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2.59 pm

Dr. Evan Harris (Oxford, West and Abingdon): It is a privilege to follow the right hon. Member for Holborn and St. Pancras (Mr. Dobson), who started and ended his contribution in a suitable tone, while the middle was packed with suitable content. I agree with almost everything that he said. He should also be applauded for choosing Sir Ian Kennedy to run the inquiry and for giving the Kennedy committee the freedom of a wide-ranging inquiry. He had the option of establishing a narrow inquiry, which might have limited potential damage and only implicitly criticised the direction that Governments, including that of whom he was a member, had traditionally taken. He made a brave move that has been amply rewarded, both in terms of the subjects covered in the recommendations of the Kennedy report and of the acceptance by the Government of many of the recommendations.

I would like to read from the synopsis at the beginning of the Kennedy report, to set the context for some points that I shall make later about the culture of blame. Professor Kennedy states:

"The story of the paediatric cardiac surgical service in Bristol is not an account of bad people. Nor is it an account of people who did not care, nor of people who wilfully harmed patients.


It is an account of people who cared greatly about human suffering, and were dedicated and well-motivated. Sadly, some lacked insight and their behaviour was flawed. Many failed to communicate with each other, and to work together effectively for the interests of their patients. There was a lack of leadership, and of teamwork.


It is an account of healthcare professionals working in Bristol who were victims of a combination of circumstances which owed as much to general failings in the NHS at the time as to any individual failing. Despite their manifest good intentions and long hours of dedicated work, there were failures on occasion in the care provided to very sick children.


It is an account of a service offering paediatric open-heart surgery which was split between two sites, and had no dedicated paediatric intensive care beds, no full-time paediatric cardiac surgeon and too few paediatrically trained nurses.


It is an account of a time when there was no agreed means of assessing the quality of care. There were no standards for evaluating performance. There was confusion throughout the NHS as to who was responsible for monitoring the quality of care.


It is an account of a hospital where there was a 'club culture'; an imbalance of power, with too much control in the hands of a few individuals.


It is an account in which vulnerable children were not a priority, either in Bristol or throughout the NHS.


And it is an account of a system of hospital care which was poorly organised. It was beset with uncertainty as to how to get things done, such that when concerns were raised, it took years for them to be taken seriously."

The right hon. Member for Holborn and St. Pancras highlighted that last point, and many of the others, in his speech.

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I am grateful to the Minister of State for the briefing that I received this morning on the Government's general approach, and for the opportunity to see this very lengthy report about an hour before the start of the debate. Making a statement, followed by questions, a few days after everyone had had the chance to read the wide-ranging proposals in the Government's report might have been a more appropriate way of dealing with this matter. Debating the matter now makes it difficult to give due credit to the Government for some of their proposals—although I shall try—or to give adequate scrutiny to some others.

Nevertheless, from what I understand of the Government's proposals, many of their responses to the recommendations are welcome. They will stand as a testimony to the people who campaigned for something to be done, including parents and Members of Parliament from the Bristol area who are here today, as well as my hon. Friend the Member for North Devon (Nick Harvey), who cannot be here today. He, too, pressed for an inquiry into this matter. If there is broad agreement on the Government's response, the children involved will not have died in vain, because steps will be taken to prevent—to the best of our ability—such things happening again.

The report is clear that there must be not only adequate resources but honesty about the amount of resources available, and about what can be delivered by means of those resources. Professor Kennedy sets out, in paragraph 29 of chapter 4, how one might imagine that a Government would be elected, and would put the resources in place, and that would be that. He states:

"On this reasoning, resource allocation in the public sector is the product of a compact between public and government.


This approach would suggest that a service can never accurately be said to be underfunded since, within a relatively short timescale, its funding is regularly adjusted to reflect the prevailing political compact. On this approach also, it is idle to talk of a 'proper level of funding' or the 'necessary level of resources', since there is no absolute or proper level. There is only a political choice which, by reflecting the will of the electorate is, by that fact, the proper choice."

He goes on to make this important point:

"To the extent that this describes the political reality of how resources are allocated to the NHS, it is an approach with a flaw at its centre. If the government of the day opts for X resources to fund a public service and then represents that service as being able to provide services which in fact cost X plus Y, then it immediately becomes possible to use the term 'underfunding'. And this has been the history of the NHS in the period in which we are interested and beyond."

He says "and beyond", because this still applies.

The report continues:

"Governments of the day have made claims for the NHS which were not capable of being met on the resources made available. The public has been led to believe that the NHS could meet their legitimate needs, whereas it is patently clear that it could not. Healthcare professionals, doctors, nurses, managers, and others, have been caught between the growing disillusion of the public on the one hand and the tendency of governments to point to them as scapegoats for a failing service on the other.


Of course, if governments had claimed that the service delivered by the NHS should be judged on the basis of a comparison with a moderately successful Second World country, no complaint could be raised. But the NHS was"—

and I would say "is"—

"repeatedly represented as a comprehensive service which met all the needs of all the public. Patently it did not do so."

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I would say that it patently still does not do so. That is why we must have an ordered debate on the priorities required. It is no good saying that the resources are in place, when clearly they are not sufficient to meet a particular need. I have said before that the resources that the Government started to put in, not when they came to power but in 2000, represent the sort of increases that we need. Indeed, the Kennedy report recognises that. In paragraph 36, on page 58, it states:

"In 2000, at last, the present government acknowledged this gap between claim and reality in the NHS. A significant boost in funding was announced."

We know that that will take years to come through in terms of increased numbers of staff, because of the time that it takes to train them, and questions must also be asked of the Government about those missing three years. Nevertheless, Kennedy does a valuable job in pointing out that the claims of politicians can sometimes create expectations that cannot be met. That can create a gap between the public estimation of the NHS and the reality, and the people working in the NHS often get clobbered as a result.

There is much in the Kennedy report about the culture of blame, and the Government often use such words in defence of their own policies. The right hon. Member for Holborn and St. Pancras was right to draw attention to the explicit terms in which the report talks about the culture of blame and the unwillingness to admit mistakes, both of which have arisen as a consequence partly of the club culture and partly of clinical negligence. The report states:

"Clinical negligence litigation, as a barrier to openness, should be abolished."

It goes on to stress that the NHS

"must promote openness and preparedness to acknowledge errors and learn lessons."

It also states:

"clinical negligence is part of the culture of blame. It should be abolished."

It recommends the introduction of

"an alternative administrative system of compensating those who suffer harm arising from medical care."

That means no-fault compensation, a policy that my party endorses, although we recognise that there might be cost implications. The cost might be greater than the amount saved in legal fees, but it might be less. We are pleased to hear that the Government have not ruled the policy out. The chief medical officer still has to report on it, and we look forward to reading the White Paper.

The lobby representing people who make a living—not unreasonably, in their view—on the basis of clinical negligence is strong, and I hope that the Government will be strong enough to resist it. It has a point to make, but reporting errors and swift compensation for patients are important. I am not sure whether the Conservatives endorsed that system when they raised concerns about the matter. Perhaps that may be clarified from the Conservative Front Bench.

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