§ Order for Second Reading read.12.52 pm
§ Mr. Michael McNair-Wilson (Newbury)
I beg to move, That the Bill be now read a Second time.
The Bill springs directly from my own experience in hospital since I was taken seriously ill in January last year with kidney failure. From the months of hospitalisation that followed came the patients' charter which I published in September and from that has come the Bill, which seeks to implement one of the charter's main proposals.
The charter's object was to enhance the status of the hospital patient and to encourage the medical staff — doctors and nurses—to recognise the individual needs of patients and the fact that each patient is a unique human being.
Sometimes during those long days in hospital I felt more like a case history than a person. The doctors had diagnosed my illness; they reckoned that they knew how to treat it, what drugs I required and so on. Every day, they took blood tests and no doubt everything was despatched to the laboratory for analysis and computer readouts.
But what of me, the individual, lying in the hospital bed? I was like every patient who has just found himself in hospital, uncertain and anxious, worried about what is really wrong with him and worried about the future the treatment that he might have to endure. The patient will probably be worried about the support that his wife and family may get at home and uncertain as to whom he should turn to for help and advice. Perhaps one would expect that beside every hospital bed there might be a leaflet to allay some of those fears. I never found such a leaflet beside any of the beds in which I lay in no fewer than three different hospitals during the course of my illness.
Information about the hospital services that are available — times of meals, visiting hours and church services — should be available to any new patient, especially to one as anxious as I was. There should be guidance on how to make a complaint if such a necessity arises. There should be something about sickness benefits, benefits to which one's family is eligible, the library service and on all areas of service in a hospital that impinge directly upon the patient and about which he or she should know. The fact that no such leaflet existed in the three hospitals in which I was a patient—one was a large London general hospital and the others were in Reading and Oxford — shows that hospitals are not thinking as carefully as they might about their patients. It is for that reason that I am introducing the Bill.
It is true that a piece of paper with details about services is not all that a hospital patient requires. I was treated wonderfully by both doctors and nurses over the many months that I was a patient. Of course, the patient who is lying in a hospital bed is anxious about his condition. He will wonder about the future and be concerned about the treatment that he will receive. Patients are lying in alien surroundings and they have probably never met those who are to look after them. They will have no contact with them, at least initially, and, alas, perhaps no sense of trust and confidence.
Nurses still remain the gentle and kind angels that we want them to be, or at least that can be said of 99.9 per cent. of those who treated me. Nurses still know how to 1372 give patients assistance at moments of stress. If a nurse holds the patient's hand at that moment, it is worth more than its weight in gold.
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. I had the advantage over many patients lying in hospital because I knew something of the medical profession whereas they did not.
I have detailed patients' anxiety and sense of concern about the future and I have discovered that these feelings are not peculiar to me. After I published the patients' charter I received a vast amount of mail from all over the country. I received letters from ordinary people who found in my words an expression of their feelings. It is because I believed that I had struck a raw nerve, or a real issue, that I considered it worth while pursuing the charter into legislative form, if that was possible. Therefore, I count myself fortunate to have been drawn No. 12 in the ballot. I have been even more fortunate to find that the Department of Health and Social Security realised that there was something wrong and offered me its services in framing the Bill.
Some will suggest that contact between doctors, nurses and their patients is not all that it might be because the NHS is now treating more patients than ever before and that patients are in hospital for shorter periods than ever before. The time span is so limited that the opportunity for nurses and doctors to get to know their patients is much more limited than it was. Perhaps the amount of work done by doctors and nurses precludes their developing an effective bedside manner. Some of the doctors told me that if they did not have so much paperwork to do they could spend more time on the wards. We should take their point on board. Sometimes I wonder why a secretary is not available to help doctors get through work that could as easily be done for them as by them. Some of the older doctors were much more willing to stop and talk and to answer questions and allay fears.
Although most nurses brought that sympathetic touch of caring and gentleness that we expect of them, some bustled past, apparently bitten by the concept of patients as case histories who had to be fed drugs and not much else.
Lying in my hospital bed, I wondered whether something could be done to improve matters. I shall refer to my experiences, not to impress the House with the fact that I have had a fairly rough time but to show the type of mistakes that can be made in dealing with anyone lying in hospital. I am grateful for the fact that, throughout my period in hospital, no one said, "He is a Member of Parliament. We must give him gold-plated treatment." I never asked for, and I believe that I never received, such treatment. I hope that the fact that I speak as highly as I do of the NHS speaks volumes.
I remember a bad moment after an early dialysis treatment, which is not the easiest treatment to get used to. I felt pretty ghastly after the treatment and hoped that I was being taken back from the dialysis ward to my bed by means of one of those archaic wheelchairs that are still so common in hospitals. I was told that I was required in the X-ray department. I said, "I really feel very ill. May I just get my strength back before I go for an X-ray?" I was told, "Oh no, it is just on the way." I was taken into the X-ray department and I continued to complain about feeling ill. I was helped out of the wheelchair to stand 1373 against the screen, and I promptly fainted. I woke up to see many faces looking down on me more or less saying, "What on earth happened to you? How could this possibly be the result of our just wheeling you to the X-ray department?" When I was back in my hospital bed, I wondered how that could have happened. Surely someone somewhere should have said, "If he is not feeling well, it would be better to help him to get better and then X-ray him." To whom does one complain? Who comes to the patient and says, "We have made a mistake."? Does anyone really care, or is this just one more of the hazards of being in a hospital?
The same question arose after 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. When I went home I was in such a poor state that I needed a district nurse to come in every day to dress my feet. Afterwards, I asked, "I said that I was sensitive to penicillin; why did you give it to me?" The answer was, "Oh well, old boy, it was the best antibiotic for your particular infection and we thought that we could take the chance." Whose chance? Whose life? Whose body? Who is the sufferer? What is the compensation? What is the complaints procedure? There appears to be no such procedure. The patient is just the fall guy who is in the hands of doctors who think that they know better than the patient. The doctors did not feel that it was worth while picking up a telephone to ring my GP and ask, "He has told us that he does not get on well with penicillin. Is that really the case?"
In another instance, 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.
I do not believe that that is good enough. Those experiences of mine can be duplicated, triplicated and quadrupled throughout the country. Too many people who have written to me about my patients' charter have told me about the same type of mistakes and the problems that they too have suffered in hospital. No one comes forward to suggest that something could be done to alleviate those difficulties.
In listing those experiences and the failure to find a complaints procedure that was adequate to meet them, I thought a great deal about how a patient's rightful needs should be met and what type of complaints procedure a hospital should have to deal with them. In my list of complaints I should probably include awkward relationships with the staff. Sometimes those will be inevitable because human beings clash with one another but sometimes there is a failure by the staff to recognise that a patient is the anxious human being that he or she is. There is bad food, mislaid property, dirty washing and lavatory facilities, poor communications between doctors and nurses and their patients, failure by the medical staff to advise and consult relations, a lack of communication between departments in the same hospital, causing unnecessary distress to the patients, and mistakes causing 1374 distress and suffering to patients. On the last point, there is a powerful case for some form of automatic compensation — a system of insurance for hospital patients to cover them against time off work, minor disfigurements through unexpected surgery, drug rashes and other minor errors. I know that someone will say, "What is a minor error, and what is a major or more serious error?"
I do not believe that it is impossible for the Health Service to devise some form of limiting factor. I know that in a case such as mine, I have cause for compensation, but I also know that if I were to go through the present procedures not only would they be unbelievably drawn-out — probably covering years — they would cost me a fortune and I should probably obtain minor damages. I should have been able to take out an insurance policy when I first went into hospital. It could be devised in such a way that something would be available.
Before we worry about compensation any further, and we should worry about it because the present system is extremely inefficient and long-winded, we should return to my first suggestion of a leaflet beside each hospital bed for every new inpatient—a short statement of what is available to him or her and how, if they wish to make a complaint, they can do so. I believe that that is a first step in an effective hospital complaints procedure. What is more, hospital complaints generally should be handled by a senior member of the hospital staff and not treated solely at ward level. That member of the senior hospital staff should be on a par with the consultant, the surgeon and the senior nursing officer. He should, in effect, be the hospital's ombudsman. To my mind, the unit administrator would seem a natural choice for that appointment. All complaints should be directed to that person. There are some who believe that complaints should not just be directed to a person in the hospital but should be reported to the district health authority.
A member of the Portsmouth and South-East Hampshire health authority wrote to me about my Bill and said:It must be a fundamental obligation of District Health Authorities and they should be required to receive regular reports on the response given by patients, both during their period of treatment and also after their discharge. This need not be an enormous bureaucratic exercise, but could be done on a sample basis. Quite frankly I would not be happy at simply relying on doctors and nurses to necessarily report the views of patients accurately. If I can quote one small example, recently in one of our district general hospitals in Portsmouth, we undertook a patient satisfaction survey of the catering services. Questionnaires were designed for patients to complete and the questionnaires were delivered to each ward with an explanation given by a member of the Catering Manager's staff to each Ward Sister on how and when the form should be completed. Several Ward Sisters were extremely diffident about the exercise and said that they would complete the forms on the patients' behalf because the patients were not capable of completing the forms properly. Fortunately the Assistant Catering Manager assisted and ensured that the forms were completed by the patients. Discussions with clinical staff are frequently as disappointing. All too often one meets the comment 'We really know what is best for the patient'.The person who sent me that letter goes on to say:The sad thing is that the NHS is a marvellous institution and in terms of the commitment from the general public, it is extremely fortunate. It has got some fantastic staff who work for the real sense of commitment and dedication, and I think many of them who inadvertently fail to recognise patients' real feelings would be concerned and upset if they were really aware of the sorrow and anxiety that patients do suffer.It may be argued that some complaints of a very minor nature need not go through the complaints procedure that 1375 I have suggested. I am not sure about that. Perhaps if somebody wants to complain about the lunch today or the supper tonight, that really is not a matter for the hospital ombudsman. But, generally speaking, I believe that complaints should go to that person in the hospital who is detailed to look after them. The consultant in the case of medical complaints, the senior surgeon in the case of surgery, and the senior nursing officer in the case of nurses, should be informed about whatever complaints have been made. I stress that I am talking about minor complaints.
I return to the point that I have made several times before—that we must recognise that a patient lying ill in bed in hospital is an anxious person. That person will be nervous of making a serious complaint against a nurse or a member of the medical staff because of a fear of reprisals or that someone may be vindictive. That is why I believe that a third party is so crucial.
I repeat that what is wanted is a member of the hospital staff whose responsibility is to follow up complaints for and on behalf of the complainant, and someone who is not frightened of running up against a senior member of the staff, doctor or nurse to ensure that the inquiries are completed satisfactorily — in effect, a hospital troubleshooter. To some extent I find myself in that extraordinary position.
I have received letters from other patients in the hospital that I am currently attending for dialysis treatment. People that I have not seen before are bringing me their complaints and saying, "Since you are a Member of Parliament, will you do something for me?" I do what I can. It seems extraordinary to me that such people who are not my constituents feel that because I have the magic initials after my name, I can do something. In so far as I can, I do. If I tell my hon. Friend the Minister that members of the nursing staff have also asked me whether I can do something, particularly about the supply of laundry to the wards, he might realise that there is quite a task to be done to ensure that the complaints not only of patients but even of the nursing staff are properly handled.
Of course, it may be said that while I am talking about patients complaining, there is no particular reason why the hospital staff itself should not go out of their way to discover whether there are complaints. I suggest that it would be no bad thing if doctors and senior nurses asked patients whether everything was all right, if they consulted relatives of patients to find out whether the patient had told them something that he had been nervous of telling nurses or doctors. Sometimes it is undoubtedly true that patients will tell their wives and those close to them about their worries, while they will hide those same worries from those who are looking after them. My correspondent from the Portsmouth and South East Hampshire health authority told me in his letter that the Harrow health care centre,a small private Health Centre in Harrow",in his words,hands out on a routine basis questionnaires to patients asking them fundamental questions like 'Did you like your doctor?', 'Did you have confidence in him?', 'Did you feel that he told you all you needed and wished to know?If the Harrow health care centre can take that attitude towards its patients, I do not see why large general hospitals could not do something similar.
From what I have said, I wish to underline that I am in rio way trying to suggest that going to hospital is a terrifying experience or that one will be badly treated or 1376 have endless grounds for complaint—in fact, quite the contrary. However, that mistakes are made I hope I have illustrated, and that patients have cause for concern is undoubted. If anyone wants to see the correspondence that I have received about my patients' charter, he is welcome to do so.
I repeat that all of us can have the greatest respect for the doctors, nurses and domestic staff in our National Health Service hospitals. We can be satisfied, by and large, that they treat those in their care as well as they can. I suppose that what I am really complaining about is a lack of communication. I am also complaining about the fact that those who look after patients do not attempt enough to discover what the patient is feeling and so build up his or her confidence and help the patient to get better.
However, as we all know, all human institutions have shortcomings and failings. I believe that a practical and easily understood complaints procedure common to all hospitals is badly needed. I am aware that some hospitals have already introduced a complaints procedure. I am particularly delighted to say that my own Newbury district hospital has produced an authoritative document. However, I have not been an inpatient in that hospital, so have not had the chance to try out its procedure. Nevertheless, I know that it exists, and that shows that some hospital authorities have thought about the subject and felt that something should be done.
I believe that something on a nationwide basis is needed. Because it does not exist now, it is a serious omission from the effectiveness of the Health Service when it is applied to hospitals. Because I believe that the omission can be put right by the Bill, I commend it to the House.
§ Mr. Nicholas Lyell (Mid-Bedfordshire)
It is a privilege to follow my hon. Friend the Member for Newbury (Mr. McNair-Wilson), who after a period of suffering, which we recognise was real, is sitting here at least substantially restored to health as a result of the efforts of the NHS. He warmly expressed his gratitude to that service, yet in his duty as a Member of the House, having recognised that there are real shortcomings, has not been shy in bringing them forward to the House and the public.
I endorse what my hon. Friend has said because many years ago I too had great reason to be grateful to the NHS when it repaired my detached retinas with great skill. I was off work for only two months and I suffered none of the difficulties that my hon. Friend suffered. But, having practised in the courts for 20 years and having done a significant amount of practice of a medical nature, I know only too well of the problems which he describes. I also know them only too well from, in a sense, the inside, because my father-in-law, Professor Charles Fletcher, has made a particular study of communications in medicine. Although he has now retired, he continues to lecture and he has published works on the enormous importance of those in the medical profession being able to communicate.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
I hope that my hon. and learned Friend will accept that, despite his father-in-law's retirement, we remain grateful for the advice that we have had from Professor Fletcher and for the continuing advice that we receive from him.
§ Mr. Lyell
I am most grateful to my hon. Friend.
The medical profession is understanding more and more the importance of communication, but there is still a long way to go. It should be a requirement is every medical school that there is at least a significant period of formal training for young doctors as to how they should approach the patient. They should realise just how vulnerable a patient is, even if everything is done with the best of intentions.
On a lighter note, but with a serious undertone, let me tell the House of a story told to me by my general practitioner about my former general practitioner who is no longer alive. He was the very best of doctors and would undoubtedly have done everything that he could to communicate. But when his successor took over a patient told him that she had finished the course of pills which had been given to her by the doctor's predecessor but that they did not seem to be working. She said, "I have been taking them exactly as he told me every 46 hours." A moment's reflection will show how that misunderstanding occurred and yet nobody would put it down to the fault of the doctor. Happily, the pills were taken every four to six hours for the following three weeks and began to have a rapid and beneficial effect!
The undertone of that is that people are extremely lost and vulnerable when they enter a strange world. I remember feeling exactly the same when I entered hospital, although it turned out to be for only a comparatively short period. I remember having something explained to me and I was told that I had some "D" mark in my eye. I kept asked what "D" mark was. I thought that I was moderately well educated but I was not familiar with the medical expression "oedema". I was continually told that there was oedema which I picked up as "D" mark. That was a small hospital with the highest standards of treatment and the kindest communication. In enormous general hospitals, and in any hospital, there is tremendous pressure. People can feel much more lost and worried than many practitioners realise.
I re-emphasise that my gratitude to the Health Service is colossal. The dedication of the staff—doctors, nurses, administrators and ancillary staff— in the face of all sorts of difficulties is real and noticeable. Against that background of appreciation, and drawing on my experience in the courts, I want to make another serious point to the medical profession which I hope will be noted, considered and acted upon. It relates to circumstances in which it is necessary to pursue and investigate a serious complaint which may lead to a claim for compensation.
As the House knows, all doctors are required to be insured and I do not think that any doctor practising in the medical profession would be uninsured. The Medical Protection Society and the Medical Defence Union, for which I have had the privilege of acting on a number of occasions, exist to look after doctors' interests. The patient, however, is not insured and finds himself in an alien world. In theory, much has been done to improve the ease with which patients can get hold of their notes to pursue an investigation, but in practice it is still extremely difficult. Objections are raised to the patient seeing the notes, to more than one doctor seeing them or to their being passed to lawyers, as is essential if a case is to be properly regarded. It is said that the patient may suffer if he sees the notes, or that doctors will be less open if the notes are not completey protected, but I believe that such anxieties are exaggerated in the minds of those who express them. The risk to the patient is very small. 1378 Advisers, whether they be medical or legal or simply friends, will take care of the notes and not allow worries to be exaggerated. The notes should therefore be far more easily available.
My second serious comment is that members of the medical profession are far too reluctant to come forward and give evidence when it is justified in negligence cases. It is extraordinarily difficult to persuade experts to give an independent opinion and, if necessary, to support it in the courts. Here I declare an interest as to some extent it is my pleasure and profit to act in such cases, although I have not done so for some time and it is no significant part of my current activities.
It is wrong that a great and rightly privileged profession should not be prepared to see justice done in cases involving its own members. Such cases are often very complex and involve questions of judgment. Consultants and other specialists should not stand back from giving an honest and open opinion, if necessary backed in the courts, if that is the only way in which justice can be achieved.
It is sometimes argued that the British Medical Association or the General Medical Council is reluctant to keep lists of specialits as that might constitute the advertisement of skills, but I do not believe that there is any merit in that argument, if indeed it is still around. I appreciate that it might be embarrassing for one practitioner to have to give evidence against another, especially in a narrow field in which they might be friends or colleagues, but the same problems arise for lawyers, architects, accountants, chartered surveyors, and so on, and in all my long experience I have not found members of those professions unwilling to come forward in an open and responsible way. In this respect, the medical profession falls short of what the public are entitled to expect and I hope that it will take serious note of my comments, which are made in a spirit of kindliness and great support for its members' professional judgment and skill and the benefits that they provide for the community.
I turn to consider some of the specific points raised in the Bill. There is enormous merit in the setting up of a formal complaints procedure of exactly the type envisaged in the Bill. The fact that such a procedure exists and that it is open will help to overcome some of the problems, at a graver level, that might sometimes lead to litigation. I emphasise that I have no wish to see us follow the Americans into endless claims. Indeed, I know very well that my hon. Friend the Member for Newbury has no wish to see that.
However, anxious patients who believe that they have a genuine complaint should have the opportunity to air it. In a high proportion of cases—I suspect in the majority of them—it will lead to the rapid reassurance that the profession would have wished to give if it had only known about the complaint. In the small minority of cases where the matter is more serious, justice can only enhance the profession's prestige.
I warmly welcome and strongly support the Bill, and I hope that it will find a rapid route to the statute book.
§ Mr. Frank Dobson (Holborn and St. Pancras)
On behalf of the Labour party I warmly welcome the Bill introduced by the hon. Member for Newbury (Mr. McNair-Wilson). Although we have jousted almost personally on one or two issues in the past, I was delighted to be sitting on the Front Bench last year when he returned 1379 to the House. I think that we all welcomed his return, particularly as we had heard such horrifying stories about the nature of the things that had been wrong with him, and about the accidents that had happened to him while in hospital. I hope that it will not sound at all patronising if I say that it is inestimably to his credit that, on coming out of hospital and returning to work, he paid great tribute to the NHS and to those who had helped him. Unlike most of us, he was capable of distinguishing between what people had been trying to do and what had gone wrong.
There can be no greater justification for private Member's Bills than that a Member of Parliament who has had painful and distasteful experiences should try to help others by changing the law. That is one of the perfect justifications for a freely elected Parliament. However, I hope that I am not being too party political if I say that when arguing against private medicine and in favour of the NHS, I always stress that one of the virtues of having everyone reliant on the NHS is that people in influential positions can get corrected something that has gone wrong. Conversely, if people in influential positions opt out of the NHS, things can go wrong without them even knowing about it.
It is extremely commendable that the hon. Member for Newbury should have introduced this Bill. We shall seek to ensure that it gets through all its stages as quickly as possible, as we should like to see it enshrined in law. It is sometimes not recognised by those who theorise that patients in hospital are ill. That is why they are there. Those who feel ill are not usually feeling their best. If one is down, in pain, confused and vulnerable, when something goes wrong one is more disturbed than one might be at home, or even in the House of Commons.
People in hospital are ill and vulnerable. Many patients are in awe of doctors and nurses and many are also 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 trouble makers if they drew attention to things that were not going right for them.
We must make it easier for hospital patients to have their complaints dealt with properly. The exceptionally well informed hon. Member for Newbury found it difficult to put messages across when he was receiving treatment in hospital. Many patients are not as well informed and confident and are not the offspring of a doctor. They have enormous difficulties making their views known. We must ensure that there is a complaints system about which everybody knows and of which everybody can make use.
I have something of an obsession about complaints procedures because before I came to the House I worked for the local government ombudsman and dealt with complaints all the time.
People working in hospitals might be perturbed that Parliament should require a complaints procedure. There is no better way of describing the procedure than John Milton's immortal words:when complaints are freely heard, deeply considered, and speedily reformed, then is the utmost bound of civil liberty attained".A good effective complaints procedure would be of advantage, not only to patients, but to people working in hospitals.
It is probably best for people with a complaint to turn first to the person about whom they are complaining or the 1380 person who is responsible for that aspect of the hospital service. However, a procedure to log complaints is still necessary. I am not talking about the need for a formal procedure to roll into operation, but logging complaints is important.
It is often difficult to complain to the person about whom one is complaining. It can be difficult if one is having a rough time with a nurse or doctor to say that one does not like what is going on. It might be easier to complain to someone else about the person who is causing the upset.
A formal complaints procedure would be to the advantage of the people working in the hospitals. We should all learn from our mistakes. If a hospital is properly organised and logs all complaints, the complaints can be used as a tool of management to identify people who are square pegs in round holes, or procedures that lead to complaints. Improvements could be made, as a result of a complaint, to the physical layout of a ward or clinic. 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.
One thing that distinguishes our system of health care from that in the United States—to the inestimable credit of our system—is the absence of the massive amount of legal activity and litigation that prevails in the American system. Operations carried out by surgeons in the United States are described in some circumstances as defensive surgery — to defend surgeons against possible legal action if something has gone wrong. That is medical madness, and must be avoided.
§ Mr. John Patten
I am extremely grateful to the hon. Gentleman—who for the purposes of this debate is my hon. Friend—for giving way. Is he aware that in some American hospitals the staff includes moral philosophers, who are employed by the hospitals to advise surgeons on the moral choices that they face before taking decisions?
§ Mr. Dobson
They may be moral philosophers, but in line with everything else in the United States I suspect that they are concerned more with money than with morality. They are probably advising the surgeon that he will be safer in court rather than in the eyes of his fellow human beings or of whichever God he may subscribe to. It is more likely to be legal than moral advice.
I firmly believe that the stronger and more effective the sytem of complaints procedures in our National Health Service—both in general practice and in hospitals—the less likely we are to get into the mad position of having lawyers shuffling all over the place. Lawyers are a desperate necessity and their services should be avoided almost at all costs. We do not want the position that prevails in the United States, where if someone wants to complain about a hospital he has to do it via a writ or a claim for damages. Such a system is to the advantage only of the legal profession, and certainly not to the advantage of the patient or the medical profession.
As my constituency includes Lincoln's Inn and Gray's Inn, I may be risking a few votes at the next general election. However, I believe that the only proper place for a lawyer in a hospital is as a patient and not as a participant.
I welcome the Bill because it will be to the advantage of patients and the majority of people who are working in 1381 the hospital service who want only to improve the services to patients. It will help those responsible for managing the hospital service to manage it better and will help keep the lawyers out of our system of health care.
I hope that the Bill will go through all its stages today, get to the House of Lords and become law as quickly as possible. That will be a great tribute to the way that the hon. Member for Newbury has turned his experiences to the advantage of everyone else. We envy him that.
§ Mr. William Powell (Corby)
I fear that I must speak as a desperate necessity who is to be avoided at all costs and as one who should be in hospital as a patient. In the face of such an attack on myself and many others, I have a rare opportunity to speak about the Bill.
Having nailed my colours firmly to the mast, I join in the congratulations that have been offered to my hon. Friend the Member for Newbury (Mr. McNair-Wilson). Hon. Members will wish him and his Bill every success. No hon. Member is better qualified to introduce such a measure, and he did so with experience, aplomb and true knowledge of the subject, having been through the system in the way he described. My hon. Friend deserves as well with his measure as any hon. Member ever has with a private Member's Bill. I say that in the knowledge that I have wished him even greater success than I would have wished on myself in the preceding debate, when I introduced my private Member's Bill.
All hon. Members have experienced, through our constituents, circumstances which have made us wish that a satisfactory and reliable complaints procedure existed for hospitals. Constituents come to us with complaints about the way in which they, their families or friends have been treated in hospital. Sometimes those complaints are not justified; they are the product of a chemistry between two persons who have not been able to hit it off, with one side not having been able to accept the good will and status of the other.
Sometimes, however, not just personal relations but the system fails. It is to remedy that defect that the Bill is designed, and for that purpose it proposes an important and necessary change. I have no doubt that it will not be necessary to resort to its procedures often, because the overwhelming majority of those who go to hospital—as patients or when visiting families or friends who are ill —have nothing but the highest praise for the nursing, consideration, courtesy and good will that the staff show to patients.
Notwithstanding the desire of the hon. Member for Holborn and St. Pancras (Mr. Dobson) to send me to hospital as quickly as he can—though I must remind him that, having been called to the Bar by Lincoln's Inn in his constituency, I am affronted by his suggestion that I should be in hospital—
§ Mr. Dobson
I interrupt the hon. Gentleman because he may have misheard me. I said that the only proper role for a lawyer in hospital was as a patient. I did not say that all lawyers should be hospital patients.
§ Mr. Powell
I am grateful for that intervention. In view of the hon. Gentleman's good will towards the Bill, it 1382 would be churlish of me to insist on an interpretation of his words, which seemed to me to be consistent with his general drift. Therefore, I do not do so.
This is a first-class Bill, introduced by an outstanding Member in the best possible cause. No Bill could be more warmly welcomed by the House. I welcome it unreservedly.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
The Government welcome the Bill, and I welcome the chance to speak briefly about our support for it.
I pay tribute to the commitment and energy of my hon. Friend the Member for Newbury (Mr. McNair-Wilson), who has displayed his customary concern for others, in circumstances in which many others would have been concerned only with their own problems. The whole House admires his attitude. Everyone who has taken part in the debate has paid tribute to my hon. Friend, and I found his speech intensely moving and interesting.
I echo the handsome compliments paid by the hon. Member for Holborn and St. Pancras (Mr. Dobson) to my hon. Friend the Member for Newbury, who has demonstrated his concern to maintain and improve the quality of services offered by the NHS. We all share that concern and all hon. Members who have taken part in the debate have paid tribute to the skill and dedication of those who work in the NHS. The Government applaud those sentiments.
We have heard about the work of doctors and nurses, but we should not forget the ancillary and paramedical staff, who play an integral part in good hospital care. The involvement of ancillary staff can be critical in creating the atmosphere of contentment in our great NHS hospitals, whether large or small. We have benefited from the valuable perspective of my hon. Friend the Member for Newbury as a recent recipient of health services. That perspective has prompted him to bring forward the Bill, which is designed to ensure that the NHS deals more effectively, according to his lights, with complaints.
We have had some interesting reflections on the nature of the NHS complaints procedure from the hon. Member for Holborn and St. Pancras and, particularly, from my hon. and learned Friend the Member for Mid-Bedfordshire (Mr. Lyell), whose 20 years of practice in the courts, sometimes involved with these issues, has given him the knowledge and experience with which to speak freely and in detail.
We also heard interesting views from my hon. Friend the Member for Corby (Mr. Powell), whose own Bill moved forward one stage earlier today. It is characteristic of his assiduity as an hon. Member and of his interest in the welfare of his constituents that he should have stayed on to speak in yet another debate; some hon. Members might have given in to the temptation to repair to a place of refreshment to celebrate the progress of a Bill of their own.
The basis of everything that my hon. Friend the Member for Newbury is intent on doing finds its source in his view that the National Health Service needs a patients' charter. That is a great issue. My hon. Friend first wrote to the Department in September 1984 to put forward his 10-point patients' charter. I think that he realises that 1383 these are complicated issues that require perhaps step-by-step movement and much detailed consultation with all those involved in our hospitals.
The concept of the charter and the themes raised in it are far-reaching. For example, point No. 2 is:No patient shall be prescribed powerful drugs until the hospital concerned has been in touch with the patient's general practitioner.My hon. Friend was too modest to refer to the matters set out in the charter, so I shall do it for him. The third point is that new patients must be covered by an insurance policy when they enter hospital.
These matters and the range of others are most thought-provoking. I am not saying that the Government support them or oppose them. I am merely saying that they are thought-provoking for my right hon. Friend the Secretary of State, my right hon. and learned Friend the Minister for Health and myself in our continuing review of NHS policy. I hope that they are thought-provoking for the medical community at large.
Apart from beginning to pilot the Bill through the House, my hon. Friend has begun to promote perhaps a slightly overdue debate in the NHS and medical circles about the nature of the complaints procedure and the responsiveness of the NHS to those we collectively hope to serve. I pay tribute to him for getting the debate going.
Nothing could have shown more clearly the need for the debate than my hon. Friend's reference to the lack of information that he experienced, at least on one occasion, while he was in hospital. There was no leaflet next to his bed, and he was given no information about church services and other forms of help which so many patients entering a hospital would seek. We expect those who run our hospitals to provide that sort of information and to make it freely available. It is wrong that that information has not been given. I am sure that that view is shared by the hon. Member for Holborn and St. Pancras.
Building on his experience, my hon. Friend the Member for Newbury has decided to initiate a debate on the nature of the responsiveness of the NHS to its consumers and the nature of the complaints procedure which, alas and alack, we must have. He has done that and has introduced an important hospital complaints procedure with, I think, the support of the whole House.
The Government are concerned to increase the consumer responsiveness of the NHS. It must be more sensitive to the needs and wishes of patients. One of the key components of the recent NHS management inquiry report produced for us by Roy Griffiths and his colleagues was the importance of assessing and ensuring consumer satisfaction. In the talks about management changes that have flowed from our acceptance of the results of the inquiry as set out in the report, what Roy Griffiths and his colleagues had to say about the importance of listening to the consumer—the patient—has been rather overlooked. That is another reason for our being grateful to my hon. Friend for introducing the Bill.
The improvements that I hope the Government are introducing into the management of the NHS are designed, among other things, to bring decision making closer to the patient and to begin to try to pinpoint exactly who is responsible for doing what at all stages in our hospitals. The introduction of general managers is providing an opportunity to stimulate initiative, energy and vitality in the management function. One necessary element in achieving this is the need to give proper attention to the 1384 needs of patients, or consumers. It is essential that NHS managers should know how well services are being delivered. The patients must be a valuable source of information. One should not simply ask the politicians, doctors, nurses, paramedicals, ancillaries, trade unionists and everyone else involved in the delivery of the service how the NHS is run. One should also ask the patients. That must be one of the touchstones of good, hard, hands-on management in the NHS. Managers should be seen to be taking account of what patients say about the NHS.
The NHS already has a quite well-established complaints procedure in hospitals on the basis of guidance that we issue to the NHS, most recently in 1981. That advice emphasises a speedy, thorough and open response at the local level as the best approach to a complaint by a patient or relative. We expect health authorities to deal firmly and fully with complaints and to ensure that complainants receive informative and frank explanation. I agree with my hon. Friend the Member for Newbury that it is possible to sort out these problems quickly by immediate intervention by management, consultants, or nurse managers. I appreciate the point made by the hon. Member for Holborn and St. Pancras about the difficulty of complaining to a person about whom one has a complaint. There are intrinsic difficulties in that process.
If a complainant remains dissatisfied, there are established procedures for a further review of the case at a higher level in the service by officers or, perhaps, by members of the authority. Those procedures are laid down in health notice HC(81)5 which was circulated in April 1981. Every Health Service manager has a copy of "Health Services Management: Health Service Complaints Procedure". There is much good basic guidance in that document.
In addition to the NHS complaints procedure, the independent office of the Health Service Commissioner can investigate patients' grievances. He has the power to investigate complaints about the actions of a health authority involving an alleged failure in service, or failure in service provision or maladministration. About 120 cases a year are investigated by the Health Service Commissioner.
It may be of interest for the House to know how the present complaints procedure works. Each year in England there are about 6 million inpatient admissions and almost 50 million episodes of outpatient treatment or treatment in accident and emergency departments. In 1983, 19,000 written complaints were received, or about one for every 3,000 episodes of treatment. Although it is a comparatively small figure given the overall volume of NHS activity, which is prodigiously large, 19,000 written complaints represent a considerable body of patients with grievances so great that they decided to write about them.
My hon. Friend the Member for Newbury has received letters from not only fellow patients in the hospital which is treating him so well but—I was slightly grieved to hear this—from nursing staff in hospitals. The number of complaints has been growing in recent years. It is generally accepted that most complaints are made not to obtain financial compensation or to give a useful indoor relief to the lawyers — this point worried the hon. Member for Holborn and St. Pancras—but to obtain an adequate explanation as to why an action took place in a particular way. The lessons learnt from the volume of complaints can be valuable.
1385 The Bill is in line with the Government's aims for a more responsible NHS. It would be one step further—should it pass into law — towards achieving a better Health Service. In many ways, the duty that the Bill would lay on the Secretary of State is already fulfilled. The legislation would also provide a vehicle for the improvement of current procedures, to which my hon. and learned Friend the Member for Mid-Bedfordshire referred in his eloquent remarks. It will also give a valuable impetus to the drive for better services.
My hon. Friend's Bill furnishes an opportunity for us to re-examine our complaints procedure. We should of course do that in full consultation with the medical and other health professions and with patients. We would determine with them the precise shape of the complaints procedure that the NHS needs to hear the patients' voice, to examine, critically perhaps, its own actions, and, most importantly, to act on the findings of those discussions. I am grateful to my hon. Friend for giving us that opportunity and impetus.
The Bill will also provide us with a valuable opportunity to consider the available publicity material. A complaints procedure about which no one knows is of no use to anyone. We must do better. If my hon. Friend was let down and was not given the information that he felt he needed, we must do better and ensure that our hospitals give that information. That is not to say that people should be encouraged to complain unreasonably about the superb service which the NHS generally provides. My hon. Friend and my hon. and learned Friend paid tribute to that.
We must be satisfied that we are not discouraging patients from voicing their legitimate anxieties. That is most important not just for patients but for the parents and relatives of those who are in hospital. They should feel much freer than hitherto they have felt to talk to staff about services and any queries that they may have. Staff should not feel inhibited from discussing such matters with complainants.
Many complaints arise out of a sense of frustration—the feeling that people do not want to talk and give information. It is difficult to legislate about that. It requires major changes in the training regime for young doctors, nurses, paramedicals, and ancillaries who do such an important job in our hospitals. It is as true now as it ever has been that good communications between staff and patients will go a long way to reducing the number of complaints and the need for action which will undoubtedly flow from my hon. Friend's Bill.
The Bill will provide my right hon. Friend the Secretary of State with an opportunity to consider afresh all the elements on which I have touched briefly, and perhaps to 1386 introduce a statutory complaints procedure which commands the confidence of patients and staff. It should make a real contribution towards the provision of a more consumer-responsive NHS. It is a duty which, as I said at the outset of my remarks, the Government welcome. We are most grateful to my hon. Friend for giving us the opportunity to welcome it.
§ Mr. Michael McNair-Wilson
I must first thank all those hon. Members who have so kindly spoken about my Bill in such complimentary terms. May I take up, especially, the kind words of the hon. Member for Holborn and St. Pancras (Mr. Dobson) and follow one thing that he said which is accurate and to the point—that when complaints are aired things are put right which are then not wrong for someone who comes afterwards. Complaints help to improve services generally for today and the future. We should see the complaints procedure in that light.
The second point I should like to make is to remind the House that there are between 1,100 and 1,200 complaints to each local health authority each year. As my hon. Friend the Minister said, that is a large number. That may be the tip of the iceberg or it may be the iceberg itself; I do not think that any of us are sure. But the more we can let patients air their views, the better Health Service we shall have.
I remind the House that Professor Andrew Matthews of St. George's hospital in London told the British Association for the Advancement of Science that, in his experience, the better a patient was informed about his treatment and about the way that he was being looked after in hospital, the less was his reliance on pain-killing drugs and the quicker was his cure. That again underlines the need for communications between the medical staff and patients.
I thank the Minister for his very kind words about my Bill and about myself. I thank him also for the many things that he has told us about how sensitive the Government are to the need to improve the consumer protection side of the Health Service—for that, after all, is what I am talking about. We all recognise that there is a shortcoming in terms of a complaints procedure, and I hope that the Bill will make good that omission.
Question put and agreed to.
Bill accordingly read a Second time.
Bill immediately considered in Committee; reported, without amendment.
Motion made, and Question, That the Bill be now read the Third time, put forthwith pursuant to Standing Order No. 58 (Third Reading), and agreed to.
Bill accordingly read the Third time, and passed.