Mrs. Mary Kelly

HC Deb 26 October 2001 vol 373 cc601-8

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

2.30 pm

Helen Jones (Warrington, North)

I am grateful for the opportunity to raise the case of my constituent, the late Mrs. Mary Kelly, and the treatment that she received at Whiston hospital. I take no pleasure in doing that because it is very distressing. However, I owe it to Mrs. Kelly and her family to outline the appalling treatment that she received at Whiston, and the cavalier way in which the hospital dealt with complaints about it.

I raise the matter at the request of Mrs. Kelly's family and because I believe that the case gives rise to serious anxieties about some of the operations at the hospital. I do not believe that the hospital has learned lessons from the case or that it is making any attempts to learn them. It is the earnest wish of Mrs. Kelly's family that those lessons are learned so that no one else has to suffer in the same way. I pay tribute to the late Mrs. Kelly's husband, her son and her daughter-in-law, who have said that that is their only motivation for raising the matter. Their conduct has been exemplary throughout, and I hope that outlining what happened to Mrs. Kelly will prevent another family from undergoing the same experience.

Mrs. Kelly first saw her general practitioner in April 1998 because she was experiencing chest pains. She was referred to Dr. Ball, a cardiac consultant at Whiston hospital. She met the first obstacle when she was told that there was a 12-month wait even to be seen. She paid for a private consultation, and it will be no surprise to my hon. Friend the Minister that the same consultant who could not see Mrs. Kelly at Whiston hospital was able to see her quickly at a private hospital. That is one of the best arguments for reconsidering consultants' contracts.

After paying for a consultation, Mrs. Kelly was seen again at Whiston hospital where she underwent an ECG in November 1998. The case then began to get complicated. After the ECG, Mrs. Kelly was referred for an angiogram but she and her family believed that she was waiting for surgery. I appreciate that some confusion might arise because angiograms are often described by medical staff as a "surgical procedure". I know the Kelly family; they are intelligent and sensible people. The confusion therefore suggests that communication at Whiston was poor from the beginning.

The problem was compounded by the fact that when Mrs. Kelly rang to ask for the date of the operation, she was always given the standard answer that the wait was 18 months. No one bothered to check what she was waiting for or to explain the position to her. She was an elderly lady, who did not like to make a fuss and so she went on waiting. While she waited, her family saw her transformed from being an outgoing, lively person.

Mrs. Kelly also suffered from osteo-arthritis. She experienced severe chest pains on several occasions and she began to deteriorate. Once she went to the accident and emergency department at Whiston hospital because she was in so much pain, and her family told me that she waited from 5.30 pm until 2.45 am before she was admitted to a ward. During most of that time she was left by herself on a chair in a corner of the A and E department.

That is absolutely appalling. Friends who have worked in A and E tell me that those suffering from chest pains are always a priority, and one of the key procedures is to calm and reassure the patient. Mrs. Kelly was not calmed and reassured by being stuck on a chair in the corner of a busy A and E department on a Saturday night with all the problems that we know such departments are subject to at such times. She was so distressed that on three or four subsequent occasions when she suffered severe pain she refused to go back to Whiston. Ironically, had she done so, she may have increased her priority for the procedures that she was waiting for, but the system worked against her from the beginning.

Mrs. Kelly waited, and while she did so she continued to get worse until she finally had her angiogram in April 2000—two years after she first raised the problem with her GP. Only then was she placed on the waiting list for surgery. It was hoped that she would be operated on within three to four months, but she was not.

Mrs. Kelly went on waiting, and while she was waiting the hospital discovered that she was also in need of an urgent hip operation. Of course, that could not be done until she had had cardiac surgery. It should have increased her priority for that cardiac surgery, but it did not, and the reasons why are hard to discover. The hospital told the family at a meeting in January this year that it was because the rheumatology department had not communicated with the cardiac department.

When the hospital wrote to me on 30 March, it said that it had unified case notes, and that the relevant rheumatological correspondence was available to doctors in the cardiac department. Which was it? Either the two departments did not communicate, or if they did, it did not make any difference.

Mrs. Kelly still waited, often in acute pain. She sometimes suffered vomiting and stomach pains because of the combination of different drugs she was taking for her various conditions. She was admitted to hospital again in August last year. She was issued with a wheelchair, and a once lively, outgoing person became almost completely housebound. She died on 7 October last year, still waiting for her operation.

Mrs. Kelly's case is most distressing. It is the worst that I have encountered since I came into Parliament. It was compounded by the fact that when complaints were made about her case it was difficult to get the management at Whiston to take them seriously. Only Mike Murphy, who became the acting chairman of the trust for a time while this was going on, tried to resolve these complaints, and I pay tribute to him for his efforts.

When Mrs. Kelly's son contacted me in August last year, I wrote to the hospital on 25 August, having followed my usual practice, which most hon. Members follow, of checking first with Mrs. Kelly to see whether she wanted me to take up her case. I received an acknowledgement from the chief executive dated 30 August, and then nothing until 29 September, when I was told that the hospital needed Mrs. Kelly's permission to correspond with me. I understand the need to be cautious in dealing with clinical information, but every other hospital I have ever communicated with knows that MPs do not take up cases unless they are asked to do so, and that in doing so there is implied permission for the hospital to discuss the case.

We still heard nothing, so my office wrote again on 26 October informing Whiston hospital that Mrs. Kelly had died and asking for a reply. We still had no reply, and we wrote again on 6 November. On the same day, my staff rang the chief executive to tell the hospital once again that Mrs. Kelly had died. There was still nothing until 10 November, when we received a fax, which, by a strange coincidence, was a copy of a letter dated 6 November. That letter is instructive about the way in which Whiston hospital was dealing with complaints. I should like to give the House a flavour of that letter. In fact, it was so distressing that at the time I did not dare show it to Mrs. Kelly's family. It said: I would like to offer my sincere apologies to Mrs Kelly and her family for the obvious anguish she has endured and would hope that this explanation offers some comfort to her. It went on to give the standards paragraphs telling me that I had the right to an independent review. Of course, those standard paragraphs are given to a patient who complains, not to a Member of Parliament. The letter was signed by the chief executive, and if that response is sent to a Member of Parliament, I shudder to think what other members of the public receive when they complain.

Since then, there has been much correspondence. Indeed, the regional office of the NHS carried out a review into the complaints, and it sent me a copy, which arrived yesterday—presumably, after I had applied for this Adjournment debate. Meetings between representatives of the hospital and the family have also taken place, but Whiston hospital has still failed to address the real issues in the case, and I hope that my hon. Friend will deal with them in her reply.

Why did Mrs. Kelly wait so long for an angiogram even when she was presenting with increased symptoms during that time? Why did she wait so long in A and E? What is the hospital doing to address the problems there? Why does there seem to be no proper communication between departments treating people in the same hospital? I have seen no attempt to address those problems in all the correspondence that I have received. Indeed, I am forced to conclude that the hospital is concerned with spin rather than substance. Believe it or not, the hospital employs someone called a patient and public relations manager. I do not want hospitals to be concerned with public relations—they are there to treat sick people, but Whiston hospital significantly failed to do so on that occasion.

When I asked why Mrs. Kelly was not told she was on the waiting list for surgery when she rang the hospital, I was given the answer that Mrs Kelly … was not told that she was not on the waiting list for surgery because at that time she was not on the waiting list for surgery. First, that was not what she was told and, secondly, I could describe the answer using a completely unparliamentary expression, which I would not be allowed to use here.

I asked what priority Mrs. Kelly was given for her angiogram, and I was told: Mrs Kelly was placed on the routine waiting list for coronary angiography. The delay between listing and the performance of the angiogram was due to the fact that at the time, this was the length of the routine waiting list. But Mrs. Kelly was not routine; she was presenting with further symptoms as time went on.

The trust has no intention of addressing those problems. Even in its response to the review of its complaints procedure, in which 12 recommendations for change were made, the chief executive said that the investigation had found that the trust had satisfactory complaints procedures. Well, if the complaints procedures are satisfactory, I am Dutch! They are certainly not satisfactory.

The tragedy is that the NHS is not like that in most of its manifestations. Recently, two of my very good friends, one of whom my hon. Friend the Minister will know, have been treated for life-threatening conditions in the NHS. They could not have received better treatment or better care. What has happened is not a failure of the NHS; it is failure of the management at that hospital and a complete failure of its communications procedures.

Ironically, yesterday, another report on the hospital was published, dealing with the Michael Abram case. In that report, too, it is clear that the communication and record keeping was not of a sufficiently high standard and that, in many cases, procedures were not followed. That is exactly the same problem, but it will be of no comfort to the Kelly family if those problems are allowed to continue. The problems and the management of the hospital need to be addressed urgently.

The Kelly family believed in the NHS, and they still do. Mr. and Mrs. Kelly worked hard all their lives. They paid their taxes, paid their dues and made no claim on the welfare state. The remaining members of the family have to live with the uncertainty of not knowing whether Mrs. Kelly would be alive today if the hospital had treated her better.

The hospital let her down from the moment when she walked through the door, and continued to let her down even after she was dead. I hope that my hon. Friend the Minister will ensure that it will not be allowed to let down other people, and other families, in the same way.

This hospital must learn the lessons of what has happened, and it must put things right. So far, it has shown no intention of doing so. I hope that the Department will ensure that it does in future, so that there are no more cases like that of Mrs. Kelly.

2.45 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I am grateful to my hon. Friend the Member for Warrington, North (Helen Jones) for raising this serious matter. I hope that she will convey my condolences to her late constituent's family. I am extremely sorry that the concerns raised by Mrs. Kelly's son and, indeed, the wider family, which my hon. Friend has taken up so assiduously, were not dealt with either promptly or efficiently by St. Helens and Knowsley NHS trust, and I entirely accept what my hon. Friend has said about the family's desire to ensure that improvements are made in the system so that such things do not happen to other people.

In my experience, many families who complain to the health service are not looking for compensation. They do not seek a financial solution; what they want is a genuine acknowledgment of what went wrong, and the changing and strengthening of systems so that disasters do not occur again. Very often, they are looking for a sincere apology from those involved.

I think that the issue has three main aspects. The first is what has happened to Mrs. Kelly, the second is the inadequacies of the complaints procedure at Whiston hospital, and the third is the question of what action can be taken to ensure that similar tragic cases do not occur.

I fully acknowledge that the time that Mrs. Kelly had to wait for an angiogram was entirely unacceptable. As my hon. Friend said, Mrs. Kelly was placed on a waiting list of between 15 and 17 months. Since then, additional investment has been made in the coronary heart disease service in Merseyside and Cheshire to meet the objectives of the coronary heart disease national service framework. Extra money is being invested for the recruitment of more consultants, and also to increase the number of cardiac catheter laboratories and cardiac theatres where angiograms are carried out.

St. Helens and Knowsley health authority has contributed £810,000 this year to support those initiatives, and a sixth cardiac surgeon was appointed in April this year at the cardiothoracic centre in Liverpool. An additional cardiac catheter laboratory is planned to open in January next year. There will be a sixth cardiac theatre before April next year. All those developments are within the same trust, serving the people of Merseyside and Cheshire.

I entirely accept that all that will give no comfort to Mrs. Kelly's family, but perhaps it will give a degree of reassurance that it has been acknowledged that waiting times for procedures of this kind have been far too long. Hopefully, extra investment in cardiac services will prevent such things from happening again.

As my hon. Friend will know, the Government are currently reviewing the NHS complaints procedure. It is working acceptably for some patients, but there are many examples of less positive experiences. We recently launched a discussion paper examining the whole procedure, and we want to make significant changes next year. However, this is not just about improving the complaints process for individuals; it is about trying to change the way in which the service works, so that the central focus of the NHS is on patients and their families. We want all who work in the NHS—those at the centre, clinicians, and trust management—to try genuinely to put patients' views at the top of their agenda when considering how to provide services, and certainly when considering how to respond to patients and their families. Later this year, we shall make further proposals in an effort to strengthen patient and public participation in the whole health service to make sure that patients get an effective and strong voice in the way in which the service is organised.

My hon. Friend mentioned provision within the trust. I am pleased to say that, instead of appointing a public relations officer, St. Helens and Knowsley trust is to participate in a nationwide initiative to establish a patient advocacy and liaison service. That is not about public relations, but about providing on-the-spot help to resolve problems when they first occur. In many cases, complaints will not reach the dreadful state that Mrs. Kelly's case has reached because people will be able to obtain immediate assistance within the trust involved. St. Helens and Knowsley trust is one of 14 trusts selected to run a pathfinder project for PALS. I understand that the trust has appointed a PALS manager in advance of the launch, which is to take place on 1 November. I hope that it gives my hon. Friend and her constituents some comfort to know that in future there will be on-the-spot help to resolve such issues.

Profound concern has been voiced about the way in which the complaint relating to Mrs. Kelly was handled by the trust. As my hon. Friend has said, the matter was taken up by the NHS north west regional office, which carried out an investigation. The regional director said that the handling of this matter was not of an acceptable standard". He was satisfied that both my hon. Friend and the Kelly family should have received a better response from the trust and said that he would write to my hon. Friend explaining that and offering her an apology. In addition, he would ensure that the trust apologised to Mrs. Kelly's family.

An immediate independent review of complaints arrangements within the trust was ordered. The review team finalised its report in July, concluding that the introduction of new arrangements had improved quality. However, the team made 12 recommendations which the trust has accepted and is in the process of implementing. Those include changing the organisation of correspondence, reviewing the use of standard paragraphs in correspondence—which, as my hon. Friend pointed out, is entirely inappropriate—monitoring complaints responses and carrying out a systematic review of complainants' views on how their complaint is proceeding. That will provide a real check at every stage on whether people are content with the handling of their complaint.

Progress against that action plan will be reviewed by the regional office to ensure that all the recommended changes are implemented. I am pleased to say that my hon. Friend's intervention regarding the Kelly case has proved to be a catalyst, driving action within the trust to improve its performance.

Helen Jones

Will my hon. Friend confirm that as well as carrying out a review of the complaints procedure, the hospital will establish a strategy for learning lessons from complaints about its clinical governance and procedures? It is not solely a matter of apologising and dealing with a complaint from a particular person, but one of learning lessons to improve the way in which the hospital is run.

Ms Blears

My hon. Friend is right. We are trying to instil throughout the NHS the principle of being an organisation with a memory, so that when such cases arise, clinicians, managers and other staff do not gloss over them but learn from them and absorb principles of good practice into future organisation.

I have some remarks about clinical governance that should give my hon. Friend some comfort about the future of the trust. I do not doubt that in the Kelly case the complaints procedure failed Mrs. Kelly's family and my hon. Friend. That underlines the importance of changing the way in which the public and patients are involved in the NHS.

As a consequence of the concerns that have been raised, I have asked the NHS north west regional office to bring to the attention of the Commission for Health Improvement the details and outcome of the independent review of complaints handling by the trust. We shall ensure that consideration of complaints and how well the trust learns from them is brought into the wider review of clinical governance that CHI assessors are due to undertake at the trust in mid-November.

My hon. Friend has also raised concerns about mental health services in the trust An independent report was published on 23 October, which clearly highlights failings in the system of care and concerns about the management of care in supporting mental health services in St. Helens and Knowsley, although it emphasises that the professional staff involved in a particular patient's care could not have predicted what happened.

In the light of that incident, the health authority and the trust have developed an action plan to ensure that local mental health services meet the needs of all patients. Subject to public consultation and ministerial approval, mental health services will transfer from St. Helens and Knowsley trust to Warrington Community Health Care NHS trust on 1 November. That is a transitional step towards ultimately transferring services to a specialist mental health trust, which is where they ought to be and which will cover the wider area.

The Commission for Health Improvement has a routine review of St. Helens and Knowsley trust scheduled for mid-November. However, in line with a recommendation of the mental health report, St. Helens and Knowsley health authority has written to the commission to request that the routine review be expanded to consider clinical governance arrangements. That will involve taking a much wider view of mental health services in the trust.

I have asked the commission to consider the complaints procedure to ensure that the organisation learns from its experiences. The commission's review and its reports will provide us with a great deal of extremely useful information in respect of monitoring and, I hope, improving services available from the trust to local people.

My hon. Friend has done the House and the NHS a great deal of good in raising those issues robustly and directly. It is crucial that we deal openly and transparently with matters that go wrong in the health service. The fullest possible information should be put in the public domain and people and their families should keep their dignity and be shown respect. They should be made to feel that their experience has not gone unremarked and unrecorded and they should not think that we have failed to act.

We have a responsibility to do our best to ensure that similar tragedies do not happen in future. Although it is impossible to say that such incidents will never happen again, I hope that it is some comfort to Mrs. Kelly's family, who fought with determination and commitment to get action taken, that we are absolutely determined that a full review of the trust will be carried out and that action will be taken, not just to improve services but to ensure that it responds properly to complaints.

Complaints are a serious matter for the NHS. We must learn to improve the services that we provide and we should not be afraid to acknowledge our shortcomings or to put in place improvements to drive up standards so that we can treat people such as Mrs. Kelly much better.

Question put and agreed to.

Adjourned accordingly at two minutes to Three o'clock.