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Mr. Lansley: I recognise that the Minister was asked to give answers to many questions and that he has not dealt with them all, but I draw his attention to the fact that I and my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) referred to the Government's rejection of a package of 10 recommendations in the Kennedy report on validation and revalidation of trusts providing children's services to build quality into the provision of services, rather than to seek to inspect them
post hoc. The Minister may refer to that at the same time as he says that the Government are going in the right direction on inspection.
Mr. Hutton: I intend to refer to that, but the hon. Gentleman is wrong in his description of the difference between validation and inspection. It is wrong to say that the Government are concerned only about measuring quality, as it were, post hoc. We are building quality into services by, for example, establishing the new national standards contained in the national service frameworks and in a range of other measures, including NICE guidelines.
Under NHS Reform and Health Care Professions Bill, CHI will have new powers to advise Ministers about a range of special measures that could be taken. The hon. Member for Woodspring asked what those special measures would be. We have been through that issue on many occasions. He is aware of the range of special measures, which could range from visits from the modernisation agency and, looking at practice and how it can be improved to taking more serious measures: for example, to curtailing the provision of a service if it is unsafe and is placing patients' lives at risk. It is wrong to say that in rejecting the recommendations on validation we have compromised the pursuit of high-quality services across the NHS. It is just a different mechanism for securing those quality improvements.
In identifying the problems and recommending solutions, we warmly welcome the fact that Professor Sir Ian Kennedy has given a broad welcome and endorsement for the NHS plan and the general direction of health service reform and investment that the Government have initiated since taking office in 1997.
The events at Bristol were, in the view of Professor Kennedy, a tragedy. No one can dispute that assessment. As my right hon. Friend the Secretary of State made clear, the inquiry team estimated that between 1991 and 1995 alone, 30 to 35 more children under the age of one died after open-heart surgery at Bristol than might have been expected had the unit been typical of other paediatric cardiac surgery units in England at the time.
In five of the seven years between 1988 and 1994, the mortality rate at Bristol was roughly double that elsewhere in the NHS. As many hon. Members have observed, the warning signs were obvious but were neither acted on nor taken seriously enough. As Professor Kennedy makes clear, the failures were both structural and individual.
Too many children died as a result. In the view of the inquiry team, a third of all the children who underwent open-heart surgery at Bristol received less than adequate care. Those children and their families were let down by the very system that was supposed to protect and care for them. The emotional consequences of those failures are still being felt today by all the families involved, who have been devastated by the loss of those so young and vulnerable.
While acknowledging that grief and sense of loss, as we must do in the House today, it is important, as the
hon. Member for Oxford, West and Abingdon did, to record the view of the inquiry team:
- "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."
- "The system for delivering paediatric cardiac services in Bristol was frankly not up to the task".
The report clearly identified failures on the part of key individuals involved, but crucial failures were also recognised on the part of the NHS itself effectively to monitor and set standards for the quality of care provided at Bristol—or indeed anywhere else in the NHS at that time—and to give a high enough priority to the needs of sick children.
- "There were no agreed standards of care, and not only no external monitoring of clinical performance but no real mechanism for doing so."
The NHS is full of excellent professionals who do their best for their patients and provide very high standards of care. Nothing in the report detracts from that; but that trust must always be earned—it can never be taken for granted.
The Government's responsibility—working with the medical, nursing and other health-care professions—is to do all that we can to maintain that vital relationship of trust and confidence between patients and the NHS. It is in that crucial area that Professor Kennedy's report is so important and where its recommendations will, I believe, make such a useful contribution.
Of course, as many hon. Members have said today, and as my right hon. Friend also made clear, things can and do sometimes go wrong. All of us know that even the very best doctors and nurses can make mistakes. As the report rightly stresses, heart surgery at any age is a risky enterprise. The trust that must lie at the centre of the relationship between patients and the NHS can, first and foremost, be enhanced by ensuring that NHS services are built around the needs of patients, with safety at the top of our list of priorities—not as an add-on.
We must be able to demonstrate that the NHS can respond effectively to concerns raised by patients and the public; that people working in the NHS are encouraged and feel able to speak out when necessary, safe in the knowledge that someone will listen and will take their concerns seriously; and that reliable and independent inspection and regulation, using national standards as a benchmark, will back up all those essential safeguards.
The relationship between doctors and their patients must depend absolutely on the principle of informed consent, where the right information is provided to the
patient, in the right way and at the right time to enable them and their family to come to the decision that is right for them.Professor Kennedy makes a number of important recommendations in that area that we accept and fully endorse. The way in which patients and, in the case of young children, their parents, are treated by doctors and other key staff is of enormous importance in establishing and maintaining a relationship of trust and confidence. We are already taking action to improve the procedures for obtaining consent, and as our responses today make clear, they will fully reflect the principles outlined in the Kennedy report. There, as in other areas, important lessons have been learned from the events at Bristol.
In essence, the main features of the new NHS architecture suggested by Professor Kennedy in his report are: openness; clear standards; quality and safety built into every aspect of service delivery; a real partnership between patients and the health professions; and a service led by managers of the highest calibre who are provided with the right level of resources to do the job expected of them.
As my right hon. Friend made clear, we accept and share that broad analysis. That is why we have already begun the process of putting those new arrangements into effect. Significant progress has been made in that area since the terrible events at Bristol occurred.
Since 1997, we have taken action to establish new standard setting and inspection bodies: the Commission for Health Improvement and the National Institute for Clinical Excellence, both of which operate outside the Department of Health.
The new national patient safety agency and the National Clinical Assessment Authority will help to tackle the problem of poor performance wherever it is identified and help doctors to improve their clinical practice.
New national service frameworks—initially covering mental health, coronary heart disease, services for older people and diabetes—have laid out clear national standards for the first time. The frameworks will cover both long-term medical conditions and children's services in the near future. As I said earlier, the national service framework on children's services will help to address Professor Kennedy's specific concerns about further improvements in the standard of paediatric care in the NHS.
The modernisation agency is helping NHS organisations to improve their performance and to spread good practice across the NHS. There is more information available to the public than ever before about NHS performance both nationally and locally, backed up by a system of rewards for good performers and intervention when necessary where performance is not good enough.
My right hon. Friend the Secretary of State has outlined how we intend to make further and better information available to the public on the performance of individual consultants and surgical teams. Those important steps will help to maintain the vital trust between doctors and patients and increase public information about the standard of health care available. That will represent significant gains for both patients and the NHS alike.
As Professor Kennedy acknowledged, the reforms will require a new relationship not just between patients, the public and the NHS; the relationship between the Government and the NHS itself needs to change so that it
better reflects the society that we live in and the complexities of such a large and diverse organisation that now employs more than 1 million people and treats more than 20 million patients each year. The Government have already embarked on important changes in that regard, to which the Kennedy report adds further impetus.My right hon. Friend has today set out the Government's view on the changing relationship between the NHS and the Department of Health. As the Government's response to the Kennedy report makes clear, the role of the Department is no longer to run the NHS as if it were a mid-20th century nationalised industry.
The proper balance needs to be struck between maximum operational responsibility for front-line service providers and the Department's responsibility to provide the accountability and the means—the resources and properly trained and supported staff—by which health care services of the highest possible quality and standard can be provided to patients.
As Kennedy makes clear and we have accepted in our response today, a key element will be to ensure that the highest priority is attached to improving the leadership and management of the NHS at every level. The new leadership centre, which we have established, together with the NHS university, which we are setting up, will play important roles in developing those vital skills. A new contractual framework for senior managers and a new national code of conduct will help to ensure that the highest standards are pursued at all times.
It is also the Department's responsibility to propose the overall framework of legislation and policy in which the service operates, and to do so in a way that reflects the need for flexibility, choice, quality and diversity in health care.
The Health Act 1999 and the Health and Social Care Act 2001 implemented important reforms. The NHS Reform and Health Care Professions Bill will also produce important further reforms, called for in the Kennedy Report, with the establishment of the new United Kingdom Council for the Regulation of Health Care Professionals and the office for health care information in the CHI, together with a stronger role for the public in decision making in the NHS.
We should not lose sight of the fact that those reforms are being implemented against the background of sustained and unprecedented public investment in the NHS, which will produce more doctors, nurses, therapists and other key staff, working in newer hospitals with better equipment and faster access to the latest technology.
In conclusion, it is our collective responsibility in the House to ensure that we learn the lessons of what happened at Bristol, and in the process see to it that we have an NHS fit for the new century. That will require the will to see through the necessary reforms and not to slow down the pace of change. It will need the necessary resources to be provided—yes, of course—to ensure that the improvements in quality, safety and capacity across the NHS take place. It will necessitate the active support of patients, public and NHS staff themselves.
I believe that all those key elements are in place. All of them will support the necessary change of culture in the NHS that Professor Kennedy rightly identified as being of fundamental importance. It is obviously true that none of us can turn back the clock. We cannot undo what was
done to those children and their families, but we can take action to put right the obvious failures identified in the Kennedy report.The action that the Government have already taken, together with the further measures that my right hon. Friend has announced today, will make a significant contribution to realising that objective. I hope that all Members from both sides of the House will support those reforms in order to ensure, as far as we possibly can, that the trauma and suffering of those children and their families will not be repeated in the future.
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