HL Deb 14 February 1995 vol 561 cc571-4

3.3 p.m.

Lord Smith asked Her Majesty's Government:

Whether, in the circumstances of the death of the distinguished surgeon Mr. Keith Abel, they consider that there are enough emergency beds in National Health Service hospitals.

Baroness Cumberlege

My Lords, I deeply regret the death of Mr Abel and extend my deepest sympathy to his family. It is for health authorities to identify local needs, including provision for emergency admissions, intensive care and neurosurgery. It is they and not central government who are in the best position to do that.

Lord Smith

My Lords, I am grateful to the noble Baroness for her reply and for sending me the clinical story from High Wycombe hospital—a tragic and horrifying tale. Does the noble Baroness realise that the doctors at High Wycombe hospital rapidly made the correct diagnosis? They said that Keith was suffering from a recent cerebral haemorrhage—recent because he became unconscious in the the car driving him to hospital. They said also that he needed an urgent neurosurgical operation to save his life, speed being the secret of success. However, they could not transfer him to any neurosurgical centre because all beds were full. That was at a time when his wife, Sue Abel, was in the hospital watching her husband die through lack of treatment. Does the Minister have any constructive ideas in relation to improving inter-hospital transfer of emergency patients to specialised centres? Treatment or lack of it should not prove fatal as happened in that tragic case.

Baroness Cumberlege

My Lords, some patients with severe brain haemorrhaging may not be able to withstand major brain surgery and we know that doctors have to make agonising decisions whether or not to operate. I am not saying that Mr Abel was such a patient. He was 68 years old—I am sure your Lordships will agree that that is not so old these days—and was receiving treatment with anti-coagulant drugs. I fear that that told against him.

The scan results available within 30 minutes of admission showed that he had suffered a large haemorrhage; he was deeply unconscious and needed medical assistance to breathe. It would be wrong to judge the whole of the National Health Service from one single case. Inevitably clinical judgments are made and many neurosurgeons are reluctant to intervene unless they believe that there will be a positive result.

Lord Strabolgi

My Lords, is the noble Baroness aware that over 3,500 patients recently had operations cancelled, with all the anxiety that causes, due to a shortage of beds in London and the South East? Is she further aware that a three year-old girl, suffering an asthma attack, had to be driven 60 miles to Cambridge because there was no hospital bed available in London, although doctors had telephoned 14 hospitals? Are the Government prepared to take some responsibility for that?

Baroness Cumberlege

My Lords, we recently had a full report on a survey undertaken on intensive care beds. The report showed that although there were sufficient beds, they were not necessarily in the right place and were not being used in the correct way. One in six cases in those intensive care beds were inappropriately placed. We have drawn the attention of all health authorities to the report. We circulated it and asked them to consider it carefully when purchasing services for their populations.

Baroness Robson of Kiddington

My Lords, does the Minister agree that in circumstances such as those we have just heard about, when no emergency beds are available, NHS hospitals should be entitled to contact the nearest private hospital with beds available rather than leaving it to a relative of the person suffering from the haemorrhage to arrange for his admittance to the private hospital? Does she further agree that on those occasions, because we are short of emergency beds, the NHS should carry the cost?

Baroness Cumberlege

My Lords, in the case cited it was not an emergency bed that was needed; it was a bed in a neurosurgical unit. We have since contacted all the hospitals approached. We found that in two hospitals there was a place and that in one case the senior registrar felt that it was inappropriate that a patient who was so ill should be transferred.

Lord Bruce of Donington

My Lords, the noble Baroness cannot have it both ways. In her first Answer she suggested that the prognosis was that the patient would not respond to treatment because of his age and his specific situation. That may well have been the case. If so, why did the same people go to all the trouble of trying to find a hospital in which a neurosurgeon could be found? The two answers do not tie up.

Baroness Cumberlege

My Lords, there is a difference between referring a patient and accepting a patient. In this case the doctors felt that it was appropriate to refer the patient. However, those in the neurosurgical units in some cases—not in all cases—felt that it was inappropriate for that patient to travel that far for that operation.

Baroness Jay of Paddington

My Lords, is the Minister aware that whatever the specific clinical circumstances of that tragic case, it is not an isolated instance? Is she aware of the reply given to my right honourable friend Mrs. Beckett by the Minister for Health on 3rd February in another place in which she was told that the attendance at casualty and emergency departments throughout Greater London had risen by 2 per cent. in the recent past? If that is the case and those figures are available, why do not the Government take direct action?

Baroness Cumberlege

My Lords, the noble Baroness will have heard my answer yesterday when I told the House the position existing in London and the investment that we are putting into accident and emergency departments. In inner London alone £14 million will be invested this year. I could go through the list but it would be tedious to repeat what I said yesterday.

Lord Cledwyn of Penrhos

My Lords, notwithstanding Mr. Abel's age, and given everything the noble Baroness has said, is it not the case that if Mr. Abel had been transferred to a neurological centre for an appropriate operation he could have been alive today?

Baroness Cumberlege

My Lords, there is a higher authority who could decide on that, not me.

Baroness Masham of Ilton

My Lords, will the Minister take into consideration the real agony of the wife or the nearest relative when such cases cannot be transferred? Is it not an insurance policy for everyone to have enough intensive care beds in this country?

Baroness Cumberlege

My Lords, we are not talking about intensive care. We are talking about a neurosurgical unit. With regard to intensive care, the recent report—a very authoritative report—did not conclude that there were not enough beds but that they were not necessarily distributed in the right places and that they were not being used in the right way.

Lord McColl of Dulwich

My Lords, does my noble friend agree that for any patient, whatever his age, on anti-coagulant drugs who has a spontaneous brain haemorrhage which is so severe as to stop him breathing, the outlook is very bad indeed? That certainly was a factor in this case. Is my noble friend aware that when I was a house surgeon in 1957 and we had double the number of beds in the National Health Service throughout the country my major problem was a shortage of beds?

Baroness Cumberlege

My Lords, I bow to the wisdom and practical experience of my noble friend.