National Health Service Hospitals

Part of the debate – in the House of Commons at 7:54 pm on 26th November 1987.

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Photo of Mr Denis Howell Mr Denis Howell , Birmingham Small Heath 7:54 pm, 26th November 1987

I sympathise with the Secretary of State, who is not able to be here, and wish him a speedy recovery. Along with the Minister for Health, the right hon. Gentleman has provided a little relief for Birmingham. We were grateful—although he will understand that we were critical—for that small amount of relief.

I did not agree with all the fund-raising schemes that were mentioned by the hon. Member for Birmingham, Egbaston (Dame J. Knight). In my many years' association with the Health Service I have certainly not met any Birmingham chefs who have been stealing sides of bacon.

The right hon. Member for Brentford and Isleworth (Sir B. Hayhoe) made a helpful and constructive speech. We should acknowledge it. Although hon. Members are critical, it does us no good to get into the trenches of old, worn-out political dogma, and that is where we have landed ourselves for much of the debate.

I raise a fundamental right—the right of a patient to live. It arises from the decision of the Master of the Rolls in the High Court yesterday. The Government's move towards a corporate state—that is what they are doing in education, local government, health and, I am sorry to say, sport — is one cause of our problems. We have heard from hon. Members from all over the country about the terrible concern of regional authorities and district hospitals which cannot meet their obligations. Not one regional chairman has thought it right to resign. One of the reasons is that the Government's placemen and placewomen now abound. I do not object to people being paid for their services, but, having served as chairman of a hospital for 16 years and never having charged a penny for having done so, I believe that the present movement reacts against the public interest and should be examined.

One of the unfortunate developments in the debate has been the pernicious attacks on consultants who, in the absence of their authority chairmen, have thought it right to stand up for their health authority. We have heard about the threat from the Secretary of State for the Environment. In a brilliant speech, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Davis) mentioned the threat that was made to a Birmingham consultant.

We heard demands from the hon. Members for Bexhill and Battle (Mr. Wardle) and for Bromsgrove (Mr. Miller) for shorter consultant contracts. Their views were couched in language that suggested that people who had the audacity to put their public duty and their Christian conscience, as they saw it, before any bureaucratic convenience might be got rid of, written to or threatened. I hope that the Under-Secretary of State will take the opportunity to denounce that and declare total freedom for consultants to bring such matters into the public domain.

I pay tribute to the consultants in Birmingham. The hon. Member for Edgbaston and I have led delegations to them. I pay tribute also to the hon. Lady and her colleagues. We in Birmingham have been united in trying to stand up for our constituents' interests. None of us would have harangued Ministers had consultants not brought those matters to our attention. More consultants told us "We are being ordered not to treat patients who will die if we do not do so." Thank God they did so. They were carrying out their duties as civilised members of society, not just as doctors or administrators. We must take account of that fact.

All hon. Members delight in the success of the operation that was carried out on the girl who has been mentioned several times today. The other child, who was mentioned by the hon. Lady, happens to come from my constituency. I shall not go over that ground again. After four or five cancellations of a hole-in-the-heart operation, it was appalling for that girl, even after a pre-med, to find that the operation had been cancelled. This is happening all the time. It is an appalling blot on our society.

Twelve months ago my hon. Friend the Member for Hodge Hill and I went to see the chairman of the West Midlands regional health authority about problems at the East Birmingham hospital, which serves my constituency and those of other hon. Members. He explained the terrible growing financial crisis. He horrified me when he said to us, as Members of Parliament, "I have to tell you that there will be deaths." I cannot think of anything more catastrophic than for a Member of Parliament to be told by a regional chairman that because we are overspent and £30 million over-committed, there will be deaths.

I praised the chairman for his honesty, and I do so again tonight, but it raises the question whether the citizen has the right to live. At the end of the day, that is what the debate is about. I give all the credit that the Government want for increased expenditure, and increased staffing levels and activity in hospital out-patients' and in-patients' departments, but that is all totally irrelevant if one is about to die or if a consultant says, "You will die unless I operate on you next week, and I have been instructed not to do so."

What is the legal position of any administrator or chairman of a local health authority who instructs a consultant not to carry out an operation when he is willing to do it and when the necessary equipment exists? In my judgment, if that patient dies, it amounts to unlawful killing.

The orthopaedic case involving our former colleague David Ennals was fairly raised. The same point was raised in the courts yesterday in a case concerning Angela Tongue. She came to see me in the first instance because she needed dialysis and kidney treatment. The consultant had been instructed not to admit her or anybody else. It was quite clear that she was going to die. I saw the consultant in Birmingham this morning, and he told me that she was admitted literally at the forty-fifth minute of the eleventh hour. She was admitted because, first, 10 Birmingham hon. Members complained bitterly, and, secondly — I ask the Minister to comment on this — because the legal officer of the regional health authority advised the chairman, who was still standing firm, that the case would be indefensible in law if the girl were not admitted and she died. That is true.

Yesterday, in the Court of Appeal, the Master of the Rolls, in rejecting the case of the young lady whom I have mentioned, Angela Tongue, said that the basis of his rejection was that financial resources were finite and always would be. According to today's edition of The Times, he went on to say: Other circumstances might arise where it would be appropriate, but if the court did entertain an application further resources would be expended by the NHS in meeting the complaints. There was therefore a very delicate balance to be struck. In 33 years, I have never criticised the judgment of the House, but the Master of the Rolls held the balance and decided that an individual's right to live was inferior to the right to support the bureaucracy in not providing the funds to enable a person to live. That cannot be a tenable proposition, and I hope that the courts will think again. The Master of the Rolls admits that the court had jurisdiction and that, in another case, he might make a different decision. I do not know where he might find a more serious case than that of David Barber, or a lady who is told that she will be dead if she is not admitted to hospital.

I agree with what the Medical Defence Union has said. A legal opinion appeared in The Lancet when the previous matter arose. In response to my letter the Secretary of State courteously wrote to me drawing my attention to the Hinkes case — the orthopaedic case. No reasonable Member would ever say that the right to go to hospital and demand treatment for a hip operation was commensurate with the right to live. It is, of course, very distressing for people who need hip operations and are in terrible pain, but that is nowhere near as serious as the plight of people who are told that they will be dead next week unless they have an operation.

I raised the point, as a layman, with Sir James Ackers nearly 12 months ago and again with the Minister. I think that I am absolutely right. Let me say to the Master of the Rolls, and to the Minister that we are not dealing with the civil law. If anyone in my constituency dies as a result of medical neglect because a consultant has been ordered not to treat him, I shall regard it as a criminal matter. There will have to be a coroner's inquest and a police investigation. I think that the legal adviser from the West Midlands regional health authority was right to say, in the case of Angela Tongue, that it would be indefensible in law if she was prevented from having treatment that was available to her.