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Earl Russell: My Lords, is the Minister aware of the message contained in the latest Wonder Bra advertisement, which says:


Lord McIntosh of Haringey: My Lords, my principle is to allow noble Lords who use Question Time to make jokes to have them unimpeded by interventions from me.

Lord Cocks of Hartcliffe: My Lords, in order to encourage and set an even better example, will my noble friend the Minister consider asking his colleagues to announce that they are donating rather more than an hour's pay towards this project?

Lord McIntosh of Haringey: My Lords, I shall follow with interest any initiative that my noble friend takes in that direction.

Lord Peyton of Yeovil: My Lords, can the Minister assure the House that those who will be responsible for the contents of the Millennium Dome actually know how much money will be available to them?

Lord McIntosh of Haringey: Yes, my Lords; without doubt. I can certainly give that assurance. Those who are carrying out the design and preparation work are very well aware of the budgets which have been set for them by the New Millennium Experience Company.

Baroness Rawlings: My Lords, does the Minister agree that support given by the Deputy Prime Minister for a fun-fair in the grounds of Battersea Power Station shows that either the Government are surreptitiously looking for a backup to their preparations for the year 2000 celebrations, or that they are hopelessly divided over them?

Lord McIntosh of Haringey: My Lords, as the noble Baroness well knows, neither is the case. Only a

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minority of the millennium funding goes on the dome. The vast majority of lottery money will be spent on celebrations, buildings and activities in all parts of the country, including Battersea. Indeed, why not?

Bristol Royal Infirmary: GMC Inquiry

2.58 p.m.

Lord Dean of Beswick asked Her Majesty's Government:

    In the light of the General Medical Council's inquiry into children's deaths while undergoing heart surgery at the Bristol Royal Infirmary, whether the Department of Health were aware or were informed of the situation at the time of the operations; and, if so, what action, if any, was taken.

The Minister of State, Department of Health, (Baroness Jay of Paddington): My Lords, my noble friend will be aware that these tragic events took place over a number of years during the term of office of the previous administration. However, I understand from Department of Health records that concerns were raised informally with officials as early as 1992. Those concerns were pursued with the Bristol trust which, in 1994, agreed plans to improve the service. In January 1995, the department took formal action to ensure that the situation in Bristol was investigated by independent experts. Your Lordships will know that a professional inquiry by the General Medical Council has just been completed.

Lord Dean of Beswick: My Lords, I am grateful to the Minister for that reply. But is it not obvious that at the time these terrible tragedies took place, the safeguards--if there were any in place--were not sufficient to prevent a large number of these children from dying? Will the Government take steps to introduce measures as quickly as possible to provide a better future for children, and anyone else who is undergoing an operation, to prevent this carnage from happening again?

Baroness Jay of Paddington: My Lords, the Government are committed to try to raise quality standards of all National Health Service treatment. For the first time in England we intend to publish comparative death rates following surgery in individual hospitals. Those hospitals will be weighted for case, mix and catchment area. We also intend to set up an independent commission for health improvement. The commission will visit every NHS trust regularly and will have special powers to investigate particular problems in any hospital. This work must be matched by more comprehensive clinical audit. For example, there are at present four national confidential inquiries into deaths after surgery, maternal deaths, still births, infant deaths, and suicides, but participation is voluntary. Among our range of new measures the Government will take action to require all relevant clinicians to participate in these professionally led external audits.

Baroness Gardner of Parkes: My Lords, no doubt the Minister is aware that the BMA's consultants and

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specialists committee has indicated a need for publication of clinical audits. The rate of deaths which the Minister has just mentioned is, of course, the most basic and simple measurement. However, the BMA is not in favour of individual practitioners being audited or their results being published. The Minister mentioned the commission for health improvement which is to be established next year. Will she ask that commission to undertake a review of the competence of consultants in all fields? Is it not the case that once a person has reached the top of his profession, there is no peer review and, unfortunately, we discover incompetence too late?

Baroness Jay of Paddington: My Lords, the noble Baroness rightly draws attention to the problems in the existing system which mean that much audit is retrospective. The commission for health improvement will undertake regular visits to hospitals to make a regular check on individual and collective performance within hospital trusts. In addition, the audit I mentioned this afternoon of clinicians and hospitals has previously been carried out on an entirely voluntary and confidential basis. We shall now require clinicians to participate in that.

Lord Tordoff: My Lords, should we not consider the effect of stigmatising a particular cardiac surgery department in Bristol--where terrible things have occurred in the children's department--without redressing the balance slightly by adding that much cardiac surgery is successfully carried out there, including an operation on myself a year last September?

Baroness Jay of Paddington: My Lords, I am delighted that the noble Lord is so obviously a striking advertisement of the good care that is available within the NHS. I think we always recognise that the vast majority of care within the health service is of the highest quality. The problem consists of identifying those who fall below the good standards of most clinicians. That is what we hope the new system will achieve.

Lord Alderdice: My Lords, does not the Minister agree that the reply that she has given indicates, to some extent, a sluggishness on the part of the Department of Health in addressing some of the concerns which were raised over a period of time? Does she not accept that if we are merely to go down the path of collecting crude mortality statistics, there could be a danger that consultants may adopt a rather conservative approach to treatment, and they would tend not to take on patients who represented a high risk as they feared a problem in respect of mortality statistics? Can I take it that the rather sophisticated measures the Minister has mentioned will address that concern?

Baroness Jay of Paddington: My Lords, of course all of these statistics are bound to be stigmatised--to use the expression of the noble Lord, Lord Tordoff--as crude. Mortality rates can, of course, be inappropriately interpreted. That is why the clinical governance arrangements which the NHS will be required to follow

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from next year will include not just an assessment of the financial health of any institution but also its broad quality outcomes. That will address the more subtle aspects that the noble Lord mentioned. I do not have time to discuss that extensive system in detail at Question Time.

Lord Hunt of Kings Heath: My Lords, does my noble friend agree that while the activities of the doctors and Department of Health officials concerned should come under the closest possible scrutiny, the activities or non-activities of the board of the trust of that hospital should also be examined? Can my noble friend assure me that the responsibilities and actions of the executive and non-executive directors of that trust will be subject to the closest possible review?

Baroness Jay of Paddington: My Lords, I do not wish to comment on the exact terms of the independent inquiry which we have announced will take place with regard to the Bristol trust once the General Medical Council's conclusions are finally reached. It is specific in the terms of the new commission for health improvement that in the last resort the Secretary of State will be able to dismiss a trust chairman and board if they have fallen short of any of the new standards.

Lord Ironside: My Lords, in view of the growing importance of quality assurance in the medical field nowadays, is the noble Baroness aware that the Bristol oncology centre has quality assurance approval to ISO 9002, which is an important part of its procedures to avoid accidents? Has the heart surgery department in the Bristol Royal Infirmary--or did it have--ISO 9002 quality assurance approval? If it has that approval, the accidents we are discussing should not have taken place.


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