§ 6.21 p.m.
§ Read a third time.
§ Clause 6 [Exercise of clinical judgment]:
§
Baroness Jay of Paddington moved Amendment No. 1:
Page 4, line 44, at end insert—
("(8) The Commissioners shall issue guidance for the purposes of clarifying—
(9) In preparing the guidance under section (8) above, the Commissioners shall consult with bodies appearing to them to represent the interests of patients, health service professionals and the bodies subject to investigation by the Commissioner."").
§ The noble Baroness said: My Lords, this amendment enables your Lordships to return to the vexed question of complaints about clinical judgment. At Second Reading and in Committee the Minister acknowledged—indeed, I think all of your Lordships who took part in the debates agreed with her—that it was extremely difficult to develop a precise definition of a clinical complaint, a precise definition which, if it were possible, would allow a positive description to be placed on the face of the Bill and would allow those practising the complaints procedure to distinguish a complaint about clinical care from one about maladministration.
§ We on these Benches were aware that the attempts we have made to suggest definitions by amendments, which have taken place both in your Lordships' House and in another place, have been inadequate. Amendment No. 1 therefore throws the responsibility on to the commissioner and would ensure that he makes national guidance available so that this very important additional category of complaint does not become discredited by misunderstandings and perhaps by local variations in practice.
§ Subsection (8) of Amendment No. 1 requires the commissioner to produce guidance about how to make such a complaint—a clinical judgment complaint—and to assist anyone who wishes to do so in assembling appropriate evidence to make his case. The clarity and accessibility which would be achieved would be of benefit both to the complainant and to those complained against. In the new and complicated area of clinical complaints to be considered by the ombudsman it seems to us particularly important that the scales of justice are seen to be clearly balanced and not weighed against a patient, a lay person, who may be questioning the professional judgment—indeed the competence—of doctors and other health service professionals.
§ For example, it has been suggested that professional representative bodies may press the commissioner to set exacting and high standards of evidence from the 1126 complainant in a case of clinical judgment. It is very important that high standards are maintained. But in clinical judgment cases it seems that the type of evidence required may mean a level of scientific knowledge or perhaps technical expertise well beyond the capacity of the average complainant. That is the purpose of subsection (8)(b), to ensure that the commissioner's office takes the responsibility for ensuring that complainants understand how to find help so that the burden of assembling evidence will not fall inappropriately on them as individuals. Subsection (9) requires the commissioner to consult with appropriate outside bodies in creating the guidance. It is worth recording that the national consumer organisations and patients' representative bodies are anxious that the safeguards embodied in the amendment are included in the Bill.
§
The health commissioner himself has already emphasised in his useful background paper, which we have mentioned on several occasions in our deliberations on the Bill, that in his new responsibilities he will rely heavily on professional advice in the area of clinical judgment. That is what should be balanced by the requirements in the amendment. The Minister said in reply to my probing amendment on this subject in Committee that clinical judgment must be a developing concept. I agree with that. She also said:
It will be for the commissioner to decide, with advice from his professional advisers, whether and which aspects of any given complaint concern clinical judgment".—[Official Report, 29/2/96; col. 1680.]
I agree with that also but I do not think it is fair, either to the health professionals concerned or to patients, to accept that each and every instance of clinical complaint will be decided ab initio by the health commissioner with his professional advisers.
§ That is why Amendment No. 1 asks the health commissioner to issue guidance which will be available to everyone. Obviously that would be appropriately circulated once he has had the opportunity to develop his thinking about this complicated area with both the appropriate professional and, importantly, the consumer representative bodies. I beg to move.
§ Baroness CumberlegeMy Lords, as the noble Baroness has said, this amendment would require the commissioner to issue guidance to complainants on how to go about providing evidence in support of their complaint and to consult with various interest groups on the preparation of such guidance. The noble Baroness will know that I have a considerable amount of sympathy for the concerns which lie behind the amendment but I would argue that the amendment would be using a sledgehammer to crack a nut and therefore is unnecessary.
We have had a number of debates about amendments which would affect the way the commissioner goes about his work. We remain of the view that, since the commissioner is independent of government, it would be totally inappropriate to set down in primary legislation detailed operational requirements on his working practices. The commissioner's work is overseen by the Select Committee for the Parliamentary 1127 Commissioner for Administration. That committee is free to make recommendations for changes in the way he operates. I have no doubt also that Mr. Reid is taking careful note of all the views expressed in the debates in your Lordships' House and also in another place.
It is important that the commissioner should satisfy himself that there are good grounds for his intervention before committing the resources needed to conduct an investigation. It is right that complainants should tell him clearly what their grievance is and why they feel it has not been adequately dealt with by the new NHS procedures. The commissioner has made this clear in his paper. But he has also said that no complaint will be rejected simply because the initial request does not clearly establish the grounds of the complaint. He has further promised that a member of his staff will contact the complainant where appropriate to clarify the grounds of the complaint.
I believe that this should provide sufficient reassurance for your Lordships that complainants will not be prevented from bringing their concerns to the commissioner because of lack of support or guidance. I also know that the commissioner is planning to issue a revised leaflet for the public explaining how to make a complaint to him under his widened jurisdiction. It will refer to sources of help locally for people wishing to complain to him, including community health councils.
Your Lordships will be aware of the excellent work CHCs do in providing help and support to people wishing to make complaints about NHS services. There are also other sources of help available to the public; for instance, citizens advice bureaux and voluntary organisations. Some trusts employ patients' advocates or patients' representatives to support complainants and we encourage the further development of this kind of help to complainants at each stage of the new complaints procedure.
In conclusion, I do not believe that the amendment is necessary and I hope the noble Baroness, despite her closely argued case, will agree to withdraw it.
§ 6.30 p.m.
§ Baroness Jay of PaddingtonMy Lords, I am grateful to the Minister for that reply. I take entirely the arguments that she has made that this is a sledgehammer to crack a nut. But I suspect that our concern on these Benches is that perhaps it is worth considering the methods by which these new procedures will be monitored and evaluated, which is in fact the subject of a later amendment in this evening's proceedings. It is important both for the confidence and understanding of the public that it is made very clear what these procedures are and how they will have their rights maintained. I am delighted to hear from the Minister that a revised leaflet will be issued. I hope that every effort will be made through the normal health service channels to ensure that members of the public are not intimidated by the new procedures and that they feel confident to make their complaints, if necessary as far up the system as the ombudsman. However, in view of the Minister's reply, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
§ Clause 10 [Reports]:
§
Baroness Jay of Paddington moved Amendment No. 2:
Page 5, line 44, at end insert—
("( ) After subsection (1) there shall be inserted—
(1A) Before making the report of the results of an investigation the Commissioner shall—
§ The noble Baroness said: My Lords, this amendment and Amendment No. 3, are also intended to improve what one might call "the balance of power" under the new complaints system—that is to say, to increase public confidence that individual patients will have the same rights as individuals appearing before the ombudsman, as will health care professionals, who may be supported by the formidable resources both of their own professional organisations and perhaps from the NHS itself.
§ The purpose of Amendment No. 2 is obviously straightforward. It is to enable complainants to see the factual summary of the commissioner's draft report after the investigation is complete, so that they can comment on factual errors or omissions. At present the body or person complained about does have access to the draft report, but the complainant does not. Surely this practice is against the spirit of fairness and openness which is supposed to inform the new NHS complaints system right the way through, and particularly the work of the ombudsman.
§ After all, at the risk of opening old disputes, noble Lords will vividly remember the advantages that were supposed recently to accrue to those Ministers who had foresight of the recent report by Lord Justice Scott. On that occasion an enormous and, in my view, justified, public row ensued, about the rights of the Opposition to be able to see the report on an equivalent basis. No one is suggesting that the reports of the ombudsman in relation to health service complaints will be subject to that degree of partisan approval or disapproval. It is certainly unlikely that the clamour would occur about complainants within the health service. But it makes it even more important that the rights of the individual should be equated with the rights of the mighty machine of the ombudsman and the complaints committee—indeed, they must be ensured by statute.
§
This matter, as well as the previous one raised by Amendment No. I, have been mentioned at every stage of the passage of this Bill through another place and your Lordships' House. In another place amendments rather similar to Amendment No. 2 received wide, all-party support. At Report stage, the Minister, Mr. Horam, said in a positive reply to my honourable friend Mr. McLeish,
1129
I will ask the commissioner to consider further his practice and invite the Select Committee on the Parliamentary Commissioner for Administration to look into, not only the question of the health commissioner, but that of the parliamentary commissioner—perhaps as a larger part of the total framework—and decide whether it is fully satisfied that the procedures that the commissioner has outlined are totally correct, and whether it should seriously consider moving towards the hon. Gentleman's suggestions and those made in Committee".—[Official Report, Commons, 25/1/96; cols. 546–7.]
Those made in Committee, as I have indicated, were supported by honourable Members on the Government side.
§ Since then the chairman on the Select Committee on the Parliamentary Commissioner for Administration, Mr. James Pawsey, MP, has written to the National Consumer Council which has been championing amendments about complainants' access to draft reports. Mr. Pawsey agrees in the letter that this is a matter worthy of further investigation, which he intends to take forward in the forthcoming inquiry into the Parliamentary Commissioner's annual report for 1995. Given this favourable climate on all sides, it seems entirely appropriate to try to ensure that this generally acceptable purpose is included and now placed on the face of the Bill. I beg to move.
§ Lord HarmsworthMy Lords, when I first read this amendment I had some difficulty with it. It is possibly owing to the wording. In what she has just said the noble Baroness, Lady Jay, has clarified it to a certain extent. I had difficulty with the words "factual summary". It seemed to me that the commissioner's job had only two stages. The first was to agree with both parties what the facts of the complaint were (and hence my difficulty with the words "factual summary": that is to say, that both understood exactly what the grounds of the complaint were and agreed them.) The commissioner's second and last stage was to, as it were, produce his report. I suspect that that is his business, and his alone.
My own view is that he is assiduous in not only agreeing with Section 11(1) of the Health Service Commissioners Act 1993 which requires him to afford the health service body complained of an opportunity to comment on the allegations. But he is also very careful by his procedures to agree with the complainant and with the body being complained about, that the facts are right. He will go back and forth, as it were, until those facts are agreed.
He has set out his procedure in a letter of 16th January to my honourable friend the Parliamentary Under-Secretary of State, John Horam, in another place. I believe that that letter has been made available to the House of Commons Standing Committee on the Bill. I wonder whether the Minister would like to make it available in the Library because it is a valuable document.
In the end there is a final safeguard, in that the body being complained about may have to account to the Select Committee on the Parliamentary Commissioner for Administration. If the facts of the case are not right then there is clearly a difficulty there. As a consequence, 1130 my view of all this is that the amendment is perhaps unnecessary. I would rather that it were not on the face of the Bill.
§ Baroness CumberlegeMy Lords, I have listened very carefully to the points made by the noble Baroness, Lady Jay, and I understand the strength of feeling behind them. As she has said, there is support for this amendment from the Benches opposite and it has been very consistent. However, we are of the view that it would be wrong to legislate on such a detailed operational matter, and this is precisely the kind of issue we feel is best left to the ombudsman's discretion, as is the view shared by my noble friend Lord Harmsworth.
I understand that the ombudsman's purpose in sending the full draft report to the body complained against, including the draft findings and recommendations, is, first, to ensure that the facts as reported are not disputed. This is particularly important as it is the body complained against which may face public criticism for its actions. Secondly, it is in order to seek appropriate redress if the complaint is justified and calls for redress. Thirdly, it is to ensure that any necessary procedural changes are agreed to reduce the possibility of the same mistake being repeated.
My honourable friend the Parliamentary Under-Secretary of State for Health, Mr. Horam, has discussed this matter with Mr. Reid, who has explained that he has strong reservations about showing a draft of the report to the complainant. Mr. Reid has stressed that the investigatory, as opposed to the adversarial, procedure is one of the tenets underlying the concept of the ombudsman. He or she should not act in the same way as the courts. He has little doubt that if he were required to show a draft of the report to the complainant in every case, the time taken to conclude the investigation would be lengthened.
Your Lordships may be aware that the commissioner's present practice has been judicially reviewed in a Parliamentary Commissioner case and was not held to contravene the requirements of natural justice. The issue raised by the noble Baroness has implications for the ombudsman in his parliamentary as well as his health service role. In this Bill we are not seeking to change the ombudsman's method of procedure and we do not wish to bring the health service side out of line with the parliamentary side.
My honourable friend has written both to Mr. Reid and the chairman of the ombudsman's Select Committee, as my noble friend has said, on 16th January, inviting them to consider this issue further in the light of the points made in another place. The Select Committee chairman has replied undertaking to do this. I will place the letter in the Library if my noble friend feels that that is helpful. This matter is being dealt with by honourable members in another place. I hope that the noble Baroness will agree to await the outcome of that and in the meantime withdraw her amendment.
§ Baroness Jay of PaddingtonMy Lords, I am grateful to the Minister for her reply. I still believe that there is a slight peculiarity about a position in which we are asked to await the outcome of the Select 1131 Committee's report. As I described in quoting indirectly from the letter of the chairman of the Select Committee, Mr. Pawsey, that will be part of the forthcoming review for 1995. It is not clear how the Government will react in the context of the reply of the noble Baroness's her honourable friend Mr. Horam. If the context is that it will be looked at more broadly than simply in relation to the Health Service Commissioner, and it is agreed by the Select Committee on the Parliamentary Commissioner for Administration that this is a 'worthwhile reform, why, when the Bill will already have passed through your Lordships' House, does it have to wait until the report is forthcoming, which may be a matter of weeks after we finish our deliberations on the Bill?
The Minister has referred to the lack of necessity to legislate on what she describes as detailed operational matters. That is a matter to which we may return when we look at Amendment No. 3 That raises the issue of the detailed evaluation of the processes suggested in the Bill. I do not accept the point raised by either the Minister or Mr. Reid about the time of the complaints procedures being extended by sending a draft report to the complainant. Surely the thing to do is to send the report both to the complainant and to the body or person complained against at the same time. Some kind of time limit can be set for them to consider the report concurrently.
But, on the basis that the Minister has encouraged me to believe that the Select Committee on the Parliamentary Commissioner for Administration will consider this issue in detail and will be prepared to take a different view—which obviously will be operationally relevant to the work of Mr. Reid and any successors—I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
§
Baroness Jay of Paddington moved Amendment No. 3:
Page 6, line 14, at end insert—
("(6) After subsection (4) there shall be inserted—
(4A) During the three years from the date on which section 10 of the Health Service Commissioners (Amendment) Act 1996 is brought into force, each of the Commissioners—
§ The noble Baroness said: My Lords, Amendment No. 3 is important in the context of previous discussion about not seeking to put some of my concerns into primary legislation. Amendment No. 3 is an attempt to increase the transparency and accessibility of the ombudsman's work and to establish an effective system for monitoring and evaluating his new activities in the early years of their operation. Those will include the details that we have discussed in earlier amendments.
§ The amendment is the result of discussions among my honourable friends in another place, myself and the National Consumers' Council. We all believe that the enlarged responsibilities of the Health Commissioner for NHS complaints are sufficiently radical to merit a special process of evaluation so that the famous level playing field is achieved. I believe that to be particularly important in view of the Minister's response to the two earlier amendments that we have discussed this evening, which she feels are inappropriate for primary legislation. I believe that the process of evaluation and monitoring becomes even more crucial.
§ Too often we are aware that there is little evaluation in the health service. In this Bill we have the opportunity to achieve it at an initial stage and avoid subsequent contrary assertions about the success or failure of any particular change within the NHS. Amendment No. 3 proposes three specific initiatives: first, that in each of the first three years of operation the ombudsman should conduct at least one complainant satisfaction survey. Secondly, he should arrange a meeting in each of the first three years of the new system for relevant interests such as patient organisations, professional bodies, advisers and managers to evaluate and discuss developments and emerging issues. Thirdly, he should publish a report of these meetings, including the complainant surveys and resulting recommendations for amending the system. The Bill already requires the commissioner to place formal reports before Parliament. I believe that such monitoring would make it possible to make a proper assessment of how the process was working in practice. It would be very easy to include the two concerns which were the subject of my two earlier amendments this evening.
§ Too often one is told anecdotally that the complaints system is working satisfactorily, but on further investigation one finds that a patient or complainant has just given up rather than been satisfactorily dealt with. The whole object of the new NHS complaints system is to make the system much more user-friendly at every level. A more obviously open way of judging and evaluating it will enable one to be sure that patients are satisfied and not just exhausted. In addition, this system of evaluating and monitoring will give patients the confidence that the system is fair and open. It will extend their knowledge of the system, which appears to be complex, although it has been revised and made more user-friendly. It will increase access to information, including the new leaflet that the Minister has described this evening.
§ In another place the Minister, Mr. Horam, said that he would raise the issue with the commissioner. Before the Bill leaves your Lordships' House it is important that we know the outcome of those discussions and 1133 whether the process of monitoring is acceptable to the commissioner and will be included in his new arrangements. I beg to move.
§ Lord HarmsworthMy Lords, I have sympathy with the amendment moved by the noble Baroness, Lady Jay, or at least sympathy with the possibility of mounting a complainant-satisfaction survey. However, I have doubts about paragraph (b). It seems to me to be too rigid in its wording. Formal meetings once a year in what may easily turn out to be a very fast-moving and changing game may be inappropriate. Such a formal structure may place the commissioner in a straightjacket which would better be avoided. The commissioner already consults widely and regularly. Under Section 11(3) of the 1993 Act he has discretion in the procedure in conducting investigations into complaints.
Last week the Parliamentary Commissioner for Administration published his Third Report (Session 1995–96) on the Child Support Agency. Perhaps I may quote from that report to illustrate how fast he may have to move. In paragraph 1 of the introduction to that report he says:
In August 1994 I decided with regret that given the number of individual complaints against CSA I was already investigating it was not the best use of my resources or of benefit to complainants for me to investigate additional individual complaints unless they involved aspects of CSA's work which had not previously been brought to my attention, or unless the complainant had been caused actually financial loss. I took the view that investigation of a number of representative cases should identify the administrative shortcomings needing to be remedied and that resulting improvements to the system should bring general benefits in which other complainants would share".If one were to read the whole of that report, one would receive the clear impression that flexibility on the part of the commissioner is desirable and that he may have to move fast and in possibly unexpected directions. As I say, in my view the amendment is too rigid in its present form.I hope that my noble friend the Minister may be able to provide us with some helpful news about a complainants' satisfaction survey. On 11th January in Committee in another place, my honourable friend the Parliamentary Under-Secretary of State, John Horam, said that the health commissioner was examining the results of a similar survey done by the local government commissioner. Is such a survey on the health side a possibility within the next three years? Can my noble friend assure us that funds are available?
§ Baroness Thomas of WalliswoodMy Lords, I add my interest from these Benches in the topic under consideration and hope that the Minister may be able to reply in an informative, useful and helpful way.
§ Baroness CumberlegeMy Lords, I shall try to be informative and helpful, but I am not sure that I shall meet the wishes of the amendment's proposer. I am grateful to noble Lords for the contributions made this evening on this issue.
The aim of the amendment is to encourage the commissioner to be pro-active in seeking the views of both complainants and people subject to his investigations. I know that the commissioner is very 1134 sympathetic to the need for such openness. However, to make such detailed statutory requirements on the commissioner is not, we feel, compatible with his independent status.
I am very happy to give my noble friend and both noble Baronesses the assurance that the commissioner intends in the next financial year to carry out a survey of satisfaction of complainants with the investigation of their complaints. He fully expects to be able to do that within the resources voted for his office. That fulfils an undertaking he gave in response to a recommendation by the Select Committee on the Parliamentary Commissioner for Administration. It is his established practice to draw attention in his annual reports to any matters of significance. I have no doubt that Mr. Reid's successor would be likely to continue that practice and to include reference to the results of a consumer satisfaction survey in an appropriate annual report, because of course Mr. Reid will soon be retiring.
My honourable friend the Parliamentary Under-Secretary of State took up concerns expressed in another place about the need for regular meetings with interested parties with the ombudsman. Mr. Reid said that he had every intention of continuing his meetings with professional and consumer bodies. That will enable him to gather useful information about how his own role is perceived and the effectiveness of the new NHS complaints procedures, which will in turn need to be taken account of in future policy making. But he also pointed out that giving him formal responsibility for evaluating the new NHS procedures through such meetings would be a long way beyond his present remit and also not the most effective way of undertaking such an evaluation.
I can also assure your Lordships that the Department of Health is committed to continuing constructive dialogue with professional, NHS and consumer bodies and to evaluating the implementation of the complaints reforms in the NHS. I hope that what I have said will provide sufficient reassurance on the issues which have been raised in the debate by the noble Baroness, the Lady Jay, and other noble Lords. I would urge the noble Baroness in the light of that to withdraw her amendment.
§ Baroness Jay of PaddingtonMy Lords, I am grateful to those who have taken part in this short debate on the matter which will have given the Minister the knowledge that there is strength of feeling about these issues. I was delighted to hear what she said about the ombudsman's intention to conduct a satisfaction survey during the next year of complaints and that he intends to continue to have wide-ranging professional and consumer body gatherings and meetings to discuss the issues which were mentioned in my amendment.
I take the point made by the Minister—indeed she was repeating the arguments made by the commissioner himself—that to extend his monitoring role beyond that may be beyond his general remit. I hope that the Department of Health will fulfil the obligation to undertake clear and positive evaluation of the new procedure and will be able to bring the results of that monitoring to your Lordships' House.
There were two major issues which I sought to achieve through the amendment; namely, the 1135 complainants' satisfaction survey and the principle of maintaining full and open meetings with external bodies. In view of the fact that the Minister has greatly reassured me about the underlying concerns which lay behind the amendment, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
§ 6.55 p.m.
§ Baroness CumberlegeMy Lords, I beg to move that the Bill do now pass.
We are at one in wishing to improve the arrangements by which NHS complaints are handled. I have been grateful to noble Lords on all sides of the House for their positive contributions on this Bill and for their support for their principles behind it.
A number of points have been raised during our debates which have served to air some important issues. The noble Baroness, Lady Jay, described the challenges presented by the extension of the commissioner's jurisdiction to cover clinical judgment. She stressed the need to ensure that the actions of professionals are properly and fairly judged. She also sought assurance that all complaints about the NHS, including complaints about purchasing decisions, will come within the ombudsman's remit. I was very glad to be able to give her that assurance.
The noble Baroness also raised concerns about the ombudsman's procedures for checking draft reports with the body complained against but not the complainant. As I hope I made clear, that is not a matter on which we would wish to fetter the ombudsman with primary legislation, but the ombudsman's Select Committee has agreed to a proposal made by my honourable friend the Parliamentary Under-Secretary of State for Health that it should review with the ombudsman his procedures for dealing with draft investigation reports.
The noble Baroness and my noble friend Lord Harmsworth raised the issue of whether the ombudsman would carry out a survey into the satisfaction of complainants with investigations. As noble Lords have heard, I was very happy to give the assurance that the ombudsman does intend to carry out such a survey in the coming financial year.
The noble Baroness, Lady Robson, was concerned about the provisions in the existing legislation which prevent the ombudsman from investigating cases which are subject to legal action. I hope that the Bill will reduce the need for complainants to seek a remedy in the courts. We could not, however, contemplate making such a radical change in the ombudsman's relationship with the courts as the noble Baroness suggested.
My noble friend Lady Cox highlighted the need for good training to make sure staff are equipped to deal with complaints. We entirely concur with that view, and a great deal is being done to ensure that staff are well trained.
I am sure that your Lordships will wish to join with me in paying tribute to the ombudsman, Mr. Reid, for his work not just in preparing for the changes resulting from the Bill but for his integrity, thoroughness and sensitivity in ensuring that complainants receive a fair hearing and a just result.
1136 Mr. Reid and his team have done much to improve the quality of administration within the NHS and we look forward to him achieving similar progress with regard to professional standards.
Finally, I am also very grateful for the constructive approach of the health care professions. The professional representative organisations have been fully involved in developing the new NHS complaints system and in discussing with the ombudsman the practicalities of operating his new jurisdiction. We wish him and them well in the future.
Moved, That the Bill do now pass.—(Baroness Cumberlege.)
§ Baroness Jay of PaddingtonMy Lords, I reiterate again that we on these Benches welcome in principle the Bill which extends the powers of the ombudsman and agree very much with the Minister about the extremely effective work that has been done by the present Health Service Commissioner and his office. We hope that his successor, and the helpers who will work with him in their greatly extended new responsibilities, will have as much success as Mr. Reid has had.
We have welcomed in particular the ex tension of the ombudsman's authority into the areas of primary and community health care and the vexed and complicated arena of clinical judgment. I suspect that we will know how well the prospects for complaints about clinical judgment go forward only once the provisions of the Bill have come under some scrutiny under the ensuing legislation.
It is important that we have an effective monitoring and evaluation system, in particular as the provisions of the Bill come underway in the first period of time. We welcome the Minister's response to our Amendment No. 3 which seems to guarantee that effective evaluation will take place, although it may be more informal than we hoped.
On Second Reading, I said that the present NHS complaints system reminded many people, including myself, of an unfriendly maze. The Bill does much to make that maze at least more user friendly if not completely straightforward, and we on these Benches wish the legislation well.
§ 7 p.m.
§ Baroness Thomas of WalliswoodMy Lords, I rise in place of my noble friend Lady Robson of Kiddington, who is unable to be present tonight. We welcome the Bill, which enhances the operation of the health service for both patients and professionals. We are generally very supportive of the aims of the Bill. As was said by the noble Baroness, Lady Jay, we particularly welcome the extension of its remit to cover clinical judgment as well as maladministration. We also welcome the fact that the scope of investigation into maladministration is extended to those providing family health services and the independent-sector providers where they are providing services for the NHS.
We regret that our amendment was not accepted. The Minister referred to that. It would have allowed a patient to take legal action in order to pursue damages at the 1137 same time as the commissioner was investigating his or her case. The commissioner can ensure that wrongdoing is not repeated but he cannot give any recompense. The courts can give a recompense but they cannot ensure that wrongdoing is not repeated. If our amendment had been accepted patients would have been provided with a possibility of achieving two separate but equally important aims. The reason for rejecting the amendment is understood but there may remain the need to achieve both those aims. We shall need to be alert to see what happens in practice.
My noble friend has asked me to thank the Minister for the clear and capable way in which she has dealt with the Bill and that I most gladly do.
On Question, Bill passed.