My Lords, with the leave of the House, I shall repeat as a Statement the Answer given this afternoon by my right honourable friend the Secretary of State for Health to a Private Notice Question in another place. The Answer is as follows:"Mr Speaker, as Members of the House are aware, last week the bodies of deceased patients were inappropriately kept in a chapel of rest at Bedford Hospital. "Let me say at the outset that what happened in Bedford Hospital was totally and utterly unacceptable. Patients and their relatives have a right to be treated with dignity and respect at all times in the NHS. In this case they were not. "We have a responsibility to get to the bottom of what went wrong in Bedford. Over the weekend an investigation was begun by the Eastern Regional Office of the NHS Executive. An initial report has been made verbally to the NHS Chief Executive, Mr Nigel Crisp. The final report of the full investigation will be published. I will ensure it is placed in the Library of the House. "I am advised by Mr Crisp that the initial findings in respect of this incident found a failure of management within the trust. The trust's chief executive, Mr Ken Williams, has now stepped down. In the circumstances that was the right thing to do. "In the past there were no clear guidelines about how dignity and respect for deceased patients should be ensured. The NHS now has guidelines that emphasise the need for standards to respect patients' dignity. They were issued by my department to every hospital in May last year. The guidance was repeated in November last year. In Bedford that guidance was not adequately implemented. "The preliminary inquiries appear to show that in the past when the mortuary facility was full, the deceased were kept in the chapel of rest. Following the issuing of guidance in May, an extra purpose-built mortuary facility was purchased at a cost of £20,000. I am advised that the additional facility was at no stage full. It was functioning normally apart from a minor problem with the doors. The problem was reported on Monday of last week but final action was not taken until Thursday. During that period last week bodies were placed inappropriately in the chapel of rest. There were no policies or procedures in place in the hospital to ensure that the bodies of deceased patients were treated with respect and dignity at all times. "This was not a cash problem in the hospital. It was not a capacity problem in the hospital. It was a management problem in the hospital: a failure to implement clear national guidance and a failure to resolve immediately a clear local problem. The issue should and could have been sorted out on the spot. "Instead, deceased patients were denied their dignity. That should never happen in any part of the NHS. Those who say that what happened in one part of Bedford Hospital is a reflection of what happens across NHS hospitals are wrong. They do not do justice to the efforts of the 1 million people who work in the health service who strive day in, day out to maintain and raise standards of care for patients. "It is deeply regrettable that in Bedford decisions taken inside the hospital prevented deceased patients receiving the respect that their relatives have every right to expect from an NHS hospital. "Yesterday the NHS Chief Executive wrote to all trusts reminding them of their duty to treat the deceased with dignity and sensitivity in line with the guidance issued last year. The Health and Safety Executive will be visiting Bedford Hospital on 18th January. The independent inspectorate for the NHS, the Commission for Health Improvement, will begin its inspection on 29th January. The inspection will now cover this matter as part of its wider inspection of the hospital. "The events in Bedford last week should never have happened. They need never have happened. I am deeply sorry that they did". My Lords, that concludes the Answer.
My Lords, I thank the Minister for repeating that Answer. Since the weekend the press reports about the treatment of dead bodies in Bedford Hospital have shocked the country. I am sure that all noble Lords would wish to sympathise with the relatives of the deceased patients involved. It is not simply the photographic images that have distressed us, nor, indeed, the fact that dead patients could be treated with such indignity or apparent lack of respect, but what these incidents appear to tell us about the workings of this hospital and about the NHS in general.I have a number of questions for the Minister. Is it true that the practice of storing bodies in the hospital chapel has been going on for months and that NHS guidance issued last May has been consistently ignored? Can the Minister confirm what he repeated in the Answer; namely, that the chief executive of the trust, Mr Ken Williams, has resigned? I ask that because although the resignation of Mr Williams has been extensively reported, it is also alleged that at a hospital staff meeting last night Mr Williams was described as having "stepped aside". Stepping aside does not sound quite the same as resigning. I should be grateful for clarification. When the Commission for Health Improvement looks at Bedford Hospital, will Ministers take steps to satisfy themselves that the board of the trust is competent to meet its responsibilities? The scandal has been attributed to the failure of the trust's management in general. However, is it the case that the chairman of the trust was asked to resign and declined? In asking that, I intend no personal slight on Professor Blowers, the trust chairman. However, it is striking that not only he but two of the other four members of the board are declared activists of the Labour Party and were appointed in the latter part of 1997; in other words, a majority of the board are openly Labour Party supporters. The Labour Party document entitled Renewing the NHS:Labour's Agenda for a Healthier Britain, published in June 1995 states:
As the Minister will recall, Dame Rennie Fritchie, the Commissioner for Public Appointments, published a report last year in which she stated:"Health authorities and hospital boards will not be stuffed full of party political placemen".
"candidates who declare political activity on behalf of the Labour Party—
My Lords, I thank the noble Earl for giving way. Perhaps I may ask him the relevance of what he now says to the Statement which has been given? I cannot see any relevance.
My Lords, I think that the words of Dame Rennie Fritchie will answer the noble Lord's question. I have already asked the Minister whether he and his fellow Ministers will examine the competence of the board of the hospital. The point made by Dame Rennie was that:
She also stated that before 1997 there were fewer political appointments, and that those that were made were far more equally balanced between the two major parties. I prejudge nothing, but I suggest to the Minister that the Government would be wise to look again at that report. I ask the Minister what steps the Government are taking to make the appointment process less politically skewed in favour of the Labour Party. However depressing the incident, the other sad part of this event is its wider message. Can the Minister confirm that much of the effort of trust boards up and down the country is still being directed towards meeting centrally-imposed waiting list targets, and that hospitals run the risk of being financially penalised if those targets are not met? Is it also not the case that many hospitals are having to cut non-clinical services in order to find the efficiency savings laid down by Ministers centrally? If that is so, is it not central Government, as well as the management of the hospital, which should accept responsibility for what happened at Bedford Hospital? Are not the incidents also eloquent testimony to the view expressed by Sir Alan Langlands, the outgoing NHS Chief Executive who said last year at the NHS Confederation Conference:"Less successful candidates have been brought forward to replace those identified on merit".
I put it to the Minister that it is that syndrome, one that his party specifically pledged to banish, that lies behind the shocking events in Bedford."people don't have the space to reflect on the work they are doing. They don't have enough time—given the torrent of instructions from the centre—to work through the needs of their local communities and to manage them in a way that makes sense locally"?
My Lords, I too welcome the Answer repeated by the Minister. Clearly, this has been a deplorable lapse of management at Bedford Hospital. However, the chief executive has done the honourable thing; he has resigned, whether willingly or not. It is worth expressing regret about his going. The hospital was, by repute, a good hospital. Indeed, in view of its track record, the incident is somewhat surprising. As a nation we expect proper respect for deceased patients and I welcome the steps taken by Nigel Crisp, Chief Executive of the NHS, and by the Secretary of State, in moving swiftly to deal with the situation in a particular hospital. However, I do not believe in "micro-management" by either House of Parliament. I certainly do not believe in mounting a case about the nature of the hospital trust in these circumstances, based on a pretty flimsy case.The question which we as a House should be addressing is whether wider lessons can be learnt from what happened in the hospital. We know that guidelines are not always enforced and we want to know whether there is a failure to enforce them in other hospitals. Is this a one-off problem or does it apply to other hospitals? Are there adequate mortuary facilities across the country? What happens when mortuary facilities are not useable or when they are full? Are the proper reporting-up procedures set out in guidelines so that people responsible are automatically bound to report problems to the chief executive or the medical director? Do the guidelines need changing? Are they adequate in the circumstances of this case? I note what the Minister says about resources and I accept it, but the question whether there is a resource issue remains. We have heard that a 2 per cent cash economy is expected within the NHS and want to know whether that is a factor in these circumstances? Finally, as regards the review of the work of hospitals conducted by the Commission for Health Improvement, can the Minister undertake that elements of it which relate to mortuary services and this case will be published?
My Lords, I am grateful to the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, for joining me in expressing sympathy in relation to the events at Bedford Hospital, particularly about the lack of dignity and respect which were afforded to the bodies and to relatives of the patients who died in the hospital. I can confirm to the noble Earl that the chapel was used once between 9th and 11th January. It is my understanding that it was also used last winter and in previous winters.The chief executive of the trust has "stepped down". Those are the words which are used. He is no longer carrying out the responsibilities and duties of the chief executive, but noble Lords will understand that contractual issues must be resolved by the trust board. The important point is that in practical terms he has stepped down as the accountable officer, the chief executive, of the trust. The noble Earl raised a wider issue in relation to the performance of the trust board. From the preliminary results of the inquiry which the chief executive of the NHS received, there is no doubt that the core problem was a failure of management within the trust. However, ultimately the boards of trusts must accept responsibility for what occurs in their name. When we receive a fuller report from the director of the regional office we shall look at guidance and at the performance of the board as a whole. Furthermore, I have no information or indication that the chairman of the trust board was asked I o resign. I understand that in the light of yesterday's review of all the events the chief executive decided it was appropriate to stand down from that position. The noble Earl, Lord Howe, asked about board appointments. I must say to him that having spent 25 happy years representing the members of those boards, I do not believe that his government had an entirely impartial approach to their appointment. This Government have taken great care to ensure that people appointed are of the highest calibre. As regards the future, he will recall that we are in the process of establishing an independent appointments commission which will begin work in April this year. The whole appointments process will be undertaken by that commission. I fully accept that boards have a great leadership role to play in the NHS. We want to ensure that they do so effectively and we want the highest possible calibre of people to serve as chairs and non-executives. The noble Earl, Lord Howe, asked about the Government's priorities for the NHS and suggested that waiting list targets and other such initiatives were in some way distorting the management effort of NHS trusts. I absolutely refute that suggestion. I believe it is right that tackling waiting is an essential priority for the NHS and that it is right for the Government to identify that as one of their key priorities. I am a great believer in an effective approach to efficiency savings where they produce savings brought about by efficiency rather than simply by taking money off budgets. Our focus is to ensure that we improve efficiency and we are making good progress in two areas. The first is in shared services in a whole health community where services can be shared between different NHS organisations. There are enormous benefits to be made in terms of quality and financial savings. The second area is procurement because more effective procurement can save large sums of money for the NHS. That is where we want the focus to be in efficiency savings. I turn to the general issue raised by Sir Alan Langlands, former chief executive of the NHS whom I have always held in the highest regard. There is no doubt that since the NHS began there has been within it a balance, an argument and a tension between central direction and local autonomy. Again, I say to the noble Earl, Lord Howe, that from time to time his Government were not beyond sending out a circular or two to the health service. The concept that we have developed of earned autonomy is the right one. We are saying to NHS organisations that those who are shown to be effective, those who meet the targets, and those who can show that they can provide an excellent service to the public will be given greater autonomy. Those trusts which are not doing so well can expect greater intervention. I am sure that that is the way to ensure that there is a consistent approach within the NHS while allowing sufficient freedom and autonomy at local level. That will enable the leaders of those organisations to develop them in the most effective way possible. I believe that I have answered the points raised by the noble Lord, Lord Clement-Jones, about the chief executive and micro-management. As regards the wider lessons to be learnt, following the incident at Bedford the chief executive wrote to every trust in the country reminding them of the guidance which had been issued on 23rd May 2000 in relation to mortuary facilities. It stated:
The chief executive has asked all trusts to confirm through regional offices that they are providing mortuary facilities in line with those guidelines, and it is my understanding that assurances have been received from all trusts. In view of that, it is clear that the Bedford incident is very much an isolated one. I do not believe that resources is an issue in this case. Bedford Hospital was able to purchase additional mortuary facilities a few weeks ago. The wider issue of whether this country has sufficient mortuary facilities must be seen in the context of our drive to improve the quality of services generally. Under the modernisation programme we have injected a considerable sum of money to help improve facilities. We have required regional offices to pull together the plans of every trust at the end of this financial year, from which we shall be able to see any shortcomings in pathology services and ensure that there is a strategy to improve them."NHS organisations should work with local councils to ensure that all services involved in the disposal of bodies, medical certification, registration, coroners, funeral directors and burial/cremation services are in place and adequate out-of-hour services are available. The NHS should ensure that mortuary capacity is adequate to meet peaks in winter deaths and take steps to provide additional facilities where this is likely to be required. Temporary mortuary facilities must meet minimum standards to respect patients' dignity. Refrigerated vehicles or trailers must not be used".
My Lords, there are two chapels in Bedford hospital. Having heard the debate, one could easily gain the impression that the chapel for normal worship or contemplation by patients or families was the building used for the storage of the deceased. That is not so. For the purposes of a number of reports and the Statement in this House, it is more accurate to refer to "chapel of rest". The chapel of rest in Bedford, which I am informed is carpeted, is attached to the mortuary and is the place to which some people are taken if they wish to view the deceased.All of us deplore a situation in which the deceased are not treated with dignity and respect. However, in my experience mortuary attendants do one of the most difficult jobs in the health service. They carry out their task with enormous care, well beyond the call of duty. One mortuary attendant whom I saw recently after a major accident acted well beyond the call of duty in caring not only for those who had been killed but the mourners and bereaved who came to visit the deceased. Let us ensure that those who do some of the most difficult jobs in our society, in particular mortuary attendants, are given the dignity and respect that they deserve, and that that message is sent to them.
My Lords, I thank the right reverend Prelate for his comments. I confirm his observation about the chapel of rest. As he rightly observed, there are two chapels in Bedford Hospital. I also share his thoughts about the contribution made by mortuary staff who perform an invaluable role and ensure that the dead are accorded appropriate dignity and respect in these circumstances. One of the issues which arises in this particular case, where there was a clear management failure, is that often the contribution of staff as regards such services is not sufficiently recognised. When we have the results of the fuller inquiry into the events in Bedford perhaps there will be some important lessons to be learnt by NHS trusts as a whole in terms of oversight of mortuary services. One matter that I am sure we shall consider is the need to ensure that the staff involved receive the support required and are given sufficient guidance and instruction to know what to do if problems arise, as they clearly arose in relation to the doors of the Bedford mortuary.
My Lords, we should not leave this matter without being sure as to the precise facts. The Minister told us that the chapel of rest at Bedford had been used for this purpose in the past and perhaps such a photograph might have been taken earlier. Can the Minister say whether the board knew that this was happening? Was the Minister aware of it? Does the Minister regret that he did not know at the time so that he could have done something about it? The shuffling off of responsibility onto chief executives, which under the new structures is happening more than ever before, is worrying. We want to ensure that responsibility is carried right up to Parliament when things go wrong.
My Lords, clearly when we receive the results of the fuller inquiry we shall know more about the events which occurred in Bedford Hospital. I can confirm that Ministers were unaware of what was happening in the hospital until the information came into the public domain. I assure the noble Baroness that if Ministers had become aware of it at an earlier stage they would have taken immediate action. It appears that the trust management, certainly the board, was not aware of this matter until a few days after the problem of the doors arose. In those circumstances, it is entirely appropriate that the chief executive, who is the accountable officer for the trust organisation, should accept responsibility for a clear failure in management action and procedures. However, there is more to be learnt. As a result of the inquiry we shall see whether further action needs to be taken in relation to the specific trust.
My Lords, is the Minister able to say whether it is yet known who took the photographs which have caused such shock and dismay and how they got into the hands of the press?
My Lords, as yet we do not know. I also regard that as a very serious matter. I assure the noble Lord that this matter is being fully investigated.
My Lords, it was said that management failure led to the proper resignation of Mr Williams. I am aware that Mr Williams is a committed NHS manager of long standing. I am concerned about the nature of the management failure which meant that resignation was appropriate. If the impression goes around that relatively minor management failures, for example a problem with doors—clearly, it was much more serious than that—led to the required resignation of chief executives, we shall undermine the morale of a key group in the NHS. Of course the NHS depends on doctors and nurses to deliver patient care, but without a very strong cadre of experienced managers who are committed to the NHS we shall not achieve the necessary results. Can the Minister comment on the precise nature of the management failure which was so serious as to demand the resignation of an experienced NHS manager of long standing?
My Lords, despite the availability of a temporary mortuary purchased by the trust some weeks ago, bodies were stored on the floor of the chapel of rest in totally inappropriate conditions. The additional temporary facility was not being used because of a problem with the doors, not because no places were available. The problem had resulted in injury to a porter and at the beginning of last week there was concern as to whether for health and safety reasons the mortuary could be used. It was for that reason that the bodies were transferred to the chapel of rest.It is clear from the preliminary investigation that there were no procedures in place to ensure that such shortcomings with the doors were dealt with immediately. Also there were concerns about record-keeping in relation to the mortuary. More generally, in a situation which for the people involved is a serious matter, the senior management of the trust were not aware of anything having occurred until Friday, which is four days after the preliminary decision took place. I believe that the inquiry will confirm that those are serious failures in management process and action. In those circumstances, it was the appropriate course of action for the chief executive to step aside. Having said that, the noble Baroness and I share an interest in ensuring that we have the highest quality managers in the NHS who believe ghat the NHS is a good place to work and provides them with the right career development and support. Following on from the NHS Plan, we are developing plans for an NHS leadership centre which will have an important role to play in helping us to identify, nurture and support future NHS leaders. That is very important. I want to do that. I want to ensure that we recognise the enormous pressures which chief executives are under to deliver a challenging agenda. However, when management failures take place I believe that the chief executives and the boards of those organisations must accept responsibility.