§ 11 am
§ Mr. Jim Cunningham (Coventry, South)
Thank you, Mr. Deputy Speaker. I also thank Mr. Speaker for granting this debate at short notice. It has to be appreciated that this is a short debate, and my hon. Friend the Member for Coventry, North-West (Mr. Robinson) will pick up any points that I fail to make. He is quite adroit at that. My hon. Friend the Member for Leicester, East (Keith Vaz), who is also here today, is lending his support on the issue, which centres on the suspension of a doctor at Walsgrave hospital some two years ago. It is worth noting, as I hope the Minister will, that this is the second time that we have had to have a debate on suspensions at the hospital.
There has been a range of problems at the hospital, but we should start by recognising that progress has been made in several areas during the past 12 months—we would not want to take that away from the new management. That progress includes an improvement in patient care, a new trust chairperson and a new chief executive of the trust, an improvement in terms of the practice of bed blocking and a tremendous effort to reduce waiting times. There has also been tremendous progress over the building of a new hospital, the final cost of which may be £380 million or more. It is also worth stating for the record that my hon. Friend the Member for Coventry, North-West and I supported my hon. Friend the Member for Coventry, North-East (Mr. Ainsworth) as a link between us and the national health service to secure that hospital.
One outstanding issue remains—that of Dr. Mattu. He was appointed on 1 May 1997 to establish a new medical school and to help to improve standards. He also joined the cardiac department. In February 2002, he was suspended after he raised concerns about overcrowding in some wards, in which five beds were placed in four-person bays, which was interesting. There was quite a lot of controversy about it. From 1999, he raised at a series of meetings other concerns about standards and the level of care. As I say, he was employed to help to improve standards.
There have been two inquiries to investigate some of those concerns. The Commission for Health Improvement carried out an investigation and expressed several concerns. In fairness to the trust, it acted on the report and put those matters right. A further inquiry is to be held because of allegations that the first two inquiries, which were separate from the CHI report, did not appear to cover all the concerns regarding five beds in a four-bed bay. We believe that this inquiry should be independent, as that would show transparency and encourage the public again to trust the management of the hospital to deliver adequate services.
It has been estimated that the suspension and resulting legal expenses are costing the NHS about £50 million a year—a considerable sum that could be used for other purposes in the health service. Suspensions and over-long disciplinary procedures cost the NHS a great deal of money. In previous cases, the disciplinary procedure has taken two years and run up costs of hundreds of thousands of pounds. The personal cost to Dr. Mattu includes not being able to practise his skills, the emotional cost to him and his family and the cost of 26WH long disciplinary procedures. At what stage does whistleblowing become a disciplinary matter? We need guidance from the Minister on that question.
In the past three years, there have been at least three suspensions for very long periods. One case had to be resolved by the courts, one was settled out of court and now there is the case of Dr. Mattu. The new management have had the chance to wipe the slate clean as most of those cases, including that of Dr. Mattu, occurred under the previous trust management.
My hon. Friend the Member for Coventry, North-West and I are calling for Dr. Mattu to be reinstated or, failing that, for an independent panel to examine the case, or the Minister to set up an independent inquiry. We want to let the past stay in the past and get everyone to work towards one aim—the provision of a better health service for the people of Coventry. In outlining our concerns in the Dr. Mattu case, we make it perfectly clear that we do not want a quarrel with the management. If that is what we wanted, there would be no reason for us to call for arbitration.
There have been problems at the hospital, but we recognise that there have been slow improvements and that there cannot be any major improvements until the new hospital is completed. However, we acknowledge the valuable service of the staff in providing for the health of the people of Coventry and we would not want anyone to think that we are disputing that contribution. There can be a new hospital, but if staff morale is low there is a problem.
The way to lift staff morale is to treat the staff fairly, consider their grievances and try to resolve them. As a gesture in that direction, at the very least there should be some conciliation between the trust and Dr. Mattu and his advisers. It is Dr. Mattu now, but who will it be next week because the management happen to disagree with the staff on the issues that they raise?
We must bear it in mind that one of Dr. Mattu's functions on appointment was to improve standards and, in doing so, the onus was on him to raise issues about which he was concerned. Five beds being placed in a four-bed bay is a serious issue, and as that and other issues have not been resolved and there has been no independent inquiry, there are grounds for mistrust in the public mind over how the hospital is managed and for a lack of confidence in the services. I do not say that that has happened, but there is a real danger that it could.
This is a short debate and we want to give the Minister adequate time to reply. We appeal to her to consider the situation objectively. I know it is difficult for her to intervene, but where there is a will there is a way. At the very least, she should push for conciliation, if not an independent inquiry.
My hon. Friend the Member for Coventry, North-West will make further points about the hospital and Dr. Mattu's case. The people of Coventry are watching that case, as they did the previous cases, as what has been going on is very frustrating for them and the situation cannot continue. At some point, the past must be buried so that we can move on to the future and deliver what the people of Coventry deserve—a new hospital and the best services that can be provided. If that is done, staff morale will improve and, more important, the people of Coventry will have confidence in a first-class health service.
§ 11.8 am
§ Mr. Geoffrey Robinson (Coventry, North-West)
Like my hon. Friend the Member for Coventry, South (Mr. Cunningham), I thank Mr. Speaker for granting permission for this important debate at short notice. I also thank my hon. Friend for securing it. I am grateful to the Minister for being present, and I look forward to what she has to say.
As my hon. Friend said, this is the third debate that we have had on the problems of Walsgrave hospital. I had hoped that this Adjournment debate would not be necessary but it is, despite the fact that there is a new broom, and a new start, for which we thank the previous Secretary of State. We have a new chairman and new chief executive, and for the last year and a half the problems of Walsgrave had more or less disappeared from my radar screen, until now. As MPs, we are close to our constituencies, and we measure that by the postbag and representations that we receive and by the general feeling in the city about the hospital, which is probably its most important institution.
My hon. Friend said that progress has been made. The new hospital is going up, the private finance initiative project has been agreed and there is every chance that we can sustain that new start if we deal with the remaining problem. I am not sure why it has flared up again in recent weeks. Perhaps it has to do with the National Clinical Assessment Authority letter, which I hope my hon. Friend the Minister will comment on. Perhaps the situation has simply gone on far too long. It is now 20 months since the suspension and we are no nearer a resolution of the problem.
For that reason, my hon. Friend the Member for Coventry, South and I felt that the matter had to be raised in Parliament again today. It is indeed time to do so because this very week a Reader's Digest press release again identified Coventry's Walsgrave hospital as one of the principal areas for concern about suspensions. Highlighting an article in the Reader's Digest published today, the press release states:One example of a trust throwing its weight around is the University Hospitals of Coventry and Warwickshire NHS Trust"—of which the main hospital is the Walsgrave—who are at the centre of three high-profile suspensions. The most recent case concerns Dr Raj Mattu, one of the world's leading heart specialists.The press release says other things, which I shall come to, but it is a strange situation in which one of the world's leading heart specialists—those are the words of a well informed Reader's Digest article, not mine—is suspended for 20 months. People should think of the cost—not only the hundreds of thousands of pounds to which my hon. Friend referred, but the loss to the people of Coventry. At the heart of the matter seem to be nothing more than bickering, rivalry and allegations of confrontation, and perhaps harassment or bullying, made by one consultant against another. It has taken 20 months to get nowhere but deeper into confrontation and aggravation for the whole city of Coventry.
The issue will not go away, and it needs to be confronted and resolved in the very short term. The people of Coventry are fed up to the back teeth with bickering, rivalries and allegations of harassment between consultants. It is much worse than what takes 28WH place in the Oxbridge common rooms. Heaven knows, people who have served in them are aware of the bickering, fighting and confrontation that goes on there. The alternative to a settlement now is another year of the same. We will go through the procedures, which will take at least a year, and be no further advanced.
I intend to leave the Minister plenty of time to reply, but I want to say that Dr. Mattu, whom I know personally and with whom I have recently discussed the situation, as I did many months ago, was unwell for four months this year with an illness that has clearly been aggravated by the stress that this incident has caused him, and one should never overlook that. Previously, other factors delayed a resolution, but we are through those now and, as I understand it, the representatives on each side are ready to engage.
One story came to my attention just last week. Although Dr. Mattu is suspended, he still comes to Coventry and he holds three surgeries there. I am told that the fact that he does very little private work may be one issue that is causing friction between him and the other doctors. I do not know about that and cannot comment on it, but Dr. Mattu is doing voluntary work in Coventry and, I think, in Kenilworth or Leamington, where he holds three clinics. This incident took place not as a consequence of one of those clinics, but because of a chance encounter in a local pub, where he met a gentleman who has allowed me to mention his name. That gentleman is one of my hon. Friend's constituents, not one of mine, and I have told my hon. Friend that I shall be mentioning this man in the debate.
The constituent's name is Jim Brown, and he told me the following story. He was twice admitted, very recently, to Coventry Walsgrave hospital as an emergency case. On the first occasion, he was kept in overnight and discharged the next day. On the second, he was not admitted to specialist coronary care, but held for two nights in the normal emergency wards and discharged on the third day. Dr. Mattu bumped into Mr. Brown in a pub in Coventry and said to him, "You are not looking very well. Jim. What's the matter?" He knew that he had a history of coronary complaints. Mr. Brown explained to Dr. Mattu that he was suffering from something similar to what the Prime Minister had—an excessively fast heartbeat.
Raj Mattu, because he knew the person and knew about the condition, said that what he needed was electric shock treatment—precisely what the Prime Minister had. Dr. Mattu said to Mr. Brown, "Why don't you go to your GP tomorrow? The condition is very serious and if it continues it can cause long-term damage." He told him to tell his GP that he had that condition and to ask him to get him admitted to the coronary unit. He said that the people in the coronary unit were very capable and would administer the treatment that Mr. Brown needed.
Mr. Brown did just that. He went to his GP, who phoned the hospital, saying that the case was not an emergency, but that he had identified the problem—subject to hospital confirmation—and that he believed that such treatment was necessary. The treatment was administered and Mr. Brown is fine. I spoke to him on the phone and he confirmed every aspect of that conversation. He said that he is fine, and he could not understand why it took the intervention of Raj Mattu to get him that treatment.
29WH There is no doubt that we are dealing with a competent doctor. The Walsgrave may want to ask itself some questions about why, in Mr. Brown's case, there was no coronary investigation after his emergency admission, but that is not the main point that I want to make. The point is that Dr. Mattu was, and is, by any standards, an outstanding doctor. It is not just Reader's Digest that believes that to be the case—it is recognised in Coventry. Dr. Mattu was recruited in 1997 for the specific purpose of redressing what was seen as an inadequate situation in the hospital. There were two incidents—one in 1999 and the other in 2000. In the 1999 incident, in which there were five beds in a four-bedded room, a young man was admitted—I do not know the details of what happened—and it was not possible to get the equipment on to him quickly enough. He died. Both incidents were investigated, but I do not know what the judgments were. It would be nice to see the results published, although I am much more interested in the future than in the past.
What have the present chairman or chief executive to fear from an inquiry? They were not in post when those incidents took place, and the practice of putting five beds in a four-bedded room has stopped. However, if the Minister could make the results of those investigations available, it would be very interesting to see what happened.
It is no good pretending that Dr. Mattu created waves for no reason. He did so because he wanted to improve an inadequate situation and because he thought that not enough attention was being paid to what he believed was improper practice. Five beds in a four-bedded room might have been acceptable if all the patients were recovering from heart operations, but it should never have been allowed when the patients were in a critical condition, such as that of the patient who died.
I think that Dr. Mattu was a whistleblower, although that may not be universally accepted. He set very high standards and expected others to reach those standards, but that is nothing less than patients would wish. If he was difficult in that respect, that is all in the past. The question now is what should be done to resolve the present situation.
The NCAA has been contacted. The Minister will remember that the NCAA was set up with the precise purpose of accelerating the process of suspensions. It limited the number of cases in which hospital trusts should seek to suspend and set a target for the time it should take to process those suspensions. Neither of those has been observed in this case, but it predated the setting up of the NCAA.
I am told that the NCAA has written a response, and, although it says that disciplinary hearings should proceed, it is not standing in the way of a compromise or negotiated settlement. A compromise settlement must now be reached, and that could be achieved through an intervention from the Minister or arbitration by a jointly-appointed, independent party. We must cut through this process, which is dragging on—costing us millions or at least hundreds of thousands of pounds—and denying the people of Coventry the care that they need.
What is the essence of a compromise agreement? The trust should not expect to humiliate Dr. Mattu in any way or to reach an agreement that wholly supports its 30WH wishes. The essence of a compromise agreement is that each side should drop its claims against the other and no blame should be apportioned. If we start from that point, I am sure that a compromise can be reached, and I urge the Minister to set about resolving the problem on our behalf. If she were to say that procedures must be followed, we both know that the situation would continue for another year, with hundreds of thousands of pounds of extra costs, and we would be denied the good services of an outstanding doctor.
§ The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)
First, I join my hon. Friend the Member for Coventry, North-West (Mr. Robinson) in his congratulations to my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing this debate. I am aware of the local concerns regarding this issue and that there is considerable disquiet over the length of time taken to resolve the situation.
Before I discuss the suspension of Dr. Mattu, I want to say a few words about the progress being made locally at the University Hospitals Coventry and Warwickshire NHS Trust. My hon. Friends, including my hon. Friend the Member for Leicester, East (Keith Vaz), will be aware that, in 2001, the Commission for Health Improvement awarded the trust a zero star rating. That was coupled with the fact that, in the Dr. Foster report into cardiac surgery, published in November 2001, the trust was highlighted as having one of the worst cardiac mortality rates in the country and given three months to improve.
Following a number of interventions, including by the Modernisation Agency, a review by the Commission for Health Improvement in 2002 found that satisfactory progress had been made. Issues such as the high death rates, the practice of putting five beds in four-bedded bays, and strategic planning were all found to have progressed satisfactorily, but more work still had to be done. As a result, the decision was taken to franchise the trust and, as my hon. Friends have mentioned, the then chief executive, David Loughton, resigned in March 2002. The new chief executive, David Roberts, assumed the post in May 2003. He implemented a plan sustainably to improve performance at the trust.
I should like to pay tribute to the hard-working staff at the hospitals in the trust, who have turned round performance to the extent that the CHI awarded the trust two stars for 2002–03 and concluded that overall it is performing well, although work must still be done before the trust is one of the best in the country. The super-hospital for Coventry and Warwickshire is also being built, at a cost of about £359 million.
I will now turn to Dr. Mattu's case. I am aware of the issues surrounding the case, especially the long time taken to sort it out. There have been allegations that Dr. Mattu has been suspended because he is a whistleblower. The Government expect a climate of openness and dialogue to exist in the NHS, a climate that encourages all staff to be able to raise concerns about health care matters reasonably and responsibly, without fear of victimisation.
In August 1999, the Department of Health issued stronger guidance to all NHS trusts and health authorities on whistleblowing. That guidance is in line 31WH with the requirements of the Public Interest Disclosure Act 1998, which gives strong statutory protection to employees who disclose information in the public interest and are victimised for doing so. National health service employers should ensure that all staff are aware of local policies and procedures, and their responsibilities for raising genuine concerns in a responsible and reasonable way. The Department's view is that concerns raised should be dealt with locally and in accordance with those local policies and procedures wherever possible. In. luly we issued an updated policy pack to support organisations reviewing their policies on whistleblowing.
Dr. Mattu has been employed at the trust as a consultant cardiologist since May 1997. The then joint medical director at the trust suspended him from duty on full pay on 21 February, following allegations of serious bullying. The act of suspension was—and still is—neutral, pending investigation of the allegations, and was in accordance with the trust's disciplinary procedure, which states thatwhere, in the Medical Director's opinion, a practitioner's continued attendance at the workplace is or would be prejudicial to an investigation or good working, or is not in the interest of patients, the public or other staff, the practitioner may be suspended from duty on full pay pending the outcome of preliminary enquiries or the full investigation.In each case, the consideration and the implementation of the suspension should be in accordance with the health service guidelines set out in HSG (94) 49.
Following Dr. Mattu's suspension, a further allegation was received that corroborated the original complaint. There was a formal investigation into the allegations, conducted in accordance with the trust employment procedures relating to clinical staff, which had been agreed by the local negotiating committee. That committee comprised senior consultants and so forth. The procedures are recognised as being fair and appropriate. The investigation methodology consisted of taking statements and interviewing people. Dr. Mattu has remained suspended during the process; his suspension is reviewed fortnightly by the joint medical director of the trust.
In January, an independent panel meeting was held, in accordance with trust procedure and agreed with the parties, to review the evidence and to consider what further action, if any, was necessary on the ongoing suspension. The panel undertook a preliminary investigation assessment and found that the prima facie case of personal misconduct needed to be answered. Dr. Mattu has engaged the services of the Hospital Consultants and Specialists Association and a solicitor. The trust has also engaged a solicitor. Progress on the case has been slowed by the lengthy and complex disputes between the trust and Dr. Mattu and his 32WH representatives. As a consequence, Dr. Mattu is unfortunately unavailable due to sickness, as my hon. Friend the Member for Coventry, North-West mentioned.
West Midlands strategic health authority representatives met the trust on 30 July 2003 to review the processes employed by the trust to date, and in particular to ensure that the fundamental principles of due process and natural justice have been complied with.
§ Mr. Geoffrey Robinson
I know that technically the suspension is, or is said to be, a neutral act. However, the consultant concerned has been suspended and left in limbo, with all the stress that that involves. There is no countervailing pressure on the others involved. I want to raise another point; is there not something wrong with those processes, which can go on for 20 months, even allowing for the four months of Dr. Mattu's indisposition? Cannot the Minister see that the processes are not working? What will she do about the matter?
§ Miss Johnson
I assure my hon. Friend that the process is genuinely neutral. I appreciate that it may not feel like that, but it is. That is how the matter must be regarded by all parties. My hon. Friend presses me on the length of the duration of the case, and I share his concerns about that. It is of concern that it has taken so long and we do not want cases to take so long. Dr. Mattu wrote to Sir Nigel Crisp, who suggested that the National Clinical Assessment Authority should look into the handling of the case. The NCAA provides a service that deals with doctors and dentists on performance issues and gives advice about local handling and how difficulties can be resolved. Ian Stone, the chief medical officer's adviser on long-term suspensions, is also an employee of the NCAA
A group was convened and met on 3 September. As a result, options for concluding Dr. Mattu's suspension and the implications of each of the options for the trust, its employees, its employees and the wider NHS were considered. The group also agreed to provide an expert opinion on how the trust should move forward and on the support required by the trust and, if appropriate, its employees. Ian Stone wrote to the trust's chief executive on 23 October to advise him on the steps that it should take to bring the case to a conclusion. The trust will consider that advice, but the final decision on the course of action to be taken rests with the trust.
As a result of my hon. Friends' comments, I am concerned about the amount of time that the case has taken and undertake to see whether there is anything further that we can do to speed it up. However, I cannot give my hon. Friends any assurance that that will be the case. It is very difficult to resolve such long-running disputes as rapidly as everybody would wish.
§ Sitting suspended until Two o'clock.