Inquiry's damning indictment
10/09/2004

An independent inquiry panel headed by a judge has spent the past 16 months investigating the Richard Neale scandal.

The following is an edited extract from the 376-page report's executive summary

IN APRIL 1979, the chief of obstetrics and gynaecology at a hospital in British Columbia reported a series of cases where Richard Neale had shown poor judgment and poor surgical procedure.

In July 2000, some 21 years later, Richard Neale's name was removed from the GMC Register - he was, in common parlance, "struck off".

What happened in those 21 years is the subject of this report and the conclusions we reach show that both the system and those operating in it were not operating as effectively as they should have been to guarantee patient confidence and patient safety.

In 1984, Richard Neale applied for and was offered employment by the Yorkshire Regional Health Authority working at the Friarage Hospital and Darlington Memorial Hospital. He ceased to work at the Darlington Memorial Hospital in about 1990.

In April 1992, following internal reorganisation of the NHS, his employment was transferred to the Northallerton Health Services NHS Trust and that year the trust appointed him clinical director of obstetrics and gynaecology. In 1993, media stories revealed that Richard Neale had been struck off in Canada in 1985 and had made a failed application for re-instatement there in 1987.

Media stories in 1993 detailed Richard Neale's involvement in an incident at a public toilet in Richmond, Yorkshire, for which he was subsequently cautioned by the police.

In December 1993, Dr Richard Peterson headed an investigation panel into these disclosures. The panel reported to the trust board in January 1994 and Richard Neale was demoted from his post as clinical director.

In 1995, the Northallerton Health Services NHS Trust decided to set up a disciplinary hearing into various allegations concerning Richard Neale's conduct and activities;

Richard Neale contested all the allegations. In the event it was decided to negotiate a severance package.

After a year's sabbatical, Richard Neale left the trust's employment on November 30, 1996. Richard Neale was employed at Leicester Royal Infirmary NHS Trust between November 1995 and March 1996 and St Mary's Hospital, Isle of Wight for two periods between April and July 1996.

On July 25, 2000, the General Medical Council erased Richard Neale's name from the register. The inquiry was asked to look at what had gone on in the way the NHS had dealt with Richard Neale, principally from 1985 to 1997.

Our terms of reference asked us to assess the overall appropriateness and effectiveness of the procedures that operated in the local health services to enable legitimate concerns to be raised, to ensure that those complaints were effectively considered and to ensure that appropriate remedial action was taken.

Generally speaking, we have found that the climate in which Richard Neale operated did not lend itself to full and objective examination of what was going wrong with the doctor-patient relationship.

His attitude to some patients and some colleagues was arrogant, dismissive and overbearing; it stifled complaints by patients and criticisms by colleagues alike.

Richard Neale was over-confident in his descriptions to patients of the likely outcomes of clinical intervention. He was not a good communicator and his false description of both projected and actual outcomes including unduly optimistic prognosis often left patients confused, concerned and worried.

By his own admission in his oral evidence to the inquiry, Richard Neale overreached himself in performing certain clinical practices.

As a result he endangered patients and caused them unnecessary suffering and trauma. It is regrettable that systems were not in place to enable this to be recognised and acted upon.

The inquiry also found that Richard Neale deliberately allowed his employers to be misled on a number of occasions.

He did not disclose the fact that he faced serious disciplinary proceedings on his CV, and had subsequently been struck off in Canada; he manipulated the reason why he needed to apply to be re-instated in Canada; he avoided responsibility for his poor judgement in giving false details to the police and sanitising and minimising his part in the Richmond public lavatory incident.

The inquiry has found that Richard Neale was not subject to adequate checks on his clinical ability by his peers.

Clinical audit had not at that stage been properly developed and his peers were largely unfamiliar with his area of clinical expertise. Indeed, we heard from one of his immediate medical superiors that he considered Richard Neale to be "more knowledgeable" than himself.

The inquiry has also established that the General Medical Council were fully informed of both the circumstances surrounding the Canadian authorities removal of Richard Neale from the register in Canada, and of the police caution accepted by Richard Neale following the Richmond public lavatory incident.

In both cases, the response of the GMC was to note the information but to take no further action on Richard Neale's fitness to practice in the UK.

As to the actions taken by the Yorkshire Regional Health Authority once it became aware of the extent of the difficulties in Canada, we describe their response as inadequate.

They did not properly investigate the circumstances of what had happened and as a result, Richard Neale's fitness to practise was never properly examined.

His consequent appointment as clinical director to the Northallerton Health Services NHS Trust was inappropriate.

We have also commented on the style of the reference that Richard Neale, obtained from Northallerton.

We understand the difficulties that the Trust perceived itself to be in, but we consider that its judgement was poor in its assessment of its duty to Richard Neale, its duty to future employers of Richard Neale and perhaps even more importantly, its duty to future patients of Richard Neale.

We have found that the references that Richard Neale received were, in our view, misleading, and did not serve the general public or health employers to best purpose.

Generally, the inquiry found that complaints handling at the Friarage Hospital, was not done well.

Training was poor and patchy; lines of accountability and responsibility were not clear.

Patients were not actively encouraged to follow up their initial complaints, and they were given little or no help to find their way through what, to them, was an alien system.

Their failure to implement national guidelines on dealing with complaints was lamentable.

The result of this was that patients were discouraged from raising complaints in the first place and then given no support or encouragement to pursue the complaint