HC Deb 16 January 1990 vol 165 cc265-72

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

11.8 pm

Mr. Tony Speller (Devon, North)

I have sought this opportunity to raise the matter of compensation arrangements for patients damaged by radiation overdoses at the Royal Devon and Exeter hospital in Exeter. That hospital looks after the radiation side of treatment for people in my constituency of Devon, North and a further five constituencies in the south-west of England.

Since the problem arose, several questions have been asked in the House and several comments and statements made, of which the most apposite was that made by the then Under-Secretary, my hon. Friend the Member for Derbyshire, South (Mrs. Currie), two years ago. She said that Exeter health authority intends to deal with claims as expeditiously as possible in a way which will cause as little distress to patients and their families as the circumstances will allow. The Authority has instructed its solicitors to reflect this desire."—[Official Report, 13 December 1988; Vol. 143, c. 753.]

That was two years ago, and time passes. It passes quickly in this place, but it passes slowly on a sick-bed. Recently, I asked my hon. Friend the Minister of State what had happened about claims for excessive dosages of radiation. I wanted to know how many had been settled, what ranges of payments had been made, and how many cases remained to be settled. I also asked whether the Minister would list how many settlements had been made. What was the highest? What was the lowest? Finally, I asked the Minister to list the number of payments that were made to staff who were sacked. Of course, two of the staff were actually sacked for negligence or professional misconduct.

Sadly, my hon. Friend the Minister of State, answering all those questions, which were of great importance to my constituents and to my colleagues in the area, said that all those matters were for Exeter health authority as far as they affected patients or their representatives. The two physicists who were dismissed received severance payments. Those details are confidential to the parties concerned.

The Minister of State told me, "Don't ask the Minister, ask the health authority." The health authority, which has been in correspondence with my hon. Friend the Member for Honiton (Sir P. Emery), keeps saying, "Everything is confidential." There comes a time when we must take confidentiality by the scruff of the neck and ask, "Is this merely a smokescreen? Is confidentiality merely the excuse for obscurity—the excuse for no action?"

The history of this sad case in Exeter is straightforward. In February two years ago—23 months ago from now, to be exact—a new radioactive cobalt source was fitted and calibrated to one of the machines used to treat patients who have problems or expected problems with cancer. The machine was calibrated with a 25 per cent. excess in the dosage. Every person who received treatment received 25 per cent. radioactivity over and above the basic dose.

There is no secret about that, except that it happened in February. Nobody checked that the equipment had been properly calibrated. It does not say very much for the physicists—they have gone with severance payments. It says very little, for the administration—quite a few of them have gone elsewhere without penalty. It says very little frankly, for the consultants or the doctors who treated patients who had been damaged, and damaged over a period of five months.

It came to pass that, in July 1988, after five months, he machine was rechecked. It should have been checked months before, but it was not. No one was penalised, except the poor patients. But then, of course, they trusted our Health Service, the consultant, the person who administered the treatment, and the nurses. Several of them spoke to the nurses and said, "I was told that it would not hurt, but it hurts. I was told that it would not burn, but it burns." One of my constituents was burnt through the breast into the back and was given, gratis, a bottle of calamine lotion and told to apply that. That does not reflect tremendously well on the quality of the care administered in that place.

Patients complained to the nurses, and some of the nurses mentioned it to the doctors, but their complaints never reached a consultant. According to the Thwaites report, not one consultant was aware of the damage done and not one consultant was aware of the complaints. I do not know why the medical hierarchy is so scared of consultants—one never speaks to them. My constituents and others were damaged for life, their life expectancy was shortened, and no one paid any attention to their complaints or queries. It is the old business—the expert knows best.

In July when the calibration was rechecked, the 25 per cent. mistake was not found, but thank God—I say that sincerely—on 12 July 1988, Exeter health authority agreed to enter into some form of national check on the equipment in use. That special check—not the routine checks, because there was none, and not a random check after five months—found the fault.

What happened then? The brief answer is, nothing. There was clearly a "fox in the henhouse" in that organisation, but the patients and the Members of Parliament knew nothing. No one was told anything for some time. Then a nurse—I do not know her name—got in touch with a national newspaper, asking whether it knew about what had happened. The paper did not know, but checked with a local reporter on the Exeter Express and Echo, who checked with me. I had not heard about it. The long and the short of it was that when the paper telephoned the hospital and said, "We're going to break this story," all of a sudden a press report was issued and a meeting held—all with such speed that all my constituents, and those of other hon. Members, also learned from local radio and television that they might have been terminally damaged.

But even then the matter was not taken as seriously as it should have been. It was a case of, "Oh well, it is an overdose, but don't worry. It'll be all right." One of my constituents was told, "Don't worry, my dear, your name isn't on the list," but she recognised on television the piece of apparatus on which she had been checked. She said, "That is the piece," and was told, "Oh yes, you are on the list." Just imagine—a young woman who is in the depths of despair is told, "You aren't on the list of those damaged,"—thank heavens, happiness—but she sees the very machine on television. What sheer inefficiency.

The then Minister, my hon. Friend the Member for Derbyshire, South was very straight and said, "Yes, there has been a mistake. Yes, the Health Service—us—is at fault. Yes, we accept our responsibility and yes, restitution will be made." At that stage, all of us thought that something would happen swiftly.

In fact, two men were sacked. They were sacked because their machine had overdosed and because it had not been checked, but was found wanting after someone else had checked it. They were sacked, but they were paid in compensation sums that I cannot discover. The Minister says, "Ask the health authority," but the health authority says, "It's confidential." Although it is public money, the amounts are confidential. Rumour has it—I say no more than that—that one of the men received about £50,000 and the other about £40,000. They will not tell us, so I cannot prove it. I hope that my hon. Friend the Minister will tell us, because those figures put into pretty shabby perspective some of the offers made to my constituents.

The employees were not prosecuted and as far as I know, they were not disciplined. They work elsewhere, but no restitution has been made to those affected, except good money to those two men as restitution for being sacked. In the businesses in which I have been involved, if one is sacked, one leaves, but not with a lot of money.

Although I speak basically of my constituents, the picture is larger. The health authority identified 217 people who were treated during the period of overdosing, of whom, as at the end of last week, 121 are dead; and 96 remain. I do not deny for a second that many of those people were terminally ill, and no one is suggesting for a moment that there has been some vast killing. That is not the case, but none the less, folk were damaged. Professor Joslin, the specialist brought in by the health authority, says that about 33 people are at no risk at all, so we are down to about 60 people.

The problem is always that there is confusion. We cannot find the details. All that we can tell is that the health authority hopes to pay out what it calls PSA claims—which stands for pain and suffering allowances. It is now two years since that pain and suffering was inflicted, but the health authority only hopes to have the claims finalised by April. The pain and suffering is not finalised, but I repeat that the health authority hopes that the claims may be. The health authority admits liability. Indeed, in answer to a question in the House, I was told that insurance was not needed because the funds had been found from the authority's own resources.

Perhaps therein lies the core of the problem, because a pattern is apparent to me. There is a great dragging of feet in paying these poor people, although there is no doubt about liability. It is not like settling a claim for a car crash when, if one side has not filled in the form, its company will not pay out the loss. Indeed, my hon. Friend the Member for Honiton suggested way back in December last year that we should talk about some form of independent panel or assessor to put zip into the process. There is no zip whatever in the health authority.

It is not difficult to argue about why a claim cannot be paid. It is the old Catch 22. The health authority says, "Until you make a claim, we cannot pay you." The people who have been damaged and their lawyers say, "We cannot make a claim until we obtain the medical details that you hold. You who injured us hold the records that prove how much you injured us." The position changes as the weeks and months progress. The effects of radiation on a body that is perhaps already damaged inevitably change. We cannot expect the position to be static. That is why I appeal to the Minister to provide for an instant payment. I do not care how it is worked out. Perhaps there should be three bands of payment, which will not be a final payment.

Today I was talking to lawyers from the United States of America. I described the case of my constituent who was burnt through the breast to the back. I asked what damages they would seek. They said that they would not seek tens of millions, but certainly they would seek millions. I understand that the tacit verbal offers going around are about £5,000 for the blighting of a human life and for the people who can no longer work. If that is true and if no one has been punished, it is a disgrace to us all.

There were 217 injuries. Fewer than 100 of those people survive. How many settlements have been made in the 18 months that have passed since the problem first became known? Fewer than 10 settlements have been made. Some people have died. Of my eight constituents who were involved, five are dead. Perhaps their widows or families will be compensated, but that is no consolation to the person who has gone or to the family. The money is needed now. That is why I appeal to the Minister to think of some form of payment that can be made now. He might create three bands of payment. I am not an accountant, but perhaps they can be payments of £5,000, £10,000 and £20,000. The final payment will be much higher, but for goodness' sake, let us, as a nation and as a Health Service, pay something to those people now.

A claimant taking us through the courts would probably finish up with a six-figure payment. If, as I suspect, the men sacked for inefficiency were given £50,000, it will be hard to deny the person damaged twice that sum.

I conclude by saying that the compensation paid instantly was to those who moved from their jobs. It is strange and unreasonable that those who were sacked took the money with them but those who were injured are still waiting. Some payment must be made to those who were injured. We are talking about £1,000 here and £5,000 there. I do not say for a second that my hon. Friend the Minister and the health authority do not accept the problem. The problem is that they will not expedite it. The wheels of the law grind almost as slowly as the wheels of medicine.

I have spoken to the lawyers who represent my constituents. They say that they are doing what they can, but that they are waiting for papers from the health authority. The health authority says that it would like to pay, but that it is waiting for the claims. No paper, no claim. No claim, no paper. That is the top and the bottom of the argument.

Somewhere along the line, we the Government, not the health authority, must take the bull by the horns and do something to help the people injured who still live—we hope, healthily. Some are women who are young by my standards, healthy, strong, able and determined. They are not likely to die, praise God, but they are likely to be damaged. They are not likely to have to leave work but they may never work as they did. Their career and family opportunities have been damaged by us and by our Health Service. It is not fair that we the Government, who care for our people and our constituents, should allow the health authority to get away, almost literally, with murder.

11.23 pm
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

My hon. Friend the Member for Devon, North (Mr. Speller) has once again done a great service to his constituents by securing this Adjournment debate supported by my hon. Friend the Member for Honiton (Sir P. Emery) who also has a great constituency interest in the matter. The matter has been of continuing concern to him and to other hon. Members in neighbouring constituencies.

I am aware of my hon. Friend's concern that everything possible should be done to speed up the negotiations between Exeter health authority and the patients or their representatives in securing agreed compensation payments. However, as the House will appreciate, it is a matter of great sensitivity and confidentiality, and not one in which I or my Department are directly involved, although we are indirectly involved.

Negotiations are taking place on the wake of this most regrettable incident in the radiotherapy department of the Royal Devon and Exeter hospital early in 1988, on which my predecessor answered questions in the House in July of that year. The incident led to the accidental overdosing of 207 patients undergoing radiation treatment. The circumstances surrounding the incident were investigated by an independent panel of inquiry led by Professor Sir Bryan Thwaites, who subsequently reported to the health authority in December 1988 with 21 recommendations, all of which are being implemented by the health authority.

I hope that my hon. Friends have seen that report. The preface to that report is signed by the chairman of the Exeter health authority. It is dated 6 December 1988 and in it he says: 1 wish to express my deepest sympathy to everyone affected and to record here my lasting regret that an incident such as this ever occurred. Unfortunately, what these reports"— he is referring to the reports of a committee of inquiry— or indeed, any inquiry into such a regrettable incident, cannot do is to lessen the anguish which has been experienced by the patients and families who discovered that they were involved. I am sure that my hon. Friends would associate themselves with those remarks.

Following the incident, the health authority acknowledged that the overdosing had been caused by negligence on the part of its employees failing to calibrate the equipment properly, and invited every patient affected, or their executors, to make a claim against the authority.

My hon. Friend touched upon the severance payments of the two physicists involved. They were payments consequent upon their dismissal for negligence over the affair. There are no legal suits against the health authority and no legal prosecution was considered possible against the two individuals involved.

As I have explained previously, the severance payments involved are confidential to the parties involved, but I am advised that it is speculation that the sums involved were of the order of £40,000. I can tell my hon. Friend that the figure that he mentioned is greatly over-estimated. I understand how my hon. Friend feels about those payments but they were to avoid any prolonged appeal process which would have prevented the posts being refilled as soon as possible. It was a simple matter of priorities, and the continuing care and safety of the patients came first.

At national level, the Standing Medical Advisory Committee's sub-committee on cancer subsequently set up a sub-committee on quality assurance in radiotherapy which is hoping to report by the end of the year. My predecessor also wrote to regional chairmen on the sensitive handling of untoward incidents in the best interests of patients, following the lessons learned at Exeter.

In addition to the Thwaites report, from which I have quoted, a confidential medical risk assessment for the health authority was carried out by Professor Charles Joslin of Leeds university on each of the patients affected, initially through the medical records of the patients concerned. That assessment has formed the basis of the health authority's early work on the claims.

Of the 207 patients originally affected, I am sorry to say that 121 have since died, but not, I hasten to add, necessarily earlier than they would have done had they not received the overdose. The House will realise that they were all suffering from cancer. Of the 86 survivors, 35 are thought to be at insignificant risk from the overdose, in the main because only a small part of their treatment was given on the miscalibrated machine.

I understand that the position at the beginning of this year was that there had been claims from a total of 103 patients to date, of which 95 were still to reach final settlement. However, a variety of payments to 65 claimants have so far been made. The number of claimants who have had their claim finalised and to whom a full agreed payment has been made is eight. A further seven claims have been met in settlement of pain, suffering and loss of amenity". Interim payments have been made to 50 other eligible claimants, and the total so far paid out is more than £400,000 in varying amounts according to the degree of physical harm judged to have been done by the radiation overdose.

Thirty-three of the remaining 38 claims where no payment has yet been made—including one claim which was subsequently withdrawn—were on behalf of patients assessed to be at insignificant risk. A further five claims are in respect of deceased patients assessed to have been in a low risk category, which are still under consideration and in respect of which no payments have yet been made.

My hon. Friend will, I am sure, appreciate that settlements are bound to take a little time even though the claims are not being pursued in the courts. Legal representatives of the patients have to decide whether to advise pressing for early settlement or to delay pursuing a claim until the client's medical condition is clearer. This has to be entirely a matter between the patients and their legal advisers. Some effects may be long term, while others may be short-lived. Meanwhile, the health authority stands ready to register any further claims and pursue them with all diligence.

While the health authority is willing to do all that it can to expedite matters, it nevertheless has a duty to be fair and scrupulous in weighing claims, since it has a duty to the taxpayer as well as to the claimants. The nub of the issue is to determine the amount of damage caused by the excess radiation, since radiation treatment itself is intended to be damaging to cancerous cells, but inevitably there is peripheral damage to health tissue, and a great deal of painstaking work has gone into that.

In claims of this kind, there are two kinds of damages. The first is for pain, suffering and loss of amenity; and the second is for special damages to cover such things as the need for domestic help, taxis, dressings and so on. It is the former that will usually be the larger amount and the subject of considerable debate. Those special damages—the second class to which I referred—can be derived from medical evidence, actual costs incurred and life expectancy tables. It is clear that some legal advisers are, perfectly legitimately, holding back on the second issue until they are fully clear about the implications for their clients.

The health authority has therefore, with the full agreement of the solicitor who is co-ordinating the claims, separated the two sets of damages in order to speed things up. Meetings are being held with legal representatives of both sides to settle at least the pain, suffering and loss of amenity claims as quickly as possible, and the health authority is anxious that all those claims can be settled by the end of April.

Mr. Speller

Will all claims be settled or just those for pain, suffering and loss of amenity?

Mr. Freeman

If I may finish the paragraph, I shall be happy to answer that point.

If the claims are not settled, it will not be from want of will on the part of the health authority.

My hon. Friend asked whether all the claims would be settled or just those in the pain, suffering and loss of amenity category. I cannot give him an assurance that all claims in the second, so-called special damages, category will be settled within that timetable. That is partly because, as I have said, I understand that for perfectly legitimate and reasonable grounds the advisors acting for the patients involved wish to assess various other factors. Therefore, I am advised that the authority is not in a position to estimate whether that second category of claims can be settled by the end of April. As to the second category of damages, on which I am not in possession of comprehensive advice tonight, I shall write to my hon. Friends the Members for Devon, North and for Honiton, with an estimate of the timetable for settlement of the claims.

Sir Peter Emery (Honiton)

I thank my hon. Friends the Minister and the Member for Devon, North (Mr. Speller) for allowing me to intervene. Everyone is concerned about the excessive length of time involved. I made the suggestion to a previous Health Minister and to the health authority's chairman that there should have been established immediately a panel comprising a leading Queen's counsel or judge concerned specifically with compensation, a specialist—someone of the calibre of Mr. Joslin—in cancer, and an insurance specialist concerned specifically with the aspect of compensation for medical accidents.

My proposal was that such a tribunal should quickly review every case and make a recommendation for compensation. No legal rights would be taken away from the individual, and if he or she then wanted to continue with the legal process that had already been under way for some considerable time, they would be at liberty to do so.

Had that been done, many of the claimants would have received money before they died and have enjoyed the mental benefit of being free from anxiety. The health authority's chairman is concerned because many of those involved are worried about the publicity that their own cases have attracted.

Will my hon. Friend the Minister consider using a mechanism such as I have described to achieve a settlement on any appropriate occasion in future? I feel sure that my hon. Friends the Minister and the Member for Devon, North, and Mr. Murray French, Exeter health authority's chairman, want to do whatever they can to help the patients concerned.

I should like my hon. Friend the Minister to reveal that he has said privately to me, and to publicise from the Floor of the House tonight the fact that any person in the queue who is concerned at the delay, and believes it to be the fault of the health authority, should contact him personally.

Both he and I believe that much of the delay has been woven by the lawyers. I am sorry to have to say that, but while certain of the lawyers have stated that they have been working for nothing, I hope that their fees will amount to no more than 10 per cent. of the value of the settlements—so that they are seen to live up to their word. Leaving that to one side, can my hon. Friend the Minister see his way to finding a solution more quickly?

Mr. Freeman

In the one minute remaining to me, I give my hon. Friends two assurances. I am advised that there is no dilatoriness on the part of the health authority and that the matter is one for resolution between it, its patients, and their legal representatives. I share the concerns expressed by my hon. Friend the Member for Honiton. I take a close interest in the matter, and I will make further inquiries and write to both my hon. Friends if I can add anything further to tonight's brief debate.

Question put and agreed to.

House adjourned accordingly at twenty-two minutes to Twelve midnight.