'WOMAN'S HOUR' BBC RADIO
4, 22 NOVEMBER 1999
DISCUSSION RE. NHS COMPLAINTS
PROCEDURE WITH MRS GILLIAN BEAN
CO-DIRECTOR OF S.I.N. and DR.
ALAN BEDFORD, CHIEF EXECUTIVE OF EAST
SUSSEX, BRIGHTON AND HOVE HEALTH
NOW WILL YOU GET A FAIR HEARING
IF YOUR DOCTOR MAKES A MISTAKE AND YOU WANT TO COMPLAIN?
One patient group thinks the NHS complaints
procedure is a confidence trick played on the trusting patient at the expense
of the tax payer and tomorrow the Commons Select committee on Health is
publishing a report which is expected to be highly critical of the system.
At present, the procedure, which was introduced in 1996, has three stages.
The first, a local resolution which is intended to sort out the problem
locally; or you could ask for an independent review, granted to less than
a quarter of patients. The third stage is disciplinary when you can go
to the ombudsman or to the General Medical Council. Critics argue for a
new independent statutory authority.
Alan Bedford, a spokesman for the NHS
Confederation which represents Health Service Managers, is also Chief Executive
of East Sussex, Brighton and Hove Health Authority and joins us on the
line from Lewes. Gillian Bean is co-founder of S.I.N. - Sufferers of Iatrogenic
Neglect, a patients campaign group - she's on the line from Nottingham.
P. Gillian, it sounds on the surface
a good idea to get as many patients as possible sorted out at a local level
without having a legal battle and expensive enquiries.
G. Yes, indeed it does - and thank
you very much for inviting us on the programme - but we have found , in
the experience of our members, that local resolution may well work when
its a very minor complaint but if you are dealing with a serious complaint
about substandard medical care then in fact, in our experience, it is very
loaded against the patient and we cannot get a fair hearing.
P. How is it loaded?
G. Because after the local resolution
you may or may not be able to meet with the consultant, usually you cannot.
You then go to a meting with the medical director present . You find that
when the transcripts of these meetings are issued, they are a travesty
of what has really happened. There are omissions, usually of what the complainant
has wished to point out, there are misleading statements, there are indeed
at times fabrications. Now the patient then has to complain about the transcript
which is only issued on the approval of the clinician.
P. A number of problems there in terms
of the actual procedure. And also, Alan Bedford, there's been a couple
of studies done by the Public Law Project and Help the Aged where patients
generally felt intimidated because they felt there was a kind of imbalance
of power between the patient and the doctor.
Ch.Ex. We understand that patients
who have had disappointing experiences during their treatment are going
to feel very suspicious that the complaint is going to be dealt with properly.
But I have to say that I don't recognise the process that Gillian describes
at all. I think the system, if properly run, is very fair to the patient.
There's an element of independent review at many stages in the enquiry.
I mean, for example, if there is an independent review panel, it is chaired
by an independent person, independent of the Health Authority.
P. Now you're talking about the second
Ch.Ex. Yeah, so I think the lady we
were speaking to must be saying the same thing as well. There is an awful
lot of independence. The Health Service would not in any way condone misleading
statements. But there is a very careful considered process and I think
it is working well, although it could work an awful lot better.
P. Well, Gillian, patients can always
go to independent review can't they if they have got problems?
G. Yes we can, although I would suggest
to Mr Bedford that he gets in touch with our group so we can furnish him
with evidence which will show very clearly that what I have said are the
facts of the situation.
P. Okay. What about the broader point
that there is independence in the complaints procedure?
G. You can go to an independent review,
however you have to bring in a convenor. This is a member of the board,
a non-executive member of the board, so they are hardly impartial. The
convenor decides on the terms of reference, not the complainant, and will
have to get advice on a clinical matter.
P. So, Alan, if you've got someone
who is a member of the Health Trust or the Authority who's deciding whether
the complaints proceed, is that impartial?
Ch.Ex. Well, I can understand that
some patients would think it isn't impartial, but the convenors are non-executive
directors of Health Authorities, they are not members of staff. They are
appointed by the Secretary of State to have an independent overview.
P. They're not paid?
Ch Ex. There is an honorarium for non-executive
directorship to cover the time that they are giving. But in my experience
they take the role very seriously. They have to consult an independent
chairman, nothing to do with the hospital whatsoever, before they come
to the conclusion about whether an independent review is set up. But I
think, but what I'd like to say is the most important thing as far as hospitals
and community services are concerned is that they operate a complaints
procedure with sensitivity, that they do understand and show they understand
how anxious the complainant can feel.
P. Is that the experience of people
who come to your group?
G. Oh no it isn't, quite the reverse.
They are in absolute despair and trauma because they also find that their
medical care is jeopardised because they have complained. And in fact,
the non-executive member, the convenor, has to seek clinical advice and
goes in fact to the medical director of the very Trust against which the
complaint is being made; and it is that clinical director who will decided
whether there is a clinical problem and you can then go to a professional
review. But in fact it means that this independent professional review
has very few sanctions.
P. That's rather a frightening idea
Alan for patients, the idea that their medical care could suffer if they
dare to complain?
Ch Ex. Well I would be horrified if
I ever discovered that anyone's medical treatment had suffered as a result
of their complaint. I understand that many patients are anxious about complaining
against clinicians in case it somehow affects their treatment. But I think
I would have to say that 999 out of 1000 clinicians would act in the most
professional way possible, would understand the complaint had passed the
natural process that we should expect.
P. Gillian, what would you like to
see to replace the current procedure?
G. Right. I refute all that actually
and even if you go to the ombudsman, he is not actually allowed to investigate
a complaint where a complainant has a remedy by way of proceedings in a
court of law. So our members find you cannot take a serious complaint through
the complaints procedure.
P. Okay, so what's the answer then?
G. Right. An independent statutory
authority to fully investigate complaints. This authority should have the
power to take disciplinary action against any doctor or manager
who fails to fully co-operate and/or mislead during the course of any investigation.
P. Alan, why not have an independent
authority like that?
Ch. Ex. I think if we had an independent
authority, it would mean setting up a huge, new, expensive bureaucracy
rather than dealing with complaints near the point of the complaint. The
people who know most about the service are those working in the local service
and provided that there are safeguards like bringing in independent clinicians,
independent chairpeople, independent reviews at the appropriate time, its
much better to deal with things locally than create some new bureaucratic
P. Surely Gillian, just finally, more
red tape is the last thing the NHS needs?
G. Well I would agree if it worked,
but it doesn't work. And the other thing we wish to have is a total review
of how iatrogenic damage is dealt with in this country. We suggest that
doctors instead of trying to cover up and deny mistakes, will admit they
have mistakes and get a victims compensation fund set up, part paid for
by the taxpayer and part paid for by the medical-legal organisations.
P. We'll have to leave it there. Gillian
Bean, Alan Bedford, thank you for joining us and if you'd like more information
about what we have been discussing, call the information line on 0800 044