HC Deb 16 January 2001 vol 361 cc201-11 3.31 pm
Dr. Liam Fox (Woodspring)

(by private notice): To ask the Secretary of State for Health if he will make a statement on the proposed inquiry into the storage of corpses at Bedford hospital.

The Secretary of State for Health (Mr. Alan Milburn)

As Members are aware, last week the bodies of certain deceased patients were inappropriately kept in a chapel of rest at Bedford hospital.

Let me say at the outset that what happened at Bedford hospital was totally and utterly unacceptable. Patients and their families have a right to be treated with dignity and respect at all times, in all parts of the national health service. In this case, they were not. We have a responsibility to get to the bottom of what went wrong in Bedford.

Over the weekend, an investigation was begun by the eastern regional office of the NHS executive. An initial report was made verbally to the NHS chief executive, Mr. Nigel Crisp. The final report of the full investigation will be published. I will ensure that it is placed in the Library.

I am advised by Mr. Crisp that the initial findings on this incident identified a failure of management within the trust. The trust chief executive, Mr. Ken Williams, has stepped down. In the circumstances, that was the right thing to do.

In the past, there were no clear guidelines about how dignity and respect for deceased patients should be ensured. The NHS now has guidelines that emphasise the need for standards to respect patients' dignity. The guidelines were issued by my Department to every hospital in May last year. The guidance was repeated in November last year. In Bedford, that guidance was not adequately implemented.

The preliminary inquiries appear to show that in the past, when the mortuary facility was full, the deceased were kept in the chapel of rest. Following the issue of guidance in May, however, an extra purpose-built mortuary facility was purchased it a cost of about £20,000. I am advised that the additional facility was at no stage full. It was functioning normally, apart from a minor problem with the doors that was reported on Monday of last week, but final action about that was not taken until last Thursday. During that period last week, bodies were placed inappropriately in the chapel of rest. No policies and procedures were in place in the hospital to ensure that the bodies of deceased patients were treated with dignity and respect at all times. This was not a cash problem in the hospital; it was not a capacity problem in the hospital: it was a management problem in the hospital—a failure to implement clear national guidelines and resolve a clear local problem immediately. The issue should and could have been sorted out on the spot.

Instead, deceased patients were denied their dignity. That should never happen in any part of the NHS, and those who say that what happened in one part of Bedford hospital is a reflection of what happens throughout NHS hospitals are simply wrong. They do not do justice to the efforts of the 1 million people who work in the health service, who strive day in, day out to maintain and to raise standards for patients.

It is deeply regrettable that decisions taken inside Bedford hospital prevented deceased patients from receiving the respect that their relatives had every right to expect from an NHS hospital. Yesterday, the NHS chief executive wrote to all trusts reminding them of their duty to treat the deceased with dignity and sensitivity, in line with the guidance that we issued last year.

The Health and Safety Executive will visit Bedford hospital on 18 January. The independent inspectorate for the NHS, the Commission for Health Improvement, will begin its inspection on 29 January. This matter will now be covered as part of its wider inspection of the hospital.

The events that took place in Bedford last week should never have happened, and need never have happened. I am deeply sorry that they did.

Dr. Fox

I think that everyone would accept that what we have witnessed is indeed a national scandal, and we all wish to send our sympathy to the relatives whose loved ones were treated so appallingly; we can only imagine their distress.

Will the Secretary of State confirm that such events have been going on for years at Bedford hospital, summer and winter? How often has the same thing happened? The shortage of pathology facilities has been raised by consultants, but not until the pictures appeared in the papers was any action taken. Indeed, it seems that, yesterday, the most urgent task for the consultants was to find out who had leaked the picture.

Is it true that the hospital's chairman was also asked to resign, but declined to do so? What contact has the NHS had with relatives who may be seeking to take legal action? How many other hospitals have similar pathology problems, and how many other scapegoat resignations can we expect? The Secretary of State said nothing about a proposed inquiry, despite the fact that that possibility has been widely mentioned in the newspapers.

These events are symptomatic of a wider problem. Indeed, one of the hospital consultants said that health service managers were being prevented from spending funds on pathology facilities, but scapegoated when problems arose. He continued: The Government forces the managers to spend money on political initiatives such as the waiting list initiative, rather than on improving pathology facilities … We see pathology as a priority but Mr. Milburn … would rather it was spent on treating non-urgent cases within 18 months. The Secretary of State is right to say that what happened was not caused by a cash problem—but it is not simply a local problem either. The NHS is being used to deliver ministerial targets, rather than dealing with the clinical problems of doctors and their patients. There is no point in the Secretary of State trying to hide behind the good reputation of medical staff, when his policy is undermining their value.

The Prime Minister talks about patients being treated on the basis of clinical priority, yet the Secretary of State sends in waiting list hit teams to ensure that those in the NHS do his bidding. The simple truth is that the Government have increasingly appointed Labour party stooges to run the health service, as Dame Rennie Fritchie said in her damning report. Bedford hospital's chairman, who is a serving Labour county councillor, must not be involved in, or in charge of, any inquiry.

This horrendous episode has blown the lid on the Government's incestuous and corrupting running of the NHS. This is one occasion when the Secretary of State cannot blame the previous Government, funding or the management. These are his priorities, carried out by his people, on his watch, and it is his responsibility.

Mr. Milburn

On the hon. Gentleman's specific questions, the anecdotal evidence shows that this sort of practice has been going on for a number of years, but I am absolutely determined to get to the bottom of it. I hope that the investigation will report next week, and when its report is published and laid before the House, right hon. and hon. Members will be able to see for themselves exactly how long the practice has been going on. Let me emphasise that this sort of practice has absolutely no place in a modern national health service, and we will do everything that we can to help to eradicate it.

On the investigation's independence, I made it clear in my statement that an investigation is being undertaken, and the work of the independent inspectorate, the Commission for Health Improvement, CHI, will complement it. As I think the hon. Gentleman knows, the commission—in Committee during the passage of the Health Act 1999 he opposed its establishment—will publish its conclusions. Again, I give an undertaking that those conclusions will be published in full. Although CHI's final conclusions are not normally placed in the Library, I will do precisely that in this instance. I am not aware of whether the chairman was asked to resign, but the investigation will no doubt reveal that. Again, the report will be published in full and made available to hon. Members.

Many people in the House and outside will conclude that, given the circumstances that we are discussing, it was a mistake for the hon. Gentleman to indulge in a party political tirade. What happened in Bedford was wrong. It should have been avoided. It could have been avoided. It is now being dealt with, but it is simply not true to say that it is typical of NHS staff or the wider health service; nor do I believe that it negates the real progress and improvements that are taking hold in many parts of the NHS thanks to the investment and the reforms that the Government are making.

Mr. Patrick Hall (Bedford)

May I tell my right hon. Friend that after the understandable shock and amazement at the events at Bedford hospital last week, most people, including the relatives of those who unfortunately died at the hospital during the past few weeks, want to see firm action to put the problem right? They want constructive, critical questions to be asked about the practice so that it does not happen again, and they will not be impressed by some of the cheap party political comments that we have just heard. Given that we are talking about the dead having been treated with a lack of respect and dignity, those comments have come across to me and many others as remarks that do not show respect to those people.

May I thank my right hon. Friend and his Department for the swift action taken yesterday to investigate events at Bedford hospital? May I thank him also for the speedy interim conclusions that were arrived at yesterday?

I welcome my right hon. Friend's decision to extend CHI's already planned inspection of Bedford hospital at the end of the month to include the management problems that are still being revealed. Does he agree that a root-and-branch shake-up of management practices at Bedford hospital is needed? Although there is always a case for more resources in the NHS, what happened last week was clearly nothing to do with resources; it was to do with management.

I seek my right hon. Friend's assistance with regard to the relatives of people who have died recently at Bedford hospital, some of whom have contacted me, to say that in the past day or so they have asked the hospital management whether their relatives were those left on the floor in the undignified way that has been described. Unfortunately, as of this moment, the hospital has been unable to give anyone any information; indeed, some have been told that information will not be available for at least a week. Will my right hon. Friend personally assist me in ensuring that my constituents get the information to which they are entitled, so that they can grieve?

Mr. Milburn

I am extremely grateful to my hon. Friend for his comments. We spoke last night about some of these issues. He is right to emphasise the important point that this matter is not about cash, resources or the capacity of the mortuary facilities because, as I said, at no point were those facilities fully used. Still less is this matter about clinical priorities or waiting lists. This was a management failure in one part of one hospital. However, I suspect that it reveals a more endemic problem in the management culture in that hospital.

My hon. Friend rightly raised the concerns of his constituents and the many relatives who are still grieving and who are deeply upset about what has happened in Bedford. He is right to say that at the moment we are unable to say which patients were inappropriately kept in the chapel of rest. I asked that question of the eastern regional office of the NHS executive just a few hours ago. Bearing in mind my hon. Friend's comments, I will urge the regional office to try to get to the bottom of the matter and to find out precisely who was treated in that inappropriate and appalling fashion. As soon as we have answers, we will of course make them available to my hon. Friend and, mole important, to the relatives of those who died.

Mr. Nick Harvey (North Devon)

I echo the concerns of those who have said that the procedures at Bedford hospital failed to preserve the dignity of the deceased. However, I do not believe that their dignity will have been in any way enhanced by the contribution of the Conservative party spokesman, the hon Member for Woodspring (Dr. Fox).

I welcome the fact that the chief executive at Bedford hospital has accepted responsibility in this matter and done the honourable thing by tendering his resignation. Many others in the health service have failed to do so when equally, if not more, significant errors have been made. I welcome the fact that the Government have twice issued guidelines about the dignity of the deceased. I welcome also the recent remarks of the chief medical officer, who signals that the Department of Health and the NHS will in future have a better attitude to the issue of organs that are retained after autopsies in hospitals. What steps can the Secretary of State take to ensure that all hospitals throughout the country have adequate mortuary resources to give practical effect to the guidelines that he has issued?

Mr. Milburn

I am grateful to the hon. Gentleman for his considered remarks. He is right to say that there are wider issues that we must think about, particularly in response to the Alder Hey inquiry, which has now reported. He is aware that, last week, the chief medical officer, Professor Liam Donaldson, Held a summit not far from this place about the terrible issue of retained organs in the NHS. I will seek to make a statement on that before too long.

As for the specific issue raised by the hon. Gentleman concerning mortuary facilities in the NHS, as I said in my statement, the chief executive of the NHS, Nigel Crisp, contacted all the trusts in the country yesterday, asking for assurance that the guidelines that we issued in May last year and repeated last November were being adhered to in all parts of the country. We have now received those assurances from all the trusts. I expect all the trusts to adhere precisely to the letter of that guidance, and I certainly do not want a repeat of this sort of incident in any part of the NHS anywhere.

Ms Margaret Moran (Luton, South)

I thank my right hon. Friend for his sympathetic, sombre and swift response to the incident, which is in sharp contrast to the reaction of the hon. Member for Woodspring (Dr. Fox), who has done a great disservice to, the families of the deceased.

May I tell my right hon. Friend that the whole issue has sent shockwaves, not just through that particular hospital, but through Bedfordshire health authority as well? Having spoken to the chair of the authority a short while ago, I am assured that a review is also being carried out at my own hospital, Luton and Dunstable hospital. It is a great pity and tremendous shame for us all that the failure to fix a door handle, which appears to be the root of the problem, should undermine tic badly positive work that is taking place in Bedfordshire health authority, not least in Luton and Dunstable hospital, where a new accident and emergency unit has jus opened.

Will my right hon. Friend therefore undertake to look more closely at the estate management and maintenance practices of health authorities and hospitals, which seem to underlie the problem? More particularly, will he assist in rebuilding morale and confidence—not just among staff, but among users of our health service—which is being badly undermined by the climate of fear that Conservative Members are seeking to engender?

Mr. Milburn

As for the specific issues raised by my hon. Friend, preliminary investigation results indicate that that was precisely the problem. Unbelievably, there was a problem with the hinges and door handles in the temporary mortuary facilities, which could have been dealt with on the Monday. It was reported to the works department in the hospital then, but no one regarded it as sufficiently urgent to deal with immediately. As I said, it was not until late on Thursday that the problem was rectified. The problem could have be en rectified at once: it could have been rectified literally overnight.

There were some faults at those facilities, but what concerns me more is the fact that although there was a specific problem in one part of the hospital, there was no reporting mechanism up the line to ensure that it was dealt with at a more senior level in the organisation. The investigation, led by Mr. Houghton, the regional director of the eastern regional office, will need to look at that extremely carefully, and it is right that it should do so. There are likely to be general lessons to be learned, and if there are we shall seek to make them available to the NHS in Bedfordshire and across the whole country.

Sir Nicholas Lyell (North-East Bedfordshire)

The Secretary of State rightly recognises that what happened at Bedford hospital was unacceptable. We all share and sympathise with the distress of families whose loved ones were affected. Does the Secretary of State accept that, when considering the chief executive, Ken Williams, who has taken the blame and resigned, we should remember that a great deal of good work has been done in Bedford hospital during the many years in which he has been in office? He has done much, above and beyond ordinary working hours, to help patients in the vicinity.

Is not the key question whether there are adequate mortuary facilities in Bedford hospital and hospitals throughout the country? It is plain from what I have been told that, until the supplementary mortuary was provided, mortuary facilities at Bedford hospital were inadequate.

Mr. Milburn

indicated dissent.

Sir Nicholas Lyell

I see that the Secretary of State is shaking his head, but will he ensure that the inquiry publishes the proportion of each hospital's mortuary facilities in relation to the population that it serves so that, in future, the House and the country can be satisfied that the NHS generally provides adequate facilities for the inevitable deaths that occur and for their proper and humane management?

Mr. Milburn

I am sure that, as a result of the investigation, there will be some lessons that we will want to extend across the NHS, but, with the greatest respect to the right hon. and learned Gentleman, he is wrong about mortuary capacity in the hospital. As I understand it, the sequence of events is this: there had been problems, perhaps going back over several years, and the investigation will get to the bottom of that. In 1999, the hospital installed an additional temporary mortuary facility. Last year, it decided to purchase that temporary mortuary facility rather than rent it again.

As I understand it, the permanent mortuary facility at Bedford hospital has 24 places. The additional capacity that has been made available over the past few months has an additional 15 places. In other words, there are places for 39 deceased patients. At no point last week was all that capacity being used. That is the essential point that the right hon. and learned Gentleman should bear in mind. It was nothing to do with cash. It was nothing to do with capacity. It was nothing to do with a shortage of resources. It was everything to do with the fact that a very small problem became a very big problem for many patients and their relatives.

Mr. Brian White (Milton Keynes, North-East)

Last night, I received an e-mail from a constituent whose uncle died at Bedford hospital last week. She says: As someone who voted labour for the first time … I don't want any more privatisation—what we've had so far hasn't worked. What I do want is … a real commitment to increased public service spending whereby the emergency which existed at Bedford can never happen again. Will the Secretary of State deal with the perception to which he has referred? Funding was not the problem, but, as the comments of the Opposition spokesperson showed, everything that goes wrong in the health service is automatically turned into a funding issue. Will he assure the House that he will deal with the perception held by the general public as well as the reality of what he has discussed?

Mr. Milburn

I am grateful to my hon. Friend. In this case, we should all dwell on the facts of the matter. In this case, I believe that making generalisations and party political generalisations, from either side of the House, is peculiarly unhelpful. If people stop to examine the facts and what went wrong, they will quickly realise that, despite the generalisations and sweeping accusations that are flying around the Chamber and the media, those comments are wrong. That is why we have tried to act as quickly as we can.

When I first heard about the matter on Sunday, I contacted the NHS chief executive, Nigel Crisp, and asked him to get on to it and undertake the investigation straight away. To his credit and to the credit of the eastern regional office of the NHS executive, they did so immediately and made contact with Bedford hospital. As a consequence, I have been able to say some of what I have said today. The truth is that we shall have to wait a while before we get the full results of the investigation. If, at that point, Members on either side of the House want to make sweeping generalisations, that will be a matter for them to determine. At this stage, we do not have all the facts, and what facts we have suggest that there was a management difficulty in a part of the hospital. The problem was that it was not gripped at the top of the hospital.

Sir Brian Mawhinney (North-West Cambridgeshire)

Pending the publication of the report, many will accept the Secretary of State's initial assurances that there was a failure of management and that sufficient mortuary facilities were available. Will he turn his mind to a broader connected issue? There will be times when hospital mortuaries are full. Will he publish—at least for the eastern region, but preferably for the country—what mortuary facilities hospitals should turn to if their own mortuaries become full? If that information were in the public domain, it would provide considerable reassurance to patients and might help the Government to deflect some of the understandable criticism from distressed relatives. I hope that he will take that suggestion seriously.

Mr. Milburn

I am happy to consider that suggestion. I shall double check, but I think that in the guidance we suggested what hospitals should do if they were concerned about their mortuary facilities not being adequate, especially at certain times of the year. I shall consider the right hon. Gentleman's suggestion and reply to him in writing.

Dr. Howard Stoate (Dartford)

May I say how disappointed I am that the hon. Member for Woodspring (Dr. Fox) tried to turn this tragic incident into another bandwagon? This is clearly a very serious issue. I am pleased that my right hon. Friend supported the 1 million-plus staff who do an excellent job in the NHS. Does he recognise that such a tragic incident undermines public confidence in the NHS and reduces morale among its staff? What can he do following this incident to reassure people that, when their relatives enter the NHS to obtain treatment from dedicated staff, they will be looked after with respect and dignity, and that this incident is very unlikely to recur?

Mr. Milburn

I am grateful to my hon. Friend. First, we must take appropriate action where the problem has occurred, and that has happened and will continue to happen not just in the next few days but in the next few weeks, especially when the HSE and CHI undertake their inspections of hospital services in Bedford. It will be very important indeed to reassure the constituents of my hon. Friend the Member for Bedford (Mr. Hall), who use Bedford hospital, that this terrible event was out of the ordinary for that hospital.

Secondly, we must remind people that, however awful this incident was—it was dreadful and completely unacceptable—it is not the custom and practice of NHS hospitals, it is not the custom and practice of NHS staff and it is certainly not the custom and practice of the national health service as a whole.

Mr. Graham Brady (Altrincham and Sale, West)

The Secretary of State knows that in November last year I asked a number of parliamentary questions about mortuaries in the NHS following serious concerns about the mortuary at Trafford general hospital, which serves my constituents. At that time, it came to light from the responses to those questions that there is no national inspection regime for NHS mortuaries, and that the Department of Health cannot tell me which NHS mortuaries meet necessary minimum, standards. Surely that situation cannot be allowed to continue. Will the right hon. Gentleman take responsibility for establishing which NHS mortuaries meet necessary minimum standards, and will he publish that information?

Mr. Milburn

We shall certainly consider those issues as part of the wider implications arising from the current investigation into the incident at Bedford hospital.

Mr. Patrick Nicholls (Teignbridge)

Does the Secretary of State share my unease, and perhaps surprise, that it was necessary to issue guidance about the correct treatment of bodies? He told us that that was done twice. Was that guidance issued because other concerns had reached him about the treatment of dead bodies? Although I accept what the Secretary of State says, and that for the purposes of these o changes we are not dealing with a funding issue; nevertheless, there must have been more than one person involved in the treatment of those bodies. There may have been tons or there may have been dozens. Although I accept that it was a management failure and not a financial problem, I have a lingering unease about the fact that so many people must have felt it appropriate to treat bodies in that way in Bedford hospital. That raises the concern that the practice is more endemic and widespread than the right hon. Gentleman would ever want it to be. Will he comment on those propositions?

Mr. Milburn

The hon. Gentleman is right to say that the problem has occurred before. I am in no way making a party political point, but there were issues before the general election about mortuary facilities being full at some hospitals. The right hon. Member for North-West Cambridgeshire (Sir B. Mawhinney) will remember that. It is, therefore, important that we invest appropriately. Part of the reason behind the guidance was to try to impress on local hospitals that they need to do just that because, in the end, they have to take the right local decision. I actually agree with what the hon. Member for Woodspring said in last week's detate on the Health and Social Care Bill. He conceded: It is impossible to run an organisation that employs almost 1 million people from behind a single Minister's desk.—[Official Report, 10 January 2001; Vol. 360, C. 1096.] We have a duty to locate respossibility where it belongs. The responsibility for rut ping individual local hospitals rests with people who work in them. The responsibility that we have to discharge as a national Government and, perhaps, as a Parliament, is to try to assure people that national standards are maintained as far possible, and that we police and monitor them so that patients in every part of the country are confident that they are getting access to full and fair services. That is precisely why we issued guidance twice last year.

Dr. Peter Brand (Isle of Wight)

I strongly welcomed the guidelines when the Government issued them. Investment in mortuaries is always placed behind investment in, for example, children's wards. It is important that it is given due credence in our planning. Does the right hon. Gentleman accept that what happened at Bedford hospital was not unusual in the national health service or in private undertaking establishments during the winter? I am not saying that it is an acceptable practice, merely that it is not unusual.

Does the right hon. Gentleman agree that one of the most worrying aspects of the case is that it took a picture in the newspapers, which really denied those people their dignity and respect, for action to be taken? I cannot condone what the press or, indeed, the person who took the picture did, but is it not sad that we do not have a better way of getting action when there is a problem than literally having a shroudwave on the front page?

Mr. Milburn

Much of what the hon. Gentleman says makes absolute sense. I very much lope that in hospitals up and down the country, those people who are responsible for running them and the clinicians who are engaged in providing such services realise the importance of them.

As for Bedford hospital, I understand that in the next financial year it will receive £1.5 million extra to spend on capital projects. It will be for that Hospital to determine where best to spend the extra investment. That is right and appropriate because the people who best know the needs of patients who use the hospital are the people who run the organisation—the doctors, nurses, managers and so on. It is our responsibility to give them the tools to do that job, such as the resources and the framework, including the national standards by which they should abide precisely to avoid some of the problems that the hon. Gentleman raises.

Mr. Nigel Evans (Ribble Valley)

It was an appalling photograph and I am sure that the whole House sends its condolences to the relatives of the deceased.

Bedford hospital may now receive inquiries from relatives of the deceased for information. Will the Secretary of State ensure that they get proper and accurate information and, indeed, any counselling that they may seek because of their distress? I heard him say that he believes the incident to be unique to Bedford hospital, and we can only hope that that is the case. Can he assure us that proper investigations will take place and that the procedure will be correctly followed by all hospitals? Indeed, what whistleblowing arrangements are available to anyone who works within the NHS who believes that procedures are not being properly followed, so that respect and dignity for the deceased can be restored?

Mr. Milburn

I am grateful to the hon. Gentleman for his remarks. On the question of providing information to relatives, as I said in response to my hon. Friend the Member for Bedford—many of his constituents have inevitably contacted his local offices—we will try to obtain what information we can. I am trying to impress on the hospital and the local health service that they need to get the appropriate information as quickly as they can to the relatives. That must be the right thing to do.

On the position in other hospitals, as I said in response to the hon. Member for North Devon (Mr. Harvey), yesterday we asked trusts to assure us that the guidance that we issued in May and November 2000 had been and is being adhered to. We have received responses from all parts of the country, and I have received that assurance. As I am sure the hon. Member for Ribble Valley (Mr. Evans) is aware, I have to rely on such assurances.

We have also issued clear guidance to the service on whistleblowing and stipulated that all trusts should have a policy in place so that staff at any level in an NHS organisation—be they the most senior or the most junior—have a legitimate opportunity to raise their concerns in public on behalf of the public. I expect that to be the position in Bedford and in every hospital in the land.

Mrs. Eleanor Laing (Epping Forest)

I agree with the Secretary of State that this is a serious matter that should be properly investigated. However, will he please explain how CHI can carry out an independent inquiry when the commission is not an independent body, but is obliged to take instructions from the Government?

Mr. Milburn

The hon. Lady is wrong about that. CHI is independent from Government in precisely the way that the inspectorate—

Mrs. Laing

No, it is not.

Mr. Milburn

With respect, when the hon. Lady asks a question, I shall answer it if she gives me the opportunity to do so. CHI is independent in precisely the same way as Ofsted is independent in relation to schools. CHI is not run by me or the Government; it is run by the people who are responsible for running its services. It reports independently and it publishes its own conclusions and findings.

Let me be clear. The hon. Lady wants to have her cake and eat it. She wants me to instruct CHI to do something, and I have done that. I said that it should take on board the events that have happened in the past week in Bedford in the inspection that it will carry out from the end of this month. That is the right thing to do. As I said to the House, alongside the normal procedure of the commission publishing its conclusions, I will also, as a matter of courtesy to the House, make those conclusions available in the Library so that all Members can see for themselves what the results of the independent inspection in Bedford throw up.