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Lord Hunt of Kings Heath: My Lords, I thank the noble Lord, Lord Alton, for making those important points. Yes, the problems at Alder Hey Hospital are very much focused on one man. Although the system

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clearly had several failings, which added to the awful impact of what Professor van Velzen did, there is no doubting the fact that he is, by a very long way, the most culpable person in this sorry affair.

I agree with the noble Lord that Alder Hey Hospital has for many years had a wonderful reputation, not just in this country but throughout the world. Although it is suffering at the moment from enormous criticism and adverse publicity, I still say that its work is first class. It is important for people who work in the hospital to have confidence in it and to believe that it is a fine hospital, as should people from Liverpool and others who come to it from all over the country because it is of such repute and quality. The appointment of a new chair today allows a fresh start to be made. The hospital's reputation must be treasured and supported, and improved in future.

In response to the various questions that the noble Lord asked, the answer is, I think, yes to all of them. We want to ensure that, with regard to legislative changes, a criminal offence will apply to those who break the law. As I explained, the current problem, apart from the obscurity of the Human Tissue Act 1961, is that there are no sanctions against a doctor who breaks the law.

I agree with the noble Lord's comments on the family. The report of the Chief Medical Officer is strong in that regard. If there is to be proper and informed consent, parents and relatives need fully to understand what has happened to their loved ones--they should be told in as sympathetic and supportive a way as possible--why a post-mortem is necessary, and why it may be helpful if certain organs or tissues are retained to help with research and education. If we can do that properly, I am convinced that many parents will give their consent.

The noble Lord was absolutely right to say that that approach was not adopted at Alder Hey Hospital. Even when parents signed a consent form, they did not know what they were signing. The word "tissue" does not convey to many people the concept of an organ of the body. Indeed, until I became involved in this issue, I thought that "tissue" meant a bit of skin and that it could not refer to the heart or another organ of the body. Parents did not understand what they were signing. In addition, it is clear that parents were asked to sign a form without any explanation. That is the key lesson that we need to learn.

Lord McNally: My Lords, does the Minister agree that one of the great triumphs in the field of public health in this country in the 20th century was the massive drop in infant and child mortality rates? The earlier higher rate was caused by disease and defects. The horrific report and the work carried out at Alder Hey Hospital and Great Ormond Street Hospital have to be seen against that background.

I return to the question that my noble friend asked about culture. The general public are concerned not so much about one doctor as about the desensitising of medicine, especially among senior researchers. What

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plans does the Minister have to ensure that what the right reverend Prelate the Bishop of St Albans referred to as the proper respect for human dignity is part of the culture of medical and nursing training? That is an important part of putting right the problem.

The Minister referred to the fact that a number of firmer codes of practice are being put in place. However, the medical profession is notoriously hierarchical. Can the noble Lord assure the House that within the health service protection exists for whistle-blowers? That protection is also a guarantee against mavericks who try to ignore codes of practice.

Lord Hunt of Kings Heath: My Lords, I am grateful to the noble Lord for raising those points. I accept the point that he made about the importance of research. Indeed, in the Statement I referred to the enormous impact which the research at Alder Hey Hospital has had on the saving of many lives. We need to reflect on that.

However, the extraordinary and disturbing point about the Redfern report is that, although the practice during the van Velzen years was to retain organs from every child after a post-mortem, virtually no research of any value was carried out during that period. Therefore, parents and relatives did not even have the comfort of believing that at least the organ retention served some purpose. That is a stark and disturbing fact.

The noble Lord then went on to ask how we change the culture and ensure that the code of practice and other initiatives are ingrained in the National Health Service. I am convinced that the medical profession wishes the culture to change. I believe that the Alder Hey case and, indeed, a number of other disturbing cases which have taken place over the past two or three years have come as a profound shock to the profession. From meetings which I have held locally and with the leaders of the profession, I am convinced that the great mass of doctors recognise that they must change. Equally, I recognise that procedures and processes must be put in place to encourage that to happen, and I believe that change will occur in a number of ways.

First, the code of practice will need to be implemented in full by every NHS trust in the country. We shall use our power of direction to ensure that that is the case. That will be backed up by the clinical governance process which will ensure that, just as in the past the boards of trusts have been concerned with financial issues, they must now ascertain corporately that the proper procedures are in place so that clinical decisions are carried out in a framework which ensures effective governance. That process has not been in place before and it is already beginning to bite. Already doctors are approaching trust boards to say that current practices in certain hospitals must change because they are no longer acceptable in safety terms.

In addition, through the new assessment centres which we are setting up, I believe that we have developed a much more robust way of dealing with poorly performing doctors. In the past, culturally the health service has had great difficulty in tackling

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poorly performing doctors. The new mechanisms that we have established enable us to deal with such a situation in a less confrontational way than in the past and at an earlier stage so that problems can be nipped in the bud. Taking all that into account, I am confident that we can effect the type of change the noble Lord asks for.

Lord Stoddart of Swindon: My Lords, the Statement and the report sound more like a Frankenstein novel than an actual situation. Our sympathy must go out to the parents who are suffering gravely as a result of the actions at Alder Hey Hospital and elsewhere.

I very much welcome the Government's Statement and the actions that they are to take. Although I understand that they have received criticism, I also welcome some of the statements made by the Secretary of State, particularly in relation to his desire that patients should be treated with respect and consideration. I believe that he is on to a very good point. All too often in the National Health Service patients are treated as supplicants rather than paying patients who, on average, pay 40 per week per family for that service.

We have heard of many scandals in the health service. I have been involved in one or two cases which have occurred, for example, in mixed-sex wards. Such incidents horrify people in all parts of the country. I welcome the new approach of the Secretary of State towards not only this but other matters, too. I hope that my noble friend can assure me that this inquiry will not simply be a flash in the pan but an ongoing examination of how people are treated in the National Health Service and whether they are treated as individuals and not as a mass. I hope that my noble friend will be able to give me that assurance.

Lord Hunt of Kings Heath: My Lords, I thank my noble friend for raising those apposite points. I believe that circumstances have arisen in which patients and members of the public have not been shown the proper respect and consideration which are due. My noble friend mentioned mixed-sex wards. I know how much concern that matter has brought to patients--particularly older patients. He will know that we are determined to phase out mixed-sex wards. We have made considerable progress but there is more to do.

I also believe that the National Service Framework for Older People will reflect many of the points that my noble friend has raised. After all, older people are the biggest users of the National Health Service, and it is they who sometimes find that they do not receive the respect and consideration that they deserve. I know that your Lordships have raised the issue of mixed-sex wards and the question of how people should be addressed when they are in hospital. The assumption that people always want to be called by their first name is not necessarily correct. We need to respect how people wish to be treated and addressed.

My noble friend also raised a fundamental question which goes to the heart of the culture and philosophy under which people in the National Health Service work--how the service is led and how people are

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trained. I believe that we have a massive job to do in turning around that situation. I agree with my noble friend that it cannot be dealt with in a flash-in-the-pan manner. We must ingrain it within everything that we do. I believe that some of the changes announced in the National Plan will be important in that regard--for example, the appointment of modern matrons with more authority at ward level, and changes in the curriculum which affect nurses in particular.

Many mistakes were made in Project 2000. Training was taken away too far from wards and into universities. I am sure that it was right to link training to academic ability and to ensure that universities were involved in the training process, but not at the expense of practical skills and work. I, for one, regret what happened to enrolled nurses. I believe that through phasing them out we lost a huge raft of people who knew how to talk to and treat people with respect.

I turn to the question raised by the noble Lord in relation to whistle-blowing. We issue guidance and advice to all NHS organisations on that matter in line with the requirements of the Public Interest Disclosure Act 1998. We also encourage staff to raise concerns about standards of patient care.

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