The following is an annotated extract from a personal journal of recent months. Events are recorded in normal type and contemporary thoughts and commentary in italics.
June 1998
The prolonged hearing of the disciplinary committee of the General Medical Council on the doctors charged with professional misconduct in the Bristol paediatric cardiac surgery unit concludes at last. The media coverage has been extensive, simplistic, and condemnatory. The cardiac surgeons, Mr James Wisheart and Mr Janardin Dhasmana, and the then chief executive of the trust, Dr John Roylance, are found guilty. They need police protection as they leave the hearing.
I suppose all doctors must share the deep sympathy I feel for these men. I cannot remember meeting a single doctor who was not trying to do his best for his patients, although success and failure are of course distributed as in all spheres of human activity. Were the events accurately reported? What were the pressures on this team? Paediatric cardiac surgery is an extremely demanding specialty. Were these adult surgeons under pressure to take this on? Since the destructive reforms of 1990 the prevailing ethos of cooperation in the NHS has changed to competition. There is widespread feeling among my colleagues that the GMC under the current chairman, Sir Donald Irvine, has a mission to be the saviour of self regulation in medicine. Have these surgeons been offered as sacrificial lambs on this altar? It is vital that innovation and the ability to take on high risk procedures are not stifled, but these sad events will mark a watershed for medicine and bring to an end the often inspired but sometimes overenthusiastic amateurism that has characterised much English medicine.
Richard Smith’s leader in the BMJ, “All changed, changed utterly,” expresses an apocalyptic view of the Bristol events but also defines the issues raised. In an intemperate comment on the GMC findings Frank Dobson, the secretary of state for health, expresses his personal views on the guilt and inadequate punishment of the major figures and, under pressure from parents not represented at the GMC hearing, announces that he will set up a public inquiry into all aspects of these events.
This seems to have become a Pavlovian political response to any situation in which there is serious public anger: Stephen Lawrence, BSE, Bloody Sunday... who is it going to help?
July 1998
Arrangements for the inquiry are under way, and a chairman, Professor Ian Kennedy, and two members of the three member panel, a senior paediatric nurse and an academic lawyer, have been appointed. The place for a medical member is unfilled.
Why have they not yet recruited a doctor? It will be a difficult job, probably best filled by a paediatric cardiac surgeon—but it could be impossible for another member of such a small specialty to take this on. Presumably someone will do so; I wonder for what motives?
21 August
Call from a paediatrician colleague who works at the Department of Health. Is there any chance that I might be able to take a two year, full time post as the medical member of the panel of the Bristol inquiry?
Coming totally out of the blue, this induces mixed feelings. This would obviously be a difficult and undoubtedly harrowing job, but it could be important and influential; the brief of the inquiry will be much wider than I had realised. I am a little flattered to be asked. What are my credentials? I have long experience in teaching hospital clinical paediatrics and plan to stop clinical medicine when I am 60 next year. Perhaps my most relevant area of experience has been my responsibility for the medical aspects of the paediatric liver transplantation programme at Addenbrooke’s for the past 12 years. I certainly took this on in the spirit of well meaning amateurism with no training in the field and I have first hand knowledge of the problems of providing a front line service involving high risk surgery with inadequate financial backing and staffing.
Further discussions with staff at the Department of Health provide a little more background to the inquiry, but the only written information I can extract is the initial press release. Eventually I am able to make contact with Una O’Brien, the civil servant who is to be secretary for the inquiry, and I learn the terms of the appointment. I send my resumé and begin to give it serious thought.
Several late night telephone conversations later I feel that, although this looks much more like a duty than a pleasure, my background experience is appropriate to take on the job and it is an important role that I should accept.
15 September
I am formally offered and accept the job. Greeted with enthusiasm, welcomed to the panel, and asked to attend the first meeting on 22 September. Should I not meet Ian Kennedy beforehand? Would it not make sense to have a preliminary meeting? What if we don’t get on together? The other panel members have not met each other or him. Apparently these matters are of no concern.
This is distinctly odd. I have been included on the panel for an important public inquiry without meeting anyone involved and without any background reading or preparation other than that gleaned from the press. I suppose they know what they are doing? In spite of these reservations I have taken the job, so I rearrange the date of my retirement and prepare to spend much of the next year in Bristol.
22 September
Arrive at Department of Health early as suggested but Una O’Brien is too busy to meet me as arranged. Ushered to large and lightly populated offices with computers showing screen savers. Meet a lawyer, press agent, and other support team members showing signs of underemployment. I am told several times that the BSE inquiry now employs 83 people; it is implied this is a little over the top but “our team will grow.” The two other panel members arrive and seem very pleasant and sensible. We are joined by Ian Kennedy and Una O’Brien and start the meeting. There is to be an introduction by the chairman, then discussion. The primary purpose of the inquiry is to “lance the boil” created by these sad events. We have semijudicial powers but are not a court or a trial and are not involved in any compensation claims, though our findings may be used. There are more than 200 families who wish to give evidence, but it would be impossible to see them all. There are currently notices in the major papers asking those who wish to give evidence to submit written statements first. The first phase of the inquiry will be devoted to finding out exactly what happened. This will inevitably be very harrowing. In the second phase we will be able to draw conclusions and make recommendations, with advice from all relevant representative bodies and individuals.
I offer only two significant comments. I wonder whether families still in a state of unresolved grief many years after the events will be overrepresented among those wishing to give evidence (this is contested). I also mention some concern that, since the primary purpose of the inquiry is to examine supposed failings in a surgical specialty, it would give our report more credibility—especially with the medical profession but also with parents—if a surgeon was included on the panel (also contested).
After the meeting I confirm the terms of my appointment in detail, including the starting date, duration, salary, and terms. I am to email a short resumé of my background for distribution to the press. I will receive a letter of appointment from the secretary of state; the terms will be confirmed with my chief executive. I agree to be in Bristol on 26 October to prepare for the public opening on 27 October.
I am somewhat reassured. The team seems friendly and committed, although hardly professional in its approach at this early stage, and many members, especially the leading counsel, have yet to be recruited. I like the other panel members and feel I could work with them. I am more convinced that the medical panel member needs to have experience in at least a similar field.
The same evening, just after I have emailed my resumé, a call from Una O’Brien. She is “really, really worried” about my concern at the lack of a surgeon on the panel. The deaths of the children in question may have been due to many others in the chain of command of surgery. My presence on the panel is not as a representative of the medical profession but as an individual. I am asked to consider these matters over the weekend.
During the weekend I crystallise my thoughts a great deal. I develop some ideas on medical mentors and sabbatical leave and briefly convince myself these would really enhance the lot of consultants coping with the increasing pace of medical change. I return committed to accepting the terms of the inquiry as constituted and determined to contribute as effectively as possible.
28 September
Visit from Una O’Brien. She and Ian Kennedy have decided my inclusion in the panel “wouldn’t work”! Absolutely nothing personal of course—they need a doctor with different experience. What experience? No idea at all. Apologies, thanks for help so far. Goodbye.
Not having been sacked from a job before, I am really rather stunned and simply express deep surprise. Of course my pride is a little dented but, clearly, far more important considerations are relevant here. I say I will speak to Ian Kennedy.
30 September
Ring Ian Kennedy. Sorry, “was not of the impression that I had been either hired or fired,” but he was concerned by my comment that the panel should include a surgeon. He can think of “about 16 specialties” that might wish to be represented. He agrees they need a doctor but with different experience. What experience? No idea, haven’t started to look. Nothing personal of course, would I like to submit my ideas to the panel? He has a duty to do the best he can in this job. Can he help with any disruption caused by my brief change in plans? Moderately apologetic. Goodbye.
This seems to me to be poor person management, and I feel aggrieved. But I suspect a political agenda underlying these events. Most doctors I know feel strongly that the panel must include a doctor with first hand experience of major surgery in children.
The medical profession is already feeling under political and public siege. Is this a further attempt to undermine the principle of self regulation? The profession has responded with impressive speed and decision to the lessons of the GMC hearing. Like every specialist in the land, I am submerged in directives outlining my new duties in clinical governance, audit, and appraisal.
Afterthoughts
I reflect that the inquiry will consume a huge amount of NHS money and will reopen many wounds that, however caused, should now be healed or healing. Perhaps it may yet prove useful.
It is possible that some families will be afforded a clearer insight into the true difficulties of funding, organising, delivering, and accomplishing leading edge surgery and may thus come to understand more clearly what happened to their children and whether a different outcome was possible
It is possible that a more honest, rational, and less punitive view of the roles of the central figures may be achieved and, without the need for the panel to prove its ability to discipline doctors, some of the villains and some of the heroes may change their roles.
It is possible that some useful recommendations on the organisation and delivery of health care and the training, motivation, and surveillance of doctors may emerge. But my brief experience of the world of public inquiries leaves me with no optimism whatsoever.
