§ Motion made, and Question proposed, That the sitting be now adjourned.—[Mrs. McGuire.]
9.30 am§ Mr. Jim Cunningham (Coventry, South)First, I thank Mr. Speaker for granting me this debate, which is the third on Walsgrave hospital. I know that a number of hon. Members wish to speak, so I shall try to get through what I want to say as quickly as I can. My hon. Friend the Member for Coventry, North-West (Mr. Robinson) has been held up because of a road accident, but he is definitely on his way here.
The debate has cross-party support and there is nothing political about it, as it involves the welfare and well-being of the people of Coventry. I shall be jumping in and out of the Commission for Health Improvement report; hon. Members will not want me to go through the whole thing and bore the heck out of them. We welcome the management and personnel changes and the management restructuring that have taken place at the hospital. We also welcome the fact that steps have been taken to implement the CHI report.
The impression has been given from time to time that we have been critical of the hospital staff. To the best of my knowledge, no hon. Member has criticised them. Indeed, we believe that they have done an excellent job in difficult conditions. According to my postbag, the public have always praised the medical treatment they received from the staff.
I ask my hon. Friend the Minister, why has there been a delay in publishing the CHI implementation report? We expected it in January, but it was not made available until March. I am at a loss to understand the reasons for that delay. Why was there a delay in signing the contracts for the new hospital? There might be a perfectly logical reason for that, but the people of Coventry would be worried if the project were delayed, because they are anxious to have a new hospital.
Hon. Members are aware that a number of concerns about the hospital have been raised over the years. For example, the style of management and the relationship between consultants and management is highlighted in the report. Another worry is the suspension of consultants, the cost of those suspensions and the loss of the consultants' skills for long periods. Legal redress has a financial cost. That money—thousands of pounds—could be recycled into the national health service, rather than being spent on long-winded procedures that try to gain someone redress and justice.
Then there is the general cost to the trust of the loss of good will. The CHI report touches on that when it mentions the relationship between consultants and previous management. Next is the question of how long it takes to deal with the suspensions. For example, not too long ago, in the case of a consultant in Coventry, it took up to two years. Those are long-winded 74WH procedures. There is also a cost to individuals—to their self-esteem and pride. More important, the families also suffer, whatever the outcome, and they are often innocent. I hope that the Minister studies those procedures and speeds them up.
Over the past few weeks, another consultant has been suspended, although we cannot judge why. Again, however, the trust and the hospital have been denied the services of a top consultant in his field. There is concern about what is happening. The previous management suggested that they could not deal with some problems at the hospital because planning and programming the new hospital diverted their attentions. I do not know how true that claim is, but I certainly question it.
About two years ago, we had a problem with bed blocking. I became involved during the parliamentary recess. I readily acknowledge that we cannot simply blame the trust, because three agencies are involved, but the issue requires more attention. The three agencies cooperate as best they can on a problem that creates anxieties among families who, because of lack of cooperation or of social workers, must wait for relatives to be discharged from hospital. It is a difficult issue, but we must nevertheless tackle the concerns.
There has been a lack of consultation between the trust and local MPs about not only the new hospital, but matters of common concern, so I hope that efforts are made after the debate to involve local MPs much more. People know that we are in the business of trying to help the NHS, not of knocking it. My hon. Friends and I are concerned to work with the trust and the management locally to provide the best health service for the people of Coventry. That is what this is all about and why we have constantly raised those issues over the past two or three years.
I hope that my hon. Friend the Minister responds to another concern about consultants. When does whistleblowing become serious misconduct? I know one or two consultants who blew the whistle in the best interests of their hospital or trust, but found themselves charged with misconduct. I am sure that my hon. Friends know of similar instances. Where the charge is not misconduct, employers have invented a new charge of bullying. My hon. Friends know that the trade union movement has pushed for several years for something to be done about bullying, certainly in the classroom and the workplace. I have no evidence of this, but I would not like to think that employers are using the charge of bullying as a catch-all, just as some employers charge individuals with gross misconduct, which is a catch-all and very serious. We must give a lot of thought to the charge of bullying.
I recently introduced a ten-minute Bill based on the Kennedy report about Bristol. I thought that it would be useful to include two aspects of the report in my Bill, which is still proceeding through the House. For example, it provides for trusts to have two additional members or for two members to be designated with responsibility for upholding the public interest, regardless of what the trust may do. As I am sure my hon. Friends know, trusts have a dual function, which I want to remove. Again based on the Kennedy report, the second part of my Bill would allow facilities to be provided for staff to upgrade their skills after two or three years. I know that my hon. Friend the Minister is considering that issue.
75WH I welcome the CHI report's recommendations. CHI initially became involved as part of a routine review of the hospital's facilities between February and July 2001. The findings were published in September 2002. So far, I welcome the action taken by the trust to implement the CHI report, as I am sure my colleagues do, but there are still two areas of concern. Before I come to them, it is worth reminding the House that there were five initially: the practice of putting five beds in a four-bed bay, the high death rates for non-emergency admissions, the organisation of the emergency departments and the emergency assessment unit, the relationship between some consultant medical staff and senior managers, and the need to address current service problems.
Satisfactory progress has been made with the bedding bays, death rates for non-emergency admissions and the service problems, but progress on organising the accident and emergency departments is limited. The relationship between some staff needs improvement, a subject that I touched on earlier.
Outstanding problems are still to be resolved. Although progress has been made by the trust to ensure patient safety across the split site services, the agreement and implementation outlined in September has not occurred. Will my hon. Friend the Minister comment on that in her winding-up speech? The trust has stated that it intends to implement one of the three structural solutions proposed by the external review, but CHI is concerned that the proposals are costly and that no priorities have been identified.
No contingency plans are in place should full funding for the changes not be available and CHI remains worried that only limited progress has been made between consultant medical staff and senior managers. Two clinical service teams have been found to have significantly dysfunctional working practices and some senior staff remain disengaged from management colleagues. The trust has proposed a new management structure to strengthen the role of clinical staff and has employed external teams to change management and build teamwork, but it is too early to evaluate the possible impact of that.
I welcome the changes made in the trust, especially the appointment of the new chairman, with whom I look forward to working, as I am sure my colleagues do. We should learn lessons from the CHI report, and I hope that there will be no need for more debates on Walsgrave hospital. We have never tried to tell anyone how to run a hospital, but we are certainly interested in the well-being of the hospital staff and consultants and, ultimately, the service delivered to the Coventry public. We should draw a line under the past and make a fresh start, so that we can all work together to provide the best medical facilities for the people of Coventry.
§ Mr. James Plaskitt (Warwick and Leamington)I am pleased to contribute to the debate, as I was regrettably unable to attend when Walsgrave was discussed in this Chamber previously. Although Walsgrave is not my local hospital—Warwick has a different district general hospital—what happens there is of considerable concern to my constituents and to me, as many of them are treated there.
76WH I endorse what my hon. Friend the Member for Coventry, South (Mr. Cunningham) said. I have not had occasion to deal with complaints from my constituents on the clinical care that they have received in the hospital or the quality of work from its staff, but plenty of casework about what goes on at Walsgrave has been brought to me over the years and all the issues raise questions about management.
I use Warwick hospital in my constituency as a benchmark. It has had several management problems during the past few years, including considerable turbulence in management personnel, and we recently lost the chief executive as a result of questions about the management of figures supplied to the Department of Health. That turbulence has created great difficulties for the hospital but, throughout the period, not one clinician has said that they have lost confidence in its management.
In contrast, I received a petition signed by more than 80 clinicians at the Walsgrave, telling me that they have lost confidence in the management of the hospital. Clearly a serious state of affairs has been reached. I have received evidence not only from constituents, but in the form of the petition signed by clinicians, and I know of the concern of my colleagues who represent Coventry constituencies. I hear whispers and comments in the health community.
That is the background, but as a responsible Member one looks for objective assessment of what is happening. The report by the Commission for Health Improvement provides that, and it puts the problems into sharp focus. As colleagues have said, most alarm bells rung in the report are relevant to the way in which the place is being managed and run, but less relevant to the standards of clinical care. Yet although it is, in essence, a management issue that we are dealing with, there are clinical consequences and my concern is focused on that aspect.
By way of illustration, I want to raise the case of Mr. John Clifford, a resident of Lapworth in my constituency. In July 2000, he attended the surgery of his GP, who detected heart problems. Mr. Clifford was examined and it was discovered that he had a faulty aortic valve. He and his family were told that a replacement operation was required and that such operations have a 95 per cent. success rate. They were told of the importance of the operation being done within, ideally, six months.
Mr. Clifford was placed on a waiting list and he and his family were told that hopefully—that was the expression used—the operation would be done in or before April 2001. During 2001, Mr. Clifford's condition deteriorated. His GP contacted the hospital several times to urge that the operation be brought forward. The April 2001 deadline passed without a date for surgery being offered. In despair, the family contacted the Walsgrave again in October 2001. The consultant told Mr. Clifford that he would be seen within the next three to four weeks.
In November 2001, the family remained very concerned about Mr. Clifford's condition and contacted the hospital again. Because of their concern and the urgency of the case, they said that they would contemplate private treatment, only to be told that there was no point. Nothing would be gained by securing 77WH private treatment, as Mr. Clifford was third on the list and his operation imminent. Yet by January 2002 a date for treatment still had not been given.
Mr. Clifford was very ill over Christmas and new year. Eventually, on 26 January, he was admitted as an emergency case to Warwick hospital. On 4 February, with Mr. Clifford in Warwick, the family received a letter signed by Mr. Loughton of the Walsgrave:
I am pleased to inform you Mr. Clifford will be called to come into hospital for his surgery within the next few weeks. If for any reason this does not happen, Mr. Clifford will then be given the opportunity to utilise the private sector".That came after the family had been told that there was no point in going private because he was third on the list. On 6 February, in a worsening condition, Mr. Clifford was transferred back to the Walsgrave hospital, where a consultant examined him, said that he was too ill to be operated on and told the family that he had missed his "window of opportunity". On 13 February, Mr. Clifford died.The community health council is investigating the case, at my encouragement, and I understand that Mr. Richardson, head of communications at Walsgrave hospital, has told a local newspaper that an internal review of management procedures has taken place in order to examine what happened in Mr. Clifford's case. However, he has told us that the results will not be published. Will my hon. Friend the Minister tell us whether that is a common procedure, whether, in her view, it is acceptable and whether the Department can obtain the findings of that important inquiry, which the hospital seems unwilling to share?
I cite the tragic case of Mr. Clifford as an example of what can happen when a hospital has dysfunctional management. I therefore read the March update from CHI with considerable concern. It reviews progress following its earlier report, but still finds:
Limited progress has been made by the trust to build effective working relationships between doctors and managers".The clinical governance review found thatrelationships had broken down between some consultant medical staff and senior managers. In particular, some doctors did not feel safe to raise concerns about clinical risk.It continues:CHI remains concerned about the limited progress in the area. CHI was particularly concerned that some senior medical staff remain disengaged from management colleagues. CHI found further evidence of two clinical teams with significantly dysfunctional team working.Those are serious findings, and to have them reiterated in a follow-up visit by CHI is worrying. CHI says that the role of the trust board is vital in correcting the problems, and I am sure that we agree. It also says that the board has been strengthened by new members since the CHI clinical governance review, adding:There needs to be an ongoing commitment and recognition by the Board that these issues should he tackled.That is an understatement—dysfunctional management and the breakdown in the relationship between management and clinicians contributed to the tragic outcome for my constituent, Mr. Clifford.78WH I cite a press release issued by the hospital on 11 March. It indulges in an element of self-congratulation based on Dr. Foster's independent hospital guide, which is available on the web and which I have checked. Walsgrave hospital receives a five-star rating—apparently not a bad evaluation—but even that guide points to problems in the cardiothoracic service and the high death rates at the hospital. I conclude by mentioning the guide and the Walsgrave's interpretation of it because Mr. Loughton concludes his press release by saying that my right hon. Friend the Secretary of State for Health has said that
no chief executive should be 'looking for the excuse book'".Indeed they should be looking for the excuse book, given what has happened and what is still happening. There should be no hiding place. Will the Minister comment on what she thinks should happen to chief executives who have such a record on leaving their post? Should they pop up in due course, elsewhere in the national health service?
§ Mr. Geoffrey Robinson (Coventry, North-West)I am grateful for an opportunity to take part. I congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing the debate and on introducing a ten-minute Bill. I also welcome the Minister, who is attending for the first time, I believe, one of our three Adjournment debates on matters relating to Walsgrave hospital. We are sure that she will give a lucid and serious reply to the deeply worrying concerns that remain in our minds despite the enormous step forward that has taken place since our previous meeting in this Chamber, when the Minister of State promised to take on board what we said. Since then, Mr. Loughton has handed in his resignation. Without any personal animosity, and respecting the proper limits on our privileges in this House, we regard that as an important step forward. However, ahead of that suspension, a further suspension took place, which is a cause of grave concern to us all. Let me say why.
In none of our criticisms in any of our Adjournment debates have we sought to speak other than wholly positively about the nurses and support staff at the hospital. This is purely a management issue. We believe that the performance of some consultants at Walsgrave has not been up to the standards that the national health service or the Department of Health would allow to continue if they knew the full facts.
In its second report, CHI emphasises that one key area in which great improvement is still necessary is working relationships between consultant staff and management. Now there has been a further suspension, that of Dr. Mattu, which is bound to be, at the very least, a setback to any improvement. We already know that there has been an initial meeting of the consultants at which a wide range of concerns were raised. The necessary signatures for an emergency debate were forthcoming and we shall be plunged back into exactly the same destabilising process that applied in the case of Mr. Barros D'Sa, which lasted over 20 months. Later, I shall say something about the time that suspensions take, because I am sure that the Minister finds that as unacceptable as I do, and I know that the Government are taking steps to accelerate the process.
79WH The problem with the suspension of Dr. Mattu is that it is following exactly the same lines as that of Mr. Barros D'Sa. There is no hint of criticism of his professional competence. On the contrary, he is the top man in his field and he has an international and national reputation. I believe that he has given papers in north America, which, by any standard, leads in virtually all aspects of coronary care, diagnostic and surgical. In fact, Dr. Mattu is giving a paper there this very week.
We have a major national shortage of surgeons and doctors and the distinguished surgeon Sir Magdi Yacoub is scouring Europe and north America to recruit top surgeons and consultant cardiologists, but we, in our wisdom, have managed to suspend probably our top man in the field. That is worrying.
The same applied with Mr. Barros D'Sa. There was not the slightest hint of professional incompetence in his case. In addition, the charges are exactly the same—harassment and intimidation. I cannot take a view on those charges, and I do not expect the Minister to give us her view this morning, but I hope that she gives the matter her attention, because that would mean a lot to us in the circumstances.
The charges come from a junior doctor, who worked for Dr. Mattu and made a series of recriminations that, frankly, if boiled down to their essence, do not amount to much more than self-interested tittle-tattle motivated by the fact that he did not get everything that he wanted. There is a childish quality to the charges, which hardly merit a suspension when we so desperately need people such as Dr. Mattu.
One cardinal sin may have been committed: the complainant attacking Dr. Mattu alleges that he said that the incident might bring about the suspension or dismissal of Mr. Loughton. If that were a hanging charge, all the MPs here today would be suspended. Having some experience in such matters, I could advise my hon. Friends on how to handle it.
Dr. Mattu was one of 80 people involved. He did not simply say, alone in conversation with one of the junior staff, that there was a move to secure Mr. Loughton's resignation. Eighty people went public in a debate or ballot, and many of them went public outside the secret ballot to make it clear that they had no confidence in the chief executive. There was an open movement, backed by most of the surgeons, to achieve that very end. Therefore, the charge has no significance or seriousness.
There is another similarity with the whistleblowing incident in the case of Mr. Barros D'Sa. There was a terrible record of colorectal perinatal death rates at the Walsgrave, but that was not accepted. We raised it with the hospital management—I did so myself at a very early stage—but no action was taken until we received the Commission for Health Improvement report. Two steps have been taken since: a new colorectal specialist has been recruited and the surgeon whose performance was unacceptable no longer does that job, but it took us two years to get to that point.
Finally, thanks to CHI, we have eliminated the problem of having five beds in a four-bed room. Dr. Mattu made that point to me nearly two years ago, but nothing was done. I wrote to the management and I 80WH wrote to David Loughton personally at least twice, telling him that the practice must change. Dr. Mattu was so forceful and confrontational on the subject that I felt that the very least I could do was write a letter, or he would perceive the fault as mine.
Dr. Mattu is that sort of person— he cares deeply, and I can see how that might upset people, but that is no reason for suspension. He may be a little to blame for the fact that personal relationships between him and his staff in the department are not perfect, but knocking heads together—including Dr. Mattu's, if required—is the right strategy. We should not have to go through a lengthy and costly suspension procedure that also seems to me, although I pass no final judgment on it, to be of questionable necessity.
In passing, I address the question of Mr. Loughton's resignation. I ask respectfully what the redundancy arrangements will be. Will there be severance pay or will he move to another position in the NHS? The Minister may not be able to give an answer this morning, but the people of Coventry have a considerable interest in knowing what is going to happen.
I address two other aspects of the suspension procedure in respect of Dr. Mattu. I am not sure what guidelines are set down by the Minister or the NHS executive, but the process followed in this case is unacceptable and smacks of the arrest procedures characteristic of a communist or fascist dictatorship. The Minister is bound to refer to the fact that the relevant letter was signed by the medical director, but it would be naive of any of us to imagine that the hand of Mr. Loughton was not behind it.
I can assure the Minister that Mr. Loughton has been boasting to other senior consultants and consultant representatives, some of whom he probably thought would be favourable to Dr. Mattu. Mr. Loughton has assured them that the matter has gone to the highest level in the national health service—my right hon. Friend the Secretary of State on the one hand and the chief medical officer on the other—and that everyone is wasting their time opposing it, almost as if the outcome is prejudged and the suspension not a neutral act as it was meant to be.
David Loughton is leaving now and we can speak with a frankness that may not have been possible before. At public meetings, he let it be known to consultants and others in the hospital that he had a hit list of five people whom he was going to get rid of before he left, by suspension or some other method. We have all heard that and we believe what we hear when it comes from reliable sources who have heard it from the horse's mouth. Perhaps that was his parting shot. Nothing that can be said about the action in question will do other than convince me and, I think, my hon. Friends that it was inspired by David Loughton.
The manner of Dr. Mattu's suspension is unacceptable. Two people—the medical director and deputy personnel director—banged on his door and demanded entry. He let them in and they made it clear what they were about. He said that he had the right to be represented, but they questioned the need for representation. Dr. Mattu had no forewarning. There was no prior discussion, airing of grievances or attempt at conciliation with the parties involved. It is almost as if people wanted to provoke the incident. Dr. Mattu was 81WH shown to the door and marched off the premises. He was not allowed to take his computer, which was his own. The locks on his door were changed and the details on his floppy disk, or whatever was in the computer, impounded by NHS staff, who I understand had nothing better to do than start transcribing the whole lot to see what they might find out about him.
That gives my hon. Friend the Minister an idea of the way in which the process can be conducted and the military behaviour of the management, and I hope that she is reassured that the steps that we have taken—bringing those matters to this place three times—have not been taken lightly. We are pleased that the chief executive has gone, but, following his last throw of the dice, we must pick up the pieces.
Another important point is the sheer length of these suspensions. I know that the Department has published a new notice, probably at the Minister's initiative, insisting that dealing with such cases should be speeded up and suggesting the manner in which that could be achieved. I raise the issue because another surgeon at the hospital, Miss Briony Ackroyd, has been suspended for, I think, more than two years. It is not acceptable that suspensions are allowed to last so long at enormous cost. That is the bizarre aspect. I believe that it costs the best part of £400,000 or perhaps £500,000 to deny the people of Coventry the services of such a good surgeon.
Similarly, Raj Mattu is a top-flight surgeon—the best in his category. There is great need and we are trying to recruit people from abroad, but he may be out for up to two years for harassing or having a set-to with some of his junior staff. We all have those problems, but we sort them out. I can remember similar incidents in the Department where I worked. We had rows and yelled at one another, but we knocked heads together and solved the problems ourselves. That is what this is about.
When the Minister reads the charges levelled at Raj Mattu, she will see that this is nothing but a case of people falling out and saying things in the heat of the moment that they should not have said. The top man has been suspended, however, which is nothing short of crazy.
I hope that my remarks are sufficiently clear, and I would be grateful if the Minister considered the overall issue and where the case of Briony Ackroyd stands. I know that Miss Ackroyd would like the matter to be resolved. There are too many questions for the Minister to deal with today, but I have utter confidence that she will answer them. We are pleased to see her in her place.
§ 10.9 am
§ Mr. Mike O'Brien (North Warwickshire)I congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing the debate about the situation at Walsgrave hospital and on gaining Mr. Speaker's consent to another discussion of a subject that so concerns us.
This is the third debate on Walsgrave. The last one involved seven hon. Members in an unprecedented display of concern following publication of the initial Commission for Health Improvement report. The situation is not new. It did not suddenly develop last year after publication of the report, but has been developing in the management and the culture of the hospital for probably more than a decade. In recent 82WH months, especially following publication of the report, the public and hon. Members who represent them realised that they could not allow the culture that had developed in the hospital to continue to cause these problems. Public confidence in the delivery of NHS services in our area was being increasingly damaged, and the CHI report was the last straw. All the MPs who represent constituencies in the area had to take a stand.
The problem at Walsgrave is clearly dysfunctional management. The clinical staff, senior consultants, nurses and those who support them have all worked enormously hard to deliver good quality medical care to patients, but they have been handicapped by the quality of organisation that is supposed to run the hospital. We must restore public confidence and make it clear that the staff have been doing a tremendous job, despite the handicaps that they face.
It is time for a new start and a new culture. We no longer need the Thatcherite approach to management, if I may describe it like that—management by diktat from the top, whereby an individual decides to run things as he thinks appropriate without consulting others who work with him. For a time, a weak management board allowed the chief executive, David Loughton, to carry on in such a manner, but we have the opportunity to make progress with the public-private partnership that the Government have approved and prospects at the hospital are brighter.
The new culture, the new hospital building that the public-private partnership will produce and the development of the new teaching hospital plans will all enable us to paint a bright picture for the future of Walsgrave. That should start to restore confidence that not only are there good workers at the hospital, but there is the prospect of good management and delivery of a first-class service.
The most recent CHI report still fills us with concern. On the five key issues, the action plan shows some improvement in some areas. On reducing the number of beds in bays from five to four, the first CHI report expressed concern that five-bed bays put patients in danger, despite the hard work that the staff put into caring for them. Some problems have been addressed and the response in the new report is satisfactory. Satisfactory progress has been made on analysis of death rates, but more work needs to be done.
Some progress has been made on organising care in the two accident and emergency departments and the emergency assessment unit, although it is unsatisfactory and more work must be done there. Inevitably, progress on rebuilding working relationships was limited while the chief executive, David Loughton, was in post. I hope that his decision to go enables those working relationships to be improved. Like my hon. Friends, I am concerned about references to the two clinical teams with significant dysfunctional teamworking, which the management must tackle.
There has been some satisfactory progress in dealing with the serious service problems, but, as my hon. Friends said, until there is a new building and better facilities can be provided to deliver services, the longterm problems will remain and will need constant vigilance by the new management. However, a new chief executive and the current chairman, Mr. Stoten, should be able to create a new culture and start to deliver further improvements.
83WH I share my hon. Friends' anxieties about the disciplining of consultants at Walsgrave hospital, which must change. There must be a more sensible, and faster, approach to the matter, but it is not the consultants' job to run hospitals. NHS management is given the responsibility of running hospitals on behalf of the public. However, it is the responsibility of those who provide patient care to inform their Members of Parliament and other public representatives if problems arise, and they must be able to do so.
I want the Minister's assurance that if consultants have serious anxieties about care in a hospital such as Walsgrave, they will be able to take that concern to their Member of Parliament. There should be no restriction on them doing so, such as a disciplinary obligation on consultants to go through a certain procedure before talking to their MP. The NHS is a public service and Members of Parliament are responsible for ensuring that it is delivered. If there is a concern, I should be able to bring it to the Minister's attention and consultants should be able to talk to their MP.
§ Mr. RobinsonMay I reassure my hon. Friend that in my experience of dealing with consultants, none of them wanted to run the hospital? They wanted the hospital to be run properly and in respect of clinical care, for example, they did not want five beds in rooms designed for four. They felt that surgeons whose perioperative fatality rate was far too high should not be retained and they were worried that in a four-year period Coventry had almost the worst record in artery and valve heart surgery. Those are the concerns that consultants brought to my attention.
§ Mr. O'BrienI accept what my hon. Friend says. Consultants do not appear to be seeking to run the hospital, but it is right to make it clear that a public service must be delivered, and managers are employed in the NHS to do that. Consultants should also look to themselves and develop a culture in which they can work with the new management at Walsgrave hospital.
I do not want to have to go to the electorate in three or four years and face public expressions of concern about how the hospital is run. The problems must be sorted out now. I hope that everyone at the hospital pulls together and I am sure that they will. I am pleased that the new chairman is prepared to come to grips and I hope that he continues to address the issues seriously.
The Government's decision to franchise the chief executive's post struck me as odd. I can see why a Minister might decide to franchise the whole team, but I cannot understand the decision to franchise, from within the NHS, only that one post. Why was it taken? I am not sure what difference it will make, as it only delays the appointment of a chief executive by obliging a franchising procedure to be carried out, although there may be a good and logical reason for doing so.
Why was the team not franchised? I am not advocating franchising, however, as I do not think it necessary. The best approach would have been to carry on and appoint a new chief executive from within the NHS. A limited number of people can apply, as probably only a handful have the necessary experience 84WH of running a very large hospital. Considering the numbers, I do not think that franchising will make a difference.
No doubt the Minister has a reason for taking that course of action; I am merely curious about it. Perhaps it is a way to express concern that things have reached a pretty bad pass in the management of the hospital and to show that she wants fundamental change. If that is the case, I accept it. The board, by and large, is new. Many senior management posts in the hospital are acting or are held by new people. We are getting a new management team in anyway, which is good. The objective must be to restore confidence, and I am sure that we can do that.
§ Andy King (Rugby and Kenilworth)I shall keep my remarks brief because, as my hon. Friends have pointed out, we have been here three times already.
The people of Rugby feel that Mr. Loughton should not have been allowed to resign, but should have been removed much earlier. They, and the people of Coventry, would have suffered far less if that had happened. The report points out some improvements. There certainly have been some improvements since the arrival of the new chairman, and I feel much more positive about the future, especially since we heard the good news of Mr. Loughton's departure. What concerns the people of Rugby. however, is that he seems to be hanging around for a considerable period. We want him to go as soon as possible. As my hon. Friend said, the people want to know that he will not walk away with some handsome package into another top job somewhere else. We must not be seen to reward someone who has not done the job that he was paid to do—delivering the best quality services.
CHI is doing an excellent job. The whole purpose is to ensure, through clinical governance, that people receive the highest possible quality of service. I am sure that my hon. Friends have shared my experience. Constituents come to me regularly, with details that defy belief and reason, about the way in which they have been treated when they have gone to Coventry and Warwickshire hospitals.
The following examples date from after the first CHI report. In November a constituent took his wife, who was 23 weeks pregnant, had stomach cramps and was bleeding, to Walsgrave hospital. He said that the labour ward could only be described as prehistoric. It was cold and dirty, the wallpaper was peeling and the floor coverings were taped together.
Another constituent with varicose veins was seen by four different consultants. Some were in the same department; others were in different departments. On every occasion her notes were missing. Staff had no idea why she had been referred. Internal communications between departments were non-existent.
When another constituent took her son to Walsgrave, he was moved to 10 different beds in 15 days. To add insult to injury, when he returned to St. Cross in Rugby by ambulance, the staff did not know that he was arriving. That tells a terrible tale of incompetent management in life-threatening situations, which must not be allowed to continue.
85WH The second CHI report called for significant improvements in those five areas. I am delighted that it found it impossible to paper over the cracks and give the impression that those significant improvements had taken place, because, as was rightly pointed out, the core of the problem was poor management and the dreadful culture that persisted in the hospital. As the report said, that problem must be tackled and those cultural changes must take place. We know that it takes time to change a culture, but unless that happens, we will be in the same cycle in the years ahead. As representatives of the people of Coventry and Warwickshire, we cannot stand by and watch. The future is positive, and I look forward to seeing the new chief executive in post. I wish him well—[Interruption.] I apologise; I wish whoever is in post well. be it him or her. Whoever it is, they will need all the support that can be given to them.
I have already arranged a meeting in May with staff representatives and the chairman, and I intend to ensure that such meetings take place regularly. I have met several consultants and found them to be committed people who are determined to deliver the best quality services that they can. I appreciate the hard work that the Minister has done to help, especially those in Rugby, as we were taken over by the Walsgrave hospital. I thank her for her assistance in ensuring and safeguarding the local hospital services for my constituents in Rugby.
§ Mrs. Caroline Spelman (Meriden)Thank you for allowing me to make a brief contribution, Mr. O'Brien. I am not, I believe, the only speaker not to have been present from the start of the debate, and I have been present at every stage of the battle to get justice done for our constituents. My constituent, Simon Standley, alerted me to the problem after he suffered a failed renal transplant at the Walsgrave hospital, and I speak with him very much in mind. He was there for four and a half months, and was able to observe at close quarters the profound problems that were later identified in the CHI report.
At Mr. Standley's request, I shall return to the issue that was raised by the hon. Member for Coventry, North-West (Mr. Robinson). Something is awry in the unfair way in which the whistleblowers were dealt with at the hospital. I speak with the consultant Mr. Barros D'Sa in mind, and also on behalf of the cardiologist Mr. Raj Mattu. When the whistle was blown, the management wanted to suspend Raj Mattu, who had been brought in to solve the problems in the department. Ultimately, the suspension was dealt with by the medical director, which is the correct procedure. However, his suspension will be overseen by the chairman and chief executive who originally called for that suspension, which represents a conflict of interest. The cardiologist holds strong views, as one would expect of a person brought in to troubleshoot a department and get things done. I wished to raise that issue with the Minister, and I shall confine my remarks to that remaining injustice. I look forward to her comments in response to the wider issues raised by colleagues.
§ Dr. Evan Harris (Oxford, West and Abingdon)This has been a serious debate and has raised serious issues. Although some hon. Members are veterans on this 86WH subject, this is my first venture into it, so I will be cautious. My experience is of management and consultant conflict in the cardiac unit at the John Radcliffe hospital in Oxford, which has experienced similar problems, although not as deep as those at Walsgrave hospital.
The problem has been going on for a long time, and hon. Members with local constituencies have deeper knowledge of the situation, so it would be inappropriate for a Front-Bench spokesman such as myself to go into such detail. Hon. Members have demonstrated that when seven or eight of them act in concert—they have been able to have three debates on this subject so far—they can bring a great deal of experience, wisdom and insight to an issue, as well as bringing pressure to bear on their local trust in order to effect change. Both the hon. Member for Coventry, South (Mr. Cunningham), who secured the debate, and the hon. Member for Meriden (Mrs. Spelman) deserve praise and applause for their assiduousness in bringing forward such matters.
I wish to draw out some of the questions regarding the wider issue of performance indicators, and how useful they are compared with Commission for Health Improvement reports. I shall also comment on the franchising process mentioned by the hon. Member for North Warwickshire (Mr. O'Brien), and discuss whistleblowing.
The hon. Member for Coventry, South rightly struck a positive note when introducing the debate by welcoming the role of the Commission for Health Improvement, as well as its involvement and follow-up report, and the management change. He was at pains to point out that he and many other commentators on this subject are not generally criticising the staff at any level, which is important to mention. Although some appraisals of hospital performance are valid, I contend that some are not, and they may have a negative impact on morale at a time when retention and recruitment are critical in terms of capacity and quality of care.
Among his concerns, the hon. Member for Coventry, South identified management style—a point that has resonated throughout the debate—and the relationship between consultants and managers. It is important to make clear, as did the hon. Member for North Warwickshire, that consultants do not, and should not, want to run hospitals. The hon. Member for Coventry, North-West (Mr. Robinson) said that, in his experience, the consultants in his area did not wish to run hospitals. However, in my experience, people with a lifetime involvement in a hospital do not necessarily embrace changes that may weaken their power. That is not always a bad thing, although some may describe it as a wrecking attitude. Nevertheless, we must recognise that the balance of power should shift away from senior consultants in hospitals. Most of them understand that, although of course we should note that some do not, as the hon. Member for North Warwickshire pointed out.
§ Mr. Geoffrey RobinsonI would not like the idea to get around that any of the three consultants mentioned in my contribution had that sort of problem. They are certainly not resistant to change. They have problems 87WH because their changes are resisted by management—changes that would be wholly to the good in terms of improving health care.
§ Dr. HarrisI accept what the hon. Gentleman says, and stress that my remarks are general.
The costs incurred through the loss of consultant input from those suspended, the number of consultants suspended and the time for which they are suspended have been raised many times. This is a further reminder that procedures must be speeded up. It is difficult to say that no people who are under investigation should ever be suspended, because if a complaint is made, it is difficult for someone to come out as a whistleblower if they must work with the person against whom serious allegations have been made. Speed of process will be important.
The hon. Member for Warwick and Leamington (Mr. Plaskitt) said that he had heard no complaints about clinical care per se, and that complaints were mainly about management. It is important to stress that—although the two things are connected.
The hon. Gentleman also drew attention to a petition from 80 clinicians. We must be careful about sacking by petition, because many politicians—and, indeed, Governments—would be in deep trouble on that basis. He was right to say that the Commission for Health Improvement report—an independent report following an in-depth study—was helpful. The inspection was routine, and it was fortuitous that it happened. Going back was also important.
The hon. Gentleman related well the striking and tragic case of his former constituent, Mr. Clifford. Although it is difficult to draw conclusions without hearing the other side of the argument—there usually is another side—one cannot get away from the fact that that gentleman was first told that he needed a relatively urgent operation in July 2000, yet more than 18 months later he still had not had it. The point is that he needed his operation within six months. If patients who have waited longer but whose cases are less urgent are prioritised, which is the risk with maximum waiting times, there is a danger there will be less political focus on others. Mr. Clifford had been waiting almost 18 months when he underwent his tragic emergency admission. A lesson must be learned about the need for admission to be governed by clinical priority—and, of course, about the need for sufficient capacity.
The hon. Member for Coventry, North-West made a refreshing speech; characteristically, no holds were barred, and he spoke with his usual candour. He gave his view on the allegations against the suspended consultant, although he was careful to say that he was not making a final judgment. There is an issue about temptation, because we know that people might give a view that did not take account of the junior doctor's difficulties in the case in question. I do not want to be drawn on details because I accept that the hon. Gentleman's knowledge of them is greater than mine. However, speaking generally from my experience as a spokesperson for junior doctors, I know the number of times that I was approached by junior doctors who said that they were terrified of making any complaint 88WH because they feared that it would be seen as a spat between two equals. The power structure between a consultant and a junior is very different, because a junior doctor relies on a consultant for his or her reference. The sooner we move to a system of open references, the better.
As the hon. Member for Meriden said, there is a balance between whether there should be maximum freedom for whistleblowing from the outset or whether trusts are right to have procedures whereby people approach problems internally first. In the Labour Government's first term, they said that they would get rid of gagging clauses. However, my experience—and, I think, that of other hon. Members—shows that staff are still scared to speak to their Members of Parliament. That point was made by the hon. Member for North Warwickshire.
The hon. Member for North Warwickshire asked a good question about why franchising, rather than advertising, is being used for the post, given that the Government are restricting applications to those from within the NHS. I suspect that that is because franchising is a new policy for which the Government can take credit, by definition, because they invented the term. Hospitals that are doing badly can only do better. When they do better with a new manager, the Government will say that that is a direct result of franchising, rather than of the new manager.
Finally, I must mention performance indicators. The Sunday Express set out the position by pointing out that there are three sets of performance indicators in use at once. The star rating system was slammed by health service journals and others as irrational and subject to fiddling. It causes the distortion of resource allocations and clinical priorities, and measures such things as capacity, over which hospitals have little control. Further indicators are the Dr. Foster ratings and the CHI report. All the indicators drew very different conclusions about the hospital. John Richardson, a spokesman for the University Hospitals Coventry and Warwickshire NHS trust, said that the naming of the hospital as a poorly performing trust was catastrophically damaging to its staff and unduly worrying to its patients.
That was not said about the CHI report, which allows the press to go into the detail of the specific allegations and to see that the concerns are not mainly clinical but are about some of the broad-ranging performance indicator systems that are being used, such as the Government's performance indicator. There is an element of blame shifting in the system; we must be aware of that.
Someone referred to the Secretary of State's comment that no chief executive should be looking for the excuse book. That message could come back to haunt the political chief executive of the NHS, because in the end, the proper performance of hospitals is a matter for the politicians.
§ Mr. Simon Burns (West Chelmsford)Like other hon. Members, I begin by congratulating the hon. Member for Coventry, South (Mr. Cunningham) on bringing this important debate before the House of Commons yet again. Its importance is highlighted by the presence of so 89WH many Labour Members who represent constituencies that are directly affected, and of my hon. Friends the Members for Meriden (Mrs. Spelman) and for Solihull (Mr. Taylor). The debate is important because—not unnaturally or unreasonably—hon. Members want to secure the best health care for the communities in their constituencies.
In Walsgrave hospital, we have seen the high standards of health care that we and our fellow citizens expect unravel for far too long, and now they have completely collapsed. It is important to repeat what many hon. Members have said: we are not criticising the dedicated staff who work in that trust and that hospital. What has happened in that hospital has been described by many hon. Members both in this debate and in the past: the trust has a dysfunctional management team, and that has caused many critical problems with the provision of health care in what should be a first-class hospital offering first class patient care to the people of Coventry and the surrounding area. For far too long, it has been blighted by a series of ongoing disputes. They have torn the hospital apart. Consultants have, in effect, been at war with the senior management, and especially with the chief executive. That has resulted in a dismal level of health care and patient care, which led the hospital to receive a zero star rating in the league tables issued in late 2001.
The hospital has been riven by suspensions of consultants, resignations, bullying, low morale and a desperate atmosphere of suspicion, tension and recrimination. In short, the atmosphere and conditions in which people have had to work, and which patients have had to put up with, are poisonous. That has led to low morale among the patients and the staff, who have had to do a very difficult job in very difficult circumstances.
Nowhere is that more apparent than in the damaging CHI report, which makes for shocking reading. Its criticisms of the hospital—which should be a centre of excellence for local health care—are convincing and damning. It states that the trust scores significantly higher than the national average for the percentage of patients readmitted within 28 days of being discharged, and for the percentage of non-emergency admissions who die within 30 days. Overall, the hospital's comparative death-rate score is 14 per cent. higher than the national average for emergency admissions, and a staggering 60 per cent. higher for non-emergency admissions.
Many critical areas of the hospital have suffered from overcrowding. We have heard from hon. Members the example of the five beds in the four-bay wards. The CHI report also condemned the level of cleanliness; it said that some areas were dirty, unhygienic and unkempt. That is in a hospital, where one would expect cleanliness to be so good that one could—metaphorically—eat off the floor. That was not the case at Walsgrave.
The CHI report contains 68 individual criticisms or areas in which action is called for. Perhaps the most important, in the context of the breakdown of confidence between the consultants and the chief executive, is about the relationship between senior management and staff—that senior staff felt isolated, disempowered and undervalued.
90WH CHI's action plan says:
Clinical Risk Management is seriously undermined by some senior clinical staff feeling intimidated and threatened by senior managers when reporting concerns about clinical practice".I find that a staggering complaint to be levelled at the management of a national health service hospital in this day and age. The report continues:Confidence, communications and relationships between some senior medical staff and senior managers need to be restored in order to develop effective working relationships.That is an equally damning indictment, but what I find worrying is that CHI's follow-up comments about areas in which there is a need to restore trust and heal the breach between consultants and management make it clear that not enough is being done fast enough to allow the hospital to move forward rather than be constantly tainted and affected by what has happened in the past.With that breakdown in communications, it is hardly surprising that 66 per cent. of the senior medical staff have, in effect, passed a motion of no confidence in their chief executive. Looking at that fairly superficially, I would think that it is unheard of in the NHS, and must be a key indicator that something is very wrong. The situation has been going on far too long; it is a total mess.
The chief executive, David Loughton, seems to have been the cause and catalyst of many of the problems that have emerged in the hospital, through his management style, his high-handedness and his actions. His suspension of surgeons such as Mr. Barros D'Sa and Mr. Raj Mattu seems incomprehensible, and gives credence to the accusations that his management style was based on bullying and intimidation. That is a deeply flawed management style that is not needed, and should not be welcome, in the national health service.
Mr. Loughton has now announced that he is leaving the post, although I understand that he may not do so for up to six months from 6 March, when he made that announcement. In the light of that, I have several questions for the Minister, and I would appreciate it if she could give specific answers—if not in this debate, by writing to me.
Did Mr. Loughton genuinely resign, or was he pushed? Why has he been allowed to remain in post for such a long time, given what we have seen, given the zero rating of the hospital under the Government's system of tables, given the damning indictment in the CHI report and the criticisms that hon. Members have made to Ministers over a long period? It was quite clear that something was wrong with the hospital and the trust. When Mr. Loughton had lost the confidence of a significant number of the medical staff with whom he had to work, and the trust's performance was so poor, why was he able to survive for so long, when such positions as his are critical in assuring the highest performance of this country's trusts and hospitals?
Can the Minister provide a financial figure for what the suspension of consultants, which carried on for so long because the system to resolve the problems that caused them was long-drawn-out and complicated, has cost the health service, and thus the provision of health care?
I should also be grateful to know why Mr. Loughton remained in post once the CHI report, which damningly highlighted many problems and showed the need for 91WH action, was published. In other parts of the world, such as business—although I accept that a hospital is not a business—if the chief executive were presiding over such calamity and failure they would have gone long ago. I should also be interested to know what the Government and the Department of Health have been doing about that sad saga, and why they did not do more to bring those problems to an end.
Finally, with the departure of Mr. Loughton, I too should like to know whether he is to be moved on to another job within the health service. To be fair, that has been common practice in the health service by Governments of all political parties, regardless of how poor performance has been. Will he leave the health service—which would be a blessing for it—and be paid off with a financial package of cash and pension rights? If someone is responsible, or seemingly responsible, for completely ruining a trust and the provision of health care in an area, it adds insult to injury for the patients and staff who have had to put up with and work in those conditions if the person who seems to have caused them is handsomely rewarded financially.
§ The Parliamentary Under-Secretary of State for Health (Yvette Cooper)I, too, congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing a debate on the progress in implementing the clinical governance action plan at the University Hospitals Coventry and Warwickshire NHS trust, and in particular on the issues at the Walsgrave hospital.
My colleagues and I are fully aware of the concerns that have been raised locally and the issues highlighted in the CHI report. Those issues are of great concern to people in the area who need to use health care services in Coventry. Obviously, I appreciate how strongly hon. Members in that area feel, and over time they have raised those issues in Parliament and with Ministers. All the hon. Members who have spoken have made clear their support for both the excellent work being done by many of the clinical staff at the trust, and the care that is very often provided for patients. As we discuss the concerns that have been raised, it is important to acknowledge that.
The Commission for Health Improvement's rolling programme of clinical governance reviews began in 2000, and it examined the University Hospitals Coventry and Warwickshire NHS trust in February 2001. During the review, CHI examined the clinical governance structure within the trust, taking the views of patients, staff and local partner organisations. As hon. Members have mentioned, the report, which highlighted five areas requiring immediate attention, was published last September. The areas requiring attention were the practice of placing additional beds in bays not designed for that purpose; the need for a review and analysis of mortality rates for non-emergency admissions; the organisation of care between the two accident and emergency departments and the emergency assessment unit; the relationships between some consultant medical staff and senior managers when concerns about clinical risk were raised; and the need to address current service problems.
92WH Hon. Members will be aware that as a result of the CHI report the trust was awarded a zero star rating in the NHS performance ratings in September 2001. Accordingly, the trust's chief executive was given three months' notice to achieve satisfactory performance improvements in those five areas. It is worth pointing out that that is the first time we have had a proper procedure that flags up such problems and provides both an independent external assessment and a proper process for developing action plans. Where such problems are not likely to be dealt with, they can be turned round by new procedures for bringing in alternative management and arrangements. Those sorts of procedures are now available in the NHS for the first time. They are extremely important, and have been critical in handling the issues at Walsgrave hospital.
The trust's work in developing its action plan was extensive. Its staff have worked hard, not only in the areas identified by CHI, and on 22 and 23 January this year CHI assessed progress against the five major areas of concern. My hon. Friend the Member for Coventry, South asked whether there was a delay in the implementation of the report. I understand that the report was always intended to be issued about eight weeks after the visit, so it was always expected in March.
CHI observed that some progress had been made, especially on problems such as a fifth bed in four-bedded bays. Satisfactory progress has been made in analysing mortality rates and identifying a programme of developments, although, as my hon. Friend the Member for North Warwickshire (Mr. O'Brien) said, more work needs to be done. Some progress has been made to accident and emergency services, limited progress has been made in addressing poor relationships between medical staff and managers. and satisfactory progress has been made on current service developments.
In summary, the trust has made satisfactory progress in three of the five areas, but limited progress in two areas. The commission noted some improvements but, as hon. Members have made clear, it continued to raise concern about the working relationships between some doctors and managers of the trust, and in some teams. As a result, it was decided to franchise the management of the University Hospitals Coventry and Warwickshire NHS trust. An advertisement will be placed next week to seek a high calibre chief executive to take the agenda forward, with the continued support and direction of the chairman.
My hon. Friend the Member for North Warwickshire asked why we are using franchising instead of reappointment. The process of franchising is only for trusts that are zero rated, to signal the need for broad and substantial change to solve their problems. It builds change into the process of appointment, with the development of action plans to turn the trust round, and franchise plans on how the key issues will be addressed by an incoming chief executive. Trusts can appoint experienced NHS leaders who have already been appointed elsewhere in the service. There are various differences, and I shall be happy to write to my hon. Friend about the significance of franchising.
Several hon. members have spoken about the suspended consultants. They will be aware that it is difficult for me to comment in detail on individual cases. My hon. Friend the Member for Coventry, North-West (Mr. Robinson) referred to Miss Ackroyd, whose case is 93WH awaiting the outcome of an inquiry by the General Medical Council. Other hon. Members referred to the recent case of Mr. Mattu, which is being examined internally by the trust. It is important to say that the suspension of an employee is a neutral act and does not prejudge the outcome of a case. All the cases are subject to detailed procedures under health service guidance issued in 1990, and employment law. I share the concern that the procedures take too long. It is not acceptable for cases to drag on, often at great cost to employer, employee and the health service.
§ Mr. Geoffrey Robinsonrose—
§ Yvette CooperI am tight for time, so I shall not take interventions.
We are introducing improvements to speed up cases, including the establishment of the National Clinical Assessment Authority, and an extensive review, involving medical and professional organisations, to try to speed up the processes and improve the care of patients.
Hon. Members have also expressed concern about whistleblowing. All trusts are required to introduce procedures so that staff at all levels can raise matters of concern without fear of retribution. It is critical that they should be able to do so through existing line management. If necessary, however, they should be able to bypass management arrangements. It is also important that people should be able to talk to their Members of Parliament. As so many hon. Members have raised that matter, I shall examine it further in the local area.
I shall also examine the tragic case of Mr. Clifford, which my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt) raised. Obviously, it will be little consolation to the family to have the matter investigated now, but I am keen to look into it further and get back to my hon. Friend.
Hon. Members have also raised a series of further questions to which, unfortunately, I have not had time to respond. I hope that I shall be able to reply to them later, and I undertake to write to all hon. Members about the additional points that they have made. I understand the concerns that have been expressed, and, like other hon. Members, I strongly want improvements to be made in their local trust. We now have in place a system to deliver those improvements, and to flag up problems when they arise. That is right. As hon. Members have said, we can now move forward, improve care and look to a new future for the local community.