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Dr. Harris: What about the six-month limit?
Mr. Milburn: I am grateful to the hon. Gentleman for that reminder. As regards the six-month limit, urgent or
emergency cases must always come first in the NHS. However, if capacity is going begging in other parts of the NHS, or even in the private sector, which could be used for the benefit of NHS patients who face a serious operation such as heart surgery, we should use it. No one will be dragooned into exercising choice. By definition, choice is a matter of individual volition. Individuals will be able to choose—and rightly so. If that means that we will be able to reduce waiting times for people who, as everyone agrees, are waiting too long for treatment at present, it is a sensible course.The other element of our response to the Kennedy report is to address what it rightly identifies as the confused system of accountability that existed for standards, regulation and management in the NHS. The report sums that up well:
- "We cannot say that the external system for assuring and monitoring the quality of care was inadequate. There was, in truth, no such system."
It is easy to forget how far the national health service has come in only four and a half years. There are new national standards for services—for cancer, mental health, care of the elderly and coronary heart disease. There is greater transparency in local service performance. There is a new legal duty of quality and a new system of clinical governance to enshrine improvements throughout the NHS. The National Institute for Clinical Excellence evaluates new treatments. For the first time, the NHS has an independent inspectorate—the Commission for Health Improvement. With the NHS modernisation agency, there are now new systems for when things go wrong and more help to learn from what goes right.
Within that strong national framework, greater devolution to local NHS services can take place. However, Kennedy recommends that we go further still. There are five recommendations in particular that we will take forward.
First, we agree with the thinking behind the inquiry's recommendations on the separation of inspection functions from the overall management of the service. As devolution takes hold in the NHS, the Department of Health will move from a day-to-day management role to a more strategic one. It will set overall direction and ensure that there are proper arrangements for management, standard setting, inspection, improvement and accountability.
Secondly, inspection will be strengthened and made more independent. Through the National Health Service Reform and Health Care Professions Bill, the Commission for Health Improvement will have a new function of inspecting individual NHS trusts and other providers that offer NHS care against a set of agreed and published criteria. Where the commission finds evidence of unacceptably poor services, it will be able to recommend
that special measures are taken. The hon. Member for South Cambridgeshire (Mr. Lansley) asked about that a moment ago. In future, the commission will also make an annual report to Parliament on its overall findings on the quality of services provided to NHS patients—a further mark of its independence.Thirdly, there will be greater co-ordination among those organisations responsible for assuring the quality of care in the NHS. That will necessitate closer working and, over time, organisational integration between the CHI, the social services inspectorate, the National Care Standards Commission and the Audit Commission, so that health and social care services are subject to a common set of standards, irrespective of whether they are provided by public, private or voluntary organisations. In the meantime, I confirm that we will establish a new non-statutory council for the quality of health care to bring those organisations together with other relevant organisations, such as the national patient safety agency, the National Clinical Assessment Authority and, of course, the National Institute for Clinical Excellence.
Fourthly, there will be reforms to professional self-regulation. Kennedy says that it should be organised in such a way that it provides adequate and transparent safeguards for the patient. Through the NHS Reform and Health Care Professions Bill, which is currently before Parliament, we are actioning the Kennedy recommendation that there should be a new body—a council for the regulation of health care professions—to ensure that the individual regulatory bodies, such as the General Medical Council and so on, act in a more consistent way. I can also tell the House today that in the spring we will publish the Government's proposals for the reform of the GMC alongside its own radical proposal for the revalidation of doctors. As a minimum, reform will need to secure a GMC that is smaller, with much greater public and patient involvement, with faster, more transparent procedures and with meaningful accountability to the public and the health service.
Fifthly, we will strengthen the system for reporting and analysing adverse clinical events and so-called near misses. The national patient safety agency that we have established is currently testing how such information can best be gathered and fed back to the NHS. The aim is to have a national system in place this year. Among other changes, we will establish a confidential telephone helpline, as recommended by Kennedy, to allow staff and patients to report problems and mistakes.
Those changes, alongside others in the Government's response today, will strengthen the national framework for standards within which NHS care should be provided, so that patients everywhere receive high-quality care. There is one important caveat to all this, however. No one can guarantee, even with the best standards system, that mistakes will not occur. Medicine is not a perfect science; it is a human science. Even the best doctors can make the worst mistakes. Our task therefore is not to pretend that we can somehow eradicate every error; our job is to ensure that systems are in place to detect errors, to minimise them and, perhaps most important, to learn from them.
Mr. Hugo Swire (East Devon): In the spirit of the Kennedy report, and given that liability in most of those cases was agreed as long ago as 1998, what pressure—as a part of clearing up this appalling episode—will the right
hon. Gentleman now be prepared to apply to the NHS litigation authority to settle outstanding cases such as that of my constituents Jim and Bronwen Stewart's son, Ian, as soon as possible?
Mr. Milburn: I can tell the hon. Gentleman that pressure, as he describes it, has been applied. Indeed, when I met the Bristol heart children's action group, I told the chairman, Mr. Steve Parker, whom he will know, that I would try to facilitate a discussion between Mr. Parker and Mr. Stephen Walker, who leads the litigation authority. That meeting took place on 12 December. As the hon. Gentleman knows, a substantial number of cases have been settled and £1.8 million has been paid out thus far in damages. A small number of cases are still outstanding and the litigation authority will try to speed those through as quickly as it can. However, some cases are not in the hands of the litigation authority but in those of the claimants' lawyers. It is for those lawyers to try to be as speedy and co-operative as I believe the litigation authority is.
I was saying that, to minimise and learn from the errors, we need to develop a more open culture in the NHS and certainly move beyond any culture of blame. Anyone who has read the Kennedy report will find its tone, given the seriousness of the issues that it addresses, very refreshing.
I have asked the chief medical officer, Sir Liam Donaldson, to assess the feasibility of implementing a controversial Kennedy recommendation, but one that needs serious consideration. Staff who report an adverse incident promptly should be immune from disciplinary action other than, of course, if they have committed a criminal act. We shall assess the feasibility of being able to do that. That is also why we are considering reforms to the current system of clinical negligence that Kennedy says
- "institutionalises the notion of blame."
There is one final point. Lest we forget, the tragedy at Bristol was a failure in services for children. Too many children were failed by a system that was supposed to keep them well, make them well and keep them from harm. Improvements are now coming through. At a national level, they are being overseen by Professor Al Aynsley Green, the Nuffield professor of child health at Great Ormond Street hospital, who I have appointed as national clinical director for children. At a local level, each primary care trust and NHS trust will have a senior member of staff taking responsibility for improving children's health. By the end of this year, there will be new national standards for the care of children in hospital. Those standards will be in place for the first time.
Thankfully, few of us in the House have experienced the tragedy that the Bristol parents have faced. That said, I am sure that I speak for the whole House when I say that that does not diminish in any way the determination of us all to learn the lessons and change the system that let those families and children down so very badly.
Some of the reforms necessary to do that are already in place; some are being put in place through legislation at this time; and some, as I have outlined this afternoon,
will require further reforms in the future. Legislative change takes time and cultural change takes longer, but no one should be in any doubt that the reforms required to open up the NHS, to make it more accountable to its patients, to strengthen regulation and to raise standards are now under way.There can be no greater loss for any parent than the tragedies that parents faced at Bristol. There can be no greater lasting legacy than that we learn the lessons, reform the structures and change the health service so that it is better able to ensure that what happened then is not repeated again.
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