HC Deb 31 January 2002 vol 379 cc520-34

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

6.36 pm
Mr. William Hague (Richmond, Yorks)

I am grateful for the opportunity to raise a most important constituency matter on the Adjournment of the House. I am most grateful to Mr. Speaker for selecting the matter, as I know that he selects the subject to be raised on the Thursday Adjournment. For obvious reasons, it is a long time since I had the opportunity to raise a matter on the Adjournment of the House, and looking at the attendance for such debates, I think that this occasion will be much less noisy than those I was used to as Leader of the Opposition. I am grateful to the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), for being present to listen and respond to my remarks.

I want to talk about the case of the disgraced consultant, Mr. Richard Neale. It is a bizarre, tragic, deeply disturbing and utterly scandalous tale, and it will need briefly retelling in the course of my remarks, although it has become widely known. It is the story of a gynaecologist, Mr. Neale, who was struck off the medical register in Canada in 1985 because of serious incompetence after the death of two patients. He went on, despite warnings to this country from Canada, to practise in the Friarage hospital in Northallerton, which is the principal hospital in my constituency, for 10 years, leaving a trail of pain and sorrow behind him. He then went on, after being, in effect, dismissed—in practice, he was paid off—by that hospital, to practise in Leicester, the Isle of Wight and London, causing more pain and suffering to the women in his care, before finally being struck off for professional misconduct in the United Kingdom in July 2000, 15 years after he was struck off in Canada.

This is an extraordinary story. For the Department of Health, of course, it is an embarrassment. For the patients, whom we might more properly refer to as victims, it is a personal or family tragedy. For the House, it should be a vital matter to ensure that these things do not happen again. Some of the facts of the case have become widely known. They have been documented on the BBC programme "Panorama" and in The Northern Echo, a newspaper in the north of England. They have been documented by the action and support group for medical victims of Mr. Neale. I pay tribute to the people who formed that group, particularly Sheila Wright-Hogeland, who has been its inspiration. The decision of the General Medical Council to strike Mr. Neale off the register, albeit 15 years after he was struck off in Canada, was widely publicised at the time.

Some action has been taken; some procedures have been changed and, no doubt, some lessons have been learned. After many representations and requests, the Department of Health has established an investigation into what happened, although it was set out in a fairly low-key announcement last July, with carefully worked out terms of reference, which were set out in a Department of Health document to which I shall refer later.

I put it to the Minister that the investigation announced so far is not adequate to the scale of the scandal. It has a limited time frame, which cuts off the investigation in 1995, yet there were things that should not have happened after 1995, or so it seems to me. It is confined to the local health services, yet this matter must concern the Department of Health and the General Medical Council. The terms of reference do not allow consideration of private patients, of whom there were a large number. The investigation will not have the power or terms of reference that it needs, and I believe that a public inquiry is needed.

I have a suspicion that the Minister will say in response to those thoughts that this is a tragic story—it is—but that it is not on the scale of the Bristol babies or the Shipman scandals and that we cannot have a public inquiry into everything. I suspect that she will put it more delicately than that, because it will be set out in a slightly more roundabout way in her brief, but that will be the gist of what she says. Those in the Department of Health may think that we cannot hold a public inquiry into everything that goes on.

I put it to the Minister that this is an almost uniquely chilling case because not only was serious harm done to unsuspecting patients over a long time, but warnings were given to some people, somewhere in Britain's health establishment. Some people working in the health service knew what was happening and how bad a doctor that man was, but nothing was done. So this case is different from many others, and it has not just come to light recently. For a long time someone, somewhere knew what was happening to women in the care of the health service in North Yorkshire and then elsewhere.

The people affected want to know—I want to know, as the Member of Parliament for many of them—what really happened, and an inquiry into local services in a narrowly defined time frame with limited scope may well not be able to tell us all that we need to know about what happened or to ensure that every procedure has been put right and every precaution taken.

Let me develop this story in a little more detail; I am fortunate in having a little more time for this Adjournment debate than would normally be available. Let me make it clear that in no way is this related to current controversies about the national health service. The NHS is committed to openness. In its document on clinical neglect the Department calls for a more responsive and patient-focused approach to both complaints and clinical negligence claims handling". It calls for greater openness in the NHS to concerns—so patients know that they will be heard, and organisations can learn from mistakes". So what I am calling for is exactly what the Department of Health has called for in its own document on clinical negligence.

Let me also make it clear that, in general, I have nothing but praise for the staff and management of the Friarage hospital, Northallerton. It is often short of resources, but it has many excellent consultants. What happened in this case is in no way representative of the service that my constituents generally receive from consultants in that hospital or of the management decisions taken by the local management of that hospital—but it did happen, so we must face up to it.

Neale's record in Canada should have rung "loud alarm bells"—not my words, but those of the chief medical officer and the former director of public health in Yorkshire, Professor Liam Donaldson. The disciplinary committee of the College of Physicians and Surgeons of Ontario found Neale guilty of incompetence and professional misconduct after the death of a patient whom he was treating. The inquest into that death showed that he had given the patient a banned substance and then attempted to falsify her records. After the death of another woman on whom he had operated against medical advice, another doctor in British Columbia described Neale as completely incompetent and incapable of making reasonable decisions about patients. Neale's record in Canada was one of dishonesty and clinical incompetence. The former head of obstetrics and gynaecology at the Prince George hospital in British Columbia, Dr. Lee, summed it up when he said that Neale had no judgment … should never have become a surgeon. He continued: He is a menace to every patient that he touches … he should never be allowed to practise. That was the opinion in Canada, and it was not that Neale was a bit of a problem and that he had merely given the wrong prescription now and again. In the opinion of his colleagues, he should never have been allowed to practice.

Neale was struck off in resounding terms by the College of Physicians and Surgeons of Ontario. He was charged with failure to maintain the standard of practice of the profession … and conduct or an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional". This document—hon. Members will be relieved to know that I shall not discuss it all—details what Neale did that was appallingly wrong in the case when the patient died. The report concludes: The Discipline Committee considered the evidence, found the allegation of incompetence against Dr. Neale to have been proved. In view of that finding the committee did not consider it necessary to make a finding on the second allegation. The committee did however consider the second allegation and, but for the finding of incompetence, would have found that the action of the doctor amounted to professional misconduct of a most serious nature. The chief of obstetrics and gynaecology reported that due to repeated demonstration of poor judgment, Dr. Neale had been asked to withdraw from the call roster for Obstetrics and Gynaecology in their hospital. The other members of that staff did not wish to have Dr. Neale care for their patients. In British Columbia, as a result of poor judgment and poor procedure, all his privileges had been withdrawn in April 1979. That was the scale of the problem when this man practised medicine in Canada.

Despite having been struck off the register in Canada, in 1985, incredibly, he was able to come to Britain and was employed as a consultant obstetrician and gynaecologist in Northallerton. His references were checked in what was described as the usual way and only later did it appear that there were inaccuracies in them, with the misrepresentation of the status of some of his referees. He did not declare his past record to the Yorkshire regional health authority, but no additional attempt was made to find out the truth about him and there was no automatic checking of his Canadian history.

Sir Donald Irvine, president of the GMC, told "Panorama" in 1999: If we knew today somebody had been struck off abroad we would want to be systematic about inquiries into that doctor's practice. I have to say that has not always been the case. I have to say that in the past our systems have been rather more unsystematic than we would accept as credible now. Even today the GMC is not obliged to investigate doctors struck off in non EU countries". No action was taken against Neale then because no one knew that he had been struck off the register in Canada.

What is far more alarming is the fact that no action was taken when his record began to come to light in 1986 and he was allowed to carry on practising. Dr. Andy Sear, a former friend of Neale in Canada, telephoned the GMC in Britain in 1985 or 1986 to warn about Neale and his record in Canada. In a statement, Dr. Sear said: I knew that Richard Neale had a job in Britain. I was alarmed that Richard was managing to work as a consultant and that he would harm other people. It was time to warn the authorities before it was too late. I called the General Medical Council in London and was put through to the registration department. I asked them if they were aware of the problems he had had in Canada …. They said thank you very much, very politely, for the contact. They said they were aware, but that having problems in another country did not preclude a doctor practising in Britain, if he hadn't done anything in Britain. I thought that was very high handed. So if a doctor had not done anything in Britain, the GMC would not necessarily want to take action.

When the Yorkshire regional health authority found out about the allegations about Neale, it conducted an investigation. Dr. John Green, who conducted the investigation, said that he was unaware that Richard Neale had been struck off and he didn't recall that the health authority knew that he had been asked to go for retraining to avoid being struck off. He said that the investigators did not speak to the Canadian doctors who stopped Richard Neale operating in their hospitals in Canada, but we decided that they had been unduly conservative. Even when the regional health authority was made aware of Neale's record, instead of sacking him immediately and terminating his contract, he was able to continue to practise. The GMC was made aware of Neale's history by Dr. Green, but decided to take no action.

This is a very serious matter. At no time were patients warned about Neale's record. If they had been, of course, they would not have accepted treatment from him. Because no action was taken against Neale, he was also able to work at other, private hospitals—based on a supposedly unblemished record at the Friarage hospital in Northallerton.

So the man went on. He even applied to go back on the register in Canada and he was again rejected in resounding terms. People there knew about this man. The Yorkshire regional health authority even provided him with a reference, saying that he was being promoted to chairman of the surgical division at Northallerton, but the Canadians turned him down. The discipline committee of the College of Physicians and Surgeons of Ontario issued a report in 1987 when he reapplied to the register in Canada, saying: There was no evidence of a change in the pattern of his impaired judgement. The inability to make good clinical judgements is a condition difficult to rectify … Committee members were impressed that he had poor judgement as a young doctor and, in spite of additional training, continued to have poor judgement. On the basis of deep-seated attitudinal and judgement problems, it was felt that Dr. Neale does not qualify for licence reinstatement. Even when Neale was refused his licence application, nothing was done in this country. It is unforgivable that a report detailing how he was incompetent, dishonest and lacking in judgment was not acted on. Despite sending a reference in support of his application for a Canadian licence, no one in Britain ever wondered about the outcome or ever found out that his application had been rejected. So he went on to cause great problems for many people. There is a long list of harrowing medical stories. I shall certainly not go through all of them, but I want to give the House a glimpse of what we are talking about.

In 1977, Neale so badly botched bladder surgery at the Shaftsbury hospital in London, where he was before going to Canada, that his patient is still undergoing intensive treatment and reconstructive surgery 25 years later. Neale told her that he would operate after he got back from a lunchtime drinking spree to celebrate his successful job application in Canada. A senior consultant later told the patient that Neale had "just ripped through everything" and torn apart several internal organs.

Neale discharged one patient from hospital prematurely in the face of strong protests from nursing staff. It transpired that the patient had a giant haematoma in her abdomen that caused her extreme pain such that she could not walk and had to crawl, even to the lavatory. Neale refused to re-admit her to hospital and insisted that she was "fine". The haematoma went untreated, became badly infected and ate into her bone, causing irreversible skeletal damage and permanent severe pain. She is now registered disabled. Another victim had the femoral nerve roots to her leg slashed as Neale performed a routine hysterectomy. She was left totally incontinent and unable to walk without the aid of two sticks.

That is just a glimpse of the medical incompetence of the man. The abuse that he also dished out to patients is almost beyond belief. A Jehovah's Witness who could not receive blood was near death after an operation, but Neale declined to order any blood substitute after he had promised to do so. After her husband offered to pay for it, he screamed across the bed over the fully conscious patient, "Can't you see she's dying anyway? It's not worth bothering to order the blood substitute. Either she'll be dead or she won't by the time it gets here." Such, apparently, is the conduct of the man.

Nurses have made statements saying that they knew how bad he was. One nurse of 27 years standing informed the action group for the medical victims that people were perfectly well aware of the clinical and surgical mayhem that he was causing at the Northallerton hospital, as well as being aware, from 1986, of his Canadian history. She said that the hospital insisted publicly that it knew of no clinical problems with Neale over the years, yet a gag order had been placed on all employees who were working with him—they were on pain of dismissal if they spoke openly about him.

The same type of statement—again harrowing reading—has been made by another nurse who worked with him at a private hospital, confirming his refusal to adhere to even the most basic hygiene procedures, pre-operatively or during surgery. She said that he never bothered to "identify structures" but "simply slashed through everything", often including vital organs. That has become the familiar story.

It is not a trivial matter, or even just a case of a problem doctor; the issue is more serious than that. After years of clinical negligence and incompetence Neale was finally dismissed in Northallerton on non-clinical grounds. Not being available when on call, bad treatment of junior staff, misrepresenting his role, false travel claims and appropriating NHS supplies for private practice eventually brought about his dismissal by the Friarage hospital. He was also arrested in 1991 and given a police caution after an incident in a public lavatory, behaviour that does not sit easily with being a respected medical consultant. Given that the case against Neale, later proven at the General Medical Council, showed negligence and incompetence dating back to 1986, and given that some people knew about it, it is not clear why no public authority was aware of that incompetence. It is unacceptable that he was not sacked for his conduct, both clinical and non-clinical.

Neale then received a pay-off and a reference from the Friarage hospital to shift the problem elsewhere, one of the most controversial aspects of the whole case. The former director of operations at the hospital told "Panorama": Getting rid of a doctor is not easy and so Dr. Neale was paid £100,000 to leave and given a good reference. I think there was a grave risk we were sending him out to inflict him on others but we were prepared to take that risk because the risk to our own people and service … was not one we were prepared to take. The reference allowed him to carry on practising at Leicester royal infirmary, on the Isle of Wight, at London's Portland hospital and in Harley street. Leicester royal infirmary heard about the matter from the press and complained to the Yorkshire regional health authority that the reference was misleading. At the time, the infirmary's spokesman said that he felt "extreme dissatisfaction" with the reference— not a surprising reaction.

Again, I must emphasise how serious this is. We have all heard of "kind" references about employees who are no longer wanted, but when it concerns a consultant gynaecologist with an appalling track record that many people knew about and who went on to practise on other patients, it is serious indeed. Neale went on to practise until a warning letter was sent out in June 1998 after publicity started to arise about the case.

In January 1998, a BBC North East documentary programme, "Close Up North", carried a story about Richard Neale. At the beginning of February 1998, the director of operations at Northallerton wrote to Professor Liam Donaldson, then regional director of the NHS for the north and Yorkshire, about Richard Neale's record in Canada and his dishonesty in the United Kingdom. It was five months later, in June 1998, before a warning letter was finally sent out around hospital trusts and authorities in the UK warning them about Richard Neale and advising them to consult urgently if they were proposing to employ him.

The story finally began to come out in public. In July 2000, the professional conduct committee of the GMC found Neale guilty of serious professional misconduct and directed his erasure from the register. They found him guilty of 34 out of 35 counts of serious professional misconduct. The president said that it was a shocking and disturbing case: For far too long he caused unnecessary pain and suffering to many women and showed a determined and alarming lack of insight … The case, like others recently, raises a number of important, wider issues for the whole system of medical regulation … his case highlights serious deficiencies in NHS procedures … It is difficult to understand why local action on his poor practice was not taken much earlier … The Neale case underlines, yet again, why there is such an urgent need to implement the systemic view of all doctors' practice". Neale was struck off by order of the GMC with immediate effect. There is a certain irony in that, after the 15-year history of the whole miserable business. The GMC concluded: The Committee have directed the Registrar to erase your name from the Register. They have also concluded that, given the serious and persistent nature of the findings against you, it is necessary for the protection of the public that your registration be suspended with immediate effect. Thus, 15 years on, he was suspended with immediate effect, firmly locking the stable door after it had been open for so long.

The case is tragic and extraordinary for hundreds of women and their families. It highlights many deficiencies in procedures and within the GMC. A doctor who should never have been allowed to practise in the UK was able to work unnoticed by the authorities for well over a decade, even though the truth about him was given to the authorities in various forms and at various stages while he was practising. I therefore believe that we need a more substantial, open and public inquiry than has been announced so far.

It being Seven o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, That This House do now adjourn.—[Mr. Ainger.]

Mr. Hague

I am grateful for the continued opportunity to speak a little longer, but I hope that the Minister will reply soon.

I believe that there is a need for a public inquiry. We know—and no doubt the Minister will enlarge on this—something of the Department's approach and its reasoning for not allowing such an inquiry. An internal memo from Professor Donaldson, the chief medical officer, to Health Ministers, dated 30 July 2001, appeared in The Northern Echo. It referred to the carefully worked out terms of reference for the investigation. I have been a Minister, and I know what "carefully worked out terms of reference" means in a civil service memorandum: it means that the terms of reference have been drawn up to limit the scope of the investigation. That is the tone and the meaning of the memorandum, which states: There is some pressure from the Cabinet Office not to challenge the Judicial Review"— that is, the attempt by the action group to open the matter up to a public inquiry by judicial means— so that an adverse judgement on holding inquiries in private is not registered. This relates to another high profile matter where the intention is not to have a full-scale public inquiry. I am sorry that the Cabinet Office has tried to enmesh this business in its determination not to hold a public inquiry into the foot and mouth disaster, to which the memo was obviously referring.

The memo continues Capitulation"— to a public inquiry— would be disastrous. Not only would we end up with three public inquiries"— the memo refers to two parallel cases— but all these are 'problem doctor' cases … There might be 50 such cases a year and we cannot be forced to accept such a precedent. The damage to the NHS of regular public inquiries would be immense. I put it to the Minister that if there are 50 cases of anything like this nature every year, we will need the inquiry to end all inquiries. We will need a huge public inquiry. Presumably what is meant is "50 cases in which doctors have done something wrong"; but as I hope I have demonstrated, this is not a case of the average doctor who has done something wrong so he needs a wrist-slapping. People may have died because of what he has done. That is clearly what is believed in Canada. This is a case of appalling incompetence, and appalling neglect of the need to protect the public.

The memo says: A further argument is that there is little further to be learned that has not been learned from other major inquiries into health service failures. Clearly there is a lot to be learned. Clearly much has gone wrong in the last 15 years. I know of no other inquiry that has covered all this ground and resolved all these issues. I therefore submit that a public inquiry is needed.

In a response to e-mails to The Northern Echo, the Secretary of State himself said: I am deeply concerned. When things goes wrong we need to learn the lessons. That is why openness is so important. Openness is very important in this case. I believe that we need an inquiry with an independent and impartial chairman, not from the Department of Health. I know that the Department has already suggested a concession in that regard, for which I am grateful. The inquiry should also be able to take evidence under oath, and have the power not only to subpoena witnesses but to examine the evidence of private patients. Private patients deserve some redress and some consideration from the Government and Parliament of the country.

The inquiry should also have power to determine the role of the General Medical Council, and terms of reference enabling it to examine all the circumstances before and after the employment of Neale at the hospital, not just during his employment. I believe that the inquiry should be conducted in the presence of the press and the public.

The investigation announced by the Department of Health does not meet those criteria. It is said that the victims can attend the inquiry, and can go out and tell the press what has been happening. Is that the form of openness that is now to be preferred in our society? Should not the press be free to report the proceedings, and report them straight? Must it rely on rumour and the passing on of news at second hand, when the matter involved concerns the public to such a huge extent?

The terms of reference that the Department announced for the investigation are inadequate, as they extend only from 1985 to 1995, which is not sufficient to catalogue the inadequacy of the system since 1995 and prior to Neale's appointment in 1985. The investigation may well fail to cover the NHS pay-off and reference, and the GMC claims that it did not receive a complaint from NHS management until February 1998. All that is beyond the scope of the investigation that has been announced.

The investigation will not be able to take evidence from private patients, even though they paid for treatment because of waiting lists or because Neale told them that that was a better way to go. The inquiry's enhanced terms of reference look only at local NHS services, but the Neale case goes wider than Yorkshire, has implications for the NHS and GMC as a whole, and has highlighted serious deficiencies in health service procedures. We must ensure that all the lessons are learned.

Everybody affected by Neale feels that there has already been too much foot dragging. Everything has been done a bit late, and we have had to campaign to get anything. To get an investigation, an action group had to he formed and lobbying had to take place. Throughout the history of this case, officialdom has dragged its feet; everything has been done behind time, when it was too late. It is not surprising that the people affected now want an inquiry out in the open. Ministers have nothing to fear from that. The case extends over a long time; no one is saying that today's Health Ministers bear responsibility for the origin of the problem. That is not their fault as Ministers, but it will be their fault if every lesson for the future is not learned in a fully open and transparent way, which is why we need a public inquiry into this appalling and disgraceful scandal.

7.6 pm

The Parliamentary Under-Secretary of State for Health (Yvette Cooper)

I congratulate the right hon. Member for Richmond, Yorks (Mr. Hague) on securing this debate and raising an issue that is important and serious both for those who came into contact with Mr. Neale, including the right hon. Gentleman's constituents, and for NHS patients generally.

The right hon. Gentleman made a series of points which I shall try to address as best I can. The Government take these matters very seriously indeed and are determined to ensure that procedures are in place to minimise the risk to patients as far as possible. However, millions of patients have received the highest-quality care from the NHS; it is important that we do not lose sight of the excellent service provided by the vast majority of NHS staff, and I welcome the right hon. Gentleman's opening remarks about the excellent service provided by the NHS in his constituency.

There is universal agreement that patient safety must have priority. Any concerns about the conduct or competence of health professionals treating NHS patients must be properly investigated. Of course no system can be foolproof: when mistakes happen, a service is found wanting, or a professional is found to be incompetent, we must ensure that we learn the lessons necessary to avoid any future repetition to the extent that we are able to do so. That may involve local or national investigations, and of course there are differences of view about how best to approach these issues.

In the case of Mr. Neale, there were clearly great failures in the system. I agree that the case is serious and involves all kinds of unacceptable failings in the system in the mid 1980s through to the mid 1990s. From what we now know, there appears to have been a series of mistakes that badly let down those patients who went to Mr. Neale expecting at the very least a reasonable standard of treatment. Mr. Neale let them down in the way in which he treated them, and the NHS let them down by failing comprehensively to protect them.

The right hon. Gentleman set out a chronology of events and problems at different stages in the employment of Mr. Neale. I hope that the right hon. Gentleman will forgive me for not wanting to pre-empt the results of the inquiry that we have launched to ensure a thorough investigation of what went wrong with the NHS systems that were then in place to protect patients. We are determined to learn the lessons of what went wrong in this case, as well as those of other incidents, in order to improve substantially the quality of care for NHS patients and give them the confidence that the right systems are in place to afford them the protection that they need. At this stage, it is important that Ministers do not pre-empt the diagnosis of the problem or the suggestions that result from the inquiry. However, I should like to respond as far as I can to the points that the right hon. Gentleman raised in terms not only of the inquiry itself but of the broader themes that are raised by the events that took place in relation to Mr. Neale.

As the right hon. Gentleman mentioned, the Secretary of State for Health announced on 13 July last year a full independent investigation into the way in which the NHS had handled complaints about Mr. Neale's activities in the 1980s and 1990s. Of course, the NHS has moved on considerably since 1997 and the proposed inquiry was intended to look not only at the systems that were in place at the time but at the extent to which improved systems could deal with the deficiencies exposed by the case. The right hon. Gentleman raised issues about whether the inquiry should be public. As he mentioned, those issues are to be the subject of a judicial review that is due to start on Tuesday 5 February, so there will shortly be full scrutiny of the Secretary of State's decision to hold an investigation into this case other than by way of a public inquiry. As is so often the case in such circumstances, a view must be taken about the right approach for achieving the best outcome. That may involve, as it has in this case, a decision about the relative merits of a public inquiry, as opposed to a private one. Both attract arguments for and against, but in the end, it is a matter of judgment in each case on the basis of the particular circumstances that it involves. It is almost inevitable that the final decision will not satisfy everyone.

In general terms, the decision to hold an inquiry in private was based on the Secretary of State's concern that the systems that were then in place in the NHS for handling complaints should be thoroughly investigated, that the inquiry should be scrupulously fair and that the outcome should restore public confidence in the complaints system as quickly as possible. It was my right hon. Friend's view that those aims would be achieved most effectively by an independent inquiry that took evidence in private and published a report of its findings and recommendations. Following representations, he agreed that the inquiry proceedings could be attended throughout by all the witnesses, affording them the opportunity to hear what was said not only by their legal advisers but by other people.

In making his decision, the Secretary of State has taken account of the many relevant factors and weighed carefully the arguments on each side. He has given special consideration to the views of the group supporting the victims by agreeing to significant modifications to the form that the investigation should take. All the information has been comprehensively stated in the evidence provided for the judicial review by the chief medical officer. It is obviously difficult to attempt to paraphrase or reproduce that careful analysis, which is extensive, but I can say that it covers the benefits of quicker resolution and of being better able to get to the truth if more people are comfortable giving evidence in private because there are sensitive areas of care. Clearly, the matter will be considered by the judicial review and it would be unwise for me to attempt to anticipate or pre-empt the task that will shortly be before the courts.

The right hon. Gentleman expressed concerns about the inquiry's terms of reference. In particular, he mentioned the ability to subpoena witnesses. The Secretary of State has considered the matter and we are not aware of evidence of problems with getting witnesses to testify in similar cases, but my right hon. Friend has said that, if there is evidence that that proves a problem in this case, he is willing to reconsider whether additional powers need to be given.

The right hon. Gentleman raised concerns about the inquiry's terms of reference and scope. Ultimately, its scope will be a matter for the inquiry itself to determine. The terms of reference give the members of the inquiry quite wide scope in deciding the most important issues that need to be investigated. They state that the inquiry will need to investigate the concerns or complaints raised concerning the appointment, practice and conduct of Richard Neale in respect of his employment as a consultant in the NHS. To investigate the actions which were taken for the purpose of (a) considering the concerns and complaints which were raised; (b) providing remedial action in relation to them; and (c) ensuring that the opportunities for any similar future misconduct were removed. To assess and draw conclusions as to the effectiveness of the policies and procedures in place. To make recommendations informed by this case as to improvements which should be made to policies and procedures which are now in place within the health service, (taking into account the changes in procedures since the events in question). It is not for me to determine exactly what the inquiry will choose to examine, but the terms of reference give it scope to concentrate on the issues that it feels are most important when looking at the evidence and listening to the testimony that those who have suffered at the hands of Mr. Neale will give.

It is important that we do not think that we need to wait until the inquiry ends before making improvements to the NHS. Many improvements have already taken place but it is critical that we establish a learning culture in the NHS. It must be able to learn from problems, difficulties and failings continuously, not simply when high-profile problems are covered in the national media.

Time after time, the blame culture has led to failures in the NHS, as the Bristol inquiry has recently shown. We have set out to change that culture to one of trust, where there is greater openness and partnership between patients and professionals and where lessons may be learned when things go wrong.

I want to respond to some of the broad themes that arise from the right hon. Gentleman's chronology of the events surrounding Mr. Neale's case. From the evidence we have seen, it is clear that one of the major concerns raised by Mr. Neale's case is the failure to pick up on the clinical problems with his practice, which subsequently formed the basis of complaints to the General Medical Council. Those were simply not picked up early enough. Nor was the extent of the problem recognised despite a series of investigations. It is clear that we need to ensure not only that systems are in place to identify clinical problems early but that they are responded to properly, openly and effectively.

The changes over the past five years or so are aimed at creating a culture change. They focus on improvements in quality and patient safety, reform of professional self-regulation and guidance for professionals. They are aimed at preventing to the extent possible those failures that have led to cases such as that of Mr. Neale.

The introduction of systems of clinical governance places a clear responsibility on the organisation to deliver and continuously improve patient care—it is the mechanism for ensuring, among other things, that NHS organisations can demonstrate that they are meeting the statutory duty of quality set out in the Health Act 1999. We need to have systems in place for local reporting and picking up adverse events, providing the mechanism for identifying and responding to cases of persistent poor practice by individual health professionals.

Improvements include the establishment of the Commission for Health Improvement to review and report on quality improvement in health care organisations. Its principal role is to improve the quality of patient care in the NHS across England and Wales. CHI undertakes clinical governance reviews as well as investigating serious service failures in the NHS when requested to do so.

An office for information on health care performance will be established within CHI with responsibility for publishing relevant information for patients. We are taking steps to publish information about the "success rates" of individual consultants—a move that might have brought some of Mr. Neale's practices to light earlier—building on national audit work already in train. Information about cardiac surgery will become available in 2004, with other specialties following.

In line with the findings of "An Organisation with a Memory" we have established the National Patients Safety Agency to provide a single national system of reporting and analysis of adverse events and near misses that occur within the NHS, and to ensure that effective learning takes place to make the NHS a safer place for patients. We will be taking further steps to rationalise the number of bodies inspecting and regulating health and social care.

We also need to reform the NHS complaints procedure to ensure that there is a procedure in place that can flag up patient complaints, particularly when there are persistent complaints around the same health professional, as was the case with Mr. Neale. The purpose of the reforms in which the Government are already involved is to ensure that the procedure is more independent and responsive to the needs of patients while maintaining the confidence and support of NHS staff. We are aiming to send out guidance to the NHS and commence training in early summer with a view to the reformed procedure being implemented later this year.

We have also established the National Clinical Assessment Authority to help NHS employers assess the small minority of "poorly performing doctors" and make recommendations about whether and under what circumstances they will continue to practise in the NHS. It is important that we do not simply identify the problems, but have proper systems in place to assess those problems effectively and accurately and respond to them, as well as giving NHS employers guidance in being able to respond at local level.

Another major concern in the case of Mr. Neale is the failure of the regulatory system to respond effectively and appropriately when it was found that he had effectively been struck off the medical register in Canada. The right hon. Gentleman made important points about that. If patients are to be protected, we must ensure that professionals are not simply able to move around to escape proper scrutiny or effective regulation. That was a matter of serious concern for the Government in the light of the Neale case.

We have already acted quickly to free up the General Medical Council procedures. In August 2000, we introduced some interim reform measures that significantly improved the GMC's ability to act quickly to protect the public and to make sure that NHS employers know when the GMC is considering a case. New procedures enable the GMC to take into account certain criminal convictions of a doctor when abroad. In the spring, we will extend the GMC's powers to enable it to take into account disqualifying decisions taken by authorities outside Europe, as was the case with Mr. Neale. The GMC will not have to re-prove the case against a doctor, which has been the problem in the past in handling cases such as that of Mr. Neale.

In the spring, we will also announce our proposals for the radical overhaul of all the GMC's fitness-to-practise procedures. That will improve the independence of the hearings in relation to GMC members, who in future will be responsible for the investigation and prosecution of cases but not the hearing of the case. We expect that the new arrangements will speed up the disciplinary processes, which have been subject to frustrating delays in the past, and make the processes and outcomes more understandable to the public.

The establishment of a new council for the regulation of health care professionals, as proposed in the NHS Reform and Health Care Professions Bill, will also help to strengthen and co-ordinate the system of professional self-regulation. I believe that it is essential that professional self-regulation commands public and patient confidence. The new council will work with the regulatory bodies to build and manage a strong system of self-regulation that is open and transparent; that responds; that allows robust public scrutiny; and that explicitly puts patients first. The council should provide for greater integration and co-ordination between the regulatory bodies and the sharing of good practice and information.

The right hon. Gentleman also referred to concerns about Mr. Neale's practice in the private sector. He may be aware that, under the Health Act 1999, the Secretary of State does not have the power to set up an inquiry that would cover that. He is also right that we need better regulation of the private sector. That is why it is right that we will introduce in April regulation of independent health care through the National Care Standards Commission, which will set national minimum standards for the private sector. All providers will be required to meet core standards, and standards specific to the particular services that they provide, which will be patient centred and will specifically address clinical treatment.

In drafting those regulations, patient safety was the foremost consideration. Currently, when health authorities register and inspect premises, they take no account of the quality of services provided, and those who own or manage hospitals accept no responsibility for the treatment either. The patient enters into a contract with the doctor, not the hospital.

After 1 April, those who run the establishment will be held responsible for the quality of the services provided. They will be required to have in place policies and procedures for clinical governance, and to have a formal complaints system. If patients are dissatisfied with the outcome of the complaints procedure, they may approach the National Care Standards Commission direct.

The right hon. Gentleman discussed in detail some of the harrowing cases that came to light as a result of the events surrounding Mr. Neale, which have certainly proved distressing. That is why it was also felt important to offer additional treatment and support to those former patients of Mr. Neale. The care programme for members of the support group for ex-patients of Richard Neale started at the end of April last year. The initial clinical assessment phase has involved in-depth consultations with more than 100 of the women concerned.

The process is ongoing, and I understand that more than 70 referrals have been made for further expert assessment and investigation, and, if appropriate, treatment. The majority of referrals have now been seen by Mr. Paul Hilton, urogynaecologist and clinical director for women's services at the Royal Victoria infirmary, Newcastle. The few remaining will be seen in the coming weeks.

I share the right hon. Gentleman's concern that the safety of patients in the NHS should be paramount. As I have said, we have already introduced since 1997 a series of practical and effective measures to try to improve the clinical governance system and the way in which the NHS responds to mistakes and problems, enabling it better to identify problems at an early stage, and in particular to learn lessons from them. We must recognise that sometimes, things will go wrong, but we must also ensure that lessons are learned at an early stage, rather than many years later, after too much further damage has been done.

It is important that the inquiry fully investigates the problems relating to Mr. Neale's treatment of patients, his employment in the NHS and the systems then in place. It must make recommendations about problems in the systems at that time, so that we can better improve existing systems.

The inquiry was set up after great consideration, with terms of reference and conditions that the Secretary of State believes will best provide us with a thorough investigation and speedy answers. They will enable the NHS to learn effectively from the tragic events, and I hope that we can ensure that the events and actions surrounding Mr. Neale do not happen again.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Seven o'clock.