Meeting of the Parliament [Draft]

Meeting date: Thursday, February 29, 2024

Official Report 1120KB pdf

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Eljamel and NHS Tayside Public Inquiry and Independent Clinical Review

The next item of business is a statement by Neil Gray on Eljamel and the NHS Tayside public inquiry and independent clinical review. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.

14:23  

It has been one of my great privileges in my first few days as Cabinet Secretary for NHS Recovery, Health and Social Care to have seen and heard about just a small fraction of the excellent work that is going on in our health services across Scotland. I know that we have incredibly dedicated doctors, nurses and care workers across our systems, and I am truly grateful to them every day.

All of us, whether for ourselves or through our families or friends, have interactions with the national health service. Therefore, there is nothing more important to me than ensuring that our health service is safe and effective and that all patients receive the high standard of care that we would all expect. However, should any concern be felt about the care or treatment that is provided in our health service, it is absolutely right that patients or their families know that there are clear channels to raise those concerns and that they can have confidence that their concerns will be investigated swiftly and effectively and that, where necessary, appropriate action will be taken.

In September, my predecessor, Michael Matheson, set out in a statement to the Parliament that we would establish a public inquiry into the actions of both Mr Eljamel and NHS Tayside, and that we would conduct an independent clinical review for the former patients of Mr Eljamel who want their cases to be reviewed.

In recent days, I have met—albeit briefly—a number of patients and patient representatives who have suffered terribly as a result of the actions of Mr Eljamel. I did so at the protest outside Parliament last week and at another meeting this morning. The experiences that those brave individuals shared with me are truly shocking, so I record my regret and sorrow that their search for answers has taken so long. They also have my heartfelt respect for their determination to get to the truth of what has happened.

That is why the aims of the inquiry are so important. It will seek to establish who knew what and when, and what factors contributed to the failures that were described in NHS Tayside’s “Due Diligence Review of Documentation Held Relating to Professor Eljamel”. In providing answers to patients who raised concerns about their poor experiences of care, the inquiry will make recommendations to ensure that the appropriate levels of governance and scrutiny are applied in the future, in order to prevent a similar circumstance from occurring in any other health board in Scotland.

Public inquiries are not undertaken lightly, but the commitment that Michael Matheson made, which I whole-heartedly agree with, reflects the importance of ensuring that, when repeated concerns and questions are raised, those who are accountable for acting on them do so, the effectiveness of their actions is scrutinised, and lessons are learned and necessary improvements are made.

In addition, work is under way to assess how the various recommendations from previous inquiries and reviews have been implemented in order to assure me—and, ultimately, the people of Scotland—that lessons have been learned. Interventions that are found to work to improve patient safety and increase the quality of care must be embedded in the system.

As many people will be aware, Mr Eljamel was employed by NHS Tayside from 1995 until 2014, and concerns about his practice were first raised at NHS Tayside in 2011. As a result of a complaint that was received at the end of 2012, two more complaints that were received in 2013 and two significant clinical event analyses, NHS Tayside commissioned the Royal College of Surgeons of England to review his practice on 20 June 2013. Following receipt of the Royal College of Surgeons of England’s final report, Mr Eljamel was suspended in December 2013. Most complaints were received after he had been suspended.

In total, nine reviews of his practice have taken place, including NHS Tayside’s “Due Diligence Review of Documentation Held Relating to Professor Eljamel”, which was published last August. That report laid bare the failings in NHS Tayside’s response to concerns about Mr Eljamel. It was clear from that review that those concerns were not acted on or followed up with the urgency and rigour that they deserved.

As Parliament is aware, in September my predecessor Michael Matheson announced that an independent clinical review was being commissioned alongside the public inquiry. A number of extensive conversations have taken place between officials and prospective review chairs in order to ensure that the most appropriate and qualified individuals were identified to take forward the vital investigatory processes.

Mr Eljamel’s former patients have the right to answers, and we, as a Government, and our public bodies must learn from their experiences to ensure that such things do not happen again.

From my discussions with former patients, including those whom I met outside Parliament last week, I understand the strength of their frustrations and their upset and, therefore, the importance of the investigations being progressed as quickly as possible. The people of Scotland must have confidence in our national health service and its systems, and they must have trust that complaints will be investigated. My plan is that the public inquiry and the independent clinical review will help to build back lost trust.

One of the first things that I did when I came into office three weeks ago was ask for an update on appointment of the chairs of the public inquiry and the independent clinical review. I know that colleagues and former patients also have a keen interest in the progress that has been made. Today, I can report that both chairs have now been appointed. The Hon Lord Robert Weir will chair the public inquiry. Lord Weir is a sitting judge who was appointed to the supreme courts in April 2020, having sat as a temporary judge of the High Court from 2017. I am confident that Lord Weir, as a serving judge with expertise in personal injuries, will bring rigour and transparency to the inquiry. I will meet Lord Weir and my officials this afternoon, when we will discuss the planned meeting between Lord Weir and the patients group that is to be held in the coming weeks, at which they will seek to endorse the terms of reference for the inquiry.

My officials have also progressed several essential inquiry establishment activities, including the processes to appoint the solicitor and secretary to the inquiry to support Lord Weir in developing a plan. That plan will set out the activities that are to be undertaken and a delivery timeframe—including for the establishment of an inquiry team—the processes and practices to be utilised, outline investigation plans and proposed dates for the publication of inquiry reports.

Moving on to the independent clinical review, I can announce today that, under the terms of the National Health Service (Scotland) Act 1978, I have appointed Professor Stephen Wigmore, regius chair of clinical surgery and head of the department of surgery at the University of Edinburgh, to chair the review process. He has extensive experience of leading similar clinical reviews, and I am confident that he will apply the same level of leadership and integrity to the independent clinical review. His unique skill set and experience will enable a thorough and independent review of clinical records for patients who wish to be included. Professor Wigmore is a transplant and hepato-pancreato-biliary surgeon. As such, and given the area of Mr Eljamel’s practice, he will be supported by a group of expert neurosurgeons.

The review will be different from the previous ones because it will offer an individualised approach for each former patient who wishes to take part. Professor Wigmore has been discussing with my officials the appropriate support that will be required to enable the reviews to take place in a timely but progressive manner.

The terms of reference for the review have been drafted by my officials and are with the chair for consideration. As my predecessor outlined, it is expected that engagement with former patients and patient advocates will take place prior to finalising the terms of reference.

It is anticipated that the independent clinical review will begin in April, when patients will be proactively contacted to advise them how to request a review of their clinical records. Given the potentially large number of former patients, it is expected that they will be identified and contacted in tranches in order to ensure that no one is missed. Once a more definitive timeline is available, the independent clinical review team will advise former patients by email or by a letter through the post. In the meantime, work is already under way to identify all the patients who have been impacted by Mr Eljamel’s practice.

It is the intention of the independent clinical review to offer the opportunity for review to all patients who have concerns about their treatment and care from Mr Eljamel while he worked in NHS Tayside. As my predecessor previously advised members, those clinical reviews will allow a person-centred and trauma-informed review of each patient’s clinical records. The reviews will also address patients’ individual needs and circumstances, and will aim to offer bespoke personalised answers such as an inquiry could not offer.

The independent clinical review will be separate from the public inquiry; but it is expected that the findings of the clinical review may form evidence that will be considered by that public inquiry in due course.

Finally, as the new health secretary, I assure not only Parliament but—more importantly—those who have suffered at the hands of Mr Eljamel, how seriously I take the public inquiry. We must get to the truth of what has happened in order that we can continue to rebuild trust with the public and ensure that vital learning is applied so that we can prevent similar events from occurring again. I will continue to update Parliament as the work progresses.

The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes, after which we will move on to the next item of business. Members who wish to ask a question and have not yet done so should press their request-to-speak buttons.

I thank Neil Gray for advance sight of his statement regarding the very welcome appointments of the Hon Lord Robert Weir and Professor Stephen Wigmore. I also thank him for his very quick and effective engagement with me on this matter during his short time so far in post.

We have all heard—in my case, for 10 years—harrowing stories about the intense and permanent physical and psychological pain of Eljamel’s patients and of families being broken apart. We have heard heartrending accounts of victims trying to get to the truth, only to be knocked back at every turn.

During those 10 years, I have dealt with no fewer than seven health secretaries and, although I do not for a minute doubt the sincerity of their sympathy for what patients have had to endure, there have been far too many instances of dither and delay, all of which have, understandably, served to heighten patients’ anxiety that there was some sort of cover-up.

In short, we should have been at the start of the public inquiry long before now. Although the work will now be within the remit of the judge, and, quite rightly, independent of Government, will the cabinet secretary provide a categorical assurance to Parliament that he will review the process by which the Scottish Government oversees the work of its health boards, and develop a foolproof process by which there is full transparency of the decisions that are made, both clinical and administrative, and full disclosure of who has been involved in those decisions?

I begin by thanking Liz Smith for her tenacity in the work that she has undertaken on behalf of her constituents over far too long a period. We can agree that we are in a situation in which people have had to wait far too long to get answers and to get to this point.

I am happy to consider what more can be done to review our processes, but I expect that part of the public inquiry’s evidence taking will be to ensure that such transparency and rigour are applied across all our public services, including the Government.

I thank the cabinet secretary for advance sight of his statement and welcome him to the health and social care portfolio.

I welcome the announcement of the chairs of the public inquiry and the clinical review process into the Eljamel scandal and NHS Tayside. I pay tribute to the tenacity of the many campaigners, but in particular to Jules Rose and Pat Kelly. We would not be here today without their determination to see justice done.

It has taken almost six months for the chairs to be appointed but 10 years for the Scottish Government to agree to the review, and many of the victims of Dr Eljamel are getting older. In my view, their campaign strapline says it all: “They dither, we die.” On that basis, will the cabinet secretary pledge that the inquiry will get every resource that it needs and that the clinical review will properly proceed at pace? All the former patients need to be properly consulted, and not just to endorse the terms of reference, which should be finalised without delay.

I want to touch quickly on the clinical review of cases. The cabinet secretary will appreciate that the victims’ trust is in short supply. Can he therefore give a cast-iron guarantee that Jason Leitch, the national clinical director, will have no role in the review of cases or in the inquiry, given—

Cabinet secretary.

I thank Jackie Baillie for her questions. I reiterate her tribute to Jules Rose and Pat Kelly, whom I had the fortune to meet last week outside Parliament and again this morning, when we discussed what I was going to announce to Parliament today. I pay tribute, as Jackie Baillie did, to their tenacity and the hard work that they have put in to get us to where we are today. She served them well in her comments.

On the resources of the public inquiry and the clinical review, yes, I give that undertaking. On the public inquiry’s terms of reference, there is a meeting to be established with the patients, their representatives and Lord Weir. It will be for that discussion to ensure that the terms of reference meet their expectations.

I have said in response to correspondence from Liz Smith that, although Jason Leitch heads the department and, as a director of it, receives briefings about the progress of the review and the independent inquiry, he does not have any day-to-day responsibility for their oversight.

I refer members to my entry in the register of members’ interests. I hold a bank contract with NHS Greater Glasgow and Clyde. Will the cabinet secretary give further detail on how the public inquiry and the independent clinical review will work in parallel and complement one another?

Although the two processes will be operationally independent, I hope that they will complement each other in providing answers to former patients, and providing the distinct answers that they require at different stages.

The public inquiry will focus on the actions of Mr Eljamel and NHS Tayside, while the independent clinical review will produce individual case reviews, which will be provided directly to the former patients or their families, and a report on the collective reviews and common themes. It is expected that the findings of the clinical review may form evidence that will be considered by the public inquiry in due course.

I declare my interest as a practising NHS general practitioner.

I welcome the public inquiry, and I welcome both chairs. Eljamel has brought the medical profession into disrepute. He is a disgrace.

Although there have been clear clinical failures, it is abundantly clear that NHS managers have significant questions to answer about their role in allowing Eljamel to continue to work despite mounting evidence, and about other decisions that they took.

Does the cabinet secretary agree that NHS managers should be regulated, as doctors and nurses are, by an independent body with the legal purpose of protecting, promoting and maintaining the health and safety of the public?

Sandesh Gulhane is right to point out the fact that clear failings have been underlined by the due diligence report into clinical failings—of that there is no doubt—and that there have also been failings of management. I expect the public inquiry to look into that in detail, and I expect recommendations to come through that to inform better practice. As he would expect, in order for us to rebuild people’s trust, I expect the Government to respect and implement any recommendations.

I remind members that I am still a nurse and that my experience was in the perioperative environment.

Will the cabinet secretary speak to the importance of ensuring that patients are involved in every step of the process, so that their voices and experiences are heard?

Colleagues from across parties have set out the importance of ensuring that patients are at the heart of the process. The very essence of a public inquiry is to put the public front and centre and to provide a platform for their experiences to be listened to and their voices heard. To that end, the terms of reference for the review and the inquiry will be developed in consultation with patients and their representatives, to ensure that the right focus and scrutiny are given to the right issues. Throughout that, the aim will be to identify the right lessons to be learned and areas in which patient safety and care improvements are required, and then to deliver.

My constituent Pat Kelly’s experience of his own case note review, which he received in 2022, was utterly dreadful. Will the new independent clinical review process ensure that patients’ views and evidence are included, rather than simply review documentation in which patients have no faith?

My constituents and their fellow victims have almost no trust left in NHS Tayside. The culture of cover-up in the health board has denied them justice for years. What discussions has the cabinet secretary had with the new chief executive of NHS Tayside, to lay out to her that that leadership culture of cover-up and denial—of managing headlines instead of delivering honest transparency—must change?

I recognise Michael Marra’s work on behalf of his constituent Pat Kelly in bringing these issues to the chamber and to the Government. In the first instance, I recognise the lack of trust that I have heard about from the patients. I more than understand and appreciate that. That is why the clinical review and the public inquiry must proceed in a way that meets and services the needs of the patients, and it is why the consultation with them by Lord Weir and Professor Wigmore will be so important.

When it comes to recommendations for NHS Tayside, the public inquiry must take its course. In the interim, however, my expectation is that all health boards should take seriously the complaints and the concerns of the people who report them, and that we should all share the clear channels and routes by which people can raise concerns and complaints—through the independent ombudsman process, for example, as well as the whistleblower process that rests within health boards—to ensure that patients’ concerns can be addressed.

Given the pressures on the national health service with which we are all familiar, is the cabinet secretary satisfied that there will be adequate access to clinical advice and input to enable Professor Wigmore to undertake the independent clinical reviews, so that the process is deeper than simply examining historical records and can provide good clinical analysis for individuals who have been so wronged through their treatment by Professor Eljamel?

I recognise John Swinney’s long-standing interest and work in this area. Professor Wigmore will be supported by a group of expert neurosurgeons, given the area of Mr Eljamel’s practice. Once the number of eligible former patients is identified, Professor Wigmore will consider what level of support is required to facilitate timely reviews. That opportunity will need to be open to any former patient who wishes to take part. As such, I reassure Mr Swinney, and colleagues on all sides of the chamber, that we will not allow anyone to be turned away because of cost or resource.

The Parliament and the Government have tested the patience of Mr Eljamel’s victims, but these appointments are serious, and I thank the cabinet secretary for that.

Time is short for many of those involved, and they have suffered very deeply for many years. What, practically, can the cabinet secretary do to ensure that both the inquiry and the review are carried out in good time?

I thank Willie Rennie for his question and for his involvement in raising these issues over a long period of time. I well recognise the strength of feeling that he outlines and the need for the processes to operate in a timely way. I cannot give a confirmation on the length of time that the public inquiry will take—that is for the chair to determine independently with regard to how he chooses to proceed.

I know that the clinical reviews are due to begin in April, and I hope that that will provide some comfort to patients, who have waited too long for these processes to begin, that there is a momentum building and that the processes are beginning in order for them to get the answers to questions that they seek.

Can the cabinet secretary reassure former patients who arrange an individual clinical case review that they will be treated with the utmost dignity and respect under the review process?

Absolutely—I absolutely give that assurance. I do not believe that, in my conversations with Lord Weir shortly, and in any conversations that I have with Professor Wigmore, I will need to impress that upon them. I think that they will take that incredibly seriously. We must put the patients at the heart of the process—we must ensure that they are treated with dignity and respect, and that they get the answers that they so desperately crave.

First, I offer apologies from Maggie Chapman, who was very keen to ask a question but who, due to a personal emergency, cannot be in the chamber this afternoon. I ask this question on her behalf. What work is on-going to ensure that, when all potential victims have been identified, they are kept up to date with the inquiries as they progress in order to ensure that they have all the answers that they deserve? How, in the meantime, can trust be rebuilt between the public and the health board?

With regard to ensuring that trust is rebuilt, I set out in my statement the importance of that in the process. I am due to meet Lord Weir briefly this afternoon, and I will ensure that, in that discussion, I impress upon him not only the question about timescales that Willie Rennie raised, but the point that Gillian Mackay makes about ensuring that participants, and potential participants, are kept updated. I will ensure that that is also communicated to Professor Wigmore.

Will the Scottish Government ensure that all the records of all its meetings and engagements with Eljamel’s former patients, which go back a long time, will be made available to the public inquiry?

Yes—the Scottish Government will co-operate fully by ensuring that all documentation that we have available is passed on.

Can the cabinet secretary say more about how the inquiry, once it is in place, will ensure that lessons are learned and that robust safeguards are in place for patients?

As I indicated, the public inquiry will produce findings and recommendations. It will be for the Government to work with all parties and public bodies to ensure that the necessary improvements are made, including those relating to patient care and safety. We are all beholden to do so. I spoke in my statement about the need for services to maintain or regain trust. We must respect the process and the recommendations in order to ensure that lessons are learned, and I absolutely intend to do just that.

That concludes this item of business.