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The Parliamentary Under-Secretary of State for Health (Anne Milton)
It is a pleasure to serve under your chairmanship, Miss McIntosh. I congratulate my hon. Friend the Member for Ilford North (Mr Scott) on securing this debate. He has set out, with considerable passion, some of the detail that led to the death of Carmel Bloom following her operation to remove a kidney stone. It was a moving speech and I commend him for the support that he has given to Ms Bloom’s brother, Bernard, who has worked tirelessly to try to establish the sequence of events that led to his sister’s death.
My hon. Friend has worked tirelessly to give support not only to Ms Bloom’s brother but to the family. I should like to take this opportunity to extend my sympathies to the family. Being unable to find out the circumstances of Ms Bloom’s death or to get any closure is a terrible burden to live with.
As my hon. Friend has eloquently said, there have been numerous investigations and inquiries into the treatment that Ms Bloom received. I know that in 2002 there was a coroner’s inquest that recorded a verdict of death by natural causes. The second post mortem did not provide conclusive statements and a further inquest in the presence of a jury found the cause of death to be
“progression of pre-operative infection following surgery, to which the absence of post-operative intubation, ventilation and monitoring contributed.”
However, none of those investigations or inquiries has brought the closure that is required by the family, or a feeling that they have found out the true circumstances of what happened.
As my hon. Friend has said, there were fitness to practise hearings into the behaviour of two clinicians, but those hearings found that the failings of neither clinician amounted to misconduct. The hearings came to the judgment that it was not necessary to issue a warning in either case. As I say, none of those investigations or hearings has resulted in an explanation that has satisfied my hon. Friend or indeed Ms Bloom’s relatives.
I have nothing but admiration for people who pursue answers to questions, sometimes, sadly, in the face of considerable adversity. Unfortunately, it is really down to their tireless efforts that we learn more and more about the failings of systems. What is important is that we ensure that we learn lessons and that those failings do not happen again.
As my hon. Friend said, Mr Bloom has taken up his case with the Metropolitan Police Service and so my hon. Friend will appreciate that, in the light of ongoing inquiries, I cannot comment further on any police action. I know that that might be a disappointment to Mr Bloom, but it is essential that due process is allowed to take its course free from interference from the influence of Government Ministers.
I also want to commend my hon. Friend for his tribute to Julie Moody. Whistleblowers, for want of a better word, are an important part of this process and we have strengthened the protection of people who have information that we feel is important. That information, when it reflects on the safety and efficacy of treatment, is absolutely vital and it is important that those people are protected.
Services provided by independent hospitals such as the Spire Roding hospital are subject to regulation and inspection. All health care providers in England, whether they operate in the independent sector or in the NHS, are subject to both professional regulation and system regulation. It is important that those things work and are effective.
Health care professionals are required to be registered with their relevant professional regulator. As my hon. Friend knows, in the case of doctors, that is the General Medical Council. He is absolutely right that the GMC’s purpose is not to act as a trade union—the British Medical Association is the trade union for doctors—but to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. It does that by controlling entry on to its register, and by setting standards for medical schools and postgraduate education and training. The GMC registers doctors to practise in the UK and, where necessary, it has the power to issue warnings, remove a doctor from the register, suspend a doctor or place conditions on a doctor’s registration.
Interestingly, in preparing for this debate, I got out some figures about the GMC. In the last year that we have figures for, the GMC undertook 270 fitness to practise hearings, which resulted in 68 instances of doctors being struck off the register and 77 instances of doctors being suspended. I think that those figures give my hon. Friend some idea of the sort of activity that the GMC is engaged in.
At the time of Ms Bloom’s death, independent hospitals were registered with the then Commission for Health Improvement, but since that time a new system of registration has been introduced, which focuses on the outcomes of care that matter most to patients. Although I will not be able to respond to all my hon. Friend’s comments and questions today, it is perhaps important for me to set out some of the changes that have been made.
All health care providers are required, as part of their registration with the Care Quality Commission, to have an effective complaints mechanism that will enable them to learn from the experience of patients. That is an important point to make. Often we cannot change what has happened and we cannot always correct mistakes. People want to know what happened, but most importantly they want to know that things have changed as a result of what has happened to them or to their family and that lessons have been learned.
In the first instance, a complaint would be considered by the provider itself. In the case of the Spire Roding hospital, if a complaint is not resolved to the satisfaction of a patient at the hospital level, I understand that an independent review can be requested from Independent Healthcare Advisory Services. On 1 October last year, the registration of independent health care providers was transferred to the new registration system operated under the Health and Social Care Act 2008. Under that new system of registration, all providers of a regulated activity—whether they are privately or publicly funded—are legally required to register with the CQC. Providing a regulated activity without being registered is indeed a criminal offence and in order to be registered a provider has to meet and must continue to meet 16 registration requirements. Those requirements set out the essential levels of safety and quality for the provision of health care and adult social care in England. Those are essential levels of safety and quality, and as I have said already they focus on the outcomes that matter to patients and all service users.
Where a provider provides services that do not meet those essential levels of safety and quality, the CQC now has additional enforcement powers that were not available in 2002. For example, it can now issue a warning notice for non-compliance and a new financial penalty notice can be issued in lieu of prosecution through the courts. In extreme cases, the CQC has the power to close down a specific service or ward, or to cancel a provider’s registration and/or to bring a prosecution for non-compliance. If the CQC does bring a prosecution, the courts are now able to impose a larger fine of up to £50,000 where a provider has failed to meet essential levels of safety and quality. Those powers should provide some assurance to patients and service users that wherever they access health and adult social care they will receive a service that at the very least meets essential levels of safety and quality.
The CQC is risk-based and it should be a transparent regulator. That transparency is very important. Its inspections are informed and guided by the intelligence that it gathers about providers, and its inspection reports are publicly available on its website. I understand that there have been three inspections of the Spire Roding hospital in the last few years and that there were two inspections in 2009.
I can assure my hon. Friend that we want robust and effective regulation of health care providers and that we want to improve current arrangements. The health reforms that are currently before Parliament will strengthen the role of the CQC, by giving it a clearer focus on regulating the essential levels of safety and quality. In addition, we have also set up HealthWatch as a new and powerful consumer champion for users of health and social care services. It is very important that that voice for patients and the public is heard. HealthWatch will be established as a committee of the CQC and it will provide a direct route for the views of service users to reach the regulator.
Anne Milton
I know that time is running out on us and I will certainly get back to my hon. Friend. My door and the doors of other Ministers are always open if it would be useful to have a meeting to clarify some of the issues that we have discussed. Of course, as I have said we cannot necessarily interfere in processes that are already under way.
I know that what I have said today will not change things for Ms Bloom’s brother and the rest of her family and friends, and I also know that the ripple effect of a case such as this one goes far and wide. Sadly, what I say today cannot provide the closure that they want, but hopefully I can work with my hon. Friend to give him and Ms Bloom’s family and friends some of the answers that they so desperately seek.