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Mr. Lansley: On that point, the hon. Lady and her colleagues from Bristol have experience of the opening of the new children's hospital last year. On reflection, what is her view of this matter? The Kennedy report looked at the concentration of paediatric services in a children's hospital, co-located alongside other acute district general hospitals that could provide specialties that could not frequently be expected to be available in a children's hospital. The treatment of burns might be one sort of treatment that a children's hospital could not be expected to maintain full-time and would have to be co-located. Bristol has moved to that point; in Cambridge, we do not have such a service and we look to a children's hospital in London. What is her experience of that in Bristol? Would she prefer that, or would she prefer something different from the current system?

Valerie Davey: The hon. Gentleman asks questions to which I do not pretend to have the answers. I checked, and the Kennedy report speaks about operating such a service alongside a district general hospital. In Bristol, we have some regional capacity. Do we therefore take that phrase to refer to regional acute services? The debate continues. There is a lot of history to the location of the children's hospital in Bristol. The hospital is well served by the equivalent of district general hospital capacity, but what about the regional level of capacity?

I welcome the comments of other hon. Members today. I do not have the answer to the question, and we have not always received a unanimous response from clinicians and professionals on the matter. The question is a huge one. The Department needs to consider it carefully when it gives advice. I shall scrutinise its response to Kennedy very carefully.

I am sorry not to have an answer, but I do not apologise. It is beyond any hon. Member to offer a definitive response.

My final point has to do with focusing on the patient, and putting the patient at the centre of the health service. That strategy is informing the Government's approach to the NHS, and should also inform the public debate, as I said earlier.

That may sound strange, as one would expect the public to have understood the notion that patients are central to the health service already. However, as a matter of custom and practice, people have always deferred to the medical profession. The questioning by parents, especially in Bristol, has given us all a new approach, and set out a new agenda for the NHS that we need to follow.

The clear presentation of information by the cardiac surgeons in Bristol is a good beginning, but we must still listen to parents. The now established charity Constructive Dialogue for Clinical Accountability is made up of parents, the public and clinicians, and their aim is to ensure better dialogue. They want to make sure that communication between health care professionals and patients is developed. The charity believes that parental contribution and input to children's health care should be recognised as having a value equal to the contribution of professionals.

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The charity issued a press release today that highlights the section of the Kennedy report that suggests that the NHS must work with people, and that it must celebrate its successes and make known its shortcomings.

It is invidious to name individual parents, but Maria Shortis and Trevor Jones have worked hard for many years to establish the CDCA. Although they are getting increasingly professional, they used lay terms to tell me that clinicians are not gods.

"Clinicians make mistakes," they said, "and we need to recognise that. It is no good them telling parents that all will be well, when it may not be." They told me that parents need to be treated as mature people. Obviously, they are concerned about their children, but they want the truth. Parents want to know what the probability is that an operation will succeed, but they understand about human error. That is their down-to-earth message. Thanks to some funding from the Department of Health, they have been holding training sessions around the country. They have taken on the GMC and the BMA, and have earned those organisations' reluctant respect.

Trevor Jones wants health funding money to go to doctors, not lawyers, as he put it. That blunt point has been echoed in the Chamber today. He does not want large sums to be diverted into medical negligence actions.

Interestingly, Trevor Jones made a link with the need for better provisions for informed consent. He said that truly informed consent requires better understanding. If clinicians took the time to talk in a mature fashion to parents about an operation's likely outcome, parents would have more trust, there would be far less litigation and money would be spent properly in the NHS.

I assure Ministers that the CDCA will not be entirely content with the response from the Government today. It will welcome what has been said, but its campaign continues. Its press release speaks about accountability and independent regulation, the adequate funding of quality services and active patient partnership. Then comes the sting in the tail: if the Department of Health is in charge, to whom is it accountable? Questions as pertinent and difficult as that will go on being asked.

I am convinced, from my experience with the Bristol cardiac unit, that lessons have been learned and acted on. However, the words of the Kennedy report still resonate with me, as they do with other hon. Members. We cannot guarantee that similar events are not happening elsewhere as we speak. I want to ensure that the lessons learned by the Bristol cardiac surgeons are learned by all similar departments in the rest of the country, and that professionals in every other discipline learn those lessons and act on them.

The culture of secrecy and of the patronising attitude to patients has begun to be dispelled in Bristol. I am sure, given what my right hon. Friend the Secretary of State said today, that the major task of ridding the whole NHS of that culture has been begun and is already, in part, in hand. All of us now must ensure that the process is taken forward nationally, throughout the NHS.

3.57 pm

Mr. Andrew Lansley (South Cambridgeshire): I am pleased to be able to contribute to the debate and to follow the hon. Member for Bristol, West (Valerie Davey). Clearly, she and other colleagues have put an enormous

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amount of time, energy and effort into supporting the work of the parents who suffered the tragedies at Bristol royal infirmary over the years. They have tried to keep the issues to the fore and ensure that they have been followed up. It is to the credit of everyone involved, including the right hon. Member for Holborn and St. Pancras (Mr. Dobson), that we can debate these matters today with the benefit of a report that is both comprehensive and challenging.

In addition, I hope that hon. Members who have lived with these problems for many years will agree that we must today make sure that hon. Members who have only read about them in the Kennedy report think about the report's conclusions as they affect parts of the country other than Bristol. The lessons have to be learned by people in other parts of the country and they have to be acted on. In that way, the hope is that we can prevent the repetition elsewhere of the tragedies that took place in Bristol. We can do that by systemic change in the NHS and by promoting awareness and additional openness in the service. In that way, we can ensure that the accountability rightly described by the hon. Member for Bristol, West is being exercised by those who bear that responsibility. Members of Parliament to a large extent share in that responsibility. I am therefore pleased to have the opportunity to think about those issues from the other side of the country, as it were—from Cambridge. We are being challenged to think about how they will affect us and the configuration of our services for children.

Several hon. Members have said that it is challenging to try to deal with the range of issues as there are so many. There are 198 recommendations, which makes it challenging to try to respond to the report, and indeed to embrace the Government's response and to comment on it. I shall not attempt to do that across the board but focus on just one area.

When reading the report, one of the issues that sprang out at me was its criticism of the lack of priority that has been given to children's health services over many years. Today, rightly, the Secretary of State and others have focused on the lessons than can be learned for the NHS as a whole in terms of accountability, professional regulation, consent for treatment, inspection of the service and so on, but underlying all that is the fact that the tragedies occurred in respect of children's health services. It seems that one of the reasons why they occurred was because a relative lack of priority was given to children's health services, which were not integrated and managed in a way that would have inhibited the lack of performance. They were too often seen to be at the periphery of the professional practice of a hospital.

Chapter 29 of the Kennedy report sets the matter out clearly. It paints a stark picture:

It mentions the Platt report of 1959 and the Court report of 1976. It does not go through them all in detail but elsewhere one can find references to the national confidential inquiry into peri-operative deaths in 1989, the 1991 guidance issued by the Department on children and young people in hospital care, the 1993 Audit Commission report, and a range of reports in the run-up to the 1997 general election, including one on hospital services by the Select Committee on Health and the Government's response to it.

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Throughout that period, a series of reports often made similar remarks. They talked about the need for a child-centred approach to children's health care services; about recognising the difficulties for children of being treated away from their families; about a holistic view of the needs of children; about the given level of expertise required to deal with specialist factors associated with children; and about not treating children as a by-product of the professional expertise of treating adults—children are not simply a small version of adults when it comes to medical practice. The reports also talked about the need for minimal hospitalisation—it should happen only when absolutely necessary. There must therefore be a different approach to the relationship between hospital care and community care.

The Kennedy report says in chapter 29, paragraph 14:

What we learn from that is that it is not sufficient to publish reports. It is not sufficient even to publish Government responses to reports. They may be more comprehensive and compelling, but they must be turned into action. There must be delivery in response. There must be delivery in relation to children's health services and an increased priority for those services within the NHS if we are to avoid a new, but different form of tragedy occurring somewhere else because of a lack of specialist expertise and a lack of integration of health care services for children.

Several issues arise from that. Specific recommendations arising from the Kennedy report concern the future configuration of children's hospital and health care services. At the moment, it is difficult to see precisely how the Government will respond to those. There are relatively few instances where the Government's response rejects what the Kennedy report has said but there are some. The Secretary of State rightly focused on what he is accepting in the Kennedy report—the recommendations on introducing strengthened inspection procedures and the role of the Commission for Health Improvement—but he might have gone on to say that he is rejecting the Kennedy report's recommendations in relation to validation and revalidation of children's hospital services.

According to the Government's response, if I characterise it correctly, to accept those recommendations would run the risk of losing capacity in the NHS for the delivery of services for children because of the failure to validate or revalidate a particular service. I am uncertain about that line of argument.

It seems that there is an interesting difference in the mind of Ministers. They say that we should not have validation or revalidation of services because if the answer is that a service is not good enough, quality standards will not be met, the service will not be able to be offered and patients will suffer because of the lack of that service for the time being. Therefore, we must have an inspection system whereby the Commission for Health Improvement has strengthened powers to the point where it can call for special measures to be taken in order to remedy problems straight away.

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What are those special measures and how swiftly can one act on the commission's findings? If it is not very swiftly, by implication services provided to children will not be of sufficient quality and will not meet the necessary level of validation.

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