HC Deb 07 July 1999 vol 334 cc1147-56

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

10.26 pm
Audrey Wise (Preston)

In 1990 the then Preston health authority appointed Mr. Les Howell as general manager. He is now suspended and has been informed that his contract has been terminated. The purpose of tonight's debate is to examine that situation and relate it to wider concerns about mental health and community services in Preston.

When Mr. Howell was appointed, his remit was to merge two directly managed units—one covering mental health and the other dealing with community services—that would together form the priority services unit. The previous general manager of the mental health services had been dismissed and the services provided were variable to poor, except for those covering learning disabilities, which were good. Mental health services were in a disgraceful condition.

The trouble had been long standing. In 1972, there was a major statutory inquiry—the Payne inquiry—into Whittingham mental hospital. The report showed abuses and ill-treatment of patients. One patient died as a result of ill-treatment.

On taking over in 1990, it appeared to Mr. Howell that little had changed. As always, some staff were doing their level best, but in general the standards at Whittingham hospital were appalling. For example, toilets on the corridors were locked to stop patients accessing them. Sexual abuse of patients was discovered, a senior psychologist was dismissed and a charge nurse was sent to prison for two years for having unlawful intercourse with a patient. Pornography was found, and attempted suicides were frequent and sometimes successful. In one case a 16-year-old girl was found hanging from a shower rail.

In 30 years in the national health service the new general manager, Mr. Howell, had never experienced such a bad situation and seriously considered leaving six months after his appointment. However, he stuck it out, successfully integrated two management teams and created the new combined unit and later the Preston Guild community trust.

The closure of Whittingham hospital was successfully managed. It included negotiations with 46 other organisations to achieve the successful transfer of patients and resources. The closure programme was agreed at 36 months and delivered on time with only 18 compulsory redundancies, although 760 staff had been declared at risk.

Although hospitals such as Whittingham certainly needed to be closed, there are many unresolved issues. In the case of Whittingham, unusually, local people supported the existence of mental health facilities on the site. Mr. Howell proposed developing the site into a health park that would provide a comprehensive range of mental health services such as forensic services including high security, also palliative care, and a range of holiday and respite facilities for mentally and physically disordered people.

The idea was presented to the regional chief executive, Professor Tinston, received politely, and deferred. Mr. Howell formed the view that it was not favoured. That may be because it is preferred that the site should be sold for housing development, which is very much against the local community's wishes and will not help to meet any of the clear needs for improved facilities for mental health services. I would much prefer an imaginative idea such as Mr. Howell's, and I regard it as characteristic of the man that he was working on such a proposal.

My hon. Friend the Minister suggested to me that the trust should build on its past record".—[Official Report, 8 June 1999; Vol. 332, c. 460.] That implies that there is a record worth building on; and there is. The Guild trust has a unique facility for the care of patients with advanced Huntington's disease, which is a genetically carried severe degenerative disease—one of the most distressing diseases that there is. Frank Gardham house is the only dedicated facility in the country; the only other one in the world is in Melbourne, Australia.

It is generally acknowledged that the inspiration for Frank Gardham house came from Mr. Howell. It was designed and developed and is managed jointly with carers. Last August, my right hon. Friend the Secretary of State for Health presented Mr. Howell with a special NHS 50th anniversary award to the trust for Frank Gardham house. The only problems are that it should be replicated elsewhere and that North West Lancashire health authority should fund more beds for local people. Current funding allows for only three or four people from our area.

As the local Member of Parliament, I am painfully aware that that is insufficient. As with all genetic diseases, there can be area clusters, and Preston is such an area for Huntington's disease. Unfortunately, the health authority does not share the view of the NHS or the Secretary of State about Frank Gardham house and I have had to raise questions about funding and provision for my constituents that have not, in my view, been dealt with satisfactorily.

I am sorry to say that the situation has worsened since Mr. Howell's suspension last autumn. Indeed, I have since been informed by the health authority that The Authority has consistently maintained that, as far as possible, services for people with this condition should be provided in the community. In 1995, I made representations about the need to admit a patient with Huntington's who was living in a night shelter. I have copies of correspondence that show a complete lack of understanding by North West Lancashire health authority of the needs of patients with Huntington's. There was even a claim that their needs could be met by a social care package from social services.

There was considerable unwillingness to pay for a suitable service. In a letter to me, the chief executive, Mr. David Edmondson, simply passed the buck to the Guild and blamed it for failure to admit the patient. He did not tell me that the Guild had already raised the patient's plight, nor did he then make it clear that the health authority really did not like paying for the provision and would prefer it to end.

I now understand from both the acting chief executive of the Guild and North West Lancashire health authority that the Guild is reviewing its range of provision with a view to moving towards a more community based service in the future, thus reducing the need for residential places. Frank Gardham house is a small specialist unit with deeply involved carers. In my view, it is part of the community; but of course it costs more than care in the patient's home or a nursing home.

I have already informed my right hon. Friend the Secretary of State that I intend to fight hard for the maintenance of the service. I consider that Mr. Howell's removal was seen as an opportunity to worsen the service. One of the criticisms levelled at Mr. Howell is that he has a bad relationship with Mr. Edmondson. I strongly suspect that that may be connected with Mr. Howell's propensity to want more funding for services such as Frank Gardham house, arising from his passionate concern for patients.

The Preston area contains many people from minority ethnic communities. Under Mr. Howell's leadership, very good relationships have been built with those communities. Projects include jointly organising workshops and local conferences sponsored by the Guild trust. They have helped local communities express their views on how to make services more accessible and appropriate for their cultures. Projects have included mental health, women's issues and services for children, and the results have been recorded in various languages and reported back to the communities. That is why there is such support for Mr. Howell among the ethnic minorities.

Last September, a national conference on health care for minority ethnic groups was organised by the Guild trust, with the co-operation of six other trusts, and three universities and colleges. Unfortunately, the appropriate health authorities, including North West Lancashire, declined to take part.

Apart from a conference organised by the Department in 1997, that was the first national conference on the issue. Having participated, I can vouch for its resounding success. It was informative, constructive and thought provoking at every level. It involved both professional and lay people from all communities in the UK, and it crossed the health and social services divide which, as my hon. Friend the Minister knows, is usually all too wide.

I do not believe that that conference would have taken place without Mr. Howell's inspiration and guidance. It was intended to be the first step towards setting up an institute of minority communities health and social care, but I have not observed any progress towards that aim since his suspension.

Mr. Nigel Evans (Ribble Valley)

Will the hon. Lady give way?

Audrey Wise

No. The hon. Gentleman had an Adjournment debate a few weeks ago, and should be satisfied with that.

Since Mr. Howell's suspension, I have received many expressions of support for him from all sections of the minority communities in Preston and throughout Lancashire. I have also received expressions of support for him from carers of trust patients.

One of those who wanted to get rid of Mr. Howell described him as very clever, imaginative and passionate about the Health Service. That is quite a good reference from an opponent. However, a person who brings single-minded commitment to his job, which entails sorting out problems such as I have outlined, is apt to make enemies, and Les Howell has clearly done that.

Now the opportunity has been taken to get rid of him. How did that opportunity arise? As is not uncommon in organisations dealing with mentally disturbed patients, incidents have taken place that have sparked concern and inquiries.

Two such incidents occurred in 1996. The first involved two patients, Julie Byelong and her husband Douglas. Douglas Byelong was on conditional discharge by order of the Secretary of State, the condition being that he lived in his flat, which he failed to do. Julie Byelong absconded on unsupervised leave granted as part of a medical decision. They committed the serious offences of attempted murder and kidnap. Both had been patients at the Langdale unit, a medium-secure forensic unit for Lancashire and south Cumbria. The majority of its patients are detained under the Mental Health Act 1983, and most suffer from severe mental illness.

A detailed report into the matter states: The service has been historically under resourced. I regard that as a very significant statement. Various recommendations were made and were being progressed according to plan, but it seems to me that problems of under-resourcing almost certainly persist.

The second incident involved a discharged patient, Daniel Holden, who later committed murder. The court found that he was not mentally ill at the time of the murder. It was agreed—by the court and by a subsequent inquiry—that the trust bore no responsibility for the fact that he committed murder. However, the inquiry found that there were deficiencies in the care that he had received in the community while a patient, and made some recommendations about that. Surprisingly, it also imported into the report some strong criticisms of the chief executive. I have analysed the report carefully, and those criticisms do not seem to me to be properly justified by the report's factual findings.

Mr. Howell took exception to the report, and made what I consider to be a mistake in the way that he handled it. That gave his opponents an opportunity, and they took full advantage of it.

Mr. Howell replied to the draft Holden report before he consulted the board, although he did consult the then chairman. Mr. Howell's reply was a defence of the trust as well as of himself. It was understandable and probably justified, but it was a lapse of judgment to send it before consulting the board. The chair, Mrs. Diamond, was then pressured into suspending him on threat of a vote of no confidence in herself as well.

The Galbraith inquiry was then set up. Mr. Howell had understood that his suspension was without prejudice and he was in favour of an inquiry. However, the inquiry panel interpreted its terms of reference as meaning that it should set aside all issues of Mr. Howell's achievements and consider only whether there had been a loss of confidence in him.

Every other inquiry had given lists of those who gave evidence and had made detailed reference to factual matters and documents. The Galbraith inquiry did not disclose who gave evidence, nor any documentary back-up, nor the basis on which it decided whom to interview and whom to refuse to interview. Having confidence in Mr. Howell was given no weight, but losing confidence in him carried great weight.

The then trust chair is heavily criticised for having too much confidence in the chief executive. Insinuations are made about the capability of the then human resources director, who has now successfully obtained a position with another trust, but who also had, apparently, the fatal flaw of having confidence in the chief executive.

Two non-executive directors, Mr. Nelson and Mr. Mallidi, had been very reluctant about the suspension in the first place, but three non-executive directors had favoured it. Therefore, the margin was not exactly huge, but the impression has been given that no one had any confidence in the chief executive and that he was unable to work with other people.

Some staff were critical. I have discussed that with some of them, but they did say to me that Guild trust services were second to none and far better than others in Lancashire, and that they had a staff training system that was also second to none. However, they apparently gave the chief executive none of the credit for that of which they approved, and all the blame for what they did not like. Most of what they did not like appeared to result from changes in the NHS through the establishment of trusts, many criticisms of which I agree with.

The Galbraith report established that some people have lost confidence in Mr. Howell, but not whether that loss of confidence was well founded or justified. I have never seen such a shoddy or flimsy document on which to base serious action. Mr. Howell has been thoroughly victimised. He has faced no specific charges, so has had no opportunity to rebut specific charges. Vague assertions of loss of confidence are not the same as being guilty of wrongdoing that justifies the deprivation of a person's livelihood, yet that is what is happening.

The Minister of State, Department of Health, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), told me that the proper procedures have been followed and that there has been proper consultation with the regional office."—[Official Report, 8 June 1999; Vol. 332, c. 460.] I wonder whether he really thinks it is permissible for the NHS to sack an employee without disciplinary procedures. I think that, on reflection, he will decide that it is not.

A chief executive with a difficult job to discharge may become unpopular with some people, especially if he finds it necessary to complain about some of their work. Mr. Howell had indeed complained about the work of two of the executive directors—the director of finance, Mr. Tomlinson, and the then director of nursing, Mrs. Hedley. I have details of that available, but no time to elaborate here.

As I have said, the board was divided. Three non-executive directors opposed Mr. Howell, while the then chairman and two non-executive directors supported him, although they reluctantly agreed to the suspension.

At first, Mr. Howell was extremely anxious to return to the Guild trust. His first reactions were a robust desire to vindicate himself and the work of the Guild trust and to resume his work. However, his health has subsequently been badly damaged by what has been a long and bitter dispute, and by his feelings of injustice and victimisation. He has been isolated, had no access to papers from which to prepare a case and, indeed, no one to whom he could present a case. He was, and remains, strongly of the view that there should be a proper public inquiry into all those circumstances. However, as I said, his health has been badly damaged and he wishes to take early retirement on medical grounds, to which he may well be entitled. A proposal for early retirement had been put to him and he has accepted it, subject to clarification which was never received.

My right hon. Friend the Secretary of State has now appointed a new temporary chair and a new board. I have been astonished to find that, without even seeing Mr. Howell or his representatives, it has decided to terminate his contract. It has even ignored the fact that he is probably entitled to early retirement on medical grounds, which would not involve the trust in any expense. Instead it has issued press releases publicising its decision, even while ostensibly allowing Mr. Howell a right of appeal. Incorrect statements implying that Mr. Howell had been demanding large sums of money have been allowed to gain credence and his reputation has been damaged—in his opinion, irreparably.

Mr. Howell has played an important part in building an improved service in my area. He has committed no misdemeanours or offences of any sort, he is passionately devoted to patients and their families and to the national health service, yet he is rewarded by being deprived of several years' employment. That is damaging to the NHS as well as a great injustice.

Mr. Evans

Let the Minister reply.

Audrey Wise

I do not expect the Minister to give me a definitive reply and I am aware that I have left him little time, but I hope that he will earnestly reflect on what I have said. Indeed, I am sure that he will do so.

10.46 pm
The Minister of State, Department of Health (Mr. John Denham)

I should begin by congratulating my hon. Friend the Member for Preston (Audrey Wise) on obtaining this Adjournment debate. The events at the Guild Community Health Care national health service trust have generated a considerable amount of public and political interest. Indeed, this is the second time that the House has debated events at the trust in just under a month.

My hon. Friend has spoken of the good work of the trust and the achievements of the former trust chief executive, Mr. Les Howell. His contract has recently been terminated and he has appealed against that decision. Obviously, hon. Members will understand that it would not be appropriate for me to comment on the correctness of the action or the appeal that is pending at this time.

The trust's difficulties have been widely discussed and reported in recent weeks, but, as my hon. Friend acknowledged, they go back much further than that. The former chairman's decision, formally to suspend the chief executive on full pay and without prejudice from 5 October 1998, followed successive inquiries and reports by different, independent panels, all of which had identified unsound practices and failure to follow the appropriate procedures.

The effect on a trust whose patients are often disturbed and vulnerable people was obviously a matter of the utmost concern to those who commission its services, to the local community and to the people who work in it.

At the risk of repeating some of the history, in early 1997, the North West Lancashire health authority received the report of an inquiry that it had commissioned into an incident involving a patient who had absconded from the Langdale unit. That report made 44 recommendations for improvements to the clinical, nursing, administrative and security services at the trust. The report also referred to some poor external relations, most notably the relationship between the Guild and the lead commissioner of its services, North West Lancashire health authority. Furthermore, the report observed that the provision of community services had evolved in an unplanned and inchoate fashion". The draft report into the care and treatment of Daniel Holden, however, which East Lancashire health authority received in the summer of 1998, precipitated the actions to suspend, and subsequently to dismiss, the chief executive. Daniel Holden was on the Langdale unit's supervision register when he murdered a neighbour in Darwen in March 1997. Since the patient was an East Lancashire resident at the time, it fell to that health authority to launch an independent inquiry in line with statutory requirements. The report concluded that the chief executive's responsibilities had not been adequately discharged and that the board should, therefore, consider how to bring about changes in anagement style that would enable the trust to make a fresh start.

The inquiry had been conducted over six months, and its final report, the Holden report, itemised failures by the trust to carry out certain fundamental procedures correctly, if at all. By last summer, there were indications that the trust had taken steps to address the recommendations of earlier reports and that some of the clinical, nursing and administrative inadequacies identified had been put right.

On 20 August 1998, however, East Lancashire health authority invited the trust to check the draft Holden report for any factual inaccuracies, so that a final report could be produced and formally received and considered by the Health Authority. I am advised that the response of the trust's chief executive to the draft report was the cause of concern for some members of the trust board.

On 1 October, three executive and three non-executive directors of the Guild visited the regional offices of the NHS executive to voice their concerns to the chairman of the north-west regional office and the regional director. On 2 October, the three non-executive directors gave the chairman, Mrs. Diamond, a letter in which they called for Mr. Howell's suspension.

Regional officials met Mrs. Diamond a week later. She had already spoken to Mr. Howell and advised him to stay at home on extended leave while the trust board considered how to respond to the Holden report. The regional director explained to her that, unless Mr. Howell were formally suspended from his post, he would remain the accountable officer for the trust and that that would not be satisfactory. As a consequence, Mrs. Diamond wrote to Mr. Howell suspending him on full pay and without prejudice from 5 October.

The trust board then unanimously agreed to commission an investigation into the specific criticisms of the chief executive in the Holden report. The regional office offered advice about suitable candidates to undertake this work; a list of several names was put forward for consideration, and the chairman and non-executive directors took the final decision.

The inquiry team consisted of a chairman, Mrs. Ann Galbraith, former chair of a major trust in another region, and one other panel member, Mr. Neil Campbell, chief executive of the Dumfries and Galloway health board. The terms of reference were agreed unanimously by the trust board on 20 October.

The panel drew up a list of people to be interviewed and then offered all Guild employees, by means of a special edition of the staff bulletin, the opportunity to give confidential evidence to the inquiry. The panel's report, known as the Galbraith report, was completed just before Christmas. It upheld many of the findings of the Holden report and concluded that the chief executive's position was "untenable". The report refers to people being keen to record their appreciation of Mr. Howell and to illustrate his achievements during his employment at the Guild", but it also stated: The panel is greatly concerned by the sheer weight of opinion showing a lack of confidence in the management style of Mr. Howell. The panel advised the trust board that Mr. Howell had lost the confidence of a significant number of the individuals and organisations with whom and with which he had had regular contact.

At a meeting on 29 December 1998, the chairman and non-executive directors agreed to accept the report's first recommendation, which indicated that Mr. Howell's position had become "untenable". After discussing her own position with the regional chairman on 9 January 1999, Mrs. Diamond resigned as chairman two days later. Between January and March, the non-executive directors had further discussions and on-going negotiations with Mr. Howell's representatives.

On 19 April, the Secretary of State met Mrs. Kirk, the current chair of the trust, and concluded that she was the right person to lead the trust. She agreed to take up the post for six months with effect from 17 May. The Secretary of State and Mrs. Kirk discussed the need for a fresh start, and the House will know for reasons that I have previously outlined that three non-executives were subsequently removed from office and two resigned. A new non-executive team was appointed from 18 June.

Mr. Evans

Will the Minister give way?

Mr. Denham

No, I cannot possibly give way at this time.

After looking into the background to Mr. Howell's suspension, Mrs. Kirk concluded that the need to establish strong leadership was paramount and that the trust's genuine attempts to negotiate with him had stalled. She recommended to her trust board that Mr. Howell should be dismissed. It unanimously approved that course of action and the chairman wrote to inform Mr. Howell that his appointment would be terminated from 11 June. He has since exercised his right of appeal, and I understand that a meeting has been arranged for 13 July to exchange documentation and agree the process for the appeal and the dates for the hearing.

Mr. Evans

Will the Minister give way on that point?

Mr. Denham

No. The hon. Gentleman had an extended Adjournment debate just a few weeks ago.

The appeals panel that has been established by the trust consists of Mr. Ian Pirnie, the former chairman of Ashworth high security hospital and present chairman of Morecambe Bay health authority, Dr. Nuala Swords-Isherwood, chairman of Stockport Acute Services NHS trust and Mr. Mike Deegan, chief executive of Warrington Hospital NHS trust, who was previously director of human resources for the NHS Executive. The panel is charged with establishing whether the chairman and non-executive directors of the trust have acted appropriately in terminating Mr. Howell's contract of employment. The dispute is between Mr. Howell and his ex-employers, and it is for the panel to judge whether the interests of natural justice have been properly served.

This has been a unique and difficult chapter in the history of NHS trusts, but our overriding objective throughout has been to ensure that the patients and staff of Guild Community Health Care NHS trust are provided with the best possible conditions in which to receive and deliver treatment and care. I hope that matters will be brought to a satisfactory conclusion as quickly as possible, that all the people affected by the events of recent months can resume their normal lives and that the trust can get on with the business of providing good quality health services to the local community.

Question put and agreed to.

Adjourned accordingly at four minutes to Eleven o'clock.