Q151 Mr Davidson: Surely these are entirely different to this point. I understand completely your issue about affordability because we would assume that the Department always wants to make sure that something is affordable, but it is entirely possible for you to be enthusiastically supportive of something, provided it is affordable. That is entirely distinct from what is said here which is what you have agreed. May I ask Mr Nettel and Mr Bell whether or not this is their impression? Were you of the view that the Department really did not care one way or the other, or did you think that they were either enthusiastically for or against this in principle?
Mr Nettel: They did not represent a homogeneous view. There were people doing different things and different functions within the Department legitimately that could be interpreted as having quite widely differing levels of enthusiasm about the scheme proceeding.
Q152 Mr Davidson: And that that would therefore be somewhat confusing.
Mr Nettel: It was from time to time difficult for us to interpret precisely what was happening.
Mr Bell: That is a fair answer. Certainly the perspective we had towards the period from March to May 2005 was that the Department was interested in getting an outline business case proposition, but we did not have any confidence that, at the end of the day, whatever outline business case proposition would-
Q153 Mr Davidson: I understand that. Was that your impression of the Department's position?
Dr Goodier: Julian summed it up very well.
Q154 Mr Davidson: Mr Taylor, how can that be? I do not want to accuse the Department of Health of being not fit-for-purpose, but that really is the phrase that comes to mind. If you are partnering people or organisations, how can it be that you are sending out mixed messages?
Mr Taylor: A pretty clear message had gone out from the Department in January 2005 that at that stage we had very, very significant reservations about the likely affordability of the scheme and that is a matter of record.
Q155 Mr Davidson: Sorry, you keep diverting onto that and I understand completely that you will always have this issue about affordability, but the issue that seems to be covered in this paragraph, which you or your predecessors have agreed, is the question of just the general intent, the sharing of the vision and the desirability. Now if you are saying to me that you do not accept what has been written in the Report, I accept that now. There is an issue about whether or not you should have checked it earlier on.
Mr Taylor: What I am saying is that I can understand how this perception, which has just been described by my colleagues, arose. On the one hand we were by this stage asking some very tough questions about the scheme and on the other hand we were still trying to work with the campus partners to make it work. I can see that they come across as mixed messages. In the eyes of the Department it was a balance which we were to-ing and fro-ing between affordability and supporting the scheme and probably, with the benefit of hindsight, we should have come down harder one way or the other. I am being straight with you about that. Probably the Department should have taken its critical approach to this at an earlier stage, but I fully understand why colleagues wanted to work with the partners as apparently new opportunities to keep this scheme open arose and they should not be criticised for that.
Q156 Mr Davidson: That is fine. Saying that you can now is very helpful because it is all about learning lessons. Could I therefore come to the role of the Brompton? I get the impression that the Brompton was really never as keen to be involved as the others were on seeing this going forward and that the fact that you made a pre-condition that you were not going to have a merger then trapped everybody into preserving your position. Can you just clarify for me whether or not there was anything more to that than just simply being precious? I recognise there was a huge amount of vested interest, particularly from clinicians who lead so many of these things and they would wind up patients and so on and so forth. You wanted to keep your autonomy and independence. Was there more to it than that?
Mr Bell: My examination of the record points to more issues and more amplification to your question. You have to remember that the Brompton is a combination of a merger itself of the Brompton and the Harefield hospitals which came into being in 1998 and when we signed up to become members of the scheme in February 2000 we were still in the throes of trying to make a challenging merger of two hospitals located 14 miles apart work. For us to have considered at that time that we could move forward with a scheme in which we would further merge would have been a greater step than we were ready to take.
Q157 Mr Davidson: Okay, I can understand that perhaps at that stage but I just get the impression that that carried on all the way through and that you continued to be precious throughout this whole exercise. Is that fair?
Mr Bell: It is fair and the reason for that is that mergers do come with a fair amount of challenge and cost and really the position that we-
Q158 Mr Davidson: I understand that. Time is limited. Mr Taylor, can I just come back then to this point in paragraph 18 where the Department seemed to have believed that a merger was actually necessary between the two hospitals, but did not actually do anything about it. That sounds a bit unduly hands-off, does it not?
Mr Taylor: There was a recognition at the time that the outline business case went forward and subsequently, that if the issue of the merger had been pressed then Brompton and Harefield would have pulled out of the scheme.
Q159 Mr Davidson: So Brompton and Harefield effectively had a veto on it because they were having difficulty amalgamating themselves.
Mr Taylor: It is not fair to say that they had a veto.
Q160 Mr Davidson: Let me be clear. They did not have a veto, but they were going to pull out if they did not get their own way. That sounds pretty much like a veto to me.
Mr Taylor: Yes, it is a very strong condition; I agree.