HC Deb 31 January 1996 vol 270 cc917-34

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

9.34 am
Dame Jill Knight (Birmingham, Edgbaston)

It is now 10 years since a constituency case alerted me to the need for changes in the way in which doctors are dealt with in cases of suspension for alleged medical misconduct. Since then, I have raised the issue three or four times in the House. Action has been taken, although, as I shall seek to demonstrate, regrettably it has not solved the problem.

A lady came to my constituency surgery. She was gentle, apologetic, nervous and tearful. She was clearly stressed and told me that her husband was a consultant anaesthetist at the Queen Elizabeth hospital. He had been suspended and accused of medical negligence. She was upset because he was being paid his full salary, but was sitting at home and doing absolutely nothing; he was not allowed to do anything. She said that he was clearly upset because he had no wish to take money that he was not earning. On the other hand, bills had to be paid. It was not possible not to take the money, but it upset both of them greatly. That situation had been going on for 18 months.

I wrote to the health authority about the case and received a guarded response. I wrote again, and another year went by. Eventually, at the end of all that, he was found to be innocent of all charges. Meanwhile, his wife had died.

That doctor was most unjustly and wrongly treated, and his case is not unique. Other doctors are and have been in a similar position. I am worried about the injustice that they have suffered. I am also worried about the money that has been wasted paying them—money that could certainly have been better used by the national health service. Of course it is right that if people are suspended and there is nothing proven against them they should be paid. However, that does not solve the problem. I am worried about the waste of the state's huge investment in training those doctors in the first place, let alone the extra training for consultants. The doctors about whom I am talking today are or have been consultants.

It is perfectly true that the number of such cases is not huge, but I am sure that the House will agree that even one case is too many. Of the 101 cases of which I am aware, only 16 were found to be justified. That means that 85 doctors have been unjustly put through that hell, and it certainly is a hell. The resulting stress is severe, and it has four major sources. One source is the length of time that the cases take. I have cases on record that have lasted anything from two days to 11 years. The mean length of time to resolve them is two and a half years. In three cases, the doctors involved died while suspended, before their cases could be resolved.

In another case, the dispute dragged on for so long that the doctor reached retirement age before it was fully resolved. Although the disciplinary inquiry fully exonerated him at that time, and he was still below retirement age, the employing authority refused to give him his job back.

One doctor had to go to court a year after his suspension commenced to discover why he had been suspended. I was surprised to find that it is not uncommon for another set of allegations to be made if the first looks likely to fail. One doctor had to prepare defences for no fewer than four different successive allegations made over a long period before the authority decided to withdraw all the charges against him. One can only imagine what he went through during that time. I remind the House that justice delayed is justice denied. Something must be done to shorten the long periods during which the accused man or woman is under an extremely serious cloud.

The second reason for stress is the effect that such happenings have on a doctor's career. I have pointed out that it takes two and a half years on average to clear up such accusations, which is a huge chunk out of any medical career. I doubt whether any doctor could get back on the career ladder at the place where he or she would have been if the allegations had not been made.

Dame Elaine Kellett-Bowman (Lancaster)

My hon. Friend is referring to extremely honourable people, most of whom were exonerated. However 16 doctors were not exonerated, and what if one of them were to work as a locum, as one did in the north-west? Nobody knew that the doctor had been suspended, he secured successive jobs and he proved to be an absolute menace.

Dame Jill Knight

I hold no brief for anyone who practises medicine after he or she has been found guilty of professional misconduct.

Dame Elaine Kellett-Bowman

It was before.

Dame Jill Knight

The same applies to any doctor who practises when he or she is suspended. I hold no brief for any of those 16 doctors: I am not pleading the case of doctors who should not be practising. Like my hon. Friend, I deeply regret the actions of the doctor to whom she referred. That was clearly wrong—particularly if that doctor was receiving full pay, which is the standard practice, during his suspension.

According to my findings, only a tiny minority of doctors are found guilty. Therefore, it is not unreasonable to draw the attention of the House to the injustice suffered by the majority. I understand perfectly that some individuals are very difficult to work with—that happens everywhere. There is no committee, office or school which does not have a member or an employee who could be described as an awkward cuss who does not get on with his or her colleagues. We have all had experiences of that nature, but it is not right to pillory the person who does not fit. Doctors should not be pilloried on the grounds of medical incompetence when no such incompetence exists and they should not have to face trumped-up charges.

The third reason for stress is the cost of defence. The present disciplinary procedures are based on three national health service circulars. They define the categories for disciplinary action as: professional incompetence, professional misconduct and personal misconduct. The classification vitally affects the composition of the disciplinary tribunal panel—for example, whether there is a doctor on the panel and whether the existing professional defence organisations will assist the accused.

Although in their promotional literature such bodies promise to assist in all cases of employment dispute, it does not work out that way. One doctor was forced to pay £10,000 to defend himself successfully against allegations of professional wrongdoing. In that case, the defence body wrote that it was "not minded to help". Another doctor spent about £40,000 refuting allegations, while a third spent more than £50,000 attempting to refute trumped-up allegations. That money is not recoverable and, as far as I am aware, it is paid after tax. There is no right of independent appeal in cases of personal misconduct.

The fourth cause of great stress to doctors is the appalling stigma associated with suspension. In the constituency case that I mentioned at the beginning of my speech, the wife died—perhaps as a result of the shame, the upset and the worry of that situation. One suspended doctor made a very telling comment. He said: The hammer blow of suspension is utterly demoralising. One's confidence and trust in one's professional ability and eventually one's own self-esteem is severely undermined". It is also true that the more conscientious and self-critical a doctor is, the greater his demoralisation. Doctors' professional and social standing is undermined. Such people are usually pillars of their society; they are well known and respected. They are probably members of local clubs and they enjoy a certain position in society. When the rumour of their suspension circulates, their position in society alters immediately and the stigma is terrible. They are ostracised, even though they are almost certain to be found innocent. People say that there is no smoke without fire and that there must be something in the allegations, but, if we use a little imagination, we can appreciate how hard it must be for such doctors and their entire families.

There is no better example of that than the constituency case to which I referred. Wrongly suspended doctors frequently suffer permanent ill health, and three doctors have committed suicide. Even when completely exonerated and compensated financially, very few doctors are able to come to terms with their treatment. Even after many years, they cannot let go. A core of deep resentment is established and it contributes to a serious depressive state. 'The cases have been checked and documented; I assure the House that I have studied the matter very carefully.

I do not know whether hon. Members are aware that all suspended doctors are locked out of their hospitals and that they could also be denied NHS treatment at those hospitals. One suspended doctor who suffered a cardiac arrest and was admitted as a patient to the intensive care unit of his hospital—perhaps his heart attack was caused by his circumstances—was transferred to another hospital because he was told that he was an embarrassment. I think that that is appalling.

Suspended doctors have also been denied the right to visit family members or friends who are patients in hospital. When the wife of a suspended doctor who had been locked out of his hospital for one year—the lock-out was instigated six months after his suspension began—was admitted to hospital as a patient, she was forced to appeal to the community health council for permission for her husband to visit her in hospital. Many community health councils are excellent bodies, but they do not work at the speed of light. By the time that council had finally decided to grant permission for the doctor to visit his wife in hospital, she was dead. Another doctor was locked out and forbidden to visit his wife as she lay dying of cancer in a hospital ward. Yet another was locked out and barred from collecting essential photographic evidence which he required for his own defence. The health authority apparently knew precisely why he wanted that evidence and they denied him the right to get it.

Another doctor had his suspension and lock-out maintained for nearly nine months after a disciplinary hearing had acquitted him of all charges. The verdict had been concealed from the doctor so he did not even know that he had been acquitted, but the lock-out was maintained for nearly nine months. I have no idea why that occurred, but I have strong ideas about the morality of such a situation.

Dame Elaine Kellett-Bowman

Is there no duty on the people holding those hearings to inform the doctor of the result? That seems quite extraordinary.

Dame Jill Knight

My hon. Friend makes a very good point. I have found so many injustices, and that is apparently another. I can only tell her and the House that that case actually happened. Whatever rules that exist do not work, and that is why I was so anxious to raise this subject today.

We are all told that suspension is supposed to be a neutral act, but I feel sure that those who have listened to me this morning would agree that those factors are not neutral. People have been treated appallingly. The notion that suspension is neutral is clearly not sustainable.

I believe that the information that I have sought and been given on this matter is entirely reliable. If it is, I find some of the reasons given for suspension extremely trivial. With all the consequences of a suspension that I have described, one would have thought that doctors could not be suspended without very good reason.

A serious offence, which could possibly justify dismissal, is not defined. Some of the reasons that I have discovered are trivial. There seems to be a wide variation in suspension reasons between different administrators. What some administrators judge to be a serious offence seems bizarre. One consultant was suspended for writing a repeat personal prescription for his ward sister. Another was suspended because he went through the clinical case notes of one of his own patients and took out papers that he, as the doctor, considered were redundant. A third was said to have over-claimed on his petrol expense. A motoring organisation later gave evidence that he had under-claimed to the tune of some thousands of pounds. The health authority finally had to pay him back.

One consultant histopathologist was threatened with a charge of professional incompetence because he sought a second opinion on a few slides. That is quite extraordinary. Surely it should not be an indictment to ask for a second opinion in any branch of medicine. That must be common because none of us can be so certain of our judgment on every case. Doctors should not be barred or accused if they ask for the opinion of a colleague who also knows the facts of the case.

My hon. Friend the Minister for Health may believe that the two guideline circulars, which were issued by the Department of Health to remedy some of those wrongs, are efficacious. With great regret, I have to tell him that they are not. HGL(94)49 was intended to shorten the period of suspension and suggested that doctors should be fully informed as to why they were being suspended. HC(90)9 was also intended to shorten the disciplinary period. Not one hospital authority or trust anywhere in the past six years has observed the rules regarding disciplinary action as laid down in those circulars. That is quite appalling.

Ms Hilary Armstrong (North-West Durham)

I am sure that the hon. Lady knows that a consultant from one of my local hospitals, Shotley Bridge hospital, has been suspended for four years. I have raised the issue in the House and the trust has now agreed to do something about the case. Suspension for such a long time is not in the interests of the doctor, the hospital or the patients. It is certainly not in the interests of the taxpayer, because the case has dragged on for more than four years and the doctor has been suspended on full pay. Therefore, he has not been making his contribution to the service and the taxpayer has been the loser. Such matters should be settled in a more effective, efficient way for the sake of the doctor, the patients and the taxpayer.

Dame Jill Knight

That is precisely the case that I am making and I agree very much with her. I have no doubt that many hon. Members have had such cases that have worried us. I am anxious to put on record that there have been efforts to put matters right, including the circulars that I mentioned. However, they have not succeeded in solving the problem and that is what worries me. In every case where dismissal was a possibility, the health authority has ignored the guideline documents.

It is probable that the guidelines are unenforceable. I turn for evidence of that to the minutes from the Public Accounts Select Committee of 15 March 1995, less than a year ago. The public accounts experts struggled for two and a half hours to try to unravel why a woman doctor was suspended for 11 years at a cost of £600,000 to the taxpayer and the health service. The Select Committee worked hard on the question and anyone reading the report will recognise the scale of the job it had to try to find out whose fault it was. My goodness, anyone reading the report will see that the Select Committee's job was like playing blind man's bluff at the same time as playing pass the parcel. The more I read the report, the more I thought it was a cross between Agatha Christie's "Murder on the Orient Express" and J. B. Priestley's "An Inspector Calls. It was no one's fault and nobody could be nailed for it, except the poor doctor who was suspended for 11 years. Extraordinarily, however hard the Select Committee struggled, it could not find out whose fault it was, why it all happened or how it could possibly have taken so long. The main witness who gave evidence to the Select Committee said that the rules to which I have referred were unenforceable.

Furthermore, in all cases alleging personal misconduct, the ACAS code of progressive warnings under the Industrial Relations Act 1971 has also been ignored.

In 1988 there was a joint working party report on the matter, but it was not very conclusive. Nothing has come out of that report which has alleviated the problem, although it did cite some interesting cases including some in which doctors had sued for damages—an eventuality that I have not yet mentioned.

The fastest disposal of a contested case looked at by the working party took one year. The total cost was about £250,000. That included legal fees, costs and the salary paid to the doctor. Five years ago a doctor was awarded £100,000 in damages and that has to be added to the other costs involved. Two cases are estimated to have cost £4 million between them and another has already cost £1 million and is still proceeding. There are many other examples, but I hope that I have given the House sufficient to make my case. One estimate suggests that there are about nine or 10 new cases every year and the average cost is £400,000. So we could be losing as much as £4 million per annum for the health service.

I am asking my hon. Friend the Minister to look seriously at the case I have made and I feel confident that he will do so carefully. On cost grounds alone, the situation cannot be allowed to continue.

I have already mentioned that there is no right of independent appeal in the cases I have outlined and there are other aspects that worry me. The chairman of the tribunal panel is chosen by the prosecuting health authority from a list provided by the Lord Chancellor. In the past, health authorities have rejected certain nominations as being "unsuitable"—they have said no more than that. In all alleged misconduct cases, the tribunal panel is chosen by the prosecuting health authority. I hope that my hon. Friend the Minister is listening carefully because it is a serious issue of justice that the judging panel should be set up fairly.

The fact that the panel is chosen by the prosecuting health authority could suggest bias. There is a growing tendency to classify all charges as personal misconduct because that makes it easier for the health authority to control the panel. In those circumstances, the authority is the instigator, the prosecutor, the judge and the appeal court. It is Gilbertian in its scope. In one recent case a panel member was the very person who authorised the suspension of the doctor in the first place, and he was on the hospital board that subsequently decided to prosecute. The same board decided to bar from taking part in the judgment any member of the tribunal panel who was not a board member. Yet it is a well-established principle in European and English law that no body can be the judge in allegations that it, has made. There must be an independent assessment.

Under European law a doctor has a civil right to practise if he is so qualified and approved. That right can be removed only by a body appointed by law—the General Medical Council or the courts—and only after a fair and open trial. That has been agreed by the British Government. There was a recent case in which a French doctor's right to practise was challenged, but the doctor was found to be in the right.

The consultants I have mentioned have been denied their right to practise because suspension means that they cannot act at all. Therefore, in the eyes of European and English law, they have been told, unfairly and wrongly, that they cannot practise, although there has been no judgment by the GMC or a court. Surely that is wrong. To comply with European law all cases of suspension should rightly be referred to either the GMC or, where there are accusations of personal misconduct, to the courts or to an industrial tribunal. That has not been happening. On and on go the months and years in which a doctor is not allowed to practise in the circumstances I have outlined.

If I were the Minister, I might feel a frisson of apprehension about the possibility of being taken to the Court of Human Rights in the not-too-distant future by a doctor who has been prevented from practising without proper and accepted judgments being made.

It will be apparent to hon. Members that I feel strongly about all this. However, I want to make it absolutely clear—it would be unfair if I did not do so—that I do not regard this as the fault of the Government. All the reports that I have read suggest again and again that it is the fault of the extraordinary way in which some health authorities operate. They are responsible. I have already cited the case in which 11 years went by. That was not the Government's fault. Having said that, the buck always stops with the Secretary of State. It is an unfortunate truth and we must recognise it. He is forced to take responsibility for everything that goes wrong and these things are very wrong. I urge my hon. Friend the Minister to urge our mutual right hon. Friend the Secretary of State to set things right.

10.6 am

Mr. Roger Sims (Chislehurst)

My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) has performed a signal service by bringing this matter to the attention of the House and ventilating it publicly. I congratulate her on her success in obtaining the debate and on the manner in which she has presented her case. The House will be aware that I am a lay member of the General Medical Council and, in accordance with our rules, I should declare an interest in that I receive from the GMC a modest fee in recognition of my work as a lay screener.

My hon. Friend has illustrated effectively the dilemma facing any hospital trust when a complaint is made about a doctor, particularly when it reflects on his professional ability. Clearly, if a complaint is made, the trust—the doctor's employer—will be open to criticism if it suspends him immediately, particularly if what follows is a saga such as that outlined by my hon. Friend. Equally, it could be open to criticism if it did not suspend a doctor about whom complaints had been made. My hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) mentioned a case, with which I am familiar, which demonstrates that point.

If a doctor were found to have performed a certain surgical procedure or taken some medical steps with serious consequences and it were found that complaints had been made about him previously and nobody had done anything about it, the trust could find itself open to criticism. There is a difficult balance to be struck.

Dame Elaine Kellett-Bowman

The doctor to whom I referred was under suspension, but was practising as a locum.

Mr. Sims

That is a further dimension. Although things have improved a bit, a doctor can be suspended from one hospital and then offer his services elsewhere. If that new hospital does not make some inquiries about the doctor, what follows may be similar to what my hon. Friend the Member for Lancaster described.

A doctor may be suspended quite unexpectedly from his point of view, as he may believe himself to be completely innocent. The complaint may be without any foundation, so the suspension would be extremely distressing for him and his family. It is literally a waste of money because he is being paid for doing nothing. In addition, the hospital and the local community are deprived of his skills while he is suspended.

The main issue is how long it takes to resolve the matter when a complaint has been made and a doctor suspended. My experience is that it is by no means uncommon for it to take 18 months or even two years. Why? We can draw some comparisons with the time that it takes the police to make inquiries in civil and criminal cases. It often takes many months before the matter can be brought before the court. Why does it take that long?

A hospital may receive a complaint from a patient or a patient's relative that may be of such a serious nature that it feels it has to suspend the doctor. The hospital will want to pursue the matter. It will ask for further details about the complaint and then put the full complaint to the doctor, who will have the opportunity to respond. The complainant is given the opportunity to comment on what the doctor has said. An inquiry panel must then be assembled at a time and place convenient to all concerned. I accept that going through those procedures could take some time, but surely not a year, 18 months or two years.

When the panel has heard the evidence, it may conclude that the doctor is innocent and he will be cleared of the charge. However, if it decides that the complaint is justified in some respect, it may decide to punish the doctor. He may then wish to appeal against that decision—a process that can take a very long time indeed.

The problem is that that is not the end of the matter; there is a further dimension. The panel will make a judgment on the extent to which the doctor has failed to comply with the terms of his contract. A similar process applies to general practitioners. The decision will affect the doctor's professional standing. If the original complaint involved negligence—if there is any question about his medical skills—there may have been some justification for suspension. However, if it was an administrative matter, such as some of those referred to by my hon. Friend the Member for Edgbaston, I would find it extraordinary if the doctor were suspended.

If the hospital trust finds the doctor at fault and raises doubts about his professional competence, there is a virtual double jeopardy because the papers will be sent to the General Medical Council, which must then decide whether that doctor should be allowed to continue to practice or whether there should be an inquiry, possibly leading to suspension or even to his name being erased from the register.

Not only is that doctor suspended, not only is he is being paid for a job that he is not allowed to do—which must be extremely frustrating and demoralising for him—but he knows that at the end of the local process he may have to appear before his national body—and that could lead to serious consequences.

For most employees, employers deal with problems through admonishment or even by giving someone the sack. At least those employees can then try to get other jobs. For a doctor, however, that is not the case, as he may have to appear before the GMC and he may be suspended or even have his name erased from the register. He will have lost his livelihood. We must be aware of the serious consequences that can follow a charge of negligence.

In my capacity as a lay screener, and because I sit on the GMC preliminary proceedings committee, I deal with a number of such cases. It is quite unfair on a doctor to bring him to account for incidents that happened three or four years ago. Part of the reason for the delay is that it takes a long time to go through the process described by my hon. Friend and then through the appeal procedure, which is far too protracted. I hope that my hon. Friend the Minister will take that on board and take action to expedite the whole process.

I fully accept that the interests of the patient are paramount; we must ensure that only competent doctors serve patients. However, we must not forget the interests of the doctor, who must have a fair crack of the whip. I hope that my hon. Friend the Minister will feel able to do something about the problem.

10.16 am
Mr. Simon Hughes (Southwark and Bermondsey)

I welcome the initiative of the hon. Member for Birmingham, Edgbaston (Dame J. Knight), who was kind enough to brief me yesterday on the range of her concerns. The overall matter is very important, as are the legal issues that it raises. The hon. Lady pointed out the apparent contradiction with European law in that in theory a doctor is in practice, but cannot practise because he has been deprived of the ability to do so. That raises proper legal issues.

I want to suggest to the Government a way to deal with the problem. I shall first make a point that widens the issue—there are parallels elsewhere. I do not do so in any arrogant way; I want to help in the process of finding a way forward.

The case has been made. The hon. Lady cited the most horrendous examples. No one in the health service, the health authorities or any other walk of life undervalues the significance consequences for an individual who is suspended but then later found fit to carry on. It is difficult to unwrite that bit of employment history. That applies not only in the health service, but in other parallel public services.

One point that the Minister might consider is the apparent non-compliance with the guidelines. The hon. Lady said—I have no reason to doubt her—that no trust has complied with the rules. The Department needs to deal with that speedily.

Similar issues in the public domain have arisen in two or three other professions. First, there have been well-reported cases of police officers being suspended because of allegations made over long periods. Secondly, teachers are often suspended for lengthy periods after allegations, often serious and worrying, by pupils. It may be a long time before the individual can return to teaching. The rumour, speculation or allegation may be made public, and the teacher's career may be severely damaged as a result.

I declare an interest in relation to the teaching profession. I have discussed the matter with the Association of Teachers and Lecturers—a teaching union for which I act as a consultant and which, as with the hon. Member for Chislehurst (Mr. Sims) and the GMC, pays me a small amount for my advice. It does so also for some Conservative Members.

Mr. Deputy Speaker (Sir Geoffrey Lofthouse)

Order. The House is debating hospital doctors.

Mr. Hughes

The parallel that I have drawn with teachers is relevant to the hon. Lady's case, and I will suggest a way forward that applies to them all.

Perhaps the Minister could consult on the use of employment law. The matter may ultimately be for the Department of Education and Employment. If the problem ranges more widely than trusts and the health service, there should be another way of dealing with it. It would be nonsense to have one system in the health service and a different one for other public services, such as local authorities and the police.

The hon. Member for Chislehurst spoke of reviews. If the Crown Prosecution Service or another authority takes too long to process a case, it is called before the magistrate to report progress. When a suspension occurs a court or, more appropriately, an industrial tribunal should have the power or be required periodically to consider the evidence from all the parties. If an individual were suspended today, for example, it would be his automatic right to have the state of the investigation regularly considered by an external person, beginning in one month's time. The suspended professional should be able to say, "I am being kept out of my job. Nothing is happening quickly. What is going on?", and an objective third party could say, "You're right. This is unacceptably slow." That third party could lay down a timetable and rules to govern the investigators.

Fundamental to the hon. Lady's case is a guarantee that the persons considering disciplinary action are entirely independent. In registered nursing homes, a disciplinary suspension and the adjudication on the individual's ability to continue in employment can be dealt with by the same people, which is entirely inappropriate. Of course the adjudicators can take evidence from the individuals who enforced the suspension, but the adjudicators must be independent and be seen to be independent. An external element may also be needed.

The House has just dealt with the final stages of a Bill to improve the procedure for health service complaints. It is unlikely that any of the hon. Lady's proposals can be incorporated in that measure. However, that Bill has just gone to the other place. It may be appropriate for any possible amendment that can quickly be made to be incorporated in that Bill. At most, that can accomplish only some things—the issue is much wider. I hope that the Minister will deal with action that can be immediately implemented by his Department, but it may be for the Department of Education and Employment to examine the issues as they apply to all professions across the range of public service.

10.24 am
Mr. Henry McLeish (Fife, Central)

I am pleased to participate in the debate and to echo the congratulations extended by other hon. Members to the hon. Member for Birmingham, Edgbaston (Dame J. Knight) on bringing the issue before the House. She graphically illustrated the problems that arise during suspension—including delay, the impact on the individual's career and the stress caused to the doctor and his or her family.

Major problems continue to arise, despite two measures having passed through the House over the past year—the Health Service Commissioners (Amendment) Bill and the Medical (Professional Performance) Act 1995—which strengthen health service complaints procedures. The inordinate time taken in some cases of suspension cannot be justified. If trusts look carefully at their procedures, they may reach the same conclusion.

To be fair to the Government, they have improved the procedures for processing complaints. The new three-tier system will operate from 1 April, and the monitoring powers of the General Medical Council has been strengthened. However, consideration of the matter must go beyond the structures and institutions in pinpointing why major problems continue.

Every trust has the ability to modify or change its procedures—the Minister will correct me if I am wrong. The hon. Member for Edgbaston said that national standards are needed. Fairness should apply not just in Birmingham or Glasgow but across the length and breadth of the country, and we are not seeing that. I repeat that the time taken to process some cases cannot be justified. What is going wrong?

One answer is that not enough priority is given to individual cases. The British Medical Association, among others, has pointed out that the issue is clearly one for the individual. On the other hand, there are implications for the hospital involved. The BMA points out that the suspended consultant may lose clinical skills, especially if the suspension lasts two, three or four years. A backlog of cases can be created when a specialist is lost to a hospital, and there is additional pressure on colleagues. That can be another problem in a health service that is already subject to strains and tensions.

The BMA also points to the lack of continuity of patient care. There can be nothing worse for a patient than to lose the services of his or her usual consultant. Of course, serious offences may be involved. No one is arguing that there is no case for the safeguard of suspension—but often it should be exercised as the course of last resort. Trusts may be opting for suspension rather than another course, which may not be best.

I agree with the hon. Member for Edgbaston that cases should be resolved more quickly. Obviously the issues are complex. [Interruption.] I do not know whether the Minister is mumbling in agreement or just mumbling to one of his hon. Friends behind him.

The Minister for Health (Mr. Gerald Malone)

I was commenting to one of my hon. Friends.

Mr. McLeish

That is gratifying at this time of the morning, rather than being insulted—as I am usually.

Mr. Malone


Mr. McLeish

There is a mood of magnanimity this morning, at least in this debate.

Why do appeals and suspensions take so long? Trusts are not short of administrators, clerical employees and bureaucrats—people who want to do such work. Why should there not be a national standard and a time constraint? Some individuals will need to be suspended immediately and the cases will take a long time to resolve. The Minister could therefore aid the House in further discussions by painting a picture of what is happening nationally. We need more information.

In his winding-up speech, perhaps the Minister will be able to provide information on the number of complaints against hospital consultants and doctors being processed, the average length of the cases, and where they are occurring. I suspect that in some areas, that information would not be heartening. Clearly, in Birmingham and other areas, cases are arising routinely. The other issue that concerns me is the cost of the processes when we need to be spending as much as we can on the real business of hospitals.

Adjudication procedures concerning allegations of medical misconduct of hospital doctors is an excellent issue to discuss in the House. Although we clearly do not lack structures and institutions to cope with the problem, we must look to the trusts at the front end to improve matters. I am sure that the Minister will respond positively and I hope that he will seek information from each trust about what it is doing so that he can make a judgment on whether many of the delays are necessary. I am sure that an informed debate based on information from trusts will help to speed up the process, ease the misery of many doctors and consultants and ensure that the health service, through the trusts, is providing front-line patient care rather than dispensing of its energies or dissipating them through long suspensions.

10.31 am
The Minister for Health (Mr. Gerald Malone)

I am grateful to have an opportunity, courtesy of my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), to address what the speeches of other hon. Members have shown is an extremely important subject. I am not sure whether I shall be able to go along entirely with the attempt of the hon. Member for Fife, Central (Mr. McLeish) to write part of my speech for me. I agree with him, however, and with my hon. Friend, that the matter is important not only for the medical profession but for patients—as my hon. Friend the Member for Chislehurst (Mr. Sims) said.

It is right that the House should debate a matter about which there is clear concern. Although I cannot go the whole way with my hon. Friend the Member for Edgbaston in some respects, some of the cases that she described seem to raise extremely serious issues, so I should be grateful if she would take them up in more detail—although that would not be appropriate in a debate on the Floor of the House. If what she is saying is borne out by evidence, I would be extremely concerned as it would be clear that the employing trust was not adhering to the very detailed guidelines on important matters.

The guidelines are constantly being reviewed and updated, as my hon. Friend said. She said that much progress has been made in recent years. The detail of the guidelines is such that I hope to be able to convince the House that the Government take the matter very seriously as a national responsibility, although that responsibility must be developed locally between employer and employee.

Dame Jill Knight

I am grateful to my hon. Friend for the receptive way in which he is replying to my remarks. There would be no problem whatever in furnishing him with more detailed information. As he rightly said, and as I judged, it would not be correct to go into great detail, giving names, places and so forth in this debate. Would he therefore agree to see a small deputation of people who have been studying the matter? They are all doctors and they could cite chapter and verse. It might help my hon. Friend to see them as a groupx2014;not a very large group—because they are knowledgeable and have spent a long time tabulating and examining cases.

Mr. Malone

I am grateful to my hon. Friend. If she would let me have details of what she is proposing, I shall—as always with any request that she makes—look on it very sympathetically.

It might benefit the House if I clear a little of the fog around the issue. It is important to understand the issue in its various components. There is the issue of suspension; the separate, but related, issue of disciplinary proceedings, which runs to a strict timetable; and paragraph 190 appeals should a medical practitioner employed by a hospital decide to exercise that right. When describing various cases, hon. Members have shown that, where separate procedures have been taken one after the other, there has been some muddying of the waters in understanding what rules apply to each procedure.

I do not wish to be defensive, but I am sure that the House will understand that where there is a need in the procedures to be fair to the interests of the public and the individual medical practitioner, there can be delays for a number of reasons. I do not want to refer to any particular case, but the Medical Defence Union—if it is representing a medical practitioner—or the British Medical Association may want to take a considered view of the matter, and take some time to investigate it fully, in order to present the case on behalf of their member. That is quite right, and in some cases it is an understandable reason for delay.

Illness of the medical practitioner is another reason why there might be delays, which on superficial examination might appear inordinately long, in the processes that we have set down. It is important to study each case to see whether it raises issues of unfairness. When it does, it is a matter about which nobody should be complacent.

My hon. Friend the Member for Edgbaston made much of suspension. It is important to see the matter in context. Evidence to the Public Accounts Committee revealed that only six cases of suspension had endured for more than six months. The six-month period is important because the system requires suspensions of more than six months to be reported to regional health authorities. That will continue after 1 April under the NHS executive because Ministers consider it vital to be informed of delays that go beyond the time limit set out in the guidance. It also encourages trusts to ensure that they comply with the guidelines which, as my hon. Friend said, are set out in HSG(94)49.

It is important to understand the aim of the guidance, which is to avoid unnecessary suspensions. We do not want to be suspending doctors for any reason. Employers are encouraged to consider suspension as something that might be necessary, but that should be avoided if at all possible. They are also told to ensure that, if practitioners are suspended, it should be for the minimum period necessary. I am sure that my hon. Friend was not suggesting that employers should not be entitled to use suspension—

Dame Jill Knight

No, I was not.

Mr. Malone

My hon. Friend confirms from a sedentary position that that is so.

The House must consider suspension from both sides of the mirror—if I may put it that way. If we had a debate that was prompted by a patient's interest, where something had gone wrong and a clinician had not been suspended and where I was not able to assure the House that it was a balanced process and suspension was available to hospital trusts—the employers—the House would rightly take a pretty dim view.

We must consider whether suspension is carried out reasonably and in accordance with the guidance. Suspension should be seen as a neutral act. This goes to the heart of the point made by my hon. Friend the Member for Edgbaston. Suspension is not intended to do other than protect the interests of patients, staff or, indeed, the practitioner. It is meant to assist the investigative process. Of course, it is understood that it is a measure that could have extremely serious consequences in both human and financial terms—my hon. Friend gave us a clear example of that—especially where the suspension proves to be lengthy. That is why timetables are set.

Suspension may be considered when a member of staff needs to be removed immediately from the employer's premises to protect the interests of patients, staff or the practitioner. That, I suggest, is the extreme end of the spectrum. One can foresee circumstances in which it would be necessary. It should be confirmed immediately in writing—this deals with fairness—so that the person who is suspended is made fully aware of what is going on. The letter should state clearly the effective date and time of the suspension, and the content of the allegations and confirm that a full investigation will follow.

As it is a neutral act, it would be extremely unfair not to suspend on full pay, because to do anything else would be to prejudge the issue. I remind the House that suspension takes place at a point when no judgment has been made about what is alleged.

A review of the suspension should normally be undertaken at least every two weeks, and the outcome reported to the chairman or non-executive director who is responsible for the matter. The practitioner concerned should be informed of the outcome of each review. If the investigation has not been completed within three months of the date of suspension, a report should be made to the trust board or health authority outlining the reason for the delay and indicating how long the suspension is expected to continue. It should also include a plan for the completion of the investigation.

The guidance is clear on fairness and on setting a timetable. Should delay appear to be built into the process, the guidance clearly sets out a timetable whereby an employing trust must justify any delay. The importance of that is that suspension cannot continue to be disregarded for an inordinate period.

Mr. Simon Hughes


Dame Jill Knight

Will my hon. Friend give way?

Mr. Malone

I shall give way to the hon. Gentleman first, and then I shall give way to my hon. Friend.

Mr. Hughes

What can a suspended employee do if he or she believes that there is delay, that the guidance is not being complied with or that the reports are not proceeding? What can they do to speed up the process and ensure that the guidance is complied with?

Mr. Malone

It depends entirely on the circumstances. The process is designed for both parties, and under it the person who is suspended can be involved and encourage progress. There is nothing that says—I presume that this is the point that the hon. Gentleman makes—that further deadlines must be complied with, because during the suspension process investigations are undertaken. The suspension is reviewed regularly by a designated person to whom the person under suspension can complain or draw attention to the fact that matters are not proceeding properly. At that stage, any failure in the process can be brought to the attention of those who are responsible for speeding it along in the most appropriate way.

Although my hon. Friend the Member for Edgbaston rightly said that speed is important, in other circumstances it might not be of the essence. The person under suspension might wish to make their own preparations for what may follow. It is a two-sided argument, and that is as important an aspect of it as the other.

Dame Jill Knight

What my hon. Friend said a moment ago seemed to suggest that the guidelines should have been able, and were able, to stop such cases occurring. I cited the suspension of Dr. Bridget O'Connell, whose case was dealt with by the Public Accounts Committee only last March and who had to wait 11 years, despite the fact that the guidelines were in existence. Surely in that case the guidelines were proven to be ineffective.

Mr. Malone

The House examined the matter some time ago and was well informed on it. I think that my hon. Friend would concede that, following inquiries, the guidelines were improved. I am dealing with suspension; the case to which she referred continued after going through a number of complicated processes. I do not think that the case to which she refers falls into the category of suspension. She raises a wider point, which I shall come to. I intend to deal with the whole process and how it should take place.

The recommendations of the working party, in 1990, gave rise to further guidance. It made a number of recommendations about the disciplinary procedure, all of which were taken on board. They dealt not only with the setting up of inquiries but with the timetable for the completion of the disciplinary process. It might be helpful if I set out the timetable to the House.

After the chairman has decided that there is a prima facie case to answer and has informed the practitioner, the practitioner has four weeks in which to comment on the case. After receipt of the practitioner's comments, the employing body can decide, within two weeks, to follow that procedure. Thereafter, the chairman of the inquiry panel is appointed and the panel meets within 13 weeks. The hearing is concluded within one week. A report is produced and the factual part is sent to the practitioner within four weeks. The practitioner makes comment within those four weeks, and the report then goes to the health authority within four weeks. It is a strict timetable and it must be complied with in such inquiries.

My hon. Friend questioned whether inquiries might be biased. It is important that an investigating panel is seen to be independent of the employer; that is in the interests both of the employer and of the practitioner. Although it is set up by the trust responsible for the appointment of the practitioner, it is important to understand that the panel is distant from it. The guidance stipulates: No member of the panel should be associated with the hospital(s) in which he works". Not only should no panel member be an employee of such a hospital, no panel member should even be associated with one.

The guidance continues: In all cases the panel should be small, normally of three persons, including a legally qualified Chairman, not being either an officer of the Department of Health or a member or officer of the employing trust. The chairman will be nominated in each case which arises by the Secretary of State from a panel appointed by the Lord Chancellor. That is an important safeguard for the investigating panel. I am not sure what better safeguards one could build in.

That passage continues: In cases involving professional conduct, the members other than the Chairman should contain an equal proportion of professional and lay persons, unless the charges relate only to relationships between a doctor…and his professional colleagues, when it would clearly be appropriate to have a panel wholly or predominantly of professional members, apart from the Chairman. The independence of the investigating panel is ensured and supported by those guidelines, which have been set out carefully to deal with such matters.

One of the other points raised by my hon. Friend the Member for Edgbaston relates to compliance. The hon. Member for Fife, Central raised that matter too, and asked the sensible question: whether, as all that guidance exists, we are certain that it is being complied with. My hon. Friend suggested that no trust is complying with it—an assertion for which, if she does not mind my saying so, I should like to see a little more authority. I would be concerned if it were true, but I do not think that it is. It is important that the guidance has force, and is not disregarded.

Guidance for national health service trusts, which are separate and independent bodies, has developed since the health service reforms. Hospital trusts have a history of heeding it, and it is heeded in this instance, but guidance is no more than that, and I do not pretend that it is.

I would not go down the road favoured by the hon. Member for Fife, Central, and suggest that we should enforce the guidance rigidly on a national basis. I agree that the guidance forms an important framework that underpins the rights of individuals, Inn it would be unfortunate if the ability to deal with matters at a proper level—between employing trusts and their employees—were lost, and we were to go beyond setting out guidance with which we expect trusts to comply, but upon which we understand that they may wish to build.

Mr. McLeish

No one would disagree with the logic of the Minister's contribution. The central point is the fact that we have structures, institutions, guidance and processes. That is not the issue. I do not say that we necessarily want a heavy hand directing from the centre, but what we have heard has made it clear that there are excesses in the system. Perhaps the cases that have been mentioned are profoundly complex and take masses of time to resolve. None the less, it would be instructive for the Government and for us if we could find out what is happening throughout the country, so that any further consideration by the Minister could be informed by what was happening in the trusts. This is not a case of the trusts ignoring the guidelines, but it is clear that the application of them may differ from one trust to another. That may be healthy in some respects, but we need consistency and fairness, and that consistency would be better informed if we knew what was happening throughout the country.

Mr. Malone

The system gives me that information, should there be undue delay. I have explained to the House that, if there is undue delay in resolving a suspension and turning it into either a full inquiry or a dismissal of the complaint, the information is gathered after six months. When evidence was given to the Public Accounts Committee, six such cases were outstanding. Considering that more than 17,000 consultants are employed by the NHS, that is a small number.

When such a delay has been brought to our attention, of course inquiries are made about whether it is reasonable; we fully expect people to comply with the guidelines. The guidance is not simply thrown out into the blue yonder, with Ministers washing their hands of it and saying, "We have written the guidance, and that is all we intend to do." It is important to us that there is general compliance. However, I reiterate the fact that we expect employers to build on the guidance in a manner appropriate to their local circumstances.

It is important that all procedures are clear and flexible and ensure that patients' interests are protected, that fair treatment is provided for practitioners, that cases are dealt with as speedily as possible, and that professional advice is taken in appropriate circumstances in individual cases. Those are the principles on which the guidance is based.

My hon. Friend the Member for Edgbaston raised several specific points, with which I shall now deal. First, she said that suspension was sometimes used for trivial reasons. The guidance clearly implies that suspension is a serious matter and should not take place for a trivial reason. However, what is a trivial reason in the eyes of one party may be an important reason in the eyes of another. I can certainly give my hon. Friend the assurance that I would not expect trivial reasons to lead to suspension. I would expect employers to consider all such issues carefully, as the guidance requires them to, before taking the important step of suspension.

My hon. Friend also talked about the process not affecting the right to practise. It does not. The hon. Member for Southwark and Bermondsey (Mr. Hughes) rightly said that there are other ways in which the right to practise can be handled—through the General Medical Council.

Perhaps it would be helpful to my hon. Friend if I were to clarify the position. Suspension is a neutral act, so if a practitioner under suspension decided to resolve the matter himself or herself by simply moving out of the context of that employment and getting another job, that would be entirely possible. Nothing would have been proven against the practitioner, and it would be wrong to prejudge the issue by saying that the right to practise should be diminished by the act of suspension.

Dame Elaine Kellett-Bowman

Should not the fact that the practitioner is under suspension be disclosed to the hospital to which he applies?

Mr. Malone

Suspension is a neutral act. My hon. Friend is suggesting that suspension should be seen as something other than a neutral act.

The House has put legislation on the statute book which allows immediate referral to the GMC if the suspension involves a serious matter of basic professional competence, and that is the correct route in such cases. That is a decision for the individuals involved. We must not forget—I am sure that my hon. Friend the Member for Edgbaston does not forget—that a reference to the GMC can be made by someone other than the employing body; it could be made by a fellow practitioner. There is a range of ways in which to handle that aspect of the ability to carry out medical practice, apart from the act of suspension.

This has been an important debate. I thank my hon. Friend for giving me the opportunity to address some of her concerns directly and to explain the position on suspensions and investigations. I hope that I have also given the House an assurance that the Government take the matter extremely seriously. I hope that my hon. Friend will bring the individual cases that she has raised to my attention. I shall be happy to consider them, and I have said that I shall consider her request for a meeting with those who have raised them with her.

When we talk about the suspension of a member of any profession, we are dealing with a difficult and sensitive area. The hon. Member for Southwark and Bermondsey alluded to some parallels. It is vital to the public interest and to patients that we get it right. We have made excellent progress in recent years. Where we have been able to learn lessons, we have always been happy to translate them into the guidance that we expect to be reflected across the service. We have an open mind on these matters. Where improvements can be made-we can discuss that with the profession in particular-we are more than happy to make progress and build on the current guidelines.

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