Hospital Complaints Procedure Bill

HL Deb 17 April 1985 vol 462 cc777-90

8.31 p.m.

Lord Colwyn

My Lords, I beg to move that the Bill be now read a second time. I ask your support this evening for the Hospital Complaints Procedure Bill which was taken through all its stages in the other place on 22nd February by the honourable Member for Newbury, Mr. McNair Wilson. It arose basically from his experiences as a patient within the National Health Service and consequent development of a patients' charter, and is designed to establish better contact between patients and their relatives with staff and administrators within the hospital services.

The Bill lays a duty on the Secretary of State to give directions to regional health authorities on the complaints procedures to operate in each NHS hospital and publicity to be given to the procedures. Although there are a very small number of complaints in relation to the total number of cases, there is no doubt that there are occasions when patients are unable, or are unwilling, to communicate with busy staff during hospitalisation, which nowadays involves much shorter periods in hospital than in previous years. This time in hospital is often so short that the opportunity for the patient to get to know the doctors and nurses is much more limited. The ever-increasing amounts of administrative work tends to take doctors away from the wards and makes an effective bedside manner a much more difficult relationship to establish.

Although this Bill refers to hospital complaints, it is much more about communication and the establishment of conditions that will lead to harmonious relationships between patient and hospital. The NHS already has a quite well-established complaints procedure in hospitals on the basis of guidance issued in 1981. This guidance covers all suggestions and complaints which patients might make in connection with health services and includes a specific procedure for dealing with complaints regarding clinical judgment by hospital medical and dental staffs There is also a leaflet, published in 1982 by the DHSS, which is produced to help patients, or relatives and personal friends acting on their behalf, who have comments or a suggestion or complaint to make about their stay in hospital. I do not know whether this leaflet is readily available to all patients, but at present, in the vast majority of cases, the patient will be required to complain to the very person he is complaining about. I feel that this is unreasonable. Usually the patient lying ill in hospital will be extremely anxious and nervous of making a serious complaint against a nurse or member of the medical staff because of fear of reprisals or that someone may become vindictive. This Bill is designed to enable hospitals within the NHS to establish a position for a hospital ombudsman—a member of the staff who will be responsible for following up complaints for and on behalf of the complainant: someone who would not be intimidated by senior members of staff.

Looking at the Bill in detail, Clause 1(1) lays a duty on the Secretary of State to use the power he already has in Section 17 of the National Health Service Act of 1977 to give directions to health authorities for the purpose of laying down the complaints procedure to be followed in all NHS hospitals.

Clause 1(1)(a) and (b) specifies the complaints procedure to be used and the arrangements to be made by authorities and hospitals to give publicity to the scheme to ensure that the patients and their relatives are aware of the procedures available to them to lodge a complaint. Clause 1(2) ensures that the Health Service Commissioner is not precluded from carrying out investigations under Part V of the National Health Service Act 1977 into cases that have been investigated under any procedures laid down in the direction to be made by the Secretary of State.

Clause 2(2) provides for the Bill to come into force on a day to be specified in regulations. This will enable the considerable amount of work to be done and consultations held on drawing up the precise form of the complaints procedure laid down in the directions. Clause 2(3) restricts the operation of the Act to England and Wales. This will need an amendment as I am advised that it is intended to extend coverage of this Bill to Scotland and that Northern Ireland would expect to follow suit with an order in council not included in this Bill.

There are in this Bill as it is printed some technical defects which I intend to amend at Committee stage to make it correct in its application to health authorities in England, Wales and Scotland. In its present form it is in error in the way it refers to regional health authorities alone. Regional health authorities are not responsible for the management of hospitals, and there is no regional tier in Wales. In addition, Scotland is to be included within the scope of the Bill and health boards are the relevant authorities there.

Finally, I must make a few comments on behalf of my medical and dental colleagues and others who work within the hospital services. This Bill will appear to them as yet another complaints procedure to add to the long list of procedures already in existence. With the help of the Medical Protection Society I have listed the various avenues of complaint that are available today.

They are: the civil law, with particular relevance to negligence, assault and defamation; the criminal law, with particular relevance to drugs legislation and certification; the General Medical Council and General Dental Council, concerned both with serious professional misconduct and fitness to practice; the ombudsman in matters other than clinical judgment; health circular No. (81)5, which deals with complaints regarding clinical judgments; HM(66)15, which is concerned with methods of dealing with complaints by patients; HM(61)112, which deals with matters concerning the hospital doctor's personal conduct, professional conduct and professional competence; HM(60)45, which is concerned with the prevention of harm to patients resulting from physical or mental disability of hospital staff.

We have also the service committee and tribunal procedure which is concerned with the general practitioner's terms of service and under which he can be fined or excluded from providing general medical service. Finally, there are the inquiries set up by the Secretary of State under Section 84 of the National Health Service Act 1977.

This is a long and formidable list to confront anyone and I hope that the success of this Bill before us this evening will enable the Government to take a look at these existing procedures and consider the possibility of a much needed review. There is no doubt in my mind that it will be the patients who eventually suffer if the availability of too many complaint procedures becomes a growing industry. I think that this Bill will be able to help both patients and medical staff, and I ask for your Lordships' support this evening. I beg to move.

Moved, That the Bill be now read a second time.—(Lord Colwyn.)

8.40 p.m.

Lord Ennals

My Lords, I am sure that all noble Lords will be grateful to the noble Lord, Lord Colwyn, for introducing this Bill which as he said comes to your Lordships' House from another place. I and my colleagues fully support the Bill with the amendments which he hints will be brought forward at the Committee stage.

It would have been eminently suitable had the Bill been presented, as was originally intended, by the noble Baroness, Lady Cox, with all her experience within the Health Service. I think that it is inappropriate at the moment to congratulate her on her appointment. I have two hopes. The first is that we shall not lose her experience and wisdom about the nursing profession in this House. The second is—and perhaps this is a little more impertinent—that the smoking habits of so many of the Government Whips will not in any way damage her health. I know that she will not be caught into taking up the habit. My concern is that she may inhale the fumes. As an aside, I think that there should be a Government health warning pinned to the lapels of Government Whips. But perhaps that is overstepping the mark.

Since I am being so personal, I think that it would be appropriate to congratulate Mr. Michael McNair-Wilson who introduced the Bill in another place and did so from his own experience. He had been seriously ill with kidney failure. He was full of praise for doctors, nurses and all others who helped him back to health. He had a great deal of good to say about the National Health Service. Perhaps I may quote two comments. In the Second Reading debate in the other place he said: Nurses still remain the gentle and kind angels that we want them to be". He went on to say: or at least that can be said of 99.9 per cent". I just wish I knew who the 0.1 per cent. were against whom he had a complaint. Of doctors, he said: Doctors, by necessity, are more awesome characters. If I had not been fortunate enough to be the son of a doctor I think that I would have been more browbeaten by them than was the case". Nevertheless, he had this great respect for the medical profession. I assure him and your Lordships that I have, too. Perhaps I should give that assurance to the noble Lord, Lord Winstanley, who will be speaking next.

Mr. McNair-Wilson said that there were problems, and perhaps I may quote just two to which he referred when he presented the Bill in the House of Commons. He said: I was asked whether I was sensitive to penicillin. I replied that I was and that my GP did not usually give it to me. At that time I had an infection, and I was given a pill, which turned out to be penicillin-based. I suffered the mother and father of a drug rash which, on its own, kept me in hospital for five weeks". I think that everyone would agree that he had reason for complaint. He gave another example. He said: someone left a stitch in my leg while removing something that was necessary for dialysis. The stitch went septic and I got septicaemia. I still have a wound in my chest as a result of that mistake. Again, to whom do I complain? Who will offer me compensation? Who will listen to my problem? Sadly, no one seems to want to take the blame". Such problems do not occur only in the Health Service. I think that such complaints are pretty common in society generally. He came to the conclusion that: There should be guidance on how to make a complaint if such a necessity arises".—[Official Report, Commons, 22/2/85; cols. 1375 to 1377.] I am sure that he is right, and that of course is the purpose of the Bill.

When I was Secretary of State I was worried about this situation. In April 1978 I issued a consultative document for consideration by the health professions and those representing patients. The outcome of that was Health Circular HN(81)5 issued in April 1981. Perhaps I may quote just the first paragraph: A consultation document on the initial handling of complaints was issued with Health Notice HN(78)39 in April 1978 for comment by health authorities, community health councils and a wide range of staff, professional and other organisations. From the response it appears that the consultation document was well received in the main. A great deal of comment was sent to the Department, including much of a detailed nature that is appropriate to local arrangements rather than to broad central guidance. There is general agreement that the Department should advise on simple, easily understood, basic procedures; and this Circular and accompanying Memorandum seek to provide such a framework in the light of comments received". Of course, the circular has a weakness; it has no statutory backing. I think that that is precisely what is required, and that is what the Bill seeks to do. I have no doubt, as the noble Lord said, that where the procedures set out in the circular have been effectively carried out, they have been of great value. It was certainly my belief when I began the consultation that there would need to be some statutory provision to require health authorities to have a system that would be satisfactory to patients.

The noble Lord said that some doctors did not want the Bill—and I can state that that applies to the BMA—because they believe that the present voluntary system works well. The BMA tells me that in England alone: In 1982 … there was a total of 16,218 written complaints on all aspects of the hospital service; of these, 7,005 related to clinical judgment. By far the majority of these complaints were withdrawn or resolved locally", which is the best way to do things. It went on: In 1982 … there were 5,720,000 discharges and deaths; the number of clinical complaints per thousand of these discharges and deaths amounted to 1/". That does not mean that there were not other complaints which people would like to have brought had they felt able to do so. The fact that there were only a limited number of complaints does not necessarily mean that there were not some patients who felt difficulties and doubts about bringing forward complaints.

Mr. Frank Dobson, the shadow health Minister, speaking from the Labour benches in another place in the debate on February 22nd, said: People in hospital are ill and vulnerable. Many patients are in awe of doctors and nurses and many are affected by a sense of gratitude to all the people who are trying to make them well. As a result legitimate complaints are not voiced by patients because they feel that they would appear ungrateful or that they would be regarded as troublemakers if they drew attention to things that were not going right for them." [Official Report, Commons, 22/2/85; col. 1383.] I think that that is the feeling of many patients. We must ensure that there is a complaints system about which everyone knows and of which everyone can make use.

I think that we recognise that it is often difficult to complain, as the noble Lord, Lord Colwyn said, directly to the person about whom one is complaining. It can be difficult if one is having a rough time with a nurse or a doctor to say that one does not like what is going on. One may fear that it is rude or that the next stage of the treatment may be worse still. A formal complaints procedure would also be to the advantage of people working in hospitals. Certainly if the hospital management makes proper use of the complaints procedure not only will that benefit the individual making the complaint, it will enable the hospital to provide a better service by identifying what is going wrong and putting it right.

In my view the Bill has it right. It does not try to impose a complicated system. It requires the Secretary of State to ensure that health authorities have in operation an effective system. I thought that it was well described in the Explanatory and Financial Memorandum. It: requires the Secretary of State to exercise his powers under section 17 of the National Health Service Act 1977, which enables him to give directions to health authorities as to the exercise of functions". I hope that the Secretary of State will not necessarily make new provisions which will be complicated or difficult. I think that the circular that went out was roughly right but it was not a requirement. I think that the purpose of the Bill is to ensure that good practice is a requirement rather than just an advantage where it occurs.

I want very warmly to welcome this Bill, and to assure your Lordships that when we come to Committee stage we shall want to see the Bill through as rapidly as possible with the sort of amendments which the noble Lord, Lord Colwyn, has very kindly said he will introduce. If he does not, then I shall do so: but I am sure he will.

8.51 p.m.

Lord Winstanley

My Lords, I must at once join with the noble Lord, Lord Ennals, in thanking the noble Lord, Lord Colwyn, for introducing this Bill in a mood, I would think, of benevolent neutrality. I would say that on the whole I agree with almost everything the noble Lord, Lord Colwyn, has said in introducing the Bill. There are one or two points to which I might return briefly in a moment. I also agree substantially with everything that was said by the noble Lord, Lord Ennals, though perhaps I would not go all the way with him on the matter of secondary smoking which is a slightly separate matter upon which we are not now required to comment.

It seems to me to be not altogether without significance that we should have here a Private Member's Bill coming from another place; a Private Member's Bill which had a very short Second Reading debate which was very interesting—I have read it all—but then had a Committee stage, Report stage, and Third Reading on the nod. In other words, it is a Bill which went through very rapidly with virtually no scrutiny at all. We have that to deal with a subject which frankly takes up, I should think, the larger part of the postbag of the ordinary member in another place: constituency problems relating to—perhaps complaints is the wrong word—anxieties expressed in letters. The noble Lord, Lord Ennals, does not agree with me. It may be that I received these letters because I am a doctor. It may be that people thought that I being a doctor it was appropriate to write to me of their anxieties about the hospital service and the Health Service. It is a fact that there are a great many on this subject. Here is where perhaps I would take issue for a second with the noble Lord, Lord Colwyn; and I shall come to that in a moment.

The noble Lord, Lord Ennals, told us, and rightly, that the British Medical Association on the whole regards this Bill as superfluous and says that it is not necessary. It says there are sufficient avenues for complaint already and that to add others is merely an additional complication and would be superfluous. I wonder whether that is not a little complacent. The noble Lord, Lord Colwyn, said, and rightly, that there are many avenues of complaint. He explained them at length and very clearly, and I am grateful to him for doing that.

He went through precisely what the different avenues are, even explaining that one of the avenues was the civil court which frankly is not a very satisfactory avenue. I am quite sure the noble Lord, Lord Colwyn, would accept that the law in Britain is so constructed as to make recourse to the law unpleasant, time-consuming, costly and unsatisfactory. Indeed, if every citizen was to seek justice to its uttermost through the civil courts nobody would be doing anything but working in the courts. We should all have to be solicitors. I do not think that that is an avenue which is wholly satisfactory. The other avenues exist, but this surely is the problem: they are not sufficiently signposted.

An anxiety in a patient is a potential complaint. It has been my experience over the years—and I have had a lot of experience in this field—that very often, provided the avenue for the processing of a complaint is sufficiently open and unobstructive, then the complaint itself disappears. The one thing which is certain to escalate the total number of complaints is a feeling that there is nowhere to make the complaint and that there is no one who is going to look at it. It is a fact—indeed this was referred to in the British Medical Association statistics which were sent to the noble Lord and to others—that on investigation it is found that many of the complaints are later withdrawn because once their complaints have been looked at and once they feel that they have had a proper answer, many people feel that the whole thing is answered. They are satisfied. That is the problem with so many different routes to which the noble Lord, Lord Colwyn, referred.

What does this Bill do? It places a duty on the regional health authorities to take quite specific steps, and presumably to publicise those in such a way that the public and patients know of them. It places a further duty on the Secretary of State who, it is at least implied in the Bill, will have to monitor the working of all this and give directions, should the need arise if regional health authorities or others are not taking the necessary steps. That surely can only be for the good.

I know that there will always be complaints and I know the kind of case that the noble Lord, Lord Ennals, mentioned. I would merely say that I do not myself belong to the school of thought which has arisen since 5th July 1948 when the National Health Service first started that everyone has to live forever or it is somebody's fault. Fortunately we have not quite arrived at that situation here, though they have got rather close to it, if I may say so, in the United States. I hope that we do not do so here, where civil suits for negligence and so on become almost the rule rather than the exception. I think that would be very disadvantageous indeed.

I believe that to avoid that kind of thing we need open channels of complaint through which people's anxieties can be processed and can be examined fully. Therefore I do not go along with the British Medical Association in saying that this is superfluous. I think it is helpful. I accept that it is a very limited measure. I rather take the view of the Royal College of Midwives, who have written—as no doubt they have written to other noble Lords—saying: if it is a complaint about hospital complaints, why not patients outside hospitals? Why not indeed? It is a limited measure.

The noble Lord, Lord Colwyn, referred to the fact that it does not apply to Scotland but that later there may be amendments which will make it do so. With regard to Wales, the position at the moment is somewhat uncertain because the Bill refers to regional health authorities in Wales. Possibly to make it quite explicit that this refers to Wales there might have to be some textual amendment in the Bill with regard to health authorities in Wales which are not regional health authorities. But that is a different matter.

In general I believe that anything that clarifies the situation and makes it clearer to patients that there are avenues via which complaints can be forwarded, and that those complaints will then be looked at, is for their good and the good of the Health Service. In my experience, dealing with a number of cases to which I referred—the noble Lord, Lord Ennals, said he did not get as many, perhaps because he was a Minister and they were filtered out by Members before they reached him; but he knows that there are many—one of the principal complaints in hospitals is lack of information: the inability of patients and their relatives to actually find out precisely what is happening. When they have found out, often they are wholly satisfied; but often they are anxious and uneasy because they cannot find out.

One of my favourite stories, which is said to be true, as are all good stories—and I will repeat it even at this late hour—is of a telephone call to a hospital near Manchester. A voice said, "Is that such-and-such hospital?" The telephonist replied "Yes". "I am inquiring about a patient, Mr. Reginald Smith, in the orthopaedic ward". "One moment please," said the operator. There was a pause, and then she came back, "Yes, Mr. Smith has had his operation; his condition is satisfactory, and he is expected to be discharged on Tuesday." "Thank you very much." "Just a moment, is that a relative?" "No," he said, "it's Mr. Smith speaking. They tell you nothing in here".

There is an element of truth, if I may say so, in that. We really need to do something about making it absolutely clear that patients and their relatives are entitled to know what is happening to them. A patient plays quite an important part in his or her illness. I think the lack of information in the hospital area very often leads to a whole number of complaints which otherwise would not have arisen at all.

Therefore in general I welcome this Bill as being a limited measure. I hope we may be able to clarify its relationship to Wales and perhaps Scotland, and various other things, at the Committee stage and perhaps extend it a little further. However, for the moment I certainly welcome it and hope that it gets its Second Reading.

8.59 p.m.

Baroness Masham of Ilton

My Lords, I thank the noble Lord, Lord Colwyn, for so clearly explaining this Bill. I welcome the Bill, as I believe it will improve the quality of patient care. I have the greatest admiration for the work done in our National Health hospitals; but, as with all organisations, there are at times complaints which are far better dealt with if there is a very clear and briefly spelt out procedure which the patients are fully aware of.

Many people admitted to hospital feel worried, unsure, and even frightened. If something goes wrong and there is no clear procedure to follow, patients or their friends or relations can become aggressive, the grievance can grow out of all proportion, and they can feel that nobody cares. The quicker and the more localised the place in which the problem can be dealt with, the better it will be.

In the first stage of a complaint, there should be a recorded acknowledgment. Many complaints, I would hope, could be solved at the first stage. If a complaint goes further and there has to be a process such as a disciplinary procedure, the conclusion should not take longer than about four weeks. That seems a reasonable time. If it is complicated with legal claims, then it might take longer. The complainant should be kept informed at each stage.

This Bill materialised because a Member of another place had personal experience of hospital staff not listening to him, as explained by the noble Lord, Lord Ennals. These days, one hears much about the team approach in hospital—the team being all the professionals, leaving out the voice of the most important person, the patient. I hope that the Bill will make everyone realise that the patient is a very important feature in the hospital scene. He is a person with a heart and a soul.

Busy acute hospitals have become almost like a conveyer belt system. Some staff have an excellent approach, explaining and involving the patient and relatives. I have met consultants and nurses who have an excellent procedure. But all of us, I am sure, have examples where it has not been so good. As an acute patient myself, I was on one occasion complaining on behalf of another patient. She was a young girl from Scotland, a long way from home, with little family support. She had broken her neck and was paralysed in all four limbs. At night, she was turned, like all such patients, to prevent pressure sores. She was a prisoner in head traction and the nurse had not placed a small pillow under her neck in the correct position. The girl asked for this to be done. The nurse, who happened to be Dutch, told her to speak English and was really sarcastic. The helpless patient was so upset that she spent most of the night crying. I reported this case the next day to the ward doctor. The nurse was transferred to another ward.

Yesterday, I heard of the case of a woman who had a rare blood group. She had been admitted to hospital for the second time to have a hysterectomy. The first time there had been no supply of her special blood. She had told the hospital staff that she hoped that this time it would be there. It was not until she was in the theatre, having had her pre-med, that it was found by the surgeon that the special blood had not been ordered. The operation was cancelled for the second time. What a waste of everyone's time, and what extra anxiety for the patient!

I hope that this Bill, when it becomes an Act, will make all staff more efficient and receptive to the patient's requirements and requests. I feel that it should be the health districts which exercise the functions in each hospital for dealing with complaints. Maybe it should be the duty of the regions to monitor which procedure is working best and which is most efficient, so enabling them to put out guidelines to the districts. The nearer to the local level complaints are heard, the quicker they will be dealt with.

It seems to me that it should be the duty of districts to draw the procedure to the attention of patients. Some hospitals are much better than others at bringing information to all sorts of patients. We should have built into the Bill that the notice explaining the complaints procedure should contain the information that, if patients do complain, the complaint will be investigated. The patients must be reassured that they will not be victimised because they have made a complaint. I hope that the Bill will help to improve communications within hospitals. I am pleased that it is to be extended to the whole of the British Isles.

9.5 p.m.

Lord Dean of Beswick

My Lords, like previous speakers, I should like to express my appreciation to the noble Lord, Lord Colwyn, for the manner in which he introduced this important Bill. We should place on record also our appreciation of a Member of another place, Mr. Michael McNair-Wilson, for introducing the Bill in the first place. I had some practical experience of complaints procedures before the Health Service was reorganised. In fact, I was the last deputy chairman of the old Manchester Executive Council of Health. Although that body at the time did not deal with hospitals, it did deal with medical complaints. I have to say now, as I have said previously, that one of the most difficult facets of complaints against medical people is getting colleagues who work alongside them to give critical evidence. That is proved beyond doubt from my experience as chairman of a service committee at that time.

In welcoming any Bill that makes the procedure easier, I am not speaking in a frivolous sense. We do not want an avalanche of trivial complaints that will clog the machine. We are talking about genuine complaints. The noble Baroness, Lady Masham, has quoted one case. I know that the hour is late, but I should like briefly to illustrate what I consider the most serious case that I have known in the Health Service, certainly in the Leeds area. I was particularly involved because the case was brought to my attention. I shall not mention any names.

The case was finally resolved by an out-of-court payment to a man who had been widowed through the negligence of a consultant. The woman had died of a brain haemorrhage while undergoing an operation at which the consultant was not in attendance to carry out the final details of the operation. The matter was only dealt with because of the dedication of another person at the same hospital, a consultant anaesthetist who was sick and tired of anaesthetising patients who were going for neurosurgery but who were having to be taken back because the surgeon who was scheduled to perform the operation was not in attendance. Let me say that this matter would never have been pursued but for the diligence of the then chairman of the Community Council of Health for East Leeds, Mr. Leslie Rosen, who has since retired. It was a very serious case. At the time the husband did not know that his wife may well have lived—and I only say "may well"—but it certainly caused the Minister of Health at the time, Mr. Gerard Vaughan, a great deal of concern. If this procedure can prevent that sort of case, well and good.

When such a case comes to light, lay people, quite rightly sometimes and quite wrongly in the majority of cases, assume that it is only the tip of the iceberg. But in that particular hospital at that time there was no question but that that was not a one-off case. A code of treatment or a standard of negligence had been accepted by professional people in that hospital which was beyond belief. Now, because of the action of some diligent people who followed the case to the end of the line and obtained some form of justice, that has been corrected.

As the noble Lord, Lord Colwyn, and all subsequent speakers have said, the Bill must be gone through with a fine tooth-comb because it is only the skeleton of a Bill. At a later stage we must build into it procedures which, in my opinion, will be foolproof but easily explainable to lay people, because it is lay people about whom we are talking. There is no point in saying to the overwhelming number of people who go into National Health hospitals that there are a variety of ways in which they can complain. As Members of this House and of another place have said, the overwhelming majority of ordinary people who go into hospital instinctively do not wish to complain because they do not consider that it is in their own interests to complain about someone who is probably giving them the ultimate treatment for the condition or illness from which they suffer. I am prepared to say that if we get this Bill right at later stages, it will be of immense value in that situation.

I make one final plea. I have been asked by the trade union which will be mostly involved at the lower level, COHSE (and I have not been in any way retained by them), which has over 200,000 members who could be involved in some respects, to say that they are clearly in favour of the principles embodied in the Bill. They simply ask that, if any of their members are complained about—and they accept that, human beings being who they are, some of their members may be involved—they will be given elementary justice, and that if the complaint is to be heard they are fully notified and given ample time to prepare a defence. As people at that level are not sometimes the most articulate, they ask that such people be catered for by being represented by someone of their choice. If it is a pretty trivial complaint, they may be represented by the equivalent of what I would call the shop steward in a factory; but if the complaint is more serious, they ask that the union can and will be given the chance to make sure that the member receives the rudiments of justice which we as Britishers have come to expect.

On a personal basis, in the past, before the Health Service was reorganised, I was involved in this sort of thing. I believe that the Bill introduced by the noble Lord, Lord Colwyn, goes a long way towards making it much easier for ordinary rank and file folk who have a genuine complaint to pursue it. I hope that we shall find some means to keep out of the complaints procedure some of the frivolities that may creep in, because as ex-Members of another place and as Members of this House we can all find some of those. With those few remarks, I support the principle of the Bill.

9.13 p.m.

The Earl of Caithness

My Lords, I am pleased to have the opportunity to speak on this Bill so ably introduced by my noble friend Lord Colwyn, and to express the Government's support for it. Before I do so, I should like to thank the noble Lord, Lord Ennals, for his kind remarks about my noble friend Lady Cox. Personally, I am pleased that the ratio of smoke in the Chief Whip's office will be reduced. However, I would also point out that on his side of the House there is a certain Whip in the Opposition Whip's Office who also complains about the smoke.

Lord Taylor of Blackburn

My Lords, will the noble Lord give way? There are many of us who welcome the smoke in the Whip's Office, regardless of what the Front Bench has to say.

The Earl of Caithness

The noble Lord, Lord Taylor, has support from a noble friend of mine sitting not very far away.

My Lords, complaints arise from only a tiny fraction of the vast number of contacts between NHS staff and members of the public. In 1983, just over 19,000 written complaints were received—about one for every 3,000 episodes of treatment. Criticisms of the Health Service can be looked at in two ways. First, they can be seen as an indicator of levels of dissatisfaction on the service provided. Alternatively—and I believe rightly—they can be regarded more positively as providing Health Service management with the comment from patients that they must have if they are to make services more responsive to the needs of patients.

Experience suggests that the majority of complaints are not made with the idea of obtaining financial compensation but to receive an adequate explanation of why a particular action took place in a particular way and to gain some reassurance that similar misfortunes will not befall others. In this sense complaints may be seen as most useful to managers in assessing levels of satisfaction with the services provided and the way they are delivered; and a useful guide to where systems or procedures could be improved.

The Bill is concerned with enabling patients, or those acting for them, to voice their complaints, whatever the nature of those complaints. This is in line with the Government's concern to increase the responsiveness of the NHS to the needs of its consumers. One of the key components of the recent NHS management inquiry report produced by Mr. Roy Griffiths and his colleagues was the importance of assessing and ensuring consumer satisfaction with the services provided. This means the Health Serice should be trying more than ever to listen and respond to the voice of its consumers.

Many of the problems which arise in the course of a hospital stay or a spell of treatment do not call for a formal investigation. The majority of minor difficulties can be cleared up as they arise and should be dealt with on the spot by the staff responsible. This is a vital part of any complaints procedure and requires effective communication between patients and health care staff. Patients must feel they have the right to voice their concern and should be given some encouragement to do so. But perhaps for the majority of people it is the existence of a complaints procedure and the way in which they are made aware that the procedure exists that can ensure that they feel able to express their comments.

For many years hospitals have been given guidance on the establishment of complaints procedures. The most recent guidance was issued in 1981, as the noble Lord, Lord Ennals, said. This guidance emphasises that a speedy, thorough and open response at the local level is the best approach to resolving a complaint. We expect health authorities to deal fairly and fully with complaints and to ensure that complainants receive an informative and frank explanation of what went wrong, and I know that health authorities take this role seriously.

However, we are not complacent about the procedures which exist. We recognise that there are a number of ways in which they might be improved. Perhaps one of the major areas which can be readily identified as needing improvement is the publicity given to the complaints procedure. As I have said, every hospital should operate a complaints procedure in line with the department's guidance; but despite our efforts to ensure that there is a well-publicised complaints procedure, we are aware of the variation between hospitals in this respect.

This Bill would lay a duty on my right honourable friend the Secretary of State to promulgate a complaints procedure with statutory force and with statutory requirements on the publicity to be given to the procedure. It provides a valuable opportunity to re-examine the existing procedures and the publicity given to them. It will act as a vehicle for introducing improvements. These were points raised by all noble Lords and have shown the need for this Bill. In drawing up the directions which the Bill would require, there would of course be full consultation with the medical profession, the other health professions and organisations representing patients' interests.

The noble Lord, Lord Dean, mentioned a number of amendments that he would like to move at later stages. Perhaps, with all due respect, I may suggest to him that his points will not be ignored. They will be looked into and taken note of, but perhaps the consultation that I have just mentioned is the right way of putting them into the directions rather than through Parliament in the Bill.

Lord Dean of Beswick

My Lords, may I deal with that point briefly? The Minister has kindly said that the professional bodies would be consulted regarding the measures to be included. Do I take it from that that he will also include the particular organisation I mentioned, COHSE?

The Earl of Caithness

My Lords, I believe so. We want the widest possible consultation that we can get in order to get the directions right.

Much of the guidance we already have is basic common sense and good practice. We would aim to build on that in consultation with the groups that I have identified to develop a better procedure which will make it easier for the patient's voice to be heard; which will make it easier for management to tune in to that voice; and which will encourage NHS management to act on the signals it receives. We do not wish to encourage people to complain unreasonably about the services the NHS provides, to which I am sure all noble Lords would wish to pay tribute. But we must be sure that we give patients and their relatives and friends the opportunity to voice their legitimate concerns freely and without fear or favour.

I believe that many complaints could be avoided with better communications at all levels. But it is difficult to legislate for that. Instead we must aim to promote a better exchange of information by, in the first place, demonstrating the willingness of the Health Service to take the views of patients seriously. A statutory complaints procedure and statutory requirements for the publicity to be given to that procedure provide one of the elements necessary for this. This Bill provides an opportunity for a step towards improving the responsiveness of the NHS to the consumer voice. Accordingly, the duty which the Bill would lay on my right honourable friend the Secretary of State for Social Services to introduce a statutory complaints procedure is one which the Government would welcome.

My Lords, I commend this Bill to your Lordships.

Lord Colwyn

My Lords, I am grateful to all the noble Lords and the noble Baroness who have spoken in support of the Bill. I hope we shall be able to speed its progress through the next stages. I am also grateful for the help I have been given by my noble friend Lord Caithness in the further explanation he has given. I was also pleased, for once, to agree with everything that the noble Lord, Lord Ennals, said from the Front Bench opposite. My noble friend—if I may call him that—Lord Winstanley, brought his usual logical medical experience to bear and I confirm that I intend to move an amendment to ensure that the Bill is effective in England and Wales and in Scotland. I shall look forward to further helpful contributions from the noble Baroness, Lady Masham, and from the noble Lord, Lord Dean of Beswick, at the Committee stage.

A combination of legal decisions and the piecemeal accumulation of departmental circulars has resulted in there being difficulties in very few cases. Prior to his departure from the DHSS, Dr. Gerard Vaughan took action with the full co-operation of the medical profession. I hope that this Bill will result in a new simplified structure which should separate and clarify as far as possible the safety of future patients, professional discipline and legal liability within our hospital services.

On Question, Bill read a second time, and committed to a Committee of the Whole House.

House adjourned at twenty-two minutes past nine o'clock.