With this it will be convenient to discuss the following:
‘before the end of that period’.
Amendment 4, page 1, line 8, at end insert—
‘together with an estimate of the target date for completion of the investigation.’
Amendment 1, page 1, line 8, at end insert—
‘(b) The Commissioner shall subsequently keep the complainant informed, as far as reasonably practicable, as to the progress of the investigation.’
Amendment 5, page 1, line 8, at end insert—
‘( ) If the reason for the delay specified in Section 2HA is lack of financial resources it shall be the duty of the Commissioner to set out the action which is being taken to remedy that lack of financial resource’.
Amendment 2, page 1, line 15, leave out ‘, and’ and insert—
‘(ba) the reasons for each of those delays, and’.
The new clause would simplify the Bill enormously. It would require the health service ombudsman to resolve any complaint within 12 months of the date on which it was received. As we are paying tribute to my late friend Eric Forth, may I say that the new clause would have commended itself enormously to dear Eric, because it puts on the tin what people say we want to put on the tin. With the greatest of respect to my right hon. Friend Mr Davis, I think he has been timid in his Bill. We know that 99% of these cases are dealt with within one year. The new clause would require that 100% of them be dealt with within one year, and there would also be a sanction, because a breach of a statutory duty can be justiciable. That would concentrate minds. If it looked as though a complaint was being dealt with slowly, the health service ombudsman would be able to say, “You’ve got to get a move on because we’ve got a statutory duty to resolve this within one year.”
It is indicative of the bureaucracy enveloping our country that instead of getting to the nub of the issue, my right hon. Friend has been seduced, no doubt by officials in the Department of Health, into coming forward with something that is, in effect, meaningless. Without the new clause, the Bill says, “If you’ve got a complaint and it hasn’t been resolved within 12 months, hard cheese. But don’t worry, it may well be referred to in the annual report of the health service commissioner in due course. But we can’t tell you exactly when it is going to be resolved.”
We must recognise that we are talking about the last stage in the complaint-handling process here. People who make a complaint have a reasonable expectation that their complaint should be dealt with quickly. As my hon. Friend Mr Nuttall said, quoting from “A voice for change”, the most recent annual report, which is for 2013-14, of some 4,000 complaints accepted for investigation 67% were concluded within one month and 95% were concluded within six months. So the norm is very much for one month, with the outlying cases taking more than six months. Some 5% are taking more than six months, with only 1% taking more than 12 months.
I am not sure whether the hon. Gentleman heard the comments by the Minister on the previous group of amendments but I think she addressed that point precisely. There is a complexity within the system that cannot be anticipated, and it would artificially fetter the discretion of the commissioner if an arbitrary time limit were put in place. Does he not agree that there are occasions when the complexity is such that we simply cannot fix the rigid metallic corset of a time limit on it without diminishing the value of the investigation?
With the greatest of respect to the hon. Gentleman, I do not accept that, which is why I tabled the new clause. As he says, the Minister was addressing new clauses 1 and 2, and I would not at this stage anticipate her response to the debate we are now having on new clause 3. If a statutory duty is in place, minds will be concentrated. That means that the ombudsman would, for example, be able to explain to a complainant who it was who was not providing the information that was necessary in a timely fashion and say, “If we don’t get a move on, your complaint will be time-barred because we will dismiss it on the basis that we have a lack of evidence.”
Following on from the point made by Stephen Pound, may I say that I am not entirely sure that corsets are normally metallic—I believe they are generally made of whalebone? Leaving that aside, I wonder whether my right hon. Friend Mr Davis ought to be introducing a shorter time limit, because we all know that work expands to fill the time available. [Interruption.] Parkinson’s law, indeed. As soon as a 12-month time limit is introduced, that is the time that will be taken. If 95% of complaints are being dealt with within six months, six months would seem to be quite a good limit.
I agree with my hon. Friend. It is a pity that he did not put down an amendment to my new clause to replace the limit of 12 months with one of six months. We know that the Bills that we debate on Fridays involve an iterative process. If the new clause were accepted today by my right hon. Friend, we would start off with a 12-month limit, which might in due course move to six months. That deadline, which will have the effect of concentrating minds, makes the measure legally meaningful, whereas, at the moment, everything in the Bill is legally meaningless. The Bill is, as someone has said in relation to the draft clauses of the Scotland Bill, “legally vacuous”.
How does my hon. Friend deal with the problem that there might be some issues that are outside the control of the ombudsman? For example, the ombudsman might be hoping for a response from a health provider that he is simply not getting. How would the ombudsman then obey the statutory duty that we would be applying?
Unlike quite a lot of organisations, the ombudsman is accountable to this House. If the ombudsman were experiencing the difficulty to which my right hon. Friend refers, I would expect the ombudsman, the chief executive or chairman to contact my hon. Friend Mr Jenkin and say that they wished the Public Administration Committee to look into the matter and put pressure on the recalcitrant Department. In a sense, my right hon. Friend is saying that, because we may have customers—if that is the right expression—who are minded to delay things, we should facilitate them in enabling them to delay things beyond a year. We need to focus on who the real customer is. The customer is the person who has made a complaint, and whose complaint has been accepted for investigation by the ombudsman. In my view, they are entitled to have a decision on that complaint within 12 months, which is why I put in this statutory duty.
Again, my hon. Friend makes a first-class point. I hope that, when the Minister responds to this short debate, she will support the line that is being taken. We need to ensure that there is no scope for statutory bodies to avoid their responsibilities to deliver and that we facilitate the ombudsman to reach a result within 12 months of a complaint being made.
At the moment, the ombudsman is dealing with about 4,000 complaints a year, some 3,000 of which are related to health. The cost of those complaints to the taxpayer is about £4,000 a time. As the taxpayer is investing that amount of money, a reasonable return on that would be to say that those complaints should be dealt with in a maximum period of one year. If we pass new clause 3 and include it in the Bill, we will have a useful piece of legislation, instead of an empty vessel—although even an empty vessel with the name of my right hon. Friend the Member for Haltemprice and Howden on it will be cherished by many people, especially his constituents.
Amendment 3 is more specific. It will require the commissioner, in fulfilling the obligations set out in clause 1, to explain the delay before the end of the 12-month period, rather than after it. At the moment, there is a lacuna here—perhaps it is a deliberate one—to ensure that the minimum pressure is applied, which will show that we are just engaged in gesture politics. I hope that that is not correct. As it stands, clause 1(2) says:
“Where the Commissioner has not concluded an investigation before the end of the 12-month period…the Commissioner must send a statement explaining the reason for the delay to the person who made the complaint.”
But it does not say when the commissioner should send that statement. Unless there is a requirement on the timing of that statement, the measure is completely meaningless. It may be that that statement will be sent at the same time as the ultimate decision is made. In an effort to make the Bill do what my right hon. Friend wants it to do, which is to put pressure on the health service commissioner to deal with complaints in a timely fashion, I am suggesting a modest amendment.
Amendment 4 is on the same theme. When that statement is sent, it would not just explain the reason for the delay, but contain an estimate of the target date for completion of the investigation. I accept that, in itself, that would not be much use, because if there is another target date—it could be in another year—there may still be no remedy for the complainant. At least, though, it would force the ombudsman service to apply its mind to how much longer it thought it was reasonable for the investigation of the complaint to take.
Amendment 5 brings us into a slightly different territory. I suspect that a main reason for the delay in dealing with these complaints is a lack of resource. The amendment would add to clause 1 the words:
“If the reason for the delay specified in Section 2HA is lack of financial resources it shall be the duty of the Commissioner to set out the action which is being taken to remedy that lack of financial resource.”
Again, if the delay is due to financial reasons, it is surely important that the world outside, and particularly the complainant, should know about that so that they can make the necessary complaints. It is also important that the ombudsman is able to say, “Well, because of a lack of financial resources, I am not able to deal with these cases as quickly as I would have wished. Therefore, I am asking Parliament for more money to help us meet our case load.”
There is a £15 million budget for this exercise. Each case currently costs some £4,000 on average. The average compensation payment that was paid out in 628 cases amounts to less than £1,000. I am not sure that anyone coming from another planet and looking at this system would say that it is financially well focused. The average cost of dealing with a complaint is over £4,000. The average amount paid to a successful complainant is just less than £1,000. That shows that there is a potential problem in relation to the funding of the ombudsman service. That may be exacerbated by the ombudsman’s decision to take on more complaints for investigation by “lowering the threshold” for investigating such complaints. As the annual report makes clear, the consequence of that is an increase in the number of complaints being investigated, only a reduced proportion of which is being concluded in favour of the complainant. Expectations among the complainants are being raised, but they are not being delivered on by the ombudsman because a lot more cases are being taken on which probably should not have been taken on in the first place. The report states that because the ombudsman is
“taking on many more investigations than before, the proportion of investigations…upheld or partly upheld has inevitably declined”.
I think that the expression “inevitably declined” is a bit of an underestimate, because it has declined from 86% to 42%, which is a dramatic reduction in one year.
Might one not read that in a positive way by saying that if the complaints are found not to have been justified that suggests that the national health service is doing a pretty good job?
I do not go along with that, I am afraid. It is rather like saying that we should encourage the maximum number of complaints against something, engaging bureaucracy and taxpayer expenditure to deal with the complaints, to give some perverse satisfaction to the people who want to say that the Government service, in this case the health service, is doing a good job. If we want to measure consumer satisfaction with public services, there is a much more direct way of doing it than looking at how many complaints against their services have been made and rejected.
By way of an aside, one difficulty with the ombudsman service is that it cannot take on complaints from public sector organisations. In my constituency, for example, a head teacher of a school that was unfairly done down by Ofsted was told—or it was implied—that he could complain to the ombudsman service, but the ombudsman service deemed his complaint to be outside its scope. Although he is an individual, as he is the head of a school, Ferndown upper school, the complaint is regarded as coming from a public organisation and therefore does not come within the scope of the ombudsman’s rules. I would prefer to see the scope of the ombudsman to investigate issues widened, while keeping a focus on complaints that are prima facie likely to be well founded, to going down the road of saying that we should have many more complaints and that when we reject those complaints it means that the public services are doing very well. That is where I would disagree with the ombudsman service’s strategy, which is to try to maximise the number of complaints.
When people make complaints, it often involves quite an effort on their part and they normally make them on the basis that they expect a positive result. They do not make them hoping that their complaint will be rejected, thereby endorsing the national health service, local government organisation or other body for performing in a way that did not result in the complaint against them being justified. The best organisations are organisations that have no complaints against them and I should have thought that that was what we should be aiming for—a health service in which there were no complaints, or in which all the complaints were dealt with much sooner than the stage at which they came before the ombudsman.
Those are my amendments. I shall leave my right hon. Friend Mr Arbuthnot to address his amendments 1 and 2. If some of these amendments were accepted, I think the Bill might have some worth and value.
My hon. Friend Mr Chope suggests that I might like to address amendments 1 and 2. During the last debate, my hon. Friend Mr Nuttall pointed out that I was not suggesting that the health service ombudsman should keep the complainants properly informed and I said that I was persuaded that it was not actually necessary to do so. What I should have said was that I had proposed an amendment to do so in the next group of amendments, but during the course of that debate I persuaded myself out of the value of amendments 1 and 2 so I think it would be best for me simply to sit down and not move them. What my hon. Friend the Minister and my right hon. Friend Mr Davis said in answer to that debate satisfied me that more detailed legislation for the ombudsman, apart from the extent to which my right hon. Friend wishes to change the law, is probably not helpful.
In answer to my hon. Friend the Member for Christchurch, I do not agree with the rather rigid approach that his new clause 3 might introduce. Inevitably, there will be some complaints that are so complicated and in which so many people are involved in answering the issues that it would be a bad idea to put on to the ombudsman a duty that, with the best will in the world, they might simply not be able to fulfil. During the course of the morning I have been looking for a quotation from Idi Amin, referring to someone who had displeased him. He said, “When we catch him, he will be executed. He will have a trial, of course, but by trial I do not mean one of those things that goes on all day.” I think that that is the approach favoured by my hon. Friend in the new clause. I hope that he will forgive me if I do not support his new clause and fail to move my amendments.
I do not intend to detain the House for long on this group of amendments. Suffice it to say that I think there is merit in new clause 3, to the extent that it concentrates the mind of the ombudsman. At the moment, there is simply a requirement to report and that is the end of it. If nothing seems to be done, it just carries on. My concern is that the whole object of the Bill is to stop the situation that occurred in the case that led to its introduction, in which an investigation carried on for the best part of two and half years. As I read the Bill, it seems to me that there would be nothing to stop that happening again. A case could be reported as being outstanding in the annual report at the end of year one, and at the end of year two it could still be outstanding and nobody other than the complainant and the ombudsman’s staff would know anything about it.
Amendment 3 places a requirement on the commissioner to notify the complainant before the end of the period and again that seems to me to be eminently reasonable. Given that the purpose of the Bill is to try to get things dealt with within 12 months, it seems sensible that if it is apparent to the commissioner that that will not be the case, they should inform the complainant before the end of the period. Otherwise, quite legitimately, the complainant will expect the result at the end of those 12 months if they have not heard anything. It is pretty sensible to expect that. Whether that would happen anyway remains to be seen.
Amendment 4 would require the commissioner to provide at the same time an estimate of the target date for completing the investigation, which seems very sensible. The commissioner would say, “Look, we’ve not quite managed to do it in 12 months, but we certainly will in another three.” I see no reason why that should not be set out in the Bill.
I am pleased that my right hon. Friend Mr Arbuthnot decided not to proceed with amendment 1, which relates to keeping complainants informed, as we dealt with that in the previous group. Everyone agreed that that was not a matter for legislation but should happen anyway as a matter of good practice.
I am rather less happy that my right hon. Friend has decided not to proceed with amendment 2, which would insert after subsection (4A)(b) the words
“the reasons for each of those delays”.
The general report, as set out in subsection (4)(a), should include details of how long investigations concluded in the year to which the report relates took to be concluded and how many of them took more than 12 months. That means giving a stark figure, for example saying, “We had 30 investigations outstanding at the end of the year.” It seems sensible also to require the reasons to be included. That would allow us to drill down and find out exactly what is causing the delays.
That leads me neatly to amendment 5, which stands in the name of my hon. Friend Mr Chope. It would insert the following provision:
“If the reason for the delay specified in Section 2HA is lack of financial resources it shall be the duty of the Commissioner to set out the action which is being taken to remedy that lack of financial resource.”
I am reluctant to support that. In my humble opinion, it is almost certain that any public official will reach the conclusion that what they really need to make their job easier and speed up the service they provide to the public is more resources. Unless we expect them to start having jumble sales and raffles—we have all tried using our own resources in that way to raise more funds—really the only thing they can do is come to Parliament and—
My hon. Friend makes an absolutely brilliant and incisive point, because has not the whole lesson of the past five years been that public services have been able to deliver more with less? That should also be true of ombudsmen, and therefore the amendment is otiose.
I am grateful to my hon. Friend. That has indeed been the lesson of the past five years, and we have seen some sparkling examples of people in the public sector doing more with less—our police service, for example. The same is true of the ombudsman. They have said that they have lowered the threshold and changed the way they work in order to try to meet demand so that fewer inquiries from the public are turned away.
It occurs to me that that allows me to say that that is all thanks to our long-term economic plan—the first time I have managed to get those words into Hansard.
My hon. Friend has achieved his wish.
I think that what is set out in amendment 5 would fall into a set pattern, with the commissioner saying every year, “Well, if you gave us a bit more money, we’d have a few more staff and things would get better.”
With the greatest respect, I think that my hon. Friend misunderstands the amendment. The idea is to increase transparency so that rather than the commissioner being able to complain sotto voce that this is all because they do not have enough money, that would have to be brought into the open, and then the very points that he and my hon. Friend Jacob Rees-Mogg have been making about the ability of many public sector organisations to get a lot more bang for their buck could be exposed to public debate.
Following that point from my hon. Friend Mr Chope, I think there is a risk that the amendment would transform the role of the Public Administration Committee, which currently provides oversight and acts as the guardian of ombudsmen, turning it into a champion for more money. I think that would be quite dangerous. I do not want to see the Committee go from being a regulator, comptroller and holder-to-account to being a champion for more money.
I am grateful to my right hon. Friend for that point, which I suspect adds weight to my opposition to amendment 5. I appreciate what my hon. Friend the Member for Christchurch has said about transparency, but I suspect that in press releases and in evidence given before the Committee the ombudsman would be able to do that anyway. When questioned about the reasons for delays, they would feel that they could easily say whether it was down to resources, either in public utterances to the media or more formally in evidence to the Committee.
I started off being flattered by the suggestion from my hon. Friend Mr Chope that I had been in some way seduced into mitigating the Bill, but I think that I am far beyond the point at which seduction, either metaphorical or real, is an option. Perhaps that is why, when it comes to new clause 3, which I think is the most substantive amendment in the group, I am not as much of an expert as Stephen Pound and my hon. Friend Jacob Rees-Mogg appear to be on the subject of corsets. As I understand it, corsets constrict things at one point and let them out at another. The risk in new clause 3 is that it would put such constraints on the ombudsman that problems would be created elsewhere.
There have been two problems with the operation of the ombudsman over the past few years: not meeting timetables and making mistakes. On a number of occasions the ombudsman has got things wrong, which has made things even more acutely painful for the people seeking help and support, because the ombudsman has had to go back and correct mistakes. Indeed, that happened on a number of occasions in the very case that is at the centre of this piece of legislation. Were we to go down this route, we might create a series of problems arising from the ombudsman making erroneous recommendations and proposals, which would of course lead to the issues being multiplied down the generations, rather than dealt with straightaway.
We must also remember that some of the issues that the ombudsman deals with not only require information from other Departments and other parts of Government, but sometimes involve contested arguments and may have legal liability associated with them, so we should not forget that there is a natural justice aspect to this. Finally, these issues are very often on the edge of science. The sepsis problem was one such issue, for which the medical profession is still seeking new solutions. We should be wary of going so far on this that we cause another set of problems. That is why I think the Bill as printed strikes the right balance.
My right hon. Friend refers to potential legal liabilities, but my understanding is that anybody who comes before the ombudsman with a complaint has to give a guarantee that they are not intent on taking legal redress.
I am not sure that the legal liability relates simply to the person bringing the complaint. It could relate to other people too, such as those contracting services. It also relates very much to reputation. Someone may, in effect, be asked to make a confession according to a timetable, which is not a good idea in a statute.
I agree with my hon. Friend Mr Nuttall in his critique of amendment 5. On amendment 4, I would leave that to practice guidelines, rather than putting it into law. It is dangerous, as I said earlier, to create lots of onerous responsibilities in law. The aim of the Bill is to exert pressure and give a degree of public guarantee, not to try to tell the ombudsman how to cross every t and dot every i.
The one amendment with which I felt some sympathy but am still uncertain about is amendment 3. I presumed from the Bill that the ombudsman’s department would respond close to the 12-month point when it knew that it might go past it. Earlier, it is likely to have to adjust the timetable; later is not tolerable. I am uncertain whether it may lead to perverse or unintended consequences if we do exactly what my hon. Friend the Member for Christchurch has proposed. I will have to think about that. The Bill has to go through a Lords stage. I ask my hon. Friend not to press the amendment today, but I give him an undertaking that I will look at the matter closely and see if I can come up with a form of words that I can suggest as a change in the Lords; I will let him know if I am not able to do that.
I shall not speak for long, but I think it right to respond to the contributions, and to speak on the options proposed by Mr Chope. As we know, new clause 3 proposes to make it a statutory duty for complaints to be resolved within 12 months. We do not think that that is necessary. It is clear that the Bill sets out sufficient steps to achieve that. I agree with Mr Davis that, as we know, the overwhelming majority of cases are dealt with within that time, but there are obviously reasons why it may sometimes take longer. As hon. Members suggested, there may be complex cases, other agencies may be involved, or there may be an historical or long-running case that requires the extraction of data from decades past, which it may take a long time to collate. It is often not the ombudsman’s fault that these things take time. We therefore do not think it appropriate to make meeting the 12-month deadline a statutory duty.
On the amendments, it is proposed that when the ombudsman contacts complainants, she gives them an estimate of how long the investigation might take. We discussed the point earlier in relation to new clause 2. We Members of Parliament can get updates from the ombudsman on the progress of cases and share those with our constituents if they want further updates. To be fair, if we think about all the processes in which we support our constituents, this is one in which updates are provided, and complainants are provided with information about how their complaints are progressing and when an outcome might be provided.
Amendment 1 would require the commissioner to keep the complainant informed of progress. There is nothing wrong with this in principle. We should encourage the ombudsman to do this anyway. As I mentioned, as Members of Parliament supporting those complaints, we can receive updates. On the point about financial resource, I have looked closely at the amendment and listened to the debate this morning, and think that where delays occur in the progress of complaints, more often than not that is down to the complexity of the cases, rather than a lack of financial resources, so amendment 5 is not necessary. We do not believe that new clause 3 or the five amendments are necessary.
I shall try to respond to some of the points that have been made, without reiterating them.
New clause 3 would place a duty on the health service ombudsman to resolve any complaint within 12 months of the date it was received on, regardless of its complexity. We all have sympathy with the reason behind it, and we all want to see investigations conducted by the health service ombudsman, and indeed the NHS, carried out as efficiently as possible. None the less, it would be wrong to rush cases, or to seek to put an artificial time limit on them. What is most important to us as Members acting on behalf of our constituents is that the investigation is conducted appropriately and robustly, which depends on the facts of the case. This is particularly true, as others have said, when the investigation deals with serious or complex issues.
We are all familiar with the fact that the cases investigated by the health service ombudsman generally tend to be complex and serious because they often involve an element of loss, personal tragedy, illness or disability, so they are inevitably sensitive. It is important that those investigations are conducted in a timely fashion, but on the odd occasion when they need to continue beyond the defined period, it is important that there are not artificial constraints, and that we do not constrain the handling of a complaint by focusing on the deadline, rather than the requirements of the case. That may have an unintended impact on the quality of the investigation and the complainant’s expectations about the outcome.
The Bill as drafted will hold the ombudsman more accountable for delays of over 12 months than at present, which is right, but it acknowledges that there will be some cases, albeit very few, where it is appropriate and justifiable for an investigation to take longer. Some of my right hon. and hon. Friends have alluded to the reasons for that. In other aspects of my portfolio, I have seen some of those reasons. My hon. Friend the Member for Christchurch made a working assumption throughout his comments that one reason may be delay on the part of the investigator, but sometimes it is due to other players in that investigation.
In another part of my portfolio, something extremely important has been unexpectedly delayed by the bereavement of the chief investigator. That could not have been anticipated, but it has added greatly to the delay. Cases brought to the ombudsman nearly always involve illness, and evidence may need to be taken from someone who is still ill or in recovery. It may be difficult to get that evidence, or to ask them to respond to a point made during the investigation. If the person is still suffering the effects of their illness, there may need to be an appropriate delay to allow them to recover sufficiently to give their evidence.
The Bill’s promoter, my right hon. Friend Mr Davis, made an extremely good point about expertise. Complex medical issues are rarely black and white. In a debate that has already alluded to corsets and seductions, I hesitate to speculate on the number of shades of grey that might be involved in investigations, but it is clear that they exist. Sometimes, tracking down the right expert may be not a national endeavour, but an international endeavour, if the case involves a rare illness or there is a dispute about the medical opinion. Drawing on my experience of nearly 18 months as a Health Minister, I know that that is sometimes the case and we should allow for it, because it would not benefit the investigation if we did not. For those reasons, I hope that my hon. Friend the Member for Christchurch will agree not to press the new clause, and that he will feel not that he is condoning poor or slow administration, but that he is merely accepting that some things just take longer to address.
Amendments 1 and 4 raise a similar issue, namely the accountability of the ombudsman to those using her services. Again, I understand the sentiment behind the amendments, but I think they both overlook the more general issue of good practice. In any case where investigations are delayed, public services and public offices such as the health service ombudsman’s office should keep people informed as a matter of course and as part of the approach that we expect of them.
It is right that there should be a duty to inform the complainant of the reasons for the delay when an investigation has not been concluded within 12 months, which is what the Bill makes provision for. That is an important step, and it will increase accountability, but amendments 1 and 4 go further by placing a further duty to keep complainants whose investigations have not been concluded within 12 months informed of subsequent progress as far as is reasonably practicable. Amendment 4 would require the ombudsman to provide the complainant with an estimate of when an investigation would be concluded, to a set time scale.
I understand the sentiment behind the amendments, but I am not convinced that they need to be made to the Bill. Obviously, it is important that, in all cases, we seek to keep the complainant informed, as far as is reasonably practicable, of the progress of the investigation. That includes the likely time scale, which can vary during the investigation. A possible practical consequence of the amendments could be that focus is taken away from keeping all persons making a complaint informed of progress throughout the investigation, and is replaced with a narrow focus on a requirement to do so only when the investigation is likely to take 12 months. For those reasons, I hope that my right hon. Friend Mr Arbuthnot and my hon. Friend the Member for Christchurch will not press those amendments.
Amendment 2 makes a strong point about the accountability of the health service ombudsman to Parliament and to those using her services. As my right hon. Friend the Member for North East Hampshire has explained, it would place a further duty on the ombudsman. In each of her parliamentary and health service roles, she is independent of Government and accountable to Parliament through the Select Committee on Public Administration; she is also required to lay before each House annually a general report on the performance of her functions. I am not convinced that the amendment would add greatly to her accountability to Parliament and, indirectly, to those who use her services.
The Bill already places a duty on the ombudsman to provide information to Parliament about the number of NHS cases not resolved within 12 months and enables the Public Administration Committee, on behalf of Parliament, to determine whether further questions need to be asked and what those questions might be. If we required details of individual cases to be published, there would be a danger that that would enable a particular case to be identified. Some of those cases that take longer to investigate because of their complexity and, sometimes, relative celebrity might be overly easily identified if the amendment were carried. It is important for the ombudsman to be open about the number of cases outstanding and the action being taken to reduce them, but not—I know Parliament would not wish this —at the expense of patient confidentiality. I hope that, in the light of those concerns, my right hon. Friend will agree not to press the amendment.
The Bill’s promoter, my right hon. Friend the Member for Haltemprice and Howden, has already said that he will consider the issue raised by Amendment 3, for the reasons he has outlined, so I will not add to his comments. I think it is right to consider it, but not to take the amendment any further today. It is good practice for any person making a complaint to be given, as soon as is practicable after the complaint has been received, a sense of how long the investigation might take and, as has been said, to receive updates whenever that time scale needs to be updated. I would not wish to narrow the focus to giving updates only at the 12-month point. Although the amendment raises an important issue, I am not drawn to it at the moment and accept that the Bill’s promoter will consider it. That is probably the right thing to do, because it focuses only on notifying the complainant before the end of the 12-month period. Of course, good practice suggests there should be regular dialogue with the complainant throughout the investigation.
Finally, other Members have made very good points about amendment 5, which centres on investigations that take more than 12 months to conclude. My understanding is that lack of resources has played no part in any single investigation by the health service commissioner that has taken more than 12 months. My hon. Friend Mr Nuttall made an interesting point about the possible unintended consequence of the insertion of a resource clause. The amendment does not pick up on an issue that we have reason to believe is a major problem, so it would not be right to legislate on it. The strength of the Bill is that it picks up on a specific identified issue of poor complaint handling by the health service ombudsman. For that reason, I hope that the amendment will not be pressed and that the Bill will proceed unamended.
May I thank everybody who has participated in this debate and my right hon. Friend Mr Davis, the Bill’s promoter, for his generous offer to at least consider amendment 3? I do not mean to be churlish, but it is a problem that we are debating the Bill on the penultimate private Members’ Friday. If my right hon. Friend were to choose, on reflection, to incorporate amendment 3 in an amendment in the other place, he would, in effect, jeopardise his Bill, because we would then have to consider it again after it had been amended. The Minister has indicated her potential support, so perhaps she would like to intervene on me to guarantee that, should that eventuality arise, the Government would give the Bill the necessary time to ensure that it was not frustrated by that process but reached the statute book. I must say that I am tempted to press amendment 3 to a vote, because it might be easier to include it in the Bill now rather than have a promise that something will be done later.
One could sum up this debate by saying, “Excuses, excuses, excuses.” It is so easy for public sector organisations to make excuses about why they cannot meet particular time limits.
My hon. Friend has made a valid point about the remaining number of private Members’ Fridays. I hope that the ombudsman will at least read this debate and recognise that it would be best practice to put into her report the relevant time—in other words, as amendment 3 says,
“before the end of that period”.
I am grateful to my right hon. Friend for putting that suggestion, which could help, on the record.
On the issue of excuses, I fear that we are entering the territory of double standards. When my constituents who are company directors are required to submit their company accounts by a particular day and fail so to do, or when other constituents are required to submit their tax return by
My hon. Friend has made a minor slip. The ombudsman is not a Department; it oversees Departments, responding to and being overseen by a parliamentary Committee.
At the end of the day, my hon. Friend may have a very good point about the timing of amendment 3. If he is right, the alternative would be for me to make it very plain to the ombudsman that that is what Parliament expects. It is certainly what I expect and what I intended in drafting the Bill. Rather than jeopardise the Bill, we should make sure, as is very easy to do, that the ombudsman understands that point, as does the parliamentary Committee overseeing it, which is our final recourse.
My right hon. Friend is right to say that we are talking not about a Department but about a parliamentary sponsored organisation that tries to hold the Government to account. Yesterday, the House discussed the whole saga of Equitable Life, and what a long drawn-out saga it was. We know that the ombudsman tried desperately to get timely responses from the Treasury and other Departments, and was frustrated at every turn. Looking back at that, we can see that being able to say that she had a statutory obligation to deliver the result of an inquiry within a particular period would have helped rather than hindered her in the work she had to do.
I completely understand my hon. Friend’s point. I tried to draw out the fact that the interests of complainants may not be served by the proposal. As we all know, serious and complex complaints sometimes involve a death or serious injury, which means dealing with a bereaved family. The course of events over the 12-month period may not run smoothly for the very people making the complaint and wanting it to be resolved sensitively, sensibly and properly. This is not about Departments or the NHS making excuses, but about acknowledging that the sensitivities of the complainants and their loved ones mean that the ombudsman needs a little more time in some instances.
I hear what my hon. Friend says. In essence, the more usual scenario in cases of bereavement is that people want what they describe as closure sooner rather than later. The Bill has been introduced to emphasis that it is the will of the House that such matters should normally be dealt with within 12 months.
My hon. Friend is wrong about one thing: the ombudsman’s power rests on trust in the accuracy of the case that he or she makes. Equitable Life’s problems did not arise from that, but from the complexities of moral hazard and other such issues. A better example was the case of the state earnings-related pension scheme, in which the ombudsman, the Public Administration Committee and the Public Accounts Committee, under my chairmanship, was able to get the Government to pay out what turned out to be billions of pounds because of errors identified from accurate—though not, as it turned out, fast—investigation. The things we must not jeopardise are the accuracy and effectiveness of the ombudsman’s investigations.
My right hon. Friend gives an example of which he had direct experience. All I can say is that it is a pity that people who present their tax return late are not allowed the same indulgence—saying that their affairs are very complex, or that their accountant let them down—to avoid a penalty. There is an issue with ensuring consistency in the rules.
We have had a good run round the circuit on this matter. As in the previous debate, this again emphasises that, as Eric Forth said, Bills should never go through on the nod without proper discussion. Although people may have looked at the Bill and thought it a pretty minor piece of legislation, even such a Bill—I have not seen many that are more minor—is worthy of discussion to work through its implications. Having said that and thanked hon. Members for their contributions to this short debate, I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
I beg to move, That the Bill be now read the Third time.
I am delighted that the Bill has reached this stage. My hon. Friend Mr Chope may think it is minor, but I do not think it will be minor for the people whose lives it will affect, whose complaints are dealt with more quickly and who will get closure more briskly as a result.
I want to take this opportunity to thank colleagues who have been supportive throughout the process, especially those who helped me to take the Bill through Committee. I thank colleagues who have helped me to meet some or all of Eric Forth’s six rules of good legislation, which is important and should particularly be borne in mind with private Members’ legislation.
As other Members have said, the original raison d’être of the Bill was the Sam Morrish case. However, it is not only about that case; all of us have had constituents with cases involving such important and recurrent issues. It is worth recounting the Morrish case because it highlights those issues very well.
In June 2014, the health service ombudsman published the report on an investigation into the care and treatment provided to Mr and Mrs Morrish’s son, who tragically died of septic shock on
In the report on Sam’s death, the ombudsman highlighted the lack of action taken to save the lives of people suffering from sepsis. The key point is that the ombudsman’s investigation is not just to address the complaint, but to prevent such cases happening again. She stated that the case demonstrated that the failure to diagnose and treat sepsis rapidly can have tragic consequences. Crucially, she found that Sam failed to receive appropriate care and treatment, but that had he done so, he would have survived.
The contents of the eventual report were commendable, but it took the ombudsman more than two years to investigate and report on the national health service’s handling of Sam’s case. During that time, a series of factual errors were made, which Mr and Mrs Morrish repeatedly had to correct; that must have been awfully painful, but we cannot address that aspect of the issue in this Bill. As a result, the Patients Association, which supported the Morrish family in their complaints, said that the ombudsman was not “fit for purpose”. The ombudsman apologised to the family personally:
“We took too long to investigate this case and made errors in the draft report. I recognise the family’s experience of us has contributed to their distress”, which is to put it mildly.
As my right hon. and hon. Friends are only too aware, Sam Morrish’s case is not a singular instance, but something that comes up time and again. The stringing out of complaints in the NHS only causes further distress to patients and their families. There is a danger that such delays will lead to the underlying problems remaining unaddressed and uncorrected. When things go wrong, it is vital that lessons are learned. By improving the ombudsman service, we will take a small step towards ensuring that they are.
Although the ombudsman service is committed to changes that will require it to meet a timetable and, if it does not, to explain why, the future management of the service might not be as good as its current management. That is why the legislative backing is being provided. The Bill is just legislative backing; it is a guarantee. It will give the organisation the power to meet what should be a self-evident aim.
The Bill is straightforward, simple, not that minor and absolutely non-partisan. It has wide support across the health service, the ombudsman service and both sides of this House. The simple aim is to improve the effectiveness of the health service ombudsman, who is the final tier of the national health service complaints system and often the last port of call for distressed patients and families. The Bill achieves that goal primarily by requiring that when the health service ombudsman takes action, they do so with a view to concluding the investigation of complaints within 12 months. If that time scale is not met, they must explain why to the complainant.
The Bill is a first step. I expect that in the new Parliament, there will be a complete review of the ombudsman service and the complaints mechanisms that feed into it. That will be an unalloyed good because too often, as my hon. Friend the Member for Christchurch said, Departments are too slow, too unaccountable, too prone to excuses and not sufficiently committed to delivering the service our constituents want. The Bill intends to rectify that.
The current ombudsman, Dame Julie Mellor, has done a very good job. The Bill intends to reinforce that and to ensure that it is continued in the generations to come.
I want to say briefly that when we deal with a Bill about complaints against the national health service, we inevitably concentrate on the complaints. However, an essential part of this debate should be a recognition that, by and large, the national health service does a fantastic job and its doctors, nurses, managers and support staff are dedicated to the improvement of people’s lives, with what has recently been described as “institutionalised altruism”. The national health service is a wonderful part of our national life. We are not going to privatise it. It is an icon that we mess with at our peril. Nobody will succeed in persuading people that we are going to privatise it. If we were stupid enough to try such a thing, we would lose the election and the public know that. We need to say that time and time again.
For all its wonderfulness, from time to time the national health service slips up and makes a mistake. That will not happen on the majority of occasions or even on a hugely significant number of occasions proportionately, but when things go wrong, the question is how we deal with the mistakes. Do we cover them up? The answer is no we do not. We have to listen. Inevitably, the ombudsman will get things wrong from time to time. My right hon. Friend Mr Davis referred to one tragic case in which that happened. The question is how we deal with such mistakes.
My right hon. Friend’s Bill is an excellent step in improving things. It is not a minor step, but a very important one. It will add to the openness with which the ombudsman deals with things. It needs and deserves the support of the House.
There is a haulage contractor in my part of the world who bears the name James Nuttall. I am sure that he will be flattered that his name has been mentioned.
I congratulate my right hon. Friend Mr Davis on piloting the Bill through to Third Reading. Although he came 19th in the ballot, had the draw been done in the traditional way, he would have come second and piloted the European Union (Referendum) Bill, which would have been a slightly weightier task.
Yes, I am afraid so. That Bill is not going to reach the statute book.
I hope that this Bill does reach the statute book. It is a short Bill. As the promoter said, it is simple and straightforward. It aims to set a clear target for the ombudsman to operate within. When the target cannot be met, it requires that reasons be given.
As was mentioned at the outset this morning, this is the first occasion on which the Bill has been debated on the Floor of the House. The exploration of the matters that were raised on Report was therefore useful, because it teased out matters that could usefully be considered in the forthcoming review and examination of the ombudsman’s procedures. I am sure that those who conduct the review will read this debate and reflect on those matters.
I wish the Bill well this morning. I am sure that it will receive a Third Reading. I also wish it a speedy passage through the other place in the days that remain before the Dissolution of this Parliament.
I hope that I have not been too harsh on my right hon. Friend Mr Davis in the course of this debate.
In preparing for Third Reading, I looked at the explanatory notes to the Bill. The summary states:
“The Health Service Commissioner for England (Complaint Handling) Bill seeks to increase the effectiveness of the Commissioner (known as the Health Service Ombudsman), who is the final tier of the NHS complaints system. It does so primarily by requiring the Health Service Ombudsman to take action with a view to concluding investigations of complaints within 12 months”.
The Bill does not actually do that. That is my concern. I fear that the Bill is in danger of raising expectations, because it does not require the health service ombudsman to do anything to bring forward a resolution of complaints within 12 months. All it does is to say that if she does not, she has to include references in the annual report and communicate with the complainant.
Even on the basis of the summary in the explanatory notes, I fear that the Bill falls short of the expectations of its promoter. Obviously, if we are in the business of littering the statute book with more pieces of legislation, there is no reason why this piece of legislation should not be added to the others.
I add my congratulations to Mr Davis on the progress of his private Member’s Bill, which contains important reforms that we support.
The measures will rebalance the complaints procedure in favour of the citizen and away from the bureaucracy. If someone feels that they have been mistreated or have been the victim of a medical accident or malpractice, they deserve swift redress. What many complainants want is a clear decision, communicated swiftly, and assurances that the medical procedures and administrative processes have changed to prevent unnecessary harm or pain from happening to someone else. In fact, only last night, I met one of my constituents who is going through the process, and their primary motivation is that no other friend or family member should experience what they have gone through.
For most complainants, it is not about financial compensation. It is about justice. When a service such as the NHS lets someone down, the injustice feels so much worse because of the high regard in which it is held. I echo the comment of Mr Arbuthnot that we should commend the thousands of men and women who work in our national health service and do such a wonderful job on a daily basis, but there are of course occasions when things do not go right. That is why the Bill is so important.
Long delays in getting answers to complaints merely exacerbate a problem and build a sense of grievance and alienation. People feel like they will never get answers and are being strung along, and of course that is not good enough. The right hon. Member for Haltemprice and Howden should therefore be congratulated on his Bill, which is entirely straightforward and has a simple, non-partisan approach and purpose. As others have said, it has wide support throughout the health service and in the ombudsman service itself, and I hope it will have support in all parts of the House when we conclude the debate.
Anyone listening to the tragic case of little Sam Morrish, which the right hon. Gentleman outlined this morning, cannot fail to recognise that this reform is needed. As the House has heard, it took the ombudsman more than two years to investigate and report on the national health service’s handling of Sam’s case. During that time, a series of factual errors were made, which Mr and Mrs Morrish repeatedly had to correct. It is fair to say that they were let down badly by the NHS. They lost their little boy, and the process that they had to endure to seek justice and redress took too long and compounded their tragedy. They deserve every ounce of sympathy that the House is capable of offering. I hope that they are listening and hear that we really are on their side.
The Patients Association, which supported the Morrish family in their complaints, said at the time that the ombudsman was not fit for purpose. Hon. Members of all parties will have had to refer constituents’ treatment in the NHS to the Parliamentary and Health Service
Ombudsman, and some of those cases—not many—will have taken a great deal of time to be processed. One thing is clear: when the ombudsman falls short, it is essential that it is open and transparent. The idea of an annual report setting out the details of how long investigations and complaints have taken to be concluded is welcome. It makes a great deal of sense, because it will allow the public to see the amount of work that the ombudsman has had to do in a 12-month period and understand why, in some cases, it has had to take longer than 12 months to reach some kind of conclusion and resolution.
The Bill’s provision on accountability to Parliament and the public is an important change. It is a small one, but it will make a great difference to the ombudsman’s work and people’s confidence in it. It is also important to note that the ombudsman welcomes the call for greater transparency and openness about its performance.
Perhaps it is worth reflecting at this point on the fact that, since the ombudsman was established in 1967 to help Parliament to hold public services to account, there have been many reforms and changes. To its credit, it has embarked on a modernisation programme since 2012, and its statutory annual report to Parliament, “A voice for change”, explains how, as a result of the first phase of that programme, it concluded six times more investigations in 2013-14 than in the previous year, completed 99% of cases within 12 months and halved the average length of investigations from 432 days to 223 days. That represents solid progress, and I congratulate the ombudsman’s staff on the work that they have done.
The reality is that there is still progress to be made, however, and I wish to press the Minister on two points, to which I hope she will be able to respond. On
I note that some have called for much wider changes to the ombudsman service—we have had an extensive debate about it over the past two and a half hours. I draw Members’ attention to the recommendations in the Public Administration Committee’s recent report, “Time for a People’s Ombudsman Service”, which included proposals for different scrutiny arrangements that would make it easier for Parliament to hold public services to account. The Cabinet Office has committed to the Committee that it will carry out a review of the ombudsman landscape, and the Opposition look forward to the outcome. With the indulgence of the House, perhaps the Minister will update us on whether that review has begun and what its scope is or will be, because that will shape the way in which the Bill is introduced.
I understand that the ombudsman has now launched the second phase of its modernisation programme, focusing on what people can expect from investigations and examining the quality of its service. I understand that it will consult NHS users and patients’ groups on the development of a new service charter, which is very welcome.
The age of deference has passed, and citizens expect high standards of service, real choices and accountability from their public services. The digital revolution allows the citizen to be more informed about their medical conditions and treatments than any other generation in history. The NHS in England treats 1 million people every 36 hours, and when things go wrong, as they inevitably will in an organisation of the size and complexity of the NHS, citizens have the right to honesty, transparency and swift redress. The Bill takes some important steps in the right direction. I look forward to its being passed.
We have had a thoughtful and productive debate, and I congratulate right hon. and hon. Members from all parties on their contributions. The shadow Minister made a thoughtful contribution about some of the wider issues relating to the ombudsman’s work and some of the inquiries and reviews that are ongoing. I hope that she and the House will forgive me if I do not respond immediately to those points, as they are not directly germane to the Bill. I will look to get a response to her questions to her after the debate, if that is acceptable to her.
I put on record my appreciation of the consensual way in which all parties have approached the Bill. As the House is aware, very few private Members’ Bills make it beyond Second Reading, so it has been good to see the commitment throughout the House to improving how the health service ombudsman handles complaints.
I hope that we will be able to get the Bill on the statute book because the Government fully support it. It fits within the transparency revolution that the Secretary of State for Health has driven, and it is an important Bill that will improve the accountability of the health service commissioner for England to complainants and Parliament.
Obviously we would not be here without the sterling efforts of my right hon. Friend Mr Davis, whom I commend for his work to improve the experience of people who make a complaint about the NHS. I also commend my right hon. Friend Mr Arbuthnot and other Members who raised on Report some of the issues underlying good practice in complaints handling. That has enriched the debate on the Bill. I am sure that, when the ombudsman and her team read the transcript, they will find it helpful to see that Parliament has given some time and thought to how they go about their business. I am sure they will also note with pleasure the positive comments that have been made, particularly about Dame Julie Mellor’s efforts to improve and enhance the work of her organisation.
I thank my officials in the Department of Health, the Clerks of the House and everyone who has contributed to the Bill. I reiterate that I commend my right hon. Friend the Member for Haltemprice and Howden for bringing this short but important Bill to the House. There will be moments when all of us have constituents whose burden at a moment of vulnerability and distress is reduced by the measures in it. I reiterate the Government’s full support for it.
Question put and agreed to.
Bill accordingly read the Third time and passed.