Final Report > Chapter 12: Responses to Concerns and Actions Taken, and Whether Such Actions were Appropriate and Prompt > Responses outside the UBH/T > The Royal Colleges

The Royal Colleges

13 The Inquiry heard no evidence of concerns about the quality of care in PCS in Bristol being raised with the Royal Colleges. Given his position as a consultant in the hospital where junior anaesthetists were raising questions, Professor Prys-Roberts in his capacity as President of the Royal College of Anaesthetists may be considered to have been in a strong position to support junior colleagues. But this additional responsibility also meant that Professor Prys-Roberts was focused on national issues and perhaps distracted from events in Bristol.

14 The most direct involvement of the Royal Colleges with the Bristol hospitals was through their assessment of whether a hospital should be designated as suitable to have posts for training. In 1991 the Children's Hospital was refused such designation for a training position in paediatric cardiology because of the disadvantages associated with the split site and service. We heard from Sir Barry Jackson, President of the Royal College of Surgeons of England (RSCE), that there was no means at the time whereby information collected by the Royal Colleges through individual accreditation procedures could be brought together and thus learned from. This position, we were told, has not altered. We also heard from Sir Barry about the distinction drawn between assessing suitability for training and assessing quality of care. [12] Regrettably, therefore, for a number of reasons, the Royal Colleges were not equipped to respond adequately to any concerns which may have been raised, far less to identify concerns for themselves. [13]

15 The Royal Colleges were also involved in giving advice to the SRSAG, both directly through the membership of Sir Terence English, and through the Working Parties which were asked to report to the Group on PCS. The Royal Colleges' contribution was, however, that of advice. They had no power to require that action be taken on their advice. On one view, therefore, there was involvement without responsibility: the liberty to comment without the duty to do anything. The RCSE, for example, through Sir Terence, had developed in the 1970s a new and potentially important system for monitoring outcomes in cardiac surgery in the form of the UKCSR. Unfortunately, it was not possible to resolve the ensuing ambivalence among surgeons about passing these data to the DoH. There was reluctance to make individual unit returns available to the DoH before 1991, but at the same time, there was a presumption that the DoH had access to them. Professor Sir George Alberti, as President of the Royal College of Physicians of London (RCP), spoke of hoping that his College in the future would `nudge everything up a bit', [14] but that the Colleges had no power to make things happen. The result was most unsatisfactory.

Footnotes

[12] T28 p.6 Sir Barry Jackson

[13] In Chapter 16, in the section of our Report dealing with the adequacy of care, where we refer to monitoring of quality, we make the points that the Royal Colleges: did not include information on the quality of care received by patients in their criteria of assessment of suitability for training; varied in the thoroughness of their visits (Dr Shinebourne's visit to the Children's Hospital can be compared with the two visits from the RCSE. Both visits suggested a less than rigorous attention to the detail of the PCS service at the BRI); did not exchange information between each other, thereby preventing a full picture of the quality of a hospital's care from emerging; did not have any powers other than to grant or deny designation of training posts; and did not assess the ability to train the consultants to whom training posts were designated. All of these add up to a very unsatisfactory state of affairs

[14] T9 p.4 Professor Sir George Alberti