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Doctors ponder post-Bristol future
When Health Secretary Alan Milburn stands up in the House of Commons on the afternoon of the Bristol inquiry report, he holds all the cards.
This is the moment that doctors around the country have been anxiously awaiting since 1995, when news of a scandal in the West Country began to filter out.
Mr Milburn holds a blank sheet - the power and popular support to tear down the way doctors are regulated and build something new.
There were some doctors who predicted that Bristol would be no more than a blip or a footnote - an opinion soon revised in face of massive public outcry.
Sir Barry Jackson, president of the Royal College of Surgeons of England over the past few years, is in no doubt about the significance of Bristol.
He told BBC News Online: "I think that Bristol will be looked upon as a defining moment in the practice of medicine in this country."
Previously, doctoring, while an intensely difficult profession to enter, for some it was relatively easy to stay within it for years without making much effort to keep skills up to date in a fast-changing world.
Most doctors would also admit that it was possible for very poor practioners to stay in the game for years.
While their inadequacy might be an open secret in the profession, no patients were any the wiser and the authorities rarely became involved.
Now the UK profession is hurrying in a raft of reforms - doctors, on a regular basis, will have to prove they are still up to the job through audits of their work, and regular appraisals.
'Change or leave'
Sir Barry is confident that change will be accepted.
He said: "There are some of my colleagues who don't like the changes at all, but there are others who welcome them.
"The majority feel they are inevitable and a very good thing."
He said while there were likely to be a few "stick in the muds" who obstinately refused to bend, they would face a stark choice - change or leave the profession.
But the key question is this - will these changes be enough to stop Alan Milburn introducing more Draconian measures in the wake of Bristol, when there will certainly be great public demand for a shake-up.
Most vulnerable is the General Medical Council, which has been accused of not acting quickly enough to halt the practice of failing doctors.
Many, in both government and the profession favour a radical reshaping.
Never has "patient power" been so fully expressed as in the drive by parents whose children died or were brain-damaged at the Bristol Royal Infirmary.
At the forefront of much of this was Maria Shortis, who helped found the Bristol Heart Babies Action Group and tease out a little of the truth about the hospital's record.
Her latest project, called Constructive Dialogue for Clinical Accountability, aims to bring doctors, managers and patients together in discussions.
However, plenty still needs to be done, she says, hoping that the report will be a catalyst for firm action.
"I think that the GMC needs to be disbanded and some kind of independent medical inspectorate that is not punitive put in place.
"That picks up or reports back on clinical errors - but not as a way to name and shame people.
"All doctors make mistakes - all doctors are human. They need some sense of what they are doing so they can be helped if they underperform.
"The problem is, they don't want independent regulation because they think it will be punitive."
Cost of change
In cardiac surgery itself, many experts are now concerned that the public, looking abroad, will expect too much from its surgeons.
Paediatric surgeon Martin Elliott, from Great Ormond Street Hospital in London, says that when the public see hospitals in the US and Australia with superb success rates, they do not realise exactly what it would take to bridge that gulf.
"Reducing it from 5% to zero needs another exponential increase in expenditure.
"That is something that the public has to deal with."
Even now, with his field firmly in the public spotlight, there is no evidence of the massive cash injection needed, he says.
"We're slipping behind so fast. It's like the Railtrack disease."
Improving services, he says, will need politicians to make choices which may prove hard to swallow.
For example, as bigger heart centres normally achieve better results, merging some of them to form "supercentres" could be advantageous.
"For instance, in London there are three units - how are they going to close one of those units politically?
"Remember what happened in Kidderminster - and just think what would happen if that were Guys, the Brompton, Great Ormond Street, what the effect would be."
He said it is now important for the government to guide the future of the service by deciding how good it wants it to be - and then coming up with the right amount of money to make it happen.
"What does the government want us to be - the best in the world, average, or OK?"
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