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Mr. Heald: Is the hon. Gentleman seriously saying that the medical profession should be able to veto information? I believe that Professor Kennedy said that
that was part of the problem at Bristol. Surely, on reflection, the hon. Gentleman will see that it just is not right.
Dr. Harris: I am merely saying that the data should be scrutinised. It would have to be decided whether they should be scrutinised by the medical profession alone or by an independent body—not a dependent body that would have to jump when the Government set criteria.
The Secretary of State acknowledged the drawbacks. That is why I was so pleased to learn of the basis on which the Society of Cardiothoracic Surgeons will work with the Department of Health to produce data. I believe that the medical profession—like the hon. Member for Woodspring, I do not speak for it—is willing to produce such data, as it does in journals all the time. But the idea that publishing data is the only way in which to establish whether they are any good flies in the face of a scientific approach.
The Government should say, as indeed they have, that they want to see performance data. They should agree with the responsible bodies—which I think should be the CHI and, in the case of medical data, the relevant royal college—the criteria, and the adjustments needed to ensure that they are valid. They should then establish a peer review system, which should involve not just the medical profession but data analysts and experts and, indeed, members of the public—who have been left out of the equation—before the publication of data that could be misleading.
The hon. Member for Woodspring made the point himself. He said that data had been published leading to the removal of staff from a hospital on the basis of a poor neonatal mortality rate, although the hospital was a regional centre taking the more difficult cases. The publication of such data certainly leads to more information in the public domain—hurray for that—but it damages the morale of people working hard with difficult cases, and makes the public tend to avoid the best units because they appear to have produced the worst results.
As I told the hon. Member for Woodspring before he left, I thought his response dishonourable when he said that expressing such legitimate concerns—he was echoed to an extent by the Secretary of State, who cannot resist making such glib party political points—
Mr. Heald: On a point of order, Madam Deputy Speaker. Is it in order to call an hon. Member dishonourable?
Madam Deputy Speaker (Sylvia Heal): That is not really a point of order. The hon. Gentleman has, of course, raised it with the Member concerned.
Dr. Harris: Let me make it clear that I said that I thought it dishonourable—a dishonourable thing to do—to say, when legitimate concerns are being expressed about the quality of data, that the Liberal Democrats therefore do not want information to be published. I did not think that I had used the words referred to, but I am certainly happy to consider the hon. Member for Woodspring honourable. I am saying that to say such a thing is dishonourable, and wrong. I believe that people
will be more willing to co-operate with the publication of information if they have assurances of the sort given by the Secretary of State in his opening remarks about the need to ensure that it is appropriate.
Mr. Swire: I thank the hon. Gentleman for giving way on what is obviously a matter of great interest to the Liberal Democrats, as is evidenced by their presence in the Chamber. Does he think that the publication of data would have been helpful in cases such as the one before the General Medical Council today, concerning Dr. John Brennan and Dr. Graham Urquhart and the cancer tragedy in Devon?
Dr. Harris: I do not have the details of the case. Given what I have already said about the quintuple and even sextuple jeopardy that doctors face, I question whether it is right for a politician—whether or not he or she is in full command of the facts—to pass comment. We need to learn from cases in which people have been found negligent and in which suppression of data is involved, but I advise the hon. Gentleman to await the report on the case before urging the Government to act as quickly as possible.
Mr. Swire: To clarify that point, the charges against those two doctors have been proved. We are waiting this afternoon for the ruling of the General Medical Council on what will happen to them.
Dr. Harris: In that case, we should await the ruling. It appears that we do not have long to wait.
The Government's response to the Kennedy report contains many recommendations that are welcome, but I ask the Minister to consider allowing us a further opportunity to discuss the issue when we have had a chance to digest the report and some of the other initiatives that daily issue forth from the Department of Health. My central concern is that it is no good for the Government to defend all their reforms by saying, as the Secretary of State appeared to do at one point, that we need to get rid of the old order. As with the slaughter of the first born, any crazy idea could be justified, given the nature of the Kennedy report and the serious concerns that it expresses about what happened.
The Government must justify every one of their proposals on its merits, and in many cases they have done so. However, getting rid of a culture of blame will not be achieved by just saying the words. It will mean ensuring that politicians from all parties do not seek to scapegoat—on the basis of inadequate information—those who work hard in a system that does not have the resources to deliver what politicians have been guilty of encouraging the public to believe can be delivered. With that caveat, I warmly welcome many of the recommendations in the Government's response.
3.32 pm
Valerie Davey (Bristol, West): Bristol—and especially the parents of those children who died or suffered brain damage during that difficult time—has waited a long time for good to come out of that tragedy. The Kennedy report was welcomed for both the quality and the quantity of its recommendations. After the Secretary of State's speech
today, and once we have had time to study the report in more detail, I am sure that the Government's response to it will also be warmly welcomed.The Secretary of State widely endorsed the recommendations in the Kennedy report. The tenor of his speech was one of willingness to learn and to recognise the difficulties and the dangers of what had happened in the past. That is all part of moving forward and bringing some good out of the tragedy.
I am also sure that the parents would wish once again to thank my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). I am sorry that he has had to leave the debate temporarily, but I want him to know that the parents have not forgotten their first meeting with him in May 1998. I met some of them after they had been to see him. They told me that at last they had some hope for the future. As he recorded, they were glad that for the first time someone in authority had listened and appeared to be willing to take them seriously and share their pain. I thank him for that and also for the thoughtful and thought-provoking speech that he made this afternoon.
I doubt whether even my right hon. Friend recognised, at the time when he set the report in motion, just how important it would be, not only for Bristol but for the whole of the NHS. Some of the parents, however, realised that something momentous had to happen—a change in the culture—to ensure that what had happened to them did not happen again. That is why they put so much tenacity, determination, love and thoughtfulness into their struggle. They acted with such dignity in all that they did that I wish to pay tribute to them.
I also wish to acknowledge the work of colleagues, some of whom I know regret that they are unable to be present in the Chamber for this debate. My hon. Friends the Members for Bristol, South (Dawn Primarolo) and for Bristol, East (Jean Corston), as well as the hon. Member for North Devon (Nick Harvey), tabled questions in the 1990s—and in one case in the late 1980s—and sought to represent their constituents involved in the issue.
The parents have also set up a new charity, Constructive Dialogue for Clinical Accountability—the CDCA—and I shall mention later some of the work that it has done. Its work corresponds closely with the Kennedy recommendations and the Government's proposals in seeking recognition for patients' contributions, alongside those of the professionals, to the future of the NHS.
I also wish to thank both medical and administrative staff of the Bristol royal infirmary who, since the tragedy, have worked to restore trust between patients and the medical staff. The staff have borne the brunt of much of the criticism, but the quality of treatment, especially in cardiac surgery, has now reached a very high level. That is due to their commitment and hard work.
In the Minister's response to the debate, I would be grateful if he could respond to a poor article in the Bristol Evening Post that concluded, from the faults at the BRI and the Secretary of State's comments earlier this week about the future for failing hospitals, that the hospital was to be taken over by private administrators. Those conclusions were simplistic in the extreme, and I would be grateful for the Minister's comments.
The Secretary of State, in his foreword to the Government's response, says that bringing about the changes that the Government seek in the NHS will require "time and commitment". I assure him of the commitment of the staff at the BRI and, in the time that has been available, they have done great things.
It is not appropriate this afternoon to deal in detail with the 198 recommendations and the Government's response to them. However, as other hon. Members have done, I wish to draw out some of the underlying themes that are so important but which involve more intangible aspects that are more difficult to monitor but essential if we are to achieve the change in culture. The need for openness and accountability is a thread that runs through the report and that ran, today, through the Secretary of State's speech. The summary of the report states:
- "Openness and transparency are as crucial to the development of trust between healthcare professional and patient, as they are to the trust between the NHS and the public."
The fragmentation of the NHS and the establishment of competing trusts was not helpful in establishing the kind of trust that is essential—as opposed to the organisational kind of trust—to monitoring within the NHS. We need monitoring, and we need national standards for that monitoring of clinicians and managers. We have seen the disastrous consequences in Bristol where, as my right hon. Friend the Member for Holborn and St. Pancras said, there was a breakdown not only with systems but with individuals. When the two came together in Bristol, there was a culture of secrecy that is now being tackled.
Results in Bristol are now speaking for themselves. We have seen new data, although we have heard questions today about whether they are detailed enough. However, we have to start producing data, and those of the associate parliamentary health forum—as well as the work of Dr. Foster that was published recently in The Times—show that Bristol is doing remarkably well in cardiac performance. Bristol has the lowest standardised mortality ratio in the country, taking into account all forms of heart surgery.
The teams concerned need to be congratulated on publishing the data. They are the first cardiac unit to recognise the importance of publication, and they have done it of their own volition. That is something important to come out of events at Bristol. The beginning of a solution to the tragedy is for those clinicians in the cardiac unit to say, "This is what we have to do to raise standards. We have to work as a team."
I recognise that it is not just a question of the data. The data have been produced because the doctors and clinicians at Bristol have recognised their importance. They have worked together as a team, and have been willing to publish. They have seen the importance of that and they are now getting praise for it. It is not undermining their credibility, but enhancing it in Bristol, the country and this House. I want to applaud that, and it is recognised on both sides of the House.
Confidence is returning and a report by the Department of Health's review team on paediatric and congenital cardiac services is very encouraging. In summary, it states
that the Bristol unit can be "proud" of what it has achieved, that its "high quality clinical outcomes" were to be applauded, and that:
- "The concept of close continued work with parents and families is obviously of vital importance to consolidate the improving confidence in the Unit."
I endorse the Government's work to establish national terms of reference. Many of us—certainly people of my generation—find it almost impossible to believe that those national standards were not in place when we took our families to hospital. We were vulnerable, and yet we put our trust—rightly, I am glad to say, in almost all cases—in clinicians without national monitoring. My constituents and I now seek such monitoring in terms of what we mean by a national health service.
The second important theme concerns the regulation of professionals. I congratulate the Government on proposing the Council for the Regulation of Health Care Professionals. That was directly recommended in the report and must be an important step in the right direction. Part of that body's responsibility is for education, as was mentioned by the hon. Member for Oxford, West and Abingdon (Dr. Harris). We look to that body to bring people into the medical profession from a far wider base.
At Bristol, we have recognised that, in some cases, medical schools have not drawn as widely as they should from the general public. We need people to bring wider experience to the medical profession; that would be useful. The report pointed that out, and I am sure that the medical department at Bristol university will be aware of that and will begin to tackle it.
I want to recognise the part played by Stephen Bolsin. It is perhaps not well known that he is in Australia now and has written about the benefits of a new electronic personal professional monitoring scheme that trainee anaesthetists are using. That scheme is bringing greater clarity and openness to the system, and it makes us realise that the impact of Bristol—which resulted, sadly, in the professor having to leave Bristol for Australia—is causing international ripples around the world.
Thirdly, the need for child-centred facilities has been mentioned. It is clear that the care of the child in most families is central and unquestioned. The fact that it was not central in the health service has raised eyebrows and caused deep concerns. With the establishment of the children's hospital in Bristol, we have far greater provision than anything available in the 1980s and early 1990s.
We need to scrutinise Kennedy carefully, as well as the Government's response. There is real dialogue in Bristol about whether we centre everything for children in the children's hospital—meaning that all other disciplines must be around that hospital—or whether we emphasise the in-depth departmental provision for, say, burns or neurosurgery. There is a genuine and open debate in cities such as Bristol as to where we locate children's services. There is no debate about the quality of those services and their prioritisation within the NHS in every city and district. How that is done is part of an ongoing debate.
No one should expect the Government's response today to be the final determining factor in the development of a quality NHS.
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