§ Order for Second Reading read.9.35 am
§ Sir Geoffrey Johnson Smith (Wealden)
I beg to move, That the Bill be now read a Second time.
The Bill is designed to amend the provisions of the Health Service Commissioners Act 1993 that apply to the ombudsman's powers to investigate complaints against doctors and other health service providers such as pharmacists, dentists and ophthalmic surgeons. The Bill is therefore not confined to one section of the medical profession.
I am grateful for the cross-party support that the Bill has attracted. I should like to thank the sponsors in particular; they also span the political divide. It is worth mentioning some of the sponsors by name because they have persistently shown a great interest in health matters. Some of them not only take an interest in health in the House but are registered medical practitioners. They include: my hon. Friend the Member for Southend, West (Mr. Amess), who is a member of the Select Committee on Health, the hon. Member for Isle of Wight (Dr. Brand), who is the Liberal Democrat spokesman on health, and also serves on the Health Committee, the hon. Member for Wakefield (Mr. Hinchliffe), who chairs the Select Committee and the hon. Member for Bradford, West (Mr. Singh), who is a former hospital manager. The sponsors include two doctors. I am grateful to them for sparing their time.
The purpose of the Bill is to close a loophole in the Health Service Commissioners Act 1993, which allows general practitioners and others involved in health matters to retire to avoid investigation by the health service ombudsman. For example, GPs who are worried about being investigated by the ombudsman can simply retire from the national health service to avoid answering for their actions. That is all the more worrying because GPs who officially retire from the national health service can avoid investigation and continue to practise as locums or in private practice even though a complaint which calls into question their professional conduct and ability remains unresolved.
If the Bill makes the statute book, it will bring GPs and other health professionals into line with hospital doctors. In his annual report for 1998–99, the health service 665 commissioner, Mr. Michael Buckley, drew attention to the need to tackle the matter that the Bill covers. I am especially grateful to the Consumers Association for bringing the ombudsman's recommendation to my attention and for its help in preparing the Bill.
Although the Bill will affect only a few individuals each year, it will tackle a basic injustice. We have recently witnessed action by the Home Office to consider sanctions against retired police officers following the Macpherson inquiry in the Stephen Lawrence case. The Bill will introduce similar provisions to protect patients.
It is important that patients are reassured that the laws governing health services professionals are primarily designed to protect them. As well as protecting patients, the Bill would support thousands of honest and reputable doctors who tirelessly serve our communities, and would ensure, too, that the minority of doctors who should not be practising do not tarnish the reputation of exemplary doctors. It is in no way a witch hunt.
The Consumers Association has campaigned for several years for a robust system of redress in health care. I was made aware of it about a year ago when I read a report in Which? magazine—I am a subscriber—of the case of Mr. Peter Smith, whose wife had died of leukaemia, a condition that her doctor had overlooked. Mr. Smith took his complaint to the health service ombudsman, who agreed to investigate. Unfortunately for Mr. Smith, the general practitioner in question retired and the investigation was abandoned. He will never know if his complaint would have been upheld. Neither will Yvonne Fisher.
In February 1998, Mrs. Fisher called a doctor after finding her 83-year-old mother, Mrs. Valles, ill at home. The practice said that none was available. Later that afternoon, her mother's condition deteriorated and she collapsed. Mrs. Fisher left her with neighbours, drove to the practice and asked that a doctor attend to her mother urgently. Finally, a doctor visited and examined Mrs. Valles. He said that she had suffered a slight stroke and was unconcerned by Mrs. Fisher's pleadings that her mother had not eaten or drunk anything, could not walk unaided and was very weak. The doctor merely commented that that was usual with strokes.
The doctor then told Mrs. Fisher that her mother ought to be moved to a nursing home as she would never be able to look after herself again. In the meantime, he insisted that Mrs. Valles should not be on her own and that she was fit enough to embark on the two-hour journey to her daughter's home. Mrs. Fisher reluctantly put her mother in her car and drove home. On arrival, Mrs. Valles collapsed. An ambulance was called, which took her mother to a local hospital. She died shortly after arrival.
Mrs. Fisher was so incensed at the treatment that she and her mother had received that she decided to complain. She took the complaint to the West Surrey health authority, which refused to hold an independent review. That led Mrs. Fisher to contact the health service ombudsman for England, who agreed that there was a case and started an investigation. I emphasise that the complaint went to the ombudsman for England, because his remit does not run to Scotland. If the Bill meets with the House's approval, we shall have to consider what action can be taken in respect of the Scottish Parliament.
666 Mrs. Fisher was relieved to discover that the ombudsman was to investigate her case, only to have her hopes of justice dashed when she was informed that the doctor had decided to retire and that the case therefore had to be dropped. She decided to go public because she cannot believe that doctors can avoid investigation in that way. She hopes that the Bill will be made law so that in future people will be able to see that an investigation has been properly conducted and completed.
The Bill is supported by many notable organisations, including the British Medical Association and the Royal College of General Practitioners. Mr. Michael Buckley, the ombudsman, fully supports it and has called on the Government to take up the issue. Although this amendment to the 1993 Act would benefit only a few individuals, their plight must not be ignored. They deserve justice in the same way as any other person who put his faith in a system only for that system to fail him.
I hope that hon. Members on both sides of the House agree that the Bill represents an important first step to safeguarding patients' interests. I want it to succeed, which is why I propose only a modest change in the ombudsman's powers. No doubt the Government will wish to consider other changes in his powers and those of the General Medical Council that would improve redress in health. One could be the extension of the ombudsman's remit to the private sector, and there are others, one of which was pointed out by the Consumers Association. It published the results of its investigation into the GMC's procedures for dealing with complaints, which uncovered a system that any objective person would have to conclude could be improved. The Consumers Association has also called for the proportion of lay to medical members on the GMC to be increased to reduce the existing imbalance in some of the procedures and to drive forward reform.
The Bill represents a first step—other reforms will take time and I urge the Government to introduce legislation at the earliest opportunity—but it would sit neatly in a range of reforms that they may introduce to reflect the needs of patients and the medical profession. It is important to take this step, which will not prejudice any others that the Government may consider to strengthen the confidence that people rightly should have in an investigative complaints procedure.
Although I have concentrated my remarks on doctors, the Bill would achieve improvements in respect of other practitioners. However, the doctor-patient relationship is the backbone of the health care system. Recently, the Shipman case has shown how weaknesses in the system of redress serve only to discredit or undermine the confidence and trust between doctor and patient. I hope that the House agrees that that must be resolved.
§ Angela Smith (Basildon)
I am pleased to speak in the debate and to be a sponsor of the Bill. It is traditional to congratulate a Member on drawing a number high up in the ballot, but I confess that I have never understood that parliamentary convention. Drawing a high number is a matter of luck, but a Member deserves great credit for his choice of Bill and we should congratulate the right hon. Member for Wealden (Sir G. Johnson-Smith) on introducing a measure that would benefit a number of people. This Bill is about empowering consumers and patients and giving them confidence.
667 If Members from all parties outlined their reasons for standing for election, they would all say that justice, fairness and giving confidence were first among them. Those three tenets are our reasons for becoming Members of Parliament. Today's debate is about accountability, and it continues our discussion on restoring or maintaining faith in public servants—a category into which we ourselves fall—in respect of a number of issues. We should consider the Bill—which is moderate and sensible—in that context.
My view is that the system contains a number of deficiencies in relation to complaints and accountability. Although the Bill cannot possibly address them all, limiting what it sets out to achieve will make it far more successful. It targets an important specific area: ensuring that a general practitioner's retirement from the national health service does not prevent the health service ombudsman from carrying out a full investigation of a complaint. Patients visiting a doctor or a dentist must have faith that they will receive the best possible treatment. If they receive the wrong treatment or are treated unacceptably—or merely think that they have been treated unacceptably—they must know that they have recourse to a fair and just complaints system. No one in any profession should be able to duck their responsibilities by retiring or transferring to the private sector.
That debate takes place in a number of public services—the police being a prime example. Today, we can take an important step forward in patient protection and patient confidence. We should be clear that the Bill is not a panacea, but it would address one specific point.
It is unfortunate that, in the past few months, we have been made aware of some horror stories involving doctors and dentists. It was interesting to note that an opinion poll published yesterday found that that had not dented public confidence in doctors and dentists—in fact, it is still as high as it has ever been. When hon. Members talk to individuals—as we do in our surgeries and in conversations in our constituencies—we find great dissatisfaction among those who think that their complaints are not being taken seriously. It is a matter not necessarily of confidence in an individual practitioner, but of being taken seriously.
Some of the issues that have come to light in the press have been as a result of dissatisfaction at the failure of internal investigations. I say with some regret that I do not believe that the relevant regulatory medical authorities have come out of recent events with much credit.
I am sure that other hon. Members have had cause to take up complaints made against doctors by constituents. They will be as dissatisfied as I am with the delays in, for example, the procedures of the General Medical Council in investigating complaints and in responding to correspondence from Members.
One of the first cases that was brought to my attention as an MP was from my constituent Mr. Burgess. He had a complaint against his mother-in-law's GP after she had died. Like many people, he contacted me not as the first port of call but in desperation and frustration at the pace at which his complaint was being dealt with. Even after he referred the case to me, promised deadlines were missed, and I have had to write several times to ascertain what is happening. When a deadline is missed, I write again and am told that it has been extended. Where the GP has not responded to inquiries from the GMC, the case 668 has not been followed up until I have written to ask about it. There seems to be no sense of urgency about the investigation of the complaint, and scant acknowledgement that my constituent has complained out of genuine and heartfelt concern. A lesser man would have given up. I am still waiting for a response to an inquiry that I made on behalf of another constituent last November.
That does not give me much confidence in the system. What makes matters worse is that, in extreme cases, when a doctor or dentist retires or leaves the NHS for the private sector—sometimes in extremely dubious circumstances, as the right hon. Member for Wealden said—there is no way of following through a complaint unless criminal proceedings can be instigated.
It remains open to unscrupulous doctors and dentists who are facing an investigation and are worried about its outcome merely to retire. They can then carry on practising with no founded complaint against them.
The health service ombudsman has said that this issue should be addressed. The right hon. Gentleman rightly said that only a few people will be affected by the Bill, but the principle is important. There may only be a few isolated cases, but that does not lessen the pain and concern of the people involved. There is the potential for a more general, larger, national problem, and it is through the good will of doctors and dentists that we have not had greater difficulties. Our role as parliamentarians and legislators is to spot such loopholes and to attempt to close them.
It is important constantly to review the work and effectiveness of the public sector ombudsmen, and consider taking action, especially when they draw issues of concern to our attention. I await with interest the outcome of the review of the public sector ombudsmen that is currently with Cabinet Ministers, in the hope that we can use that to strengthen their role and act to increase public confidence. The Bill is about public confidence and protection.
I pay credit to the work of the Consumers Association in supporting the Bill and drawing such matters to our attention. There is also considerable local impetus, which is always important when we are dealing with such issues. I have received representations from my local Basildon and Thurrock community health council. It is an effective local body, and it wants to know that its concerns are being taken seriously. I have worked with the council on a number of occasions, and with Mark Ham and his team in Basildon, who want to be assured that complaints and concerns will be followed through to the very end, and that no doctor or dentist will be able to evade his or her responsibilities during investigations.
Like many others, the local community health council has had cases in which doctors under investigation have retired, so that the investigation has come to an end. That is of great concern to the council, and it has asked me to raise the issue in the House today, because this problem affects the support that it feels able to give patients who seek its advice.
The fact that a loophole exists affects patients' confidence in the system, and may result in their not proceeding with complaints because they do not think that it is worth while if a doctor can retire or move out of the NHS to avoid the complaint being considered. The system is a deterrent to complaints, and we shall never know how 669 many complaints have not been made for fear that they will not be taken seriously and that the doctor will not be fully investigated.
The vast majority of doctors deserve our confidence, but unless we are prepared to deal with the issues that severely test our faith in the system, we do a disservice to all doctors. Unless we tackle the real fears and concerns, we cannot expect the public to trust us, or the medical profession as a whole. When that situation develops, it undermines the work of many good doctors.
This is just one aspect of the reform of the ombudsmen's powers. It is a small reform, but it is important if we are to retain public confidence. I believe that we should considerably increase the ombudsmen's powers in this and in other areas. We cannot address that issue today, but this Bill is a welcome and necessary start.
I hope that the Minister will accept that the flaws in the system need to be dealt with as soon as possible. It is not only confidence in the medical profession that is at stake—as I have mentioned several times—but confidence in our own profession. If such problems are highlighted and we fail to act, we are failing to live up to our own responsibilities, and we have no right to criticise and complain about other professions not living up to theirs.
I hope that the Minister will accept the principles behind the Bill, note the strong support from both sides of the House, and favour early action.
§ Sir Peter Emery (East Devon)
It is with great pleasure that I support the Bill introduced by my right hon. Friend the Member for Wealden (Sir G. Johnson Smith). He has been fortunate in the ballot, and I congratulate him on the Bill that he has allowed me to help him bring before the House. The hon. Member for Basildon (Angela Smith) made a pleasant speech, and in reply to her worry about the ballot, I have to tell her that, having been in this place for 41 years, I have been one of the seven signatories only once. I think that my right hon. Friend the Member for Wealden, who came into the House at the same time as I did, is more fortunate, because this is his second private Member's Bill. He had a Bill on—what was it?
§ Sir Peter Emery
Meals on wheels, which is a very important service. We move from meals on wheels to health.
§ Sir Geoffrey Johnson Smith
I introduced that Bill at the behest of the Women's Royal Voluntary Service. I should like to thank my right hon. Friend for playing some part in this Bill. During my absence on official business, he gallantly stood in for me on First Reading: I am most grateful to him for presenting the Bill to the House.
§ Sir Peter Emery
That is very kind of my right hon. Friend. I think that gallantry is a slight overstatement, but I am delighted to accept it.
I shall be brief, because much of what needs to be said has already been said. I am also interested in the next Bill, the Food Labelling Bill, which would have a great effect 670 on my constituents, and on the farming industry in particular. I want to ensure that that Bill gets a Second Reading this time.
It is obvious that it is nonsensical that someone can escape from investigation by leaving the service and saying, "That's it. Whatever mistakes I may have made, you can't go any further in investigating what I did, because I am no longer part of the service." That cannot be right, but it obviously was not considered during the passage of the original legislation. The Bill is designed simply to ensure that, when the action of any person working in the NHS needs to be investigated, that person will not be able to escape by resigning.
Such a requirement is desirable for two reasons. First, it would assure patients—our constituents—that genuine complaints will be investigated, and that no one will be able to thwart the process by leaving the health service. Secondly, it would enable those working in the service to state that any errors or complaints will be investigated fully and properly, irrespective of whether they are still so employed. The Bill proposes to insert after "if they are"—employed in the service, that is—the wordsor were at the time of the action complained of.That simple change is proposed in paragraphs (a) and (b) of clause 1(2).
Having had to deal with private Members' Bills when I was a Minister, I can tell the present Minister that civil servants are inclined to say, "This Bill deals with a minor issue. Many other matters need tidying up. Why not say to the Bill's promoter, 'We like your idea, but perhaps you will give way and allow us to introduce legislation that covers the wider issue more comprehensively'?" Those of us who have been in the House for a long time will have heard that sort of thing from Ministers of all persuasions, and I fear that the present Government may take the same line now, although I hope that they will not.
Of course the law could be strengthened in other respects. It is obvious, for instance, that some change is needed to the General Medical Council, and greater powers of investigation may also be necessary. A number of matters that are not in the Bill, however, might be covered under its general aegis. We accept that other aspects of the health service may need to be reformed, and we would support the Government in such action, but I plead with the Minister not to ask my right hon. Friend to withdraw his Bill and wait for the Government to act.
The Minister is fairly new in her post, but I am sure she knows that getting a private Member's Bill into the Government's programme is terribly difficult, and the more minor the Bill, the more difficult it is. If the Government took the line that I have described, even the little alteration proposed by this Bill might not be made for four, five or six years. I am sure that the Minister will be able to elaborate on other matters that need to be dealt with, but I implore her to allow my right hon. Friend and the Bill's sponsors their little but, I think, important amendment to the original Act. It is simple and definite, and could, we suggest, be implemented three months after the enactment of the Bill.
The Minister would do a disservice if she postponed such action, which I think should be taken immediately—indeed, it ought to have been taken some time ago. We have the opportunity now. The Bill has all-party support and we want the Government to add theirs.
§ 10.5 am
§ Mrs. Janet Dean (Burton)
I support the Bill, but I wish that it went a little further, especially in dealing with potential problems in the private sector. It does nothing to prevent someone working in that sector from engaging in malpractice which an ombudsman would not be able to investigate.
I have another concern, which may be answered later. How long after the retirement of a doctor could an action be brought? The arrangement in the Bill seems to be open-ended. While I accept that it is vital for patients to be protected, and to feel that they are protected, I think it equally important to prevent circumstances in which a doctor, many years after his or her retirement, could be brought before an ombudsman because of an action that took place a long time ago. That loophole must be closed.
The Consumers Association has raised several issues in that context. It points out, for instance, that important information about a practitioner's performance may never come to light. That should be dealt with, especially in the light of recent events. A doctor may retire from general practice, but then work as a locum or move to the private sector, and an ombudsman will not be able to investigate. It is vital that information is available to enable a complaint to be dealt with right through to the end.
§ Mr. Philip Hammond (Runnymede and Weybridge)
The hon. Lady mentioned the private sector. I wonder whether she was as disappointed as I was by the Government's failure to take the opportunity in the Care Standards Bill to ensure proper regulation of clinical standards in that sector. Can I take it from the tone of her remarks that she would support amendments to that Bill to bring about such regulation?
§ Mrs. Dean
I am sure the Government will consider that. No doubt the Minister will respond to the hon. Gentleman's suggestion later.
People must feel that they have the right to take their complaints as far as is necessary. I hope that most people, whether or not their complaints are genuine, will approach their own doctors or dentists, so that the problem can be investigated in the surgery, as close as possible to its source. We all know of cases in which medical problems have not been diagnosed as early as they should have been. In such cases, people want to know that a lesson has been learned. Although we seem to be following America with litigation, most people do not want to take such action; they simply want to be reassured that when a mistake has been made—when, for example, a medical condition has not been identified, and the patient has been put at risk—the fact has been recognised and steps have been taken to ensure that the same thing does not happen to someone else. It is the same when, tragically, someone has lost a loved one. That person wants to feel that that is unlikely to happen again—that someone has learned a lesson.
People search for answers and for reasons, especially if they have lost a loved one. Most of the time, the questions cannot be answered, but people need to be able to talk. That is probably the most important thing that doctors, dentists and others can recognise. Although loss of life is less predominant in the dental profession it does occur. People need to know that they can discuss these things and to feel that the matter has been resolved. Following 672 on from that, it is vital that people have confidence in the whole procedure. If the case goes ultimately to the health service commissioner, they will need to be sure that he will address the matter.
As the right hon. Member for Wealden (Sir G. Johnson Smith) has said, it may happen in only a few cases, but it is appalling to think that someone can reach the stage of submitting a complaint to the commissioner, only to be told that the person concerned has retired. After retiring, that person may still operate as a locum. People would be afraid if they thought that someone who had been brought to the attention of the commissioner was treating them as a locum.
As I say, people should have confidence in the system. They should be able to feel that, once a case reaches the commissioner, the matter will be fully investigated. I can think of nothing worse than getting to that point and then finding that the doctor has retired. They must for ever feel frustrated. We all know of constituents who come to our surgeries who experienced some tragedy 10 or 20 years ago—not necessarily medical—and who still live with it. Unless they can get to the bottom of their difficulty, they are never able to put it to one side. I go back to the point: if the matter can be resolved as close to the problem as possible, that will be far better because people are then much more likely to get over it.
Throughout the medical profession, there would be less litigation if answers could be given sooner. I know that it is a vicious circle. People are afraid of being taken through the legal system and, therefore, of answering certain questions, but I wish that we could find a way around that so that people would feel that they could respond to a patient's anxieties and concerns and answer them properly. There would then be less litigation in the first place.
As I say, I am concerned that cases should not be open ended. Someone who, perhaps, has an obsession should not be able, years later, to disrupt the life of a general practitioner who has been happily retired for five years or so. We need to address that point, so that a case is not considered a long time after the event.
However, we should also be able to close the loophole to which I referred. I am not sure whether anything can be done through the Bill, or indeed through Government legislation—although the right hon. Member for East Devon (Sir P. Emery) does not like that idea—so that we have more control of, and people have more redress over, those operating in the private sector. It concerns me that that is not dealt with in the Bill. It is incredible that the 1993 Act should be found to have such a shortcoming and that an alleged incident when someone was practising cannot be investigated. We should do anything that we can to close the loophole.
§ Mr. Kelvin Hopkins (Luton, North)
It gives me great pleasure to support what is a small but important Bill. I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on introducing it. I am one of those who remember him in his previous job as a 673 television presenter on the excellent "Tonight" programme some years ago. I was rather surprised to find how long ago the programme was put on.
§ Mr. Hopkins
Indeed; it reminds me of how old I am, too.
At that time, I had no aspiration to become an hon. Member, but it gives me great pleasure to debate this important issue with the right hon. Member for Wealden and, indeed, to be on the same side.
The ombudsman concept is Scandinavian in origin. It is an important concept and institution in our constitutional arrangements. It is typical that it came from that civilising region—so many of its ideas have been initiated, adopted and imitated elsewhere. As a member of the British-Swedish all-party group, I take a great interest in Scandinavian affairs.
It is important for our constituents to have the right to take complaints to an ombudsman. They are known as ombudsmen rather than commissioners. I do not know about other Members' constituents, but mine refer to them as ombudsmen, ombudspersons or whatever, rather than commissioners, even though in law they are known as commissioners, I think. It is a vital backstop for constituents to pursue their complaints.
I want to follow up the comments of my hon. Friend the Member for Burton (Mrs. Dean). Many constituents become somewhat obsessed with their problems, particularly if they are medical. They come to me, or even go to the community health council, but they do not meet medical experts who can help them. If they have the right to pursue the matter through to the ombudsman, at least they will have the benefit of professional advice and comment. Neither they nor I possess such knowledge.
Importantly, the Bill eliminates certain loopholes. As we have heard, family health service providers can go into bankruptcy or liquidation. I do not suggest that they do that deliberately—but, who knows, if they are in serious difficulty with a patient and can get away with it, they might do that. If a practitioner were of a certain age, he could choose judiciously to retire just before a problem arose, if he realised that he had made a mistake but no complaint had yet been made. He could retire before the complaint came forward, perhaps even before the patient realised that he should complain. Some professionals are clever enough to be able to use such a ruse to escape being pursued by someone who has been wronged by them. Sometimes, it is a question of incompetence or lack of effort, rather than a medical misjudgment. Nevertheless, they can avoid being pursued.
I address my remarks specifically to general practitioners. They could apply equally to dentists, opticians and pharmacists, but I am most concerned about GPs because they face the whole range of human ailments. I understand their difficulty. If one is faced with the possibility of every type of illness and condition, to make a judgment in a 10-minute consultation is difficult. I do not underestimate that difficulty and I also understand that to keep up to date with medical practice and new discoveries is difficult. Nevertheless, sometimes they still have to be brought to account for mistakes.
674 General practitioners work under great pressure, partly because Britain's ratio of GPs to patients is not good. We have to improve it. The Government foresee a future when the ratio is better, so that our aspiration to be the best in the world is realised—but we are some way from that goal. I am concerned about the ratio, as are many other hon. Members.
I talk about my local GPs because that is my experience. Generally, I have a very good relationship with them; they are very good GPs. I speak with them occasionally. I also have a good relationship with the members of the new primary care group. We have meetings and, occasionally, we even have dinner together—including groups of GPs—so that we can keep up to date and in touch with one another.
Nevertheless, one hears—sometimes through the community health council, but sometimes through cases brought to me personally; I am sure that other hon. Members have the same experience—of cases in which patients have not been treated appropriately. In such cases, it is very difficult for patients first, to make a judgment, and secondly, to challenge a GP. In asking a difficult question, one may put at risk one's good relationship with the GP. We all appreciate those difficulties. Those patients are able to go to their CHC or to me, as their Member of Parliament. Ultimately, however, they have to be able to go to an ombudsman.
I should like to digress slightly to deal with one point, although I think that it is legitimately within the ambit of this debate. I believe that group practices are better than single GP practices in avoiding a patient's need to visit an ombudsman. I ask my hon. Friend the Minister and her colleagues to try to persuade as many single GP practitioners as possible to join together in group practices. Group practices are a way of avoiding problems, as doctors within the group are mutually supportive and are able to consult one another if there is doubt about a patient's case.
Recently, I had a case where a patient complained about one member of a group practice, went to another member, was diagnosed with a serious condition and referred to hospital. Previously, the patient had been prescribed analgesics and told to go home to bed. A second opinion can be important, and it is quite easy to obtain one within a group practice. Moreover, within such practices there are collective pressures on doctors to ensure that care standards remain high.
Although I have no statistics to support the contention, I suspect that group practices have fewer problems than single member practices have. I am not saying that single GP practices do not do a very good job in most cases. However, there are GPs who perhaps belonged to a group practice, did not have a happy experience there, chose to go out on their own and, subsequently, have had difficulties with certain patients. Those patients need to be able to go to an ombudsman.
I suspect that it is precisely those GPs, especially if they are older, who would be able to take retirement as a way out of facing a difficult situation—to avoid dealing with the complaint of a patient who has been misdiagnosed and treated wrongly in one way or another. Mistakes are possible in the best of worlds. However, I think that group practices are better at preventing most mistakes from occurring initially, and at dealing with them if they do occur.
675 I have a personal experience that demonstrates that there are differences between individual members of the community. Some constituents are professionals. Some, like me, may have a scientific and even quasi-medical background. Some years ago, I went to my GP and told him that I had an umbilical hernia and needed an operation. He was slightly affronted by my presumption and said, "I'll examine you and decide what's wrong with you." He examined me and said, "You have an umbilical hernia and need an operation." In such situations, my wife calls me "clever clogs". I hasten to add that I would not presume to make a self-diagnosis in every case.
Most members of the population are not capable of making a self-diagnosis, but have to rely absolutely on their GP's word for what is wrong with them. If one is given an analgesic for a malign tumour, for example, it is a serious mistake. Pressure on GPs must be maintained. Even good professionals must be kept up to the mark and know that there is a complaints procedure that really works. They must know that there are no loopholes that will enable them to escape their responsibilities.
As I said, most members of the population—most of my constituents—are not as pompous as I am and therefore do not think that they know what is wrong with them. They depend on their GP. It is absolutely vital that, when they go to their GP, they know that they are talking to a professional who is up to the job and who will do his or her very best to ensure that they are diagnosed and treated correctly. The Bill will help to ensure that every GP behaves appropriately and professionally towards their patients.
§ Mr. Brian Jenkins (Tamworth)
I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on coming fourth in the lottery for private Member's Bills. I aspire to obtaining such a slot, but suspect that I shall have to serve in the House for another 40 years before I do so. I may not make it. The right hon. Gentleman—who has made it—has chosen to address a very sensitive issue. Although I understand why he chose it, I should like to raise a few related issues, on which I invite interventions—particularly by the Minister—if I need to be put right.
I am what is known as a cynical individual. I thought that, originally, our national health service was based on the concept that our doctors are not employees, but contractors, and that we pay them as contractors. Under that contract, complaints are dealt with on an almost commercial basis. We are able to investigate complaints about the performance of specific aspects of the contract, but only on those specific aspects. Under the contract, the patient is less a traditional consumer—a consumer is able to choose a service and decide whether to pay for it—and more a recipient of the service. The health service commissioners look after patients' rights and welfare under the contract, to ensure that we are getting a good deal. That is one of the problems.
Let us suppose, as an analogy, that a garage down the road is selling Fords, Rovers and Mercedes, that someone bought a Ford from it, and that the car turned out to have a problem. How would we feel if, when the person complained, the garage owner said, "I no longer sell Fords", and that person had no contractual right to complain directly? Patients are in that type of ball game.
676 I have no problem with the Bill, which starts to address that issue, but I want to know why we are not going further in amending the legislation. Like the hon. Member for Runnymede and Weybridge (Mr. Hammond), I think that regulation of the private sector should be tightened up. I am not against a nanny state, because we have a duty to protect our citizens from those who do not provide a good level of service, in whichever sphere it is provided.
Like my hon. Friend the Member for Luton, North (Mr. Hopkins), who focused in his speech on single general practitioner practices, I should like to try to put the situation in the health service in perspective. I have frequent contact with the medical profession and I see my doctor regularly. At his surgery, we often spend five minutes on my case and 10 minutes on his, as he describes problems in the health service. What are some of those problems?
When my doctor joined his practice, there had been 1,200 applicants for the post. A few years ago there was another opening for a partner, but there were two only applicants. If we are to maintain high service levels, there will have to be competition in the profession. Britain is not, however, churning out enough well-qualified, good doctors to meet our needs. We therefore have many single member practices, located primarily—although this is not written in gospel—in the poorest inner-city areas. Many capable, good doctors decide to join a group practice in the leafy suburbs and shires of England. We shall end up with a different strata of service. How can an ombudsman, or commissioner, say that the level of service is not good enough?
§ Mr. Andrew Dismore (Hendon)
I follow what my hon. Friend is saying, but as a London Member I am concerned that he does not recognise the excellent work of dedicated general practitioners in group practices on housing estates, who carry out forward-looking work and are in the forefront of developing the NHS. I suspect that some of the practitioners to whom my hon. Friend is referring may be a little behind the game.
§ Mr. Jenkins
I did put in the caveat that I was not speaking specifically. Of course, the more challenging work needs to be done where health needs are greatest—in poor, deprived, inner-city areas. I am well aware that emphasis should be placed on urban areas. It all may look fine on paper, but if we ask the commissioner to hound down the bad doctors, he may say, "If we get rid of the bad doctors, who will take their place?" We do not have enough doctors to go round. The statistics show that the worst covered areas are in deprived inner cities. Doctors will not want to work in those areas because the work is hard and the rewards are not sufficiently good. They would rather have an easy life.
In considering the legislation, we must ensure that the commissioner is in a position not only to name and shame, but to question the Government.
§ Mr. Hammond
Before the hon. Gentleman moves on from single-handed practices, I remind him that single-handed practitioners bring value to the system in sparsely populated rural areas. I am sure that he will agree that in pressing the case for group practices, for all the valid reasons that he and the hon. Member for Luton, North (Mr. Hopkins) have outlined, he would not want 677 that to result in denial of access in sparsely populated rural areas as people were forced to travel further to get to a GP.
§ Mr. Deputy Speaker (Mr. Michael J. Martin)
Order. We must be careful that we do not go wide of the Bill and get into a general health service debate.
§ Mr. Jenkins
Thank you, Mr. Deputy Speaker. You jumped in just in time to stop me responding to that intervention. However, I totally agree with the hon. Member for Runnymede and Weybridge (Mr. Hammond) about the problems in sparsely populated areas.
I am trying to set the legislation in the context of what is possible in the real world. It is no good passing laws that are unenforceable. Not only must we close the loopholes, we must discuss the role of the commissioner and how the providers of health care should be brought into line. That includes the role of the British Medical Association and the General Medical Council.
We should ask why it is so difficult to investigate the work of a doctor. I hate to refer to specific cases, so I shall speak hypothetically of a case in which a doctor who had been culpable of the death of a young child continued to practice for more than 20 years before his right to practice was withdrawn. Why are we not getting such people out of the system? Why are they not retrained?
I am very lucky in that the GPs in my local practice have worked together closely for the past three or four years. When they become a trust, one of the doctors will have the role of a mentor. One of his functions will be to draw up the standards of his colleagues. I welcome that, but who will drive up his standards? Who will watch the watchers? The health authorities will lose power when the cash goes directly to the trusts, and when that happens who will control them? I worry that if we do not have an independent commissioner to act on behalf of the patient rather than the purchaser, we shall force people to go to the law. However, lawyers will only take a case that is winnable.
As the hon. Member for Burton (Mrs. Dean) said, we should also recognise that, on retirement, a GP should not be hounded until his dying day. There must be a reasonable time limit for investigations. However, a GP must not be placed in the position where he cannot work for the health authority or the NHS, but can continue to practice in the private sector in a practice that was purchased and built up using public moneys.
My local GP practice, as a former fundholder, was expanded using money that was not spent on patient care. The receptionist is employed by the practice. He is a contractor who gives me a ticket. I then go to a private shop where a pharmacist gives me drugs produced by a private company. The only time I meet an employee of the health service is when I go to hospital. Yet we speak as though we had a publicly run service staffed by public employees. It is not; it has always been a publicly funded private service. We must maintain safe scrutiny on behalf of the patients. At the end of the day, the commissioner must be the patients' champion.
My hon. Friend the Minister, in particular, must recognise that the Bill, welcome though it is, is only a small part of what must be a continuing programme to try to improve the delivery of a quality health service.
§ Mr. Andrew Dismore (Hendon)
I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on securing his place in the ballot and selecting such an important subject for his private Member's Bill. Its long title goes beyond the specific matters in the legislation and raises wider issues.
Perhaps I should declare a sort of interest. Although I have never been an ombudsman, in my practice as a personal injury lawyer, I have taken a few pounds off the NHS in respect of medical negligence claims. Obviously, I have not done so since I was elected as I would not dream of pursuing my own party on such issues. Nor do I have the time to practise and be a Member of Parliament. However, my experience and that of my law firm in dealing with medical negligence cases against the NHS and the private sector provide a certain insight into how the NHS deals with complaints and how the ombudsman service works.
The reason why the Bill is so important is set out in the health service ombudsman's annual report on the health service commissioner for England, Scotland and Wales 1998–99 at paragraph 4.13 which states:It was inevitable that the experience of the first few years of my extended jurisdiction would raise problems caused by the wording of the legislation which governs my role … A further issue on which I have expressed my concerns to the Department of Health is my inability to investigate complaints against GPs who retire or cease NHS work after the events complained of—or even during my investigation.He stated that he was advised by his lawyers that the wording of the 1993 Act
precludes me from investigating such a complaint if the GP has left NHS work since the event complained of, and requires me to discontinue my investigation if the GP retires before or during my investigation. That occurred in two cases in 1998–99. In my view this is a clear injustice. It is unfair to complainants, and has the effect of giving GPs—and, by the same token, other FHS practitioners—immunity from investigation by me after they retire, which is not shared by clinicians employed by Health Authorities and Trusts: I may investigate their actions after they retire, in the context of a complaint against their employing organisation.He also expresses the hope that there will be an early legislative opportunity to deal with the problem.
The words of the health service commissioner are important, because he raises the issue in detail, but the issue goes further. The right hon. Member for Wealden mentioned a case that was referred to by the Consumers Association in Which?, and the facts of that case support what he is trying to achieve. The facts bear restating, because they concern a reader, Mr. Peter Smith, who contacted Which? after the investigation into his wife's GP was dropped. Which? states:Peter's wife, Dorothy, a retired headteacher, died from leukaemia, and Peter complained to the ombudsman that Dorothy's GP hadn't diagnosed it.In the months before her death, Dorothy had visited her GP several times. But she was diagnosed only after she'd paid for private tests and another GP had acted on the results. Sadly, she died three months after this.Peter had complained to the Health Service Commissioner, but the Commissioner dropped his investigation on legal advice when he discovered that Dorothy's GP had retired from his practice.679 That is a scandal and clearly reveals a loophole. The Consumers Association, in its briefing on the Bill, said that itmeans that … complaints, which have been deemed as worthy of investigation by the Health Service Commissioner's Office are not seen through to their logical conclusion … Important information about a practitioner's performance may never come to light while the individual practitioner can continue to treat other patients … Practitioners who are concerned about the outcome of the Health Service Ombudsman's investigation can simply retire from NHS practice as a means of avoiding having to answer for their actions—and most importantly—Patients are denied their right to have their complaint thoroughly considered and investigated.The right hon. Member for Wealden referred to the actions that have been taken by the Home Office to deal with that loophole in relation to the police service, in the wake of the Stephen Lawrence inquiry. I shall not pursue that point, save to say that if it is important for police officers, it is equally important—if not doubly so—for doctors. In that context, Nick Stace, the senior public affairs officer at the Consumers Association, has said:GPs should not be allowed to get away with avoiding complaints by simply retiring. If GPs have got something to hide, there is even more reason for the public to know. Consumers want fair treatment. This Bill is an obvious first step in achieving this.I also contacted Action for Victims of Medical Accidents and it also supports the Bill. It said:We welcome this Bill, which is intended to close a loophole that allows doctors to avoid investigation by the Ombudsman by retiring.The Ombudsman does not lightly undertake an investigation—I shall give some of the statistics on that later—If a doctor has behaved in such a way that the Ombudsman has decided that his behaviour should be investigated it is important from the point of view of the patient or the patient's relatives that the investigation takes place. For the doctor to be able to escape being investigated simply by retiring is not only unjust but leaves the impression that doctors are not accountable.Lack of accountability has been the major issue for patients for years … It is only recently that the Ombudsman has been allowed to investigate matters of clinical judgment … That was a major source of frustration to patients.To those, however, who find themselves in the position where the Ombudsman actually is able to investigate, and agrees to investigate, only to have the doctor escape investigation by simply retiring, it seems a travesty of justice.I echo those comments.
I also contacted the local medical committee in my local health service area of Barnet and it also supports the Bill. The BMA also supports the Bill, and has said:Retiring from the NHS does not prevent the GP to continue to practise as a locum—a temporary stand-in doctor—or to practise privately.That is an important point when one considers the role that locums play in the NHS, especially in the inner cities—as my hon. Friend the Member for Tamworth (Mr. Jenkins) pointed out—in covering overnight care. GPs are run off their feet during the day and house calls at night are often done by locums or contracting services brought in by the GPs. Often, locums see patients in great distress, at times when they might not be entirely clear in their descriptions of their symptoms. The locums also do not know the patients' histories, and one of the great strengths of our family doctor service is the continuity that comes from the same practice looking after the same family for generation 680 after generation. That can break down if a locum is called out to cover for illness or holiday, or to provide overnight care. There is, therefore, a greater risk that problems may arise with locums.
§ Mr. Jenkins
If a locum has no access to individual records and is called out, as part of a commercial activity, and then makes a mistake because of the lack of access to those records, is his competence or the system in question?
§ Mr. Dismore
Both would possibly be in question, but we have to be realistic. As it becomes more common for records to be computerised, we may have an answer to that problem, but it is inevitable that locums will be used. My concern is not the competent locum, who will bear in mind the conditions in which he has to operate—which may include not having a complete medical history—but those doctors who have retired from the NHS to avoid an inquiry by the ombudsman and who still practise as locums. Their competence may be in question, as well as their ability to operate in the circumstances that I have described.
It is important that the BMA welcomes the Bill. It supports the initiativeto ensure that a complaint against a GP could be investigated regardless of whether or not the GP retired from the NHS and to remove the loophole through which GPs can evade investigation. Information as to the performance of the doctor revealed in the investigation would assist in the assessment of the GP as part of the revalidation process and as part of any investigation by the General Medical Council.My hon. Friend the Member for Burton (Mrs. Dean), who is no longer in her place, made an interesting point about time limits, which are not addressed in the Bill. While I understand the point made by her and my hon. Friend the Member for Tamworth, we must proceed cautiously. When considering the complaints procedure in the NHS, of which the ombudsman forms part and which the Bill aims to improve, we need also to consider the relationship between the complaints procedure and clinical negligence cases. If the time limits for complaints are less generous than those set out in statutory and common law, we run the risk of throwing the baby out with the bath water, in that the only remedy then available to the patient who wanted to make a complaint after the time for complaint had run out would be to go to law. I am sure that we all agree that it would be better if we could devise a system that satisfied complaints without recourse to law.
§ Mr. Jenkins
It is one thing to have a time limit of, say, six years, but a catalogue of events may stretch back 20 years. Memories fade and records are not necessarily kept, so justice cannot be achieved after such a long time.
§ Mr. Dismore
I do not wish to start a peroration about the way in which the limitations legislation works, because that would stretch your patience a little too far, Mr. Deputy Speaker. However, I still keep up to date by reading the law reports in the quiet hours while waiting for late-night votes and many cases involve interpretation of the law on limitations. While we have a standard bar of three years for bringing a claim, there are many exceptions and it is important that those exceptions are translated into any complaints procedure in the NHS. The 681 most important exception is the date of knowledge exception, because people may be injured by an incompetent doctor but not know that they have been injured until several years later when the symptoms re-emerge. We read frequently of cases in which patients have been troubled by something for several years and they are opened up and it is found that a bit from some previous operation had been left inside them. There is no way for patients to know about that, as they are unconscious during operations. All they know is that there is something wrong with them. We have to be careful about introducing time limits, and the limits set out in the legislation are the ones that should be introduced into the ombudsman process. Serious problems could arise if we were to do otherwise.
My main problem with the Bill is that it does not go far enough. The reports from the health service commissioners and from the Select Committee on Health, which has examined the matter over several years, point out serious problems with the original Health Service Commissioners Act 1993. Its most serious loophole was that it placed clinical negligence outside the complaints procedure. That loophole was closed by the Health Service Commissioners (Amendment) Act 1996, but many problems remain. I hope that we will be able to plug more of the loopholes in the 1993 Act as we consider this Bill in Committee.
The Bill has an ambitious long title. It is toAmend the Health Service Commissioners Act 1993.That ambition is let down somewhat by the modesty of the amendment that it proposes. However, the scope of the long title would be sufficient to allow the concerns expressed by hon. Members of all parties to be addressed.
On 7 December 1999, GP magazine highlighted one of the problems of the existing system. It reported:the Medical Defence Union's deputy head of advisory service, Dr. Patrick Hoyte, said the powers of the NHS ombudsman were so weak it was unlikely a GP would feel compelled to retire to escape a ruling.He told GP: "The ombudsman can only name and shame. How much of a sanction that is is debatable. I'd be surprised if a GP would think of retiring to avoid an investigation.I think in cases where GPs have retired it may be purely coincidental.That may or may not be true, but the Medical Defence Union gives the game away when it states that the ombudsman has very few powers. The Bill may catch one or two more doctors who could be named and shamed, but it will not solve the problems of most of the patients who resort to the ombudsman.
The quotation in GP magazine is instructive. The Medical Defence Union's job is to insure doctors against clinical negligence claims, and it has done more than any other body to obstruct complaints being brought and satisfactorily disposed of. It tells doctors to be careful about what they say to patients for fear of compromising their legal position. It fights medical negligence cases tooth and nail and strings them out for years. It is part of the problem, not the solution. By rubbishing the ombudsman service in that way, it is ensuring only that there will be more work for the insurance companies, for whom more complaints brought through the courts mean more trade.
§ Sir Geoffrey Johnson Smith
I respect the hon. Gentleman's wisdom, gained as a practising lawyer in this field, but I hope that he is not suggesting that the Bill should be dropped because it does not go far enough. Wider reform would be a matter for the Government, but we must get our priorities right and deal with what we know we can deal with. The Bill has raised no objections and is a modest but significant improvement on the 1993 Act. We should not wait for the grand legislative scheme that he is beginning to outline. It is hard for me to swallow the concept of waiting and throwing the Bill out at this stage. I cannot foresee the Government including the provision in a Queen's Speech, given that there is already a long waiting list of measures bidding for recognition by the House of Commons.
I hope that the hon. Gentleman will agree that whatever modest change the Bill may make should go ahead, and that we should not spend a great deal of time trying to do what we know the Government one day may wish to do.
§ Mr. Deputy Speaker
Order. The right hon. Member for Wealden (Sir G. Johnson Smith) has made an important point. The Bill before us is a very narrow piece of proposed legislation, and it is determined by its title and by its contents. The hon. Gentleman is looking at matters that could be amended at another time, and I remind him that we can consider only what is before us this morning.
§ Mr. Dismore
Thank you, Mr. Deputy Speaker. However, the Bill's long title states that the aim is to amend the 1993 Act. That is very ambitious, and I believe that it would be in order for us to table amendments in Committee to deal with the shortcomings in the existing system identified by me and other hon. Members.
I have no objection to the Bill. I support what the right hon. Member for Wealden is trying to achieve. However, the long title permits us to address other issues by means of amendments to the Bill in Committee.
§ Mr. Deputy Speaker
Perhaps I can assist the hon. Gentleman. As I mentioned, the Bill's scope is determined not only by its title, but by its content. He must confine himself to the content of the Bill.
§ Mr. Hopkins
I am slightly worried by something that my hon. Friend the Member for Hendon (Mr. Dismore) said. Will he say whether problems could arise at the interface between the areas covered by the Bill and the legislation that it amends, and the areas that are not? Is it not important to ensure clear definition so that the Bill's scope is as wide as possible? If the limits of its application are blurred, people might be able to evade its provisions.
§ Mr. Dismore
That is an important point. We have to look at the role of the ombudsman, which is clearly set out in his report. He states:My core role as Health Service Ombudsman is to deal with complaints. My office is not at core an audit or educational body, although we do a lot of work to feed the outcomes of our work into those important areas.683 The ombudsman is part of a much wider NHS system of dealing with complaints, and we have to see his role in that context.
I shall not test the House's patience by going through the whole NHS complaints procedure, but we must understand why people get frustrated when they bring a complaint against a GP who has retired or who goes on to retire. Before the ombudsman can get involved, the internal complaints procedure has to be exhausted. One of the problems with the internal complaints procedure is that it takes so long.
The first stage of the internal procedure is the local resolution, under which the health authority trust and the relevant primary care practices are required to establish procedures for investigating and resolving complaints. If that process fails, the second stage is the independent review panel. Patients and carers who are not satisfied with the outcome of local resolution are entitled to request an independent review to consider the complaint. If they make that request, the complaint is reviewed by a convener, who is usually a non-executive director of the relevant trust or authority.
Patients who are still not satisfied can refer the matter to the health service commissioner. The Bill seeks to solve the problem of GPs who retire before a complaint to the ombudsman can be determined.
It is my experience, and I am sure that it is shared by hon. Members who have had to deal with complaints against doctors, that the NHS internal complaints procedure can take many months to grind through the various stages. For example, I was told about the case of a woman who underwent a biopsy on her cervix, having been assured that it would not affect her fertility. The procedure was not properly carried out and in fact they sewed up her cervix. She was not happy: she obtained the medical records, made a complaint, the trust said that it had lost the records, she sent it copies, there was a lot of delay, no meetings were offered, the trust would not agree to an independent review, she lost faith and she litigated the case.
If it takes perhaps a year before a case even reaches the ombudsman and the ombudsman then takes another year to investigate it, the general practitioner concerned could have died of old age, never mind retired, by the time the case is concluded. We must examine the way in which the ombudsman looks into the complaints procedure. The point was made that GPs would retire anyway. They may not be doing it to avoid litigation or a complaint, but we must bear that eventuality in mind. If the complaints procedure takes for ever to exhaust, retirement before a conclusion is reached is likely to occur.
The other problem that may motivate GPs is the appalling attitude that doctors sometimes exhibit when complaints are made against them. They try all sorts of tricks to avoid complaints, which is regrettable. In his report, the ombudsman stresses—
§ Mr. Oliver Letwin (West Dorset)
I have been listening with fascination to the hon. Gentleman's remarks. As I have the impression that he may be intending to continue for some time, and I know from experience that his energy is almost inexhaustible, could he give us an estimate of how long he intends to continue wittering?
§ Mr. Deputy Speaker
Order. It is not for the hon. Gentleman to concern himself about how long another hon. Member speaks. As long as he is in order, he is entitled to speak.
§ Mr. Dismore
I am grateful to you for your protection, Mr. Deputy Speaker. I was talking about the attitude of doctors to complaints and the tricks that they sometimes try to avoid liability.
§ Mr. Hammond
As the hon. Gentleman is making a point about doctors' attitudes, does he think that doctors are different in that respect from other professionals, particularly lawyers?
§ Mr. Dismore
I think that there are good and bad in both professions. I would be out of order if I digressed about the way in which the Law Society is, or is not, trying to clean up its act. Reputable legal practices—including, I hope, my own—have proper complaints procedures, as required by the Law Society. They view complaints in the correct light—not as something to be frightened of, but an opportunity to work out what went wrong, put it right, learn from experience and improve the processes. Some doctors, however, do not regard complaints in that light, although the ombudsman made it clear in his report that he thought that the British Medical Association—the profession—viewed complaints more constructively.
I should like to answer the hon. Gentleman's question by quoting something from the magazine Pulse. It was said by the chair of the local medical committee in the constituency of the right hon. Member for Wealden and is revealing about his attitude towards complaints. Dr. Ted King was commenting on the Bill and I think that he was having a bit of a pot at the right hon. Member for Wealden, quite unfairly. Dr. King said, in opposing the Bill, that the mood was more about revenge than justice. He said that serious complaints could still be pursued by patients through the civil courts, so patients would mainly use the new law to pursue trivial grievances. Dr. King said:Most complaints are not serious—there is a large revenge element which occurs when patients don't get what they want.Those comments were made directly about the Bill.
§ Mr. Deputy Speaker
Order. I think that the hon. Gentleman is going wide of the debate before us. He cites cases of neglect or possible neglect, but the Bill deals specifically with doctors who seek to retire after a charge is made against them. That makes it a very narrow matter indeed.
§ Mr. Dismore
Thank you, Mr. Deputy Speaker. I referred to that quote because it shows the right hon. Member for Wealden's own local medical committee having a go at the Bill and, presumably, indirectly having a pot at him. I am sure that he is far too clever a politician to have a go at the doctors in his constituency, but I do not see why I cannot at least answer on his behalf.
§ Sir Geoffrey Johnson Smith
I am surprised that anyone should wish to have a poke at me on this subject. I have always enjoyed very close and friendly relationships with the medical profession in my 685 constituency and elsewhere. Two members of my family are doctors, by the way, but that has nothing to do with the Bill.
§ Mr. Dismore
I assume from what the right hon. Gentleman says that neither of them are close to retirement.
My point goes back to what I was saying regarding the Medical Defence Union. If the ombudsman's service is to operate effectively and people are not to avoid liability by using the loopholes that exist and those identified by hon. Members, there will have to be a sea change in the way in which some—not all—doctors, approach complaints.
§ Mr. Hopkins
A propos the recent comments made by Conservative Members, may I say that I am finding my hon. Friend's speech particularly interesting and illuminating? Within the scope of the debate, I hope that he will make every point that he has at his disposal, because I am learning a lot from listening to him.
§ Mr. Dismore
I am grateful to my hon. Friend. If I stray too widely from the matter before us, Mr. Deputy Speaker, I am sure that you will bring me back to order. Perhaps I will be able to fill in the gaps for my hon. Friend in the Tea Room afterwards. The Bill raises important points, and I have striven to put it in context. We cannot look at the health service ombudsman without looking at how complaints first arise.
The BMA's efforts in continuing education and re-evaluation are important in this context. If I may refer to the recent intervention of the hon. Member for Runnymede and Weybridge (Mr. Hammond), my profession is concerned to ensure that lawyers have continuing education and keep themselves up to date. We have put in place all sorts of measures to achieve that. I am pleased that the BMA has recognised the need for re-evaluation of doctors.
§ Mr. Dismore
Doctors who will be retiring because they are coming to the end of their life in practice are the most likely to require re-evaluation and retraining. That is why I think that what the BMA said is important.
You have told me clearly, Mr. Deputy Speaker, that you are not minded to allow me to deal with some of the wider issues that have been raised in the debate by other hon. Members. I had hoped to be able to say something about the problems of private medicine. Other hon. Members managed to get away with it, but I get the impression that I will not.
I turn to the important issue of sanctions. The ombudsman's service, as presently constituted, does not have the powers that it needs to deal effectively with cases. We heard earlier that it was pretty much a toothless tiger: all it can do is name and shame. If a GP retires and is not in practice, naming and shaming will not make much difference to him. I hope that, if the Bill proceeds to Committee, one of the issues that we shall discuss is the sanctions that can be imposed.
§ Ms Bridget Prentice (Lewisham, East)
The sanctions that the commissioner can impose are important to the 686 public and how they respond to his remit. Has my hon. Friend any idea as to what sanctions might be appropriate given that, for the patients concerned, what is often most important is that their grievance has been aired, listened to and dealt with positively by the commissioner?
§ Mr. Dismore
That is a very serious omission, but I shall not try your patience, Mr. Deputy Speaker, further.
Sanctions are not just a question of securing an apology or an ex gratia payment. They are important for doctors who, by retiring, try to avoid the liabilities that might attach to them. That point is addressed in paragraph 4.6 of the ombudsman's report.
§ Mr. Jenkins
My hon. Friend mentioned the length of time that it takes for an internal inquiry to happen and trigger the point at which the ombudsman is brought in. That time might allow the GP to come to arrangements regarding his retirement decision. If my hon. Friend is lucky enough to serve on the Committee considering the Bill—I doubt whether he will be—will he press the Minister to ensure that the ombudsman is brought in much earlier? People do not think that they will get justice if a doctor judges a doctor who judges another doctor and the process is made to drag on until the ombudsman, whom the public regard as their champion, is introduced.
§ Mr. Dismore
My hon. Friend makes a valuable point about the way in which medical complaints are investigated. However, I get the feeling from your previous remarks, Mr. Deputy Speaker, that you will not permit me to go down that route. Perhaps that is unfortunate.
The health service commissioner's report makes an important point about when an investigation is kicked off but he does not follow it through. This is one of the ills that the Bill aims to address. In paragraph 4.6 of his report, the commissioner says:During 1998–99 there were other occasions in which complaints to me raised issues which I thought appropriate to pass to the regulatory authority concerned, because there was a possible risk to the health or safety of patients.That is one of the points with which the Bill deals. He adds:However, the effect of the wording of the legislation governing my role is to restrict the circumstances in which I can pass such information to another organisation, such as the GMC or the Commission for Health Improvement. For example, I cannot disclose information to another organisation if I decide not to investigate the complaint, or if the matter of concern falls to be disclosed in one of my reports.The Bill deals with doctors who retire, and that relates to the circumstances that the commissioner has described when his investigation cannot continue.
The ombudsman adds:As a result, paradoxically, I have less scope to bring concerns to the GMC, for example, than a private citizen has. And my medical and nursing advisers are in a potentially invidious position if they consider that they have a professional duty to act on concerns arising from their scrutiny of a complaint to me.687 That is a particular ill with which the Bill seeks to deal in relation to GPs who retire, but only in so far as the investigation can continue. If the ombudsman decides for some reason that, after starting to investigate a complaint, he will not continue with it, he might not refer that information on to the General Medical Council or the Commission for Health Improvement.
§ Mr. Tony McWalter (Hemel Hempstead)
I am bit concerned by my hon. Friend's use of the word "retire". A doctor aged 30 could easily retreat into the private sector while the heat was on. After the inquiry has been dropped, there is no reason why he should not return to the health service. I do not want my hon. Friend to give the impression that the provisions apply only to elderly doctors who have begun to get slack.
§ Mr. Dismore
I am grateful to my hon. Friend. I would have liked the opportunity to comment on private medicine, but given the views that you, Mr. Deputy Speaker, have expressed, I suspect that you will not allow me to go down that route. However, other Members have raised that point.
We need to consider what people expect from the complaints procedure against a GP who has retired or one who has gone into private medicine, and the Bill will deal with cases involving GPs who retire. People expect to have their complaints properly and promptly investigated. They want to know what happened and they want to be sure that it will not happen to anyone else. Many of the problems that result in claims for medical negligence would disappear if we could create a system in which complaints are investigated and the doctors concerned apologise.
I can give an example from my own experience. I was a victim of medical negligence myself. I had to have an injection in a shoulder for a tendon problem. When I see a doctor in hospital I have always made it clear what I do for a living just to keep him on his toes. However, we became so involved in discussing that issue that the doctor injected the wrong shoulder—a classic example of getting the wrong limb. He immediately explained what had happened, what the effects would be, said that he was sorry and that was the end of the story. I have suffered no long-term ill effects—as far as I know anyway. The approach taken by that doctor is what we are trying to achieve by having a more effective complaints procedure in which the ombudsman is the pinnacle of the process.
The Bill may have implications for resources. We know from the ombudsman's report that the number of cases that he investigates is not that great compared with the total number of complaints that he receives. In 1998–99, he received 2,869 complaints, of which 119 were investigated. Of the 119, roughly half the complaints62—were about clinical matters. His report suggests that two or three of those complaints would have been caught by the Bill, so quite a few complaints could be investigated under it.
I am concerned about the principle of quis custodiet custodes and making the ombudsman system work effectively. His report illustrates graphically the length of time that he takes to deal with complaints. I am concerned that the Bill may increase his work load to such a degree that he cannot deal with complaints effectively.
688 The end of the report deals with the number of cases and investigations that the ombudsman has handled. It takes up to a year—three or four years ago, it took even longer than that—to deal with a complaint and that simply undermines the whole system. If the Bill adds to his work load—he investigates only a small proportion of the total cases involved—even by only 10 or 20 cases and the resources are not there to enable him to do his job effectively, it will have a knock-on effect on other cases and the undesirable consequences that I described earlier. The complaints process will take longer, people will become unsatisfied and they will resort to law as the only recourse left open to them.
We need to ensure that the public have confidence in the complaints procedure. To do that we have to ensure that it is timely and effective. You, Mr. Deputy Speaker, have prevented me from describing the ways in which the present system is not effective because it has no teeth. There are gaping loopholes in the Bill in relation to private medicine and Members on both sides of the House have referred to that. There are also many other problems, such as the lack of co-ordination between social services and the NHS.
Although the Bill deals with one small loophole, we should take the opportunity to address the wider issues. I am pleased that in response to the request from the health service ombudsman, the Government set up a wide-ranging review of public sector ombudsmen. That was done in March 1999, following the submission of a paper to the Government—
§ Mr. Deputy Speaker
Order. I cannot allow the hon. Gentleman to continue that point. I remind him that Standing Orders of the House give the Chairman powers to prevent him from continuing in this manner, and he is getting close to the point at which I will invoke them.
§ Mr. Dismore
I am grateful to you, Mr. Deputy Speaker. I was just about to conclude my remarks, which may cause relief to many.
I say to the right hon. Member for Wealden that although I welcome and support his Bill, it will not solve the problems of the ombudsman. The real answer to those problems is the conclusion of the review that the Government have set up to deal with all the problems of ombudsmen generally, including co-ordination.
§ Sir Geoffrey Johnson Smith
Whatever the truth of that, the hon. Gentleman will agree that in the meantime we might as well take what is on offer and pass the Bill, and the Government can deal with the wider scheme much later. The Bill will not upset the Government's programme and does not contravene anything that they have proposed. I hope that if he cares to serve in Committee, the Bill will receive his support there.
§ Mr. Dismore
I said at the beginning of my speech that I have no objection to the Bill. It is worthy, but it is very little, and although its title is ambitious, the Bill will not fulfil those ambitions. I wish the Bill good luck in its remaining stages, but we will eventually have to address the other issues. I would be satisfied if the Minister, in her response to the debate, indicated that the Government will introduce much broader proposals very soon. If that process is going to take a long time, the right hon. Gentleman has a valid point.
§ Mr. Philip Hammond (Runnymede and Weybridge)
I shall be brief. Listening to the hon. Member for Hendon (Mr. Dismore), I often have the impression that no one has told him that in this place, unlike in his previous profession, there is no meter ticking and he is not being paid by the hour.
I congratulate my right hon. Friend the Member for Wealden (Sir G. Johnson Smith) on securing his place in the ballot and introducing this small but important Bill. We are dealing with a simple solution to a narrow problem. The hon. Member for Hendon suggested that the work load of the health service commissioner might explode as a result of the Bill, but he was being disingenuous. Very few cases are affected by the loophole that my right hon. Friend has identified. The hon. Member for Luton, North (Mr. Hopkins) described the health service commissioner as a backstop provision, after other mechanisms for dealing with complaints in the health service have failed. The Bill will therefore affect only a few people.
§ Mr. Jenkins
Although I accept that the Bill will affect only a few people, my concern is that the commissioner's existing work load is such that those few cases will lengthen the time in which cases are dealt with, as my hon. Friend the Member for Hendon said. We need to put in extra resources to ensure that that does not happen.
§ Mr. Hammond
I suggest that on resourcing the hon. Gentleman addresses the Minister.
To return to my point, although only a small number of people will be affected, at the moment those people are deprived, through the loophole, of the pursuit of justice. My right hon. Friend has introduced the Bill to remove that sense of injustice.
As hon. Members on both sides of the House have noted during the debate, this issue is, in broader terms, gaining increasing public awareness. There is the question of police officers who retire and avoid being pursued by the proper mechanisms for dealing with maladministration or misconduct. We amended the Protection of Children Act 1999, during its passage through the House, to ensure that it dealt not only with those whose misconduct was detected while they were employed, but with those whose crimes or misdemeanours were detected after their employment ceased. This Bill is riding a tide of public awareness.
The health service commissioner himself has drawn attention to the loophole, as the hon. Member for Hendon explained at some length by quoting from the commissioner's report. The problem arises because, unlike the secondary health care service—our hospitals—where the institutions are enduring and do not depend on the presence of individuals, most of our primary care services are provided by independent contractors, as the hon. Member for Tamworth (Mr. Jenkins) pointed out. Although primary care is publicly funded, the services are effectively privately provided. That means that when providers of general medical, optical and dental services retire or cease to offer those services to the NHS, they cannot be pursued by administrative mechanisms.
One of the objections to the Bill which has been mentioned by more than one hon. Member is relevance. It is suggested that because the health service 690 commissioner has relatively blunt teeth, it is not conceivable that doctors would retire deliberately to avoid sanctions that are not very onerous. That misses the point. My right hon. Friend the Member for Wealden is suggesting not that doctors will retire for the explicit purpose of avoiding justice at the hands of the health service commissioner, but simply that when doctors retire or move out of the NHS, perhaps for reasons unrelated to complaints, those who are pursuing complaints may feel that they have been denied natural justice. Closing the loophole will address that.
There is a wider issue of the effectiveness of the health service complaints procedure and the question of whether the commissioner needs stronger powers. As my right hon. Friend the Member for East Devon (Sir P. Emery) said, those concerns, legitimate though they are, are no excuse for inaction when in this private Member's Bill we have the opportunity for action without any cost to the Government's legislative time.
My right hon. Friend the Member for Wealden and other hon. Members have drawn attention to questions about the role of the General Medical Council and the possible extension to the private sector of procedures for dealing with complaints and medical malpractice issues. Although we cannot debate that this morning, clearly there is a need for properly regulated mechanisms in the independent sector to ensure that patients are treated safely and properly, whether they choose to get medical treatment in the NHS or the private sector. It is the Government's primary responsibility to ensure a safe framework within which patients may make that choice.
I hope that the Government will in time recognise that and examine the health sector with the same evenhandedness with which they now propose to examine the residential and nursing care sector in the Care Standards Bill. Under that Bill, regulation of local authority and private sector provision will, for the first time, be placed on an even basis.
There is clearly a balance to be struck between the public's right to protection and the profession's need to self-regulate. Self-regulation must be seen to be working, and the hon. Member for Basildon (Angela Smith) made an important point about public confidence. It is in the public interest and that of the professions themselves that self-regulation works properly and is seen to do so. Even with proper, effective self-regulation, there will be a role for the health service commissioner as the final tier of the administrative complaints system in the NHS.
My right hon. Friend the Member for Wealden has made modest proposals to deal with a problem that is highly specific, glaringly obvious, not very widespread, but none the less important. The Opposition will be sympathetic to Government proposals to improve the health service over time, but whatever the Minister can tell us today about the Government's wider intentions in the long-term should not be used as an excuse for inaction now. I hope that the Government are minded to allow my right hon. Friend's Bill to proceed to Committee for more detailed examination.
§ Mr. Alan Williams (Swansea, West)
I shall be brief. I am one of the Bill's supporters and I congratulate the right hon. Member for Wealden (Sir G. Johnson Smith) on introducing it.
691 Having served with him in Committee and during late-night sittings in the Chamber, I have great admiration for the hon. Member for West Dorset (Mr. Letwin). I admire his assiduity and the breadth of his parliamentary interests, but I seem to recollect that the length of his speeches is subject to a singular elasticity. If longevity becomes a punishable offence, he will face a lifetime ban from the House.
The subject of the Bill mirrors the frustration experienced by members of the Public Accounts Committee on numerous occasions when we have dealt with the national health service. I do not say that there is anything wrong with the trust structure of the NHS, but because of that structure incompetent, inefficient senior administrators who have failed need not leave the health service. All they have to do is leave one trust and move to another, picking up their severance pay on the way. Thus, they escape any penalty and avoid any risk of dismissal from the health service.
The target for which the right hon. Member for Wealden aims is a modest one, but it needs to be hit. The practice of using retirement as a means of evading accountability is well understood in this country's police forces, nowhere better than in the Metropolitan police, as the PAC discovered. The problem is greater in other spheres than the health service, but it must be addressed wherever it exists.
The issue of unfairness has been debated, and I shall not repeat points on which we all agree. One of the trends exacerbated by the problem is the greater use of litigation. I am not one of those who deplores the use of litigation in connection with the health service. I have sat through numerous inquiries into failures of the health service, although I should add that it has also had many successes. Nevertheless, the fact that litigation has become an appropriate response has to be deplored.
Many people are driven to the law because of the inefficiency and ineffectiveness of the current systems, both in the NHS and the medical profession generally. Because the NHS has failed and the profession refuses to address the problem correctly, we have been forced down the American route, whereby litigation has in many cases become the sole outlet for the dissatisfaction and frustration felt by many of our constituents. We in south Wales have recently had the experience of a local man—not a constituent of mine—dying in a Swansea hospital after the wrong kidney was removed. That should not have happened. When such things happen, there must be accountability. There has to be justice for the family.
I am sorry that my hon. Friend the Member for Hendon (Mr. Dismore) has left the Chamber, because I wanted to issue a caution to him in connection with private Members' Bills. Mr. Deputy Speaker, you know that I would never challenge your judgment on debate in the Chamber. However, as we are always told when we attempt to raise Committee matters on the Floor of the House, certain matters are for the Committee to deal with. The Chairman of the Committee might use his discretion to allow a far wider debate of the matter in hand. I caution my hon. Friend against attempting to exploit that in terms of amendments to the Bill.
All my experience as a Member of Parliament leads me to believe that the wider a private Member's Bill's scope, the less chance it has of reaching the statute book. In my 36 years in the House, I have never drawn number one in 692 the ballot. We all dream of getting a great private Member's Bill passed, but only a few such Bills—four or five—are passed in the lifetime of a Parliament, and those only get through when the Government provide extra time. A private Member's Bill that goes the normal parliamentary route stands a far greater chance of reaching the statute book if it is well focused and kept within the minimum scope necessary to achieve its intended objectives.
If my hon. Friend becomes a member of the Committee, I encourage him to use whatever breadth the Chairman allows to air broader issues relating to the commissioner, but he should not attempt to insert extra provisions in the Bill that would make it far harder to get through Report, which is extremely limited and easily sabotaged.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)
I welcome the opportunity to debate the important issues raised by the Bill introduced by the right hon. Member for Wealden (Sir G. Johnson Smith). The role of the health service commissioner is extremely important. Although the national health service has procedures for dealing with complaints, there are inevitably some cases that even its best endeavours cannot resolve to the complainant's satisfaction. When that happens, the commissioner provides an essential additional option for complainants, who might otherwise be left without the assurance that their complaint has been taken seriously and thoroughly investigated.
We have heard several useful contributions this morning; I shall refer briefly to some of them. My hon. Friend the Member for Basildon (Angela Smith) expressed doubt about the wisdom of congratulating those who draw numbers high up in the private Members' ballot on their achievement. I am reminded of Napoleon's response on being told about the abilities of one of his generals: he asked, "But is he lucky?" We all know that both ability and an element of luck are needed for success in politics. I therefore congratulate the right hon. Member for Wealden on his luck and join my hon. Friend the Member for Basildon in congratulating him on his choice of Bill.
My hon. Friend is a supporter of the Bill, as are many eminent right hon. and hon. Members on both sides of the House and some outside organisations. My hon. Friend raised the question of the review of the complaints procedure as a whole. That takes us outside the remit of the Bill.
With great charm, the right hon. Member for East Devon (Sir P. Emery) offered a caution about civil servants who might advise Ministers that, although the Bill is worthy, more can be done at a later stage, so it is best to do nothing now. That is the civil service rephrasing of "God, make me virtuous, but not yet." I hope that my colleagues and I will be able to resist temptation. The right hon. Gentleman also reminded the House of a previous achievement of the right hon. Member for Wealden. His contribution may be regarded as small, but he helped many older people and NHS patients by broadening access to meals on wheels. Today's Bill follows in a good tradition.
My hon. Friend the Member for Burton (Mrs. Dean) raised the important issue of time limits, to which I shall return later. In that context, she raised the question of 693 clinical standards in the NHS and in the private sector. It is important to realise that the NHS is a managed service, whereas the private sector is regulated. Thorough regulatory powers introduced in the Care Standards Bill will ensure, using various methods, that proper clinical standards are observed.
My hon. Friend the Member for Luton, North (Mr. Hopkins) paid tribute to the ombudsmen and reminded us of some of the other enlightened developments from the Scandinavian countries. He was correct to point out that we have among the lowest general practitioner complements in Europe, and we therefore need to train more doctors. I am delighted that he intends to support the Government in that, rather than suggesting that we should all follow his example by diagnosing our own illnesses.
My hon. Friend the Member for Tamworth (Mr. Jenkins) questioned whether control and regulations could be taken wider. I tend to agree with other hon. Members who have commented that the fact that this is a small measure should not be allowed to detract from its contribution to ensuring better services. The Bill should be seen in a wider context.
I am delighted that my hon. Friend the Member for Hendon (Mr. Dismore) is now using his considerable legal skills to support the House and the Government, rather than pursuing medical negligence cases. Even though that will deprive some members of the public of his skills, I believe he does a much better job in this place. He raised the issue of sanctions and raised one concern which I shall take the opportunity to put right.
The commissioner has in the past expressed concern about his inability to pass information to other bodies. That problem was resolved in the Health Act 1999, which amends the Health Service Commissioners Act 1993. Since October 1999, the commissioner has been able to pass on information when he considers it necessary in the interests of patients' health, safety and welfare.
Finally, I express my thanks to my right hon. Friend the Member for Swansea, West (Mr. Williams) for sharing his considerable experience of how to ensure the success of private Members' Bills. I congratulate him on being a sponsor of the Bill.
On the issue of other professionals, my right hon. Friend may be interested to know that, with regard to possible disciplinary action against police officers following retirement, the Home Office is taking the matter forward in the light of recommendations made in the report on the Stephen Lawrence inquiry. I hope that we not only aspire to being a joined-up Government, but will show that that can be achieved.
Returning to the substantive matter of the Bill, may I take the opportunity to put on record the Government's admiration of, and gratitude for, the work of the commissioner and his office? Many of the speakers this morning confirmed my experience as a constituency Member. We are often faced with distressed or desperate constituents who come to see us as their last chance of getting their problem, whatever it may be, sorted out. We all know that it can take all our reserves of tact and sensitivity to deal with such situations, yet the commissioner's officers face them every day, and it is important to acknowledge the effort and commitment that that demands.
694 It may be useful to give a little background to the present situation. Until April 1996, the health service commissioner could not investigate complaints about family health services practitioners—that is, general practitioners, family dentists, pharmacists and opticians. They were explicitly excluded from his jurisdiction. Nor could he consider complaints about matters of clinical judgment, and the extent to which he could look at complaints about independent providers of health care to NHS patients was limited.
That changed in 1996, when the current NHS complaints procedures came into force. In parallel with those reforms, and in order to provide a consistent system for all NHS patients, the Health Service Commissioners (Amendment) Act 1996 extended the jurisdiction of the commissioner to bring family health services providers, and complaints involving clinical judgment, within his remit. It also removed the limitations on his capacity to investigate independent providers.
The widening of the commissioner's remit represented the biggest change to his jurisdiction since the role was originally established. For the first time he was, and is, able to investigate complaints about any aspect of NHS treatment and services, regardless of where or how it was delivered. No one should underestimate the importance of that.
Nevertheless, as the right hon. Member for Wealden explained, there is a loophole in the wording of the 1996 Act. Sections 2A and 2B have been interpreted as requiring that the individual or organisation being complained about must still be providing NHS services at the time of the commissioner's investigation. If they are not, they are outside his jurisdiction. I understand from the commissioner's office that there have been a few cases where he has felt obliged to accept legal advice that he could not investigate a particular complaint because the practitioner involved had ceased to provide NHS services.
The right hon. Member for Wealden seeks in his Bill to plug that loophole by amending the wording of the 1996 Act so that, for example, retired GPs, or independent providers who have sold up, will remain subject to investigation by the commissioner.
I have considerable sympathy with the right hon. Gentleman's view on that. I also know that the commissioner himself has expressed concerns about the situation. Not only has he written to officials in the Department of Health, but he raised it in his annual report for 1998–99. I agree that it seems intrinsically unfair that complainants should not be able to pursue their concerns simply because the person about whom they wish to complain has retired. I understand also that it could be seen as a way for recalcitrant practitioners to avoid facing up to their responsibilities.
I should like to believe that the vast majority of practitioners would never behave in such an unprofessional manner, but I suppose the reality is that some will, given the opportunity offered by the loophole. Moreover, there is a further element of unfairness in that it is not a problem in the hospital sector, because it is the hospital trust as an organization which is the subject of the complaint, not a particular individual in it. Thus the commissioner can investigate even if the clinician involved has retired, left the country, or whatever. It does not seem right that a complaint involving a retired hospital doctor can be pursued while one about a retired GP 695 cannot, so I understand and sympathise with what the right hon. Member for Wealden is trying to achieve in his Bill.
Opponents of the Bill may argue that, even if it were enacted, it would still not be possible to make GPs or private nursing home owners co-operate with the commissioner's investigations. That is not true. The commissioner has the same powers as a judge when it comes to obtaining evidence, papers and so on. I am certain that he would not hesitate to use those powers if he considered it necessary. However, they are useless if the individual involved is not within his jurisdiction in the first place. The key point is to get those ex-practitioners within his jurisdiction, as the Bill seeks to do.
I must also consider these issues from the perspective of accountability and trust. We take the accountability of GPs very seriously indeed. As my right hon. Friend the Secretary of State told hon. Members on 1 February, the relationship between individual doctor and individual patient is built on trust. For that relationship of trust to work, GPs must be accountable for what they do. My right hon. Friend was speaking in a very different context on a very sombre occasion, following the sentencing of a GP for a series of crimes which Mr. Justice Forbes, the judge presiding in the trial, described as a calculating and cold-blooded perversion of his medical skills.
The independent inquiry that we have announced, chaired by Lord Laming of Tewin, will examine all aspects of that case and make recommendations to protect patients in the future. The inquiry will consider all the circumstances and it would be wrong of me to pre-empt that by dwelling on the case today.
However, there are two reasons why I have referred to it. The first concerns loopholes. As the right hon. Member for Wealden explained, there is a perceived loophole in the wording of the 1996 Act. We are not afraid to close loopholes where that is necessary. In the case to which I referred, we found that the way in which the NHS tribunal works meant that the NHS would continue to pay a person convicted of most serious crimes for about another month following the conviction. That was inconceivable, and we took action immediately to make sure that it did not happen.
We also found that there was nothing to require a doctor to disclose to prospective partners or to a health authority a past criminal conviction or a previous professional censure. In the case to which I referred, the doctor had a past conviction for obtaining and misusing a controlled drug and he had a record with the General Medical Council, but in the past that appeared to count for nothing. That, too, must change. There was also no requirement for GPs to report deaths in their surgeries or other serious incidents to health authorities. That, too, needs to change.
The case also put the existing powers and processes of the General Medical Council under the spotlight. We have said that the GMC's involvement in that case will be examined by the inquiry, so that lessons are learned and recommendations for reform made. However, we are also acting quickly to give the GMC the powers that it says it needs. They include: interim suspension, to enable the GMC to take action in the public interest; a new committee to consider interim suspension, with much greater lay involvement; and an ability to strike off for 696 life except in the most exceptional circumstances. I repeat that we are not afraid to close loopholes when necessary in the interests of patients.
The second reason why I mention the case is the need for greater accountability of clinicians for the benefit of their patients. For a relationship built on trust to work as it should, it is important that patients can be assured that they can complain if they have a problem, that their complaint will be taken seriously and dealt with properly, and that if something has gone wrong, it will be put right.
The Government and the medical profession are taking action to modernise regulatory structures and to identify and deal with poor performance because of the need for better accountability of clinicians. That is why the GMC is developing proposals for assessment and revalidation at five-yearly intervals of all doctors' licences to practise. We are urging the GMC to keep up the momentum of developing those proposals.
To strengthen and underpin that work, the chief medical officer produced recommendations, which were published in November 1999, in his report "Supporting Doctors, Protecting Patients". His recommendations are comprehensive, and form part of a modernization programme designed to prevent, identify and deal with the small minority of doctors whose performance gives cause for concern, and to take quick action to remedy that. For example, the chief medical officer proposes that there should be an annual appraisal of all doctors. That is a key proposal.
Appraisal will cover all aspects of a doctor's performance, including compliance with contractual requirements. The chief medical officer proposes that health authorities should be able to suspend a GP when the circumstances suggest that patients may be at risk. Until now, health authorities have been unable to do that. He further proposes that GPs' participation in external clinical audit should in future be mandatory. At present, it is not.
Consultation on the chief medical officer's proposals finished at the end of February. The GMC's proposals for assessment and revalidation will need to tie in with them. We shall now consider the responses as a matter of urgency, but we shall press ahead as quickly as possible with measures that benefit and ensure the safety of patients.
The need for true accountability means that we shall also apply the system of clinical governance to all doctors. That will promote high standards of care and ensure accountability in a way that has not existed before. It will place quality at the heart of health care by ensuring access to effective, prompt, high-standard care whenever a patient is treated in the NHS. Clinical governance provides NHS organisations and individual doctors with a framework for quality improvement.
Too often, we hear of incidents that occur in the NHS that should have been avoidable if the lessons of past experience had been properly learned. That is why we asked the chief medical officer to convene an expert group to examine the mechanisms whereby the NHS currently analyses and learns from adverse health incidents, and to make recommendations for improvements.
The main components of clinical governance are clear lines of responsibility and accountability for the overall quality of clinical care; a comprehensive programme of quality improvement activities; clear policies aimed at 697 managing risk; and procedures through which all professional groups can identify and remedy poor performance. It is about a positive, demonstrable change of culture to one of learning, so that quality infuses all aspects of the NHS's work. Our aim is a coherent framework for clinical quality improvement, on the basis of best activity and practice, and with the highest standards.
All those steps, which will improve the accountability of doctors without preventing them from getting on with their job of treating and caring for their patients, are essential and will be established. They will provide assurance and reassurance for patients. We have a responsibility for that.
However, we also have a responsibility to ensure that we are scrupulously fair to the practitioners and providers who could be affected by the proposals in the Bill. The right hon. Member for Wealden expressed the hope that the measure would not be perceived as providing for a witch hunt.
One of the key elements of any complaints process must be that it is fair to all parties. The proposals in the Bill would potentially leave the practitioners and providers involved susceptible to investigation by the commissioner indefinitely. To me, that seems just as unfair to those individuals as the current system—as perceived by those who object to it—is unfair to complainants. Speaking as a lawyer, may I say that even the legal system recognises the unfairness of indefinite liability in civil cases, and sets limitation periods. I therefore believe that if the extension to the commissioner's jurisdiction were introduced, it should not be an indefinite power, but should be appropriately time limited. That would remove the permanent sword of Damocles that would hang over the heads of those individuals—most of whom, we must remember, will have been committed hard-working people with no reason to suppose that they might be complained about. It will also deal with the perceived risk that I mentioned earlier of less scrupulous practitioners retiring or resigning simply to avoid investigation.
However, determining an appropriate time limit is not easy. The commissioner has a time limit within which complaints must be submitted to him. It is generally not more than one year after the complainant becomes aware of the events being complained about. However, I appreciate that the commissioner has discretion to waive the time limit in special circumstances.
§ Mr. Dismore
I have concerns about the time limit, which I expressed in my speech. I am worried about the mismatch between complaints through the complaints procedure and possible legal action. If one of our aims in improving the ombudsman's service is to get rid of litigation, does my hon. Friend believe that there is a case for reconsidering time limits to try and achieve that objective?
§ Ms Stuart
We need to have a time limit that matches other procedures and does not add to confusion, but that streamlines the process. One option might be to apply a similar time limit to complaints about ex-practitioners: a year under potential discretion. However, there are issues 698 involving the way in which the commissioner should be expected to deal with cases in which he decides to exercise his discretion to waive his time limit, with the effect that the ex-practitioner will have been out of NHS practice for more than a year.
Another option might be to go for the three-year limitation period used in most cases by the civil justice system. That would be in line with practitioners' civil liabilities. Claims can still be brought against them after they have ceased NHS practice. That would also deal with circumstances in which the commissioner decides to apply his discretion to his own time limits.
§ Mr. Hammond
Can the Minister make it clear whether she is talking about a time limit for the initiation of the complaints process at its first level or for the commissioner's involvement? If the process at the lower tier had already started, would she allow it to continue without limit or is she saying that there should be no capability in any case to refer a retired person to the commissioner after a certain time had expired?
§ Ms Stuart
I am grateful for the opportunity to clarify that. The perceived loophole is that a practitioner is beyond the scope of existing measures if he is no longer in the NHS when a complaint is made. The issue is how long he has been out of the NHS and the time limit on pursuing him after he has left the service. If the Bill is to progress, we need to discuss an appropriate time limit, and the health service commissioner may have views on the most practical way forward. An open-ended time limit is unsatisfactory at this stage and I do not think that it would either help the commissioner or be fair to practitioners. We need to consider further what would be an appropriate time limit to take forward.
§ Mr. Alan Williams
In that case, will my hon. Friend consider the Government's tabling an amendment in Committee to deal with that problem and so perhaps make the Bill acceptable to them?
§ Mr. McWalter
Does my hon. Friend not agree that the Bill would be a great improvement on current law even without such a change, and that we should consider it from that perspective?
§ Ms Stuart
I do. The Bill is a way forward and would be an improvement.
May I share some of the Government's concerns? A practitioner may still get off the hook if the time limit is brief, but we have to reach a compromise between what is fair and what is workable for all parties concerned. We must also remember, of course, that the commissioner does not have indefinite powers to investigate. The amendment that the Bill offers would not change that in any way.
Perhaps the worst aspect of the current situation is that there have been cases of the commissioner beginning an investigation only to have to discontinue it because the 699 practitioner resigns or retires. For example, in a case involving one GP, the statement of complaint was issued, but the commissioner was informed that the GP was due to retire in two months. As there was no way that a proper investigation could be carried out in that time, he had no choice but to decide not to pursue the case.
It must be absolutely heartbreaking for complainants in such cases—who have been led to believe, in good faith, that their concerns will be properly considered—to be told that that will not happen after all. It must also be incredibly difficult for the ombudsman to have raised a complainant's expectations only to have to disappoint him. The right hon. Member for Wealden eloquently explained Mrs. Fisher's case, which is a good example of the current problem. Tabling an amendment that set a time limit would still allow such cases to be caught, and, in the example that I gave, the commissioner would have been able to continue his investigation, irrespective of the GP's retirement.
The right hon. Gentleman and other speakers mentioned the review of the organisation of public sector ombudsmen that is under way in the Cabinet Office. We should all be fully aware of the review as we were invited last year to participate, via a survey of all Members of the House. Nevertheless, I want to say a few words about how the initiative is progressing.
The review was set up by the Government in March 1999 in response to proposals made by the Commission for Local Administration, the parliamentary commissioner and the health service commissioner. Against the background of more integrated services, which the Government have been working hard to develop, the ombudsmen felt strongly that the time was right for a wide-ranging review of the way in which they conducted their respective business and suggested the creation of a single body. That would do away with potential conflicts of jurisdiction, which they believe are intrinsic to their current structures.
The review's terms of reference did not point the review team down particular avenue. Value for money and the best interests of complainants featured as key issues to be taken into consideration. In reaching its conclusions and formulating its report and recommendations, the team consulted widely among the representative and professional bodies, central Government Departments, local government departments, members of the public and academics, and I understand 700 that the Consumers Association submitted evidence. The team also canvassed the views of all Members of the House.
However, the review raises the issue of how useful the timing of the Bill may or may not be. Irrespective of the detail of the report's recommendations, the very nature of the review, and the terms of reference it was given, makes it more or less inevitable that the jurisdictions of all the public sector ombudsmen, including the health service commissioner, will need to be scrutinised very carefully. That process must be comprehensive and thorough. The aim must be to ensure that we have mechanisms that are modern and dependable. They must live up to the expectations of the general public who will be using them, and must be fit for the 21st century.
I shall not pretend to the House that this change can be made quickly. Indeed, I firmly believe that it would be a grave mistake to try make it quickly, because the matter is too important to rush. However, it is also important to close the loophole identified by the Bill. There is an argument that, in the context of this major review of the ombudsmen, now is not the time to be making changes to his jurisdiction. That is a fair point. We know, however, that the current wording of the 1993 Act is already causing problems for the commissioner, and it is right that, having been given an opportunity to resolve this difficulty via this Bill, we should do so.
At its heart, the Bill is about professional accountability. As I have explained, we take that extremely seriously, and are taking action on a number of fronts to support and strengthen GP accountability in particular. The Bill offers another way of doing that, and it would be perverse for the Government not to support any proposal that achieves that aim. The right hon. Member for Wealden may like to know that officials of the National Assembly for Wales are content with these proposals.
§ Sir Geoffrey Johnson Smith
With the leave of the House, I should like to thank the Minister for the commitment that she has just made—subject of course to our looking favourably on the time limit that I understand she is to suggest. I would certainly be willing to consider that, in the hope that we could gain the overall support of the Committee. I am grateful to her for that offer.
§ Question put and agreed to.
§ Read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 63 (Committal of Bills).