Health Service Commissioners (Hansard, 22 May 1980)

§ Mr. Patrick Jenkin

Following is the text of the document " Investigating Patients' Complaints: Complaints relating to Clinical Judgment " sent to me by the chairman of the Joint Consultants Committee on 31 January 1980, and that of my reply to the chairman dated 1 April. Investigating Patients' Complaints Complaints relating to Clinical Judgment 1. First Stage: If a complaint about clinical matters is made either orally or in writing, it is the responsibility of the consultant in charge of the patient personally to deal with the matter. If another member of the hospital medical staff is involved, the consultant should discuss the complaint with the doctor concerned and at all later stages in this procedure. It may be helpful to discuss the complaint with the patient's general practitioner. The consultant should arrange within a few days to see the patient or relatives who have made the complaint¹, to discuss the matter and seek to resolve the patient's anxieties. If there is any delay he should get in touch with the patient and explain the reason. When the consultant sees the patient, he should make a brief, strictly factual, record in the hospital notes. 2. Second Stage: If the complaint is not resolved at Stage 1, the consultant must at once inform the Regional Medical Officer. He may also wish to discuss the matter with his professional colleagues. After these discussions, he may consider that a further talk with the patient might resolve the complaint. If this fails, or if the consultant feels that such a meeting would be pointless, he should discuss with the Regional Medical Officer the value of offering to the patient the procedure outlined under 3 below, whereby the Regional Medical Officer would nominate two independent consultants to see the patient jointly to discuss the problem. If such an arrangement was acceptable both to the consultant and the patient, the third stage would be set in motion. ¹ Footnote: The doctor's first responsibility is to the patient. It is anticipated, therefore, that complaints will be made by or on behalf of patients. In the case of minors, those with physical or mental disability limiting their competence to deal with the matter themselves, or 325W deceased patients, it would be appropriate to consider complaints made by relatives. 3. Third Stage—Second Opinions: Arrangements would be made by the Regional Medical Officer for two independent consultants to consider all the aspects of the case. One would be nominated by the appropriate Royal College, the other would be a consultant in the same specialty from a comparable hospital in another Region. The names of the consultants selected to provide the second opinions would have to be approved by the consultant concerned with the complaint. They would also be submitted to the patient and it might be suggested that he or she should discuss them with the general practitioner. The ' second opinions ' would have an opportunity to read all the clinical records. They would also have an opportunity of discussing the case with the consultant concerned and any other member of the medical staff involved, prior to seeing the patient. The meeting between the two independent consultants and the patient would be in the nature of a consultation. The patient might well be accompanied by a relative or close friend and might wish to ask the general practitioner to accompany them. The consultant who had been in charge of the patient at the time of the complaint, would not be present at the meeting, but should be available if required. A full discussion about the clinical aspects of the problem would be undertaken with the object of resolving the patient's anxieties. In some cases, the second opinions would be able to convince the patient that the clinical judgment of the medical staff concerned had been responsibly exercised. If no satisfactory solution could be achieved, there would be nothing more that the second opinions could offer. No formal report would be submitted, but the Regional Medical Officer would be informed in writing that the patient appeared to be satisfied or not to be satisfied following the consultation with the second opinions. The Health Services Commissioner: Complaints concerning clinical judgment received by the Health Services Commissioner would in future be referred back to the Regional Medical Officer. The RMO would then discuss with the consultant whether the latter had had full discussion of the problem with the patient. If this had already been done, or if it failed, the RMO would consider with the consultant involved whether, if agreeable to the complainant, the activation of the ' second opinions ' procedure would be helpful. Text of my reply:— I have now been able to consider most carefully, with Dr. Vaughan and my official colleagues, your letter of 31 January and its enclosures. I am grateful to you and your colleagues for the time and effort that you have put into seeking a solution to the difficult problem of how complaints about clinical judgment should be dealt with. I should say right away that I can see the advantage in an approach based on independent peer review which is the one that the Joint Consultants Committee has followed. I must also tell you, however, that 326W there are several features of the proposals which I find difficult to accept, and which would be difficult to defend in Parliament. The most important of these are that the consultant concerned would have sole responsibility for deciding how a complaint should initially be handled; that the consultant could, if he wished, effectively prevent the proposed machinery for an independent review from being brought into operation; and that it is not clear how the proposals would operate if the ' second opinions' should conclude that there are grounds for criticism of the consultant concerned. I also see difficulty if, as I read the proposals, there would be no role for the Health Authority. I am sure you will have seen from the Press that pressure is mounting in Parliament for a solution based on the Select Committee's report. An ' early day ' motion to that effect has been signed by some 80 MPs and Mr. Ashley has successfully introduced a Bill to extend the Health Service Commissioner's jurisdiction. (One member spoke to oppose the introduction, but there was no one to support him and the Bill was therefore introduced without a vote.) There have also been three Parliamentary Questions since I became Secretary of State asking what action I propose to take on the Select Committee's report. I am therefore most concerned that, now that your proposals have been published (in the British Medical Journal), we should press ahead towards a full and satisfactory solution to this problem. At the same time I recognise the difficulties which confront you and your Committee colleagues, and I would wish to do everything possible to help in a constructive way. I am therefore asking Sir Henry Yellowlees to send you as soon as possible a memorandum which the Department is preparing, which builds on the Joint Consultants Committee's proposals and which would form a starting-point for further discussion betwen members of the JCC and Departmental officials; it might be appropriate to associate the medical defence organisations with the discussions too. For the reasons I have indicated above, such discussions would have to press ahead quickly and I shall wish to keep in close touch with progress; at a later stage, there may be advantage in my arranging a meeting with you and your colleagues.