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Hearing summary

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 ‘Whistleblower’s advocate’ or ‘go-between’. Dr Hammond described some of his impressions of the Bristol cardiac unit, gained whilst working as a House Officer at Bath’s 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.

 

FULL TRANSCRIPT

 

   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 œ9.99.
  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

Published by the Bristol Royal Infirmary Inquiry, July 2001
Crown Copyright 2001