HC Deb 18 November 1987 vol 122 cc1176-82

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

11.1 pm

Mr. Colin Shepherd (Hereford)

I am grateful to my hon. Friend the Under-Secretary of State for coming to the House tonight to grapple with a difficult problem about which I feel strongly and which has been running on for far too long already.

The problem is similar to one I raised in the House almost exactly six years ago, which involved an untoward incident which affected my then constituent, Mr. David Woodhouse, who, distressingly has made no recovery. The problem revolves around the birth. three years ago last Wednesday, of Rebecca Field at the Hereford county hospital, as a consequence of which she is partially paralysed and totally dependent on artificial ventilation.

I want to pay tribute to the courage and determination of Rebecca's parents, who have set out to give her the best life they possibly can on very limited means. They have spared themselves no effort. I should like to take this opportunity to thank all the agencies, such as social services, who have contributed in such a variety of ways to improve the quality of life for the Field family. There have been financial contributions to establish a trust fund, and the Ben Hardwick fund has helped towards specialist family transport. There has been a community effort to get the family on a normal keel.

There still remains, however, a fundamental and unsolved problem — the unsatisfactory investigation of what happened in that "untoward incident". I believe that it is perfectly understandable that there should be acute frustration in the Field family at the present state of affairs. In the Woodhouse case, the problem was cracked, if not broken, by the setting up of a sort of eminent persons group, who sifted through the evidence and formulated an opinion of what had gone wrong. In that case, it was sufficient to facilitate the start of legal proceedings by the family, but it is worth observing that the patient was, and is, in no position to disagree with the findings. My hon. Friend the Minister will appreciate that there is a difference in the Field case.

I shall recap the events. The birth took place on 11 November 1984. As a consequence of what happened at the birth, the experienced midwifery sister saw fit to put her objections in writing and make a report to the hospital administration — an extraordinary move, which was brought about by her distress. I believe that the staff midwife also submitted a report, although I do not know how that came about.

I presume that some form of preliminary investigation was done, because the eminent persons group investigation was set up, including among its members Professor Turnbull and Dr. Joan Andrews — both eminent members of their profession of gynaecology. They reported on 15 April 1985. The difference between the Woodhouse case and this one is that Woodhouse is in no position to express an opinion, whereas Mr. and Mrs. Field certainly are. They cannot reconcile themselves to the uncomfortable analyses and conclusions of the report, even though it contains severe criticisms.

It is worth while reiterating that the Fields were not the original complainants. Perfectly reasonable questions have still not been addressed. Is it not a reasonable assumption, for example, that the registrar—the locum—got into difficulties during the delivery? Was the registrar perhaps negligent in not seeking assistance from the duty consultant obstetrician and gynaecologist; and was the registrar negligent in, apparently, not having considered the caesarian section option when it became apparent that a forceps delivery was indicated? To what extent did the non-executed order to perform an episiotomy constitute negligence or professional incompetence?

The Turnbull-Andrews report mentions what appears to be a misleading curriculum vitae for the locum registrar. To what extent was the health authority negligent in failing to note or take account of that? In the words of the report, the authority did not really make it clear that she had not held a formal Registrar's post. What is more, no references were available or taken up. To what extent was the health authority negligent about the way in which it staffed its obstetrics and gynaecology unit in the hospital? All those questions are unresolved, and need resolving.

There are disturbing references in the report to differences of opinion about how gentle the delivery was. The mother was physically hauled down the bed three times by the force exerted during the forceps delivery and had to be held hack by her husband—he is no slight figure himself — and two nurses. It is not surprising, therefore, that the parents attach little credibility to findings that the delivery was gentle.

The parents do not identify themselves with the description of events during the crucial part of the delivery. It bears no resemblance to their traumatic experience. It is disturbing that the conclusions about the registrar's handling of the delivery should use the words "unsatisfactory enough" — that surely means that the delivery was riot handled satisfactorily. I can understand the family's frustration at being stymied in their quest for compensation, which would enable them to lead a life that is as near normal as possible.

The Fields retained the services of a solicitor at an early stage, and, through the offices of legal aid, were able to seek expert medical opinion. In this they appear to have been hampered by their inability to furnish the independent expert whose advice they sought with all the paperwork relating to the case—medical records, case notes, reports and submissions by the staff midwife, the midwifery sister, the junior doctor, the paediatrician and the senior house officer.

I exclude the registrar from the list, as professional incompetence or negligence might lie with her—among others. To my knowledge, only rather incomplete case notes have been furnished, and I am bothered about the position of the obstetrician in Manchester, who interviewed the Fields and discussed the Turnbull-Andrews report with them. As a result of scrutinising the rather inadequate case notes, he told the Fields that he felt unable to continue to give them advice. That was their one opportunity torpedoed.

Persistence with the Law Society has resulted in that society being impressed by the Fields' situation, which I believe has been buttressed by a submissions, from recollection, by the midwifery sister. The Fields are now at the point where they have been facilitated to take out writs but not to serve them. Therefore, the matter is not yet sub judice. However, they cannot go ahead without medical evidence and at present there appears to be no easy way of getting it. Therein lies the log jam.

In the wider context, it seems quite clear that the eminent persons' group approach to this sort of problem has been less than fully satisfactory. Where there is a genuinely held difference of opinion among the lay people involved, it will always be difficult to find professional people who perhaps feel strong enough to take on people as powerful in their professions as those who are appointed to eminent persons groups. Therefore, it is possible that medical evidence will not be easy to find at any time.

In an excellent private Member's Bill, my hon. Friend the Member for Newbury (Mr. McNair-Wilson) brought forward the Hospital Complaints Procedure Act 1985. However, I have found that this does not fit the bill; besides, it does not really relate to this sort of case and has not yet been brought into force. There is on the Order Paper early-day motion 256, which calls for a Royal Commission to look into medical accidents. However, that is a lengthy attempt to put forward solutions that may not necessarily help in this instance because such a Commission would be set up long after the event. As far as I am aware, no progress has been made on the new DHSS guidelines on untoward incidents.

I am sure that my hon. Friend will be sympathetic to the plight of this family. We are now no nearer to knowing how Rebecca came to be damaged, but severely damaged she undoubtedly is, and doubts about negligence, wherever it occurred, have clearly not been dispelled. To deal with this, we need to be able to reopen the inquiry, so that all the documents can be examined and witnesses cross-examined. I hope that my hon. Friend will feel able to instruct the health authority to make available to the Fields all the papers from the start to the present time.

I think that the Fields are totally financing the ventilator and its maintenance, upon which Rebecca depends entirely for her existence. I understand that about 100 other people in Britain also depend on 100 per cent. ventilation, but in each of those cases the cost is fully borne by the National Health Service. Can my hon. Friend tell me if there is any reason why the Field family should be any different or whether I have got this wrong? I should certainly welcome advice on this matter. I know that my hon. Friend will be moved by this tragic event that happened to a decent family in a nice part of the world. I hope that she will be able to help.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

I congratulate my hon. Friend the Member for Hereford (Mr. Shepherd) on his success in the ballot and I am grateful to him for bringing the sad case of Rebecca Field before the House. All hon. Members will sympathise with the family who have been involved in what should have been a joyous event but which turned out to be a most tragic incident.

Mrs. Field was admitted to Hereford county hospital for the birth of her third baby, and on Sunday 11 November 1984 she was transferred to the labour ward. Her progress was monitored throughout the day. By the early evening, it had become clear that Mrs. Field was becoming increasingly distressed and tired. Medical staff were informed and asked to assess Mrs. Field for assistance with the delivery. On delivery the baby, a little girl called Rebecca, appeared to experience breathing difficulties and she was immediately incubated and placed on a Resuscitaire machine. Within 25 minutes of delivery, Rebecca had been transferred to the special care baby unit so that she could be placed on a ventilator. Since then, Rebecca's breathing has been maintained by mechanical ventilation. It appears that the spinal cord was broken and as a result she is paralysed from the neck down, although she appears to be mentally normal. I understand that she may have a normal life expectancy.

I have listened carefully to the points made by my hon. Friend and applaud the way that he has made them. I have also read the reports of the independent consultant and the district health authority, and the statements of the midwifery staff and others. Through my advisers, I have been in contact with the regional health authority both yesterday and today. Therefore, perhaps he will allow me to comment briefly on some of the points that he made.

Most complaints are investigated and dealt with by officers of the district health authority, in this case Hereford. This is a long-established procedure that has been followed in thousands of cases. Complaints relating to the clinical aspects of a patient's treatment may be referred, under a more recent procedure — circular HC(81)5— to the regional medical officer, in this case the West Midlands regional health authority. If the RMO considers it appropriate, he may appoint two consultants from another region to investigate and report to him about matters of clinical judgment. The RMO was following established procedures. The procedure is not normally considered appropriate if legal action is contemplated. I understand that, as my hon. Friend said, as of today no writs have been issued.

Unusually in this case, the regional medical officer's action was a response to concerns expressed not originally by the family but by staff present at the birth. Thus, both the district health authority and the regional health authority are involved. The purpose of such inquiries is to establish facts and to ensure that account is taken of lessons learned. They are not substitutes for court action.

Two reports have been produced by the regional and district health authorities. The first report was produced by Mr. Key, who was then district administrator, for the chairman of the health authority. The purpose of the report was to enable the chairman of the DHA to decide what further action should be taken. The report was copied also to the regional medical officer and to the regional health authority chairman, and, as a report of an untoward incident, was considered by the district health authority. At that stage no formal complaint had been received from Rebecca's parents. I understand that no formal complaint has ever been received from them.

Nevertheless, it was considered appropriate that a further inquiry should be held. The regional medical officer Commissioned the inquiry under the circular that I mentioned and invited two independent experts — Professor Turnbull of the Nuffield department of obstetrics and gynaecology and Miss Joan Andrews, consultant obstetrician from St. David's hospital, Cardiff — to conduct it. Both those consultants are eminent authorities and I have no doubt about their impartiality or ability.

The report was completed by April 1985 and sent to the regional medical officer, and from there to Mr. Key. Copies were also made available to the family.

Subsequently, the medical records have also been made available to the family's legal adviser. Therefore, I make two points. First of all, I understand that documents have not been withheld. If my hon. Friend was to tell me that anything has been withheld, if it is within my power I shall endeavour to ensure that it is made available.

Mr. Shepherd

I confirm that the report made by the midwifery sister and the staff midwife have been made available to the family's legal adviser, together with a copy of the interim report made by Mr. Key to the chairman of the health authority.

Mrs. Currie

My hon. Friend did not mention whether Professor Turnbull's report has been made available. If it has not been, I will ensure that it is, as it should have been.

Mr. Shepherd

It has been made available, although I understand that was done unofficially, so as to help the family at the time.

Mrs. Currie

Officially or unofficially, I am glad to hear that it has been made available.

My second point is that there have already been two inquiries—the one by the district health authority and the one by the regional medical officer under the circular. I hope that my hon. Friend will understand if I resist any temptation to ask for a third. I have looked at a copy of the report and in my view it provides a comprehensive review of the unfortunate incident surrounding the birth of Rebecca Field. The regional medical officer has found the report to be first-class, comprehensive and a model of its kind. All the documents were available to Professor Turnbull and Miss Andrews. All the staff concerned were interviewed and were helpful, and there were no barriers to an efficient inquiry.

A number of recommendations were made and changes have been introduced both in practice and procedures. The regional medical officer is satisfied that the district's response to the recommendations is satisfactory, and so are my medical and legal advisers. While possible legal action is being contemplated, my hon. Friend will understand if I am cautious in what I say about the details of the matter. We should also be sensitive that we are talking about a handicapped little girl and her future.

Nevertheless, it is open to Mrs. Field's legal advisers to consider how the report can be used and to seek further independent advice if that seems appropriate. In advising the House tonight, I want to put it on record that I and the health authorities concerned have every sympathy with Mr. and Mrs. Field and with Rebecca. Regardless of the outcome of any possible court action, the district health authority has always been prepared to provide all the care that Rebecca needs in hospital. There she would have 24-hour attention and the necessary equipment. Understandably, Rebecca's parents prefer to have her at home. That means that the DHA cannot provide precisely the same level of care around the clock without lessening the service for others in need.

Regardless, therefore, of the circumstances surrounding Rebecca's birth, we have a dilemma about the delivery of services to that child and her family which has been going on now for two and half years since Rebecca came home. I understand the difficulties on both sides, especially as Mr. Field has given up work to care for the child. Therefore, I asked my officials today to consult the regional and district heath authorities to discover whether there is any way that assistance can be provided more flexibly and a proper care plan drawn up for Rebecca's future. In my view, that should include appropriate arrangements for ventilation, so that the problem to which my hon. Friend referred should not be a burden on the family. I believe that the parents should be involved in the development of such a plan—perhaps I should say must be involved, in view of some of the circumstances that I have seen outlined in the papers.

I hope that what I have said tonight shows that I have looked carefully at the documents concerned and am well appraised of the issues. Sadly, there is no good outcome to this tragic case and all our thoughts are with the family concerned. However, I have initiated certain discussions to add to those that are currently under way. I am sure that my hon. Friend joins me in hoping that these matters will be brought to a satisfactory conclusion as speedily as possible.

Question put and agreed to.

Adjourned accordingly at twenty-one minutes past eleven o'clock.