§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hill.]
§ 10.3 pm
§ Mr. Michael Howard (Folkestone and Hythe)
At the outset, I should like to express my appreciation to my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and my hon. Friend the Member for Rutland and Melton (Mr. Duncan) for their presence tonight. My hon. Friend the Member for Ashford (Mr. Green) and the hon. Member for Dover (Mr. Prosser) have told me that they have engagements in their constituencies, which is why they are not here.
The subject of this debate is the most painful that I have encountered in the fifteen and a half years that I have had the honour to represent the Folkestone and Hythe constituency in this place. It will be necessary for me to deal, however briefly, with some of the individual cases involved—cases of women who placed themselves in the care of a consultant gynaecologist, who gave him their trust and who have suffered physical and mental anguish ever since. Those cases will be harrowing to recount and distressing to listen to, not least for those who have already suffered so much.
Mr. Rodney Ledward worked as a consultant gynaecologist in south-east Kent between 1980 and 1996. He worked both in the national health service and in the private sector. In 1996, Mr. Ledward was dismissed by South Kent Hospitals NHS trust and removed from BUPA's list of approved consultants. In September 1998, the General Medical Council found him guilty of several cases of serious professional misconduct, and withdrew his professional registration.
At the latest count, about 418 of Mr. Ledward's former patients have contacted the South Kent Hospitals NHS trust or the South East Kent community health council, or both, to express their concerns about the treatment that they received while under his care. The South East Kent community health council, to whose chairman, Paul Watkins, and chief officer, Jean Howkins, I pay tribute, has called on the Secretary of State to hold a public inquiry into how these tragic cases were allowed to happen and into the lessons to be learned from them, both for the NHS and for the private sector. I support that call, and that is why I have asked for this debate.
To explain what happened, it is necessary to refer to some of the individual complaints that have been made. They include unnecessary and inappropriate surgical procedures, including hysterectomy, perforation of the bladder and the bowel causing incontinence and mental trauma following the discovery by women and their families that, unnecessarily, they could no longer give birth.
One woman was apparently left with a dead full-term baby inside her in the maternity ward for three days before being induced. Several women with mild stress incontinence had bladder repair surgery without the usual pre-operative investigation, which might well have led to alternative non-operative methods of treatment. Many patients are still grossly incontinent. I need hardly dwell on the blight that this has cast over their lives.
Many women had hysterectomies performed on them at an unusually young age. Some were in their 20s. Some have since been told that they were too young and that 582 their hysterectomy was unnecessary. The consequences for them and their families are obvious and final. Many still suffer from very bad adhesions and have had to have further operations—in one case, as many as 17 further operations. Many are still in constant pain.
One woman had an ovary removed. Shortly after the operation, something burst and she was found to have 38 abscesses. She was readmitted to hospital and had to have a colostomy. She still suffers great pain.
Some women had their ovaries removed without consent. A number have reported being seen in the course of a NHS consultation and being told, quite wrongly, that the treatment that they needed was not available on the NHS.
There is one case that I shall describe rather more fully. It is the case of Brenda Johnson. In September 1994, she went to her general practitioner with bladder problems that were causing her concern. Her doctor referred her to Mr. Ledward, who said that she needed a repair, but would need a hysterectomy in six months' time. He suggested that she had a vaginal hysterectomy, which he said was a simple operation with no stitching, and that she would be fine within a few days. She was told that the waiting time for an NHS patient would be two years, but she could have the operation carried out within a few days privately in St. Saviour's hospital.
Mrs. Johnson says:
You put your life and body into these surgeons' hands so you have to trust. I didn't think it was so severe and went back to my GP who agreed with me but said, 'Trust the surgeon, he may have seen something I haven't.' I asked around and was assured by other people who had hysterectomies it would be fine after a few weeks. With great reluctance I went ahead.On Thursday 13 September 1984, aged 37, Mrs. Johnson was operated on at St. Saviour's hospital. She was bleeding after surgery and became very seriously ill as the evening wore on. Her anaesthetist saw her and contacted Mr. Ledward to say that she was in mortal danger. He did not return for many hours. Mrs. Johnson was in a terrible state and unconscious. Eventually further surgery took place. Mrs. Johnson's husband was called into the hospital in the early hours of the morning and told that she was dying. For five days she was barely conscious. She says:
I was in absolute agony and kept under sedation with morphine. I had a blood transfusion in one arm, a saline drip in the other and a catheter. When I started to regain proper consciousness, after five days, I could hardly move a muscle and was in sheer agony. I thought, 'You wouldn't let a dog suffer like this.Since then, Mrs. Johnson has suffered constant pain. To add insult to injury, the action that she brought to receive compensation for her pain and suffering was dismissed by the High Court. She has obtained no redress. I hope it may still be possible for that to be put right.
The questions that arise from Brenda Johnson's case and all the other cases are not difficult to identify. How could such a state of affairs have gone on for so long? When did the various authorities—the former South East Kent health authority, the former South East Thames regional health authority, the South Kent Hospitals NHS trust, St. Saviour's hospital, the General Medical Council—first become aware of concerns about Mr. Ledward's professional conduct and performance? How many complaints did they receive about him? What action did they take? What has happened to the medical records and consent forms of Mr. Ledward's former 583 private patients, which are alleged to have disappeared or no longer to be available? Above all, what lessons can be learned from these tragic events to ensure that, so far as it is humanly possible to do so, nothing like them ever happens again?
§ Dr. Howard Stoate (Dartford)
I am grateful to the right hon. and learned Gentleman. Does he believe that, were the complaints procedures in private hospitals to be the same as in NHS hospitals, that might have alleviated some of the problems about which we have heard tonight?
§ Mr. Howard
I shall come to that. I fear that the course of events in the national health service in these cases does not enable me to answer that question with a simple yes. We would be wrong and utterly complacent if we assumed that complaints procedures in the NHS are anything like all they should be. However, I entirely agree that more should be done in relation to the regulation of the private sector. I shall deal with that point.
I do not lightly ask for a public inquiry. The Minister will probably tell us how expensive it would be and how much time it would take, but I do not see what other means there is to satisfy public concerns on the matter. My constituents who have suffered want to know the course of the investigations. They want to know that all the right questions are being asked and that all the answers have been tested.
Comparisons will inevitably be drawn with the public inquiry that is taking place in Bristol. The tragic events that I have drawn to the attention of the House this evening are, in my view, at least as serious as the events that led to the Bristol inquiry. Moreover, those events raise questions that will not be covered by the Bristol inquiry. In particular, they raise questions about the private sector in health care and the need for it to be effectively regulated. I understand that those involved in the provision of private health care would welcome such regulation. Indeed, I am told that they have been asking for that, but so far their pleas have fallen on deaf ears.
Be that as it may, these questions, and the others that I have raised, are serious and weighty. South East Kent community health council—an authoritative and serious body—reached the conclusion that they would be answered effectively only by a public inquiry. I agree with its conclusion, as does my hon. Friend the Member for Ashford and the hon. Member for Dover. I hope that the Minister will tell us that he agrees, too.
§ The Minister of State, Department of Health (Mr. Alan Milburn)
I congratulate the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) on securing the debate. He and I would prefer not to be having it, but it is important, especially for the women patients who have been affected by the appalling practice of one hospital consultant, Mr. Rodney Ledward.
Let me say at the outset how sorry I am—on behalf of the whole Government and, I believe, the whole House—to all the women who have been affected by Mr. Ledward's activities. They should never have had to experience the physical and mental distress that the right hon. and learned Gentleman outlined so graphically.
584 Like every other person who has had any contact with these events, I am appalled by two things: Mr. Ledward's activities and the fact that they were allowed to go on for so long. The right hon. and learned Gentleman has set out very clearly his views—and, quite rightly, the views of his constituents—on these matters. Let me express my own views about Mr. Rodney Ledward. He was an incompetent, irresponsible and arrogant surgeon who seemingly had little or no regard for his patients. Women came to him when they were feeling vulnerable and scared, expecting first-class treatment. Instead, he caused a catalogue of harm, which is both horrific and unforgivable.
Mr. Ledward has not only undermined confidence in services at South Kent Hospitals NHS trust, but has damaged public confidence throughout the health care system. Since the days of Mr. Ledward, the trust, as the right hon. and learned Gentleman knows, has recruited new doctors to its obstetrics and gynaecology department, and has also set in place new quality control procedures.
Let me describe the three ways in which the Government and the health service are responding to these events, and respond to the specific points made by the right hon. and learned Gentleman. First, the immediate priority has been to identify former patients of Mr. Ledward who might need help. The trust shares my deep concern, and that of the right hon. and learned Gentleman, about the activities of Mr. Ledward. It is making every effort to assist any former patients. I am pleased that the local community health council has commended the trust for dealing with the situation in an open and responsive way since Mr. Ledward was struck off by the General Medical Council.
Special arrangements have been set in place to help former patients. The right hon. and learned Gentleman is right to say that, to date, 418 patients have called South Kent Hospitals NHS trust. I can tell him that 168 have already been seen. Preliminary analysis shows that 22 NHS and 15 private patients may have suffered injury as a result of an operation by Mr. Ledward.
I would encourage any former patients of Mr. Ledward to contact the trust, if they have not already done so. It will then assess, quite properly, each patient's needs, and provide appropriate services, including medical care, counselling, claims for compensation or simply the facility to talk through any problems or concerns that they may have.
Secondly, I shall describe how we are investigating the background to these awful events. I have heard the right hon. and learned Gentleman's call for an independent public inquiry. As he knows, he is not alone in calling for such an inquiry. My right hon. Friend the Secretary of State and I will consider those views extremely carefully, and make an announcement as soon as possible on how we intend to proceed. I promise him that, whatever happens, the Government will publish the facts, so that the patients affected, the public and national health service staff can see how those events unfolded.
What I can tell the right hon. and learned Gentleman this evening is that, after the General Medical Council decision and after serious concerns were raised by a number of Mr. Ledward's former patients, including the right hon. and learned Gentleman's constituents, the Secretary of State instructed the NHS trust to carry out an urgent internal review of the circumstances leading up to 585 Mr. Ledward's dismissal, and to report to the Secretary of State. That report has now been received, and has provided a useful starting point. However, it has raised even more questions, to which I have asked the NHS trust to provide answers. I want to be able to provide as comprehensive an answer as possible to all the questions the right hon. and learned Gentleman and others have posed.
Let me give the right hon. and learned Gentleman a flavour of just some of the questions that have been prompted by the preliminary analysis. Why did no alarm bells sound when Mr. Ledward apparently had 12 medical litigation cases against him in the years from 1983? Given that concerns were apparently raised about Mr. Ledward with the regional health authority as early as 1991, why was nothing done? Why was no investigation prompted when, in 1994, following a serious complication involving surgery by Mr. Ledward on a female patient, he apparently agreed to be on call for his own patients?
Given that doctors appointed to Mr. Ledward's department were apparently told, at the time of their appointment, that there were concerns about the department that they were joining, why was nothing done? If it is true that serious concerns were raised about Mr. Ledward's practice in 1995, in relation to his attitude to patients, his unnecessary roughness during physical examinations of those patients, his unnecessary highlighting of private practice options to NHS patients, and his non-attendance at NHS ante-natal clinics, how is it that subsequently nothing was done?
Why did not the standard-setting role of the royal colleges manage to penetrate the world in which Mr. Ledward operated? Why was Mr. Ledward in charge of clinical audit in that hospital from 1989–96? How did policies in place in the health service at that time fail to prevent or detect and stop those horrendous events?
Those are only some of the questions that are raised by this deplorable case. We are determined to get answers to them all, and to the questions that the right hon. and learned Gentleman and his constituents are asking. The existing evidence reveals that the problem has a long history. Inadequate mechanisms were in place for dealing with it and, most appallingly of all, the women affected by it were the last to know what on earth was going on. That is what is most deplorable about all this.
The third issue is how we are now seeking to ensure that such a tragedy is never repeated. It is important to stress that, overwhelmingly in the national health service, patients receive safe and effective care and treatment day in, day out. Most doctors do an excellent job, but when things go wrong, in the NHS or elsewhere, it is patients who suffer. As we see in this case, the consequences can be appalling. As the right hon. and learned Gentleman rightly said, nobody pretends that mistakes will not happen. They will. Doctors, clinicians and others working in any health care system are only human.
However, failings such as these highlight the need for new safeguards. We need to develop a new culture of openness in the NHS that acknowledges, highlights and deals with problems promptly, rather than pretending that 586 they do not exist. The preliminary evidence in this case shows overwhelmingly that that was the problem in the hospital in question. We also need a new system of quality assurance that supports clinicians in developing and maintaining good practice, and that nips problems in the bud.
The chairman of the British Medical Association, Dr. Ian Bogle, recently wrote:the days when doctors thought they could turn a blind eye to the incompetence of their colleagues have gone.Dr. Bogle is right. It is in no one's interests—neither patient nor doctor—to cover up cases of outright failure.
The Government believe that new safeguards are necessary for patient safety and public confidence. We are taking five important steps. First, we are establishing a new duty of clinical governance to put quality assurance systems in place in all parts of the NHS. Secondly, we are placing a new emphasis on publishing clinical outcome data, so that results can be compared over time and between clinical teams. Thirdly, all doctors will in future be required to participate in a national audit programme, including specialty and sub-specialty national external audit programmes, to ensure that their performance is up to scratch. Fourthly, individual doctors will be required to share their results with the medical director of their NHS trust and the trust's lead clinician for clinical governance. Fifthly, a new external body—the commission for health improvement—will be established, whose job will be to monitor quality standards externally and to intervene promptly if necessary when things are going wrong, as they clearly were in the case of Mr. Rodney Ledward.
Those five points summarise the action that the Government are taking. The medical profession, too, has to play its full part. I believe that the leadership of the profession recognises the need for change, but that recognition must be matched by a commitment from the profession as a whole to take prompt and effective action. Without that, the whole system of professional self-regulation will not command the public's confidence.
The Government, like the profession, want professional self-regulation to work, but no one should be in any doubt that the system is under test. It must become more modern, more open and more accountable. If professional self-regulation is to be the bedrock of high clinical standards in the future, it cannot operate in isolation. It must form part of an integrated framework of new mechanisms that embrace the profession, the regulatory machinery, the educational bodies and the NHS.
I know that all this comes too late for the women who suffered at the hands of Mr. Ledward. We shall do everything that we can to help them. We shall get to the bottom of how Mr. Ledward was allowed to wreak such damage on so many of them, and we shall learn the lessons of these terrible events, so that we can do our very best to ensure that patients in the future are protected from bad doctors such as Mr. Ledward.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock.