The BBC's Matthew Hill on the Bristol inquiry

Professor Ian Kennedy, chairman of the public inquiry said self-regulation and doctors' accountability would be considered by the inquiry and recommendations could be made.

This could lead to a huge shake-up in the medical profession.

The self-regulation system has come in for much criticism following a hearing by doctors' regulatory body, the General Medical Council, into the Bristol case.

It has resulted in a number of reports by doctors' organisations, suggesting ways to improve self-regulation.

Professor Kennedy was speaking at the preliminary hearing into the heart operations inquiry which was attended by both supporters and opponents of the two heart surgeons at its centre.

About 100 members of the Bristol Surgeons' Support Group and parents of the children who died or were injured following heart operations at the Bristol Royal Infirmary (BRI) packed out the hearing at Bristol's Council House.

They heard Professor Kennedy say that it would be open, independent, sensitive and informal and would look at every relevant medical record covering the period.

Professor Ian Kennedy: the hearing will be open and independent

He promised it would be "as inclusive as possible" and he added that he did not want the inquiry to become a trial.

"We were not set up to engage in a trial fixing blame. Our focus is much, much broader than that. It is to inquire into what happened and what can be learnt," he said.

Professor Ian Kennedy on the preliminary hearing

"It will cover the whole culture, the whole ethos, of the way health services were provided in this country at the time."

Professor Kennedy also warned that some of the evidence that the inquiry would consider would for some be "almost too painful to contemplate."

Cultural earthquake

Members of the Bristol Heart Children's Action Group, the main parents' group, sollicitors and the United Bristol Healthcare Trust told the hearing they wanted to give evidence.

The trust was worried about confidentiality.

The preliminary hearing was held on Tuesday. The full inquiry is expected to begin early next year.

The case, which has caused a cultural earthquake among doctors, should last about 18 months.

The public inquiry will consider a wide range of cases, including allegations of brain damage and 140 cases of children who died after operations.

It was called after public protest at the outcome of the GMC hearing.

The hearing found three doctors - surgeons Mr James Wisheart and Mr Janardan Dhasmana and manager Dr John Roylance - guilty of serious professional misconduct.

Mr Wisheart and Dr Roylance were banned from practising while Mr Dhasmana was prevented from operating on children for three years. He has since lost his job at the BRI.

March

Earlier on Tuesday, about 100 supporters of Mr Wisheart and Mr Dhasmana marched through the streets of Bristol.

Donald Boots of the supporters' group said the 500 members of the group included some parents who lost children in operations.

Bristol surgeon supporters say they have saved many lives

Many are relatives or former patients of the doctors who say they owe them their lives.

Some of the marchers carried placards saying "Heart surgeons save lives, not kill 'em" and "Thanks for saving mum's life".

Mr Boots said: "We think it totally wrong that Mr Wisheart was struck off and we are very concerned that Mr Dhasmana does not have a job. I would have no qualms about him operating on me. He is an excellent surgeon."

Some parents of children who have survived heart operations say they believe there has been a witchhunt against the surgeons.

One mother said: "It is not down to the surgeons who are very special people who have saved thousands of lives."

'Institutional failure'

Two parents on their different experiences of heart operations at BRI

Michaela Willis of the BHCAG, whose son Daniel died after a heart operation performed by Mr Dhasmana, said he should have stopped operating after a number of children had died following heart surgery.

But she added that it was not just the surgeons who were at fault.

"There has been an institutional failure," she said.

She welcomed the inquiry and the fact that it was looking at both the problems at the BRI and at the NHS as a whole.

"It could happen all over again if it is not sorted out," she said.

Traumatic

The BBC's Liz Igoe looks at the background to the public inquiry

Stephen Parker of the main parents' group, the Bristol Heart Children's Action Group (BHCAG), said: "It is a very traumatic thing for any parent to go through.

Steve Parker: the parents have been through a hell of a lot

"You lose a child and then you find out that your child might not have died if you had taken them to a different surgeon.

"They have gone through a hell of a lot and they need everybody's support and help now."

The BHCAG is angry that the GMC hearing only looked into the deaths of 29 children and four cases of alleged brain damage.