Schedule 5

Part of Health and Social Care Bill – in a Public Bill Committee at 3:45 pm on 17th January 2008.

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Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 3:45 pm, 17th January 2008

New clause 4 seeks to establish a complaints handling function within the Care Quality Commission. Hon. Members will note that we skipped lightly across some earlier parts of the Bill because we had the promise and the prospect of dealing with this important issue more appropriately at this point.

New clause 5 seeks to establish an independent complaints handling body. Amendments Nos. 86 and 87 would neutralise the Government’s attempts to remove this responsibility through amendments to the 2003 Act in respect of the CQC and the complaints framework. I should state from the outset that the argument for removing the complaints handling function from the CQC has some merits given that it has been such a drain on the Healthcare Commission’s resources. During the oral evidence sessions, Dame Janet Smith, now Lady Justice Smith, stated that

“health care complaints are in a mess and causing great dissatisfaction.——[Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 44.]

In considering these amendments, the Committee must consider where such complaints will go, and if it is happy with the status quo as concerns social care complaints, where part-funders and self-funders have no recourse to second-tier complaints. That point was also made by the hon. Member for Romsey during  discussion of another part of the Bill. We have to look at whether the Committee is happy that the places where such complaints will go will be allowed to remain.

As regards the quality of complaints, the Committee should note that there are approximately 95,000 complaints in the NHS per annum. The Healthcare Commission reviews about 5 per cent., which is some 7,600 complaints. My figures have been derived from a series of parliamentary questions and other sources. In 2006-07, the health ombudsman received 863 complaints, 239 of which were to do with continuing care and 623 with other health matters. In the same year, the local government ombudsman dealt with six complaints into adult care services and two complaints into residential care. I do not have the figures for local authorities. If the Minister has them, it will be very helpful to view them.

The Healthcare Commission handled 5,867 complaints in 2004-05, 7,644 a year later, and 7,696 a year after that. In 2007-08, up to 14 December last year, 5,515 complaints were made. I hope that that gives the Committee some idea of the scale of what we have to tackle here.

I am grateful for the Minister’s confirmation this morning that the backlog of complaints for the past two years was 5,180 and 2,298 respectively. The Healthcare Commission is reaching its estimated target of closing 95 per cent. of complaints within two months, which is encouraging. All Committee members will have had letter from constituents complaining about the inordinate length of time it has taken to consider and complete some complaints. We would all like to see a more streamlined approach, but one that is still effective.

The Committee will also be aware of the written submission of the parliamentary ombudsman. I am sure that the Minister will seek to remind the Committee that the parliamentary ombudsman states:

“I fully support the Department’s proposals.”

However, her evidence throws up some important statistical questions that the Minister should answer before the Committee allows the CQC to lose its complaints function.

In the final paragraph of her evidence, the ombudsman states:

“I have already explored with the Treasury the additional funding I am likely to require.”

On that hangs her evidence and presumably her support. I would not want to criticise her of empire building, but I think that it is important that the Committee is aware of what additional funding she is likely to require especially as the first cut from the CQC will be reported as a gross saving by the Department, but could be a net loss to the taxpayer. The Committee also should know what costs to the Exchequer it is voting for as a result of the proposals in the Bill. The ombudsman refers to forecast increases in her work load. She notes that

“in the short term the changes will result in an increase in the number of enquiries made to my office and the number of investigations I evidence I note that when the Scottish health system moved to a similar model, the number of investigations increased, but not unmanageably so”.

It would be useful if the Minister could tell the Committee, or write to it to explain what “short term” means in that context, what the figures in Scotland were, and what the forecast figures in the case of England are.

The Department has not so far provided an assessment of the increase in work load for the ombudsman. On Second Reading, the Secretary of State said:

“We will stay in touch with the ombudsman to see whether staffing is sufficient to ensure that they can cope with any increase in work.”—[Official Report, 26 November 2007; Vol. 44, c. 468.]

The Minister said that the Government discussed capacity with her and that she is satisfied that she will not be overburdened, but that they will have to deal with those issues carefully. I hope that he is in a position to give the Committee firmer figures today.

It would be helpful if the Minister could expand on the difference between the nature of complaints investigation by the Healthcare Commission, and the nature of complaints handling by the ombudsman, as the latter looks at maladministration or service failure.

The Committee would also be reassured if the Government would outline how the winding-up of the complaints process at the Healthcare Commission, and the handing over to the ombudsman, will work out. Obviously, local providers will need time, with the commission in support, to bring their own complaints systems up to scratch. We cannot have a system whereby the ombudsman wakes up one morning with 7,000 complaints on her hands.

Another issue that the Committee should consider is the lack of a two-tier complaints structure for social care. Currently, people who have their care part funded or wholly funded by the local authority can complain through the local authority social services complaints procedure. That was raised by my hon. Friend the Member for Tiverton and Honiton in her excellent example on the previous amendment. If people are dissatisfied with the outcome of their complaint, they can ask the local government ombudsman to investigate.

Self-funders have no such option. They are at the mercy of their own home's complaints procedure, and have no other avenue apart from the courts. This debate very much plays back into the ongoing debate that this Committee has had about human rights—a number of hon. Members throughout the House are very exercised by that, and rightly so—and the disjunction between the public and private sectors in this area.

During a Westminster Hall debate on vulnerable adults, the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), stated:

“The problem is that self-funders, of whom there are an increasing number, have nowhere to go if they are dissatisfied with the way in which the provider investigates their complaints. The regulator, as things now stand, does not investigate individual complaints. On receipt of such a complaint, the regulator can visit the home, examine practices there and take action, but they cannot investigate the individual complaint. That is an important distinction. I am committed to considering how that can be put right. In a modern care system, it is unacceptable that self-funders should not have the protection  that other residents have of being able to rely on an independent element in the process, if they are dissatisfied with the handling of a complaint by the very home that they are complaining about.”—[Official Report, Westminster Hall, 11 December 2007; Vol. 469, c. 52WH.]