HL Deb 09 May 1985 vol 463 cc808-15

7.50 p.m.

Lord Colwyn

My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, That the House do now resolve itself into Committee.—(Lord Colwyn.)

On Question, Motion agreed to.

House in Committee accordingly.

[The LORD AYLESTONE in the Chair.]

Clause 1 [Hospital complaints procedure]:

Lord Colwyn moved Amendment No. 1: Page 1, line 6, leave out ("Regional Health Authority") and insert ("health authority in England and Wales and to each Health Board in Scotland").

The noble Lord said: As currently drafted the Bill covers only regional health authorities and, therefore, applies only to England. There are no regional authorities in Wales or in Scotland, and the Bill is intended to apply to both. In addition, regional health authorities in England are not the authorities directly responsible for the management of hospitals. The amendment will ensure that the directions which the Bill requires to be given are addressed to all authorities having hospital management responsibility. Clause 1 lays a duty on the Secretary of State to exercise his existing power to give directions to health authorities so as to require arrangements to be made for establishing and publicising specified procedures for dealing with complaints in all NHS hospitals. The amendment extends the categories of authority to whom such directions will have to be given to district health authorities in England and Wales, health boards in Scotland and special health authorities. I beg to move.

Lord Ennals

I think I can make one of the briefest speeches on record. All the amendments that are to be moved by the noble Lord, Lord Colwyn, are ones that we recognize, and that he himself recognised on Second Reading. He promised that he was going to bring them forward, and he has brought them forward entirely satisfactorily. I want to say that as far as these Benches are concerned, we totally support the amendments.

The Earl of Caithness

I do not know whether or not we have the SDP with us at the moment. I stand up briefly to say in respect of all my noble friend's amendments that we give them very warm support and hope that the Committee will accept them as they are. I think that they improve the Bill substantially.

On Question, amendment agreed to.

Lord Colwyn moved Amendment No. 2: Page 1, line 7, after ("1977") insert ("or section 2(5) of the National Health Service (Scotland) Act 1978").

The noble Lord said: The effect of this amendment—a technical amendment which includes the necessary reference to the relevant legislation governing health boards in Scotland—is to permit equivalent Scottish legislation to be applied in issuing directions to the health boards. I beg to move.

On Question, amendment agreed to.

Lord Colwyn moved Amendment No. 3: Page 1, line 10, after ("Authority") insert ("or Board").

The noble Lord said: The effect of this amendment is to provide for references to health boards in Scotland to be included. This amendment is consequent upon previous amendments and ensures that Scottish health boards are referred to in the Bill as necessary. I beg to move.

On Question, amendment agreed to.

Baroness Masham of Ilton moved Amendment No. 4: Page 1, line 13, at end insert— ("( ) arrangements are made to ensure that complainants do not suffer any disadvantage as a result of making the complaint: and").

The noble Baroness said: As your Lordships know, this Bill came about because of some serious negligence in the treatment of a very ill Member of another place. The amendment which I bring before the Committee now would, I feel, improve this Bill, as I know that some people who may have very genuine complaints will not come forward as they will fear that they may be victimised for so doing. I have asked many people about this, including doctors and nurses working in hospitals. They feel that the message should be clearly made known to patients that they will be at no disadvantage if they have genuine complaints. I believe that this could improve the care, comfort and consideration of patients.

Last night, the wives of two noble Lords who sit on the Government Front Bench told me that they had had babies at a hospital not far from here. After giving birth, both these ladies had been left lying as they were, covered with sweat and feeling exhausted, for a considerable time without being cleaned up and made comfortable. One of them was very angry, the other became very cold and was sick. It may be that if there had been a clear channel of complaint this practice of neglect would have been rectified for other patients.

A member of the staff in your Lordships' House told me that a friend of his was lying very ill in a South London hospital. One of her legs was in plaster and she could hardly move. She felt something crawling up her good leg. It was a cockroach. She was so frightened that she made no official complaint. I think that this amendment would improve the Bill if it were accepted. I beg to move.

Lord Ennals

I very much hope that the noble Lord, Lord Colwyn, who has presented the Bill and is piloting it through your Lordships' House, will accept this amendment. I warmly supported the Bill, support it now and will support it at every stage because I think that in our Health Service, while it is on the whole extremely efficient, there are cases where people are not treated as well as they should be. The purpose of Lord Colwyn's Bill is that people should have a way in which they can make their complaints.

It is not that we are wanting more complaints than are necessary. We want there to be a clear, open, understood channel through which people who feel they are not getting the right treatment, or that someone is being rude to them or lacking in consideration, or that the Health Service seems to be impersonal, may make their complaint. That is the purpose of the Bill. There is a danger that that fine purpose can be undermined by the fact that some people, as the noble Baroness, Lady Masham, has said, although they have what would seem to be a legitimate complaint, will say, "I'm not going to bring it forward".

I speak from a different sort of experience. Some years ago I spent nearly three years in hospital. There were times when there were patients who, I thought, were, I will not say "mistreated", but not treated in the way they should have been. I can think of occasion after occasion when I have said to one of my colleagues in the ward, "I think you ought to make a complaint about that". They said, "No, I will not make a complaint. They will take it out on me". That was their fear. The vast majority of people in the Health Service would not conceivably take it out on someone who complained, though there are some who would.

I think this is simply to deal with that situation and, as Lady Masham has said, to strengthen the Bill, so that there are no inhibitions against people who feel that they have a genuine complaint bringing that complaint forward without any fear that as a result of doing so they will suffer a disadvantage. I support the amendment proposed by the noble Baroness and hope that both the Government and the noble Lord, Lord Colwyn, will support it, too.

Lord Auckland

I should like to associate myself with the amendment which the noble Baroness, Lady Masham, has moved, and with the comments by the noble Lord, Lord Ennals. There is always the danger of frivolous complaints being made at times. One accepts this; it happens in all walks of life, in the services or in the Health Service or anywhere else. But there should be a definitely laid down procedure here, and, in the Bill as I read it, the procedure is not convincing enough.

I think that the amendment is particularly important in relation to the long-stay hospitals, where patients are in hospital, very often unavoidably so, for long periods of time. One accepts the fact that the nurses and all those working in these hospitals have an extremely difficult task to perform. Of course, there are times when harsh treatment of patients takes place and this can seldom be justified. So I would hope that my noble friend will take on board what has been said.

8 p.m.

Another problem also is that since the reorganisation of the Health Service there are no longer house committees and hospital management committees. In the days of the house committee—I myself served, as many of your Lordships will know, for 18 years on the house committee of a mental hospital in Surrey—there were sometimes complaints, although they were mostly small ones. Although the house committee could not deal specifically with the complaints themselves, they were able to move them to the hospital management committee, and very often complaints could be dealt with quickly in that way. However, since the reorganisation I believe it to be true that these complaints cannot be dealt with so quickly. Speed is of the essence, because a small complaint, if not dealt with, can inevitably grow into something larger. Therefore, I believe that the Government should accept this amendment; and even if they cannot accept it as worded I hope they will study it very carefully because the essence of the amendment is all-important.

Lord Prys-Davies

I, too, should like to support this amendment; and I apologise to the noble Baroness for not being here when the Committee began work on these amendments. I would wish very much to support the noble Baroness. I think it is important that there should be a complaints system which allows people to make complaints without fear of victimisation. I recall how, 16 years ago, the Howe Report on the allegations of ill-treatment in certain wards in a hospital for the mentally handicapped in Cardiff found (and here I quote from the report) that: an atmosphere had come to exist in those wards where it was useless or positively hazardous for staff to complain of matters which disturbed them on the wards. Two members of the staff who did so complain had to leave the hospital. The late Richard Crossman found this to be the biggest single deficiency which the report exposed, and in my view it would be optimistic to believe that this mischief has been completely eradicated by 1985.

I therefore consider that the noble Baroness is absolutely right to press for the Bill to include an amendment along these lines. I would not necessarily agree that the wording is perfect—indeed, it may be imperfect—but I hope the Minister will take this on board and, if need be, will introduce it in another form. But the principle I heartily support.

The Earl of Caithness

My noble kinswoman Lady Masham seeks by this amendment to protect a patient pursuing a complaint, or the subject of a complaint by a relative or friend, from any possibility of reprisals by hospital staff. I can understand her intentions in this. In order for patients and others to feel confident about bringing their concerns to light, it should be made clear that patients will not suffer any lessening in the care and attention they receive as a result. As I told your Lordships in our Second Reading debate, on 17th April 1985 at col. 790: 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". My honourable friend the Parliamentary Under-Secretary of State for Health, Mr. John Patten, speaking on this Bill in another place, referred to a procedure, which commands the confidence of patients and staff. That is what the Government want, and I believe it is what your Lordships and my noble kinswoman want.

The Government recognise that this question of possible victimisation of patients making complaints is an important one, but it is an area for which it is very difficult to legislate. The main element is staff attitudes, and those we cannot change by a stroke of the legislative pen. What we can do is to provide the framework for complaints to be made, heard and evaluated, to be replied to and acted upon.

I submit—and I am sure that the noble Lord, Lord Ennals, with his very wide experience, would agree—that it would be manifestly impossible to "ensure" (to use the words of the amendment) that patients do not suffer. I am confident that in the great majority of cases no such problems are experienced. There are instances, of course, where patients fear, and very occasionally suffer, some subsequent hostility from hospital staff. Such reactions are regrettable, and they should not occur. Where they do, disciplinary or professional misconduct procedures may be warranted. What we must do is to train staff to adopt a positive, objective attitude towards dealing with patients' complaints, and to reassure patients and to remove any fears they might have about talking over their concerns directly with the hospital staff at the time. The amendment proposed by the noble Baroness would not be, in our view, the right means of tackling this sensitive and difficult issue.

That is the bad news. The good news is that in view of the very great concern expressed in this Committee by your Lordships—and we do appreciate your Lordships' feelings in this matter—we will ensure that suitable provision is included in any new guidance which will be required under the directions following the consultation which we are going to have as a result of this Bill. We believe that is the proper place for it to be dealt with. We feel it can be more flexible and can be adapted to suit the circumstances. Having taken account of all the views of the professional bodies that we are going to consult, we think probably that is the place in which to put it. I hope that my noble kinswoman will feel able, with that assurance—

Lord Ennals

May I intervene to ask one question? I am delighted with what the noble Earl is saying. I do not know, of course, whether the noble Baroness will be equally pleased, but I wonder whether there will be consultation about the guidelines. I think that is important, and I should like to be reassured about the consultation before feeling myself to be fully satisfied.

The Earl of Caithness

I remember dealing with this very fully on Second Reading, and I think I assured your Lordships then that there would be full consultation to get the guidelines right. Therefore, perhaps I may say to my noble kinswoman that I hope I have reassured her. We have taken this amendment well on board in our thinking, and I hope she will agree, and also that the noble Lord, Lord Colwyn, will agree, that the place to put it is in the directions.

Lord Colwyn

I do agree with my noble friend the Minister that this amendment has the very best of intentions and is quite rightly aimed at preventing possible victimisation of patients after a complaint has been made. However, I must agree with him in not being able to accept the amendment: first, because I do not think that this wording is suitable for the legislation I am proposing; and, secondly, because I would hope that when the Bill eventually becomes law the inevitable extensive consultations with health authorities and hospital staff will without any doubt come up with a complaints procedure which will prevent the very problem that my noble friend Lady Masham and the noble Lord, Lord Ennals, are rightly concerned about. With this assurance, I hope that my noble friend will withdraw her amendment.

Baroness Masham of Ilton

I thank all noble Lords who have supported this amendment. I myself am not quite sure. We are a very small and select Committee here tonight, but it must be remembered that this Bill may affect millions of people throughout the country, both patients and staff; and, as the noble Lord said, staff do complain on behalf of patients, and members of staff can victimise other members of staff. This is a serious matter.

I also feel that having something written into the Bill is better sometimes, because Bills get consolidated in time and guidelines get lost. I would be happier if my noble kinsman would take away with him everything that we have said and discuss it with his colleagues, and of course with the noble Lord, Lord Colwyn; because it is a serious matter, and if it is going to be effective one wants to be sure that one is doing the right thing. I think we all want to do the right thing with this Bill. It is only a small Bill, but it could have a very wide and lasting effect on people.

I should like my noble kinsman to say, if he can, that he will take it to his more senior colleagues to discuss it before the next stage. If they felt it was important to write it into the Bill in a different form, perhaps he would do this.

The Earl of Caithness

Alas, it is not up to me to say; it is not my Bill. It has been discussed. All the amendments down this evening have been discussed at a high level in my department, but I am afraid I cannot answer my noble kinswoman directly. It is not up to me. It is up to my noble friend Lord Colwyn to decide.

Lord Colwyn

I feel sure that I can say to my noble friend Lady Masham that the consultations will cover this point very adequately. I can assure her that if at any stage I feel they do not, we shall see what we can do about it. With that assurance, I would ask her to withdraw her amendment at this stage, and we shall watch to see how it goes.

Baroness Masham of Ilton

I thank my noble friend Lord Colwyn and I shall therefore withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Colwyn moved Amendment No. 5: Page 1, line 19, after ("1977") insert ("or Part VI of the said Act of 1978").

The noble Lord said: Clause 1(2) is to ensure that the Health Service commissioners are 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 directions to be made by the Secretary of State. This amendment provides for reference to the equivalent legislation in Scotland.

The directions to be issued by the Secretary of State should not interfere in any way with the work and jurisdiction of the Health Service commissioners. Section 116(1) of the National Health Service Act 1977, which precludes investigation of any action in respect of which a complainant has a right of appeal, reference, or review before a tribunal constituted under any enactment, might bite under the procedures to be laid down by direction if they were not specifically exempted in this way. The amendment ensures that equivalent provision is made for Scotland. I beg to move.

On Question, amendment agreed to.

Lord Colwyn moved Amendment No. 6: Page 1, line 21, after ("section") insert ("(a) in its application to England and Wales.").

The noble Lord said: In moving this amendment I should like to speak also to Amendment No. 7.

Amendment No. 7; Page 1, line 22, at end insert— (b) in its application to Scotland, expressions which are also used in the said Act of 1978 have the same meanings as in that Act.").

These are two technical amendments which flow from the extension of the Bill to include Scotland. They ensure that correct reference is made to the interpretation of expressions in the Bill. These ensure that the interpretations applying to Scotland are included. I beg to move.

On Question, amendment agreed to.

Lord Colwyn moved Amendment No. 7:

[Printed above.]

On Question, amendment agreed to.

Clause 1, as amended, agreed to.

8.15 p.m.

Clause 2 [Short title, commencement and extent]:

Lord Colwyn moved Amendment No. 8: Page 2, line 5, leave out ("Scotland or").

The noble Lord said: This amendment in Clause 2(3) deals with the extent of the Bill. It deletes the reference to excluding Scotland. This is consequent upon extending the scope of the Bill to include Scotland and is a necessary technical amendment. I beg to move.

On Question, amendment agreed to.

Clause 2, as amended, agreed to.

In the Title:

Lord Colwyn moved Amendment No. 9: Line 1, leave out ("Regional Health Authorities") and insert ("health authorities in England and Wales and Health Boards in Scotland").

The noble Lord said: As the previous amendments have been carried, the Long Title of the Bill must be amended to reflect the altered coverage of the Bill. It is consequent on those amendments and the wording reflects that used in Clause 1(1), as amended. The Long Title of the Bill refers only to regional health authorities. The amendment provides for the inclusion of a reference to district and special health authorities in England and Wales and health boards in Scotland. I beg to move.

On Question, amendment agreed to.

Title, as amended, agreed to.

House resumed: Bill reported with the amendments.

The Earl of Caithness

My Lords, I beg to move that this House do now adjourn during pleasure. I confirm that we will not come back to the Local Government Bill until a quarter to nine.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 8.17 until 8.45p.m.]