Annex A > Chapter 28 - Concerns 1993 > Concerns > Discussions with the Department of Health (DoH)
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Discussions with the Department of Health (DoH)
68 Dr Jane Ashwell, a Senior Medical Officer (SMO) at the DoH from 1991 to 1995, described in her written evidence to the Inquiry the contact she had with clinicians at the BRI:
`I then met Dr Bolsin at the Royal College of Anaesthetists, in what I believe was about December, 1993, although I have no record of that date. After the College meeting, he approached me on the steps of the College and asked me if he could discuss something privately. I have no written record of what was said and what follows is to the best of my recollection.
`He was concerned about the outcomes of cardiac surgery in a number of children at the BRI. He had anaesthetised some of them and he continued to have responsibility for future cases. I understood that he was talking to me as a professional colleague and one who had practised as an anaesthetist and would understand the difficult position he felt he was in, but also might have useful advice on what practical and procedural steps he could take.
`Such approaches are not unusual for officials in the DoH. Any approach has to be considered and a judgement made about handling. In this case, I understood Dr Bolsin's enquiry to be confidential in the sense that I would not normally divulge what he said to others without his explicit agreement.
`This was the only occasion on which he sought advice on his concerns about paediatric cardiac surgery at the BRI.
`On the basis of what he told me, and with his agreement, I raised the issue with Professor Farndon, in his capacity as a Clinical Director in the BRI. I expressed my concern that issues over the quality of cardiac surgery had been raised with me and indicated that I thought that it should be addressed locally. I expected that the matter would then be investigated further.
`I confirmed in a letter to Dr Bolsin dated 13th December 1993 that I had spoken to Professor Farndon and had raised the issue, although I had not mentioned Dr Bolsin by name. I also enclosed what relevant Departmental guidance I found.
`Dr Bolsin replied on 10th February 1994, thanking me for what I had done and indicating that he thought there would be little benefit from further Departmental intervention. He said he was convinced that I had assisted in the resolution of the matter.
`Dr Bolsin did not speak to me again on this matter.' [73]
69 Dr Bolsin in his written evidence to the Inquiry stated that in his contact with Dr Ashwell he:
`... explained my concerns about the paediatric cardiac surgical unit at the Bristol Royal Infirmary and provided her [Dr Ashwell] with my provisional figures for the Bolsin/Black data collection and analysis. She agreed to review the data and then provide me with some advice in due course.
`I subsequently received a letter from Dr Jane Ashwell referring me to the GMC guidelines and the "three wise men" procedure. This letter confirmed that Dr Ashwell had been contacted the next day by Professor Farndon, who had expressed to her exactly the same concerns as I had expressed to her.' [74]
70 In her letter to Dr Bolsin dated 13 December 1993, Dr Ashwell wrote:
`You spoke to me in confidence last Thursday. By complete coincidence John Farndon spoke of the same matter to me on Friday. I did not mention you. This letter includes what I expect you would receive, were you to write to the Chief Medical Officer.' [75]
71 In December 1993 Professor Farndon attended a meeting at which Dr Ashwell was also present, as an observer from the DoH. He stated:
`She approached me after the meeting to see if I could spare some time to talk to her ... she raised with me a concern which had been expressed to her about performance in the paediatric cardiac surgery unit. At this stage, both Dr Ashwell and I were aware that statistics were being prepared by Dr Bolsin. I cannot remember the specifics of the conversation. In general terms we discussed the concerns that some people [76] had about paediatric cardiac surgery. Something was discussed about the mechanisms by which those concerns had arisen, and about the ways forward, to either substantiate or refute the concerns.'
`I took the meeting to be an informal one, in that we left one place and she wished to talk to me in confidence out of the venue of the previous meeting about some other concerns. I did not interpret this as an "official" Department of Health approach to me about any concerns in Bristol.' [77]
72 Professor Farndon was asked whether it was his recollection that he raised outcomes in paediatric cardiac surgery with Dr Ashwell or whether she raised the issue with him. Professor Farndon said:
`My recollection was that she raised it with me and invited me to walk around to another office block of the Elephant and Castle [78] to talk to me.' [79]
73 Professor Farndon told the Inquiry:
`I just found it strange and almost unreal that here was someone from the Department of Health, knowing about issues and talking to me after a meeting was complete when other business was being done, and I suppose one had to think, "Is the Department of Health knowing about this formally [or] informally? Is this a formal approach to me to do something about this? Am I still part of a process of trying to help this situation?"' [80]
`... if there were a clear instruction that she had a concern, it was in her domain to have responsibility for clinical performance and that she knew, for example, that there was a problem in Bristol, if she wanted me to be part of that, and a clear signal had come to me from her that this was a responsibility she wanted me to take, I would take it very seriously.
`But as I say, this was admixed with a chat about other anaesthetic colleagues that she knew and I knew.' [81]
75 Professor Farndon was asked whether he thought it was his responsibility to take the matter forward in any way:
`... every one of us is so burdened with our own responsibilities in our own domain, one hopes that one does not have to assume responsibilities from areas where there may be no area of expertise, no professional interaction whatsoever. And I felt up to that point that I had given advice as well as I could.' [82]
76 Professor Farndon explained that he had said:
`To Dr Bolsin and to Professor Angelini and to others who have said to me about the situation: "Talk together. Is there a problem? Is there not a problem?"' [83]
77 Professor Farndon also stated that he did not know what Dr Ashwell's role, as an SMO at the DoH, would have been in the resolution of any problem in paediatric cardiac surgery at the BRI. [84]
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Footnotes
[73] WIT 0338 0004 - 0005 Dr Ashwell
[74] WIT 0080 0116 Dr Bolsin
[75] UBHT 0061 0265. The paper which Dr Ashwell enclosed with the letter was HC(90)9 `Disciplinary Procedures for Hospital and Community Medical and Dental Staff', which can be found at WIT 0037 0079
[76] Professor Farndon, when asked in the oral hearings to whom he was referring in this sentence, stated: `People such as Professor Angelini. I am not sure, again, at what stage others spoke to me, whether people like Sheila Willatts or Cedric Prys-Roberts spoke to me around that time.' Counsel to the Inquiry suggested that Dr Bolsin might also be included in this list. Professor Farndon agreed. T69 p.124
[77] WIT 0087 0008 Professor Farndon
[78] Department of Health, Hannibal House, Elephant and Castle, London
[79] T69 p.130 Professor Farndon
[80] T69 p.126 Professor Farndon
[81] T69 p.129 Professor Farndon
[82] T69 p.127 Professor Farndon