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Mr. Graham Brady (Altrincham and Sale, West): Does the Secretary of State agree that, in reducing mortality rates for children's cardiac surgery, it is essential to have not only the best possible performance in the United Kingdom but the best performance that can be achieved? Will he tell the House how this country compares to other developed countries, whether we are near the top of the league, and whether there is anything that we can learn from overseas?

Mr. Milburn: There are, as always, lessons to be learned from elsewhere in the world. As I said earlier, we have some of the most world-renowned paediatric cardiac surgeons in this country. That is something that we should trumpet loud and clear. In many ways, we provide children's heart surgery that is up there with the best, and we must make sure that it continues to be so. That is why we must keep providing new investment, and ensuring that we take advantage of the way in which technology and treatments are moving forward. As I have said many times in the House, one of my personal top priorities is to ensure that heart disease services for children and adults improve. That requires not only more investment but certain changes to the way in which health care is being delivered, and we will continue relentlessly to pursue that in the years to come.

Jean Corston (Bristol, East): I thank my right hon. Friend for his statement and for the prompt way in which he has responded to some of the recommendations made by Professor Kennedy and his inquiry team. I also reiterate the thanks to my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) for setting up the inquiry and, most of all, for making it a public inquiry, because that did so much to restore the confidence in the process that we were putting in place of the parents whose children so tragically died. I would also like to thank my right hon. Friend the Secretary of State for confirming that the events surrounding this tragedy were entirely atypical of what goes on in the NHS in Bristol every day of the year.

Will my right hon. Friend pay particular attention to the role of the chief executive of a health care trust, and confirm that the chief executive should be the court of last resort for members of staff who want to raise concerns? They should be able to raise those concerns in an atmosphere free of stigma, and the final result should not end up involving shooting the messenger, as it did, sadly, in Bristol.

Mr. Milburn: I agree with my hon. Friend about the public inquiry. Public inquiries are not easy, as Professor

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Kennedy and his panel found, but they have conducted this one with great aplomb. They have written a report that is not only an easy read but extremely well considered, and I pay tribute to them once again.

It is absolutely right that the chief executive should be the court of last appeal, and the chief executive of the trust in Bristol, Mr. Hugh Ross, has introduced a new system for the reporting of concerns. There is a whistleblowing system in place, and a means of raising concerns at various levels in the managerial hierarchy. However, Mr. Ross has quite rightly retained the prerogative for individual members of staff who are concerned about raising an issue with their direct line manager to raise it with him personally. That is a good idea, and it speaks for the real progress that has been made in Bristol over the past few years.

Nick Harvey (North Devon): I commend the Secretary of State on his statement and the steps that he announced in it and echo the appreciation of the right hon. Member for Holborn and St. Pancras (Mr. Dobson), who set up the inquiry. As one of those who campaigned for and gave evidence to it, I welcome its report, which I believe is of sufficiently broad scope to help those parents who feel that light needs to be shed on events at Bristol to enable them to understand and come to terms with what happened.

The Secretary of State drew a distinction between clinical and management accountability. He said, "The children were failed by the very system that was supposed to make them well," and that accountability was confused. On management accountability, will the right hon. Gentleman give further thought to how management at all levels of the NHS can be persuaded to understand that it must be open and accountable? When Members of Parliament such as the hon. Members for Bristol, East (Jean Corston) and for Bristol, West (Valerie Davey), myself and others started to ask questions on the affair, the shutters were pulled down and we were given misleading answers. Perversely, that caused me to take a far greater interest than I would otherwise have taken.

All areas of the NHS must be open for legitimate scrutiny from Members of Parliament, the media and elsewhere, or mistakes will turn into tragedies and tragedies will turn into scandals.

Mr. Milburn: I agree with some of those sentiments and I pay tribute to the hon. Gentleman for his role in handling the consequences of the Bristol tragedy.

The hon. Gentleman is in many ways right about the way that managers behave. They have a pretty difficult job. They have to be accountable to me and, therefore, accountable to the House. That must be right in a public service. They are also accountable to their local communities and to representatives of local communities. That must be right too.

This is a two-way street. We sometimes talk pretty glibly about partnerships between patients and professionals and so on and so forth, as if rights and responsibilities flow only one way. They do not. If patients and professionals are to work more in partnership, that places a greater onus and a greater responsibility on the patient. If informed consent has been given, the patient has signed a contract with the professional. That changes some of the relationships. That is true, too, in terms of

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the relationship between Members of Parliament, public representatives and the NHS, but, in broad measure, I agree with what the hon. Gentleman had to say.

Mr. Win Griffiths (Bridgend): Like other Members, I congratulate my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) on instituting the public inquiry. I also congratulate my right hon. Friend the Secretary of State on making his statement to the House and responding so positively and quickly on crucial points.

My interest arose out of a tragedy that struck two families in my constituency and, listening to what has been said, I was reminded of the replies that I got from the trust, which amounted to saying, "Things are very difficult and great skills are involved, but, fundamentally, there are no problems." We know from the report that there were serious problems in Bristol.

I appreciate what has been said about paediatric services, but from my own experience and from what other Members have told me, I think that there is still a wider problem in the health service with accepting that there must be an entirely new approach to those problems. I hope that my right hon. Friend will undertake to bring together health service clinicians and those who are involved with these matters to talk through what is needed and ensure that such tragedies cannot occur—not just in paediatric and cardiac services, but right across the health service.

Mr. Milburn: I agree with my hon. Friend's comments, but he should not underestimate the extent to which there has been movement over the past few years. I met the Society of Cardiothoracic Surgeons yesterday and it is about to publish its latest outcome data, which are retrieved from its member surgeons. The society told me about a survey of its members on whether they support the open publication of outcome data so that those data are seen not just by the profession but by patients. Eighty per cent. of the cardiac surgeons surveyed supported open publication. That is a huge movement from where we were just four or five years ago. It expresses a recognition in the medical profession and among individual doctors that the closed world that epitomised Bristol during those tragic years will not do nowadays. Things have moved on. The important thing to realise is that it is not just the Government who have moved it on, but the profession.

Andrew George (St. Ives): I echo the appreciation of right hon. and hon. Members for the inquiry and the manner in which it was undertaken. I agree that the primary emphasis should now be on looking forward, learning lessons and taking action. I seek the Secretary of State's advice about the relevant cases that fall outside the reference period of the inquiry, such as that of Mr. and Mrs. Barnes in my constituency, whose son William died in 1983 following an operation by Mr. Wisheart. Like many others, they are anxious to find out more about what happened before the reference period. They seek the support of the Secretary of State and his officials to find out what happened outside that period. I should be grateful if the Secretary of State would advise on that.

Mr. Milburn: The hon. Gentleman makes a good point. If it is helpful, I will contact the inquiry secretariat

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to see what information they have gathered during the inquiry, which has been going on for three years, and whether it is relevant to his constituents. I shall write to the hon. Gentleman and let him know, and if he is unhappy with that, we can think about how best to raise the matter.

Mr. David Hinchliffe (Wakefield): Are there not some important parallels between what happened in Bristol and the clinical problems that have occurred elsewhere? I am thinking in particular of the case of the surgeon Christopher Ingolby in my area. I know that my right hon. Friend is familiar with the case. Clinicians and managers were aware of serious problems for some time, but they were not made public. Patients and their families were kept in the dark. The Secretary of State has rightly mentioned key reforms, which have overtaken events and will markedly improve things, but one piece of the jigsaw is perhaps missing. Public involvement in and scrutiny of the health service could pick up some of the concerns that are known among professions, nursing staff and managers, but never see the light of day elsewhere. Could my right hon. Friend say a little more about public involvement?

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