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Mrs. Anne Campbell (Cambridge) : Perhaps I should begin by explaining that women in Cambridge have choices about where they can have their babies under the national health service. They can choose to go to Addenbrooke's, which is high-tech and is appropriate for natural births and high-risk babies. There is also Hinchingbrooke hospital, which, although it lies in the Prime Minister's constituency of Huntingdon, nevertheless is within travelling distance of Cambridge.
The advantage of Hinchingbrooke for many women is that it is small, more personal and is organised on completely different lines from the large teaching hospital at Addenbrooke's. It has a rather unusual organisation. It has no registrars, only consultants, nursing staff and senior house officers. A significant number of women will choose Hinchingbrooke because it is small and because of its personal nature, but perhaps more importantly, because of its very low perinatal mortality rates. I am sure that the Minister will want to stress that point when he responds.
If a hospital normally deals with low-risk cases, it would be expected to have a low perinatal mortality rate. I suspect that the lowest perinatal mortality rate of all is among those women whose babies are born at home. I hope that that will not be a statistical argument to be used to justify the inaction on the case that I want to talk about this evening.
Choices have always been available to women in Cambridge, and I hope that that will continue. When I telephoned the chief executive of Cambridge district health authority this morning, he told me that there had been rumours that Hinchingbrooke was under some threat of closure. It is important to the women in my constituency who want a choice--and also to the women in the Prime Minister's constituency who want a local hospital-- that it remains open.
I certainly do not intend to fuel the closure rumours ; nor do I want the hospital to be closed. I must add, however, that at least two serious complaints have been made about it by women in my constituency. It is vital for confidence in the system to be restored, and for women who have their babies at Hinchingbrooke to be convinced that past mistakes will not recur.
This is not just a case of everyone being more vigilant, or of blaming one or two individuals. It is a case of engaging in an open, honest and frank discussion about the things that have gone wrong, and ensuring that management procedures are in place to minimise the risks in future.
The case that I am going to describe involves both clinical and management failure. I know that managers at Hinchingbrooke will say that they have spent many hours investigating the complaints. That is true ; but what has emerged after many hours, days or even weeks of investigation is a complete whitewash. There is no formal indication of where the mistakes were made, no indication of the procedures that were not followed or were not in existence and no indication that the management want to
Column 395do anything except hush it all up and hope that there will be no unfavourable publicity. The point of this debate is to bring the issues out into the open.
I am sure that the health service commissioner, who produced a report recently, will agree with some of the points that I am going to make. His most recent report states :
"It is not just inefficient, it is pitiful and shabby when NHS authorities make out that they welcome complaints but then deal woefully with them."
The complaint that I shall be examining has been dealt with woefully, and inadequately.
My frustration, and that of my constituents, is compounded by the fact that the responsible authorities are no longer democratically accountable to the electorate whom they serve. There is no one, apart from the Secretary of State, to whom I can turn and say, "You are the elected representative who is responsible for this mess." There is no one to whom I can say, "You are the person who is accountable at the end of the day."
Trusts and district health authorities no longer have elected representatives who are accountable to local people. The trusts have appointees who are well paid for their services, who hold their meetings in secret and who do not have to listen or respond to my complaints or those of my constituents. They treat the trust as a business, maximising its profits, trying to ensure good public relations and making certain that the district health authorities will continue to purchase their services by providing them as cheaply as possible. There is no incentive for the trust to admit its mistakes or fully investigate the complaints, as the following account will reveal.
I referred earlier to two serious cases. They are the cases of Mrs. Cheree Graves-Bacchus and Ruth McCall. I know that Mrs. Graves-Bacchus is deeply unhappy with the clinical treatment and the management of her complaint ; however, the case that I shall use as an illustration, and describe in some depth, is that of Ruth McCall. I intend to describe in graphic detail the events as they occurred. The story began on 28 February 1992 when Ruth was admitted to Hinchingbrooke, 19 weeks pregnant and experiencing labour contractions. Sadly, the baby was stillborn four days later, at 20 weeks' gestation. A post-mortem revealed that the cause of the premature, pre- viable delivery was infection with the bacterium group B streptococcus. That bacterium causes virulent uterine infection, but it is treatable and, if caught at an early stage, it can be treated with antibiotics.
At a follow-up appointment with the consultant at Hinchingbrooke, Mr. John Hare--Ruth's own consultant--assured her that any future pregnancy would be monitored closely for the same infection and that she should also regularly take preventive antibiotic treatment. Ruth became pregnant again and two months later a swab taken by her general practitioner showed another bacterial infection. She was prescribed antibiotics and the pregnancy continued. She was considered a high-risk case and was seen by Mr. Hare every two weeks and was regularly prescribed swabs and antibiotics.
As you can imagine, Mr. Deputy Speaker, following her previous experience Ruth feels a certain amount of anxiety and she is given counselling for this by the midwife counsellor at Hinchingbrooke, Pat Ingham. She has been
Column 396told that following her previous experience changes have been made at the obstetrics unit and that, first, patients would be allocated to the continuing care of the on-duty consultant until their own consultant became available. Secondly--this is significant--she was told that all premature labour patients would be given immediate antibiotic drug therapy.
That did a great deal to reassure Ruth. However, on Saturday 28 November 1992 Ruth's membranes ruptured at 29 weeks' pregnant. She arrived at Hinchingbrooke at midday and saw the midwife, who recorded the baby's heartbeat. It appeared that all was well. The heartbeat was strong and regular and there was no sign of abnormality. Mr. Hare was on holiday. The on-duty consultant was Mr. Al Kurdi, who has rather different professional views from Mr. Hare. In view of what she had been promised by Mr. Hare, Ruth was stunned and upset when Mr. Al Kurdi told her that in his view a genital wart virus was the cause of the premature rupture of the membranes. I believe that, although that was Mr. Al Kurdi's professional judgment, there was no evidence that Ruth had a genital wart virus and no scientific evidence that the virus causes premature rupture of the membranes. Mr. Hare later agreed that there is no research to suggest that, and that Mr. Al Kurdi's insistence obscured his judgment. He ignored the existing hospital guidelines and Mr. Hare's own care plan, which stated clearly that Ruth would be given antibiotics if she was admitted early.
Mr. Al Kurdi refused to consider either delivery or antibiotic treatment. Dr. Miles, Hinchingbrooke's consultant paediatrician, later agreed that, if antibiotics had been prescribed, the baby would have had a better chance of survival. No swab was taken to check for infection despite the fact that a one-hour swab test is available to detect this particular group B streptococcus bacterium and that that was later said to be the normal practice. Mr. Al Kurdi said that he did not feel that it was necessary.
Ruth was given a steroid injection at about 2 o'clock. Mr. Hare later commented that that was reckless without antibiotics. Ruth was then admitted to the Hazel ward. That is the ante-natal ward, not the labour ward, which suggested to staff, according to Mr. Hare, that Ruth was not high risk. Ruth also asked midwives for antibiotics, but was told that Mr. Al Kurdi had forbidden them for 24 hours. By this time, Ruth was becoming anxious, but, like so many women in that situation, she felt that perhaps the hospital knew best and that she was not best placed to judge. However, many of us who have been through pregnancy and childbirth will understand the turmoil that she must have felt in those crucial few hours.
During the night, Ruth had a loose bowel movement and reported that the baby was moving less actively. However, those signs of labour and foetal distress were ignored by the staff. By 6 am Ruth was getting desperate and asked for the baby's heart to be monitored, which was done at 7 am. It revealed that the heartbeat was slower than usual, but that, too, was ignored.
By that stage, Ruth felt panicky, cold and ill. She checked her sanitary pad and found a green slime, a highly indicative sign of infection. She begged to see Mr. Al Kurdi immediately. I ask you, Mr. Deputy Speaker, to use your imagination--how would anyone feel in such circumstances ?
At 9 am, Ruth asked for a full cardio-tocograph and, to her distress, the midwife found no heartbeat. Ruth was now desperately cold and hysterical and persistently asking for
Column 397Mr. Al Kurdi. She was given four different answers as to where he might be. The senior house officer on duty arrived before Mr. Al Kurdi, but said that he could not do anything as he had not been trained to deal with the ultrasound machine. Mr. Hare later said that it was inappropriate to leave a senior house officer in charge. At approximately 10.30 am, Mr. Al Kurdi finally arrived, some 21 hours after he had first seen Ruth, leaving her without any medical care. He looked at the baby on the portable ultrasound scanning machine--there was no heartbeat and the baby was motionless. Mr. Al Kurdi claimed that the screen was too small to see what was going on and that he would do another scan the following day. Ruth and her partner were outraged and the midwife burst into tears, at which point Mr. Al Kurdi admitted that it was highly likely that the baby was dead.
Mr. Al Kurdi then made a number of extraordinary suggestions. The first was that Ruth must have bled at some time in early pregnancy but concealed the fact. When a baby dies in such circumstances, it is almost inevitable that the mother will feel guilty and feel that she is to blame, so the effect of that suggestion on Ruth was extremely distressing. The suggestion was also untrue.
Mr. Al Kurdi then suggested that the cord had prolapsed. He denied that infection could have caused early death and claimed that at 29 weeks the baby would probably not have survived anyway. These points were later said to be false by Mr. Hare. He also said that in Ruth's case his established treatment plan should have been carried out by another consultant.
I have outlined the clinical incompetence in this case and the tragedy to which it led ; I shall now describe the mistakes made at the hospital after the stillbirth of Ruth's second baby. Ruth was in a very distressed state, but she made an initial complaint and subsequently sent a letter, neither of which was acknowledged immediately. After the post mortem, Mr. Hare wrote to Ruth giving her a late and inaccurate notification of a placental chromosomal anomaly, for which he later apologised. I do not usually subscribe to conspiracy theories, but, if I were trying to dissuade a mother in those circumstances from continuing with her complaint, that would be a highly effective way of doing so--trying to put the blame on the woman and on some congenital abnormality.
On 26 January Ruth wrote to Mrs. Wells Johnson, the nursing director at Hinchingbrooke, asking for a full investigation, and action to prevent similar events from occurring. Mrs. Wells Johnson responded by suggesting that the baby's death was due to a prolapsed cord. That was not true, and again, she later apologised for saying it.
Two weeks after her daughter's death Ruth telephoned Mrs. Pat Ingham, the midwife who had been counselling her for anxiety during the pregnancy. Pat Ingham said that she could not speak to Ruth, but she telephoned Mr. Hare, who in turn telephoned Ruth's general practitioner. The GP visited Ruth and told her not to contact Pat Ingham again because whistleblowing in the NHS was risky, and she could lose her job for speaking to Ruth.
The stress on whistleblowing is significant, because that is one of the reasons why no full and accurate investigation of what happened is taking place. There is much nervousness about the case, and I believe that the people who know the truth are afraid to speak out. Ruth's solicitor then wrote to Mr. Morris, the Huntingdon coroner, asking for an inquest. It was to be the first inquest held in Huntingdon to investigate a stillbirth.
Column 398Mr. Al Kurdi stated under oath that the baby may not have been normal. Mr. Hare agreed later that that was clinically irrelevant. Mr. Al Kurdi also said that prescribing antibiotics would have raised false hopes about the baby's survival. He also stated that he could not consider delivery, because of the low survival rate in the Hinchingbrooke special care baby unit. That was also later denied by the hospital. Mr. Al Kurdi claimed that a swab had not been taken because of a misunderstanding. The hospital pathologist who conducted the post mortem confirmed that the baby was normal, and that death had been caused by overwhelming streptococcus B infection. During the inquest, what was most distressing to Ruth was the fact that, after Mr. Al Kurdi finished his evidence, the Hinchingbrooke nursing director, Mrs. Wells Johnson, put her arms round his shoulder and said, "Well done." After the inaccurate statements that Ruth believed had been made at the inquest, that was highly distressing. The other important aspect of the case that it is important to mention is Ruth's belief that Mr. Al Kurdi misled the coroner under oath, and had also placed a misleading entry in the case notes, suggesting that he had seen her much earlier than he did. Following the inquest, also at Ruth's insistence, a meeting was held attended by Ruth, Mr. Hare, Dr. Miles, the Hinchingbrooke paediatrician, Christabel Mulvey, the Cambridge community health council representative, and Mrs. Wells Johnson. All Ruth's complaints were noted in the minutes, and afterwards Mrs. Wells Johnson wrote to Ruth confirming that changes to the unit discussed at the meeting would be carried out. However, Ruth had been promised that on a previous occasion, and in view of her previous experiences and of the occurrences at the inquest, she was not satisfied that a full and impartial investigation had been carried out, or that any disciplinary action was contemplated.
On 1 April, Ruth met Mr. Willis, the chief executive at Hinchingbrooke, and Dr. Henderson, the medical director, and told them her view. Also on 1 April, there was an incident at Hinchingbrooke which led to Mr. Al Kurdi being accused of indecent assault against another patient and he was suspended from all duties. On 5 April, I wrote to the chief executive of Cambridge district health authority outlining the case and asking for an investigation. Ruth was advised by the district health authority that disciplinary action would not be taken and she was told that an annexe B disciplinary investigation was considered appropriate. The person she saw at the district health authority dictated a letter for her to write requesting such action. An annexe B disciplinary investigation is reserved for very serious complaints. The Cambridge district health authority obviously believed that this was a very serious complaint and it supported Ruth in her action to get some effective disciplinary investigation.
However, Dr. Henderson then wrote to Ruth proposing to initiate an annexe E inquiry. This is an internal disciplinary investigation for less serious offences. Ruth was concerned that her case was not considered serious enough for an annexe B inquiry, despite the advice from the Cambridge district health authority, the purchaser in the case.
As Hinchingbrooke is now a trust hospital, the decision on which line of inquiry to follow was no longer in the hands of the director of public health ; it was up to the individual hospital concerned. On 1 June, Ruth had a meeting with Dr. O'Brien, the regional director of public
Column 399health, who stated that, if Mr. Al Kurdi was acquitted of indecent assault charges, he should return to the hospital to face an annexe B inquiry. He wrote to Hinchingbrooke recommending that, and he also wrote to the Department of Health deploring its outdated circulars which predated the health service reforms.
The outdated circulars referred to complaints procedures and we feel that that was one reason why Hinchingbrooke had not taken effective action in the case. Ruth then received a letter from Mr. Willis stating that it had now been decided that an annexe B disciplinary action should be proceeded with, but that because of the time scale needed to gather medical evidence, it seemed logical that Mr. Al Kurdi's case should cover Ruth's case and that of the complainant in the court case.
In June 1993, Ruth received a letter from Mr. Willis--a situation report-- in which he said :
"We have therefore recommended that action as laid down in Annexe B should be initiated and our Chairman has decided to proceed. We are therefore at the stage described in paragraphs 6 and 17a of Annexe B. The Chairman will be writing to Mr. Al Kurdi to inform him that he considers on the evidence presented so far that a prima facie case exists which must be answered . . . It therefore seems logical and is the opinion offered by our legal adviser and agreed by Dr. O'Brien that the disciplinary proceedings in Mr. Al Kurdi's case should cover both your case and that of the complainant in the court case." Mr. Willis also said that the unofficial estimate by Howard Weston, the hospital's solicitors, of the cost of an annexe B procedure was that it would be a minimum of £100,000 and was more likely to approach £200,000. That point is also significant. The fact that the cost would fall on a small trust hospital is a point that the hospital would find very significant. Without a separate budget for disciplinary proceedings and complaints, it was almost inevitable that the hospital should weigh the cost carefully in deciding whether to continue along that line of complaint. Mr. Willis went on to say, confirming my worst fears and Ruth's worst fears :
"It would be irresponsible of us to commit too much expenditure, in view of the peculiar circumstances of the case and when, as you know, we have no budget to pay for it."
In January this year, at a meeting held at the regional health authority with Mr. Willis, Dr. Henderson, Christabel Mulvey and the new regional director of public health, Dr. Pat Troop, it was confirmed to Ruth that an annexe B inquiry would be held if Mr. Al Kurdi was acquitted and that, if he was found guilty, he would be summarily dismissed and the case would be referred to the General Medical Council. It is also agreed that he will remain suspended until the annexe B inquiry can take place. However, the hospital is most concerned about its public relations. Following Mr. Al Kurdi's acquittal, the hospital announced that it is delighted with the verdict and Mr. Al Kurdi can now return to work. That is in direct contradiction to everything that Ruth was previously told. Following the dismantling of the annexe B inquiry, Ruth was offered a stage 3 complaint professional review which was undertaken on 27 May. The consultants verbally upheld Ruth's complaint and expressed fears about the safety of the unit. However, their formal report is brief--it has only one and a quarter pages. I have a copy here. The consultants did not even comment on the issue of misleading the coroner or the false entry in the case notes, and none of their serious verbal comments is recorded. I quote from the conclusions of the inquiry :
Column 400"Mr. Al-Kurdi's management of Mrs. McCall on her admission to the labour ward on 28 November followed accepted lines of treatment but was at variance to the care plan she agreed with Mr. Hare. We feel that having a care plan agreed between Mr. Hare and Mrs. McCall, it would have been wiser to have followed that agreement rather than departed from it.
We feel that the situation around the time of the death of Mrs. McCall's baby could have been handled more tactfully by Mr. Al-Kurdi."
That is a disgrace and is not fit to be called an investigation or an inquiry.
Christabel Mulvey of the community health council wrote to the regional director of public health to complain about that, and to ask whether the consultants concerned had been reported elsewhere. She has not yet received a reply to her letter. I understand that an annexe E inquiry, which is for less serious complaints, is still being proceeded with, but I must ask whether that is an appropriate response to Ruth's complaint.
There are many points of general concern about this case. The first point-- I hope that the Minister will respond to this ; it is perhaps one of the easiest points to respond to--is the Department of Health's circular relating to disciplinary action which has not been updated to take into account the NHS changes. We assume that the role of the director of public health is to be taken by the medical directors of the individual trusts. However, it is obvious that the circular needs to be updated as a matter of urgency.
To make my next point, I shall quote from an article by Liam J. Donaldson in the British Medical Journal on 14 May 1994. I quote first from the abstract. He said :
"Existing procedures for hospital doctors within the NHS are inadequate to deal with serious problems. Dealing with such problems requires experience, objectivity and a willingness to tolerate unpleasantness and criticism. Because most consultants' contracts are now held by the NHS trust hospitals, however, those who have developed skill over the years in handling these complex issues are now no longer involved."
He went on to say :
"I fear for the position of NHS trust medical directors. They are taking on this work for the first time but they will be dealing with their peers who work in the same institution. They will not be at an appropriate distance to sustain objectivity as were their predecessors, the regional Health Authority Medical Officers and Chair People."
That is something which has arisen as a result of the NHS reforms. It is a serious point, which I hope the Minister will deal with later. As the regional health authority is no longer involved, there is no supervision or monitoring of the handling of disciplinary actions by individual trusts.
The annexe B disciplinary procedure for serious matters is thorough and legalistic. The estimated cost by Hinchingbrooke of between £100, 000 and £200,000 is probably accurate, but it has no funds to pay for the actions. Therefore decisions invariably have to be partly financial. I am sure that when the costs were borne by the regional health authority at least the risk was spread over many hospitals and budgets could bear that more easily.
Disciplinary procedures are obviously an employer-employee matter, yet Ruth was informed that annexe B was also to provide some response to her complaint. The citizens charter outlines the expectations that patients should reasonably have. In Ruth's case, however, there was neither a named carer nor a timely response to the complaint. When NHS trust hospitals fail to meet the standards of the citizen's charter there is no one to monitor any trust's adherence to the principles.
Column 401Cambridge health authority advised Ruth that an annexe B action was appropriate and one of its staff even dictated the letter that she wrote to request such action subsequently. In a letter of 3 June, Cambridge health authority described that as "informed advice". Despite the early view of the Cambridge health authority and the regional director of public health that the very expensive and formal annexe B was the most appropriate mechanism for dealing with this serious case, it is now Hinchingbrooke's sole decision as to what action to take and, apparently, to change its mind as it sees fit. I do not consider it appropriate that it should be the trust itself that should take the decision about how it investigates complaints against it. Stephen Thornton, the chief executive of the district health authority in Cambridge, wrote to me on 3 June and said : "it is for the Trust to find the resources to carry out investigations into complaints and to operate disciplinary procedures. Like any other element of their cost, this ultimately finds its way into the prices charged by the purchasers." It is obvious that price has been an important element in investigating this complaint.
Complaints procedures and disciplinary procedures are currently under review. "Being Heard", which was published in May 1994, is a report of a review committee on NHS complaints procedures. Christabel Mulvey, of the community health council, wrote to the regional health authority saying :
"I hope you share my concern about this report. For such a serious complaint to be dismissed in this manner is disgraceful. I also hope that you will be commenting to the Wilson Committee on the ineffectual nature of the Stage III complaints procedure and that something better must replace it."
I endorse that view totally. I hope that the Wilson committee will consider that serious complaint as part of its deliberations. This is a serious complaint, but the issues have not been properly addressed for several reasons. First, the inexperience of the medical director of the trust, who is now taking the role previously played by the district or regional health authority, has been a factor. Secondly, Hinchingbrooke does not have a spare £100,000 to £200,000 to spend on mounting disciplinary actions and there is no separate budget for complaints. Thirdly, since the trust is now a business and needs to maximise its profit, any bad publicity will lead to fears of withdrawal of funds. Fourthly, clinical incompetence, if it is proved, may lead to litigation and even more expense for the hospital. At no point has my constituent, Ruth McCall, sought financial compensation for the distress she has suffered. Her sole reason for pursuing the case is to ensure that other women and babies do not suffer as she did.
I began my speech by declaring that Hinchingbrooke is an important part of the provision of maternity services for women in my constituency. Confidence, however, needs to be restored. It is not restored by an internal disciplinary procedure that is a cover-up and a whitewash. Apart from the need to restore confidence, I hope that the hospital will consider some structural changes.
My hon. Friend the Member for Darlington (Mr. Milburn) has compiled figures from answers to a number of parliamentary questions about the numbers of managers and health-care staff in each district health authority. It emerged from his careful and perceptive analysis that Huntingdon health authority had the highest ratio of managers to health-care staff of any health authority. I
Column 402suggest that more money spent on direct health care and less on managers might have had a beneficial effect in the case that I have outlined.
Despite a disproportionately large number of managers there has been a singular failure to deal properly with a complaint. I shall quote the words of my constituent when summing up her experiences in a letter to the DHA on 7 July. She wrote :
"I am not exaggerating when I say that the business of pursuing this complaint has been as distressing as the death of my babies and has left me exhausted, disheartened and truly despairing." I have brought the matter to the Floor of the House because of the impossibility of getting the issues properly debated elsewhere. I hope that there will now be a full and proper annexe B inquiry and that the Minister will give me his full support.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : I congratulate the hon. Member for Cambridge (Mrs. Campbell) on being successful in the ballot and securing the debate. I am glad to take the opportunity to respond to her concerns about maternity services at Hinchingbrooke hospital, and especially about the case of Mrs. Ruth McCall.
As the hon. Lady is aware, the Hinchingbrooke hospital is a modern district general hospital. It has about 400 beds and provides the people of Huntingdon and of the surrounding area with a wide range of excellent in- patient and out-patient facilities and day-care services. It opened in 1983 and has quickly established a reputation as one of the best medium-sized general hospitals in the country. The hon. Lady remarked on several occasions about the way in which the hospital is run. In particular, she said that it is run for profits. There are no such things as profits in the national health service. Hospitals have to try to balance their budgets against the resources that are made available to them through contracts with health authorities by providing as efficient a service as possible and by signing new or larger contracts with health authorities. There is no question of profit, and it gives something of a misleading impression of the motivations within hospitals to say otherwise.
Mrs. Audrey Wise (Preston) : Is it not true that a hospital must balance its books, and that unexpected costs of the sort outlined by my hon. Friend the Member for Cambridge (Mrs. Campbell) in dealing with a disciplinary case could severely disrupt the process of balancing books and, therefore, distort the situation that she has outlined ?
Mr. Sackville : That would be true of any enterprise in the public sector. There must be budgets for every part of the NHS. If unexpected costs fall on a certain hospital, those who are in charge of its finances must make provision through arrangements with health authorities or by meeting the costs within existing budgets. I am questioning the use of the word "profit" because of the impression it gives about the way in which a hospital is run and the motivation of those who run it. NHS hospitals are run for patients, not for profits. That may mean finding additional resources to treat more patients, but it does not mean that hospitals have a profit motive, which implies some sort of personal gain.
Column 403disciplinary procedures ? For example, how many hospitals would set aside a sum as large as £200,000 to investigate a serious complaint ?
Mr. Sackville : I cannot answer those questions specifically, but hospitals must be aware that unexpected costs can arise, often as a result of a particular patient's expensive treatment. That possibility must be taken into account in setting a hospital's financial arrangements.
Ms Dawn Primarolo (Bristol, South) : When the business plans for this hospital and others go to the Department of Health, does the Department scrutinise the budgets to ensure that they are properly planned and can meet all eventualities, including the possibility of disciplinary action ? If not, why does not the Department do so, given that it is not prepared to pick up the bill for such action ?
Mr. Sackville : If the Department of Health was to sit in the centre trying to second-guess all the budgetary arrangements that have been made, we would need a large number of civil servants. We have regional outposts where our officials inspect all the trusts' annual budgets. That process is part of our monitoring of hospitals so that we know in good time whether a hospital is running into financial difficulties. If we do not know that in advance, patients will suffer.
The obstetrics and neo-natal paediatrics departments were two of the first to be opened at the Hinchingbrooke hospital. As it was a new hospital, there was scope for innovation and organisation of its staffing structure. The most significant of those innovations was to provide medical care on a two-tier rather than a three-tier system. For maternity, that means that care is given by trained doctors rather than doctors in training and the role of midwives is enhanced. So long as a woman's labour is normal and requires minor or common intervention, care is generally given by midwives. Enhancing the role of midwives is one of the fundamental aims of the "Changing Childbirth" paper, which I shall mention more fully in a moment. Over the past 10 years, the maternity unit at Hinchingbrooke has become justifiably popular with expectant parents. The hospital was originally set up to cater for the needs of people living within the Huntingdon health district, which produces about 1,800 births a year. The current rate at Hinchingbrooke is some 2,700, which shows that many women go there from other districts, partly because of the maternity unit's reputation.
Hinchingbrooke is justifiably proud of its neo-natal services. I noted the hon. Lady's attempt to dispose in advance of any good results achieved by the maternity unit. May I point out that the overall survival rate is among the best in the country. All consultants in obstetrics and neo-natal paediatrics are highly trained in neo-natal intensive care and provide a first-class and much appreciated local service.
The hon. Lady initiated the debate obviously as a result of wishing to mention the on-going complaint concerning Mrs. McCall, who was receiving maternity care at the hospital, which resulted in the tragic events of 1992. I take the opportunity to convey my sympathy to Mrs. McCall and her family. I can only guess how she suffered then, and no doubt is suffering from the immense sadness of her loss.
Column 404Hinchingbrooke is, as the hon. Lady said, in the process of conducting an inquiry into that matter. There has been a delay in completing that task, which was partly the result of the police investigation, to which the hon. Lady referred, into a separate and unrelated incident as regards which I understand that the consultant in question has been cleared.
The allegation is that the delivery of the child in November 1992 was clinically mismanaged in the way that the hon. Lady described. That has been the subject of an independent review. The conclusions of that review, as she said, were that the consultant's management of the care was along accepted lines of treatment, but at variance with the care plan that had been agreed with the consultant originally in charge of the case, who was on holiday at the time. The assessors said that it would have been wiser to have followed that plan, and that the handling of the situation at the time of the tragic incident could have been better.
I understand that Mrs. McCall has further anxieties and questions arising from that review, and those are currently being investigated in disciplinary proceedings under annexe E. I would, however, point out that the review is following the guidelines set out by the circular, and will be conducted by independent professional assessors. I can assure the hon. Lady that Hinchingbrooke has already introduced revised protocols and guidance to staff dealing
Mrs. Anne Campbell : Can the Minister confirm that an annexe E procedure is an internal disciplinary procedure, which is normally used for less serious complaints, and that the annexe B procedure is used for more serious complaints ? Does he feel that the specific case that I have outlined would be less serious ?
Mr. Sackville : I hope that the hon. Lady will understand that that inquiry is on-going, and I cannot make any comments about the decisions taken by the hospital in that case. I can only tell the hon. Lady that it will be examined by independent assessors, and that I have no doubt that a very fair assessment will be made of the case.
Hinchingbrooke has already introduced revised protocols and guidance to staff dealing with maternity cases to ensure that agreed care plans are followed, irrespective of the consultant in charge at the birth.
Mrs. Campbell : I challenge the Minister on his use of the words "independent assessors", because I understand that an annexe E procedure is an internal disciplinary procedure, and would be carried out by the trust hospital itself. It would not be subject to independent assessment in the same way that annexe B would be.
Much is made of the large number of complaints in the NHS, and many people suggest that that is something that we would want to hide--the contrary is true. Let me put the general matter of complaints into perspective. Last year 55,000 complaints were received out of a total of 45 million in- patient and out-patient treatments. That represents about 0.1 per cent. of patients expressing some degree of dissatisfaction. That is clearly an impressively high level of general satisfaction with NHS services.
Column 405We are, of course, striving to do better and we have two key goals in mind : to improve the handling of complaints and reports from the health service ombudsman that are sent to all NHS providers in order to give clear lessons, and to ensure that the NHS complaints procedures are as simple and speedy as possible, and fair to patients and staff. To that end, the Government are currently consulting the independent review committee on complaints under Professor Wilson. There is clear evidence that there is dissatisfaction with the complaints procedures in the NHS--we would be the first to admit that. Although the present system has the support of parts of the profession, there have been criticisms of the clinical complaints procedure--on the lack of a lay element and the delays in arrangements. Those concerns were expressed to the review committee under Professor Wilson. Its recently published report recommends that clinical complaints should be able to be considered by panels with a lay majority, that there should be an overall deadline of three months for all stages of NHS procedures to be completed, that the health service ombudsman should have the substance of clinical complaints
Mrs. Anne Campbell : I want to take up the point that the complaints procedures should be heard within three months. Is the Minister aware that my constituent has now been waiting 20 months for a response to her complaint ?
Mr. Sackville : That is entirely unsatisfactory. We need to have a system in the NHS that not only deals with complaints promptly, but does so in a way that gives the maximum confidence to all those involved that the complaint is being properly handled.
As I was saying, the third aspect of the Wilson report is that the health service ombudsman should have the substance of clinical complaints brought within his jurisdiction. Currently he may consider only possible maladministration of the procedure. My ministerial colleagues have said that a decision will be forthcoming later in the year on what changes should be made to the current clinical complaints procedure. The consultation period on the Wilson report will end on 15 August.
I certainly hear what the hon. Lady says when she quotes Mrs. McCall on the subject of making and trying to take forward the complaint, which has been extremely distressing for her--I understood her to say that the process was as distressing even as the incidents that lay behind it. I am aware that a great many improvements need to be made to the complaints system in the NHS and I am confident that the outcome of the
Column 406disquietened and disturbed by the account that we have had today. The Hinchingbrooke was an important hospital that was looked on with great favour by the Select Committee. It seems that the position of the staff and the mothers dependent on the Hinchingbrooke has been altered in a detrimental way.
I have listened carefully to the Minister, but the point which he has not answered and which must be of great concern to all of us who want good care, especially good maternity care, is what the Government will do about the financial aspects of these matters. We think that the financial aspects have, over the course of time, become dominant, but the Minister has not dealt with them. It is not simply a matter of improving the complaints procedure ; the funding should not be a matter for individual hospital trusts. What do the Government have in mind on that point ?
Mr. Sackville : We have to ensure that a system is established that does not involve a conflict between the financial needs of the hospital and the need adequately to investigate complaints. Professor Wilson has made a number of suggestions on that--for example, the use of lay assessors. If the hon. Lady is saying that the entire complaints procedure should become some form of national commission and should be centrally funded, that would be a major step, and not something to which I could commit the Government.
Ms Primarolo : Does the Minister agree that the case as outlined by my hon. Friend the Member for Cambridge (Mrs. Campbell) shows that patients' wishes and the openness of the national health service are not being honoured ? Justice has not been done, and has not been seen to be done. The stumbling block appears to be the conflict between commerciality and the lack of funds.
Will the Minister take on board the specific problem of lack of funds for a disciplinary procedure in hospitals ? Will he ensure that such a case never happens again in any other hospital ? Will he further ensure that the case raised is dealt with correctly and that the proper procedures are undertaken ?
Mr. Sackville : I do not accept that a case has been proved that the complaint was handled unsatisfactorily because of a lack of funds. I have already conceded that we must establish a procedure that does not involve a conflict of interests that will inhibit the investigation of complaints.
I end by reiterating my sympathy for Mrs. McCall and her family. I am sorry that I cannot say more in detail about the case because there is a continuing investigation. I share the concern which has been expressed about the case.
Mr. John Marshall (Hendon, South) : First, I congratulate my hon. Friend the Member for Banbury (Mr. Baldry), who is temporarily out of the Chamber, on his return to the Foreign Office--and, indeed, his return to the Chamber. He was Parliamentary Private Secretary to our right hon. and noble Friend Baroness Chalker, the Minister for Overseas Development, so he will obviously approach his new portfolio with great interest and experience.
This is a sad day in the history of Cyprus. It is the 20th anniversary of the Turkish invasion in 1974 when, at the dead of night, thousands of Turkish troops parachuted from the skies. That resulted in the partitioning of the island and in hundreds of thousands of Cypriots becoming refugees. Many people lost homes that had been in their families for generations.
I well remember that on one of my earlier visits to Cyprus I met a Cypriot who worked for the Cypriot Government. He said, "We took slightly longer before we fled because my father thought he should take the title deeds to our home as well." Then he added, "And much good it did him and us," because ever since then they have not been able to return to their home.
Last autumn I went to Cyprus with my hon. Friends the Members for Chelmsford (Mr. Burns), for Edmonton (Dr. Twinn) and for Basildon (Mr. Amess). One of the most traumatic occasions that we experienced was when we went with the mayor in exile of Famagusta to see from the border the home in which he had lived and from which he was now barred. It must be frightful for tens of thousands of people to go to that border, to see the homes where they once lived, and which are still their legal property, but to know that they are inhabited by Turkish settlers or soldiers and certainly by people who pay no rent for the homes that were once theirs and in the care of which they have no say. Many tens of thousands of people who fled from Famagusta and Kyrenia are in that dreadful position. There can be few greater denials of human rights than for an individual to be prevented from living in the home that his father, grandfather and great grandfather have also been pleased to call home.
It is not just a question of refugees. As a result of the events of 20 years ago, more than 1,500 people are missing whose fate is unknown. The hon. Member for Hornsey and Wood Green (Mrs. Roche) and I--accompanied by, among others, the right hon. Member for Chesterfield (Mr. Benn)--were in Trafalgar square on Sunday. It is probably the last time that I shall appear on the same platform as the right hon. Member for Chesterfield, certainly in Trafalgar square.
Among those in the audience were a number of ladies who were dressed all in black because they did not know what had happened to their missing relatives. They could be wives uncertain of the fate of their husbands, mothers not knowing what had happened to their sons and daughters, or men and women who did not know what had happened to their parents. It is a scandal that 20 years later thousands of individuals still do not know what has happened to their dear ones. There are 200,000 refugees, thousands of people do not know what has happened to those whom they hold dearest, and 38 per cent. of the island is inhabited by Turkish Cypriots--although they comprise only 18 per cent. of the population.