Annex A > Chapter 1 - The Background to and Conduct of the Public Inquiry > Preparation of the Final Report > Structure of Annex A

Structure of Annex A

117 Annex A is an account of the evidence that the Inquiry took to assist it in discharging its duty under the Terms of Reference. The entirety of the Phase One (Oral Hearings) evidence that went before the Panel is available verbatim in Annex D. This Annex constitutes a permanent record of the salient parts of it.

118 Inevitably, any account is bound to be selective. Even in an account as extensive as this, there may be occasions on which evidence which had some impact upon the Panel in reaching its conclusions will necessarily be touched on only briefly, or even not restated. This does not mean that it was ignored. However, this Annex sets out with the intention of presenting that evidence which was regarded as being of greatest importance to the Panel in making its determination.

119 The broad context within which the specific events at Bristol must be set is first examined from the national context (though, inevitably, there will be frequent references to Bristol, for the sake of economy of text and clarity). Thus this Annex starts with an examination of the manner in which the national, regional and local bodies of the NHS, and national regulatory and professional bodies, functioned in exercising responsibility for health services.

120 The Annex then sets out the mechanisms of audit which were applicable on a national and regional basis, and the national and regional financial organisation that may have had an impact upon Bristol.

121 The Annex then offers an outline of congenital heart disease, its diagnosis and treatment, and examines the evidence of the organisation of neonatal and infant cardiac surgery (NICS) - the treatment of congenital heart disease in the under-1-year-olds - as a supra regional service (SRS), the designation of the BRI as a supra regional centre (SRC) to perform NICS, and the impact of developments in Wales upon the development of Bristol as such a centre.

122 Having set the scene nationally and regionally, the Annex then focuses upon Bristol: first, generally, the organisation of care within the hospital; and, secondly, the delivery of the paediatric cardiac surgical services within it. The care given to children who were patients is set out (broadly speaking) in the order of a child's journey through the process of care: referral, pre-operative care, surgical care, post-operative care, and counselling and support for parents.

123 Towards the end of the account of the evidence, there appears a specific focus first upon the adequacy of the surgical services provided at Bristol, and then on the expression of concerns, and the way in which they were handled, which ultimately led to the setting up of this Inquiry.

124 In order, however, to set the scene, there follows an Introduction giving a short history of the principal developments in the structure and organisation of the NHS that preceded the years covered by the Inquiry's Terms of Reference. It notes some of the milestones during that period, so that the context for the rest of the evidence is properly set.

<< previous | next >> | back to top