§ Sir Nicholas Lyell (North-East Bedfordshire)
I am glad to have the opportunity to introduce this debate on Bedford hospital. My hon. Friend the Member for Mid-Bedfordshire (Mr. Sayeed) cannot be here, but he associates himself with what I have to say. I am also glad to see the hon. Member for Bedford (Mr. Hall) in his place.
Bedford hospital hit the national press on Sunday 14 January, when a local newspaper, Bedfordshire on Sunday, published a sensational picture, widely syndicated in national newspapers, showing bodies on the floor of the chapel of rest at Bedford hospital. One of the bodies was partially uncovered to show the legs and part of the head of the deceased. There was, rightly, widespread concern at such an unacceptable situation.
On Tuesday 16 January, the Secretary of State came to the House to answer a private notice question tabled by my hon. Friend the Member for Woodspring (Dr. Fox). The Secretary of State rightly described the situation as unacceptable, and informed the House that the initial findings of an investigation begun on the Sunday by the eastern region office of the NHS Executive had identifieda failure of management within the trust."—[Official Report, 16 January 2001: Vol. 361, c. 201.]and that the chief executive, Mr. Ken Williams, had "stepped down". He said that the final report would be published and placed in the Library. However, he went on to tell the House then and there that the situation had nothing to do with funding and everything to do with the failure of management. The clear implication to the world was that the failure was the responsibility of the chief executive, and he had rightly agreed to fall on his sword. That was it; it was a problem unique to Bedford and the fault of management; the report might be of marginal interest but, in effect, the matter was done and dusted.
As soon as I read the newspaper reports, I took the opportunity to speak to the chairman of the region, Mrs. Rosie Varley. There had plainly been strong pressure from the very top for immediate action. She told me that Mr. Williams had agreed to stand down. I confess that I was not happy, but the impression was given to me that somehow the practice had been allowed to become a regular occurrence; that no competent chief executive could have failed to have known what was going on, and that although everyone liked Ken Williams—there were considerable suspicions that the half-covered body had been something of a set-up—he was none the less right to have agreed to go.
When I questioned the Secretary of State on 16 January, I pointed out the excellent work that had taken place in Bedford hospital during the 10 years that Ken Williams had been chief executive, and his own hard work above and beyond ordinary working hours to help patients in difficulty. However, when I questioned the adequacy of the mortuary facilities, the Secretary of State indicated dissent. He insisted that the problem had nothing to do with cash—nothing to do with a shortage of resources—but everything to do with top management at the hospital.
227WH I must tell the Secretary of State that the belief in Bedfordshire is different. One thing is common ground: that what was shown in the photograph, and in particular the fact that one of the bodies was uncovered, was unacceptable. However, views are very different about the fundamental causes, exactly how the situation came about, where responsibility should lie and what is a fair and proportionate reaction.
The Secretary of State now knows that the chief executive has strong support at every level in the hospital. He has received a letter signed by no fewer than 70 members of the medical staff committee—I think that that represents the whole committee—asking that Ken Williams be reinstated, and I understand that a petition supporting Mr. Williams has received more than 800 signatures from people working at the hospital. Above all, a strong feeling exists that, when the story broke, there was an almost immediate demand for a head on a plate.
It was said that the result was unfair, and that the particular incident was a set-up in which the chief executive and senior management were deliberately kept in the dark while the press was informed. Problems of adequate mortuary facilities at times of pressure are widespread in the NHS and Bedford's antiquated mortuary has been known as a problem to management at regional level for not only years but decades. Problems of underfunding were specifically set out in the original reports of the inquiry by eastern region, but were deliberately removed from the report before it was published at the insistence of the Department. Indeed, the fact that the report has been altered was, in substance, admitted both in an answer to a parliamentary question that I put down, and by Mrs. Kate Phipps, who chaired the inquiry, during a recent interview on the "Today" programme.
The debate seeks answers to a series of questions that, unless properly addressed, will lead to an unfair result. The background to the matter is a growing fear in the NHS, which is becoming all too well founded, of a steady growth of a blame culture. I am not happy about it. If things go seriously wrong, those who are genuinely to blame must take responsibility, but if we are going to be tough we must also be fair. The questions that I raise must be answered if justice is to be done and seen to be done.
Bedford hospital made real improvements during the years when Ken Williams was its chief executive. Its buildings have been upgraded, notably its marvellous Cygnet maternity and paediatric unit, and its new accident and emergency unit, opened in 1997 by the then incoming Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). Relations between medical staff and administrators have improved, and the strong feeling among other staff is shown by their petition.
On other objective fronts, the hospital has won a series of awards. Cleanliness was a matter of recent concern in the NHS; Bedford hospital is the eastern region beacon site for cleanliness. In December 2000, it won a charter mark for its hotel services. It is among the top 10 for the lowest hospital mortality in the region. Recently, it won the Bedfordshire borough council 228WH heartbeat award for food hygiene and healthy eating. It has supported Dr. Rob Thomas in his efforts to become hospital doctor of the year for his cancer services, which is of huge credit not only to him but to the hospital's support for him. It is a well-run hospital.
I come now to the mortuary facilities, of which the Secretary of State s statement to the House of 16 January fails to paint a fair picture. Like more than 100 other hospitals in the NHS, Bedford's mortuary facilities are antiquated. Under the present Government and the previous Government, of which I was a member, resources have been concentrated on front-line medical functions. Bedford has been significantly underfunded for decades, being either the worst or second worst funded trust in the whole of the eastern region, and consistently behindhand in the necessary catching up as money gradually ca me out of London to the provinces.
The health authority in the region was fully aware by the end of 1997 that non-clinical revenue costs were underfunded. The right hon. Member for Holborn and St. Pancras, when Secretary of State, was expressly told about that when he opened the new accident and emergency department. A letter from the Department, dated 22 June 1997 states:I recognise that significant contribution to Bedfordshire's problems is the distance between current funding and the capitation target.The author of that letter was none other than the present Secretary of State when Minister of State.
Many mortuaries throughout the NHS are out of date. I say that not to blame the Secretary of State, who inherited the position, but to emphasise that that needs to be taken into account in doing justice to those who manage the hospitals. According to the chair of Clinical Pathology Accreditation (UK) Ltd., which supervises mortuaries, more than one third of the 300 mortuary and post-mortem facilities that were visited had significant problems relating to their mortuary conditions,some of them comparable to those at Bedford hospital trust".The statement continues:What Bedford needs is a new mortuary and so do many hospitals across the country.The CPA chairman fairly described staff at Bedford hospital asdoing their level best against a background of underinvestment and underfunding.Those were important matters to take into account, yet they were simply not mentioned in the published public report—and neither were the circumstances in which the photographs were taken.
I do not blame the press, which exists in a free society as a watchdog for the public. However, if justice is to be done, the circumstances in which the press was tipped off must be carefully considered. Mr. Willy White, the regional representative of Unison, freely admits that he deliberately told the press rather than the management, let alone senior management. In doing so, he deliberately breached the hospital's whistle-blowing policy, which he had helped to write only six months previously. His excuses were that it was a long-standing problem and that he was aggrieved over unfair treatment of another member of staff, Monica Carmichael. She is entitled to fairness and her case has properly gone to appeal, but the present problem was not of long standing. 229WH The temporary mortuary had been installed only at the end of December and for four days it had been out of action due to a build-up of a partial vacuum with which anyone with a fridge freezer is familiar. We all know that freezer doors cannot be opened if warm air has got in. That should have been put right more efficiently, but how can that be laid at the door of senior management unless they were told about it?
§ Mr. Patrick Hall (Bedford)
On the temporary mortuary unit hired and then purchased by the hospital, does the right hon. and learned Gentleman agree that, although it has the capacity for 24 bodies, it could be used for a maximum of only eight because of its siting and certain health and safety rules? Does that not suggest mismanagement of the use of that particular unit? If it had been used fully, we would not have seen the bodies on the floor of the chapel of rest in the mortuary. Does the right hon. and learned Gentleman accept that that problem should be acknowledged and addressed?
§ Sir Nicholas Lyell
The hon. Gentleman is right about the temporary mortuary units, which are not perfect. They have health and safety problems, but they were used in a dozen NHS hospitals with approval before Bedford bought this particular unit It was a problem, but not a hanging offence, and it had not been drawn to the chief executive's attention.
Much was made by the Secretary of State of the new guidelines issued in May 2000 and of their breach by Bedford hospital. I assumed from listening to the Secretary of State that those guidelines had made it clear that in no circumstances should bodies be stored in places such as the chapel of rest. It is not a consecrated chapel, just a nice little room. However, the guidelines do not say that at all. These much vaunted guidelines say no more than:any NHS Trusts should ensure that mortuary capacity is adequate to meet peaks in winter deaths and take steps to provide additional facilities where this is likely to be required. Temporary mortuary facilities must meet minimum standards to respect patients' dignity; refrigerated vehicles and trailers must not be used.There is not a word about chapels of rest.
Let me explain exactly where the chapel of rest is. It is in a secure area. It is a small room, not consecrated, but reasonably nicely furnished, immediately adjacent to the mortuary itself. There is no question of it being open to the public. The only specific point in the guidelines was the prohibition of the use of refrigerated lorries.
Finally, on the basis of the facts, there remains a strong suspicion at Bedford hospital that the uncovered body had been deliberately placed there by someone to sensationalise the photograph. I do not blame the press; they photographed what they were shown. However, it is strongly believed by most of the staff, and others, that the scene was set up by the Unison representative because, as he said, he felt vindictive about the handling of another union case involving a member of the Manufacturing, Science and Finance union.
There are further worries in relation to that case. The Secretary of State is a member of, and is sponsored by MSF. There are fears in Bedford that what was seen as his personal over-reaction may have resulted from lobbying on the subject by Mr. Roger Kline, who 230WH worked closely with him in the past and who, like Mr. Willie White in the first 48 hours after the story broke, was loudly demanding the dismissal of the chief executive.
I am asking the Secretary of State to have the matter looked at again by an impartial arbiter, perhaps a Queen's Counsel with experience in the national health service and employment law. There is a widespread feeling in Bedford hospital, at every level and regardless of party affiliation, that the full truth has not come out and that justice has not yet been done.
As I said at the outset, the practice of storing bodies in an unrefrigerated area, albeit a secure one next to the mortuary, is not appropriate to modern conditions. The fact remains that priorities for funding over the years—it is not only this Government's fault—have been elsewhere. There remain scores of hospitals where mortuary facilities are inadequate, as they are in Bedford. The suggestion of the Unison official in the press that the chief executive should simply have indented for a new mortuary was unrealistic. Indeed, such a request was made 10 years ago. He could not possibly have been expected to know what was deliberately not reported to him.
When such problems arise, it is essential that they should be corrected for the future, but it is also important that the response should be proportionate, or confidence will be destroyed and morale undermined. If a manager is to be scapegoated in these circumstances, it will permit injustice not only in this instance, but will fail the staff of the health service as a whole.
§ The Minister of State, Department of Health (Mr. John Denham)
I congratulate the right hon. and learned Member for North-East Bedfordshire (Sir N. Lyell) on securing the debate on Bedford hospital. I also acknowledge the presence of my hon. Friend the Member for Bedford (Mr. Hall).
We need to look at the outcome of the investigation into the circumstances that led to the storage of bodies on the floor of the chapel of rest, although as the right hon. and learned Gentleman said, the chapel at Bedford hospital is not consecrated. This is a matter of great concern locally—indeed, it was of great national concern at the time the photographs were published. I can assure the right hon. and learned Gentleman that the incident and the continuing debate are of great concern to me, and I welcome the opportunity to explain the facts surrounding those distressing photographs and to reassure him of our commitment to in-patients at Bedford or other hospitals to ensuring that they are treated with respect and dignity at all times. That must continue in the inevitable number of cases that arise when people die in hospital. It was in the interests of patients that my right hon. Friend the Secretary of State asked for a full report into the circumstances surrounding the incident. Patients need to be confident that, in a patient-centred NHS, what happens behind closed doors is of the same standard as that which can be seen on the wards.
Most people found the published photographs shocking and it caused anguish to many, not least the constituents of the right hon. and learned Member for North-East Bedfordshire. It cannot be right for bodies 231WH to be left lying on floors over a period of days, in some cases, when people believed that their relatives were being looked after in a dignified way. The pictures showed that the patient's dignity was not respected in a way that we all have a right to expect in today's modern NHS.
My right hon. Friend the Secretary of State was as horrified as everyone else when he saw the photographs and he promised the House that a full report of the investigation would be placed in the House of Commons Library. The eastern regional office of the NHS executive had begun to carry out an investigation within hours of the photographs being published, and its preliminary findings confirmed that a fuller investigation was needed. It is worth saying that the investigation team included a non-executive director from Bedfordshire health authority; it was not solely a team put together from within the regional office. The team interviewed more than 60 people, ranging from the porters and managers at the hospital to the coroner and representatives from the newspaper who took the pictures. The investigation confirmed that those recently bereaved had been caused additional distress at the thought that their relative might have appeared in the photograph. It also became clear that a serious breach of hospital security had been committed.
In addition, the investigation established that some of the bodies had been there for some days, that this was not the first time that bodies had been stored in this way, that rules of patient confidentiality were broken, as one of the deceased could be identified from the photograph, and that the handling of coroner's cases was potentially compromised. The porters, it was established, were not involved in the purchase of the additional body storage facility and that had contributed to the problems with that facility.
It is worth reminding the Chamber that, by the time of the incident, trusts had received two sets of guidance—health service circulars 1999/239 and 2000/016—which detailed action to be taken in respect of mortuary facilities. HSC 2000/016, issued in May 2000, set out the arrangements required by NHS trusts to ensure that mortuary capacity was adequate to meet peaks in the number of winter deaths and to take steps to provide additional facilities where those were likely to be required. It also stressed that where temporary mortuaries were required, they should meet minimum standards to respect patients' dignity.
However, that guidance was not brought to the attention of staff involved in the handling of bodies, despite its having been reinforced at a regional meeting of chief executives in November 2000 and during winter planning meetings between the regional office and local health care systems. As a result, there was no recognition of the urgent need to repair a fault on the door of the additional mortuary facility. The report states:
From the evidence provided it is clear that the practice of placing bodies on the floor of the chapel of rest had been custom and practice for more than five years. Consequently, the Trust failed to treat the deceased with dignity and respect".It has been suggested that the root cause of this whole issue is one of funding. As my right hon. Friend the Secretary of State has already made clear in the House, 232WH that is not the case. Storage was available in the additional facility, which meant that the floor should never have had to be used. The floor was used because of a management failure to make it clear to all staff that the deceased should be treated with dignity. As the use of the floor had become custom and practice over a period of years, there was consequently no sense of urgency in getting a fairly minor problem with the doors resolved.
Things are changing in today's NHS and some of the practices common in the past are no longer acceptable. This is just such a case. Having pointed out that the alternative provision had been made, but there was a management failure to tackle the problems that arose in the additional facility, let me address the issue of funding.
§ Sir Nicholas Lyell
When one is considering fairness, would the Minister agree that the senior management can deal with a matter only if they are told about it? Is it not quite clear that they were not told?
§ Mr. Denham
Clear guidance set out in health service circulars was made available to chief executives right across the NHS. That guidance, in the eastern region, as elsewhere, was reinforced in the whole series of activities that now surround planning for the winter period. Everything was done to ensure that the chief executive of every trust understood the importance that was attached to the issue within the NHS, given the criticism that the NHS had received in previous years over the use of inappropriate temporary mortuary facilities. It is against that background that the events that I am describing should be seen. Indeed, it was when confronted by the findings of the preliminary investigation and public anger and concern that Mr. Williams felt it right to stand down from his post in the interests of the hospital.
On the funding issue, Bedfordshire has moved further from its weighted target allocation in recent years, but it is worth looking at what has been done with the resources. Bedfordshire will have received increased resources of £92 million, an increase of more than 30 per cent. since 1997, after taking account of the growth announced for 2001–02. Even after allowing for inflation, that has enabled more than £60 million to be invested in services. Bedfordshire has also benefited financially from the designation of Luton as a health action zone.
In recent years, the health authority has lived within its resources, and the trust has balanced its income and expenditure, so Bedfordshire has enjoyed a substantial real increase in NHS resources. Following a report in 1997 by the accrediting body, CPA, the trust upgraded its post mortem facilities. The report did not refer to the capacity of the mortuary, but since then, the trust has bid twice for pathology modernisation money without raising the expansion of the mortuary's capacity. The trust has never put forward a business case for a new mortuary; nor has the trust board raised the mortuary as a problem.
The investigation report acknowledged that the trust has less mortuary capacity than other, similar-sized hospitals and that it recently lost accreditation for its pathology services, including the mortuary, because of 233WH core facilities. It is clearly in everyone's best interests that the problem is tackled as soon as possible. The regional office has been asked to work closely with the trust in developing plans for a modern and enlarged mortuary facility.
I return to the events that took place. The report states:On this occasion, additional mortuary capacity was available, but was not being used because of a door defect that was not rectified for four days. This was because of confusion about accountability at middle management level and poor communication between departments".The failure of the door of the additional mortuary was never treated as an emergency, which is why it took four days to put right, and must be seen against a background in which it had been custom and practice to use the chapel of rest.
It has been suggested that the incident was the result of a conspiracy to discredit Ken Williams or to seek revenge against him. The investigation was not able to establish that that was the case, but irrespective of whether there had been action or activity of that sort, there was a management failure in respect of mortuary facilities and that would not be changed, whether or not people had acted with malicious intent or bad faith in the case.
The professional staff interviewed by the report team were unanimous in saying that there was an open policy in the trust and that they were confident that staff concerns would be listened to. That view was not shared by all the non-professional staff interviewed; some porters and union officials feared recriminations if they persisted in expressing their anxieties. It is clear that there have been difficulties in relationships following the 234WH dismissal of a member of staff last year and the trust will need to address that matter over time. No one was prepared to admit to the investigation team that he or she had allowed Bedfordshire on Sunday access to the mortuary and there was no opportunity to question people about their motive in taking the course of action rather than raising their concerns with trust managers. Neither the editor nor the photographer from Bedfordshire on Sunday would say how they gained access to the mortuary, although they agreed to state the days on which the photographs were taken. That enabled the bodies in the photograph to be identified, as required within the investigation team's terms of reference, but it failed to open any other avenue of investigation to the team.
There were suggestions that parts of the final report were left out of the version placed in the Library. The report laid in the Library was that written by officials in my Department and the investigation team stands by that report. Before it was completed, an early draft was shown to the trust to ensure that there were no factual inaccuracies and it was amended accordingly. The draft report was added to and edited as the investigation team worked on completing the final document. I have been assured by the chairman of the investigating team, Kate Phipps, that nothing of relevance was removed or left out of the final report and it is therefore a true reflection of the findings of the investigation.
The investigation of the incident does not end here; the body that was clearly identified in a photograph was a coroner's case, which was the responsibility of his office until released to the family. The coroner—
§ It being Two o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.