Who? Why? What? And
How?
With the launch of the remote links in April, several queries have been
raised by members of the public prompted by seeing live pictures from
the Inquiry hearings. Here is a round up of the most frequently asked
questions.
The Remote Links: how do they work?
From April 26, live pictures, transmitted direct from the Bristol Royal
Infirmary Inquiry, have been watched via state-of-the-art video links
in three Community Health Council (CHC) Offices across the South West
and South Wales.
Images from the Inquiry chamber are sent digitally via ISDN lines to
high-tech equipment installed in Barnstaple, Cardiff and Truro, where
members of the public are able to follow the day-to-day discussions of
the Inquiry on television screens. Viewers are able to watch, and listen
to, witnesses giving evidence and read documents as they are exhibited
in the hearing chamber.
The cameras which operate in the Inquiry chamber are voice activated,
so they always follow the person who is talking, either the Panel Member,
Counsel, Legal Representative, or Witness.
The Panel: who are they and what have they been
asked to do?
Inquiry Chairman, Professor Ian Kennedy’s terms of reference are:
"To inquire into the management of the care of children receiving
complex cardiac surgical services at the Bristol Royal Infirmary between
1984 and 1995 and relevant related issues; to make findings as to the
adequacy of the services provided; to establish what action was taken
both within and outside the hospital to deal with concerns raised about
the surgery and to identify any failure to take appropriate action promptly;
to reach conclusions from these events and to make recommendations which
could help to secure high quality care across the NHS."
Three fellow panel members assist him: Professor Sir Brian Jarman, Mavis
Maclean and Rebecca Howard.
Introducing the Panel…
Professor Ian Kennedy is Professor of Health Law, Ethics and Policy
at the School of Public Policy, University College, London. He holds degr
ees in law from universities in the UK and USA and is a Barrister and
Honorary Bencher of the Inner Temple. Until December 1996, he had been
Dean of the Law School at King’s College, London, for ten years and
was Director and then President of the Centre of Medical Law and Ethics,
which he founded in 1978.
He has a long involvement in public service including membership of the
Medicines Commission and the Department of Health’s Expert Advisory
Group on AIDS. He chaired the Secretary of State for Health’s Advisory
Group on Xenotransplantation and, most recently, the Minister of Agriculture’s
Advisory Group on Quarantine. He is Chairman of the Nuffield Council on
Bioethics and serves on the Archbishop of Canterbury’s Advisory Group
on Medical Ethics and the International Forum on Transplant Ethics. The
Reith Lecturer in 1980, Professor Kennedy has taught and lectured throughout
the world. He is the author of texts on medical law and ethics, co-editor
of the leading journal on medical law and a member of the editorial board
of ten national and international journals.
Professor Kennedy was appointed by Secretary of State for Health, Frank
Dobson, to conduct the Bristol Royal Infirmary Inquiry under Section 84
of the National Health Service Act 1977.
Professor Sir Brian Jarman is Emeritus Professor at Imperial College
School of Medicine at St. Mary’s Hospital in London W2 and a member
of the Standing Medical Advisory Committee to the Government. He is also
a locum GP at Lisson Grove Health Centre in London NW8 and was previously
Head of Division, Primary Care and Population Health Sciences at Imperial
College School of Medicine. He is a Fellow of the Royal College of Physicians,
a Fellow of the Royal College of General Practitioners and a Member of
the Faculty of Public Health Medicine.
Mavis Maclean is Senior Research Fellow at the Centre for Socio-Legal
Studies, Wolfson College, Oxford. She is qualified in sociology and law
and has conducted research into, and written about, compensation for accident
victims. She now works in family law and family policy with a particular
interest in the children of separated parents. She is the academic adviser
to the research secretariat of the Lord Chancellor's Department and a
former member of the Lord Chancellor's Legal Aid Advisory Committee.
Rebecca Howard is the Executive Director of Nursing at the Manchester
Children’s Hospital and a registered sick children’s nurse with
over 20 years’ experience. Mrs Howard has contributed to the development
of national policy in the area of children’s services and has a special
interest in paediatric intensive care.
The Witness: How are witnesses
chosen to give oral evidence?
If you attend one of the remote transmissions or the hearing chamber
in Bristol you will see witnesses giving evidence. These people must first
give written statements to the Inquiry, but have been invited to give
further evidence orally to enable the Inquiry to pursue issues raised
in their written submission.
The examination is based on the information they have prepared in their
written statement ordinarily with the help of a solicitor. Witnesses can,
at any time, give further information to the Inquiry if they feel it is
relevant. Some witnesses will be recalled to give evidence on more than
one occasion, about different areas of the Inquiry’s investigation.
The Legal Team: what happens
to a witness statement when it has been submitted to the Inquiry?
The Inquiry legal team aim to look at each statement within two days
of receiving it. If any individual or organisation is criticized, they
will be offered a chance to respond.
The work is undertaken behind the scenes by a legal team made up of solicitors,
paralegal staff and administrators. However, the work of the Inquiry also
involves examining witnesses who give oral evidence. So the legal representatives
you may see on the screens include the following.
Introducing the Legal Team…
Brian Langstaff QC – Counsel to the Inquiry
The Counsel’s task is to give independent legal advice to the Inquiry,
and to present the evidence. He is assisted by two other Counsel, Eleanor
Grey and Alan Maclean. It is essential in an Inquiry such as this that
the task of analysing, presenting, and examining the evidence is shared.
No-one should read any particular significance into the fact that Miss
Grey, or Mr Maclean asks questions of a witness rather than Mr Langstaff
– or vice versa.
Counsel’s role is strictly impartial. It is to assist the Panel
in its investigation of the facts and its search for the truth. It is
not his role to prosecute nor to prove a particular case. Instead, Counsel
is there to present all the evidence thoroughly and rigorously, and to
advise the Inquiry members on matters of law and evidence.
The witness will be questioned by Counsel to the Inquiry. This questioning
will be supplemented by questions from members of the Panel. At the end
of this questioning, the witness’s legal representative will have
an opportunity to put questions to the witness by way of re-examination.
In his opening statement on March 16th,
the day oral hearings commenced in Bristol, Mr Langstaff outlined the
following guiding principles by which the Inquiry will proceed:
The Inquiry starts with a clean slate; it has many questions to ask,
but as yet no answers. It has to be open.
- The Inquiry is just that – an inquisitorial process. It is not
a trial. There is no case. There are no sides.
- The Inquiry is comprehensive.
It will be the most accessible public inquiry yet – through video
links, the Internet, and publication of the formal evidence to libraries
and Community Health Councils.
Sitting behind the Inquiry Counsel you will see other legal representatives
attending on behalf of witnesses and related organisations.
Legal Representatives
As the Inquiry is not a trial and follows an inquisitorial procedure
rather than that of a court, the role of the legal representatives of
witnesses and relevant organisations is generally not to make oral presentations.
However, they have a crucial part to play in getting statements and advising
the Inquiry Counsel on lines of questioning. If anyone should wish to
raise an issue to be addressed by a particular witness, they should do
this through their legal representative, who will in turn request Inquiry
Counsel to include the matter in the questions to be put to the witness.
The legal representatives perform many vital functions. These include:
Preparation of formal statements for those they represent. Since these
constitute evidence, they must be accurate, relevant and both clear yet
detailed - no small task.
Attending hearings when those they represent give evidence, to assist
them through the process.
Re-examination of those they represent to ensure that they have given
a proper account of themselves and to clear up any ambiguity.
Liaison with Inquiry Counsel to ensure that relevant lines of inquiry
are pursued, issues explored, and that oral evidence is fully and fairly
explored.
The option to prepare a commentary on the significance of the evidence
of those they represent after it has been given, so that any points made
are emphasised and its relevance fully evaluated.
Advising those they represent whether further statements adding to what
they have already said should be submitted.
Monitoring the oral hearings, either at the hearing or, more often, on
the Internet, and the written statements submitted to the Inquiry, to
decide if any reply is called for on behalf of their clients.
The option, with the permission of the Inquiry Chairman, to cross-examine
a witness when fairness demands it, or when some dispute of fact may be
resolved.
The Inquiry is, in effect, a team process. The legal representatives
of witnesses and related organisations have already played a significant
role in helping the Inquiry Legal Team to formulate questions and to pursue
avenues of inquiry. It is expected that this will increase, with all representatives
assisting Inquiry Counsel and thereby playing their part in ensuring that
the Panel gets to the bottom of things.
Other People You May See
While you watch the hearing you may also see the following people: stenographers,
who record the hearings and prepare the transcripts, Inquiry Secretariat
staff, media representatives and members of the public.
Behind the Scenes: What happens every day whether
there are oral hearings or not?
The role of the Legal Team has been dealt with, but there is other work
going on behind the scenes.
To date over 800,000 pages of evidence have been submitted and electronically
scanned for consideration by the Inquiry. Documents include: medical records,
management data, correspondence, national publications etc. Each week
people are still coming forward with new information for the Inquiry and
we urge people to contact us if they feel they have anything relevant
to say to assist the Inquiry.
Transcripts, witness statements and other information published on the
Inquiry’s website are regularly added to and updated; and information
is also made available to libraries and Community Health Councils in the
South West and South Wales. The Inquiry Newsletter is published on a regular
basis and the media are kept up-to-date with progress via news releases.
A Group of Experts has been brought together and is beginning to tackle
a variety of issues. The experts’ views will of course be made public.
Blocks of Evidence: When will we hear from staff
who worked at the Bristol Royal Infirmary?
The Inquiry was opened by parents giving accounts of their experiences
- from their child's original referral through to post-surgery. Families
will be called throughout the Inquiry to contribute to subsequent blocks
of evidence.
The second block of evidence is currently looking at the national scene
- including evidence from the Department of Health, witnesses from the
Supra-Regional services, the Royal Colleges and professional organisations.
Block two will be completed by mid May. This sets the national scene into
which Bristol fitted.
The third block will look at the Bristol services – questions will
be focussed on management issues relating to the Bristol Services, including
how they were set up and how they were organised. Witnesses will include
managers and doctors (some of whom acted in a dual management/clinical
role) from the Bristol Royal Infirmary, past and present; and staff from
the local and regional health authorities. Doctors will be recalled at
a later stage of the Inquiry, during the fifth block of evidence, to answer
questions specifically about clinical issues. They will not therefore
be questioned about surgical expertise or particular children’s cases
during the third block.
The Inquiry will then go on to look at the management of the care of
the children - among the issues covered will be pre-operative care; surgery;
post-operative care; post mortems; and dealings with parents. It is hoped
that this block will be concluded before the summer recess at the end
of July.
In the autumn the fifth block will look at the adequacy of the service
- including staff training; informed consent; medical and clinical audit.
Clinical issues will be examined in detail at this stage, following scrutiny
of children’s cases by the Inquiry’s experts.
The final block of evidence covers concerns raised about surgical services
at the hospital between 1984 and 1995 and any failure to take appropriate
action promptly.
The Inquiry's expert witnesses will be called throughout as necessary.
It is anticipated that these public oral hearings, which are phase one
of the Inquiry and focus on services in Bristol, will last until the end
of 1999.
Internet website:
www.Bristol-Inquiry.org.uk
E-mail: inquiry@doh.gov.uk
Telephone: 0845 3000 613
(calls charged at local rate)
Fax: 0171 972 4602
FREEPOST ADDRESS:
Bristol Royal Infirmary Inquiry
Freepost, Lon 15129, London, SE1 8BR
No stamp is required.
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