HC Deb 13 March 1986 vol 93 cc1272-81 5.15 am
Mr. Brian Sedgemore (Hackney, South and Shoreditch)

It is always a pleasure to speak in this House, and never more so than at 5.15 in the morning. This debate is about the dangers to patient care caused by the way in which the medical establishment has treated Wendy Savage and Pauline Bousquet. It is Pauline Bousquet who asked me to raise this issue, because she is desperately concerned about obstetrics and gynaecological care in Hackney.

I believe that there are five main strands to the current argument, and it is important to disentangle them. First, there is the conflict between those who say that mothers should have a real say in the method of childbirth and those who argue that it is for the doctors, the experts, to decide. Secondly, there is the argument about natural childbirth versus high-tech childbirth. I believe that that argument is misleading, because there is no doubt that both Wendy Savage and Pauline Bousquet have used high-tech methods when such methods have been needed. Thirdly, there is the right of people in the medical profession to dissent from establishment views, whatever those views may be, at any particular time. Fourthly, there is the issue of the right of women doctors to participate as equals in the National Health Service and to question the chauvinism and old-fashioned attitudes of the male establishment towards its female colleagues. Finally, there is the issue of personal ambition, spite and pique, which tends to give the lie to the image created about the medical profession by "Emergency Ward 10" and similar soap operas.

I think it is disturbing that Wendy Savage and Pauline Bousquet are both women, both in trouble, both in the east end and both work in old established hospitals. We must ask ourselves whether that is just a coincidence, or whether it is a symptom of a much wider problem in the National Health Service. Wendy Savage is a senior lecturer at the London hospital. She, in effect, has been put on trial in relation to her clinical judgment in a way in which none of her male colleagues could ever have expected or would be expected to be put on trial. She has faced five weeks of hell, and she now has several months of waiting to find out whether she will get her job back. She has been the subject of the most terrible gossip and rumour, which shames the medical profession. Her trial has been manifestly unfair and manifestly unnecessary, and it is appalling that the Health Service has been made to do without her services over this recent period and dreadful that the local community, which supports her, has lost the use of her services, simply because she has radical views which she boldly states and honestly puts into practice.

The main case that I want to talk about concerns Pauline Bousquet. She is a consultant obstetrician and gynaecologist who used to work at the Mothers' hospital in Hackney. In 1975, rumours began to circulate about her ability to do her job properly. I regret to say that they were caused by her colleagues who did not like the way in which she was treating her patients. One of the things they did not like was the fact that she had long consultations with her patients. Mr. Hudson, who has recently been reappointed as a consultant at St. Bartholomew's hospital, behaved unprofessionally and introduced bad blood into the medical system. He was largely responsible for the rumours that began to circulate at the Mothers' hospital.

In 1978 Pauline Bousquet ceased to be invited to certain meetings at the hospital. She was worried about the haste which had been introduced into childbirth at that hospital. She was concerned about the use of drugs and epidurals to speed up labour, which she thought precipated in certain cases the need for caesarean operations.

In 1978 Mr. Hudson left the Mothers' hospital, but before leaving he wrote a letter complaining about Miss Bousquet's conduct. Miss Bousquet says that that letter was a load of "manifest nonsense." The medical establishment began to take some of the complaints seriously. In 1979 Dr. Murphy, the area medical officer, wrote to Miss Bousquet calling into question her professional ability. He had received complaints from Mr. Crocker, who is now a consultant at Norwich, and Mr. Glyn Evans, who is a consultant at the Mothers' hospital. The complaint about Miss Pauline Bousquet was 22 pages long and involved eight cases.

I regret to say that it looks as though, from the evidence that Miss Pauline Bousquet has given me—she has shown me all the documents, except for the names of the patients on them—that Mr. Crocker and Mr. Glyn Evans made statements in their complaints which were untrue and could not be substantiated by the medical notes. Of course, it is the medical notes that provide the main evidence in these cases. It is deeply regrettable that those two highly professional people made the same errors which could not be justified by the medical notes. That suggests that malice was involved and that it was not just a mistake. They could not have made the same errors unless one person copied from the other. They were not making the proper independent professional assessment that one would expect in such cases.

I am concerned at the fact that there may be, in the NHS, consultants who are prepared to operate in that way with respect to their colleagues. That is not the way in which professionals in any service should operate. There should be an investigation into the conduct of those two people. I ask the Under-Secretary of State to encourage the district health authority to set up such an investigation.

Pauline Bousquet asked two professors to go through the eight cases raised against her. They have done so and have concluded that her conduct could not be faulted and that the care she gave to all her patients was good.

The district health authority, especially Dr. Grant, has said that it does not question Pauline Bousquet's professional or clinical conduct. Whereas Dr. Murphy, the area medical officer at the time, was prepared to hold an inquiry into Miss Bousquet's conduct until she proved that it would be nonsense to have such an inquiry, he was not prepared to hold an inquiry into the conduct of some of her colleagues when attention was turned to their professional ability. That is worrying for the people of Hackney.

As I understand it from professional people concerned with obstetrics in Hackney, in three of the cases serious question marks were raised over the treatment received by the mothers. Those were the cases undertaken by Miss Husband and by Mr. Crocker, whom I have mentioned. However, perhaps even more important is that subsequently question marks were raised over the care given in another 11 cases, and those cases date from 1975 to 1983. The quotations that I have concerning those cases are: "babies were seriously at risk", "some appalling things were happening", and "in one case a baby died". I believe that there ought to be an inquiry into the 11 cases, and I ask the Minister to help in that. We want reassurance in Hackney for mothers in the way that they are cared for when they are pregnant.

In July 1980 Miss Bousquet gave up her emergency rota at the Mothers' hospital. She was not quite clear what was involved in giving up that emergency rota, because almost immediately a number of the consultants refused to deal with her cases and she lost them all. One result of that was that by September 1980 a rather appalling situation had arisen in Hackney.

I have a copy of the minutes of the Hackney health council at that time, and they say this in connection with the Mothers' hospital: Thus only 50 per cent. of the patients were under consultant care, the remaining patients being under the care of registrars and this was very unsatisfactory. I should like the Minister to give us an assurance that that situation will not arise again in Hackney. It is disgraceful that only 50 per cent. of the patients were then under consultant care.

To sum up my position on obstetrics, as opposed to gynaecology, I make the following requests. First, I should like an inquiry into the conduct and motivation of Mr. Hudson, Mr. Crocker and Mr. Glyn Evans. Their conduct should be examined, because it would appear that they have badly blackened the character of Miss Pauline Bousquet, and that is tragic. Secondly, I believe that there should be a clinical inquiry into the behaviour of Miss Husband and Mr. Crocker and those consultants who were concerned with the 11 cases to which I have referred. Thirdly, I ask the Minister to give us an assurance that there will not be a recurrence of the situation where 50 per cent.—or indeed any—of the mothers in Hackney find themselves without consultant care when they are expecting.

Although there is an inquiry going on at present into Miss Pauline Bousquet's case, that in no way concerns obstetrics, which is the issue about which I have been talking so far. That inquiry concerns gynaecology. Therefore, we need the inquiry for which I have called.

I should now like to discuss briefly gynaecology and the case of Miss Pauline Bousquet. Over the past few years Miss Bousquet has had most of her gynaecology work taken from her. She lost her out-patients at St. Leonard's hospital when that hospital was closed down, she subsequently lost her two clinical sessions at St. Bartholomew's hospital, and since 1984 she has not been allowed to operate at St. Bartholomew's.

There is now a curious situation, whereby this highly skilled and able consultant is employed to carry on nine gynaecology sessions a week, but in fact carries out only two of those sessions. It is absurd that the Health Service can waste talent in that fashion. It is even more absurd when one realises that Miss Bousquet has the support of the British Medical Association, local doctors, local people and the community health council.

Miss Bousquet has had strong backing from the British Medical Association, which believes that the district health authority has behaved badly towards her and breached the conditions of her contract. Mr. Peter Forster, the industrial relations officer of the BMA, wrote to Dr. Grant saying: As a consultant, it is essential for Miss Bousquet to maintain a close contact with her specialty and to remain abreast of all current developments which occur within her specialty, as well as the obvious need for her to practice her requisite skills. Therefore, it is, I would argue, incumbent upon the employing authority to provide her with an adequate level of work. In other words, if the NHS gives her a contract of employment, it is no good Dr. Grant appearing on television, as he did the other night, and saying that Miss Bousquet gets paid. She does not want money for nothing. She wants to do her job. She is a highly skilled gynaecologist and should be allowed to work.

The medical establishment at Barts, as part of this long 10-year attack which has destroyed Miss Bousquet's reputation, is undoubtedly about to make this lady doctor redundant. It is all very well for Dr. Grant, whom I know and respect, to say that it is rationalising the services. It is putting this consultant out of work. The district health authority is behaving unjustly to an individual.

There is a smell of an obstetric cover-up in Hackney. The Minister should ensure that it does not take place, so that mothers can have their babies, knowing that they will receive the best treatment. Finally, patients have been denied some of the skilled and vital care that they need. It is time that the district health authority, helped by the Minister, acted on the matter.

5.31 am
Dr. John Marek (Wrexham)

I thank my hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) for tabling this important debate, which raises a matter of concern to his constituents in east London, and congratulate him on having the debate selected sufficiently early for us to spend some time on it. He has dealt mainly with the case of Miss Bousquet, and I should like to talk about the background to the case of Mrs. Wendy Savage.

An inquiry has just finished and we are awaiting its decision. Both cases are about gynaecology and obstetrics, and how women wish to have babies. Should women be told, mainly by men doctors, how they should have babies, or should they be allowed more freedom? Mrs. Savage says that there is no good evidence to show that having a baby at home is more dangerous than having it in a hospital. She says that many facilities are inadequate, and that we as a nation do not use the skills of midwives sufficiently. Nevertheless, her claims and practice appear to have passed unrecognised by her colleagues, and she has been suspended and has had to go through a traumatic inquiry which will cost a large sum.

I do not have the advantage of my hon. Friend of representing the area and being conversant with the details of the cases. My opinion comes solely from reading what the responsible press has written. The legal costs were estimated at about £50,000 in November. By the end of the inquiry the press estimates that the legal costs may be £150 ,000.

Does the Minister think that such inquiries should be allowed to take place in the future? Mrs. Savage will be saddled with enormous legal costs, approaching £150,000, because of an inquiry into medical practice and principle. There should be a procedure for carrying out this type of inquiry without the burden of cost falling upon one person. The month-long inquiry has now finished.

The challenge was the suggestion that there was entrenched conservatism—I hasten to add with a small c—within the medical profession and that that was responsible for the poor service that many woman received in east London. Mrs. Savage criticised certain middle-aged obstetricians whose senior registrars had to cover for them because they were busy in Harley street.

The Tower Hamlets health authority cannot escape criticism for this ponderous procedure. The health authority was threatened with legal action during the inquiry by Mrs. Denise Lewis. Mrs. Lewis was one of the patients whose treatment under Mrs. Savage was used by the authority as evidence of professional incompetence. Mrs. Lewis told the authority that she had no complaints about her treatment.

It transpired that three of the five women whose cases were being used as evidence against Mrs. Savage offered to give evidence on behalf of Mrs. Savage. The cases are being considered by the inquiry and we shall he anxious to learn the outcome. One may speculate about the cases but it appears that there is division on only one case.

Other problems appear to exist in east London. In February it was reported in the newspapers that the head of obstetrics at the London hospital wished to get rid of his senior lecturer, Mrs. Wendy Savage, as soon as she was appointed head of the department. This was Professor Jurgis Grudzinskas. This has been denied by the professor, but nevertheless, there must be bad blood between the various consultants who serve in that area. This cannot be good for the constituents of my hon. Friend the Member for Hackney, South and Shoreditch. I hope that the Minister will endeavour to find a solution.

A team which does not work in harmony, which is more concerned with arguments against a colleague and concerned to win those arguments and appear before tribunals and courts, cannot be caring for my hon. Friend's constituents. They are not receiving the service that they expect from the National Health Service.

The inquiry heard evidence from both sides but the majority of the evidence was in defence of Mrs. Savage. She was highly commended for her handling of complicated births. Dr. John McGarry, senior consultant obstetrician at the north Devon hospital commended her. Half way through the inquiry it became clear that Mrs. Savage lost fewer babies at or just after delivery than other consultants at the London hospital. In 1984–85 her overall perinatal mortality rate was 11.3 per thousand deliveries against 13.7 for the other consultants. This is significant. I am not saying that one should therefore disregard everything else, because one has to look at the individual cases used in the tribunal to make sure that there was no gross negligence in any particular case, because if there was, action has to be taken. However, it is significant that she lost fewer babies than other consultants.

The problems were compounded by the fact that the health authority used individual case notes, and there was concern that individuals could be identified by the details given to the tribunal. This may be slightly by the way of the issue that my hon. Friend has raised, but everybody will be concerned about this, and the General Medical Council also protested about the identification of patients at the inquiry. The matter was patched up, and eventually the inquiry started again. However, there are no guidelines or rules about how individual, confidential case notes can be disclosed to public inquiries.

I am sure that if my hon. Friend had been given certain case notes, with the names removed, he would not try to discover who the people in the notes were and correlate the cases with them. However, I would not put that past certain members of society, and certain members of the press. Indeed, it could be said that the press has a duty to find out names, but it also has a duty to be responsible. It is important to make sure that confidentiality is preserved so that the press, and anybody else, no matter what their motives are, are unable to find out names relating to case notes, and the medical history of any individual person. Is the Minister satisfied that this cannot be done? If he is not, will he look into the matter, and, if necessary, issue guidance to health authorities as to how they should go about releasing confidential files, albeit without names on them?

The tribunal also heard about Mrs Savage's impossibly over-extended workload, which, it was claimed, interfered with the quality of care that she could give to cases. Professor John Dennis, the expert called in by the Tower Hamlets health authority, said that a redistribution of the workload at the London hospital "might be needed". I take it that that is a professional understatement of the case, if a man of his eminence says that, something needs to be done.

I do not want to enter into a debate about whether the NHS is properly funded—I am sure that we could debate that for many hours. However, I hope that we can agree that the demands on the NHS are always there, and new ones are always being made. The service will always be pressed because of the possibilities presented by medical advance, and it is disgraceful that Miss Bousquet, against whom no charges have been made, is not being employed to anything like full capacity. There is something wrong with the way that the Health Service is being managed in east London.

Mrs. Savage has also said that women were terrified of rumours of "knife happy" doctors. This might have been played up by the press, but that is the fear, because it is known that it is easier for doctors to perform a caesarean than to go through the problems of counselling and the more detailed and individual care that is required for natural birth. It is easy to see how such rumours can spread. In that part of London it appears to me that the consultants say, "Let's have a caesarian if there is any doubt about the birth. Whether one should take that attitude or the attitude of Mrs. Savage and Miss Bousquet is a matter of serious concern and for serious debate. It is a medical matter, and not one which should have been debated in a tribunal with a person's professional livelihood at stake. I should like to see that debate taking place in other journals such as The Lancet, and to be debated in conferences before any generally accepted decision comes out of it.

I move on now to the end of the inquiry, and I quote from The Guardian of 28 February 1986: A maternity unit at a leading London teaching hospital takes so long to arrange emergency deliveries by caesarian section that it should be closed, the inquiry into the conduct of Mrs. Wendy Savage was told yesterday. It continued:

Doctors should be able to operate on urgent cases in 10 minutes but at the London Hospital's Mile End branch, where Mrs. Savage is a consultant obstetrician, there could be an hour's delay, the inquiry heard". If one is to have a caesarian operation, one should be ready and have that operation in five, 10, 15 minutes, and not have to wait for an hour while an anaesthetist comes from down the road. If what is reported is true, the Minister cannot be happy about the operation of the National Health Service in that hospital. I hope that his Department will look at that and, if necessary, make the health authority there remedy matters.

It is clear that, if the department cannot arrange for a caesarian to be done at about 10 minutes notice, the unit should not be in business but should be closed. I do not want to see that department closed. If there is to be a unit there, it must have the proper facilities, and that means that caesarian operations ought to be available in 10 minutes if necessary.

The inquiry finished. Various professors supported Mrs. Savage. There was not very much evidence given against her, except perhaps on the one case of Mrs. A. U. Eventually it was said that Mrs. Wendy Savage's colleagues at the London hospital may have colluded to get rid of her.

This is a very difficult point. It is one to which the remarks made by my hon. Friend the Member for Hackney, South and Shoreditch lend substance. I am of the opinion that there is a case here for the Minister to inquire into. The Minister ought to investigate what is going on in the Health Service in east London. Are there men consultants in the service who are conspiring together because they see Mrs. Savage and Miss Bousquet as irritants, as women, as people and as professionals who have a different view from theirs of how they should engage in and carry on their profession? I think the country would like to know the answer. I would like to know the answer. Is there such a plot, such a caucusing in the tea or coffee room by these men gynaecologists, because they want a nice, quiet, easy life when they do not have to think too hard about how babies should be delivered, and in what different ways they should be delivered? This may exist also in other parts of the country, but has not yet come to the surface. It is important because there is an issue of medical principle as to how we ought to run our hospitals and how much choice women should be given in having their babies delivered.

I hope that the Minister will look at these questions.

I do not intend to add anything to what my hon. Friend the Member for Hackney, South and Shoreditch said about Miss Bousquet, apart from the fact that the British Medical Association rightly support her case and that general practitioners in the area very much support her case. It is a tragedy that her talents are not being used to the full. I hope that the Parliamentary Under-Secretary of State for Health and Social Security will look into this case and not wait until the tribunal has completed its inquiry and issued its judgment. The judgment will be issued in two parts. It will deliver judgment on individual cases of malpractice or negligence that have been brought before it. It will find either that there has been negligence or that there have been faults or that there has not been negligence or fault. The tribunal will also deal, I hope, with the general principle of how women should he treated in hospital. That is my main concern.

The Under-Secretary of State ought to consider that matter and find out what has been the role of the consultants and the health authority, and why it embarked upon this very expensive tribunal. I hope that he will publish the results of his inquiries to reassure the public that the National Health Service is acting upon principles that can be defended in public.

The Parliamentary Under-Secretary of State ought to issue guidance about the whole problem to all health authorities, but that is a different question. We shall have to await the outcome of the inquiries that I hope he will undertake. If something has gone wrong in east London he needs to issue guidance. I hope that he will do so and look forward to what he has to say.

5.53 am
The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

There will be some relief among my Treasury colleagues and in the City that the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) has turned his distinctive attention, at least for the moment, from their areas of concern to those of the Department of Health and Social Security, although I am not so sure that the DHSS will share their relief. It is sad, however, that the hon. Member has brought to the consideration of this question the same technique of using the privileges of this House to make personal attacks on individuals—this time individuals in the National Health Service.

I do not intend to comment on the individual case of Pauline Bousquet. An inquiry is in progress, which goes back quite a long time. I do not intend to comment on the Wendy Savage case, either. The House knows that no decision has yet been announced, and it would therefore be improper for me to comment on that case.

I was surprised that the hon. Member for Wrexham (Dr. Marek), who spoke from the Opposition Front Bench, felt able to comment in quite so much detail and in such a manner about that case, given the stage that that inquiry has reached. I was not quite so surprised that the hon. Member for Hackney, South and Shoreditch felt that he was able to comment upon it.

Dr. Marek

I have not commented upon any private information that I may have. My comments were confined to what has appeared in the press. This inquiry is not sub judice. It is a tribunal of inquiry. I am sure that the tribunal is capable of dispassionately considering the case without being influenced by what either I or the Parliamentary Under-Secretary of State will say in this debate.

Mr. Whitney

I am sure that there is no risk of the tribunal being influenced by what I shall say. I consider that it would be improper to make comments of any nature. But when the hon. Member for Wrexham reads what he has said in Hansard I think he will be surprised by how far he went in his comments.

The hon. Member for Wrexham raised the general question of this type of inquiry . It arises from procedures under what is known as HM(61)112. Action is required in serious cases which could result in dismissal. This may therefore involve setting up an independent fact finding panel of inquiry, chaired by a lawyer. The task of such a panel is to establish the facts concerned and to report to the employing authority. The panel may also, if asked to do so by the authority, make recommendations about disciplinary action to be taken against the particular doctor. That procedure has been in place for some time and hitherto has operated, as I understand it, to general satisfaction as a procedure.

The inquiry about Mrs. Savage was held in public, which is an unprecedented step for such an inquiry, and, not surprisingly perhaps, it attracted a great deal of media interest. Therefore, some issues have arisen, including the confidentiality of documents, to which the hon. Member for Wrexham referred. In the aftermath of that inquiry we shall have to take account of the implications for the future, should such eventualities arise again.

Rather than dwell further on the two cases that were raised I should like to pick up one or two general points which arose in the contributions from the hon. Gentlemen. As for natural child birth, we believe and expect that all obstetricians should take account of the preferences of women whose delivery is under their care, as far as their professional judgment allows them to go. That is a policy which we support. As the hon. Member for Wrexham said, it is a serious matter and a medical matter. I do not believe that the sex of the doctor should be important. It would be wrong to assume that only female doctors are capable of showing the sensitivity that is required.

Dr. Marek

What the Minister has just said is interesting. Would he care to comment upon whether women doctors should be available for those women who wish to be looked after only by women doctors?

Mr. Whitney

Yes, I am happy to come to that. Wherever possible we hope that that will be the case. Naturally the question of availability arises. I shall detain the House briefly so that I may set out the position as it is developing. I hope that the hon. Gentlemen will recognise that it is developing in the direction which they want because there is an increasing number of women in the medical profession and in particular in the disciplines of obstetrics and gynaecology.

We recognise the preference of many women patients, especially those from particular cultures or traditions, to be treated by women doctors. It is Government policy—and we have made this clear both to health authorities and to general practitioners—that, wherever possible, arrangements should be made for patients to be seen by a female doctor when this is requested. For example, the chief medical officer wrote only last January to general practitioners and to health authorities pointing out that many women, particularly Asian women, have deep moral or religious objections to internal examination by a male doctor. The chief medical officer asked general practitioners to respect these sensitivities and, wherever possible, to refer such women to a female consultant and to stress that the patient should be seen by the consultant herself. That answers a point made by the hon. Member for Hackney, South and Shoreditch.

If health authorities and family practitioner committees are to be able to offer this choice, there must be a sufficient number of women doctors in all specialties. This is where the Department has particular responsibilities. It has been policy for many years that entry to medical school should be on the basis of ability alone, irrespective of sex. As a result, the proportion of women in the medical school intake has increased from 24 per cent. to 46 per cent. last autumn. Of course, it will take some years for that to feed through to the National Health Service. In 1985 the proportion of women among medical graduates was 41 per cent. The proportion in the most junior hospital grades was 34 per cent. The proportion in the career grades, in hospital and in general practice, was only 17 per cent. But in all grades the trend is, clearly, towards an increase both in the proportion and absolute number of women doctors.

In obstetrics and gynaecology, the focus of this debate, the trends are particularly encouraging. At present, only 12 per cent. of consultants in the specialty are women. But looking at doctors in training—consultants in the pipeline, as it were—I note that 20 per cent. of senior registrars and over 40 per cent. of registrars, excluding those overseas graduates who are unlikely to make their careers in this country, are women.

Looking even further ahead, obstetrics and gynaecology appears to be one of the most popular specialties among women medical graduates. Recent research commissioned by the Department shows that nearly half of those graduates expressing a firm preference for the specialty were women.

Moreover, we should remember that not all obstetric and gynaecological care is provided by the hospital service. General practitioners and community health doctors deal with many minor gynaecological problems and provide family planning services. GPs also take part in shared care schemes and some take complete care of women throughout their pregnancy and delivery.

I am happy to report that the number of women entering general practice is also on the increase; the proportion rose from 13 per cent. of the total in 1975 to 19 per cent. in 1985. Women also provide over 60 per cent. of the staff in the community health services. All in all, women doctors already provide a very substantial proportion of obstetric and gynaecological care in this country, and will provide even more in the future. The situation is not nearly as bad as the hon. Member for Hackney, South and Shoreditch suggested in his characteristically alarmist speech.

Mr. Sedgemore

The Minister has give no reassurance about the treatment of women in Hackney in terms of obstetrics and gynaecology. He must have known, because of the number of occasions on which I have raised the matter, that it concerned Hackney. He has tried to hide behind the fact that, according to him, an inquiry is taking place. There is not an inquiry going on into obstetrics in Hackney. The inquiry is simply about the number of gynaecological sessions Miss Bousquet does. Why will he not answer the debate?

Mr. Whitney

I have made a clear statement. I will not answer individual cases, for the reasons I gave. The situation in the Health service as a whole is healthy, as I have demonstrated. The hon. Gentleman knows well that if he has any further comments or complaints about an element of a particular health authority, he is always at liberty to approach that authority.

The red herrings that the hon. Gentleman has sought to raise tonight are unjustified. The situation of women patients and doctors, in the important disciplines of obstetrics and gynaecology, are secure and guaranteed. There is no cause for the degree of concern that the hon. Gentleman has sought to create.