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Mr. Milburn: I am extremely grateful to my right hon. Friend for his contribution. I should like to place on record my thanks, as well as those of the whole House and people in Bristol, to him for his courage in establishing the public inquiry. Let us remember that the decision was extremely controversial when it was made, but it has proved, with the benefit of hindsight, to be absolutely right.

My right hon. Friend was right about the setting of standards. In the report, Kennedy was extremely critical of a hands-off approach in the national health service. In fact, there were two lines of accountability in the NHS—clinical and managerial. As my right hon. Friend knows, because the two lines never met, problems relating to clinical outcomes and surgical mistakes were never gripped as one hopes that they would be nowadays.

My right hon. Friend was right about publishing outcomes, but he knows as well as I do that the science of ensuring that the data that we publish are rigorous is pretty rudimentary. There is an awfully long way to go to ensure that they command confidence not only in the professions, but—in a sense, this is more important—among patients. It is pointless to publish information that is inaccurate and gives a misleading impression.

Only yesterday, I had the pleasure of meeting the cardiac surgeons committee. I spoke to Mr. Ash Pawade from Bristol, who, as my right hon. Friend knows, is a surgeon who specialises in children's heart surgery and has a reputation that is not only national but international. Like the committee, I am convinced that great progress is being made in respect of the ability to publish rigorous data that will properly inform patients and professionals, and in which we can all have confidence.

On my right hon. Friend's final point, it now seems right to review the issue of clinical negligence and its operation. I have some sympathy with his comments. I am sympathetic to the position of ordinary doctors and of surgeons in particular. Day in, day out, while we talk so easily about getting rid of the blame culture, they face the threat of being dragged through the courts as part of a clinical negligence claim. In the end, it seems difficult to reconcile the idea of openness in the national health service with the threat of legal action. We must consider the matter and keep it under review. Indeed, I have asked the chief medical officer to chair a committee of experts to examine it. We will introduce a White Paper in the new year that will, I hope, make recommendations for radical reform.

Dr. Evan Harris (Oxford, West and Abingdon): I want to place on record my sympathy with the situation of the families from Bristol, and pay tribute to them and their action group for their persistence in setting up the inquiry and in continually contributing to it, thereby enhancing its status. I join the Secretary of State in commending his predecessor, the right hon. Member for Holborn and

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St. Pancras (Mr. Dobson), for his foresight in setting up an inquiry which was not narrow but which had a very wide remit. I want also to pay tribute to my hon. Friend the Member for North Devon (Nick Harvey) for his assiduous work in asking questions both locally and in this place.

I thank the Secretary of State and the inquiry for their courtesy not only in allowing me the opportunity to be shut in a room with the Conservative spokesman for an hour to read and digest a 500-page report with 11,000 pages of annexes, but for the extensive nature of the report and the wide-ranging recommendations that it makes.

We believe that credit is due to the Government for already having implemented some quality control mechanisms—and the Commission for Health Improvement and clinical governance. We welcome the steps that they have taken so far. However, my fear, which is reflected in the view of the inquiry team, is that the case is not isolated and that similar circumstances are arising elsewhere. As the Secretary of State so rightly said, it is a system problem. Does the right hon. Gentleman accept the figures suggesting that while 30 to 35 babies died unnecessarily in Bristol, as many as 25,000 avoidable deaths nationwide may have been caused by errors in medical care? Does the right hon. Gentleman therefore accept that a culture change is needed to tackle the macho style of medicine, which is based on individualism rather than team work? Does he also accept that protection for the whistleblower remains inadequate in a system where, for example, junior doctors rely on the patronage of senior doctors to get promotion?

I was pleased to hear the Secretary of State's response to the right hon. Member for Holborn and St. Pancras, but will he go further? The report is clear about the impact of the recommendations on the tort system of medical negligence. It states:


It stresses that the NHS


It also states that


It recommends the introduction of


That is no-fault compensation. I hope that the Secretary of State will clarify that the expert panel's scope will include the ability to implement the recommendation for a switch to no-fault compensation for which my hon. Friends have previously called.

Does the Secretary of State accept the need for not only patient bodies but the public to


Will he assure us that he will be able to deliver that after the abolition of community health councils and health authorities?

Providing misleading performance data in the absence of clarification is unhelpful. Does the Secretary of State acknowledge the role of referring clinicians and

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commissioners, who failed in the case that we are discussing to deal with patients' questions and check outcomes? How does he expect those roles to be tackled when local public health advisory functions are dissolved?

Does the Secretary of State accept the inquiry team's emphasis on public service ethos? Does he welcome the report's recommendation that continued extra funding is required because quality costs, especially consultant expansion? If that is understood, the children will not have died in vain.

Mr. Milburn: I am grateful for the hon. Gentleman's comments. On his last point, the report rightly acknowledges the contrast between previous under- resourcing and current investment. Professor Kennedy rightly calls for the investment to be sustained. That is music to my ears. I agree that it is the right thing to do, and I hope that we can achieve it.

Let me consider some of the hon. Gentleman's other substantive points. He mentioned a macho style and the merits of whistleblowing. Dr. Bolsin did people an enormous favour. However, the need for whistleblowers is a sign not of success but of failure. We want a national health service that can blow its own whistle if necessary, and be honest with people.

We, too, should be honest. It is easy for Members of Parliament to criticise. Professor Kennedy makes the important point when he reminds the report's readers that these heart operations are incredibly complex. When a baby's heart is operated on, it is the size of a walnut. Such an operation requires dexterity, expertise and skills at which most of us can only wonder. We must therefore be cautious when apportioning blame, although we must acknowledge that mistakes were made and that big cultural changes must be effected in the NHS. I hope and pray for a time when we do not need whistleblowers in the NHS because it publishes validated, rigorous information that commands confidence with the public and professionals. The report goes some way towards achieving that.

The chief medical officer's committee will consider the merits and disbenefits of no-fault compensation, which is not as straightforward as the hon. Gentleman suggests.

Professor Kennedy is right about embedding the patient's and, indeed, the public's voice in the NHS. He explicitly makes the point that if patients are to be better informed, their voices need to be heard inside the NHS, not outside it.

Valerie Davey (Bristol, West): I thank my right hon. Friend for his important statement and welcome the report's in-depth study of complex circumstances. However, before we look to the future, I ask the House to join me and all hon. Members whose constituents have suffered in the tragedy in extending sympathy to the parents and families of those who died or were seriously disabled.

I ask my right hon. Friend to ensure that, as he continues with the Department to improve the NHS further, the experience of those families is never forgotten.

Mr. Milburn: I join my hon. Friend in extending the sympathy of the Government—indeed, of the whole House—to the families concerned. I also thank her for all

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her work, which has been widely taken into consideration during the past few years in dealing with some of these issues. Yes, it is important that we do not lose sight of the families' expertise. We owe them a great debt of gratitude. It would have been easy for them simply to pursue a case against the national health service in court but, instead, they have quite legitimately raised concerns about the operation of the NHS.

When I met representatives of the families earlier this week, I was powerfully struck by the fact that, in the end, they wanted some fairly simple things: an understanding and an explanation of what had happened to their families and, most important of all, an assurance that it would not happen to other families. That selflessness is something that we can only commend.


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