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Mr. Milburn: I agree with my hon. Friend. There are common factors in many of these horrendous cases, not just in Bristol but elsewhere. Usually, the common factor is that people in the hospital and the NHS environment around the hospital have known that there has been a problem, but the patients and their families have not known. We must change that.
I have heard people say that the problem in Bristol was that there were no data, so no one knew what was going on and there were no measures to assess how well a surgeon was doing against the national average. That is not true. Data were available, and had been developed by surgeons themselves. We must publish information more openly, so that the public, local GPs and the primary care trusts, as well as the doctors in the hospitals, know what is going on.
Two years ago, we published for the first time clinical indicators of death rates following surgery. The data are raw and rudimentary, but none the less are a significant step in the right direction and will make patients more aware of what is going on in their local health service. We must do more of that in the future, but we can only do so in conjunction with the medical profession.
On the issue of public scrutiny, Kennedy is pretty clear and explicit that that is where we must make changes. We must not just open up the national health service to make information more available, but get the public in at the heart of the service.
Kennedy comments on the existing structure of community health councils and on our proposals in the last Parliament for patient forums. We shall return to that shortly, but I think there is an important lesson to be learned from all this: if we are genuinely to have a national health service that is focused on the needs of patients, we must have more power for patients.
Ms Gisela Stuart (Birmingham, Edgbaston): My right hon. Friend rightly points out that we need to learn for the future from inquiries such as this, so that such mistakes are not made again. He also draws attention to the availability of data, and the way in which they were analysed.
I understand that the report reaches strong conclusions about the number of operations that have been performed in a safe environment. Before too long my right hon. Friend will have to make a decision about the future of heart transplant centres, and part of those data will no doubt influence it. May I urge him not just to look at the number of individual operations performed by an individual surgeon, but to pay due attention to the needs of the team work involved and the collective activity that provides the necessary expertise? Will he treat the data holistically, rather than in a mechanistic way?
Mr. Milburn: My hon. Friend has raised an extremely important point, which I know is of great concern to her constituents and those of many other Members—not just in Birmingham but, as she will know, in Sheffield and Manchester.
Real dilemmas are involved. There is, for instance, the dilemma of having to choose between maintaining a local service—to which Kennedy refers explicitly—and ensuring that patient safety comes first. My accountability to the House means that I must ultimately be accountable for patient safety, and patient safety must come first in the reaching of these difficult decisions.
My hon. Friend is aware of the state of play. I assure her and others that no final decisions have been made, and that before any are made there will be open and full consultation.
Dr. Howard Stoate (Dartford): My right hon. Friend has pointed out that it was not so much a lack of data as a lack of monitoring that led to the tragic events in Bristol. That extends well beyond surgical outcomes. Dr. Harold Shipman managed to kill many of his patients; data must have been available, but no one had monitored the fact that many more patients were dying in his surgery than in any other surgery in the land, because it is extremely rare for a patient to die in a doctor's surgery.
Has my right hon. Friend given any thought to how monitoring might be extended well beyond surgical outcomes, across the whole range of primary care services? Has he given any thought to what sort of data might be published and how they could be made accountable and meaningful, so that patients could judge the whole range of NHS services rather than just surgical outcomes?
Mr. Milburn: My hon. Friend makes an extremely good point. There is a huge amount of data around; the problem is that those data are often pretty rudimentary, and are not integrated.
The hospital episode statistics data that we collect identify deaths in hospital, particularly deaths following surgery. What we do not have in the NHS is a means of collecting data relating to deaths outside hospital, so we
give a rather false impression when we publish some of the statistics. However, some of the information is available through the Office for National Statistics, and we are engaged in a project to establish how we can best integrate ONS and HES data to give a rather more rounded picture of mortality rates.I support the Kennedy recommendation for all the responsibility to be put "offshore" from the Department of Health and, in a sense, from the medical profession, but for work to be done in conjunction with the profession through the new office in the Commission for Health Improvement. That will co-ordinate collection and publication of information.
Julie Morgan (Cardiff, North): I welcome the report and the recommendations, but will my right hon. Friend confirm that the responsibilities of the new national director of children's health services cover England alone? If that is so, can he ensure that the director liaises with the National Assembly for Wales? I am sure my right hon. Friend is aware that children in Wales who need heart surgery must travel to centres in England—in many cases, to the one in Bristol—whereas the cardiological investigation will take place in Wales. It is important that there be no loophole. Can my right hon. Friend ensure that the new national director liaises closely with the National Assembly for Wales?
Mr. Milburn: I can certainly give that undertaking. My hon. Friend is right that the new national director applies to the NHS in England. There are other arrangements for Wales but given the flow of patients from Wales to England it is important that there be contact between the two organisations.
Mr. Stephen McCabe (Birmingham, Hall Green): I welcome the Secretary of State's statement on this sad affair. Given that the report by the National Specialist Commissioning Advisory Group predates the findings of the inquiry by quite a considerable time, will he give an assurance that he will not make any decision on the findings of the NSCAG report until the full implications of the inquiry have been properly considered? Will he make the NSCAG and inquiry reports available to hon. Members, so that we can consider the findings in tandem before crucial consultations and decisions are arrived at?
Mr. Milburn: On NSCAG, I have nothing much to add to what I said to my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart): clearly, we will need to ensure that the implications of Kennedy are understood before we make any decision. That must be right. All I can say is that final decisions on the matter are some way off.
On the report from NSCAG, I will write to my hon. Friend.
Points of Order
4.32 pm
Mr. John Greenway (Ryedale): On a point of order, Madam Deputy Speaker. During Prime Minister's questions, I asked about the Government's intentions with regard to the east coast main line franchise. The Prime Minister appeared not to know, but I subsequently discovered that at 3.30 this afternoon the Secretary of State for Transport, Local Government and the Regions issued a press release extending GNER's east coast main line franchise for only two years. That is a significant departure from the recommendation that I understand he received from the Strategic Rail Authority, which apparently recommended that GNER be given a new 20-year franchise.
Surely the matter is of such importance to hon. Members, and we are so near the summer recess, that the Secretary of State should have come here to make a statement, so that we could ask him why the Government have done that. They have shunted the upgrade of that important strategic route into the sidings for at least two more years, and thrown into complete uncertainty not only passenger use of the line but the whole future of the east coast railway.
Madam Deputy Speaker (Sylvia Heal): Statements are, of course, the responsibility of the Minister concerned, but I am sure that hon. Members are aware that Mr. Speaker has made it plain that he likes important statements to be made in the Chamber.
Kevin Brennan (Cardiff, West): On a point of order, Madam Deputy Speaker. Is it in order for hon. Members to bring mobile phones into the Chamber? In the middle of the important and serious statement by the Secretary of State for Health, the mobile phone of the hon. Member for Henley (Mr. Johnson) went off—I am afraid that he has now left the Chamber. Given that there is a place for him to hang his sword, could not a place be provided for him to hang his mobile phone before he comes into the Chamber—and if not, could instructions be given for the tunes that we hear in the middle of such serious statements to be less annoying?
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