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Baroness Jay of Paddington: I am sorry to speak after the noble Baroness, Lady Miller. I am afraid that I was not quick enough to realise she was speaking on behalf of the Minister. With the permission of the Committee, I should like add a few points in support of the amendment. I was interested to hear the noble Baroness, Lady Miller, mention the King's Fund because, as I am sure she is aware, its latest contribution to the discussion about London advances the argument for the establishment of a strategic health authority rather than the reverse.

As the Committee will remember, in its original report the King's Fund gave one view of London's health services. From reading its more recent appraisal of the situation, as I understand it, much of that has been reversed. It claims that newly emerging evidence suggests that the capital's health care needs have been underestimated, and rather than call, as it did in its original document, for a reduction in funding, it now suggests that purchasing should be increased by £200 million.

I cite that finding because it suggests that there are strategic problems in London that need to be addressed, and probably need to be addressed in the long term in a rather more detailed and consistent way than was

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possible under LIG, which, as the noble Baroness, Lady Miller, said, was set up for a specific purpose and a specific time-limited project only.

I agree with the noble Baroness, Lady Robson, and, I am afraid, disagree with the noble Baroness, Lady Gardner. The London boroughs area has several specific problems which are worthy of the attention of a strategic policy body of the kind for which we have argued in general terms in relation to regional health authorities. Perhaps I may mention a couple of points which were not mentioned. There is considerable concern about the lack of take-up of GP services in London. There are a number of people among the floating population who are not registered with GPs and so are not available for the kind of primary care which, as we know, it is intended will become the more formal basis of the health service. The floating population ranges from the affluent young, who just happen to live in bed-sit accommodation and never register with GPs, to the huge numbers of homeless and rootless.

Perhaps I may illustrate again from my own local health authority. The number of people registered with GPs decreased between 1990 and 1993. Those who are not registered with GPs are still using the acute sector A&E departments and the minor injuries units for their primary care services. In the past, Ministers have referred to that use of the A&E departments for primary care services as inappropriate. Obviously, in an ideal world, that is the right word, but the fact remains that we have not yet sorted out London to make it possible to establish primary care services which are acceptable to that peculiar population of floating people who are not registered with GPs and in a way which enables one to be confident about the reduction in acute sector beds.

That leads me to the 64,000 dollar question about London: is it under-bedded or over-bedded? That is what I might refer to in shorthand as the "Professor Jarman" debate. That is another issue which is best addressed on a strategic level by a broad approach which cannot be dealt with usefully at the local health authority level. It is something which must be agreed upon, considered and referred to in a way which takes account of the broader areas both in inner and outer London, and it must achieve the right balance.

The other areas of concern to local health authorities in London relate to such issues as the discussion on whether a hub and spoke approach is taken to the arrangement of services. Again, that should be decided strategically by taking an overview. It cannot be achieved by looking only at local health authority needs and resources.

In its latest document to which I referred at the beginning of my remarks, the King's Fund said that there are three issues which need to be addressed: first, what is the capital's fair share of national resources; secondly, what is the appropriate way to respond to the healthcare needs of Londoners—that is, how to achieve a balance between primary and acute care in a rather peculiar population; and thirdly, how any necessary changes in the balance between health and social care can best be implemented. Those seem to be strategic questions which can be best addressed by a strategic

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body. Those issues cannot be covered by the regional outposts which, as the noble Baroness, Lady Miller, said, will be overseeing the work of the local authorities. Positive, directed and advocate-based arguments are required in order to carry out an analysis of those very difficult issues relating to the particularly difficult situation of the population in inner London. I support the amendment.

Baroness Robson of Kiddington: I thank the noble Baroness, Lady Jay, for her strong support of my amendment. In answering for the Government and in refusing to accept the amendment, the noble Baroness, Lady Miller, went into some detail describing what was happening in London and how the London Implementation Group had finished its work and that it had worked for some time. Without mentioning their names, she referred to task forces which have been set up to cover various aspects of the London health and social services problem. Is not the fact that those bodies have been set up an admission that London needs an overall strategic planning authority?

The membership of that authority needs to be established in accordance with Part I of Schedule 5 of the 1977 Act and not on the basis of ad hoc committees which look piecemeal at the various problems.

I am desperately sad that the noble Baroness cannot see her way to accept my amendment. I shall not press it now; but I shall certainly return to the matter at a later stage.

Amendment, by leave, withdrawn.

Clause 1 agreed to.

6.45 p.m.

Lord Rea moved Amendment No. 9:

Insert the following new clause:

("Independent health complaints authority

. After section 8 of the National Health Service Act 1977 there shall be inserted—
"Independent Health Complaints Authority.

10.—(1) It shall be the duty of the Secretary of State to establish a Health Authority to be known as the NHS Complaints Authority.
(2) The Secretary of State shall, before 1st April 1997, by regulations made under any of sections 13 to 17 (as appropriate) of this Act, provide for the Authority established under subsection (1) above to exercise all the duties and responsibilities of Health Authorities under the Hospitals Complaints Procedure Act 1985 ("the 1985 Act").
(3) It shall also be the duty of the Secretary of State to require, by directions made under section 1(1A) of the 1985 Act, each NHS trust to make provision for its complaints system to be supervised by the Authority established under subsection (1) of this section.
(4) The membership of the Authority shall be established in accordance with Part I of Schedule 5 to this Act.".".).

The noble Lord said: In moving this amendment, I shall speak also to Amendment No. 31 which refers to Schedule 1 of the 1977 Act.

I should say at the outset that the creation of an independent complaints authority as suggested by the amendment is not the only way in which to achieve a uniform, National Health Service-wide fair and

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independent complaints procedure. But in the context of the Bill, it seems the most suitable way to respond to the need for overdue improvements in the present inadequate systems for processing complaints.

Complaints need to be dealt with as speedily, fairly and independently as possible in order to give as much satisfaction as is reasonable to the complainant. But it should also lead to changes in the National Health Service which minimise the chances of the problem recurring.

I am well aware that the Government have published recently the document Acting on Complaints, which is their reply to Professor Alan Wilson's report dated May 1994, Being heard. That response is to be welcomed; but we should like the Government to go further.

The Patient's Charter has very laudable objectives, but it needs teeth to be effective. There must be a good mechanism enabling patients to point out where they feel that the National Health Service has failed to live up to those high standards or has been responsible for unnecessary suffering or expense for them or their relatives.

At this stage I do not intend to make any political points about the reasons why there has been such a recent increase in complaints. There will always be complaints against the National Health Service where sick people are undergoing operations involving questions of life or death.

In its critique of Acting on Complaints, the National Consumer Council states:

    "We urge the Government to keep up the momentum towards a common complaints system".

This amendment is offered in that spirit. Paragraph 176 of Professor Wilson's report, Being heard, states:

    "All unnecessary differences between NHS complaints procedures should be avoided to establish maximum commonality between them",

not coterminousity. He refers to 29 other paragraphs in the report to back up that central recommendation.

In particular, the report draws attention to the difference in procedures between complaints against family health service practitioners and those against hospital staff. In Acting on Complaints, it is suggested that there should be three separate groups of panels to hear complaints: first, non-clinical hospital complaints; secondly, primary healthcare complaints; and thirdly, clinical complaints. That is completely against the recommendations at paragraphs 177 and 178 of the Wilson report, which states that the division between hospital and FHSA complaints procedures,

    "is confusing to the public ... and wrong in principle".

Again, there is no need for a separate system for complaints about clinical judgments. Common principles and features must apply to the handling of all complaints. That is the principle underlying the amendment.

There is also an uneasy feeling that complaints procedures are administered by people who are too close to the providers. That has increased since almost all provider units are run by trusts which also have to provide the structure for dealing with complaints against themselves. Acting on Complaints provides that a

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convener, who is a non-executive director of a trust or a member of the health authority in the case of primary care complaints, will decide, with an independent chairman, whether to convene a panel on any complaint. The independent chairman of the panel will be chosen from a list held by the regional office of the National Health Service Executive. I accept that in most cases, such a chairman will be of high integrity and wisdom.

However, the fact that the list is held by the National Health Service Executive may itself raise a few eyebrows. We believe that by putting the complaints procedure outside the trust or health authority concerned, there will be a greater feeling that justice will be seen to be done.

The role of the health commissioner—that is, the ombudsman—will remain important and should remain outside whatever complaints procedures are in place. It may be tempting to place the whole complaints mechanism under the ombudsman, thus increasing the role of his department, but that would be wrong as it is very important to maintain an appeal mechanism which is clearly separate from the National Health Service. Moreover, there are complaints about complaints, and how the latter are handled, which have recently increased. In the report of the Select Committee on the health ombudsman for last year, which has just been published, the ombudsman, Mr. William Reid, is quoted as saying:

    "I was getting rather fed up of seeing the same mistakes made again and again and the trend of handling local complaints getting worse".

Mr. Reid is also quoted in the same report as saying:

    "When people find they are treated discourteously ... that one question is answered but four are not ... that it takes a very long time to get a reply [which is] couched in terms [that] a lay person would not [understand], it is hardly surprising that they want to complain to someone independent".

But the wait of 45 weeks before a complaint is heard by the ombudsman suggests that his office and staff need to be expanded.

However, if complaints were handled better locally, such an expansion of the ombudsman's office would become unnecessary. If properly implemented, a complaints authority with local supervision in all health authorities should improve procedures and reduce the number of appeals to the health ombudsman which are now at a record level. Although it is not on the face of the amendment, the new complaints authority should recognise the role of community health councils in supporting complainants. But I would hope that the authority would take a conciliatory rather than an adversarial position in the majority of cases.

I have spoken now for eight minutes and I believe that I have said enough. Nevertheless, I shall be most interested to hear the Minister's opinion and that of other Members of the Committee. I beg to move.

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