HC Deb 20 July 1964 vol 699 cc235-44

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

1.35 a.m.

Mr. Arthur Lewis (West Ham, North)

I am sorry that at this late hour, or should I say early hour, I have to keep the officials and the staff of the House for another half hour, but I want to raise the tragic case of one of my late constituents and his widow.

Mr. Speaker, I should like to begin by thanking you for your kindness in enabling me to have this Adjournment and by paying a tribute to the Press generally, and particularly to my local Press, the Stratford Express and the East Ham Recorder, and to the Sunday Express, who, for no reason other than that they think that an injustice has been done, have given publicity to this case. I also pay tribute to the coroner of West Ham for allowing me to have the post mortem examination report, and to the Minister, both for coming here this morning and for the help that he has given me in correspondence.

This is a really tragic case. I am not here to try to apportion blame, or to point the finger of condemnation at anyone. I want to try to get help and assistance for the widow of the late Mr. Jarvis, and some help and assistance for his children.

My late constituent was a man of 56. and a lithographic artist. He had been in hospital shortly before his death. He was under treatment, and he was known to be a very sick man. He went to the London Chest Hospital for a bronchoscopy examination. This examination is not dangerous in any way—I know because I have had it—and there is nothing difficult about it from a medical point of view, but it does cause a great deal of pain and suffering and it lowers the patient's general resistance.

Mr. Jarvis went to the London Chest Hospital on 6th April. He had a bronchoscopy examination, and he was so overcome that he collapsed. That afternoon his wife was approached by the local police who advised her to get in touch with the hospital immediately. She did so at 2.30 p.m. She was told that her husband had stopped breathing, that he had been put in an oxygen tent, and that she ought to go to the hospital. By the time she got to the hospital her husband was barely conscious, but she was relieved to find that he was breathing again.

Her husband had not recovered sufficiently to be able to leave the hospital, so he was kept in that night. The following day he was told that he would be discharged, even though the previous day he had been seriously ill and his wife had been told that he had stopped breathing. There is no dispute that he was suffering from severe respiratory trouble.

When the time came for him to leave the hospital he naturally asked for an ambulance to take him home, because he lived quite a way away. One can imagine his surprise, and more so the surprise of his wife, when he was refused any transport whatsoever. His wife naturally tried to get a taxi, but was unable to do so, so she had no alternative but to conduct her husband home by public transport, which meant travelling on two buses and a tube train. Eventually the poor man got home, but, as his wife said, he was so exhausted and ill that he was in a state of collapse and had to go to bed. Unfortunately he never recovered. He died during the night. That was a terrible thing.

After an investigation had taken place the Minister, who has been very kind and helpful, sent me a letter confirming the facts that I have just enumerated, and went on to say that he thought that under the circumstances it would have been better if transport had been provided. That is my point. I thank the hon. Gentleman for his reply. He also said—and I agree—that the post mortem pointed out that the man was liable to drop dead at any moment, therefore the bronchoscopy was not the cause of death. I have never argued that, and that is not the argument of the man's wife.

But the hospital authorities cannot have it both ways. If the man was so seriously ill that he had been in hospital for some weeks shortly before going into the London Chest Hospital, and if he suffered from bronchitis and coronary disease and was liable to drop dead at any moment, one of two things should have happened. When he underwent the examination at the London Chest Hospital and it was found that it affected him adversely so that he almost collapsed—he stopped breathing and had to go into an oxygen tent—the authorities should have seen whether he was fit enough to go out and should have insisted on the provision of transport; he should not have had to ask for it. In fact, they refused transport.

I realise that the post-mortem examination could not have shown whether the strain of travelling all that distance from the hospital to Forest Gate had any contributory effect on the death. All that the pathologist's report says is that he died from bronchitis and coronary disease, and that he was so seriously ill that he was liable to have an attack at any time. I suggest that in this case the widow is entitled to some compensation. I do not want to advise my constituent to go to the worry and trouble of issuing a writ, because I do not think that that would be helpful to her, her children or to the hospital authorities. However, since the Minister has admitted to me—in correspondence and a Parliamentary Answer—that it would have been better had transport been provided for Mr. Jarvis, I suggest that, leaving aside any legal question, from the moral point of view something should be done because this shows that there was some neglect or negligence on the part of the hospital authorities.

I am convinced that had this man been given transport home he would not have been so exhausted and would have been able to arrive home and, having gone to bed, in all probability might have recovered from the bronchoscopy. I hasten to point out yet again that I agree that the bronchoscopy was not responsible for his death. I have had one myself and I agree that, from the medical point of view, it does not cause any damage. Nevertheless, a man suffering from congestion of the lungs goes through a tremendous ordeal when having a bronchoscopy, for it necessitates tubes being stuck up the nose and the patient having to suck a certain amount of coloured fluid through those tubes into the lungs. That is by no means a pleasant experience, particularly for a man who is already suffering from congestion and similar difficulties. It is exhausting and unpleasant for even the fittest of people.

Since the hospital authorities knew that Mr. Jarvis had undergone that treatment and that he had been in hospital just previously, apart from the fact that he had been placed in an oxygen tent and had had to spend the night in hospital, he should have been provided with transport home, particularly since it was known that he was liable to drop down dead at any moment. I am not commenting on the medical side of this case. On humanitarian grounds, I am suggesting that there is hardly a person who would not in similar circumstances have said, "Let me help you home." The average person would ask a friend or acquaintance if they are able to provide assistance in reaching a bus, train, or even going as far as taking the person all the way home. I suggest, therefore, that a callous indifference was displayed in this case.

Whatever is the final outcome in this case, I hope that the Minister will set a thorough inquiry on foot to ensure that these things do not happen in future. Any person in Mr. Jarvis's position should in future be provided with ambulance or other transport home. I have previously asked whether ambulances were available at the time, but that question has not been answered. Was there any question of a shortage of ambulances? Whatever the reason, I hope that the Minister will say that he agrees that in this instance the hospital authorities should make an ex gratia payment, which would not involve any question of responsibility or liability; merely that instead of the sympathy which has been expressed in correspondence and verbally, something tangible should be done.

1.49 a.m.

The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)

I know that the hon. Member for West Ham, North (Mr. A. Lewis) has raised this matter with the very best of motives, and I have therefore listened to him with the closest of attention. When I first heard from him on the subject my reaction was that here was a matter that should be looked into most carefully, and I called for an urgent report.

May I say at the very outset, and before answering the hon. Gentleman, that I have the deepest sympathy for Mrs. Jarvis in her bereavement, and can fully understand her feelings about the circumstances in which it occurred. It is sad enough to lose one's husband; it is a terrible thing for a wife to feel that perhaps her husband's death might have been avoided.

The hon. Gentleman tabled a number of Questions following Mr. Jarvis' death, and the Answers I have given him, which have appeared in the OFFICIAL REPORT, set out the main facts of the case. Unhappily, Mr. Jarvis, who was 56 years of age, was not a man of robust physique. He was suffering with his heart and chest, and had a nervous condition of some long standing. It might be helpful if I were to set out the details of the events preceding his death so that the record should be clear.

It was in January that a doctor at Plaistow Hospital referred him with a general medical report to the London Chest Hospital for a bronchoscopy—that is, a diagnostic examination of the lungs. On 6th April, Mr. Jarvis attended the London Chest Hospital again for a further bronchoscopy. He had been extensively investigated at Plaistow Hospital and the doctors at the London Chest Hospital had no reason to believe that a bronchoscopy could not be carried out in the normal manner. I might mention that this kind of examination is carried out frequently at the hospital; indeed, it is carried out on as many as 25 patients a week as a matter of routine.

The examination on Mr. Jarvis was carried out under a general anaesthetic. It revealed no abnormality but, following the examination, as the hon. Member has correctly described, Mr. Jarvis had difficulty with his breathing, so that it was necessary to give him assisted respiration for about three hours and it was decided to keep him in hospital overnight. Usually, patients are sent home on the same day when they are sufficiently recovered from the anaesthetic. Mrs. Jarvis, because of the difficulty I have mentioned, was very properly sent for, and when she arrived her husband was conscious.

At 1.30 p.m. the following day Mr. Jarvis was examined by two doctors in the hospital, who decided that he was fit for discharge. I am advised that he was able to walk about, and the doctors did not think it necessary to order an ambulance to take him home. Mrs. Jarvis, who had come to meet her husband, tried to obtain a taxi, as the hon. Gentleman said, but was unable to do so. She asked a nurse if an ambulance could be provided. Since the nurse knew that the doctors had not recommended ambulance transport, and as ambulances are not normally provided for walking patients, she did not arrange for one to be provided. So Mr. and Mrs. Jarvis went home by bus and train.

On the following morning, Mrs. Jarvis found that her husband had died. The doctor who was called in was uncertain of the cause of death, the coroner was notified, and he arranged for a post mortem to be undertaken. The coroner noted from the pathologist's report—I believe that the hon. Member has received a copy, that— … there was ample natural disease"— that was the term used: present to account for death. He decided that there was no reason to hold an inquest.

The pathologist's report stated that the autopsy did not disclose any evidence of a miscarriage of the procedure of bronchoscopy, and I am advised that it showed that Mr. Jarvis was suffering from a heart condition from which he might have died at any time. I must tell the hon. Gentleman that I have no evidence that Mr. Jarvis' death was hastened by his hospital treatment or by his journey home. The hon. Member will appreciate that I am not a medical man and I was bound to ask for medical advice on this point. I can assure him that I have no evidence that either the hospital treatment or Mr. Jarvis' difficult journey home hastened his death.

Having received these reports, my own feelings were that in all the circumstances it would have been better if transport had been provided. I expressed that view to the hon. Member, and I still hold to it. Of course, I was looking at this entirely as a layman and admittedly with all the advantages of hindsight, but decisions of this kind can only be taken by doctors, having regard to their knowledge of the patient's medical condition at the time and the nature of the journey he has to make.

At this point I ought to say something about the instructions for the use of ambulances. They state clearly that ambulances should be provided on the recommendation of a doctor. We must remember that ambulances are frequently required to meet emergency situations. In view of this it is most important that the use of the ambulance service is properly regulated. We have a clear duty to ensure that the service is always adequate to provide for those uses where the doctors are satisfied that an ambulance is needed.

As the House will recognise, this is a matter of balancing an assessment of the patient's condition against the difficulties of the journey he has to make. This is a decision which the doctors have to make in the light of the circumstances of each ease as they see them. In Mr. Jarvis's case they decided that it was not necessary to provide transport. This was essentially a matter for medical judgment. Thus the proper procedure for the ordering of ambulances was followed at the hospital in that the decision was taken by the proper person. There was no question of an ambulance not being available had the doctor recommended one. The hospital does not experience difficulty in obtaining ambulances on request from the London Ambulance Service.

The hon. Member has claimed that the proper course would be to pay compensation to the widow, but I think that we must be clear in our minds as to what is meant by payment of compensation. In a letter dated 10th July, in which the hon. Member was kind enough to tell me what he had in mind, he said that I will claim that either the doctors knew that Mr. Jarvis was so seriously ill that they ought to have provided transport, or they did not know, which shows that they could not have given him the thorough medical examination which his condition warranted. In a further letter dated 14th July, the hon. Member told me that his purpose was not to try to blame either the doctors or the hospital administrative staff but only to ascertain whether in this case an ex gratia payment could be made without admission of liability.

I believe that the hon. Member and I have exactly the same objective, namely that if Mrs. Jarvis has a just claim it should be met. But what is the claim? And if there is a sound claim, against whom should it be pursued? These are the vital questions with which we are concerned. I hope the hon. Member will forgive me if I say that there has been some ambiguity in his approach. The impression which I get from his letters and from what he has said tonight is that he contends, on the one hand, that there has been negligence while, on the other hand, he does not seek to lay specific blame on either the hospital doctors or the hospital administrative staff.

If it is alleged that there was negligence, if it is claimed that this unfortunate man should not have been sent home by public transport and that this experience in some way hastened his death, that, in short, there is justification for some legal claim, the action does not lie against my right hon. Friend but against the board of governors of the hospital or against some member or members of the hospital staff. I should explain to the House that proceedings against a hospital board in respect of anything done in carrying out its functions under the National Health Service Act are required to be brought against the board in its own name.

The hon. Member has put his plea for compensation—I accept that he has done so with the best of motives—directly to my right hon. Friend. From what I have just said, I am sure he will appreciate that to pursue this course is to ignore the question of any claim against the board of governors or its staff. As I have pointed out, if there were any basis for legal proceedings, they would lie against the board or some of its members or members of its staff, who would then have the opportunity of being represented.

It might well be asked in such a case whether it would be appropriate for my right hon. Friend to offer an ex gratia payment. I ought to remind the House in this connection that the very purpose of ex gratia payments is to meet the situation where clear moral entitlement has been established but where there is no satisfactory remedy in law. I am bound to say that that situation does not arise in this case.

Having said that, I can well understand how any hon. Member approaching a sad problem of this kind might have done so in the way that the hon. Member has done tonight. All of us will recognise that he is concerned to do whatever is best for his constituent and her children. It seems clear, however, that the course which he wishes my right hon. Friend to adopt is not the right one. If it is still seriously alleged that the hospital authority or its staff were responsible for Mr. Jarvis's unfortunate death, the law provides the means by which these allegations can be tested.

Mr. Lewis

The point which I put to the hon. Gentleman was that I did not want to have the woman troubled again with the sadness of having the case all over again if there was a way in which she could be compensated by an ex gratia payment. I reiterate that I have not said that I can prove that there was negligence; neither can I prove the contrary. All I say is that in my opinion, as a non-medical person, there must have been some contributory cause in sending the man home in the way he was sent, knowing that he was such a sick man. From what the Minister now tells me, it appears that the only way to resolve the matter is for the widow to apply for legal aid and to take the matter through the court. There appears to be no other way in which the Minister can help.

Mr. Braine

It seems to me that that is the only course which can be pursued. It does not fall to me to give advice to the hon. Member's constituent, but I feel that in all the circumstances which I have described, it would be wise for her to seek legal advice.

Mr. Lewis

I am glad that the Minister has finished his reply a little early to enable me to say this. I appreciate the position. I am not asking for a reply now, but will the Minister consider, before the House rises for the Recess, whether he could have a word with the hospital governors or the regional board, whichever is the appropriate authority, to see whether that body in turn would consider this suggestion.

I think that as the responsible Minister the hon. Gentleman has power to draw to the attention of the authority concerned for the hospital both his communication in writing to me and the debate which has taken place tonight. It is, I think, within the Minister's prerogative to point out to the authority concerned that it might consider this. I do not ask the Minister to recommend one way or the other, because I would still prefer the board, if it could see its way clear to do so, to come to a settlement rather than have this poor woman go through this tragedy all over again, going to court, first getting the legal aid certificate, undergoing the means test basis of application, getting solicitors' advice and probably have the whole thing dragging on for months. The courts are about to rise for the vacation and probably the case would have to wait until the autumn. All this would be quite tragic on top of the tragedy which this woman has already had. If the hospital authorities could say that they have a means whereby they could help this lady and come to some token arrangement, or if they could consider that, it would be better for all concerned. If not, I agree with the Minister that I should have to suggest to her that she should take legal advice. Could the hon. Gentleman consider that?

Mr. Braine

The hon. Gentleman has now set out his views on this subject at considerable length. I have no doubt that the matter will be closely studied by the board of governors of the hospital concerned. I think we must leave the matter there tonight.

Question put and agreed to.

Adjourned accordingly at five minutes past Two o'clock.