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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: 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 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 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
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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