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Mr. Mark Francois (Rayleigh): May we have an early debate on the cost of public inquiries? The recently published planning Green Paper includes specific Government proposals to prevent public inquiries from dragging on for years at great public expense. If that is now Government policy on public inquiries, why have they allowed the Saville inquiry into Bloody Sunday to be granted a blank cheque?
Mr. Cook: Because it is not a planning inquiry.
Mr. John Baron (Billericay): Given recent comments by former military chiefs that the armed forces are dangerously overstretched, particularly following the Afghanistan deployment, and given that British military reservists are being compulsorily called up for first time since the Suez crisis, does the Leader of the House accept that this country must either increase the defence budget or reduce its commitments to ensure that no damage is done to our fighting capability and that lives are not unnecessarily put at risk?
Mr. Cook: It is important to ensure that our armed forces can carry out the tasks that we give them and that
those tasks can be carried out without putting unnecessary and unreasonable strain on family commitments. It would be much easier for us to achieve that had the Conservative Government not cut 30 battalions from the military. I would like to hear how the hon. Gentleman would square any commitment to increase our military capability in terms of numbers, equipment and capacity with the commitment made today by his leader that the Conservatives' first priority is cutting tax.
Mr. Ian Liddell-Grainger (Bridgwater): The Leader of the House will be aware of a situation in the Somerset and Avon area over the past few days—a gentleman has induced young girls to remove their clothing. The police are unable to pursue the matter because a loophole in the law precludes them from doing so. The White Paper "Setting the Boundaries: Reforming the Law on Sex Offences", published in July 2000, proposes to bring the loophole under control. Will the House have a chance to introduce that proposal as quickly as possible and close the loophole before other children are put at risk?
Mr. Cook: I am aware of the case to which the hon. Gentleman refers and I share the sense of surprise and puzzlement of all Members that the incident does not constitute an offence. He will be aware that a sex offences review is under way. We attach high priority to it and we shall bring its conclusions before the House at the earliest opportunity. In the light of recent events, the review will want to consider this particular point.
Bristol Royal Infirmary
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kemp.]
1.24 pm
The Secretary of State for Health (Mr. Alan Milburn): I hoped that we could have the debate earlier, in November, but, as some Members know, we had to consider emergency legislation dealing with human reproduction cloning at that time. Nevertheless, I trust that today's debate will give the House an opportunity to take a step back from the normal yah-boo politics of health—an opportunity for a more considered response to events at the Bristol royal infirmary that I believe people will come to see as a turning point for the national health service and a catalyst for change.
We are publishing today, to coincide with the debate, my Department's response to the report of the Kennedy inquiry. I should acknowledge at the outset that whatever is said here today, and indeed whatever was said in the report, will inevitably be of little comfort to the families of children who died or were damaged at Bristol. I have met the parents more than once, and I only hope that the action we are taking will help to assure them that we have all learned the lessons of what went wrong.
Sir Ian Kennedy and his team did an outstanding job, and I want to record my thanks to them for producing a report that I consider fundamentally important to the future development of the national health service.
The Kennedy inquiry into the care and management of children receiving complex heart treatment at the infirmary between 1984 and 1995 was established by my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). Examining events at the infirmary between those dates, the report recognises that much has changed since then—not least at the infirmary itself, where, as I learned when I went there recently, cardiac care for both children and adults is now among the best in the country.
It is important to put the Kennedy report in context. Overwhelmingly, despite the real problems that undoubtedly exist in the NHS, patients receive good care and staff do a brilliant job. It is worth reminding people that the NHS is not full of bad doctors; it is full of good ones—people who are doing their best for patients, sometimes in difficult circumstances.
The report, however—in my view, at least—provides a searing analysis of the failings in organisation and culture that were prevalent not only in Bristol but throughout the NHS during those years. In brief, they were a failure to put patients at the centre of care, a failure of communication, a lack of leadership, paternalism, and what the report calls a "club culture", in which people got on in their careers by not rocking the boat. No standards were laid down against which performance in the NHS and quality of care could be measured. That was compounded by a decades-long underfunding of NHS services that is only now beginning to be put right.
Those broader organisational failings were most manifest in the specialist children's services. At the infirmary, and undoubtedly elsewhere in the NHS, children's services were last in line when it came to the allocation of resources. The report estimates that at Bristol all those factors—no single factor was responsible—conspired to bring about the unnecessary deaths of between 30 and 35 children.
As those who read the report may conclude, perhaps the greatest tragedy of all is that concerns were raised in and indeed outside the hospital about standards of care in paediatric cardiac surgery. Many people knew what was happening, but no one acted. The fact that it took a whistleblower, Dr. Stephen Bolsin, to bring the problems to the fore is perhaps the most serious indictment of the culture prevailing at that time.
The fault at Bristol, however, lay not with bad people, wrong though a few senior managers and senior clinicians were to act as they did. Underlying the whole Bristol tragedy was a much more profound structural and cultural problem—that of an NHS ultimately more geared to its own needs than to those of its patients, in which the question of accountability was confused in regard to services, professionals and patients.
I think most people would conclude today that a different relationship is needed between patients and services. When we published the NHS plan 18 months ago we tried to paint a different picture of the future of health care in our country, in which patients—and their safety—always come first; in which patients are in the driving seat and able to make informed choices about their care; in which there is a new culture of trust, not blame, in the NHS, with lines of accountability that are clear and a willingness to learn from mistakes; and in which the NHS is decentralised within a clear public service ethos, defined NHS principles and a framework of tough national standards which are regulated independently.
We endorse the Kennedy report's vision for the future of the NHS, but no one should underestimate the challenge involved in delivering it. As the report recognises, the NHS today is a very different health service. The report acknowledges that the underfunding that was such a feature of the NHS then is beginning to be addressed now. More significant for the longer term, the events at Bristol have spurred the Government and the medical profession to work together to put in place new standards and structures to improve the quality of care. As the Kennedy report says:
- "Recent developments give cause for optimism. These include statutory responsibility for the quality of health care, the development of clinical guidelines through the National Institute for Clinical Excellence, and the monitoring of performance through the Commission for Health Improvement."
As the report highlights, however, further action still is needed if we are to prevent another tragedy on the scale of Bristol. The Government's response to the Kennedy report that we have published today addresses the 198 recommendations he made. Many we have accepted either directly or in principle, and work is under way to implement them. In a minority of areas we have chosen to adopt a different solution to that proposed by the inquiry panel. In essence, our response to Kennedy falls
into two parts. The first includes the organisational and cultural changes needed to put the patient at the centre of the NHS. The second involves the changes needed to assure quality and secure improvements in services.The reforms that are about putting patients centre stage involve giving patients more information, more power and more choice. The NHS at the time of the events in Bristol lived in the shadow of its own history: it was an organisation for which Government provided limited resources and in which doctors were left in charge of providing limited services, and patients—frankly speaking—were expected to be grateful for the limits of what they received. In today's world, most people would conclude that that will no longer do. People today expect services to respond to their needs—and rightly so. They want services that they can trust and that offer faster, higher-quality care. Increasingly, they want to make informed choices about how to be treated, where to be treated and by whom.
Those changes require a new culture of openness in the NHS. The days have gone when parts of the NHS could behave as if they were a secret society. In the end, the NHS does not belong to anyone other than the public and patients it serves. A service designed around the needs of patients has to give more power to its patients. As Kennedy said, the patients voice should be
- "on the inside rather than on the outside."
Kennedy describes the relationship between services and patients in the Bristol era as
- "based on a paternalistic approach to families and to the care and support they needed."
Professionals have the right to be valued by Government and patients and to exercise their skills and judgment for the benefit of patients. They have a responsibility to participate in audit and clinical governance, to work not on their own but as part of a team and to treat patients with respect and dignity.
- "the culture in Bristol was not one which encouraged openness and honesty in the exchange of information between and amongst healthcare professionals and between them and families."
In the light of the Kennedy report, it is clear to me that such information should not be published by Government but should be published independently. That is why we have accepted the inquiry recommendation to establish the office for information on health care performance within the Commission for Health Improvement.
As the Kennedy report makes clear, there was no shortage of data about clinical outcomes at Bristol. The problem was that no one was responsible for analysing them or acting on them. The new office within the CHI will address that fundamental faultline.
There was another problem: parents and families did not have access to data at Bristol. The Kennedy report calls for that failure to be addressed through the publication of information on the performance of individual hospitals and consultant units. Open publication is the right thing to do. For data on surgical outcomes to be published, of course, they need to be robust, rigorous and risk-adjusted. They also need to command the confidence not just of patients, but of surgeons themselves.
The events at Bristol have, I believe, fundamentally changed the view of the medical profession about the publication of outcome data. There was a time when the very idea was regarded as unacceptable. Today, it is the profession itself that is leading the drive towards more open publication.
The cardiac surgeons are in the vanguard here. For example, the Society of Cardiothoracic Surgeons has published the results of coronary surgery for heart units in the UK and, within the last week, has extended this information to include the results of aortic valve operations over the last three years.
I am pleased to say that, following discussions, the society has agreed to go further still. We have now reached agreement that, from April 2004, 30-day mortality rates for every cardiac surgeon in England will be made public. This goes further than the Kennedy report recommendations. It means that, for the first time, patients themselves will be able to see the clinical outcomes that heart surgeons are achieving. We have of course to guard against defensive medicine. That is why the society itself will be involved in publishing this data, alongside the new office for information on health care performance, to ensure that the data systems are properly resourced and that the data themselves are credible and properly risk-adjusted and take rolling averages over a number of years.
This is just the first step to publishing more information on individual consultant outcomes over time.
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