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5.6 pm

Mr. Oliver Heald (North-East Hertfordshire): The hon. and learned Member for Dudley, North (Ross Cranston) made a good point about the protection that those who want to give information to the authorities require under the Public Interest Disclosure Act 1998. I, too, will be interested to hear the Minister's response to that point. His contribution also shows that lawyers have their uses, as he gave us a fine technical legal analysis of the Act. Perhaps lawyers are not all bad. Have I made the declaration?

We welcome this debate, which has been a good one. My hon. Friend the Member for Woodspring (Dr. Fox), who opened for the Opposition, called for such a debate last year. We understood why it was not possible to hold it in November, but we welcome today's opportunity to consider the Government's response to the report. The debate has concentrated on the issues of information, openness and trust that are at the heart of what Professor Kennedy said in his report. I shall deal in a moment with some of those issues and the comments that have been made about them.

The debate has also been characterised by an understanding of the courage that has been shown by a number of people during the history of this dreadful situation. Of course, first among them are the parents, who have had to show great courage in tragic circumstances. It is hard to know how one would feel about losing a beloved child. There must be at least some comfort in the thought that something has come out of the tragedy. This is a very full, detailed report—I do not think that anybody could criticise it for not being fully comprehensive. The Government have listened and I pay tribute to them for that. The response that they have made today shows that they are taking the matter seriously, as they should. The courage of the doctors who deal with tiny babies and their surgery has been mentioned by a number of hon. Members, as has that of the former Secretary of State in initiating a public inquiry. So, the debate has brought out some of the good qualities in this dreadful situation as well as the bad ones, which we should not, of course, ignore.

My hon. Friend the Member for Woodspring paid tribute to the parents' courage from the perspective of a constituency Member of Parliament from the Bristol area. Several hon. Members spoke from that perspective and agreed with his comments about the parents and doctors who have brought about change at Bristol.

My hon. Friend spoke about the importance of informing the choice that parents make. He posed a question, which I hope the Minister will answer.

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If comprehensive and balanced data show that a specific clinician in a specific hospital has a poor record, to what extent will it be possible for that to inform parents' choice? Will parents or patients be allowed to base choices about referrals on the data? If that cannot happen now, will it be possible in future?

My hon. Friend also mentioned consent and knowledge. He said that in some circumstances, informed consent was difficult to obtain—for example, in emergencies and when procedures are experimental. It would be helpful if the Minister could outline any proposals for handling emergencies and experimental procedures.

The Minister will be pleased to know that I shall not mention community health councils. However, if NICE produces guidance that has not been approved by the Minister, who makes the decision about affordability? It would be odd to leave it to NICE, given ministerial responsibility to the Treasury.

My hon. Friend the Member for Woodspring made two other points. First, he referred to people from non-traditional backgrounds entering medicine and its allied professions. Will the Minister explain more fully what the Government have in mind? What would be the benefits? Secondly, hon. Members from all parties paid tribute to the General Medical Council, which has proposed reform and been prepared to meet the challenge of change. Do the Government have any proposals for speeding up investigations? Although the GMC should not be too hasty, a proper sense of speed is necessary for discipline and accountability as well as for the courts and dealing with clinical negligence.

The right hon. Member for Holborn and St. Pancras (Mr. Dobson) made several important points. He was rightly given credit for choosing Professor Kennedy and for setting up a public inquiry. He said that there were failures at all levels and that one must always ask the Florence Nightingale question: "Who's in charge here?" He made important points about openness and the compensation culture. The extent to which the Government are prepared to move against the current arrangements on clinical negligence is not clear in the report. What is the Minister's thinking on recommendation 119?

The current system clearly has problems. As my hon. Friend the Member for Woodspring said, it takes a long time to reach a result, and the legal costs often outweigh the compensation. However, most of us believe that there should be some form of legal redress in clear cases of negligence. We have ideas about moving more towards mediation, perhaps, or having a tribunal-based system, and about bringing informality into the system and trying to speed it up, building on the Woolf reforms, and so on. Is the Minister able to give us his view on this? It is important to avoid a compensation culture. I think that the Americans, if they had a choice, would probably not have the system that has developed in their country. Let us make sure that we do not have a compensation culture. Achieving that will not, however, be entirely straightforward, and it would be interesting to hear what the Minister has to say on the matter.

The hon. Member for Oxford, West and Abingdon (Dr. Harris) felt strongly that we should not have a blame culture, and I agree with him. It was something of a non sequitur, however, for him then to say that the information that is published has to be strictly controlled by the medical profession. I accept that what the Society of

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Cardiothoracic Surgeons has done is excellent and a good example of teamwork—that is obviously what we must aim for—but it would be wrong if the medical profession or anyone else had a veto on information being published. It is important that information should be placed in the public domain, even if it is not quite as complete as one might hope.

My hon. Friend the Member for Woodspring and the Secretary of State were right to say that to suppress information is never helpful. If incomplete information comes into the public domain, there are always opportunities for people to put it right. My hon. Friend gave an example of information from a regional centre, where one might expect the more difficult cases to be dealt with, not being clearly labelled as having come from there. His example showed what happens when information is put out that is not completely accurate. It was put right, because people are not prepared to accept false information. To suppress information is not the answer.

The hon. Member for Bristol, West (Valerie Davey) made an important speech about the doctors who have worked so hard to improve the situation at Bristol. She rightly concentrated, as did my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), on the importance of child-centred provision. Although the hon. Lady did not claim to have all the answers—that was very honest of her, and something that we all ought to do more often—the points with which she was wrestling were important ones. There is no doubt that Professor Kennedy felt that this was an area of great weakness, in that suggestions for improving child-centred provision have been ignored for 40 years. It would be helpful if the Minister were able to give us some idea of why the validation and revalidation of children's hospitals is not to be pursued, and why he feels that relying on the Commission for Health Improvement is an adequate response to the recommendation.

Clearly, there are issues about structure involved here, which my hon. Friend the Member for South Cambridgeshire outlined. There are also issues about the quality of the provision. Having met nurses and others who deal with children in hospital, I know that they say, "It isn't good enough to have surgeons who normally treat adults treating children, because they do not really understand how to deal with a child." Very different kinds of clinical procedure are needed when dealing with a child. I understand, for example, that children recovering after an operation need particular care—more so than adults, although we also expect a high standard of care for adults. With children, there are different considerations, and it would be helpful if the Minister would amplify the extent to which that will be dealt with in terms of structures, standards and monitoring, as hon. Members have requested him to do.

My hon. Friend the Member for Woodspring asked a question that I remember asking the Minister in Committee not so long ago: what are the special measures? If the Commission for Health Improvement produces a report stating that a situation is unsatisfactory, the Secretary of State obviously has some powers of intervention. I believe, however, that the measures being suggested go beyond those simple powers. Will the Minister tell us today what they are? Will he also say why

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the Government do not support the recommendation that travel costs and parental access should be more fully funded?

The hon. Member for Kingswood (Mr. Berry) made four points. He was surprised and shocked that there were no clear standards of care when the incidents occurred and that monitoring and an agreed means of evaluation were not in place. He also made an important point about the culture change that has occurred. My hon. Friend the Member for Westbury (Dr. Murrison) was trained at Bristol royal infirmary and he explained that years ago there was a hierarchical culture and arrogant attitudes among some surgeons, although he strongly made the point that that has changed.

Society's attitudes are changing and we are moving from a culture in which we accepted hierarchies and that the surgeon or consultant was not to be challenged or questioned to one in which we accept that patients have a voice and that they are entitled to information. We also accept that citizens are to be empowered, and I welcome that. It is not as surprising as the hon. Member for Kingswood suggested that things were as they were, but it would be surprising if they remained that way. It is a good thing that citizens are becoming more able to make choices and be informed.

The hon. Gentleman also made a point about whistleblowing and noted that health funding is important to standards. It is easy to ignore the basic funding position or the basic background against which a doctor works, but we should not do so. Inadequate equipment and buildings, which the report refers to, make it difficult for a doctor to perform and it is difficult for those in charge of monitoring performance and ensuring that it is achieved to set a world-class standard when world-class tools are not available for the job. We must all consider that issue and I am sure that we shall debate it further.

I do not want to speak at great length and there is much for the Minister to respond to. This has been a serious debate of the highest quality and, rightly, there was none of the usual party political knockabout. The report and this issue are so important that descending to that would not have been a good thing. I look forward to the Minister's remarks.


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