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Birmingham Specialist Community Health NHS Trust
12.59 pm
Dr. Lynne Jones (Birmingham, Selly Oak): I would
have preferred not to have to secure this debate. The serious matters to which I will
refer are complex and cover a lengthy time scale. I must apologise for the tortuous events
that I shall describe, but I must put them on record because there are serious failings in
the system of investigating complaints about clinicians and managers in the NHS.
My involvement began at the end of October 1998, when my
hon. Friend the Member for Cannock Chase (Dr. Wright) passed on some correspondence he had
received from Dr. Imad Soryal, who is a consultant in rehabilitation medicine, about
clinical practice at Hillcrest ward 3 unit at Moseley Hall hospital in my constituency.
The documents included eight-month-old correspondence from the then clinical director of
the unit, Dr. Steve Sturman, which was addressed to the unit's clinical manager. There was
also an account of an incident on 2 October in which a patient, Peter Collins, was subject
to degrading and inhumane treatment, including being denied bowel care for six and a half
hours. I undertook to pursue the serious issues raised in those documents.
Although I was familiar with Moseley Hall hospital, I did
not have any specific knowledge about the service provision at Hillcrest ward 3. My
initial response to the correspondence was to make an unannounced visit on 9 November
1998. I found nothing untoward during the short time that I was there, although I noted
that there were a number of empty beds. I subsequently received a letter from the general
manager, John Wells, inviting me to meet him and Dr. Jim Unsworth, who had taken over as
clinical director.
While the meeting was being arranged, I phoned Dr. Soryal
to inform him that his correspondence had been passed to me and to question him about its
contents. I particularly wanted to clarify the relationship between Dr. Sturman and Dr.
Unsworth, and I was told that Dr. Sturman had given up his role as clinical director
because there had been insufficient progress in taking up his suggestions to improve
matters that he had raised with management. Dr. Soryal also explained what happened when
he became involved as on-call consultant in the case of Peter Collins, a patient who had
had a large brain tumour removed.
I wrote to Dr. Sturman to inform him that I had seen a
copy of his letter. I asked him what response he had received to it, and whether he was
satisfied that his concerns had been appropriately and adequately addressed. I also
contacted South Birmingham community health council to ask what it knew about the unit. I
was sent a note prepared by its then chair, which seemed to support the concerns expressed
by Dr. Soryal and Dr. Sturman. The note stated:
The community health council had raised its concerns at a meeting with Birmingham
health authority on 21 September 1998, when it was promised that it would be sent a copy
of the service specification. In fact, that document was never sent. I finally got hold of
a copy in
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April 1999, and passed it on to the community health council. Subsequent events
demonstrated that the service specification was not being met.
I took up the invitation to meet Dr. Unsworth and John
Wells, the general manager, and Dr. Unsworth explained the work of the unit, which
provided care for adults under 65 who suffered from degenerative conditions such as
multiple sclerosis, acquired impairment and traumatic and non-traumatic brain injury. They
both denied that bed occupancy was low and Dr. Unsworth dismissed clinical psychology and
other issues that Dr. Sturman had identified as important. I was informed that in relation
to the incident involving Mr. Collins, there had been an internal inquiry and that the
main issue had been the professional conduct of one member of staff, who turned out to be
Dr. Soryal, although he was not mentioned by name. Dr. Unsworth informed me that he knew
where I had obtained my information and that he also knew that staff who had left the unit
bore grudges. Dr. Unsworth and Mr. Wells suggested that I contact the clinical manager,
who later turned out not to be clinically qualified, with various other queries, so I
immediately wrote to her requesting information in advance of our planned meeting, which I
had arranged but later cancelled after no information was forthcoming.
After it became known that I had visited Hillcrest ward 3,
a member of staff on the wards, who was anxious that her identity should not be revealed,
contacted me. She gave me a copy of an anonymous letter that had been sent to the former
chief executive of the Southern Birmingham Community Health NHS trust in 1995. The main
grievance was the imposition of 24-hour contracts that would make it difficult for nurses
to plan family life. It was also stated that in the staff's view the way in which the
changes had been implemented would make it difficult for them to voice their grievances or
identify a member of the management structure to whom they could express their concerns.
Management abused their authority by unilaterally imposing
on the organisation a major change that caused some members of staff to fear victimisation
if they expressed their opinions. Loss of staff morale was mentioned, as was their ability
to care effectively for patients. Concern was also expressed about inadequate cover by
trained staff on duty between 9.15 pm and 7.45 am. I was given the names of former staff
who might discuss with me their experiences on the unit that indicated intimidation of
staff and patients. I should make it clear that it was not the person who gave me the
anonymous note who provided those names.
Copies of complaints from former patients were also given
to me, including one that referred to poor treatment, racism and an attempt by Dr.
Unsworth to undermine Dr. Sturman. Those events occurred long before Dr. Soryal appeared
on the scene. I also received two replies from Dr. Sturman which made it clear that he
never received a written response to the detailed concerns expressed in the letter that
was included in the bundle given to me by my hon. Friend the Member for Cannock Chase. Dr.
Sturman said that he had been disappointed to be told--presumably by the clinical
20 Dec 2000 : Column 164WH
manager--that an early meeting to discuss his letter would not be possible, although he
added that he was able to conduct a few training sessions for nursing and therapy staff.
Dr. Sturman said that he was saddened not to have been able to make more progress during
his time as clinical director.
I obtained a copy of the investigation of the incident of
2 October involving Mr. Collins to which Dr. Unsworth had referred. The investigation was
conducted by Dr. Alistair Main, clinical director of services for the elderly, and a
senior personnel officer. The acting chief executive wrote to tell me that he had
discussed the report with the director of personnel, and with Dr. Unsworth in his capacity
as medical director of the trust--a post that he held in addition to those of clinical
director of Hillcrest and medical director of the regional rehabilitation unit. After
seeking legal advice, the approval of the chairman of the trust was obtained to institute
intermediate procedures for the discipline of consultant medical staff and the consultant
in question was to be Dr. Soryal. Dr. Main concluded that the way in which the matter was
handled by the nurse manager, whose conduct Dr. Soryal had complained about, could not be
criticised, but Dr. Soryal was criticised for poor professional judgment.
Dr. Main's report proved to be extremely one-sided. He
did not interview Mr. Collins or his wife. By that time, Dr. Unsworth had moved Mr.
Collins, without notice, to a local nursing home. He subsequently received proper
treatment at Rivermead rehabilitation unit in Oxford. Dr. Unsworth's judgment of Mrs.
Collins suggested that she refused to believe that her husband was cognitively impaired,
or that he had shouted and used abusive language. Her supposed lack of acceptance of his
cognitive and frontal lobe defects was the crucial factor in events leading to the
breakdown in confidence between the nursing staff, Dr. Unsworth and Mr. and Mrs. Collins.
It was those events that led Mr. and Mrs. Collins to make complaints. It was also
suggested that Mr. Collins bore responsibility for not accepting bowel care early in the
morning.
I have not discussed the details of Mr. and Mrs. Collins'
complaint because it is subject to a separate and on-going complaints procedure. I have
read Mrs. Collins' formal complaint, and Dr. Main's interpretation is a travesty of the
views expressed in it. Mrs. Collins, who is a graduate psychologist, in fact demonstrates
rather greater insight into her husband's condition than the professionals who were
supposed to be caring for him. She offered to assist ward staff, as she was trained in
lifting and handling, but her offer was rebuffed.
It subsequently became clear that the evidence given by
the nurses and the registrar was heavily influenced by behind-the-scenes intimidatory
pressure. Nevertheless, despite its inadequacy, Dr. Main's report offered some interesting
insights into the running of Hillcrest ward 3. The nurse manager, who was on G grade, was
able to select which patients were accepted on to Hillcrest on the basis not of clinical
need, but of her perception of their suitability for the unit. She was able to transfer a
patient from one ward to another without consulting his consultant or family and was able
to control the information that was given to certain consultants. She had advised Dr.
Sturman not to talk to the family. The
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clinical manager, who had a background in occupational therapy, was able to influence
the psychology services that people needed, which seemed to be none at all, despite the
views of the former director, Dr. Sturman, to the contrary. Those views were ignored.
Alistair Main took no steps to help staff who felt
intimidated to come forward and give evidence confidentially, although he was aware of the
anonymous letter, which he dismissed. He said that he had no time for staff who made such
accusations but who wished to remain anonymous for fear of losing their jobs. No attempt
was made to investigate the grievances that were raised, yet that could have been done had
there been the will to do so. On the positive side, Dr. Main did at least request a
non-punitive and constructive inquiry into the unit by an individual or team from a
similar specialist rehabilitation unit and a list of sensible issues to be reviewed. To
cut a long story short, I pressed for such an inquiry, which was eventually agreed to.
I must add that at no point was I acting on behalf of Dr.
Soryal, who was being advised by his BMA representative. My concerns were solely about the
services offered to patients. I have kept the documents that were sent to me and were
confidential in relation to other people who contacted me.
The independent inquiry was a model of good practice. All
senior and middle grades of staff on the unit were interviewed, as well as 50 per cent. of
the junior staff--who were randomly chosen--and interviews took place away from the unit.
I began to receive feedback that staff were pleased at the way in which the inquiry was
being conducted and felt confident enough to express themselves.
During the inquiry, which was chaired by Professor
McLellan of Southampton general hospital, members of the panel were so worried about the
possible maltreatment of staff and patients that they felt obliged to tell the chief
executive of their most acute concerns. As a result of that information, the G grade nurse
manager was suspended. In its full report, the inquiry team recommended that the nurse
manager's suspension should be confirmed and that she should be formally investigated for
oppressive and unprofessional practices. The team also recommended that the post of
clinical manager should be discontinued and that Dr. Jim Unsworth should be replaced as
clinical director of the unit, while continuing in his role as director of the West
Midlands Centre for Rehabilitation, of which the unit is a key component. As a result, two
female staff were suspended from work and Dr. Unsworth was suspended from his role as
clinical director. Formal disciplinary inquiries were then instituted using internal trust
procedures.
Contrary to the view that my hon. Friend the Minister
expressed in a letter to me--I am not sure where she obtained the information--I had no
criticisms of the independent inquiry or its conclusions. The McLellan report exposed the
inadequacy and bias of the earlier Main report. That is an important point, to which I
shall return.
I was approached with further allegations about
inappropriate behaviour on the part of Dr. Unsworth, but this time the complaint was
unrelated to Hillcrest ward 3. The complainant was an orthotist, Alan Drew. He had already
submitted a formal complaint about
20 Dec 2000 : Column 166WH
Dr. Unsworth to the General Medical Council, but it was unsuccessful because the
allegations did not impinge on Dr. Unsworth's competence to practise as a doctor. I add
that that has never been in question. I advised Mr. Drew to put his concerns in writing
and contact his Member of Parliament to request that they be investigated. Mr. Drew did so
and sent me a copy of his correspondence.
On 21 February, I wrote to the outgoing chair of the
former trust, to inform her that I had received feedback to suggest that some more senior
staff--whose evidence would be crucial in the disciplinary process that would follow the
inquiry--might feel that silence would be the best policy if their career progression was
not to be damaged. I also sent a copy of a letter dictated by Dr. Sturman in February to
Dr. Unsworth, which enclosed a copy of his letter to the clinical manager, to which I
referred earlier. Dr. Sturman stated that, because of his overcommitment, he felt unable
to provide a safe or adequate service to his patients, adding that he was prepared to
carry on with the clinical director's brief for a little longer.
Dr. Sturman stated, however, that if there was little
positive response to the letter to the clinical manager, he would have to conclude that
she and her colleagues did not want to work with the clinical director structure, and that
there was little point in carrying on. He was looking for evidence of change within two
weeks, and would then stop using the service because, he said, it was clearly morally
wrong to use it when there were such grave concerns about its efficacy and organisation.
That judgment was vindicated by the McLellan report. Dr. Sturman also told Dr. Unsworth
that any complaint or legal action would be indefensible, yet no action was taken in
relation to Dr. Sturman's concerns.
I enclosed the correspondence from Alan Drew with my
letter. On second thoughts, I felt that it needed further investigation and should be
taken into account before any conclusions were drawn about the possibility of disciplinary
investigation into Dr. Unsworth's conduct. I copied the correspondence to my noble Friend
Lord Hunt of Kings Heath at the Department of Health, and to the chair of Birmingham
health authority.
The chair advised me in response that Dr. Sturman had
discussed his letter of 23 February during his interview with the team investigating what
disciplinary action might be justified. The internal audit service was to investigate
financial allegations made by Mr. Drew, and there would be an investigation into other
allegations. I subsequently learned that the investigation was to be carried out by none
other than Dr. Alistair Main. Despite misgivings, I accepted assurances that the outcome
of the independent inquiry had resulted in Dr. Main reappraising his earlier efforts. I
was reassured by the acting chief executive that the inquiry would be open and
objective--but I should have known better.
When it was eventually announced that disciplinary action
was felt appropriate against two members of staff, but not Dr. Unsworth, I was surprised.
Sylvia Fry, who conducted the investigating interviews, told me that Dr. Sturman and Dr.
Unsworth had said that the concerns in the 1998 correspondence had been tackled. I did not
feel that to be credible, considering the contents
20 Dec 2000 : Column 167WH
of the McLellan report and the appalling treatment to which we know that Mr. Collins
was subsequently subjected.
I had also had access to three of the statements
collected by Sylvia Fry and had spoken to another individual who had not yet been
interviewed. Also, of course, there was the Alan Drew complaint, which was completely
separate. I was told that his allegations had been thoroughly investigated, but how could
the investigation have been complete when he was not even interviewed? I have gained
evidence that that inquiry, again conducted by Alistair Main, was far from thorough.
I think it important to read a copy of the letter that
Alistair Main sent to one of the witnesses. It states:
I have been asked to investigate a recent complaint by your colleague
Alan Drew, made in a letter to his MP with the encouragement of Lynne Jones. I have been
asked specifically to look at documentary evidence around Alan Drew's association with the
RRC-- the regional rehabilitation centre--
over a number of years, to ask for the views of those working most closely with him...to
make a judgement about whether there is a case to answer. In a sense this is raking over
old coals following Drew's submission to the GMC in 1998 against Jim. The GMC decided to
take no action but the recent letter to the MP... has been circulated in high places and
the Chairman of BHA-- Birmingham health authority--
is taking a keen interest in the matter.
I would value your written comments... about anything you consider to be relevant to Alan
Drew's relationship with colleagues at the RRC, and specifically around the Coventry
issues contained in the attached extract of Drew's letter to the MP. I can say that the
RRC's managers' views of events are in stark contrast to Drew's.
Despite the leading nature of that letter, I know that the response that was received
confirmed some of Drew's allegations and concluded that there might be some substance to
the complaint, and that it might need to be investigated. Cynthia Bower, the new chief
executive of the new Birminghamwide trust, which replaced the old community trust, tried
to assure me that the investigation was thorough. To be as charitable as possible, I can
conclude only that what she said must have been based on assurances that she did not
bother to check.
I have been very concerned about the behaviour of Cynthia
Bower since she took on the job of chief executive of the new Birminghamwide trust. Her
behaviour seemed to lack insight into the situation that she had, unfortunately,
inherited. For example, on her first visit to Hillcrest ward 3 on taking up her position
as chief executive, she was accompanied by Dr. Unsworth, despite the continuing
disciplinary inquiry. Dr. Unsworth was seen to be influencing the manner in which the
trust implemented the McLellan recommendations on the future of the unit, even though
McLellan had recommended that he should not have a role. Cynthia Bower's memorandum to
staff included the information that she and Jim Unsworth would begin work to redefine the
new director post, thus implying that he still had a hands-on role in relation to the
future of rehabilitation services. Other consultants felt excluded from the process.
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Cynthia Bower seems also to have been unaware of the
impact of Dr. Unsworth's announcement in March that he would be leaving the trust--an
announcement that was mentioned in the trust board's April minutes and in her circulars to
staff--while failing to submit his resignation. That did not come until September. He was
not then required to work out his three months' notice and he received full pay. Dr.
Unsworth is seen to be close to the chief executive, who is a close friend of his partner.
In view of this, I believe that the chief executive should have taken greater care to
dissociate Dr. Unsworth from any future developments at Hillcrest ward 3.
I wrote to Cynthia Bower informing her that I found it
remarkable that the investigation should have found sufficient evidence for action to be
taken against the nurse manager and the clinical manager but not enough to justify action
against Dr. Unsworth. I told her that all the feedback that I had received would suggest
that he was more than aware of the way in which those two individuals ran the ward. I had
received accounts from independent sources of how they would collectively humiliate Dr.
Sturman. We know that Dr. Unsworth was fully aware of the contents of Dr. Sturman's letter
of 23 February 1998 and his grave concerns about practice on the unit. All the evidence
suggests that no action was taken to deal with those concerns.
I quoted the McLellan report, which stated:
A few of the consultants felt that they were often undermined
inappropriately by the Clinical Manager and the Senior Nurse Manager. It also said:
Junior medical staff felt ward and nurse managers treated them poorly and they...felt
humiliated by the way the Nurse Manager and the Clinical Manager treated them. It added
that those staff felt they
did not get any support from Dr. Unsworth. Another extract that I quoted noted that
Staff did not feel able to challenge bullying of individuals by Ms Millman because Dr.
Unsworth and Ms Colbear would always support Pat Millman.
I mentioned that, according to the report,
Staff complained to the enquiry that Dr. Unsworth-- and the
physiotherapist partner to the nurse manager--
had arraigned and threatened nursing and medical staff for having given testimony that was
responsible for the nurse manager's suspension. In addition, I included the following
passage, stating that the nurse manager
could not have established such an effective regime for suppression of innovation and
taken it to such extremes without the unwavering and ill-judged support of Dr. Unsworth
and the clinical manager.
The report also stated:
Mr. Deputy Speaker : Order. I hope that the hon. Lady realises that only seven
minutes remain in which the Minister may contribute. This is supposed to be a debate.
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Dr. Lynne Jones : I am drawing to a close, but I
must put this matter on record. The report that I quoted mentioned
medical staff in rehabilitation medicine, who despite their
professional autonomy would, in practice, have great difficulty in undertaking any
significant activity of which Dr Unsworth disapproved. It was further remarked:
Staff in the unit rarely used the internal mechanisms...because they did not believe they
would be implemented fairly. The final quotation from the McLellan report was that
there could well be attempts in the future by some members of staff to identify the
sources of some of the evidence of the Inquiry, using the same kind of intimidation that
has been such a feature of current difficulties. Indeed at the time of writing reports
were reaching the Panel that senior staff were already attempting to do this. I
subsequently learned that that member of the senior staff was Dr. Unsworth, who organised
a meeting for staff at in which he accused them of being responsible for the nurse
manager's suspension and said that they were likely to be sued for their efforts. The
report continued:
We recognise that this behaviour may be difficult to control and recommend that the trust
should take all reasonable steps to prevent it.
I also reread Alistair Main's internal report, in which Dr. Unsworth takes complete
responsibility for the staff under him, notably the clinical manager and the nurse
manager. That report shows a discrepancy between the information given by Dr. Sturman to
Dr. Main and that which he gave to Sylvia Fry, as reported to me. My main concern is about
the impartiality of the internal inquiries in the Southern Birmingham Community Health NHS
trust and subsequently the Birmingham Specialist Community Health NHS trust.
I sought a meeting with my hon. Friend the Minister to
discuss my on-going concerns, as well as with the regional director of public health, who
has still not replied, despite a letter dated 9 November apologising for not being able to
get back to me until Monday 4 December. The Minister was reluctant to meet me. I had
several telephone conversations with her office and I was asked to put my request for a
meeting in writing. I subsequently received a copy of a letter from her colleague, my hon.
Friend the Member for Birmingham, Edgbaston (Ms Stuart), to Dr. Unsworth, addressed to
"Dear Jim", and ending:
I note your comments in regard to Lynne Jones, MP. You will appreciate
that it is not appropriate for me to comment on the views expressed by Dr. Jones. However,
I will pass a copy of my correspondence to Dr. Jones so that she can be aware that we
consider the investigation into this matter to have been concluded and no further action
is planned. At that time, I was seeking a meeting with the Minister for Public Health, and
the letter was inappropriate.
I apologise for having gone on at length. There is more that I wanted to say and I am
sorry that the Minister has so little time to respond.
20 Dec 2000 : Column 170WH
1.27 pm
The Minister for Public Health (Yvette Cooper ): I
congratulate the hon. Member for Birmingham, Selly Oak (Dr. Jones) on securing the debate,
although I have only three minutes to reply to it, which is wholly inappropriate when so
many allegations have been made and anxieties raised. I shall try to respond as rapidly as
I can, but it will be difficult in the circumstances.
Concerns first arose about the in-patient unit of the
rehabilitation service of the Birmingham Specialist Community Health NHS trust in
September 1998 when a patient's formal complaint about the standards of care was received.
As a result of investigations into that complaint and other concerns raised by consultants
at the rehabilitation service, an internal investigation was ordered by the acting chief
executive. That led soon afterwards to arrangements being made early the following year to
put together a multidisciplinary review panel under the chairmanship of Professor Lindsay
McLellan, which examined, as part of an independent inquiry, all the issues involved.
On the basis of emerging evidence, the senior nurse
manager at the in-patient unit was suspended in October. Later that year, when the
McLellan panel reported to the trust, the board accepted the recommendations and proceeded
with disciplinary investigations. At that point, the clinical manager, line manager to the
senior nurse manager, and the director of the regional rehabilitation service were
suspended.
The disciplinary action was carried out under the proper
procedures and according to employment law. That disciplinary action has now concluded;
the senior nurse manager has been dismissed and the line manager has been disciplined. No
disciplinary action was taken against the director of the regional rehabilitation unit. He
was not appointed as medical director of the new trust and I am advised that those
disciplinary procedures followed all the proper procedures and that the trust acted
correctly on the basis of the available evidence under employment law.
There remain two outstanding issues: the completion of an
investigation into the patient's complaint that triggered the McLellan investigation,
which was put on hold while disciplinary procedures were implemented, and the on-going
investigation into grievances between senior clinicians and the previous trust management
at the regional rehabilitation centre. That review has not yet been completed, and it is
being conducted in accordance with annexe E of HSC (90) procedures. I do not think that
there is evidence to justify a repeat inquiry when there has already been an independent
inquiry and a disciplinary inquiry has been carried out according to proper procedures,
and when a grievance inquiry and a complaints inquiry have not yet been resolved. In
addition, substantial changes have taken place in the unit since the new trust was
established, and I am informed that there have been considerable improvements.
20 Dec 2000
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