Mrs M. Barnes (NHS Treatment)

Kevin Barron Excerpts

Thursday 6th February 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I thank Mr Speaker for allowing me to raise this subject in today’s Adjournment debate. I understand that he makes the decision on a Thursday afternoon.

I wish to discuss the treatment of a constituent of mine, Mrs Monica Barnes, who lives in the village of South Anston. I have been dealing with her over many years now, regarding different aspects of her health care, but my reason for wanting to speak today has to do with what has been recorded on her patient records at the Kiveton Park medical centre and the effect it may have had on her clinical treatment.

Mrs Barnes wrote to me on 5 July 2002. She said:

“Whenever I have attempted to obtain treatment some reference to litigation past or present has shown itself in my medical records and/or in letters of referral from the GP. This clearly shows there to be discrimination in my case. This time reference is made in the Patients Summary to the court case. See copy sent to me in very small print, enclosed.”

I have indeed got the patient’s summary. It is dated 18 January 2001. On the bottom, it says “await judges ruling”. My constituent contacted the Information Commissioner, and a letter was sent to the practice manager on 5 September 2002. It contained the patient’s summary and the court case entry. It said:

“In order for me to assess the practice’s compliance with the First Principle, I would be grateful if you could confirm whether individuals are made aware that personal data about them may be disclosed to other health professionals in the course of their care and treatment and the extent of such disclosures. In particular, could you please confirm whether such data as were disclosed in Mrs Barnes’ case are disclosed to other health professionals as a matter of routine, which of the conditions in the Schedules the practice is relying upon in order to make any such disclosure and whether individuals are made aware of the disclosure. Given that Mrs Barnes did not expect this, I would also welcome confirmation of these issues with regard to her case. If there is no legitimate basis for holding and disclosing the data in question when Mrs Barnes did not expect such processing, it is likely to be in contravention of the requirements of the First Principle.”

Mrs Barnes received a reply from the Information Commissioner on 6 March 2003. I have to say that the Information Commissioner had to write to the practice on 16 December to remind it of the letter it had been sent on 5 September 2002 about what was held on Mrs Barnes’s record.

Mrs Barnes received a reply from the Information Commissioner. It said:

“I understand that having considered its relevance to your patient summary records, the practice has removed the entry which states “court case”. (I have requested that the practice ensures that this does not appear elsewhere in your medical records).”

That was dated 6 March 2003. Presumably, my constituent would have been quite happy with such a positive reply. The letter went on to say:

“Consequently, on the balance of probabilities it does seem that the data in question is not relevant and is excessive for medical purposes. It is also our view that on the balance of probability it does seem that it was not necessary for the practice to disclose the details without your consent, when you did not expect this.”

That is a pretty firm statement that the Information Commissioner felt that it was wrong for the records to have been kept in such a way.

In the autumn of 2010, Mrs Barnes decided to join another practice in central Rotherham that had been built in the walk-in centre that had been opened. Her medical records were requested by the South Riding Health Services Support Agency, an organisation that I had never heard of in my 20-odd years as an MP, and they were sent on 3 November before being sent on to the new practice in Rotherham town centre. When Mrs Barnes visited her new doctor in November 2010, the practice had her medical records but on her next attendance her new GP said that he did not have them. Mrs Barnes told me that she was prompted to investigate their whereabouts.

In 2011, Mrs Barnes asked me to write to the chief executive of NHS Rotherham, who wrote back to me on 11 March saying that he had had the case investigated by his complaints officer who confirmed that the notes were sent on 3 November. The chief executive went on to say:

“However, I am informed that shortly after forwarding the medical records…the…practice received a letter from the Information Commissioners office advising them that the amendments were to be made to Mrs Barnes’…records. In order to comply with the Commissioners advice, the notes had to be retrieved from Mrs Barnes’ current GP via the SRHSSA. Whilst it is acknowledged that the Kiveton Park practice had Mrs Barnes’s medical records for several weeks, it is important to note that implementing the Commissioner’s advice was onerous.”

The chief executive wrote to me on the basis that the submission from the Information Commissioner had come in around November 2010, when my constituent was moving to another GP’s practice.

I then received a letter from NHS Rotherham on 1 June 2011, which accepted that the Information Commissioner’s advice was given in 2003 and not more recently, as mentioned in the chief executive’s letter. That was the reason for the retrieval of the records from her new GP, as it was felt “prudent” that the medical records should be reviewed for absolute accuracy. The two doctors concerned verified that the removal of information as advised by the Information Commissioner had been carried out.

Mrs Barnes referred her case to the ombudsman. She wrote to me in October 2011 setting out a number of instances in which she believed discrimination might have taken place and said in that letter:

“When I assessed my medical records at the Sheffield Northern Hospital in June 2011, I discovered that reference to court case etc, was still to be found in my patient summary.”

It seems clear to me that the advice of the Information Commissioner given in 2003 was not adhered to. The instruction was to remove that reference from her medical records in the practice and anywhere else it might appear.

I got involved with the Parliamentary and Health Service Ombudsman on Mrs Barnes’ behalf and corresponded with the office in December 2012. The ombudsman had earlier refused to investigate the case until the medical practice had the opportunity potentially to offer Mrs Barnes some compensation. That did not materialise, for whatever reason. My understanding was that the insurers might have wanted to consider the case and decide whether to take any action. In a letter to me in December 2012, the ombudsman asked Mrs Barnes for further clarification in three areas. The first was whether she had considered taking a legal remedy and why she might not have chosen to do so. The second was the level of compensation she hoped to recover. The letter said:

“The Ombudsman does not operate a tariff system and we are very much guided by what people hope to achieve. The levels of financial redress we may be able to recommend are modest when compared to sums that could be recovered by legal action and it is helpful for us to know whether we would be likely to meet the financial outcomes a complainant has expressed. This helps to ensure that they can be quickly directed to the most appropriate route to consider their concerns and helps to avoid complainants being dissatisfied at the outcomes we may be able to offer.”

The third point related to how Mrs Barnes felt that she had suffered damage as a result of the practice’s failings.

Mrs Barnes came back to me on this matter and we discussed in some detail how she should respond. In March 2013, I wrote to the assessor at the health service ombudsman saying that Mrs Barnes and I continued to be unhappy with the handling of her case. I reminded them that a letter I had received from them on 28 March 2012 stated that

“the Ombudsman will not normally consider a complaint unless the NHS organisation concerned has had a reasonable opportunity to resolve the complaint”.

I then went on to say that in relation to their letter dated 11 December, Mrs Barnes did not wish to go down the legal route because of the potentially high costs involved.

In relation to the ombudsman’s comment about the compensation that Mrs Barnes would wish to recover, as I have already pointed out, I said that

“she cannot risk going down the legal route because of the cost. Consequently, she feels the only route she has open to her is to go through the Ombudsman”.

I then said that I would appreciate it if they could be more specific about what level of financial redress they may be able to recommend if they were to settle the case for her. They told me that they had no tariff, which I quite understand.

On the third point, I reiterated that Mrs Barnes had previously provided them with information on how she felt about the damage suffered as a result of the practice’s failings. It was not just the one incident; there were many other incidents in the letter that I received from Mrs Barnes at the time.

Further correspondence took place between Mrs Barnes and the ombudsman, and in a letter to them, no doubt in her frustration, she said:

“I refuse to involve clinical negligence solicitors due to my having taken legal action against a particular hospital in the past with no outcome.”

Hence, presumably, the reference on her patient record. She went on to say:

“The only people who seem to benefit from litigation are the solicitors themselves. I refuse to further fill their pockets and barristers’ pockets with taxpayers’ money.”

That quote was used in a letter sent to me dated 18 June from the ombudsman’s office. Also in that letter it was stated:

“Mr and Mrs Barnes complaint correspondence referred to a number of other interactions with NHS Care that did not involve the practice since around 1990 and were not part of our considerations”.

That is an important point, and I agree with it. This complaint was about the issue of what was on Mrs Barnes’s medical record and how it may have been used by others if they had seen what was on that.

After further correspondence, I received a letter from the director at the ombudsman’s office in August 2013 after a review had taken place of the action/inaction of the ombudsman’s decision not to progress the complaint. That letter stated that when I wrote to the ombudsman on 24 June 2013 I had said that Mrs Barnes was unhappy with the decision because she did not have the money to take the case to court. It was said that Mrs Barnes had previously told the ombudsman that she was not prepared to put money into the pockets of solicitors and barristers, but not, so far as I can see, that she could not afford to take legal action.

The letter continued:

“However, while a person’s ability to pay legal costs is relevant in cases such as this, it cannot be the sole factor. Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians over more than 20 years and her claim arises from an action for which the law provides a specific remedy. In the circumstances we agree with our original decision that the matter is properly for the courts and is not one we should investigate.”

[Dr Julian Lewis (New Forest East) (Con)]

This is a very complicated case and I just want to be sure that I understand exactly what the ombudsman is recommending. My understanding is that the ombudsman is recommending that a lady who has had a lot of trouble because she once previously went down the legal route should, instead of pursuing a complaint about that with the ombudsman, go down the legal route all over again. Have I got that right, or am I missing something?

[Kevin Barron]

The hon. Gentleman is absolutely right. What gets me about the last two letters more than anything else is the fact that they are completely contradictory. The first states:

“Mr and Mrs Barnes’ complaint correspondence referred to a number of other interactions with NHS care that did not involve the Practice since around 1990 and were not part of our considerations”.

The last letter basically states, “No, we aren’t going to pursue any action at all. We’re not going to look at it.” It then states—I am sorry to repeat this, but I think that it is important—that

“Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians for more than 20 years”.

They are completely contradictory.

It seems to me that the parliamentary ombudsman, which is also taxpayer funded, has not only made contradictory statements, but handled Mrs Barnes’ case in a negative way. As we discussed when she and her husband visited my office, which they did on several occasions, this was not about what had or had not happened to her with the medical professional over the years; it was about what had been held on her personal records. In 2003 the Information Commissioner said that that was wrongly done and suggested it should be removed. We then found out that in 2010 the records were scooped back in again when they moved to another practice. I can only assume that the chief executive of NHS Rotherham did not know about the Information Commissioner’s decision at the time, because the second letter I received from the chief executive stated that it was more recent than he had been led to believe and that the records had been brought back from the new practice because they had just received information from the Information Commissioner that they had to change them.

I am deeply concerned about the situation. My constituent has effectively been railroaded into a situation she does not want to be in, and that she should not have to be in. Indeed, the British taxpayer has been railroaded into a situation that I do not think it should be in. My constituent said, not with my blessing—I give it my blessing now, though—that far too many people are forced into litigation in this country, at taxpayers’ expense, rather than following common sense by sitting down, looking at the problem and deciding what should be done sensibly, not feeding the law courts.

I have to tell the Minister that I am deeply disappointed that the Parliamentary and Health Service Ombudsman—I know that it is not directly a part of Government—can be run in that way and make those contradictory decisions. It seems to me that its decision is this: “We don’t have to do anything, so we’ll force her back to litigation if she does not want to go. That’s the end of the matter.” That cannot be correct, and I would like to know whether the Minister agrees.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate the right hon. Member for Rother Valley (Kevin Barron) on securing the debate and commend him for all the work he has done on behalf of his constituent, and for the work he did in the previous Parliament, before I was a Member, as Chair of the Health Committee. I know that he has a long and distinguished record of fighting on health issues in the House, for his constituents and more generally. I also congratulate him on his recent knighthood. I am sure that the House will echo those congratulations.

We can all agree that good-quality patient care is expected, regardless of which part of the country we live in, and that all patients should expect it. I pay tribute to the NHS staff in the right hon. Gentleman’s constituency for the work that they do.

I am sorry to hear about the difficulties that Mrs Barnes has experienced and that she is dissatisfied with the quality of the care she has received. It is never acceptable for a patient to receive anything less than the very best treatment and service from our NHS. However, I am sure that all hon. Members will appreciate that the provision of local health care services is a matter for the NHS locally and that the Department of Health and Ministers do not play a role in directly investigating individual localised health care complaints, which should, quite rightly, be investigated without political interference to ensure that there is no question of bias. There is an NHS complaints procedure to resolve concerns and to help local NHS organisations to learn from the experiences of their patients. On the anniversary of the Mid Staffordshire scandal and the Francis inquiry, it is right that we reflect on the fact that we have to learn from things that have gone wrong in our health service and make sure we put them right for the benefit of future patients.

I understand that, as the right hon. Gentleman outlines, Mrs Barnes has been pursuing this matter for many years and has made use of the NHS complaints system, up to and including the health service ombudsman, on a number of occasions. I also understand—this is an important point in the context of the ombudsman and other issues—that a number of the concerns that Mrs Barnes raises about her care relate to events involving non-NHS health care. I should make it clear that what I say relates to the NHS, and not to health care providers working outside the NHS with whom Mrs Barnes may have decided to undertake treatment.

It is relevant at this stage to say a few words about how the ombudsman system works.

[Kevin Barron]

I accept, to some extent, the Minister’s point about the wider issues, which were not a matter of referral to the ombudsman. However, a constituent might often go to the private sector needing to get things done because they are in pain, for example, and might then see a consultant they could also see under the NHS. Often the staff are the same people, and there is no great difference between the clinicians they meet. Does he agree with that?

[Dr Poulter]

The right hon. Gentleman is absolutely right. It is difficult, in terms of the care pathway, for any patient to draw these distinctions. However, the NHS complaints procedure relates to NHS care, and the ombudsman’s role is as a public sector ombudsman. That goes to the heart of some of the difficulties we are talking about.

If a complainant is dissatisfied with the outcome of their complaint locally, they have the right to take it to the health service ombudsman, whose office was set up under the Health Service Commissioners Act 1993. When complaints are escalated, it is important that they are investigated independently, free from the political process, to ensure that there is no question of bias. The health service ombudsman is completely independent of the Department of Health, the Government, and the NHS. It is therefore difficult for me to comment on the ombudsman’s decisions directly.

If a complainant is dissatisfied with the ombudsman’s decision, they may make use of her own complaints process. The recourse open to anyone after the ombudsman has made a final decision is to seek a judicial review. During the entire complaints process, we assume that patients would take legal advice whenever they think it necessary. That is in their best interests and, in some cases, it is often important that patients have advice from a completely independent source.

If, on the basis of the legal advice received, patients decide to commence legal action against the NHS, that is, of course, to be expected. The House will understand that I cannot comment on legal advice given to patients, including Mrs Barnes, as that is entirely a matter between the patient and her lawyer. Complaints about lawyers are not a matter for the Department of Health or the NHS, nor for this House to consider in this context. I am aware that Mrs Barnes has exhausted all the legal remedies open to her. Her case has been considered by a number of courts, including the Court of Appeal, and has on each occasion been rejected. It goes without saying that these matters will have been considered carefully by the various judges involved, and I should not and will not cast any doubt on their judgments.

[Dr Poulter]

My hon. Friend will be aware that patients have open access to their records and can request to see them, but it is not for a patient forcibly to remove relevant clinical information from them. I am not sure whether that was the case in these particular circumstances, but I hope to be able to reassure the right hon. Member for Rother Valley.

It is worth pointing out that, during the long line of litigation, in 2007 Mr Justice Simon said, following a hearing, that

“this is not a case of professional conspiracies by the medical or legal professions; it is a case where the balance of the evidence before the Court fell decisively and conclusively in favour of the defendant”,

meaning the NHS. There is a long history of legal rulings that make that point clearly. Indeed, I understand that the NHS Litigation Authority obtained cost orders in its favour for that case, although it was unable to recover its costs. I reassure the right hon. Gentleman, however, that I shall look into the issues he has raised about the ombudsman and the Information Commissioner and write to him about them.

[Kevin Barron]

I appreciate that. I know that there is some history to the case of Mrs Barnes, but in my humble view—I understand that the ombudsman and politicians should not get mixed up—this specific issue is not about what happened in the courts. It is about what did or did not happen at the request of the Information Commissioner. My reading of the situation is that it could have been managed and handled by the health service ombudsman and compensation could have been paid. In my view, the ombudsman sat back, possibly because of the history to which the Minister has just referred, and thought, “It’s got to go to litigation and that’s it.” When other avenues were closed off, the ombudsman’s office could have managed the situation, but it seems to me that it backed off, looked at the whole history of the case of Mrs Barnes and said that it had to go to litigation. I think that is unfair and that the ombudsman’s office could have handled things much better and smarter on behalf of my constituent.

[Dr Poulter]

I note what the right hon. Gentleman says. I have committed to looking further into the issue and to writing to him, and I hope that will reassure him further about the processes that have been followed in this case.

As I said at the outset, I am very sorry to hear that Mrs Barnes is unhappy at the care and treatment she has received from the NHS. I am also aware that, over the years, she has been seen and treated in a private capacity on a number of occasions, which, as we have discussed, complicates the issues, because it can make it difficult to establish whether the responsibility sits with the NHS—as part of either the ombudsman’s process or the NHS complaints procedure—or elsewhere. Her case has also been considered by the courts on a number of occasions and I have alluded to their conclusions.

I understand that Mrs Barnes made full use of the various NHS complaints processes, but remains dissatisfied, which we have discussed in detail today. Accordingly, she has involved the health ombudsman, but the outcome has not been as she would have wished.

As I have said—this is worth repeating—the ombudsman is independent of Ministers, the Department of Health and the Government. An option open to anyone dissatisfied with the ombudsman’s actions is judicial review, but it is not to be embarked on lightly and those considering doing so should ensure that they take legal advice.

I wish Mrs Barnes well and I appreciate the intentions of the right hon. Gentleman and his strong advocacy of her case.

Question put and agreed to.