Clause 6 — Dispute Resolution

Part of Community Care (Delayed Discharges etc.) Bill – in the House of Commons at 5:30 pm on 15 January 2003.

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Photo of Nigel Waterson Nigel Waterson Conservative, Eastbourne 5:30, 15 January 2003

I find myself agreeing with much of what Glenda Jackson has just said. I hope that that will not cause too much damage to her socialist credentials. She is absolutely right. If nothing else, the Bill is consistent, and anyone with any optimism turning to a clause headed XDispute resolution" is going to be severely disappointed because all that the Bill is concerned about is arguments between two or more public authorities. The words Xpatient" and Xcarer" are simply missing again. This provision involves two faceless bureaucracies fighting it out in front of a panel. That disappointment is reflected in the comments of Age Concern, which states that

Xour concern remains that the Bill does not offer a speedy dispute resolution process for the patient, if they disagree with the discharge plan being offered."

No such process is being proposed here.

I want to raise a few points about the practicalities of the proposals, particularly in view of all the bureaucracy involved, and I endorse some of the points already made on that by Mr. Burstow. The proceedings of this panel have the smell of something that could go on for a long time, with all the arguments going on between the public authorities, so there is no prospect of any quick decisions being taken. There is certainly nothing here for the patient or carer who says that what is being proposed for them for today, tomorrow or next week is inappropriate, and who wants someone else to appeal to. I do not believe that that kind of time scale is being envisaged, although if the Minister thinks otherwise, she will no doubt say so.

Amendments were also tabled in Committee at the behest of Age Concern and Help the Aged about having a fast-track complaints process for just this kind of situation, but, as is so often the case nowadays, they did not get debated due to time constraints. Age Concern also reflects concerns that have been expressed by at least two hon. Members in this debate when it asks whether

Xa panel established by a strategic health authority can be independent in resolving disputes between the health service and social services."

It asks the Government

Xto clarify whether the proposed panel's decisions will be binding, or simply for advice only."

It was helpful, up to a point, to have the Minister write to us following the Standing Committee about the likely contents of some of the regulations under the Bill. It was helpful, but it raised a whole series of other questions. Her document talked about the constitution of the panels under clause 6(2)(a), saying:

XThe panel will seek information from the relevant professional staff (hospital, social services, PCT) and from the patient and family"— here come the key words—

Xif appropriate."

Who can imagine a more damning comment, albeit one buried in the small print, on this legislation? How can any reasonable person envisage a situation in which it would not be appropriate to get information from the patient, the family or any other carer? Will a patient or carer be allowed to address the panel? Will they be allowed to be represented? What sort of evidence will be required? What standards or burdens of proof will be required? How is all that going to be dealt with? If people are still unhappy at the end of these proceedings, will the process be subject to procedures such as judicial review or other complaints procedures within the NHS, or could those procedures take place in parallel with the new arrangements for a panel?

How many layers of dispute resolution are we talking about? Ostensibly, we are discussing a panel hearing, but the document on the likely regulations also says:

XThe regulations could provide, for example, that a panel should not be established to hear a particular case unless the staff involved . . ."— again, that reflects the Bill's philosophy, which is that it is all to do with the staff and nothing to do with the patient—

Xcannot reach agreement on an informal basis".

There we have alternative dispute resolution, as the lawyers would call it—an informal way of trying to establish a solution to a dispute, although one would hope that that would happen automatically in the real world. The document goes on to talk about the dispute being resolved at

Xa higher management level between the relevant healthcare provider and the local authority."

Those seem to be steps to be addressed before the panel is even convened.

Finally, the document says:

XThe regulations will provide that neither party can take the dispute to court until they have attempted to resolve it via the panel."

What is Xattempted" supposed to mean? How far does the panel have to go in considering all the evidence and all the arguments to allow parties to go on to the next stage of a legal challenge? When we read the small print, we see that we are being asked to establish not only a new bureaucracy and a new panel to determine such matters, but, on the face of it, a series of hoops through which people have to leap, none of which will happen in a hurry.