§ Joyce Quin (Gateshead, East and Washington, West)
I welcome the opportunity to raise a matter of considerable local interest and concern in my constituency and the surrounding area. It relates to the grave failures and mistakes in the treatment of women over a long time in the gynaecology and obstetrics department of the Queen Elizabeth hospital in my constituency.
My hon. Friends from neighbouring constituencies have taken a great interest in the matter. My hon. Friends the Members for Jarrow (Mr. Hepburn), for Blaydon (Mr. McWilliam) and for Tyne Bridge (Mr. Clelland) have represented their constituents' concerns to my hon. Friend the Minister, the hospital and the local health authority.
Before coming to the substance of my remarks, I want to make it clear that I recognise the great improvements that have been made in my local hospital in recent years. Changes in management have been beneficial and the hospital has many excellent consultants who are supported by dedicated staff. The hospital is also a centre of excellence for some women's diseases. It offers screening services and carries out work on breast cancer. There is also a regional gynaecological oncology service. The issues are serious, but I do not want previous appallingly bad practice to undermine or tarnish the excellent work that is being done in many areas, or the progress that has undoubtedly been made.
I am glad that the Minister will reply to the debate and I know that she and the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith) took an interest in the petition that I presented to Parliament on behalf of my constituents. My constituents and those of my hon. Friend the Member for Jarrow have not had full or proper answers to their many questions over the years. My principal request is for some mechanism—ideally a public inquiry—to tackle those concerns.
As the Minister knows, Dr. Janusz Wszeborowski and Mr. Peter Silverstone have been struck off. Most of my constituents' grievances related to those two consultants. She will also know that the General Medical Council considered three cases, but not those under discussion; nor did it consider the eight illustrative cases that the current management of the Queen Elizabeth hospital submitted to it. I had hoped that the need for an inquiry would be removed if the GMC could consider those cases. The women concerned understandably feel cheated and let down by the fact that the GMC took action against the main doctors concerned, but did not examine their grievances and appalling experiences.
The transcript of the proceedings of the GMC against Mr. Silverstone relates to operations that he carried out in 1995 and 1998. Those operations were not carried out at the Queen Elizabeth hospital. What strikes me about the transcript is that the criticisms about how he carried out the operations are eerily similar to the complaints that my constituents made about operations that were carried out in previous years. That prompts the obvious question: why were the earlier complaints not investigated more fully and why was appropriate disciplinary action not taken then?
242WH The transcript refers to failures to record adequate medical histories of patients at pre-operative and postoperative stages and to arrange adequate assistance for a complicated operation. It also refers to the failure to provide appropriate medical aftercare and to recognise the limits of Mr. Silverstone's skill and professional competence and work within them. The conclusions show that those failures put patients at risk and justified his being struck off.
The Minister of State stated in a letter to me of 18 February, and in a letter of 29 October 2001 to my hon. Friend the Member for Jarrow, that there was a confidential inquiry into the workings of the obstetrics and gynaecology department. In April 1993, that inquiry concluded that there were no clinical issues that warranted formal action. She also stated that five complaints were received about Mr. Silverstone following the inquiry and between 1 April 1993 and 10 December 1993, that all were investigated and that none warranted formal action against him.
Some clear questions arise from those statements. Why was no formal action taken, especially since I understand that specific complaints led to compensatory out-of-court settlements in several cases? Was it not a matter for concern that, no sooner had one confidential inquiry been concluded, the hospital continued to receive similar serious complaints about the department in the months immediately following? I wonder how much compensation has been paid out over the years to women who complained about their treatment. I have a feeling that considerable sums have been involved. It would be good to have an answer to that question.
I could quote many distressing letters that I have received from the women concerned who, obviously, are very keen to ensure their anonymity, which I respect. Not all ' of them refer to treatment at the Queen Elizabeth hospital. Some refer to operations conducted in local private hospitals, and the concerns of those patients should also be addressed in an inquiry. One letter concerned a hysterectomy. The patient said:Mr. Silverstone performed a hysterectomy on me…a few days later I noticed a dreadful smell which was subsequently traced to the wound…the contents of my bowel were oozing through the stitches…I had emergency surgery performed by another doctor to repair the damage to the bowel which had happened during the hysterectomy…The resulting scars are horrendous and caused me problems which contributed to the break up of my marriage…I have also had to have subsequent surgery on both my bladder and bowel".
Another extremely distressing case concerned the death of a baby, caused by cerebral birth injury. An investigation was carried out into the case in 1992, a year before the inquiry mentioned in the letters sent by the Minister of State to me and my hon. Friend. Although it declared that the standard of care had fallen short of what was required, once again, astonishingly, no question of serious professional misconduct seemed to arise.
§ Mr. Stephen Hepburn (Jarrow)
I congratulate my right hon. Friend on securing the debate and taking the lead on a very important subject—gross injustice to people in our area. I support her call for a public inquiry. 243WH If the Minister put herself in the position of the people in the cases that my right hon. Friend outlines, I am sure that she, too, could do nothing but support that call.
§ Joyce Quin
I am grateful to my hon. Friend. I welcome the interest that he has shown in the matter on behalf of his constituents. Like me, he has had many female constituents affected by the problem, going back a number of years.
The numbers involved are considerable. When the trust set up a helpline in the wake of Mr. Silverstone's initial suspension by the GMC, some 85 women contacted the hospital complaining of their treatment. At about that time, several of them organised a support group and held meetings. They were surprised at the large numbers who attended. With the publicity given to the activities of the support group, the presentation of the petition and even to this debate this week, even more women have come forward and contacted me, my colleagues or the support group.
I pay tribute to the support group, its secretary, my constituent Debra Wilson, and her fellow members. Forming a group and putting forward concerns to the authorities has not always been easy. Many group members did not want to be in the public eye and were people not normally keen to complain. However, they have approached their task with purpose and determination and have been prepared to revisit experiences that they would otherwise have wanted to put behind them, to get concerns addressed.
I also recognise the efforts of the local newspaper, the Evening Chronicle, which has consistently backed the support group and its demands. In recent years, changes have taken place in the national health service that I hope will make a recurrence of such a situation. unlikely. The culture in which doctors and consultants are perceived as gods, never to be questioned, has diminished. It is also recognised that whistleblowing is necessary in certain circumstances, and should be welcomed, not condemned. It is accepted that the performance of individual consultants must be properly monitored. The culture of the royal colleges has changed—they perceive themselves less as protectors of members of their clubs and more as protectors of the public, which is what they should be. However, I would welcome comments from the Minister about any further measures to ensure that the failure to deal with such serious issues cannot recur, as well as to explain how the remaining unanswered questions can be properly addressed.
We are talking about a huge degree of physical and emotional pain. We are discussing the cases of women who have lost babies who might otherwise have survived. Some women are unable to have normal, satisfying physical relationships with their husbands and partners because of the physical damage that they have experienced. We are considering appalling mistreatment that should never have occurred, which should have been exposed and stopped much earlier. My constituents want answers and justice. As Members of Parliament, my hon. Friends and I are determined to see justice done, however belatedly. I urge the Minister to respond positively today.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
I congratulate my right hon. Friend the Member for Gateshead, East and Washington, West (Joyce Quin) on securing the debate and raising an issue that is important not only to her constituents, although the graphic illustrations of the damage caused are hugely moving, but to everyone who wants to ensure that patients get the highest possible quality of care from the NHS. I also recognise the concern and interest shown by my hon. Friend the Member for Jarrow (Mr. Hepburn) on behalf of his constituents. It is important that such matters are raised in Parliament so that they are properly aired and addressed by all of us. They are important to us all.
I am aware of the petition that my right hon. Friend presented to Parliament on 18 December, which highlighted the mistreatment, negligence and misconduct of consultant Peter Silverstone and Dr. Janusz Wszeborowski and alleged a subsequent cover-up by the Queen Elizabeth hospital authorities. Those are very serious matters. I hope that I can deal with them and outline some of the improvements made in my right hon. Friend's local hospital—as she has generously acknowledged—as well as some of the national steps that the Government are taking to ensure that examples of poor practice are caught early and do not recur.
When such events occur, it is crucial that we learn lessons from them. We must ensure that systems are put in place to ensure that other people do not suffer the sort of damage that may have occurred. Although Dr. Wszeborowski was struck off the medical register by the General Medical Council in January 2001 and Mr. Silverstone was struck off in August 2001, the events that led to today's debate go back as far as 1993. The matters in question have been the subject of concern for many years.
§ Joyce Quin
It is true that inquiries relating to those two doctors took place in 1993, but the Minister should consider that some of the cases brought to my attention go back as far as 1979. We are actually considering a period of about 20 years.
§ Ms Blears
I am grateful to my right hon. Friend for clarifying the matter and illustrating how long it has been causing concern to her constituents and other members of the public. I highlighted the length of time during which it has been investigated to show how long it has taken—in the past rather than now—all the regulatory authorities to deal with it. It is not satisfactory when that takes years and years. Many of our reforms of the way in which the GMC operates are designed to speed up some of the processes so that an inordinate length of time is not taken to deal with poor practice. My right hon. Friend now tells me that the matter goes back even further than 1993, which adds to our concern about the length of time such matters are allowed to drag on.
Mr. Silverstone worked at the Queen Elizabeth hospital as a consultant obstetrician and gynaecologist for 17 years before retiring in 1993. While employed by the trust, he was part of a team of doctors working with Dr. Wszeborowski. The trust received five complaints 245WH about Mr. Silverstone between 1 April 1993 and 10 December 1993 when he retired and those are some of the complaints to which my right hon. Friend referred. All the complaints were investigated. Two were upheld and related to Mr. Silverstone's rudeness—he was brusque and abrupt with patients. He denied that he had been, but offered personal apologies to the women concerned and also offered to meet them. Those were the sort of complaints involved and it is important that my right hon. Friend is aware that those that were upheld related to his lack of personal skills in dealing with people and his attitude rather than to clinical incidents.
Of the three remaining complaints, two concerned Mr. Silverstone's attitude and one related to treatment he had performed, but they were not upheld. The complaints that were upheld concerned attitude and behaviour rather than treatment, which is why it was decided that none warranted formal action. Like my right hon. Friend, I was concerned that there had been five complaints and no formal action to implement disciplinary procedures. I am informed that the complaints that were upheld concerned rudeness and brusqueness in Mr. Silverstone's attitude rather than treatment.
§ Joyce Quin
It is true that the complaints that were upheld related to behaviour rather than clinical practice, but other complaints made by women, many of which have been settled out of court, concerned appalling clinical treatment that resulted in physical injury and sometimes the loss of a child's life. Those complaints were also dealt with much later by the GMC and there are serious question marks about the clinical treatment that was administered as well as the behavioural offences to which my hon. Friend referred.
§ Ms Blears
I am certainly not trying to minimise the impact of the clinical or behavioural incidents on my right hon. Friend's constituents. They are serious and if she wants to raise any matters that remain of concern to her constituents I shall be happy for her to raise them individually with my Department. She has referred to clinical issues that resulted in compensation and it would not be appropriate in this forum to go into the details of legal cases and levels of compensation, but I would be happy for her to contact me about outstanding matters of concern and to provide further information so that we may examine them again.
After the inquiry into the complaints that were made about Mr. Silverstone, he was retired in December 1993. It was only in January 2001 that the GMC's interim orders committee suspended himin the interests of public safetypending an investigation relating to the circumcision of babies. He had been carrying out that work in a private capacity after his retirement from the Queen Elizabeth hospital and it did not relate to his activities in the trust. He was struck off the medical register by the GMC on 24 August 2001. As the investigation dealt with offences that were committed during his private practice after he had retired from the trust, there was not an opportunity for matters relating to particular women patients to be fully explored and considered.
In 1996, colleagues in the trust's department of obstetrics and gynaecology raised questions about some aspects of Dr. Wszeborowski's work. The investigation 246WH that followed revealed a history of patient complaints about rough handling during examinations and deliveries. He was suspended from duty in September 1997 pending action by the trust under its disciplinary procedures. He reached retirement age and left the trust's employment in December 1998, but following a referral to the GMC's fitness to practise directorate by the trust, he was also struck off the medical register.
The time that it takes to deal with those matters in disciplinary terms and through GMC procedure is an issue because it allows people to retire from service. It is difficult to explore such people's actions because time, in a sense, overtakes events. In that case, Dr. Wszeborowski left the employment of the trust in December 1998, some years prior to being struck off by the GMC.
Following the GMC's decision to strike Dr. Wszeborowski off the medical register, the Gateshead health trust set up a telephone helpline for patients who were worried about treatment they had received from him. The line was subsequently extended to former patients of Mr. Silverstone after he was suspended by the GMC, to ensure that as many women as possible were contacted and offered support and counselling.
As my right hon. Friend said, 85 women called the helpline to discuss their concerns. After those initial calls, obstetricians, gynaecologists and senior midwives reviewed their cases and every woman was called back within three weeks. Everyone was offered an opportunity to meet with a consultant and a senior midwife, who was the trust's service manager for obstetrics and gynaecology. The consultant and senior midwife met with 36 women, a further 10 women discussed their cases with the consultant over the telephone and three received advice from him by letter. Fast-track appointments were made for 13 women who needed further treatment.
The trust also allowed those women immediate access to their medical records without having to follow the formal process and five women took up that offer. It also offered independent counselling and support to all the women, although in the event only one woman took that up. It took a number of wide-ranging steps to ensure that as soon as it was alerted to the problems that those women had experienced, they were offered not only counselling and support, but the option of further treatment and a proper review by other consultant obstetricians and gynaecologists.
As my right hon. Friend acknowledged, the trust has made substantial improvements in recent years to its obstetrics and gynaecology services. There is a new consultant, Mr. Mani Das, and five more consultants have joined him since he was appointed. A number of new services have also been introduced. Now, a multidisciplinary clinical audit process that involves all staff regularly reviews their practice to ensure that there are no further examples of poor practice. There are new guidelines and protocols for the treatment of all pregnant women, including a fast-track, one-stop service for women with menstrual problems and an early pregnancy unit to deal with any abnormalities. There is also a robust risk management structure. All clinical and non-clinical incidents are thoroughly investigated and any improvements are immediately initiated. Those innovations have been well received by patients. The 247WH obstetrics and gynaecology department was ranked highly when assessed last year and is an example of good practice.
Teaching and training systems in the hospital were reported to be "excellent" following a visit by the Royal College of Obstetricians and Gynaecologists in 1999. That demonstrates that women can be assured that under the new team in the Queen Elizabeth hospital they will receive the best treatment and care during pregnancy and the delivery of their children.
The women who have been affected have been through a distressing time. The vast majority of staff in the NHS do a first-class job and this is a rare case of poor practice. It is vitally important that we have systems to pick up such cases quickly, which can act to stop them from happening. That is why on 1 April 2001 we introduced annual appraisals and work reviews for all doctors. They will ensure that doctors meet the high standards of their profession. The Government have new powers to enable the GMC to suspend doctors immediately when serious concerns arise about their performance. We are also introducing a mandatory reporting system for failures in the NHS, so that lessons are learned and mistakes not repeated.
We want to establish fast, fair and effective procedures to resolve problems of poor or unsafe practice and to avoid situations in which patients are left unprotected because no intervention is made to stop a doctor practising until a case is investigated. In the past, cases dragged on for a long time and doctors were allowed to continue practising while investigations took place. We want to ensure that that does not happen in future. We also want further to reform the way in which the GMC works to ensure that it is fast, fair and effective and puts the interests of patient's first.
We have established the National Clinical Assessment Authority, which is a central element of our work on quality. It will provide advice to employers in cases in which they are concerned about the clinical practice of doctors. It will not be an employer or regulator, but will help employers to assess doctors by 248WH carrying out an objective assessment of a doctor's performance. That is an innovation to address the performance of doctors. Following such assessments, the NCAA will advise the trust or health authority on appropriate courses of action. That should speed up the system quickly to deal with poor practice.
For the first time, we are involving lay people in such procedures, which will give patients a real voice in ensuring that doctors meet the highest possible standards. We will provide support for doctors who are ill, suffering stress or whose practice has deteriorated owing to the pressures on them. We want to support them to allow them to continue to care, while also protecting the interests of patients.
We are issuing guidelines on gynaecology and obstetrics to ensure that every trust in the country provides high quality services. I acknowledge that those new improvements do not address the deep concerns of the women in the cases that were described by my right hon. and hon. Friends. Those cases, particularly those described in the extracts read by right hon. Friend, are incredibly distressing and moving and indicate her severe concerns and those of other hon. Members.
I have seen no evidence of a cover-up by the trust, however, and have been informed that detailed investigations of complaints and subsequent determinations were made. Steps were taken to ensure that all the women who had been involved in allegedly poor treatment had access to a helpline, counselling and further treatment. If my right hon. and hon. Friends remain concerned, I would welcome further details being sent to my Department, so that we can take another look at the matter. I recognise that the cases are of extreme concern to the women involved.
I emphasise that we are ensuring that doctors provide good quality services throughout the country to all patients. We are determined that the procedures and systems will be fast, fair and effective for everyone. Patients must be protected and I welcome further information from my right hon. Friend.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Two o'clock.