COMPLAINTS: REQUIREMENTS TO BE MET (Hansard, 25 January 1996)

§ Mr. David Hinchliffe (Wakefield)
I beg to move amendment No. 2, in page 5, line 32, leave out 'In' and insert '—(1)'

§ Madam Deputy Speaker
With this it will be convenient to discuss amendment No. 1, in page 5, line 33, after 'complaints'), insert 'shall be amended as follows. (2) After subsection (4) there shall be inserted (4A) Without prejudice to the provisions of subsections (1) to (4) above, the Secretary of State may by regulations made by statutory instrument make such provision for the receipt of complaints as appear to him likely to expedite and facilitate the making of complaints. (3)".%

§ Mr. Hinchliffe
As I said on Second Reading, the Bill has my full support. However, we need to examine the wider complaints procedure and some of the issues—perhaps policy issues—that lead people to make complaints. My amendments would provide a mechanism to improve the complaints procedure.
On Second Reading, I gained the impression that the Under-Secretary thought that there was some sense in what I had said. Indeed, he referred to my Yorkshire common sense, and that encouraged me to come to this Report stage and repeat some of my arguments. He may want to rephrase his remark when he responds later.
540 I shall explain why I want to amend the Bill at this stage. I was involved with the National Health Service and Community Care Act 1990 throughout its passage in the House. Unfortunately, the Act has caused considerable confusion among users of and complainants about the health service, as well as among those who work in the service, about the responsibilities of various elements of the NHS. Therefore, we need to simplify the complaints procedure, which is why I tabled the amendments.
On Second Reading I cited the example of a constituent who had a lump in her breast and was involved with four separate agencies during her treatment and after care. Her complaints related to three of those four agencies. Her complaints were serious and I felt that there should be a simpler method than having to write to each of the agencies. We need to consider how we can improve the system for people like my constituent who encounter serious problems with the care they receive.
I am sorry to see the Minister for Health leaving the Chamber. For some reason, whenever I get to my feet he leaves and then returns when he sees on the monitor that I have sat down. One of my arguments on Second Reading, which was not fully refuted by the Under-Secretary, was that the commissioner needs to examine the increasing examples of buck passing between the various elements of the NHS during the early stages of the complaints process. I have had experience of the purchaser blaming the provider, the provider blaming the purchaser, the hospital trust blaming the community trust and vice versa. With community care and continuing care, the NHS blames the local authority and vice versa. The whole issue of alleged bed blocking is a classic example.
We need to recognise that the climate surrounding the structure of the NHS has changed. Even with the improvements proposed in the Bill, I do not believe that the complaints procedure recognises the complexity of the new NHS, especially the internal market.
Another issue in my constituency and west Yorkshire generally is competition between similar providers, both for contracts for the provision of services and for patients themselves. That causes difficulties for patients who are referred from one hospital to another, yet those two hospitals are competing within the internal market. There are many arguments between providers in west Yorkshire. I represent Wakefield, which has arguments with Leeds because, within the internal market, it is removing services from Pinderfields hospital. Within the district, there are arguments between Pontefract general infirmary and Pinderfields hospital because of the competition for contracts. Therefore, patients who move between the hospitals for treatment are occasionally victims of that competition when they want to make a complaint. The Bill needs to include a mechanism for dealing with that competition which, on occasions, causes difficulties for people with legitimate complaints, many of which may end up in the hands of the health service commissioner.
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I shall be interested to hear the Under-Secretary's response to another point that I raised on Second Reading. The role of the commissioner in examining the causal factors in a specific complaint is too narrow. My amendment would achieve a wider consideration of complaints within the commissioner's changed role.
541 Also on Second Reading, I made a point about resourcing arrangements that impact on patients' treatment. How does the commissioner's role fit into that? He needs to be able to consider the wider issues. Another example is fundholding, although I do not want to go into the merits or otherwise tonight. Nor shall I go into the merits or otherwise of the new resource allocation formula. My point is that occasionally those factors have a clear bearing on the serious complaints of patients, which may well end up in the commissioner's hands.
When I spoke on Second Reading, the Minister for Health left at the start of my speech and returned at the end of it. I asked him to read my speech. To my surprise, the best present I had for Christmas was a response from him showing that, to his credit, he had read my speech. I was not entirely happy with his letter, dated 19 December, in response to my comments about the Bill and the wider issues that I felt should be dealt with in Committee. I had made two points—the first, which I said I had made four times previously, related to fundholding. The Minister for Health wrote: You claimed that complaints handling in the NHS is characterised by buck-passing. I presume that you were unaware that buck-passing was possible until this Government introduced a formal complaints procedure into the health service. It is ironic that you should make this claim during a debate to further strengthen and clarify the new complaints procedures. You also claimed that Wakefield has lost resources. That, too, is nonsense. I shall deal with those points in a moment or two. I was pleased to note that at the end of his letter the Minister said: Seasonal greetings and best wishes for a better-informed 1996. I reciprocated those greetings in a reply to the Minister, which the Under-Secretary may have seen.
It is difficult for me to argue the case for the amendments without referring in detail to some of the concerns in my area. I want briefly to explain why we need to widen the complaints procedure in the way proposed in the amendments. I am currently receiving complaints from patients relating to the two-tier system. I do not intend to go into detail about this matter, as I have done so on several previous occasions.
I have argued with the Minister and with the Secretary of State, and I have corresponded with both. I have met every agency concerned with the NHS in Wakefield, and I have got nowhere in looking at the role of the health service commissioner. Who is the referee in these affairs? Who can give me an objective and definitive view of what is happening?
I want to mention a specific case as an example of where constituents believe that the two-tier system is impacting upon their personal experiences. Pinderfields trust is the main provider in my constituency, and it has a current contract with Wakefield health authority for roughly 20,900 finished consultant episodes across all specialisms. The projected outturn at present is approximately 25,800, a much higher figure than the actual contract. Of the difference between the contract figure and the projected figure, some 3,500 are covered by additional funding, but the balance remains to be sorted out.
542 That is why people in Wakefield believe that they are experiencing a two-tier system. That is my view, but it is also the view of a number of GPs and—I suspect—that of a number of people who work within the health service in Wakefield. But I cannot prove that that is the case. Hon. Members with similar opinions end up in the Chamber bandying claims about, perhaps for political reasons and perhaps for genuine reasons of concern about constituents' experiences. Some of the cases that I have dealt with are certainly very negative.
There should be a mechanism whereby the commissioner, in investigating complaints, can look at some of the wider issues currently affecting my constituents and those of other hon. Members. I was speaking to the hon. Member for Salisbury (Mr. Key), who followed me at Health questions in November and made exactly the same claim in relation to fundholding and the two-tier system in his area as I was making for Wakefield. I am trying to address the principle, rather than simply the practical examples from my constituency.
In my view—I stress that it is my view—the commissioner has a role to play. Two-tier systems arise when there is a disparity in funding and, in this case, we have that between the district health authority and the fundholders. On the one hand, the fundholders are able to purchase, while on the other the district health authority cannot. There is either a disparity in funding or an imbalance between the elective and emergency contracts made with the provider trust. These issues must be looked at not by someone who is involved in the political arena, but by someone who is objective and has a role in investigating complaints.
The amendment points to the need to examine such problems in the context of specific complaints, and I appreciate that these complaints may be more serious than those that I have heard from my constituents which deal with orthopaedic operations and other operations that have caused discomfort. How do we get an objective evaluation of the resources available to fundholders compared with those available to non-fundholders in an area such as Wakefield? That will clearly have a bearing on the complaints that may well end up in the hands of the commissioner.
I turn briefly to buck-passing. The Minister of State wrote to me to say that it was nonsense to argue that buck-passing existed in the health service. I received that letter shortly after I received another letter from a local provider trust concerning a severely handicapped 16-year-old young man who was living with his family in the community in Wakefield. I felt that the letter was a classic example of a matter that could be addressed by the commissioner, or by the complaints procedure that would be introduced if the amendment is accepted.
I wrote on 14 November to the Wakefield and Pontefract community health trust with regard to the young man, who was severely disabled. I worked, as one or two people know, in social work for more than 20 years before I came to the House. The young man was one of the worst cases that I have ever seen living in the community and being cared for by parents. He is completely bedfast. He cannot feed himself, wash himself or dress himself. He cannot speak, and some people refer to him unkindly as a cabbage because, frankly, he can do nothing for himself. He is totally dependent on two extremely dedicated parents who have given up their lives to care for this young man.
543 The parents contacted me for the simple reason that they wanted respite care above and beyond the brief care that they had at the time. In short, they could see that if they did not get some more relief and support, they could no longer go on caring. I have seen young men like him before, but always in a hospital environment. I cannot recall seeing anyone as vulnerable and as multiply handicapped as that young man being cared for by parents within the community.
I wrote to the Wakefield and Pontefract community health trust to ask them to consider the request for additional respite care for the family, because I felt that if anyone was deserving of such care, these parents were. I asked the chief executive to do as I had done, and pay a personal visit to the family. Hon. Members will know that one can read and write about people, but until one sees the situation, one does not know what is going on. With permission, I will quote the chief executive's reply to me. While I will not go into great detail, I want to make an important point about a specific case that relates to the amendment. I shall not name the young man or his family. The chief executive's reply was dated 5 December, and said: Thank you for your letter of 14 November. I am sure that you are aware of the range of services which we provide, namely, Rose Garth Respite Care Bungalow and the Community Team: Learning Disabilities (Children and Adults) which provides care to many, many children, adults and families throughout the District. The volume of work we carry out and the value of the care and respite given to families is often not appreciated other than by those in receipt of care. The present staff and facility resources are now fully stretched. I do not believe there is any slack in any part of the service. The Health Authority is fully aware of the demand for additional services and is familial with the number of families who are at the end of their tether. In their future plans they are sympathetic to funding additional services. It is now a matter of priority and funding, which can only be resolved by the Health Authority. This Trust will respond quickly to the availability of additional funds and extend the service to those families in real need. When that letter came to me, I had to ring the chief executive to ask, "What are you saying to me?" In short, he was saying, "It's not my problem. It is the problem of the health authority." I have written to the provider of existing respite services to ask for more. To me, this is a classic case of buck-passing. If it is not buck-passing, frankly I do not know what it is.
Having sent a copy of the letter to the family shortly before Christmas—they were not entirely happy, as one might imagine—I had to raise the matter with the health authority. My query to the Minister is, "Was I wrong to write to the provider of services to ask for more?" Do I need to raise every complaint or concern with the purchaser? If so, do we extend that to complaints received on community care, where the local authority is involved? Do I have to write to the Government, who provide the special transitional grant for community care funding? It strikes me that the principles at stake here would result in enormous complexity—even more than we have now—if they were followed to their obvious conclusion.
I am pleased to report that the outcome of this case has, eventually, been positive. The chief executive and the chair-designate of the Wakefield health authority visited the family, and were totally overwhelmed by the care and dedication of the parents. They then agreed to an extra 12 hours of respite care. Understandably, the family were aggrieved by the response of the trust, and my concern is 544 whether I handled the matter wrongly. Did I write to the wrong people? In future, should I write to the health authority on every issue? I have done that in the past, but have been referred to the provider.
I served on the Standing Committee dealing with the Bill, and I have been an Opposition Front-Bench member. I have been involved in the NHS for many years as vice-chair of a community health council and as member of a health authority. I have been actively involved in working in the NGS through social services. I am totally baffled, and I am supposed to know my way around the issue.

§ Madam Deputy Speaker
Order. Before the hon. Gentleman continues, may I remind him that he said that he was not going to go into too much detail. It is important that he makes only points that support his amendment. He is going very wide and I have been very tolerant owing to the nature of the subject under consideration.

§ Mr. Hinchliffe
I appreciate that you have been very reasonable, Madam Deputy Speaker. I think that you understand that, in illustrating why the amendments are necessary, I needed to go into such detail about individual circumstances.
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Finally on buck-passing, my amendment is aimed at improving the response to complaints, so that distress is not caused to families such as that of the constituent whom I mentioned.
In his reply to me, the Minister of State implied that I had misled the House about funding. When arguing that concern on Second Reading, I was simply pointing out that we need someone who is empowered to consider whether any funding issues have a bearing on a complaint. I was questioning, not whether we have enough money in the national health service—whatever the Government, we all accept that there will never be enough to deal with all the demand—but the Government's allocation formula for individual health authorities. That was my point on Second Reading and I do not think that the Minister of State fully understood it.
In my area—Wakefield health authority—the major purchaser of services such as those to which I referred has been told that the authority is over-funded to the tune of £7 million according to the Government's new formula. I will not go into detail about why the formula is wrong because you will not allow it, Madam Deputy Speaker. I mentioned that briefly on Second Reading and I was ruled out of order then. I simply must say, however, that the report of the district health authority of 20 December 1994 details the implications of the authority losing £7 million.
I moved the amendments because I believe that, if resourcing has a bearing on a complaint, it is appropriate for the commissioner to consider it, or for the complaints procedure to allow an objective overview by someone who understands the health service and is not a political figure, and who can conclude what is fair.
My area has been badly done to by the changes. The impact will come through this year. There will be more cases and I will have to write more letters about individual complaints. The commissioner has a role to play, if he can see objectively that we are getting a bad deal.
545 On that subject I shall conclude, Madam Deputy Speaker. Thank you for your tolerance and for allowing me to make those points. I hope that the Minister understands that I am simply asking that we consider ways in which we can clarify and simplify the complaints procedures. At the moment many people are going round in circles, including many hon. Members. If the hon. Gentleman reads the Second Reading debate, he will see that I had support from Conservative Members when I mentioned the huge increase in our work load since the internal market was introduced. We are writing letters that we did not have to write before. It is causing us work and it is causing our constituents many difficulties.

§ Mr. Horam
I referred to Yorkshire common sense when I dealt with the points raised by the hon. Member for Wakefield (Mr. Hinchliffe) on Second Reading. I also thought that Yorkshire qualities included a certain taciturnity, but that was not so evident this evening, I am afraid. None the less, the hon. Gentleman made some important arguments.
First, on complexity—a point that he has made strongly in the past—let me assure the hon. Gentleman that the idea of establishing the new three-stage procedure is to simplify and clarify the present complexity.
Secondly, if buck-passing exists, one of the functions of the ombudsman is to nail it. He is the final court of appeal and can certainly decide whether responsibility for something has been passed unreasonably between one authority and a general practitioner, or whatever the case may be. So, there is a recourse.
On the important subject of resources and the two-tier system and so forth, while it is obviously not the case that the ombudsman can look into general questions of resources, as that would be second guessing the national health service and its allocation of resources, he will be able to look into cases of individual hardship in which he considers that there might have been an unreasonable allocation of resources. I assure the hon. Member for Wakefield about that.

§ Mr. Hinchliffe
I am grateful for those comments. I was not clear whether, by an individual case, the Minister means that of a patient, a health authority, or both.

§ Mr. Horam
No, I am talking about the patient, because we are dealing with individual complaints.
I am afraid to say that the amendment is defective. I am sure that the hon. Gentleman tried hard to get it right, but it is difficult. It would change matters only for complaints made to the health service commissioner and the hon. Gentleman is concerned with complaints made at stages 1 and 2. Therefore, his amendment would not do what he wants it to do.
In the light of the hon. Gentleman's letter to me—I have it in front of me—as a consequence of my right hon. Friend the Secretary of State writing to him, and what he has said in the past half hour or so, I will consider what he has said and consider the letter and reply to him on the matters that he has raised. In view of that, I hope that he will withdraw the amendment.

§ Mr. Hinchliffe
I am grateful for the Minister's response. I recognise that the amendments have certain 546 technical deficiencies, but we have done our best to ensure a debate on some areas of concern. I think that the Minister understands our concerns, which are reasonable. On the basis of his assurance that he will write to me on those matters, I beg to ask leave to withdraw the amendment.