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Mr. Tyler: May I, as I omitted to do so earlier, apologise for the absence of my hon. Friend the Member for Cheadle (Mrs. Calton), who had hoped to be here? [Hon. Members: She is behind you.] My hon. Friend has appeared. I now apologise for missing that fact.
The hon. Member for Broxbourne (Mrs. Roe) has just referred to the steering committee. I mentioned earlier that it was not clear to me, having read the report, whether there are Members of the House—or members of her Committee—on the steering committee, or whether it is just an officer group.
Mrs. Roe: The group consists only of Officers, but of course they are accountable to the Administration Committee, so we shall consider carefully any proposals and recommendations that they make, and a case will have to be made for them. The membership of the steering group is listed in the report. They are very responsible Officers, and I am certain that any proposal that they make to the Administration Committee will have been thoroughly thought out.
I am grateful to the Minister for his support, as I said, and for his confirmation that any modernisation proposals will not interrupt a Line of Route programme and that times will not be reduced but merely rearranged.
I hope that the House will endorse the Committee's recommendations and allow the summer Line of Route to continue. The amazing reaction of visitors during the summers of 2000 and 2001, which, according to the visitor manager, is probably unrivalled by that of visitors to any other attraction in the country, points the way to the right decision, which is to acknowledge the success of the two trials and open the summer Line of Route to visitors on a permanent basis.
- That this House approves the First Report from the Administration Committee on The Summer Line of Route—The 2001 Opening and Proposals for the Future (House of Commons Paper No. 433).
Richard Neale
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ainger.]
6.36 pm
Mr. William Hague (Richmond, Yorks): I am grateful for the opportunity to raise a most important constituency matter on the Adjournment of the House. I am most grateful to Mr. Speaker for selecting the matter, as I know that he selects the subject to be raised on the Thursday Adjournment. For obvious reasons, it is a long time since I had the opportunity to raise a matter on the Adjournment of the House, and looking at the attendance for such debates, I think that this occasion will be much less noisy than those I was used to as Leader of the Opposition. I am grateful to the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), for being present to listen and respond to my remarks.
I want to talk about the case of the disgraced consultant, Mr. Richard Neale. It is a bizarre, tragic, deeply disturbing and utterly scandalous tale, and it will need briefly retelling in the course of my remarks, although it has become widely known. It is the story of a gynaecologist, Mr. Neale, who was struck off the medical register in Canada in 1985 because of serious incompetence after the death of two patients. He went on, despite warnings to this country from Canada, to practise in the Friarage hospital in Northallerton, which is the principal hospital in my constituency, for 10 years, leaving a trail of pain and sorrow behind him. He then went on, after being, in effect, dismissed—in practice, he was paid off—by that hospital, to practise in Leicester, the Isle of Wight and London, causing more pain and suffering to the women in his care, before finally being struck off for professional misconduct in the United Kingdom in July 2000, 15 years after he was struck off in Canada.
This is an extraordinary story. For the Department of Health, of course, it is an embarrassment. For the patients, whom we might more properly refer to as victims, it is a personal or family tragedy. For the House, it should be a vital matter to ensure that these things do not happen again. Some of the facts of the case have become widely known. They have been documented on the BBC programme "Panorama" and in The Northern Echo, a newspaper in the north of England. They have been documented by the action and support group for medical victims of Mr. Neale. I pay tribute to the people who formed that group, particularly Sheila Wright-Hogeland, who has been its inspiration. The decision of the General Medical Council to strike Mr. Neale off the register, albeit 15 years after he was struck off in Canada, was widely publicised at the time.
Some action has been taken; some procedures have been changed and, no doubt, some lessons have been learned. After many representations and requests, the Department of Health has established an investigation into what happened, although it was set out in a fairly low-key announcement last July, with carefully worked out terms of reference, which were set out in a Department of Health document to which I shall refer later.
I put it to the Minister that the investigation announced so far is not adequate to the scale of the scandal. It has a limited time frame, which cuts off the investigation in
1995, yet there were things that should not have happened after 1995, or so it seems to me. It is confined to the local health services, yet this matter must concern the Department of Health and the General Medical Council. The terms of reference do not allow consideration of private patients, of whom there were a large number. The investigation will not have the power or terms of reference that it needs, and I believe that a public inquiry is needed.I have a suspicion that the Minister will say in response to those thoughts that this is a tragic story—it is—but that it is not on the scale of the Bristol babies or the Shipman scandals and that we cannot have a public inquiry into everything. I suspect that she will put it more delicately than that, because it will be set out in a slightly more roundabout way in her brief, but that will be the gist of what she says. Those in the Department of Health may think that we cannot hold a public inquiry into everything that goes on.
I put it to the Minister that this is an almost uniquely chilling case because not only was serious harm done to unsuspecting patients over a long time, but warnings were given to some people, somewhere in Britain's health establishment. Some people working in the health service knew what was happening and how bad a doctor that man was, but nothing was done. So this case is different from many others, and it has not just come to light recently. For a long time someone, somewhere knew what was happening to women in the care of the health service in North Yorkshire and then elsewhere.
The people affected want to know—I want to know, as the Member of Parliament for many of them—what really happened, and an inquiry into local services in a narrowly defined time frame with limited scope may well not be able to tell us all that we need to know about what happened or to ensure that every procedure has been put right and every precaution taken.
Let me develop this story in a little more detail; I am fortunate in having a little more time for this Adjournment debate than would normally be available. Let me make it clear that in no way is this related to current controversies about the national health service. The NHS is committed to openness. In its document on clinical neglect the Department calls for
- "a more responsive and patient-focused approach to both complaints and clinical negligence claims handling".
- "greater openness in the NHS to concerns—so patients know that they will be heard, and organisations can learn from mistakes".
Let me also make it clear that, in general, I have nothing but praise for the staff and management of the Friarage hospital, Northallerton. It is often short of resources, but it has many excellent consultants. What happened in this case is in no way representative of the service that my constituents generally receive from consultants in that hospital or of the management decisions taken by the local management of that hospital—but it did happen, so we must face up to it.
Neale's record in Canada should have rung "loud alarm bells"—not my words, but those of the chief medical officer and the former director of public health in
Yorkshire, Professor Liam Donaldson. The disciplinary committee of the College of Physicians and Surgeons of Ontario found Neale guilty of incompetence and professional misconduct after the death of a patient whom he was treating. The inquest into that death showed that he had given the patient a banned substance and then attempted to falsify her records. After the death of another woman on whom he had operated against medical advice, another doctor in British Columbia described Neale as
- "completely incompetent and incapable of making reasonable decisions about patients."
- "had no judgment . . . should never have become a surgeon."
- "He is a menace to every patient that he touches . . . he should never be allowed to practise."
Neale was struck off in resounding terms by the College of Physicians and Surgeons of Ontario. He was charged with
- "failure to maintain the standard of practice of the profession . . . and conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional".
- "The Discipline Committee considered the evidence, found the allegation of incompetence against Dr. Neale to have been proved. In view of that finding the committee did not consider it necessary to make a finding on the second allegation. The committee did however consider the second allegation and, but for the finding of incompetence, would have found that the action of the doctor amounted to professional misconduct of a most serious nature."
- "due to repeated demonstration of poor judgment, Dr. Neale had been asked to withdraw from the call roster for Obstetrics and Gynaecology in their hospital. The other members of that staff did not wish to have Dr. Neale care for their patients."
Despite having been struck off the register in Canada, in 1985, incredibly, he was able to come to Britain and was employed as a consultant obstetrician and gynaecologist in Northallerton. His references were checked in what was described as the usual way and only later did it appear that there were inaccuracies in them, with the misrepresentation of the status of some of his referees. He did not declare his past record to the Yorkshire regional health authority, but no additional attempt was made to find out the truth about him and there was no automatic checking of his Canadian history.
Sir Donald Irvine, president of the GMC, told "Panorama" in 1999:
- "If we knew today somebody had been struck off abroad we would want to be systematic about inquiries into that doctor's practice. I have to say that has not always been the case. I have to say that in the past our systems have been rather more unsystematic than we would accept as credible now. Even today the GMC is not obliged to investigate doctors struck off in non EU countries".
What is far more alarming is the fact that no action was taken when his record began to come to light in 1986 and he was allowed to carry on practising. Dr. Andy Sear, a former friend of Neale in Canada, telephoned the GMC in Britain in 1985 or 1986 to warn about Neale and his record in Canada. In a statement, Dr. Sear said:
- "I knew that Richard Neale had a job in Britain. I was alarmed that Richard was managing to work as a consultant and that he would harm other people. It was time to warn the authorities before it was too late. I called the General Medical Council in London and was put through to the registration department. I asked them if they were aware of the problems he had had in Canada . . . They said thank you very much, very politely, for the contact. They said they were aware, but that having problems in another country did not preclude a doctor practising in Britain, if he hadn't done anything in Britain. I thought that was very high handed."
When the Yorkshire regional health authority found out about the allegations about Neale, it conducted an investigation. Dr. John Green, who conducted the investigation, said that he was
- "unaware that Richard Neale had been struck off and he didn't recall that the health authority knew that he had been asked to go for retraining to avoid being struck off."
- "the investigators did not speak to the Canadian doctors who stopped Richard Neale operating in their hospitals in Canada, but we decided that they had been unduly conservative."
This is a very serious matter. At no time were patients warned about Neale's record. If they had been, of course, they would not have accepted treatment from him. Because no action was taken against Neale, he was also able to work at other, private hospitals—based on a supposedly unblemished record at the Friarage hospital in Northallerton.
So the man went on. He even applied to go back on the register in Canada and he was again rejected in resounding terms. People there knew about this man. The Yorkshire regional health authority even provided him with a reference, saying that he was being promoted to chairman of the surgical division at Northallerton, but the Canadians turned him down. The discipline committee of the College of Physicians and Surgeons of Ontario issued a report in 1987 when he reapplied to the register in Canada, saying:
- "There was no evidence of a change in the pattern of his impaired judgement. The inability to make good clinical judgements is a condition difficult to rectify . . . Committee members were impressed that he had poor judgement as a young doctor and, in spite of additional training, continued to have poor judgement.
On the basis of deep-seated attitudinal and judgement problems, it was felt that Dr. Neale does not qualify for licence reinstatement."
In 1977, Neale so badly botched bladder surgery at the Shaftsbury hospital in London, where he was before going to Canada, that his patient is still undergoing intensive treatment and reconstructive surgery 25 years later. Neale told her that he would operate after he got back from a lunchtime drinking spree to celebrate his successful job application in Canada. A senior consultant later told the patient that Neale had "just ripped through everything" and torn apart several internal organs.
Neale discharged one patient from hospital prematurely in the face of strong protests from nursing staff. It transpired that the patient had a giant haematoma in her abdomen that caused her extreme pain such that she could not walk and had to crawl, even to the lavatory. Neale refused to re-admit her to hospital and insisted that she was "fine". The haematoma went untreated, became badly infected and ate into her bone, causing irreversible skeletal damage and permanent severe pain. She is now registered disabled. Another victim had the femoral nerve roots to her leg slashed as Neale performed a routine hysterectomy. She was left totally incontinent and unable to walk without the aid of two sticks.
That is just a glimpse of the medical incompetence of the man. The abuse that he also dished out to patients is almost beyond belief. A Jehovah's Witness who could not receive blood was near death after an operation, but Neale declined to order any blood substitute after he had promised to do so. After her husband offered to pay for it, he screamed across the bed over the fully conscious patient, "Can't you see she's dying anyway? It's not worth bothering to order the blood substitute. Either she'll be dead or she won't by the time it gets here." Such, apparently, is the conduct of the man.
Nurses have made statements saying that they knew how bad he was. One nurse of 27 years standing informed the action group for the medical victims that people were perfectly well aware of the clinical and surgical mayhem that he was causing at the Northallerton hospital, as well as being aware, from 1986, of his Canadian history. She said that the hospital insisted publicly that it knew of no clinical problems with Neale over the years, yet a gag order had been placed on all employees who were working with him—they were on pain of dismissal if they spoke openly about him.
The same type of statement—again harrowing reading—has been made by another nurse who worked with him at a private hospital, confirming his refusal to adhere to even the most basic hygiene procedures, pre-operatively or during surgery. She said that he never bothered to "identify structures" but "simply slashed through everything", often including vital organs. That has become the familiar story.
It is not a trivial matter, or even just a case of a problem doctor; the issue is more serious than that. After years of clinical negligence and incompetence Neale was finally dismissed in Northallerton on non-clinical grounds. Not being available when on call, bad treatment of junior staff, misrepresenting his role, false travel claims and appropriating NHS supplies for private practice eventually brought about his dismissal by the Friarage hospital. He was also arrested in 1991 and given a police caution after an incident in a public lavatory, behaviour that does not sit easily with being a respected medical consultant. Given that the case against Neale, later proven at the General Medical Council, showed negligence and incompetence dating back to 1986, and given that some people knew about it, it is not clear why no public authority was aware of that incompetence. It is unacceptable that he was not sacked for his conduct, both clinical and non-clinical.
Neale then received a pay-off and a reference from the Friarage hospital to shift the problem elsewhere, one of the most controversial aspects of the whole case. The former director of operations at the hospital told "Panorama":
- "Getting rid of a doctor is not easy and so Dr. Neale was paid £100,000 to leave and given a good reference. I think there was a grave risk we were sending him out to inflict him on others but we were prepared to take that risk because the risk to our own people and service . . . was not one we were prepared to take."
Again, I must emphasise how serious this is. We have all heard of "kind" references about employees who are no longer wanted, but when it concerns a consultant gynaecologist with an appalling track record that many people knew about and who went on to practise on other patients, it is serious indeed. Neale went on to practise until a warning letter was sent out in June 1998 after publicity started to arise about the case.
In January 1998, a BBC North East documentary programme, "Close Up North", carried a story about Richard Neale. At the beginning of February 1998, the director of operations at Northallerton wrote to Professor Liam Donaldson, then regional director of the NHS for the north and Yorkshire, about Richard Neale's record in Canada and his dishonesty in the United Kingdom. It was five months later, in June 1998, before a warning letter was finally sent out around hospital trusts and authorities in the UK warning them about Richard Neale and advising them to consult urgently if they were proposing to employ him.
The story finally began to come out in public. In July 2000, the professional conduct committee of the GMC found Neale guilty of serious professional misconduct and directed his erasure from the register. They found him guilty of 34 out of 35 counts of serious professional misconduct. The president said that it was a shocking and disturbing case:
- "For far too long he caused unnecessary pain and suffering to many women and showed a determined and alarming lack of insight . . . The case, like others recently, raises a number of
- important, wider issues for the whole system of medical regulation . . . his case highlights serious deficiencies in NHS procedures . . . It is difficult to understand why local action on his poor practice was not taken much earlier . . . The Neale case underlines, yet again, why there is such an urgent need to implement the systemic view of all doctors' practice".
- "The Committee have directed the Registrar to erase your name from the Register. They have also concluded that, given the serious and persistent nature of the findings against you, it is necessary for the protection of the public that your registration be suspended with immediate effect."
The case is tragic and extraordinary for hundreds of women and their families. It highlights many deficiencies in procedures and within the GMC. A doctor who should never have been allowed to practise in the UK was able to work unnoticed by the authorities for well over a decade, even though the truth about him was given to the authorities in various forms and at various stages while he was practising. I therefore believe that we need a more substantial, open and public inquiry than has been announced so far.
It being Seven o'clock, the motion for the Adjournment of the House lapsed, without Question put.
Motion made, and Question proposed, That This House do now adjourn.—[Mr. Ainger.]
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