Final Report > Chapter 21: Introduction > The Inquiry's Task

The Inquiry's Task

1 The final part of the Inquiry's Terms of Reference asked the Panel, in the light of findings from Bristol, to `make recommendations which could help to secure high quality care across the NHS.' [1] It was the philosopher George Santayana who remarked that `those who cannot remember the past are condemned to repeat it.' The aim of this section of our Report, therefore, must be to build a bridge between the lessons of the past and the NHS of the future and, in so doing, our aspiration is that Bristol will be remembered not merely as a synonym for tragedy but also as a turning point for the NHS.

2 This is a daunting and a challenging task. A good deal has changed in the NHS since 1995, the cut-off point for our examination of the events in Bristol, not least the very significant improvements in paediatric cardiac surgical services in Bristol itself. The quality of healthcare is currently high on the agenda of healthcare professionals, the wider public and government. It is central to `The NHS Plan' [2] and to the purpose of such recently created bodies as the Commission for Health Improvement (CHI) and the National Institute for Clinical Excellence (NICE). In responding to our Terms of Reference, we have taken account of these initiatives aimed at improving the quality of healthcare. We have not seen it as our role to overturn them. Where recent changes are likely to help address the messages from Bristol we shall say so. But we believe that the lessons of Bristol must be applied at a more fundamental level. The question which we seek to address is this: what needs to be done, in terms of the needs of patients, the culture of healthcare, the role of healthcare professionals and the role of the NHS locally and nationally for the quality of care to improve, and to keep improving? Or, to put it another way, what was it that was absent from the healthcare system as a whole during the `Bristol years', and is still absent today? For, despite the recent changes and initiatives, it is not necessarily the case that all of the lessons of Bristol have been learned. Even today, it is still not possible to say, categorically, that events similar to those which happened at Bristol could not happen again in the UK: indeed, are not happening at this moment.

3 Clearly, the Inquiry's brief is extremely broad. In addressing it, we wish to make one prior point of the utmost importance. It is inevitable that in this Inquiry the emphasis has been on failures and shortcomings in the NHS. This should not cause us to lose a sense of proportion. Every day the NHS provides a service to hundreds of thousands of patients, with which patients are satisfied and of which healthcare professionals can justifiably be proud. This must never be forgotten or overlooked, and it forms the essential backdrop to all that we say in this section of the Report.

4 While the events in Bristol are our starting point, we do not confine ourselves to recommendations relating only to paediatric cardiac services or to services in Bristol. As the evidence in Phase One made clear, while some problems were specific to Bristol, in many ways the Bristol experience exemplified what were and are national issues within the NHS. Thus, in considering our recommendations for the future, we look across the spectrum of the NHS: at its resources; at its culture; at the professionals who deliver healthcare (which we take to include doctors, nurses, other healthcare professionals and managers). [3] We also look at the systems and organisations which support healthcare, as well as at the external environment of policy, governance and regulation. Given the context of the Inquiry, the focus is necessarily on acute and children's hospitals. [4] It may well be, however, that many of the recommendations can be applied more widely to other parts of the NHS. We do not lose sight of the fact that it was a concern for the care of children which led to the Inquiry. Thus we also address the particular needs of children and their families in the NHS. We ask whether any further recommendations are called for to meet these particular needs and, if so, what they should be.

5 We believe that there is an enormous desire across the country, amongst the public, patients and healthcare professionals, to renew our commitment to the NHS and make it work for everyone. The recent injection of substantially increased funding into the NHS means that, for the first time in many years, there is now the opportunity to broaden the debate about what needs to change in the health service. We can begin to move beyond an exclusive focus on the level of funding, to embrace more fundamental issues about the culture of healthcare, the safety of medicine, and how to improve the quality of care for patients. That said, the recent injection of funding does not mean we can be complacent about resources: healthcare of good quality comes at a price. Increases in funding need to be sustained. Furthermore, if we are to continue to have a state-funded system of healthcare, the government must care about and take care of the NHS.

Footnotes

[1] We take our Terms of Reference as applying to the NHS in England

[2] `The NHS Plan', London: Department of Health, July 2000

[3] We concentrate throughout on those who provide and manage care and treatment. By so doing we do not ignore the contribution to healthcare made by others who work in the NHS

[4] We recognise, of course, that there is more to health than acute healthcare in hospitals, not least health promotion, preventative care and other social strategies