§ Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Heppell.]9.30 am
§ Derek Twigg (Halton)
I am pleased that this important debate is taking place. A number of my colleagues have been contacted by their constituents, and 12 families have contacted me over the past few weeks. They have asked me to express their concerns about a terrible and emotional issue. Indeed, it is a scandal. They are concerned about the way in which matters have been dealt with after the publication of a report and following on from various recent events. Some of my hon. Friends are present, and others would like to be. I hope that I can express many of their views. Some of my colleagues will speak when I resume my place.
My constituents are determined that their views should be highlighted in Parliament. What happened at Alder Hey hospital was a shocking scandal and almost beyond belief. Equally appalling is the way in which families have been dealt with at times by people at the hospital and by some members of the medical profession. The chief executive has been found guilty of misconduct. I note this morning that she has accepted the disciplinary panel's decision. It found that there was no alternative but regretfully to terminate her employment summarily in accordance with the terms and conditions of her contract. Miss Rowland was advised of that decision. It will be welcomed by the families concerned, as I welcome it.
Much of the parents' criticism is based on the need for further legislation. I know that my hon. Friend the Minister will refer to that. The parents believe that disciplinary action has been avoided. A typical family in my constituency who have raised concerns are Mr. and Mrs. Jarvis of Runcorn, whose son, Matthew, died aged four. The loss of their child is an important human story. We can imagine the emotional upheaval when they learned of the retention of organs.
We hear of a whispering campaign in the medical profession to the effect that families have over-reacted. I do not know how I would have reacted in the circumstances. It is clear that families have faced emotional upheaval. Mr. and Mrs. Jarvis are typical of the families involved and wanted me to voice their concerns.
The families are upset and concerned that all the doctors referred to the General Medical Council, as mentioned in the Redfern report, have been cleared, except for Professor van Velzen and Dr. John Martin. As I understand it, their hearings have not been set. Parents are concerned also that doctors' actions before 1988 and after 1995 have not been considered. They want to know why the GMC has used the Redfern 68WH report as a stand-alone document without referring to individual cases. With thousands of pages of documentary evidence, why did the GMC not call upon that material when making its decisions or call parents and relatives as witnesses? Parents cannot understand why they were not called as witnesses.
I have referred to Alder Hey hospital, but some of my constituents want other hospitals to be mentioned. For example, there is Warrington hospital, where about 60 families have been contacted and a disciplinary case has caused concern. The problem is widespread and concern extends throughout the country beyond Alder Hey.
Families are concerned about legislation. A change in the law has been promised in respect of the procedures used to gain informed consent to carry out post mortems and permission to retain organs. Pity II, the organisation that represents the families, says that it has been told that a change in the law cannot be brought before Parliament before the Session that starts in October 2002. The parents say that that is too long to wait. They fear that legal change may be diluted or even forgotten about. They want to know why the date cannot be brought forward. The matter is causing significant concern to the parents' group and among parents in Halton. I hope that my hon. Friend the Minister can deal with it this morning.
Parents are concerned about the role of the GMC. Disciplinary action has been considered but it has not been taken in most instances. That raises the issues of transparency and fairness and the way in which disciplinary action is handled for doctors. I understand that the GMC can basically take two forms of action. One is to strike off a doctor to stop him or her practising. The second is for it to send a letter of advice. Such letters went to eight doctors in the case that I am raising.
To the general public and many hon. Members, a letter of advice may not seem to be particularly strong disciplinary action. I understand from a doctor's point of view that such a letter is quite an important event in his or her career, and they would be very worried about receiving one. I understand also that there is no halfway house, such as a final warning or a yellow card system—a term that I do not particularly like—which would mean, "Next time, you're out." That situation concerns constituents, my colleagues and me.
I understand that the GMC has asked the Government to legislate on fitness to practise. It also wants more regulation. I met the council yesterday to discuss some of the issues. I considered it important that I understood its side in respect of the events. I know that the council has been encouraged by the Government to review its procedures—which is long overdue.
It seems strange that the medical profession does not have provision for taking disciplinary action locally. A doctor will be referred to the central body in London. The profession has an unusual way of dealing with colleagues who may face disciplinary action. It may be asked why alleged offences that took place in Liverpool, for example, will be dealt with in London. Why not deal with them locally? Parents have raised the issue with me. The GMC seems to be under general attack. Even doctors are attacking it for its handling of this case. I shall refer to a specific example later.
It is important that disciplinary procedures for doctors are seen to be fair and applied in a transparent manner. Last year, about 4,470 complaints and 69WH inquiries were received by the GMC, an increase on the 3,001 received in 1999. Of the 4,470, some 753 were referred to various GMC committees. There are about 180,000 doctors, but the number of complaints is a significant proportion.
Disciplinary action must be seen to be transparent and fair. At present, the GMC is seen as a toothless tiger run by doctors who look after their own. That may not be a fair view but there is that perception in many parts of my constituency and among the public generally. That underlines my suggestion that something must be done to ensure that the GMC deals with cases fairly.
I know that there are lay members on the GMC, but I still feel that it is necessary to review how disciplinary action is taken against those in the medical profession. The present system is not seen as fair.
I said that I would refer to some of the criticism of the GMC. I believe that it is important to do that, although I do not want to take too much time because other hon. Members want to speak. David Hughes, a consultant paediatrician, who is chairman of Alder Hey's medical board, said that Professor Donaldson, the chief medical officer, was looking for someone to blame when he referred many senior medical staff to the GMC. That is a scandalous accusation. He said that Professor Donaldson asked the council to investigate doctors who were criticised in the report. I am glad that he did. It is incredible that he has been criticised for doing that.
Dr. Hughes writes:It was with great distress that we witnessed the indiscriminate referral of our colleagues to the GMC by Professor Donaldson".That is an extraordinary accusation by a senior member of the medical profession against the chief medical officer. Dr. Hughes also writes that Professor Donaldsondisplayed poor judgement and political expediency.He suggests that the chief medical officer is influenced politically. By whom? He continues:This action demonstrated the need to seek individuals to blame rather than acknowledge the culture that created the circumstances for 'scandals' that were manifestly widespread and an accepted part of the system.He also criticises the GMC for the "demeaning" way in which it handled the cases and for telling solicitors who acted for the parents that charges against most doctors had been dropped.
Dr. Hughes talks about blaming the culture, not individuals. It is unbelievable that such a culture could appear out of thin air rather than being created by individuals and that it went unchallenged. It is incredible for such a senior man in the medical profession to suggest that no individual, but a culture that appeared out of thin air, is to blame. It is important to emphasise that the Alder Hey scandal revealed that no one challenged the culture, so it persisted. Even those who did not like what was happening do not appear to have challenged it.
I repeat that I find it extraordinary that a senior member of the medical profession can take Dr. Hughes's line of argument in this day and age. Arrogance exists in some parts of the medical profession and parts of the NHS bureaucracy and management. It 70WH should be challenged. It has been manifest in the treatment of the families of the children, and not least in the dismissal of the chief executive of Alder Hey. That arrogance has made matters 10 times worse. It is time not only for the medical profession to adopt more open procedures, but to accept openly that it must sometimes take the blame for mistakes. If it starts to do that, matters will improve.
I believe that several questions need answering. The medical profession should examine itself and consider the way in which problems are managed. Legislation should be introduced sooner rather than later.
§ Mr. George Howarth (Knowsley, North and Sefton, East)
Sir Alan, I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing an important debate and on his thoughtful and well informed presentation of the arguments. My hon. Friend the Member for Knowsley, South (Mr. O'Hara) is disappointed that he cannot attend, but he had longstanding engagements away from the House.
We need to distinguish between the horrendous events that my hon. Friend the Member for Halton described, especially their effect on the families—many are constituents of mine—and Alder Hey as a working hospital. As a local resident, never mind a political representative, I have many connections with the hospital through members of my family. The medical treatment and the nursing care there are exemplary. It is therefore important to distinguish between the deplorable saga of organ retention and the medical treatment that is available at Alder Hey. It is no exaggeration to say that, despite the difficulties of the past few years, Alder Hey continues to enjoy a good reputation as one of the foremost treatment centres for children in the our region and beyond.
The sorry saga that my hon. Friend outlined is an example of a wider problem in our communities. We have no clear set of routines and procedures for dealing with horrendous events. Let us consider the Hillsborough disaster. I am not trying to make a direct parallel between that and events at Alder Hey, but there seem to be no adequate procedures for dealing with large-scale, emotionally charged events.
My hon. Friend said that he looked forward to legislation, but the problem is not confined to health. I hope that we shall look beyond health, important though it is, and consider the way in which we deal with all such matters, whether through judicial processes, coroners procedures or inquiry procedures that are available to Secretaries of State and the Prime Minister. We do not handle such events well. That is not a criticism of my hon. Friend the Minister or the Government. We have simply inherited a set of accumulated practices that do not measure up to the difficulties.
When the Redfern inquiry was in progress, I was a member of the Government and I tried to arrange a meeting between me, the solicitor who represented many of the families and Lord Hunt, the Minister who was responsible at the time. I was unable to do that. In 15 years as a Member of Parliament, I have never been refused a meeting with a Minister. I am still angry about my treatment by Lord Hunt, not only because I was a 71WH member of the Government, but because I felt that such treatment of any hon. Member was a discourtesy. Today is the first opportunity to put that on the record, and I am pleased to do that.
I shall not go through all the detail that my hon. Friend the Member for Halton outlined so ably. Sir Alan, I therefore conclude by saying that I hope that, as we review the procedures, we will find better ways of dealing with such problems. We are left with a series of unresolved issues and many aggrieved families, who do not know how matters will end. Although it may not be possible to find perfect procedures, I hope that we can find better solutions than those that have applied so far.
Mr. Deputy Speaker
I did not interrupt the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth), but the correct form of address when a Deputy Speaker is in the Chair in Westminster Hall is "Mr. Deputy Speaker". Members of the Chairman's Panel are addressed by name.
§ Mr. Robert N. Wareing (Liverpool, West Derby)
I must get that form of address right.
I congratulate my hon. Friend the Member for Halton (Derek Twigg) on introducing the debate, which is about one of the most appalling scandals in recent medical history. It happened before the Minister assumed her responsibilities, so any comments that sound critical of the Government do not apply to her. She was generous enough to meet me and Robin Makin, a solicitor from Liverpool who is covering several hundred cases, on 23 October. I thank her for that.
I agree with the comments of my hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) about Alder Hey hospital, which was always regarded as a centre of excellence. It looked after children from Merseyside, the north-west, north Wales, the Isle of Man and further afield and it had a wonderful reputation, but that has been marred by recent events. It has devoted employees, and I make no criticism of the staff as a whole, but considerable trauma has been caused for the parents. They are still traumatised. After all, some have attended two, three or even four funerals to bury the hearts of their children. We must bring those responsible to book.
I understand from talking to the Secretary of State on the day that the Redfern report was published that no criminal sanctions are available. There are the disciplinary proceedings to which my hon. Friends referred, but a considerable number of wrongdoers have got off scot free. Hilary Rowland, the hospital's chief executive, was dismissed, but one might say that she is the tip of the iceberg. Perhaps "tip" is the wrong word; she may be lower down the scale and she may not have had complete responsibility, as has been alleged. In September 1999, she warned Robert Tinston, director of the north-west NHS executive, that the situation at the hospital constituted a major issue, but the executive failed to ensure that appropriate disaster planning, guidance and measures were introduced and implemented.
72WH On 23 March 2000, the chairman of Alder Hey was sacked. Professor Robert Tinston was put in charge and given personal responsibility for ensuring that arrangements for the return of the organs were in place and reporting fortnightly to the Minister on progress. On 18 July 2000, I asked the Secretary of State to make public Professor Tinston's report. Hon. Members should note when I asked my question and that I received a reply on 20 November, which stated:Internal reports between officials and Ministers are normally exempt from disclosure under exemption 2 of the Code of Practice on Access to Government Information that relates to information that would harm the frankness and candour of internal discussion, unless justifiable reasons are presented why they should not be covered by this exemption clause."—[Official Report, 20 November 2000; Vol. 357, c. 42W.]I would have thought that there is no justification for the Government concealing from those with a vital interest information about the state of knowledge regarding organs removed and retained at Alder Hey and that among those people are the parents of the children involved.
On 30 January 2001—the day that the Redfern report was published—the Secretary of State answered a question from my hon. Friend the Member for Liverpool, Walton (Mr. Kilfoyle). On the sale of live tissue to pharmaceutical companies, my right hon. Friend said:it is our understanding that there was such a practice at the hospital in the early 1990s."—[Official Report, 30 January 2001; Vol. 362, c. 184.]I am appalled. I acknowledge what my hon. Friends have said about the culture at the hospital, but, candidly, a culture that allows large private companies to profit from the remains of children is surely criminal. I hope that such activity has ceased, and I believe that it has.
We must get a strong grip on the hospital authorities, but I agree that Alder Hey must not be sacrificed because the problem is national and has existed in hospitals all over the country for a considerable time. Indeed, we know that, as long ago as 1995, Alder Hey and Liverpool university were aware of the existence of accumulated human material, so the problem arose long before Redfern was brought into play.
There have been failings much higher up the chain of command than Hilary Rowland. I have referred to one such person—the chief executive of the north-west NHS executive, Professor Tinston—and I believe that they should all go. The Government must get a grip on the situation and I want the Minister to say what is being done and what progress they are making. For example, what is being done to research the psychological features of the problem and have they kept faith by consulting all the parents who were prepared to give evidence? I hope that she supplies that information.
Many parents are suffering traumas and no doubt my colleagues have, like me, received postcards from individuals. I have half a dozen in my hand: they call for action against the wrongdoers and hope that parliamentary privilege will protect us as we make our remarks today. I do not intend to name any other person, but I am concerned about what the Government are doing.
A great many Britons go abroad as tourists or on business, so I would have thought that the international implications of the problem were being researched. We 73WH should consider what happens in other countries. For example, I understand that when a person dies in Austria, hospitals have an automatic right to strip the body of any organs or tissue that they believe that they require. That may affect British holidaymakers and British business men who visit that country, but we do not appear to know what happens, even in European Union countries. Perhaps the problem should be discussed in the Council of Ministers to achieve uniformity throughout the EU.
The good name of Alder Hey must not be sacrificed, because the problem is national, but we must legislate to ensure that criminal sanctions are available to punish wrongdoers. No such sanctions appear to exist. I would insist on a code of conduct, but not only to regulate the doctors. We need an over-arching system to regulate all in the NHS and that has to include the administrators, who must be made accountable and subject to individual scrutiny.
I hope that the Minister responds to those points and that a genuine search is made for the answers to the questions that cannot be dealt with today to ensure that this never happens again. That has been said so often in the past, but this time we must really mean it.
§ Mr. Colin Pickthall (West Lancashire)
I thank my hon. Friend the Member for Halton (Derek Twigg) for securing a debate on a matter that is important to all of us, especially those in the north-west. Eight families have contacted me since the publication of the Redfern report, and no doubt many more constituents who have not been in touch have also been affected.
I strongly agree with what my hon. Friend said about what I think he called a whispering campaign, suggesting that families were overreacting. That is not true of the families to whom I have spoken, who, although deeply hurt, have taken a restrained and responsible approach and done their homework—researching on the internet, for example, to try to ensure that they get the facts right.
Merseyside has had more than its fair share of tragedies in recent years. Like the Hillsborough disaster, the Alder Hey scandal needs to be dealt with in a comprehensive way, allowing relatives to bring an end to their grief and anger in the knowledge that all relevant information has been exposed publicly, guilt has been acknowledged and, where appropriate, action has been taken against those who have failed in their duty—and, most important, that systems have been changed so that such tragedies do not happen in future.
The grief and anger stemming from Hillsborough—I make no excuse for the comparison—has never been fully assuaged, although the disaster occurred some 12 years ago. We must not allow the feelings of the Alder Hey parents, and their friends and relatives, to go unanswered, as happened for far too long after Hillsborough. It is hard to overstate the deep distress caused to parents who discovered that their children's organs had been removed without their permission, or even their knowledge.
I want to raise a specific issue, at the request of my constituents Janette and Stephen Robinson of Skelmersdale, whose son Michael was one of the 74WH unfortunately deceased children whose organs were removed. They point out that, although some senior figures have been disciplined —we heard today that the chief executive was among them—Mrs. Karen England, who was at least involved in some of the cover-up, has avoided any formal censure, if such was appropriate, by moving to another job.
I seriously dislike referring to this lady by name, but her involvement is an important aspect of the case, and I could not describe what happened without identifying her. I realise that it is not pleasant to talk about an individual who is not present to speak for herself, but by virtue of her role as a senior administrator working with Professor van Velzen, Mrs. England must have known the truth—or at least part of it—about the removal and retention of organs. She was put in charge of handling relationships with the parents when the scandal broke, and is heavily criticised in the Redfern report for mishandling them. It seems that she may well have falsified records in at least one case, and she has certainly misled families.
When the chairman of Alder Hey was removed and the chief executive was sent on gardening leave, Mrs. England was seconded to Warrington General hospital. In January this year, she was suspended by Alder Hey, but it turned out that in the interim she had secured a full-time post at Warrington, and therefore could not be disciplined or investigated by Alder Hey. When those at Warrington looked into the case, quite properly, they found that Mrs. England had not broken her contract as far as they were concerned, so there was nothing that they felt they should do.
I realise that when one goes into a particular case like this, it may seem like a witch-hunt aimed at an individual. I do not intend that; I simply assert that there is at least a prima facie case to answer in connection with one person.
I have some questions for the Minister. I understand that she may not be able to answer them today, but perhaps she could do so later in writing. They were put to me by my constituents Mr. and Mrs. Robinson, who attempted repeatedly to speak to Mrs. England about what had happened to their son. She refused to respond, so they never received an answer. I am now seeking answers on their behalf.
First, my constituents ask why Mrs. England was allowed to remove herself from the Royal Liverpool Children's NHS Trust when an external inquiry was taking place in which she was a key player. Secondly, who at the trust supplied references in connection with the full-time post that she secured at Warrington General? Thirdly, what did Warrington General know of her background, and her possible involvement in the events that we are discussing? Is she obliged to reveal her involvement when she applies for another post?
In a letter sent to me earlier this week, Mr. and Mrs. Robinson make points reiterated today by my hon. Friends the Members for Knowsley, North and Sefton, East (Mr. Howarth) and for Liverpool, West Derby (Mr. Wareing). They say:We are not trying to damage the name of Alder Hey or to vilify the hospital. We would like some natural justice for what happened to our own child and to all the other children involved. It seems completely inconceivable that people involved in wrong doing have been let off scot free. This would not be allowed to happen to others in positions of authority in other professions.75WH I agree with all of that final paragraph in the letter, except the last sentence. This is, in fact, allowed to happen to others in positions of authority in other professions. We saw it happen in the case of Hillsborough: we saw people who should have been examined and possibly disciplined for their negligence in regard to that terrible event managing to escape by retiring at the appropriate moment. In this case, someone who may well have been involved—or at least had something to explain to the health authorities—has been able to escape, possibly by accident, through the simple mechanism of changing job and moving from one trust to another, which has removed her from any further investigation.
I do not believe that that is right. I feel that it should be addressed by the NHS as a whole, so that people such as Mr. and Mrs. Robinson and the other parents mentioned by my hon. Friends can be confident that the health service will not allow such things to happen again—or, should they happen again, will not allow those responsible to go unpunished.
Mr. John Butterffil (in the Chair)
Order. A number of hon. Members still wish to speak. It would be helpful if speeches were reasonably short, to allow time for the Minister to reply to the debate.
§ 10.8 am
§ Dr. John Pugh (Southport)
Like one of the earlier speakers, I have a family connection with Alder Hey: my brother was born there, and a young child received medical help there. Until the very recent and very sad events, Alder Hey had a sound reputation throughout the Liverpool area.
I thank the hon. Member for Halton (Derek Twigg) for raising this issue. One phrase has stuck in my mind—a reference in, I believe, the British Medical Journal to the spurious distinction between culture and individuals: culture can be blamed, but individuals cannot. I submit that that distinction has no validity. Blame cannot simply be laid on an anonymous culture; it must be embodied in the actions of individuals.
The Redfern report identified two necessary and important changes, which bear on individuals as well as cultures. As is widely acknowledged, there must be legislative change, but there must also be cultural change. What happened at Alder Hey was not simply a consequence of the behaviour of one rogue doctor; a number of people were implicated or involved, or overlooked what was going on—administrators, for instance, and the coroner's office. It is not simply the actions of that one particular doctor. The administration subsequently was not desirable. As a result of the incompetence of administrators, constituents of mine have had to suffer the pain of multiple burials of members of their family. No one would wish that upon anyone.
We must remember that there has been a police investigation and that reforms are promised which we would all collectively support—a new law on consent, a review of the coroner system and a review of management accountability. We would endorse that and be comfortable with it, but the question put by the 76WH hon. Member for Halton is whether there has been sufficient cultural change—whether it has really got home—and whether it is universal. That is what this debate appears to highlight best.
There has been an element of cultural change. I was speaking last night to Ed Bradley, who organised on behalf of parents much of the action that brought the sad events at Alder Hey to light. He is now working with the Institute of Pathologists in order to provide a better way of behaving and of proceeding, and to avoid the unfortunate aspects that have characterised Alder Hey—unfortunate is to put it very mildly.
However, there are other indications—the hon. Member for Halton has drawn them to our attention—that the cultural change has not bitten sufficiently. One mentions in that respect the comments in the British Medical Journal, where there seems to be an unwillingness to accept that to ask for appropriate disciplinary procedures is distinct from pure witch-hunting. There is a clear intellectual distinction that I think we would all support.
As I have said, I thank the hon. Member for Halton for securing the debate. If it serves any good, it is to highlight that there is some way to go in changing the culture. I hope that the Minister will bear in mind the fact that there is certainly some way to go in changing the legislation. There is work to be done there. Sadly, there is some way to go in apportioning blame.
§ Mr. David Watts (St. Helens, North)
I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing the debate. Many hon. Members have tried for some weeks to secure a similar debate to put on record our concerns and those of the parents who have contacted us over the past few weeks.
I pay tribute to Pity II, which has been campaigning for justice for that group of people for the past few years, and the solicitors who are acting on their behalf. I am not a lover of solicitors as a group, even though my son is one, but I believe that there are some good solicitors and the two who have been involved, Mr. Cohen and Mr. Makin, have done an excellent job in ensuring that the case is heard.
I would like to be associated with some of the comments about Alder Hey. There is no doubt that many parents throughout the north-west and a wider area owe their lives to the skill and dedication of staff at Alder Hey. There is no doubt that the current investigation and the controversy about what went on is having a tremendous effect on the staff who are still working at Alder Hey. The message from here is that we support those general staff, and we want that hospital to go from strength to strength and welcome the contribution that it has made over many years.
There is no doubt, however, that many parents have been let down by Alder Hey hospital and Liverpool university. We have heard a lot about the hospital, but it was a joint action. It would have happened only with the support of Liverpool university and Alder Hey. There was clear involvement of both medical and administrative staff in bringing about the problems.
No one should underestimate the grief that the parents felt. Anyone who has ever known someone who has lost a child understands that it leaves them with an 77WH emptiness and hopelessness. Often they cannot rebuild their lives. We cannot overestimate the strain, stress and profound effect that the death of a child, regardless of the age, has on a family. Therefore, it is possible to imagine what the grief would be like when they find out that the child they buried, or thought they buried, had had their organs removed without consent. The grief would refocus and they would not be able to get back to rebuilding their lives.
That is bad enough, but let us remember what happened. Even when those parents found out that their children's organs had been retained and they had a second burial for those organs, a third element of organs was left in either the university or the hospital, so they often had to have three burial services. That is a scandal.
Then the parents found out that the organs had been retained for no good purpose, that they had not been used for anything that was worth while. Therefore, not only have they gone through that traumatic experience, but they have found that it had no purpose. They were told initially that there was nothing wrong, it was normal practice and that they had no case. They were asked what they were moaning about. They were told that it was standard practice in hospitals and universities. They are very angry, and rightly so, to find out that their child's organs were retained without their permission.
The parents want to know the detail of the investigation. They want to know the detail of the administration disciplinary hearings that took place. A number of my colleagues have raised those issues. There are three administration staff at Alder Hey. One has been named today. The accusation is that that person lied to the inquiry and falsified documents. That person was then transferred to another hospital. If that is the case, it is another scandal. The one thing we need to know from the Minister is, if those allegations are true, is it acceptable for someone who has been found to do those two things to still be working in the NHS? The answer is no. I hope that the Minister will ensure that there is an investigation into that issue and that action is taken, if it is needed.
For those people who do not know, 76 doctors were referred to the General Medical Council for investigation to examine whether there was a case against them. Only a small number of those doctors are now going through the disciplinary hearing system. I was amazed when I met the GMC yesterday with my hon. Friend the Member for Halton to find out that the GMC cannot take action against a doctor unless it believes that he is unfit to practise—even if it believes that he has made a terrible mistake or misjudgment, it cannot take action. The proof has to be that he is not able to do his job and should have his registration papers removed. The test for whether action is taken against a doctor is too high.
In fairness to the GMC, it accepts that. I understand that it is campaigning for and has contacted the Government to say that it wants wider powers, to be able to take action below that threshold. That is right.
My experience is that self-regulation is no regulation at all. As a Member of Parliament, I have had dealings with the GMC before—I am sure everyone in the 78WH Chamber has. I have also had contact with the Office for the Supervision of Solicitors and even with the Association of British Travel Agents. When we try to get accountability into those professions and services, we find that we are dealing with people who are more interested in their members than the general public. The Government should take action to make those bodies independent and to ensure that, when they review issues regarding the public's interest, the public interest will come first.
§ Derek Twigg
On that last point, my hon. Friend may recall that I mentioned that doctors are now attacking the GMC too. We assume that none of the doctors is stupid. They obviously are not attacking it for no reason. Does he think that they are attacking it because they feel that it has been too hard on doctors and their colleagues, or do they want to give the impression that the GMC has been unfair—it must have been because the doctors are attacking it?
§ Mr. Watts
My hon. Friend raises an interesting point. There are two reasons for that. First, there is an arrogance in the medical profession. It believes that lay people, the ordinary public, should not be able to hold those groups to account. Secondly, it is trying to hide the facts of the case. It sets itself high standards, which we would all expect doctors to do, but it has failed in this case. It has failed in the investigation, failed to protect its good reputation and failed to take action to ensure that those events could not happen again.
I leave hon. Members with one thought. People believe that, after this scandal, the matter has been resolved, that accountability systems have been put in place and that legislation is on its way. I do not believe that it is. The purpose of the debate is to make sure that Ministers hear loud and clear that we want legislation on this matter, and that we want it quickly.
However, we must start to make sure that the good practice developed in Alder Hey following the inquiry is maintained throughout the system. Two weeks ago, a constituent told me that a hospital close to my constituency had retained organs without permission. It was not Alder Hey, and I shall not name it in this debate. I wrote to the hospital two weeks ago for an explanation, and have yet to receive one. I sent a fax yesterday, telling the hospital that I was taking part in this debate and asking whether there was any truth in the allegation.
So far, I have received no reply, so I take it that there is something in the allegation. If so, that demonstrates once again the arrogance and lack of accountability of the medical profession. I strongly urge my hon. Friend the Minister to take immediate action to ensure that the legislation is changed so that what happened at Alder Hey cannot happen again.
§ Sandra Gidley (Romsey)
I congratulate the hon. Member for Halton (Derek Twigg) on securing the debate. All hon. Members who have spoken have highlighted the human aspects of the story and, as politicians, we must take careful note of them.
I am sure that no one can fail to be horrified at the extent of what went on at Alder Hey. Most people will be familiar with the unfortunate story: a large number of 79WH organs were retained without parental consent, and that nightmare was exacerbated by the actions of van Velzen, which can only be described as bizarre. I make no excuses for him, but every profession contains some bizarre individual of whom no one is proud but who seems to get away with totally unacceptable behaviour. We need to make sure that the public are protected from those rare people.
Similar problems in other parts of the country have not received so much national publicity. For example, local hospitals in Southampton retained a large number of organs, and perhaps lessons should have been learned from their handling of the matter. They were proactive and honest about what had happened. They spent much time, effort and manpower talking and explaining things to parents.
In addition, the hospitals in Southampton apologised for what had happened. Members of the medical profession are not good at apologising and saying that they are wrong. My postbag would be halved if people occasionally could say, "I'm sorry, what we did was wrong."
However, I do not want to dwell on the past. The law as it stands is clear: organs should not be removed and retained for medical purposes after a coroner's post-mortem examination unless prior consent has been obtained. It is depressing to acknowledge that it seems to have been common practice to flout that law, but the important question is how we move on.
The hon. Member for Halton made some important points about openness in the NHS. I agree that the perceived culture is that everyone in the medical profession stands together. That often leads people to believe that matters have been covered up, and the GMC has come in for a lot of criticism.
I hope that such allegations will become things of the past. Last night, the House of Commons discussed the National Health Service Reform and Health Professions Bill, which will establish the Council for the Regulation of Health Care Professionals. I hope that the new council will take the best practice from all the different regulatory bodies, so that all such bodies perform their duties in a spirit of openness, and with greater transparency in their processes.
The hon. Member for Halton also referred to criticism of indiscriminate referral of people to the GMC. I stand to be corrected in this respect, but my understanding is that the referral of people to the GMC was indiscriminate, and that some of the people referred were doctors but were not in fact medically qualified. As the GMC deals with only the medical profession, it is therefore fair to say that some of the referrals were indiscriminate.
I am not an apologist for the GMC, but my view is that it can deal only with professional misconduct. It has no remit to deal with poor judgment, and that is why the people involved were let off. The key people involved were responsible for about 90 per cent. of the problem. What those key players did amounted to professional misconduct, and it is right and proper that they should be referred to the GMC.
There seems to be a general feeling in the debate today that everybody involved should be brought to book, even if they were only bit players. My question is, would that do anything to progress matters, and to make sure 80WH that the same thing did not happen in the future? I believe that that is what we, as politicians, should be concerned about.
§ Derek Twigg
I think that I heard the hon. Lady aright, and that she said that she considers that indiscriminate referral took place. Does she believe that Professor Donaldson, who undertook that referral, behaved unprofessionally?
§ Sandra Gidley
I am saying that I would question his judgment. Professor Donaldson thought that he was right, but I would question his judgment. Sufficient research to ensure that the correct people were referred does not seem to have been done.
§ Sandra Gidley
As I said earlier, the list of those referred to the GMC includes people who are not medically qualified. The GMC can deal only with medically qualified doctors. If that is not indiscriminate, I do not what know is.
I agree that the whole process is grindingly slow, as has been stated already. We must do all that we can to speed matters up, without sacrificing fairness. We must ensure that disciplinary action is swift and fair. That would be in the interests of patients, relatives and the medical profession as a whole. The "Doctor as God" culture is disappearing, thankfully, but it remains prevalent. I believe that it was present at Alder Hey.
The experience gives us a chance to ensure that a proper framework is in place so that we will never be in the same position again. Work has been done on a proper code of conduct, and I do not understand why legislation should be needed. Many hospitals have implemented that code of conduct, as they have no desire to become known as "Alder Hey 2". However, given the scale of the problem, I believe that legislation is needed, as there should be no possibility of anyone being able to get away with such malpractice in the future, and no excuse available if it happens.
§ Mr. George Howarth
I hope that the hon. Lady will help me on one point. Is she saying that, on the one hand, she does not think that legislation is necessary but that, on the other, there should be legislation for some other reason? I find that very strange.
§ Sandra Gidley
I am saying that it is a shame that we need to have legislation. In a perfect world—and I accept that we do not live in one—hospitals and doctors would be keen to put in place the right procedures. However, there can be no excuse for any recurrence of what happened at Alder Hey. For that reason, as a safeguard against people like van Velzen and others who are equally off the wall, we need to put legislation in place. I wish that that were not necessary, but we must protect the public. The system has been shown to fail and we must do something about that.
81WH Medical students and doctors are not trained to deal with such delicate matters. It must be extremely difficult to explain to a bereaved parent that the hospital might want to keep a child's organ for the greater good. If those matters are faced sensibly and sensitively, some parents might think it heartening that something good can come out of the situation. However, the secret and surreptitious way in which it was done meant that parents felt that their children had been violated. Medical students and doctors must have the training to ensure that that does not happen again.
Hon. Members have raised questions today about disciplinary procedures in hospitals. What plans does the Minister have to ensure that in future the hospital disciplinary systems are more effective and transparent, given that there have been accusations of cover-ups? That is not an issue solely for Alder Hey, but for all hospitals around the country.
§ Dr. Pugh
Is the hon. Lady saying that the lack of transparency at Alder Hey has made it difficult to operate a perfectly proper pathology and for the medical fraternity to feel that it is secure in doing things that would in the long term benefit children, parents and the community? In other words, has the lack of transparency and the attempts at a cover-up by some members of the medical profession harmed the interests of not only parents and communities but the profession itself?
§ Sandra Gidley
Almost definitely. The lack of transparency and doctors' unwillingness to share information and explain what is going on has a knock-on effect on everybody. We have to move towards a culture in which medics explain the problem and the situation and have a transparent disciplinary procedure, if such is necessary. In that way, the public can see what is going on and know that justice is being done.
It is fair to say that events at Alder Hey have had a knock-on effect on people donating organs. There has been a detrimental effect on the medical profession because it has not learned to move with the times and operate with greater transparency.
These are the issues that we have to address. I will finish now so that the Minister has time to address them.
§ Mr. Simon Burns (West Chelmsford)
I add my congratulations to the hon. Member for Halton (Derek Twigg) on securing this important debate. As we are all aware, it is more than two years since the tragic and horrific scandal that occurred at Alder Hey children's hospital became known. What took place over the past decade needs no explanation here; suffice it to say that the deeply disturbing actions of some at that hospital are the most horrific and distressing that I have heard about in our health system.
We cannot begin to know the pain and suffering that was caused to so many parents and their families by the callous, barbaric actions of a few at Alder Hey. That pain and suffering continues for far too many. As all hon. Members who have contributed to the debate have said, this is a deeply upsetting and disgraceful affair.
82WH It is also important to put this matter in context, as the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth) said in his speech. There was a culture at the hospital that involved some people, but we should, to be fair, draw a distinction and avoid making a sweeping condemnation of the hospital itself. Alder Hey has, throughout its history, pioneered significant improvements in surgical techniques and care, and has made a valuable contribution to paediatric medicine. Inevitably, Alder Hey will for ever be scarred by these cataclysmic events, but we must try to ensure that the work of the hospital is not harmed in the future because of the horrific events of the past.
There is no point in reliving the events surrounding this horrific case. We have all become familiar with them as the whole sad story has unfolded. Reliving what happened would serve no purpose today, especially in the light of yesterday's announcement that Alder Hey's chief executive has been found guilty of misconduct and of bringing the hospital into disrepute.
I would like an update on the progress in dealing with this case. Most importantly, can the Minister inform us of the progress that has been made with regard to the special commission that has been established to oversee the return to families of organs and tissues from around the country? It is essential that as much help and assistance as possible be provided to the families affected and that a proactive approach be taken to support them and endeavour to relieve some of the pain that they have endured over the past years.
The overriding concern of the families affected is to be able to put their children to rest so that they can try to move on with their lives. Until they can do that, there can be little relief for their bereavement. I fully understand that, owing to the nature of the case, such action is not easily achieved in all cases. That is the crux of why this case is so distressing. However, where finality can be sought, every effort should and must be made, and unparalleled assistance should be provided to ensure that it is.
Can the Minister inform us of the steps taken to ensure that all NHS trusts provide support and advice to families at the time of their bereavement? The spotlight is on Alder Hey, but it must not be forgotten that the unravelling of the events there has shown that this practice has been going on in varying degrees throughout the country. There are deeply distressed families elsewhere in the country as well as in the Merseyside area.
Can the Minister also inform us of the progress that has been made in the review of the coroners system, established following the scandal? The review was intended to inform us of the lessons we can learn from these events and thus help to establish safety mechanisms to prevent such instances from ever recurring. Linked to that is the wider review of existing law on all aspects of taking, storing and using tissue and organs from both the living and the dead. Many hon. Members have highlighted this issue, and I know that we all look forward to hearing what the Minister has to say on it.
Furthermore, there is the question of the Government's commitment to introduce legislation to make any necessary changes. Is the Minister in a 83WH position to enlighten us as to when that might happen? If that is not possible, does she have in mind a time scale that she can share with us?
I hope that the changes in the law will be supported by a new statutory code of practice that will cover organs used by the pharmaceutical industry. Can the Minister assure us that a standardised consent form to be introduced throughout the health service will accompany such a measure if one does not exist at present?
A number of hon. Members have also referred to the procedures and systems in place when it becomes apparent, following investigations, that someone has been grossly negligent in carrying out their duties or—with regard to some of the allegations that have been made in this debate—has allegedly sought to cover the tracks of the activities of some. I believe, as I think any reasonable person would, that those are very serious allegations. If I were a parent who had been affected and had had this appalling experience, I would want anybody who had been abusing the system or seeking to cover up such an abuse punished, and punished severely, not simply for the sake of vengeance but because of the degree and scale of the offence they had committed or the negligence for which they had been responsible.
I do not think it acceptable for people to be shunted around from job to job if they have been grossly negligent or inefficient in their job or have deliberately taken part in any cover-up. It is not good enough to say that, because someone has gone from one trust to another, nothing can be done to bring them to account—if the evidence warrants it. I hope that the Minister will look into that issue further if she is unable to say anything today about those concerns, which many hon. Members share. I have personal experience with my local trust of health care performance being of serious concern to health Ministers, and that was during the lifetime of the Labour Government. It could have been assumed that because certain members of staff had grossly failed, they would be removed from their jobs and would need to look for another job in another sphere. They were, however, shunted sideways to another job in the NHS. The lack of accountability for performance in the profession is extraordinary.
Everyone will agree that the case of Alder Hey is alarming and distressing. We must ensure that its consequences are dealt with swiftly and thoroughly, and with as much sympathy as possible. Above all, we must ensure that mechanisms are in place to change the culture, so that such events, which have caused so much grief and suffering to so many, can never happen again in our health system.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
I join in congratulating my hon. Friend the Member for Halton (Derek Twigg) on initiating today's debate. I have been involved for several months with the issues that have been raised by hon. Members. Some months ago, I visited Liverpool to meet many of the families, under the auspices of the Pity II group. I spent some time with them listening to their concerns, and they shared with me their grief, distress and anger at the events connected with the taking of organs without consent at Alder Hey. I discussed with 84WH the families the way forward and how we could develop mechanisms—through legislation, codes of practice, guidance and changes in the system and culture, as many hon. Members have mentioned—to try to ensure that other families are not put in a position similar to those families from Liverpool and the north-west region.
Last week, I was invited to join parents and relatives in remembrance of the children whose organs had been retained by the Alder Hey hospital at a memorial service held in Liverpool's Anglican cathedral. It was not possible to remain unmoved by such an occasion, but we need to try to keep a clear head to ensure that we take action in the future. That is what the parents want. They have to live with their grief and the damage that has been done to their families, and it will take many of them years to come to terms with what has happened. They want the Government to hear their concerns and to act upon them. That is the responsibility of Government and of politicians generally.
Everybody acknowledged that many of the children who died received first-class care at Alder Hey, and many hon. Members have today recognised the dedication of the staff. In Liverpool and across the north-west region, people respect Alder Hey for the top quality services that it provides. In the immediate sadness and grief after the death of their children, the parents took their bodies away and buried them in accordance with their cultural beliefs, but afterwards they felt let down by some of the people on whom they had relied. The parents felt that their trust had been betrayed in the light of subsequent events.
I understand why it is so difficult for these families to regain their trust in the medical profession. We all now know that organ retention was widespread throughout the NHS at the time. Although we have taken urgent steps to end that abhorrent situation, many parents are not yet ready for their confidence and trust to be restored in the organisations and, especially, in the individuals who let them down. It is up to us, as a Government, and the staff working in the NHS to try to win back that trust. That will take time to achieve because, as the Bishop of Liverpool said last Saturday, the familiesfeel betrayed, so much so that it becomes difficult to trust anybody in authority".It is our responsibility to try to heal the emotional wounds and, without forgetting the past, to put in place the practical measures that will begin to rebuild the trust of those families.
I am grateful to my hon. Friend for raising the issue, because it gives me a chance to update hon. Members on the progress that has been made since the Redfern inquiry, and on the recommendations of the chief medical officer and their implementation and development. I am hopeful that that progress will go some way towards restoring confidence in those parents and families. I am also grateful for the opportunity to place on record my thanks to the staff at Alder Hey hospital who have gone through some difficult times but have continued to care for families from across the region.
I know that families have felt frustrated in their quest for answers to some of their questions. I also know that they feel deeply that no family should ever again 85WH experience what they have experienced. It was the concerns about organ retention at Alder Hey that led the chief medical officer to conduct an investigation to see how widely that practice was followed in the NHS. That is why last year we issued the interim guidance— to which the hon. Member for Romsey (Sandra Gidley) referred—to ensure that in future there will be no ambiguity about the need to obtain consent for the retention of organs for the purposes of teaching, research or donation. That is also why we are preparing full guidance and consent forms, which are being piloted. The families have been fully consulted about the content of those consent forms and whether they are appropriate, sensitive, easy to understand and accessible.
We have to ensure that when parents consent to the retention of organs, they do so in the full knowledge of what is likely to happen to them. Hon. Members will recognise that some families are content for research to take place if they are provided with the full information. It is not that they do not want to co-operate. They know that the research can assist in preventing illnesses affecting children in the future, and that can be a tremendous testament to their own children. However, transparency, honesty and openness in dealing with families are crucial, as they mean that they can trust the profession in dealing with those matters.
The Redfern report made a series of recommendations covering serious incident procedures, the training and management of staff, record keeping, the development of audit trails, the roles of clinicians, the review of the coroner system, and the necessary review of the Human Tissue Act 1961, as well as the issue of consent. My hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) made an interesting point about the way we deal with serious incidents generally, not just those that happen in the NHS. We are poorly prepared for the emotional distress that arises from serious incidents. Over the past few years, we have seen several such incidents and I take seriously the need to learn the lessons from each of those events and to prepare an over-arching strategy, so that we do not try to reinvent the wheel. That strategy could include bereavement counselling, the role of the emergency services and contingency plans to support people after a serious incident.
When the report was published, we introduced a number of early measures that we could implement straight away. My right hon. Friend the Secretary of State established the retained organs commission to oversee the return of organs and tissue to families around the country. I have held several meetings with members of the commission, whose procedures are well established. They have kept in close consultation with all the families concerned, and have held several public meetings where families have expressed their point of view. The commission is fulfilling an extremely worthwhile role in ensuring the orderly return of organs, and in trying to minimise the distress suffered by many families who had to hold multiple funerals. Managing the process of return is an important part of the measures we have taken.
86WH The Home Secretary set in train a review of the coroners system. The Department of Health is keeping in close contact with the review. Tom Luce, a former head of social care policy at the Department of Health, has been appointed as chairman of the review, so there are clear links between the two Departments. It is crucial that the coroners review should not take place in isolation from the events that led to the need for the review.
One of the recommendations in the guidance from the chief medical officer was that we should consider new, non-invasive forms of post mortem and, where possible, use new technology, such as scanning, that can provide an authoritative cause of death. In some cases, there would thus be no need for an invasive post mortem, which would alleviate much of the distress experienced by families when such procedures are carried out on a child. The coroners review will be considering that recommendation.
The Secretary of State for Education and Skills has established a review of the joint contracts of employment between trusts and universities. The accountability of academic staff, through their contracts of employment, as between the university and the trust is a key issue, so it is an important part of the review.
A commitment was given to ensure that all trusts provide support and advice to families at the time of bereavement. An extensive mapping exercise is under way to assess existing bereavement services throughout the country—where they are patchy and where they need improvement—to ensure that every family has access, if they want it, to bereavement counselling and psychological support. From my personal experience with the families, I know that their psychological well-being has been affected by the events that they suffered, so it is extremely important to ensure that they have psychological support and counselling if they want it.
We gave a commitment to enshrine the concept of consent in law. Many hon. Members have asked when that legal review will take place and when legislation will be introduced. There was a proposal to publish a simple, two-clause Bill, but after examination it is clear that we need a wider and more comprehensive review of the Human Tissue Act. A consultation document is due to be published shortly; we are seeking the views of a range of people as to how we can strengthen the legislation on retained organs. We must ensure that we think the process through properly, that the right sanctions are implemented, and that our definition of "consent" is right.
§ Ms Blears
The consultation need not be lengthy, but I want it to be thorough because I want to get the legislation right, since this is such a sensitive matter. Obviously, the introduction of legislation depends on parliamentary time. That is why I told the parents that I did not envisage it in this parliamentary Session, but hon. Members can rest assured that I shall press extremely strongly for parliamentary time to enable a Bill to be introduced. We made a commitment to the families at the time of the inquiry, and we certainly intend to honour it.
87WH I have also undertaken to keep the families involved in the consultation process. Many of the problems in relation to retained organs have arisen owing to a breakdown of communication between people in authority and many of the families. The families have my personal assurance that I shall keep in very close contact with them.
§ Ms Blears
I want to deal both with the disciplinary procedures that have been taken against managers and administrative staff and with the GMC procedures. As hon. Members heard earlier, the former chief executive at Alder Hey has been dismissed. Members have expressed much concern, and indeed the chief executive was named in this Chamber today—as was Karen England.
§ Ms Blears
I understand that it was a summary dismissal, in accordance with her terms and conditions of employment, after the finding of misconduct. In those circumstances, there is not normally financial recompense. It is a disciplinary matter and the person has been summarily dismissed.
I understand that, in May 2000, Karen England was seconded to a temporary post at Warrington hospital for a period of up to six months, but in August 2000, before her suspension, she successfully obtained a substantive post at the Warrington hospitals trust. I also understand that that post was advertised externally, that references were taken up and that she was appointed through the usual recruitment procedures. It was not a case of her being transferred or, as one hon. Member said, "shunted", into an alternative post. She applied, references were taken up and she was appointed in the normal way.
All the disciplinary proceedings were conducted in accordance with the disciplinary procedures used in the various trusts. As there was concern as to whether the proceedings would be robust and rigorous, an external human resources adviser was appointed who had nothing to do with Alder Hey and who independently validated the procedures. Although I understand the anger, concern and frustration of the parents, the disciplinary proceedings were conducted in accordance with the individual contracts of employment and were externally validated.
I understand the desire of the parents to read the detail of those disciplinary matters, but as there is a legal mutual duty of confidence between employer and employee it is extremely difficult to put such matters in the public domain once the trusts have undertaken and resolved disciplinary proceedings. As there was concern about how the proceedings would be conducted, there 88WH was external validation by someone completely unconnected with the trusts involved. I hope that gives hon. Members some reassurance, but I entirely understand that concerns will remain.
I am pleased that the GMC is considering radical changes to the way it deals with fitness to practise issues. The Government are considering the GMC's proposals with interest and encouragement. As my hon. Friend the Member for Halton and other hon. Members said, the current system is extremely rigid: when someone is unfit to practice, one can either take action or do nothing. A halfway house system is proposed—the issuing of a yellow card to doctors that acts as a warning.
§ Ms Blears
Obviously, the regulation of the health care professions is governed by their regulating bodies. We want to ensure that we maintain that regulation system. Furthermore, the NHS Reform and Health Care Professions Bill proposes the establishment of a Council for the Regulation of Health Care Professionals. That would be the over-arching body that many Members want, and would consider how all the regulatory bodies function. For the first time, there will be a public interest element in the council, so that if a regulatory body takes a decision that is manifestly against the public interest, an independent body will be able to refer the matter to the courts for reconsideration.
That is a huge step forward. When I explained it to the families, they were extremely encouraged at the prospect that somebody could intervene when a decision was taken by a regulatory body that was clearly not in the public interest. I think that hon. Members will welcome that development. Furthermore, the adoption of a type of yellow-card scheme, so that action can be taken if similar matters arise in future, would also be an extremely positive way forward.
As many hon. Members have pointed out, the GMC has been criticised from both sides. The parents feel strongly that doctors have not been brought to account. Many doctors feel strongly that the chief medical officer was wrong to refer them. Our experience in this place makes us aware that we sometimes receive criticism from both sides, but that occasionally we may nevertheless tread the right path. Obviously, serious matters have arisen.
It is unfair to say that the chief medical officer referred doctors indiscriminately. He sent a copy of the Redfern inquiry report; it was then for the GMC to take action. Obviously, the CMG was concerned about doctors' behaviour in this case and referred the report.
The Government are taking these matters extremely seriously. I am grateful for all the contributions that hon. Members have made to the debate and I shall certainly take note of the suggestions and ideas that have been proposed. I hope that over the months to come we can begin to re-establish trust between the families that have been affected and the health service.