracy to account.
Several hon. Members argued that the role of the ombudsman should be enhanced possibly by providing direct access to the parliamentary ombudsman. Indeed, one hon. Member argued that the ombudsman should be allowed to initiate inquiries on his own authority and to pursue a particular line of inquiry within the bureaucracy.
402 Before we go down that route, we should remember that the accountability of Ministers is to the House and that the essence of the ombudsman is to enhance the effectiveness of hon. Members in calling the bureaucracy to account through the House. That is the way in which our constitution works.
My hon. Friend the Member for Suffolk, Central (Mr. Lord) and the hon. Member for Glasgow, Central (Mr. Watson) tried to draw parallels with the system operating in some Scandinavian countries. They must remember the different constitutional histories of those countries and the importance that we have historically always placed on maintaining the principle that bureaucracy is accountable through Ministers to Parliament and that Ministers can answer questions at the Dispatch Box about what happens within their Departments.
The ombudsman was established as the Parliamentary Commissioner for Administration. His principal concern is to ensure that the public service delivers to the citizen a quality of service which the citizen is entitled to expect. Public administration is, if we like, his core business.
§ Mr. Dorrell
I make no apology for asking of any organisation what is its core responsibility or business. The ombudsman's core concern is the efficiency of public administration.
With regard to the health service, the ombudsman is not properly interested in clinical judgment. One of the first things that I learnt when I arrived at the Department of Health was the entirely proper importance attached throughout the health service to ensuring that administrators do not interfere with clinical freedom. That applies just as much to the ombudsman as to Ministers and administrators within the health service.
However, that is not an excuse to allow people to hide behind clinical responsibility where that is specious. My hon. Friend the Member for Reading, West (Sir A. Durant) and my hon. and learned Friend the Member for Colchester, North were concerned that clinical freedom should not be used as a defence when that is not a real or effective defence. However, where there are genuine clinical questions, those are not properly matters into which the ombudsman should inquire. It is particularly important to emphasise that merely to establish that they are clinical questions does not make them immune from review. There is a procedure within the national health service to review clinical questions, but that is properly a procedure that has been agreed with the professions and that takes account of the special nature of clinical questions. It is important to establish the difference between administrative and clinical questions, and to insist that clinical questions go through a proper process of clinical review and that we do not seek to confuse them in the ombudsman's operations.
The hon. Member for Peckham (Ms. Harman) said that she thought that surprisingly few complaints were addressed to the Health Service Commissioner about the operation of the NHS. She advanced three possible explanations. Perhaps there was not a "culture of complaint" in the health service; perhaps there was not adequate knowledge of the procedures for complaint—although the hon. Member for Glasgow, Central pointed out that the leaflet issued last summer, in the teeth of 403 considerable opposition from Labour Members, contained a passage setting out the procedures to be followed by any individual wishing to make a complaint. The hon. Lady's third explanation was that the citizen might not know the cause of the inadequacy in health service care from which he felt that he had suffered.
I was struck by the fact that the hon. Lady did not appear to entertain the possibility that the explanation might just be that the health service, in the vast majority of cases, provided a very high standard of care of which we should all be proud, and for which we should all be grateful.
The hon. Lady and the hon. Member for Southport (Mr. Fearn) referred to the passage in the report that deals with discharge arrangements. It is indeed important to ensure that such arrangements are effective and that proper community support is given to those who are discharged from acute hospitals and who must then rely on community health services. That is part of the effective management and use of resources within the health service.
When the hon. Lady quoted from paragraph 18 of the report she quoted only the first half of the sentence, if memory serves. The passage that she quoted states, rightly:Pressure on beds means that hospital doctors do not usually want to keep patients in hospital longer than is really necessary".The sentence goes on:And, in general, patients who have adequate facilities and support—whether professional or from carers—are eager to return home.There are two quite proper pressures for a patient to be discharged as soon as that is clinically right. The first is the need—for the effective use of resources—for acute bed space not to be taken up by those who no longer need those resources. Secondly, and much more important, medicine is about encouraging people to return to the community and supporting them there rather than encouraging them to withdraw from it. I make no apology for the existence of management pressure, which is there for proper financial reasons—to ensure that resources are used effectively—and also so that patients are not kept in hospital any longer than is strictly necessary.
The hon. Lady mentioned no-fault compensation. That is an important issue. For some time, the Opposition have agreed that the proper way in which to finance the health service is to do so within a cash-limited total resource. It is recognised that a free, publicly funded health service necessarily has limited resources: there is no longer any dispute about that.
As of last weekend, there also seems to be no dispute about the prospects of an immediate substantial increase in the resources available to the health service. The Leader of the Opposition made it clear that he foresaw no such increase, except in the context of a growing economy.
When the hon. Member for Peckham argues for no-fault compensation, she must explain from where the resources that are to finance that no-fault compensation are to be diverted. That is a relatively urgent issue because this evening she argued the case for extending the principle of no-fault compensation to making payments to those people who are suffering HIV infections largely as a result of blood transfusions. I understand the human argument 404 for that, but the House must remember that when a considerable amount of money was provided earlier this year for haemophiliacs who suffered the HIV infection as a result of treatment received from the health service, hon. Members of all parties told us that that was a special case because of the double jeopardy suffered by haemophiliacs who need to attend hospital for basic care simply to remain alive. It was argued that that special case should not become a precedent for the same principle to be applied to other groups.
§ Mr. Dorrell
I shall give way to the hon. Lady in a moment because I exempt her from this charge. She has been entirely consistent and has argued throughout that there should be no-fault compensation. However, the majority of hon. Members and of people outside the House who have pressed this case have said that haemophiliacs should be a special case because of double jeopardy and should therefore be provided with the cash without it being regarded as a precedent. The hon. Lady has been consistent and has argued that both the haemophiliacs and the group that we are now talking about should receive cash on a no-fault compensation basis.
However, that makes the question even more difficult for the hon. Lady because the further we go down the road of no-fault compensation, especially involving such large sums of money for each patient, the more she must explain, against the background of the pledge that was given by the leader of her party last Sunday—that there was no extra money for the health service—from where in the existing pattern of care in the health service the resources would come to pay for the pledge that she has given this evening.
§ Ms. Harman
It is for the Minister, who represents the Government, to explain why the Government are failing to provide compensation. We have always argued that the ex-gratia compensation paid to the haemophiliacs who became infected with HIV through blood transfusions should be available for all those who got HIV through blood transfusions. It was the Government who sought to say, "Let us separate off the haemophiliacs. Let us compensate them, but leave the others without hope."
§ Mr. Dorrell
I said that I exempted the hon. Lady from the charge, but she must still explain where the resources will come from.
Hon. Members of all parties, especially my hon. Friends the Members for Reading, West and for Suffolk, Central, have commented on the importance of plain English. My hon. Friend the Member for Suffolk, Central was anxious that the word "matron" should reappear in the health service's management charts. My hon. Friend the Member for Reading, West was concerned to ensure that the leaflets that are issued by the health service and by Government in general should be written in plain English. I entirely agree with that view. Within my Department, I have a particular aversion to a word that has been used to such an extent that it no longer means anything. I refer to "appropriate". There is now the view in the Department that it is no longer appropriate to use the word "appropriate" because it has been used in so many contexts that it has now lost its meaning. I quote that as another example of the importance of ensuring that plain 405 English is used. The French have a committee for maintaining the purity of the French language. if the Select Committee finds that it has time on its hands, perhaps it could appropriate such a role for itself.
Joined by his hon. Friend the Member for Upper Bann (Mr. Trimble), the hon. Member for Londonderry, East (M r. Ross) was concerned about the fact that a Select Committee that is composed entirely of hon. Members from Great Britain should consider reports from the Northern Ireland ombudsman. I understand the sensitivity of the issue. The hon. Gentleman will understand me if I say that it has wider ramifications than for the work of the ombudsman. Therefore, it is not a matter on which I would wish to comment further except to say that the specific planning example quoted by the hon. Member for Londonderry, East was not unfamiliar to a Member representing a Leicestershire constituency. I could take the hon. Gentleman to many sites in Leicestershire where exactly the same planning issues are being addressed. The problem is not specific to Northern Ireland but none the less I understand the hon. Gentleman's wider point.
This has been an interesting, useful and important debate concentrating on the work of an important institution. It has been a privilege for all those who have participated to have had the opportunity to do so.
§ It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.