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2.4 pm
Dr. Liam Fox (Woodspring): For me, this is an issue not only of national concern but of great local importance. That goes for all those Members on both sides of the House who represent seats in and around Bristol. It is worth pointing out that all of them—Front and Back Benchers—are present for this debate.
The tragic events of recent weeks that we all witnessed on our televisions and read about in the newspapers will have brought home to those of us in the House in a very personal way the sadness and devastation involved in the loss of a child. So much worse it must be for parents who know or believe that it could have been avoided. It is with the greatest admiration that we look at the parents involved in the Bristol scandal and see not a driving emotion for revenge, but a determination to ensure that it cannot happen again.
It is also worth pointing out that life has not been easy for health professionals in Bristol recently. When I worked as a junior doctor in a bone marrow transplant unit, I learned early on that I did not have what it would take to work with sick young people, many of whom would die from the trauma involved. The people who do that show a special courage in their care for patients. The good recent results in Bristol, to which the Secretary of State alluded, should be a major boost for them.
Bristol has an excellent medical school that produces excellent doctors, and high-quality postgraduate education that produces top-quality medical personnel. I am sure that all hon. Members with constituents who work as health professionals in Bristol will want to pay tribute to those who overwhelmingly act with only one motive—to improve the care for all their patients.
Naturally, we welcome much of what is in the Government's response to the Kennedy report, and when we have time we will consider some of the issues in greater detail. We have been especially pleased with not only what the Secretary of State said today, but with what the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), said during the passage of the NHS Reform and Health Care Professions Bill about the Government's understanding of the need to move towards a single regulator for health care.
We very much welcome the strengthening of the Commission for Health Improvement. We always thought it ridiculous that when the Government negotiated the concordat with the private sector there was one body to investigate and regulate the private sector and one for the NHS. I think that it is nonsense to have two inspectorates when NHS patients can be treated in the two different systems. The assurances that the Minister of State gave
the other night were most welcome, and I hope that they will be transferred to proposals in legislation, which would certainly have Conservative support.The Secretary of State will receive even more support if that single inspectorate is strengthened further and given a public health role. The improvements in mortality and morbidity have come about because of public health issues. It is worrying that we have falling immunisation rates and a rising incidence of infectious diseases and sexually transmitted diseases. We want a body that can take concerted action, across departments. If the attitude of the Minister of State in our debates in Committee and the House the other night is anything to go by, there is a good chance that we can get agreement on both sides of the House on a substantially improved and strengthened body. That would be to everyone's benefit.
There is no doubt that the Secretary of State was right when he said that information is the key to what Professor Kennedy wants. Those of us who have been involved in what happened in Bristol are all too aware that although there was an absence of information available publicly, a great deal was available to doctors in the know in the locality. It is interesting to see the referral patterns of those who were treated in Bristol. I hope that the publication of information will ensure that that problem does not happen again.
Questions arise from what the Government say in their response to the report. They state that more information will be
- "provided to patients on how local health services compare with others"
- "greater choice for patients over where they are treated".
We are interested in some specific details. The Secretary of State talked about publishing information on 30-day mortality rates. As he said, that opens up a range of other issues. He is right to say that the medical profession itself has been leading the debate. Its openness and willingness to contemplate the publication and wider use of data differs from past attitudes. Even during my medical training, information was still regarded as something that the profession owned. There has been a huge cultural shift, for which we should all be very grateful.
I completely agree that information is, in itself, a good thing, and incomplete information is better than no information at all. Only fools and knaves fear information, and if it is incomplete, our job is to try to make it complete, not to try to withhold it. If information is to be meaningful, however, we must have certain assurances about what it will contain. It must be comprehensive and it must take into account the clinical background of those involved and the sort of units in which doctors will practise.
Recently, a case came to light concerning a hospital that was to have one of its stars withheld because its neonatal death rate was too high, until it was pointed out
to inspectors that the hospital is the regional centre to which difficult cases are sent. That demonstrates our need to have complete information in the appropriate context before we can decide on its usefulness.Information must include the value-added data that make it much more useful to patients. Of course, patients must be able to understand it, and the majority of them are not statisticians. It is difficult to look at tables of information. It needs to be presented in a way that is accessible and, therefore, useful to patients. It is no use if it benefits only those who understand the complexities of statistics.
Dr. Evan Harris: I agree with what the hon. Gentleman just said, but before that he said that the publication of incomplete data was always better than a total absence of published information. However, in his example, which concerned a star rating based on inappropriate data, the information was misleading and its publication might have damaged morale and led people to avoid using the best unit for the most difficult cases. Would not that have been worse than having no data published?
Dr. Fox: I understand the hon. Gentleman's point, but to say that it is better to have no information is to move in completely the wrong direction. If information is incomplete, one must explain why it should be improved and point out how that could be done. That gives the professions a chance to respond. Of course, it is better to have full information, but withholding information because it is incomplete cannot be beneficial in a health care system where consumers are increasingly well informed and, indeed, desire to be better informed. I find it strange that a party that used to be liberal wants to withhold any data. It seems that it has been left behind in this debate.
We are interested in what the Government said in their response about consent. Fully engaging patients in consent is one of the most important ways in which information is usefully imparted to patients in the health care process. Perhaps when the Minister of State responds to the debate he will give us more details about how the Government intend to develop that. Will we have standardised consent forms so that patients everywhere and in every sector will receive the same information about the procedures that they may undergo, about what will happen to them after an operation and about any likely risk? If so, how will those forms be drawn up?
It is worth pointing out that the system has improved markedly in recent years, with far better information given to patients who have consented to medical and surgical procedures. I hope that the Government, in making improvements to the consent process, will welcome the big improvement in professional experience and, not least, the involvement of the royal colleges. We must, however, accept that there are limitations to what we can achieve. It is far easier to get fully informed consent for elective surgical and medical procedures than it ever will be for emergency procedures. We must not throw the baby out with the bath water.
We must also make sure that patients are fully informed about experimental procedures. I believe that patients understand the need for innovation and, very often, if they are given full information, they will agree to be involved
in experimental procedures. What they find completely unacceptable, as will the House, is being kept in the dark about the real reason for such procedures. We have to achieve a balance to ensure that we are not putting at a disadvantage those who are carrying out valuable clinical trials, because that might impede the development of quality medicine.
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