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Baroness Gardner of Parkes: I believe that the complaints procedure in the health service is now working very well. I further believe that it is no longer carried out on a confrontational basis. When I was in general practice as a dentist, we were asked to put leaflets in our waiting rooms advising patients on how to complain. However, every dentist threw them into the

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rubbish bin because they did not want patients to do so. However, since that time, there has been more of a consultation between patients and dentists; indeed, there is an encouragement to say the good things and to make suggestions as well as making complaints. I believe that that has been very effective in general practice.

So far as concerns hospitals, I believe that every complaint is taken seriously and that also applies to health authorities. Indeed, I know of no complaints that fail to receive an answer. Of course, it sometimes takes quite a long time to investigate a matter and, therefore, a temporary answer has to be sent. Moreover, on occasions, full inquiries into matters have to take place which can involve a considerable amount of time and effort on behalf of the staff. I do not believe that adding the proposed extra layer of authority just to deal with complaints would bring any improvement to a system which I believe is working very well at present.

Lord Stoddart of Swindon: I shall not take very long over what I have to say. First, I do not know whether or not to support the amendment. I, too, do not want another layer of authority to be added. But, nevertheless, I understand why the suggestion has been made. Further, having heard my noble friend's opening remarks, I must say that I would now be inclined to support the amendment despite the fact that, when I first saw it, I had doubts about it.

My concern as regards complaints within the health service is that too little account is taken of the vulnerability of patients and their ability and wish to complain. I see that the noble Baroness, Lady Gardner, shakes her head. However, I have received a good deal of correspondence recently about the National Health Service. It is quite clear to me that patients do feel vulnerable, but that they are loath to complain in case their complaints are seen as being a criticism against operatives in the NHS. There are things about which patients want to complain, but they feel that if they make a complaint about, for example, the facilities, it would be taken as a complaint against their nurse, their doctor, their nursing assistant or some ancillary worker. That problem must be solved. I simply do not know whether the existing health service or the proposed arrangements will be able to do so.

Members of the Committee will know that I successfully moved the National Health Patient Accommodation Bill through this Chamber. The aim of the Bill was to provide patients with the right to be treated in single-sex wards. No doubt the noble Baroness will remember it. I have been amazed at the public reaction. It is quite clear that it was not realised within the health service that that was a problem. However, my postbag indicates that it is an enormous problem and that people, especially women, feel extremely bad because they will be treated in mixed-sex wards. It frightens and worries them; and, indeed, retards their progress. Yet, until quite recently, we had not really known about the problem because the complaints procedure was not available to reveal it.

I must tell the Minister that I am extremely sorry to say—indeed, I regret it very much—that my Bill was blocked in another place a week ago last Friday. After

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the noble Baroness has had sight of the 1,000 letters that I have received and which I intend to send to her, I hope that she will persuade her colleagues in government to change their minds. Even if they want to amend the Bill slightly, I hope that they will allow it to progress through the other place and that they will give it time.

We are discussing a serious problem. I believe that the amendment which has been moved is a real attempt to address a great problem within the health service and one which needs to be treated with great seriousness because those involved are, as I said, at their most vulnerable stage.

Baroness Jay of Paddington: As my noble friend Lord Stoddart of Swindon has mentioned the fact that he is unsure whether or not to support the amendment—although, in his concluding remarks, I believe he indicated that he would—perhaps I may just add two points that I hope the Minister will address which emerged from my noble friend's contribution. The first is the sense that patients have of the independence of the body to which they complain within the health service. My noble friend made a most important point about the degree of sensitivity which people feel when they are making complaints, especially as regards some of the subjects that he mentioned; for example, single-sex wards.

Patients feel that their complaints—about something which they regard as being a question of comfort, human rights or however they may wish to express it—will be seen as criticism of members of the medical profession. They are especially sensitive about any complaints which may be seen as criticism of the nursing profession.

We must be absolutely sure—and this is very much the thinking behind the amendment—that any complaints procedure which is acceptable and successful within the NHS is understood to be completely independent and neutral and not involved with the management of the NHS or, more importantly, seen in any way as a means of channelling criticism of the professions which most patients would not wish to do.

Secondly, can the Minister say how quickly she believes the new system will be able to work and what speed is intended to be asked of the new mechanisms in response? Again, following my noble friends Lord Rea and Lord Stoddart of Swindon, I believe that there is some concern in that there is no mention in the new proposals about how quickly a patient may expect to receive a response to any complaint. This, of course, would indeed apply to the kind of situation which my noble friend has described when someone might find himself or herself confronted with the possibility of either going into a mixed-sex ward or having an important operation delayed, or whatever it might be. I

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hope that the Minister will address those points, and I hope that my noble friend Lord Stoddart will support the amendment.

Baroness Gardner of Parkes: I hope that my noble friend will cover the role of the health ombudsman when replying to this amendment.

7 p.m.

Baroness Cumberlege: I shall do my very best also to win over the support of the noble Lord, Lord Stoddart. I think that would be a victory indeed. I have to say I admire his ingenuity in making yet another passionate plea on the issue of mixed sex wards. Although that is not part of this amendment, it is an issue that we take seriously, albeit that his Bill was not successful.

As I understand the noble Lord, Lord Rea, these amendments were tabled in the light of the recommendations of the Wilson Committee's Report on NHS complaints procedures. That committee was set up by my right honourable friend the Secretary of State in June 1993, following increasing concern within the NHS, the professions and patient representatives about the shortcomings of the existing complaints procedures. As the noble Lord said, the Government's response to Professor Wilson's report was published last week in a document entitled Acting on Complaints. This sets out detailed plans for a new NHS complaints system for England. Similar systems will operate in Scotland, Wales and Northern Ireland.

I am sure the noble Lord, Lord Carter, will be pleased to hear that before we published Acting on Complaints we consulted widely and had a very impressive response—over 620 responses were received. We are most grateful to all the individuals and organisations who gave us their views. The Wilson Committee recommended that the current confusing array of different complaints procedures should be replaced. Instead, there should be a simpler system which would put matters right more quickly for patients and use their experience to improve the quality of service for everyone. The Government have accepted this recommendation and the NHS will, from April 1996, have a simpler, speedier and more effective complaints system. I think that responds to the request of the noble Baroness about when things were going to happen. The emphasis in the new system is on quick responses to complaints at local level with an investigation or conciliation where necessary.

I wish to add a personal note. When I was a health authority chairman we used to say that a bunch of flowers was worth £40,000. As the noble Lord said, the independent panels will be set up to consider complaints which cannot be resolved using the local procedures. Finally, if a patient remains dissatisfied, the complaint can be referred to the Health Service Commissioner. I am sure the noble Lord and also the noble Baroness, Lady Gardner, will welcome the Government's intention that as soon as parliamentary time allows we will bring forward legislation to extend the commissioner's remit so that he can investigate all complaints by NHS patients.

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We agree with my noble friend Lady Gardner that an effective new complaints system can be achieved without the need for a centralised complaints authority such as this amendment proposes. The Wilson Report did look at the possibility of a complaints commission, not unlike the authority proposed in this amendment. However, it was offered as only one of four possible homes for the organisation of the second stage, the independent panels. The other three options were: chief executives of the trust or family health services authority dealing with the complaint; purchasers; and regional offices of the NHS Executive. The emphasis of the recommendations was on a rapid and effective response from front line staff and a speedy method of resolving more difficult complaints by a designated complaints officer or the chief executive. If all complaints handling in the NHS was administered by a central bureaucracy, we believe we would not achieve the required responsiveness, speed and simplicity.

I can assure the noble Baroness, Lady Jay, that we have considered all the options in this report. Our proposal for stage two is that the review panels will have a majority of lay members, completely independent of the service provider. The panels, therefore, will have access to independent professional advice on issues of clinical judgment. The decision as to whether a panel will be set up will be taken by a convener. For complaints about hospital services the convener will be a non-executive member of the trust concerned; for family health services, a non-executive of the relevant health authority. Before deciding whether or not a panel is needed, the convener will always consult the independent chairman who would chair the panel if one were to be set up. The panels themselves will consist of an independent lay chair and the panel convener. For complaints against trusts, the third member will be a purchaser representative—in most cases a health authority non-executive, or, if appropriate, a GP fundholder. In the case of family health services, the third member would be another independent member.

I am very glad to have had the opportunity to outline the Government's plans for a simpler, speedier NHS complaints procedure. I hope I have made clear that there is no need for these amendments which would simply set up a whole new complaints bureaucracy. I hope the noble Lord will withdraw the amendment.

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