18th October 1999
The Inquiry oral hearings will focus this week on the concerns raised about paediatric cardiac surgery at the Bristol Royal Infirmary (BRI) between 1984 and 1995 and actions taken during the period to resolve those concerns. The Inquiry will also hear evidence which will illustrate the national scene and address the subject of post mortems and tissue retention.
Today the Inquiry heard evidence from Dr Phil Hammond, GP, Lecturer in Communication Skills, University of Bristol, MD from the magazine Private Eye and Daily Express columnist. He commenced by confirming that he has never worked at the Bristol Royal Infirmary, nor in the specialty of paediatric cardiology, and stressed that the information he reported about the Bristol unit had come from others. He began by discussing his personal views regarding shared accountability in the National Health Service (NHS) and stated that ultimate responsibility for patient care should belong to the Department of Health (DOH), the funding body for the service. He commented on the value of audit, the importance of comparing like with like and the potential benefit of publication of results alongside self-regulation combined with external scrutiny. He then went on to comment on his perceived role as a Whistleblowers advocate or go-between. Dr Hammond described some of his impressions of the Bristol cardiac unit, gained whilst working as a House Officer at Baths Royal United Hospital in 1988. He established that he first became aware of concerns about paediatric cardiac surgery in 1992. He talked about the motivation of his sources, including Dr Steven Bolsin, Consultant Anaesthetist, and others in expressing their concerns to him and commented on a series of articles he subsequently wrote for Private Eye during the same year. Dr Hammond made it clear that he did not hide the fact that he was associated with Private Eye, but confirmed that he may not have made the information explicit to Dr Bolsin. He commented on sources of figures he received and described the emphasis placed upon the numbers of patients treated rather than the outcome of that treatment in the 1980s and early 1990s. He said that he was surprised at the lack of action from the DOH and Royal College of Surgeons following the publication of his 1992 articles. With hindsight he said he wished he had personally drawn them to the attention of key figures within the NHS at the time. He concluded by expressing his opinion that high quality training for doctors was of utmost importance and echoed a view expressed to him, that the collective will of the medical profession wished to learn from what happened in Bristol.
1 Day 64, 18th October 1999 2 (10.35 am) 3 THE CHAIRMAN: Good morning, everyone. Good morning, 4 Mr Langstaff. 5 MR LANGSTAFF: Good morning, sir. Sir, today we have 6 Dr Philip James Hammond, who is perhaps well known as 7 being the media presenter of "Trust me (I'm a Doctor)" 8 on BBC 2, and who has been otherwise known as "MD" in 9 the columns of Private Eye. 10 Dr Hammond, would you stand, please, to take the 11 oath? 12 DR PHILIP JAMES HAMMOND (SWORN): 13 Examined by MR LANGSTAFF: 14 Q. Can I have on screen, please, WIT 283/1? You should see 15 there the first page of your first statement to the 16 Inquiry. 17 A. Yes. 18 Q. If you go through, please, to page 10, you sign it there 19 dated 31st August of this year? 20 A. Yes. 21 Q. Can we go further, please, to page 283/11 and 283/12: is 22 that an annex to your statement? 23 A. Yes. 24 Q. And then can we go to 283/39: an additional statement by 25 you, is it? 0001 1 A. Yes. 2 Q. Can we go through, please, to page 44. It is signed in 3 typescript. I think you have physically signed it this 4 morning, have you? 5 A. I sent another one which you should have which is 6 signed, but I will sign it afterwards, if you like. 7 Q. It is all right, it is just for anyone who is watching. 8 A. I am happy to sign it now. 9 Q. You adopt in any event that statement as yours? 10 A. Yes. 11 Q. The contents of those statements are true, are they? 12 A. To the best of my knowledge, yes. 13 Q. You say, at page 283/35, the left-hand side, page 62, 14 this is an extract from "Trust me (I'm a Doctor)", which 15 is a book that you have written and it has been 16 published by Metro Books and available at 9.99. 17 A. Thank you. 18 Q. We see, the second paragraph, "A strong counterview from 19 Bristol from those not happy to accept the GMC's 20 investigation. Wisheart's and Dhasmana's supporters 21 believe they have been fall-guys for a much wider 22 problem, which is true". 23 When you say "which is true", you are verifying 24 that view, are you? 25 A. Yes, the purpose of the whole book is to show in my view 0002 1 Bristol is the tip of an iceberg and I believe if you go 2 into any specialty you will find a wide variation in 3 performance. If you take an expert view, you will 4 probably find one or two centres providing unacceptable 5 service. 6 The whole purpose behind "Trust me (I'm a Doctor)" 7 has been to let the cat out of the bag, that in the NHS 8 it does matter where you are treated. You cannot 9 guarantee a first class service in your centre. There 10 is a huge variation. The specific examples I have given 11 in the book, such as cleft palate surgery and biliary 12 atresia surgery in children, in my view show the same 13 systematic failure to protect children from the 14 unacceptable and a very clear example of some children 15 in certain operations getting much better treatment than 16 others. 17 You could generalise that out to adults. We know 18 for example that it has been estimated if everyone got 19 the best cancer care that the best units in this country 20 are providing, we could save 25,000 lives a year. Karol 21 Sikora said that even we had only the average 22 performance in Europe, we could save 10,000 to 15,000; 23 if it was the very best in Europe and the best in the 24 UK, we could save 25,000. 25 If we were to suddenly go after every single unit 0003 1 that has been providing less than or suboptimal service, 2 life would become one long Public Inquiry, but I am sure 3 there are plenty of units out there providing cancer 4 care, or whatever you care to name it, that are 5 providing care that, in the expert view, is suboptimal. 6 Q. The words "fall-guys". Let me focus on those for 7 a moment. That might be thought to suggest that you 8 regard the real blame as lying elsewhere? 9 A. I have always felt it would have been more constructive 10 to have had the public inquiry before the GMC inquiry. 11 Because of the remit of the GMC, they could only limit 12 the problem to two surgeons and one manager, doctor. 13 My view has always been that it has been 14 a systematic failure all the way round. The trouble is 15 that because of the GMC hearing, in the public mind it 16 has crystallised as being a problem with two surgeons 17 and one Chief Executive, which I believe is very 18 unfair. I believe there were systematic failings all 19 the way up, and ultimately I believe it is the 20 Department of Health who provides millions of pounds for 21 these specialist services who must have ultimate 22 accountability for the quality of the service. It is 23 ethically indefensible to provide millions of pounds for 24 these services and then say "We cannot step in without 25 the agreement of the relevant bodies". 0004 1 So, yes, I think there is a systematic failure for 2 which they have taken the brunt of the blame. 3 THE CHAIRMAN: Mr Langstaff, may I interrupt just for 4 a moment? Dr Hammond, I say to almost everyone who sits 5 in that chair: the most important person is the one 6 immediately on your right, because she is taking down 7 your words. 8 DR HAMMOND: Am I talking too quickly? I am sorry. 9 THE CHAIRMAN: If you talk very quickly, although it may be 10 your nature, we may lose some of what you say and that 11 would be unfortunate, so perhaps I could encourage you 12 to speak a little more slowly. 13 DR HAMMOND: Thank you. 14 MR LANGSTAFF: By using the expression "fall-guys" -- can 15 I go back to the question I asked you before you gave 16 your explanation -- are you intending to suggest that 17 they are free from blame as you see it, or that they 18 share the blame as you see it? 19 A. I think they share the blame. I am very clearly of the 20 view that what happened in Bristol was unacceptable, 21 although I have colleagues whose opinions I trust, who 22 have questioned the GMC taking the case on on the basis 23 that there was no defined minimal standard that any 24 surgeon in that case had to achieve, there was no 25 compulsory audit, so therefore, finding doctors guilty 0005 1 of failing to act on their audit when it was not 2 compulsory and failing to reach a standard when no 3 standard was defined, some people find very unfair. 4 I spoke to someone at the Medical Defence Union 5 who did not wish to be attributed, who felt that the 6 goalpost had been moved -- the GMC had moved the 7 goalpost, which was her view. My own opinion was that 8 there was no systematic way of protecting babies from 9 poor performance at that time. There was no system of 10 clinical accountability. Therefore there was no way of 11 protecting the children. To retrospectively blame it on 12 three people I think is a gross oversimplification. 13 Q. You say very much the same thing, perhaps, at 283/21. 14 It is an article which has your name on it. Can we go 15 down the second column, please? 16 It begins: 17 "I too acted on it as Private Eye's medical 18 correspondent, but releasing such information into the 19 public domain in 1992 was a very hard decision. There 20 were all sorts of problems in the Bristol unit which 21 were not the fault of the surgeons and I believe it is 22 unfair that the media has focused its blame on them". 23 Again, a question: as you see it, do you regard it 24 as unfair that the surgeons have been given the blame? 25 A. It is difficult for me to judge in a sense because I am 0006 1 not a surgeon and I will speak to some surgeons who say 2 never mind the system, ultimately it is the 3 responsibility of the individual surgeon to decide 4 whether they should be taking on an operation or not. 5 I have surgical friends who say you can feel it in your 6 bones or you can feel it in your water when something is 7 beyond your competence, and ultimately it has to be down 8 to the surgeon as well as the team. That is one view. 9 The other view which I hear in Bristol from 10 colleagues is that the surgeons are almost forced into 11 providing a service with inadequate resources and 12 facilities, which could probably be said of anyone who 13 works in any public service, whether it is the NHS or 14 the education system. 15 What I was trying to do in 1992, it was a sort of 16 cry for help to say "Whatever is going on -- 17 Q. It is really to explore your views as to the accuracy of 18 what you were saying in the article? 19 A. Yes. 20 Q. That is the point of the question? 21 A. I think it is likely my views have changed over seven 22 years. I think probably I was more adversarial when 23 I first wrote about the problems, and I think because of 24 everything that has come to light and me having heard 25 more information, I do believe that just to pin it on 0007 1 those people without having a clear system of 2 accountability -- parents I talk to find it 3 extraordinary that there was no quality assurance, no 4 quality control. I at the time found it extraordinary 5 that nobody was collecting all the information from 6 specific operations and looking for statistically 7 significant outliers and saying "There is a clear 8 problem that has to be looked into". It may be that the 9 people in the Bristol unit did not know what the results 10 were in other units. You needed someone with an 11 overview who knew what the national pattern was, who 12 said children in Bristol were having this operation but 13 if they went 70 miles east or south, they would get 14 a better outcome. I do not think we can necessarily 15 blame the Bristol surgeons for not knowing that 16 information. There needs to be someone separate saying 17 "Look what is happening in other specialist units". 18 Q. So the problem, as you at least anyway now describe it, 19 is one of having the information against which to rank 20 one's own performance as a unit and, indeed, perhaps as 21 a surgeon? 22 A. Yes, and the problem with all audit thus far, and 23 probably this is largely still the case, is that it has 24 been done anonymously in the sense that the only person 25 who can identify the figures has been the surgeon or the 0008 1 surgical team themselves, so it has been left entirely 2 down to the conscience of the individual surgeon or 3 surgical team to act on whether they thought their 4 figures were poor. I mean, the rough figures from the 5 Cardiothoracic Register should have given people some 6 indication of how other units were doing, I believe, but 7 it was never done in any systematic way. There were 8 units who did not even contribute figures to the 9 register in some way and Bristol was actually one of the 10 ones that did seem to contribute figures most years. 11 Q. You have made these judgments. You accept that they are 12 judgments that you have made? 13 A. Yes. 14 Q. Did you ever work at the BRI? 15 A. No. 16 Q. Have you ever worked in paediatric surgery? 17 A. No. I have said that in the first paragraph of my 18 statement: I have no expertise in these areas. 19 Q. You are an assistant GP? 20 A. Yes. 21 Q. So your expertise is really at some distance from the 22 work that would go on in the operating theatre in the 23 BRI, and perhaps from the work that would go on in the 24 Intensive Care Unit at the BRI or BCH afterwards? 25 A. Yes. 0009 1 Q. You have no firsthand experience of the individuals 2 concerned in what you have described as the "Bristol 3 tragedy"? 4 A. No, although I believe that the message rather than the 5 messenger or the individuals is the important thing. It 6 is the message or issue that is important, rather than 7 the individuals. 8 Q. So all you can judge Bristol on is the information that 9 people have from time to time given you; is that right? 10 A. Yes, as a journalist. In this particular instance I was 11 a journalist, but because I was a doctor, people 12 probably confided in me and told me things that they 13 perhaps would not have told a non-medical journalist. 14 So in Private Eye, I think I have probably got closer to 15 the truth than many other journalists get. 16 Q. At page 34 -- page 61 of your book -- the right-hand 17 side, you talk about this Inquiry at the bottom of the 18 page. 19 "Three simple questions for all those who were 20 summoned: What did you know? When did you know it? 21 What action did you take? My guess is the answers will 22 expose complicity at all levels, Trust, Health 23 Authority, Royal College, GMC and Department of Health, 24 and reinforce the need for open audit and a sea change 25 in the self-protective and secretive medical culture." 0010 1 So what you are calling for essentially is freedom 2 of information, is it? 3 A. Yes. I mean, I think this case and others have shown, 4 although doctors need to be involved in their own 5 regulation, we have to have self-regulation. I do not 6 believe that the medical profession can be trusted any 7 longer to self-regulate in secret. I believe we need to 8 work in partnership with other expert bodies, but 9 ultimately there that has to be external scrutiny and 10 validation of our figures. I believe that we need to 11 shift the culture as far as giving patients information 12 from what a reasonable doctor wishes to tell you from 13 what a reasonable patient would want to know. I think 14 we have to have that culture, and most reasonable 15 patients I believe, if their child was having heart 16 surgery, would want to know the success rate of the 17 surgeon or the surgical team that was going to undertake 18 that operation. I would. 19 Q. Would you want to know the comparative success rate? 20 A. Yes. If somebody said to me, "70 miles up the road they 21 get much better results on cases of similar difficulty", 22 yes, I would want to know that. 23 Q. You would want to know, if there was a difference, why 24 the difference? 25 A. As a parent, not necessarily. As a parent, if I was 0011 1 having to take on board all the emotional trauma of my 2 child being critically ill, I think as a parent I might 3 not want to go that depth. As a doctor I may want to 4 know. 5 Q. As a parent you may be faced with school league tables, 6 and school league tables will tell you a certain amount 7 of information. But you also might get the message from 8 parts of the media, at any rate, that those are figures 9 which may actually hide information rather than reveal 10 it. 11 May the same not perhaps be true of medical 12 statistics such as those you mentioned, frank success 13 rates, if, let us suppose, a hospital up the road does 14 not operate on Down's children with congenital heart 15 defects, and let us suppose for the purpose of this 16 question that if it did so, the results would be much 17 worse, one would need to know that before making 18 a comparison? 19 A. Yes. I did make the point as long as you knew they were 20 comparing like with like, that is the information you 21 need to know. 22 Q. How would you know that? 23 A. Before babies had surgery they would have to be assessed 24 as to how complex it was and what other mitigating 25 circumstances, and there are various scores that can be 0012 1 done, certainly for adult cardiac surgery. I believe 2 risk stratification is harder for paediatric surgery, 3 but I do not believe it should be impossible. 4 Q. So going back to your earlier answer, the parent would 5 need to know enough to have some basis for comparing the 6 results properly? 7 A. Yes, but I have spoken to statisticians such as Jan 8 Poloniecki, who I believe provided support for the 9 Wisheart defence team at the GMC hearing. He says he 10 has the computer software that allows any individual 11 parent or patient to come to him and he can give them, 12 knowing the results of the surgeons, a risk result and 13 it can be compared to other units. So the technology is 14 there, is what I am saying. 15 Q. The question was whether in fact it needed to be done. 16 It was going back to your earlier answer saying what 17 parents need to know is simply a comparison of one 18 success rate against the other. 19 A. Yes, provided they know they are comparing like with 20 like. 21 Q. Your plea for openness and information then is based on 22 what, giving the parent the information from which the 23 parent might make the appropriate choice? 24 A. I think ultimately I would like to see it published. 25 I think when your child is critically ill, it is 0013 1 extremely difficult to challenge the quality of care in 2 that particular institution. The most depressing thing 3 I found, filming "Trust me (I'm a Doctor)", is whether 4 it is cancer care or cleft palate surgery or you are 5 having amniocentesis to see whether your child has an 6 abnormality and the specialists are doing it well, you 7 cannot automatically assume that the obstetrician will 8 be using ultrasound guidance as he puts the needle in, 9 you have to check, even though there is a 1996 mandatory 10 guideline that it must be used. 11 In the current system of the NHS, parents and 12 patients are having to check on the quality of care. 13 I do not believe they want to do that. I believe that 14 ultimately, if we believe that the NHS is a first class 15 service in which there is no room for second best, as 16 the Department of Health tells us, then these things 17 should be published so that you can read them, for 18 example as you do in the New York Times. Under the 19 freedom of information law there, as you know, they now 20 have to publish league tables of cardiac surgeons. 21 When it first happened, it may well be that people 22 stopped operating on the sickest patients who could 23 benefit most. It may well be that some people were 24 bussed out of the area so it would not muck up the 25 figures, it may well be that people tried to massage the 0014 1 risk stratification to make it look as if they were 2 taking on sicker patients, but now I believe those 3 problems have been ironed out. 4 Speaking to people at the Society of 5 Cardiothoracic Surgeons, they say even if you come out 6 on the bottom half of the league table now, it does not 7 affect the work people get. They are far more reassured 8 by the fact it is open and being published. The best 9 analogy is of a Grand Prix. If you watch the Grand Prix 10 there are two or three people who nearly always win, 11 there is a group of people who are pretty confident and 12 could win on a good day and there are two or three 13 back-markers where you would say "I would not bet money 14 on them". I think this is true for medicine. If we 15 look at this we need to define the standard, so by 16 publishing there is no possible way people can hide from 17 poor performance. I think that is the only way 18 forward. 19 Q. You describe, in your statement, and in your book, how 20 you began to become the "whistle-blowers' advocate", 21 that is the way you described yourself. Is that the way 22 you see your role as having been? 23 A. I think it is a combination of an advocate and 24 a go-between. Clearly, as you pointed out, I do not 25 have specialist insight or knowledge into cardiac 0015 1 surgery, and the quality of what I write depends 2 entirely on the quality of my sources. But I have 3 always believed that there is a need for some sort of 4 mechanism for people who think that something awful is 5 going on in the NHS to speak out and there has not been, 6 thus far. I hope in the future there will be and that 7 I will not need to write these columns in Private Eye. 8 I hope in every region there will be a whistle-blowers' 9 advocate where people can go in confidence knowing they 10 will not be persecuted and their concerns can be 11 raised. My naivety was thinking that people acted on 12 information in Private Eye, which they do now, but it 13 does not appear they did seven and a half years ago. 14 Q. You were, as I understand it, first told in February 15 1992 of concerns about the Bristol Cardiac Unit? 16 A. Yes. 17 Q. So before then, you had no idea? 18 A. As a house officer in 1988 working in Bath, I was told 19 of, I believe, an adult cardiac surgeon whose nickname 20 was "killer". I believe I know his identity, but I have 21 no wish to divulge it without taking legal. I believe 22 that any of the surgeons that you ask at the Bristol 23 Royal Infirmary about his identity, they will be able to 24 tell you and give you more information. 25 THE CHAIRMAN: Dr Hammond, you are going too quickly, 0016 1 please. 2 A. I am sorry. I was a house officer working in cardiology 3 and a patient came in. They thought they had 4 a dissecting aortic arch aneurysm, which meant that the 5 big vessel that comes out of the top of the heart was 6 splitting. Bath did not do cardiac surgery, so it was 7 felt that patient needed to be transferred urgently. 8 I was the house officer on call, so I was nominated to 9 go in the ambulance, even though I would have been 10 completely out of my depth if the patient had required 11 emergency resuscitation. 12 They decided to go to Southampton, and I was not 13 sure why because Bristol was much nearer. This led to 14 a discussion about why one would choose to go to 15 Southampton rather than Bristol. There was I believe 16 some sort of political rivalry between Bath and Bristol 17 that may have affected the choice, but also one of the 18 doctors raised this idea of the surgeon there who had 19 worked in Bristol, who he would not have wanted 20 operating on his family, so ... 21 Q. You say in your statement that the nickname "killer" 22 having been given to one of the surgeons, you did not 23 know, you had no basis for knowing whether that was 24 a macho term of endearment or whether it concealed some 25 rather more sinister truth? 0017 1 A. Yes. That is clearly a problem in medicine in general. 2 I do a lot of after dinner speeches recently to -- 3 Q. Can I just focus on that for a moment? If that is true, 4 then what you have just said, using the name "killer" is 5 evidence or suggests the opposite. Which is the 6 position? 7 A. The people who have given me the information about 8 "killer" in Bath had worked in Bristol so they had 9 insight into the process, but no statistical knowledge 10 of his outcomes as far as I am aware, but knowing of the 11 process of his surgery, it was generally thought that 12 this was not someone you would want your own family to 13 be operated on. 14 Q. So you did not actually think it was a macho term of 15 endearment? 16 A. No, but there is no evidence. 17 Q. So why did you say that it might be? 18 A. I was making the generalised point that in medicine you 19 often hear people with nicknames like "killer" or 20 "chopper" or "shaky" or "bleeder" and you honestly do 21 not know. I have no proof in terms of outcome proof, 22 but yes, it is fair to say that there were process 23 rumours that he was not particularly good. 24 Q. You actually make the point of saying in respect of the 25 man whom you knew as "killer" that it may well be 0018 1 a macho term of endearment. You do not make it 2 generally in terms of this sort of name. You say it may 3 well be, whereas the truth is, you thought the opposite? 4 A. I think that is a fair point, yes. 5 Q. So why did you not say so? 6 A. Because I have no proof. I only have process 7 information. If this gentleman was identified, or 8 gentlewoman was identified, and said "Where is your 9 evidence?" and I said "I have hunches of process but no 10 objective outcome truth", I do not know what my legal 11 position would be. How do you judge competence? Is it 12 judged by people who work with surgeons and look at the 13 process and think, "There is something wrong with how 14 that is being performed", or is it only hard outcome 15 measures? I do not know what the outcome to that is, 16 but I suspect that was for legal reasons. 17 Q. In 1988 Bath was part of Wessex Regional Health 18 Authority, whereas Bristol was in a different Regional 19 Health Authority. So Southampton was the regional 20 centre for Wessex RHA, for adult surgery. That would 21 suggest that Southampton was the proper point of 22 referral for any hospital with an adult cardiac surgical 23 problem within the Wessex area? You are nodding. 24 I have to say that because it does not otherwise go down 25 on the transcript. 0019 1 That might give an explanation as to why it was 2 that the hospital administration, at any rate, sent the 3 case to Southampton. Did you have that understanding at 4 the time, or not? 5 A. No, because it was an emergency. My understanding at 6 the time was that if something was an emergency and 7 somebody could die imminently, you send them to the 8 nearest available unit that has a bed. It was not 9 a cold admission; this was somebody who could die at any 10 minute. My belief was why could we not go 15, 20 11 minutes to Bristol as opposed to 45 minutes to 12 Southampton? I was panicking myself, because I had to 13 go in the ambulance, but I did not think in terms of 14 regional centres and where people went then. I thought, 15 "This is an emergency. Surely we find the nearest 16 available bed". 17 Q. The surgeon you mentioned, I do not ask you for his or 18 her name, but just to clarify that it is neither of the 19 surgeons who were involved in the GMC hearing in respect 20 of paediatric surgery; am I right? 21 A. Yes, although I was told by Professor Stirrat that 22 Mr Wisheart is credited for encouraging this particular 23 surgeon to reach the decision to stop operating. So he 24 is perhaps the person who would know most about it. 25 Q. Apart, then, from your concerns coming as a house 0020 1 officer in Bath in 1988, when this transfer took place, 2 in respect of adult surgery, had you heard anything 3 before 1992 about the paediatric cardiac surgical unit? 4 A. No. I can remember working on the Special Care Baby 5 Unit in Bath, and the child had a heart problem and was 6 transferred to Bristol. I presume -- 7 Q. Without any second thought? 8 A. No. As an aside, I have since been sent information to 9 Private Eye anonymously that some of the doctors in Bath 10 did try to raise concerns with Region about the Bristol 11 service, possibly before 1992, but that is something you 12 would have to check with the doctors in Bath. 13 Q. When you say "possibly", do you know when? 14 A. No. 15 Q. Do you know who? 16 A. It was an overheard statement following the evidence 17 that Catherine Hawkins had given, somebody was talking 18 to some doctors in Bath who said "We did try and raise 19 concerns" but I do not know who. It was sent 20 anonymously and people were not identified. It is 21 perhaps an area of enquiry you could look into. 22 Q. Somebody sends it to you on the basis of something they 23 have overheard? 24 A. Yes. 25 Q. And asks you to give their name -- 0021 1 A. It was sent anonymously to me. I get two piles of 2 information in Private Eye, people who do not send their 3 identity to me. 4 Q. You do not know what the reason for the anonymity is? 5 A. No, which is why I have to treat anonymous information 6 with suspicion, because you have no way of verifying it. 7 Q. It may be they are scared, it may be they are being 8 provocative? 9 A. Absolutely. I make this point that I do not know 10 whether it is true or not. 11 Q. The substance of the information is all I am asking 12 about. You do not know the time to which the concerns 13 related. Do you know who it was that it is said to you 14 wanted to raise those concerns? 15 A. No. 16 Q. Do you know what class of person in the sense of 17 cardiologist, surgeon -- 18 A. Consultants, I believe. 19 Q. In what specialty? 20 A. I do not know. Just consultants. 21 Q. At which hospital? 22 A. It was at Bath Royal United Hospital. Somebody had had 23 a meeting and had overheard them talking subsequent to 24 Catherine Hawkins' evidence, saying that "We did try to 25 raise concerns". 0022 1 Q. If that individual who it would seem was following the 2 transcript fairly closely reads this transcript within 3 the next few days, then can I simply say, I can use this 4 opportunity publicly to say we would welcome that 5 individual or those individuals getting in touch with 6 the Inquiry Secretariat. 7 You would, for your part, reassure them that, the 8 Public Interest Disclosure Act now in force, they would 9 suffer no penalty for doing so? 10 A. You say "suffer no penalty", but I know to this day in 11 Bristol, I have a whistle-blower in Bristol at the 12 moment who raised concerns about a particular surgical 13 specialty to me, and I said "Let us go through the 14 correct channels. Let us put your name to this and go 15 to the Chief Executive". 16 I wrote a very strong letter to the Chief 17 Executive saying "You must recognise the Public Interest 18 Disclosure Act, its legal obligations, and I must insist 19 that no persecution is made of this whistle-blower 20 whatsoever. I have subsequently found out that there 21 have been calls for his resignation, people saying that 22 raising concerns is a sackable offence. 23 Although we have a new law, it does not 24 necessarily change the attitudes. Whistle-blowers are 25 still being victimised in the NHS. So I do understand 0023 1 why some people wish to remain anonymous. It is not 2 ideal, but people are by no means convinced that the 3 Public Interest Disclosure Act will protect them from 4 a very damaging persecution. 5 THE CHAIRMAN: You say you have this one example, but it 6 allows you to draw the conclusion that whistle-blowers, 7 in the plural, are not protected. 8 Can you argue so generally from that one 9 particular example? 10 A. I have another example, at the Hammersmith Hospital 11 which I have covered in Private Eye, which started 12 before the Public Interest Disclosure Act came into 13 being, but is still carrying on and I believe Mr Dobson 14 has ordered a third inquiry where there has been fairly 15 clear victimisation of another consultant. If you want 16 me to, I could go back through my notes and I suspect 17 provide other examples of where people have been 18 victimised. 19 However, turning it round, I believe, for example, 20 the response of the Brompton Hospital was exemplary and 21 the speed at which they responded to concerns and they 22 have a very clear speaking-up policy for whistle-blowers 23 and I think a lot of Trusts are doing their absolute 24 best to have whistle-blowing policies, speaking-up 25 policies in place, so I do not think it is necessarily 0024 1 the fault of the Trust or management, I think that 2 attitudes in medicine, which I think are at the core of 3 this whole Inquiry, are very slow to change. They 4 change more slowly than the law. 5 MR LANGSTAFF: So the point you are making is not that any 6 victimisation or condemnation is likely to be official, 7 but there may be individual reactions which are hostile 8 from those with whom the whistle-blower works upon whom 9 he is blowing the whistle? 10 A. Yes. 11 Q. And in essence, what you are describing is human nature, 12 is it, would you say? 13 A. I think it is, and one side of me says, "Look, if babies 14 or patients are dying unnecessarily, then it is your 15 duty as a doctor to take that flack, to stand up and 16 speak out, if you are doing it generally from genuine 17 motives, and accept that your life will be hell for 18 a few months and it will be difficult working with 19 people". 20 So, yes, I am in a state of cognative dissonance 21 about this. I get torn one way and another way. 22 I would like to think we could have an NHS in the 23 future where whistle-blowing is seen as an entirely 24 constructive thing. It can be done in confidence in the 25 first instance, but the person receiving the information 0025 1 would have absolute authority to act in all 2 investigations, as I believe in British Airways and the 3 airline industry it is seen as a good thing. That is 4 the culture we have to move towards. 5 Q. I was taking you back to 1988 when you were an SHO in 6 Bath. After that, can you just tell us over the next 7 three or four years what happened to your career in 8 medicine? 9 A. I was on the GP vocational training scheme at that 10 stage, and my first job was working in Bath, in 11 paediatrics. 12 Then I went on a linked job to Jersey for six 13 months. As well as working in geriatrics, I got quite 14 involved in junior doctor politics and campaigned for 15 increased pay and reduced hours of junior doctors on 16 Jersey, to some effect. 17 Then I came back and did an obstetrics job at the 18 Royal United Hospital in Bath, which would take me up to 19 1989. Then I did my year in general practice. 20 I did a slightly unusual GP training scheme. Most 21 people who train to become GPs do two years of general 22 hospital jobs first and then a year in general 23 practice. I was offered a scheme in Bath which just 24 gave me 18 months of jobs and then a year in general 25 practice, so when I finished that I still had six months 0026 1 to complete. 2 I took six months off, after I had done my year in 3 general practice, to pursue a career as a stand-up 4 comedian with "Struck Off and Die", and then I went back 5 down to Taunton, which should take us to 1992, to finish 6 my GP training working as a casualty officer at Musgrove 7 Park Hospital. 8 Q. So when you first met Dr Bolsin, you were working as 9 a casualty officer in Taunton General Hospital? 10 A. Yes. 11 Q. In any of the posts in which you have been in this part 12 of the country, had you had any occasion to refer or be 13 party to any referral of any child suffering from 14 congenital heart disease to Bristol or anywhere else? 15 A. No. 16 Q. Would you have had, at that time, any information upon 17 which you could base a choice as between one, two or 18 three different centres? 19 A. No. You would have local knowledge. You would ask the 20 paediatrician or the paediatric cardiologist at the 21 particular unit. In a sense, the whole of the NHS 22 depends on local knowledge. You were at the mercy of 23 your GP. Does he know who is good for cancer? For 24 super specialist services you are at the mercy of the 25 specialist: does he know? Do the cardiologists 0027 1 referring know? That is where you would go for the 2 information and it depends entirely what their 3 information was. 4 Q. In terms of the GP, he would refer to the local 5 paediatrician, presumably, to check out a child who 6 seemed to be suffering from failure to thrive, or 7 whatever it might be, and the matter would then be in 8 the hands of the paediatrician? 9 A. Yes. 10 Q. You could not, from your own perspective, say what 11 knowledge the paediatrician had or did not have as to 12 the variability between the units to whom he might refer 13 the child? 14 A. No, in a sense it is a chain of trust. You devolve 15 responsibility up to the next person and he is then the 16 gatekeeper for the specialist service as the GP is the 17 gatekeeper for the majority. As soon as you refer on to 18 a consultant, you would say he should be the 19 gatekeeper. The only time I have known there be 20 a challenge -- again, I have not followed this up and 21 I do not know particularly names, but I have been told 22 that there were GPs in Bristol who knew of Steve 23 Bolsin's concerns -- this is nothing to do with me, this 24 is independently -- who perhaps did have patients and 25 tried to refer them outside the area because they had 0028 1 heard that Bristol was not a good unit and there has 2 been some talk that the Health Authority put pressure on 3 them to remain in Bristol. 4 Again, this is entirely unsubstantiated. I have 5 not been following up leads. Since the Inquiry started, 6 I have not really wanted to go into these things in any 7 greater detail. 8 Q. As a casualty officer, no-one would have thought you had 9 any particular interest in the job you were doing in 10 children suffering from congenital heart disease? 11 A. No, but if you are at the end of a -- I did go to GP 12 meetings, so because you are on a GP training scheme, 13 although I was not specifically on the Taunton one, 14 I was invited to go along to post-graduate education so 15 you would meet other GP trainees and other people 16 training to be GPs in that area. So, yes, I would have 17 had contact with local GPs or trainee GPs. 18 Q. In any of those meetings, did you discuss the relative 19 merits of one centre performing paediatric cardiac 20 surgery compared to another? 21 A. Not specifically that I can remember, but it is likely 22 that I discussed talking about Private Eye and the 23 things I had heard. I would not have discussed it on 24 that level, but I did tend to share with people at my 25 grade, certainly, what else I was doing, so it is 0029 1 possible that I said, "Look, there have been these 2 particular warnings I have been given about Bristol". 3 Q. It was those I was going to ask you specifically about 4 because you have told us already it was not until 5 February 1992 that you first became aware of any 6 concerns from anywhere, apart from the 1988 events you 7 have told us about. 8 When was your first column in Private Eye? 9 A. It would have gone in, I think, either late January or 10 early February 1992. 11 Q. And that first column mentioned nothing about paediatric 12 cardiac surgery; am I right? 13 A. No. Because I no longer have my notes, the only marker 14 I can mention, the first marker of cardiac surgery 15 having problems was talking about resource issues, which 16 I have submitted to the Inquiry, which is 14th February. 17 Q. Let us have a look at that on the screen. It is 283/14, 18 down the bottom of the left-hand column. 19 "Meanwhile, cardiology and cardiac surgery 20 provision from Bristol is now so under-funded that GPs 21 are having to refer patients to Oxford or Southampton. 22 Fundholders preferred, of course." 23 This was talking about adult provision, was it? 24 A. Yes. 25 Q. There is nothing on the next column, I can tell you, 0030 1 so -- because the GP would not refer, as you have 2 already told us, the child to Oxford or Southampton, he 3 would refer the child to a paediatrician who would then 4 handle the onward referral, if there was to be one. You 5 are nodding? 6 A. Yes, sorry. 7 Q. So at this stage in February of 1992, you had, had you, 8 no clue of concerns about paediatric cardiac surgery? 9 A. Yes, I had. I was told fairly soon on there was one 10 particular source that the unit, the cardiac surgery, 11 Ward 5, I presume, was known as "The Killing Fields" and 12 "the departure lounge". I was told that very early on 13 in the February, but that was not something that I had 14 any factual back-up for. 15 Q. Let me just ask you about that. You have been written 16 about on a number of occasions in a number of different 17 newspaper articles, and can we look, please, at 18 WIT 283/18? March 1999. It is by Jerome Burne. 19 Did you read this article? 20 A. Yes. It contains factual inaccuracies. 21 Q. Would you look down to the left-hand column, the bottom 22 of the page: 23 "Hammond, a media doctor for nearly a decade, 24 began writing about the problems at Bristol in 1992. 'It 25 was well known within the profession that the mortality 0031 1 rates in their paediatric surgery department were 2 appallingly high', he says. 'Ambulance men would refer 3 to it as the "killing fields" and take children 4 elsewhere. But no one warned the parents whose children 5 did end up there and I thought that was terribly 6 wrong'." 7 A. No, that is absolute nonsense. 8 Q. So what is the absolute nonsense? 9 A. I have never had any insight or knowledge of what 10 ambulance men thought or where they took their children. 11 Q. So Jerome Burne has completely misattributed this? 12 A. Yes. 13 Q. Did he speak to you before he wrote the article? 14 A. Yes. He did not fax it to me afterwards. Often I will 15 ask them to fax it to me afterwards so I can check the 16 veracity, but I did not in this particular case. 17 Q. Is this the sort of thing that can happen with newspaper 18 articles? 19 A. Yes. I am quite happy to be judged accountable for 20 anything I have written and I am sure some of the things 21 I have written contain errors, but when you are 22 interviewed, I would guess there are one or two errors 23 in most of the interviews you give. Perhaps in this 24 particular case I should have written to him and said 25 "You are wrong". 0032 1 Q. You did not do that? 2 A. No, it jumped out of the page at me and I thought "That 3 is wrong", but I... 4 Q. So he may to this day, until he reads this -- 5 A. I will write to him this evening and make sure he does 6 not continue. But I have no idea what the ambulance 7 people thought. 8 Q. So who was it who described to you the paediatric 9 cardiac surgery unit as "The Killing Fields"? 10 A. I am not in a position to give the name of the person 11 without seeking further legal advice, but I could make 12 the general point that if -- 13 Q. Let me pursue it in this way. You know the name of the 14 individual? 15 A. Well, a number of people confirmed that this was -- 16 Q. No, the person you have in mind who used that 17 expression. 18 A. Yes. 19 Q. Was that individual working in the Bristol Royal 20 Infirmary? 21 A. Yes. 22 Q. Was that person working in the team that performed 23 cardiac surgery upon infants? 24 A. I am not prepared to say, because I know from what 25 I know at Bristol it would lead to further 0033 1 victimisation. I appreciate my calls for openness as 2 a journalist, but also as a journalist, I believe that 3 sources have to be protected and I am reasonably 4 confident that this particular source would be 5 victimised. 6 The information was certainly never challenged and 7 has never been challenged in seven and a half years by 8 anyone working at the Trust. 9 Q. You did not challenge the complete inaccuracy by Jerome 10 Burne in his article back in March and you are someone 11 with profile and courage. Why do you rely again and 12 again in your statement upon people not correcting you 13 as evidence that you were in fact true and accurate in 14 the first place? 15 A. I think if Jerome Burne had been questioning my 16 competence as a doctor, then, yes, I would have 17 challenged it. But I appreciate that was an oversight. 18 I have cut it out and it is in a pile of things, and, 19 yes, I should have done it. But I think if you are 20 talking about challenging the competence of a unit to 21 provide surgery, then, yes, I would have expected them 22 to make a response. 23 Q. The person who gave you the description of the unit as 24 being "The Killing Fields": when did he or she use this 25 expression? 0034 1 A. I first heard it early in February. 2 Q. Where? 3 A. In person. A friend gave it to me in person, not over 4 the phone. 5 Q. What were the circumstances of your meeting him? 6 A. It was one of a number of people working at the Bristol 7 Royal Infirmary who gave me information over a wide 8 range of issues that appeared in Private Eye. The 9 person was well aware that I wrote for Private Eye and 10 had a journalistic role, if that is what you are trying 11 to imply. 12 Q. So at this stage you had only ever produced one column, 13 in February 1992? 14 A. Yes, but since the previous October we had advertised on 15 the front of "Hospital Doctor" (a trade magazine given 16 to all hospital doctors, sent free) that we were 17 whistle-blowers' advocates. We ran a column in there 18 first and transferred a broadly similar column to 19 Private Eye. I had lots of friends and contacts in 20 Bristol and when I was offered a column in Private Eye 21 by Ian Hislop in December, I said to them, "Can you give 22 me information?" So I had quite a large network of 23 people. A lot of them were in Bristol because we had 24 trained in Bristol. The first Private Eye column 25 I wrote, I wrote with my partner in "Struck Off and 0035 1 Die", Dr Gardner. Subsequent to that I wrote on my 2 own. We had a bit of disagreement, as double acts are 3 wont to do. Tony was the funny man and wanted to 4 concentrate on comedy, and I was the straight man who 5 was always more political. After the first column, Tony 6 said, "No, I don't want to do this. You do this on your 7 own." 8 Q. So was this individual one of the friends whom you made 9 contact with and asked for information? 10 A. Yes. The reason I am pausing is that I do not want to 11 go down the track of somebody -- I think it is entirely 12 unconstructive to witch-hunt whistle-blowers. I know 13 that is not your intention, but I have a feeling when 14 you pack up and leave Bristol, when you leave London, 15 I know the medical culture in Bristol. If I say I have 16 three sources for the Private Eye in Bristol, they will 17 go "Right, Bolsin is down, let us find the other two". 18 I am not confident, knowing what I do of the culture in 19 Bristol, that will not happen. I do not believe it will 20 serve any constructive purpose. I am happy for you to 21 challenge me on anything I have written which may 22 contain inaccuracies, but if you ask me to reveal 23 sources, I would rather serve a custodial sentence than 24 reveal sources. 25 Q. You will appreciate that from our point of view we are 0036 1 concerned to get at the truth, what information was 2 there to be known, what information was known and in 3 what circles it was known. One of the problems that we 4 may have with your own evidence is that it is all 5 derivative, as you would accept. It comes from others, 6 so it is only as good as the information you are given 7 by those others. 8 A. Yes, I accept that. 9 Q. We have no means of knowing whether they are motivated, 10 those others, by hostility, greed, improper motives, 11 entirely proper motives or whatever, without having some 12 information with which to judge it. That is why I press 13 you on it, and why I will press you on it and why, no 14 doubt, we will come back to the same sticking point from 15 time to time. 16 A. May I make another point? Aside from the tag "The 17 Killing Fields", which I would imagine is incredibly 18 hurtful and damaging for the parents to hear, aside from 19 that particular term, I do not believe there is any 20 information that I have that could not be verified from 21 other sources. 22 If I felt I had a particular bit of information 23 that you could not get anywhere else from all the people 24 you have interviewed that was crucial, then I would take 25 legal advice and reconsider. I am happy to do this 0037 1 after this. 2 I would also say that I have e-mailed Dr Bolsin 3 and prior to the publication of the book, I sent him all 4 of my articles, the ones that appeared in 1992 in 5 Private Eye, and I said "Nobody has ever challenged 6 these, can you tell me whether you can spot any 7 inaccuracies in these?" He e-mailed he back to say, 8 from his point of view he could not spot any 9 inaccuracies but there were some bits of information he 10 would not have given me because he was not party to that 11 information. 12 I systematically throw away my Private Eye notes 13 every two years -- I did do it every two years. I now 14 do it every three years because I realise the libel 15 liability is three years not two years. In all honesty, 16 I cannot be sure which piece of information is 17 attributed to which source, except in cases of something 18 like "The Killing Fields", which sticks in your mind. 19 So far as the statistical information, I am not 20 clear, I am not certain, I have no evidence. I have 21 sought Dr Bolsin's opinion. He says he did not see any 22 glaring factual inaccuracies in the four 1992 columns 23 I have given to you, but I did not then want to say to 24 him, "Can you tell me which bits you could have told me 25 and which you could not?" because that would look 0038 1 ridiculous if you turn up at a Public Inquiry and have 2 got together and decided who said this or that. I did 3 not want to pursue it further. You can explore with 4 Dr Bolsin which bits of information he might have been 5 a party to. 6 Q. I have no doubt we shall, but so far as you are 7 concerned, although you may destroy your notes every 8 three years now, did you keep notes of a conversation 9 you had with Professor Stirrat and Professor Dunn on 10 14th December of last year? 11 A. Yes. I have not submitted them, but, yes, I did make 12 some notes. 13 Q. Professor Stirrat has written to us say that you 14 informed them as to your sources of information for the 15 articles which you wrote. 16 A. I told him that Steve Bolsin had been a source of 17 information. I think from a journalistic point of view, 18 I committed some heinous crime in 1995. I was in 19 Birmingham then. The Daily Telegraph and BBC Bristol 20 reported on what was happening and I wanted to make the 21 point that although Dr Bolsin was now coming out and 22 talking to the media, this had been something that had 23 been known about and in the public domain since 1992. 24 I believed Dr Bolsin deserved credit for raising 25 concerns and therefore, in that 1995 article, I praised 0039 1 his courageous whistle-blowing. It was always in my 2 mind that he was a whistle-blower and he was a source of 3 information. I have always said on subsequent 4 occasions, on Radio 4 interviews and in the media, 5 the profound effect it had on me on meeting Dr Bolsin, 6 because he was the most important source of information 7 and without him the story would not have stood up. If 8 somebody had just told me this unit is known as "The 9 Killing Fields", I would make damn sure I did not send 10 my own children there and I would not refer if it was in 11 my power to refer, but I would not have published it. 12 He provided information with one other source which 13 meant that it stood up. I felt, as he had come out with 14 it in 1995 and he was talking to the media, he deserved 15 credit because he had raised the concerns. 16 I could not understand why it had taken from 1992, 17 when it was clearly felt there was enough of a problem 18 there to at least get an urgent external opinion such as 19 the Working Party to come in -- I could not understand 20 why it had gone on to 1995, but in my mind I have always 21 said publicly, yes, I met Steve Bolsin and yes, he 22 provided me with information. 23 I was extremely surprised, when I met 24 Professor Stirrat, that he did not know that I wrote for 25 Private Eye, as it had been on my CV when I applied for 0040 1 the job in Bristol and readily talked to the students 2 about it, and has been in the media on countless 3 occasions. I was also very surprised that he said 4 Dr Bolsin had said at the GMC hearings that he did not 5 give information to Private Eye; he was not aware how 6 the information got into Private Eye. 7 Q. The purpose of the question I asked you was whether or 8 not Professor Stirrat is right in saying that at the 9 meeting he had with you on 14th December 1998, you 10 informed him and Professor Dunn as to your sources of 11 information for the articles? 12 A. No, I told him that Steve Bolsin was one source because 13 it was already in the public domain and that I was not 14 prepared to tell who the other sources were. So I do 15 not believe that they know who all the sources were, no. 16 Q. He says this to us: you subsequently confirmed your 17 information as to your source of information to him in 18 writing, and he says he does not have permission to pass 19 this information on to the Panel. Do I take it that he 20 now has your permission to pass on whatever information 21 you told him to the Panel? 22 A. Yes, and I wrote to Professor Stirrat saying he can pass 23 all his notes on from that meeting and all the 24 information. He has that in a letter from me. There 25 was a ramification from this whole meeting. I met 0041 1 Professor Stirrat at a debate -- 2 Q. Let me come back to that. We will put that on the 3 backburner for the moment. So that I get the time-scale 4 right, in February someone mentions "The Killing Fields" 5 to you, someone with inside knowledge. Or you thought 6 to have inside knowledge, or you knew to have inside 7 knowledge? 8 A. Working in the hospital. That is inside knowledge. 9 Q. It was not until the 29th April 1992 that you spoke to 10 Dr Bolsin? 11 A. No. 12 Q. You mean that is right, it was not until then? 13 A. I am sorry, it was not until that time that I spoke to 14 Dr Bolsin. 15 Q. Between the hearing of "The Killing Fields" and speaking 16 to Dr Bolsin, what enquiries did you make of anybody 17 else? 18 A. My main source of information were people at my own 19 level, so junior doctors, and I also had friends who had 20 worked or students at Bristol. The message I got from 21 the 'junior' junior doctors was that they were working 22 on this ward and were often -- these were SHO level 23 doctors working on the post-operative ward and they were 24 often left alone to manage the intensive care facilities 25 and things that some felt might be beyond their 0042 1 competence. There was a general feeling of 2 disgruntlement in doctors at my rank, the SHO rank, 3 although I do not think the more junior doctors would 4 have any more idea of comparatively whether Bristol was 5 any worse than anywhere else. They said, yes, a lot of 6 people died, adults died, babies died, the culture on 7 the unit was not a great place to work, but they were 8 more concerned with whether they could turn the machines 9 on or off than the greater thing. 10 I had one slightly more senior source, independent 11 of Dr Bolsin, who did have concerns about outcomes and 12 said, "Yes". This was someone who had worked on another 13 unit. 14 Q. Because "The Killing Fields" as you point out, you were 15 well used at this stage to medical humour, you had used 16 it in your stage show. It tends to be pretty basic at 17 times, no doubt because of the realities of life as 18 a doctor, part of working as a hospital doctor may be 19 confronting death on a regular basis, may it not? 20 A. Yes. 21 Q. And "The Killing Fields" might mean no more, might it, 22 than that inevitably with certain conditions, people 23 died? You are nodding again. 24 A. Yes, it could mean that, yes, which is why, when I first 25 had the information, there was no other evidential basis 0043 1 upon which to publish. It is why in a sense I had to 2 park it, although I talked about it on stage in a way 3 that was probably attributable to those "in the know" to 4 see if I could gather other information. But I did not 5 come out and say this particular unit. 6 Q. On the basis of a nickname, you could not, could you? 7 A. No, but when we turn round and think what a reasonable 8 patient would want to know, I appreciate this is 9 difficult, but on the medical grapevine, if my child was 10 due to have heart surgery and I found out a unit was 11 known as "The Killing Fields" and probably ascertain 12 things about morale and the fact that there was no 13 specialist cardiologist or intensivist looking after the 14 SHOs on a post-operative round, little bits of 15 information came in, but nothing I thought would stand 16 up in a published article. Certainly if I found out 17 a unit known as "The Killing Fields" on that basis alone 18 as a parent, I would not want my child to go there; it 19 is too risky. 20 Q. Even though revealing that information to parents might 21 cause a great deal of unnecessary distress and concern 22 if in fact it was just such a nickname as you have 23 accepted it might be? 24 A. Yes, so when I published in Private Eye, it was only 25 after I had met Dr Bolsin, who absolutely convinced me 0044 1 that there was a very real problem that needed to be 2 brought to attention and the reason I did it in such 3 stark terms is that I thought I would probably only get 4 one go at it. I thought the Trust were bound to respond 5 very swiftly, and then it could be tested to see whether 6 there was a problem. 7 Q. So the chronology is this: February "The Killing 8 Fields". Then over the next month or so you make the 9 various enquiries; you are writing your column now and 10 want material for it, I take it? 11 A. Yes. It was slightly unfair on Bristol, but a lot of it 12 was Bristol based because (a) we were living there; and 13 (b) we were standing against Mr Waldegrave in the 1992 14 election. So there was a sense in which we wanted to 15 say, "Things are not quite right in your constituency. 16 Sort it out". 17 Q. So you were looking for -- if I say "horror stories" in 18 Bristol, that may be too strong, but that was the angle 19 you had on it? 20 A. If you look at the whole context of what I have written 21 in Private Eye, it is very rare for me to write a story 22 like the Bristol heart surgery unit story. The vast 23 majority are about lack of resources, rivalries between 24 managers and doctors, people not getting on well 25 together. It is extremely rare. It is not as if 0045 1 I would write something like that every week. 2 Q. Anyway, you are seeing if you can find out further 3 information. You are talking to the junior doctors who 4 are complaining to you about being left on their own in 5 ICU and whether they can turn the machines on and off, 6 whether they can understand them? 7 A. Yes, not lots, but there are those I spoke to. Some 8 people are only there on three month attachments, they 9 will only be there for three months. 10 Q. But nothing about outcome? 11 A. Other than they would say, "Yes, lots of people seem to 12 be dying", but I do not know that the junior doctors, 13 certainly if they had not worked on another unit, they 14 would have no idea whether it was higher or lower than 15 elsewhere. 16 Q. Your colleague, Tony Gardner, worked, did he, in the 17 same department as Maggie Bolsin? 18 A. In the Casualty Department. 19 Q. That is where she worked, is it? 20 A. I believe so, yes. 21 Q. Is that how you came to know the name of Dr Steve 22 Bolsin? 23 A. Yes. 24 Q. So he had conversations with her and understood from 25 what she said that there was something that he might 0046 1 find it useful to tell you? 2 A. Yes. I do not know who approached who first. 3 Dr Gardner has said he is happy to provide a written 4 statement. He said he did not want me to give my 5 interpretation of what might have happened, but he is 6 happy to provide me with a written statement of his 7 interpretations. 8 Q. Your best interpretation will give us something to 9 balance his evidence against, and your best 10 interpretation is that there was a conversation between 11 you? 12 A. Yes. 13 Q. As a result of which he spoke to you? 14 A. He gave me Steve Bolsin's home phone number. 15 Q. You phoned and set up the meeting? 16 A. There may have been some delay between him giving it to 17 me and setting up the meeting because I was working 18 full-time in casualty in Taunton and standing for 19 Parliament, and I was also uneasy at that time about 20 a story that was so out of character with the other 21 Private Eye stories. When you do medical journalism -- 22 Q. Can I just stop you there. This is going to be 23 virtually the last question before we have a break, but 24 you were uneasy about the story. What did you 25 understand was going to be said to you by Dr Bolsin 0047 1 before you ever spoke to him? 2 A. Tony said to me, "This particular doctor is extremely 3 concerned about the death rates in the paediatric 4 cardiac surgery unit". I believe that was it, yes. 5 MR LANGSTAFF: Let us explore this further, then, after 6 a break. 7 THE CHAIRMAN: Yes, thank you. Shall we take a 15 minute 8 break, and therefore just after 12 noon, we will 9 reconvene. 10 (11.45 am) 11 (A short break) 12 (12 noon) 13 MR LANGSTAFF: Dr Hammond, the first meeting you had with 14 Dr Bolsin took place because you phoned him to set it 15 up? 16 A. Yes. I had been passed his phone number by Tony and 17 I phoned him, yes. 18 Q. So in the course of that phone call, you were asking him 19 to meet you for your purposes? 20 A. Yes. 21 Q. What did you give him to understand your purposes were? 22 A. As I have said in my statement, I have no specific 23 recollection of telling Dr Bolsin that I was writing for 24 Private Eye, but because both Tony and I were quite 25 proud of our media role, the fact that we were standing 0048 1 or had stood against Mr Waldegrave, that we had been in 2 various BBC documentaries, there was quite a bit of 3 local press about what we were doing, I assumed 4 certainly that he knew I had contacts with the media, 5 but it is an assumption. I have no factual recollection 6 and as I say, I have no notes of the meeting any more 7 either, so I can only say it was my assumption that he 8 knew that I had media contacts. I also assume that the 9 reason that he was talking to me was because he may have 10 known I had media contacts. 11 Q. Did he seem to know who you were when you spoke to him 12 first? 13 A. I would be very surprised if they had not heard of 14 "Struck off and Die". 15 Q. Did he seem to know who you were when you spoke to him 16 first? 17 A. Yes. 18 Q. So he had obviously heard of Phil Hammond or Dr Phil 19 Hammond? 20 A. Yes, but as I say, in the context of this double 21 act "Struck Off and Die", which was well known in 22 Bristol at that time. 23 Q. So the impression you had in the phone call at any rate, 24 was that he knew of you and that you had, shall we call 25 it, a "media outlet"? 0049 1 A. Not necessarily on the phone call, but certainly when 2 I met him for the first time. It may have been on the 3 phone call, I phoned him up and he said yes, would 4 I like to come to, I am not sure how much was the 5 initial phone call or at the meeting. The phone call 6 may have been quite short, it may have been "Maggie has 7 passed your number on to Dr Gardner and it has been 8 given to me, may I arrange to meet you?" The phone call 9 may have been as short as that but certainly when I met 10 him, that was my view. 11 Q. But your impression, thinking back on it, is that when 12 you phoned, he seemed to know what the phone call was 13 about? 14 A. Yes. 15 Q. And when you met on 29th April, he seemed to know what 16 the meeting was about, did he? 17 A. I would presume so. Most of it was him talking and me 18 listening without much in the way of prompting. He 19 spoke at great length about the problems in the unit. 20 Q. Did you make notes? 21 A. I believe I did. I certainly made some notes 22 afterwards, but, yes, I did make a few notes at the 23 time, yes. 24 Q. So you had a notepad or something to write on, and you 25 were visibly writing? 0050 1 A. My recollection is probably, although in some meetings 2 I write afterwards; sometimes I write then. So it is 3 probably. I have no definite recollection, but 4 I certainly had some notes because I subsequently 5 referred to them. They may have been taken at the 6 meeting or made shortly afterwards. 7 Q. Roughly how long did the meeting take? 8 A. Perhaps an hour? 9 Q. In essence, what was being said to you? 10 A. He told me of his very grave concerns about high 11 mortality rates in the paediatric cardiac surgery unit. 12 He told me that he had shared this information with lots 13 of other doctors, anyone who would listen to him, and 14 specifically he told me that at some stage he had 15 alerted the Chief Executive of the Trust, I do not know 16 exactly when, that there was a problem. It was his view 17 that babies were probably dying at this unit who could 18 well have survived if they had gone to other units. 19 Q. Why do you recollect it was from the conversation as you 20 remember it that he should mention that he had spoken to 21 the Chief Executive? 22 A. I do not know. Perhaps he was trying to justify his own 23 position as to what steps he had already taken. He 24 certainly did say to me that working in Taunton I should 25 try and influence doctors in Taunton to alter their 0051 1 referral patterns. I was in a department that did not 2 refer, but if he was saying I should try to tell Taunton 3 GPs there was a problem and they should avoid this 4 particular unit, then everyone deserves to know. 5 I think that was the feeling I left there. 6 I think I asked him whether he would allow his own 7 children to have complex paediatric cardiac surgery in 8 that unit, and he said no. In the absence of systematic 9 audit that can prove things in medicine that is all we 10 have ever had. 11 Q. He would have known, just cutting you short for 12 a moment, presumably that referrals did not come from 13 GPs in this field? 14 A. I would presume so. 15 Q. So if he understood you to be a GP, one might wonder -- 16 he will have to answer some of these questions -- what 17 purpose there was as far as he was concerned in talking 18 to a Taunton GP, a Taunton casualty officer, about the 19 problems in paediatric cardiac surgery in Bristol? 20 A. Yes. I mean, I was presuming as well as my role as 21 a doctor, he was aware that there had been lots of 22 articles where we had been interviewed in the Bristol 23 Evening Post and been interviewed on Bristol West, and 24 I presumed he wanted me to use my media role as well as 25 my doctor role. 0052 1 Q. Did you talk about your media role at all? 2 A. No, because it was assumed I think from the conversation 3 that Maggie may or may not have had with Dr Gardner in 4 casualty, I thought it was assumed that he knew. My 5 impression was that he was happy to talk to me and I did 6 not need to establish my credentials. 7 Q. Can we have on the screen, please, SLD 2/3? If we look 8 at the left-hand column, "before the Department of 9 Health bestows its mark of excellence on UBHT", this is 10 written on 8th May 1992. What was your copy time? 11 A. Generally, the latest you can get it in is the Friday 12 before the Wednesday of publication, so the latest copy 13 date for Private Eye articles is four days: on Monday it 14 goes to the printer, on Wednesday it appears at the news 15 stand. 16 Q. The meeting on 29th April would have been on a Monday? 17 A. I do not know. You are telling me that. 18 Q. If the 8th is Wednesday, it must follow, I think. I may 19 be wrong. It may be the Tuesday. I beg your pardon, 20 the Monday, 29th was the Monday, I think. 1st May would 21 be a Wednesday, and one goes back two days. 22 So it was immediately before you prepared your 23 copy that you would have finished the meeting with 24 Dr Bolsin? 25 A. Yes. As I have said, I had had this story on the 0053 1 backburner for a few months and not been able to 2 establish information that I thought was worthy of 3 printing and it was only after meeting Dr Bolsin that 4 I felt that I had enough to justify printing. 5 Q. Can we look at it and you can tell me what information 6 comes from Dr Bolsin and what comes from elsewhere? 7 A. I am afraid I cannot tell you that because I have no 8 notes and definite recollection of which came. As 9 I said previously, I wrote to Dr Bolsin and asked him 10 could any of it be inaccurate and he said he -- 11 Q. Pause there and let me then ask you about something else 12 which you have written. Can we, please, highlight for 13 the moment -- I am going to go split screen. Can we 14 highlight the bit beginning with "Before the DoH bestows 15 its mark of excellence" and go down to the next column, 16 "Hardly the stuff of commendations". 17 Can we put that on one side of the split screen? 18 Can we enlarge it? On the other side, can we have 19 JDW 3/150, "Focus on Bristol ...". Can we go about 20 halfway down the left-hand column, "A secret audit 21 kept ...". Can we highlight, please, "A secret audit 22 kept by consultant anaesthetists", and at the top of the 23 next page, please, right down to "doing all operations." 24 This article on the left is from Private Eye in 25 May 1995, after some of the problems at Bristol had 0054 1 become public knowledge? 2 A. Yes. 3 Q. What you say there in the left-hand column is: 4 "A secret audit kept by consultant anaesthetist 5 Dr Bolsin, which was first published in the Eye, was the 6 start of the unit's undoing." 7 What you are saying is that the figures on the 8 right -- because it is the 8th May 1992 article, that 9 was the very first article that published any figures 10 about Bristol, was it not? 11 A. Yes. 12 Q. So what you appear to be saying in 1995 is that it was 13 Dr Bolsin's figures you were quoting in 1992? 14 A. Yes, although as you see from my subsequent statement, 15 I did say that in 1995 I had no direct contacts in 16 Bristol and that I made the assumption that some of the 17 figures I was given was Dr Bolsin's audit, whereas this 18 particular Inquiry has subsequently revealed that they 19 were the unit's own audit. I believe there could be 20 a journalistic error there, but Dr Bolsin did not 21 contact me to point it out and nobody else has, so this 22 is the first time this information has been scrutinised, 23 so I accept there are some errors there. I am finding 24 out today where they might be, because nobody has told 25 me beforehand. 0055 1 Q. So it may be wrong that what was first published in the 2 Eye was Dr Bolsin's audit, leave aside whether it was 3 secret or not, for the moment. 4 A. Yes. 5 Q. Was it nonetheless your understanding in 1995 that you 6 had got the figures from Dr Bolsin that were published 7 in May 1992? 8 A. Some of them. I did have one other source of figures. 9 I cannot precisely say who was first to give me the 10 figures. As far as I am aware, if Dr Bolsin did not 11 give me figures directly, if I got figures from another 12 source, I would discuss them with him for most of them, 13 but I cannot precisely say which belong to which 14 category so he may not have been the first source of 15 information. If I had other information, I would try 16 and verify it with him to see whether he thought this 17 was true or not. 18 Q. The comparison is clear, is it not? In the left-hand 19 copy, which is the 1995 copy, you say: 20 "Dr Bolsin found the unit's mortality rate for 21 repairing Fallot's tetralogy was between 20 and 30 per 22 cent. In Liverpool 160 babies had similar operations 23 without a single death." 24 It is a straight take from what you had written in 25 1992, is it not? 0056 1 A. Yes. The information was all part of the same process. 2 Whoever was actually doing the audit, I thought this was 3 part of the same process. So the information in 1992 4 raised grave concerns and actually the figure got even 5 worse by 1995, but I assumed it was part of the same 6 process, although I cannot say exactly who was doing the 7 audit. 8 Q. You go on, in the left-hand article: 9 "He then found that the mortality rate for 10 arterial switch, an operation to correct congenitally 11 transposed arteries from the heart, was 30 per cent in 12 Bristol compared to 10 per cent elsewhere in Britain and 13 nearly 0 per cent in America. (Eye/797)". 14 We will have a look at that in a moment, but 15 I think you are likely to accept that again those 16 figures correspond to what was written by you in 17 Eye/797? 18 A. Yes. 19 Q. "This figure worsened to 61 per cent by 1993 ..." 20 Where did that figure come from? 21 A. I believe that was published in the Daily Telegraph. 22 Q. "... though parents of children had who died from these 23 operations were told they had a '70 to 80 per cent 24 chance of success'." 25 Where did that come from? 0057 1 A. That was information also in the general media, either 2 the Daily Telegraph or BBC News, I believe. 3 Q. "In September 1992, it was revealed that James Wisheart, 4 the senior paediatric cardiac surgeon, had been 5 appointed Chairman of the Hospital Management Committee, 6 Medical Advisor to the Trust Board. For whatever 7 reason, he did not alert them to the disastrous death 8 rates of his unit. Overall, a baby was twice as likely 9 to die from open-heart surgery in his unit than any 10 other in the country." 11 We will come back to that paragraph in a moment. 12 "Dr Bolsin first confronted his Trust superiors 13 with his findings in 1993, although they were already 14 well aware of them." 15 Where did you get that information from? 16 A. The 1993 came from the Daily Telegraph, although 17 Dr Bolsin had told me that in 1990, perhaps, he actually 18 told Dr Roylance that there was a problem. I do not 19 know whether he had actually given him figures then, but 20 he had alerted him in 1990 so that was my basis for 21 saying that the Trust was well aware of the problem. 22 Q. It was that contrast I was going to ask you about. You 23 have obviously spotted it. That was information which 24 you were deriving from The Telegraph, but different from 25 the information which Dr Bolsin had himself given you at 0058 1 your first meeting? 2 A. Yes. 3 Q. Why did you rely on the Telegraph rather than what you 4 recollected Dr Bolsin had told you? 5 A. Because in 1993, "aware of his findings" I took to mean 6 actually had audit figures he could show in 1993. As 7 far as I am aware, when he spoke to Dr Roylance in 1990, 8 he did not have figures, he just said "I am extremely 9 worried, I think we need to look into this". 10 Q. If you go across to the right-hand side: "Despite a long 11 crisis of morale among intensive care staff...", that is 12 a reference to your junior doctors, is it? 13 A. A number of sources said there was a crisis, yes, not 14 junior staff. 15 Q. "... the surgeons persistently refused to publish their 16 mortality rates in a manner comparable to other units." 17 Just pausing there, from whom did that information 18 come? 19 A. I cannot be certain. It may have been Dr Bolsin. You 20 will have to ask him to confirm that. 21 Q. That would suggest that the surgeons actually had 22 figures? 23 A. Perhaps. I mean, not publishing means either you do not 24 have the figures to publish or you have them and you are 25 not prepared to publish them. I do not have expert 0059 1 knowledge in that area. 2 Q. It is your words. What did you intend to convey by 3 "persistently refused to publish their mortality 4 rates"? 5 A. It would suggest that there may have been audit 6 information that might have alerted them to a problem 7 that they did not publish, but I am guessing. 8 Q. They are covering up, is the hint? 9 A. Yes. 10 Q. That is what you meant to convey? 11 A. Well, they were not allowing their work to be 12 scrutinised, is what I mean to convey. The scrutiny 13 might have discovered a problem. 14 Q. Which is it: not being as open as one might think 15 desirable, or covering up? 16 A. I did not use the words "cover up", so presumably I did 17 not want to use them. I presumably meant they were not 18 allowing their figures to be scrutinised because it 19 might point out a problem, but I could not have been 20 definite. 21 Q. It is the hint -- 22 A. I appreciate there is a hint there. 23 Q. -- that I am after. I think what you are telling me, 24 I want to confirm it before I move on, is that you 25 intended there to hint, although you did not state it, 0060 1 that there was a cover-up? 2 A. Yes, but also there was no open systematic audit of 3 units that allowed valid comparisons. 4 Q. That is what I wanted to go on to ask you about: "to 5 publish their mortality rates in a manner comparable to 6 other units." 7 You are saying in the text that other units 8 published their mortality rates in a manner which 9 invited comparison between one unit and the next? 10 A. I think if units had good results, they were fairly open 11 with their results. I think if they had bad results, 12 they probably were not. There were some units at that 13 time who were getting better results and I was able to 14 get that information. 15 Q. How did they know they were good results? 16 A. That is a fair point. How do you define "good"? 17 I think there was published information in America and 18 other areas that perhaps had been doing the switch 19 longer, and maybe they made international comparisons. 20 Q. But you are not talking about the switch here, you are 21 talking about Fallot's tetralogy and surgery generally 22 in May 1992? 23 A. I am sorry, can you repeat the point you want me to 24 make? 25 Q. You have said there was experience in America in 0061 1 relation to the switch? 2 A. Yes. 3 Q. I was pointing out that in May 1992, you do not mention 4 the switch at all. That came, I think, a month or so 5 later, but you were talking about mortality rates 6 generally. What I was asking you is how any unit which 7 did publish its mortality rates could know that the 8 results were good without there being some measure of 9 comparison with other units which were not quite so 10 good? 11 A. I think that is a fair comment. I would accept that 12 "good" is a judgment, but at least, if you are 13 submitting your figures for scrutiny -- I was told that 14 the Cardiothoracic Register and the information that the 15 Working Party looked at, some of them were not 16 compulsory, so you would have some units who did not 17 submit any figures at all, and that it was fairly patchy 18 and they did not necessarily divide them into individual 19 operations so you could judge one operation from 20 another. There were clearly some units who were doing 21 far more audit and opening their work to scrutiny than 22 others. Whether that was because their results were 23 much better than others, I do not know. 24 Q. The other units you had in mind: were they units you 25 were able simply to go to any public source like 0062 1 a library, for instance, and pick up the figures? 2 A. No. 3 Q. So how did you get them? 4 A. I was given a source of information. 5 Q. So the other units were not in fact publicising their 6 figures either? 7 A. I do not believe they were publishing them, but I think 8 they were at least sending them to the Cardiothoracic 9 Register. 10 Q. We are told, and indeed, I think we have the evidence to 11 show, that at this stage at any rate, Bristol was also 12 sending its information to the Cardiothoracic Register. 13 So your sources, if they had been at the register, would 14 tell you that they had figures from Bristol too, no 15 doubt? 16 A. I was told, as I recall, from Bristol, that the Bristol 17 figures were poor. I did not need to go to the 18 Cardiothoracic Register for the Bristol figures. 19 Q. But you would have to have a point of comparison, to 20 know they were poor? 21 A. Yes. 22 Q. And the point you are making here is that the surgeons 23 "persistently refused to publish their mortality rates 24 in a manner comparable to other units." 25 Was that something that was said to you, or was 0063 1 that your own conclusion? 2 A. It was a combination of both. I mean, I went into this 3 not knowing much about paediatric cardiac surgery, but 4 I assumed from a quality assurance point of view that it 5 would be obligatory for anyone allowed to do 6 life-threatening operations on babies that they would 7 have to openly publish their results for individual 8 operations and have external review. I was extremely 9 surprised to find out the audit itself was not even 10 compulsory. That was partly the information I was given 11 and partly my own view, which remains. 12 Q. If it turned out that Bristol were submitting their 13 results, however good or however bad they were, to the 14 Cardiothoracic Surgical Society for publication in the 15 register, then they would be doing exactly that, would 16 they, which the other units to which you refer were also 17 doing? 18 A. Yes, and recently Maria Shortis and I have met with the 19 people at the Society for Cardiothoracic Surgeons and 20 I think they said that the Bristol problem was staring 21 them in the face from the returns to the Cardiothoracic 22 Register. Which is why I believe it was a systematic 23 problem. 24 Q. That would be whoever it was who got the figures and saw 25 that those figures were markedly different from other 0064 1 figures which appeared? 2 A. Yes. 3 Q. You go on: 4 "Although Dr Roylance and the Department of Health 5 are well aware of the problems, they will not recognise 6 them officially." 7 Can I look at that? Where did your information 8 come from for that sentence? 9 A. I was told that there was a -- well, Dr Roylance I have 10 already spoken about, Dr Bolsin alerting him in 1990. 11 The Department of Health, I was told that there was 12 a Working Party report in either 1988 or 1989 that had 13 highlighted problems. Perhaps using information from 14 the Cardiothoracic Register, I do not know, but it was 15 known in Bristol that that report had highlighted 16 problems as far back as 1988 or 1989. 17 Q. Who knew it in Bristol? 18 A. I cannot say. 19 Q. Your other source? 20 A. There was another source, or perhaps Dr Bolsin may have 21 known, I do not know. I do not know which provided it. 22 I had two sources of that level of information. 23 Q. What you have told us thus far is that you had two 24 relatively high level sources of information, one from 25 Dr Bolsin, one from "AN Other"? 0065 1 A. Yes. 2 Q. And one or other of them put this to you in terms of -- 3 how did they express it to you? That there had been an 4 interim report of the Working Party which should have 5 rung alarm bells, or did ring alarm bells, or 6 demonstrated a difficult problem, or what? 7 A. It was put more simply: that it demonstrated high 8 mortality rates. 9 Q. Did you ever see a copy of that? 10 A. No. 11 Q. Have you, to this day, seen a copy of it? 12 A. I have seen things on this particular website, yes. 13 Yes, I have seen things that Maria Shortis has given 14 me. I do not know whether I have seen that particular 15 report. I may well have, yes -- no, I do not think 16 I have seen the 19 ... no. 17 Q. Let me take you to a copy of that report. It is in the 18 Department of Health bundles, and if we go, please, to 19 DOH 2/231, these are bar graphs. If we turn it 20 sideways, please, you will see there the number of 21 operations performed by different centres in the year 22 1988: Bristol, 50 closed-heart operations over 1 year, 23 49 under 1 year, 89 open over 1 year and 29 under 24 1 year. 25 Can we go on to page 232, please? We have lost 0066 1 some in photocopying. Let us turn to the next 2 page [DOH 2/233]. 3 Turn it sideways. The open operation under 4 1 year. You will recollect the number of cases, and you 5 will be able to identify, therefore, where Bristol fits 6 in this. If we just go back to DOH 2/231, you see open 7 under 1 year, 29 cases dealt with by Bristol. If we go 8 back to 233, the 29 will correspond with the higher of 9 the two dumbbells, just under 40 per cent. You 10 appreciate that the vertical axis gives you the 11 percentage mortality, the number of cases across the 12 horizontal axis. 13 So one is interpreting here these figures on these 14 charts by reference to the number of operations shown in 15 the bar chart. If we just have a quick look at 234 and 16 turn it sideways, please, 235, the open and closed over 17 and under 1 year in each case. 236. 18 In none of those last four charts do we actually 19 have a name given to the unit, but obviously one can 20 work it out, as you have done sitting here with my 21 assistance. 22 If we go the same report, but I will pick up 23 a slightly different reference to it, RCSE 2/24, you can 24 see what it is: July 1989, the interim report of the 25 Working Party which had those graphs at the end of it, 0067 1 and can we go through, please, to I think it is page 30 2 or page 31. Can we try page 30, first? Go back 3 a page. This is what the report says: 4 "There is a tendency for mortality to be higher in 5 the units performing the smallest number of cases in 6 a group of infants undergoing open-heart surgery under 7 1 year of age (Figure 3) [the bar chart that I first 8 showed you]. This is one of the anticipated results for 9 supra-regional specialisation in its field. Similar 10 results were not reflected in the other categories, that 11 is closed cardiac surgery under 1 year of age and open 12 and closed cardiac surgery in older children. 13 Figures 4, 5 and 6. "Closed-heart surgery under 14 1 year: mortality is not related to the total number of 15 operations performed but is below 5 per cent in half of 16 the centres ... and over 10 per cent in one centre only 17 (figure 4)." 18 "Conclusions ..." 19 If we scroll down and go over the page [RCSE 2/31] 20 paragraph 3: 21 "Appropriate numbers of neonates and infants are 22 undergoing cardiac surgery in five of the designated 23 centres. Two centres, Newcastle and Bristol, have 24 a less than average turnover of work and should be 25 encouraged to increase their numbers annually. We 0068 1 question the need for three designated centres in 2 London. The situation in Leeds is not known. We 3 recommend annual audit of surgical activity in this 4 field." 5 So just pausing there, do you think, from your 6 recollection of what was said to you, that it was 7 probably this Working Party report which your sources or 8 source had in mind? 9 A. Yes, but I do not necessarily think they may have had 10 access to the report; it may have been that somebody who 11 had it passed it on to somebody else and said "There is 12 a significant outlier; we think it is Bristol". I do 13 not think they necessarily would have seen the whole 14 report. All I was told was that a particular report had 15 found out this particular unit was performing badly and 16 appropriate action had not been taken to protect 17 patients. But I had no more information than that. 18 Q. What it appears to be suggesting is very much the same 19 as the material that you produced in relation to biliary 20 atresia for the Inquiry's use. So that the wider public 21 follow the point you are making, I think you are saying 22 that if you have difficult operations in respect of 23 which there is no great caseload across the country, 24 then it is far better for the public that they are done 25 in one or two centres only rather than in lots? 0069 1 A. Yes, but a couple of points. The first is that you can 2 make sure that those units have specialist surgeons, 3 they have specialist intensivists, they have the whole 4 pre and post-operative team to make sure these babies 5 get the best possible chance, but even though the 6 numbers are small, if you do it in three or four centres 7 you are going far more quickly to get statistical 8 results than if you have, as in the case of biliary 9 atresia, 15 cases where 8 of them were doing just one 10 a year, so they could never prove their competence or 11 otherwise. 12 Q. Behind it is the thesis that experience and throughput 13 compliment each other into producing better outcome? 14 A. Yes. I am not a surgeon, but, for example, Ted Howard, 15 who until he retired recently from Kings was the 16 country's leading Kasai surgeon, said the actual 17 experience of the surgeon, the process of the surgery, 18 was as important as the outcome. To attempt to do 19 a highly complex operation if you were not a specialist 20 in that field was far more likely to get poor results 21 than if you were. He had been lobbying since the early 22 1980s to get centralisation of the Kasai services. 23 It took a huge media campaign almost 20 years later to 24 achieve that. 25 Q. A very similar point appears to be being made in this 0070 1 report, bringing you back from Kasai to heart surgery, 2 that you would expect the greater throughput of cases to 3 produce better results? 4 A. Yes. The evidence in medicine is not hard. There is 5 industry evidence that familiarity with the task is far 6 more important than, say, fatigue in determining outcome 7 in medicine. There is no hard evidence as there is not 8 in many areas, but I believe that to be the case. 9 Q. In conclusion 3: 10 "As far as Bristol is concerned, two centres have 11 a less than average turnover and should be encouraged to 12 increase their numbers annually." 13 Having seen that that is what the report says, if 14 one is to assume that this must have been what your 15 source had in mind, is there anything which is 16 inappropriate as you would see it about that response, 17 saying, "Well, the problem is low numbers, therefore 18 worse than average outcomes, therefore you need to 19 increase the numbers to improve the outcomes"? 20 A. I do not believe you can just say increase the numbers 21 without ordering an external review to find out 22 precisely why the results are poor. It may not be just 23 low numbers, it may be that they do not have 24 a specialist paediatric cardiac surgeon; it may be that 25 they do not have a specialist intensivist and are 0071 1 leaving the care of these babies to quite inexperienced 2 SHOs. Purely on process measures, without looking at 3 any outcomes, I would not have been happy for a child of 4 mine to be operated on in Bristol, so purely on process 5 matters, if somebody says to me "I am going to do 6 a switch. It is the hardest operation known in 7 paediatric cardiac surgery. We do not have a specialist 8 paediatric cardiac surgeon, we do not have a specialist 9 intensivist after the operation", that alone would be 10 enough for me to say "I am taking my child elsewhere", 11 never mind the outcomes. 12 Q. If I can come back from this document on the screen to 13 SLD 2/3, I was asking you, if we highlight again, 14 please, the bottom of the first, the top of the second 15 columns, about the sentence: 16 "Although Dr Roylance and the Department of Health 17 are well aware of the problems, they will not recognise 18 them officially." 19 Did you have any material other than the fact of 20 what is probably this report, what I have just shown 21 you, to suggest that the Department of Health was well 22 aware of the problem? 23 A. No, although I was told that there was another Working 24 Party on behalf of the Department of Health going around 25 at that time, in 1992. I was not sure what stage they 0072 1 had reached in their deliberations. 2 Q. It did not report until later. 3 A. Fine. My assumption was -- one of my sources said, 4 "This is a window of opportunity to bring it to the 5 attention of this Working Party that is going around at 6 the moment. They will read this, they will think we at 7 least have to investigate this". When I am saying 8 "Working Party" I assume it then goes back to the 9 Department of Health, but I did not know at that time 10 the dates at which the Working Party reported so in fact 11 the only evidence I had was the 1989 report. 12 Q. And "they won't recognise them officially". Did you 13 know that they had been asked to do so? 14 A. No. 15 Q. The wording you use there might suggest that they had, 16 might it not? 17 A. They might have been, I am not aware of anybody asking 18 them to do so, other than me in this column. 19 Q. Because the "won't recognise" gives the impression just 20 as perhaps the "persistently refused to publish" may 21 give the impression, that there is some deliberate 22 silence being kept? 23 A. The official recognition would have come from the 1989 24 report when they said "these are very poor success rates 25 but we are not going to look into it, we are just going 0073 1 to encourage them to increase the numbers". They were 2 not recognising the problem. 3 Q. You, for your part, were not an expert in cardiac 4 surgery, or what results to expect? 5 A. No. 6 Q. And you would have imagined that whatever the Working 7 Party constitution was, it would be composed of those 8 who were? 9 A. Yes. 10 Q. If they had seen a problem themselves, you would have 11 expected them to have drawn particularly focused 12 attention to it, would you not? 13 A. My experience, and this also goes with biliary atresia, 14 is that decisions at that time were made largely on 15 output and that people did not look at outcomes 16 carefully. In fact, they did not seem to mention 17 outcomes. You talk about results, but they were keen on 18 throughput and centres being established for 19 geographical reasons. It is only recently I think with 20 this government that anybody has put quality on the 21 agenda and stopped counting numbers and waiting lists 22 and actually looked at the quality of the service. So 23 I think in that culture then, they did not look at the 24 quality of the service. They did not think, "If this 25 was my child would I want them to be treated in 0074 1 Bristol", which I felt was the ultimate answer. You 2 have to ask that question if you are on working parties 3 like this. 4 Q. The point I am going to ask you to comment on, if the 5 Department of Health had commissioned a Working Party 6 and the Working Party itself focused on throughput 7 rather than outcome in terms of success rate, there 8 would be no-one, would there, in the Department of 9 Health who would be in a position to as it were 10 second-guess the doctors; or would there? The experts 11 are saying, "Here we are, we need to increase the 12 throughput", might the Department of Health officials at 13 any rate not say, "Well, this is the medical advice we 14 have; we are not in no position to know better"? 15 A. You have put the graphs up on the screen, which 16 presumably lay people around the country can see, 17 certainly around the South West. You do not have to be 18 a genius and have to have a degree in statistics to see 19 a very significant outlier, one unit with very poor 20 results. 21 If I was in the Department of Health in a position 22 where I was accountable for quality, I would say "I am 23 not happy just to increase numbers here, I want that 24 looked into". I do not think you need to be 25 a specialist. The whole history of medicine is littered 0075 1 with specialists not getting the right answer. You 2 cannot necessarily rely on expert opinion. 3 Q. Can we go on to the next paragraph: 4 "Recently the unit failed to provide a paediatric 5 cardiac nurse for post-operative care because it was assumed 6 that the baby would not survive the operation." 7 Where did that information come from? 8 A. I honestly cannot remember. 9 Q. "Although Liverpool surgeons have successfully operated 10 on 160 babies with Fallot's tetralogy". Just pausing 11 there, where did that information come from? 12 A. One of my sources has a handle on what was going on 13 around the country. 14 Q. One of your sources in Bristol? 15 A. Yes. 16 Q. "A congenital heart abnormality, the Bristol mortality 17 rate is between 20 and 30 per cent, hardly the stuff of 18 commendations." 19 Who gave you the Bristol mortality rate of between 20 20 and 30 per cent for Fallot's tetralogy? 21 A. I cannot be certain. It could possibly have been 22 Dr Bolsin, it could possibly have been someone else. 23 I cannot be certain. 24 Q. The someone else is "AN Other"? 25 A. Yes. I had another source so I was able to check 0076 1 between two sources, which to me I felt was enough to 2 publish a story. In retrospect, I wish I had gone to 3 John Roylance and Mr Wisheart, but for reasons 4 I outlined in my subsequent statement, I was too 5 frightened to do that at the time, but I felt that the 6 two of them saying there was a problem was enough. 7 Q. And I said I would come to the next Private Eye 8 article, we go to SLD 2/5, the next one which deals with 9 figures. 10 It is the bottom left-hand column: 11 "Mrs Bottomley claims that whistle-blowing through 12 the 'correct channels' unquote will get results. Staff 13 at the UBHT have been whistling about the dismal 14 mortality statistics in the paediatric cardiac surgery 15 unit since 1988." 16 Just pausing there, in Eye 793 you had not said 17 anything about staff having raised these concerns 18 internally since 1988. By all means we will go split 19 screen if you want to see it. 20 A. No, I will take your word for it. 21 Q. What was the basis for saying that? 22 A. I would presume 1988 is the year that Dr Bolsin arrived 23 at the Bristol Royal Infirmary? 24 Q. That is right? 25 A. So he told me that staff had been concerned. 0077 1 Whistle-blowing can be whistle-blowing among colleagues 2 on a unit, it can be to the Chief Executive, it can be 3 to the consultant. I do not mean whistle-blowing as in 4 taking it outside the hospital. But if I mention 1988, 5 I presume it is when Dr Bolsin arrived at the hospital 6 and that was his view then. 7 Q. So the source for it was probably what Dr Bolsin told 8 you? 9 A. Yes. 10 Q. How many meetings did you actually have face-to-face 11 with Dr Bolsin? 12 A. I had one meeting face-to-face, and then I phoned him on 13 perhaps four or five occasions over the course of 1992. 14 Q. But not thereafter? 15 A. No. I then, at the end of 1992, the beginning of 1993, 16 moved to Birmingham to take up a lectureship and lost 17 contact. 18 Q. Which is why when you talk about what Dr Bolsin was 19 doing in 1993 -- 20 A. It was taken from stuff in the print media already. 21 Q. "While UBHT's Chief Executive [going back to the print 22 here] John Roylance, the Royal College of Surgeons, and 23 Duncan Nichol, Chief Executive of the NHS ME, are all 24 well aware of the problem, they seem more concerned with 25 silencing the blowers." 0078 1 "The problem" is what, dismal mortality 2 statistics? 3 A. Yes. I had one anonymous source who when things were 4 written in Private Eye about cardiac surgery would 5 photocopy the columns and add comments and then 6 circulate them to me, rather like the Brompton 7 whistle-blower. My experience of whistle-blowers, if 8 people whistle-blow anonymously, they tend to use 9 scattered targets, so they will go as in the Brompton to 10 this Inquiry, to Private Eye and to the Down's Syndrome 11 Association. 12 There was one person I did not have a clue what 13 the identity was who was photocopying the Private Eye 14 columns, sending one copy to me and sending counter 15 copies to various institutions. The one I remember most 16 was Duncan Nicol, because I thought what an odd choice 17 of person to send the column to, but it was clear to me 18 this person did not know who was accountable for the 19 problem either, so he was sending articles. The tone 20 was written in a similar style to the Brompton tone, 21 which is why I acted so quickly when I got the Brompton 22 letter, so it was not in harsh, aggressive doctor-speak. 23 Q. I will come back and touch on the Brompton letter at 24 a later stage, if I may, but here the source that was 25 sending you photocopies of what was in Private Eye with 0079 1 comments appended and sending round a circulation list: 2 do I take it that was not the same source as the source 3 of the information, the other high level source to which 4 you have already referred? 5 A. No, it was giving information such as "parents on the 6 unit are told they are in the best hands, or they are in 7 the best unit, or whatever, and the results do not seem 8 to bear this out", but they did not give me any specific 9 figures. 10 Q. So that is the anonymous contributor by post? 11 A. Yes. It was completely anonymous, even to me. 12 Q. This article goes on: 13 "In America the mortality rate for arterial 14 switch, an operation to connect congenitally transposed 15 arteries from the heart, is now 0 per cent. Nearer to 16 home in Birmingham it is 3 per cent. In Bristol, 17 despite the fact the operation has been performed since 18 1988, it is 30 per cent. Sadly, consultant 19 cardiologists at the Bristol Children's Hospital 20 continue to refer patients to their surgeons 'to support 21 the local unit'" and that is in quotes. 22 Where did the figures come from? 23 A. Again, it would either have been Dr Bolsin or AN Other. 24 They were the only two sources I had of figures. 25 Q. Let me just move off this screen for one moment. 0080 1 Remembering the date, it is 3rd July 1992, we can we 2 have UBHT 61/165 on the screen. 3 "Hospital Medical Committee, Audit Committee, 4 medical audit meeting report." 5 I do not know if you picked this up from having 6 looked at the transcript, but in case you have not, 7 I will take you through it. 8 At this stage we have been told -- there are 9 records to demonstrate it -- monthly audit meetings in 10 respect of paediatric cardiac surgery or what is called 11 "paediatric cardiology" here. Meetings, one of them 12 chaired by Mr Dhasmana, and we can see those who were in 13 attendance. 14 Dr Bolsin is not one of them. 15 The audit topic and criteria reviewed: 16 "Results of arterial switch" done by Mr Dhasmana, 17 that is what "by JPD" means, I think. "Findings and 18 observations": mortality similar to reported results, 19 particularly if... "consider earlier experience, higher 20 mortality from VSDs and when in hospital for long time 21 prior to switch. Action taken: persevere ..." 22 That audit meeting appears to have looked at 23 mortality for transposition of the great arteries with 24 a ventricular septal defect, and concluded that the 25 findings are similar to reported results, but presumably 0081 1 had figures in front of it, or may well have had figures 2 in front of it. 3 Did anyone talk to you about that meeting? 4 A. Not the meeting, no. I presume what you are going to go 5 on to say is that the results that were published in 6 Private Eye were similar to the results in that meeting, 7 but I was not told specifically about the meeting, no. 8 Q. Were you told where the figures came from? 9 A. No. 10 Q. Do you know whether it was Dr Bolsin or your other 11 source who gave you those figures? 12 A. No, I do not. I cannot say. Whatever the case, there 13 must have been somebody -- if it was Dr Bolsin, there 14 must have been somebody who had told Dr Bolsin because 15 he was not at the meeting, but I cannot be sure which of 16 my sources gave me that information. 17 Q. Shall we go back to SLD 2/5? Again, just focusing on 18 what is said in the bottom of the left-hand column, 19 nearer to home in Birmingham, 3 per cent. The source 20 appears to be an individual with access to comparable or 21 comparative information from different centres? 22 A. Yes. Or it may be that I was given the information and 23 I went to another source and said "Can you compare it to 24 other centres for me", so it does not necessarily mean 25 that the same source gave me the two bits of 0082 1 information. 2 Q. Can you remember which? 3 A. No. 4 Q. "Sadly consultant cardiologists ... continue to refer 5 patients to their surgeons 'to support the local unit'." 6 That is in quotes. Is it in fact a quote? 7 A. I do not know. I presume it was told to me as a quote, 8 otherwise I would not have written it as a quote. 9 Q. "As a recently retired and very eminent cardiac surgeon 10 in Southampton says, [in italics] 'Everyone knows about 11 Bristol'." 12 The "recently retired and very eminent surgeon in 13 Southampton" is Sir Keith Ross, is it? 14 A. I found out subsequently, yes. 15 Q. Because you found out subsequently, that suggests he did 16 not say this to you? 17 A. No. But neither did he write to Private Eye, and say 18 "I did not say that". 19 Q. And given your own recent experience in relation to 20 The Telegraph, you would not blame him for that, I take 21 it? 22 A. I would not. Having seen his letter to James Wisheart 23 he was absolutely outraged by this, whereas I was not 24 outraged by being misquoted by that journalist. If you 25 were outraged by something, you would take action to set 0083 1 the record straight. I find it extraordinary that he 2 did not. 3 Q. He never spoke to you, never met you; is that right? 4 A. No, I have never met him. 5 Q. The quote which is attributed to him -- how far does it 6 take us? It talks about "everyone knows about 7 Bristol". Knows what? 8 A. My feeling was that he would not specifically have 9 access to individual operation information; it was 10 a general feeling that the journalistic tactic here was 11 to find somebody in a very senior position who sat on 12 either one or both working parties, who is in a position 13 to act. This particular surgeon was chosen partly 14 because he was retired and it was thought that there 15 would be no threat to his career by raising concerns. 16 And that I had a source in Southampton who said this was 17 the general view at the time, that Bristol was known to 18 have low numbers, no specialist heart surgeon, not the 19 place you would want your own children to go. 20 Q. The process points you have been talking about -- 21 A. My recollection of this particular statement is that 22 I would have -- written like that, it would probably 23 mean this comment was made privately and was not meant 24 for public consumption, but the reason I used it was to 25 alert this particular person that there was a very 0084 1 severe problem here, knowing he was on the Working 2 Party, knowing he would have to sign up to the 3 recommendations of the Working Party having read this. 4 Q. Forgive me for a moment so I understand this. If the 5 surgeon says "everyone knows about Bristol", it follows 6 whatever there is to be known, he knows? 7 A. Not necessarily, no. I would dispute that. I would 8 think in general terms it was known within the 9 paediatric cardiac surgery community in 1992 that 10 Bristol had major problems. 11 Q. You may not be following the question. What I would 12 like you to focus on is the words attributed to 13 Sir Keith Ross, the words which are attributed to him in 14 quotes, and you have told us that that must have been 15 given to you as a quote because that is what you do, 16 "everyone knows about Bristol". 17 If the quote means that everyone knows that 18 Bristol has particular problems, then he, the speaker, 19 uttering those words, is recognising those problems by 20 uttering those very words, is he not? 21 A. Yes. 22 Q. So this would be someone who knows, upon whom you are 23 relying as a source of knowledge in your article? 24 A. I am not saying specifically that he knew the specifics 25 of individual operations. I was told that he was -- 0085 1 I believe he was on the original Working Party and so 2 would have known that Bristol was a significant outlier 3 then, and I believe he was on the current Working 4 Party. That was the context in which I used the quote. 5 I would also say that when I talked to people in 6 other units, it was quite common for anaesthetists to be 7 operating with a surgeon and to say, "Why has this baby 8 bypassed Bristol?" Over the years I have had this 9 general comment from the Hammersmith, Brompton, Guys, 10 Southampton, Oxford and Cardiff as a sender, where 11 anaesthetists have queried why babies are not going to 12 Bristol. There have been some quite harsh comments 13 which I could not possibly repeat because I think they 14 would be libellous, and there were some general comments 15 that for this sort of operation, you do not go to 16 Bristol, as in "everyone knows about Bristol". I do not 17 think that people would necessarily know specific 18 results for specific operations, but my general feeling 19 at that time is that it was known within the community 20 that it was not the place, for example, to send your own 21 children. 22 Q. The point of the last few questions I have been asking 23 you about the surgeon who was sending knowledge on which 24 you rely in your article, is to ask what was the 25 particular point in drawing the surgeon's own knowledge 0086 1 to his attention so he can do something, when the 2 assumption is that he knows it already? 3 A. From what I have just said, I do not think he knew the 4 true nature of all the problems, but he should have 5 known having been on two working parties that there was 6 a problem with Bristol. This was a journalistic tactic 7 to ensure that he took action. 8 Q. So by "everyone knows", what is Delphic about it is the 9 word which might come after "knows", as to "knows what 10 about Bristol"? 11 A. Yes. As I say, I am not a surgeon, but my few insights 12 into this particular community is that they are quite 13 close-knit and people speak and trainees speak at 14 meetings and that was the general concession, that 15 "everybody knows that Bristol has problems". 16 Q. Do you accept what Sir Keith Ross has said to us, to the 17 effect that he, for his part, did not have any knowledge 18 that Bristol was under-performing? 19 A. As I have said in my statement, I have not been able to 20 identify the precise source of that particular piece of 21 information, so I cannot confirm or refute; all I can 22 say is that Sir Keith Ross never challenged that piece 23 of information. And it has since been repeated in my 24 book which was published six months ago and even with 25 the repeat, six months ago, it has not been challenged. 0087 1 Q. You draw from the absence of challenge the positive 2 assurance of truth, do you? 3 A. No. I am saying I do not know, but it was never 4 challenged. He never saw it as enough of an issue to 5 want to challenge it. 6 Q. So can I ask you again: you have seen what Sir Keith 7 Ross has said to us? 8 A. Yes. 9 Q. You are prepared to accept it, on your present 10 information? 11 A. I can neither accept nor deny. I do not have an opinion 12 that I can offer. I have no evidence to say that that 13 was not the line at the moment. If I do manage to 14 identify and contact the source and if more information 15 comes to light, I will give it to you, but at this 16 particular moment, I do not feel I can comment on that. 17 Q. One of the problems, and again, we come back to the 18 question of sources, one of the problems you appreciate 19 that we have is that when a witness says something to us 20 directly, in a form which is intended for publication 21 and which they can be questioned on, the Panel may think 22 it more reliable than information which comes 23 unattributed at second-hand, which is necessarily 24 hearsay, all the more so when you for your part cannot 25 remember or will not reveal the source. 0088 1 Can I ask you, in that light, again, please, would 2 you name the source, the high level source, other than 3 Dr Bolsin, who was giving the information to you on the 4 basis of which you set out your articles in May and July 5 1992? 6 A. No, for the reason given previously. 7 Q. Would you undertake to ask that individual? 8 A. I have already asked, as I wrote to Mr Whitehurst, that 9 the sources I am still in contact with wish to respect 10 the guarantee of anonymity that I gave them as 11 a journalist. 12 THE CHAIRMAN: Dr Hammond, the Panel for its part 13 understands your unwillingness to identify the sources 14 of information upon which you base publications, but 15 I have to remind you, and everyone else, of the 16 consequences of that for us. The Inquiry's terms of 17 reference require us to draw conclusions. We may only, 18 as you recognise, draw conclusions if we have sound and 19 tested evidence which we can rely on. Everything we do 20 is done in public and thus the public, in my view, is 21 entitled to expect, and indeed may demand that any 22 evidence which we rely on must be made public, not least 23 so that it can be challenged and tested. 24 So clearly evidence which is derivative or 25 second-hand at best must be regarded differently from 0089 1 that which is substantiated. I am sure you understand 2 that. 3 A. Yes. One point I would make is from the statistical 4 information, I do not believe that there is any 5 statistical information that you cannot get from another 6 source. I would also make a plea to the Chairman as 7 a Professor of Ethics that my entire power to expose 8 scandal in the NHS and to stop Bristol from happening 9 again and to do the biliary atresia story which someone 10 is still so frightened about they will not come forward 11 as the original source of the information. It relies on 12 the trust that people place in me. If you seriously 13 want to prevent Bristol happening again, and that is 14 a considered aim of this Inquiry, you would not get me 15 to reveal my sources because I would be completely 16 impotent to produce any form of story like this in the 17 future. 18 MR LANGSTAFF: Sir, I wonder if on that note that would be 19 a convenient moment to have a break for some lunch? 20 THE CHAIRMAN: 45 minutes, shall we say, from now until 21 2 o'clock, and reconvene at 2. 22 (1.15 pm) 23 (Adjourned until 2.00 pm) 24 (2.00 pm) 25 MR LANGSTAFF: You had figures which we can see looking at 0090 1 SLD 2/5, still on the screen, you felt confident enough 2 to quote in your column. Did you have those figures in 3 writing? 4 A. Only that I have written them down in that notebook. 5 I do not think I had them printed, no. 6 Q. Having them written down in a notebook, what steps did 7 you take to verify the figures? 8 A. Only through discussing them with each of my sources. 9 In the end, I trusted their professional judgment to say 10 that this was a true reflection or a fair reflection of 11 the figures. I did not get external statistical 12 validation. I do not think it would have occurred to me 13 at that stage. In retrospect I might have done, but not 14 at that stage. I trust my sources. 15 Q. So neither source gave you anything in writing, but each 16 was prepared to verify the figures as being of that 17 order? 18 A. Yes. 19 Q. Shall we go from this particular Private Eye to the next 20 one, if we may, which is dated 9th October 1992, 21 SLD 2/6. It is the left-hand column: 22 "The sorry state of ... it has been confirmed by 23 an internal audit of the last two years' operations." 24 So pausing there, your information was that the 25 unit had done its own audit? 0091 1 A. Somebody had done audit on the unit. I do not know 2 particularly who had done it, but yes. 3 Q. Can you tell us which of your two sources gave you this 4 information? 5 A. If it was not immediately from Dr Bolsin, I believe 6 I would have discussed it with him. Both of the sources 7 were aware that this audit had taken or was taking 8 place. 9 Q. So the audit we are talking about as an internal audit 10 was not the private audit -- I use the word "private" in 11 distinction with the word "secret", which I think 12 Dr Bolsin would suggest was a misnomer. 13 A. As I said before, I am not precisely sure which of the 14 information I quoted was from a published unit activity 15 and which was audit performed by Dr Bolsin and others. 16 Q. So you cannot help on that, but the results -- you set 17 out that the results of procedures to correct two heart 18 abnormalities were especially poor, and you go down to 19 say: 20 "James Wisheart ... curiously has not felt it 21 necessary to inform the Trust Board or the Trust's 22 purchasers of these findings. Could it be because he is 23 also Associate Director of Cardiac Surgery? 24 "Meanwhile the UBHT continues to squander its 25 resources ..." 0092 1 So you understood that Mr Wisheart had not told 2 the Board or the Trust's purchasers of the findings of 3 the internal audit? 4 A. I understood that to be the case, according to my 5 sources, yes. 6 Q. That would suggest that the audit you were referring to 7 was indeed something prepared by the cardiac surgeons or 8 the cardiac specialists or those involved in the 9 surgical team dealing with paediatric cardiac cases? 10 A. Yes, or it could have been performed by somebody else 11 and they had shown it to them. 12 Q. Yes, one or the other. 13 A. Yes. 14 Q. Again, it was one or other of your sources, was it, who 15 said he had not felt it necessary to inform the Trust 16 Board? 17 A. Yes. 18 Q. That might suggest someone at a relatively high level 19 who would know what Mr Wisheart had or had not said to 20 the Trust Board. I do not want you to comment on that 21 just for the moment, but would you take a look, please, 22 at WIT 283/191? This is Health Service journal, 23 27th August 1998. It is a document you know well 24 because it is one of the references you give in your 25 chapter about Bristol in your book. It is fair to point 0093 1 out that it is not Dr Bolsin's own words, it is a report 2 by someone, Janet Snell, of what he may have said. 3 Can we go down, please, to the right-hand side? 4 "Dr Bolsin told Health Service Journal he has 5 a problem with being labelled a 'whistle-blower' ... 6 I started to realise there was a problem not long after 7 I joined the staff, and I went through all the due 8 processes in all the right ways many times to raise my 9 concerns. On two occasions I went right up to the 10 Department of Health, well before any of this 11 information reached the public domain. I suspect it was 12 leaked by someone higher up than me because they'd had 13 enough. Yet I was the one labelled a whistle-blower." 14 Dr Bolsin will no doubt tell us what he had in 15 mind, if indeed he said those words, but his suspicion 16 that the information was leaked by someone higher up 17 than him because they had had enough might be thought to 18 relate to someone in the cardiac services specialty at 19 Bristol who had a position which was at least 20 commensurate with his specialty, or higher. 21 From what you know, is that at least a reasonable 22 possibility that such a person was the other source? 23 A. I am not prepared to postulate on the specialty or rank 24 of the other source, because it would lead very easily 25 for you or other people to identify them, and I do not 0094 1 feel that pursuing that is constructive. 2 Q. Let me then go back to what you wrote in 1995, 3 JDW 3/150. It is the middle column: 4 "In September 1992, Eye/804 revealed that James 5 Wisheart ..." 6 That is a reference to the article I have just 7 shown you. 8 A. Yes, I believe it is. 9 Q. A very, very small point, but the article I have just 10 shown you is of course October 1992, and you refer to it 11 here as being September 1992. Is that the sort of 12 inaccuracy that there might well be in one of your 13 columns or not? 14 A. I cannot answer that. That is the first time that has 15 been pointed out to me and yes, that is an inaccuracy. 16 As I have said all along, there may be inaccuracies in 17 the columns but this is the first time in 7 and a half 18 years that they have been challenged and I am finding 19 out today. 20 Q. You make the point really against yourself in much of 21 what you write: you had not appreciated at the time you 22 wrote the columns in Private Eye that they would not 23 have the effect on people you mentioned that you had 24 hoped it would. You hoped I think at the time that you 25 were drawing matters to their attention? 0095 1 A. My belief at the time, the belief of my sources is that 2 we urgently needed somebody from outside to externally 3 validate what was happening; that there was so much 4 dispute within the hospital it was impossible for the 5 Trust to sort it out and it needed someone to come in 6 from the outside. I believed at the time the Working 7 Party were the people who would come in and say "that is 8 acceptable or unacceptable". 9 Q. Your purpose, then, apart from obviously having 10 something to write about and having a particular focus 11 on Bristol because of the pre-electoral concerns you 12 have spoken about, your purpose in publishing in Private 13 Eye this material was what? 14 A. My intent was to protect babies from unnecessary harm. 15 That argument was put to me very strongly by Dr Bolsin, 16 that is true. He was absolutely convinced that as far 17 as he was aware, babies were suffering unnecessary harm 18 and a much better outcome could have been achieved if 19 they had gone to other units. That became my sole 20 motive in thinking, "What would I want if it was my 21 child?" and asking other doctors, "Would you allow your 22 child to have these operations in Bristol?" In the 23 absence of systematic audit, I have yet to meet anyone 24 in 1992 or subsequently who would have said "Yes" as 25 a doctor and I believe that what is good enough for 0096 1 doctors' children should be good enough for all 2 children. 3 Q. You have seen that which has been written saying did you 4 not know that some of the doctors, some of the medical 5 staff had their children operated on by Mr Wisheart, in 6 fact, and I think you frankly acknowledge that that type 7 of material has come to you and -- you are nodding; 8 I have to say that. 9 A. I am sorry, no, I was not aware that doctors' children 10 had been operated on by Mr Wisheart. I did receive 11 letters from grateful parents who said they thought 12 I was being very unfair about the unit and that he had 13 done a wonderful job for their children, but I do not 14 believe I was ever made aware that other doctors' 15 children had had complex open-heart surgery by 16 Mr Wisheart or Mr Dhasmana. I did hear one instance of 17 a doctor in Bristol at the time who took his child to 18 Birmingham to have heart surgery, because he had worries 19 about the outcomes in Bristol, but I do not have any 20 more information on that. 21 Q. Again, are you in a position to give us the name of the 22 doctor? 23 A. No, if you would like me to try to investigate further, 24 I can look into it. 25 Q. We would, please. You will understand why, and we for 0097 1 our part will understand why you cannot perhaps tell us 2 immediately. 3 Just going on in the 1995 article, you say, about 4 two-thirds of the way down that paragraph: 5 "The surgical unit can have bad mortality figures 6 for a number of reasons. Sometimes it is because they 7 select particularly difficult cases; sometimes because 8 of lack of specialist staff and equipment, sometimes 9 because some of the surgeons are slow, dangerous, 10 cumbersome and too arrogant to acknowledge their own 11 limitations even when babies are dying around them. 12 Which or whom is to blame in this case is unclear." 13 It goes on. 14 So you accept, do you, that whatever the results 15 were that you were publicising, really what was called 16 for was further investigation rather than a particular 17 conclusion one way or the other? 18 A. Yes. 19 Q. One of the difficulties in getting matters drawn to the 20 attention of the individuals that you wanted the matters 21 to come before, so that they could audit the Inquiry, is 22 that they might not take Private Eye seriously enough? 23 A. I subsequently reached that view. At the time I was 24 very proud to write for Private Eye. I remember Paul 25 Foote coming to speak to our school and telling him how 0098 1 it was the nearest we had in this country to free 2 press. I had known about the Poulson affair, the 3 Profumo affair, and various other high profile cases 4 where they got it right and people did act on the 5 results. It was only retrospectively I realise I did 6 consider at the time contacting these people in person, 7 and where I felt I would not be taken seriously was the 8 fact that I was, as I said, a Senior House Officer in 9 casualty who had never worked in cardiac surgery, never 10 worked in the BRI and was acting part-time as 11 a comedian, and I did not feel that would add any weight 12 to my argument. I was also very frightened. 13 Q. You say in your book -- let me find it, if I can; 14 WIT 283/29, the bottom of the left-hand column, the top 15 of the right-hand column: 16 "Hislop said I would have to use a pseudonym and 17 for professional and legal reasons I accepted this 18 condition. I was still a junior doctor with no 19 experience of journalism and if I screwed up the Eye 20 would survive, but my medical career would be over. The 21 use of a pseudonym also allowed other journalists to 22 contribute to the column. The downside is that the 23 anonymity of authorship as much as the satire allows it 24 to be dismissed." 25 The professional reasons that you used 0099 1 a pseudonym, are they set out in that paragraph? 2 A. I was told I had to use a pseudonym, and I was reluctant 3 because the information that I had been writing about in 4 Hospital Doctor had all been about the junior doctors' 5 campaign, and I was quite happy to be seen as somebody 6 who put their name to that. I very clearly recognised 7 this Bristol story as something completely unlike 8 anything I had ever been given before. In retrospect, 9 I suppose I was happy then to have the pseudonym, 10 because I did not think for one minute anybody would 11 land something like this on my desk. But when I started 12 I wanted to say "Written by Dr Phil Hammond" or "Written 13 by 'Struck Off and Die'", but as the type of stories we 14 unfolded were given, I recognised it was safer to use 15 a pseudonym. 16 Q. So when you say you were still the junior doctor with no 17 experience and if you screwed up your medical career 18 would be over, at what stage did you think that? 19 A. Ian Hislop had said another professional writing for 20 another column, it could have been an architect or even 21 a lawyer, had put their name to it and their career had 22 been over. So it was his advice based on the experience 23 of professionals writing other columns for him. 24 Q. And you understood that? 25 A. Yes. 0100 1 Q. And accepted it? 2 A. As I say, initially I was grudging. I wanted to put my 3 name to it, but I accepted it, yes. 4 Q. You had the advantage of it, perhaps, in that when 5 things were said, you could not be got at easily? 6 A. You say that, but -- 7 Q. I am asking it, really. 8 A. Yes and no. I think it would not have been very 9 difficult for anyone to establish the authorship. 10 I told a lot of my junior doctor friends, I told my 11 colleagues in casualty. It has been on my academic CV 12 since 1992. It has been on various media programmes. 13 When I debated against Sir Donald Irvine in 1993 it was 14 on my CV and I talked about my role in Private Eye. 15 A lot of people did know I wrote for Private Eye. If 16 I was asked directly I would never have denied it, but 17 I did not then have the strength and courage to phone up 18 Mr Wisheart or Dr Roylance or Mr Doyle at the Department 19 of Health or whoever and say "I'm an SHO in casualty, 20 will you please do something about this" and I very much 21 regret that. 22 Q. Because what I think you are saying, what you could have 23 done is you could have sent even a copy of the page from 24 Private Eye to the people you mentioned, Dr Roylance, 25 the GMC, the Royal College and so on? 0101 1 A. I could have done. Perhaps the reason I did not, as 2 I said, I received an anonymous circular that was 3 already doing that. 4 Q. How large a part in that did your feeling play that you 5 express at WIT 283/40? You are saying there, in the 6 paragraph beginning at (c) that very often there is an 7 attitude of "there but for the grace of God go I", 8 amongst doctors. Again, you are nodding? 9 A. Yes. I mean, one of the things I am keen to get across 10 is that doctors who work in the media have this golden 11 persona that they must be wonderful. They think because 12 you are on television you must be somehow different. 13 All doctors I know make mistakes. We all have been in 14 situations where but for better resources or training an 15 outcome would have been different. I think it is that, 16 that we have all been there, as much as the worry about 17 what will happen to our career about whistle-blowing 18 that stops doctors from blowing the whistle. There is 19 a lot of harm, there is a lot of iatrogenesis. There is 20 increasing evidence that people do better in specialist 21 units, so if for years you have been providing care in 22 a non-specialist unit, you could be said to be 23 contributing to those poor outcomes. I think Bristol is 24 endemic within the medical profession. 25 Q. I suppose there is an element here of not wanting to be 0102 1 hypocritical, to condemn in others faults which there 2 may well be in oneself? 3 A. Yes. I mean, what tends to happen in medicine is that 4 you make a mistake and it is very rarely picked up upon, 5 or if it is picked up as a junior doctor it is almost 6 expected: you did not have the experience or training 7 and therefore you were expected to make mistakes. 8 I do think there is a difference between that and 9 a systematic problem year on year dating back to say at 10 least 1988 that has been brought to attention and is not 11 acted on over a period of time, when you compare that to 12 an individual mistake. 13 From my own experience, I had worked on special 14 care baby units and resuscitated babies in situations 15 where they might have survived or might have had 16 a better outcome if a more experienced doctor had been 17 there. So I did feel that sense of hypocrisy, yes. 18 Q. One of the other features which may have played, I do 19 not know, you have told us why it is for a mixture of 20 reasons and emotions you did not, yourself, send off 21 Private Eye or the material to Dr Roylance, Mr Wisheart, 22 Mr Dhasmana, all the things you would now with the 23 information. 24 A. Yes, and in fact I believe it is unfair if audit has 25 just come to light to publish it immediately. I think 0103 1 the reason I published in the Bristol case is that 2 people had told me, sources whom I trusted, this problem 3 had gone back to at least 1988 and many preventable 4 mistakes may have occurred in that window 1998 and 1992. 5 Q. The reason it would be unfair to publish immediately? 6 A. You have to give people a chance to act on the audit. 7 The lesson from this seems to be that audit came from 8 various sources, not all from Dr Bolsin, from the 9 cardiac register. As I have said previously, 10 specialists at the Society of Cardiothoracic Surgeons 11 said it was there staring them in the face. 12 Q. Audit is a process ideally of measuring achievement 13 against preset standards? 14 A. As you say, if the standard is not set, that is clearly 15 the problem and has been the problem in the GMC hearing, 16 just auditing, not against the standard what does it 17 mean? I think the strength here was the process 18 argument which I have used as well as the outcome. 19 There were clear process problems. 20 Returning to your original point, if I am now sent 21 confidential audit information, as in the Brompton case, 22 I fax it back in confidence immediately to the Chief 23 Executive, to the President of the Trust, to the 24 President of the Royal College of Surgeons if it happens 25 to be a surgical problem, and the Chief Executive of the 0104 1 General Medical Council. 2 Q. You have given us with your second statement the 3 endorsement from a number of bodies of that approach, as 4 being the proper approach? 5 A. Yes. 6 Q. I think the BMA goes so far as to indicate to you that 7 if you have someone who approaches you as 8 a whistle-blower, that your job and duty as a doctor, as 9 well as a responsible journalist which you wish to be, 10 I have no doubt, is to direct that person to exhaust 11 their own local reporting routes first before taking it 12 any wider? 13 A. Yes, but if you look at the Public Interest Disclosure 14 Act, it says quite clearly that in a very severe case, 15 as I believe Bristol was, you can go straight to the 16 media, you do not have to go through the correct 17 channels if babies were dying unnecessarily, which 18 I would say is very severe. It is entirely justifiable 19 to go direct to the media. 20 Q. So is what you are saying from what you know now, having 21 been through this experience and admittedly with the 22 benefit of hindsight, that you would not now do things 23 the same way as you did then? 24 A. No, I think we learn from experience. I think my 25 problem writing for Private Eye is that I did it very 0105 1 much on my own, without scrutineering myself. I reached 2 judgments and decided what to publish, and I did not 3 consult with people outside who perhaps could have 4 helped. I am now in a position where, having come so 5 obviously out as writing in Private Eye so nobody can 6 possibly be in any doubt it is me, I feel a lot more 7 scrutiny. I think that is good. I do not think in 8 retrospect what I did was particularly constructive, it 9 does not appear to have achieved any constructive 10 change. As a lecture in communication skills, the mark 11 of communication is that some appropriate action has 12 taken off from the message. In this particular 13 instance, if they decided not to take action, it clearly 14 undermined the Trust and morale within the unit; it 15 probably made interprofessional rivalries worse and the 16 poor parents who did not read Private Eye and their 17 children were operated on between 1992 and 1995 and now 18 find in retrospect this information was in the public 19 domain since 1992, it has probably made their grieving 20 worse. 21 Q. It is a point made through me by the Surgeons' Support 22 Group that one of the consequences of publishing terms 23 like "The Killing Fields" and so on is to give parents 24 a sense of guilt or shame when there may be no 25 justification for it, and that I think must be one of 0106 1 the risks of publishing? 2 A. I appreciate it is a risk. I did have several letters 3 from parents at the time. As I have said, some wished 4 to write in support of the unit and I actually discussed 5 with Ian Hislop, that was the one case I did, and Ian 6 was saying "Are you sure you have got this right?" But 7 I also had parents whose children were due to be 8 operated on and I advised them to go to Birmingham, 9 Southampton or Oxford I think, so it is possible in one 10 or two cases I might have achieved something. But had 11 there not been an element of truth in "The Killing 12 Fields", it would have passed unnoticed, had there not 13 been a Public Inquiry now where it has been widely 14 disseminated, it would have passed unnoticed. The 15 reason it is causing hurt now is because I believe there 16 was an element of truth there. That is how doctors cope 17 with tragedy. 18 Q. Is part of the difficulty with raising something in the 19 media, do you think that there is inevitably a suspicion 20 that what is written in the media may not be entirely 21 accurate and may not be thoroughly checked, speaking 22 generally, first? 23 A. Yes, I think the relationship between the medical 24 profession and the media has been a poor one. It has 25 been very adversarial, often, but having said that, 0107 1 there are doctors who have used the media constructively 2 and to their advantage, but I would accept that people 3 do not necessarily believe what they read in the media, 4 for good reason. 5 Q. If we look in terms of your own articles at WIT 283/187, 6 this is the General Medical Council writing to the 7 solicitor to the Inquiry. Can we scroll down, please? 8 Your statement to us includes a report of your 9 conversation with Dr Michael O'Donnell, and the point 10 you are making is that Dr O'Donnell had told you he had 11 raised with GMC colleagues the question whether the GMC 12 should look into the claims made by Private Eye. 13 Let us keep that on one side of the screen, and go 14 to where this is said. Page 6. It is 283/6. It is the 15 indent halfway down the page: 16 "I omitted the GMC in error but in 1998 Dr Michael 17 O'Donnell told me that he raised the question with GMC 18 colleagues about whether the GMC should look into 19 Bristol. He also told me that for years he had 20 submitted information to Private Eye." 21 Did you speak personally to Dr O'Donnell? 22 A. Yes, we were recording a radio programme "Taking the 23 Pulse" which was a celebration of 50 years of the NHS, 24 so he was a studio guest in a programme I was chair of. 25 Q. Had you known him before that? 0108 1 A. I had known of him, not known him. 2 Q. Did you make notes of what he said to you about the GMC? 3 A. Yes. I do not know whether I still have them, but 4 I made notes of them. I wrote it originally in Private 5 Eye and in the Express, and subsequently spoke to 6 Dr O'Donnell and asked him if he had seen the articles 7 and he said yes, and he was very happy with them. 8 Q. Indeed, you venture in a later part of your statement 9 that when he said he had raised matters about Bristol 10 with members of the GMC, he was assured there was no 11 problem because "Wisheart is a good chap". Your phrase? 12 A. Yes, I wrote those words down, yes. 13 Q. Dr O'Donnell's recollection, as reported to us by the 14 General Medical Council, you can see set out on the 15 left-hand side: that in fact what he told you is the 16 difficulties faced in the 1980s and 1990s by GMC members 17 who wanted the GMC to concern itself with competence, 18 but that he did not ask the GMC to look into Bristol. 19 What do you say about that? May he be right? 20 A. I do not believe it was officially minuted as having 21 taken place at a GMC meeting, but my recollection is 22 clearly that he said he discussed it informally with 23 colleagues at the GMC. 24 Q. Informally? 25 A. As I said to you before, Wendy Savage has been looking 0109 1 into this on behalf of the Wisheart team. She has 2 written to Dr O'Donnell to ask him whether it was said 3 at an official meeting. The response I got from her was 4 that it was not said at official meetings, but my 5 impression was that it was still said informally, so 6 that is the extra bit of information I have. But I am 7 clear in my mind that is what was said at the time, 8 yes. And as I said, I sent him a copy of the book, 9 I sent him the Express article, I talked to him about 10 the Express and Private Eye article, and he said he had 11 seen the Private Eye article and it was fine. He has 12 not complained about the book and he has had it in his 13 possession for three or four months. 14 Q. Do you wish to revise your recollection of what 15 Dr O'Donnell may have said to you, having seen what is 16 said on his behalf by the GMC? 17 A. All I can say is that mine was a true report of what 18 I thought he said, and he has never challenged it to me. 19 Q. You used the expression "what you thought was said"? 20 A. Clearly there are implications for someone challenging 21 what was said. I made notes at the time and wrote it 22 and asked him if he seen it and he said there was no 23 problem and he liked the mention. 24 Q. It may be quite helpful if in due course you would 25 forward your notes on this. 0110 1 A. If I can find the notes, I will certainly forward them, 2 yes. 3 Q. Can I then move aside from that and deal with a number 4 of specific matters which arise in the course of your 5 statements. 6 Can we go to WIT 283/2, please, halfway down the 7 page: 8 "The 1995 article was written using figures that 9 were already in the public domain from the Daily 10 Telegraph article ... and the BBC West report." 11 I have shown you the 1995 article. You would 12 accept, no doubt, that the figures that you quote in 13 1995 are exactly those which you quoted earlier in 1992? 14 A. Yes. The extra information that was provided subsequent 15 to what I had already printed in Private Eye. 16 Q. So it is actually a casual use of language? 17 A. Yes, I am sorry, I am a journalist. 18 Q. You go on: 19 "I have no contact with any sources at BRI, I had 20 not followed the story up because I was told in 1992 21 that the Royal College of Surgeons and the Department of 22 Health were going to take action to protect patients." 23 I have not asked you why it was, having raised 24 this issue, having come back to it in no less than three 25 or four editions of Private Eye, why, it being a story 0111 1 of a nature you had not otherwise had, the only story 2 you had actually been spoken to by your editor 3 specifically about, why you did not follow up and see 4 what had happened? 5 A. Because my aim -- well, because I was assured at the end 6 that the Department of Health and the Royal College of 7 Surgeons had been made aware of the problem and we were 8 looking into it, and I mistakenly trusted that they 9 would act. 10 Q. Who gave you the assurance? 11 A. One of my sources. It could have been Dr Bolsin, it 12 could have been the other one, I am not sure. 13 Q. So it was somebody within the UBHT who said "Do not 14 worry Phil", or "Dr Hammond -- 15 A. Yes, but at the end of 1992, the Department are aware, 16 and, yes, journalistically, you are right to point out 17 I should have followed it up. It is a lesson I have 18 since learned: that you cannot assume just because you 19 are told something that action will necessarily happen. 20 Q. You go on down towards the bottom of the page: 21 "A junior anaesthetist at the time expressed 22 dismay and disgust that all the consultant anaesthetists 23 had not rallied around Dr Bolsin and ... refused to 24 anaesthetise for the operations in question." 25 The words "at the time", what time are you talking 0112 1 about? 2 A. I do not know what the date was. I can chase it up if 3 you want and find out exactly when it was. It was 4 during the time this came out but I do not know 5 specifically. 6 Q. Whether it was 1992, 1995? 7 A. I would have said it was earlier rather than later. 8 Q. But are we to leave it at the level of "I would say"? 9 A. If I had more information, I would have written it 10 down. If you want me to go and find more information on 11 that point, I will. It was certainly a feeling that you 12 cannot do the operation unless there are anaesthetists 13 there, and one of the junior anaesthetists could not 14 understand why all the anaesthetists were not standing 15 en bloc and saying "No, we will not do these 16 operations". Usually the anaesthetic specialty is one 17 where people rally around and stick together, in my 18 experience. 19 Q. If we turn over the page, the same question, really, 20 about timing, under (1) Audit not acted on: 21 "I was told that as far back as 1988/89, the 22 unit's own overall figures demonstrated high mortality 23 rates." 24 When were you first told that? 25 A. This was all in 1992. 0113 1 Q. Under (2), the third bullet point down, you were given 2 information about the outcome of a specific operation, 3 namely Fallot's tetralogy, arterial transposition, 4 arterial switch, and the sources of that are the sources 5 you have mentioned so far? 6 A. Yes. 7 Q. We are talking again, are we, about 1992? 8 A. Yes. 9 Q. You were told -- it is the last bullet point under 10 (2) -- that at one other unit experiencing 11 difficulties ... you set out what you were told. Who 12 was it who told you that? 13 A. That was someone I met actually after the "Struck Off 14 and Die" performance. I do not know the identity of the 15 person. One of the difficulties with the information 16 I got off having performed a cabaret and talked about it 17 is that you would meet people in a bar and discuss these 18 things, but you would not necessarily make a note of 19 their name or where they worked, but I have a clear 20 recollection of somebody saying in the London unit they 21 had done three or four and decided to stop, because we 22 had the discussion about when you stop, what is the 23 standard, do you do 6 or 10 or whatever. I presume if 24 you go to Guy's Hospital, you will be able to check 25 whether that is true or not. 0114 1 Q. Again, under (3): "I was told there were no defined 2 minimal standards." 3 Do you know when you were told that? 4 A. This would have been the kind of thing either Dr Bolsin 5 or the other source would have told me. That would have 6 been in 1992. 7 Q. And the next two bullet points? 8 A. Through my cabarets and other letters sent to Private 9 Eye and various things, I managed to ascertain that 10 around the country other units were doing better, so 11 they did not exclusively come from those two sources. 12 The bottom one was exclusively from those two sources. 13 Q. The top of the next page. Again, at (4) the first 14 bullet point, "I was told ..." 15 A. Partly it was the anonymous circulars I was getting that 16 came from somebody who used more compassionate language 17 than a doctor might use, that parents were being told 18 they were in the best hands and it is the best unit, and 19 I did ask my sources, as I was interested in 20 communication skills, what precisely the patients were 21 being told. 22 Q. When were you told about this? 23 A. This would have been around 1992. I did not have 24 specific figures, but I did ask -- I was always very 25 interested about what are the parents being told. If 0115 1 a unit is not as good as another unit, it does not 2 necessarily matter provided the parents are being told 3 "We do not have particularly good figures here but we 4 are trying to improve our numbers, to get them up". 5 I wanted to know what the parents were told and that is 6 my recollection of what was told. 7 Q. And your source again, as best you can describe him or 8 her? 9 A. One source was, as I say, the anonymous whistle-blower 10 to Private Eye, through what they wrote. I am sure 11 I would have asked Dr Bolsin and my other source, and 12 possibly other junior staff sources as well. 13 Q. Because Dr Bolsin, for instance, would be unlikely to be 14 in the company of parents when they are contemplating 15 surgery. He comes in at a later stage, as one would 16 normally expect? 17 A. That is something to put to him. I do not know whether 18 he had more information to add to that, but it was more 19 likely to come from people lower down the tree. 20 Q. When you deal with an expert opinion from sources within 21 the Trust, you were told various things, the information 22 which you give is essentially second-hand? 23 A. Yes, I appreciate that. 24 Q. It is anecdotal, largely. How did you satisfy yourself 25 as a doctor and as a scientist of its accuracy? 0116 1 A. I think ultimately, in the particular situation, you can 2 only trust the reliability of your sources. 3 Q. So the answer is you did not, but you had to rely upon 4 the information you were given? 5 A. Yes. 6 Q. Under the second bullet point, you were told you should 7 attempt to alter the referral pattern of the GPs; that 8 is Dr Bolsin, is it? 9 A. Yes. 10 Q. Despite what had already happened and referring to 11 doctors "in the know", that is in quotes: is that 12 because it is a colloquial expression, or is it because 13 that was the form of words actually used to you? 14 A. I can remember someone using the term "in the know", so, 15 yes, I believe that was a quotation. As I had not 16 practised as a GP apart from my training year when I did 17 not see a child with complex heart surgery, I may not 18 have been completely au fait with the pattern of 19 referral. I may have believed GPs did have some input 20 into where the children are sent. 21 Q. You have probably answered generally the points that 22 might be made in respect of the next bullet point, the 23 time of the operations and so on. It is something which 24 you relied upon your informant for, you did not yourself 25 check? 0117 1 A. No. 2 Q. And the next point "probably would not send their own 3 children for heart surgery in Bristol". How many people 4 working in Bristol told you that? 5 A. It was a report of a discussion that one of my sources 6 was having with various doctors on the unit. I believe 7 that it was fairly well known that there were problems. 8 Q. So the answer is, no doctor at Bristol told you that? 9 A. I would have asked Dr Bolsin, certainly, whether he 10 would have considered sending his own children there. 11 He very clearly said "No". But I was told that the 12 discussion that happened around the unit was that was 13 the conclusion that was reached. 14 Q. In -- 15 A. I have to say actually on that point, some of the junior 16 staff I spoke to would have reached that conclusion as 17 well, I think. 18 Q. I have been asked to ask you in respect of the note at 19 the bottom of the page, how it was that the meeting with 20 Maria Shortis came about. 21 A. I think Maria sent me a letter. She had founded -- an 22 institution, pressure group, called "Constructive 23 Dialogue and Clinical Accountability" which is really 24 concerned with moving the agenda forward and learning 25 the lessons from Bristol. She had started the campaign 0118 1 for an independent inspectorate and audit, but the key 2 thing was for doctors and patients to work in 3 partnership, so Maria was trying to recruit doctors who 4 would work with patients to try and achieve the same to 5 prevent Bristol happening again. 6 She wrote me a letter which detailed in clearer 7 terms than possibly I could need for this. I had never 8 seen such an informed and focused lay opinion, and 9 I said immediately, yes, I would be happy to work with 10 her. 11 Q. She, it seems, has or had friends who were doctors in 12 Bristol. Is it your impression -- she can speak about 13 herself, I have no doubt -- from what she said to you 14 that she herself was unaware, despite the friendships 15 she had with others, of any particular problems with the 16 cardiac surgery department until very much later during 17 the 1990s? 18 A. I am sure Mrs Shortis could tell you more accurately. 19 My feeling was that she had asked at some stage her 20 Bristol friends after her daughter had been treated, but 21 I do not know what time that was. I was given the 22 answer, "No, it is well known you do not send your 23 children to Bristol for heart surgery". 24 Q. If we can go on to the next page, you mentioned sources 25 outside the Trust. Can you first of all identify the 0119 1 nature of the sources? 2 A. I suppose that the most reliable source of information 3 came from anaesthetists who were working in the units, 4 mainly in hospitals in London where babies were being 5 bypassed around Bristol. Often, again, I did not write 6 down specific names, but I believe if you go to the 7 Hammersmith, Brompton, possibly Guys, and ask them about 8 what opinions were expressed at that time about why 9 babies were bypassing Bristol, they would give the same 10 view. 11 Q. So this was talk amongst anaesthetists? 12 A. Anaesthetists reporting. I do not believe they were 13 people who necessarily who knew of Steve Bolsin. They 14 were people raising a question because they did not 15 understand why babies were not going to their nearest 16 heart surgery unit. 17 Q. Anaesthetists would not normally have anything to do 18 with the immediate referral; the referral would be via 19 cardiologist or paediatrician, presumably, and would be 20 to a department -- one would expect, would one, that the 21 child coming into the hospital would be seen in the 22 first place by a cardiologist and then subsequently by 23 a cardiac surgeon, if surgery was going to take place? 24 The anaesthetist would only come into the picture down 25 the line. That is broadly right, is it not? 0120 1 A. Yes. 2 Q. So the question I am asking, really, for the purpose of 3 helping the Panel evaluate the source and accuracy of 4 the information, what it can tell us, is the source 5 appears to be people who meet the child in the operating 6 theatre or in the anaesthetic room before the operation 7 for the first time, or thereabouts -- they may have seen 8 the child the night before, as an anaesthetist might 9 well do -- but otherwise would not know why that child 10 came to that particular hospital? 11 A. My feeling from speaking to people is that it was just 12 generally discussed. It was an issue, perhaps the 13 surgeon brought it up initially, I do not know, but 14 subsequently, in 1998, at a transplant conference, I met 15 an anaesthetist who worked at Guys and he said that it 16 was a common point of discussion, that the anaesthetists 17 were as au fait with it as the surgeons, and as I wrote 18 in my book, some of them had contacted Cardiff and said 19 "Why are the cases not going to Bristol?" 20 If you would like me to try and track this person 21 down, if I can, I will, but I presume if you are 22 visiting other units, you will find this information 23 out. 24 Q. We would be very grateful for direction in that visit, 25 so if you would please do what you can and let us know 0121 1 about it, we would be grateful. 2 For the moment, you know they were anaesthetists 3 with principal point of contact? 4 A. I think you will find it was generally well known that 5 Bristol was a small unit, with small throughput, not 6 having the specialist services to produce good results. 7 I think a lot of people would not have wanted their own 8 children to go to Bristol on process grounds and I think 9 that was well known within the specialty. 10 Q. You would add the split site? 11 A. I am not a specialist. I would have thought it would 12 make a difference, but Professor Angelini's evidence 13 when he worked in Rotterdam was a split site was known 14 to get excellent results. I am not sure if I am in 15 a position to comment on it. Those are the only 16 opinions I know. 17 Q. Can we go overleaf to page 6? At paragraph 7, you talk 18 there about your impression that there did not appear to 19 be a clear mechanism for dealing with problems at 20 Bristol. This is your impression really as 21 a commentator, is it, on what you see? 22 A. Yes. As I said, I was very surprised when I found out 23 that there was no systematic audit and some body that 24 came into active audit was identified as poor. The fact 25 some people were writing to Sir Duncan Nicol and others 0122 1 were writing to the Department of Health suggested they 2 did not know who was responsible either. There did not 3 appear to be a clear chain of accountability and if 4 there was, I did not manage to ascertain it. 5 Q. A few lines further down you talk about specifically 6 bringing the attention of Dr Roylance, Virginia 7 Bottomley and so on, and you name a number of people. 8 The process you had in mind here was what? Because you 9 mentioned those names in Private Eye, those individuals 10 would hear of it? 11 A. For example, I knew that people in the Department of 12 Health would have press agencies that would cut out 13 every use of their name and would probably be brought to 14 the attention of somebody who worked there. From 15 a communication point of view it was a failure. It was 16 assuming if you brought it to somebody's attention they 17 would act appropriately. 18 Q. It assumes that it is brought to their attention, 19 secondly that they act upon it, and thirdly I suppose 20 that they think it worthy to act upon? 21 A. It was brought to the attention of Sir Terence English, 22 Sir Keith Ross and various people. 23 Q. You have the compliment, I think, that Dr John Zorab 24 picked up the Private Eye article and used it as 25 a springboard for writing to Sir Terence English, that 0123 1 he, at any rate, paid attention to what was being 2 written in the columns of Private Eye. 3 Looking at the detail of what you put here, the 4 "purchasers", five lines down, are not named. Who do 5 you have in mind? 6 A. I do not know, is the answer. It was the 7 purchaser/provider split and I used the term "purchaser" 8 as I used in previous columns. I cannot in all honesty 9 say who I think the purchasers were. Was it a District 10 Health Authority thing or a Regional Health Authority? 11 I do not have expert knowledge in that area. 12 Q. I think at a later stage you talk about Avon Health 13 Authority, but of course Avon Health Authority did not 14 exist at this time, it only came into being on 1st April 15 1996. 16 So by the "purchasers" you just hoped that 17 somebody who was purchasing from Bristol would read 18 Private Eye and say, "There might be a problem here"? 19 A. Yes. 20 Q. "We had better make enquiries"? 21 A. Yes. 22 THE CHAIRMAN: Mr Langstaff, I wonder whether I may 23 interject? Is it Dr Hammond's evidence, therefore, that 24 when he says "I specifically brought the problem ..." it 25 might better read "I specifically sought to bring the 0124 1 problem ..."? 2 A. Yes, thank you. 3 Q. You say under (8), the second paragraph, that not only 4 did you write in Private Eye, but as you told many other 5 doctors and "talked about the problems at my local 6 cardiac surgery unit on stage". 7 When you say you told "many other doctors", these 8 were what, GPs? 9 A. Yes, people I met when I was doing a lot of after dinner 10 speaking, going to dinners and things. A lot of people 11 read Private Eye and knew I was writing for it, and we 12 talked about it on stage. 13 Q. This would be along the lines of satirical humour, would 14 it? How would you refer to Bristol? 15 A. Yes, it was done in a satirically humorous way. In 16 retrospect whether it appears at all humorous, I doubt. 17 I mean, humour, satire, is not meant to be a solution, 18 but it is an extremely effective way of crystallising 19 a problem. I was not laughing at poor children who 20 suffered in these units, but I was trying to bring it to 21 attention. 22 Q. Can we go overleaf? The indented paragraph that we have 23 here, the last two sentences of it: 24 "I have been told a Bristol GP who knew Dr Bolsin 25 or knew of his concerns encountered resistance from the 0125 1 Health Authority." 2 Do you know when that was? 3 A. It would have been at the time. 4 Q. Which time? 5 A. The context in which I heard it, I spoke at a women's 6 group for GPs in Bath and spoke about my book and 7 somebody mentioned it as dinner table conversation, but 8 I have long ago stopped chasing up these sort of leads 9 because I now find it profoundly depressing. Every lead 10 leads to the same thing and I do not want to be an 11 investigative journalist looking into this problem any 12 more. Every dinner I go to, people express opinions and 13 say "so-and-so knew then and so-and-so knew then", 14 hundreds of them, and I have just given up writing them 15 down. It is really profoundly depressing. 16 Q. Help me, if you can. Can you give us any better 17 indication as to the time that this Bristol GP 18 encountered resistance from the Health Authority? 19 A. Dr Bolsin told me in 1992 he was telling anyone who 20 would listen, so I presume it was in the context of 21 that, somebody who had spoken to Dr Bolsin, so I imagine 22 it would have been about that time. 23 Q. Do you know what form the resistance took? 24 A. No. It was a remark that somebody had said, whether 25 they had a child to refer or they wanted to insist in 0126 1 a future situation something would change, I gather the 2 Health Authority was approached. 3 Q. At this stage there were problems after 4 purchaser/provider splits in securing extra contractual 5 referrals, were there not? 6 A. Yes. 7 Q. So the GP was, because of the way the fund-holding was 8 administered, naturally encouraged to send his case 9 within the contract that the Health Authority had 10 organised as a purchaser? 11 A. Yes, and I believe, as I say in that paragraph, that 12 this particular thing was hugely detrimental, as in 13 cleft palate services and biliary atresia services and 14 possibly in this case. 15 Q. What one would expect from the way the Health Service 16 was administered, in the early 1990s at any rate, would 17 be that any GP wanting to send his case to some other 18 unit would have to justify that on proper scientific 19 grounds? You are nodding. 20 A. Yes. 21 Q. I suspect that the position might have been taken in the 22 early 1990s -- I do not know, it is speculation and I am 23 inviting your comment -- that there was no verifiable 24 scientific basis for choosing to send a child elsewhere? 25 A. I think that is true, but I think that can be extended 0127 1 to the whole of medicine. You could probably say in 2 1992 there was never any verifiable scientific basis for 3 quality control in any specialty whatsoever. You are 4 saying the whole of the NHS was completely unaccountable 5 and there was no scientific verification of any quality 6 of service. So therefore, nobody could ever get an 7 extra-contractual referral. 8 Q. Do you know anything further about a particular child, 9 where the child went? 10 A. No, I can attempt to look into it. It will be hard, but 11 I can attempt to look into it. 12 Q. Can we go then over two pages to page 9? You say in 13 respect of Dr Bolsin, the third paragraph down, that 14 Dr Bolsin was clearly very stressed and under pressure, 15 but his clarity of thought and purpose was consistent. 16 In what way did he manifest the stress? 17 A. He just gave a sense of somebody under pressure who was 18 quite frightened, the implications of what he was 19 saying. It was the impression of somebody who looked 20 actually very unhealthy. He looked as if he might 21 possibly be distressed. He looked tired, had bags under 22 his eyes. He looked as if I had seen him in the surgery 23 I might be worried about the level of stress he was 24 under, but in contrast, when he opened his mouth, what 25 came out of his mouth was incredibly clear. But, yes, 0128 1 I mean, observing him, just looking at him, my view as 2 a doctor was that he was very much under stress. 3 Q. So this is observing him physically rather than 4 observing the way that he said things, the way that he 5 acted? 6 A. The way he said things always was very measured and very 7 precise. 8 Q. Nothing in that to indicate stress or pressure? 9 A. No, but also, he told me about the pressure he was 10 under, the fact he had raised concerns with Dr Roylance 11 before and he said himself that he was under a lot of 12 pressure. 13 Q. So when you are talking here about him being clearly 14 very stressed and under pressure, it is a mixture of two 15 things. One is the way he looked physically and the 16 other is the content of what he was saying to you about 17 being under pressure? 18 A. Yes, but the content of what he was saying to me about 19 the problems in the unit was always very precise. 20 Q. You say "always". You met him once and you had the four 21 or five phone calls? 22 A. Yes, in all my conversations with him, yes. 23 Q. Your supplementary statement, page 39 deals I think in 24 large part with the reasons why you personally did not 25 take matters further, and you are responding to the 0129 1 statement of Sir Keith Ross. You say in paragraph 2 2 that there was another source in Southampton who 3 expressed concerns about poor results for complex 4 paediatric heart surgery in Bristol. Can you give us 5 the nature of that source? 6 A. It was someone working within the specialty. It was 7 a name I was given from one of my other sources to 8 contact. 9 Q. And the nature of the specialty is cardiothoracic? 10 A. Working on the unit. I am not sure which specialty, but 11 someone working on the unit within that specialty. 12 Q. So the specialty would be cardiac? 13 A. It could have been a cardiologist, an anaesthetist or 14 a surgeon. Less likely to be a surgeon. I have not met 15 that many other surgeons, other than trainees. 16 Q. And the same paragraph, the last sentence: but also the 17 view that you received from sources in other centres at 18 the time. What other centres? 19 A. These particular points I have already been through. 20 There were people in -- 21 Q. So it is simply going back to where we have already been 22 in evidence? 23 A. Yes, certain London centres. 24 MR LANGSTAFF: I do not have very much more to ask you, 25 Dr Hammond, but it may be convenient, sir, for a short 0130 1 break before, as it were, we finish the day's session. 2 THE CHAIRMAN: Thank you, Mr Langstaff. Shall we take 3 15 minutes, then, and reconvene at about 3.20? 4 (3.05 pm) 5 (A short break) 6 (3.20 pm). 7 MR LANGSTAFF: Dr Hammond, as I indicated before the break, 8 there are very few questions which I have still to take 9 up with you. 10 Can we look, please, at page 283/28? The bottom 11 of the left-hand page, the top of the right. You talk 12 there about risk stratification. You are not an expert 13 in cardiac surgery? 14 A. No. 15 Q. But you are obviously an informed commentator. The 16 point you are making is that risk stratification is 17 a necessary starting point before one can properly 18 compare the results of one unit and another? 19 A. Yes. Ideally, yes. 20 Q. But for adults, one can, it is accepted, have a form of 21 risk stratification, but the point that is often put is 22 that for children it is much more difficult? 23 A. Yes. 24 Q. Do I take it that you have a response for that? 25 A. It is possible that you are saying in paediatric cardiac 0131 1 surgery it is impossible to compare like with like 2 without adequate risk stratification. I appreciate to 3 this day there may not be a system that everybody agrees 4 with. All I had at the time was the judgment of people 5 giving me information who had worked in other units that 6 babies with comparable severity, illnesses, were doing 7 far better. That was not ideal; it was the best 8 information available to me. Subsequently I have heard 9 when new cardiac surgeons came into Bristol operating 10 on, as far as we know, a similar patient population, the 11 results suddenly became much better. That is the best 12 information that I am aware of. 13 Q. So you say, look at Bristol itself, change the surgeon, 14 have a dedicated paediatric cardiac surgeon and the 15 results appear to be better. You comment at WIT 283/31, 16 the right-hand side: 17 "We knew James' results ..." 18 You are saying "as one of the managers told me in 19 1998", and then the bit that is now highlighted on the 20 screen, what is said there: 21 "Always in the hospital, always working, a picture 22 painted at the weekend, his white Volvo in the carpark, 23 he worked so bloody hard he used to fall asleep in board 24 meetings." 25 What was the Manager who said that? 0132 1 A. I have his name and I will find it for you. I cannot 2 remember it offhand. I believe you may already have 3 sought evidence from him. 4 Q. So you will give us his name anyway? 5 A. I would have to check it, yes, but I am pretty certain 6 I have kept a copy of his name. 7 Q. Thank you. That will be helpful. You appear to accept 8 that Mr Wisheart -- and I think it may be Mr Dhasmana -- 9 were people whose commitment to working as cardiac 10 surgeons was never in question? 11 A. Yes. I would accept that, and right from the beginning, 12 I have spoken to people who trained in Bristol who 13 always praised their commitment and their dedication. 14 Q. Your criticisms -- and I appreciate that they are made 15 on the basis of what has been said to you, so it is to 16 get an idea, an overall picture of what has been said to 17 you that I am asking you these questions. Your picture 18 is rather that the problems at Bristol were problems of 19 process rather than individual surgery; is that right or 20 not? 21 A. We come back to this split at the beginning that I spoke 22 to you about the interpretation. In Bristol there are 23 those who believe that it was a system failure and the 24 surgeons were almost forced into providing a service 25 with inadequate resources. Mr Wisheart asked for 0133 1 a specialist paediatric cardiac surgeon but none was 2 provided so he carried on doing the operations himself. 3 Those who feel that as a surgeon you have to take 4 individual responsibility for your competence, and if it 5 is brought to your attention that results for individual 6 operations are not good, then you have to take account 7 of that. I suspect the truth lies somewhere between the 8 two of them. 9 Q. There is nothing more I think that I particularly want 10 to ask you, save this: you wish to make a point, as 11 I understand it, about the way in which experience and 12 numbers matter and the way in which audit matters? 13 A. You have caught me there. Did I tell you that 14 beforehand, that I wanted to make this point? 15 Q. You make it in your statement, and you make it by 16 sending the additional material. 17 A. Yes. I am sorry. I think that is an important point. 18 I am not a surgeon, but the experienced surgeons I have 19 spoken to, for example, Professor Ted Howard who is 20 involved in the biliary atresia story has said it is the 21 process that is as important as the outcome. It is the 22 training of the surgeons that is absolutely 23 fundamental. I can remember Ash Pawade talking about 24 how he believed his training was better in this 25 particular technique than some surgeons in the UK might 0134 1 have. 2 All of my life in the media has been dedicated 3 almost to raising concerns about how doctors are 4 trained. I believe the problems at Bristol go right the 5 way back to house officers turning up on the ward on the 6 first day and being expected to do procedures that are 7 beyond their competence. It is only recently we have 8 defined competencies that house officers should have and 9 in most medical schools they are not checked before they 10 become house officers. There are a lot of junior 11 surgeons doing operations for the first time without 12 supervision, even present in the hospital. I think 13 there are many issues in Bristol that are generic to the 14 NHS. It will take a lot of sorting out. 15 I think the other point I would make is that 16 I feel I have learned from my experience. I do not feel 17 particularly proud with my role in this. I am happy to 18 be called to account for it. I think if I had my time 19 again, a more constructive thing to do might be to find 20 out the units who are doing an operation well and launch 21 an immediate campaign to say "I think these children 22 should be treated in these units". I think if you start 23 going into scapegoating and blame it is very 24 destructive. The tactic we used on "Trust me (I'm 25 a Doctor)" is to find the good units and say "Why cannot 0135 1 the NHS be brought up to this level?" 2 One final point is that having worked with 3 Mrs Shortis in CDCA, I have found the medical 4 establishment now and the Department of Health are far 5 more open. They are very happy to discuss these things 6 and have been very open and honest with us in our 7 meeting with the Society of Cardiothoracic Surgeons. 8 They admitted to Mrs Shortis that Bristol was an 9 avoidable tragedy and said to me in a sense Bristol 10 "needed to happen", these issues needed to be 11 addressed. I think if people at the very top of the 12 hierarchy are making those admissions openly and 13 frankly, I think there is the collective will in 14 medicine to make something of this. Whether we are 15 given the will and resources to do it, we will have to 16 wait and see. 17 Q. I have asked you a lot of questions. Is there anything 18 else you would wish to add at this stage? 19 A. No. I think I can go back with the sources I am in 20 contact with I can ask them again if they wish to give 21 information and any other information I am given which 22 I think will be relevant I will forward to you. 23 Q. Thank you. There have been a number of occasions when 24 today I have asked you for names and you have been kind 25 enough to indicate that you would check and put such 0136 1 pressure as you can in the light of your belief that 2 openness is the best policy. 3 A. I would say openness without victimisation. 4 Q. You appreciate that I cannot, in the role that I have 5 here, give you specific advice as to libel. You 6 mentioned earlier, for instance, that there were 7 comments which you would not repeat because you thought 8 they might be libellous. We will be interested to know 9 the nature of those comments, crude as the expression of 10 them may be, if, upon having such advice as you think 11 appropriate, you consider that it is reasonable in law 12 that you should provide them to us. I have to leave 13 that, you will understand why, in your hands. That is 14 why I say it publicly as I do. I have little doubt that 15 you will check the transcript of your own evidence and 16 pick up any references that need to be picked up. 17 It follows from what I have been saying to you, if 18 you have anything further to add, and we hope and expect 19 that you will have, that you will do so and do so sooner 20 rather than later, if you would. 21 Unless there is anything else you want to add, 22 those are all the questions I have for you, but there 23 will be some, no doubt, from the Panel. 24 THE CHAIRMAN: Thank you Mr Langstaff. Dr Hammond, there 25 are not immediately any questions from the Panel; the 0137 1 ground has been covered well by both you and 2 Mr Langstaff. 3 There were, I repeat and remind you, a number of 4 occasions when you kindly indicated that you may be able 5 to make further material available. In addition to what 6 you are able to recall from today in terms of what you 7 said, you may be able to help us. If it would help you, 8 we will ourselves look through the transcript and remind 9 you that on this or that matter you may be able to do 10 something for us. If that would help you, we would be 11 more than happy to do that. 12 I am sure that when we reach Phase II of our 13 Inquiry, there may be again things that you may want to 14 help us with there. That of course is some way off, but 15 nonetheless, will eventually take place. 16 But for today, thank you very much indeed for 17 coming. It has been very helpful. We have learned 18 a lot and I am very much in your debt. Thank you. 19 MR LANGSTAFF: Sir, tomorrow we have Sir Alan Langlands, 20 followed by Her Majesty's Coroner for Avon, Mr Forrest. 21 We begin at 9.30. 22 THE CHAIRMAN: Forgive me, Dr Hammond, you are free to stay 23 or leave, but we always cover the business of the next 24 day at the end of this day. Thank you, Mr Langstaff. 25 Thank you everyone. We reconvene, as was said, at 9.30. 0138 1 (3.36 pm) 2 (Adjourned until 9.30 am on Tuesday, 19th October 1999) 3 4 5 6 I N D E X 7 8 9 DR PHILIP JAMES HAMMOND (Sworn) 10 11 Examined by MR LANGSTAFF ..................... 1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 0139