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Thursday, 19 July, 2001, 11:45 GMT 12:45 UK
Bristol babies inquiry chairman, Prof Ian Kennedy quizzed
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The long-awaited official report into the baby heart deaths at Bristol Royal Infirmary 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 patronised 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 189 recommendations.

What does Professor Kennedy think of his findings? Do his recommendations go far enough? Will the inquiry change anything?

Professor Kennedy answered your questions after the publication of the report.


Transcript of interview:


Newshost:

Professor Kennedy thanks for joining us. Before we turn to the e-mails, one of the most striking statements that you have made about this tragedy is that it could happen again.


Professor Kennedy:

We said that if people were seeking an assurance from the panel that it couldn't happen again, we couldn't give that assurance. As regards paediatric cardiac surgery in Bristol - no parent or patient could be better cared for there. But at the present moment there may be some corner of some hospital where something is happening which is harming patients and we simply don't yet have the mechanism properly to be able to find out about it so as to do something about it and that has to change.


Newshost:

You made a number of recommendations - I think it was 198 recommendations. The sense that I got from that was in some way you were throwing down the gauntlet for the Government.


Professor Kennedy:

That is an interesting and I think revealing way of putting it. I think there was an element of that to say - we have looked at this, we have heard a lot of evidence, we have given a lot of time and thought to this, and this is what we think ought to happen if there is an NHS which is going to be committed to its original principles - which were to serve patients and put them at the centre of healthcare and everything must follow from that but that isn't the current state of affairs.


Newshost:

Daniel Cove in London asks: Of all the recommendations you make, which is the single most important one, in your opinion?


Professor Kennedy:

I am not going to say that because if I do say that some of the others won't be taken account of. What I will say is that there are recommendations which call for more or less urgent action. It is also very important to notice that a lot of the recommendations are not addressed to government. We don't need permission from Whitehall before we can demand of healthcare professionals - nurses doctors or whatever - that they be courteous, respectful, open and honest with their patients. That can happen tomorrow if the will were there and if attitudes changed accordingly and if patients and others asked for it. Most healthcare professionals already sign up to that as a principle of their conduct every day - that is why we have such good care. But those who don't need to change.


Newshost:

How much of a big job is this for the NHS?


Professor Kennedy:

If the change in the culture, change in the management and the change in the structure were to be put into place, it will take some time. But I stress, the biggest change has to happen in what the New Zealand rugby players would call - the top three inches. In other words in the hearts or the minds of those who are currently working in the NHS.


Newshost:

Andrew Wikhart of Edinburgh asks: Do you think the Government is committed to implementing the recommendations you made about reform of the NHS?


Professor Kennedy:

Those recommendations which call for governmental action - and not all of them do - we hope that the Government will put them into effect - that is why we have written the report. I just hope the Government will. We have had enormous co-operation from the Government. We are an independent report, we haven't been told what to say and we have said what we think ought to be said. But we are going with the warp of Government policy but perhaps pushing it to a little bit more radical or a little bit sharper focus in some respects. It is through programmes like this, through journalist and through members of the public to keep an eye on things. We say in the report that too often promises have been made in the past and haven't been delivered but this time the public is watching.


Newshost:

Mr Milburn said in the House of Commons - we are going to accept some of these recommendations, others we are going to go away and think about. Will this be something that you will be looking at very closely?


Professor Kennedy:

He said that he was going immediately to act on some recommendations and that is very pleasing because they were described as urgent needs and then he is going to consult widely from the public and from interested people. We just hope very much that that process of consultation doesn't become another form of delay or another way of not doing anything. I have absolutely no reason to think that that is the Government's position but every reason to believe that the Government is broadly supportive of what we recommend. I also have every reason to know that it would not be an easy job to bring about this cultural change.


Newshost:

That brings us on to the supplementary question from Andrew Wikhart in Edinburgh. A lot of the recommendations are recommendations of a change of approach - things that are actually quite hard to measure - how will we know that the changes have been made?


Professor Kennedy:

One of the big changes which we urge will take a while to accomplish but it will be that we will be able to obtain information on the performance of a trust on the performance of a specialised unit - on the performance even of a consultant's team. That kind of information will then significantly affect the relationship between patient and healthcare professional. We will see changes emerging from that - in other words, change builds upon change. If doctors, nurses and healthcare professionals generally treat patients as most doctors and nurses do, that will have an effect and patients will be much more trusting of their healthcare professionals and so we will build that essential trust which is at the bedrock of all our healthcare.


Newshost:

Professor Ray Kemp, Oakham, UK asks: I'm interested in hearing Professor Kennedy's thoughts on how the Government's proposed introduction of No Fault Compensation (NFC) in the NHS squares with his findings of a "club culture" among doctors. Will NFC help to increase the accountability, transparency and risk management that is so obviously needed in the NHS - or will it merely serve to protect bad practices?


Professor Kennedy:

We don't recommend anything called No Fault Compensation, that's the recommendation, as your correspondent rightly says, of the Government. I don't think that is the right approach. No Fault Compensation merely means, as I understand it, that you replace the need to show fault with some kind of strict liability but you still have to go to court, you have to sue, you have to prove things called causation. What we propose is to get rid of the need for a person who has need - financial need or whatever else need - as a consequence of something that happened in medical care - to get rid of the need of that person to go to court and sue anybody and to pay lawyers and so on and to build a system where that person will be provided for in terms of compensation needs or whatever else.

Meanwhile we have to build a system in which doctors and others are able safely to admit their errors, to recognise near-misses, to talk about them and be open about them and in that way to enhance the idea of a safe system of care in a hospital. Systems of liability, whether there are clinical negligence liability, No Fault Compensation systems or any other kind, stand in the way of openness and of being candid and honest with patients or admitting something has gone wrong. The incentives, if you know you are going to be sued, are to deny or hide the papers or obfuscate or delay and that doesn't help safety because we never learn from it. So in response to the Professor's question, I am not advocating No Fault Compensation and I wished, in a sense, that the Government were not. I am advocating a far more radical split; patients with needs, satisfy their needs and doctors or nurses who behaved inappropriately - deal with that through the appropriate regulatory mechanisms - remove the barriers to openness and honesty and thereby create a culture of safety.


Newshost:

What struck me about what you are proposing is not just that members of staff should be encouraged to blow the whistle but they should be obliged to blow the whistle.


Professor Kennedy:

Not quite obliged but certainly we believe a lot in the carrot more than the stick. If you are able enough to say - look I have done something that wasn't right - you should be immune from discipline - you should be rewarded for that ability to enhance the system of care for the patient. But if you don't and you cover anything up which could harm patients in the future, then at least you should be open to the possibility of being disciplined just for that cover-up alone.


Newshost:

Penny Mellor, Staffordshire UK asks: Do you think that this report is some sort of vindication for the parents of those children who died at Bristol?


Professor Kennedy:

It's certainly a comment on the tenacity, courage and on the persistence of parents and there are many perspectives amongst the parents - it is not a homogenous group at all. But all of them have shown enormous patience - waiting three years - and are to be admired for that. I just hope that they find in the report the kind of answers and understanding that I was trying to give with my colleagues when we wrote the report.


Newshost:

Paul T Horgan, Crowthorne, England asks: Do you think that the status of doctors in our society has substantially changed over the last 5 years since this scandal first hit the headlines?


Professor Kennedy:

There is no doubt that Bristol has been a watershed - one can almost measure attitudes and behaviour in the NHS as being pre-Bristol or post-Bristol - I don't mean the report but the occurrence and everything that followed from that. So to that extent, yes, there have been changes. I would make one other point, that we are very careful in the report not to talk about doctors, nurses or about managers particular - we talk about healthcare professionals because all doctors manage and all managers care for and about patients. These divisions - these tribal divisions - sometimes get in the way of remembering what is the most important thing; namely, you are all there for the patient and you have to co-operate in properly organised teams. It is not just doctors but all healthcare professionals are slowly, slowly changing and the culture is changing and we are there in our report to provide another impetus to that change.


Newshost:

Paul Horgan goes on to ask: Do you think as a result of this, the public are now going to be much less tolerant of medical errors? In the old days we used to hold doctors in greater esteem.


Professor Kennedy:

I don't we were ever tolerant of medical errors - what was the case was that we didn't know about them very often and when we found out were usually angry. In a new culture that we and the panel contemplate, because you the nurse, manager or doctor would have said I am sorry something has gone wrong - that anger will be there but it will be dissipated by an understanding almost immediately after the event and so that kind of festering distrust and hostility will, one hopes, be reduced. That is what we are looking for.


Newshost:

Maria Bowles in Sheffield asks: Why is it, do you think, that doctors can sometimes take such an arrogant attitude to patients? Do you think this is something that can be easily changed?


Professor Kennedy:

I don't want to adopt adjectives which are provocative in this context because part of the process I am engaged in is a process of healing and a process of mutual understanding. There are healthcare professionals out there who will be outraged by any suggestion that they behave other than entirely properly and for the vast majority of healthcare professionals that is true, they do behave properly. Up and down the country every day, hundreds of thousands of patients are treated and treated well. Don't let's get anything out of perspective - that said, there are some behavioural patterns in healthcare professionals - not limited to doctors but perhaps hospital consultants are a particular example - that have to change. They have to treat patients with all the respect and openness and honesty the patients deserve. But we have to make it possible for them to do so by removing some of the culture of blame and name and shame and litigation that so constrains them.


Newshost:

Anne McCormack, Bristol asks: I was watching you on TV and thought your voice broke when you said that you had written the report "in some anger". How has this inquiry touched you?


Professor Kennedy:

It was not the report written in anger, it was the chapter on children written in anger and I guess my voice did crack because there is anger that children's healthcare services have been neglected and have not received the priority they deserve for so long. As I have said, they have been a so-called Cinderella service - for 30 or 40 years they have been described as such and sadly Cinderella has never been to the ball and there has never been an improvement and it does make one angry.


Newshost:

You described earlier in the interview this report as a watershed in the history of the NHS. Just how significant do you think your inquiry is?


Professor Kennedy:

I think I said Bristol was a watershed rather than the report. I would hope that the report is seen as a contribution to that process. It is a very important report in that it asks some very fundamental questions about what we are entitled to expect of the NHS and those who work in it. It is very wide-ranging and it is very thorough, I like to think, and it asks hard questions that for a very long time have been fudged and they now have to be confronted. Confronting hard questions is painful for everybody and nobody likes to do it and English people least of all because we try not to talk about things that are rather difficult - well now we have got to face them.


Newshost:

But the NHS post-Bristol is already a very different place but there still needs to be more change.


Professor Kennedy:

I have heard it said by the Chief Medical Officer for example that the health service is of a different nature than it was at the time of Bristol. I think this is probably a quotation too far. I think it is different but it is not all that different that we don't need to change it a lot more and don't let complacency break out the first day the report is out. We want, as the report says, eternal vigilance and not some sense of - oh it's alright we are making those changes already and if government is saying that then government better start saying something else.


Government response

Key stories

Key figures

Parents' stories

Background briefing

Analysis

Bristol year by year
See also:

14 Sep 98 | The Bristol heart babies
Panorama: Broken hearts
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