‘Learning from Bristol’: Healthcare in the 21st Century

Abstract

As early as 1986, the quality of the paediatric cardiac service at the Bristol Royal Infirmary was the subject of adverse comment. Soon after his appointment as consultant anaesthetist in September 1988, Dr Stephen Bolsin became concerned about the length and outcomes of operations upon children and made repeated attempts to secure a comprehensive investigation into paediatric cardiac services.l It was not until January 1995, following the death whilst undergoing an operation of eighteen month-old Joshua Loveday, that an independent inquiry of paediatric cardiac services at the Bristol Royal Infirmary was established. Allegations of serious professional misconduct were made to the General Medical Council (GMC) and proven against cardiac surgeons Mr James Wisheart and Mr Janardan Dhasmana and the Chief Executive of the United Bristol Healthcare NHS Trust Dr John Roylance. The demands of parents whose children had undergone cardiac surgery at the Bristol Royal Infirmary for a public inquiry were met in June 1998.2 The Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995 (hereafter the Kennedy Report) is the closest we will come to a balanced account of the Bristol Story, versions of which have already been told in newspapers, documentaries and televised drama. Yet the Kennedy Report cautions that in the retelling of events there may be a coherence which was lacking at the time and stresses the importance of understanding events at Bristol in the context of the National Health Service (NHS) at the time (a period of 12 years which commenced 14 years before the beginning of the Inquiry). Broadly speaking, this penod was characterised by an attempt to apply the model of the market to public services, including the NHS, in an effort to maximise efficiency and cut public spending. This model was incompatible with the foundational pnnciples of the NHS 'a publicly-funded service, free at the point of delivery, that it provide a comprehensive service and that there be equity in people's access to its services'3 to which many of its employees are committed. Furthermore, throughout the period the health service continued to be underfunded: the level of funding was insufficient to deliver the service which the government claimed would be provided, a matter of frustration to patients and healthcare professionals alike.4 We only need look to recent healthcare 'scandals' which have caused widespread public concern arising from the activities of individuals and about the quality of care provided within the NHS to find similar stones. Evidence to the