Behind Bristol child deaths
Market failure, staff shortages
By Charlie Kimber
THE REPORT into the deaths of dozens of young children at Bristol Royal Infirmary during the 1980s and 1990s was released last week. It is a devastating insight into health service failings which go far wider than Bristol.
The Kennedy report says that up to 35 babies under a year old died unnecessarily at the hospital. A third of all babies referred between 1984 and 1995 received less than adequate care.
How did this happen? The press and TV highlighted the actions of one surgeon. But, virtually ignored by the media, the report also shows that staff shortages and the effects of the internal market lie behind the tragedy. The report points to a crisis in staff numbers, facilities and training. The heart surgery department was so understaffed that doctors could not participate effectively in surgery or intensive care. There was also a shortage of nurses trained to care for children, and to work in the operating theatre and the intensive care unit:
"Perhaps the most significant deficiency was the lack of availability of cardiological advice and assistance to the surgeons in the operating theatre." The report links this to a wider NHS crisis. It says that around 25,000 people die unnecessarily every year: "Professionals and patients have been consistently asked to participate in and tolerate a service which has been increasingly underfunded in terms of what has been asked and expected of it."
The inquiry team was "shocked" by what it saw at the children's centre at Bristol: "There was a sense of dilapidation. The corridors were dirty. The intensive care unit was cramped and crowded." Such findings help to demolish the notion that babies died simply because of the failings of a few bad doctors.
The report also hints at a scandal which runs much deeper inside the NHS and is set to get worse as Tony Blair drives private firms and PFI into the centre of the NHS. The Bristol child deaths were linked to the march of the market. Children died so that politicians like then Tory health secretary Kenneth Clarke could boast that they had squeezed more out of the health service without putting in more money. In a market-based NHS facilities compete against one another to provide operations at lowest cost.
There is intense pressure to get though more patients than "rivals". Bristol had a quota to meet. The report found that even though the hospital facilities were overstretched children were put in for operations so that the hospital could hang on to its special status as a regional service provider.
Catherine Hawkins, who was chief executive of the regional health authority responsible for Bristol Royal Infirmary from 1984 to 1992, revealed three years ago what market pressures meant. People knew there was something wrong at the hospital, but the targets still had to be met. She said, "At many of our district health authority reviews we found a reluctance to encourage referral by cardiologists to the Bristol Royal Infirmary."
But "the civil servants were hell bent on the numbers game-they weren't bothered about the outcome of the operations. They just wanted to be able to quote a big increase in the number of operations being undertaken." In 1989, as the Tories' NHS market changes were being prepared, a Department of Health report revealed that the Bristol unit had fewer than average children referred to it, and also had the highest number of deaths of all children's heart units.
It did not recommend any further investigation and instead advised that Bristol "be encouraged to increase their numbers".
THE KENNEDY report makes some sensible suggestions about openness inside the NHS. But other proposals would be counter-productive.
Simply publishing statistics about the performance of surgical teams could lead to a "league table" mentality which entrenches market pressures. Real progress demands two changes-driving the market out of the NHS and introducing much more accountability of consultants. New Labour is doing none of this.
The government tried to abolish the Community Health Councils which provide independent audit of hospitals' performance. Ministers want to reduce consultants' private work-but only by throwing them a huge pay rise.
A review last week by the Office of Health Economics of 30 developed countries showed Britain trailing Hungary and the Czech Republic on the number of beds and money spent inside the NHS.
A KEY factor in this scandal is the elitism and lack of accountability among those at the top of the NHS. The NHS senior hierarchies are stuffed with unelected and unaccountable people. The Kennedy report says at Bristol Royal Infirmary there was a "club culture", with too few people having too much power.
James Wisheart was not only consultant heart surgeon at Bristol. He was also medical director of the trust, and did private work for BUPA. In 1994 he was granted an A merit award worth 40,000 a year. This was in addition to his 56,000 basic salary. He continues to receive 20,000 a year despite being struck off the doctors' register.