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Mr. Evans: Let the Minister reply.
Audrey Wise: I do not expect the Minister to give me a definitive reply and I am aware that I have left him little time, but I hope that he will earnestly reflect on what I have said. Indeed, I am sure that he will do so.
10.46 pm
The Minister of State, Department of Health (Mr. John Denham): I should begin by congratulating my hon. Friend the Member for Preston (Audrey Wise) on obtaining this Adjournment debate. The events at the Guild Community Health Care national health service trust have generated a considerable amount of public and political interest. Indeed, this is the second time that the House has debated events at the trust in just under a month.
My hon. Friend has spoken of the good work of the trust and the achievements of the former trust chief executive, Mr. Les Howell. His contract has recently been terminated and he has appealed against that decision. Obviously, hon. Members will understand that it would not be appropriate for me to comment on the correctness of the action or the appeal that is pending at this time.
The trust's difficulties have been widely discussed and reported in recent weeks, but, as my hon. Friend acknowledged, they go back much further than that. The former chairman's decision, formally to suspend the chief executive on full pay and without prejudice from 5 October 1998, followed successive inquiries and reports by different, independent panels, all of which had identified unsound practices and failure to follow the appropriate procedures.
The effect on a trust whose patients are often disturbed and vulnerable people was obviously a matter of the utmost concern to those who commission its services, to the local community and to the people who work in it.
At the risk of repeating some of the history, in early 1997, the North West Lancashire health authority received the report of an inquiry that it had commissioned into an incident involving a patient who had absconded from the Langdale unit. That report made 44 recommendations for improvements to the clinical, nursing, administrative and security services at the trust. The report also referredto some poor external relations, most notably the relationship between the Guild and the lead commissioner of its services, North West Lancashire health authority. Furthermore, the report observed that
The inquiry had been conducted over six months, and its final report, the Holden report, itemised failures by the trust to carry out certain fundamental procedures correctly, if at all. By last summer, there were indications that the trust had taken steps to address the recommendations of earlier reports and that some ofthe clinical, nursing and administrative inadequacies identified had been put right.
On 20 August 1998, however, East Lancashire health authority invited the trust to check the draft Holden report for
On 1 October, three executive and three non-executive directors of the Guild visited the regional offices of the NHS executive to voice their concerns to the chairman of the north-west regional office and the regional director. On 2 October, the three non-executive directors gave the chairman, Mrs. Diamond, a letter in which they called for Mr. Howell's suspension.
Regional officials met Mrs. Diamond a week later. She had already spoken to Mr. Howell and advised him to stay at home on extended leave while the trust board considered how to respond to the Holden report. The regional director explained to her that, unless Mr. Howell were formally suspended from his post, he would remain the accountable officer for the trust and that that would not be satisfactory. As a consequence, Mrs. Diamond wrote to Mr. Howell suspending him on full pay and without prejudice from 5 October.
The trust board then unanimously agreed to commission an investigation into the specific criticisms of the chief executive in the Holden report. The regional
office offered advice about suitable candidates to undertake this work; a list of several names was put forward for consideration, and the chairman and non-executive directors took the final decision.
The inquiry team consisted of a chairman, Mrs. Ann Galbraith, former chair of a major trust in another region, and one other panel member, Mr. Neil Campbell, chief executive of the Dumfries and Galloway health board. The terms of reference were agreed unanimously by the trust board on 20 October.
The panel drew up a list of people to be interviewed and then offered all Guild employees, by means of a special edition of the staff bulletin, the opportunity to give confidential evidence to the inquiry. The panel's report, known as the Galbraith report, was completed just before Christmas. It upheld many of the findings of the Holden report and concluded that the chief executive's position was "untenable". The report refers to people being
At a meeting on 29 December 1998, the chairman and non-executive directors agreed to accept the report's first recommendation, which indicated that Mr. Howell's position had become "untenable". After discussing her own position with the regional chairman on 9 January 1999, Mrs. Diamond resigned as chairman two days later. Between January and March, the non-executive directors had further discussions and on-going negotiations with Mr. Howell's representatives.
On 19 April, the Secretary of State met Mrs. Kirk, the current chair of the trust, and concluded that she was the right person to lead the trust. She agreed to take up the post for six months with effect from 17 May. The Secretary of State and Mrs. Kirk discussed the need for a fresh start, and the House will know for reasons that I have previously outlined that three non-executives were subsequently removed from office and two resigned. A new non-executive team was appointed from 18 June.
Mr. Evans:
Will the Minister give way?
Mr. Denham:
No, I cannot possibly give way at this time.
After looking into the background to Mr. Howell's suspension, Mrs. Kirk concluded that the need to establish strong leadership was paramount and that the trust's genuine attempts to negotiate with him had stalled. She recommended to her trust board that Mr. Howell should be dismissed. It unanimously approved that course of action and the chairman wrote to inform Mr. Howell that his appointment would be terminated from 11 June. He has since exercised his right of appeal, and I understand that a meeting has been arranged for 13 July to exchange documentation and agree the process for the appeal and the dates for the hearing.
Mr. Evans:
Will the Minister give way on that point?
Mr. Denham:
No. The hon. Gentleman had an extended Adjournment debate just a few weeks ago.
The appeals panel that has been established by the trust consists of Mr. Ian Pirnie, the former chairman of Ashworth high security hospital and present chairmanof Morecambe Bay health authority, Dr. Nuala Swords-Isherwood, chairman of Stockport Acute Services NHS trust and Mr. Mike Deegan, chief executive of Warrington Hospital NHS trust, who was previously director of human resources for the NHS Executive. The panel is charged with establishing whether the chairman and non-executive directors of the trust have acted appropriately in terminating Mr. Howell's contract of employment. The dispute is between Mr. Howell and his ex-employers, and it is for the panel to judge whether the interests of natural justice have been properly served.
"the provision of community services"
had
"evolved in an unplanned and inchoate fashion".
The draft report into the care and treatment of Daniel Holden, however, which East Lancashire health authority received in the summer of 1998, precipitated the actions to suspend, and subsequently to dismiss, the chief executive. Daniel Holden was on the Langdale unit's supervision register when he murdered a neighbour in Darwen in March 1997. Since the patient was an East Lancashire resident at the time, it fell to that health authority to launch an independent inquiry in line with statutory requirements. The report concluded that the chief executive's
"responsibilities had not been adequately discharged"
and that the board should, therefore, consider how to bring about changes in management style that would enable the trust to make a fresh start.
"any factual inaccuracies, so that a final report could be produced and formally received and considered by the Health Authority."
I am advised that the response of the trust's chief executive to the draft report was the cause of concern for some members of the trust board.
"keen to record their appreciation of Mr. Howell and to illustrate his achievements during his employment at the Guild",
but it also stated:
"The panel is greatly concerned by the sheer weight of opinion showing a lack of confidence in the management style of Mr. Howell."
The panel advised the trust board that Mr. Howell had lost the confidence of a significant number of the individuals and organisations with whom and with which he had had regular contact.
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