HC Deb 27 March 2001 vol 365 cc937-44

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

11.2 pm

Mr. Geoffrey Robinson (Coventry, North-West)

On the occasion of this Adjournment debate, I am grateful for the opportunity to discuss the lack of confidence in the chief executive of Walsgrave hospital, which serves the whole of Coventry, including, of course, my own constituency.

A most unhappy situation, lasting some 19 months, led to my initiating the debate. The staff unions are opposing the consultants and the chief executive himself thinks that the current unrest could lead to problems arising over the new private finance initiative hospital for Coventry. I am led to believe from articles in today's edition of the Coventry Evening Telegraph that the surgeons are split on the matter.

I have to tell my hon. Friend the Under-Secretary of State for Health, who will reply to the debate, that one senior surgeon even thinks that there could be political manoeuvrings against the professional class of surgeons by her Department, but I am anxious to assure her that I do not share that view; nor is it widely shared by the surgeons at Walsgrave.

It is not my intention to apportion any blame for the unhappy situation with which we in Coventry are confronted. I believe that the management has a lot to answer for and I also believe that management, with one simple step that I shall deal with shortly, could put an end to this great unhappiness and great lack of certainty. The purpose of raising the matter on the Adjournment is to urge that the situation be brought to a close, to outline the simple step that could bring it to a speedy resolution and to say frankly that, after 19 months, it has gone on for far too long.

The problems of today started back in September 1999 with a whistleblowing incident. Members of the House will be aware of the whistleblowing legislation that was introduced by the Government in 1998. In 1999, three surgeons at Coventry blew the whistle on surgeons in the colorectal department because of the peri-operative mortality rate. One of the whistleblowers was Mr. Alban Barros D'Sa, who remains suspended. The immediate reaction to the whistleblowing was to suspend one of the whistleblowers; 18 months later, he remains suspended. His position should be resolved to bring order to the current disorder.

The whistleblowing incident has reached a satisfactory conclusion for one of the surgeons on whom the whistle was blown. The professional advisory panel that reported to the hospital in December 1999, only three months after the incident, made three recommendations. All have been acted upon. The surgeon has been moved from colorectal work, and a new specialist will be recruited for the work. The third recommendation was that a performance audit of the department's work in the previous four years should be undertaken. A performance audit of only two years was carried out, but I ask my hon. Friend to consider one aspect of it.

One of the reasons for blowing the whistle was the peri-operative mortality rate of operations conducted by one of the surgeons in the colorectal department. I choose not to name him tonight because I believe that he is competent in other areas, but that he should not undertake colorectal work. While he had a pen-operative mortality rate of 20 per cent. over two years, the specialist had a rate of only 5 per cent. or 6 per cent. The national target is 5 per cent.

The statistics for reviewing performance are calculated on P values. Why do the figures show no significant difference between those surgeons' work? If we are generally applying P values, and drawing comparative conclusions, how can we claim that there is no difference in performance that poses a problem for patients when, in a two-year period, one surgeon has a 20 per cent. Peri-operative mortality rate and another has one of only 5 per cent.? The various statistics that we use, and the way in which we use them, currently lead us to that conclusion.

I revert to the position of Mr. Barros D'Sa. He was a whistleblower who was subsequently suspended on four counts. All were considered, and except for a part of one of them, he was found not to be at fault. It is important to stress that Mr. D'Sa's professional competence has not been questioned. No one claims that he is anything other than a good surgeon. When we are so desperately short of cancer surgeons and others—colorectal work is associated with cancer problems—how can a surgeon of acknowledged competence and with an undisputed professional reputation be left idle for 18 months?

Six months ago, part II of the report of an independent panel of three surgeons was produced. They were led by a noted local Queen's counsel, Jeffrey Burke. They reported that Mr. D'Sa was at fault for oppressing a junior. It is not for me to argue Mr. D'Sa's defence, which is not the purpose of the debate, but he says in his defence that he was quizzing the junior doctor rather aggressively about peri-operative mortality and failures of the operations conducted by the surgeons on whom he blew the whistle. I mention that simply in passing.

The substantive recommendation of the independent panel was that Mr. D'Sa should be reinstated. It referred to his hitherto unblemished record. The management of the hospital could easily have accepted the part II recommendation, and reinstated Mr. D'Sa with a warning. The panel believed that he should receive a written warning. The matter would thus have been brought to a speedy conclusion six months ago.

Instead of doing that, the management issued what it called a document of mitigation. As the judge it came up against was to rule, it was not so much a document of mitigation as of aggravation. In it, the management saw fit to include, as the major reason for not reinstating Mr. D'Sa, a letter that he had written to his Member of Parliament, my hon. Friend the Member for Coventry, South (Mr. Cunningham), and copied to me as the Member of Parliament for North-West Coventry. Since we regard all matters to do with the cathedral, the police and the hospital as constituency issues, I felt it right that we should question the management's procedure in using a private and confidential letter that Mr. D'Sa wrote to his Member of Parliament as a reason for not reinstating him.

As you are aware, Mr. Deputy Speaker, we took the issue to Mr. Speaker. It would be fair to say that we had to recognise that Members' correspondence does not enjoy privilege or, indeed, qualified privilege. What we say in this House enjoys total privilege and there is no way in which I would abuse that. I understand that any correspondence that I have with my hon. Friend the Minister or other Ministers enjoys qualified privilege. However, Mr. D'Sa's letter, which was private and confidential and naturally critical of the management, was included in the management's so-called document of mitigation and submitted to those concerned as a reason for not reinstating him.

Despite all our opposition to the management proceeding in this manner, the chief executive was determined to do so. The case went to court, as we knew it would, and an injunction was taken out by the lawyers representing Mr. D'Sa. I hate to say it, but the management was humiliatingly defeated at the injunction hearing. Not only was it expressly forbidden to rely on or use the letter addressed to my hon. Friend the Member for Coventry, South and copied to me: it was refused the right to rely on any surrounding information other than what was, quite rightly, in part II of the independent report prepared on the issue.

One would have thought that that would be the end of it. Enough money had been spent, enough time wasted and enough management attention dissipated—all to no good end, except for the immense legal costs. Has that contributed one iota to patient care or to concern for those who need it most in the hospital? Of course not. This has been a great and costly diversion of resources.

The management, which had taken the case to court, was condemned to pay all the costs, including those of the surgeons. One would have thought that was the end of it and that we could now proceed with the normal implementation of the independent recommendation in part II of the report. However, that was not acceptable. I am informed that the management is still pursuing the case and seeking leave to appeal against the ruling of the court. That will mean more costs, more delays and further harm. The vote of no confidence that the surgeons have determined to hold on the conduct of the case concerning Mr. D'Sa will proceed, and the Electoral Reform Society is being brought in to supervise it.

There will be growing concern in the constituency among patients and prospective patients that the hospital is in disarray. That is in no one's interests, and in no way do I want to contribute to that uncertainty by bringing this matter to my hon. Friend's attention. On the contrary, I believe that it is necessary to highlight the one simple action that can be taken that will put an end to the matter once and for all. It will remove uncertainty, restore confidence and re-establish between surgeons and management the co-operation that is so vital to the good functioning of any organisation. It is very simple. The management should be prepared to follow the recommendations of part II of the report, which was prepared by independent experts in the field who were appointed to do the job, and to proceed with the reinstatement of Mr. D'Sa.

That is why I brought the matter to the attention of my hon. Friend the Minister. I do not expect her to be able immediately to respond to my concerns about the way in which the statistics for judging the competence of surgeons are used. I hope that she will look into that matter and get back to me. However. I hope that she will be able to use her good offices to intervene, or to say that she is sufficiently aware of the situation and that it has gone on long enough, at too much cost and with too much dissatisfaction in the hospital; I hope too that she will ensure that the part II recommendations are introduced.

11.15 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)

I congratulate my hon. Friend the Member for Coventry, North-West (Mr. Robinson) on securing time to debate a topic that is clearly of considerable concern to him, as well as to my hon. Friend the Member for Coventry, South (Mr. Cunningham), and the Under-Secretary of State for the Environment, Transport and the Regions, my hon. Friend the Member for Coventry, North-East (Mr. Ainsworth), in whose constituency the Walsgrave hospital lies, but who, by convention, cannot raise any matters that relate to the hospital in the House. I am glad to see that my hon. Friends are in the Chamber for the debate.

For my hon. Friends' benefit, I wish to start with a few general observations about the Walsgrave hospital. Some newspaper headlines have given the impression that the hospital is in total crisis. The Walsgrave Hospitals national health service trust changed its status to that of a university teaching hospital at the end of October last year, when it became the University Hospitals Coventry and Warwickshire NHS trust. The trust is made up of Walsgrave hospital, Coventry and Warwickshire hospital and the Hospital of St. Cross in Rugby.

Against the backdrop of a challenging agenda, including changes to the configuration of services, the trust has achieved success in a number of areas. The cardiac services directorate has gained national recognition for mitral valve repairs and receives referrals from throughout the country. A new renal dialysis satellite unit has recently been opened at the Hospital of St. Cross in Rugby. I recently visited the hospital and saw the new unit. The trust's renal transplant department is in the upper quartile nationally for graft acceptance. The radiology department has recently taken delivery of a new £1.2 million mobile magnetic resonance imaging scanner, to be moved regularly between the South Warwickshire General Hospitals NHS trust, the George Eliot Hospital NHS trust and the University Hospitals Coventry and Warwickshire NHS trust.

Work has recently started in the radiotherapy and oncology department to provide state of the art linear accelerator facilities,involving an investment of about £6 million. In partnership with the local community trust, a walk-in centre has been established, offering a seamless service to patients.

The trust is also taking the lead as the English national pilot site for colorectal cancer screening. With a catchment population of around 1 million, the uptake to date is well in excess of the target set for the pilot.

These are just some of the successes that the trust can demonstrate, in addition to which it reports a reduction in the number of nursing vacancies, and a 30 per cent. increase in the number of consultants. Of course, last year the trust achieved accreditation as a university teaching hospital.

The first issue of substance in tonight's debate was the suspension of a medical consultant at the University Hospitals Coventry and Warwickshire NHS trust. Where concerns are raised about professional misconduct it is right that, as an employer, the national health service is able to investigate concerns expressed about the competence or behaviour of that employee.

Although that course of action should be a very rare event, occasionally it is necessary to suspend an employee. It is important to stress that, although it is not always perceived as such, in legal terms suspension is a neutral act and must not be used as a disciplinary sanction. Suspension is intended to protect the i interests of patients, other staff and the employee or to assist the investigative process.

As my hon Friend the Member for Coventry, North-West will be aware, issues around staff management are a matter for the employing national health service body—in this case, the University Hospitals Coventry and Warwickshire NHS trust. That includes matters relating to the suspension of staff from their duties. Clearly, it would not be appropriate for me to intervene or comment on the individual case highlighted by my hon. Friend in the House tonight, as I understand that the case is still subject to legal proceedings. However, I note the points raised by my hon. Friend and will ensure that they are drawn to the attention of the regional director of the NHS executive regional office.

My hon. Friend will be interested to learn that we are revising guidance on the handling of suspensions. In future, there should be less need to suspend employees, because medical staff with developing problems can refer themselves—or be referred by their employers—to the National Clinical Assessment Authority—the NCAA. Through a swift and accurate identification of problems and solutions, the NCAA is intended to ensure that fewer suspensions will be necessary.

The NCAA will issue guidance to NHS organisations late in 2001 to help them to identify suitable cases for referral, and to advise them on how to make such referrals. As part of its remit, the NCAA will also consider any outstanding cases that are still awaiting resolution.

In future, NHS employers must ensure that suspension is used only after all other alternatives have been considered—for example, a period of supervised retraining pending outcome of formal investigation; voluntary restriction; or referral to the NCAA with voluntary restrictions. When an employee is suspended, employers must ensure that it is for the minimum necessary period of time.

My hon. Friend draws attention to the importance of taking seriously concerns raised about the performance of individual staff members. We expect a climate of openness and dialogue in the NHS, and a culture and environment that encourage staff to feel able to raise concerns about health care matters sensibly and responsibly, without fear of victimisation.

Wherever possible, concerns raised by staff should be dealt with locally, in accordance with local policies and procedures. However, in some cases, individuals have considered the local response provided to them to be inadequate; as a consequence they have sought to raise their concerns with the NHS executive.

Officials are liaising with the regional offices to develop a protocol for handling cases raised with the NHS executive. That is likely to include identifying a first point of contact in each region. Public Concern at Work—a leading authority in that sphere—has offered to provide staff working in the Department and the NHS executive with training on how to respond to individuals who contact the NHS executive to raise concerns. Of course, I realise that the case raised by my hon. Friend is still subject to legal proceedings, but I shall ensure that the regional office is aware of his concerns. I hope that some of the issues that he highlights are less likely to occur in future because of the measures that we are putting in place.

Before I address my hon. Friend's concerns on the standard of colorectal services at the trust, it is important to raise a matter covered in the local press today. I read a leading article stating that Surgery in the hospital is in turmoil. I must confess to the House that, in preparing for the debate, I have seen nothing that would lead me to such a sweeping conclusion. We need to be very careful when using language that causes great concern to the local population about the standard of service provided by their local NHS hospital. I believe that it could do a great disservice to the hard-working staff at the trust to read lead stories making such general accusations.

On the standard of colorectal services at the trust, I am advised that my hon Friends have already had sight of the outcome of the detailed investigations conducted by both the trust and the regional director of public health following the concerns that were raised. I have read the report; the regional director agreed that there were issues that needed to be addressed at the trust. I understand that the regional director of public health made recommendations relating to future staffing levels for the service, and to the appropriate grading for staff involved in provision of colorectal surgery at the trust. I am informed that the trust is acting on those recommendations, and that a fully qualified colorectal surgeon has been appointed and is expected to start employment with the trust next week. I have asked the regional office to continue to monitor the establishment of that service at the trust in the short to medium term. I take the point made by my hon. Friend the Member for Coventry, North-West about the basis of some of the statistical analysis. I think it would be best for me to write to him after the debate with precise details of how the analysis is determined.

My hon. Friend also expresses concerns about the trust's senior management team, noting that there had been a vote of no confidence by a very small number of surgeons at the trust. I am aware that, on 26 February, my hon. Friend and some of his colleagues met Nigel Crisp, the chief executive of the NHS so that he might have an opportunity to take account of their concerns about the management of the trust. I understand that, following that meeting, Nigel Crisp spoke to the regional director of the NHS executive and asked him to ensure that concerns raised by my hon. Friends were being addressed.

I am also of course aware of the issue that was raised as a point of order in the House on 17 January, relating to the use of a letter. Mr. Speaker has responded and it would be inappropriate in that context for me to add anything further.

Mr. Geoffrey Robinson

Does my hon. Friend agree that it was disgraceful for the management to seek to use a letter written in confidence to my hon. Friend the Member for Coventry, South (Mr. Cunningham) and copied to myself, as a reason for not reinstating and putting in hand the part II recommendations? Would she not as a parliamentarian, let alone a Minister, deprecate that form of behaviour?

Ms Stuart

As a parliamentarian I also accept the Speaker's ruling. The Speaker has responded to the issue and I am content with that.

I recognise that my hon. Friend has some very real concerns about the matters that he has raised today, and of course it is important that they are addressed. It must be recognised that the University Hospitals Coventry and Warwickshire NHS trust has been faced with a challenging agenda over the past few years. It has made great progress in many areas. The trust has had to implement some major developments regarding the reconfiguration of services. The trust's management has driven forward the development agenda while maintaining good quality services to the population that the trust serves.

At the start of my speech, I provided my hon. Friends with examples of some of the successes and improvements made by the trust, but every institution is capable of even further improvement and I am sure that that will happen in this case, too.

Even though there have been service changes, it is incumbent on the trust chief executive and chair to ensure that the services provided at the trust meet the needs of patients and ensure their safety. As I outlined earlier, the colorectal service at the trust has been investigated by the regional director of public health. Following his investigations, the trust has acted on his recommendations with regard to future management of the service, and a new fully qualified colorectal surgeon is expected to start work at the trust next week.

Mr. Robinson

That point has been covered. Will my hon. Friend say why, in her opinion, the management will not accept the findings of part II as a simple resolution of our problems so that we can get back to the good progress that we all recognise that the trust has been making?

Ms Stuart

The management and the management style of each trust is a local issue. The difficulty is that, as I understand it, there are still legal proceedings in this case. It would be inappropriate and foolish of a Minister to try to second-guess anyone else's reasons but, more important, it would help no one at this stage not to allow a due process to continue. We have made it clear that both the chief executive of the NHS and the regional office are well aware of the situation, but ultimately issues regarding employees are the responsibility of the local employing trust, which must take the decision. Our role is to ensure that proper processes are followed.

Mr. Robinson

It is on that point that we find it most difficult to accept what my hon. Friend is saying. The simple fact is that this process will cause great costs to the hospital—tens of thousands of pounds of further useless legal costs are being incurred, all to no good purpose, because the legal problems, of which I am as well aware as my hon. Friend is, will continue only as long as the trust is intent on a legal resolution. The trust has a recommendation, which it could and should implement. The further this matter goes on, the more difficult the position that my hon. Friend the Member for Coventry, South and I are put in, because our letter, a confidential House of Commons document, is being used—or an attempt is being made to use it—by the trust management to furthen its legal case, in which it has already been humiliatingly denied.

Ms Stuart

I think that my hon. Friend is trying to tempt me into pre-empting either a decision of the court or a management decision by an NHS trust. Surely it must be up to local trusts, as the employer, to have the final decision on the most appropriate way to proceed, and I would not wish to pre-empt the reasons for their decision.

It would be inappropriate for me to comment in detail, but I suggest to my hon. Friend that if he is still dissatisfied with the answers provided today, he should request a meeting with the Minister responsible for the midlands region, the Minister for Public Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), so that his concerns can be looked at in more detail. I am sure that he will meet my colleagues to discuss his concerns if he thinks that is necessary.

On employment matters relating to an individual consultant where legal proceedings are still on-going, it would be inappropriate for a Minister to do anything other than to say that it is a local matter for the trust and that we will ensure that the due process is being followed.

Question put and agreed to.

Adjourned accordingly at half-past Eleven o'clock.