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Tuesday, 24 July, 2001, 10:28 GMT 11:28 UK
Bristol babies inquiry: Does it go far enough?
The long-awaited report of the inquiry into the Bristol heart babies scandal has been published.
It blames flawed surgeons for unnecessary deaths at the unit and concludes that between 30 and 35 children who underwent heart surgery at Bristol between 1991 and 1995 should not have died.
It condemns a "club culture" among doctors at the unit, who adopted a paternalistic attitude to patients and were caught up in professional rivalries.
The multi-million pound inquiry runs to 500 pages, with 12,000 pages of back-up statistical data. It makes 198 recommendations.
Among those recommendations are a call for better information to patients and improvements to the management of NHS services.
Do the recommendations go far enough? Will this report give any relief to the families of the dead babies?
This debate is now closed. Read a selection of your comments below.
Rachel Rose, UK
It should not need to be up to the public to examine performance in "league tables" (in the Health Service or Education). Both of these institutions already have very well paid bureaucracies in place above them, who seem both unable and unwilling to sack people. In a business, managers identify those who cannot do their job and eliminate them. Why are people in public-paid professions not accountable for their mistakes and incompetence?
I look with horror on a report that proposes periodic re-evaluation of all physicians as a cure all for substandard medical care. Have you people ever heard of credential review, ongoing peer review, sentinel event analysis, etc, etc, etc? This is standard operating procedure in U.S. hospitals, thanks to the Joint Commission.
As the father of one of the many children left brain damaged, but counted as a success because they survived, I ask why this Inquiry chose to ignore this outcome?
Equally patients must get more involved, take time to understand what is happening, ask for success rates in writing before being admitted, and find out who their surgeon or specialist will be and check him or her out. By asking questions, we as patients force issues like success rates into the open. Then, in this supposed open market, patients can pressurise GPs to choose the best hospitals. If the NHS structure has to change, then we as patients may as well use those changes to our advantage. We have to accept that the days of assuming "doctor knows best" are gone!
I applaud the report, particularly its desire to move away from the culture of American-style medical litigation to encourage a culture where doctors admit mistakes and are not hounded out of their profession for reporting the mistakes of others. This is simply professional responsibility which no statutory body can ever enforce. However, where there are clear cases of medical negligence, realistic compensation payments to patients must be sufficiently swift and generous that the system is taken seriously.
Lorraine Swann, England
The report blames lack of leadership and monitoring, but most of all an attitude that children were not the priority. How many of us feel like this when we go to visit our local GP or hospital? It is not a question of resources, management or leadership. It is about transferring "power" out of the medical profession and Whitehall and giving it to the patient. My recent experience in the private health sector has hardened my views that the medical profession is motivated by the same thing as most of us, financial reward.
We are a new, well-travelled generation and unlike our forebears we are experiencing healthcare in other parts of the world. Even some of the third world countries put our NHS to shame. Resources and leadership are lacking in many of these countries, but a paying customer is treated with care and dignity. The 'word of mouth' is very powerful in those countries. A mediocre doctor and one that does not put his/her patients first soon gains a reputation and loses 'business'.
I don't wish to be a devil's advocate, but I wonder how scandalous what happened in Bristol really is. Infant mortality in the developing world is far higher than it is in the UK, and I'm sure these surgeons did not set out to kill these unfortunate children, who would have died without intervention. At least there was someone to make an attempt at saving them, which is more than can be said for most such babies elsewhere. As with the organs scandal, is it time for some perspective?
David Wrede, Scotland
After the disgraces of Rodney Ledward, Richard Neale, Harold Shipman and now this, how many more tragedies before it's realised that the GMC must be abolished and statutory regulation be put in it's place. The GMC's function is to protect doctors and not patients. As such it is the greatest threat to public health in this country. The government don't want to do anything about it because they don't fancy tackling the resistance they would inevitably face. In fact if they don't encounter any resistance they're probably not making any effective change.
We doctors all make mistakes, like everyone else. Sometimes patients may die as a result. This will inevitably happen sometimes, but can be minimised if there is the right culture, the will, and the resources.
This report should mark a turning point, but extra training and better quality control all consume resources.
The blame culture also needs to be addressed. Criticising doctors without giving us the tools to get on with the job isn't enough. People who are living in fear of being sued will always cover up for each other-the issues of witch hunting and scapegoating will have to be addressed too if people are to be encouraged to own up to mistakes and try to learn from them and do better.
I say "Well Done" to those who bravely alerted the world to the issues in this enquiry. I deeply regret that such public spirited actions are not more widely found. Let us hope for a more open form of medical council and removal of surgical clubs to defend the indefensible.
The NHS is a socialized beaurocracy with minimal accountability. I know because my business has involved me in the UK with the NHS and in the US with the private health care system. The UK is now conditioned to expect a low grade health system which the mis-informed actually think is "free". Low expectations means poor performance. On a recent visit back to the UK I was shocked at the standard of patient care in the UK. It would not be tolerated here. Wake up Brits, its not too late!
John Ex-pat CA USA
For far too long has the medical profession taken a pompous attitude to their patients . Treating them as commodities rather than human beings.
Scratch the surface and I am sure you will find many other Bristols just waiting to be exposed. Public impatience is growing at the inability of Doctors to police themselves and to blow the whistle where necessary.
It is time for them to be judged qualitatively and quantitatively and leave the reverential dogma behind. Doctors also need the guts to stand and be counted when they find fault with their colleagues. We all know the consequences when they don't!
Three cheers to Stephen Bolsin - what a wonderful person!
As a medical student I agree with
the comments of David Wrede above.
I want to work in a healthcare system
which has enough resources and investment
in our staff and our systems to reduce
risk. Can Alan Milburn and Co deliver this?
Only a government run system has the power to suppress
decades of negative reports and statistics.
This scandal is the best argument so far for opening up
the NHS to private competition.
Socialist systems promise good care and service, but in
practice they always develop an authoritarian and
highly secretive mentality that puts the doctor and the
hospital first and the patient a long way second.
As one of the statisticians involved in the assessment of the data for the BRI Inquiry I disagree with some of the views of Dr Polonieki, but agree with others. The vital point is that there is always variation in death or success rates that is simply random. The demand to have individual surgeon's rates will lead to more uncertainty and will make it more difficult to find units that are performing badly. Unless an individual surgeon has a very large series of operations indeed, the uncertainty in that rate will be too high to allow any useful conclusions to be drawn. Interviewers on Newsnight and others do not understand this point and unless it is understood the public will be encouraged to have unrealistic expectations.
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