The teams, which include the major medical organisations and leaders of the professions as well as patients, have been told to devise ideas for modernising every aspect of the service."The time has come to have an NHS where the patients are listened to and not talked at," Mr Milburn said.Critics said the consultation would distract attention from the serious business of spending money. Since the announcement in March by the Chancellor, Gordon Brown, of an extra £2bn for the NHS for this year, hospital chief executives have found themselves in the unfamiliar position of looking for new ways to expand.The NHS Confederation and the Consumers' Association said the consultation should be on a rolling basis to provide patients with a continuing voice but the British Medical Association warned against raising expectations beyond what even the extra billions pledged could provide.Dr Ian Bogle, chairman of the BMA, said: "We hope that the Government is prepared to face up to potentially unpalatable messages, namely that public expectations of the NHS may require even more funding than has been earmarked for the next five years. Doctors in particular are very concerned that this survey will reveal that, despite all the pressures upon the NHS, the public expects even more."The BMA said special efforts should be made to obtain the views of those not normally canvassed, such as the elderly and the chronically sick.Mr Milburn told a meeting of one of the modernisation teams in London: "One of the biggest challenges we face is to transform the NHS from a service built around the needs of professionals to one built around the needs of users." He said he wanted an NHS "where the consumer is king".. The "professional arrogance" and paternalistic attitude of doctors who removed hundreds of organs from dead children without parental knowledge or consent led to a "social and ethical time bomb waiting to go off", an inquiry report said today. The "professional arrogance" and paternalistic attitude of doctors who removed hundreds of organs from dead children without parental knowledge or consent led to a "social and ethical time bomb waiting to go off", an inquiry report said today. The report into the removal of hearts from children at Bristol Royal Infirmary called for a strict new code of practice to be introduced regulating the removal and retention of organs and the treatment of bereaved parents.The interim report, produced by the Bristol Royal Infirmary inquiry, includes almost 70 recommendations covering coroners' inquests and post mortem examinations carried out by hospitals.Its authors criticise the way in which doctors routinely took human material from dead children for a variety of purposes and kept large collections without the knowledge of parents or the public.The hearts of 170 children at the Bristol hospital were removed during post mortem examinations and kept for educational purposes without parents' knowledge, causing great distress to those parents when they later learned that they had buried their children with organs missing.The scandal emerged during investigations into high death rates of children who underwent heart surgery at the Bristol hospital between 1984 and 1995.The inquiry into heart surgery at the hospital, which is being led by Professor Ian Kennedy, was widened to include the way organ removal was handled and today's report focuses on this issue.The report found that during the inquiry's terms of reference and indeed for some time after "there was in essence, a professional arrogance, justified when necessary by the recourse to traditional paternalism, that parents, on this view, are best kept from the details but would be thankful if they knew what was being done".It added: "Fundamentally, there was a social and ethical time bomb waiting to go off. It is no surprise that the explosion of anger, when it came, was huge."The report said the cause lay in two conflicting attitudes, which were the parents of a recently deceased child continuing to regard the organs as part of the child's body and therefore still the child, and the pathologists and clinicians for whom such material was simply a dehumanised specimen.The study called for a strict code of practice to be introduced to help solve this conflict which would be based on two fundamental guiding principles: first and foremost, respect for parents and their dead child; second, the value of continued access to human material for the advancement of medical care and treatment.It recommended parents should be told exactly what was going on and what the benefits would be from organ removal, as well as making sure that parents were told in an appropriate manner and at a suitable time.Evidence within the report showed that parents found themselves asked to discuss the signing of papers at a time which was too close to the death of their child, when they were "clearly and understandably unable to comprehend what was being put to them".The report recommended: "Obtaining parents' consent should be seen as a process, and not just a signing of a form.

As part of that process parents should be allowed proper time to reflect and be informed that they may change their mind until such time as they sign a form indicating their consent."It was also recommended that parents should be told that they may refuse consent for the retention of organs and be able to do so in a supportive atmosphere where they had access to clear and comprehensible information.The report branded the law regulating the removal, retention, use and disposal of human material as "obscure, uncertain and arcane" and recommended that it should be amended or clarified.It recommended that the code of practice, backed with appropriate enforcement mechanisms for example, incorporating it into the employment contract of clinicians should be backed by the Government.. Primary school pupils can no longer hit the high notes because the art of singing is declining, the leader of Britain's choir schools said yesterday. Primary school pupils can no longer hit the high notes because the art of singing is declining, the leader of Britain's choir schools said yesterday. The modern tunes many children are taught - as with pop songs - involve only a narrow voice range, Richard White, chairman of the Choir Schools Association and head of Polwhele House School in Truro, Cornwall, suggested.He told the association's conference in Canterbury, Kent, attended by heads from the 44 choir schools: "Singing used to be a strength in primary education but is fast becoming something of a rarity, resulting in many children... being denied the opportunity of discovering that they have musical talent."He said that even children who auditioned for choirs from primary schools where singing was a regular feature often had to be retrained. Many had "chest voices" that take them "beyond the upper limits that should be used with this part of the voice. Sadly, many have not discovered the head voice so vital for the top and most glorious parts of a child's registers," he said.

"Maybe songs for children, like tunes in new hymn books, are being transposed down a few keys to avoid any confrontation with the odd D or E, or maybe the primary school singing repertoire, where it exists, just as the pop repertoire, tends to restrict itself to the narrow range of the chest voice." Traditional tunes were no longer sung, he said.Mr White said he was in no way criticising colleagues in maintained primary schools. Many would like to provide more singing but could not find the teachers or the time to do so.He said recruitment of choristers gave cause for concern. Over the past three years, 11 choir schools reported a decrease in applications, eight an increase and 22 no change.He urged the Government to safeguard singing in primary schools. While he welcomed the allocation of £30m of lottery money for the development of music and singing, he feared it might only benefit those who were already involved in music.Richard Crozier, director of professional development at the Associated Board of the Royal Schools of Music, said: "There is a tendency for schools to sing songs which children find very appealing. There is a good argument for doing that, but they have a more limited range of notes. Teachers do not receive enough training in music teaching and are not comfortable in leading singing."* Small rural schools should be encouraged to pool resources and form "mini-federations" to survive, council leaders said yesterday.A report by the Local Government Association suggested they should use computer technology to share specialist teaching and open school buildings to village communities at evenings and weekends.It said village schools had to be maintained to prevent a "spiral of decline" in the countryside. There are 2,700 primary schools in England with fewer than 100 pupils; 700 have fewer than 50 pupils.