HC Deb 30 May 1961 vol 641 cc214-26

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Gibson-Watt.]

12.16 a.m.

Dr. J. Dickson Mabon (Greenock)

I wish to raise tonight the question of the dismissal of a young doctor, Dr. Patrick Palmer, from Raigmore Hospital, Inverness, to 24th December, 1960.

This is an important matter, and I am obliged to the Secretary of State for Scotland for being present at this late hour to answer the debate. It is appropriate that such a senior Minister—indeed, the Minister ultimately responsible—should answer in this case, because it is not only a matter of concern to Dr. Palmer, but a matter of great general principle which involves the position of house officers throughout the hospital service.

At 8 a.m. on 22nd December, 1960, Dr. Palmer, who had been up until 5 a.m. that morning attending to a patient who was an emergency admission, was awakened from his sleep and told that a casualty was in the out-patient department awaiting his attention. He made inquiries about the patient and was told that she was suffering from a scalp wound. The person concerned, a ward orderly, had fallen off her bicycle. The doctor shaved and dressed, and decided to have his breakfast. It took him forty minutes to do that and get to the out-patient department. Because of the geography of the hospital he wanted to go through the out-patient department to the ward to prepare the patient he had admitted in the middle of the night for an immediate operation. I have no doubt that everyone is glad that that patient fully recovered.

By 8.40 that morning that young man had had an average of five hours' sleep over the previous five days, an experience which even we in Parliament do not share, and I have no doubt that in such circumstances people get irritated easily. I have seen the present Secretary of State for Scotland irritated in the middle of the night. It is something which happens to us all.

Mr. E. G. Willis (Edinburgh, East)

In less trying circumstances.

Dr. Dickson Mabon

As my hon. Friend says, in less trying circumstances.

This young man was rude to the sister in attendance at the out-patient department when in rather shrewish fashion she reproved him for not coming immediately he was telephoned forty minutes before.

Dr. Palmer was dismissed by the deputy superintendent at one o'clock that day with a promise of a month's salary, but I leave that aspect of it. The deputy superintendent said that he had consulted the young doctor's senior, Mr. Hamilton, the consultant surgeon, and he had agreed to the dismissal. When Mr. Hamilton was given the full facts of the circumstances, not only did he disagree with the decision to dismiss him, but he said later that he doubted whether in the circumstances he would have acted otherwise.

I raise this because this young man has a stain on his professional reputation, which ought to be erased. First, we are not sure why he was dismissed, and the right hon. Gentleman in his correspondence says: In fact, there is no material disagreement over the facts. I challenge that. I have since been told that the right hon. Gentleman has not been completely informed of the facts. If he has been completely informed of the facts, there has not been a proper balance of judgment in this case. For example, I am told in the Secretary of State for Scotland's letter that he was summarily dismissed, the primary reason being the neglect of the patient.

I have a testimony from the ward orderly patient saying that she was perfectly satisfied with the treatment she was given, and that she in no way holds Dr. Palmer in any disregard as a consequence of having been forty minutes late.

I also have a letter from the chairman of the special committee of the board of management, Mr. Smith, who has given me authority to quote this. In the first paragraph he says: The patient, Miss Jessie MacDonald, appeared at the hearing of the appeal and was questioned by the Committee. She unreservedly paid tribute to Dr. Palmer's attention to her and thanked him. Having gone into the treatment he gave her I cannot see how anyone could suggest that the patient was neglected. Had she fallen off her bicycle outside her home instead of outside the hospital it would have taken a general practitioner more than forty minutes to have got to her house, and he would not have been reproved for having delayed in getting there.

It seems to me outrageous that as a consequence of this alleged forty-minute delay Dr. Palmer could be charged with having been neglectful to the patient. I seek tonight to have that stain on the professional character of Dr. Palmer removed by an admission from the Secretary of State that this young man was not dismissed as a result of neglect of the patient.

I challenge the procedure adopted by the board of management in this case. There are so many anomalies and malpractices within the machinery adopted in this case that I cannot understand why the Secretary of State declined a public inquiry. Being a reasonable person, I was perfectly willing to settle for a private inquiry which would be able to satisfy Dr. Palmer and the officials concerned that the deputy superintendent acted rather hastily. I pressed this on the Secretary of State but the right hon. Gentleman could not see his way to adopt that course. A public inquiry would have revealed a great deal more which would not have been to the discredit of Dr. Palmer.

I know Dr. Palmer. He was a student at the university some years after I qualified. He was a very high-spirited young man who liked going to parties and I have no doubt that at some parties he may have misbehaved himself. But there is nothing in his record to say that when on duty he was other than responsible. I have here a certificate issued under the Medical Education Act, 1950, signed by Dr. Palmer's own chief, Mr. A. T. R. Hamilton, the consultant surgeon at the hospital, and countersigned by the superintendent of the hospital, Colonel Gordon, saying that he had carried out his duties in a satisfactory manner from 1st August, 1960, until 24th December, 1960, which includes the day on which he was dismissed. I should like it made clear tonight that he was dismissed because of his alleged rudeness to the sister.

He told this woman, when he was reproved and nagged at by her, to shut her mouth, or words to that effect. Perhaps the words which he used were a little stronger. I wonder whether other men in other positions may not have used similar words. I have heard surgeons use similar and even stronger words when sorely taxed in the middle of an operation, or under the pressure of events when examining a patient, and the nursing staff have always taken it in good part. That is one of the bonds between the nursing profession and the medical profession, the give and take in relations with one another in times of tribulation. But this exceptional woman decided to take up the matter with the matron and she got this young man into trouble. The deputy superintendent seemed unable to resist the representations of the matron in the matter, and after this young man had finished his operating list for the day he was told of his dismissal.

I wish to go on to say how this machinery was used. This young man was evicted from the hospital thirty-six hours after his dismissal. He was evicted under the most disgraceful circumstances. The police were called in on the afternoon of the 24th December—Christmas Eve—and asked to consider evicting this young man from his quarters, as he was no longer a servant of the hospital. The police declined, showing better sense than the officials. At 1 a.m. on 25th December his room was entered forcibly by the superintendent and the deputy-superintendent, the secretary, the head gardener and one or two other assistants. These "brave" men proceeded to manhandle this young man and his belongings out of the hospital and to deposit him on the main Inverness-Perth road. Is that the way to treat a professional man who has given such splendid service, as I can testify from dozens of letters from patients in Inverness and adjoining districts? No wonder that people are annoyed. All the senior medical men at the hospital and the B.M.A. in Scotland have protested about the treatment of this young man.

This dark cloud is not, however, without its silver lining, for at least the Secretary of State has now agreed to review the system. Why was the chairman of the board of management allowed to sit in judgment on this case when the appeals committee report was before it? I am led to believe that in fact the chairman was asked by the hospital secretary or by Dr. MacLellan, or both, to agree to the police being summoned to evict this young man. If Colonel Mackenzie agreed to this, why was he allowed to preside at the board of management meeting which decided this matter? This was settled by the casting vote of the chairman who himself had given a positive vote in the deliberations of the committee in regard to the appeal. I quote from Mr. Smith's letter. He was chairman of the special appeal committee. In his letter of 26th May he wrote: At the meeting, after the submission of the report of the special appeal committee, which was followed by considerable discussion, the chairman invited Mr. Swannie to refer to any possible repercussions. Mr. Swannie is the legal adviser to the Scottish Hospital Service and was not invited there, I understand, by the board of management, but by either the chairman or the secretary. He was asked to give his opinions. At this meeting the man mainly concerned in the matter. Dr. Palmer, was not legally represented. The letter went on: Mr. Swannie in the course of his reply, stated that if the board reversed the decision, Dr. Palmer might take an action against the board and members might have to give evidence in court. He concluded his remarks by strongly advising the board to leave the decision as it had been made. The chairman then asked the members to make proposals and Mr. Smith formally moved that the report of the appeal committee that the sentence of dismissal was not justified be accepted by the board. This second motion was overruled by adjournment of the meeting. The adjournment was for tea. During tea the board of management saw the members of the appeal committee, two of whose names we know and the chairman and Mr. Swannie lobbyed board members arguing that the good name of the hospital was being risked if they reinstated this young man. The letter goes on: Immediately on the resumption of the meeting, the chairman moved that dismissal was justified. Mr. Smith moved a direct negative. The chairman's casting vote was for the dismissal. It seems most outrageous and much deserving of a public inquiry. In the light of the behaviour of the officers concerned it is important that there should be a public inquiry. It is almost impossible to get house officers to go to this hospital. Their duties are extremely onerous. One has only to look into the day of a houseman there to realise that these young men, who have no shift hours terms and no trade union, have to carry on all the time keeping the hospital going.

It is not normally realised by the general public what a vital part is played by house officers. It is, therefore, all the more important that hon. Members, who are the custodians of the National Health Service, should make sure that these men are fairly dealt with.

I have a letter which was written not to me, but to another hon. Member by a doctor in that hospital who is a friend of the hon. Member concerned. I think, actually, that he is a distant relative. He says: I must close on a rather cowardly note and say that I would prefer my name kept out of this, if possible. A colleague of mine, active in the Palmer cause, has been warned to watch his step and that his activities are not unobserved by the senior administrator! He has the offer of a good job in Australia and this has merely encouraged his activities, but regrettably I am not so fortunately placed. There are too many undercurrents and ugly forces at work here as I think you will learn in the days to come. That is an unsolicited comment from a doctor in the hospital. I have been given permission to quote from the letter, but I wish to observe the request that the writer's name should not be mentioned.

In this kind of atmosphere, and from the events I have described, is it not time that this whole affair was investigated? Is it not time to find out exactly what is going on? There is this alleged rudeness to a sister. Then there was what I consider to have been the initial mistake on the part of a person who was in the running for a good job with the regional hospital board and who was frightened to undo that mistake. Then followed the other events I have described. A decision was arrived at and, in my view, it was a decision that could not have been inflicted upon a G.P. in similar circumstances.

Thus, I submit that there is still a good case for a public inquiry to be held into this whole matter. The Secretary of State will grow in stature if he agrees to this suggestion. If he does not, he will be condoning the frame-up of this young man in relation to the appeal and the whole thing from beginning to end.

If the Secretary of State refuses to hold an inquiry he will be doing what he said, while in opposition, he would never do; protecting bureaucrats and allowing the individual to become a piece of flotsam in the State machine. The Secretary of State used to deny that he would allow such a thing to happen. I invite him to think again and to hold a public inquiry, which is this young man's due.

12.33 a.m.

The Secretary of State for Scotland (Mr. John Maclay)

The hon. Gentleman the Member for Greenock (Dr. Dickson Mabon) has put his point of view on this case with vigour and energy. I do not complain about his having raised this matter this evening, because the point he made about the importance of the individual is indeed important. But there is a wider matter involved also, with which I shall try to deal. I must, first, restate the main facts leading up to the dismissal of Dr. Palmer, and the reasons for my decision not to institute an inquiry, either public or private.

At 8 a.m. on the morning of 22nd December, 1960, Dr. Palmer, a resident house officer at Raigmore Hospital, was in the residency in the hospital grounds. He was called, by telephone, by the sister-in-charge of the casualty department to attend a patient suffering from a head inquiry.

By 8.15 a.m. he had not arrived and the sister called him again. As he did not undertake to come at once, she also reported the position to the matron; and the matron asked to be informed if Dr. Palmer had not come to the casualty department by 8.30 a.m. By 8.30 a.m. he had not arrived and the sister informed the matron, who herself telephoned Dr. Palmer and asked him to attend the casualty.

Dr. Palmer arrived in the casualty department between 8.40 and 8.45 a.m. When he arrived words were exchanged between him and the sister-in-charge and he subsequently attended the patient.

I am not a doctor and I do not know how one knows whether or not a head injury is serious. However, the matron reported the matter to the deputy group medical superintendent, who later in the day interviewed Dr. Palmer. No satisfactory explanation was given and no reason for the delay in attending the casualty, and at that stage Dr. Palmer did not express any regret at what had happened. The deputy medical superintendent thereupon dismissed Dr. Palmer because of his failure to attend the patient promptly. His rudeness to the sister was not the reason for his dismissal.

I should inform the House at this point that there is a comprehensive memorandum for house officers employed in the Inverness Hospitals Group which specifies in some detail what is expected of them. It states among other things, If a house officer is requested to attend the casualty department he will do so as quickly as possible or ask the sister to contact one of his colleagues who is more readily available. New patients in the casualty department must be seen as soon after their arrival as possible. There are other remarks, but that is the key point and it is clear that the hospital attaches great importance to prompt attendance to casualties when they appear.

Dr. Dickson Mabon

rose—

Mr. Maclay

I must make this clear and I have little time. Dr. Palmer decided to appeal against the dismissal. Since 1953 there has existed in the hospital service a procedure for dealing with appeals against disciplinary action, including dismissal. The procedure was set out in a memorandum by my Department in that year. Among other things it asks employing authorities to set up an appeal committee from among its own members to hear each appeal and to interview the employee concerned. The members of that committee should not include anyone who has been directly involved in the case. The report of the committee is then submitted to the employing authority whose responsibility it is for reaching a final decision in the case.

When it received Dr. Palmer's appeal the board of management appointed an appeal committee of five. The committee interviewed Dr. Palmer and the other people concerned in the events of that day, 22nd December. Dr. Palmer was given full opportunity to justify his actions or, if he thought fit, to apologise for what had happened. No apology was in fact given. The appeal committee did not make any specific recommendation to the board of management about the action which the board should take and merely minuted the personal reactions of members about the severity of the disciplinary action which the medical superintendent had taken.

The board of management then discussed the report of the committee very fully and considered a motion that the dismissal should be upheld. This motion was supported by seven members of the board, including two of the five members who were on the appeal committee, and there were seven members against the motion. The chairman gave his casting vote in favour of the dismissal. The hon. Member referred to the chairman's part in all this. I am informed that the chairman had no knowledge of the dismissal of Dr. Palmer until after the event.

Dr. Dickson Mabon

And the eviction?

Mr. Maclay

That is irrelevant to the problem which the Secretary of State has to consider. My problem as Secretary of State is what happened up to the point of dismissal and what happened in relation to the appeal. What happened thereafter is not relevant.

When this decision became known dissatisfaction was expressed in various quarters and suggestions were made that I should hold an inquiry into the whole matter. Before I indicate to the House the precise considerations which I had in mind in considering these representations, it would, I think, be useful if I reminded the House of the constitutional position covering the relationship between the Secretary of State and the hospital authorities. This is very important, and I agree that it goes beyond the individual concerned; it is a big issue.

As hon. Members are aware, the National Health Service (Scotland) Act, 1947 set up regional boards and boards of management to act as agents of the Secretary of State in running the hospital service. There is no doubt that the ultimate responsibility lies upon the Secretary of State and that he can issue formal directions to hospital authorities on any matter, large or small. That is the position. But the working of the service would be impossible if the Secretary of State in fact sought to run the whole service himself or to revise executive decisions made by his agents merely because he might have made a different decision had he been in their place. This is very important. It affects the working of the service. He must leave responsibility for day-to-day decisions to those to whom responsibility is delegated and who know the local situation. This does not mean that the Secretary of State ought never to intervene. It does mean, however, that intervention is justified only in very unusual circumstances.

It was against this general background that I had to consider these representations in favour of inquiry into Dr. Palmer's dismissal. It seemed to me that intervention could be justified in this case only if, first of all, there was some serious dispute about the material facts—

Dr. Dickson Mabon

Which there is.

Mr. Maclay

—no—secondly, that there was evidence that the board of management had failed to follow the procedure for dealing with appeals laid down by my Deparment or, thirdly, that the board's conclusion was so far removed from what a fair-minded person would think reasonable in the circumstances that it could not possibly be allowed to stand without review.

Despite what the hon. Gentleman says, there was no dispute about the facts—they have never been argued about—and I have satisfied myself that the board of management had complied with the procedure for dealing with appeals. This left only the third possible justification for an inquiry. The decision in this particular case was obviously a matter of judgment, and in matters of judgment there is room for genuine differences of opinion. Different people may give different weights to the various considerations bearing on the decision.

Failure to deal promptly with a casualty is a serious matter, as the hon. Gentleman will agree, and the board, after fully considering the circumstances, decided that dismissal was justified. While this is a severe form of disciplinary action, the decision is essentially one for the board itself, and I repeat that I should feel justified in intervening in such a decision only if it were so far removed from what a fair-minded person would think reasonable in the circumstances that it could not possibly be allowed to stand without review. It did not, and still does not, seem to me that the decision in this case is in that category, and accordingly I do not consider that any action on my part would be appropriate.

I have, of course, dealt with this case in the context of the existing disciplinary procedure which the board of management carried out. This procedure has been in existence in its present form for eight years, and no serious criticism of it had previously been made to me. I have already told the representatives of the Joint Consultants Committee, which represents the hospital doctors, that I should be glad to consider with them any suggestions they might have for the improvement of the procedure. I should, of course, have to consult the other representatives of the staff organisations as well, since this procedure does not apply only to hospital doctors but to all grades of hospital staff.

I should also make it clear that in considering my decision on this case I have been concerned only with the action which I myself might or might not take under the powers available to me, and the ordinary avenues of redress through the courts are unaffected by anything that I have said.

One point on which the hon. Member touched was in relation to Dr. Palmer's registration. I understand that, despite his dismissal, Dr. Palmer was given a certificate by the Inverness Board of Management to the effect that his services had been approved as satisfactory by the consultant under whom he was working up to the date of his dismissal. That might seem to be in conflict with certain things that happened—

Dr. Dickson Mabon

It certainly does.

Mr. Maclay

—but I am informed that, because of this, the four and a half months that he spent at Raigmore will count towards the period of one year's house officer service required for full registration. My point is that the granting of a certificate to a provisionally registered doctor is, I am advised, related to his chief's assessment of his clinical work, and need not be affected by an incident of this kind—

Dr. Dickson Mabon

Oh.

Mr. Maclay

I am advised that that is the procedure, and we are entering on very dangerous ground if we question that procedure.

I am grateful, I say it frankly, to the hon. Member for bringing this case up, because I think that there is still some doubt about the whole position, and it seems to me to be essential that the whole facts should be laid before the House. I have no doubt that in the circumstances I could not, consistent with my duties to the whole hospital service in Scotland, have ordered a public inquiry, because I do not see what could possibly have come out of it. The facts were not disagreed at any stage in the discussions. We are up against this very difficult problem of judgment, and I do not see how we can run this hospital service in Scotland if the Secretary of State is to interfere with the detailed decisions of people who are responsible for the daily running of the hospitals unless he is convinced that their decision is so outrageous that he must intervene. I can only say that I have not been convinced that that is the position in this case.

I hope that the hon. Member will feel that in having ventilated the problem he has served a useful purpose. If there is doubt about the system of appeals which has been working up to now, we will examine it again to see if there is any better way of making people feel happier about it, but I do not believe that, if there had been a different method of appeals, there would have been any different decision in this case.

I hope the hon. Member will feel that, in the time at my disposal, I have dealt with the matter adequately, and that it should now rest.

Dr. Mabon

Oh, no. Most unsatisfactory.

Question put and agreed to.

Adjourned accordingly at fourteen minutes to One o'clock.