§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Patnick]10.15 pm
§ Mr. John Carlisle (Luton, North)
I am grateful to you, Mr. Speaker, for giving me the opportunity to raise this matter on the Floor of the House. I wish to raise the case of Mr. Derek Brown, a constituent of mine, and the problems that he has had since a heart bypass operation in March 1988. This debate has become necessary because certain facts need to be given a public airing. Hopefully, my hon. Friend the Minister will listen with interest to a case of which I know that he has some prior knowledge. Hopefully some good may come out of this sorry saga, which I must necessarily relate to the House this evening.
The unnecessary delays after my constituent's operation, the alleged negligence on the part of some of the staff, the misinterpretation of certain facts which were before the staff after Mr. Brown's operation and the delayed diagnosis now mean that my constituent finds himself unemployed. He had a very reasonable job. His character has become irrational and he suffers from loss of memory. He is unable to walk any distance. He needs a wheelchair so that his wife can take him to the shops. He is unable to pursue his favourite pastime, the leisure of walking. He is in constant pain daily and hourly and has to take a large number of drugs. He cannot take a bath without extreme discomfort.
Sadly, because he has been prudent enough to save money and put it aside for his family and has his own home, he cannot qualify for legal aid, or, indeed, any form of social benefit. He cannot afford the alternative treatments that could be available to him, such as acupuncture, because his resources are limited.
Throughout the sorry saga, Mr. Brown has been sustained and supported by his loving wife and his daughter Susan during a time which has been extremely difficult for the family. I hope that my hon. Friend the Minister realises the importance and gravity of the case, which leads me to bring it to the attention of the House tonight.
It may be of some use if I relate as briefly as possible the sorry saga of the operation and what occurred afterwards. The words of Mrs. Brown in a letter which she wrote to Mr. Plant, the chief executive of Brompton hospital, will give the House some idea of the type of malady that my constituent has suffered. She said in November 1988 of her husband Derek:After attending as an out-patient for approximately eighteen months he was advised by Dr. Honey that a bypass operation would give him a better quality of life. After a four month wait he was admitted in mid February 1988 and the operation was performed by Mr. Lennox on Wednesday 17 February 1988.When I first saw my husband straight after the operation in Intensive Care, his condition gave me cause for concern. Although unable to talk he indicated for a pencil and paper and wrote that he had a very bad pain from the waist down. The nurse said it was just cramp and rubbing his legs would ease it. I rubbed his legs for at least an hour but he was still in pain so they informed a nearby doctor who agreed it was just cramp.He was then transferred to the High Dependancy Unit and by Thursday morning the pain had increased further. I was becoming concerned and expressed this to the doctor who still insisted that the pain was due to cramp; however I felt it had 250 to be more than cramp as he was not a person to complain. He was then put on Omnipon but the pain still persisted. By the time Mr. Lennox"—the consultant surgeon—came to examine Derek, the pain was intense, also there was loss of feeling in both legs. I insisted on talking to Mr. Lennox as he left the ward who said that everything possible was being done; it was a case of resting and waiting. On Friday he was taken down for a CT scan and I was eventually informed by the registrar that the scan revealed that the aorta was torn, he said it had torn when they clamped during his by-pass operation. They later informed me that a consultant from St. Stephen's hospital was coming to see Derek that day. I waited until 10.40 pm but he had still not arrived and no one had the courtesy to explain his absence. Months later I discovered that his visit had been cancelled when the scan results were known.On Saturday I was told that Derek might be transferred to Charing Cross hospital at some point. I then asked why this could not be done immediately and was told that it was a case of waiting; for what I do not know.At 3 am on Sunday, 21 February, a telephone call to my room informed me that Derek was being transferred to Charing Cross straight away. When I arrived at the ward minutes later I was met with the horrifying sight of my husband in absolute agony, held down by the ward sister and two nurses. The bottom half of his body was a terrible colour, completely starved of blood and there was no doctor in attendance. Derek begged me to get someone to relieve his pain but according to the sister the maximum dosage of omnipon had been administered. After a nightmare journey by ambulance the staff of Charing Cross hospital were waiting to receive him. A CT scan and x-rays revealed blood clots everywhere. Operations were then performed to remove these and I was informed that the situation was very serious and in fact my husband may have to have both legs amputated in order to save his life. Thanks to the skill and dedication of the team led by Professor Greenhaugh this measure was not necessary.However, two days later Professor Greenhaugh said that he was pleased with the right leg but that the left leg was causing concern and would require a further operation. This would have to be done without a general anaesthetic and Derek's agreement. At this point I was told that, should the operation prove unsuccessful, the left leg would have to be amputated. Once again the skill of the surgeon, Mr. Lane, saved the leg.Many other things caused great concern during the time he was in the High Dependency Unit, including renal kidney failure, liver problems, a very low blood platelet count which necessitated two sessions on a dialysis machine. On one occasion Derek went completely out of his mind, he ripped all his drips out and tore off all his dressings which were over open wounds. He sat on a chair all day with blood running down his legs, refusing to have anyone come near him. The doctors tried to assure me that this was temporary and that this was the result of the physical and mental stress which Derek had suffered. However later that day the doctor became worried and Derek was taken for a brian scan which fortunately was clear. During the night, he thankfully reverted to his normal self. One by one most of these problems were overcome. Derck was finally transferred to a general ward where he made further progress although still in pain.After that he returned to Luton and Dunstable hospital, was treated in the pain unit and since has had treatment at Stoke Mandeville hospital. As I said earlier, he still suffers minute by minute from a pain that I believe was partly caused by the unnecessary delays that occurred after his operation.
After the operation Mrs. Brown was naturally very anxious and had an interview with Mr. Lennox, the consultant surgeon, which lasted two and a half hours. Mr. Lennox said that he did not know what had happened to his patient at Charing Cross hospital a matter of hours after he had seen him at Brompton hospital. Mrs. Brown said that it was a most unhappy interview. Following that my constituent, Mrs. Brown, had several months of 251 correspondence with certain people, including Mrs. Hardy of Brompton hospital, Mr. Geffen, the consultant in public health medicine in North West Thames authority, Mr. Plant, the chief executive, and others. At all times all that she received was sympathy and some sort of understanding, but never an explanation of exactly what had happened to her husband.
She called on me as her Member of Parliament and together we went to see a Dr. Braithwaite at Brompton hospital who was extremely helpful and explained to us exactly what had happened after the operation. Mrs. Brown also applied to the health commissioner for some assistance, but was told that Mr. Brown's case did not fit the aegis and responsibility of the commissioner. At the same time she went to Action for Victims of Medical Assistance, and although it offered some help, it was seemingly unable to offer anything more than sympathy.
That result meant that I and certainly my constituent, Mrs. Brown, and her daughter felt that the matter should be aired and that a further review should take place. So we started to press for a clinical review. I regret to say that our efforts were thwarted at certain times by certain officials, who tried to make out that, were a review to take place, my constituents would not be able to take the matter to litigation should they choose to do so. I sought the help of my hon. Friend the Member for Kettering (Mr. Freeman), the present Minister's predecessor, and he was extremely helpful. Indeed, the present Minister too has been very helpful. It was confirmed that if my constituents wished to have a clinical review they could have one, and that it would not affect litigation—a course that was still in their minds.
The clinical review took place on 17 December. I was present, together with Mrs. Brown and her daughter Susan. A promise was made at that time that the result would be made known to me and to my constituents by the end of the month. On 21 January I was informed that the results would take a few more weeks. Time was beginning to run out for the Browns. If they were to mount any form of litigation, they would have to decide before 1 March whether to issue a writ against the hospital. I suspect that there may have been in the minds of those in authority, either at North West Thames or at the Brompton, that the time for litigation was beginning to run out. In those circumstances, they might have avoided that action.
The results of the review were given in confidence to myself and my constituents, but as this is a matter about which the House should hear, I make no apology for revealing some of that information now. Basically, the review concluded that the clinical management during the operation was satisfactory. With that, my constituents and I do not argue. However, the review criticised the long delay between the Wednesday on which the fateful operation was performed and the Sunday morning when Mr. Brown was finally taken to Charing Cross hospital. The review report says that the process took very much longer than was necessary. I believe that it took very much longer than was necessary to diagnose the condition from which my constituent was obviously suffering. Blood could not reach his legs, and the poor man was in the most terrible pain. It is a fact that the nurses and other members of staff fobbed Mrs. Brown off with the story that the problem was cramp. But the hospital should have known that that condition is very rare after an operation such as this one. I believe that, with hindsight, the diagnosis was understood to be wrong.
252 Throughout this time, Mr. Lennox, the consultant, was a somewhat shadowy figure. Indeed, the review report, quite rightly, levels some criticism at him for the way he acted in this case. For example, he did not himself perform the operation; it was performed by Mr. Livesey, the registrar. Only when the review had been concluded—after three years—did my constituents find out that Mr. Lennox had not taken part in the operation, although he had virtually given them the impression that he had operated. The report says that he did not remember whether he had seen the patient at any stage prior to the operation. Obviously his memory is not one of his greatest assets. The report criticises him for having said that his routine was always to be in the operating suite but that he could not remember for certain whether he was there at the time of Mr. Brown's operation. So this high-ranking consultant surgeon could not remember whether he was in attendance.
After the operation he said that he did not see the patient until the second day, by which time, of course, Mr. Brown was in the most terrible agony. So far as Mrs. Brown was concerned, Mr. Lennox was in charge of the operation, but her attempts to talk to him were in vain. Only on the occasion of one of her visits, when a sister ran after Mr. Lennox and asked—virtually begged—him to come back and talk to Mrs. Brown, did she finally get round to speak to the man who obviously was responsible for the operation on her husband.
The report and the events that have been described to me by my constituents give me some suspicion that Mr. Lennox displayed enormous arrogance, was totally uncommunicative to Mr. and Mrs. Brown and, sadly, showed an uncaring attitude to the case.
Two lines of redress are open to my constituents. First, there is litigation. On my advice, my constituents have issued a writ against the Brompton hospital in order to keep within time. However, I know that that is not within my hon. Friend's responsibility and you, Mr. Speaker, would be right to pull me up on that. The other line that is open to my constituents is some form of compensation by the special health authority, and that, I think, is the line that they will take.
It is for my constituents to decide whether to go down the legal road or to seek compensation. It is not a matter for any hon. Member and certainly not for my hon. Friend the Minister, but I want justice for my constituent whose life has been ruined, largely because of the delay which occurred after the operation. I want some form of relief for my constituent who will suffer pain for virtually the rest of his life. He is now without means of support and completely reliant on his wife and her job and, to a lesser extent, on his daughter. His wife and daughter have been incredibly supportive during a very difficult time.
Will my hon. Friend make a fuller investigation of the facts of the case that I have presented to him, in addition to the clinical review that took place? Obviously, the review has not been satisfactory in terms of understanding the full extent of the problem that occurred at that time.
The special health authority must accept its responsibility for what went wrong. I was rather saddened that at one meeting that I had with the chief executive of the special health authority, Mr. Plant said that if compensation was given to the Brownsany money granted would necessarily reduce amounts available for other patients.253 That is probably one of the most disgraceful comments that has ever been made within the NHS. It was virtual blackmail, telling my constituents that money was available but should they get it others would suffer.
I bring to the attention of the House the case of one of my constituents who is in desperate need of assistance and who has genuinely suffered through malady, mistakes, negligence and delay that occurred after the operation. No criticism is levelled at the man who performed the operation or at the Charing Cross hospital which, on finding Mr. Brown in that particular state, was marvellous. But criticism must be levelled at the Brompton hospital, at the surgeon and at those around who did not recognise the condition and, as a result, have left my constituent in a terrible state with the terrible problems that he suffers today.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)
My hon. Friend the Member for Luton, North (Mr. Carlisle) is an old friend and an old parliamentary hand, and he has used the procedures of the House to draw attention to one of his constituents whom he feels has not received proper treatment from the NHS. It is a classic example of the way in which Adjournment debates are intended to be used, allowing hon. Members to draw attention to inadequate performances within the public sector and to seek redress on behalf of their constituents. I congratulate my hon. Friend on that even if, in the process, he made me feel somewhat uncomfortable as the Minister responsible for the NHS.
I begin by reciting what I hope can be regarded as common ground in the case. It is clearly common ground that the outcome of the operation performed on Mr. Brown was, to put it mildly, disappointing. The outcome was a cataclysmic decline in the expectation of the quality of life that Mr. Brown and his family had, as a result of the fact that he has lost his job, that he suffers mental stress because of the failure of the operation and that he can no longer enjoy a healthy life. In particular, he can no longer enjoy walking which he used to do. As somebody who also enjoys walking in open country, I particularly feel for that. I asked myself, as my hon. Friend was speaking, how I would have felt, faced with the fact that I would no longer be able to enjoy that pleasure as a result of a failed operation within the national health service. So it is common ground that there was a cataclysmic failure of an operation on my hon. Friend's constituent.
I hope that my hon. Friend will accept that the regret that he feels, and obviously that Mr. Brown's family feels, at the outcome of the operation is shared by all who were involved in it. Although my hon. Friend criticised Mr. Lennox and Mr. Plant, they share that regret. The staff at the Brompton will feel particular regret and sadness that they, as people who spend their lives dedicated to a caring profession, failed in the case of Mr. Brown to fulfil the promise which the national health service offers of a return to health wherever that is possible. That much, therefore, can be regarded as uncontroversial.
My hon. Friend, although entirely proper in his use of the Adjournment procedure, puts me in a difficulty on two counts. The details of the treatment of any patient within the national health service are confidential. The reports to 254 which my hon. Friend referred are headed "Confidential". It is, therefore, not open to a Minister to reply in detail, quoting from parts of a report that might present a more balanced picture to the House. So I am constrained on the one hand by confidentiality and on the other by the fact that my hon. Friend was open with the House about the allegation of negligence which stands in the background against some of the employees of the national health service and, therefore, against the national health service itself.
I am neither a lawyer nor a medic, and I am therefore anxious in what I have to say to demonstrate that there is, as I have already said, regret on the part of all in the national health service at the outcome of the case. Clearly, I do not wish to compromise the commitment of the health service to confidentiality in dealing with its patients, or to compromise the position of the national health service if it is to find itself in the near future the defendant in a case of negligence.
Having said all that, I think that it is of interest to the House to hear what procedures exist for addressing cases where patients are properly dissatisfied with the outcome of treatment within the national health service. As my hon. Friend has hinted, there are, broadly speaking, two ways in which a patient can pursue a case if he is not satisfied with the results of the treatment that he has received.
First, if he believes that the national health service or doctors or clinical staff working within it have been negligent, the patient has a right, as any sufferer from the tort of negligence has, to sue the health service and to demonstrate in a court of law that its employees were negligent and that, therefore, the health service stands with a debt of damages to the damaged patient. That is not a matter for me and not something which is properly debatable in the House.
Secondly, and standing separately from the possibility of redress through litigation, the patient can seek administrative review of the way in which the case was treated by the national health service through the clinical complaints procedure. The clinical complaints procedure goes through several stages. The third stage, the last stage of which has already been gone through in Mr. Brown's case, provides for an independent professional review. In that case, the regional medical officer will want to be satisfied that the complaint is of a substantial nature, but is unlikely to be the subject of more formal investigation by the authority or of legal action before it initiates the process. Two independent consultants, working in the appropriate field and at least in a comparable setting but in a different region, review the case. The review is in the nature of a second opinion, and that will have been explained to the complainant.
The reviewers will submit a confidential report of their findings to the regional medical officer, who will decide how much of the clinical content of their report is reflected in the final letter to the complainant, which is sent to the officer who commissions the review. That is the end of the clinical complaints procedure. Mr. Brown's case has gone through that independent professional review.
As I made clear in my letter to my hon. Friend last June, the object of the clinical complaints procedure is to resolve the complainant's anxieties about the treatment that a patient has received, or to make any necessary recommendations to the health authority, or to individual staff concerned, if it seems possible that a similar situation could occur in the future.
255 The purpose is not to consider questions of compensation—as has been made clear to my hon. Friend and to his constituent at all stages of the clinical complaints procedure.
A key stage in the clinical complaints procedure is a review of the case by independent doctors. The aim of that review is to provide a fresh, professional opinion on the clinical handling of the case. If, in the opinion of the independent doctors, their review is taking in areas outside their expertise, or more appropriate to a court, they may halt the proceedings and report their findings to the regional medical officer.
The clinical complaints procedure is intended to deal with complaints of a substantial nature but which are not, prima facie, likely to lead to litigation. If at the time a complaint is made the complainant made it clear that he intended to pursue litigation, there would be no point in the health authority starting a procedure which would later be superseded by the courts.
That is the context of the question whether the clinical complaints procedure baulks a later resort to litigation. There is no suggestion—and there should never be—that by going through an administrative procedure a citizen forswears his right to litigation. That is not the position. The health service seeks to establish that there is not a clear intention, at the beginning of the administrative procedure, to resort to litigation. My hon. Friend and his constituent made that statement at the beginning of the administrative procedure that I have been talking about. My hon. Friend was concerned about the delay in the completion of the procedure, but I give him an absolute assurance that the delay was not in any way designed to baulk the 1 March date that he mentioned. Indeed, the 256 handling of the clinical review was not out of line with the time that such procedures normally take. If anything, it was on the short side of average. The regional health authority stands discharged of any charge that it was attempting to baulk my hon. Friend's constituent's right to litigation.
I must comment in passing upon my hon. Friend's suggestion that the fact that Mr. Lennox did not perform surgery on my hon. Friend's constituent was in some sense unusual. It is a perfectly normal procedure in the national health service. Doctors who are well advanced in their training perform operations, subject to the overall clinical management of a consultant who may not be in the theatre at the time the operation is performed. That is a well-established part of training in the NHS.
My hon. Friend then sought to raise the question of a claim for compensation against Brompton outside the context of negligence litigation. No health authority, including Brompton, is able to agree to make a compensation payment when there is no likely prospect of a claim for compensation being successful. In this context, compensation is paid against the possibility of an action for negligence. No health authority is able to pay compensation that is divorced from the principle of negligence. That is precisely the principle that the House reaffirmed by a very large majority in a debate on 1 February. The House has reaffirmed its view that compensation should be paid only when negligence can be proved. If that is my hon. Friend's case, his redress lies in the courts, not in this House.
§ Question put and agreed to.
§ Adjourned accordingly at fifteen minutes to Eleven o'clock.