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Dr. Andrew Murrison (Westbury): The hon. Gentleman makes an important point about the changes to regulation, inspection and audit that have taken place in the NHS over the past 10, 15 or 20 years. Does he agree that those changes have been features of our national life in general and that institutions other than the NHS have changed in that way? Such change is not unique to the NHS.
Mr. Berry: That is a fair point, although there is a certain importance in relation to the NHS—life and death—that is perhaps not always attached to other areas of life.
Dr. Murrison: That is a good point. Of course, the NHS is crucial—I know, I have worked in it. Other areas of our national life are, arguably, just as important—in particular, health and safety, and there has been a great deal of improvement in the way in which health and safety issues pervade life in this country. Perhaps the hon. Gentleman might like to reflect on them, because they are also matters of life and death.
Mr. Berry: I am always delighted when Opposition Members support improved regulation for matters such as
health and safety. I entirely agree with the hon. Gentleman, but we are debating the Kennedy report and the point that I wish to stress is how welcome it is that we now expect in the NHS the use of national standards and monitoring in a way that did not occur at the time of Sir Ian Kennedy's report.My second point is about the importance of open reporting. It may seem an obvious point, but let us not forget that the actions of Dr. Stephen Bolsin as a whistleblower led to the suspension of heart surgery at Bristol in 1995. We owe him an enormous debt of gratitude. It is not easy to speak out in such circumstances but, fortunately, I have never felt under the pressure that he must have been under. It is not easy to speak out and challenge authority, not least when one's job may be on the line. In his case, it clearly was.
Stephen Bolsin spoke out, made himself deeply unpopular and put his employment prospects at severe risk. We must give credit where it is due. As other Members have said, the Kennedy report refers to the time when there was a club culture and
- "an imbalance of power, with too much control in the hands of a few individuals."
The other issue is the way in which the clinical negligence system acts as a disincentive to open reporting. How does one reconcile increased openness in the NHS with the threat of legal action? Members have referred to recommendation 119, in which Kennedy recommended the abolition of the clinical negligence system and its replacement with an alternative system for compensating those patients who suffer harm as a result of NHS treatment.
I know that it is a controversial issue, but I urge the Government to consider the recommendation sympathetically, and I believe that they are doing so. Yes, litigation takes time, people may have to wait ages for an outcome and there are the costs that have been mentioned, but I am sure that most people would prefer money to go to the NHS rather than in legal fees. There is no guarantee, under a litigation system, that those who suffer harm as the result of NHS treatment will receive compensation. Many people decide not to pursue litigation because of the emotional stress and the costs involved.
The key point is that the current arrangements can discourage openness and, as my right hon. Friend the Member for Holborn and St. Pancras rightly said, that is probably bad for patients because they do not know what is going on. There are serious disadvantages with a litigation culture, so I welcome the Government's commitment—and their response today—to reforming the system of clinical negligence compensation. I look forward to the White Paper that will be produced in the near future.
My third point is about the need for a properly funded NHS. Kennedy, in his account of the situation at Bristol royal infirmary between 1984 and 1985, described it as
- "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."
My final point is to echo comments that have been made about the BRI today. It must have been difficult in recent years for people at the BRI to work as effectively and as enthusiastically as they have done in the aftermath of these events. I cannot imagine the pressures that they faced in those circumstances. Therefore, I wish to pay tribute to the contribution of the staff at the BRI today. The nurses, doctors, managers and everyone else have had the onerous responsibility of achieving change since the tragic events took place.
Today's survival rates for children's heart surgery at Bristol are now among the best in the country. We need to recognise that that has been achieved in difficult circumstances, which is a tribute to the staff currently working at the BRI.
We must learn the lessons from Bristol, but the Kennedy report and the Government response are not just about the BRI; they are about the NHS as a whole.
4.36 pm
Dr. Andrew Murrison (Westbury): The Kennedy report is a magisterial tome, particularly the 530-page version. I prefer the slim volume but, like most hon. Members here today, I have ploughed my way through the big brother. It is to be thoroughly commended. I welcome it wholeheartedly.
It is a great shame that the Government did not produce their response earlier. However, those of us who sat on the Committee considering the National Health Service Reform and Health Care Professions Bill will recognise certain strands that have been reflected in the Bill.
It is good to see that so many people involved with the Bristol royal infirmary—Members for constituencies in Bristol and the surrounding area—are present. We must recognise that the BRI is a tertiary centre that draws from a wide area. Many Labour and Conservative Members—although, sadly, not many Liberal Democrats—have been involved in the debate.
I declare an interest in that I trained at Bristol. I have the highest regard for the BRI, which turns out first-rate doctors. This is a sensitive report that acknowledges that. It does not resort to the blame culture in which politicians of all persuasions at times indulge. It does not subscribe to the cult of the easy target. Where politicians have, on occasions, been insensitive, Kennedy has trodden warily.
The report begins by laying down what most of us who have dealings with the BRI know to be true—that it is full of dedicated staff doing the very best that they can under difficult circumstances. I expect that, like many here, I struggled with the volume on first reading but, for me, the thrust was given not in the report, but by Professor Kennedy's subsequent newspaper statement when he was reported as saying:
- "The report does not make a virtue of the number of people criticized and is at least as scathing about institutional failings in the NHS as it is about the deficiencies of individuals."
My perception is that medical schools have, somewhat belatedly, realised that society has changed and that we demand a more conciliatory style of practitioner, with far better communication skills. The trend in our medical schools and in subsequent professional development has been towards enduring skills at the expense of more ephemeral learning of facts. It is a welcome development that has been driven by the profession and not by Government. We should pay tribute to the hard work that has been put in. I submit that that hard work will bear far more fruit than the Government's attempts at reform, no matter how well meaning.
Despite my up-beat assessment, I counsel caution. In July, The Times asked Professor Kennedy:
- "Could Bristol happen again? Could it be happening right now?",
Indeed, if we require proof of that we need only refer to the investigation by the Commission for Health Improvement into St. George's, Tooting that was published just four months ago. It concluded that the deaths of eight out of 11 heart transplant patients over a 10-month period at that hospital could not be explained away by chance. The report revealed that not only did surgeons and managers choose their patients inappropriately for transplant, but that the unit was infested with rats and cockroaches, which is disgusting.
I wish to dwell on communication because it is axiomatic that doctors have been bad at it, and this report is certainly witness to that fact. I think that all are agreed that we need to ensure that patients have more time with doctors. Indeed, that is an important aim of the current negotiations to develop the new contract for GPs and consultants. Five minutes for the patient is simply not good enough and I know very well that it is dangerous, both for patients and practitioners.
The British Medical Association's board of medical education is doing well in promoting communication and learning skills for doctors, but at the end of the day the key factor is time available for the patient. I fear that the Government must take a large portion of the blame for failing to recognise that for every bright idea, initiative or stipulation that they impose on practitioners, there is an opportunity cost—less time and poorer communication with patients.
On Tuesday, during the debate on the NHS Reform and Health Care Professions Bill, the Minister of State dismissed the second tracker survey because it covered
events in the last three months of 2000. He said that it was an historical document because it reflected a situation that was 12 months old. The events recorded in this report are at least six or seven years old and we must not suppose that what applied then applies now.The report paints a grim picture of mismanagement and institutional failure at the BRI and extrapolates its assessment to the NHS as a whole, but we do countless professionals, whose dedication to patients puts many of us to shame, a grave disservice if we fail to register the improvements that have been made since 1995 and to recognise that many of the problems unearthed at Bristol originate much further back in the history of the NHS.
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