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Mr. Milburn: My hon. Friend makes a cogent point. The existing complaints procedure is inadequate. It must be changed and made more independent. However, we should not use the failures in the system to excuse the failures of individuals at Alder Hey. The complaints were clear and consistent, and did not come just from patients. Ironically, many of the complaints about van Velzen's procedures came from other doctors. For example, there was a huge backlog in the number of post-mortem cases and he did not undertake the appropriate histological examination. Doctors in the trust complained about that to van Velzen, to the pathology department and, as the report makes clear, to managers. Sadly, the appropriate action was not taken. We must learn the lesson of that and ensure that internal procedures work. We need checks and safeguards but, more important, we must use external complaints from patients to introduce change rather than to cover up problems.
Mr. Harry Barnes (North-East Derbyshire): Did any of the complaints lead to internal inquiries at Alder Hey? Untoward incident procedures are dealt with internally. If there were internal inquiries, what were their substance? Were they anything more than a cover-up and whitewash of those unhappy events?
Mr. Milburn: When my hon. Friend gets an opportunity to read the report, he will see that an endless succession of inquiries was conducted by the university, the hospital authorities and senior clinicians, but they came to nought. Is not that precisely the series of events that we see all too often in the NHS? Everyone knows that there is a problem, but no one does anything about it and the patients suffer. That is why we need not only a new culture and way of working in the NHS, but new systems. That is why clinical governance, a statutory duty of quality, a patient advocacy service and a patients forum that is independent of the hospital are needed in every trust. Those will make a profound difference because they will break down the barriers that have often meant that serious complaints have not been dealt with as they should have been.
Dr. Howard Stoate (Dartford): The dismay expressed by all hon. Members will be shared by the many people who work in the NHS who will feel extremely let down by what has happened. How can we ensure that such tragic events, from which we must learn great lessons,
Mr. Milburn: I very much agree with my hon. Friend's comments. It is important that the trenchant criticisms of the Redfern report and the chief medical officer do not allow us to lose sight of the truism that the overwhelming majority of people who work in the NHS--the doctors, nurses, managers and so on--are doing their best for patients. They are good--not bad--people. We cannot allow a few bad apples to damage the reputation of the health service as a whole. It is true that profound cultural changes must take place.
Public confidence will be most undermined if problems are covered up--we will not be able to deal with them unless we can get them out in the open. By dealing with them, we will rebuild public confidence in Alder Hey and in the health service as a whole.
Mr. Hilary Benn (Leeds, Central): Further to the point made by my hon. Friend the Member for Keighley (Mrs. Cryer), when my right hon. Friend reviews the law will he take the opportunity to examine some of the areas of legal uncertainty that currently surround the taking of organs for donation, such as issues pertaining to elective ventilation? With the informed consent of patients and their relatives, we might be able to increase the number of organs for donation.
Mr. Milburn: Those are hugely important and sensitive issues, and we will of course have to consider them. There is a more general point that we have to view informed consent as something that applies not only to a narrow group of patients but to every single patient in the NHS. We have a long way to go, but I believe that the changes in law, training and practice recommended by the chief medical officer, which I have outlined this afternoon, will produce the right results.
Motion made, and Question put forthwith, pursuant to Standing Order No. 114 (Northern Ireland Grand Committee (legislative proposals and other matters relating exclusively to Northern Ireland)) and Standing Order No. 116 (Northern Ireland Grand Committee (sittings)),
1. The matter of human rights and equality in Northern Ireland, being a matter relating exclusively to Northern Ireland, be referred to the Northern Ireland Grand Committee;
2. The Committee shall meet at Westminster on Thursday 8th February at 2.30 p.m.; and
3. At that meeting--
(a) the Committee shall take questions for oral answer; and shall then consider the matter of human rights and equality in Northern Ireland, referred to it under paragraph (1) above;
(b) the Chairman shall interrupt proceedings at 5 p.m.; and
(c) at the conclusion of those proceedings a Motion for the adjournment of the Committee may be moved by a Minister of the Crown pursuant to Standing Order No. 116(5) (Northern Ireland Grand Committee (sittings)).--[Mr. Pope.]
One key proposal is for flexible opening hours for pubs and clubs, with the potential for 24-hour opening. The aim of that proposal is to discourage binge drinking before closing time and to avoid the mass exodus on to the streets of drinkers from town centre pubs after 11 o'clock. Research indicates that over 50 per cent. of all arrests for drink-related crimes occur at that time, while 47 per cent. of all incidents of violence and disorder take place at closing time on Friday and Saturday evenings.
Fear of alcohol-related violence and intimidation has also meant that large numbers of people avoid town centres on weekend evenings, and that has had a significant effect on many town centre economies. It is hoped that the introduction of flexible opening hours would lead to a significant reduction in reports of drink-related offences and arrests, a reduction in the incidence of bingeing and drunkenness, the increased availability of transport facilities and fewer reports of noise nuisances.
Flexible hours have the potential to create a new generation of more responsible, socially aware drinkers, who are less likely to get drunk and less tolerant of drunkenness and drunken behaviour. Longer opening hours would help to place greater emphasis on the social function of pubs, and encourage people to drink less, or at least more slowly and responsibly. However, any relaxation of licensing regulations in favour of prolonged opening must proceed with caution.
Under the proposals in the White Paper, the courts would consider reasonable objections to an application for extended hours based on crime and disorder issues, public safety and public nuisance considerations, but the burden of proof would fall on the objector, not the applicant. It would be far from easy, in advance of the licence being granted, to provide substantive evidence that the extension of premises' opening hours would lead to an increase in crime and disorder or cause unreasonable public nuisance.
If local authorities possessed a town centre strategy, clearly defining what is and what is not acceptable in licensing and planning terms, it would be possible to provide the substantive evidence needed. Unfortunately, few local authorities possess such a strategy. In the light of the White Paper and the Human Rights Act 1998, many local authorities face the problem that, having raised no objection to one application for extended opening hours, they find it extremely difficult to object to a second application for a similar extension of opening hours, even if they have strong grounds for believing that the presence
The assumption made in the White Paper is that if more pubs and clubs are allowed to open for longer, there will be both a gradual drift from premises and lower densities of people in each place. There is a case in Dartford for allowing certain premises to open for longer to reduce the number of people on the street at any one time, but there is a feeling that allowing a significant number to be open for longer would lead to a greater and potentially unsustainable influx of people into the town centre to fill any spare capacity that would be created.
We need not simply flexible opening hours but staggered opening hours in our town centres. Given, though, that a system of staggered opening hours is unlikely to be achieved through a voluntary agreement between licensees and the licensing authority, there is a clear need for a new regulatory framework to be introduced.
If a town centre management strategy framework existed with a clearly defined town centre strategy and guidelines for the development of a night-time economy, local authorities would be able better to assess the impact of each application for extended hours, and would be able to point to the framework if it felt that a particular application was unsustainable.
I would like to see local authorities placed under a legal duty to produce such a town centre strategy management framework. Authorities would also have a duty to consult local residents, the police, the emergency services and licensees on its contents to ensure that it fully reflected the needs, rights and responsibilities of each section of the community.
Though the local authority would still have to accept the burden of proof should it decide to object to an application, it would be able legitimately to object if it deemed it not to meet the development criteria set out in its framework.
Officers of my local council tell me that the lack of an effective consultation mechanism between the council, the police, licensees, residents and emergency services has undermined any attempts to establish an effective town centre strategy.
A town centre management framework would not only enable more joined-up thinking to take place but would allow local people to have a genuine say in how they want their town centre to develop. It would also require the local authority to evaluate what expansion of the local night-time economy could be tolerated within the existing service infrastructure, and require it to establish a set of clear long-term objectives for the development of the town centre. As such, it would make the licensing procedure more open, more transparent and more accountable. Having been involved in the consultation process, local people would have a clearer understanding of how the licensing system operated and how their town centre was being managed, and would be more inclined to make representations to the local authority and so play an active role in shaping the future of their own community.