Focus: Westminster – Consultants blamed about consultants' complaints

BMJ 1997; 314 doi: (Published 22 March 1997) Cite this as: BMJ 1997;314:845
  1. John Warden
  1. parliamentary correspondent, BMJ

    Recalcitrant … devoid of compassion or humility … a shame to their profession. Consultants in the NHS, or a minority of them, are sometimes suspected of failing in their duties. But seldom have they been subjected to such an indictment as last week by a Commons select committee.

    What towering scandal of medical malpractice could have provoked such an attack? In fact there was no such scandal. The select committee was angry about the cavalier attitude some consultants adopt towards complaints about non-clinical mishaps. This causes them to fall foul of the health service ombudsman and, inevitably, the parliamentary select committee which monitors his investigations. Over the years MPs on the committee have made it clear that they do not like arrogant consultants.

    Typically, such consultants offend by paying dilatory attention to complaints from patients or their relatives, which they loudly declare to be irritating or trivial. The committee hit back by calling before it Professor Sir Norman Browse, chairman of the Joint Consultants Committee, and Sir Donald Irvine, president of the General Medical Council, in the hope that they could influence the behaviour of their colleagues.

    The pair got off on the wrong foot by suggesting that the committee might be exaggerating the scale of the problem. This produced the damning verdict of being “a touch complacent.” One MP on the committee told of a complaint that was never pursued because, as the patient explained: “I have to go under the knife shortly, so I don't want to make a complaint against that guy.”

    By the end of their interrogation, Sir Norman and Sir Donald were more inclined to accept the committee's criticisms and agree that the proper handling of complaints was an aspect of “total care” and ethical behaviour. Yes, they would revise the GMC's Good Medical Practice to encourage a “modern interpretation of our profession.” And they promised that the GMC's new performance procedures would pick up consultants who persistently offend. Above all, it was established that an apology was not an admission of fault.

    If these messages reach the top of the profession the select committee will have done a good day's work. At the same time, it is not difficult to sympathise with the consultants. This column has previously noted how the standards of perfection applied by the ombudsman contrast with the manifest imperfections of the NHS, which consultants face every day. Another possible source of conflict is that the ombudsman is invariably a retired top bureaucrat. They are inherently allergic to sloppy paperwork by overworked doctors.

    Against that, the system can demonstrate impartiality. In the same report the committee unreservedly backs a consultant who was overruled by a devious management which discharged elderly patients to long term care without medical cover, only for three of them to die within days (p 848).

    There is now a new ombudsman, and after the election on 1 May the committee's complexion will change too. In the next parliament it will begin looking into complaints about clinical practice now that these are within the ombudsman's jurisdiction. Meanwhile, the consultants need to get their act together.

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