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Dame Jill Knight: No, I was not.
Mr. Malone: My hon. Friend confirms from a sedentary position that that is so.
The House must consider suspension from both sides of the mirror--if I may put it that way. If we had a debate that was prompted by a patient's interest, where something had gone wrong and a clinician had not been suspended and where I was not able to assure the House that it was a balanced process and suspension was available to hospital trusts--the employers--the House would rightly take a pretty dim view.
We must consider whether suspension is carried out reasonably and in accordance with the guidance. Suspension should be seen as a neutral act. This goes to the heart of the point made by my hon. Friend the Member for Edgbaston. Suspension is not intended to do other than protect the interests of patients, staff or, indeed, the practitioner. It is meant to assist the investigative process. Of course, it is understood that it is a measure that could have extremely serious consequences in both human and financial terms--my hon. Friend gave us a clear example of that--especially where the suspension proves to be lengthy. That is why timetables are set.
Suspension may be considered when a member of staff needs to be removed immediately from the employer's premises to protect the interests of patients, staff or the practitioner. That, I suggest, is the extreme end of the spectrum. One can foresee circumstances in which it would be necessary. It should be confirmed immediately in writing--this deals with fairness--so that the person who is suspended is made fully aware of what is going on. The letter should state clearly the effective date and time of the suspension, and the content of the allegations and confirm that a full investigation will follow.
As it is a neutral act, it would be extremely unfair not to suspend on full pay, because to do anything else would be to prejudge the issue. I remind the House that suspension takes place at a point when no judgment has been made about what is alleged.
A review of the suspension should normally be undertaken at least every two weeks, and the outcome reported to the chairman or non-executive director who is responsible for the matter. The practitioner concerned should be informed of the outcome of each review. If the investigation has not been completed within three months of the date of suspension, a report should be made to the trust board or health authority outlining the reason for the delay and indicating how long the suspension is expected to continue. It should also include a plan for the completion of the investigation.
The guidance is clear on fairness and on setting a timetable. Should delay appear to be built into the process, the guidance clearly sets out a timetable whereby an employing trust must justify any delay. The importance of that is that suspension cannot continue to be disregarded for an inordinate period.
Dame Jill Knight:
Will my hon. Friend give way?
Mr. Malone:
I shall give way to the hon. Gentleman first, and then I shall give way to my hon. Friend.
Mr. Hughes:
What can a suspended employee do if he or she believes that there is delay, that the guidance is not being complied with or that the reports are not proceeding? What can they do to speed up the process and ensure that the guidance is complied with?
Mr. Malone:
It depends entirely on the circumstances. The process is designed for both parties, and under it the person who is suspended can be involved and encourage progress. There is nothing that says--I presume that this is the point that the hon. Gentleman makes--that further deadlines must be complied with, because during the suspension process investigations are undertaken. The suspension is reviewed regularly by a designated person to whom the person under suspension can complain or draw attention to the fact that matters are not proceeding properly. At that stage, any failure in the process can be brought to the attention of those who are responsible for speeding it along in the most appropriate way.
Although my hon. Friend the Member for Edgbaston rightly said that speed is important, in other circumstances it might not be of the essence. The person under suspension might wish to make their own preparations for what may follow. It is a two-sided argument, and that is as important an aspect of it as the other.
Dame Jill Knight:
What my hon. Friend said a moment ago seemed to suggest that the guidelines should have been able, and were able, to stop such cases occurring. I cited the suspension of Dr. Bridget O'Connell, whose case was dealt with by the Public Accounts Committee only last March and who had to wait 11 years, despite the fact that the guidelines were in existence. Surely in that case the guidelines were proven to be ineffective.
Mr. Malone:
The House examined the matter some time ago and was well informed on it. I think that my hon. Friend would concede that, following inquiries, the guidelines were improved. I am dealing with suspension; the case to which she referred continued after going through a number of complicated processes. I do not think that the case to which she refers falls into the category of suspension. She raises a wider point, which I shall come to. I intend to deal with the whole process and how it should take place.
The recommendations of the working party, in 1990, gave rise to further guidance. It made a number of recommendations about the disciplinary procedure, all of which were taken on board. They dealt not only with the setting up of inquiries but with the timetable for the completion of the disciplinary process. It might be helpful if I set out the timetable to the House.
After the chairman has decided that there is a prima facie case to answer and has informed the practitioner, the practitioner has four weeks in which to comment on the case. After receipt of the practitioner's comments, the employing body can decide, within two weeks, to follow that procedure. Thereafter, the chairman of the inquiry panel is appointed and the panel meets within 13 weeks. The hearing is concluded within one week. A report is produced and the factual part is sent to the practitioner within four weeks. The practitioner makes comment within those four weeks, and the report then goes to the health authority within four weeks. It is a strict timetable and it must be complied with in such inquiries.
My hon. Friend questioned whether inquiries might be biased. It is important that an investigating panel is seen to be independent of the employer; that is in the interests both of the employer and of the practitioner. Although it is set up by the trust responsible for the appointment of the practitioner, it is important to understand that the panel is distant from it. The guidance stipulates:
Not only should no panel member be an employee of such a hospital, no panel member should even be associated with one.
The guidance continues:
employing trust. The chairman
That is an important safeguard for the investigating panel. I am not sure what better safeguards one could build in.
That passage continues:
The independence of the investigating panel is ensured and supported by those guidelines, which have been set out carefully to deal with such matters.
One of the other points raised by my hon. Friend the Member for Edgbaston relates to compliance. The hon. Member for Fife, Central raised that matter too, and asked the sensible question: whether, as all that guidance exists, we are certain that it is being complied with. My hon. Friend suggested that no trust is complying with it--an assertion for which, if she does not mind my saying so, I should like to see a little more authority. I would be concerned if it were true, but I do not think that it is. It is important that the guidance has force, and is not disregarded.
"No member of the panel should be associated with the hospital(s) in which he works".
"In all cases the panel should be small, normally of three persons, including a legally qualified Chairman, not being either an officer of the Department of Health or a member or officer of the"
"will be nominated in each case which arises by the Secretary of State from a panel appointed by the Lord Chancellor."
"In cases involving professional conduct, the members other than the Chairman should contain an equal proportion of professional and lay persons, unless the charges relate only to relationships between a doctor . . . and his professional colleagues, when it would clearly be appropriate to have a panel wholly or predominantly of professional members, apart from the Chairman."
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