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Dr. Howard Stoate (Dartford): I am grateful to the right hon. and learned Gentleman. Does he believe that, were the complaints procedures in private hospitals to be the same as in NHS hospitals, that might have alleviated some of the problems about which we have heard tonight?
Mr. Howard: I shall come to that. I fear that the course of events in the national health service in these cases does not enable me to answer that question with a simple yes. We would be wrong and utterly complacent if we assumed that complaints procedures in the NHS are anything like all they should be. However, I entirely agree that more should be done in relation to the regulation of the private sector. I shall deal with that point.
I do not lightly ask for a public inquiry. The Minister will probably tell us how expensive it would be and how much time it would take, but I do not see what other means there is to satisfy public concerns on the matter. My constituents who have suffered want to know the course of the investigations. They want to know that all the right questions are being asked and that all the answers have been tested.
Comparisons will inevitably be drawn with the public inquiry that is taking place in Bristol. The tragic events that I have drawn to the attention of the House this evening are, in my view, at least as serious as the events that led to the Bristol inquiry. Moreover, those events raise questions that will not be covered by the Bristol inquiry. In particular, they raise questions about the private sector in health care and the need for it to be effectively regulated. I understand that those involved in the provision of private health care would welcome such regulation. Indeed, I am told that they have been asking for that, but so far their pleas have fallen on deaf ears.
The Minister of State, Department of Health (Mr. Alan Milburn):
I congratulate the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) on securing the debate. He and I would prefer not to be having it, but it is important, especially for the women patients who have been affected by the appalling practice of one hospital consultant, Mr. Rodney Ledward.
Let me say at the outset how sorry I am--on behalf of the whole Government and, I believe, the whole House--to all the women who have been affected by Mr. Ledward's activities. They should never have had to experience the physical and mental distress that the right hon. and learned Gentleman outlined so graphically.
Like every other person who has had any contact with these events, I am appalled by two things: Mr. Ledward's activities and the fact that they were allowed to go on for so long. The right hon. and learned Gentleman has set out very clearly his views--and, quite rightly, the views of his constituents--on these matters. Let me express my own views about Mr. Rodney Ledward. He was an incompetent, irresponsible and arrogant surgeon who seemingly had little or no regard for his patients. Women came to him when they were feeling vulnerable and scared, expecting first-class treatment. Instead, he caused a catalogue of harm, which is both horrific and unforgivable.
Mr. Ledward has not only undermined confidence in services at South Kent Hospitals NHS trust, but has damaged public confidence throughout the health care system. Since the days of Mr. Ledward, the trust, as the right hon. and learned Gentleman knows, has recruited new doctors to its obstetrics and gynaecology department, and has also set in place new quality control procedures.
Let me describe the three ways in which the Government and the health service are responding to these events, and respond to the specific points made by the right hon. and learned Gentleman. First, the immediate priority has been to identify former patients of Mr. Ledward who might need help. The trust shares my deep concern, and that of the right hon. and learned Gentleman, about the activities of Mr. Ledward. It is making every effort to assist any former patients. I am pleased that the local community health council has commended the trust for dealing with the situation in an open and responsive way since Mr. Ledward was struck off by the General Medical Council.
Special arrangements have been set in place to help former patients. The right hon. and learned Gentleman is right to say that, to date, 418 patients have called South Kent Hospitals NHS trust. I can tell him that 168 have already been seen. Preliminary analysis shows that 22 NHS and 15 private patients may have suffered injury as a result of an operation by Mr. Ledward.
I would encourage any former patients of Mr. Ledward to contact the trust, if they have not already done so. It will then assess, quite properly, each patient's needs, and provide appropriate services, including medical care, counselling, claims for compensation or simply the facility to talk through any problems or concerns that they may have.
Secondly, I shall describe how we are investigating the background to these awful events. I have heard the right hon. and learned Gentleman's call for an independent public inquiry. As he knows, he is not alone in calling for such an inquiry. My right hon. Friend the Secretary of State and I will consider those views extremely carefully, and make an announcement as soon as possible on how we intend to proceed. I promise him that, whatever happens, the Government will publish the facts, so that the patients affected, the public and national health service staff can see how those events unfolded.
What I can tell the right hon. and learned Gentleman this evening is that, after the General Medical Council decision and after serious concerns were raised by a number of Mr. Ledward's former patients, including the right hon. and learned Gentleman's constituents, the Secretary of State instructed the NHS trust to carry out an urgent internal review of the circumstances leading up to
Mr. Ledward's dismissal, and to report to the Secretary of State. That report has now been received, and has provided a useful starting point. However, it has raised even more questions, to which I have asked the NHS trust to provide answers. I want to be able to provide as comprehensive an answer as possible to all the questions the right hon. and learned Gentleman and others have posed.
Let me give the right hon. and learned Gentleman a flavour of just some of the questions that have been prompted by the preliminary analysis. Why did no alarm bells sound when Mr. Ledward apparently had 12 medical litigation cases against him in the years from 1983? Given that concerns were apparently raised about Mr. Ledward with the regional health authority as early as 1991, why was nothing done? Why was no investigation prompted when, in 1994, following a serious complication involving surgery by Mr. Ledward on a female patient, he apparently agreed to be on call for his own patients?
Given that doctors appointed to Mr. Ledward's department were apparently told, at the time of their appointment, that there were concerns about the department that they were joining, why was nothing done? If it is true that serious concerns were raised about Mr. Ledward's practice in 1995, in relation to his attitude to patients, his unnecessary roughness during physical examinations of those patients, his unnecessary highlighting of private practice options to NHS patients, and his non-attendance at NHS ante-natal clinics, how is it that subsequently nothing was done?
Why did not the standard-setting role of the royal colleges manage to penetrate the world in which Mr. Ledward operated? Why was Mr. Ledward in charge of clinical audit in that hospital from 1989-96? How did policies in place in the health service at that time fail to prevent or detect and stop those horrendous events?
Those are only some of the questions that are raised by this deplorable case. We are determined to get answers to them all, and to the questions that the right hon. and learned Gentleman and his constituents are asking. The existing evidence reveals that the problem has a long history. Inadequate mechanisms were in place for dealing with it and, most appallingly of all, the women affected by it were the last to know what on earth was going on. That is what is most deplorable about all this.
The third issue is how we are now seeking to ensure that such a tragedy is never repeated. It is important to stress that, overwhelmingly in the national health service, patients receive safe and effective care and treatment day in, day out. Most doctors do an excellent job, but when things go wrong, in the NHS or elsewhere, it is patients who suffer. As we see in this case, the consequences can be appalling. As the right hon. and learned Gentleman rightly said, nobody pretends that mistakes will not happen. They will. Doctors, clinicians and others working in any health care system are only human.
However, failings such as these highlight the need for new safeguards. We need to develop a new culture of openness in the NHS that acknowledges, highlights and deals with problems promptly, rather than pretending that
they do not exist. The preliminary evidence in this case shows overwhelmingly that that was the problem in the hospital in question. We also need a new system of quality assurance that supports clinicians in developing and maintaining good practice, and that nips problems in the bud.
The chairman of the British Medical Association, Dr. Ian Bogle, recently wrote:
The Government believe that new safeguards are necessary for patient safety and public confidence. We are taking five important steps. First, we are establishing a new duty of clinical governance to put quality assurance systems in place in all parts of the NHS. Secondly, we are placing a new emphasis on publishing clinical outcome data, so that results can be compared over time and between clinical teams. Thirdly, all doctors will in future be required to participate in a national audit programme, including specialty and sub-specialty national external audit programmes, to ensure that their performance is up to scratch. Fourthly, individual doctors will be required to share their results with the medical director of their NHS trust and the trust's lead clinician for clinical governance. Fifthly, a new external body--the commission for health improvement--will be established, whose job will be to monitor quality standards externally and to intervene promptly if necessary when things are going wrong, as they clearly were in the case of Mr. Rodney Ledward.
Those five points summarise the action that the Government are taking. The medical profession, too, has to play its full part. I believe that the leadership of the profession recognises the need for change, but that recognition must be matched by a commitment from the profession as a whole to take prompt and effective action. Without that, the whole system of professional self-regulation will not command the public's confidence.
The Government, like the profession, want professional self-regulation to work, but no one should be in any doubt that the system is under test. It must become more modern, more open and more accountable. If professional self-regulation is to be the bedrock of high clinical standards in the future, it cannot operate in isolation. It must form part of an integrated framework of new mechanisms that embrace the profession, the regulatory machinery, the educational bodies and the NHS.
I know that all this comes too late for the women who suffered at the hands of Mr. Ledward. We shall do everything that we can to help them. We shall get to the bottom of how Mr. Ledward was allowed to wreak such damage on so many of them, and we shall learn the lessons of these terrible events, so that we can do our very best to ensure that patients in the future are protected from bad doctors such as Mr. Ledward.
ion put and agreed to.
"the days when doctors thought they could turn a blind eye to the incompetence of their colleagues have gone."
Dr. Bogle is right. It is in no one's interests--neither patient nor doctor--to cover up cases of outright failure.
Adjourned accordingly at twenty-nine minutes past Ten o'clock.
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