Inquiry Update
Since oral hearings resumed in September the Inquiry has heard evidence
on issues of counselling and bereavement services, paediatric cardiac
morphology (the form of the heart), the role of the Department of Health,
pre-operative/operative/post-operative care, post mortems and tissue retention.
During the summer recess work continued at the Bristol Inquiry offices
with an analysis of evidence which had been heard and collected between
March and July.
This process has involved a lot of sifting of evidence, inevitably, and
has resulted in the commissioning of further evidence. The Inquiry is
still appealing for evidence from junior doctors and nurses who had been
at the Bristol Royal Infirmary or the Bristol Children's Hospital during
the period covered by our terms of reference, 1984 to 1995.
In October, the Inquiry will be looking at the history of the details
of concerns which were raised in Bristol. We expect to hear, amongst others,
from Professor Vann Jones and Miss Janet Maher; we anticipate hearing
from witnesses who occupied positions and functions in the Regional Health
Authority; we will hear from both Professor de Leval and Dr Stewart Hunter;
from Professor Angelini; from Dr Phil Hammond, and Dr Peter Doyle, and
we will revisit the national scene with Sir Alan Langlands, who is Chief
Executive of the NHS Executive and Sir Kenneth Calman, Chief Medical Officer
from 1991 to 1998.
It is expected that before evidence is heard from Bristol clinicians
in November and December, we will receive the results of the first stage
in the analysis of statistics. It is likely that the clinicians principally
involved in the treatment of children will deal with both the question
of adequacy and the question of the concerns raised, and answer such questions
as arise in respect of informed consent.
The Inquiry is on schedule to complete the first phase - hearing oral
evidence, before Christmas. Closing submissions for Phase One will be
heard in Bristol on 9/10 February 2000.
Inquiry seeks review case parents
The Bristol Royal Infirmary Inquiry is still seeking 14 families whose
children's cases have been selected as part of a detailed review by the
Inquiry's expert group.
The Inquiry team announced in August this year its proposals to review
a sample of cases taken from over 1,800 children and babies who received
either open or closed heart surgery over a 12-year period.
Inquiry staff are in regular contact with many families whose children
underwent complex cardiac surgery at the Bristol Royal Infirmary (BRI)
between 1984 and 1995. These parents will already know whether or not
their child's case is included within the review.
However, there are some parents who have yet to be traced. Parents whose
child underwent heart surgery at the BRI or Bristol Children's Hospital
between 1984-1995 and have never been in contact with the Inquiry should
get in touch if they think their child's case may be part of the current
review (local call number 0845 3000 613).
Inquiry staff have written to the last known address of all 80 sets of
parents whose children are included in the review.
It is the first time that a sample of cases, drawn from virtually all
the paediatric cardiac activity at the Bristol Royal Infirmary and Bristol
Children's Hospital between 1984 and 1995, has been so thoroughly reviewed.
The review exercises are being carried out by teams from the Inquiry's
group of independent experts.
Professor Ian Kennedy, Inquiry Chairman, said: "The sample, initially,
of 80 case notes will be an important contribution to the Inquiry's understanding
of the adequacy of the services at the BRI and Children's Hospital.
"We are making strenuous efforts to contact every parent whose child's
case has been selected for inclusion in our review.
"We have had a good response from parents to our initial letters
but there are some who have yet to reply."
The clinicians on the Inquiry's Expert Group have been formed into review
teams which consist of five members:
* paediatric cardiac surgeon;
* paediatric cardiologist;
* paediatric anaesthetist/intensivist;
* paediatric pathologist; and
* paediatric nurse or intensive care nurse.
Review teams will look at the adequacy of key aspects of pre-operative,
surgical and post-operative care, as well as the adequacy of care overall.
The report forms from the exercise will form the basis of a single review
summary which will be presented to the Inquiry panel during the autumn
hearings.
This review exercise will supplement a wide range of sources for assessing
the adequacy of the services provided.
The Inquiry team has published a document setting out an explanation
of its work to review the clinical case notes. The document is available
on the Inquiry Internet website and copies can be requested from the Bristol
office.
If you have any questions or would like further information please contact
Claire Bache, Medical Records Assistant on 0117 938 8727 or call our local
call number 0845 3000 613.
50 Experts to assist Inquiry
The number of independent experts who will assist the Bristol Royal Infirmary
Inquiry has reached more than fifty.
A national Group of 35 Experts was appointed in March to assist the Inquiry.
An additional 16 members have since been added to that group.
The Group covers 14 different areas of expertise ranging from paediatric
cardiac surgery to NHS finance and management and statistics.
Professor Ian Kennedy, Inquiry Chairman, said: "The Group gives
the Inquiry access to particular focussed areas of expertise. This complements
the expertise we already have on the panel through Professor Sir Brian
Jarman, Rebecca Howard and Mavis Maclean."
Professor Kennedy continued: "The areas represented by the Expert
Group reflect the breadth of the issues which we are examining. We are
not just concerned with areas of clinical expertise, such as surgery,
but also with education, training, audit, management, finance and statistics."
Individual members of the Group are the Inquiry's Experts rather than
acting for any individual or organisation. They give their opinions in
the wider public interest and all the formal evidence from the Expert
Group will be published.
It is the first time at a Public Inquiry that Expert evidence has been
used in this way - moving away from the model used in trials where such
evidence is presented in an adversarial setting.
Experts assisting the Bristol Royal Infirmary Inquiry normally give written
opinions. They may also attend oral hearings and provide background information
to the Inquiry's legal team.
Hearing Schedule
Every Saturday, main local newspapers carry information about the next
week's witness programme. The Inquiry is seeking to ensure that as many
people as possible are aware in advance of the timetable for the Oral
Hearings and of the witnesses being heard. Notices appear in three newspapers
which cover South Wales and the South West, printing the following week's
witness schedule on a Saturday. The newspapers are the Western Morning
News, the Western Daily Press and the Western Mail.
News Releases detailing the following week's timetable of witnesses are
also sent to local and national media representatives and published on
the Inquiry's News Release page.
Phase Two Issues
Phase Two of the Inquiry will look at relevant wider issues and the Inquiry
Panel intend to take a national perspective, informed by their learning
from Phase One, the examination of children's heart surgical services
at the Bristol Royal Infirmary and Children's Hospital which is currently
underway.
During the second phase, the Inquiry panel focus will be on examining
current and potential future policy initiatives which could help to improve
the quality of care in the NHS.
Written papers are being commissioned from a wide range of organisations
and individuals. The papers will be published and they will be supplemented
by a series of eight to ten public seminars between January and April
2000.
Seven themes have currently been identified for Phase Two. They are:
* children in the NHS;
* culture of healthcare;
* aiming for quality in the NHS;
* managing performance in the NHS;
* regulation and accountability in the NHS;
* education and training within the NHS; and
* information systems in healthcare.
The objectives of Phase Two are to assist the Inquiry Panel to meet the
requirement in their Terms of Reference to "make recommendations
which could help to secure high quality care across the NHS"; and
to ensure that recommendations are relevant to the NHS of the future,
practical, achievable and within a realistic level of resources.
The approach will be wide-ranging and, where it can assist the Inquiry,
papers and contributions will be invited from outside the healthcare sector
and from individuals and organisations outside the UK.
Live Links
Since April 26, video links have transmitted live pictures from the Bristol
Royal Infirmary Inquiry to three Community Health Council (CHC) Offices
in Cardiff, Barnstaple and Truro.
Pictures from the Inquiry chamber are transmitted digitally to high-tech
equipment installed in the CHC offices, 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 can see and hear the Inquiry Panel as they ask questions.
Full transcripts of the Inquiry hearings are available each day via the
Inquiry's web and are posted to libraries and CHC offices each week.
If you would like to make use of this facility the addresses and contact
names for each site are listed below:
Martin Jenkins, Cardiff CHC tel: 01222 377407
Ground Floor, Park House, Greyfriars Road, Cardiff, CF1 3UE
Mark Lytham, Cornwall CHC tel: 01872 264402
9 Castle Street, Truro, Cornwall, TR1 3AF
Linda Stapleton, North Devon CHC tel: 01271 373739
24 Castle Street, Barnstaple, EX31 1DR
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