Final Report > Chapter 14: External Assessment and Monitoring of the Quality of Care in Bristol > The NHS generally
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The NHS generally
18 The story of how the quality of clinical care generally and the PCS service in particular was monitored externally, therefore, is one of muddle and confusion. Witnesses pointed in a bewildering variety of directions. Some said the responsibility lay, to some extent, with the SRSAG or the DoH: including Sir Kenneth Calman, Chief Medical Officer 1991-1998, [16] Professor Crompton, Chief Medical Officer for Wales 1978-1989, Dr Ian Baker, Consultant in Public Health Medicine, B&DHA, Sir Terence English, former President, RCSE, Sir Michael Carlisle, former Chairman, SRSAG, [17] and Dr Norman Halliday, former Medical Secretary, SRSAG (in relation to the period after Trust status, although he qualified this by emphasising that he relied on the views of medical personnel rather than any system of formal monitoring). Moreover, Dr Halliday stated: `... the statutory duty for provision of health services rests with the Health Authorities ... The Supra Regional Services Advisory Group did not alter the statutory arrangements.' [18] Dr Halliday also said that the supra regional service (SRS) was a funding arrangement, and that the SRSAG did not have responsibility for monitoring the quality of the care provided by SRCs:
`I was the architect of the Supra Regional Service arrangements. It was I who drafted all the papers, made all the proposals and negotiated with the profession. At no time did we consider that the Advisory Group which would eventually be set up would have responsibilities for any of the services. Their role was to advise the Secretary of State on which services would be centrally funded. It was a funding arrangement.' [19]
19 Witnesses also suggested that responsibility lay with the Royal Colleges, or, more locally, with the health authority, or the hospital or trust, or the treating clinicians. Dr Halliday at one point or another in his evidence told us that responsibility lay with each of these.
20 As we have seen, Sir Alan Langlands commented:
`... there was confusion ... the distinctive roles and responsibilities of each of the players was not adequately clarified. I think that the Department of Health, the NHS Executive in particular, must take some responsibility for that. It falls into my category of systemic failure. You cannot expect people to behave sensibly in this position unless they are absolutely clear where they fit in.' [20]
21 The confusion, was not, however, just some administrative game of `pass the parcel'. What was at stake was the health, welfare, indeed the lives of children. What was lacking was any real system whereby any organisation took responsibility for what a layperson would describe as `keeping an eye on things'. The SRSAG thought that the health authorities or the Royal College of Surgeons were doing it; the Royal College of Surgeons thought that the SRSAG or the trust were doing it, and so it went on. No one was doing it. We cannot say that the external system for assuring and monitoring the quality of care was inadequate. There was, in truth, no such system.
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Footnotes
[16] Sir Kenneth accepted that at least the SRSAG should ensure that systems of monitoring were in place: but if not the SRSAG, then the DoH had a responsibility
[17] T15 p.3 Sir Michael thought that the DoH had an accountability as a contractor