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EDUCATION BILL [MONEY]
PUBLIC ACCOUNTS COMMISSION
- That Mr. Phil Gallie and Dr. Ian Twinn be appointed to the Public Accounts Commission in place of Sir Peter Hordern and Sir Thomas Arnold, under the National Audit Act 1983.--[Mr. Anthony Coombs.]
PUBLIC ACCOUNTS
- That Ms Angela Eagle be discharged from the Committee of Public Accounts and Mr. Gerry Sutcliffe be added to the Committee.--[Mr. Anthony Coombs.]
EUROPEAN LEGISLATION
- That Mr. Kevin Hughes be discharged from the Select Committee on European Legislation and Mr. John McAllion be added to the Committee.--[Mr. Anthony Coombs.]
NORTHERN IRELAND AFFAIRS
- That Mr. Thomas McAvoy be discharged from the Northern Ireland Affairs Committee and Dr. Norman A. Godman be added to the Committee.--[Mr. MacKay.]
TREASURY
- That Mr. Clive Betts be discharged from the Treasury Committee and Mr. Ian Pearson be added to the Committee.--[Mr. MacKay.]
Dentists (Scotland)
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Anthony Coombs.]
10.28 pm
Mrs. Maria Fyfe (Glasgow, Maryhill): I thank Madam Speaker for giving me the opportunity to raise my constituents' concerns in an Adjournment debate. My involvement in the affair began when two of my constituents asked for my help. They had attended a local dentist by the name of William Duff. They had been given treatments that were both unnecessary and grossly unsatisfactory, creating long-term dental problems and the necessity for substantial remedial work. They had complained to Greater Glasgow health board.
It took months for those cases to be heard while Mr. Duff gave endless reasons not to turn up for the inquiries. In a third case, my constituent did not even receive a response when she wrote on two occasions to the Department of Practitioner Services. Finally, Greater Glasgow health board was faced with an authoritative professional opinion to the effect that my constituents' complaints were more than justified. Indeed, the consultant's professional opinion showed that there was far more cause for concern than had been realised.
Far from responding helpfully and putting matters right, the health board has rejected my constituents' claims on bureaucratic grounds, expecting them to provide evidence that they do not have and cannot reasonably be expected to have. So far, the Scottish Office has not responded any more helpfully, although I gather that legal advice is being sought by the Department in some cases.
At first, I thought that those were fairly routine matters and the regular experience of Members dealing with a constituent's complaint of unfairness by an authority. I now know that, far from my constituents' distress being isolated incidents, a man's career was well known over a number of years to Greater Glasgow health board.
At its meeting on 21 September 1993, the board agreed that the inclusion of Mr. Duff in the list of dental practitioners would be prejudicial to the efficiency of the provision of general dental services. The board's legal advisers submitted representations to a tribunal on 11 January 1994. It was not until February this year that the tribunal directed that Mr. Duff should be struck off every health board list in the country after a Greater Glasgow health board committee found him in breach of his terms of service, much too late to protect who knows how many unwitting patients from this man's greed.
It was greed that lay at the bottom of the matter. Mr. Duff is a fully qualified dentist. The fact that he has been removed from health board lists does not prevent him from working in private practice. Many people, seeking a dentist, might imagine that in paying a private sector dentist they were buying a superior service, but in Mr. Duff's case at least they would be extremely misguided.
As the excellent "World in Action" programme recently pointed out, people think of bacteria as the enemy, not their dentist. Most of the time, of course, they are right. If it had not been for the evidence given to the patients by Mr. McCrossan, who examined their mouths at the dental hospital, and given to me by another dentist, a highly experienced one who teaches postgraduate
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I shall give the House an idea of how bad some individual cases have been. Angela Mulhern had work carried out by Mr. Duff in 1993-94. She is now a constituent of the Minister with responsibilities for health. Having no previous history of dental trouble, she now is unable to work regularly, and has had to give up her job and her home. The health board refused to investigate her complaint because she cannot give the specific dates of her treatment. But Mr. Duff has removed her records from the practice. Her treatment has never been completed, so the time bar rule should not apply. She is being told that it does. Mr. McCrossan said of her treatment:
In Nicola's case, Mr. McCrossan wrote:
Mairi Patrick's case became known to me only recently. Mr. McCrossan commented:
Mr. Duff first came to attention in 1987, when he was fired by the dentist who employed him at that time. His treatments of at least 10 patients were set out in a damning report to Ayrshire and Arran health board, but it had no responsibility to tell anyone else.
Mr. Gordon McMaster (Paisley, South):
Earlier tonight, after my hon. Friend had some publicity about her Adjournment debate, I received a telephone call from Nicholas Gilmour, who, in 1987, was a constituent of mine and attended the same dental practice as I do in Johnstone, where I have had nothing but excellent treatment. He tells me that William Duff worked in that practice in Johnstone and that he was given three crowns, two of which were unnecessary. He had to undergo very painful operations. In 1987, Argyll and Clyde health
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Mrs. Fyfe:
My hon. Friend raises an important point. It shows that three health boards have had experience of that dentist, yet because there is no obligation to transfer information, that kind of thing can go on and on until it is finally stopped. Like my hon. Friend, I wonder what happened on that occasion.
After the experience with Ayrshire and Arran health board, Mr. Duff moved to Maryhill. About 20 of his cases were subsequently referred to Greater Glasgow health board for action by the regional dental officer. Some of his patients had been treated with a substance called endomethesone, which contains a steroid and a mummifying agent. The latter's effects wear off up to two years later. It hid the continuing presence of infection in the patients' teeth, which flared up later. Mr. Duff was using it as a quick fix, because careful treatment to remove all the infection took more time, and time was money to him. There was no way a patient could know that, which is reason enough for the time limits on hearing complaints from patients to be reviewed once again, as even the recent reform would not necessarily take account of that.
In one year, Mr. Duff received £450,000 from the national health service, and more than £1 million in two and a half years. Average gross income per annum is £90,000, which, after deduction of expenses, leaves a dentist with an average income of £37,000. Mr. Duff was always at the top by far in the Scottish league table of dentists' incomes from 1992 to 1994. Very reasonable suspicion of Mr. Duff's care and attention of his patients was naturally aroused in the profession. Those people knew that he could not be making that money and taking the care required. Questions arose about the possibility of false claims for work that had never been done.
Mr. Duff made a practice of getting patients to sign the form authorising treatment at the start of treatment, and in at least some cases that I know of, they did not sign at the end. When one member of the health board--a member of the Scottish Dental Practice Board--raised that matter, one might think that surely Duff's number would be up. But no. That person's repeated threats of resignation from the health board fell on deaf ears, because the lay members of the board--that quango appointed by the Secretary of State--supported Duff. Their attitude, apparently, was that his high earnings showed that he must be a good business man and that his production line was more efficient than the rest. One might say that the whole affair gives a new meaning to the saying, "No gain without pain." Mr. Duff's gain meant other people's pain.
This is not a completely isolated case. There are fears among those who care about quality in the NHS that Mr. Duff, whose story is well known to dentistry students in Scotland, might have influenced a number of younger dentists to try to get away with it. In 10 years he has made enough to buy a house worth £220,000, in Kilbarchan, and a BMW estate and a Land Rover Discovery, both with personalised number plates.
My complaint is not that there are rich pickings for the unscrupulous, nor is it a complaint about dentistry in general. Thankfully, most of us can and do trust our
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I agree with the British Dental Association that it is much better for a patient's complaint to be resolved as soon as possible. It is time that our system ensured that.
Secondly, it is necessary to review the monitoring system to ensure that standards are upheld, and that the NHS is not paying either for non-existent or shoddy work. The Scottish Dental Practice Board should notice if a dentist has an unusual prescribing pattern, and should be able to insist on cases being heard by the health board without delay, but at present no such safeguard exists.
Thirdly, Mr. Duff's patients have consistently had to refute misrepresentations of the facts, and have had endlessly to deal with the fact that their evidence has been officially ignored. I therefore want an independent investigation of each complaint that has been raised against Mr. Duff.
"I know of no pattern of dental disease which attacks the posterior teeth so severely, yet leaves the anterior teeth unaffected . . . Not all of the treatment was clinically necessary--generally the quality of the treatment is well below the level I would expect from a competent dental practitioner . . . Miss Mulhern had no pain before treatment, but has never been free from pain since."
I have been pursuing the cases of Moann Russell and Nicola O'Neill for two years with Greater Glasgow health board and the Scottish Office. In Moann's case, the consultant, Mr. McCrossan, wrote:
"I must question whether the original dentistry was required . . . I am appalled by the dismally poor quality of the work . . . It is a tribute to nature that she had no acute symptoms at the time of her visit to me."
In addition, the dental service committee found in May 1995 that the treatment claimed for on the GP17 forms did not match that recorded on the patient's dental record card.
"Apart from the treated teeth Nicola's mouth is in excellent condition. This sort of treatment plan I would have expected in a badly neglected mouth . . . Our problem now is to attempt to repair the damage that has been done".
Nicola was under age to give her own consent when treatment began with Mr. Duff. The form is signed by one Susan McEwing, a person not known to Nicola.
"the vast majority of the work is of poor quality, far below what I would expect".
The health board has refused to pay for re-treatment because her complaint was made later than the 13-week limit.
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