Select Committee on Public Administration Minutes of Evidence


Examination of Witnesses (Questions 40-43)

SIR MICHAEL BUCKLEY AND MS HILARY SCOTT

THURSDAY 7 FEBRUARY 2002

  40. On that point about doctors making lots of money out of people's ill health, what about cosmetic surgery and so on? Where do people go if they have a complaint?
  (Sir Michael Buckley) If it is under the NHS, then cosmetic surgery is just as much within the jurisdiction as anything else. If it is purely private, the private sector is establishing some complaints procedures of its own. There may, of course, be recourse to the courts, and finally the National Care Standards Commission does have the remit of considering care right across the whole of the health sector, irrespective of whether it is public or private.

  41. So there is a multiplicity of organisations, therefore people out there must be totally bemused. Would you agree with that?
  (Sir Michael Buckley) Indeed so.

  42. Can I move on to the question of clinical negligence and what discussions you have had with the Chief Medical Officer about this, whether it is difficult to make progress because doctors band together, stonewall, to protect their interests?
  (Sir Michael Buckley) The Chief Medical Officer has set up an advisory committee, and I am a member of that committee, so I am involved in the discussions. I think it is entirely a matter for you to ask the Chief Medical Officer whether he is satisfied with the rate of progress and what difficulties there may be. What I have suggested within the context of both this and changes in the complaints procedure is that it seems to me, and it always has seemed to me, that there is, so to speak, a spectrum of complaints from the really quite trivial—a classic example is the temperature of tea on the wards—right through to very serious clinical negligence cases, particularly obstetric cases, when one may well be looking at damages in seven figures. Clearly, at the lower end the normal complaints procedure is fine; at the other end, I think it has to be a matter for the courts. When one is looking at the middle, I think the present situation is not satisfactory, and what I would prefer to see is a greater ability within the NHS complaints procedure to pay financial redress. One of the things, to be fair, since I have spent quite a bit of time criticising the Government, where I think central government has made considerable progress in the last ten years or so is a greater willingness to pay redress for maladministration. This Committee's predecessor studied that, and the attitudes which were expressed at the time of that study in 1992 were very different from those that there are now, and it seems to me that if central government, and indeed local government, can set up systems which will allow the payment of modest financial compensation—we are not talking about huge sums of money—that would help to remove some of the problems. We know that some NHS chief executives do pay maladministration compensation in what they regard as appropriate circumstances, but I think their task is made difficult by the fact that they are always having to look over their shoulder at the auditors, and the fear that they may be getting out of line with general practice in the NHS. If there were some sort of code of practice, such as the Inland Revenue have, which would give guidance on this sort of thing, it would be of considerable benefit.

Chairman

  43. There was a feature on the Today programme on the radio this morning about GPs whose patients had refused to have the MMR vaccination. Here were GPs who were striking patients off their list because they had not accepted the MMR vaccination and therefore they were in danger of losing their £2,000 bonus for meeting their target for getting vaccination rates up. Is this not outrageous? Secondly, if someone complained to you, could you do something about it?
  (Sir Michael Buckley) Only what I would do in any other circumstances of striking off, which is to examine whether it is reasonable. As I understand the guidance by the profession, it is not acceptable to terminate a patient relationship simply for financial reasons. So it seems to me that it is in fact contrary to the guidance that the General Medical Council has issued. I would not condone such behaviour if it were to be established. However, one other aspect one has to consider is whether it is sensible to set that sort of target.

  Chairman: That is a fine point to end on. We shall see you again shortly to continue this conversation. This is the first half. We are very pleased to have you. You have said some most interesting and challenging things that we shall reflect upon as to how we can carry some of them forward with the robustness with which you invited us to implicitly. We have had a very good session and we will have another one shortly. Thank you very much for coming along.


 
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