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House of Lords

Monday, 22nd May 2000.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Hereford.

Lord Bernstein of Craigweil

Alexander Bernstein, Esquire, having been created Baron Bernstein of Craigweil, of Craigweil in the County of West Sussex, for life--Was, in his robes, introduced between the Lord Levy and the Lord Puttnam.

Baroness Andrews

Elizabeth Kay Andrews, OBE, having been created Baroness Andrews, of Southover in the County of East Sussex, for life--Was, in her robes, introduced between the Lord Ashley of Stoke and the Lord Dubs.

Elderly Patients: Standards of Care

2.48 p.m.

Lord Morris of Manchester asked Her Majesty's Government:

    When they expect the National Health Service Executive and the General Medical Council to complete their investigations into Dr Rita Pal's dossier of cases of abuse of elderly patients in National Health Service hospitals overdosed with diamorphine.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, these allegations necessitate the tracing of patients' notes in order to verify the claims made by Dr Pal. Although this may take some months to complete, I can assure my noble friend that these allegations are being dealt with very seriously.

Lord Morris of Manchester: My Lords, I am grateful to my noble friend. Is he aware that, while they are deeply shocking, Dr Pal's eye-witness accounts of the killing of elderly patients in NHS hospitals by overdosing them with diamorphine, a class-A drug more commonly known as heroin, are not the only, nor even the most easily corroborated, cases of patients being so abused for the stated purpose of easing the bed shortage? When does he expect to see the reports of the two investigations? And can we be assured that, if tough action is called for to bring to account those responsible, then tough action there will be?

Lord Hunt of Kings Heath: My Lords, I wish to make it clear to the House that these are allegations and stand to be investigated by the GMC. I cannot

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give my noble friend a date for the conclusion of those investigations for the reason mentioned in my first Answer, but I can assure him and the House that the Government are committed to the highest possible standards of care in the NHS for older people. That is why we have established a national service framework, which will report later in the year.

Lord Clement-Jones: My Lords, does the Minister agree that allegations such as these demonstrate the need to have proper statutory protection for older people and that the national service framework, which will be purely voluntary, will be inadequate to protect those older people?

Lord Hunt of Kings Heath: No, my Lords, I do not agree with that. These are allegations. We have to be very cautious before we make statements alleging that these things are happening until the facts have been thoroughly investigated. National service frameworks are an essential component of ensuring high-quality care in the future. We are committed not just to developing national service frameworks but to ensuring that they are published and agreeing that they will be implemented.

Baroness Knight of Collingtree: My Lords, is it not the case that it is not only in National Health Service hospitals that elderly patients are alleged to have been murdered by diamorphine injection? Is it not the case that the police are pursuing a number of allegations of this kind? Do the GMC and the NHS Executive involve themselves with research outside NHS hospitals or is that the responsibility solely of the police?

Lord Hunt of Kings Heath: My Lords, the GMC is concerned with the professional competence of individual doctors. The Department of Health and the NHS Executive are directly concerned with the performance of the National Health Service. If the noble Baroness is referring to care homes, the Care Standards Bill, which has already passed through your Lordships' House, is designed to ensure a high and consistent standard of inspection, including issues to do with the quality of treatment provided in those establishments.

The Lord Bishop of Hereford: My Lords, can the Minister assure the House that, whatever the outcome of these investigations and whatever measures may need to be taken to prevent the abuse of diamorphine in elderly patients, nothing will be done to prejudice or compromise the proper and generous administration of diamorphine in the treatment of terminally ill patients? There is a need to spread the good practices of the hospice movement more widely among the medical profession.

Lord Hunt of Kings Heath: My Lords, the point made by the right reverend Prelate is particularly apposite. Diamorphine is a drug that is legitimately used to treat those who are terminally ill. It is

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important that we adopt a measured approach to what sometimes can be very scurrilous allegations. In the end, the procedures we are putting in place--in particular as regards the development of the national service framework--will ensure that we achieve a consistent and high quality service for older people. It is important that we await the results of the GMC investigation into this matter before we become too embroiled in allegations which, to be frank, are not proven.

Baroness Gardner of Parkes: My Lords, following on from the intervention of the right reverend Prelate, with which I wholeheartedly agree, can the Minister say whether he will ask the National Institute for Clinical Excellence to look into the recommended dosages, uses and so forth for diamorphine?

Lord Hunt of Kings Heath: My Lords, a long list of investigations has been referred to the National Institute for Clinical Excellence. As regards future referrals, we shall of course keep this under constant review. Full consideration will be given to suggestions such as that just put forward by the noble Baroness.

Lord Ashley of Stoke: My Lords, is my noble friend aware that too many allegations have been made about withdrawal of treatment for this to be left to the GMC? The Government should set up an inquiry into every hospital trust to ensure that all practices in this area are above board. Is he further aware that this particular case arose because the woman doctor concerned was a whistle blower? She was able to blow the whistle only because she was leaving the profession. What message can the Government send to future whistle blowers to reassure them that they will be protected when they feel the need to speak out?

Lord Hunt of Kings Heath: My Lords, I believe that my noble friend knows that firm procedures and guidelines are already in place to enable staff to raise concerns about aspects of patient care. We expect all NHS trusts to ensure that those guidelines and procedures operate effectively. I am of course aware of concerns in this area. However, I believe that the House also needs to be assured that when allegations are made, they are considered as carefully as possible. That is why this matter has been sent to the General Medical Council.

In general, the Government are committed to high quality care for older people. In terms of safeguards, we have introduced a new system of risk assessment called "controlled assurance" which will match clinical governance to medicines management and ensure that a continuing assessment is set up to monitor prescribing in NHS hospitals. I believe that that is the approach that will produce results as quickly as possible, rather than a system of separate inquiries along the lines mentioned by my noble friend.

Lord McColl of Dulwich: My Lords, does the noble Lord agree that this subject forms part of a general

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campaign to promote the notion that the elderly are using up all the resources of the NHS? However, does the Minister agree with Professor Richard Himsworth, of Cambridge, who clearly demonstrated that it is not the elderly who are burning up NHS resources but rather the dying? It is only that it so happens that most people are old when they die. However, if they die in their teens or twenties they burn up just as much in the way of resources.

Lord Hunt of Kings Heath: My Lords, I do not disagree with that comment. We should not ever begrudge the resources used by the NHS in providing support and care for older people. However, it is essential to ensure that a consistent and high quality standard of service is maintained throughout the NHS. That is what the national service framework for older people will enable us to provide.

Organophosphates: Workshop on Research

2.56 p.m.

The Countess of Mar asked Her Majesty's Government:

    What was the outcome of the workshop on research on organophosphates held on 28th March.

The Minister of State, Ministry of Agriculture, Fisheries and Food (Baroness Hayman): My Lords, this broadly based scientific workshop was set up to assist the development of a targeted research programme, taking forward the recommendations of the Committee on Toxicity and other research questions identified in the workshop. It was an extremely productive day, with useful input from all those who attended. The record of the proceedings has now been finalised and is being made public. It is being published on the MAFF, Department of Health and HSE websites and copies are being sent to all participants. Copies have also been placed in the Libraries of both Houses.


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