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The hugely anticipated inquiry into children's deaths at Bristol Royal Infirmary will also be seeking wider lessons on the powers of professional groups in the NHS, writes Alison Moore

What is expected to be the NHS's longest and most costly public investigation gets underway next Tuesday. The Bristol Royal Infirmary inquiry is expected to last well into next year and could cost more than£5m.

It may be 18 months before its recommendations are published, but it is already expected to have far-reaching ramifications for hospital services throughout Britain.

The inquiry was set up after the General Medical Council struck off two doctors and censured a third over a series of deaths among children undergoing complex cardiac surgery at Bristol Royal Infirmary.

The GMC inquiry heard harrowing evidence of death rates far higher than at other surgical centres, colleagues struggling to have surgeons investigated, and parents being given misleadingly optimistic prognoses. In the 53 cases it looked at, 29 children died and a further four suffered brain damage.

On 18 June last year consultant heart surgeon James Wisheart and John Roylance, former chief executive of United Bristol Healthcare trust, were struck off for serious professional misconduct. The GMC ruled that consultant surgeon Janardan Dhasmana should not perform heart surgery on children for three years. Some parents have already started action in the civil courts.

Within hours of the ruling health secretary Frank Dobson announced a public inquiry into the cases, chaired by Professor Ian Kennedy, an expert in medical, legal and ethical issues.

It soon became clear the inquiry would look far beyond the clinical management of individual cases into contentious areas that have rarely seen the light of public scrutiny. Unlike the GMC hearings, which focused on a small number of cases, it will examine child heart operations in an 11-year period, potentially some 2,000, and 'reach conclusions from these events and make recommendations which could help secure high-quality care across the NHS'.

At a preliminary hearing last October, Professor Kennedy said: 'The objective of the inquiry is to understand what happened in Bristol, why it happened and what lessons can be learned for the benefit of the NHS as a whole.'

The task is vast. Staff working for Professor Kennedy and his team have already scanned more than 500,000 pages of documentation.

Among the issues the inquiry expects to address are the relative powers of the professional groups, attitudes towards 'whistleblowers' and patients who complained, and the role of the trust, health authorities and the Department of Health. Controversial areas may include how clinical and medical audit is run and the role of managers; appraisal and training of clinical staff, and the degree of information given to patients when informed consent is obtained.

The inquiry will also look at how to deal with a surgeon's 'learning curve' - when they start doing unfamiliar operations, typically with a lower success rate than an experienced surgeon.

Since October the inquiry team has been sifting through statements from hundreds of potential witnesses and is now starting hearings at a converted office building in the centre of Bristol.

For the rest of the year it expects to look at how the hospital managed children with complex heart problems between 1984-95. Professor Kennedy will consider looking at cases outside these dates, or operations on adults, if relevant.

Some of the most distressing evidence - from the families - is likely to come in the first few weeks. Then the inquiry will focus on the national context in which the operations took place and the management of care of individual children. Finally, it will look at the adequacy of services and how concerns about treatment were dealt with.

The second phase will look at broader issues for the NHS and is expected to last several months. One issue the inquiry team has had to face before hearings have even begun is the intense interest in the case - from the media, healthcare professionals and hundreds of parents whose children were treated at Bristol. The inquiry website has recorded more than 1,000 hits a week and will be updated each evening with transcripts of the day's public hearings.

Video links to towns in the South West and Wales are planned - the hospital treated children from a wide area - and transcripts will be placed in public libraries in the region. But many bereaved parents are likely to want to attend the hearings in person, to give evidence or just to listen. The offices include a 'quiet room', a family room and a room with a live video link to the proceedings.

Families who find the experience too distressing will be guided towards counselling services: the inquiry's recommendations to 'help secure high- quality care across the NHS' will come too late for them.www.Bristol- inquiry.org.uk