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The Minister of State, Department of Health (Mr. John Hutton): I am reluctant to interrupt a good and thoughtful speech, but I take the opportunity to clear up any confusion in the hon. Gentleman's mind. Clearly, the Department will not turn a blind eye to services that we know are unsafe. We will not hesitate to take necessary action. If that means closing a particular service when the evidence is clear that it is not safe, of course we shall do that. We will not expose children to unsafe medical practice at any time it is drawn to our attention.

Mr. Lansley: I am grateful to the Minister. It would not have occurred to me that Ministers would turn a blind eye. Perhaps I should explain where my concern lies. It seems that one can take two attitudes in relation to services of that kind. One can say that services must meet a high standard before they can be offered. On the other hand, one can say that if services do not meet a minimum standard, they cannot be provided.

Often, inspection will find many quibbles. Inevitably, there is a large area that falls below a minimum standard, which means that the service cannot be offered. That service will have to show a path back towards a higher level comparatively, but there is a big gap between that and the point in a validation or revalidation system that demonstrates that one has met a certain measure of quality in order to provide a service in the first place.

The issue is brought into sharp focus in the validation of services that are not supranational or specialist. As the Minister will know, the Kennedy report sets out clearly the particular concern about hospitals across the country providing a specialist service when they did not have the necessary level of throughput. The issue then is whether validation is the better route. Is it better to say to non-specialist hospitals or those that do not have the necessary level of throughput of activity to deliver high clinical outcomes, "You cannot pursue that kind of service unless you meet quality standards"? That is a validation system rather than an inspection system.

The two are not mutually contradictory. Of course, having validated the provision of a service, one continues to inspect it to ensure that it is being provided to a satisfactory standard. However, it is not necessarily right to conclude that the validation and revalidation of children's services is complementary and desirable—perhaps especially as we want services with specified throughput rates in order to achieve safe clinical outcomes.

I raise that issue because I realise that to a certain extent Ministers are still thinking about it. Although on the face of it, the recommendations have been rejected, the configuration of services remains to be determined. National service frameworks must be completed this year because their shape will affect what flows from them.

As I said in an intervention on the hon. Member for Bristol, West, we need to consider the proper configuration of services because the lead times can be long. In Cambridge, Addenbrooke's hospital—one of the country's leading hospitals—is considering the shape of clinical

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services at and around the site for 2020. For example, it is not currently the intention of the Addenbrooke's NHS trust board or the related health authorities to provide a children's hospital at Cambridge. That is because, although in every other respect Cambridge would be a satisfactory place in which to provide such a service, the catchment area comprises about 4 million people. I understand that the figure for Bristol is about 5 million. Cambridge is 56 miles from Great Ormond Street hospital, which is in the constituency of the right hon. Member for Holborn and St. Pancras, but Bristol is 119 miles from Great Ormond Street. Presumably, the distance to Birmingham is somewhat less.

One might conclude from the above that there are implied criteria for the continuation and strengthening of a children's service at Bristol that would not apply to Cambridge. There are criteria as regards the number and location of units throughout the country that provide children's services in a specialised children's hospital. However, I am not clear about those criteria; nor am I clear about how the Bristol royal children's hospital has responded to them or whether it has used different criteria from Cambridge.

Cambridge is precisely the right place for a children's hospital: it has a teaching hospital, it has nurse education, and it has not only a district general hospital but the regional capacities for many services. That relates to a point made by the hon. Member for Bristol, West. In the time frame under consideration—up to 2020—Papworth hospital may come alongside Addenbrooke's as an independent hospital NHS trust providing cardiothoracic services. The Rosie—a maternity hospital—is part of the Addenbrooke's trust, so we have expertise in neo-natal intensive care and the associated paediatric services.

One could easily conclude that Addenbrooke's was precisely the type of medical campus on which one would want to site a children's hospital. The development of children's services in the NHS would point to that conclusion. However, people at Addenbrooke's and in the NHS have not reached that conclusion and are not working towards that end. Why are they not doing so? Have implied criteria already been established for the configuration of services? If there are no such criteria, we need to draw them up soon—in the course of setting out the national service frameworks—to decide whether we need to make changes.

Otherwise, in a few years, hospitals such as Addenbrooke's will offer paediatric services in a range of specialities but those services will not be grouped together in a dedicated children's hospital. That would give rise to the problems that were mentioned earlier. The peripherality and fragmentation of children's hospital services may be continuing throughout the country because we have not thought quickly or clearly enough about the desirability of reconfiguring hospital services and of creating additional children's hospitals.

In the past, hospital services for children have—because of the relatively small number of children who have to undergo certain operations and procedures—been located in quite distant units. The Kennedy report made it clear that fewer centres result in greater competence and better clinical outcomes. The report points out that for certain conditions, such as congenital heart disease, there may be a case for having only two units in the country that provide those services.

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By implication, therefore, children and their parents and families will have to attend hospitals at a great distance from their homes. That will result in considerable costs for those families and there will also be effects on the general health of the children. Many charities can offer help; for example, the Sick Children's Trust offers families long-term support when children spend a long period in a hospital that is some distance from their home.

The report made some recommendations about travel support for children and their families, but the broadening of such support was not accepted by the Government, although their response today seems to suggest that they are willing to consider further steps to improve such support in due course. Perhaps the Minister can comment on that in his response to the debate. One of the ways that children's health care services differ from adult services is the complete dependence of children on their families. There are consequences for their health when they are sent to distant hospitals and we need to recognise that.

I thank the Secretary of State for his introduction to the debate. One important point is that we should not only publish data but should recognise that they will show us the difference in performance and clinical outcomes between different hospitals.

The Secretary of State talked about cardiac surgery. I have previously raised with Ministers the need to assess clinical outcomes in tertiary hospitals. For example, the Papworth hospital, as a cardiothoracic institute, has extremely good clinical outcomes. The publication of additional data will show that there is every reason for such institutes not to be merged into district general hospitals. That might make sense in terms of co-location but the clinical excellence provided by a separate institute with a clear focus would be lost.

If hospitals such as Papworth and Addenbrooke's can live alongside one another as two hospitals on one site retaining their tertiary expertise, that will be to the overall advantage of the health service. However, we must recognise the better clinical outcomes in tertiary hospitals, so I welcome the publication of data that would enable us to do that.

Much rests on the effectiveness of the Commission for Health Improvement. I have no way of knowing how good the commission will be in undertaking its task. It has been examining paediatric services at Addenbrooke's and it is also visiting Papworth. I have every confidence in both hospitals and await the commission's findings. Ministers should consider how much rests on the CHI. As we have learned only too painfully from the events at Bristol, we have to discover where things are going wrong and rectify them. We must also keep an open mind as to whether there are new ways of ensuring that services are correctly configured and provided to a high standard.

4.19 pm

Mr. Roger Berry (Kingswood): The dominant emotion that I, like other hon. Members, felt, and still feel, in preparing for this debate and on re-reading the Kennedy report was one of deep sadness at the events that led to children unnecessarily dying or being damaged and deep sorrow for the parents who had to endure not only that experience with their children, but many years of trying to get to the bottom of the tragedy's causes.

Unlike in many debates in the Chamber, I feel desperately sad about the situation, and I am sure that that is true of every other Member. I also feel anger because,

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as has been said already, concerns were being expressed about the situation at the Bristol royal infirmary as early as 1984. This debate is taking place 18 years after those initial concerns were expressed.

In case there was ever any doubt about the importance of reform in the NHS, or the importance of the Kennedy report and the Government's response to it, I refer to the fact that, almost unbelievably, 18 years after initial concerns were expressed, we are debating the issue today. That cannot be other than entirely unsatisfactory.

Alongside the sadness that I feel for the children affected and their parents, I would also express, as other hon. Members have, my admiration for the parents who have consistently pursued over the years their campaign for a full and proper public inquiry.

I should like to congratulate, first and foremost, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). As he and other hon. Members intimated when we discussed the statement made in July, it was not as though establishing a full public inquiry was without its difficulties. Inevitably, some people will always wish to resist such a course of action. I should certainly like to express my great admiration for his decision to hold a proper, full public inquiry. It was the right decision to take; the tragedy is that it was not taken much earlier.

I join other hon. Members in thanking Sir Ian Kennedy and his colleagues for an extensive report, which took a fair amount of time to produce. Many hon. Members—my hon. Friend the Member for Bristol, West (Valerie Davey) was one—asked when we could have the report and see the outcome. I am sure that we would all agree that while the report took some time to produce, it is not only extensive in terms of the number of recommendations and pages; but a seminal document on the way in which we run our NHS, so it was well worth waiting for.

To complete my thanks, I thank my right hon. Friend the Secretary of State for Health for his statement this afternoon and for the Government's response to the Kennedy report. Inevitably, as the Government's response was available only a short time before this debate commenced, and although speed-reading courses are very effective these days, we need more time to digest some of the detail. However, the summary of the Government's response makes it clear that they are acting positively on virtually all the key recommendations. I thank my right hon. Friend and his colleagues in the Department of Health for the way in which they have dealt with this matter.

The Kennedy report is entitled "Learning from Bristol", and I want to take up a point made by the hon. Member for South Cambridgeshire (Mr. Lansley). I have resided in Bristol for a very long time and am aware of events at the Bristol royal infirmary, but a substantial part of the report deals with the lessons for the future—lessons for the whole NHS. The report could just as easily been on events in another hospital in the United Kingdom, so we should acknowledge that it is as much about general failings in the NHS at that time as it is about individual failings in Bristol.

I want to make four brief points, the first of which relates to the need for standards to evaluate performance and assess the quality of care. Again, like my hon. Friend

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the Member for Bristol, West, I was surprised to discover when I was first elected to the House almost 10 years ago that there were no well laid down standards or procedures for assessing the quality of care.

I was born in the year that the NHS was set up—within a few days—and I owe a lot to the NHS, not least being here today, but it had never occurred to me that throughout the 1980s and early 1990s there was no regime to establish standards for evaluating performance or basic procedures for assessing the quality of care. As I picked up the picture as a Member, I found it astonishing that we did not have such a framework, and I was certainly reminded of that when I read Sir Ian Kennedy's report.

As all hon. Members know, the report reveals that, in the late 1980s and early 1990s, there were no national standards and monitoring was virtually non-existent. I was shocked by this comment in the Kennedy report:


I shall not quote the report extensively, but it went to say that that was


Much progress has been made in recent years. The Kennedy report indicates areas where things can be improved, but we now have clinical guidelines, through NICE, national service frameworks, the CHI and much more. Kennedy states in his report that that gives rise for optimism and provides it as the basis for recommendations about improvements, but I simply make the point that I cannot have been the only citizen in Bristol, or elsewhere, who in the early 1990s and before did not realise that there was a problem of the kind that Kennedy analyses. That revelation will have come as a great shock to the vast majority of people. People need to know not only that such systems are in place, but what standards of clinical care patients are entitled to; indeed, they have a right to know that.


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