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Dame Elaine Kellett-Bowman: Is there no duty on the people holding those hearings to inform the doctor of the result? That seems quite extraordinary.
Dame Jill Knight: My hon. Friend makes a very good point. I have found so many injustices, and that is apparently another. I can only tell her and the House that that case actually happened. Whatever rules that exist do not work, and that is why I was so anxious to raise this subject today.
We are all told that suspension is supposed to be a neutral act, but I feel sure that those who have listened to me this morning would agree that those factors are not neutral. People have been treated appallingly. The notion that suspension is neutral is clearly not sustainable.
I believe that the information that I have sought and been given on this matter is entirely reliable. If it is, I find some of the reasons given for suspension extremely trivial. With all the consequences of a suspension that I have described, one would have thought that doctors could not be suspended without very good reason.
A serious offence, which could possibly justify dismissal, is not defined. Some of the reasons that I have discovered are trivial. There seems to be a wide variation in suspension reasons between different administrators. What some administrators judge to be a serious offence seems bizarre. One consultant was suspended for writing a repeat personal prescription for his ward sister. Another was suspended because he went through the clinical case notes of one of his own patients and took out papers that he, as the doctor, considered were redundant. A third was said to have over-claimed on his petrol expense. A motoring organisation later gave evidence that he had under-claimed to the tune of some thousands of pounds. The health authority finally had to pay him back.
One consultant histopathologist was threatened with a charge of professional incompetence because he sought a second opinion on a few slides. That is quite extraordinary. Surely it should not be an indictment to ask for a second opinion in any branch of medicine. That must be common because none of us can be so certain of our
judgment on every case. Doctors should not be barred or accused if they ask for the opinion of a colleague who also knows the facts of the case.
My hon. Friend the Minister for Health may believe that the two guideline circulars, which were issued by the Department of Health to remedy some of those wrongs, are efficacious. With great regret, I have to tell him that they are not. HGL(94)49 was intended to shorten the period of suspension and suggested that doctors should be fully informed as to why they were being suspended. HC(90)9 was also intended to shorten the disciplinary period. Not one hospital authority or trust anywhere in the past six years has observed the rules regarding disciplinary action as laid down in those circulars. That is quite appalling.
Ms Hilary Armstrong (North-West Durham):
I am sure that the hon. Lady knows that a consultant from one of my local hospitals, Shotley Bridge hospital, has been suspended for four years. I have raised the issue in the House and the trust has now agreed to do something about the case. Suspension for such a long time is not in the interests of the doctor, the hospital or the patients. It is certainly not in the interests of the taxpayer, because the case has dragged on for more than four years and the doctor has been suspended on full pay. Therefore, he has not been making his contribution to the service and the taxpayer has been the loser. Such matters should be settled in a more effective, efficient way for the sake of the doctor, the patients and the taxpayer.
Dame Jill Knight:
That is precisely the case that I am making and I agree very much with her. I have no doubt that many hon. Members have had such cases that have worried us. I am anxious to put on record that there have been efforts to put matters right, including the circulars that I mentioned. However, they have not succeeded in solving the problem and that is what worries me. In every case where dismissal was a possibility, the health authority has ignored the guideline documents.
It is probable that the guidelines are unenforceable. I turn for evidence of that to the minutes from the Public Accounts Select Committee of 15 March 1995, less than a year ago. The public accounts experts struggled for two and a half hours to try to unravel why a woman doctor was suspended for 11 years at a cost of £600,000 to the taxpayer and the health service. The Select Committee worked hard on the question and anyone reading the report will recognise the scale of the job it had to try to find out whose fault it was. My goodness, anyone reading the report will see that the Select Committee's job was like playing blind man's bluff at the same time as playing pass the parcel. The more I read the report, the more I thought it was a cross between Agatha Christie's "Murder on the Orient Express" and J. B. Priestley's "An Inspector Calls. It was no one's fault and nobody could be nailed for it, except the poor doctor who was suspended for 11 years. Extraordinarily, however hard the Select Committee struggled, it could not find out whose fault it was, why it all happened or how it could possibly have taken so long. The main witness who gave evidence to the Select Committee said that the rules to which I have referred were unenforceable.
Furthermore, in all cases alleging personal misconduct, the ACAS code of progressive warnings under the Industrial Relations Act 1971 has also been ignored.
In 1988 there was a joint working party report on the matter, but it was not very conclusive. Nothing has come out of that report which has alleviated the problem, although it did cite some interesting cases including some in which doctors had sued for damages--an eventuality that I have not yet mentioned.
The fastest disposal of a contested case looked at by the working party took one year. The total cost was about £250,000. That included legal fees, costs and the salary paid to the doctor. Five years ago a doctor was awarded £100,000 in damages and that has to be added to the other costs involved. Two cases are estimated to have cost£4 million between them and another has already cost£1 million and is still proceeding. There are many other examples, but I hope that I have given the House sufficient to make my case. One estimate suggests that there are about nine or 10 new cases every year and the average cost is £400,000. So we could be losing as much as £4 million per annum for the health service.
I am asking my hon. Friend the Minister to look seriously at the case I have made and I feel confident that he will do so carefully. On cost grounds alone, the situation cannot be allowed to continue.
I have already mentioned that there is no right of independent appeal in the cases I have outlined and there are other aspects that worry me. The chairman of the tribunal panel is chosen by the prosecuting health authority from a list provided by the Lord Chancellor. In the past, health authorities have rejected certain nominations as being "unsuitable"--they have said no more than that. In all alleged misconduct cases, the tribunal panel is chosen by the prosecuting health authority. I hope that my hon. Friend the Minister is listening carefully because it is a serious issue of justice that the judging panel should be set up fairly.
The fact that the panel is chosen by the prosecuting health authority could suggest bias. There is a growing tendency to classify all charges as personal misconduct because that makes it easier for the health authority to control the panel. In those circumstances, the authority is the instigator, the prosecutor, the judge and the appeal court. It is Gilbertian in its scope. In one recent case a panel member was the very person who authorised the suspension of the doctor in the first place, and he was on the hospital board that subsequently decided to prosecute. The same board decided to bar from taking part in the judgment any member of the tribunal panel who was not a board member. Yet it is a well-established principle in European and English law that no body can be the judge in allegations that it has made. There must be an independent assessment.
Under European law a doctor has a civil right to practise if he is so qualified and approved. That right can be removed only by a body appointed by law--the General Medical Council or the courts--and only after a fair and open trial. That has been agreed by the British Government. There was a recent case in which a French doctor's right to practise was challenged, but the doctor was found to be in the right.
The consultants I have mentioned have been denied their right to practise because suspension means that they cannot act at all. Therefore, in the eyes of European and English law, they have been told, unfairly and wrongly, that they cannot practise, although there has been no judgment by the GMC or a court. Surely that is wrong. To
comply with European law all cases of suspension should rightly be referred to either the GMC or, where there are accusations of personal misconduct, to the courts or to an industrial tribunal. That has not been happening. On and on go the months and years in which a doctor is not allowed to practise in the circumstances I have outlined.
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