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Mr. McNamara: My hon. Friend has only three minutes left and I would like him to say what he intends to do about protocol 6, clause 33 and absentee landlords.
Mr. Michael: As my hon. Friend is well aware, that is covered by the Human Rights Bill rather than this Bill.
I should like to deal with some of the points made by the right hon. Member for North-West Cambridgeshire (Sir B. Mawhinney), who made some favourable and constructive comments about the Bill. I hope that the debate in Committee will see us looking practically at the issues before us. We will be able to answer many of his points in the detail.
We have considered how the anti-social behaviour orders and the local partnerships can work in a way that will ensure that they are practical. I can give the right hon. Gentleman an assurance that there is no conflict with the way that the policing plan operates, as set out in the Police Act 1996. Indeed, the local strategies will fit well with those approaches and create building blocks that will give an enhanced role to the strategic approach that the police authorities are intended to provide.
I am looking forward to the opportunity of serving on the Committee considering a Bill that contains so many significant and important elements.
As a magistrate and youth worker, I was very frustrated over the years by working in a creaking system that failed to engage young people. Young people were processed through the system as spectators in discussions about the offences in which they were supposed to have taken part--the system often dealt with them so late that they had forgotten what they had done by the time they were punished. The lives of victims were damaged, the community was undermined and the lives of young offenders were ruined.
The Government are taking action. The Bill gives the tools for the job to our partners the police, local government, the courts, parents and the community. That is why I believe that it will be a successful instrument for tackling crime and disorder in the community.
Question put and agreed to.
Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 63 (Committal of Bills).
Queen's recommendation having been signified--
Motion made, and Question put forthwith, pursuant to Standing Order No. 52(1)(a),
Question agreed to.
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
Mr. Tony Colman (Putney):
I beg leave to present a petition that was promoted and organised by the Putney Society, led, in this case, by Mandy James, convenor of the transport panel, assisted by Christine Reeves, David Radcliffe, Jean Dolman, Brian Towner and Judith Chegwidden, and signed by 5,479 residents of Putney, expressing their opposition to a fifth terminal at Heathrow airport. The petition states:
Motion made, and Question proposed, That this House do now adjourn.--[Jane Kennedy.]
Mr. Nigel Beard (Bexleyheath and Crayford):
Current law and practice are harsh on the victims of medical accidents, as some form of blame has to be established before compensation for injury is due. Even where blame is justified, litigation is protracted, uncertain and expensive. Where an individual suffers permanent injury and is the exception to a general expectation of successful treatment, there may be no blame. As a result, either no compensation is available, or an attempt is made to demonstrate malpractice where there was none. Such claims of malpractice engender a defensive attitude to all complaints, throughout the medical profession and the health authorities.
In some cases, injury may arise through testing or developing a new medical procedure. There are bound to be heightened risks of unexpected side-effects arising from therapeutic innovations. If doctors are to be blamed and punished for taking such risks, they will be disinclined to initiate or test new methods, and innovation will be stifled. That is particularly true of doctors in some high-risk specialisations, such as obstetrics.
Litigation on account of alleged medical negligence is now epidemic in the United States of America, and, although there are many fewer cases in the United Kingdom, the number here has been rising by about 15 per cent. a year for the past five years. A survey in 1996 showed that 37 per cent. of consultants and senior registrars had been sued at least once.
In the time available, I want, first, to demonstrate that current arrangements for compensation through litigation for medical negligence fail both patients and doctors, and risk jeopardising innovation in medicine generally. Secondly, I want to persuade the Minister that a no-fault compensation scheme for medical accidents would overcome most of the difficulties.
Accepted medical practice is the yardstick by which a doctor is measured. That means that a doctor will not be found negligent if a patient is treated in accordance with a practice accepted by a responsible body of medical opinion. A medical negligence trial will therefore focus on defining what accepted medical practice is in the circumstances of a particular case.
The result is that any trial becomes a battle of strength between opposing experts. However, the plaintiff may have great difficulty in finding experts who are willing to testify. Doctors do not like to voice public criticism of their peers. Colleagues in the same authority simply refuse to testify against one another, and witnesses have to be found from another part of the country. For the defendant doctor, however, finding witnesses is far easier. As a result, cases drag on and on for as long as eight, nine or 10 years after a writ has been issued. During that time, no special provision is available to the victim, whose family may have to cope as best it can with a dreadful tragedy.
The outcome is also uncertain. In the case of Whitehouse v. Jordan, late at night Mr. Jordan attended Mrs. Whitehouse, whom he had never seen before. He attempted five or more times to deliver her baby using forceps before deciding to deliver by caesarean section.
As a result, the child was profoundly handicapped. The fact that brain damage was caused in the course of delivery was never in question, but there were huge differences among eminent experts about whether what was done was accepted medical practice.
Mr. Jordan was found not to have been negligent, and, after a process lasting eight years, Mrs. Whitehouse was left to bring up her handicapped child, then aged 11, without any compensation to ease the burden. Equally, to have found Mr. Jordan negligent would have been unjust. He came to the case late at night for the very first time and took a course of action that many medical experts agreed was the right one.
In another case, Wilsher v. Essex, the test of accepted medical practice worked against a young junior doctor, who inserted a catheter into a vein instead of an artery. He asked a senior registrar to check what had been done, who failed to notice the mistake. The judgment of the junior doctor was not by the standards of a trainee or a learner but by the standards of more experienced and qualified colleagues.
Both those cases illustrate how unfair the present system can be to both patients and doctors.
The result of this litigation lottery is that only a small percentage of those suffering from a medical accident ever obtain compensation. Figures from the Legal Aid Board show that only 17 per cent. of legally aided medical negligence actions are successful. That compares with personal injury cases, including road and work accidents, where success rates are 85 to 90 per cent.
There is a view expressed that medical negligence cases are no different from any other negligence cases. The figures show clearly that that is not so. Establishing fault in medical cases is far more difficult than in others.
The litigation system is not cheap. In 1997, Lord Woolf, after his review of ways of streamlining civil litigation, observed that enough money to run a large health service trust was being spent annually on legal costs to deal with medical negligence claims. At the end of his survey, there were found to be 20,000 claims outstanding against the national health service, with over 90 per cent. of those litigants on legal aid. That adds to the overall problem because when a claimant is legally aided and loses, the NHS cannot apply for costs. In1995-96, the NHS paid out £150 million in medical negligence settlements, with a disproportionate £56 million coming from London regions.
In summary, we have an expensive system to deal with medical accidents, which is not working. It is not compensating victims of medical accidents fairly, and it is subjecting doctors and health trusts to pressures with which they are ill equipped to cope.
Of the cases examined by the Legal Aid Board in 1996-97, 32 received £500,000 or more in compensation. However, the average damages awarded stood at about £4,107. It is disturbing that the cost of those cases was, on average, marginally greater than the compensation awarded, at £4,122.
All this is not just my judgment. The British Medical Association has said:
No-fault compensation schemes already operate in New Zealand and Sweden. Neither system is perfect, but they demonstrate that a no-fault compensation scheme is workable, and appears to deliver benefits to many claimants that the present UK adversarial system does not.
In 1978, the royal commission on civil liability and compensation for personal injury--the Pearson report--looked into a scheme for no-fault compensation in the United Kingdom. Although it decided not to recommend such a scheme, it called for progress on the New Zealand and Swedish schemes to be monitored. Several members of the commission found the arguments finely balanced.
The cost of a no-fault scheme is another question. In 1988, the King's Fund and the centre for socio-legal studies, Oxford, estimated that, in addition to continuing costs of the Department of Social Security, the present litigation scheme, based on 10 claims per 100,000 of the population per year, would cost £75 million per year, whereas a no-fault scheme may cost £120 million per year. Set against that are the delay and individual misery that might be saved by the no-fault scheme.
In addition, a far higher proportion of compensation goes to the victim under a no-fault scheme. In New Zealand, 93p of every £1 spent goes to the victims, and only 7p goes to administration. In Britain, the National Consumer Council claims that for every £1 awarded as compensation, 85p is taken up in costs.
In the time available, the issues cannot be dealt with in the detail that would make the case conclusive, but the lengthening list of individuals and inquiries that have considered a no-fault scheme as the right way to tackle the present inadequacy of litigation lends substantial support to the argument. Both the BMA and the Royal College of Physicians support the proposal. Sir Peter Middleton, in his "Review of Civil Justice and Legal Aid", suggested that the Government should investigate the alternatives to the current system of compensation, with specific reference to medical negligence.
In 1990, the present Secretary of State for Social Security and Minister for Women, and in 1991 Ms Rosie Barnes, the then Social Democratic party Member for Greenwich, brought Bills before the House to introduce no-fault compensation schemes, but they did not have the support of the Government and so did not progress. I do not believe that any of the criticism made of those Bills was insurmountable. There is nothing from existing schemes abroad or from previous objections to indicate that a no-fault compensation scheme for medical accidents is impractical or exorbitantly expensive.
That, for the purposes of any Act resulting from the Crime and Disorder Bill [Lords], it is expedient to authorise--
(1) the payment out of money provided by Parliament of--
(a) any expenditure of a Minister of the Crown incurred under or by virtue of the Act; and
(b) any increase attributable to the Act in the sums payable under any other Act out of money so provided; and
(2) the payment into the Consolidated Fund of any sums received by a Minister of the Crown under or by virtue of the Act.--[Jane Kennedy.]
That the Nursery Education (England) Regulations 1998 (S.I., 1998, No. 655) be referred to a Standing Committee on Delegated Legislation.--[Jane Kennedy.]
Question agreed to.
10 pm
The petition of the Putney Society declares that local residents oppose the construction of a fifth terminal at Heathrow because the environmental costs will outweigh the economic advantages. The petitioners therefore request that the House of Commons urge the Secretary of State for the Environment, Transport and the Regions to refuse planning permission for the proposed new terminal.
To lie upon the Table.
And the petitioners, as in duty bound, will ever pray.
10.1 pm
"For many years the medical profession have been concerned about the social injustices of the present tort based system and established a working party to look into instituting a no fault compensation system. Such a scheme, we believe, would relieve the patient of the necessity of lengthy and expensive legal cases, and
8 Apr 1998 : Column 455base compensation principally on the injured person's need. It is not our intention that such a scheme should protect professional staff if errors were made."
That last point--that the present system, for all its faults, may ensure the accountability of the medical profession--is worth dwelling on. Even today, there is a separate medical disciplinary procedure to ensure professional standards. That system would have to be adapted, but there is every reason why such a revised disciplinary system should continue to operate alongside a reformed compensation scheme. Indeed, it is likely that the absence of prolonged legal proceedings would better ensure that a doctor who is truly blameworthy could be brought to account quickly. Discipline and compensation do not need to be linked.
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