NHS Redress Bill [Lords]

As colleagues and Opposition Members have done, I welcome to his new role the Minister of State, my hon. Friend and neighbour the Member for Leigh (Andy Burnham). I am sure that he will do a great job. I welcome the Bill, which aims to ensure that patients and their families can obtain redress by way of an investigation, apology or compensation when something has gone wrong with NHS treatment or care. I particularly welcome the broadening of the scope of redress specified in clause 3 to provide for explanations and apologies. It is extremely important for a patient or a patient’s family to be offered an explanation and an apology when things have gone wrong. Like other hon. Members, in the 13 months since I was elected I have dealt with a number of cases in which the provisions of the Bill would make a considerable difference for constituents. One case stands out for me as a perfect illustration of a situation in which a patient’s family desperately need explanations and apologies. Many hon. Members are familiar with such situations among their constituents. In that case, there was inadequate and delayed diagnosis of a condition that was terminal, leaving the family feeling that the patient’s life ended prematurely and with little time for the patient or his family to prepare for his death. The family feel that the treatment and care that the patient received as a hospital in-patient were ““totally disgraceful””. I shall describe the case in a little more detail, as it shows the extent of systemic failure and why my constituent, Mrs. Dawn Smallman, feels that she desperately needs an answer and an explanation for what happened. Most importantly, the hospital in question needs to admit its errors and take measures to ensure that what happened to the patient, Mrs. Smallman’s father, does not happen to anyone else. Regrettably, the hospital seems unable to do that. The case is that of Mr. Stanley Collins, who died on 30 August 2005, three days after being discharged from the Royal Bolton hospital. Specific areas of complaint were raised by Mr. Collins’ daughter. Mr. Collins had a stomach cancer which proved terminal. It was finally diagnosed only a week before his death. He had, however, been attending the hospital as both an in-patient and an out-patient since October 2004 and had undergone colonoscopies, endoscopies, biopsies, scans and X-rays. There seemed to the family to be signs of a serious illness. Mr. Collins was in great pain, he was very ill for the last few months and he was anaemic, but hospital staff insisted, almost to the last, that his condition was neither serious nor terminal. Mr. Collins felt that his condition was not taken seriously. When he was taken in great pain to the accident and emergency unit, the triage nurse merely referred him to the unit’s on-call GP. The GP called for some tests to be done by the family GP to identify the causes of pain, but the request for tests was lost in the hospital’s administrative system. That was just a month before Mr. Collins died. A few times during the last two months of his life, Mr. Collins was admitted to the Royal Bolton hospital as an in-patient. During these stays, the family felt that he was treated very badly. They felt that he was neglected and left to suffer great pain and a lack of dignity. Many aspects of this inadequate patient care involve basic standards of care and professional practice. First, throughout the last weeks of his life, Mr. Collins suffered great pain, yet medical staff dealing with him did not respond with adequate pain control. His family tell me that they repeatedly asked for pain relief, yet observed that he was often kept waiting hours to be given that. Secondly, in Mr. Collins’ condition, he needed help at times—for example, to use a commode—yet even that help was not available when he needed it, although it is a basic aspect of care for the seriously or terminally ill. Thirdly, a ward where Mr. Collins stayed during the last few weeks of his life was described by his family as filthy, with dead insects and even toenail clippings not being cleaned away. Next, basic needs such as the provision of clean drinking water and a clean glass were not provided by the staff on the ward. Perhaps most serious of all was the way in which hospital staff dealt with Mr. Collins in the last week of his life. In this respect, lessons must be learned. A week before he died, Mr. Collins’ family attended a meeting at which the consultant was to give the diagnosis and prognosis for him. The news that Mr. Collins had a cancer that was now terminal, with no real treatment options, was delivered to him and his family on an open ward in the hearing of other patients and visitors. Indeed, Mr. Collins’ daughter found that the news of her father’s condition was overheard by a relative of a work colleague of hers. Mr. Collins had to ask how long he had to live in the hearing of other patients, and he was told that he had a very short time. Perhaps unsurprisingly, given that low standard of professional practice, hospital staff also failed to deliver the palliative and nursing care that might have made Mr. Collins’s last seven days of life more tolerable. With very little time to live, he wanted to be at home with his family, but even that was not handled well. First, it took from Tuesday to Saturday to get a hospital bed at home for Mr. Collins and for the palliative care consultant to arrange his medication. Secondly, hospital discharge was arranged on Saturday 27 August by emergency ambulance, but the ambulance never came. Eventually, Mr. Collins’s family came into hospital and found him left in a chair with no help with toileting, no pain control—his drip had fallen out and had leaked all over the floor—and no opportunity to summon help, because the emergency button was out of reach. Disgusted by that treatment, Mrs. Smallman and her mother, who is disabled, signed a form to discharge Mr. Collins themselves by car. Mrs. Smallman said that trying to bundle her father into the car was the worst thing that she has had to do in her life. Finally, hospital staff discharged Mr. Collins with oral medication rather than the intravenous medication that he needed. On a bank holiday weekend, the district nurses told Mrs. Smallman that it would be practically impossible to get the drugs that Mr. Collins needed for pain relief—it is, of course, particularly difficult to get oral morphine post-Shipman. Mrs. Smallman and her sister spent the bank holiday weekend, which comprised the last few days of their father’s life, driving around on-call doctors and dentists in Bolton trying to get prescription forms signed and to obtain the necessary permissions for the district nurses to administer the medication that their father needed. The district nurses who were trying to help Mr. Collins contacted the C4 ward of the Royal Bolton hospital, which told them that Mr. Collins was ““no longer their responsibility””. Mrs. Smallman has said:"““You cannot imagine the burden placed on us to get this medication in order to relieve his pain. There were times when he was in agony. You cannot imagine what it was like racing back to ""him with his medication, never knowing if you would be back in time or if he would die while you were out.””" On the day that Mr. Collins died, his GP visited him. Astonishingly, the hospital had sent no information on Mr. Collins’s diagnosis to his GP. On her father’s death, Mrs. Smallman has said:"““I wish I could say that his death was peaceful, but it was not—he died in pain with absolutely no dignity whatsoever””—" thanks, she feels, to the Royal Bolton hospital. Lack of information from the hospital even made it difficult for Mr. Collins’s GP to certify Mr. Collins’s death, as he had been sent no information about the diagnosis. Much of the evidence that I have recounted clearly indicates poor standards of nursing and medical care, bungled administration and very poor communication. However, the situation has been made worse over subsequent months by the inadequate response by the Royal Bolton hospital to complaints from Mrs. Smallman. Since raising her complaint with the hospital on 3 October, Mrs. Smallman has found that responses from the hospital have not been sent to agreed time scales and have often been three to four weeks late, that copies of responses have not been sent to me—I have had to chase every single response from the hospital—and that the responses have been inadequate, which is the worst thing for the family. The delayed answers and prevarication by those investigating the bereaved family’s complaints have left the family feeling more angry and upset. The family’s feelings of anger were originally due to what it regarded as undue delay in diagnosing Mr. Collins’s terminal condition and the poor standard of treatment and care that he received both in hospital and on his discharge home to die. In making her original complaint, Mrs. Smallman knew that nothing could bring back her father or change how he was treated. She raised the complaint to obtain explanations and an apology and to help prevent any other patient or family from suffering in the same way. It is clear to me and my constituent that the current system for redress is inadequate, and I welcome the change introduced by the Bill. Standards of professional practice were patently not met in that case. The Government cannot manage the practice of every NHS consultant, but we need to bring about a change of culture to allow acknowledgement when a whole system of treatment and care fails a patient and his family, which seems to have happened in this case. When standards of both professional practice and communication fail, we need a system of redress in the NHS which acknowledges and investigates such failures, explains what has happened and apologises to those affected. We know that cancer care is improving, but we also know that it is still patchy. It is more than three years since the Commission for Health Improvement report ““NHS cancer care in England and Wales”” highlighted the fact that some consultants have poor communication skills in giving bad news. What happened to my constituent’s father, Mr. Collins, and his family should be seen as an unacceptable standard in communicating such bad news. Indeed, good communication is a key part of the cancer plan. Cancer patients and their families increasingly want help to enable patients to die at home without pain and with some dignity, which did not happen for Mr. Collins, who died in pain and with no dignity. He did not receive the palliative care which he should have received and which many other patients now receive. The Healthcare Commission has reprimanded some NHS hospitals for failing to pay sufficient attention to complaints, and the number of complaints that went to independent review doubled in 2005. The commission felt that too many trusts were failing to respond promptly and effectively to complaints. That has unfortunately been the case for my constituent, Mrs. Smallman, in her complaint against the Royal Bolton hospital. There is still time for the hospital trust to change the situation and handle the complaint more effectively, and I hope that it will. I welcome the Bill and the new scope for redress, which will offer the explanation and apology that my constituent and her family need, and benefit other patients and their families.