The former head of the Department of Health has told the Bristol Royal Infirmary Inquiry that there was 'no system' of measuring the quality of care provided by the NHS in the 1980s.
Sir Graham Hart, director of operations at the NHS management board from 1985 and subsequently permanent secretary at the DoH until 1997, told the inquiry there was a 'deeply rooted reserve' against the department becoming involved in clinical performance.
He said the reserve was founded on a feeling that 'ministers who are politicians should not be involved in the clinical treatment of patients' and on a fear of doctors' reaction if they tried.
But when inquiry counsel Brian Langstaff QC later returned to the issue, Sir Graham said the 'mainstay' of quality for patients and public 'should lie in the qualifications and professional conduct of the people who are chosen very carefully to carry out this work - the consultants' plus their colleagues and employers.
Inquiry chair Professor Ian Kennedy commented: 'One of the features of our taking evidence is that no matter whom we have spoken to - whether it be a health authority, a trust, a royal college and now the department - they have always found someone else to be responsible.
'Hearing from you on the point of view of the department saying 'ultimately it is back to the doctor'' has effectively squared the circle of our difficulty.'
Sir Graham responded that there was a 'shared responsibility', which did not mean 'seeking to step aside from responsibilities'.
Sir Graham stressed he felt the situation had changed since the early 1980s and welcomed moves such as the introduction of the Commission for Health Improvement. He said he could not recall if he had seen allegations about poor survival rates for babies at the infirmary printed in Private Eye, but 'in general one would expect it to be taken seriously'.
He regarded allegations that the DoH had been involved in a cover-up as 'pretty scandalous'.