Rapid Responses to:

EDUCATION AND DEBATE:
Rudolf Klein
Competence, professional self regulation, and the public interest
BMJ 1998; 316: 1740-1742 [Full text]
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[Read Rapid Response] Lessons for audit from the Bristol Case
Susan Kerrison   (18 June 1998)

Lessons for audit from the Bristol Case 18 June 1998
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Susan Kerrison,
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8 Ellesmere Road LONDON NW10 1JR

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Re: Lessons for audit from the Bristol Case

As Treasure (1) and Klein (2) point out one the main questions arising from the Bristol enquiry is why so many warning signals went unheeded. In particular, although audit data from the UK Cardiac Surgery Register which appeared to raise quesions about the performance of the Bristol unit was available, it was not acted upon. In some ways this is not surprising. When audit was first introduced there was great reluctance to associate it with policies for professional accountability. One of the consequences of this was that Royal Colleges had no mechanisms in place to act upon the findings of the national and regional audits they commissioned. Research (3) undertaken in the early 1990s on the audit programme of the Royal College of Physicians found that audit had the characteristics of a research activity, owned by the individuals undertaking the work, disseminated by them through publication in journals and presented at scientific meetings. At that time the Royal College of Physicians had no organisational mechanisms for dealing with the findings of audit.

The differing role of the GMC, the Royal Colleges and the DH in relation to the accountability of doctors remains unclear. The "rapid response" system being set up by the RCS is clearly a step forward but it remains to be seen whether Royal Colleges will be able to set up organisational structures robust enough for rigorous peer review.

1. Treasure T Lessons for the Bristol Case BMJ;3161998:1685-86 2. Klein R Competence, professional self regulation and the public interest BMJ 1998;316:1740-1742 3. Kerrison SH, Packwood T, Buxton M Review of Supra Hospital Audit in Medical Specialities Health Economics Research Group, 1994 Brunel University .