§ Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]
§ 7.1 pm
§ Helen Jones (Warrington, North)
I speak on behalf of my constituent, Mr. Stanley Ford, and his family to draw attention to his deplorable treatment at Wythenshawe hospital. I do so without any pleasure because this is an appalling case that raises serious questions about the management of both the South Manchester University hospitals trust, of which Wythenshawe is a part, and the strategic health authority.
Let me say at the outset that the problems experienced by Mr. Ford were caused not by the clinical staff but by management. Indeed, the Ford family have expressed their appreciation of the work of the health care staff at Wythenshawe hospital. I know that my hon. Friend the Member for Wythenshawe and Sale, East (Paul Goggins), who unfortunately cannot be here tonight, has the highest regard for the clinical care delivered at the hospital.
These problems were caused by a management that has shown itself to be incompetent, uncaring and unwilling to take complaints seriously or to learn from them. However, it is a case from which we must learn if we are to ensure that no family goes through a similar experience. I raise this case not because I believe that the NHS is generally like that, but because I have experienced myself, and through my friends and family, the marvellous health care normally provided. When managers act in this way, they let down not only the patients involved but the many good health care staff who deliver excellent care every day.
Mr. Ford's case was first drawn to my attention in June by his daughter, who sent me an e-mail telling me a very sorry tale. Mr. Ford had had a number of heart attacks and was listed for surgery at Wythenshawe hospital. His operation was due to take place on 22 March, and it was cancelled by the hospital. It was cancelled on a further four occasions prior to his daughter writing to me and then once more on 14 June, after she got in touch with me. Not surprisingly, those cancellations had a devastating effect on Mr. Ford and his family. He and his wife are both 74, and the repeated cancellations were taking a toll on Mrs. Ford's health, both because of the strain that they imposed and in the difficulties that she experienced in looking after her sick husband. Mrs. Ford's daughter wrote to me:I am sick of dragging him off to the hospital, getting all ready for the op, for it to be cancelled at the last minute.She also said that her parentshave worked and paid their dues all their lives. This is no way for them to be treated.She was absolutely right. The test is whether it would be good enough for our parents—it would not be good enough for my mother or, I am sure, the parents of anyone else in the House. If it is not good enough for them, it is not good enough for anyone's parents.
I expected that because Mr. Ford's case was so bad it would be resolved quickly. After confirming that he wanted me to take his case, I wrote to the hospital, expecting that I would quickly get an assurance that 1105 Mr. Ford would have his operation and that the problems that had arisen would be dealt with. I am afraid, however, that the hospital did not take the complaint as seriously as it should have done—it did not appear to be shocked or scandalised. Instead, I got a letter from someone called the assistant complaints co-ordinator-apparently, six cancellations do not merit the attention of senior staff at that hospital—who would not tell me anything and would write instead to my constituent for "reasons of confidentiality".
I wrote again to the chief executive and told him that if I could not get answers from the hospital I would table questions in the House. Throughout, the chief executive has refused to communicate with me without assigned authority from the patient, a matter to which I shall return. I have not encountered that attitude in any other trust, and it is particularly bizarre in this case because the reasons for the cancellations had nothing to do with the patient's medical condition; they were to do with what was happening at the hospital. In fact, I have had great difficulty in getting information throughout, al though on 2 July, having said that it would not communicate with me, the hospital sent me a copy of a letter to my constituent which was both inaccurate and fatuous. It referred to four cancellations, whereas there had been six—an error that it had to put right in a letter of 12 August. However, the monitoring and management systems in place in that hospital must be called into question if it was not even clear about how often the operation had been cancelled.
The hospital also made no attempt to address the reasons why Mr. Ford had had to wait so long. Instead, it said that if an operation was cancelled, it was usually rescheduled within 28 days, and added:I am sorry this did not happen for you and I hope this has not caused you additional stress.Frankly, six cancellations of any operation, particularly a serious heart operation, would cause anyone a great deal of additional stress and it is patronising in the extreme to suggest otherwise. However, the letter revealed the way in which the hospital dealt with complaints. It was simply a wash of warm words and made no attempt to deal with the issues behind the problem. It treated every cancellation as a separate issue, and nowhere did it recognise the need for systems to be in place to flag up the fact that one patient was experiencing many cancellations of his operation. Its failure to address that problem is another serious flaw in its management systems.
Let us look at why those cancellations took place. I have accumulated voluminous correspondence from the hospital, the strategic health authority and even from a civil servant at the Department of Health, all of which say that there are issues involving capacity at the hospital. That has the merit of being a good excuse, but unfortunately it has the demerit of not being true. There was only one occasion when it applied —on 29 May, when Mr. Ford's operation was cancelled because there were not enough beds in the intensive care unit. The reasons for the other cancellations were very different. On 22 March, the operation was cancelled because of sickness among theatre staff. We all recognise that hospital staff, like the rest of us, can become ill. I have endeavoured to ascertain how many staff were sick on this occasion and what grades they were. That is not because I want to point the finger at any individual for 1106 being ill, but because questions are raised about the hospital's rostering and substitution arrangements in such an event. I was told in a parliamentary answer that five nurses were sick that day but that four worked overtime to compensate. All credit to them.
If the theatres were only one nurse short, what was happening on that day? What were the rostering arrangements? What arrangements were made to try to fill the gaps in theatre assistants? Most important, what action did the hospital take on that day on cancellations? Did it cancel the list for one theatre, or did it consider the clinical needs of all the patients on the list that day and take decisions accordingly? Did it perform a number of simple operations or were people graded on clinical priority? I hope that my right hon. Friend the Minister will consider these issues seriously.
The other reasons for cancellations were perhaps even more worrying. On 31 May and on 12 and 14 June, Mr. Ford's operations were cancelled because of outbreaks of methicillin resistant staphylococcus aureus in the intensive care unit. We know that it is difficult to deal with MRSA. However, two outbreaks in the hospital in such a short time must raise queries about infection control procedures and hygiene procedures in use at the hospital.
The Association of Medical Microbiologists makes it clear how MRSA is to be controlled. That is by scrupulous hand washing, isolation of the patient where necessary and regular damp-dusting. I hope that my right hon. Friend will carefully examine the procedures that were undertaken by the hospital after the two outbreaks. What review of its hygiene procedures was put in place, and what changes has it made as a result?
The most worrying reason for cancellation, however, was on 13 May. Mr. Ford was listed for his operation, but before it could be carried out he needed a trans-oesophageal echocardiograph. That can be carried out only by a cardiologist or a trained anaesthetist. Yet the relevant consultant was away on this occasion, and it was known elsewhere in the hospital before the operation was scheduled that the consultant would be away. At best, that is a piece of gross incompetence. At worst, it is a case of booking someone in for an operation when it was known that it could not take place. I hope that the Minister will examine the issue seriously and ascertain what was going on in the hospital, where I know there have been queries about the management of waiting lists on other occasions, and ensure that it does not happen to other patients on further occasions.
I have said that Mr. Ford was let down by the management of the hospital. I hope that I have said enough to demonstrate that. However, he was let down in the management not only of his case but of the complaints that were made afterwards. The hospital did not take his complaint seriously. Instead, it denied the family information, or was very slow in coming back with information. On one occasion it even tried to blame the family for a number of the cancellations.
There was a cancellation that was separate from those that I have highlighted, when Mr. Ford developed an infection. His family called his GP, who made it clear that he would not be able to have the operation. The 1107 family immediately telephoned the hospital to tell it so, so that somebody else could have Mr. Ford's slot, as it put it to me. For behaving responsibly, as we ask national health service patients to do, the family was accused by a member of staff of cancelling several operations. That is the culture that worries me. It appears that there was no culture in the hospital of examining complaints and learning from them.
All organisations can make mistakes, although in Mr. Ford's case there were serious mistakes. The least that could have been expected was for the hospital to examine its systems, to decide what went wrong and to ensure that it did not happen again. Instead, there was a passing of complaints down the line to junior staff, a failure to deal with them adequately and a failure to address what went wrong within the hospital system. A culture of arrogance prevailed not only in the trust, but in the strategic health authority.
I have already said that the trust will not answer questions from a Member of Parliament without signed authority. I have never come across that in a trust before, although I understand that that is left to the discretion of the chief executive. I think that the trust is legally wrong, and I asked the chief executive to give me his legal advice on the matter, but he declined to do so. In any case, I know that the Department of Health is looking at the problem. I hope that it will ensure at the very least that trusts cannot hide behind the Data Protection Act 1998 to avoid being accountable for their actions. I believe that that is what was happening in this case.
I encountered the same problems with the strategic health authority. When I got no joy from the hospital, I telephoned the chief executive of the strategic health authority to raise some issues with him. He was not available at the time, and I asked for a return call. Unfortunately, it took more than a month and two letters to the health authority before I got a return call. The chief executive, Mr. Goodwin, was then, in my view, extremely rude and aggressive. He was interested not in dealing with the complaint, but in getting rid of it. He even said to me in the course of the conversation that one of the problems was thatMPs do not always act in good faith in these matters.I hope that the Minister will make it clear that such an attitude is not acceptable from senior managers in the health service. It is a slur on all Members of all parties in the House and it is not a way of dealing with matters. If there are managers who deal with Members of Parliament like that, how on earth do they deal with patients?
I hope that the Minister will ensure that the problem is addressed in future. Our real difficulty is that managers in the NHS are not always held accountable for what they do. Doctors are accountable for their practice, as are nurses. Managers, unfortunately, can send a few anodyne letters and walk away. The Ford family cannot walk away. Mr. Ford is now seriously ill and his family face the burden of looking after him, as well as the additional stress imposed by the hospital's actions. I pay tribute to their tenacity in pursuing the case. Their only motivation has been to ensure that no family goes through the same problem again.
1108 I hope that in his reply, my right hon. Friend, who I know will be as concerned about the case as I am, will ensure that proper investigations are carried out, that the necessary action to rectify the problems in the hospital is taken, and that the managers concerned are held accountable for what they do and are made to ensure that no family suffers in the same way in future.
§ The Minister of State, Department of Health (Mr. John Hutton)
I warmly congratulate my hon. Friend the Member for Warrington, North (Helen Jones) on drawing the attention of the House to the case of her constituent, Mr. Stanley Ford. I also warmly congratulate her on presenting her arguments so clearly and effectively.
Let me say at the outset that I agree with my hon. Friend that the way in which Mr. Ford and his family have been treated is completely unacceptable and falls well short of the standards that we are all entitled to expect from our national health service. I shall say more about that in a few minutes. The case has rightly raised A set of wider concerns to which my hon. Friend referred, including the question of how confidential patient information can be shared with right hon. and hon. Members who make inquiries on behalf of their constituents. I shall say more about that in a moment. I am grateful to my hon. Friend for her warm remarks about the nurses and doctors at Wythenshawe hospital.
I begin by apologising to Mr. Ford and his family for the cancellation of his treatment at Wythenshawe hospital on six separate occasions between 22 March and 14 June. Clearly, that was completely unsatisfactory for everyone concerned, and particularly frustrating and stressful for the patient and his closest relatives and friends. The trust has apologised to Mr. Ford and his family, and rightly so. It is extremely sorry for the three-month delay in treatment that Mr. Ford endured as a result of his operation being cancelled on so many occasions, and the inevitable effect of consecutive postponements on his family. Mr. Ford eventually had his operation on 24 June, and I am sure that the House will join me and my hon. Friend in wishing him and his family well at this difficult time.
Mr. Ford's experience highlights many of the problems in the NHS that we as a Government, through our investment and reform programme, are determined to tackle. As I am sure my hon. Friend is aware, we are making available a substantial increase in the level of funding for the NHS during the next few years. That investment, coupled with the wider reforms that we are making to the service, should deliver an NHS that is better equipped and enabled to respond much more effectively to the individual needs of its patients, something that should have happened in this case, but clearly did not.
The NHS is still short of capacity. We need more staff, beds, operating theatres and equipment. Since 1997, we have made some progress in expanding the NHS. There are more nurses and doctors. The numbers of beds in the NHS is rising again for the first time in more than 30 years. We are in the middle of the biggest hospital building programme in the history of the NHS, which will see the NHS grow in size as well as capability. In the north-west alone my hon. Friend will want to know that 1109 eight new hospitals have been given the go ahead since 1997, and together with the changes that we are making to the way in which we deliver our services—for example, separating emergency cases from elective activity—we shall be able to make faster progress in reducing the number of operations that have to be cancelled at short notice.
I know that that will provide no direct comfort to Mr. Ford and his family. I accept that. But I hope that Mr. Ford and his family will be able to accept that we are fully committed to improving the NHS, and making sure that the extra investment makes a real difference to the way in which the NHS operates.
This case raises concerns in a number of areas, including the NHS's approach to cancelled operations and the standards of cleanliness in our hospitals. The Government are committed to ensuring that the NHS takes action to address the concerns that my hon. Friend has raised tonight.
It is clearly unacceptable that pre-planned operations are cancelled. An operation can be a traumatic enough experience without the added concern of it being cancelled at short notice. That is why from April 2002, under the NHS plan, when a patient's operation is cancelled by the hospital on the day of surgery for non-clinical reasons, the hospital must offer another binding date within 28 days, or fund the patient's treatment at the time and place of the patient's choice.
The NHS also has to improve the way it manages operating theatre lists. The NHS modernisation agency is helping to develop and spread good practice across all NHS trusts, including that in south Manchester, with dedicated support provided to the worst performing trusts. As part of that project, South Manchester University Hospitals NHS trust has been given additional resources this year to help it to implement the new guidance and reduce the incidence of cancelled operations.
As my honourable Friend has mentioned, Mr. Ford's operation was cancelled three times because of an MRSA outbreak at the hospital. MRSA is a serious problem in the NHS, as it is in hospitals throughout the world. The Government are aware of the seriousness of the problem and that is why we have set standards to ensure that there is a managed environment that minimises the risk of infection to patients, staff and visitors. Recent analysis of how hospitals perform in that area has shown an improvement during the past two years, but more needs to be done and actions are under way nationally, regionally and locally.
For example, we have taken action to improve the standards of hospital cleanliness including the investment of an additional £60 million over the next two years, and the institution of a nationwide clean-up campaign with unannounced inspections of cleanliness. We recognised that not all hospitals were as clean and tidy as patients wanted and that in some places standards of cleanliness had deteriorated to a point where they were no longer acceptable. The clean hospitals programme has seen significant improvements. The new patient environment action teams have carried out nearly 1,400 inspections in around 500 NHS hospitals during the past 21 months. By September 2001, there were no hospitals deemed to 1110 have unacceptable levels of cleanliness. In particular, levels of hospital cleanliness have risen, in particular in the South Manchester University Hospitals NHS trust.
Most of us would accept that it might be necessary sometimes to cancel elective surgery for legitimate reasons—for example, the ill-health of the patient concerned. In Mr. Ford's case, staffing shortages and an infection outbreak contributed to a number of the delays. But six cancellations is obviously an excessive number. They could and should have been avoided. I know that South Manchester University Hospitals NHS trust has taken the matter seriously and is committed to taking the necessary action to address the problems exposed by Mr. Ford's ordeal.
My hon. Friend raised particular concerns about answers to parliamentary questions that she has received in relation to staffing levels in the trust on the day that Mr. Ford's hospital treatment was initially cancelled. I assure her that I shall look into the points that she has raised with me this evening because the trust does have a high rate of cancelled operations—too high. That fact was reinforced when the Commission for Health Improvement reported in July. Under its new management team, which has been in place since the events in the spring to which my hon. Friend referred, the trust has re-examined its internal procedures to identify areas of weakness in which immediate remedial action is necessary.
The trust acknowledged that it lacked a robust and clear system for dealing with cancellations. Too many different systems were in use, with insufficient coordination and understanding. The trust has already reviewed its cancelled operations policy and will take decisive measures designed to make certain that staff are available at all times to carry out trans-oesophageal echocardiograms. The trust has also reviewed the capacity of Wythenshawe hospital and is implementing a plan to increase its number of beds by 36. The majority of those beds are already in place, which will be of particular help in reducing the number of cancelled operations.
I was encouraged by the trust's own candid assessment that its performance had not been adequate in terms of cancelling and rescheduling operations. It has resolved to ensure that it has a senior manager with overall responsibility for ensuring that the number of cancelled operations is reduced substantially. The trust will also carry out an evaluation of its pre-operative assessment procedures with the objective of reducing cancellations. improving patient care and modernising communication systems in the hospital.
I can tell my hon. Friend that the trust is now working to a clear objective of an 80 per cent. reduction in cancelled operations on the current rate. I am pleased to note that the number of cancelled operations at the trust has fallen significantly in recent months. However, I will pay close attention in future to how the trust performs in that area. I am sure that the trust and all its staff want the service that they provide to patients to be improved in that regard, as they are absolutely committed to the welfare of all their patients. So do I, and so, I am sure, does she. The trust and the wider NHS in the Greater Manchester area are looking at a number of other ways to improve on current performance, including 1111 identifying spare capacity in other trusts in the area, investing in additional capacity and making better use of existing capacity.
On the problem of MRSA at the trust, in the cardiac intensive care and high-dependency units, new and more rigorous cleaning arrangements have been introduced following the recommendations of the infection control team. The trust's management is continuing to monitor the situation closely and I will ensure that my hon. Friend is kept informed of progress.
I am also aware that my hon. Friend has raised concerns with the trust about its willingness to share information with her about Mr. Ford's treatment. We recognise that the matter of trusts sharing information with MPs about their constituents raises sensitive issues. The Department recently issued for consultation a draft code of practice for NHS staff on confidentiality issues. Specifically, the code recommends that where a Member of Parliament states in writing that he or she has a patient's consent for disclosure, that should be accepted without further resort to the patient.
I am also aware of the exchange of correspondence in the summer between my hon. Friend and the Greater Manchester strategic health authority. Clearly, there was an unacceptable delay in responding to her concerns. Both the director of health and social care in the north and the chair of the strategic health authority have reviewed those events, as well as investigating the reasons for Mr. Ford's cancelled operations. By now, she will have seen their respective conclusions and have had time to reflect on their comments.
1112 The trust, the strategic health authority and my officials agree that action needs to be taken, and it is being taken. The South Manchester University Hospitals NHS trust is already taking action to reduce the number of cancelled operations at Wythenshawe hospital. The Greater Manchester strategic health authority has instructed trusts to include more information about rescheduled operations in their weekly performance management returns and will monitor carefully south Manchester's rate of cancellations. The strategic health authority has overhauled its own procedures for responding to inquiries from hon. Members. The directorate of health and social care in the north will oversee the implementation of all those performance improvements.
I reassure my hon. Friend that I believe that lessons have been learned. Action is now being taken. Mr. Ford and his family should not have been put through their ordeal. There can be no doubt about that whatever and I regret very much what has happened. It is now the job of the trust and the local NHS to ensure that, as my hon. Friend has said, such cases are not repeated.
§ Sitting suspended, pursuant to order [29 October].12.13 am
§ On resuming—
§ Question agreed to.
§ Adjourned accordingly at thirteen minutes past Twelve o'clock.