|
|
|
|
 Home
Page
Search
Final
Report
Interim
Report
Evidence
- Transcripts
- Witness Statements
- Submissions
- CCNR Report and associated
documents
- Statistical Reports and associated
documents
- Background Papers
- Expert Papers
Inquiry
Seminars
About
the Inquiry
Help
|
 |
Daily transcripts
Hearing summary
20th May 1999
Today the Inquiry heard evidence from Professor Gareth Crompton, former Chief Medical
Officer, Welsh Office, from 1978 to 1989. He said that he accepted and endorsed the
evidence given by Peter Gregory, Director of NHS Wales, earlier in the Inquiry. He
described his role to act as chief advisor on medical matters arising to the Secretary of
State for Wales. Professor Crompton outlined the discussions surrounding the
establishment of the Welsh Cardiac Centre during the late 1980s and early 1990s and went
on to comment on the evident undercurrent of dissatisfaction with the Bristol Supra
Regional Service for infant and neonate cardiac surgery. He said that concerns were raised
with him by Dr Andrew Henderson, a Cardiff Cardiologist, relating to the quality of the
Bristol services. Professor Crompton said that several visits were made by Welsh Office
staff to Bristol during the 1980s. He said in 1986 he visited Bristol, accompanied by Dr
Jennifer Lloyd and Dr Deirdre Hine, at which time issues around outcome were discussed
with the paediatric cardiologists and paediatric cardiothoracic surgeons, who acknowledged
that they were below average for more complex procedures but were hoping to see
improvements as a result of greater numbers of patients being referred to Bristol. He said
his group attempted to get comparative data relating to outcomes from the DHSS (Department
of Health and Social Security), but were unable to. Professor Crompton confirmed that he
also raised concerns about Bristol informally with Professor Sir Donald Acheson, Chief
Medical Office at the Department of Health in 1986/7, who referred him to Dr Norman
Halliday, Medical Secretary, Supra Regional Services Advisory Group, who gave evidence to
the Inquiry last month. He said he met Dr Halliday and passed on the concerns of Dr
Henderson to which he received no confirmation that there were any problems, other than
about waiting lists. Professor Crompton concluded by saying that he would have hoped that
a system of performance data collection, and analysis of that data, would have been
available to the DHSS about Supra Regional Services.
|
FULL TRANSCRIPT
1 Day 21, 20th May 1999
2 (9.30 am)
3 THE CHAIRMAN: Mr Langstaff, good morning.
4 MR LANGSTAFF: Good morning, sir. Sir, this morning we have
5 the advantage of hearing from Professor Crompton who
6 was, as you will recall from the evidence of Mr Gregory,
7 the Chief Medical Officer for Wales for very much of the
8 period with which we are concerned. Professor Crompton
9 is represented by Mr Murphy.
10 Professor Crompton, would you like to come
11 forward, please? We normally stand to take the oath.
12 PROFESSOR GARETH CROMPTON (SWORN):
13 Examined by MR LANGSTAFF:
14 Q. Professor Crompton, your full name is Gareth Crompton,
15 is it?
16 A. Yes, sir.
17 Q. And you were the Chief Medical Officer at the Welsh
18 Office from 1st January 1978 until 31st August 1989?
19 A. Yes.
20 Q. You have, I think, recently retired from public and
21 academic life?
22 A. 18 months ago, sir.
23 Q. As the Chief Medical Officer for Wales, you were the
24 chief adviser, were you, on medical matters to the
25 Secretary of State for Wales?
0001
1 A. Yes.
2 Q. And you were also head of the Health Professionals
3 Group?
4 A. Correct.
5 Q. May we please have on the screen WIT 70/1?
6 Is this the first page of your statement to us?
7 A. The first half of it, yes.
8 Q. You having corrected me; may I ask you to turn to
9 page 72, and indicate a further correction which I think
10 you want to make to the bottom of the page. We see the
11 word "visited" in the fourth line up from the bottom.
12 We see "Bristol and Southampton based clinicians visited
13 Wales on a regular basis". I think you want to correct
14 the text to make that "visiting"?
15 A. Thank you.
16 Q. If we turn over to the next page, the word
17 "infrastructure" in that line should, I think, read
18 "influence"?
19 A. Thank you.
20 Q. With those two changes, can we turn to page 75? That is
21 your signature at the bottom?
22 A. Correct.
23 Q. With those two changes, do you adopt this statement as
24 your evidence-in-chief?
25 A. I do.
0002
1 Q. When you were first asked to recall matters which had
2 arisen back principally in 1986 and 1987, at around that
3 time, did you find it at easy task?
4 A. No. I found it very difficult. Since my retirement, as
5 I have said, I have not carried on any medical practice
6 whatsoever, although I do read at least one journal
7 a week, and sitting down to think about the period the
8 Inquiry is interested in, it is quite difficult to
9 recall specific events and I continue to have difficulty
10 in being certain about the dates. I did not keep any
11 files myself, and it is only the documentation in the
12 bundles of the Welsh Office that I have sent the Inquiry
13 that in large measure has helped me to recall some of
14 these events.
15 THE CHAIRMAN: Mr Langstaff, forgive me for a moment. It is
16 just the microphone; we may need to move it forward just
17 a shade, because we cannot hear terribly well. I do
18 apologise for interrupting you during your evidence,
19 forgive me, but it is better if we can hear your
20 evidence.
21 MR LANGSTAFF: You have a naturally gentle voice.
22 Can I ask you about the process by which you came
23 to remember sufficient to write your statement? When
24 you first knew that this Inquiry was enquiring into
25 events with which you had been in part concerned, did
0003
1 you make notes for yourself?
2 A. Mr Gregory of the Welsh Office, you have heard evidence
3 from, he telephoned me in the middle of March, I think
4 it was, about my doing the same, and I sat down the next
5 day -- it was in three hours at home - and scribbled on
6 10 or 12 sheets of paper, some headings of what
7 I remembered.
8 Four or five weeks later, when I went through the
9 main bundle of the Welsh Office evidence submitted to
10 you -- and I studied that thoroughly over two or three
11 days -- it showed me that in fact some of my
12 recollections previous I scribbled down were either out
13 of date or in fact substantially different to what
14 I thought.
15 THE CHAIRMAN: Can we move the microphone a little bit?
16 PROFESSOR CROMPTON: Shall I repeat all of that?
17 THE CHAIRMAN: Do forgive me, I mean, this is just simply an
18 intrusion on your evidence, and I apologise, but it is
19 merely that the stenographer who is on your right also
20 needs to hear. It may be advantageous, although we are
21 over here, to address your remarks to Mr Langstaff so
22 that the stenographer can also hear them. We will not
23 in the least be put off by that. If you could just
24 speak a tiny bit louder, then we will be happy and we
25 can proceed. I do apologise for interrupting you
0004
1 again.
2 PROFESSOR CROMPTON: Thank you.
3 MR LANGSTAFF: We will try and get the technology right as
4 best we can, but you were telling us, I think, that you
5 had made some scribbles on 10 or 12 sheets of paper over
6 a period of three hours, when you had the documents sent
7 to you from the Welsh Office. You looked through those
8 and they showed that your initial recollections were not
9 entirely accurate in some respects?
10 A. That is correct.
11 Q. In particular, are dates difficult sometimes for you to
12 place with any precision?
13 A. That is true. As is in the written evidence in one or
14 two places I am saying something was either 86 or 87,
15 that is a genuine difficulty in recollection that
16 I have.
17 Q. If at any stage in the course of your evidence, I ask
18 you a question and you find it difficult to remember
19 with accuracy, will you indicate that to us at the
20 time? It is important, not least for those others who
21 may be particularly concerned to hear your evidence,
22 that we know precisely what it is and if you have
23 difficulty in recollection, that is important just as if
24 you have a certainty of recollection.
25 A. Yes. That is okay.
0005
1 Q. I think you first saw Mr Gregory's statement to the
2 Inquiry after it had been sent to the Inquiry?
3 A. Yes, and after he had appeared at the Inquiry.
4 Q. You have since, have you, read through the transcript of
5 what he said?
6 A. Yes, I have.
7 Q. How far do you accept and endorse that which he,
8 Mr Gregory, told us?
9 A. I accept and endorse that, what he said, in its
10 entirety. There is no difference of view in what he
11 said that I have, and had I myself presented that and
12 said those words, then I would have been content that
13 they were correct.
14 Q. Since you have endorsed and accept his evidence to us,
15 I shall not, for my part, take you through in detail any
16 of the material with which we were concerned when he
17 gave evidence. We already have it, and since you accept
18 and endorse what he says, there will be little point in
19 my asking you simply to repeat it.
20 I do want to focus on a couple of aspects in
21 relation to which he gave evidence, and in relation to
22 which he told us that we might better defer to you if we
23 wanted a medical view and a fuller view.
24 A. Thank you.
25 Q. Can I ask you first of all, broadly, about one of those
0006
1 matters?
2 If you take a look at your statement -- page 4,
3 paragraph 13 will come up on the screen -- you say this:
4 "In the last couple of years of the quinquennium,
5 to 1989, the Welsh public and their representatives, the
6 press, radio and TV reporters, got increasingly critical
7 of the Welsh Office policy in its reliance on the
8 English supra-regional centres.
9 "The main thrust of the argument centered on the
10 long distances such parents had to travel, the distress
11 and inconvenience to parents, high cost to families,
12 both direct and indirect. This applied to all the
13 centres used by the Welsh parents", and then you add
14 this, "but there was also an evident undercurrent of
15 dissatisfaction with the Bristol centre."
16 When you say "evident undercurrent", you mean
17 evident to you?
18 A. Two points, if I may, first. When you read my statement
19 you substituted "parents" for "patients".
20 Q. I am sorry. You are absolutely right. I am grateful
21 for the correction.
22 A. Thank you. I was aware of some communications that the
23 Welsh Office had had from an organisation concerned with
24 these patients. I cannot remember the name of the
25 organisation.
0007
1 Q. The Heart Circle?
2 A. That would be it. I remember that. There were the
3 occasional references to the problems of these patients
4 in the columns of the Western Mail maybe and the South
5 Wales echo, which we saw. We in the Welsh Office at the
6 time had a cutting service, a newspaper cutting service,
7 which covered events in all of Wales to do with the
8 Health Service in whatever way, and I was a regular
9 reader of the cutting service, so one had a feel of what
10 the public and the public representatives were saying.
11 There was an anxiety being reflected about our policy,
12 as I say, and the South Wales press did seem to indicate
13 that there was some feeling of dissatisfaction about the
14 arrangements with Bristol. I put it no stronger than
15 that.
16 Q. What was the general nature of this dissatisfaction as
17 it appeared to filter through to you from the press?
18 A. Largely to do with the fact that the Secretary of State
19 for Wales had promised, some years before, that there
20 would be a new paediatric cardiac centre in Wales and
21 that this had taken a longer time to come about than
22 perhaps most people would have expected.
23 Secondly, the issues to do with the inconvenience
24 to parents, in particular, of the distances, even though
25 Bristol was the nearest of the supra-regional centres
0008
1 used by South Wales clinicians. And particularly at the
2 time the letters from the Children's Heart Circle had
3 seemed to come to an acute point of showing that
4 dissatisfaction in relation to Bristol.
5 Other than that, it was the feeling we had in
6 regular conversations with my colleague, Professor
7 Andrew Henderson of the University of Wales College of
8 Medicine -- he was the senior cardiologist there --
9 where he was reflecting that the Bristol centre perhaps
10 was not improving year on year in the quality of its
11 service, as perhaps his colleagues and himself would
12 have thought would have happened by then.
13 Q. Can I try to narrow down the focus of dissatisfaction?
14 In geographical terms, this would be South Wales, would
15 it not?
16 A. Yes.
17 Q. Because North Wales, we understood from the evidence of
18 Mr Gregory, were happy with the services they had from
19 Liverpool and were not large enough to ask for services
20 of their own?
21 A. Correct.
22 Q. Mid-Wales may have found it easier to travel to
23 Birmingham than --
24 A. Or to London.
25 Q. Or to London, so they were not unhappy with that
0009
1 arrangement. You are nodding. I say that simply for
2 the transcript.
3 A. That is correct.
4 Q. So in terms of Welsh dissatisfaction, one was looking at
5 South Wales. Within South Wales, do we understand it
6 correctly that patients were referred to a number of
7 centres in England and not just to Bristol?
8 A. That is correct, and as the record shows in the Welsh
9 Office bundle sent to the Inquiry, the paediatricians in
10 Gwent, in the Royal Gwent Hospital, Newport, and the
11 Nevill Hall Hospital, Abergavenny, not only were they
12 content with the service at the Bristol supra-regional
13 centre, but they were positively strong in their
14 advocacy of it in letters to the Welsh Office, and
15 indeed, when I met those consultants in those Gwent
16 hospitals, from time to time, it was a sort of regular
17 contact the Chief Medical Officer would have with the
18 service.
19 There is also a record in the bundle from
20 Dr Goodwin at the West Wales General Hospital
21 Carmarthen, late in the five-year period that I was at
22 the Welsh Office concerned with these matters, but he
23 was, again, showing support for the service given and
24 the quality of the service given him by the Bristol
25 centre.
0010
1 Not all of South Wales used the Bristol centre to
2 any great degree. For example, some of the referrals
3 from Cardiff bypassed Bristol, by and large either to
4 one of the London centres, or more latterly to
5 Southampton.
6 Q. So within South Wales, referrals to a number of
7 different centres, some to London, Hammersmith, some to
8 Southampton, some to Bristol?
9 A. Yes.
10 Q. So far as distance is concerned, there would have been
11 little inconvenience in travelling to Bristol compared
12 with travelling to Southampton or to Hammersmith, would
13 there?
14 A. If one was using the train service, there is a very good
15 train service from Cardiff, or indeed from Swansea, to
16 each of those three centres you have just mentioned. An
17 extra hour into London, possibly an extra hour to
18 Southampton. That is the nature of the difference in
19 the time-scale.
20 Q. So for parents going to visit children while looking
21 after the family that remains at home, Bristol would be
22 the centre of convenience by comparison, at least to the
23 extent of the hour or so's travel?
24 A. Indeed.
25 Q. And in terms of transferring a child, a patient, by
0011
1 ambulance or car to Bristol, easy communication,
2 presumably?
3 A. Much easier by car to Bristol.
4 Q. So Bristol would have been the centre of geographical
5 convenience?
6 A. Yes, indeed.
7 Q. And you tell us that of the three main reasons for
8 dissatisfaction, one was the distance that patients --
9 the word that I inadvertently transcribed as
10 "parents" -- the patients had to travel, and the
11 reality, so far as Bristol is concerned, is that they
12 would not have to go that much further from Cardiff to
13 get to Bristol, is it?
14 A. Sure. And for the Gwent patients, some of them would be
15 easier to get to Bristol than to Cardiff.
16 Q. When you are not looking at the screen, would you mind
17 pulling the microphone a little bit closer towards you?
18 It is fairly sensitive, but we just want to make sure
19 that it picks up everything which you have to say.
20 So of the features which you mention, the distance
21 will be more of a problem for the Hammersmith and
22 Southampton centres than it would be for Bristol?
23 A. Correct.
24 Q. And yet, from what you indicate in your statement, the
25 number of referrals from South Wales to Bristol compared
0012
1 to those going to Hammersmith and Southampton did not,
2 as you saw it, materially alter over the period with
3 which we are concerned?
4 A. I think the fact is that clinicians in their referral
5 patterns -- and you will have noted from my written
6 evidence that there was no restriction on a referral in
7 so far as Welsh Office policy was concerned; we did not
8 direct anybody where to send their patients, or where
9 not to send their patients: total clinical freedom in
10 this respect. This was the case for all specialties as
11 far as I remember within the total body of medicine,
12 except when there were special arrangements made
13 nationally, for example, for dangerous diseases like
14 ebola fever and Lassa fever, things like that. Other
15 than that, there was no direction or guidance whatsoever
16 as to where people should refer patients on for further
17 opinion and treatment.
18 So that where individual clinicians had been
19 accustomed to those services, say from the London
20 sectors, then those clinicians continued to refer
21 patients on to those centres well after the date of
22 establishment of the supra-regional centre at Bristol in
23 the specialties. I support anybody's rights, in fact,
24 to have done that.
25 It may be of interest to the Inquiry that even
0013
1 after Wales had its new paediatric cardiac centre from
2 1991, that it took well over a year, perhaps two years,
3 for the Welsh district general hospital paediatricians
4 to begin to change that pattern of referral and use the
5 Cardiff centre. They did not believe at the beginning
6 that the service that would be offered in Cardiff would
7 be on a par with or better than the centres that they
8 used, and this indeed was the case for the Gwent
9 consultants in particular.
10 Q. I was going to ask about that very matter, because when
11 the centre began in Cardiff to operate, it would have
12 been operating in a field in which there had already
13 been established referral patterns?
14 A. Correct.
15 Q. For it to succeed, it would have to be anticipated that
16 those referral patterns would at least over a fairly
17 short period of time, change.
18 A. Indeed. That is the case. I think it is important to
19 point out that my colleagues and I in the Welsh Office
20 were not confident early on that the Welsh sector would
21 be able to attract the vast majority of the South Wales
22 patient population to a Cardiff centre and away from the
23 other English regional sectors, not just the Bristol
24 centre, but the London ones, the Southampton as well,
25 because we knew from the epidemiological data,
0014
1 particularly highlighted in the Welsh Medical Committee
2 report of 1981, that the potential catchment of
3 population for the paediatric cardiac centre at Cardiff
4 was very much at the lower end -- below the lower end of
5 patient volume that had been recommended by the Joint
6 Committee of the Royal College of Surgeons of England
7 and the Royal College of Physicians of London, so we
8 were worried that there be a sufficient throughput of
9 patients, particularly infants and neonates, to enable
10 the clinicians in the Cardiff centre to keep up their
11 clinical skills, to be sharp and improve their skills
12 and to be able to sustain that over a long period of
13 time.
14 The first cardiologist appointed for the new
15 sector, Richard Kirk, worked exceedingly hard in his
16 communications with and visiting of the DGHs in South
17 and Mid-Wales to bring to notice to his paediatric
18 colleagues in those hospitals the levels of skill and
19 facilities that there were in the new Cardiff centre, to
20 attract them to that centre. So, if we had that problem
21 in 1991 and 1992, in getting a switch of referral
22 pattern from within South Wales to the Cardiff centre,
23 it should be of no surprise to the Inquiry if in fact
24 Bristol failed to attract the change of referral pattern
25 from Mid and South Wales earlier on in the period in the
0015
1 life of the Bristol supra-regional centre.
2 Q. What happened after the Cardiff centre began was that
3 referral patterns in fact did change, as I understand
4 it?
5 A. But not immediately.
6 Q. Over what period?
7 A. I would say that it was not what we had hoped for,
8 for perhaps two years.
9 Q. So referral patterns changed slowly, but by and large,
10 over two years?
11 A. That is my recollection.
12 Q. We may possibly conclude that in so far as Bristol was
13 concerned, the referral patterns did not change over two
14 years, or four, or very much over the period of 1984
15 until 1990, but I want to ask you a little bit more
16 about those figures in a minute.
17 If that is the case, why should it be, as you see
18 it, that Cardiff, once established, would succeed in
19 altering fixed referral patterns, but Bristol, having
20 been established, did not?
21 A. I think that perhaps the most important factor from 1991
22 on in Cardiff was the huge commitment of time that the
23 paediatric cardiologist, with support from the others in
24 his team, made in the visiting and the revisiting, and
25 the persistent seeking of trying to influence the DGH
0016
1 paediatricians in Wales to give the Cardiff centre
2 a chance to show what it could do, if I can put it like
3 that. They were very assiduous in doing that.
4 At the time, when there was no large number of
5 ongoing referrals coming to the Cardiff centre, that
6 changed obviously with time. It would be difficult,
7 I would presume, for the Bristol centre to have been as
8 proactive in seeking additional referrals, because, as
9 I would judge it, they had a major continuing service
10 day in, day out, every day of the year in fact to see to
11 the patients coming in anyway. It was
12 a long-established centre. Cardiff was starting from
13 new, effectively.
14 Q. So one feature, the feature which you identify, is the
15 time available to the cardiologist free of other
16 clinical duties to get out "on the road", as it were,
17 and go around the DGHs and convert the paediatricians to
18 the cause of Cardiff?
19 A. That was, I think, a very important difference at that
20 time.
21 This said, may I just add that when, in the period
22 after the premature death of Dr Leslie Davies, who was
23 the cardiologist in Cardiff, largely with an adult
24 practice -- I mention this in my evidence -- when he
25 died there was an acute crisis in South Wales, and there
0017
1 was an increased referral to Bristol substantially from
2 South Wales at that time.
3 The other reason was that the London centres
4 became busier and busier and were not able to take the
5 South Wales referrals with the usual speed and despatch,
6 in the best available time in so far as the needs of the
7 patients were concerned, and people referred more to
8 Bristol.
9 Additionally, the Bristol cardiologists were seen
10 not as visiting the hospitals in Gwent, but further
11 across South Wales, as far as Carmarthen.
12 Q. The evident undercurrent of dissatisfaction to which you
13 refer in paragraph 13 is something which, as
14 I understand it, you deduced principally from the press
15 and also from your contacts with Professor Henderson.
16 Was there any other source of it?
17 A. Not as far as I was aware. I think, again, it is
18 important to highlight that I was not, as CMO, the sole
19 person dealing with the subject within the health
20 professionals at the Welsh Office. One of the two
21 Deputy Chief Medical Officers had that responsibility,
22 and were being supported by a Senior Medical Officer.
23 They would see more day-to-day material than I was able
24 to, given the wider range of my own responsibilities.
25 Q. Can I take you back in time from the period in the last
0018
1 couple of years up to 1989 to which you refer in
2 paragraph 13, back to 1986?
3 Professor Henderson wrote a paper which we will
4 see at Welsh Office 1, WO 1, page 225.
5 This is September 1986. I am sorry that it is not
6 as easy as it might be to read.
7 If we can look at his description of the problems
8 of the present service at page 227, paragraph 3:
9 "Although we have been fortunate in having
10 a diagnostician of the calibre of [this is Les Davies],
11 we have been able to offer only a very limited cardiac
12 surgical service covering the simpler cases. Cases in
13 Cardiff requiring complex surgery are referred to the
14 better centres in Southern England, Great Ormond Street,
15 the Brompton, Southampton. Others in Wales bypass
16 Cardiff altogether."
17 He notes at the end of that paragraph:
18 "Gwent tend to refer to Bristol as relatively
19 near."
20 What it may be thought he was there indicating is
21 that the better centres in Southern England were Great
22 Ormond Street, the Brompton and Southampton, but not
23 Bristol. Bristol's claim for patients was not on the
24 basis of excellence but on the basis of nearness,
25 proximity.
0019
1 Was that, as you recall it, his view?
2 A. Yes, indeed. He forgets to mention in that, at that
3 point, however, the strong view of the Gwent consultants
4 about the high value they put on the service given at
5 Bristol. He did not share that view.
6 Q. No. But you were a friend of Professor Henderson, were
7 you?
8 A. I was a friend of Professor Henderson. I regarded him
9 as a valued colleague. He had been very helpful to me
10 throughout this period. I had initiated the request to
11 the Welsh Medical Committee, I think in 1979, to provide
12 authoritative advice to the Secretary of State for Wales
13 about cardiothoracic services in Wales, a report
14 received from the Welsh Medical Committee later in 1981,
15 which you have, and Professor Henderson, much to his
16 credit, made major contributions to the preparation of
17 that report.
18 In the years that followed, he continued to give
19 valuable advice to me and colleagues in the Welsh Office
20 throughout the period until I left, and subsequently
21 when I was the Honorary Director of Public Health
22 Medicine at South Glamorgan Health Authority with
23 responsibility for Cardiff and the Vale of Glamorgan.
24 So, yes, he was a friend and a colleague. Also,
25 I have to tell you that I had very good relationships
0020
1 with the paediatricians in the Gwent hospitals and with
2 the paediatricians throughout Wales, and with the
3 Directors of Public Health Medicine of each of the Welsh
4 health authorities, who were also taking an interest in
5 these matters.
6 Q. This document we are looking at, we can see, if we look
7 at page 233, is dated at the bottom 2nd September 1986.
8 So that I put this in context, in the summer of
9 1986 there had been an application for approval in
10 principle, had there, of a cardiac unit in Cardiff?
11 A. Correct.
12 Q. Which included a request for approval in principle of
13 the performance of neonatal and infant cardiac surgery?
14 A. Correct.
15 Q. That followed the 1981 report to which you have referred
16 in respect of which Professor Henderson was
17 instrumental?
18 A. With others.
19 Q. With others?
20 A. Correct.
21 Q. So by September 1986, the question of the moment for the
22 Welsh Office and the Welsh Medical Committee was whether
23 or not approval in principle should be given or not for
24 such a development. Am I right?
25 A. Correct.
0021
1 Q. What then happened, as Mr Gregory was able to tell us,
2 was that in September 1986 there was the report of the
3 Joint Working Party of the Royal College of Surgeons and
4 Physicians?
5 A. Correct.
6 Q. Which recommended the continuation of the supra-regional
7 system in England and Wales upon the theoretical basis
8 that such surgery for the under 1s needed to be
9 concentrated in a few centres only, to ensure the
10 continuation of proper services and the development of
11 surgical expertise, amongst other things?
12 A. Correct.
13 Q. The reaction to that -- here I am looking forward
14 a little bit beyond September into October 1986 -- in
15 the Welsh Office was to accept that view even although,
16 so far as surgery on the under 1s was concerned, it
17 placed a dent in Welsh aspirations for the time being?
18 A. Correct.
19 Q. It will follow that that was not a view which would
20 naturally commend itself to Professor Henderson?
21 A. Correct.
22 Q. We read this document -- one sees from the end of it --
23 that it appears to be a plea for the development of the
24 whole service, that is, one including neonatal and
25 infant cardiac surgery in Cardiff, amongst other
0022
1 reasons, because otherwise one would not attract
2 a doctor, a surgeon, of sufficient quality. That was
3 his view, I think, was it?
4 A. Certainly his view was that it would be difficult to
5 attract paediatric cardiologists of good calibre if
6 there was not the prospect of accompanying paediatric
7 cardiac surgery at the same time and not unnaturally,
8 the surgeon would wish to be able to carry out the full
9 range of surgery in such a department.
10 Q. If we go to page WO 1/239, there was a meeting on
11 8th October 1986 which you chaired?
12 A. Yes.
13 Q. At which I think you had a report in relation to the
14 earlier meeting of the Supra Regional Services Advisory
15 Group in England from Mrs Vass?
16 A. Correct.
17 Q. And if we look at page 242, paragraph 13, we see that
18 that meeting, the meeting in October 1986, met to
19 consider, amongst other things, the provision of
20 neonatal and infant cardiac surgery, whether it should
21 or should not take place in Cardiff?
22 A. Correct.
23 Q. Paragraph 14 notes -- it is the fifth line down:
24 "Provision at UHW for this service (included in
25 the approval in principle submission) would therefore
0023
1 constitute duplication of the service available at
2 Bristol", and it notes that Bristol was under-utilised?
3 A. Correct.
4 Q. Then 15:
5 "It was recognised that Professor Henderson was
6 particularly anxious that the paediatric unit at UHW
7 should be staffed by people of suitable calibre and that
8 the lack of provision of a neonatal and infant cardiac
9 service could result in qualified staff not being
10 attracted to posts at Cardiff. The meeting considered
11 that the Welsh Office should decide on and declare their
12 policy on this matter and agreed that the proper course
13 should be to support the SRSAG's ruling that cardiac
14 surgery for the under 1 year-olds should be carried out
15 at a supra-regional centre."
16 If we go overleaf, it refers to the report we have
17 just mentioned, the September report of the Joint Report
18 of the Colleges of Physicians and Surgeons.
19 So, with the one exception, paragraph 16, that
20 a study was to be conducted by Planning Research
21 Consultants, we can see, page 244, the last sentence of
22 paragraph 18, that the view of your committee, the
23 committee you chaired, was that the SRSAG's ruling that
24 children under 1 should be treated at the centre in
25 Bristol should be supported?
0024
1 A. Correct.
2 Q. You then, I think, got a letter, did you, from, or
3 a memo from Professor Henderson. We can find that
4 at 1/4. It is dated 20th October 1986.
5 He suggests, I think to you, that the doubts about
6 the neonatal component of the services had been raised
7 for the first time in the previous week. I discussed
8 the implications of that comment with Mr Gregory, and
9 you stand by what Mr Gregory has said, as you have
10 indicated, but can I just pick up, at the very bottom of
11 the page, under the "Need for a comprehensive cardiac
12 centre in Wales", Professor Henderson makes the point,
13 it is about six lines up:
14 "There can be no arbitrary rejection of babies
15 below a certain age. Care starts when it is needed,
16 that is at birth or even with prenatal foetal screening,
17 now. Immediately available expertise is of particular
18 importance for neonates. Moreover, transporting very
19 sick neonates long distances, even if they could be
20 identified and diagnosed, is life-threatening and
21 enormously stressful for families. It is no longer
22 acceptable. A corollary is that paediatricians do not
23 refer suspected cases to centres without adequate
24 surgery if they can possibly help it ..."
25 He refers, then, to referrals to centres without
0025
1 adequate surgery, and his view of Bristol is at page 6.
2 We can see it in paragraph 9:
3 "It has been suggested elsewhere that Bristol
4 provide [the service] ... Moreover, it is no secret
5 that their surgical service is regarded as being at the
6 bottom of the UK league for quality, and it is difficult
7 to see how this problem could be resolved in the
8 foreseeable future."
9 Those are fairly strong words about fellow
10 professionals operating not far away, are they not?
11 A. They are indeed.
12 Q. Did you speak to him about those words?
13 A. I was aware of his privately expressed views before this
14 time. The problem was that he never ever offered me, or
15 any of my colleagues, anyone in the Welsh Office, any
16 evidence as to why he held these views; and in the
17 absence of evidence, one would presume that what he had
18 was hearsay. It was no basis for us, indeed, to advise
19 the Secretary of State for Wales to ignore the strong
20 policy advice which the Department of Health in London
21 were getting, and in the reasoning behind the creation
22 of the small number of supra-regional centres.
23 We, my colleagues and I, supported by our
24 administrative colleagues in the Welsh Office Health
25 Department, were very worried if we were rushing into
0026
1 a new cardiac centre in Cardiff without being sure that
2 there was available to us for appointment a sufficient
3 choice of candidates for consultants in these
4 specialties to enable us to have a high quality service
5 with best possible outcomes right from the beginning.
6 It was our judgment that you would need considerable
7 good fortune in fact to track people of the calibre we
8 needed to provide that service. Thus we understood and
9 accepted what Professor Henderson was saying to us about
10 what the shape and content of the new Cardiff centre
11 should be in principle. We did not share his confidence
12 that we could deliver that at that particular point in
13 time.
14 Q. What I was focusing on, I hope, were the concerns
15 expressed to you, not just it would appear from the
16 signatories to this memo from Professor Henderson, but
17 also from Mr Butchart, who was a consultant cardiac
18 surgeon. We see their names at the bottom of the page,
19 and Dr Hughes, who was Chairman of the Division of Child
20 Health?
21 A. Yes.
22 Q. So all three were putting their names to a statement as
23 to the regard in which the Bristol service was held.
24 What you say is, "Well, there were no figures to
25 back that up"?
0027
1 A. There was, as I say, no evidence that one could
2 challenge what was going on there. I have said in my
3 evidence that at some time around this time, either late
4 1986 or 1987, I made a point of speaking to my colleague
5 at the Department of Health, the Chief Medical Officer
6 and the Senior Medical Adviser to the government,
7 Professor Sir Donald Acheson, in the margins of another
8 meeting -- the meeting was in London -- and he properly
9 referred me to speak with Dr Norman Halliday, the Senior
10 Principal Medical Officer of the Department of Health
11 with responsibility, as I understood it, for regional
12 hospital services in England, and was central to the
13 progressing of the advice coming from the Supra Regional
14 Services Advisory Group.
15 So in that sense, I followed up this view of
16 Professor Henderson, now supported by the others, at
17 around that time. I cannot be sure whether it was
18 immediately after this or indeed before I had this
19 letter, that I was coming round to the view that
20 I should share this expressed anxiety that was coming to
21 me in Wales to colleagues in the Department of Health.
22 But again, I had no evidence to take to them in
23 support of that view. That made it slightly difficult
24 for me to go to another Department of State without
25 evidence to say that there may be something not quite as
0028
1 good as it might be in part of the earlier area of
2 responsibility.
3 Q. You, for your part, of course, had no direct
4 responsibility for Bristol?
5 A. My responsibilities were --
6 Q. Is that right?
7 A. Yes. My responsibilities were restricted to reflect
8 those of my own Secretary of State.
9 Q. So you took the issue, you say, to the person who did
10 have some responsibility, the Medical Secretary to the
11 Supra Regional Services Advisory Group, Dr Halliday?
12 A. I did not know at the time that he was the Secretary to
13 that group. As I say, it was first of all mentioned,
14 not in writing, just a conversation in the margins of
15 another meeting with Sir Donald and he properly advised
16 me to go and discuss it with Dr Halliday. That, I did.
17 Q. Do you recall where it was that you spoke to
18 Dr Halliday?
19 A. In his office. I have only been to his office once,
20 and that was the occasion on which I spoke to him about
21 this.
22 Q. Do you remember broadly what you said?
23 A. I said that I was getting repeated comments from
24 Professor Henderson about his view that the quality of
25 the service in the Bristol centre was not improving year
0029
1 on year, as might have been expected. That was the
2 essence of what I said. I had no evidence other than
3 that, and that was, I think, a fair summary of what
4 I had heard from Professor Henderson from time to time.
5 Q. From what you said, do you think it might have been
6 taken that you were referring to the numbers of cases
7 dealt with at Bristol not improving?
8 A. It was not the reason for my raising it with
9 Dr Halliday, but I was aware that the waiting time in
10 all of the centres, including Bristol, was getting
11 longer for patients from Mid and South Wales. I recall
12 distinctly that this was an issue which rested with him
13 in so far as all of the English centres were concerned,
14 and he, and I believe his group, were considering how in
15 fact to deal with that.
16 Q. What he told us -- it is transcript Day 13, page 50 --
17 is that he spoke to you about Welsh plans. I asked him
18 whether he was aware in 1986 of concerns that had been
19 expressed by Professor Henderson in respect of the
20 service provided at Bristol, and he said:
21 "It does not ring a bell, no. I mean, throughout
22 all the discussions with the Welsh Office and everyone
23 in that area, there were constant concerns about
24 Bristol, but they were vague concerns and they appeared
25 to be about the problems of referral."
0030
1 How far would you say that was an accurate
2 recollection of the conversation as you remember it?
3 A. He certainly focused on his concerns about waiting
4 times. The pity of it is that this conversation was an
5 unminuted one and I have no confirmation of what went
6 on. He would be mistaken if it was his belief that
7 I did not raise the matter of Professor Henderson's
8 expressions about the standing of the Bristol centre
9 compared with other regional English centres, and the
10 other thing is that in his visits to Wales he normally
11 saw the appropriate Deputy Chief in my department and/or
12 the Senior Medical Officer in support, and I would not
13 be knowing what the nature or the extent of the
14 conversations were when he was in Wales on those
15 occasions. He was usually brought along to my office by
16 colleagues, would say "Hello" just before he was on his
17 way back to London to catch his train, or whatever.
18 In terms of myself, it was the one visit to his
19 office that I remember clearly, and bringing this to
20 notice.
21 Q. So what you are saying is that you have a clear
22 recollection, and good grounds for it, to recall that
23 you did mention the question of the quality of service
24 and the standing of Bristol compared to other centres,
25 reflecting concerns that had been raised with you by
0031
1 Professor Henderson in Wales?
2 A. I was reflecting what Professor Henderson was saying to
3 me. You must remember that I also had information from
4 the Gwent consultants which was contrary to that. In
5 the absence of factual data, my case was fairly weak,
6 was it not, because I would have presumed that
7 Dr Halliday would have at his fingertips the data for
8 each of the English sectors, and know very well how
9 Bristol performed compared with the others. I just did
10 not have any of that.
11 Q. You were looking for data, because you did not have it?
12 A. I had asked Professor Henderson -- not every time I saw
13 him, because I saw him regularly, but from time to time
14 when he was fairly strong, as he was in the letter which
15 is on the screen now, "Come on, Andrew, where is your
16 evidence? Give me evidence and I can do something about
17 it". But he did not give me any.
18 Thinking back over the years about it, I would
19 suppose that perhaps he did not have, at that time, the
20 factual evidence either that he would be reflecting what
21 was the kind of "commonroom gossip" between British
22 cardiologists when they met, as these people do from
23 time to time and that it was part of the chitchat of
24 cardiologists. I was not aware of that; I was not part
25 of that circuit. The evidence may have been only privy
0032
1 to a few of them.
2 Q. But you thought that Dr Halliday did have the figures?
3 A. Well, let us put it like this: I would assume that the
4 Department of Health or an organisation who was acting
5 on behalf of, advising the Department of Health, would
6 have been collecting the data and that it would be
7 a surprise if that data was not available to the
8 Department.
9 Q. So assuming, as you have indicated by that answer that
10 you did, that he had the data if you could not get the
11 figures from Professor Henderson, and if it was, as it
12 must have been, useful to have the figures, either to
13 substantiate what he was saying or the opposite, did you
14 hope that by contacting and speaking to Dr Halliday, you
15 might get at least an indication of what the figures
16 showed, from him?
17 A. I would have hoped that he would have been in a position
18 to have assured me that there was no basis to what
19 Professor Henderson was saying to me, or that if there
20 was a problem, that he had been able to share
21 a confidence as to the extent of it, if he knew. But
22 I do not recall any acknowledgment either way in that
23 conversation about that. Perhaps it is time I should
24 draw attention to that minute of Dr Jennifer Lloyd?
25 Q. I am going to come to that in a moment. So far as your
0033
1 conversation with Dr Halliday is concerned, did you
2 actually ask him for the figures, or what the figures
3 showed?
4 A. No, I did not.
5 Q. As you and I have been talking about this, we have
6 received in the Inquiry a written formal statement from
7 Professor Henderson himself. I have not had a chance to
8 see it and nor have you.
9 A. Correct.
10 Q. What I am going to ask the Chairman to do, if it is not
11 inconvenient to you, is to have a slightly earlier
12 coffee break than we might normally at this stage. It
13 is, I suspect, unlikely I am going to detain you for
14 much more than 45 minutes or so after the break, perhaps
15 an hour, but it may be a convenient moment for you to
16 have a look at what Professor Henderson has to say on
17 paper to us now, just as it will be for us.
18 PROFESSOR CROMPTON: Thank you.
19 THE CHAIRMAN: You might look behind you to see whether
20 a quarter of an hour may be a slightly short period, or
21 whether you would like a slightly longer period. We
22 normally take 15 minutes, but I think it might be proper
23 to take a slightly longer period.
24 MR LANGSTAFF: Can we say 20 minutes?
25 THE CHAIRMAN: If you are sure that is enough. I am quite
0034
1 happy to say 25, if you prefer it.
2 MR MURPHY: 20 minutes sounds fine.
3 THE CHAIRMAN: So we will reconvene in 20 minutes, which, in
4 my arithmetic, is around 10 past 11, thank you.
5 (10.50 am)
6 (A short break)
7 (11.15 am)
8 MR LANGSTAFF: Two matters, Professor Crompton. First of
9 all, just going back for one moment to the conversation
10 that you had with Dr Halliday in which you raised
11 Professor Henderson's concerns, you told us you raised
12 the concerns which he had?
13 A. Yes.
14 Q. Do you recall whether you mentioned Professor Henderson
15 by name?
16 A. I pretty certainly would have done so.
17 Q. You are pretty certain you would have done so?
18 A. Yes.
19 Q. Professor Henderson, in his letter which we treat as
20 a statement to the Inquiry, appears to be making,
21 I think, these points -- tell me if you think there is
22 anything in addition which comes out on a first reading
23 to you. May I say, of course, that my question is in
24 one sense a comment and others are free, therefore, to
25 comment further upon it to the Inquiry. I say that
0035
1 because my words go on the Internet and will be picked
2 up in community health centres in this general area of
3 the country --
4 THE CHAIRMAN: And, if I may add, Mr Langstaff, comment
5 subsequently if he so wishes, given the time we have all
6 had to see the statement.
7 MR LANGSTAFF: Of course. I am grateful for being reminded
8 of that.
9 What he seems to be saying is that he, for his
10 part, had no hard evidence, is the way he puts it, of
11 Bristol problems.
12 A. Yes.
13 Q. That nonetheless, he maintains that that was the general
14 view of those to whom he talked, whom he cannot now, it
15 seems, identify by name, save that this was a general
16 view. And it was a general view not in respect of
17 surgeons but in respect of outcomes which may themselves
18 have been influenced by infrastructure in particular.
19 So far as the history of the concerns and his
20 expression of concerns to you about Bristol, is there
21 anything which you would pick out from his statement
22 which I have missed in that short summary?
23 A. To be honest, I would need perhaps an hour or more to
24 read that very closely and read into it what he says.
25 I regret I did not have enough time to do it to the
0036
1 depth that I wished to study it, but to add, at no time
2 did Professor Henderson, speaking with me or indeed when
3 he was speaking to people in the same room as myself,
4 ever say anything about the surgeons in Bristol
5 specifically; it was always outcomes of the Bristol
6 centre.
7 Q. So your experience of his complaints bears out, or
8 coincides with, his own statement to us that he was
9 expressing a view as to outcomes rather than a view as
10 to individual surgical expertise?
11 A. Correct.
12 Q. In the chronology we had gone so far as to get to
13 20th October 1986, when Professor Henderson wrote to you
14 the letter which we have just been looking at.
15 One point he makes, which I would ask you to deal
16 with, he said in that letter that it had not been until
17 the previous week that he had realised that it was no
18 longer agreed that the surgical service to be performed
19 in Cardiff would exclude infant and neonatal cardiac
20 surgery.
21 Leaving aside any question of the timing, is he
22 right in saying that until the events of
23 September/October 1986, it had been anticipated that any
24 surgical service developed in Cardiff would have
25 included neonatal and infants?
0037
1 A. My recollection is that previous to that, there had been
2 no specific mention of inclusion or exclusion of infants
3 and neonates.
4 Secondly, whilst he is correct, in the evidence
5 which I have briefly seen, to say that things did not
6 have to be the same on either side of Offa's Dyke, this
7 is a reflection of, probably correctly, a conversation
8 he had had with me in the early years of this period,
9 which would be that the Secretary of State for Wales was
10 not necessarily constrained by decisions in England as
11 to what he might decide to do in the provision of
12 services or the pattern of services in Wales.
13 That said, there would have to be, whether it
14 would be in this case or in any other case, strong
15 reasons as to why Welsh Office officials, including
16 myself, would have to advise the Secretary of State for
17 Wales to do something very different from what was the
18 pattern in England, because normally we would have very
19 strongly wished to stay within the guidance given by
20 bodies like the Joint Royal Colleges and in this
21 instance also the Supra Regional Services Advisory
22 Group. That was the position certainly of the Secretary
23 of State for Wales throughout.
24 Q. Taking it on from the 20th October, you had understood,
25 as you had in all the conversations you had with
0038
1 Professor Henderson, the nature of his concerns. When
2 he referred to Bristol as being at the "bottom of the
3 league" -- let us look and see how he now puts his
4 recollection of what he meant by that. WO 1/380. It is
5 the bottom of the page:
6 "It was, I am sure, understood by all that the
7 'league' referred not to any numerically listed order
8 of merit for which there were, of course, no data on
9 surgical output on which to base any numerical league
10 order - indeed it would be difficult to devise
11 a simplistic numerical measure. We use the word simply
12 as a metaphor introduced for impact in the circumstances
13 to convey the indication that infant cardiac surgical
14 success rates were lower than in most (or all) of the
15 other designated supra-regional centres."
16 In what sense did you understand him to be using
17 the expression "league"?
18 A. I did not believe that in fact he was ever telling me
19 that it was at the very bottom of any league that there
20 might be -- I did not know there was a league, but any
21 league there might be of the outcomes or the measures of
22 outcomes of each of the centres. I was fairly certain
23 that the Bristol centre was in the lower half of the UK
24 centres, but somebody had to be at the top and somebody
25 had to be at the bottom. I do not even know who at the
0039
1 time was at the top, or indeed where the Welsh centre
2 was when we opened it in the 1990s, except I knew that
3 we were doing rather well in that time. I never saw
4 a performance table in relation to the specialties
5 during my year in practice.
6 Q. That was not the question. The question was whether you
7 understood when he referred as he did -- let us go back
8 to see the words he used. It is WO 1/6. Paragraph 9:
9 " ... no secret that their surgical service is
10 regarded as being at the bottom of the UK league for
11 quality."
12 He says that is a metaphor; everyone understood it
13 that way. My question was, did you?
14 A. Let me put it like this. I do not want to appear to be
15 unappreciative of the advice I got from Professor
16 Henderson over the years, but some of us on occasion
17 believed he was prone to a slight exaggeration, but that
18 that was intended to spur us on to get going, to do
19 rather better in what we were progressing over the
20 centres.
21 Q. The question I am asking is in relation to the language
22 he uses, which, as you say, is "colourful", and you were
23 indicating may have been designed for a particular
24 object. But the question is whether or not, by using
25 that language, you thought he was saying, "I have data",
0040
1 or whether you thought he was simply making a point
2 colourfully and emphatically?
3 A. I believed that he might have data, and I was, at the
4 time, curious as to why, if he had the data, he would
5 not share it with me, or with the Office.
6 Reading today's documentation in the interval, it
7 is now obvious that he did not have the information,
8 which would explain why he did not give me the data he
9 did not have.
10 Q. One further question in relation to this letter from
11 Professor Henderson. If you go back to page 5, can we
12 focus on the second paragraph, under "neonatal cardiac
13 surgery", the paragraph beginning "Provision of
14 expertise". Let me read it to you:
15 "Provision of expertise necessarily represents
16 a compromise between adequacy of throughput and the
17 price in clinical and human terms of not having
18 a locally based service."
19 This sentence then follows:
20 "The concept of a limited number of neonatal
21 cardiac surgical centres was the appropriate compromise
22 some years ago, but changing practice means that it is
23 no longer so."
24 He goes on to say, "Well, we have not changed the
25 concept because of representations from the relevant
0041
1 committees".
2 That is his view expressed to you in a document
3 dated 20th October 1986.
4 Can I invite your comment as to whether there may
5 seem to be a contradiction between that view and the
6 views he had expressed 6 weeks earlier at page 230?
7 He begins the second paragraph, under paragraph 7,
8 with the words:
9 "The concept of limiting the number of neonatal
10 cardiac surgical units is thus soundly based in
11 principle."
12 He goes on to discuss the numbers that there
13 should be, given the estimates of workload.
14 Does he appear to be saying two different things,
15 heading in different directions in those two different
16 documents?
17 A. On the face of it, that would appear to be the case.
18 However, I was conscious that the specialty was rapidly
19 advancing and I know that Professor Henderson had close
20 contacts with the Southampton unit and their catchment
21 was broadly the same size as South and Mid-Wales, but
22 that the throughput of patients to that unit from within
23 that catchment seemed to be right at the highest
24 projection of the Welsh Medical Committee in its 1981
25 report.
0042
1 That was important, I think, if it was true,
2 because the anxieties that the Welsh Office had were
3 that a unit in Cardiff drawing almost wholly from Mid
4 and South Wales, would probably be non-viable and of
5 high risk perhaps to infant and neonatal patients by
6 reason of insufficient throughput. However, if this
7 upper limit of projection even beyond that was already
8 happening by 1986 and Professor Henderson was aware this
9 was happening in Southampton and maybe other places,
10 then it was an important fact to bring to Welsh Office
11 notice, because it would give us greater degrees of
12 confidence were we in fact to proceed with infant and
13 neonatal surgery, right from the very beginning of the
14 new centre. That is the only opinion I can offer on
15 your question.
16 Q. The reason for my asking you is simply to follow up your
17 recent answer to the effect that Professor Henderson
18 sometimes overstated his case in order to make it --
19 that was the purport of the answer you gave me, as
20 I understand it -- and to ask whether the documents
21 which we have, directed to you as Chief Medical Officer,
22 were themselves written to argue a case, rather than to
23 alert you to a particular view as to this situation or
24 that situation?
25 A. There might well be an element of that. You see, in the
0043
1 context of what was happening generally in Cardiff at
2 the time, there were people with different priorities.
3 For example, at the University Hospital of Wales, where
4 the cardiac centre was at the time, and still is,
5 situated, there were a considerable number of colleagues
6 of Professor Henderson in other disciplines, who would
7 not have wished to support an expansion of the cardiac
8 centre because the University Hospital of Wales site had
9 fairly strict county council, Cardiff city planning
10 restrictions, as I understood it. There was
11 consideration, for example, of the relocation of the
12 Welsh burns and plastic surgery centre from the old
13 premises at St Lawrence Hospital, Chepstow, and it was
14 the strong wish at the Medical College that that should
15 go also on to the University Hospital of Wales site.
16 They would be competing for the available land on that
17 site.
18 At South Glamorgan Health Authority -- this is
19 when I was still in the Welsh Office -- up to round
20 about this date we understood that there was no
21 objection there in principle to expanding the cardiac
22 capacity at University Hospital, Wales. But round about
23 this time, the Health Authority decided to proceed on
24 the basis of having the whole of cardiac surgery at the
25 Llandough Hospital site near Penarth, some six miles or
0044
1 so away from the main teaching centre; Llandough
2 Hospital itself was part of the teaching complex. So
3 that Professor Henderson and his colleagues during part
4 of this was relying on the Welsh Office and the
5 Secretary of State to seek to challenge the South
6 Glamorgan Health Authority's view as to location. So
7 there were many people with different views at this
8 time, and it was one of the reasons for the delays and
9 the progress. So it was necessary, perhaps, for him and
10 his colleagues to be fairly strong in their
11 representations to us. I do not criticise him for it.
12 Q. Can we look at document 1/263, please? This is
13 a background report which is dated December 1986,
14 prepared by Dr Jennifer Lloyd. It deals with the
15 background, first of all, at page 263.
16 If we go to page 264, and the subject matter of
17 the report is set out in the second paragraph, it is to
18 consider the views expressed as to whether there should
19 be a comprehensive paediatric service in Wales
20 incorporating neonatal and infant surgical services, or
21 not.
22 It describes the progress. It says, under
23 "Progress", that you and senior medical staff have now
24 had a series of meetings to discuss the issue with
25 colleagues within the Department of Health and Social
0045
1 Security, who have responsibility for infant and
2 neonatal cardiac surgery, and that information has been
3 sought from Regional Health Authorities throughout
4 England.
5 That, I take it, was so?
6 A. That would largely have been done by colleagues in the
7 department junior to myself.
8 Q. Then it describes, if we go over to page 265, a visit to
9 Bristol Royal Infirmary and Bristol Children's
10 Hospital. This was a visit which I understand from your
11 statement you were part of?
12 A. Yes, indeed. I actually initiated the request to the
13 South Western Regional Health Authority through
14 Dr Jennifer Lloyd, that we make this visit, and as on
15 these occasions, I was usually supported by the Deputy
16 Chief concerned and the Senior Medical Officer.
17 My recollection is that Dr Deirdre Hine, now Dame
18 Deirdre Hine, was on that visit with me, as was
19 Dr Jennifer Lloyd.
20 Q. Page 265, we are on. Towards the bottom of that
21 paragraph, this is said:
22 "In frank discussions", do you see that?
23 A. Yes, thank you.
24 Q. You must have had in mind at this stage, I take it, the
25 concerns which Professor Henderson had expressed to you?
0046
1 A. Yes.
2 Q. You had no data from him?
3 A. No.
4 Q. You were looking for whether there was or was not
5 anything objective to support the concerns he expressed,
6 I take it?
7 A. That is the case. We faced the Bristol team with fairly
8 direct questions, in fact, very direct questions.
9 Q. Hence the words "frank discussions"?
10 A. Yes.
11 Q. "Frank discussions" may refer not only to the
12 questioning but also to the answers?
13 A. I believe that the answers we got were honest and seemed
14 to be full. The clear recollection I have is that we
15 were told that indeed they knew that they could do
16 better; that it was their intention to improve year on
17 year; and that the local health authority, whether it
18 was Bristol and Weston or the RHA, I would not know, had
19 by 1986 greatly improved the fabric of the accommodation
20 that was in the Bristol unit. They were impressive, and
21 there were pieces of kit, notably in the x-ray
22 department, relevant to this programme, and there seemed
23 to us to be no reason at all in terms of the investment
24 made by the health authorities, that --
25 Q. Are you perhaps jumping ahead in time to the time when
0047
1 the catheter lab was developed, I think at the end of
2 1986, and the surgical unit reformulated in 1988?
3 A. When we visited there had been big improvements compared
4 with what we had seen in the underdeveloped unit in
5 1984, and we were told of what else was in train, and it
6 seemed that the people locally were taking a grip on
7 what was necessary in a supra-regional centre doing this
8 kind of surgery.
9 Q. So they had developed, were developing?
10 A. Yes.
11 Q. Had a grip, and you say that, looking at the sentence,
12 you say Dr Lloyd writes that there was "a positive wish
13 to increase throughput and continue the trend of
14 improving outcome with the ensuing maintenance and
15 developing of skills."
16 The link there appears to be the familiar link,
17 between the number of operations performed and the
18 development of expertise, enabling one better to perform
19 the next series of operations that come along?
20 A. This is the key principle, and underlying the whole of
21 the discussion, and the consideration, reconsideration,
22 of policies throughout the country, not just in Bristol.
23 Q. So what they were saying, was, was it, "We are hoping to
24 do greater numbers and thereby improve"?
25 A. Exactly that.
0048
1 Q. Recognising that, if one were to put it colloquially,
2 they may not have been doing desperately well up until
3 then?
4 A. They were not doing desperately 'un-well', that is the
5 point. They knew that they should be doing better
6 compared with some of the better centres, and were
7 expecting, in fact, to match them in a period of time.
8 Q. Page 266. Perhaps we ought to get the very last line of
9 265.
10 "We were unable to obtain from DHSS, who do not
11 hold figures broken down by units, any figures on
12 outcome by centre."
13 Just pausing there, that sentence suggests that
14 someone on your team had asked.
15 A. Yes. Jennifer Lloyd asked on my request. She
16 specifically, in planning a visit, was asked by me to
17 obtain data that would compare the Bristol centre with
18 each of the other centres. That statement there, that
19 there was no data made available to us, is correct.
20 Q. And no doubt, when she asked for data, she would have
21 told someone in the DHSS why, broadly, she was asking
22 for data?
23 A. I presume so.
24 Q. I mention that because it rather supports what you have
25 been saying about the content of the conversations you
0049
1 had with Dr Halliday.
2 A. Yes.
3 Q. Going back to the top of page 266:
4 "We did, however, raise the question of outcome
5 with Bristol staff. They put to us the accepted point
6 that outcome is influenced greatly by case mix."
7 Stopping there, they had given you two reasons,
8 then, for their own less than average performance. One
9 was the numbers, which were low; the other is the case
10 mix?
11 A. Yes.
12 Q. Dr Lloyd goes on to say:
13 "They were quite open in quoting outcomes for some
14 of the commoner procedures they undertake."
15 That expression, "quite open in quoting outcomes",
16 might suggest to a careful reader that there might have
17 been something about the outcomes they would not have
18 wished necessarily to be open about, in other words, the
19 outcomes were not desperately good?
20 A. Could be.
21 Q. Is that your impression of what was being said?
22 A. I did not think at the time that anyone was avoiding
23 answering our questions fully.
24 Q. That is not the point. The question is what the answers
25 revealed.
0050
1 A. I am sorry, could you ....
2 Q. Were they saying: "For some of the commoner procedures
3 we undertake, we are not doing as well as other
4 centres"? Words to that effect?
5 A. During that visit I think they presented us with some
6 statistics which are in the Welsh Office bundle, and
7 that shows that in relation to the simpler procedures,
8 they were certainly at par with the other averages in
9 the other centres in so far as what it says, but they
10 were below par in relation to the more complicated
11 procedures. There was no discussion of individual
12 procedures, types of operations, et cetera. There was
13 no detailed discussion just, let us say, in relation to
14 Welsh patients.
15 Q. Who was it that you recollect being there on the Bristol
16 side?
17 A. Dr Jordan, Dr Joffe, Mr Wisheart. We had only met
18 Mr Dhasmana on the 1986 visit, very briefly, in the
19 margins of a clinical area, and from the Health
20 Authority or region, Dr Freeman and Dr Pitman. I cannot
21 remember if both were there. I am slightly confused as
22 to who was there in the 1984 visit. Certainly, in 1986,
23 both cardiologists and Mr Wisheart for nearly all of the
24 time of the visit, and these questions about clinical
25 outcomes was part of the discussion taking part with
0051
1 those people present.
2 Q. Just reading on in 266, for most of the more commonly
3 occurring conditions, their figures compare well with
4 other centres. That may, it might be thought, as
5 a matter of English, support the suggestion that for
6 some of the more commonly occurring conditions they did
7 not. But it goes on to read:
8 "They acknowledge, however, that surgeons in
9 different centres develop special expertise in rarer
10 conditions and that outcomes may therefore vary greatly
11 for these between centres."
12 That is a summary about rarer conditions and about
13 how good the outcomes were or were not in Bristol.
14 A. Yes.
15 Q. Do you recollect what was said to you by the individuals
16 you have identified as to the outcome of the surgery
17 that had been performed in the rarer conditions?
18 A. I do not recall exactly, but I think that there was no
19 detailed discussion of that, because my impression was
20 that the people we were talking with were fully
21 cognisant of their strengths and weaknesses, and were
22 actually intending to improve in all respects where they
23 needed to.
24 Q. It is not a question that I want to know whether they
25 were or were not cognisant of those strengths and
0052
1 weaknesses, but how they put them, how they expressed
2 those and at the moment I am asking about weaknesses as
3 opposed to strengths.
4 A. They seemed to be quite open about it.
5 Q. Is it a fair inference from your recollection prompted
6 by this report of Dr Lloyd that they acknowledged as
7 a weakness their performance in some of the rarer
8 conditions?
9 A. Yes.
10 Q. So far as strengths are concerned, the impression one
11 may have is that the strength they were relying upon
12 was, as it were, prospective, it was in connection with
13 the continued development of the infrastructure, the
14 site, the equipment and the like and the numbers?
15 A. Yes.
16 Q. Did you hear or discuss any plans to deal with the split
17 in site as between the Children's Hospital and the Royal
18 Infirmary?
19 A. I remember that this was a matter of considerable
20 anxiety. It was clearly an arrangement, the split site;
21 it was not conducive to best standards of patient care.
22 The longer that it remained like that, was one of the
23 factors that led to the less favourable outcomes.
24 Q. The results of this particular visit were taken to the
25 Welsh Medical Committee by you and Dr Lloyd and others,
0053
1 as I understand it?
2 A. Correct.
3 Q. On 21st January 1987, page 272, we have the
4 extraordinary meeting of the Welsh Medical Committee to
5 discuss the question of the content of the surgery to be
6 established in Cardiff.
7 Can we look at 275? Can we look, please, at the
8 points which are identified there? This is the summary,
9 I think, of the result of the discussions that Bristol
10 offered the certainty of a service, and so on, and we go
11 down to (vi):
12 "Because it had been shown the quality of service
13 was closely related to numbers dealt with ... there
14 would be a danger of there being two second-rate units
15 at Cardiff and Bristol if the proposals being put to the
16 committee were accepted."
17 A. Correct.
18 Q. And obviously the impact on Bristol surgery of the
19 development in Cardiff.
20 So these were the sorts of considerations which
21 fed the committee at its meeting?
22 A. Yes.
23 Q. And can we go the page 279? Professor Henderson,
24 I think, spoke to his concerns and we see what is said
25 there four paragraphs down:
0054
1 "Bristol seemed to a number of clinicians not to
2 be offering the very best possible service."
3 You had also had, at this meeting, as I showed
4 Mr Gregory and as the Panel will recall, a letter of
5 support by Dr Prosser from a number of the
6 paediatricians in Gwent?
7 A. Yes.
8 Q. I almost said "cardiologists", but there had only been
9 the one cardiologist in Wales dealing with paediatrics?
10 A. That is right.
11 Q. That was Dr Davies?
12 A. Correct.
13 Q. Who died in 1985?
14 A. Correct.
15 Q. There had been no surgery in Cardiff before this
16 development took place, any paediatric cardiac surgery,
17 had there?
18 A. Certainly there had not been any complicated paediatric
19 cardiac surgery done in Cardiff until the new unit
20 there. There would have been some done on older
21 children. Certainly none on infants and neonates.
22 Q. Do you know where Dr Davies referred his patients for
23 surgery?
24 A. Mostly to London.
25 Q. Returning to page 279, it deals with the concerns.
0055
1 Did you, or anyone, challenge him when he said that
2 Bristol seemed to a number of clinicians not to be
3 offering the very best possible service by asking "Where
4 is your data? Where are your facts?" anything like
5 that?
6 A. It was a fairly brisk sort of meeting, and I recall some
7 challenge coming from my two colleagues, or maybe one of
8 my colleagues, Dr Hine, when this was going on, and
9 indeed, from some other members of the Welsh Medical
10 Committee.
11 Q. I think we see, at page 283, the start of that
12 discussion:
13 "The Chairman again thanked Professor Henderson."
14 Then we go down four lines from the bottom of that
15 paragraph:
16 "The CMO and colleagues had quite recently visited
17 Bristol and carefully considered its plans for the
18 future, existing facilities and, as far as possible, the
19 quality of the service provided."
20 We can turn over, I think, to 284: the summary,
21 I think, of the results of the investigations you had
22 made in the second paragraph:
23 "Although comparable data for outcome figures were
24 not available for Bristol, the subject had been raised
25 with Bristol clinicians who had demonstrated on crude
0056
1 figures that these were improving as throughput
2 increased."
3 A. That is correct. The figures of course are very crude;
4 they are not stratified in any way, but they are the
5 best that had been made available to us.
6 Q. When you raised the question of the figures at your
7 earlier meeting at Bristol, had you said to any of the
8 doctors there, "Well, concerns have been expressed about
9 the outcomes at Bristol", anything like that?
10 A. Oh, yes. I mean, you know, we faced them up and said,
11 "We hear on the grapevine that things are not very well
12 in the hospital; that there is a below standard
13 service", things like that, and they responded as fully
14 as I explained before.
15 Q. We come then to page 286, when, having considered the
16 matter, the Welsh Medical Committee agreed -- it is at
17 the bottom of the page, the last sentence of the
18 paragraph in quotes:
19 "Consequently, neonatal and infant cardiac surgery
20 should continue to be provided from Bristol."
21 I am not going to read the rest of it to you;
22 I have been through it with Mr Gregory.
23 A. Could I just say, please, I think in the second line of
24 that main paragraph, I believe that the Chairman of the
25 Welsh Medical Committee may have intended to say
0057
1 "paediatric cardiac service", not "paediatric
2 cardiology service". None of the rest of it makes
3 sense.
4 Q. I think we picked that up with Mr Gregory, but you are
5 spot-on, I think.
6 There is very little else that I wanted to ask you
7 about in connection with the Welsh Office and Bristol
8 arising out of this period of time, save perhaps to pick
9 up one or two of the references from the evidence of
10 others, which I will do in a moment if I may.
11 Can I ask you to have a look at a document
12 a couple of years down the road, or a year down the road
13 from here? It is 1/317.
14 It is a letter to Dr Chamberlain from the Welsh
15 Office, 15th December 1987. It is from you?
16 A. Yes.
17 Q. Can we have a look at the fourth paragraph, please?
18 "There is local controversy at present regarding
19 our policy reliance on the nearest supra-regional centre
20 for infant and neonatal cardiac surgery ..."
21 Was that a reference to Bristol?
22 A. Yes.
23 Q. What was the local controversy to which you were
24 referring?
25 A. The points about distance and inconvenience, as seen by
0058
1 parents, and of course within our own Cardiff situation,
2 the pressure coming upon the Welsh Office to proceed
3 with and build and commission a new paediatric cardiac
4 centre.
5 Q. A matter of days after this, on 23rd December, you
6 received a letter from the South Gwent Community Health
7 Council which we have at 1/319. This is from South
8 Gwent. It begins by talking about community health
9 councils having been concerned for some time at the
10 absence of any effective paediatric or neonatal
11 cardiology or cardiac surgery facilities in South Wales
12 itself.
13 Then it refers to Bristol and the fact that no
14 such services are to be provided at Cardiff.
15 It talks about the new cardiac centre being built.
16 Can I again, just for other purposes, confirm with
17 you that once the decision to open a centre in Cardiff
18 had been taken, there would inevitably be a lead-in
19 time?
20 A. Yes.
21 Q. When was it that the centre actually opened?
22 A. The first patients, I believe, in the middle of 1991.
23 Q. So from decision to implementation of the decision would
24 be about four or five years?
25 A. Correct.
0059
1 Q. And that time-scale must have been envisaged by all from
2 the outset, I suppose?
3 A. Well, we had to deal with the South Glamorgan decision
4 about Llandough Hospital and get them to change their
5 minds on that. We had to await the State's review of
6 the Health Authority. We were, at the same time, trying
7 to rapidly increase the capacity of University Hospital
8 from about 300 patients per annum up to a certainty of
9 600 per annum to 800, so there were all sorts of
10 complicated issues. We were failing to recruit
11 a paediatric cardiologist to replace Dr Leslie Davies.
12 The hospital, in a small city with a small catchment
13 compared with the other major centres in this field,
14 were having difficulty recruiting nurses in the cardiac
15 centre and in the old USW accommodation as well as in
16 intensive care, and there was a problem with recruiting
17 junior doctors of the requisite calibre as well.
18 So things were considerably complicated, and so it
19 was not just the only reason for the delay in building
20 the new unit, the new unit being upon a greenfield site
21 integrated into the hospital as part of the paediatric
22 department but also with close staff links with the
23 Department of Cardiology.
24 Q. I took you out of the line of concentration upon this
25 particular document. If you go to the second
0060
1 paragraph,, there is a complaint about a young boy from
2 South Gwent who died following cardiac surgery in
3 Bristol, and the author, Mr Roberts, suggested that he
4 had accompanied the father to an interview with the
5 consultant concerned, who apologised that there had been
6 a delay of 12 months before he had been admitted to
7 surgery, and referred to the delay being caused by the
8 level of demand imposed on the unit and asking you, in
9 the last paragraph, to ascertain whether you are
10 satisfied that the Bristol unit can provide a level of
11 service capable of meeting the needs of South Wales as
12 well as of its own region, and confirmation that Bristol
13 is able and willing to continue to provide a neonatal
14 service.
15 This is an expression of concern in an individual
16 case.
17 A. Yes.
18 Q. The controversy which you described in your earlier
19 letter was not, or was it -- tell me -- fuelled by
20 individual cases so much as by policy concerns?
21 A. No, it was not.
22 Q. It was not which?
23 A. There was no consideration of individual cases.
24 Q. So it was policy concern?
25 A. It was policy concerns; total policy concerns.
0061
1 Q. This particular letter then, was it a one-off or not,
2 this sort of letter?
3 A. In relation to the fact that it refers to an individual
4 case, as far as I was concerned, it was a one-off.
5 Q. Did you investigate or have investigated the issues
6 which it raised?
7 A. You will notice my initials by the date of 7th January
8 there. That is a letter for action to my deputy.
9 Q. Can we look at the annotation, because you can read it.
10 What were you saying to Dr Hine, your deputy?
11 A. It says "Please reply after discussion with", I do not
12 know whether that is --
13 Q. Something "as appropriate"?
14 A. Something "as appropriate".
15 Q. Again, from recollection, was there a problem with
16 waiting lists, delays, caused by the pressures upon the
17 use of surgical facilities in Bristol? Or were there
18 not?
19 A. I think over the period, that the waiting list
20 progressively got longer, or the waiting time got
21 longer.
22 Q. And that would indicate, would it, a pressure of all
23 types of surgery upon the available operating theatre
24 facilities?
25 A. That would be my assumption. I was not, within Welsh
0062
1 Office, involved in the day-to-day detail of these
2 matters, in matters which Dr Hine when she was there and
3 later one of the acting deputies together with Dr Lloyd
4 would have been concerned with on my behalf.
5 Q. Can we go now to something three months later?
6 UBHT 62/428.
7 This is a letter from Dr Baker to your deputy,
8 Dr Hine, about the services in Wales.
9 The last paragraph. He is asking for a comment:
10 "For neonatal and infant cardiac services [he says
11 to Dr Hine] you were able to gain an indication from
12 South Glamorgan representatives that in relation to the
13 Welsh Office policy of these services not being
14 undertaken in Wales, that they ... would continue to
15 gain services from elsewhere and not from Bristol. It
16 was anticipated that other Health Authorities in South
17 Wales would continue with their referral patterns to
18 Bristol."
19 Did anyone in the Welsh Office encourage those in
20 South Glamorgan to use Bristol?
21 A. I do not believe that any of us in the Welsh Office, at
22 any time, encouraged any clinician to use any of the
23 centres other than the one of their own choice.
24 Q. So this is simply a statement of observation of what was
25 happening?
0063
1 A. I think so.
2 Q. The implication of it would be, would it, that despite
3 the development in Bristol, the referral patterns from
4 Wales were not altering?
5 A. Broadly, yes.
6 Q. Can we have a look at Department of Health 4/81?
7 This is a Bristol document. It deals with infant
8 and neonatal cardiac services, the comparison of
9 admissions by region, and it deals with the number of
10 admissions to the South Western region, the Regional
11 Health Authority and North Wessex and Wales. There is
12 a contribution to the Bristol numbers.
13 The blocks on the right-hand side, albeit
14 estimated figures for 1992 to 1993, in the far right,
15 appear to show a steady decline in the number of total
16 admissions -- this would be open and closed surgery and
17 presumably other admissions -- from Wales over the
18 period 1989 down to 1992.
19 From your perspective, what would you suggest the
20 reasons for that would be, the centre in Cardiff not at
21 this stage having opened?
22 A. The two blocks for 1991, 1992 and 1993, are certainly
23 affected by the Cardiff centre. The block for 1991 --
24 I have not seen this before. I was not aware of that
25 step down there.
0064
1 It may be that it reflected the patients admitted
2 by the Bristol centre from Wales were competing with the
3 heavier number coming from the South West region and
4 that our people might very well be exploring other
5 centres like Birmingham or Southampton to get an
6 admission.
7 Q. The evidence of Mr Gregory, you have told us you accept?
8 A. Yes.
9 Q. In the course of that evidence there are one or two
10 little references which I want to pick up with you, if
11 you do not mind.
12 The first is that Mr Gregory indicated to us that
13 you would be able, from your own contact with clinicians
14 in Wales, to say whether other clinicians, apart from
15 the signatories of the Henderson letter, if I can call
16 it that, appeared to you to share his view. Plainly
17 those in Gwent, Dr Prosser and others, did not. Did you
18 ask others for their views?
19 A. Yes. Not just in relation to the subject, but I used to
20 travel around odd parts of Wales pretty regularly,
21 particularly, I would be asking about the use made by
22 Welsh clinicians of services in the neighbouring regions
23 of England, whether they be Mersey, the West Midlands or
24 the South Wales region. It was a routine I had to brief
25 myself as to what benefits we were getting from our
0065
1 neighbours across Offa's Dyke.
2 There is a letter from Dr Goodwin in the file from
3 Carmarthen in support of the Bristol centre in about
4 1990. This would be round about the time just before or
5 after I left the Welsh Office -- I cannot remember the
6 date of it now -- so I was not aware of anything like
7 the strength of feeling elsewhere in South Wales that
8 I have come across in material from, say, Professor
9 Henderson and his colleagues. Parts of South Wales,
10 Gwent being one, and maybe in the Swansea hospitals,
11 some people might be saying that they were entirely
12 happy with referring on to Cardiff anyway; different
13 hospitals, different priorities, and the views of the
14 competition locally.
15 Q. In the course of his evidence, Mr Gregory dealt with the
16 advocacy. This is Day 10, from page 137, line 22, to
17 page 138, line 2 -- I say that so others can pick up the
18 reference -- referring WO 1/287, the top of the page:
19 "Close liaison should be established between the
20 paediatric cardiology service in Cardiff and the
21 supra-regional paediatric cardiac surgery service in
22 Bristol."
23 The question which I ask you in relation to that
24 is whether those steps, or steps to establish such
25 liaison, were taken and if so, by whom?
0066
1 A. Just for me to get the context of this, could I see the
2 page before that?
3 Q. Can we go back to the start of the document, please,
4 scrolling back through it?
5 A. Thank you. This is the --
6 Q. It is January 1987.
7 A. It is the minutes of the Welsh Committee of January
8 1987. The point had been made to us, I am not sure if
9 it had come from outside Cardiff, that collaboration
10 between the Bristol centre and Cardiff would perhaps
11 lead to a better service for Welsh patients and that
12 with that continued into the future, when there was the
13 new Cardiff centre, there could be some specialisation
14 in various procedures by individuals in both centres.
15 It certainly was discussed with public health colleagues
16 in the meeting I had at Region in, I think, 1988, but
17 there was not much enthusiasm for this approach from the
18 local clinicians in Cardiff.
19 Q. Thank you. If you excuse me for a moment, I am just
20 making sure that the references which were made on
21 a number of occasions to you by Mr Gregory, when he
22 referred to you, are picked up by me in the evidence,
23 both in response to my own notes and to those which
24 I have had from others.
25 In 1988 Dr Somerville and others took part in
0067
1 a study of the need for cardiology services and cardiac
2 services in Wales?
3 A. This followed my request to Dr Douglas Chamberlain, now
4 Professor Douglas Chamberlain, on the Joint Colleges'
5 Committee on Cardiac Services: they were very helpful to
6 us, that group of people you mentioned.
7 Q. Before she and those in the Working Party of which she
8 formed part considered the question of how services
9 should be developed in the course of which they went, as
10 we understand it, to look at the facilities at Bristol,
11 did you alert her at all to the concerns that had been
12 expressed by Professor Henderson?
13 A. I do not think that they visited with me before they
14 started their consideration of the question posed to
15 them. I saw them at some point in the investigation and
16 whilst I cannot recall exactly what was said on that
17 occasion, I doubted if in fact they were unaware of what
18 we had been told by Professor Henderson.
19 Q. The point is made that, in their report in relation to
20 the possible development of services in Wales, nothing
21 is said that is overtly critical of Bristol.
22 A. Correct.
23 Q. I shall take it no further with you at this stage, save
24 to make the point, as I am invited by others to do in
25 the course of this evidence, to ensure that some balance
0068
1 may be kept between the allegations we have heard and
2 the responses which by and large we have not yet had the
3 advantage of hearing.
4 A. Thank you.
5 Q. That is the purpose of putting that particular question
6 and matter to you.
7 Dr Crompton, I have asked you a number of
8 questions about the events, particularly in 1986 and
9 1987, and matters surrounding them. Is there anything
10 you would wish to add to us to ensure that your evidence
11 to the Inquiry is as complete as possible?
12 A. Thank you. It is a regret of mine that my recollection
13 of the detail of this period is a problem to me and
14 I apologise for that. I think that in so far as I am
15 able to, that is about it, I think. Thank you.
16 MR LANGSTAFF: Thank you very much, Professor Crompton.
17 There may be questions from the Panel.
18 EXAMINED BY THE PANEL:
19 MRS MACLEAN: Thank you, Professor Crompton. Just a small
20 point of clarification for my understanding. You
21 described in your meeting with Dr Halliday that one of
22 the subjects of discussion was the question of waiting
23 lists in Bristol. I was not quite clear whether that
24 was waiting for the services of a cardiologist or
25 actually waiting for cardiac surgery? I know the two
0069
1 are not completely independent, but it would be helpful
2 to understand where the pressure on the system was at
3 that time.
4 A. I am sorry, I cannot help you. I went to see
5 Dr Halliday about what Professor Henderson was telling
6 me. It was Dr Halliday who highlighted the waiting
7 time, the waiting list issue. Whilst I might have known
8 of its existence, I did not know anything of the detail,
9 to be honest, and thinking back, and reading
10 Dr Halliday's evidence, it brought to my memory and my
11 recollection of the time that he was focusing on that
12 conversation about having waiting lists, but I thought
13 he was referring also to similar experiences in the
14 other supra-regional centres.
15 MRS MACLEAN: Thank you.
16 THE CHAIRMAN: Professor Jarman?
17 PROFESSOR JARMAN: You have told us that on the visit in
18 1986, you asked Dr Jennifer Lloyd to go to the DHSS to
19 get data about outcomes at Bristol because there was
20 some concern about that.
21 A. Correct.
22 Q. You said, when asked, that she indicated that the
23 DHSS, the reason why she was asking for the data, you
24 presumed that was so?
25 A. Yes.
0070
1 Q. You also mentioned that informally you had mentioned the
2 problems at Bristol to Sir Donald Acheson, the CMO in
3 England at the time?
4 A. Yes.
5 Q. I just wondered how you, as an ex-CMO, would comment on
6 what you would have thought, what sort of action might
7 have been taken in the circumstances in which the CMO of
8 Wales was expressing a concern about one of the English
9 hospitals?
10 A. This was part of my difficulty, was it not: that what
11 I at best had was hearsay from one particular part of
12 Wales.
13 Q. But you had expressed a concern?
14 A. Yes, because I thought it was important that if it was
15 not known that this was being said to the Department as
16 a colleague CMO, it was important that I told the DOH
17 CMO of what whisper was going around in my
18 neighbourhood. I stress, I did not make formal
19 arrangements to see Sir Donald, I raised it in the
20 margins maybe of a GECC or GMC whatever. He certainly
21 perfectly properly told me to go and discuss it with
22 Dr Halliday.
23 Q. But the question was, what sort of action you would have
24 expected the Department of Health in England to have
25 taken in those circumstances?
0071
1 A. If what I was saying was news to them --
2 Q. Do you think it was?
3 A. Well, from Dr Halliday's reaction, it did not seem to
4 have been news, because he focused on the waiting list
5 issues, not the quality and outcomes issues, and as far
6 as I knew maybe similar things were being said in other
7 parts of England about other centres, he might be privy
8 to, I was not. I did not know what was known or not
9 known to Dr Halliday, and he kept any confidences that
10 he had.
11 Q. But you still have not quite answered my question: what
12 sort of actions you, as an ex-CMO, would have expected
13 from the English counterparts?
14 A. I would have expected from the beginning, when they
15 established the supra-regional centres, that there would
16 have been a system of data capture and analysis and
17 publication from each of the centres, distributed freely
18 to the Department of Health and to Regional Health
19 Authorities who were sending patients there from Wales
20 or wherever and that the Supra Regional Services
21 Advisory Group would have been in full knowledge of all
22 the facts relating to this important initiative. If
23 that was not the case, then I am surprised.
24 PROFESSOR JARMAN: Thank you.
25 THE CHAIRMAN: Mr Murphy?
0072
1 MR MURPHY: May I just raise two matters briefly?
2 THE CHAIRMAN: Just come forward.
3 RE-EXAMINED BY MR MURPHY:
4 Q. Professor Crompton, you have told us that you enquired
5 of Professor Henderson whether he had any evidence to
6 substantiate the views that he had expressed to you
7 about Bristol?
8 A. Correct.
9 Q. You have told us that he gave you no data, and of course
10 we now know that he had no data, from his own evidence.
11 A. Correct.
12 Q. But did he give you any anecdotal evidence at all that
13 was adverse to Bristol?
14 A. He said that the views he had were what he had gathered
15 from discussions with other people in the specialty.
16 There were no examples given of individual patients from
17 Wales that had an unexpectedly unfavourable outcomes in
18 being treated at Bristol, so that was the nature,
19 actually, as I understood it, of the substance of what
20 he was saying.
21 Q. Was there anything specific that you felt you could
22 follow up?
23 A. I followed it up because of -- he was, in terms of
24 seniority in the specialty, the very high standing that
25 he had in the specialty, and that he would not have --
0073
1 it was not that I asked him more than once for
2 information, he mentioned this from time to time
3 regularly over the year and round about the time of
4 1986/87, I thought it was about time that I made what he
5 was saying to me known to my colleagues in the
6 Department of Health.
7 Q. One final matter. You referred to the Bristol meeting
8 of the Welsh Medical Committee at which Professor
9 Henderson attended on 21st January 1987. Could I ask
10 you, please, to look at WO 1/283?
11 You have already looked in some detail at the
12 fourth paragraph beginning:
13 "The Chairman again thanked Professor
14 Henderson ..."
15 A. Excuse me, my screen is still blank.
16 THE CHAIRMAN: It is my fault and I apologise.
17 MR MURPHY: You have looked at the paragraph beginning:
18 "The Chairman again thanked Professor
19 Henderson ..."
20 A. Yes.
21 Q. Those gentlemen then left. The next paragraph. Can
22 I just ask you to look at the last sentence of the next
23 paragraph, please, beginning with the words, "The
24 implications ..."
25 A. Yes.
0074
1 Q. "The implications that the quality and staffing of the
2 service at Bristol was inferior was considered by the
3 Welsh Office medical staff to be unproven and unfair."
4 Was that the conclusion as a result of the
5 challenges that you made to Professor Henderson and
6 Mr Butchart that day?
7 A. This is an almost verbatim record of Dame Deirdre Hine's
8 statement in the Welsh Medical Committee that day, and
9 those of us who visited Bristol at the end of 1986
10 shared that view. It was also my view.
11 MR MURPHY: I have no more questions.
12 THE CHAIRMAN: I am very grateful. Thank you, Mr Murphy.
13 MR MURPHY: May I raise one matter? The statement of
14 Professor Henderson has been given a Welsh Office
15 reference -- I gather that is going to be changed.
16 THE CHAIRMAN: I am grateful to you for pointing that out.
17 That is most helpful. It will be changed. Thank you.
18 Dr Crompton, thank you very much indeed for coming
19 and sharing your recollections with us. I recognise
20 that they are properly so described, because we are
21 talking of events some time ago, and you have demitted
22 from office some long time ago also, but we are very
23 grateful to you for having come.
24 If there are other matters which come back to you,
25 or you discover other materials that you feel may be of
0075
1 assistance to us, we shall be here for some time and
2 therefore either yourself or through others, if you
3 would let us have whatever other material you may wish
4 us to see, and in particular, if you have any further
5 comments on Professor Henderson's statement which has
6 just been admitted, then we would be grateful to have
7 them, but for the moment, thank you very much indeed.
8 Perhaps if you just sit for a while, Mr Langstaff
9 can tell us something of the programme for next week,
10 before we adjourn.
11 MR LANGSTAFF: Next week we have one witness only to hear.
12 We have him on the Monday and the Tuesday. The rest of
13 the week I must emphasize yet again is in no sense
14 wasted; it is being used most definitely for
15 preparation, reading, thought and consideration, and
16 I need to emphasize, perhaps yet again, that this
17 Inquiry is largely a paper inquiry, receiving evidence
18 largely on paper, and a lot of comment on paper, and
19 open to receive yet more. I repeat yet again, the
20 invitation which I have made now a number of times to
21 anyone who has anything they think they wish to add, to
22 please come forward and do so.
23 But we have, on Monday and Tuesday, Mr Nix.
24 Mr Nix was, latterly, and is now, the Deputy Chief
25 Executive of the UBHT. He was for some considerable
0076
1 time involved in the financial direction of both the
2 Trust and its predecessor at the Bristol and Weston, and
3 the evidence which he gives spans the entire period with
4 which we are concerned from a financial and
5 administrative perspective.
6 We are thus beginning to hone down from the
7 national scene which we have been looking at and which
8 we will continue to look at over the next month or so,
9 to the local scene, and how that was organised and run.
10 THE CHAIRMAN: Thank you, Mr Langstaff. I think it is
11 important to emphasize that particular shift from the
12 national context in which Bristol had to manage its
13 affairs to looking at how Bristol was in fact, during
14 that period, managing its affairs.
15 So we adjourn now and reconvene on Monday at
16 10.30. Thank you very much.
17 (12.45 pm)
18 (Adjourned until 10.30 am on Monday, 24th May 1999)
19
20
21
22
23
24
25
0077
1 PROFESSOR GARETH CROMPTON (SWORN)..................... 1
2 Examined by MR LANGSTAFF........................ 1
3 Examined by THE PANEL: ........................ 69
4 Re-examined by MR MURPHY....................... 73
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
0078
Return to top of page
Published by the Bristol Royal Infirmary Inquiry, July 2001
© Crown Copyright 2001