§ Mr. John Hannam (Exeter)
(by private notice): To ask the Secretary of State for Social Services if he will make a statement on the radiation overdose given to patients receiving radiotherapy at the Royal Devon and Exeter hospital, Exeter.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)
The telecobalt machine at the Royal Devon and Exeter hospital was installed some years ago and is of a type commonly in use in the National Health Service to treat cancer patients. On 12 February 1988, a new cobalt source was installed as part of a routine service. Due to an error of calibration, the machine was then set to give a 25 per cent. higher dose of radiation. On 12 July 1988, staff dealing with patients drew attention to side effects in a small number of patients and the machine was checked. The error was immediately found and rectified. The machine is not itself faulty and continues in use.
Immediate steps were taken to identify the 153 patients who had been treated on the machine during this period. An independent assessor, Professor Charles Joslin of Leeds university, has been asked to give an opinion on each case. All the patients concerned are being called in this week and treated or counselled as necessary.
Exeter health authority has set up an inquiry drawing on the expertise of Professor Joslin, and an independent physicist called in at the authority's regional scientific officer, and the Health and Safety Executive. Their reports are expected to go to the health authority as soon as possible. I am satisfied that appropriate action has been taken and that patients should continue to have confidence in radiotherapy as a major lifesaving treatment both in Exeter and elsewhere.
§ Mr. Hannam
I and all hon. Members express sympathy to those facing terrible uncertainty as a result of this unfortunate error. Is my hon. Friend aware that there is great concern about the lack of a fail-safe check-up system for the recalibration of radiotherapy equipment? Should not the Health and Safety Executive give a clear specification of the requirements for such checks and the responsibility for such a system be placed on the health authority?
Finally, can my hon. Friend say to what extent the excess doses of radiation given to patients fell within the range of normal treatment practice elsewhere by other clinicians?
§ Mrs. Currie
On the last question, I am sure that my hon. Friend would not wish me to give a clinical view which might reflect on particular patients, but I am assured that much of what he has said is correct.
With regard to a fail-safe device, guidelines for inspections are set out in two sets of statutory regulations, both of which are accompanied by detailed guidance which builds on earlier similar guidance. I refer my hon. Friend to paragraph 7.22 of the guidance, which does not appear to have been followed in its entirety. We expect the Exeter inquiry to address this issue and I have asked the Health and Safety Executive to advise me further.
§ Mr. Matthew Taylor (Truro)
Will the Under-Secretary of State confirm that all patients have been or will be contacted successfully and that there is no problem in identifying all concerned in this instance? Will she also confirm that all other machines which might be subject to similar errors will be checked and all steps taken to ensure that no such overdoses are taking place elsewhere and that none will occur in the future?
§ Mrs. Currie
Yes, we are not in any doubt about the nature of the error, the date on which it occurred or its duration. There is no doubt which patients have been affected, and they either have been or are being contacted. As to the second part of the hon. Gentleman's question, the output of the machines should be checked monthly, which is normal practice in National Health Service hospitals. I have asked the Health and Safety Executive to advise me further on the matter.
§ Sir Peter Emery (Honiton)
Will my hon. Friend accept that, while there is much concern about the matter, everybody in the locality has much praise for the work that the Royal Devon and Exeter hospital does? When 153 patients are involved, some of whom are young children, there is much concern. How is the division between clinical control and executive management supervision affected? It seems that a clinical decision was taken but that it was very difficult for the executive management to spot the problem.
Will my hon. Friend confirm that there will be an independent chairman of the inquiry? It has been suggested that the deputy chairman of Exeter health authority might be appointed. That would be a mistake, because somebody from outside Devon should be appointed to ensure that nothing is being hidden. Why has there been a delay of over 10 days from 12 July to date? Patients should have been notified; many of them learned about the problem only because of television. That must be a terrifying factor, that should never be allowed to happen again.
§ Mrs. Currie
Yes, I agree with much of what my hon. Friend says. I concur with my hon. Friend that radiotherapy machines save lives. There is no doubt that, had patients not been treated on them, the condition from which they were suffering could have been terminal. I understand that the equipment is the responsibility of the physicists, and that advice from an outside adviser who is a physicist has been called for by the health authority. As to the question of an independent chairman, the health authority has called immediately for an inquiry, and it is appropriate that the inquiry should be conducted within that framework. I have said that I expect the inquiry, through the regional health authority, to report to me with its recommendations.
As to the delay in notifying patients, I understand that the intention was first to obtain a judgment on cases, if at all possible, so that the patients could be reassured or offered further treatment if necessary. In my view—I think that my hon. Friend will share this view—notifying patients where there is cause for concern should be a top priority. I have asked my officials to advise me urgently on a possible standard procedure that we could offer to all health authorities, bearing in mind that patients should have as much information as possible to set their anxieties at rest. Patients should not hear about the problem from the press first.
§ Mr. Robin Maxwell-Hyslop (Tiverton)
Can my hon. Friend tell me whether Professor Joslin's report will be published and when she is expecting that it will be available to hon. Members as well as to the public at large and, indeed, to the general practitioners who referred the patients to the Royal Devon and Exeter hospital in the first place, because they will obviously have the more intimate and day-to-day contact with the patients?
§ Mrs. Currie
I am advised that Professor Joslin is offering detailed clinical guidance, case by case, on all 153 patients treated by the machine. It would almost certainly not be appropriate for that information, which is confidential, to be published. He will, however, be making a report, as requested, to the health authority, and I expect it then to take a view about whether a summary of it may be made available. We certainly intend to learn from all the lessons.
§ Mr. Speaker
Order. I remind those Opposition Members who were rising that this matter specifically refers to the Royal Devon and Exeter hospital. I shall call the hon. and learned Member for Leicester, West (Mr. Janner), but it is not about Leicester.
§ Mr. Greville Janner (Leicester, West)
No, Mr. Speaker, but it could be.
Has the Minister taken legal advice as to whether or not a prosecution would be permitted of the Royal Devon and Exeter hospital, or any other where such a hazard has been caused not only to people at work but to those who are affected by its undertaking? If such a move were excluded by Crown immunity, it is not time that the rule was changed?
§ Mrs. Currie
It is far too early to answer questions such as that, as the hon. Gentleman, who is a lawyer, knows perfectly well. Responsibility for the safety of this type of equipment both for patients and for staff lies with the Health and Safety Executive in the first instance. I have asked it to check that the guidance which says that the equipment should be checked monthly is being followed and to advise me whether any further action is necessary.
§ Miss Emma Nicholson (Torridge and Devon, West)
On Saturday, I had an opportunity to see some of my constituents, who are patients affected by the higher than anticipated doses of radiation. They have asked me to convey to the Minister their genuine confidence in the work of the consultant and the hospital technicians, and their extreme confidence that ameliorative action will be taken. Although this incident has added to their anxiety about their disease treatment, they are comfortable with the action that is now being taken.
§ Mrs. Currie
I am grateful to my hon. Friend. That is certainly the message that I have had, too. Many of the patients being cared for in this way were receiving palliative treatment—in other words, low dosages anyway—which was designed to make them more comfortable. I understand that a number of the other patients were taking part in a trial of low dosage treatment and, therefore, my anxieties are somewhat relieved.
§ Mr. Ron Leighton (Newham, North-East)
Will the Minister deal with the advisability of having a chairman for the inquiry from outside that health authority?
§ Mrs. Currie
Our procedure, which we have followed on previous occasions when there has been any cause for concern, is to ask the health authority to carry out an inquiry. In this case, the health authority has already decided to do so and we will wait to see what it proposes to do and whether any action is necessary.
§ Mr. Tony Speller (Devon, North)
I must own that the tenor of the impressions given by my hon. Friends suggests that a bucket of whitewash is adjacent already. I wish to speak for one constituent who had a course of treatment during May. At that time she was told, "No, you never get burned by this treatment." She was burned to the extent of needing in-patient treatment in the South Molton hospital. At that stage, someone should have said, "If people are not normally burned, why has this woman been burned?"
I must state that, at 2.30 this afternoon, this lady had not had any notification since the health authority discovered the problem a fortnight ago. I am glad that the press got hold of this leak some time after the authority discovered the problem. What happened was that this lady heard about the too high dosages of radiation on the radio. She then telephoned the hotline number. She was told, "If you have not heard, you are not concerned." She therefore relaxed. The next day, on the television, she saw a picture of the apparatus, which she recognised, so she telephoned again. She was told, "Yes, you are concerned." Just imagine the feeling of this poor person.
§ Mr. Speller
This is an important matter, at least to us locally. Quite frankly, the surgeon or the chap who appeared on the television gave what can only be described as a flip collection of answers, including such answers as, "Some people have asked for higher dosages because they get better quicker." There is a whiff of scandal here, which I hope we shall not try to cover up.
§ Mrs. Currie
I hear what my hon. Friend has said, and he knows me well enough to be aware that there is never any whitewash around when I am in charge of something. As I said a moment ago, it is my firm view that patients should be contacted with as much information as possible, and as soon as possible. I understand why that was not 30 done in the case of the Exeter health authority—it has been trying hard to get a proper clinical view for each patient before they are contacted. That is a reasonable thing to try to do, but in the circumstances I hope it will ensure, and indeed that we can develop procedures in future to ensure, that patients are well informed in advance.
I cannot comment further on the clinical advice that my hon. Friend's constituent was given, except to say that it is quite normal to have mild side effects from treatment of this sort. If it is to cure the cancer, it sometimes causes other damage as well.
§ Ms. Harriet Harman (Peckham)
Does the hon. Lady recognise that people are worried not just because a mistake of this nature was made, but that it remained undetected for so long? Will she ensure that all hospitals follow the good practice that is followed in some—and which is not in the regulations—which is that machines are checked on the basis of output rather than simply by calculating what the machine should be sending out? That check should be made every month and should be made by two physicists.
As the district health authority has admitted liability, will the hon. Lady ensure that compensation for suffering and anxiety is speedily assessed and paid? Will she tell the House how long ago the machine in question was installed?
§ Mrs. Currie
In connection with the last question, I cannot answer in detail, but I know that the machine has been in use for some time. lt has been in use in Exeter for a number of years. The answer to the first question is yes.
The answer to the second question is yes, and I shall simply read into the record paragraph 7.22 of the guidance which goes out with the statutory regulations. It says:A qualified and experienced radiation physicist should be made responsible for ensuring that all gamma and beta-ray apparatus is checked for correct operation and applicability of the output data in use, at least once every month".That has been the guidance for a very long time and we would expect the health authority to know about it.
In answer to the third question about compensation, I think our first job is to look after patients' health and we can concern ourselves with other issues, if necessary, later.