§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Maclean.]10.14 pm
§ Mr. Stuart Bell (Middlesbrough)
This is the first occasion that the Cleveland child abuse crisis has been brought to the Floor of the House other than through parliamentary statements and questions. I have taken the opportunity of raising the matter on an Adjournment debate because of the deep concern that my constituents feel at the turn of events following the publication of the consultants' statement in The Guardian. It is a matter of regret to me and to my constituents that once again the consultants should feel that they ought to prove their innocence on matters which have been through the courts. The motion arises out of the action of 11 paediatricians, who submitted a statement to The Guardian newspaper, among others, in which they stated:In our opinion, the majority (quite possibly 90 per cent.) of the children were abused, and the paediatricians' diagnoses were accurate to a far higher degree than the public realise.The sequence of events that led to the submission of that statement will not be time-consuming in relation to the role of the consultants within the NHS. Towards the end of last year, at a specialists' sub-committee of the Northern regional health authority, the future of Dr. Marietta Higgs was discussed. It was decided that a recommendation should be made to the regional health authority that Dr. Higgs be reinstated in Cleveland. Some of the consultant paediatricians at that meeting had come from as far away as Carlisle, let alone Cleveland. Some of the Tyneside consultants also formed part of a support group organised in the new year under the guidance of Dr. David Scott and his wife Anne. It transpired later that Dr. David Scott had worked with Dr. Higgs on a study of cot deaths, and that his wife Anne had been a former secretary to Dr. Higgs in that study.
That support group met early in February and a draft letter of support for Dr. Higgs was prepared and submitted by Dr. Nigel Speight, a consultant paediatrician at Dryburn hospital in Durham. Dr. Speight has long been an avowed supporter of Dr. Higgs. He telephoned me in her support when the crisis began, and invited himself to a television broadcast on the extent of the crisis. However, he did not give evidence to the Butler-Sloss inquiry.
In Cleveland in January, the Communist party got into the support act when it called a meeting in Middlesbrough to discuss the Cleveland child abuse crisis, although the crisis was now fading from public memory. After that meeting, addressed by another ardent supporter of Dr. Higgs, Ms. Bea Campbell, who subscribes to the view that one in four of the population are abused as children, it was decided to set up a support group similar to the one in Newcastle, again with the avowed purpose of reinstating Dr. Higgs in her old neonatological job at Middlesbrough general hospital.
The draft letter of Dr. Speight found its way to Middlesbrough and was discussed at a meeting of consultant paediatricians on 15 February. Dr. Geoffrey Wyatt, who was banned from child sexual abuse cases by the regional health authority following his involvement in the Cleveland child abuse crisis, and who accepted that ban as well as a reprimand and warning as to his future conduct, presented on an overhead projector facts and 502 figures which seemed to justify the diagnoses that he and Dr. Higgs had made at Middlesbrough general hospital. Apparently, Dr. Wyatt proposes to publish those facts and figures in an article in The Lancet. The meeting discussed the statement of Dr. Speight, made some deletions, principally in reference to police surgeons, and agreed its onward submission to the press. The purpose of the letter was contained in its last paragraph:Following the crisis in Cleveland, Doctor Higgs has been seconded to look after babies at the Princess Mary hospital, a university teaching hospital in Newcastle. We strongly support and would welcome the return of Doctor Higgs to her former post in Cleveland where she was employed with special skills for the care of sick newborn babies.Pressure on the Northern region health authority, as the employer of Dr. Higgs, has become urgent, in view of the allegation that her secondment to the Princess Mary hospital in Newcastle was about to end, and the fact that a paediatric post was about to be advertised for Cleveland by way of an advance appointment to cover the future retirement of Dr. Hilary Grant, the senior consultant paediatrician.
In any event, Dr. Higgs is still on the books as a consultant paediatrician at Middlesbrough, and her work has been carried on by locums. There were also court proceedings which I do not intend to cover tonight.
The statement was supposed to be a letter signed by all 11 consultants from Tyneside and Cleveland, but such was the haste to get it out that signatures could not be gathered. The author of the statement had already left for Khartoum. The statement was sent out by Val Hall, who turned out to be Mrs. Dr. Geoffrey Wyatt, although Dr. Hall has since said that she was merely the secretary. In fact, her role has been greater than that. Dr. Hall is also a member of the Cleveland support group, and she has been in touch with several members of Parliament, seeking their support for Dr. Higgs.
There is nothing reprehensible in any of those activities, except the deceit and dissimulation that has accompanied them in the failure to declare an interest. There was, of course, an anguished reaction by parents and children who were innocently caught up in the crisis.
It might be convenient to state the number of children who were involved. About 121 children were diagnosed as allegedly having been sexually abused. Of those 121 children, 98 were returned home by the courts. There were eight arrests but only four successful prosecutions. Two men hanged themselves in Durham gaol, and in two other cases in which the only evidence was the diagnostic technique of reflex anal dilatation, the charges were dropped. It is against that tide of the court decision that the paediatricians, in their statement to The Guardian and elsewhere, seek to swim.
Hardly surprisingly, parents and children alike, settling down about 18 months after the crisis, were traumatised by the sudden appearance of the consultants' statement which was promptly picked up and relayed throughout the media. Some children immediately asked their parents whether it meant that they had to go back to Cleveland hospitals. Mothers and children, too, had nightmares. Children were afraid to return to school on the Monday morning after the mid-term holiday, because they feared that someone would take them away. There was dread and horror that the cycle of repeated physical examinations and disclosure work was back again.
There is no new evidence available to the consultant paediatricians that was not in the hands of the Butler Sloss 503 inquiry, to the medical assessor appointed to that inquiry, or to the courts that dealt with the cases. When I called him on this specific point, the author of the letter, Dr. Nigel Speight, accepted that he had seen no medical records. The evidence that was available to the courts in relation to the 98 children was weighed carefully by High Court judges, magistrates and registrars alike, who preferred the alternative available medical evidence which concluded that the children had not been abused.
The consultant paediatricians were not entitled to bring new grief and anguish to the innocent families of Cleveland. The question for the Minister to weigh is this: how can they justify their conduct, ethically and professionally? Several of the Cleveland consultants who agreed the statements under their name are still in charge of children who were caught up in the crisis. After publication of the statement in The Guardian, many parents were encouraged to go to those consultants, and everyone who did so was assured that they were not included in the 90 per cent.
The most appropriate statement of the so-called evidence was given by Dr. Douglas Hague, the regional general manager of the health authority. On local television, he said:The precise figure will never be known partly because of the weakness of the medically recorded evidence.That weakness was revealed even by the signatories to the statement that appeared in The Guardian. Thus, Dr. Peter Morrell and Dr. Marietta Higgs examined a seven-year-old girl at Middlesbrough general hospital on 5 May 1987. They diagnosed vaginal and anal abuse, but the minutes of a case review meeting held on Friday 5 June 1987 show that Dr. Peter Morrell pointed out that there was no conclusive medical evidence of sexual abuse. It is to the credit of Dr. Peter Morrell that he changed his mind.
Dr. Nyint Oo, another signatory to the statement, along with his co-signatory, Dr. Diaz, examined three children aged five, seven and 10 who had been diagnosed by Dr. Higgs as having been sexually abused. This examination took place at 10 o'clock on the evening of Wednesday 24 June. According to the parents of the children, they were roused from their hospital beds for examination. Both Dr. Oo and Dr. Diaz disagreed with the diagnosis of Dr. Higgs, and all three children were allowed home.
Another signatory, Dr. Caroline McCowen, could not agree with Dr. Higgs' diagnoses after an examination which she made on 10 July 1987 on three children, all girls, aged 10, eight and two, and those three children were subsequently reunited by the courts with their parents.
Are these now the children whom the consultants say were being abused all along? To their credit, those consultants, along with three others in Cleveland, have since offered their apologies to the families for the distress that they had caused. It is a pity that they did not go further and retract their 90 per cent. statement, leaving that task to the regional general manager of the northern regional health authority and the Minister of State, Department of Health.
The families, however, cannot leave matters as they stand. They cannot leave their future in the hands of irresponsible statements. They have waited to hear what the Paediatric Association might have said about the letter. There has been a deafening silence. Sadly, the paediatricians—the consultants in this matter of the letter—exercised power without responsibility. Fortunately, I 504 have 21 letters in support of the parents and the children from other doctors and consultants throughout the country which rectify the balance, but the parents have seen the destruction of childhood innocence in their children by repeated medical examinations and disclosure sessions. Now they are seeing the steady destruction of what is left of their children's childhood.
Inquiries are now being made about what legal action can be taken against the consultants. I have therefore spoken on behalf of the families with a firm of solicitors, and submissions will now be prepared by the families with a view to bringing that legal action.
Thirteen families with 25 children have also begun, or are about to begin, legal proceedings for negligence and assault against those whom they hold responsible for depriving them of their children and their children of their innocence. The consultant paediatricians may feel that they can express their opinions through the press. The families will express theirs through the courts.
I have a series of questions for the Minister. As he may know, appointments to the rank of consultant are made pursuant to Statutory Instrument 1982 No. 276. Is he satisfied that the procedures for these appointments remain adequate? Equally, under present service contracts, once a consultant has a job description, it may change radically without the knowledge of the health authority as employer. Is that sensible?
A procedure has been adopted by the northern region by which all new consultants are told six months after commencing duty to ask whether their provisional timetable has changed in practice. Should that procedure be adopted throughout the country? Consultants may also, in accordance with a Government circular, be considered in a disciplinary framework by their employing authority where there is concern about them in any of four main areas—professional competence, professional conduct, personal conduct and contractual commitments. Were the consultants, in signing their statement to The Guardian, in breach of discipline in relation to their contract of service?
The Government circular to which I refer is HM(61)(112), which sets out the formal disciplinary action open to an employing authority when allegations have been made which involve professional incompetence or professional misconduct. Has the chairman of the Northern regional health authority looked at the statement in the press as a breach of discipline?
The evidence of Mr. Liam Donaldson, the regional medical officer to the Northern region at the Butler-Sloss inquiry was:There is currently considerable dissatisfaction on the part of the many employing authorities that this is the only formal mechanism in existence for serious disciplinary action against consultant medical staff in respect of professional incompetence or misconduct. It is lengthy, extremely expensive, highly legalistic, the burden of proof required is much higher than with disciplinary procedures involving other grades of staff and as a result it is seldom used.Can the Minister state whether he believes that this is satisfactory for a disciplinary procedure within the Health Service dealing with consultants?
Mr. Donaldson also said that the lack of a formal procedure for matters which, although serious, are not serious enough to result in dismissal, has led to national discussions between the profession, the DSS and the NHS to try to resolve this matter. Where are these discussions? What stage have they reached? What progresss has been 505 made in making consultants more accountable to their employers? Do they have an automatic right of appeal to the Secretary of State upon dismissal? If so, is it right?
Am Ito understand that a warning that was given to the consultants who signed the statement by Sir Bernard Tomlinson, the chairman of the regional health authority, falls within the disciplinary framework?
§ Mr. Richard Holt (Langbaurgh)
My constituents, who live in the south of Middlesbrough, wish to be entirely associated with the remarks of the hon. Member for Middlesbrough (Mr. Bell). When investigating the conditions of consultants, I was amazed to find that they have an automatic right of appeal, and that thereafter no action is taken against any consultant until he reaches retirement age. I was given to understand that the longest period that anyone has been in that position is 17 years.
§ Mr. Bell
I am grateful for the hon. Member's intervention. He and I have our political differences, but both of us have accepted that it was not a political problem that divided us. This has united our constituents. Throughout the crisis in Cleveland the hon. Gentleman has been a steadfast supporter. It should be placed on record that he has steadfastly looked after those constituents who came to him with their problems.
My other question for the Minister concerns the Northern regional health authority, among others, being the employer of the consultants. What was clear in the Cleveland child abuse crisis was the distance between the consultants who were employed by the region and the district authority. It appears that the district authority had no control over the consultants, other than to provide hospital accommodation and facilities, and patients through the local health service. It seemed to me, and to others, that a great gulf was created because of that lack of accountability and remoteness from the health authority where they worked. It seemed appropriate to me that it might be better if they were employed in future within the local service and be responsive to the health district.
It has struck all concerned in the matter that we render homage, in a sense, to consultants within the Health Service for their work, and we respect the norms within which they work, and their efforts, but there must be accountability, as there is for the rest of us. The statement to The Guardian went far beyond what consultants ought to have said. At least five of those consultants had no knowledge of events in Cleveland. One of them who signed the statement had come to the area only a year before, and had no personal knowledge of the situation. The other six had personal knowledge from their files, and were going far beyond their duty as consultants in revealing what was in those files.
I shall be most grateful to the Minister for any response that he can give me.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)
I congratulate the hon. Member for Middlesbrough (Mr. Bell) on being successful in the selection for the Adjournment debate and on the clarity and forcefulness with which he has presented his case to the House. I will try to answer all his questions in the time 506 available. If I do not cover them all, I assure him that I and officials in the Department of Health will study the record of the debate and, if necessary, I will write to him.
I also welcome the intervention of my hon. Friend the Member for Langbaurgh (Mr. Holt). I know of his deep concern on behalf of his constituents in the case being debated. I also welcome my predecessor, my hon. Friend the Member for Derbyshire, South (Mrs. Currie). I know of her lasting and great concern about the events that happened in Cleveland. Her presence is clear evidence of her continuing interest.
I agree with the hon. Member for Middlesbrough that the whole business is a sorry, depressing and tragic tale, not least for the children. In a sense it is a tragedy that there should still be uncertainty and concern in the north-east about the events that occurred some time ago.
Since the subject of our debate is the role of consultants in the National Health Service, it may be helpful if I say a little about their rights and their responsibilities; rights and responsibilities are, of course, closely linked.
Consultants are the main senior medical staff of the hospital service, and they have individually a very considerable degree of clinical autonomy. Each consultant who sees patients is responsible for the clinical care of those people, adults or children. Consultants alone are responsible for their clinical decisions. But as members of the medical profession they are guided by the standards set by their profession. They do, of course, work within a contract with their employing authority, which may include a job description.
Consultants are responsible for the resources they use, and the Government are taking steps, such as the resources management initiative, to ensure they have the information they need. One such experiment is taking place at the Freeman hospital in Newcastle. The medical profession has taken its own initiatives in developing medical audit, that is the systematic, critical analysis of the quality of medical care. In the recent White Paper on the National Health Service we have welcomed these initiatives and set out our proposal to extend medical audit throughout the Health Service.
In answer to the hon. Gentleman's first question, let me say that consultants are entitled, under the nationally agreed terms and conditions of hospital medical staff, to publish books and articles and write letters to the press and to deliver lectures and speeches without the prior consent of their employing authority. As always, however, the right to speak out must be balanced by responsibility for the consequences of what is said.
I hope that the 11 consultant paediatricians in Cleveland gave adequate consideration to that responsibility before deciding to write to The Guardian as they did. The events of the crisis in Cleveland, so well documented by Lord Justice Butler-Sloss, seriously damaged public confidence in the paediatric and child protection services in Cleveland. Much good work has been done since to re-establish faith in the quality and sensitivity of those services, and I can only regret anything which might serve to undermine that.
There are, of course, limits to the freedom of action of consultants. Naturally, I cannot make specific comment on the particular consultants mentioned by the hon. Gentleman. He will realise and understand that the whole question of disciplinary action in individual cases is a matter for the employing authority. The Department of Health does not employ consultants it is regional health 507 authorities, designated teaching district health authorities and special health authorities who are the employers. It is for them to determine what course of action to follow, taking account of published depart-mental guidance and the prescribed terms and conditions of service of senior hospital medical and dental staff.
In broad terms, disciplinary proceedings may be initiated for reasons of personal misconduct, professional misconduct or professional incompetence. Under the terms and conditions of service of senior hospital medical and dental staff, there is, as my hon. Friend the Member for Langhaurgh indicated, a right of appeal to the Secretary of State against a decision of the employing authority to dismiss.
Any proceedings relating to the subject of this debate are the responsibility of the Northern regional health authority. However, I can tell the House that the chairman of the NRHA deplored the intervention by the 11 consultants when he issued a statement on 23 February. Further, I understand that the regional general manager and regional medical officer have between them spoken to most of the consultants individually and reminded them of their wider responsibilities not to undermine public confidence in paediatric services.
In 1987, a working party was set up with representatives of the Health Departments, the NHS and the professions to recommend possible improvements in disciplinary procedures. The White Paper "Working for Patients" and the subsequent working paper on consultants indicated our intention to open negotiations with the profession on the basis of proposals contained in the report of the joint working party. The changes should result in improved procedures which will, for example, enable cases to be dealt with more quickly, benefiting both the health authority and the doctor concerned.
The hon. Member for Middlesbrough raised questions about how contracts were held and about the relative roles of districts and regions. As he knows, the contracts for most of the consultants who signed the letter to The Guardian are, I understand, held by the regions—as are most consultants' contracts, even though the consultants are employed by, and work in, individual health districts.
As is evident from the White Paper, we do not propose that contracts should be held other than by the regions. However, we propose two important reforms. First, the district health authority will play a far greater role in deciding who is appointed and which job is to be filled. 508 Secondly, we intend that the consultants' job description should be prepared with the full co-operation and involvement of the district health authority and should be regularly reviewed.
Therefore, the hon. Gentleman and my hon. Friends will appreciate that we propose a fundamental change in the way that consultants work in the Health Service. Although their contracts will still be legally held in the region, they will be managed by the district health authorities.
The hon. Gentleman referred to the claim by some consultant paediatricians in the north-east that "in their opinion" a majority, possibly over 90 per cent., of the children were abused. I re-read parts of her report this afternoon, and Lord Justice Butler-Sloss, after a thorough and detailed inquiry, did not reach conclusions on this matter, I think for good reasons.
Child sexual abuse presents great difficulties in identification and diagnosis. Particularly when it takes place within families—and unpalatable though it is, we have to recognise that it does happen within families—it is surrounded by secrecy and deception. Often the physical signs are ambiguous or non-existent. Cases where the investigating agencies are confident abuse has occurred may not be taken to court, because the perpetrator cannot be identified, or because the uncorroborated evidence of child witnesses is unlikely to secure a conviction in criminal proceedings.
It was always unlikely that a definitive verdict on each of the Cleveland cases could ever be reached, and it is clearly impossible now. Continual debate over numbers is likely to prove fruitless. May I further comment on the consultants' statement that they believed, to quote from The Guardianthat some genuinely abused children have been wrongly returned home by the Courts".I regret this criticism of matters appropriately dealt with by the courts.
I share with Lord Justice Butler-Sloss the hope that the troubles of 1987 will recede for all those concerned with the protection of children in Cleveland, and that they will work together to tackle the exacting task of helping children who are subject to sexual abuse to the lasting benefit of the children, the families and their community.
§ Question put and agreed to.
§ Adjourned accordingly at seventeen minutes to Eleven o'clock.