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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate my right hon. Friend the Member for Southampton, Itchen (Mr. Denham) on securing a debate on this important subject. I congratulate him, too, on the measured and thoughtful way in which he put his case. I freely confess that he has given me much to think about. In case I do not get a chance to make this point at the end, I assure him that everything he has said will be considered by all those dealing with the case and I shall ensure that we all reflect on the points that he has made. I will also ensure that all his points are brought to the attention of my right hon. Friend the Minister of State, who normally deals with issues such as this.
It will hardly surprise my right hon. Friend—who, as he said, was a distinguished health Minister himself—that I begin by paying tribute to the vast majority of doctors and other health-care professionals who give a first-class service to the huge majority of patients and the million people who are treated safely and successfully every day in the national health service. Yet experience tells us that no matter how dedicated and professional staff are, things do go wrong in complex health-care systems, with serious repercussions for patients and their families. Although small in proportion to the volume of good health care delivered daily, such events can, as my right hon. Friend said, erode public confidence.
Patients deserve high-quality health care and must have the utmost confidence in the services that are provided—and, crucially, in the health-care professionals involved in their delivery. In situations involving life and death, when they are vulnerable, patients want and are entitled to expect doctors on whom they can rely. I understand how the tragic events that occurred at Southampton General hospital and afterwards may have combined to undermine that confidence. I also understand why the family of Mr. Phillips feel let down, both by individuals and by the system. At this point, let me add my condolences, albeit belatedly, on their loss.
As the General Medical Council's case against Dr. Misra is still going on, my right hon. Friend will understand that it would not be appropriate for me to comment on these events in detail. He will be aware that the GMC's professional conduct committee is unable to proceed further until Dr. Misra's appeal against his conviction has been heard. The GMC's interim orders committee has considered whether it was necessary for the protection of the public, or in the public interest or Dr. Misra's own interest, to impose restrictions on his registration pending the PCC's hearing. The committee decided, in the light of all the evidence before it, that interim action was not necessary in this case. Dr. Misra therefore remains fully registered with the GMC.
As for Dr. Misra's appeal against his conviction for manslaughter, I am informed that at a directions hearing on 15 June, the Court of Appeal decided that preliminary legal arguments relating to the legality of the offence of gross negligence manslaughter—particularly in relation to the field of medicine—and its compatibility with the European convention on human
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rights would be determined at a hearing on 20 and 21 July. Following that decision and any subsequent appeal to the House of Lords, and should the convictions stand, further issues will be determined at a court hearing, which will be listed not before September this year.
Mr. Deputy Speaker (Sir Michael Lord): Order. I am reluctant to stop the Minister in mid-flow, but I am a little concerned about the sub judice rule. Can the Minister tell me that the matter has been thought through, and that nothing he says this evening will prejudice either the GMC or, more particularly, court cases that may arise in future?
Dr. Ladyman: You are absolutely right, Mr. Deputy Speaker. That is why I am being more circumspect than I am sure my right hon. Friend would want me to be. I have said all that I am going to say about the specific case; now I am simply putting on record the timing of the case, and when decisions relating to it will be made. I shall describe the generality of the position and justify the way in which we have reached it, rather than talking about the specifics. I am sure that that will disappoint my right hon. Friend and his constituent, but I hope they will understand.
Let me return to the theme of confidence. A key strand of the NHS quality agenda is assuring patient safety. Patients need to be confident that the NHS is doing all it can to prevent and detect errors early, before tragic consequences occur. They also need to be confident that the NHS can learn from such incidents and prevent them from re-occurring, and to have confidence in the professional regulatory framework that is responsible for ensuring that health-care professionals are competent, up to date and trustworthy. As we have seen from other high-profile incidents and investigations, public confidence in the NHS is almost synonymous with confidence in the medical profession.
I am sure that the House will agree that however effective systems are in reacting to an incident, it is clearly preferable that measures be put in place to help detect such incidents, and to prevent them from occurring in the first place. Concerns about a doctor's performance could emerge from a number of sources even before a serious error or incident occurs. It is essential, therefore, to have systems in place to recognise these problems early on and to deal with them effectively, so that the risks to patients are minimised and doctors in difficulty can be helped and supported.
The Government established the National Clinical Assessment Authority in April 2001 as part of a package of measures aimed at underpinning and improving the quality of clinical care in the NHS. The NCAA aims to improve public confidence in the performance of doctors and dentists by helping local organisations to manage performance problems swiftly, effectively and sensitively; by promoting the development of excellent local and national procedures for preventing, identifying and resolving performance problems; and by assessing individual doctors and dentists and recommending practical ways in which their performance can be improved.
Such efforts involve striking a balance between the central importance of protecting patient safety by addressing performance problems, and not needlessly
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"writing off" doctors and dentists who could be returned to safe and valued practice. The NCAA has shown that it can help the NHS to strike that balance; indeed, my right hon. Friend acknowledged the importance of doing so. In 2003–04, the NCAA received 524 referrals, of which 93 per cent. reflected specific performance concerns. In terms of advice, assessment and support, its approach is unique among health care systems.
Sadly, as experience has shown, no system can be entirely error-free. However, evidence has also shown that when things go wrong, the causes can often be traced back to a systems error, rather than to the fault of an individual. As the case of Dr. Misra sadly demonstrates, some groups—particularly junior doctors—may, through inexperience or lack of training, make errors that other, more experienced colleagues would usually avoid. The consequences for the patients concerned can be severe—that is clearly the most important issue—but the consequences for the doctor involved can also be serious, as we have seen. That highlights the critical importance of establishing robust systems for supervision and training, and the need for those who supervise students and junior doctors to take those responsibilities seriously, as the GMC's document "Good Medical Practice" clearly points out. An automatic decision to blame and punish staff makes it more likely that errors will be covered up, and that the right lessons will not be learned. The evidence shows that if an organisation's culture is open and fair and people are encouraged to speak up about patient safety incidents, patient safety is improved, as those organisations learn about what has gone wrong and are able to put things right in the future.
In July 2001, the Government established the National Patient Safety Agency. The role of the NPSA is to improve the safety of NHS patients by promoting a culture of learning from, and reporting, patient safety incidents, and to manage the national reporting system that supports that function. Again, the NHS is leading the world by introducing the first truly national reporting system for adverse incidents. The NPSA has already begun to have an impact on patient safety, and it is working on a range of practical solutions to help make care safer for NHS patients.
One such solution is the "incident decision tree", which was launched recently as a web-based toolkit. It has been designed to assist managers in dealing openly and fairly with staff who have been involved in patient safety incidents. As I have said, a culture based on
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individual blame and punishment makes it more likely that problems will be driven underground and the root cause not tackled. However, there will clearly be times when individual clinical performance must be addressed and staff held accountable for their actions; this toolkit aims to help managers to pose the right questions in order to establish whether that might be the case. It provides a clear path through which to identify cases where deliberate harm, reckless behaviour or criminal act has been involved, to ensure that the right action is taken.
If such behaviour is found to be the root cause of an incident, the regulatory body must then consider whether the individual concerned is fit to remain on the professional register. Patients and professionals alike need to be confident that the procedures for making those decisions are effective and fair. We are therefore in the process of modernising and strengthening professionally led regulation, particularly in respect of the GMC.The GMC exists to protect patients and the public interest by regulating and guiding the medical profession. In response to pressure from both the Government and the public, and in consultation with patients, the GMC has developed the most far-reaching reform package in its history. The foundations for change were laid when Parliament approved the Medical Act 1983 (Amendment) Order in December 2002.
Patients and the public will benefit from simpler GMC proceedings and rules, speedier and more efficient processes and greater openness than before—
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