NHS chief executive Sir Alan Langlands told the inquiry last week that individuals and 'the system' were responsible for preventing clinical failures.

He said that in the early 1990s, the Department of Health relied on professional self regulation, the 'developing discipline' of audit, the 'rudimentary' internal market and remaining ties to the centre to pick up problems but 'all of these would have to be perfectly aligned to ensure failure did not occur'.

Asked to comment on whether the DoH had been responsible for Bristol's paediatric cardiac services, because they were funded centrally, or whether health authorities were responsible, as part of their public health functions, he declined 'to choose either/or'.

Instead, he argued that clinicians, HAs, the trust and the DoH all had some responsibilities and the 'crucial thing' would have been to make sure roles and responsibilities were clearly defined.

'What I want to avoid is any notion that somehow no-one is responsible, ' Sir Alan said.