Mrs. Jean Brett (Hansard, 15 October 2001)

§ Mr. Richard Page (South-West Hertfordshire)

This is a tale of error, denial and bureaucracy, but it is also a tale of courage and determination. It is the story of how Mrs. Jean Brett went against the national health service in a battle that started with her operation in March 1988. Ninety-nine out of 100 people would have given up by now and just walked away, but Mrs. Jean Brett is one in 100, as those who have seen her battling to keep Harefield heart hospital in existence will testify.

I look the Minister straight in the eye and say that to do full justice to this painful saga would take hours, but I have only 15 short minutes to present the case. Many years ago, I promised that when I saw the whole story coming to a conclusion I would raise it on the Floor of the House, because I wanted to ensure that it would never happen again. What I have to describe is disgraceful and shows bureaucracy and Government Departments at their worst.

To begin, I can do no better than quote from the opening paragraphs of a full-page article in The Observer of 22 April by a reporter called Yvonne Roberts. She starts: Jean Brett was a buoyant, confident woman with a career in teaching when she was diagnosed with glaucoma by her ophthalmologist in 1985. Stunned, she was told it was an incurable condition leading to weakening or a complete loss of sight.

Mrs Brett was prescribed eye drops which, she says, caused such a severe and persistent reaction that she was forced to take early retirement three years later at the age of 52. She subsequently underwent an operation on her right eye at Watford General Hospital, performed by her consultant.

The eye haemorrhaged. It now has a pronounced droop and continues to cause pain. 'I had become a shadow of my former self,' she recalled. The article continues: In 1992, she was told an operation would also be required on her left eye. Mrs Brett insisted— very wisely— upon a second opinion. At Moorfields Eye Hospital in London, she learnt that not only was the operation unnecessary, she had never had glaucoma.

'I didn't know whether to hug the consultants or scream,' she said. 'I'd given up a job I loved and lived for years with pain only to learn I had done so for no good reason.'

Mrs Brett attended a follow-up appointment at Watford General Hospital. What she sought, she says, was an explanation. 'I had been diagnosed and treated for seven years for something I'd never had. I also wanted an apology and a way of establishing whether anybody else might also have been similarly misdiagnosed.'

But nine years later, after spending £30,000 of her own money in legal fees and in spite of the intervention of the Ombudsman, two MPs, one Minister, Hillingdon Community Health Council and an independent conciliator, her case is unresolved."

Such a brief outline does not cover the patently inexcusable delays. In November 1992, when Mrs. Brett asked for an apology and an explanation, she was told by a hospital manager to make a formal NHS complaint, which would be answered in about two months. She was told that solicitors should not be used, as compensation in the NHS could be arranged.

1026 I see my hon. Friend the Member for Uxbridge (Mr. Randall), who has been very supportive throughout the campaign, in his place. He knows Mrs. Brett and her campaign to try to keep open our heart hospital at Harefield very well.

Seven months after the hospital manager's message, Mrs. Brett was told that Watford hospital had engaged solicitors and that she should do the same. The hospital did not, however, tell her of the options of community health councils, the ombudsman or clinical review procedures. She was told only of the most expensive option: solicitors. Two years passed, after which, as the article in The Observer stated, Mrs. Brett was not only tired out but £30,000 lighter. On the face of it, Watford hospital had won, but it had made a slight miscalculation: it had not reckoned with Mrs. Brett.

In 1996, Mrs. Brett asked that the NHS complaint be answered, and an independent review panel was convened under a new procedure. At that point—surprise, surprise—the most important half of Moorfields eye hospital records went missing. In December 1996, despite the fact that two independent consultants who had examined Mrs. Brett said that she had no sign of glaucoma—I am no expert, but I am given to understand that it is an irreversible eye disease—the panel did not admit that she had been misdiagnosed. We should bear in mind the fact that she had had one unnecessary operation and that the consultant wanted her to undergo the procedure for a second time.

Enter the ombudsman, to whom the review panel replied ambiguously that it was unable to conclude that there was any misdiagnosis". So the two independent specialists and Moorfields were wrong, but Watford hospital was right. Eventually, on 23 December 1997, the chief executive of Watford hospital admitted to Mrs. Brett that there had been a misdiagnosis, but the promised formal apology failed to appear.

Following my correspondence in February 1998 with the Secretary of State for Health, of which the Minister will be aware, a recommendation for conciliation emerged. That state of limbo continued until Hillingdon CHC entered the scene—one of those councils that the Government want to abolish. It stepped in to recommend an independent conciliator, Roxanne Glick. The Glick report appeared in May 1999.

The article in The Observer continued: Roxanne Glick, the conciliator appointed by what is now, after several mergers, the West Herts Hospital Trust, published her investigation into the Brett case in 1999. She described the Trust's politicking and prevarication as 'astounding' and 'wholly unprofessional'. Two years on, none of her recommendations have been properly implemented.

Glick said last week: 'Mrs. Brett is entitled to a large amount of money but won't receive it. The Trust gave me access on what had become a very complicated case. It knew exactly what to expect from my final report. Mrs. Brett has been wrongly diagnosed. She was forced to go down a route which has caused her and her family a huge amount of stress. Sadly, her case is not an isolated one.' Detailing the way in which Watford hospital then handled the matter is not possible, given time constraints. Suffice it to say that a £3,500 unilateral ex gratia offer was made on a "take it or leave it" basis, with no prior discussion or debate. The Minister knows the basis on which ex gratia payments are offered and may be taken up. The answer to the offer was a decided no. 1027 In April 2001 The Observer article appeared. On 25 April I asked the Secretary of State for Health whether he would reconsider the hands-off policy on ministerial intervention. At the same time, I asked for an assurance that the Glick report had been studied. On 7 June 2001, I received a response signed by Lord Hunt that made it clear that the Glick report had not been studied. In addition, the letter contained the extraordinary statement that Mrs. Brett's treatment had been appropriate and that further ministerial intervention would be inappropriate. I cannot regard that reply as a serious one. Not least because there had been no ministerial intervention up to that date, the reply shows the dangers of Ministers signing letters put in front of them by officials when they have not studied the background material. In addition, those who have any connection with the Maxwell case know that I simply do not give up that easily.

The time has surely been reached to bring an end to a sad and sorry story. The inaccuracies of the replies and actions over the years are too numerous to mention in the time available to me. I can only speculate about and shudder at the amount of management time and money that the national health service must have been wasted during this period—money that could have been put into patient care. Why should my constituent—why should anyone—have to go through such an ordeal to get an answer and fair play?

Why has the Glick report recommendation that the past glaucoma cases of the responsible consultant should be examined to establish the soundness of the diagnoses not been implemented? I ask the Minister to investigate why, despite my representations, the nightmare has been allowed to continue unchecked for so long, and to ensure that similar cases can be prevented in future. I ask that an independent assessor be appointed to determine what recompense might be paid to my constituent. The ball is now firmly in the Minister's court.

§ The Minister of State, Department of Health (Mr. John Hutton)

I am grateful to the hon. Member for South-West Hertfordshire (Mr. Page) for raising his constituent's case tonight. He has done his constituent a signal service. Like all right hon. and hon. Members, I was sorry to hear about the health problems that Mrs. Brett has experienced and that her subsequent complaints to Watford general hospital were not dealt with to her satisfaction. The hon. Gentleman has asked me to respond to several specific concerns about Mrs. Brett's case, and I shall deal with each in turn shortly.

It is important that we bear in mind the fact that the national health service treats tens of thousands of patients every day. Last year, it treated more than 12 million patients in England, 43 million patients attended out-patient clinics and more than 14 million attended accident and emergency departments. Mount Vernon and Watford hospitals NHS trust treated more than 46,500 in-patients, 189,000 people were seen as out-patients and more than 63,000 attended accident and emergency.

As I am sure the hon. Gentleman acknowledges, medicine is, sadly, not always an exact science, so when things go wrong it is important that there is a simple, clear and transparent system for dealing with complaints and concerns which enables them to be dealt with quickly and 1028 effectively. Clearly, that did not happen in Mrs. Brett's case. We accept that although the complaints procedure works effectively for many patients, some, like Mrs. Brett, have had less positive experiences of the NHS's handling of complaints.

The complaints system was introduced in 1996. The objectives were to make it easier, simpler and quicker to complain and to be fairer to patients and staff, so that concerns were resolved as thoroughly and as openly as possible. The commitment was made by the previous Administration, who introduced the complaints procedure about which the hon. Gentleman has been complaining.

A commitment was given to evaluate the complaints procedure once it had had time to bed down to ascertain whether it was meeting its policy objectives. In 1999, therefore, the Department of Health commissioned an independent two-year UK-wide evaluation project to examine the complaints procedure.

The evaluation report, which was published last month, confirms that there is obviously room for improvement. It highlighted four key messages from patients who had experience of the complaints procedure: that complaints are often not handled well and take too long to resolve—I am sure that that is the opinion of the hon. Gentleman's constituent, Mrs. Brett; that communication between staff and patients and complainants is often poor; that the process is not always sufficiently independent and is perceived to be biased; and that there is no real system to learn from experiences and to make the necessary improvements in other places.

The report went on to make 27 suggestions about how the complaints procedure and arrangements for managing it could be improved. The hon. Gentleman will be glad to know that I shall not go through all 27 suggestions, as will everyone else who is listening. However, its recommendations fell into four broad categories. First, it identified the need to change the way in which the NHS deals with complaints. For example, there is a need to ensure that all staff receive appropriate training and support so that they can deal with patients' concerns more effectively as and when they arise.

Secondly, to ensure consistency across the NHS, there is a need to standardise procedures throughout the service and throughout the country, no matter what part of the NHS it is. Thirdly, increased independence of the procedure would ensure that the independent review is genuinely independent and perceived to be so by patients and staff. Fourthly, there is the need to strengthen monitoring and accountability within the procedures to give more responsibility to trust boards for monitoring the quality of complaints handling within their organisation and considering the role for other outside organisations.

We certainly need to find ways to ensure that complaints about services that cut across health and social care—although this was not such a case—can be dealt with as smoothly as possible, given that there are currently two separate stand-alone procedures. With joint provision of cases across health and social care increasing, and especially with the advent of the new care trusts, we are examining how the two complaints processes can be harmonised.

Alongside the evaluation report that was published on 3 September, we invited views from NHS staff, members of the public and patient representative groups about four key issues. We asked for views on the 27 suggestions 1029 made in the report, and in relation to a series of key questions. First, what impact would a reformed procedure have on people and organisations? Secondly, how should performance in handling complaints be monitored and managed? Thirdly, what limits should there be for making and dealing with complaints? Finally, how can the current procedure be reformed to make it genuinely independent?

Our objective is to implement the necessary reforms next year. It is not just about improving complaints procedures for individuals. At the same time, we need to ensure that patients and the public have a better opportunity to be involved at a strategic decision-making level as well. That is why we intend, subject to legislation and the agreement of the House and the other place, to replace community health councils with patients' forums for every NHS trust and primary care trust, with a new national body to set standards and ensure consistency, and with local participation agencies, to be known as local voices, to enable citizen involvement in wider health issues.

In addition, the Department of Health has already agreed to implement all the recommendations made in the "Organisation with a Memory" report. A new independent body, the National Patient Safety Agency, will run a new national reporting system to record adverse events and near misses in health care. That will ensure that lessons learned in one part of the NHS are properly shared with the whole of the NHS.

In addition, the new National Clinical Assessment Authority will provide a fast response to concerns about doctors' performance and will provide a central point of contact for the NHS where concerns about a doctor's performance arise.

Another obvious challenge—the hon. Gentleman was right to draw attention to this—is to improve overall quality in the NHS, and thereby reduce the number of complaints, by developing and improving external inspection of services throughout the NHS.

Clinical governance provides NHS organisation and health care professionals with a new framework for quality improvement which, over time will, I hope, develop into a single coherent local programme for assuring and improving the quality of clinical services. Additionally, one function of the Commission for Health Improvement is to help the NHS to identify and tackle serious or persistent clinical problems. Information about complaints handling is considered by the commission in the context of its clinical governance reviews of individual NHS organisations. We need to ensure that the system for dealing with and monitoring the management of complaints develops in harmony with all those wider developments so that complaints are dealt with as effectively as possible and individual organisations and the NHS as a whole can learn from mistakes.

As the hon. Gentleman can see, all those things demonstrate the ways in which we are committed to learning from mistakes and to introducing a truly patient-centred NHS, which is the cornerstone of the NHS plan. While we can never guarantee that experiences such as that of Mrs. Brett will never happen again, our aim is to introduce a new system which will be as robust and responsive as possible in future.

I want to deal with the specific issues relating to Mrs. Brett which the hon. Gentleman brought to the attention of the House. He set out in detail the background 1030 to her long-standing complaint. He asked in particular that the trust implements the recommendations in the Glick report by apologising to Mrs. Brett, paying her compensation for injury and upset and conducting a proper review of its ophthalmology department. Finally, he urged Ministers to intervene in the case and ask an independent assessor to consider a further round of conciliatory discussions. My advice is that, following the trust board consideration of the Glick report, Mr. Eames, then chief executive of the trust, wrote to Mrs. Brett on 19 July 1999 making a full and unconditional apology; establishing that an audit of the ophthalmology department would be carried out by the trust's clinical audit team; offering an ex-gratia payment for the distress caused to Mrs Brett; and offering a meeting to discuss the trust's response. I have a copy of that letter with me this evening and I am sure that the hon. Gentleman has seen it, too. I am advised that the meeting referred to in the letter on 19 July 1999 never took place and that Mrs. Brett was unhappy with the compensation that was offered and refused to accept payment.

The review suggested by Mr. Eames and recommended by the Glick report was conducted by the trust's medical director and concluded that glaucoma was managed in a manner equivalent to that in similar NHS units. Those conclusions were shared with Mrs. Brett. The hon. Gentleman rightly drew attention to the fact that Mrs. Brett appears to have exhausted the NHS complaints procedure, so he raised the need for a further specific review of her case. He is legitimately concerned for the welfare of his constituent and wants to ensure that every effort is made to resolve her continuing concerns following her treatment in 1989. I share those concerns, but I do not think that that is the right way forward.

The hon. Gentleman will be aware that, thanks to the changes we have made, the Commission for Health Improvement now conducts regular inspections and reviews of the performance of NHS hospitals and the quality of care that they provide. I think that the most sensible way I can respond positively to the hon. Gentleman's concerns is to bring them directly to the attention of the Commission for Health Improvement in advance of its visit to West Hertfordshire Hospitals NHS trust. My considered opinion—I assure the hon. Gentleman that I have looked at the evidence and the file on the case—is that the best course of action would be for Mrs. Brett to reconsider the meeting offered to her by the trust as part of the package offered following the Glick report. I shall ask if e new chief executive of the trust, Mrs. Harrison, to offer Mrs. Brett a meeting to discuss a range of issues referred to by Mr. Eames in his letter of 19 July 1999. I hope that that will meet, at least in part, some of the hon. Gentleman's concerns.

I do not doubt, however, that in this particular instance the NHS complaints procedure left Mrs. Brett and her family feeling considerable anger and unhappiness about her treatment. Her direct experience and that of others like her of both patient participation in the NHS and the complaints procedure itself has had an adverse effect. I hope that the measures that I have set out this evening will ensure that Mrs. Brett's experience of complaining about NHS treatment will not be shared by others in future.