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Daily transcripts
Hearing summary
10th June 1999
Today the Inquiry heard from Mrs Rachel Ferris, General Manager for the Directorate of
Cardiac Services, UBHT (Nov 1994 – present) who outlined her NHS career in Bristol
which began in 1985 at Farleigh Hospital. She commented on the ethos of UBHT which she
described as being anti-bureaucratic and lacking in strategic direction. Mrs Ferris then
described the evolution of the Cardiac Services Directorate and the professional
relationships between the directorate and the executive board. She commented on the
regular meetings which took place to discuss Directorate business and described changes
which have taken place since 1994, primarily the integration of nursing services across
cardiology, cardiac surgery and cardiac intensive care. Mrs Ferris was asked about her
perception of the role and management style of the Chief Executive and the Director of
Operations/Nurse Advisor. She then commented on her discussions with purchasers about
their concerns about the waiting times for, and quality of, Bristol’s cardiac
services and went on to outline the development aims of the Directorate. Mrs Ferris was
then asked about her view of the management ability of the Associate Clinical Director for
Cardiac Surgery, Mr Dhasmana and concluded by describing the tensions within the
Directorate following the publication in the media of concerns about paediatric cardiac
surgery in 1995.
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FULL TRANSCRIPT
1 Day 27, 10th June 1999
2 (9.30 am)
3 THE CHAIRMAN: Good morning, everyone. Good morning,
4 Mr Maclean.
5 MR MACLEAN: Good morning. Can I say how grateful we are
6 for the Panel allowing us a little extra time this
7 morning. The reason for that was to allow Mrs Ferris to
8 read some comments on her evidence that have come in
9 overnight.
10 Today's witness is Mrs Ferris, General Manager of
11 the Cardiac Services Directorate at the UBHT. Can
12 I call Mrs Ferris, please.
13 MRS RACHEL CORRIE FERRIS (SWORN):
14 Examined by MR MACLEAN:
15 Q. Your full name is Rachel Corrie Ferris?
16 A. That is right, yes.
17 Q. As I have already said, you are the General Manager of
18 the cardiac services directorate of the UBHT?
19 A. Yes, I am.
20 Q. And that is a post that you have held, I think, since
21 November 1994?
22 A. Yes.
23 Q. Can we have WIT 89/1, please? Is that the first
24 page of the formal written statement that you made to
25 the Inquiry?
0001
1 A. Yes, it is.
2 Q. If we go to page 36, that is your signature, is it not?
3 A. It is, yes.
4 Q. Have you read that statement through recently?
5 A. Yes.
6 Q. Are you happy for that to stand as part of your evidence
7 to the Inquiry, or is there anything you would like to
8 alter in that statement?
9 A. No, I am happy for it to stand.
10 Q. I think you submitted, along with that statement, the
11 document that begins at WIT 89/38. That continues over
12 the page at 39. That is the document you drew up in,
13 I think, August 1995?
14 A. Yes, that is right.
15 Q. We have had some comments on your evidence. We have had
16 comments from, in no particular order -- actually the
17 order they have been scanned into the database --
18 Margaret Maisey; have you had a chance to see those?
19 A. Yes, I have.
20 Q. From Professor Vann Jones?
21 A. Yes.
22 Q. From the UBHT itself?
23 A. Yes.
24 Q. From Janet Maher?
25 A. Yes.
0002
1 Q. From Mr Ash Pawade?
2 A. Yes.
3 Q. Mr Dhasmana?
4 A. Yes.
5 Q. And Mr Wisheart?
6 A. Yes. I have just seen those two this morning.
7 Q. Can we go back to page 1, please, of that file, and just
8 look at your background? You were appointed to the NHS
9 as a graduate management trainee in September 1983?
10 A. Yes.
11 Q. What were you a graduate of?
12 A. Politics and government.
13 Q. You went straight from university into the Health
14 Service?
15 A. Yes, I did.
16 Q. If we scan down that page, we see that you worked in
17 September 1985, between then and August 1988, at
18 Farleigh Hospital?
19 A. Yes.
20 Q. Was that when you first met Mrs Maisey?
21 A. Yes, it was, yes. Mrs Maisey was based there as I think
22 at that stage she was the unit administrator for the
23 South unit and her office was based at Farleigh
24 Hospital.
25 Q. Farleigh Hospital was one of the hospitals embraced
0003
1 within the South Unit?
2 A. Yes.
3 Q. That was one of the two units of the Bristol & Weston
4 Health Authority?
5 A. That is right. The other was the Central unit.
6 Q. If we go over the page, please, to page 2, you entered
7 general management in an acting capacity at the Winford
8 Orthopaedic Hospital in August 1988?
9 A. Yes.
10 Q. And you have been in general management ever since?
11 A. Yes, that is right.
12 Q. And if we look down that page, we see that you spent
13 a time in the Eye Hospital?
14 A. Yes.
15 Q. Between 1989 and 1992?
16 A. That is right. There were two specific roles at the
17 Eye Hospital: initially as the outpatient services
18 manager and then for a period of around 11 months I was
19 General Manager of the Eye Hospital.
20 Q. That was obviously a smaller organisation than the BRI?
21 A. Yes, it was.
22 Q. Because you then moved in November 1992 to be associate
23 General Manager of certain departments within the
24 Directorate of Medicine in the BRI?
25 A. Yes, that is right.
0004
1 Q. So although you had been the General Manager of a whole
2 hospital before, was that move in November 1992 a move
3 up or down?
4 A. It was more of a sideways move. I was looking at
5 wanting to gain additional experience in the acute
6 field, particularly keen on sort of acute bed
7 management. Whilst I was looking after the non-acute
8 specialties within medicine, the role also involved
9 overall bed management for the medical directorate, and
10 I was keen to have that experience.
11 Q. You spent a relatively short period between November
12 1992 and May 1993 in the Directorate of Medicine. You
13 then moved to the Directorate of Surgery?
14 A. Yes, that is right.
15 Q. Why was that?
16 A. I think the original move to the medical directorate --
17 it was a move that I wanted, but it was particularly to
18 gain experience and I really, having had that, although
19 it was a short period of time, wanted to further the
20 experience that I had had, and felt that an opportunity
21 within surgery would allow me to do that, and it was
22 also as part of a discussion with the General Manager of
23 medicine, Janet Maher, who at that time also moved from
24 being the General Manager to Medical Manager. When she
25 moved, I took the opportunity to move out to surgery
0005
1 with her.
2 Q. In November 1994 you became the General Manager of
3 cardiac services?
4 A. Yes.
5 Q. Before we go to that, can I take you to WIT 89/40,
6 please? These are the comments of Mrs Maisey, from whom
7 we heard yesterday, on your statement.
8 A. Yes.
9 Q. Can I ask you to look at paragraphs 2, 3 and 4, please,
10 and then tell me to what extent you agree with what
11 Mrs Maisey says in those paragraphs.
12 A. I think there are some inaccuracies in Margaret's
13 recollection as she has indicated in those paragraphs.
14 The move to Winford Hospital came following the
15 interview for the post at Bristol again; she has got it
16 the other way round. She states that in section 4 of
17 her comments, but actually the move to Winford came
18 because I had been for a post at the Bristol General and
19 I was advised actually at the end of the interview that
20 I would not be appointed to the post, but that she was
21 keen to help me develop and asked me to come and see
22 her, basically, to see if another opportunity could be
23 provided.
24 Q. Mrs Maisey was keen for that?
25 A. Yes. She said she felt I had performed well at
0006
1 interview and that if I was interested, I should talk to
2 her about further experience.
3 Q. So it is right, is it, then to say as she does in
4 paragraph 4 that she took an interest in the progress of
5 your career?
6 A. I think at that stage she was very interested in the
7 career. She was interested in setting up the secondment
8 to Winford, but I think the interest in the career -- as
9 I have said in my statement, there were a number of
10 difficulties in our working relationship and I think
11 that affected her interest in my career.
12 Q. Is it right that your moves to the medical and surgical
13 directorates which we have just seen, before you went to
14 cardiac services in 1994, were part of an in-house
15 development programme for managers that the Trust was
16 implementing?
17 A. No, that is not correct. I think the expression
18 "in-house development programme" is something of
19 a euphemism. The actual move to medical directorate was
20 based on Margaret's request that I move from that
21 directorate, and I was not a willing participant in that
22 move. I was concerned that it was not in the best
23 interests of the ophthalmic unit for the newly appointed
24 General Manager to be leaving post after 10 months in
25 post.
0007
1 Q. Can we take it stage by stage? You were General Manager
2 of the Eye Hospital?
3 A. I was, yes.
4 Q. For the latter part of your period at the Eye Hospital?
5 A. Yes, that is true.
6 Q. You were originally the outpatient services manager?
7 A. Yes.
8 Q. When did you become General Manager of the Eye Hospital?
9 A. I am afraid I have forgotten the actual time period, but
10 I was there around three years. It was the last year of
11 the time that I was there that I became General Manager.
12 Q. You left in November 1992, so essentially --
13 A. Essentially before that, yes.
14 Q. So what you are telling us now about are the
15 circumstances in which you left the Eye Hospital?
16 A. Yes.
17 Q. And took up the job as associate General Manager in the
18 Directorate of Medicine?
19 A. That is right, yes.
20 Q. What was Mrs Maisey's role in that?
21 A. Mrs Maisey was keen I should move to the medical
22 directorate because she had a situation where she wanted
23 to bring a manager or a professional adviser out of
24 a professional department and give them a management
25 opportunity, and she felt that the Eye Hospital would
0008
1 provide a very good training ground for managers, and
2 that is what she hoped to achieve.
3 Basically, she asked if I would move to facilitate
4 that.
5 Q. And you agreed?
6 A. No, I did not agree at that stage, although it involved
7 a lot of difficulty in my relationship with Margaret,
8 and I did feel -- I had certainly agreed at some stage
9 that because I had become a General Manager very
10 quickly, I had still other experience to gain and I was
11 keen to gain experience in other directorates, so
12 ultimately I was keen to do something like the move to
13 medicine. I felt that the reason I disagreed was that
14 I had only been in post for a short period of time,
15 I had not had an opportunity to achieve any of the
16 objectives that I had wanted to in that particular post,
17 which also had not given me an opportunity to
18 demonstrate that I could achieve the objectives in that
19 particular post, and I felt it was disruptive for the
20 hospital and the clinicians at the Eye Hospital, who
21 were also concerned that it was very disruptive.
22 I think it fair to say that they were unhappy about the
23 proposal at that time as well.
24 Q. But it is right, is it not, that by November 1994, when
25 you became General Manager of the cardiac services
0009
1 directorate, the fact that you had immediately prior to
2 that been an associate general manager first in the
3 Directorate of Medicine and secondly in the Directorate
4 of Surgery, you were, as Mrs Maisey said, well placed
5 and had relative experience for the job you are now
6 doing?
7 A. Yes, she is correct in saying that.
8 Q. So for your long-term career, in terms of what you are
9 doing now, Mrs Maisey's suggestion was probably quite
10 a sensible one?
11 A. Yes, I think that is fair to say.
12 Q. If we go over the page, then, in Mrs Maisey's comments,
13 to page 41, she was on the interview panel when you were
14 interviewed, I think, in September 1994, for the job
15 that you now hold?
16 A. Yes, that is true.
17 Q. Who else interviewed you for that job?
18 A. I think Professor Vann Jones --
19 Q. He was the Clinical Director?
20 A. He was the Clinical Director. I am not sure whether --
21 because I had been interviewed not long prior to that,
22 I am not sure whether it was Ian Stone. There were
23 three other Panel members: definitely Professor Vann
24 Jones and Margaret. I cannot recall the third.
25 Q. Was Dr Roylance on the Panel?
0010
1 A. I am not sure, I cannot recall. It was definitely
2 Mrs Maisey and Professor Vann Jones, and it may have
3 been -- it was either John Roylance or Ian Stone.
4 I simply do not remember.
5 Q. The cardiac services directorate included adult
6 cardiology at the BRI?
7 A. Yes, it did.
8 Q. It included adult cardiac surgery?
9 A. Yes.
10 Q. And for a short period, when you became General Manager,
11 it still included open heart paediatric cardiac surgery?
12 A. Yes, it did.
13 Q. But by the time you became General Manager, moves were
14 afoot to take open heart paediatric cardiac surgery to
15 the Bristol Children's Hospital?
16 A. Yes. I started in post in November 1994 and it was
17 planned that Mr Pawade would start in April/May 1995 and
18 the service would move originally in September 1995, but
19 it actually moved in October 1995.
20 Q. And cardiac services as a directorate was established in
21 your view, when?
22 A. I believe the directorate was established in April
23 1994. I know that there has been discussion about
24 a shadow directorate prior to that, but I was under the
25 impression that the directorate was formally created in
0011
1 April 1994.
2 Q. And it was created with a Clinical Director?
3 A. Yes.
4 Q. Who was Professor Vann Jones?
5 A. That is right.
6 Q. And associate clinical directors of cardiology and
7 cardiac surgery?
8 A. Yes.
9 Q. Those were respectively?
10 A. The Associate Director for surgery was Mr Dhasmana and
11 for cardiology was Dr Pitts-Crick.
12 Q. By the time you became the General Manager of cardiac
13 services, as we have seen, you had been an associate --
14 you had been a General Manager of the Eye Hospital and
15 an associate General Manager of the directorates of
16 medicine and surgery?
17 A. Yes.
18 Q. In this same Trust, so by the time you became General
19 Manager, you would have been familiar with the ethos of
20 the UBHT?
21 A. Yes, I think that is true.
22 Q. And it had always been led by Dr Roylance; he had always
23 been the Chief Executive?
24 A. Yes, he had.
25 Q. At the time you were appointed as General Manager to
0012
1 cardiac services, what was your impression of the ethos
2 of the Trust?
3 A. I think, as I have said in my statement, I felt the
4 Trust was lacking in strategic direction; there was very
5 much a sort of culture of avoiding bureaucracy and of
6 a real abhorrence of anything that was considered to be
7 process management, anything that, you know, established
8 standards. I know that there was a lot of discussion
9 about one of the British Standards and one of the
10 departments, I think the medical physics department,
11 going for a British Standards award and that was very
12 much considered to be very process management orientated
13 and not consistent with the values of the Trust.
14 Q. Can you just give me, for a lay person so I can
15 understand it, a definition of "process management"?
16 A. I think there is a feeling by the Trust that if you
17 are spending time defining processes of an organisation
18 and of actually monitoring the performance, monitoring
19 standards as they would in industry in a very
20 mechanistic fashion, that then you would lose sight of
21 the overall business of the Trust, which was patient
22 care, and spend all your time on setting and monitoring
23 standards and monitoring processes, saying "This is the
24 process, this is how it works", and you would lose time
25 doing that and lose sight of the overall purpose of the
0013
1 organisation.
2 Q. Tell me if I have it wrong, but does that mean that
3 there was a discouragement of, for example, writing down
4 lists of indicators that certain objectives that had
5 been achieved, and you were not encouraged to go round
6 with a clipboard ticking off?
7 A. It was certainly that. The culture was very much
8 against having a paper culture. The idea was that
9 communication would be face-to-face, that everything was
10 verbal, that -- there was this fear that if you spent
11 all your time writing things down, all you would be
12 achieving would be to back up what you have said and not
13 be getting on with the work you needed to be doing; that
14 it was irrelevant and a waste of time.
15 I have to say, I subscribed to the view I did not
16 want to be involved in unnecessary administration and
17 bureaucracy, but I did feel because the culture was so
18 very much against paper and so keen to have a sort of
19 verbal culture that we did lose track of where we were
20 going and what we were doing, and people were very
21 unclear about what it was they should be doing.
22 Q. Can I take you back to your statement, to WIT 89/4,
23 paragraph 5?
24 You say when you had been appointed to previous
25 posts, you had asked your immediate manager for an
0014
1 indication of the key priorities and issues for the new
2 job.
3 What were those previous posts that you are
4 referring to?
5 A. I think the posts that you have already looked at, you
6 know, in my CV at the beginning, in outpatients, at the
7 Eye Hospital, in medicine and surgery. I had looked at
8 some of the key tasks. I mean, I had not gone to
9 previous managers and said "I am new to post, tell me
10 what to do, I do not know how to do my job", but I felt
11 it was right to update myself with the key issues in the
12 area I was working to discuss those and to look at what
13 the key priorities are and to be able to prioritise your
14 own action at the start of a post, so I had done that in
15 previous posts.
16 Q. When you were Associate General Manager in first of all
17 medicine and then surgery, who was your immediate
18 manager?
19 A. My immediate manager in both medicine and surgery was
20 Janet Maher.
21 Q. She was --
22 A. She was the General Manager.
23 Q. Of first of all medicine and then of surgery?
24 A. That's right, yes.
25 Q. When you were the General Manager of the Eye Hospital,
0015
1 who was your immediate manager?
2 A. It would be Margaret Maisey who I worked more directly
3 with. The Eye Hospital was a little different in that
4 I had been there already for a couple of years before
5 I took up post, so it was not necessary to spend a lot
6 of time talking to Margaret about what the key tasks for
7 ophthalmology were, because I had already been involved
8 with them for two years prior to that.
9 Q. When you went to the cardiac services directorate, you
10 say here you asked Mrs Maisey for advice about the
11 immediate priorities?
12 A. Yes.
13 Q. Why did you ask Mrs Maisey as opposed to anybody else?
14 A. Because she was the person I had been most involved with
15 in my career within the Trust. I actually asked
16 Mrs Maisey, I recall, at the end of the interview,
17 I started the process of talking to her about some of
18 the key tasks there.
19 Q. Who was your immediate manager as General Manager of
20 cardiac services?
21 A. Within cardiac services, I perceived that I was working
22 very closely with the Clinical Director, the
23 relationship with the Clinical Director was such that,
24 you know, we considered ourselves to be sort of a unit;
25 we worked together very closely, so I was obviously
0016
1 accountable to the Clinical Director, but it was not
2 like that in terms of our general work. I did not see
3 a line management relationship between me and the
4 Clinical Director of cardiac services, I perceived us as
5 a unit that worked closely together. Beyond that, I saw
6 myself as accountable to Margaret Maisey, and I saw the
7 Clinical Director as accountable to John Roylance.
8 Q. Have you ever heard of the expression of Clinical
9 Directors and General Managers being in a "bubble"
10 together?
11 A. I certainly read that in the transcripts this week.
12 I do not recall hearing the word "bubble". It may just
13 be that I have forgotten it over time. I think it is
14 certainly true that the General Managers and Clinical
15 Directors were a very close unit, and I think that is
16 true today. I see myself very much as part of the unit
17 with the Clinical Director. We are almost one.
18 Q. So you saw yourself as being a close colleague of the
19 Clinical Director?
20 A. Yes.
21 Q. In the same team as the Clinical Director?
22 A. Yes.
23 Q. But not in a line accountable to the Clinical Director?
24 A. No.
25 Q. Is that fair?
0017
1 A. That is fair, yes.
2 Q. Did you ever have any discussion with Professor Vann
3 Jones about the proper lines of accountability?
4 A. I do not think so. When I started we spent time
5 together talking about how we would work, when we would
6 meet and what our working arrangements would be, but
7 I do not think we ever talked about my accountability to
8 him or who I would be accountable to.
9 Q. I am sorry?
10 A. We did not really discuss who I would be accountable to
11 when I started.
12 Q. Did Professor Vann Jones ever set you any goals or
13 objectives as General Manager?
14 A. He did not set me any goals or objectives. We used to
15 meet regularly and decide at those meetings what we
16 wanted to do. I mean, sometimes we would meet and
17 I would say, "Well, I am going to go away and do this",
18 but there was never an objective-setting process in
19 a formal sense. We met weekly and had a working
20 relationship and that is how we determined what it was
21 we would be doing within the directorate.
22 Q. In your view was it valuable for General Managers such
23 as yourself to have specific objectives?
24 A. Yes, I think it was key. I mean, I do not want to give
25 the impression that General Managers walk around with
0018
1 a sheet with a load of objectives on it, and every day
2 we have it attached to our clipboard and say "Today we
3 are going to achieve this objective". I certainly do
4 not want to give that impression. What I thought was
5 important was that we, the Clinical Director and I,
6 should know what sort of direction it is we want to
7 take, where we want the directorate to go, and how we
8 want to try and achieve that. That was key. I think it
9 is very important now, and it is something that we do.
10 Q. Was not that something that in Dr Roylance's Trust, his
11 philosophy would be, that it was down to you as the
12 General Manager and Clinical Director who were in the
13 same "bubble" to get together and set your objectives
14 for the directorate? It was your job?
15 A. I think to an extent that is right, and looking at
16 Margaret Maisey's response to comments on my statement,
17 she makes that clear. She says something about not
18 wishing to usurp the responsibility of the Clinical
19 Director and General Manager, but I think that implies
20 that the setting of objectives is an entirely bottom up
21 process, that directorates are in themselves somehow
22 autonomous, they set their objectives, they achieve
23 their objectives and they somehow do it in isolation
24 from the organisation of which they are a part.
25 What I was asking Margaret Maisey for, and the
0019
1 reason I would dismiss her comments about this is that
2 I was saying, "Yes, it is right that we should set
3 objectives, but we have to do this in some sort of Trust
4 framework. We have to know what position this
5 directorate has within the Trust and what you, as
6 a Trust, are hoping to achieve", because it is important
7 that the objectives of directorates are consistent with
8 those of the Trust. We were never autonomous.
9 Therefore, what I was seeking was a framework -- I did
10 not want Margaret to do our job for us, but I did not
11 agree, and still do not agree, that this is entirely
12 a bottom up process. This is a 2-way process and the
13 objectives of directorates have to be consistent with
14 the overall objectives of the Trust and the
15 organisation, otherwise we are autonomous islands
16 existing within this loose organisation, and I do not
17 think that works.
18 Q. So to what extent would you agree with this formulation
19 of that: that each directorate could set its own
20 objectives and establish its own strategy with the
21 General Manager and Clinical Director working together,
22 but that strategy was set within the overall strategy of
23 the Trust?
24 A. Yes. I think that of course there are people that are
25 managing the directorate who have to be working on
0020
1 setting the objectives, but it cannot take place in
2 isolation from the Trust. It has to be part of an
3 overall strategic direction for the organisation. There
4 has to be a framework that that process takes place
5 within.
6 Q. If we go to paragraph 6 of your statement, just scanning
7 down the page, you say the reason for you saying in the
8 previous paragraph you had little guidance from
9 executive level in cardiac services, "the reason
10 appeared to be that under Dr Roylance the philosophy was
11 that anything seen as bureaucratic or process management
12 or administrative was undesirable"?
13 A. That is right, yes.
14 Q. Reading that paragraph, and perhaps reading it as
15 a whole, it would appear as though you are expressing an
16 element of surprise or that this was novel to you when
17 you got to cardiac services, that this was Dr Roylance's
18 philosophy?
19 A. No, I do not think that it was novel. I think
20 Dr Roylance's philosophies were well known. He was
21 a very well known individual and his values and comments
22 were well known.
23 Q. So why had you not come across the same problems, as you
24 would put it, as General Manager in cardiac services,
25 the problems you are alluding to here; why had you not
0021
1 come across those when you were General Manager of the
2 Eye Hospital, for example?
3 A. There is a difference, because cardiac services was
4 a newly created directorate. It had been created as
5 a major objective of the Trust; although I know
6 Dr Roylance did not want to state objectives, it was
7 stated as a major objective of the Trust to bring
8 together a directorate based on disease and to provide
9 a service for patients who had that particular disease.
10 Therefore, I very much felt that if that were the
11 case, we could not just stop with the creation of the
12 directorate, there had to be something more to it than
13 that. Having created a directorate that was something
14 new and something different, there had to be something
15 further that came out of that; it could not just be
16 created and exist and do nothing.
17 Q. But had not Dr Roylance and the executive directors done
18 their job to the extent that the overall strategy of the
19 Trust was to create this new directorate? They created
20 a new directorate. You were the General Manager, and
21 now it was up to you, within the bubble, to get on and
22 run the show?
23 A. No, because they created the directorate with no further
24 thought as to why they had done it and what it was
25 hoping to achieve. It was a pointless thing to have
0022
1 done, if it was not to actually achieve anything as
2 a result. The reason I wanted to, if you like, market
3 the service to the Trust was that the Trust could not
4 see any reason in a way how that particular directorate
5 fitted into the Trust, and what it was supposed to be
6 achieving. It was just created and that seemed to be
7 the end of it.
8 Of course I agree that some of the objectives and
9 future planning should occur within the directorate, but
10 as I have previously said, it seemed important that that
11 was in an overall framework for the Trust, and that just
12 was not there. Once the directorate had been created,
13 there was nothing more to be done, it seemed.
14 Q. Can we go to UBHT 34/229, please? This is a meeting of
15 the Executive Committee of the Trust and I think we
16 looked at this yesterday with Mrs Maisey very briefly.
17 It is not a meeting you were at. Can we go to 232?
18 I am sorry, if we go back, to give it some
19 context, to 231, to the foot of the page, "Matters
20 arising":
21 "Mr Wisheart record that Mrs Sarah Hoyle,
22 Mrs Mansell Griffiths, Mrs Margaret Maisey ...", and so
23 on. I see we have the same place twice. Can we go to
24 230, bottom of the page, the Chief Executive report:
25 "2 working groups had been established to advise
0023
1 Dr Roylance on the creation of new directorates", and
2 then 232, please, "which it was hoped would assist the
3 move to single client group directorates: cardiac
4 services to combine cardiac surgery and cardiac medicine
5 to allow flexibility between the 2 services."
6 So that is the initial planning of the directorate
7 being put in train?
8 A. Yes.
9 Q. That is nearly two and a half years before you were
10 appointed?
11 A. Yes.
12 Q. If we go to UBHT 81/191, this is a Directorate of
13 Surgery Management Board meeting. You were at that,
14 because you were the Associate General Manager of an
15 area of that directorate. We see your name there.
16 A. Yes.
17 Q. If we scan down that page, "Matters arising":
18 "Cardiac services has been established and
19 Professor Vann Jones has agreed to be Clinical Director
20 with the support from the current Associate Clinical
21 Directors", and those were Mr Dhasmana and
22 Dr Pitts-Crick?
23 A. Yes.
24 Q. You told us earlier that cardiac service was not
25 established in April 1994?
0024
1 A. That is right.
2 Q. This is June 1993?
3 A. That is right. My understanding from discussion at the
4 time was that that was sort of a shadow arrangement; it
5 was not until 1st April 1994 that the directorate really
6 became a directorate.
7 Q. So at this stage you yourself were not involved in
8 cardiac surgery because your responsibilities as
9 Director of Surgery were trauma, orthopedics and A & E?
10 A. That is right, yes.
11 Q. To the extent that Professor Vann Jones is a shadow
12 Clinical Director, if that is an accurate description,
13 was there a shadow General Manager?
14 A. I think that Lesley Salmon played that role. Whether
15 she was called a shadow General Manager, she still
16 remained within the Directorate of Surgery management
17 structure, and I understand that she was still
18 accountable to Janet Maher as the General Manager for
19 surgery, the Directorate of Surgery. So I do not think
20 that answers your question, does it, but -- yes, it was
21 identified as being the General Manager, but as far as
22 I understand it, she did not separate from the line
23 management relationship to the General Manager for the
24 Directorate of Surgery.
25 Q. So to the extent that there was, it was Lesley Salmon?
0025
1 A. Yes.
2 Q. Professor Vann Jones, I think, remained as Clinical
3 Director of the directorate until early 1996 when he
4 resigned?
5 A. Yes.
6 Q. Was Professor Vann Jones an enthusiast for taking up the
7 post of Clinical Director, as far as you were aware?
8 A. I think he was enthusiastic. He found the role very
9 difficult, very challenging, and I know that, you know,
10 he found it a very complex role.
11 Q. What else was he doing whilst he was Clinical Director?
12 A. He still had a very large clinical commitment as
13 a cardiologist and with his personal Chairs, Professor
14 role as well, so he had a large clinical commitment as
15 well.
16 Q. Did he have a set number of sessions per week when he
17 was devoting himself to Clinical Director duties?
18 A. I do not think he specified a specific time for dealing
19 with clinical directorate duties. I do not think he
20 took up the option of having sessions, because
21 I think -- I do not know why. You would have to ask
22 him. I do not think he took up particular Clinical
23 Director sessions, although we used to meet at regular
24 times and he used to give time in that sense.
25 Q. In your statement you set out a diagram, a table,
0026
1 WIT 89/6.
2 This is the organisational structure when you took
3 office?
4 A. Yes, although this was not published as an
5 organisational structure, this was something that I felt
6 would aid the Inquiry, so I have just done this for the
7 statement. It was not a published and circulated
8 structure at that time.
9 Q. This is your own diagram, recently produced?
10 A. Yes, just to try and give an indication of what it
11 looked like.
12 Q. We see that you are in the same box -- not a bubble,
13 a box -- as Professor Vann Jones?
14 A. Yes.
15 Q. And the two Associate Clinical Directors either side,
16 and then there are two senior nurse managers, two
17 grade H nurse managers?
18 A. Yes.
19 Q. One from the surgery side and one from the cardiology
20 side?
21 A. Yes.
22 Q. Fiona Thomas and Jenny Postow.
23 What I want to focus on briefly is the double
24 asterisk beside Clinical Director and the note at the
25 foot:
0027
1 "Anaesthetic staff were not part of the cardiac
2 services directorate but were accountable to the
3 Clinical Director for Anaesthesia, Dr Monk."
4 A. Yes.
5 Q. So anaesthesia was a completely separate director in the
6 Trust, and always had been?
7 A. Yes.
8 Q. Can we go to WIT 89/57, please? These are the comments
9 of Mr Wisheart on your statement. You have seen these,
10 I think, this morning?
11 A. Yes, I have.
12 Q. If we go to the foot of that page, Mr Wisheart comments
13 on your diagram:
14 "I do not agree with all the details of this
15 diagram, but the point to which I wish to draw attention
16 relates to the note where it says ..."
17 He sets out the note.
18 If you go over the page, 258:
19 "The statement is correct in the managerial sense,
20 in that they [the anaesthetists] were primarily part of
21 the Directorate of Anaesthesia and their salary lay
22 within the budget of that directorate. However, they
23 were full and equal members of the Cardiac Surgical
24 Board."
25 What do you understand Mr Wisheart to mean by
0028
1 saying they were "primarily part of the Directorate of
2 Anaesthesia"?
3 A. I think what he is saying is correct in the managerial
4 sense they were part Directorate of Anaesthesia, but
5 their duties involved them in working in cardiac
6 services, so therefore they were involved in the
7 business of the cardiac directorate. As he says, they
8 were members of the meetings that we had for cardiac
9 services. But, yes, they were part of the Directorate
10 of Anaesthesia. They were managed by the Clinical
11 Director and General Manager for anaesthesia. The
12 budget lay within that directorate, and they were
13 a separate directorate. They still are a separate
14 directorate.
15 Q. The Cardiac Services Directorate had a committee which
16 met. It was called what, the governing committee?
17 A. There was a small cardiac services Management Board that
18 met monthly, which had a very small representation --
19 I think myself, the Clinical Director, the Professor of
20 cardiac surgery, one anaesthetist and I think the
21 radiologist as well, so it was a small group with mainly
22 medical staff and myself.
23 Q. And then the surgeons had their own meeting and the
24 cardiologists had theirs?
25 A. The management meetings, in cardiac surgery there was an
0029
1 associate directorate meeting and the same for
2 cardiology and the cardiac surgeons also had from time
3 to time a surgeon's meeting where the surgeons got
4 together.
5 Q. So there were four separate meetings: the Cardiac
6 Services Management Board, the Associate Director of
7 Cardiac Surgery, an Associate Director of Cardiology
8 meetings, and from time to time, other surgeons'
9 meetings?
10 A. Yes.
11 Q. Which of those four, if any, is the cardiac surgical
12 board that Mr Wisheart is referring to?
13 A. I am not sure what he means by the Cardiac Surgical
14 Board; whether he means the Associate Director for
15 Cardiac Surgery or the Cardiac Surgery Management Board,
16 it is not clear from his comment.
17 Q. The top meeting, the Cardiac Services Management Board,
18 anaesthetists and radiologists would attend that, would
19 they?
20 A. Yes. There is always one anaesthetist and usually one,
21 Peter Wilde, who is now the Clinical Director for
22 cardiac services, used to go as a cardiac radiologist.
23 Q. So they would be attending the governing meeting of the
24 cardiac services directorate, although they were both
25 themselves members of another directorate?
0030
1 A. Yes.
2 Q. Did that meet any confusion, or did that work well?
3 A. The meetings themselves did not work particularly well.
4 The Cardiac Services Management Board meetings did not
5 work well because they were small and not well
6 represented. I would say that most of the decisions and
7 discussions took place at the associate directorate
8 meetings, although the Cardiac Services Management Board
9 was meant to be the most important of the meetings.
10 Q. You have drawn us another diagram, another table as
11 well. If we go to WIT 89/7, this is how it is now?
12 A. Yes.
13 Q. What I want to focus on is Fiona Thomas's role. We saw
14 her in the previous diagram. She was one of the H grade
15 nurses, she had come from the surgery side?
16 A. Yes.
17 Q. But there was another H grade nurse on the cardiology
18 side?
19 A. Yes.
20 Q. Now in your directorate there is one clinical nurse
21 manager?
22 A. Yes.
23 Q. Covering both surgery and cardiology?
24 A. Yes.
25 Q. We see that from the bottom line, do we, "cardiac
0031
1 theatres and cardiology department nursing"?
2 A. Yes.
3 Q. So there has been a change brought about there in the
4 nursing hierarchy of the directorate?
5 A. Yes.
6 Q. What was the impetus for that?
7 A. I felt that the two parts of the directorate were very
8 separate and that there were a number of areas where we
9 needed to introduce more flexibility in how the nursing
10 staff actually worked. For example, within the catheter
11 laboratories I wanted to reduce some of the demarcations
12 and problems there, but also, because we were short of
13 staff in other areas, I wanted to be able to rotate
14 staff through from cardiology, through to theatre,
15 through to intensive care, and I felt that there would
16 be a clearer focus if we had one nurse manager that was
17 responsible for doing that. We could then manage the
18 nursing staff as a group of nursing staff and make much
19 better use of the staff that we had.
20 Q. When did this change come about?
21 A. I cannot remember the exact date, I am afraid, but
22 probably two years ago, or may be more? A couple of
23 years ago, I think.
24 Q. Did the Director of Nursing of the Trust have any role
25 in that type of change?
0032
1 A. I remember that Margaret Maisey was not particularly
2 keen on I grade posts within the Trusts. Over a period
3 of time the I grade nurses reduced very much, so there
4 were probably only a couple of I grade nurses left, but
5 Margaret and I did not particularly work very closely on
6 that, so there was no particular comment from Margaret
7 on that.
8 Q. What was the role of the Director of Nursing so far as
9 you were concerned?
10 A. It was a very limited role. Margaret Maisey's role was
11 much more the Director of Operations.
12 Q. Let us take it in stages. When Margaret Maisey was
13 Director of Operations, she was also the Nurse Adviser
14 to the Trust?
15 A. Yes.
16 Q. In that role of Nurse Adviser, what were her
17 responsibilities, as far as you perceived them?
18 A. I think to advise the Trust and to be involved in sort
19 of nursing standards and practice and looking at nurse
20 competence and those sorts of issues, although there was
21 no, as there is now, very clear nursing strategy and
22 a clear way of developing nursing staff, but she would
23 advise and the other Nurse Adviser that I worked with
24 would advise on training issues and competence and
25 standards of practice.
0033
1 Q. How did that role, Nurse Adviser, differ from the role
2 of Director of Nursing Mrs Maisey later took?
3 A. I think the Director of Nursing role was much more
4 important, was a more clearly defined role, certainly
5 with clearer objectives. The way the role has developed
6 now has been to really look at having a very detailed
7 strategy for nursing and to look at nursing across the
8 whole Trust to bring some Trust focus to nursing,
9 because obviously at the time the clinical directorate
10 structure left everything very much to directorate
11 level. So the new Director of Nursing is much more
12 proactive and has been much more of a way of enhancing
13 the nursing profession within the Trust.
14 Q. The situation that obtained when you were first General
15 Manager in the cardiac services in terms of waiting
16 lists and demand for services was what?
17 A. When I joined the directorate -- I am sorry, could you
18 say that again?
19 Q. I did not put it very well. I was trying to ask you,
20 what was the waiting list position in November 1994?
21 That is a much more simple way of putting it.
22 A. I cannot remember how many patients were waiting above
23 a particular time, but the position when I took over the
24 directorate was that there were very long waits both for
25 cardiac surgery and for cardiology. And that, you know,
0034
1 patients were waiting from the start of the time they
2 first became ill, it could be up to two or three years,
3 if they required surgery, before they actually received
4 surgery. There was a very long chain of events from
5 actually the patient first experiencing chest pains to
6 seeing a GP to then having a length of wait for an
7 outpatient appointment, followed by maybe a length of
8 wait for a diagnostic test, a length of wait for another
9 outpatient appointment to see a surgeon, and then
10 surgery, if that was the course of action that was
11 decided. So there were very long waits.
12 Q. To what extent did you focus upon the position of
13 children who might undergo open heart surgery at the BRI
14 in the year when you were General Manager before the
15 split site was ended?
16 A. Not really at all. My focus in-post was very much the
17 adult work and the adult service and the decision had
18 been made to move the children and for Ash Pawade to
19 start in the May and for the service to move, so I had
20 a very limited role in terms of managing the children's
21 service, the children's aspect within the directorate,
22 and looking at issues there.
23 Q. Was there someone perhaps in a shadow capacity at the
24 Children's Hospital who was taking on responsibility for
25 the children operated on at the BRI in the months
0035
1 leading up to Mr Pawade taking up his post?
2 A. There may have been, but I think that -- I do not know.
3 You would have to ask the Manager of the Children's
4 Hospital, but --
5 Q. You were the General Manager of cardiac services at the
6 BRI. What discussions did you have about the management
7 of surgery on children between November 1994 and October
8 1995, and with whom?
9 A. I think there were discussions about the transfer of the
10 service, but if you are talking about contracting and
11 sort of financial arrangements for children's
12 operations, then, yes, they came up in a limited fashion
13 at contract monitoring meetings, but there was no
14 detailed discussion. I did not have a detailed
15 discussion with purchasers or other users of the service
16 about paediatric waiting times and price and those sorts
17 of issues.
18 Q. That deals with purchasers, outside of the Trust. What
19 about discussions between you and, say, a General
20 Manager at the Children's Hospital?
21 A. There were discussions. I recall that I attended
22 meetings up at the Children's Hospital about the actual
23 transfer of the service. That was very much to look at
24 issues like transfer of equipment, staffing issues,
25 transfer of staffing, training nurses and things. That
0036
1 was specifically related to the transfer.
2 Q. If we go to paragraph 75 of your statement at
3 WIT 89/28 -- we will come back to this paragraph again
4 later, but this paragraph deals with an incident in
5 March 1995 involving a child.
6 A. Yes.
7 Q. I assume a child who was due to undergo open heart
8 surgery at the BRI?
9 A. Yes.
10 Q. We will come back to this later. You refer to
11 discussions with, I think, Mr Wisheart and Dr Hayes,
12 a paediatric cardiologist, and with Dr Roylance and with
13 Mr Pawade. But there was no mention of any discussion
14 with any other -- not General Manager -- or no
15 discussion with the management of the Children's
16 Hospital?
17 A. No.
18 Q. Why not?
19 A. Because the child was on Mr Wisheart's list and was due
20 to be operated on at that stage at the BRI, so I did
21 perceive that to be an issue I should be dealing with.
22 Q. So it was:
23 A. It was within my remit, yes.
24 Q. So children operated on by cardiac surgeons at the BRI
25 in 1995 were within your remit in the same way as
0037
1 adults?
2 A. Yes.
3 Q. The long waiting list for cardiology and cardiac
4 surgery: is that a problem that had persisted for some
5 time when you took office?
6 A. I think that there had been concerns before I took up
7 office about the length of wait for both cardiology and
8 cardiac surgery, yes.
9 Q. What is the position now?
10 A. There are still concerns about the length of wait for
11 both cardiology and cardiac surgery, although we have
12 been able to reduce the length of time for both
13 cardiology and cardiac surgery. We are having
14 a difficulty at the moment with surgery with waiting
15 lists rising again, but there has been a period where
16 waiting lists have reduced.
17 Q. Shortly after you took office as General Manager, the
18 paediatric work moved to the Children's Hospital, and
19 that allowed more adult work to be carried out at the
20 BRI?
21 A. Yes, that is right.
22 Q. So that allowed a reduction in waiting lists, did it?
23 A. Yes. It allowed us to expand the service, and we have
24 continued to try and do that service.
25 Q. You presumably know that there had been a series of
0038
1 expansions of the service at the BRI from the mid-1980s
2 until the mid-1990s?
3 A. Yes.
4 Q. And that would now be characterised as fairly
5 significant, would it, from 275 cases a year to -- what
6 is it, 1,400 or thereabouts?
7 A. It is about 1,300 at the moment. Yes, it is
8 a significant increase over the years.
9 Q. Can we go to your statement at 89/9, please?
10 You mention costs. Over the page to page 10,
11 paragraph 15, the foot of the page, the last sentence:
12 "I was aware of the fact that the cardiac services
13 being provided in Bristol were more expensive than in
14 other areas and that we were losing work to the centres
15 in London because they were able to provide the services
16 more cheaply."
17 A. Yes.
18 Q. Why was Bristol more expensive than other centres?
19 A. It is a good question. I think that other centres were
20 maybe actually pricing their services differently.
21 I know some of the prices offered by the London
22 providers were related to not actually the cost of the
23 service; they were to a certain extent subsidised.
24 I think the Oxford price, which was the other area that
25 we compared ourselves with, actually priced differently
0039
1 so that they priced a core price but with a supplement
2 for the intensive care stay. So we were actually
3 comparing different things. Purchasers were comparing
4 different things.
5 Q. Was the length of stay of patients in hospital in
6 Bristol longer than elsewhere?
7 A. I think that there were other areas that were
8 discharging patients earlier and that was something we
9 looked at when we introduced the discharge co-ordinator
10 role for the directorate, which was a specific post to
11 look at trying to achieve earlier discharge for
12 patients.
13 It was, again, difficult to get comparative data,
14 because some people provided, for example, Walsgrave
15 explained that they were discharging a number on the
16 third day following cardiac surgery but they were not
17 giving you average length of stay. We certainly felt
18 that we did have longer lengths of stay, but it was hard
19 to get absolutely hard information about that.
20 Q. Let us look at paragraph 17 in that same page. You
21 say -- this is a paragraph that Mr Langstaff discussed
22 with Dr Roylance; you may have seen that on the
23 transcript:
24 "Cardiac disease is one of the major causes of
25 death ... I felt the Trust was not committed to
0040
1 developing the service."
2 As we have just discussed, the Trust, and earlier
3 the Health Authority, had carried through an expansion
4 of cardiac services from 275 operations a year to
5 I think at this stage, what was it, about 800 or 900
6 operations a year in a 10 year period?
7 A. Yes, I think that is true, but I think what had happened
8 is that with the creation of the directorate, the plans
9 for further expansion were quite limited and we were not
10 keeping pace with the demand, the local demands and the
11 demand from purchasers across the region.
12 Because there was no Trust framework in which to
13 decide how the service was going to progress, it really
14 was a feeling certainly that we had within the
15 directorate that the Trust was not committed to further
16 development of the service and I notice there are
17 comments that it was not a matter for the Trust to be
18 committed to developing the service, and that was
19 a matter for purchasers to increase their investment in
20 the service. I think that we disputed that within the
21 directorate and were aware that there were a number of
22 other resources available for developing the service
23 that were not entirely reliant on increased income from
24 purchasers. For example, we knew that the facilities
25 were limited and the capacity was limited and that
0041
1 capital resources were available within the Trust, and
2 indeed, we were able to obtain extra capital to develop
3 part of the service in 1996, but we were aware that
4 capital was available and we were also aware that
5 resources were available for service developments.
6 I felt that it was very important that cardiac,
7 although it had developed tremendously, was still very
8 much behind the sort of type of service that was
9 required to keep pace with the demands being expressed
10 from purchasers across the region.
11 Q. Let us just break that down a little. Despite the fact
12 that there had been this significant increase in the
13 number of operations over ten years, it is right, is it
14 not, that the number of operations and cardiological
15 investigations had never kept pace with the demand;
16 there had always been a pent-up demand for cardiac
17 services?
18 A. Yes. There always will be, and it is very hard for
19 the service to keep pace with demand, because demand
20 will always be outstripping supply.
21 Q. So there is nothing particularly strange about the fact
22 that the Trust had not taken steps to keep pace with
23 demand?
24 A. No, it is not unusual for tension to be there between
25 demand and supply, but I think we felt that the gap was
0042
1 so great and that the potential was there, it was not us
2 in the directorate saying "We want to develop this
3 service". The opportunities and requests were coming
4 from the purchasers across the region with whom we were
5 dealing, and that was the frustration within the
6 directorate.
7 We realised that demand would outstrip supply, but
8 although there had been a large expansion, it was
9 looking very limited in terms of the future expansion we
10 were able to achieve to at least try and keep pace with
11 some of the requests coming in from purchasers.
12 Q. You say in the last sentence in paragraph 17 you felt
13 that the Trust was not committed to developing the
14 service.
15 A. Yes.
16 Q. What did you mean there?
17 A. We were not looking for the Trust to build a new cardiac
18 unit, but we were looking for help in terms of improving
19 the facilities that we had for cardiothoracic services.
20 Q. You mean the Board were not committed to developing the
21 service?
22 A. Yes.
23 Q. The directors?
24 A. Yes. We felt that the Trust, the Board, the Chief
25 Executive, was not committed to developing the service
0043
1 and that we were having to, as all directorates do, all
2 directorates will fight hard to try and develop the
3 services they are working in, but we felt that there was
4 a complete disinterest from the service.
5 Q. But this Board had fairly recently taken the decision to
6 move paediatric cardiac open heart surgery to the
7 Children's Hospital in order to allow yet another
8 expansion of adult work at the BRI. Surely that was
9 demonstrating a commitment to the further expansion of
10 the service?
11 A. That was limited and there was no further commitment to
12 develop a service after that. That is why we felt
13 within the directorate it had to be a clear objective of
14 the directorates to push the development of the service
15 even further. We knew that the creation of the
16 additional capacity with the children's service was
17 going to be very limited.
18 Q. Can we go to paragraph 24, page 13? You have mentioned
19 this already, Mrs Ferris. There is no point in reading
20 that paragraph out, but the last sentence:
21 "In April 1996, the Trust Board agreed that the
22 directorate should be reorganised."
23 A. Yes, that is right.
24 Q. Along the lines that you had been suggesting. This was
25 very largely the same Trust Board as had been in place
0044
1 when you became General Manager of cardiac services?
2 A. Although in April 1996 there was a new Chief Executive,
3 but, yes.
4 Q. Apart from that, it was, I think, substantially perhaps,
5 off the top of my head, entirely the same.
6 To what extent did you think that the fact that
7 there was a new Chief Executive was decisive in the, as
8 you perceived it, change of attitude of the Trust Board?
9 A. I think the appointment of the new Chief Executive was
10 very important, because -- you referred to the paper
11 that we worked on, the "brainstorming" paper in August
12 1995. Following that, we started a very clear process
13 of developing the strategy of the directorate and we
14 were assisted in that process by the new Chief Executive
15 and as a result of that, we were asked to put together
16 a very clear paper for the development of the service,
17 that, you know, made very clear the requirements of the
18 service, which we did.
19 That paper was completed in January 1996, and then
20 was approved by the Board in April 1996. That involved
21 a significant capital cost of just under 3 million,
22 which was identified, although, as I have noted in one
23 of the comments on my statement, it was the Trust's
24 comments that the money was not actually made available,
25 but it was accepted that this is what needed to happen
0045
1 and that that would then be part of the Trust's
2 longer-term strategy and the Trust's estate strategy.
3 Q. Mrs Maisey in her comments on your statement, we need
4 not go to this document, but paragraph 8 of her comments
5 on your statement, WIT 89/42, she says:
6 "The Trust Board [and she means under Dr Roylance,
7 I think, in context], were very proud of the cardiac
8 services and Dr Roylance always referred to them as the
9 'jewel in the crown' of UBHT."
10 Did you ever hear Dr Roylance, or hear tell
11 Dr Roylance referring to cardiac services in that way?
12 A. Not at all. The "jewel in the crown" phrase was
13 actually something that the directorate used when we
14 made a presentation to, I think it was called the
15 Marketing and Development Committee, in, it must have
16 been 1995. We decided that we really wanted to give the
17 directorate a high profile and we wanted to go in with
18 some sort of phrase that would be remembered by that
19 committee and would help us in terms of developing the
20 directorate.
21 So that phrase, the "jewel in the crown", was
22 something that came up from the directorate and at the
23 meeting that we made that presentation, I think
24 Dr Roylance had already left the organisation by then.
25 Q. Do I understand your evidence to be that the decision
0046
1 that the Trust Board took in April 1996, which you refer
2 to in paragraph 24 -- it is on the screen -- would not
3 have been taken, in your opinion, if Dr Roylance had
4 still been the Chief Executive?
5 A. I do not think so, because the comments I have already
6 made about understanding the future strategy of the
7 directorate within the sort of Trust framework went
8 against the development of the directorate, and I think
9 when Hugh Ross started he was very keen to develop the
10 strategies of the directorates within that Trust
11 framework, and I think he recognised very quickly that
12 the directorate did need to develop in a way that we
13 said it should develop. He was actually very helpful to
14 us and came to one of our strategy meetings in December
15 1995 to help us, to achieve the writing of a long-term
16 strategy plan that we wanted to. It was his suggestion
17 that we would then put to the Board a paper that made
18 very clear what we needed in terms of the facilities for
19 the service, so that the Board could consider that. So
20 it was very much his initiative that we should write the
21 paper we wrote in January 1996, talking about the
22 relocation of the service on to one site.
23 Q. I just want to deal with a couple more points, and then
24 perhaps it is time for a break --
25 THE CHAIRMAN: May I just clarify the answer given? When
0047
1 you say "I do not think so", I am not putting words into
2 your mouth, but do you mean, "I do not think it would
3 have"?
4 A. Yes.
5 THE CHAIRMAN: It is important for me to understand the
6 answer.
7 MR MACLEAN: You are agreeing with the hypothesis in the
8 question?
9 A. Yes.
10 Q. You said that the phrase the "jewel in the crown" was
11 one that you had used within the directorate, or the
12 cardiac services directorate itself used. How would it
13 be that that directorate could be thought of, even by
14 itself, as being the jewel in the crown, if the Trust
15 Board were not committed to it and showed such a lack of
16 interest in it?
17 A. The purpose of that presentation, and it was a little
18 tongue-in-cheek, that title, but the purpose of that
19 presentation was for us, for the directorate, we wanted
20 to persuade the Trust that we could fit into and could
21 be a major strength of the Trust and that we could
22 achieve that. So, you know, you have mentioned that
23 term, but it was very much a sort of tongue-in-cheek,
24 you know, way of trying to bring attention to the
25 directorate's plans.
0048
1 Q. When we were discussing the Trust Board's decisions in
2 April 1996, it is right, is it not, that by that time
3 there had been a good deal of discussion in the public
4 arena about cardiac services at Bristol generally, and
5 paediatric cardiac services and surgery in particular?
6 A. Yes.
7 Q. So it would be right, would it not, to take into account
8 the fact that the Trust, in 1996, was faced with
9 a rather different scenario in terms of the public than
10 that which had faced Dr Roylance's Board earlier?
11 A. Yes.
12 Q. So to what extent would you agree with the suggestion
13 that it was perhaps rather less surprising that the
14 Trust Board, given all that had happened by April 1996,
15 should be prepared to invest in cardiac services in
16 order to reassure the public as to the quality of the
17 service?
18 A. I think by that stage the profile of cardiac services
19 was very high, but perhaps not for the right reasons,
20 and I think it is understandable that the Trust Board
21 should be keen to improve the facilities and develop the
22 service, yes. I am agreeing with you.
23 Q. So might it not be that it was those events that had
24 taken place, rather than the fact that Dr Roylance
25 happened to be replaced by Mr Ross, that in fact was the
0049
1 true reason for the April 1996 decision?
2 A. I think that is part of it, although I do believe
3 strongly that the new Chief Executive did put more
4 emphasis on the development of strategy for the Trust,
5 and you will see that actually at that time an awful lot
6 of work went on within the Trust to look at the whole
7 Trust's long-term strategy, and as part of that, there
8 were very clear messages about the development of both
9 children's services and oncology services at the same
10 time, so cardiac became in a way part of those three
11 regional specialties.
12 So, yes, I would agree there was a major interest
13 in developing the service because of the past history of
14 the service. That has to be taken into account; but
15 also, there was the development of strategy that had
16 targeted the development of the three regional
17 specialties. I think that was very much as a result of
18 the new Chief Executive's approach to the development of
19 strategy.
20 Q. So, from your perspective, you perceived a greater or
21 an increased strategic thinking concerning cardiac
22 services?
23 A. Yes.
24 MR MACLEAN: Sir, I wonder, is that an appropriate moment
25 for a short break?
0050
1 THE CHAIRMAN: Yes, shall we take 15 minutes and then
2 reconvene at 11 o'clock?
3 (10.48 am)
4 (A short break)
5 (11.05 am)
6 MR MACLEAN: Can we go to the document that you supplied
7 along with your statement, Mrs Ferris? It is
8 WIT 89/38.
9 First of all, if we look at the page as a whole,
10 there are some annotations on this, some handwriting.
11 Whose is it, do you know?
12 A. I think that is mine. It is mine.
13 Q. Can we look at the top part of the document? You were
14 the sole author of this document?
15 A. Yes.
16 Q. "The creation of the cardiac services directorate
17 represented the achievement of a major UBHT Trust
18 objective to develop a patient focused/disease based
19 directorate and this is our major strength."
20 A. Yes.
21 Q. So that achievement was an achievement of the Trust
22 Board?
23 A. Yes.
24 Q. Then you go on to set out a number of weaknesses as you
25 perceived them, which threatened the future existence of
0051
1 this fledgling directorate, and you summarise them.
2 I do not want to go through them all, but can I look at
3 just some of them, please?
4 If you go to 1.2, you say:
5 "Purchasers perceived cardiac services in Bristol
6 as an expensive service with long waiting times and poor
7 quality results (e.g. cardiac surgery)."
8 A. Yes.
9 Q. That is an example of poor quality results, as you saw
10 it. Were there any other areas of poor quality results?
11 A. I think that particular perception had come about -- all
12 of these 17 points here came about after discussion with
13 various purchasers and GP fundholders and other people.
14 One of the things that was coming up very frequently was
15 questions about the quality of results for cardiac
16 surgery, and there were questions about -- obviously in
17 paediatric surgery, things had already happened there,
18 but purchasers were concerned and worried that they
19 might well find poor quality results across the board
20 and they were asking questions about adult cardiac
21 surgery as well.
22 Q. Can I just slow you down a little bit? Those concerns
23 that purchasers were voicing were voiced in the wake of
24 publicity about paediatric cardiac surgery?
25 A. Well, yes, because --
0052
1 Q. Is that right?
2 A. Yes. I commenced in 1994 and from that time up until
3 this time, in August 1995, I conducted discussions and
4 meetings with various purchasers and events about
5 paediatric cardiac surgery were becoming known then, so
6 there were more and more questions from purchasers about
7 results and quality of service.
8 So, yes, that is true.
9 Q. Was it right, strictly speaking, to say that purchasers
10 perceived there were poor quality results, or was it
11 rather that purchasers were querying whether there might
12 be poor quality results, which is a different thing?
13 A. I think the perception was that there were poor quality
14 results, but purchasers had no evidence to support that
15 view. What they were asking me for was some way of
16 finding the evidence to suggest whether that was true or
17 otherwise. What they were saying was that there was
18 a perception that results were poor, but they did not
19 really know that that was true and they were asking for
20 information to try and support, or not, that assumption.
21 Q. If we look at 1.2 and 1.3 as well, which is about
22 communication, which was perceived to be poor, who held
23 the perception at 1.3?
24 A. That comment came up after discussion at a number of
25 levels with purchasers, and that would be with contract
0053
1 monitoring teams and Health Authority teams. It also
2 came up after discussion with individual GPs and GP
3 fundholders, so it came from a variety of sources and
4 there were a variety of examples as well. There were
5 complaints about basic communication like qualities of
6 discharge letters or letters received by GPs following
7 clinic appointments. There were also comments and phone
8 calls that I received about the difficulty people had
9 actually finding somebody within the directorate to talk
10 to if they had a problem they wished to discuss.
11 So that came from a variety of different sources
12 and was really about communication at a variety of
13 different levels.
14 Q. So part of it was communication, as it were, with
15 yourselves?
16 A. Yes.
17 Q. And part of it was communication to the outside world?
18 A. Yes, and part of it was communication about management
19 issues and part of it was communication about clinical
20 issues and about what had happened to a patient in
21 hospital. That was where the concerns about discharge
22 summaries and clinic letters came from, so it was
23 communication at a variety of levels.
24 Q. 1.4: "No proactive audit programme/strategy."
25 A. Yes.
0054
1 Q. I think you are prepared to deal in more detail with
2 audit subsequently in writing. I do not want to go into
3 it in any great detail today, but in general terms, was
4 that your perception? That was your own judgment, was
5 it?
6 A. No, none of these things -- obviously all of these
7 things have come from me as well, but that has been on
8 the basis of discussion with people that use the
9 service; and I felt that there was no proactive audit
10 programme, that had also come through from discussions
11 with purchasers and is linked to point 1 and point 2
12 where they were saying "You are not being proactive.
13 We have a perception that things may not be right but
14 you are not telling us whether that is true or not", so
15 it was coming both from myself internally but also from
16 the users of the service.
17 Q. So your (if I can use the word) "customers" were telling
18 you that this was the position, and it accorded with
19 your own opinion?
20 A. Yes.
21 Q. If you look at 1.9, which is over the page:
22 "Leadership in some areas is weak."
23 A. Yes.
24 Q. You were the General Manager and Professor Vann Jones
25 was the Clinical Director. Were you not the leadership
0055
1 of the directorate?
2 A. I think in that particular point I was referring in
3 particular to the Associate Clinical Director for
4 Cardiac Surgery.
5 Q. Mr Dhasmana?
6 A. Yes, that is right.
7 Q. So this had not come from purchasers; this was your
8 view?
9 A. Yes.
10 Q. So some of these statements are your opinion and some
11 are based on what purchasers have said, and some are
12 a mixture of the two?
13 A. Yes. If I could just say this paper was produced to
14 stimulate discussion and therefore it was an
15 amalgamation of perceptions from elsewhere, comments
16 that had been made to me from users of the service and
17 my own perceptions having been in post for several
18 months by this stage. So it was a variety of different
19 sources and a variety of different perceptions, and it
20 was deliberately written to be presented to the
21 clinicians to give them something to think about in
22 terms of how we developed the future strategy for the
23 directorate.
24 Q. So it was designed to stimulate debate and discussion
25 which was liable to look at the fundamentals of the
0056
1 organisation?
2 A. Yes.
3 Q. Can we look at 1.15? This is August 1995. From where
4 did that comment come about IT?
5 A. Was I was particularly concerned about information
6 technology. That has come from me. I was concerned
7 about it, both for contracting purposes, the Trust
8 hospital systems I felt were inadequate, but also the
9 audit systems for clinical audit, so it really came from
10 me. They obviously discussed things like that with
11 other people within the directorate, but that was very
12 much my impression of the directorate.
13 Q. If we go to UBHT 229/13, this is a letter to you, a memo
14 to you, from Mr Wisheart. I take it that when he refers
15 to 1.1 to 1.17, he is replying to your paper, because it
16 had 17 points to it.
17 A. Yes, that is right.
18 Q. He also seems to be referring to a point, 2.0, which
19 I do not think we have attached to your statement, do
20 we?
21 A. No. I do not know what the reference to 2.0 is.
22 Q. But it does appear as if the references in the memo to
23 1.1 to 1.17 do tally with the paper we have just looked
24 at.
25 A. Yes.
0057
1 Q. If we look at the third paragraph there, Mr Wisheart
2 says to you:
3 "I do not wish to copy (sic) on every point from
4 1.1 to 1.17."
5 I think it might mean "comment", but it does not
6 matter.
7 "Regarding point 2.0, the perception of a poor
8 quality service with long waiting times should be
9 countered by making our results known and Alan", that is
10 Mr Bryan is it?
11 A. Yes.
12 Q. "already has a draft audit report for 1994/95 which
13 could be used in this area."
14 A. Yes.
15 Q. What became of that suggestion from Mr Wisheart?
16 A. We did publish that report. We published it quite
17 widely. Alan produced a report which initially
18 I thought was in a very clinical format and I wanted it
19 to be amended slightly so it could be more easily read
20 by a wider audience. We did that and then produced
21 a report for 1994/95 which we circulated quite widely.
22 I need to stress at this point that Alan Bryan had
23 also, prior to this, been working for some time on
24 looking at outcomes in audit for the academic
25 department, so that information had been available
0058
1 specifically for the Professor of Cardiac Surgery and
2 the senior lecturer, but now what we were doing with the
3 1994/95 report was to look at the whole unit's results
4 and to want to circulate them widely to do as James has
5 suggested there, to try and counter poor perceptions by
6 presenting some factual information.
7 Q. So there was some information which was available at
8 that time in draft, which Mr Wisheart was saying, "Let
9 us make this known" and you took up that suggestion?
10 A. I do not know if at that date the report was in draft
11 and was later amended, but it was initially written in
12 draft and amended and sent out, and I worked on that
13 with Alan Bryan. You are implying from that we then
14 redrafted the report and sent it out. I do not know
15 that that is absolutely accurate, but, yes, the report
16 was amended at some stage to make it appropriate for
17 a wider audience and then circulated.
18 Q. About this time I think you were engaged in producing an
19 information pack about the directorate; is that right?
20 A. Yes.
21 Q. If we go to UBHT 84/33, this is the cardiac surgery
22 associate directorate meeting, so this is one half of
23 the cardiac services directorate?
24 A. Yes.
25 Q. And Mr Dhasmana was still the Associate Clinical
0059
1 Director, although I think he had made clear that he was
2 standing down by this stage; is that right?
3 A. Yes.
4 Q. And he is not actually at this meeting.
5 The surgeons who are at this meeting -- perhaps
6 you could identify those surgeons to us?
7 A. Mr Pawade, Mr Hutter, Mr Bryan, and Professor Angelini,
8 the surgeons.
9 Q. We see that Mr Dhasmana and Mr Wisheart, neither of them
10 were present?
11 A. No.
12 Q. If we go to 35, and scan down the page, at paragraph 8:
13 "The information package previously circulated was
14 discussed."
15 Had you drawn up that information package?
16 A. Yes.
17 Q. "The following points were noted". Those were your
18 initials in the right-hand column, so these are points
19 for you?
20 A. Yes.
21 Q. At point (iii):
22 "Contract monitoring information by individual
23 consultant is not useful."
24 What had the information pack contained about
25 individual consultant monitoring information?
0060
1 A. It would have contained information about the numbers of
2 procedures that had been carried out in a particular
3 period, usually a month. It was a monthly information
4 report. I think from this, that what we must have done
5 at that stage was to actually try and break down the
6 contract performance against individual consultants.
7 When we developed this package, we started off doing it
8 with suggestions from people as to what might be in it,
9 and then wanted to bring it back to decide what was and
10 was not useful. I can only assume, I cannot remember,
11 that we must have monitored by individual consultant and
12 then it was decided it was not useful and it was decided
13 not to do it.
14 Q. So it was monitoring numbers of operations carried out?
15 A. Yes.
16 Q. For each surgeon to each purchaser?
17 A. Yes.
18 Q. It was not concerned with outcome?
19 A. No. It was nothing to do with outcomes; it was simply
20 numbers of operations done. I think perhaps the reason
21 we looked at individual consultant numbers was because
22 we were aware that particular consultants would be more
23 likely to operate on patients from particular areas and
24 we wanted to see how that filtered through to their
25 attendance at outpatient clinics in other hospitals, so
0061
1 that somehow we could make a decision about balancing
2 the workload more equally across the different
3 consultants. But from my memory of this meeting, we
4 decided that that really was not a very helpful thing to
5 do, so we did not do it.
6 Q. So the fact that one surgeon might have carried out
7 a small number of operations for a particular purchaser
8 was not necessary or even at all a reflection on that
9 surgeon?
10 A. No.
11 Q. So it was right, was it not, that to publish that
12 information broken down by individual result would not
13 have been of any use?
14 A. No, that is right.
15 Q. If we go back to your witness statement at 89/12,
16 paragraph 9, this is again you pointing out that
17 purchasers and GPs, who were also purchasers, of course,
18 were saying that the service was poor.
19 Did you have any hard evidence that Health
20 Authorities or GPs were voting with their feet and
21 taking their work elsewhere?
22 A. The really hard evidence, I suppose, was that the
23 Somerset contract we had was very much under threat when
24 I started and that in the monitoring meetings they were
25 talking about taking their work away. Whether or not
0062
1 that was bluff or reality, I do not know, but
2 I certainly took it seriously. They were looking at
3 perhaps referring patients to the new unit in Plymouth
4 when that opened. That was a fairly large chunk of the
5 work, the patients that we would operate on that came
6 from Somerset. So that in itself was very significant.
7 Q. At this time, when you took office, cardiology, I think
8 in particular, was consistently overspent?
9 A. Yes.
10 Q. If we look at UBHT 299/25, this is a memo from you to
11 Dr Roylance. If we go over the page to 26, at the
12 bottom, we see that it was copied to Mrs Maisey?
13 A. Yes.
14 Q. If we go back then to the beginning, you are setting out
15 there the steps that are going to be taken in order to
16 try to redress the financial problem?
17 A. Yes.
18 Q. If we scan down so we see the whole page, you deal with
19 the two branches of the directorate in turn, cardiology
20 and cardiac services?
21 A. Yes.
22 Q. Over the page:
23 "The current overspending in cardiac services is
24 related entirely to our contract position."
25 What was happening was that too much work had been
0063
1 done on a block contract; is that right?
2 A. Yes.
3 Q. And you do not get any prizes for doing too much work?
4 A. No, you do not get paid for doing more work than the
5 contract's target allows.
6 Q. You do get paid for doing more work in a variable
7 contract?
8 A. Yes, you do.
9 Q. The block contract was with the Bristol & District
10 Health Authority?
11 A. Yes.
12 Q. You were anxious to make sure that non-emergency work
13 from Bristol & District should be essentially put on the
14 backburner whilst more work was done from purchasers
15 with variable contracts?
16 A. Yes. I think it is an important point that we were not
17 threatening emergency or urgent work, but, yes, in terms
18 of routine work, we did restrict that to try and improve
19 the financial position.
20 Q. Why send this memo to Dr Roylance? How common was it
21 for you to send memos of this nature to the Chief
22 Executive?
23 A. He asked that General Managers should do that. It was
24 asked. It was a specific request from the Chief
25 Executive that we should do that.
0064
1 Q. Do it when? Every so many months or what?
2 A. I think initially it was to be every month. I am sure
3 it was meant to be a monthly thing. As soon as our
4 financial position became known at the end of the month,
5 we would then explain to the Chief Executive what the
6 reason for the overspend was and what action we would
7 take to restore the situation.
8 Q. So these memos were regular?
9 A. They started off being regularly requested, and then it
10 did not continue. I do not remember writing more than
11 two of these.
12 Q. And they were concerned with finance?
13 A. Yes.
14 Q. Why copy it to Mrs Maisey and not, for example, to
15 Graham Nix?
16 A. I am sorry, I do not know. I recall being asked to do
17 that. The letter was to Dr Roylance and Mrs Maisey
18 wished to have a copy.
19 Q. Did that strike you as odd?
20 A. It does now, yes.
21 Q. As you recall, Dr Roylance said "Send this to me and
22 copy it to Mrs Maisey"?
23 A. Yes, and the request had come from Dr Roylance, but
24 whether it came directly to General Managers from him,
25 I do not know. I believe that this request came up at
0065
1 the monthly meeting that Mrs Maisey had with the General
2 Managers. We were asked to do that. That was one of
3 the actions from the monthly meeting we had with
4 Mrs Maisey but we were asked that it should go to
5 Dr Roylance and that it had been requested by him.
6 Q. WIT 89/17, paragraph 35. You have touched on this
7 briefly. This is a paragraph that is concerned with
8 Mr Dhasmana, essentially, who was the Associate Clinical
9 Director of Cardiac Surgery.
10 A. Yes.
11 Q. You say that your impression was that he found it
12 difficult to provide leadership in meetings and so on.
13 A. Yes.
14 Q. Was it your impression that these failings, as you saw
15 them, in Mr Dhasmana's managerial capabilities, or
16 leadership qualities, could have been addressed and
17 remedied?
18 A. No. I do not think so. My impression of Mr Dhasmana
19 was that he was a very straightforward and human
20 individual who was very good at -- he was basically
21 a very nice person who was really, I suppose in a way
22 quite simple in his approach to things. That was fine
23 and I think that helped our working relationship
24 initially, but in terms of dealing with some of the
25 difficult things, in terms of pulling clinicians
0066
1 together or helping to unite them, in terms of dealing
2 with difficult conflict situations, chairing meetings,
3 the things I have put there, in dealing with hostility,
4 he was very out of his depth so far as that was
5 concerned, and although I did want to support him as the
6 General Manager, I wanted to help him, I did not believe
7 that he had the skills to do the things that I have
8 identified there that he was not able to do.
9 Q. Mr Dhasmana has given some comments on your statement.
10 If we go to WIT 89/52, please, that is the first page of
11 his comments. You have seen this document?
12 A. Yes, I saw that this morning.
13 Q. If we go to page 54, at the foot of the page,
14 Mr Dhasmana actually is specifically commenting on
15 paragraph 38 of your statement, which we will come back
16 to in a minute.
17 He says he did attend a course, "Management skills
18 for the newly appointed consultant", but there were no
19 job description or written guidelines handed to him when
20 he became Associate Clinical Director in January 1993.
21 Would you find it surprising that he should not
22 have been handed a job description or written
23 guidelines?
24 A. I find it surprising he was not given any guidance in
25 how he should be effective in the Associate Clinical
0067
1 Director role. The course he attended would not have
2 given him anything like that, although I am aware that
3 the role of the Associate Clinical Directors, and indeed
4 the Clinical Directors, was still very much evolving and
5 developing and in fact, the Clinical Director roles did
6 differ from directorate to directorate, depending on the
7 style of the directorate, the style of the clinicians
8 within it. But, yes, I am surprised -- I am not
9 surprised because of the nature of the Trust, but
10 I would be concerned that he had not received any
11 guidance.
12 Q. So in this Trust at that time, it is not surprising, but
13 you think it would have been wise; is that a fair
14 summary?
15 A. Yes, thank you.
16 Q. Mr Dhasmana says that he did talk to, I think, four
17 different people. He spoke to Mr Baird, the Clinical
18 Director of Surgery; Mr Eltringham, who was the Chairman
19 of the Division of Surgery. Where did that role fit
20 into the hierarchy?
21 A. The Division of Surgery meetings were very much clinical
22 meetings, they were not managerial meetings. There is
23 still a debate about where the Division of Surgery fits
24 into the management machinery of the Trust, but they are
25 very much to deal with clinical and professional
0068
1 matters, whereas the directorate and associate
2 directorate roles are very much to do with the
3 management of the service.
4 Q. What was Mr Eltringham's managerial role in the surgery
5 directorate, so far as you recall?
6 A. Other than him being Chairman of the Division of
7 Surgery, I cannot recall that he had a managerial role
8 within the Division of Surgery. That may be because
9 I do not know exactly what he was doing, but ...
10 Q. So, so far as you recall, he had no managerial role?
11 A. Yes, as I recall it.
12 Q. Mr Wisheart was, in January 1993 -- I will be corrected
13 if I am wrong -- the Medical Director, I think?
14 A. Yes.
15 Q. Lesley Salmon had been the Associate General Manager.
16 As we discussed earlier, to the extent that there was
17 a shadow General Manager of cardiac services
18 subsequently, it was her?
19 A. Yes.
20 Q. And Mr Wisheart, as we see there, was at that time the
21 Associate Clinical Director of cardiac surgery.
22 Perhaps with the exception of Mr Eltringham, would
23 it or would it not be sensible for Mr Dhasmana to have
24 approached those people for some guidance as to how to
25 carry out his duties as Clinical Director?
0069
1 A. Yes, I am sure that was sensible; I am sure it was the
2 right thing to do.
3 Q. Was there anywhere else he could have turned, in your
4 view?
5 A. I would have thought that perhaps the Director of
6 Personnel maybe would have had a role, but I think
7 otherwise -- he has talked to the Medical Director and
8 to colleagues; he has talked to the General Manager.
9 I think that would be a reasonable group of people to
10 try and obtain guidance from.
11 Q. At the bottom of the page he says:
12 "My main responsibility would lie with the
13 contractual and financial obligations of the associate
14 directorate."
15 Do you agree with that?
16 A. Yes.
17 Q. "But the overall responsibility would lie with the
18 Clinical Director."
19 Do you agree with that?
20 A. Yes.
21 Q. "I was expected to be a channel of communication between
22 him and the members of the Associate Directorate of
23 Cardiac Surgery."
24 Do you agree with that?
25 A. Yes.
0070
1 Q. "I was told very clearly that I was not responsible for
2 my consultant colleagues and vice versa."
3 A. Yes. I mean, that is a matter of interpretation. As
4 I say, the roles of the Associate Clinical Directors
5 were developing. If you look at the previous page and
6 look at his obligation to the contractual and financial
7 performance of the associate directorate, he could not
8 do that without at least some, maybe not managerial
9 responsibility for his consultant colleagues, but he had
10 to be able to be working closely with his consultant
11 colleagues and actually suggesting and proposing
12 decisions that would affect the practice of his
13 colleagues, to be able to undertake or achieve that
14 objective for the financial and contractual management
15 of the associate directorate.
16 So what I am saying is that if there were changes
17 or if there were action that needed to be implemented --
18 for example, we talked about the restriction on
19 cardiology work: if we were restricting cardiac surgery
20 work for financial or contractual reasons, then
21 Mr Dhasmana would need to be working with his consultant
22 colleagues to determine how that happened.
23 So it is difficult to separate the responsibility
24 for the consultant colleagues from that objective of
25 achieving financial and contractual objectives.
0071
1 Q. If I miss out a couple of lines, tell me if you think
2 they are important, in which case I will come back to
3 them. If we go two or three lines down, do you see the
4 sentence:
5 "I believed that I did not have any controlling
6 influence as an Associate Director and relied on my
7 colleagues' co-operation and support in performance of
8 my function."
9 To what extent was it your view that an Associate
10 Director did have a controlling influence?
11 A. I do not think you can ever have a controlling influence
12 over cardiac surgeons, and I think consultants are
13 a very difficult group to have a controlling influence
14 over. I think what I perceived was that he would have
15 a more proactive role to play in terms of asking and
16 attempting to get agreement over different activities of
17 the directorate, which obviously would be affected by
18 the performance and behaviour of the consultants within
19 it.
20 So on the one hand I agree that he could not
21 manage or be in control of the consultants, but that he
22 had a very proactive role to play in terms of working
23 with them to control or change or direct what they were
24 doing within the directorate.
25 Q. To what extent is it fair to say that it was your
0072
1 perception, as I think Mr Dhasmana may well be saying,
2 that his approach was to take decisions and move things
3 forward on a consensual basis?
4 A. I think there is always going to be a difference in
5 style, but the way in which the Clinical Director and
6 Associate Clinical Director roles developed had been
7 discussed greatly within the Trust and I have been
8 involved with that in a number of other directorates.
9 The way that the philosophy with the Trust has been
10 described was that the Clinical Director's role was to
11 give some of the vision and leadership to the
12 directorate. Therefore, although it was a developing
13 role, I felt that the concept I had was one that had
14 actually been developed within the Trust. Janardan and
15 I discussed that. We discussed his role. We discussed
16 how he and I would work when I first started within the
17 directorate. We talked about these things when
18 I started.
19 Q. To what extent would it be fair to say that
20 Mr Dhasmana's approach to managerial meetings was to
21 move forward on a consensual basis?
22 A. It was not a separate forward split between consensus
23 versus, you know, a more proactive, perhaps more
24 autocratic, he is suggesting, way. He was not moving
25 forward in any way. There was no consensual style
0073
1 because he had no credibility as a Clinical Director.
2 So actually nothing was happening. It was not a simple
3 case of his approach was different to mine and I was
4 trying to ram down his throat an approach I thought
5 worked and he had a different approach. I do not
6 believe there was any approach. That was the main
7 problem.
8 Q. Mr Dhasmana says in his comments at page 53,
9 paragraph 3, first of all that meetings had become
10 fractious: and by 1995 that was the case, was it not?
11 A. Yes.
12 Q. He tried hard to get them together, to draw people
13 together?
14 A. I think he tried to do that, yes.
15 Q. Then he says he acknowledged that you intervened on
16 a few occasions, but "these were mainly on behalf of the
17 vocally strong faction. In my eyes, she was taking
18 sides instead of providing me any support as a General
19 Manager in conducting the meeting."
20 A. That was obviously the view that he had, but I recall
21 that what I was trying to do was actually to allow both
22 factions, however many factions there were, to a voice,
23 and not to allow meetings to disintegrate into slanging
24 matches between different groups of surgeons.
25 Q. So the factions were surgical factions?
0074
1 A. Well, there were differences amongst surgeons. There
2 were also differences between anaesthetists and
3 surgeons. So there were different groups.
4 Q. How did Mr Dhasmana interact with Mr Wisheart at
5 meetings of this nature?
6 A. My recollection is that Mr Dhasmana deferred on a number
7 of occasions to Mr Wisheart. Mr Wisheart was very
8 experienced at managing meetings; he was very good at
9 managing meetings. He often allowed Mr Wisheart to do
10 that, because he found it difficult.
11 Q. Was that deference that you perceived something that was
12 more apparent with Mr Wisheart than with others?
13 A. Yes.
14 Q. Why?
15 A. I mean, I do not know. I think Mr Dhasmana and
16 Mr Wisheart worked closely together. Mr Dhasmana
17 obviously had a lot of respect for Mr Wisheart and
18 Mr Wisheart, I think, possibly -- maybe this is an
19 incorrect assumption, but I think Mr Dhasmana saw
20 Mr Wisheart as more experienced in some of the things
21 I have mentioned, particularly dealing with
22 confrontations and dealing with meetings. But I think
23 to an extent that is speculation.
24 Q. Can I go to page 18, paragraph 37, please? This is back
25 to your statement.
0075
1 "I expected to be able to discuss with my Clinical
2 Director the strategy and planning issues and the
3 decisions that needed to be made before meetings took
4 place .... It was not possible to do this with
5 Mr Dhasmana."
6 But Mr Dhasmana was of course never the Clinical
7 Director?
8 A. No, that is incorrect. What I mean is that I expected
9 to be able to discuss with the Clinical Director and the
10 Associate Clinical Directors depending on -- you know.
11 I expected to be able to discuss those issues with all
12 of them.
13 Q. You say you felt that he, Mr Dhasmana, found it
14 difficult to understand some of the concepts with which
15 you had to work?
16 A. Yes.
17 Q. Which?
18 A. I think he found the way in which the system of
19 contracting worked quite difficult to understand.
20 I remember none of the surgeons liked the system of the
21 internal market, but were actually quite good at
22 understanding how it could benefit the directorate, and
23 Mr Dhasmana found it hard to understand that and hard to
24 understand about things, you know, the difference
25 between a block contract and a variable contract and how
0076
1 to maybe profile work, how to understand the effects of
2 demand, what the effect of, you know, increasing demand
3 from a particular area would have on the way we provided
4 the service, those sorts of issues, really.
5 Q. So as we have discussed, if you were doing more and more
6 work for a block contract purchaser, you did not get any
7 financial thanks for it.
8 A. Yes.
9 Q. That would mean you had to take decisions or try to
10 reach a view that you would stop doing non-emergency
11 block purchaser work and start doing variable work?
12 A. Yes.
13 Q. That essentially involved getting the surgeons to agree
14 or telling the surgeons which patients they could or
15 could not treat?
16 A. Yes, of course, because obviously if you are switching
17 the work you are doing and operating on people from
18 another area, the surgeons are doing those operations,
19 so yes, it does require them to co-operate with that.
20 Q. I will move away from Mr Dhasmana, unless there is
21 anything else you want to add to this area of
22 discussion?
23 A. No.
24 Q. Mr Dhasmana in due course resigned, I think, as
25 Associate Clinical Director?
0077
1 A. Yes.
2 Q. And he was replaced by Mr Hutter?
3 A. Yes.
4 Q. Can I turn to Mrs Maisey, whom we discussed briefly
5 earlier?
6 If we go to page 20, please, if we go to the foot
7 of the page, paragraph 47, we have discussed the fact
8 that you knew Mrs Maisey in 1985. You say you felt
9 bound to challenge a number of Mrs Maisey's comments and
10 decisions.
11 What period are we discussing there? Was this
12 when you were at cardiac services, or previously, or
13 both?
14 A. No, this was during the whole period of time that
15 I worked within the organisation, so from 1985 up to the
16 time Mrs Maisey retired.
17 Q. You use the word "challenged" her comments and
18 decisions. That is a strong word to choose. What was
19 the nature of the "challenge"?
20 A. There were a number of issues. Do you want specific
21 examples? There were issues, for example, when
22 I managed the service at Winford and we were
23 implementing the clinical nurse grading structure, we
24 disagreed with the way in which that was implemented.
25 So there were some fairly significant challenges.
0078
1 Q. It is one thing to challenge somebody's decisions. Did
2 that lead to bad blood between you?
3 A. I think to a certain extent Mrs Maisey welcomed
4 challenge. That was one of the things she liked about
5 the people around her. So it did and it did not. On
6 the one hand she felt pleased to have people that did
7 challenge her, but on another level, I think she was
8 irritated by that, and I wanted to implement things and
9 I felt there were obstacles to doing it.
10 Q. Did you perceive any change in Mrs Maisey's attitude or
11 approach when she ceased to become Unit General Manager
12 at the Central unit, as it was then, and became Director
13 of Operations at the Trust?
14 A. No. Her style was the same.
15 THE CHAIRMAN: May I just clarify for my own mind, are you
16 using the word "challenge" as an alternative to
17 "disagree", or are you using it in as the rather more
18 forceful idea of confrontation?
19 A. It could be both, depending on the circumstances.
20 I think more "disagree". Sometimes it could be
21 confrontation, yes.
22 MR MACLEAN: But that type of disagreement is something that
23 Mrs Maisey, as you have told us, welcomed. Was it
24 something that you saw as not unhealthy in the
25 relationship between managers?
0079
1 A. I think disagreement between managers can be very
2 healthy. The difference here, I feel, is that there
3 were -- the examples are very arbitrary decisions,
4 decisions made without judgment or knowledge and
5 therefore, you know, when you are disagreeing with
6 somebody on the basis of those sorts of decisions, that
7 is not quite so healthy because you then do not have any
8 opportunity to take that further or to work that out and
9 to do something about it.
10 So, yes, I think it is healthy, and I enjoy
11 working in a situation where you are able to challenge
12 and feel comfortable to challenge the decisions of those
13 around you, but it was not quite like that in terms of
14 my relationship with Mrs Maisey.
15 Q. Can we go to page 25, paragraph 63? Now we are talking
16 about cardiac services.
17 A. Yes, we are.
18 Q. You say you "did not feel able to be open or to confide
19 in my immediate colleagues and managers."
20 By "managers" there, we are talking about ...
21 A. I am talking about the other General Managers within the
22 Trust, so my counterparts in other areas.
23 Q. It seemed to me that managers would watch to see who was
24 in favour, and those who were not were avoided. You
25 felt there was a culture of fear and blame?
0080
1 A. Yes.
2 Q. Who was in fear of whom and who was doing the blaming?
3 A. The General Managers were in fear of the action that
4 would be taken by Mrs Maisey if they did not fit into
5 the perceptions or requirements that she had of them,
6 which I think is different to being worried and
7 performing well in their post, in that they are worried
8 about what would happen. There was a real fear of the
9 arbitrary way in which some managers were in favour and
10 some managers were out of favour, and I was very
11 interested to read the statement of Steve Boardman, who
12 also talks very much about the "club" and who was in and
13 who was out, and who would be "put back in their box" if
14 they were not doing what they were told.
15 In Margaret's comments about what I said about the
16 management development group, I think she was thinking
17 that I was saying there was a culture of fear and blame
18 at the management development group.
19 Q. Can we look at that? It is wit 89/44, paragraph 13. Is
20 that the passage?
21 A. Yes.
22 Q. What is your comment on that?
23 A. The management development group itself was an
24 opportunity for the managers to go every week to express
25 their delight that they did not happen to be in Margaret
0081
1 Maisey's spotlight in that particular week, so that
2 group was actually quite a supportive group for the
3 General Managers working within the Trust, because we
4 would come along every week with some sort of relief
5 that it was not our turn in that particular week to be
6 in Margaret's spotlight.
7 Q. When it was your turn to be in the spotlight, what was
8 the spotlight spotlighting?
9 A. It would involve all sorts of shouting and belittling
10 and undermining of people in public arenas, so that the
11 person themselves were left in no doubt as to what
12 spotlight they were in. It would also involve that --
13 I am not necessarily talking about myself, I am talking
14 about many other people within the Trust. It also
15 involved them being discussed with other managers in
16 other meetings but without them being present, so that
17 everybody knew who was "unpopular" at that particular
18 time.
19 Q. So if you were, for example, were to be spotlighted in
20 one of these meetings, you would be spotlighted in front
21 of other General Managers?
22 A. Yes, you would.
23 Q. So to what extent is it fair to say that when Mrs Maisey
24 here is referring to it being difficult to see how the
25 management development group sessions could be seen to
0082
1 be used to display a culture of fear and blame --
2 A. Yes, I think she is right. The management development
3 group was not an opportunity to perceive the culture of
4 fear and blame.
5 Q. So she is right about the particular instance?
6 A. Yes. I think she misunderstood what I was saying.
7 I was saying that the philosophies of the Chief
8 Executive were made particularly known through the
9 management development group and then I went on to say
10 there was a culture of fear and blame. It did not
11 follow on. Perhaps there should have been a new
12 paragraph there. It did not follow on from the comments
13 about the management development group.
14 Q. You say in your statement, still about Mrs Maisey,
15 page 32, at the foot of the page you refer to
16 Dr Roylance and as you saw it pushing back
17 responsibility to directors. Then you say, at the end
18 of the paragraph:
19 "I saw Mrs Maisey's role as controlling the
20 General Managers in order that Dr Roylance could get on
21 with other things."
22 A. Yes. I think that Margaret Maisey played a very
23 particular role for the Chief Executive. I think that
24 was her role. She herself, I think, on many occasions,
25 described herself as the Rottweiler of the Trust, so
0083
1 I think her own view was consistent with that.
2 Q. You may have seen in yesterday's transcript, if you
3 looked at it --
4 A. I am sorry, I have not had an opportunity to look at
5 Mrs Maisey's transcript from yesterday.
6 Q. Mrs Maisey was shown some articles from Private Eye.
7 I do not want to show them to you, but one of those
8 articles referred to Mrs Maisey as being Dr Roylance's
9 "sidekick".
10 A. Yes. Well I would agree with that, yes.
11 Q. Can we go back to Mrs Maisey's comments on your
12 statement at page 47?
13 She deals there with systems of appraisal. Let us
14 look at this paragraph:
15 "There were systems of appraisal in place in my
16 time as Unit General Manager [before the Trust]. There
17 was a system of annual objectives drawn up and agreed
18 with the next in line to each manager and approved and
19 countersigned by the superior."
20 She then says, essentially, that the pay for the
21 next year was performance related.
22 Then she says:
23 "There was a system of assessment of performance,
24 for example, used whilst we were preparing for the Trust
25 status and for clinical directorates", and the nurses
0084
1 had their own system.
2 To what extent, as an Associate General Manager
3 and later as a fully fledged General Manager in the
4 Trust, did you have such a system of appraisal in
5 respect of your performance?
6 A. I stated in my statement that there was no system of
7 appraisal in place within the Trust. That is obviously
8 incorrect. I apologise for that.
9 What I was getting to was, there was a system of
10 performance related pay and as at the time that I was
11 General Manager for the Eye Hospital, I benefitted from
12 that system. I think as an Associate General Manager,
13 I received an appraisal by the General Manager.
14 However, I think when the system of performance related
15 pay was withdrawn, there was no system for staff
16 performance and development review for General
17 Managers. I have not had a performance review since
18 I was an Associate General Manager working in the
19 Directorate of Surgery. So she is right to say there
20 were systems, but I do not believe there were systems
21 for General Managers and decisions made about General
22 Managers were not based on the results of information
23 that had come out of individual performance reviews.
24 Q. So that remains the case now?
25 A. Yes, although the Trust is influencing a system of
0085
1 individual development of the performance review at the
2 moment.
3 Q. Can I go back to page 46 --
4 A. I am sorry, just to qualify that, that was for General
5 Managers. There have been for a long time systems of
6 performance review for other staff within the Trust.
7 They have been in place for some time.
8 Q. Thank you. 46, the first new bullet point. This is
9 still Mrs Maisey's comments on your statement:
10 "There was every opportunity for staff to raise
11 any matter of concern of interest or of a personal
12 nature. Other than the complaints process, a procedural
13 system was not seen to be the way to handle the issues
14 described by Rachel ... My relationships with staff
15 were such that a number of staff not only brought to me
16 for discussion and advice their professional needs ...
17 but also their personal issues ..."
18 I think it follows from your evidence that you did
19 not perceive Mrs Maisey to be approachable from your
20 point of view in that way?
21 A. I need to clarify this. Mrs Maisey was not approachable
22 in terms of most areas. She was, and I know from other
23 staff, happy to talk to them about the sort of things
24 that she has mentioned there, some of the personal
25 issues, marriage, pregnancy, divorce and separation,
0086
1 that sort of thing, but I think because of the culture,
2 the way she worked and her personal style, if you had
3 a complaint or a problem that she thought was valid,
4 maybe she would think about it, but the opportunities
5 were not there. They certainly were not there if there
6 was a problem as there was with paediatric cardiac
7 surgery. There was no opportunity to talk to her about
8 that, because her philosophy was that she was not
9 interested or did not deal with things she did not agree
10 with, and therefore there was no way of actually taking
11 that further or discussing it.
12 Q. To the extent that you perceived a culture of fear and
13 blame, as you have put it, how did that manifest
14 itself? What effect did that have, for example on
15 staff?
16 A. The staff were frightened to raise their concerns.
17 Staff were watching to see -- were worried about the
18 ramifications for themselves, particularly amongst
19 General Managers; if they were not in favour, then they
20 were hardly likely to go and raise their matters of
21 concern with Mrs Maisey. They did not feel that they
22 would be heard.
23 I say this, I am not just necessarily talking for
24 myself, because as both Mrs Maisey and I have said, she
25 enjoyed challenge and she and I could discuss things on
0087
1 occasion, but there were occasions where, if you were
2 not in favour, then other staff certainly experienced
3 this, the possibility was not there to raise matters of
4 concern.
5 Q. When you say "other staff" you mean staff other than
6 people at your level of general management? Did this
7 culture of fear and blame, as you saw it, cascade
8 further down?
9 A. Yes, I think it did. I think it pervaded every aspect
10 of the organisation. I think the nursing staff were
11 terrified of her. The issue I have raised about dealing
12 with drug errors is a very key point. If you talk to
13 the nursing staff, they will tell you they were
14 terrified of Mrs Maisey finding out or being involved,
15 and that drug errors was one area where they came into
16 contact with Mrs Maisey.
17 Q. Did this culture, as you saw it, have an effect on staff
18 turnover? Did people leave?
19 A. No. I cannot recall the turnover figures for the Trust
20 and whether or not they compare very unfavourably with
21 other Trusts, but I think people tended to be committed
22 to the area that they were working within and their
23 loyalties lay to that area.
24 I mean, I do not really think I can answer that.
25 I do not know what the turnover figures were. I do not
0088
1 perceive that large groups of staff were leaving because
2 they were unhappy with the way Mrs Maisey had handled
3 them. I think what it did, though, was to create an
4 organisation where people were frightened to report
5 things, particularly with drug errors, and my
6 conversations with nurses support that. They were
7 frightened to report drug errors because they felt they
8 would be disciplined, and it did not give an opportunity
9 to review the systems that were in place and make
10 improvements.
11 So I think it had a major impact on the
12 organisation, but whether that necessarily meant people
13 moved and left it, I am not sure.
14 Q. Can I just be clear? You said a minute ago you did not
15 perceive that large groups of staff were leaving because
16 they were unhappy with the way Mrs Maisey had handled
17 them?
18 A. Yes. What I am saying is, I cannot answer your question
19 about turnover supporting this feeling that people in
20 the Trust were unhappy, because I simply do not remember
21 or know the turnover figures.
22 What I am saying is that it created a different
23 type of culture where people were wanting not to report
24 things and not to address them because they were
25 frightened of the response that it would have. I would
0089
1 have to check on turnover figures and whether people
2 were leaving. I cannot answer that.
3 Q. But if things were so terrible, you would expect people,
4 in the extreme, to get up and go elsewhere, would you
5 not?
6 A. You would, but people work within the organisation and
7 it is a large organisation. Their loyalties were to the
8 ward areas; their loyalties were not to the Trust or
9 Mrs Maisey, they were to the BRI or Ward 5 or whatever.
10 Q. If people were in fear of being blamed and they did not
11 feel as if there was any outlet for their frustration,
12 then surely in the end, to the extent that the turnover
13 figures were not out of line with other Trusts, does
14 that not suggest you might be rather overstating this
15 culture of fear and blame?
16 A. I think there are other factors that come into people's
17 decisions about leaving. I do not think Mrs Maisey
18 spent all her time at ward level frightening the staff
19 to the extent that they left. If that is what I have
20 said, yes, that is overstating the case a little, but
21 I think that people were -- they maybe accepted that was
22 the culture at the time, they were used to it, but they
23 were still very frightened by it. I do not think it
24 necessarily follows that people will leave because that
25 was the prevailing culture. I mean, I am sure there is
0090
1 research on that sort of thing, but I do not have those
2 facts and figures to hand at the moment.
3 Q. To the extent that there was this culture, as you saw
4 it, people who were affected by that, perhaps at a lower
5 level than you, to whom would they take their concerns,
6 to complain or to look for protection?
7 A. It depends of the level that you are looking at, but if
8 you are talking about Ward Sisters, then they would
9 either talk to somebody like the professional nurse
10 advisers that existed within the directorates or they
11 would talk to me.
12 Q. Did anyone ever talk to you?
13 A. Within the Directorate of Cardiac Services, yes, the
14 nursing staff did talk to me. The Clinical Nurse
15 Manager for cardiac services spoke to me about her
16 concerns at the way in which drug errors were handled
17 and as a result of that, we agreed we would not handle
18 them within the disciplinary procedure.
19 Q. That is Fiona Thomas?
20 A. That is right. Can I go back? I know Mrs Maisey has
21 made the point that she was never involved in the
22 disciplinary procedure for drug errors. She may not
23 actually have been sitting there in the disciplinary
24 hearing with a member of staff, but the actual policy
25 that that was how they were handled came from
0091
1 Mrs Maisey; that was her philosophy.
2 I think that point needs to be made clear.
3 Q. Was, as it were, the penal policy, the sentencing policy
4 in respect of drug errors, more draconian in the Trust
5 than elsewhere? Is that what you are telling me?
6 A. I cannot say that that is definitely the case, because
7 I have not made a great study of what was done
8 elsewhere, but certainly that was my impression, yes.
9 That was the impression of nursing staff that I talked
10 to who were concerned about that.
11 Q. It was the impression that --
12 A. -- that it was more draconian than other Trusts.
13 Q. What do you think the system should have been? How
14 should it have been better in order to remove the
15 culture of fear and blame, as you saw it?
16 A. I think the system that we moved to, which was that we
17 would actually review every part of the event, how the
18 error had occurred -- we would still have incident
19 reports and statements from staff, but we would look
20 carefully at each link in that chain and try and work
21 out what had gone wrong and if it was human error,
22 either to look at training issues and look at how we
23 could minimise the chance of that event happening again,
24 or if it is systems error, to look at how we could
25 change the system to do that.
0092
1 I think part of the critical incident reporting
2 system we have at the moment has allowed us to do that
3 as well, but in a less threatening situation, so it
4 would not be a disciplinary hearing where somebody would
5 then be told off for doing something wrong and then
6 disciplined and we did not put right either the system
7 or the human error that had occurred.
8 Q. We have been discussing Mrs Maisey quite a bit. To what
9 extent were her attitudes, so far as you perceived them,
10 reflective of the attitude of the Trust Board as
11 a whole?
12 A. I am not sure that Mrs Maisey's behaviour was determined
13 by the Trust Board. I think she played, as I said
14 earlier, a very specific role for John Roylance. That
15 is what she did, so John Roylance could do the things he
16 felt were important to do. I do not know that they ever
17 sat down at Board level and discussed her role and
18 endorsed that particular style.
19 Q. How do you reach that view that she was specifically
20 closely working with Dr Roylance, allowing him to do
21 other things? Why do you separate her attitudes from
22 the Trust Board as a whole and link them to Dr Roylance?
23 A. Because I think that the Trust was driven by those
24 personalities and that was what was obvious to me in the
25 length of time that I worked there.
0093
1 Q. Those two?
2 A. Yes.
3 Q. As opposed to the other executive directors?
4 A. Yes.
5 Q. Mr Stone and Mr Nix?
6 A. Well, they were obviously known, but their style and
7 their philosophies were not as dramatic, really, as John
8 Roylance's and Margaret Maisey's.
9 Q. To what extent would there be an outlet to people
10 subjected to the culture of fear and blame through, for
11 example, their Trade Unions or professional
12 organisations?
13 A. I do not think that the General Managers on the whole
14 were members of Trade Unions, but, yes, there would be
15 outlets there or people would be able to talk to the
16 Personnel Department and try and approach Mrs Maisey and
17 Dr Roylance themselves. But I do not think unions were
18 particularly an outlet for general management staff.
19 Q. What about the nurses through the RCN, or Unison as it
20 now is, or the other public service unions?
21 A. I mean, yes, they would be available to take up the
22 concerns of nursing staff.
23 Q. Did you have any contact with union reps?
24 A. I have always worked closely with in particular Unison,
25 yes.
0094
1 Q. Are you able to help to the extent to which those
2 nursing unions were engaged by their members with the
3 culture of fear and blame, as you see it?
4 A. No, I do not think I can really say how far the staff
5 were engaged with the unions in dealing with that.
6 Q. This picture you describe to us, your own view of the
7 culture of the Trust: what impact, if any, in your view
8 did that have on the care of the patients in any of the
9 directorates you worked in?
10 A. It is difficult to cite specific examples, but my
11 concern always was that with that culture -- I have
12 already given the example of drug errors. If there is
13 a culture where people are frightened to report errors,
14 then obviously that will impact badly on patient care
15 because there is not an opportunity to deal with errors
16 and put systems right to ensure the quality of care is
17 as it should be.
18 Q. You saw this culture, and your perception of it.
19 I assume you thought it was a damaging culture?
20 A. Yes, I did.
21 Q. It would have been better not to have a culture of fear
22 and blame, I think that is probably obvious. Could you
23 not have taken it to the non-executive directors or to
24 the Director of Personnel, for example?
25 A. I did do that. I have spoken to Ian Stone. At the time
0095
1 I spoke to Ian Stone about the difficulties. I also
2 approached Dr Roylance, particularly about concerns
3 about Margaret Maisey, and I was unable to do anything
4 about it.
5 Q. When was this?
6 A. I spoke to Dr Roylance in May or June of 1994, because
7 I was concerned about Margaret Maisey's behaviour, which
8 I felt was unprofessional and destructive, and I asked
9 him to speak to her and intervene in some way, and he
10 did not feel that that was the right thing to do.
11 Q. This was before you went to cardiac services?
12 A. This was before I went to cardiac services. I cannot
13 remember specific examples. I know I spoke to Ian Stone
14 probably in 1990 or 1991 about Margaret's style and the
15 view was, "Well, that is the way it is", so -- you know,
16 it was very difficult to change.
17 Q. You say in 1990 or 1991?
18 A. It may have been later than that.
19 Q. It may be important because of course the Trust --
20 A. We were a Trust, then.
21 Q. The Trust came in in 1991. It would not have been
22 around in 1990?
23 A. I think we were a Trust, so it must have been 1991, or
24 maybe later.
25 THE CHAIRMAN: Mr Maclean, may I just clarify an answer, as
0096
1 I recall you referred to non-executive directors?
2 MR MACLEAN: Yes.
3 THE CHAIRMAN: Perhaps we could hear an answer about
4 non-executive directors.
5 MR MACLEAN: I asked about non-executive directors or the
6 Director of Personnel?
7 A. I did speak to the Chairman, Mr McKinley, on one
8 occasion about concerns that I had, but it was felt
9 that -- I mean, it is not really the way to address
10 problems within the Trust, but I talked to Mr McKinley
11 as well. No, I did not approach any other non-executive
12 directors.
13 Q. One more page, I think, before we finish this little
14 section.
15 Page 34. This is your own statement. This is
16 a summary really at the end. You set out a series of
17 bullet points, the summary of your experience. It is
18 the fourth bullet point, the one beginning "As I shall
19 explain". I think it is your intention, as it is
20 implied there, to provide the Inquiry with a further
21 statement specifically about this issue.
22 "Where staff did raise concerns, they were either
23 belittled or reprimanded, as in my case, or comments
24 were made to undermine their credibility and motives."
25 Who are we talking about there?
0097
1 A. The last sentence is really, I think, relating to my
2 experience of Dr Bolsin and Professor Angelini.
3 Q. Can you expand on that, explain that a little more?
4 A. When I was obviously going through a process of trying
5 to find out what is actually going on in the
6 directorate, and as I was trying to do that, and to find
7 out particularly what Dr Bolsin and, you know, things
8 attributed to Professor Angelini were, and ask those
9 questions, those people were very much undermined by the
10 people that I asked.
11 Q. Let us be clear about this: Dr Bolsin and Professor
12 Angelini were, in your view, themselves undermined by
13 others?
14 A. Yes, but what I am trying to say is, when I was trying
15 to find out what went on and what was going on, and
16 I asked either people that I had worked with or Margaret
17 or John what was happening, it was these people were
18 dismissed as causing trouble for their own agendas and
19 for their own motives, and I should not be involved in
20 this and I should not listen to this, and I should just
21 ignore this. So, from my experience, that is what
22 happened when those people are trying to actually
23 challenge and question, you know, and do the things that
24 they were doing. That was very important for me. That
25 actually affected the way I behaved when I started
0098
1 within the directorate, because I was told that
2 a witch-hunt was taking place to try and undermine the
3 credibility of Mr Wisheart, and that the people that
4 were doing it were doing it simply for their own motives
5 and for their own agendas, and should not be believed
6 and in fact should be ignored. That was what I was
7 going to talk about more when I make the next
8 statement. That is what I mean by that paragraph.
9 Q. That answer, at this stage, obviously, we do not want to
10 get into the detail of those specific concerns about
11 cardiac surgery any more than we have to, but what you
12 have done is to give us an example where I think we read
13 the paragraph with the reference to staff in the second
14 line as being Dr Bolsin and Professor Angelini. Those
15 are the specific staff you have referred to.
16 Leaving aside the concerns that became well known
17 that led into this Inquiry about cardiac surgery, was
18 this belittling or reprimanding or undermining of
19 credibility and motives something that occurred on other
20 occasions in other contexts as well?
21 A. For me personally? That was my experience of issues
22 I was trying to raise and gain some support in dealing
23 with.
24 MR MACLEAN: Mrs Ferris, I am very nearly through but
25 not completely. Sir, I think it is probably time for
0099
1 another break, if that is convenient to the Panel.
2 I think before I do, I think Mr Langstaff wishes to make
3 a few brief remarks.
4 THE CHAIRMAN: If we can ask you to sit tight for
5 a moment, Mrs Ferris.
6 REMARKS ON PROCEDURE BY MR LANGSTAFF
7 MR LANGSTAFF: Sir, as you know, our procedures are
8 designed to explore the issues in a way which are of the
9 greatest benefit to the Panel and to explore it so far
10 as we can with complete fairness to all witnesses and
11 participants. It may be thought, because of
12 Mrs Ferris's answer to some of the last questions from
13 Mr Maclean dealing with concerns, that she is giving
14 evidence which is, as it plainly is, hostile to the
15 interests of Dr Roylance and possibly others.
16 It needs therefore to be emphasised that
17 because this particular part of the Inquiry's focus is
18 on issue 3, Dr Roylance was not himself invited to deal
19 with those concerns and he has not had an opportunity
20 yet to answer them, if he wishes to do so.
21 The same may apply to anyone else who may be
22 implicated in what has been said.
23 The reason for my mentioning it is not because
24 Mrs Ferris was disentitled from giving the answer she
25 gave, plainly that was her answer to those questions,
0100
1 and nor is it to in any way criticise the questions, far
2 be it for me to criticise our own questions to
3 a witness. But by way of explanation to the wider
4 audience, as Mrs Ferris herself has said, there is more
5 to be said by any number of people from different
6 perspectives about issue N and that will be left to that
7 time. So it must not be thought by the wider audience
8 that the evidence is one-sided at this stage. It simply
9 has not been explored and it will not be explored until
10 later. What we are doing is at this stage setting the
11 scene for management style generally, and obviously
12 particular examples that come to mind of management
13 style may trespass into issue N, but that is what
14 Mrs Ferris was doing at this stage, that is what she was
15 invited to do.
16 I make that clear to do as best we can from this
17 side of the room to preserve both the policy of dealing
18 with issue by issue, and preserving as best we can the
19 impartiality which we must have in presenting the
20 evidence to you, the Panel.
21 THE CHAIRMAN: Absolutely. I mean, there need be no
22 nervousness in anyone that if matters are raised here
23 there will be an opportunity to respond to them. We
24 have said that before and you have just said it, and
25 I repeat it. It need not, in a sense, be raised, but
0101
1 I am glad, if it is raised, to be able to confirm what
2 you have just said.
3 We will revisit some of these matters because it
4 is inevitable that there will be a degree of "leakage"
5 between blocks when we deal with them. Whenever that
6 leakage happens, we will direct our attention to it
7 subsequently and in an appropriate manner and nobody
8 should be nervous about that. It will be part of our
9 procedure that we have made clear from the outset.
10 I propose that we take a luncheon break, if that
11 was what you were implying, Mr Maclean? Please advise
12 me if that is not what you were implying.
13 MR MACLEAN: I am in your hands, and perhaps that of the
14 witness as well. I would hope if we take a break of
15 half an hour, perhaps 40 minutes, we would certainly be
16 through Mrs Ferris's evidence by 2 o'clock.
17 THE CHAIRMAN: Out of respect for the witness and others,
18 why do we not say 1 o'clock. We will reconvene and come
19 back and hear more from you then, Mrs Ferris, thank you.
20 (12.22 pm)
21 (Adjourned until 1.00 pm)
22 (1.05 pm)
23 MR MACLEAN: Sir, just before lunch we were looking at
24 Mrs Ferris's witness statement, and I hope you still
25 have in front of you WIT 89/34, the bullet points page.
0102
1 Can we look at that fourth bullet point, the one
2 we were focusing on before lunch? I just want to pick
3 out one very small point.
4 You make a reference there to "reprimand" and you
5 say that you were reprimanded. What was the nature of
6 that reprimand? Was it formal, done in writing?
7 A. No, not at all, it was informal. It was very much, if
8 you look that one particular example I had in my
9 statement of dealing with a child that it was felt
10 needed to be transferred, in that context I was
11 reprimanded, asked to leave the office, not to
12 interfere. I have never been subject to any formal
13 process of reprimand.
14 Q. So it was not part of any structured disciplinary
15 procedure?
16 A. No.
17 Q. Can I go to something else? Still in your statement,
18 WIT 89/18, paragraph 40.
19 We touched on this briefly earlier:
20 "The early cardiac surgery meetings were very
21 acrimonious, particularly between cardiac surgeons."
22 That is only one half of the cardiac services
23 directorate?
24 A. Yes. There I mean the early associate directorate of
25 cardiac surgery meetings.
0103
1 Q. So this is in the very end of 1994 and through 1995,
2 is it?
3 A. Yes, that is right.
4 Q. Mr Wisheart has given some comments on your statement.
5 If we go to WIT 89/58, paragraph 3 there in the middle
6 of the page:
7 "Mrs Ferris took up her post ..."
8 He assumes you are referring to 1995 and he is
9 correct in that?
10 A. Yes. I was only in post for a month of 1994, so it is
11 mainly 1995.
12 Q. He makes, if we just scan down a little more, two
13 points.
14 First of all he says there was heightened tension
15 in 1995 between some members of the Board.
16 He refers there to "Board". You remember the
17 document we saw earlier from Mr Wisheart referred to the
18 Cardiac Surgery Board. It may be that he is referring
19 to these cardiac surgery meetings which were one part of
20 the Cardiac Services Directorate structure?
21 A. Yes.
22 Q. I assume that you are not really in a position to help
23 us with to what extent the tension among the
24 cardiothoracic surgeons was higher in 1995 than it had
25 been before, because you yourself had not been involved?
0104
1 A. No, exactly.
2 Q. Is that right?
3 A. That is right, yes.
4 Q. So does that mean that you are not in a position to
5 comment sensibly on the second of Mr Wisheart's bullet
6 points either?
7 A. I think I can comment on his second bullet point,
8 because in the first he is saying there is heightened
9 tension and comparing an earlier period with a later
10 period, and I cannot comment on that.
11 In the second meeting he is saying that the
12 acrimony was not the overriding characteristic and that
13 they were generally valuable.
14 I do not need to know what the previous meetings
15 were like to know that the meetings I attended were not
16 a particularly valuable opportunity for members of the
17 team to meet and reach decisions together. The acrimony
18 and the hostility during 1995 were very destructive in
19 terms of the way those meetings were conducted, and
20 I would disagree strongly that this focus on the team
21 meeting and reaching decisions together. There were
22 other members of the team present at those meetings,
23 such as nurses, perfusionists and physiotherapists.
24 They did not participate in the discussion very greatly
25 and they certainly were not influencing any of the
0105
1 decisions really made at those meetings.
2 Those meetings and the decisions reached followed
3 discussion amongst surgeons, anaesthetists, and I was
4 also involved to an extent as well. I think the nursing
5 staff, perfusionists, physio staff, were actually quite
6 inhibited because of the acrimonious characteristic of
7 those meetings, so I would disagree with that second
8 point.
9 Q. Can you identify for me, if there was more than one, the
10 different areas of acrimony. You suggest there was
11 acrimony between the surgeons?
12 A. Yes.
13 Q. Who else was there acrimony between?
14 A. It was between different surgeons and between surgeons
15 and anaesthetists.
16 Q. Was there division within the anaesthetists or were
17 they, as it were, united?
18 A. I think my recollection is that the anaesthetists were
19 a more united group.
20 Q. Than the surgeons?
21 A. Than the surgeons, yes.
22 Q. Can you go to your witness statement at 89/19,
23 paragraph 42.
24 You give an example of a topic which caused
25 acrimonious discussion. It was about intensivist cover
0106
1 in the intensive care unit:
2 "Someone had suggested that recruiting more
3 intensivists might help with decision-making in ITU."
4 Who had suggested that, do you remember?
5 A. No, that is why I have not put it in the statement.
6 I know that suggestion had been made on a number of
7 occasions, but I cannot remember who raised it at the
8 meetings or how it had come about.
9 Q. Then you set out the alternative view which was that
10 management of intensive care was for surgeons. Who were
11 the proponents of that view?
12 A. I think Mr Bryan was particularly keen that management
13 was a matter for surgeons rather than intensivists and
14 I think Mr Wisheart was also of that view.
15 Q. You refer to Mr Wisheart at the bottom of the paragraph
16 having some concerns as to the best way forward?
17 A. Yes. Mr Wisheart, I think he did not support that
18 particular proposal that increased intensivist cover was
19 the right thing to do, and basically I do not think he
20 wanted to do that, but there were, you know, it was
21 quite clear, and it had also come from the nursing
22 staff, maybe not through the meeting but in a variety of
23 other discussions, that they were feeling concerned
24 about conflict relating to the management of the patient
25 on intensive care. So I felt that, you know, it was
0107
1 a very important issue that needed to be debated and
2 that a decision would need to be made.
3 Q. At this time in 1995, what role did Mr Wisheart have in
4 a managerial sense?
5 A. Mr Wisheart was still the Medical Director, but within
6 the cardiac services directorate; he did not have
7 a managerial role; he was one of the surgeons attending
8 those meetings. Mr Dhasmana was the Associate Clinical
9 Director.
10 Q. So you then refer to a couple of meetings, neither of
11 which Mr Wisheart was at, where this topic of
12 intensivist was not discussed.
13 If you go over to page 20, there was a third
14 meeting. At this meeting the decision was taken to
15 increase the intensivist cover?
16 A. Yes.
17 Q. Mr Wisheart was not there?
18 A. That is right.
19 Q. But Mr Dhasmana as the Associate Clinical Director had
20 chaired that meeting?
21 A. Yes, he had.
22 Q. You say you received a letter from Mr Wisheart
23 explaining that the decision could not stand because he
24 had not been present at the discussion.
25 Was Mr Wisheart making a jurisdictional point
0108
1 about the meeting, that it was not properly formed
2 without his presence, or was his point a different one?
3 A. I think his point was that he had an opinion on this
4 particular matter and felt that he had not been able to
5 express that opinion and therefore the decision had been
6 made without him having the opportunity to be involved
7 in that decision-making process.
8 My view was that we had actually said some months
9 earlier that this was an issue that needed to be
10 discussed and Mr Wisheart was aware that we were going
11 to discuss the decision and that the meeting did not
12 have to have Mr Wisheart attending before we could go
13 ahead and discuss the decision. I think I wrote to him
14 as well and said there would be a number of
15 opportunities for him to make his point and that he
16 should do that. But I was never under the impression
17 that he had to be at the meeting, that it was not
18 a properly constituted meeting unless he was there.
19 Q. Did you understand Mr Wisheart to be saying that the
20 decision to increase intensivist cover was a decision
21 that could never stand in any circumstances; it was
22 a wrong decision and would have to be reversed, or was
23 he saying the matter ought to be looked at again in his
24 presence?
25 A. He was not saying the decision could not stand, he was
0109
1 saying he was unhappy the decision had been made and he
2 felt excluded from that and he did not like it. I do
3 not recall him saying that it could not stand and that
4 we would have to arrange another meeting to discuss it,
5 although he was very clear to make me aware of his
6 displeasure about the fact that the decision had been
7 made.
8 Q. Did you take the view that that was a reasonable point
9 for Mr Wisheart, who was a very senior and experienced
10 surgeon, to make: that this type of decision ought
11 better to have been taken in his presence? It was
12 a sensible point for him to make?
13 A. I thought it was a very sensible point for Mr Wisheart
14 to make that decision and had actually encouraged that
15 and taken all the comments and queries of the other
16 staff who were also very concerned and held a different
17 opinion about this and had tried to establish
18 a situation whereby we could discuss this issue with
19 everybody present unfortunately, then a further two or
20 three months had elapsed. Mr Wisheart knew what we were
21 going to do and when we were going to do it, and I felt
22 was unduly delaying the process because he did not want
23 a decision to be made. I therefore made it very clear
24 we were going to discuss this matter and if a decision
25 was appropriate, then we would have to make a decision.
0110
1 I think you have to bear in mind the fact that
2 there were very severe expressions of stress from the
3 nursing staff, who felt that the situation on intensive
4 care was so difficult because it was not clear who was
5 in charge of the patient in intensive care that they
6 were actually feeling that this was now becoming
7 dangerous, and I expressed this and it was evident that
8 we could not delay the situation any more because we
9 felt that without proper understanding of who was in
10 charge of the patient and what was happening on ITU that
11 we were at risk of, you know, an incident occurring.
12 So it was actually a very important issue and one
13 that could not be delayed. I thought it was absolutely
14 right that Mr Wisheart should want to be involved and he
15 had every opportunity to do so, but at the end of the
16 day a decision had to be made.
17 Q. Mr Wisheart was a businessman, a surgeon and Medical
18 Director of the Trust. Did you take steps to make sure
19 that his views were communicated to the meeting when the
20 decision was taken?
21 A. His views were communicated to the meeting at the first
22 meeting when we first debated that, and I also spoke to
23 him in-between meetings. I am sure I wrote, although
24 I will have to check the documentation, that if it was
25 impossible for him to attend -- he had assured me that
0111
1 he would attend future meetings; he had not said at the
2 first meeting "I am sorry I cannot come for the next two
3 months because of other commitments". It was not as if
4 he said that and we made a major decision anyway. He
5 had said he would be at the next meeting and was not, so
6 we organised a further meeting and he was not there so
7 I felt he had a further opportunity to make his thoughts
8 known. But I also wrote to him to encourage him to make
9 his thoughts known so that could be part of the
10 decision-making process. I think everything reasonable
11 was done to involve him and it was a decision that had
12 to be made relatively quickly. We could not keep
13 bringing it back to committee every month until several
14 months had elapsed.
15 Q. I think it is right to say in his written comments
16 Mr Wisheart has said [89/58] he does not recall this
17 particular incident and he is not aware of the letter
18 that he is said to have written, but he does indicate
19 that should the Inquiry want to pursue the matter
20 further, then he I think at least leaves a door open to
21 further comment on it. You have seen what he says?
22 A. Yes. I will be very happy to find the documentation
23 that made this situation clearer. What I am explaining
24 is that this is the situation as I know it, and, you
25 know, I can say no more than that.
0112
1 Q. What was your impression and opinion of Professor Gianni
2 Angelini?
3 A. In general terms I had a very good working relationship
4 with Professor Angelini. When I joined the directorate
5 I had found him to be very proactive and very dynamic in
6 terms of developing academic unit, and I believe I put
7 it in the "brainstorming" paper that he was a major
8 strength of the directorate and that close working with
9 the academic department would only be for the benefit of
10 the directorate.
11 Q. And Professor Angelini, does he remain in post now?
12 A. Professor Angelini is in fact the Associate Clinical
13 Director for cardiac surgery now.
14 Q. So he now occupies a role that when you started as
15 General Manager was occupied by Mr Dhasmana?
16 A. Yes.
17 Q. Can you help us with something called the Bristol Heart
18 Institute? What was that?
19 A. The Bristol Heart Institute was the creation of a new
20 academic department for -- basically it was the creation
21 of an umbrella for academic departments of which cardiac
22 surgery was one, into a new organisation. It was opened
23 in I think October 1995.
24 Q. Whose idea was the Bristol Heart Institute?
25 A. I could not be exactly sure, but I think Professor
0113
1 Angelini was very involved in that, so that they and
2 others within the University, Andrew Newby, for example,
3 that it was their thing, it was what they wanted to
4 develop.
5 Q. Andrew Newby?
6 A. Andrew Newby is a professor I think of cell biology who
7 works closely with Professor Angelini in the academic
8 department of cardiac surgery.
9 Q. Can we go to UBHT 229/5, please? It is a meeting of the
10 cardiac surgeons and I think there are 7 people present
11 at that meeting and 6 of them are cardiac surgeons?
12 A. Yes.
13 Q. You are the seventh. Can we look at this page as
14 a whole? Just blow up the box, if we can.
15 Do you remember this meeting?
16 A. Yes, I remember it very well.
17 Q. You see paragraph 1:
18 "The establishment of the Bristol Heart Institute
19 was welcomed as a positive development for the cardiac
20 services directorate. Mr Dhasmana asked for
21 clarification of the role of clinical service within the
22 institute. Professor Angelini confirmed that the
23 opportunity was available for the clinical service to be
24 part of the Institute. However, as a formal management
25 structure was not planned, a Management Board would not
0114
1 be identified. Bristol Heart Institute stationery will
2 be available as required."
3 Can you flesh out the discussion that led to the
4 writing of that minute?
5 A. Yes, I can. I actually wrote those minutes and I think
6 these are very innocuous minutes which do not reflect
7 that this was a very difficult meeting and the whole of
8 item 1 about the Bristol Heart Institute represented
9 a very difficult discussion about whether or not the
10 Bristol Heart Institute was valuable to the cardiac
11 services directorate, whether or not the cardiac
12 services directorate could benefit from the Bristol
13 Heart Institute. It focused on how the cardiac services
14 directorate fitted into the Bristol Heart Institute and
15 I know there was some concern from surgeons as to
16 whether almost the Bristol Heart Institute would take
17 over the cardiac services directorate, which is why
18 there is the reference there to the formal management
19 structure. There was the fear expressed that the
20 creation of the Heart Institute would mean the cardiac
21 services directorate would be absorbed into that and
22 there would be a management structure with Professor
23 Angelini as the person in charge of both the academic
24 department of cardiac surgery and the clinical service.
25 I think there was certainly a view that people did not
0115
1 want this. There was also --
2 Q. Can I stop you there. You make it sound as though there
3 was a fear in some quarters that Professor Angelini was
4 perhaps engaged in some sort of coup d'etat against the
5 cardiac services director. Would that be putting it too
6 strongly?
7 A. There was a fear of Professor Angelini taking over.
8 Q. Who held that fear?
9 A. I recall Mr Hutter was very concerned about that.
10 I think Mr Dhasmana to a lesser extent, and I think that
11 whilst not sort of openly critical, I know that James
12 Wisheart was very questioning of what this would
13 actually mean. So it was a sort of, if you are looking
14 for a division between surgeons, it was really Mr Bryan,
15 Professor Angelini, trying to reassure Mr Hutter and
16 Mr Hutter, Mr Wisheart and Mr Dhasmana that this Bristol
17 Heart Institute was in fact an umbrella for the academic
18 service and would not swamp, absorb or take over the
19 cardiac services directorate.
20 Q. The one person you did not mention was Mr Pawade.
21 A. That is because I cannot remember Mr Pawade
22 participating in that meeting. I am sorry, I cannot
23 help you on that. Mr Pawade had intended to come to the
24 surgeons' meeting, and I am not sure if that was one of
25 the first he came to. If it was, then I think he did
0116
1 take very much a back seat and was fairly quiet during
2 the meeting. I cannot really answer that, I cannot help
3 with what Mr Pawade said.
4 Q. He was still, at that stage anyway, the "new boy"?
5 A. Yes.
6 Q. Can we go to the bottom of that page, please,
7 paragraph 5? Maybe you can read it without it being
8 blown up any further. The next meeting was 9th November
9 at 8 o'clock in the morning. You suggested "the
10 discussion would be more productive if agenda items were
11 planned and relevant information circulated in advance."
12 The action for that was "JPD", Mr Dhasmana?
13 A. That is right.
14 Q. Where does that come from?
15 A. The meeting itself had been a very difficult meeting,
16 and whilst it was important that issues like what the
17 actual Heart Institute meant, whilst it was important
18 that those things were debated, we had spent something
19 like 45 minutes discussing the stationery and who would
20 use the stationery for the British Heart Institute, so
21 it had been a difficult meeting and one Mr Dhasmana had
22 particularly struggled to control. I suggested if we
23 could plan the meetings more in advance and circulate it
24 in advance we could give people an opportunity to
25 prepare in advance of the meeting so they could be more
0117
1 structured and less difficult in the future. I did not
2 want to suggest that these meetings had to be formal,
3 but because of my experience of that one, I felt it
4 would be more productive if we took that approach.
5 Q. Can I take you then to UBHT 229/3. This document looks
6 a bit strange because it has some stickers over it. Can
7 we blow up the top of the page? We see that the text of
8 the document is about the surgeons' monthly meeting?
9 A. Yes.
10 Q. I think actually, if we try 229/4, that is the actual
11 text of the document.
12 A. Yes. It is a letter from me to Mr Dhasmana.
13 Q. If we look at the text of this, this is written the day
14 after the meeting, the minutes of which we have just
15 looked at; is that right?
16 A. Yes.
17 Q. That was the 12th?
18 A. Yes.
19 Q. You are saying to Mr Dhasmana:
20 "In order to move things forward you need to
21 identify in advance some of the areas you wish to
22 address and circulate ..." papers and so on?
23 A. Yes.
24 Q. If we go back to page 3, the handwriting at the top
25 of the page:
0118
1 "Rachel, Teresa", who is Teresa?
2 A. Teresa was my secretary at that time.
3 Q. Teresa is saying to you Mr Dhasmana has not got an
4 agenda for the next surgeon's meeting and he,
5 underlined, does not want you to circulate one because
6 it is their, underlined, meeting.
7 What do we take from the underlining and that
8 comment?
9 A. You take the emphasis on "does not want", so does not
10 want me to do anything because it is their meeting.
11 I took that very much to mean that perhaps Mr Dhasmana
12 felt I had interfered in his conduct and arranging of
13 these meetings and was fairly firmly explaining he did
14 not want that to happen.
15 I am sorry, can I just say, the reason that the
16 note to me is made there is that I had written the
17 letter to Mr Dhasmana. I do not know what the date is,
18 I would have to look at the previous screen, but I was
19 then asking my secretary to chase Mr Dhasmana to find
20 out where the agenda items had got so we could get the
21 next one organised. That was the note she left me
22 having spoken to Mr Dhasmana. The writing on the
23 right-hand side of the screen is Mr Hutter's writing,
24 and I think then, when he took -- I am sure it is
25 Mr Hutter's writing -- those are some of the items he
0119
1 thought we should be discussing.
2 Q. Your letter to Mr Dhasmana was 13th October, the day
3 after the previous meeting on the 12th, and the next
4 meeting, if I remember correctly, was on 9th November?
5 A. All right. I was obviously chasing the information to
6 arrange the meeting. I always like to circulate things
7 a little in advance to give people the chance to read
8 them.
9 THE CHAIRMAN: The 23rd was the date referred to as the date
10 at which Mrs Ferris wanted a reply.
11 MR MACLEAN: Yes. We see the date on this annotation of
12 23rd October.
13 If we look down the rest of that page, please, the
14 writing at the very bottom, it refers to "Jonathan", who
15 was Mr Hutton. He was about to become or perhaps had
16 just become Associate Clinical Director, replacing
17 Mr Dhasmana; is that right?
18 A. Yes, that is right, so I am asking Jonathan then, who is
19 taking over those meetings, what he wants to do about
20 the meeting and the one scheduled for the 9th.
21 Q. "Or would you, like Janardan, prefer to sort it out
22 yourself?"
23 A. Yes, I am trying to find out whether or not he wants me
24 to help or not help. He comes back with his list of
25 items. That is his writing on the right-hand side.
0120
1 Q. I think we can read all of that, with the possible
2 exception of at the bottom it says:
3 "Waiting lists"; is this a joint list?
4 A. On urgent referrals, yes.
5 Q. Can we go to UBHT 7/1, please.
6 This is a meeting of the Executive Committee of
7 the Trust Board, September 1995. Obviously you would
8 not be present at that. The only cardiac services
9 person who was there was Mr Wisheart, who of course was
10 Medical Director.
11 A. Yes.
12 Q. If we go to page 4, the foot of the page, just to give
13 this some context, if you scroll up to the top of the
14 page, please, and back to the previous page, these are
15 the Chief Executive's remarks, so this is Dr Roylance.
16 If we go over the page again, please, to the
17 Department of Health:
18 "The Professor of Cardiac Surgery [Professor
19 Angelini] had created a Bristol Heart Institute."
20 So as it is reported to the committee, it was
21 Professor Angelini's creation.
22 "He understood it was intended to include NHS
23 clinical facilities within the Institute."
24 The "he" there -- I am not clear who the "he" is;
25 Dr Roylance I think.
0121
1 "Dr Roylance pointed out that it was not possible
2 to subcontract clinical care to the University and he
3 could not allow annexation of part of the service in
4 this way. The Trust Board gave its support to the Chief
5 Executive that he should take up this issue with the
6 Professor of Cardiac Surgery."
7 So it would appear from that minute, would it not,
8 as though the concerns that Mr Angelini was, to use my
9 words, "planning a coup d'etat", were shared at Board
10 level as well as among some of the other cardiac
11 surgeons?
12 A. Can I just see the date of those minutes, please?
13 Q. Yes, you can. It is 7/1, September 1995.
14 A. Obviously those concerns were shared at Board level.
15 I had not been aware of this particular meeting, or
16 those concerns raised at that meeting, but the same
17 concerns were then raised at the meeting in October and
18 I think it was made very clear at that meeting that the
19 Bristol Heart Institute was not trying to annex the
20 clinical service, but what people were concerned about
21 was how did the clinical service fit into that
22 organisation?
23 There was a feeling from the group that that
24 organisation could help the clinical service in terms of
25 improving its profile within the region, and that was
0122
1 why the discussion, the lengthy discussion about Heart
2 Institute stationery took place, but as far as I am
3 aware from the meeting, there was no intention to annex
4 the clinical service. Obviously that concern had been
5 expressed earlier.
6 Q. So it is the same sort of point.
7 Can we go back to WIT 89/26, please,
8 paragraph 66? It is the one at the top of the page.
9 You say you saw the creation of the Bristol Heart
10 Institute in 1995 as "a very positive and exciting
11 development for the directorate to be a part of. It was
12 clear to me very early on, however, that some of the key
13 medical staff in the directorate did not like or Trust
14 Professor Angelini."
15 A. Yes, that is right.
16 Q. I appreciate the next sentence says you want to deal
17 with this in greater detail later. Are you in
18 a position to identify to us at this stage who you have
19 in mind?
20 A. I can do that; there is just one other thing I wanted to
21 say before that. You asked me earlier about my
22 experience of working with Professor Angelini and
23 I replied with a number of positive points. I had also
24 wanted to follow on that there were many occasions when
25 Professor Angelini could be abrasive and very
0123
1 challenging and actually upset people quite a lot. That
2 was very true then. That caused concern within the
3 group of surgeons. The people who were concerned about
4 Professor Angelini were obviously Mr Hutter, Mr Dhasmana
5 and Mr Wisheart, but also -- you have asked me about key
6 medical staff; there were other non-medical staff who
7 also had some concerns.
8 Q. Can we go to page 28, please? Paragraph 75. I think
9 I promised or threatened to come back to this
10 paragraph. You explain here an incident in 1995 about
11 a child. I do not want to go into the details of the
12 child or what was wrong with the child or matters of
13 that sort. But the child was in Mr Wisheart's list?
14 A. Yes.
15 Q. Due for surgery in due course?
16 A. Yes.
17 Q. And the plan was that the child would wait for Mr Pawade
18 to take up his post in May 1995?
19 A. Yes.
20 Q. Albeit that in May 1995, paediatric open heart surgery
21 was still for a few months more to be carried out at the
22 BRI?
23 A. Yes.
24 Q. By this time there had been some publicity about the
25 surgery at the BRI.
0124
1 A. Yes.
2 Q. You say you were not offered an up-to-date condition
3 report on the child by Mr Wisheart?
4 A. Yes. When I asked for information about the child when
5 I was first asked about the case, his view, his comment,
6 was that the child should wait, but he did not give me
7 anything, he did not reassure me or say "This is not an
8 urgent case, the child can wait, it is routine so please
9 advise the parents that it is appropriate for them to
10 wait". His view is, "The child will wait until
11 Mr Pawade starts". It was quite a blunt statement
12 there.
13 Q. So you specifically asked Mr Wisheart for an up-to-date
14 condition report on the child?
15 A. I would not have put it in those terms. I would have
16 said, "Is it appropriate for the child to wait? Is it
17 all right for the child to wait? How is the child?"
18 That sort of thing. I would not have said "Mr Wisheart,
19 please give me an up-to-date condition report", because
20 that would not have been the way I would have asked, but
21 I would have asked whether it would be appropriate and
22 whether or not there would be any difficulties with the
23 child waiting.
24 Q. But you had already been told, you say two or three
25 lines further up, that the child would have to wait
0125
1 until Mr Pawade arrived?
2 A. Yes.
3 Q. Who had told you that?
4 A. Mr Wisheart told me that the child would wait until
5 Mr Pawade arrived.
6 Q. If he told you that; he was a surgeon, you were the
7 General Manager.
8 A. But I needed more information, because the parents of
9 this particular child were very concerned about the
10 child and they needed reassuring that the child could
11 wait until the new surgeon started, and I was not
12 getting anything more, you know, any greater information
13 that could be passed on to the parents.
14 If you just go back to parents and say "The
15 consultant has said your child can wait", that is not
16 very reassuring for parents, so I was looking for
17 something a little more reassuring.
18 Q. Surely if Mr Wisheart had said, "This child will have to
19 wait until Mr Pawade takes up his post", it is implicit
20 in that Mr Wisheart does not see any pressing need to
21 operate on the child in the meantime, otherwise
22 presumably the child would be operated on in the
23 meantime?
24 A. I can accept what you are saying, and I know Mr Wisheart
25 does not remember this discussion, but it was a brusque
0126
1 discussion, it was very dismissive. I felt this was
2 a situation where we needed to be very sensitive to the
3 requirements of the parents and what they were asking.
4 I felt very much, you have no right to ask, even, so,
5 you know, I wanted to be absolutely clear that I could
6 pass some reassuring information on to the family
7 concerned.
8 Q. But can you not see that there is scope for any cardiac
9 surgeon in the position who has told you that the child
10 has to wait until somebody else takes up post, who might
11 consider it is implicit in that there is no pressing
12 danger to the child, and when you as a General Manager,
13 a non-medically qualified General Manager at that, comes
14 and says, "Well, what is the situation with this child?"
15 the surgeon might feel it is not your place to ask?
16 A. I can understand the surgeon would be concerned if
17 I were actually questioning his judgment about the
18 urgency or otherwise of the child, but what I was doing
19 was asking for information to be able to reassure some
20 parents, and that was something I had done in the past
21 with other medical staff and, you know, have done
22 recently. It is usual for some sort of dialogue other
23 than a brusque "The child will wait until Ash Pawade
24 starts". It is usual to get something more than that.
25 I was also concerned that because of the
0127
1 difficulties within the directorate and the hostilities
2 and the stress that all the surgeons were under, that,
3 and the sort of feeling that this was yet another press
4 enquiry which should just be ignored and dismissed,
5 I was very concerned about that as well. I did not want
6 to feel that I would go back to parents with little
7 information because there were concerns about yet
8 another press enquiry and yet more potential
9 difficulties for the directorate.
10 So I do not believe I was questioning
11 Mr Wisheart's judgment, I was merely trying to find out
12 more so I could be more reassuring to the parents
13 involved.
14 Q. Mr Wisheart has said -- I think we had better go to
15 WIT 89/59, in the middle of the page, the
16 paragraph beginning:
17 "I cannot recall."
18 "As the patient's surgeon, where there was anxiety
19 about the length of time a child was waiting for
20 surgery, I would normally deal directly with the family
21 to seek to achieve a resolution of the problem".
22 A. Yes. He was very good at dealing with families to
23 reassure them.
24 Q. "If the press were involved, I would consult with the
25 Press Officer of the Trust."
0128
1 A. I do not know why he did not, but was I was asked by the
2 Press Officer to investigate this. I explained to
3 Mr Wisheart that I had been asked by the Press Officer.
4 He never at any stage suggested, as far as I can recall,
5 that he would contact the Press Officer to try and
6 resolve this issue.
7 If that were his normal practice, then, I would
8 have expected that to happen on this occasion, but it
9 did not. Maybe we had some misunderstanding in terms
10 of, you know, the information that was passed on, but
11 I certainly recall explaining very clearly that this was
12 the result of a press enquiry.
13 Q. If you knew it was Mr Wisheart's practice in cases like
14 this to deal direct with the family, would it not have
15 been simpler to have a quiet word with Mr Wisheart and
16 said "Look, James, it may be an idea if you talk to the
17 parents of this patient"?
18 A. I think I tried to discuss this, you know, more widely,
19 but he was quite brusque about, "This child will wait".
20 There was certainly at the time an irritation about
21 press enquiries, I have to say, and that was difficult
22 for me to handle. People were irritated with the press
23 and I remember that Mr Wisheart was brusque about this.
24 Q. The Press Office were involved in the particular
25 instance, and you had spoken to Mr Wisheart, but you
0129
1 then spoke to the paediatric cardiologist, Dr Hayes?
2 A. Yes, I did.
3 Q. Why did you choose to do that?
4 A. Because I felt I had not had sufficient information from
5 Mr Wisheart about the child.
6 Q. But Dr Hayes would not be able to tell you anything
7 about the programming of the surgery that Mr Wisheart
8 would not be able to tell you?
9 A. Mr Wisheart had not told me. I just said that, as
10 I have said, he was very dismissive in the way that he
11 handled the situation.
12 Q. So was your concern, your question to Dr Hayes,
13 concerned with the timetabling of the surgery or with
14 the then current state of health of the patient?
15 A. I think I wanted to make Dr Hayes aware as the person
16 that had referred the child originally to Mr Wisheart of
17 the press enquiry and to find out what her views were on
18 the clinical urgency of the case.
19 Q. And Dr Hayes, so we gather from your statement, said
20 that the operation would be needed soon?
21 A. Soon, yes.
22 Q. But Mr Pawade was taking up his post in May 1995?
23 A. This was March and he was taking his post up in May.
24 Q. Did you perceive the time-lag between March and May to
25 be longer than "soon"?
0130
1 A. I do not remember the exact words used by Alison Hayes,
2 but the impression I gained from her was that March to
3 May was longer than "soon" and it would be needed sooner
4 than that.
5 Q. How usual would it be for a General Manager to have
6 this type of discussion with the cardiologist when
7 somebody had entered a cardiac surgeon's list?
8 A. It is very unusual. I do not recall another incident
9 where I have spoken to the cardiologist. I think now
10 with adult surgery I am talking to the cardiologists and
11 cardiac surgeons all the time, so I may well talk to the
12 cardiologists in passing about particular queries and
13 concerns but in terms of paediatric cases, under those
14 particular circumstances, I had not done that before.
15 Q. I think Janet Maher has given a comment on your
16 statement. You have had a chance to see that, I hope?
17 A. Yes, I have.
18 Q. It is at WIT 89/50. I want to look at paragraph 2 first
19 of all. She says that "the usual procedure for
20 arranging transfer of patients to other hospitals was
21 for the referring clinician to arrange with the
22 receiving clinician the principle of the transfer."
23 Because what happened to this patient was, the
24 patient was transferred in the end to Mr Braun at
25 Birmingham and Mr Braun operated successfully there?
0131
1 A. Yes.
2 Q. Do you agree with that paragraph of Janet Maher's
3 statement?
4 A. Yes. I think that is fair, although I think there seems
5 to be some implication in all of this that somehow
6 I personally, as a General Manager with no clinical
7 experience, was asking for the transfer of this child,
8 which is not correct.
9 Q. But she makes the point that the normal route might be
10 for the General Manager to discuss the matter with the
11 Clinical Director. The Clinical Director was not
12 Mr Wisheart, it was not Dr Hayes, it was not Mr Dhasmana
13 or Mr Pawade but was somebody else, Professor Vann
14 Jones?
15 A. Yes, although I would suggest that as this was a cardiac
16 surgery matter, it was usual, normal and correct for me
17 to have discussed it with the Associate Clinical
18 Director, who was Mr Dhasmana, and that is what I did.
19 I think, perhaps taking that further, that had it
20 been impossible to resolve this situation, as it was at
21 the end, then some discussion with the Clinical Director
22 might be appropriate. But certainly from my
23 perspective, it was appropriate to discuss this with the
24 Associate Clinical Director in the first instance, or --
25 not in the first instance, but having spoken to
0132
1 Mr Wisheart in the first instance.
2 Q. While we are here, if we look at paragraph 3, you had
3 worked with Janet Maher in both directorates of medicine
4 and surgery previously, had you not?
5 A. That is right. I had also worked with Janet Maher at
6 Farleigh Hospital in 1985. She was employed there in
7 1985.
8 Q. She takes a rather different view of Dr Roylance from
9 you.
10 A. She is a different person to me. She has a different
11 experience. So, yes. I see she does say something
12 completely different to me.
13 Q. She, as a General Manager of the directorate of medicine
14 and surgery, would have worked with Dr Roylance a bit
15 more closely than you had at this time?
16 A. Yes, she would.
17 Q. When I say "at this time" --
18 A. She had known John for longer than I had. She had
19 worked with him much more closely for a longer period
20 than I had. As I said in my statement, other than
21 a disagreement with John Roylance at the point of
22 transferring Winford Hospital to Southmead, I had little
23 to do with John personally until I started to work at
24 cardiac services.
25 Q. She suggests here that Dr Roylance preferred General
0133
1 Managers to have a clinical background of some sort?
2 A. Yes, that is quite right.
3 Q. To the extent that that is correct, she would benefit
4 from that because she had such experience?
5 A. Yes. She was a psychologist.
6 Q. And you would not because you did not have such
7 experience?
8 A. That is right.
9 Q. In your view, would that account for the difference in
10 perception of Dr Roylance between yourself and Janet
11 Maher?
12 A. I think that is true. Although Janet would have had
13 a different relationship with John Roylance simply
14 because she had known him for longer and she had felt
15 that John had provided her advice and had been almost
16 a mentor to her. So she was a different person with
17 a different background and had a totally different
18 experience to me. I think it probably is possible that
19 because I have not had a clinical background that he, as
20 she says there, may prefer, or he may have preferred
21 somebody with a clinical background.
22 Q. Did you feel that you lost out, as it were, with
23 Dr Roylance because you did not have that clinical
24 background?
25 A. I think because I did not have a clinical background,
0134
1 John Roylance had some very preconceived ideas about
2 what my strengths and skills were, and that really he
3 was of the view that because I came into the service as
4 a graduate management trainee, then automatically
5 I would fall into the sort of school of being an
6 administrator with an administrative background.
7 I think it is interesting to note John Roylance's
8 comments of Hugh Ross's management of the Trust, where
9 he says just that: "Hugh Ross was an administrator and
10 therefore his approach would be administrative". That,
11 I believe, is what John Roylance would have thought
12 about me. It would be entirely consistent.
13 Q. I think Mr Pawade has also given a short interested
14 party comment on this paragraph of your statement, but
15 I do not think it is necessary to go to that. That will
16 of course be published with all the other comments.
17 Can we go back to your statement then at
18 WIT 89/29, paragraph 76?
19 This is another incident that you specifically
20 refer to. It concerns an adult.
21 A. Yes.
22 Q. Again, I do not want to go into great detail, but in
23 this case you say you wrote to Mr Wisheart asking for
24 a statement and explaining why you needed it, so that
25 whatever had happened then would not happen again?
0135
1 A. Yes, that is right. We had no critical incident
2 reporting system and when incidents occurred, that was
3 usually the way I handled them: to get some incident
4 reports from all the various people concerned and then
5 look at the different parts of the process to try and
6 work out what might have gone wrong. That is what I did
7 in this case.
8 I have to say that this incident was made known to
9 me by Dr Bolsin, who actually reported it and then gave
10 me an incident report, which I then followed up with an
11 incident report from Mr Downes and a request to
12 Mr Wisheart for an incident report.
13 Q. So your request to Mr Wisheart was a request to
14 Mr Wisheart in his capacity as a surgeon who happened to
15 be operating on this patient, not as anything else?
16 A. No, not as Medical Director but as the surgeon who was
17 operating.
18 Q. He did reply to you, but he said there was no need to
19 look any further into it?
20 A. Yes, he did. Actually, I found his letter was not
21 absolutely clear, and this is where I sought the advice
22 of Professor Vann Jones, who has commented that he does
23 not recall this incident, or using the expressions that
24 I have stated here.
25 Q. Let us just take it in stages. Mr Wisheart has given
0136
1 a very brief comment about this, the reference is
2 WIT 89/59, but Professor Vann Jones, as you say, has
3 also commented on it.
4 Before we look at what he says, your statement
5 here says that you sought advice from Professor Vann
6 Jones. That is in accord with what Janet Maher had
7 suggested was the normal structure?
8 A. Yes. This was actually a potentially very serious
9 critical incident. It could have been fatal, so it
10 needed to be treated very seriously.
11 Q. You say that you were advised, I assume by Professor
12 Vann Jones --
13 A. Yes.
14 Q. -- that Mr Wisheart was exercising his power as Medical
15 Director and you would be wise to leave it at that?
16 A. Yes. I have spoken to Professor Vann Jones since he has
17 commented on this statement. My recollection of this
18 incident was that I actually said "What do you think
19 this letter from James means? What do you think he is
20 saying to me?" It is a shame I do not have the letter
21 here, but I asked what Professor Vann Jones thought it
22 meant. He did not use the words, in quotes, "exercising
23 his power as Medical Director". The implication he
24 gave, though, is that that is what it was; that is in
25 effect what was happening: that Mr Wisheart was telling
0137
1 me not to pursue this and he, Professor Vann Jones,
2 thought I would be wise to leave it at that.
3 An additional aspect of this is that this was one
4 of the first cases I think where Mr Wisheart had worked
5 with Dr Bolsin following some of the media reports and
6 problems with paediatric surgery, and Professor Vann
7 Jones, I think, was really trying to perhaps caution
8 that maybe this had arisen as a result of that fact and
9 that perhaps this was a malicious or mischievous intent
10 in the fact that this had been reported to me by
11 Dr Bolsin.
12 I think he was genuinely trying to say, "How has
13 this all come about and what does it mean?" and maybe,
14 you know, it should be investigated.
15 Q. So was what Professor Vann Jones saying, was it that
16 Mr Wisheart was pulling rank as Medical Director and
17 throwing his weight around, if you like?
18 A. Yes, that is absolutely what I took Professor Vann
19 Jones' comment to mean: Mr Wisheart was pulling rank as
20 Medical Director and I should not pursue the matter.
21 Q. But this was against the background of Professor Vann
22 Jones being conscious that Mr Wisheart and Dr Bolsin
23 were working together for the first time in some time
24 after the publicity that occurred?
25 A. Yes.
0138
1 Q. And that it might be impolitic to fan the flames by
2 taking this particular incident any further?
3 A. Yes. I think Professor Vann Jones thought that
4 I might be getting involved and that this was not really
5 a genuine critical incident, it was a further aspect in
6 the differences between Dr Bolsin and Mr Wisheart and
7 that I was allowing that to continue by wishing to
8 investigate the matter. I felt that was an important
9 point to make, but I still felt, and still do, that that
10 was irrelevant. It was a serious critical incident and
11 it should have been investigated.
12 Q. Are you telling us that, as you understand it now,
13 Professor Vann Jones, for his part, was intending to
14 make the latter of those two points, the one about not
15 fanning the flames, rather than the one about throwing
16 his weight around as Medical Director?
17 A. No, I think he made both points. I think he was saying
18 Mr Wisheart was pulling rank as Medical Director, but
19 also I think he was trying to justify that by saying
20 that it might be because this had been brought forward
21 in some sort of malicious way.
22 Q. I have one or two other questions, Mrs Ferris, but we
23 are nearly through.
24 Hugh Ross became Chief Executive, I think at the
25 end of 1995?
0139
1 A. Yes. It was October 1995.
2 Q. How would you characterise the differences in your
3 own job which has remained the same under Mr Ross's
4 "chief executiveship", if that is the right word,
5 compared to Dr Roylance's?
6 A. The main differences are that my job is working very
7 much within a Trust framework; that the autonomy and
8 competition of the clinical directorates has been -- you
9 know, the good things about the clinical directorates
10 have been retained but the sort of perhaps destructive
11 things, the autonomy and the competition, have been
12 removed; there is a very clear direction in the way in
13 which the Trust is managed now, and I think above all
14 there is a very strong value about openness within the
15 organisation; there are many opportunities to challenge
16 in a very non-threatening way decisions or events.
17 There is access to the Chief Executive, and access,
18 indeed, to all the executives, and that really is a very
19 strong sort of value now, that there is a lot of
20 openness and there are many opportunities to talk things
21 through. The Chief Executive is actually very firm in
22 how he behaves so he does not necessarily agree with
23 everything that is put to him, but if he does disagree
24 with you, he is very keen to look at objective
25 information and to base judgments on information.
0140
1 Likewise, I think he expects from General Managers
2 that they justify their demands and requirements.
3 I will give an example: in terms of just bed usage, the
4 directorate has continually said that we need additional
5 beds for the service and there has been a lot of support
6 for that, but that has had to be supported by
7 information from me about bed usage and infant stay,
8 turnover, throughput and so on. So there is very much
9 a feeling that information is essential and that General
10 Managers must provide that.
11 I think the Trust now has also perceived there is
12 much more central control and guidance, not just from
13 the Trust but obviously in terms of the performance,
14 management agenda of the government. There is much more
15 for General Managers to have to be working on there.
16 But overall I would summarise it as saying there is
17 a much better strategic framework and much greater
18 openness.
19 Q. You referred in that paragraph to the destructive things
20 about directorates?
21 A. Yes.
22 Q. You mentioned autonomy and competition?
23 A. Yes.
24 Q. In, I think, the next breath. What were the destructive
25 things as you saw it about the previous way in which the
0141
1 directorates were run?
2 A. I think the directorates were working very much in
3 a vacuum. They had no idea what other directorates were
4 doing, and in fact competed with other directorates.
5 Because there was no central co-ordination or strategic
6 framework for the Trust, directorates could be
7 developing for quite arbitrary reasons, based on how
8 powerful the directorate actually was at the time.
9 There was no sharing of good practice between
10 directorates, so if we are trying to solve a problem
11 with one directorate, because the communication between
12 directorates was not always that great because there was
13 competition, you did not always know somebody else
14 within the directorate was trying to solve the problem
15 you were trying to solve. So there were something like
16 very autonomous units within the organisation.
17 Q. When you say "competition", you mean the mentality was
18 that you did not share information with others?
19 A. Yes, I would say that.
20 Q. Can you go to WIT 89/25 at paragraph 63. It is on
21 the same point, the reference to the change of Chief
22 Executive. Do you see in the fourth line, the third
23 line of the sentence:
24 "I was unable to talk to Mrs Maisey or Dr Roylance
25 because there was a history of lack of support or
0142
1 guidance."
2 Just bear that in mind. If we go back a little
3 to paragraph 48, which is at page 21, the top of the
4 page:
5 "As regards Dr Roylance, I had not worked very
6 closely with him before 1994."
7 A. Yes.
8 Q. If we go back then to the previous page, paragraph 63
9 at page 25, in so far as there was a history of lack of
10 support or guidance, it would not be right, would it,
11 that you had a very long history of working with
12 Dr Roylance in any close fashion?
13 A. No. I had not worked closely with Dr Roylance.
14 I have given you examples of an earlier period where
15 I had asked for support and that support had not been
16 forthcoming. I think my relationship was mainly with
17 Mrs Maisey, so perhaps that should read that certainly
18 from my point of view there was a history of lack of
19 support or guidance more from Mrs Maisey, although I do
20 have examples of that with Dr Roylance as well. But you
21 are correct, I had less to do with Dr Roylance until
22 1994.
23 Q. So a history with Mrs Maisey and isolated incidents with
24 Dr Roylance; would that be fair?
25 A. I think that is fair.
0143
1 Q. If we just scan down the page, paragraph 66, I think we
2 have essentially dealt with this.
3 Professor Angelini: you refer to him being
4 disliked and distrusted?
5 A. Yes.
6 Q. You qualified what you said earlier about Professor
7 Angelini by saying he could be abrasive and so on?
8 A. Yes.
9 Q. Was it your view that the dislike and distrust was
10 wholly ill-founded or well-founded, or ...
11 A. No, I thought the dislike and mistrust was unfounded.
12 I accept and always have that his interpersonal skills
13 maybe lend themselves to getting people's backs up and
14 being irritating, but I think that does not explain the
15 sort of dislike, the overall dislike, and I felt that it
16 was not justified. I felt that he had a lot to say that
17 was valid. He was very questioning and very
18 challenging. He was very questioning and very
19 challenging of me also, I have to say. It was not just
20 that I got on well with him and escaped, you know, the
21 questions and those challenges, but I actually felt that
22 to question and challenge the way of providing a service
23 was a very important thing to do if we were to develop
24 and learn about how we were providing service.
25 So yes, from my point of view, I thought that that
0144
1 dislike and mistrust was unfounded. I know others will
2 have a different perspective, but that was my view.
3 Q. Can we go to page 32? Paragraph 86, the last sentence.
4 You say:
5 "Dr Roylance would not make a decision in respect
6 of Mr Dhasmana ceasing to operate on children when
7 Professor Vann Jones and I thought he should."
8 I do not want to ask you about the details of why
9 you should have come to that view. My question is this:
10 what did you understand Dr Roylance's powers as Chief
11 Executive to be to stop Mr Dhasmana operating on
12 children whilst he still would be operating on adults?
13 A. Dr Roylance was in charge of the Trust and was therefore
14 responsible for what happened within it. I therefore
15 thought that as there were difficulties with Mr Dhasmana
16 operating on children, that Dr Roylance would be the
17 right person to make that decision. In fact, that was
18 discussed with Dr Roylance, who said that what he wanted
19 to achieve was to allow Mr Dhasmana to make that
20 decision for himself, and my view was that Mr Dhasmana
21 did not have the insight to be able to make that
22 decision for himself and therefore, whilst I respected
23 that Dr Roylance was probably right, if people make
24 decisions for themselves, they are better decisions, but
25 I felt that on this occasion Mr Dhasmana would never
0145
1 make that decision for himself, and therefore, as the
2 Chief Executive of the Trust and the person who was
3 accountable for the management of the Trust, Dr Roylance
4 should make that decision.
5 Q. So you felt that Dr Roylance was not firm enough in
6 grasping the nettle?
7 A. Yes.
8 Q. Were you aware of some correspondence from
9 a Mr de Leval, a cardiac surgeon elsewhere, to
10 Dr Roylance, at this time, which said, in essence, that
11 Mr de Leval thought that Mr Dhasmana ought to be allowed
12 to continue to operate on children?
13 A. No, I was not.
14 Q. To the extent that such correspondence did exist or
15 does exist, that would obviously be a consideration
16 weighing with the other in Dr Roylance's mind from the
17 views of Professor Vann Jones or yourself?
18 A. Yes, but I was not aware of that letter. Dr Roylance
19 did not make me aware of it either. Obviously when we
20 were having that discussion, it would have been helpful
21 if that had been known.
22 Q. Of course neither you nor indeed Professor Vann Jones
23 were paediatric cardiac surgeons, and Mr de Leval was?
24 A. Yes.
25 Q. You said that Dr Roylance did not make you aware of
0146
1 that correspondence. Perhaps there is no reason why he
2 should have done. Were you aware, or can you comment on
3 Mrs Maisey's knowledge of the performance of cardiac
4 surgery at the BRI when she was Director of Operations?
5 Especially in relation to surgery on children.
6 A. I am not sure what Mrs Maisey's knowledge was. I know
7 that throughout the time that I was involved with the
8 directorate, I would have discussed and I did discuss,
9 difficulties within the directorate, but I do not know
10 what information she had about paediatric cardiac
11 surgery and what her knowledge was. I am sorry, I do
12 not know that.
13 Q. When you became General Manager of cardiac services in
14 November 1994, did you provide the Director of
15 Operations with any information or know of any
16 information provided to the Director of Operations that
17 would have made her aware of problems, if there were
18 any, in outcome with cardiac surgery?
19 A. No. Mrs Maisey would have had the audit report that we
20 published, but that was not until 1995. I certainly did
21 not give her anything or have anything to give her in
22 1994 when I started in the directorate.
23 Q. Dr Roylance made the point in his evidence, in answering
24 questions from Mr Langstaff, that the Trust could only
25 provide care that had been purchased by the purchasers.
0147
1 I paraphrase, I hope not caricature but paraphrase
2 Dr Roylance's evidence that it was not open to the Trust
3 to go out and build a spanking new cardiac services unit
4 without being 100 per cent sure that somebody was going
5 to buy the services of that unit once it was opened.
6 That is a fair point, is it not?
7 A. It is a very fair point and I think all the work we had
8 done within the directorate to talk about expansion has
9 been backed up with information and projections about
10 who is going to buy the service and where the income is
11 going to come from. I would not expect to want to build
12 and develop a service without being clear that the
13 income would be there to support that service.
14 I would disagree slightly with John Roylance's
15 view that we only fund the service through the contract
16 income, because one of the things that I was saying in
17 early 1995 was that to deal with the work that we knew
18 could come and the projections that we had done, we
19 actually needed to make some investment on the BRI site
20 and that that would not come from contract income, that
21 would come from either capital or money that the Trust
22 had for service developments.
23 What I was saying was that, "Yes, we can attract
24 more income to this directorate, we know we can, because
25 we have done some fairly robust projections, but to be
0148
1 able to cope with that work and then receive that
2 income, we do need some capital or service development
3 investment from the Trust Board".
4 So I am not sure whether it was John or Margaret
5 Maisey who said it was not up to the Trust Board to
6 invest in cardiac services. I would disagree with
7 that. I would agree with the basic assumption that
8 income should come from purchasers, but I would disagree
9 that the Trust would not be able to have some investment
10 in the service, because that was why we put money aside
11 for service development and that was one of the uses of
12 capital. I was saying "You cannot develop the service
13 and attract this income without investment from the
14 Trust into the facilities to enable us to do that".
15 If you look at 1996, we were given two things,
16 really: investment of œ132,000 from the service
17 development committee, to open up a new catheter
18 laboratory or electrophysiology laboratory, and we were
19 given permission from the Trust to open a new ward.
20 Those were the things I wanted and was asking the Trust
21 to support us with. So Dr Roylance is partly right, but
22 I would dispute the fact that all the money comes from
23 contract income, or did at that stage.
24 Q. So to what extent is it fair to say that it is your
25 view that you cannot simply in directorates such as
0149
1 yours be reactive to demand. How does one go about
2 anticipating or perhaps stimulating demand for services,
3 given that the Trust is in this position whereby
4 everything it does has to be funded from somewhere?
5 A. That is why we spent time putting together a business
6 case discussing with the different purchasers and we
7 looked at existing purchasers where we knew we had
8 existing work but we would then put in a percentage for
9 growth. So that was one way of doing a projection about
10 the future workload.
11 We then looked at the proportion of work that we
12 knew was going to other purchasers but where we could
13 make some fairly sensible projections about how much
14 work would come back -- for example, Oxford and London
15 work. So that was the second sort of area we were
16 exploring.
17 Then we were aware that with new surgeons,
18 particularly with Ash Pawade, there would be a whole
19 group of new patients and new work that would be coming,
20 so we were able to put together fairly robust
21 projections from three different areas to show how we
22 could develop the service and increase the workload that
23 we were doing.
24 Q. So that kind of service development planning would
25 involve managers and clinicians, would it?
0150
1 A. Yes, very much so.
2 Q. Are you able to comment on the extent to which that
3 kind of service development, when Dr Roylance was Chief
4 Executive, would have involved managers or clinicians?
5 A. From what I remember at the time, that service
6 development type of review was not encouraged at the
7 time. This is why I go back to my original comments
8 about wanting or about the process of objective setting
9 not being entirely bottom up but having to take place
10 within the Trust framework, so that type of service
11 planning could take place properly.
12 At the time that we did it initially, the paper
13 that we submitted in January 1996 was supported by those
14 calculations and those projections about the level of
15 work that would be flowing into the Bristol Royal
16 Infirmary.
17 I am not sure if it has answered the question.
18 I think I might have lost the question somewhere, but
19 I am sure you will tell me!
20 Q. I was just asking you, you told me that this service
21 development planning would involve managers and
22 clinicians for the 1996 type of development, and I then
23 said, "Well, are you able to comment on the extent to
24 which that same kind of service development, perhaps not
25 cardiac services but somewhere else, would, when
0151
1 Dr Roylance was Chief Executive, have involved managers
2 or clinicians?"
3 You said that you did not remember that service
4 developments and that type of review were encouraged at
5 that time?
6 A. Yes.
7 Q. Just a few other matters before we close. Paragraph 23
8 of your statement, page 13.
9 It deals with equipment. There has been a comment
10 from the Trust that you have seen.
11 A. Yes.
12 Q. How would you know that equipment was reaching the end
13 of its lifespan?
14 A. I think I have said there, at the end, I was not very
15 familiar with the type of equipment. I was very much
16 assisted by Dr Pryn of the anaesthetists who helped me
17 put together the bits for major capital items. So my
18 experience did not run to being particularly familiar
19 with equipment. I had to work with people to be told
20 that.
21 Q. Are you able to help us with the extent to which, from
22 your perspective in cardiac services, from November
23 1994, there was direct competition for funding between
24 adult and paediatric cardiac services or was there not
25 that kind of head-to-head competition between those two?
0152
1 A. My experience was not that it was head-to-head between
2 adult and paediatric; I do not know much about that.
3 But there was clearly competition across the Trust for
4 a very limited major capital budget. I think the amount
5 available was around 1.5 million a year, because 1.5
6 million of the major capital funds were put aside for
7 the building of the new Children's Hospital. So there
8 was a tiny Trust major capital allocation, and we,
9 I think, in 1994/95, the cardiac services requirements
10 were probably 4 or 5 million against 1.5. There was
11 a real gap between the money available and the sorts of
12 bids that were coming in.
13 Q. You yourself, taking your post in 1994, would have been
14 coming into office halfway through the 1994/95 financial
15 year?
16 A. Yes.
17 Q. And for the 1995/96 financial year, to what extent did
18 the cardiac services directorate budget include money
19 for any residual operations on children?
20 A. I am sorry, can you say that again?
21 Q. For the first 6 months of the 1995/96 financial year,
22 paediatric operations were still taking place at the
23 BRI?
24 A. Yes.
25 Q. So would the funding for those have been in your
0153
1 budget for 1995/96?
2 A. Yes, the funding transferred when the service
3 transferred in October, but there would be no funding
4 for major capital in either the adult or paediatric
5 budgets. The capital budget was entirely separate from
6 the revenue budget we had, but the revenue budget would
7 contain ...
8 Q. I think it follows simply as a matter of history that
9 you were never involved in the cardiac services directly
10 when there was supra-regional designation for neonatal
11 and infant services?
12 A. No, I was not involved at that stage.
13 Q. So you cannot help us with the funding on that?
14 A. No, I cannot.
15 Q. We talked earlier about your perception of
16 Mr Dhasmana's lack of managerial grip, as you saw it?
17 A. Yes.
18 Q. Was that in your view a common problem with the
19 clinicians that you came into contact with in managerial
20 posts?
21 A. I think I had worked with a number of Clinical Directors
22 and Associate Clinical Directors and they all varied in
23 their understanding of the managerial concepts with
24 which they were working. They were all at different
25 stages of development. But I think Mr Dhasmana's
0154
1 understanding of the -- you know, how he should be
2 functioning, was probably less than others that I have
3 worked with, although, as I say, that role was
4 developing.
5 But certainly, his skills in terms of chairing
6 meetings and making decisions and things were very weak
7 in comparison with other people with whom I have worked.
8 Q. So particularly accentuated in his particular case?
9 A. Yes, I think so.
10 Q. I am just checking with those sitting behind me to see
11 if there is anything else.
12 Paragraph 62 of your statement, page 24. This
13 whole page is concerned with May 1995 and an "away day"
14 that you organised for the staff of the cardiac services
15 directorate.
16 A. It was for the nursing staff actually, for the Sisters.
17 Q. You say in late 1995, paragraph 62, you appointed
18 Dr Gardener?
19 A. Yes, that is right.
20 Q. To provide formal support and counselling?
21 A. Yes.
22 Q. And I take it correctly, do I, that the reference to
23 bereavement, dealing with bereavement, stress and people
24 feeling impotent in their work is a reference to helping
25 nursing staff cope with the death of patients?
0155
1 A. Yes, that is right. It was.
2 Q. To what extent was this a development of work that had
3 gone on before, or was this a completely new innovation
4 for these nurses?
5 A. I do not know how much work had gone on before.
6 Dr Gardener certainly never entered until late 1995.
7 I know she was available or she had been around because
8 she worked in the academic department of cardiac
9 surgery, but I do not believe that she had a formal role
10 for support and counselling until this date in late
11 1995. She started earlier, in 1995, facilitating the
12 away day, but I do not believe there was a formal
13 arrangement until later.
14 MR MACLEAN: Mrs Ferris, thank you very much for that
15 evidence. Can I say a couple of things. First of all,
16 I touched on audit very briefly once or twice. I have
17 not come back to it quite deliberately. I know that
18 there is much that you can help us with on the
19 developments of audit since you became General Manager,
20 and which may well have been common across the Trust and
21 across other Trusts. I know that you intend to provide
22 us with a further statement. I hope you will be content
23 to deal with audit as part of that as well, separately?
24 A. Yes, I am happy to do that as well, yes.
25 Q. Is there anything else, apart from that area and the
0156
1 area of concerns that you have mentioned several times
2 in your statement which you are going to deal with
3 separately, is there anything else arising out of the
4 discussion we have had today that you want to say now?
5 A. I do not think so.
6 Q. If there is anything else, then of course we can put it
7 in writing and send it to the Inquiry, given that we
8 will be having a further statement from you in any
9 event. Obviously it can be dealt with then.
10 Thank you very much. There may be some questions
11 from some members of the Panel.
12 Examined by THE PANEL:
13 PROFESSOR JARMAN: Yesterday when I was talking to
14 Mrs Maisey I asked her about her role as Director of
15 Operations in monitoring quality by outcomes and who had
16 the responsibility, and in fact, page 166, I asked her
17 who was responsible for outcomes. She replied, "The
18 responsibility had to be in the directorates". Do you
19 have any comment on that --
20 THE CHAIRMAN: It is quite difficult for the stenographer to
21 pick up your voice, so may I possibly ask you either to
22 look forwards or look towards the stenographer, and then
23 we can make sure we have your answer.
24 A. I think what she is saying is correct. I would say
25 that the development of outcomes and measuring of
0157
1 outcomes, that would start within the directorate and
2 indeed, that is what we did with looking at the 1994/95
3 audit report and comparing our outcomes with the
4 national average for national mortality for cardiac
5 surgery.
6 PROFESSOR JARMAN: Would you have had earlier annual reports
7 of the paediatric cardiac surgery unit at the BRI?
8 A. I have not seen any annual reports, other than the one
9 that was done I think last year for paediatric cardiac
10 surgery. I did not see an annual report for paediatric
11 cardiac surgery when I was there.
12 Q. I wondered if you had seen the one mentioned twice in
13 the Inquiry, Days 13 and 23, for 1988, which showed the
14 BRI had twice the national average, in general terms?
15 A. For paediatric.
16 Q. For paediatric open heart surgery at the BRI?
17 A. No, I saw figures in the course of discussion with other
18 people, but I did not see a specific report.
19 Q. So you were not aware of those reports?
20 A. What was the date, again?
21 Q. The reports for 1988 and there was also one for 1989,
22 for the earlier years?
23 A. No, I would not be aware of those. I had not seen
24 those.
25 PROFESSOR JARMAN: Thank you very much.
0158
1 THE CHAIRMAN: Mrs Ferris, thank you. I know it has been
2 a long day for you, but it has been very helpful for all
3 of us, and we are very grateful to you for you having
4 come to see us -- I beg your pardon, Mr Miller.
5 MR MILLER: You hardly recognised I am here, sir.
6 THE CHAIRMAN: Not at all, how could one possibly miss you?
7 MR MILLER: Can I just try -- I do not know whether I will
8 succeed -- to resolve a conflict on the statements of
9 this witness and Mrs Maisey about line management?
10 I just wonder whether we can clarify it while Mrs Ferris
11 is still here.
12 Re-examined BY MR MILLER:
13 Q. There may be a distinction between theory and reality,
14 but you in your witness statement, 89/20 paragraph 46,
15 say as regards the managerial chain of command:
16 "General Managers were accountable to the Chief
17 Executive, Dr John Roylance, through the Director of
18 Operations, Mrs Maisey."
19 In paragraph 48 you go on to say, once Hugh Ross
20 came then you were accountable to him.
21 Mrs Maisey in the short statement that was put
22 in yesterday, I think it is paragraph 9 of that
23 statement -- can I tell you what she says? She says
24 that you were responsible as the Manager to the Clinical
25 Director of the directorate, who in turn was responsible
0159
1 to the Chief Executive.
2 So she is saying that your immediate superior, the
3 person to whom you were accountable, was the Clinical
4 Director?
5 A. She is right in theory. I think that was one of the
6 things I was trying to explain earlier. Because the
7 relationships with Clinical Directors are so close, in
8 practice it does not function as a line management
9 relationship. But yes, in theory, both then and now,
10 General Managers are accountable to the Clinical
11 Director within the directorate.
12 Q. We have seen an example this morning of you going, as
13 it were, straight to the Chief Executive, writing to
14 Dr Roylance, copy to Mrs Maisey, and there are other
15 examples of that.
16 A. Yes.
17 Q. But in terms of problems within the directorate, where
18 would your first port of call be?
19 A. I would always try and resolve any problem as close to
20 the problem itself, but if necessary, it would be to the
21 Clinical Director. Now that is still the case. So it
22 might be that I would have a discussion with an
23 Associate Clinical Director first, or an individual
24 consultant, but if I could not progress an issue, it
25 would be to the Clinical Director and not outside of the
0160
1 directorate that I would go.
2 Q. We know that Mrs Maisey had two, perhaps one and a half
3 hats. She was Director of Operations and Nurse
4 Adviser. I think when Mr Ross came she concentrated
5 more on the Nurse Adviser, towards the end of her career
6 with the Trust. Who took over the Director of
7 Operations role?
8 A. There was no Director of Operations role after
9 Mrs Maisey left. She was replaced with initially
10 a Director of Business Development, but now Service
11 Development and Review, which is Mr Gleave, who is
12 sitting in the audience.
13 Q. In terms of functions, what did Mr Ross do? Did he
14 take over any of the functions that Mrs Maisey had had?
15 A. I think Mr Ross had a very much more operational and
16 direct link. John Roylance was very far removed from
17 the directorates and the operational things and I think
18 Hugh had a much more hands-on closer relationship with
19 the General Manager.
20 Q. So was that closer in part to the functions that
21 Mrs Maisey performed?
22 A. Yes. I think so.
23 Q. So you had more contact with the Chief Executive than
24 you had previously?
25 A. Yes.
0161
1 Q. The only other thing I want to ask you very quickly.
2 You were taken to paragraph 75 of your witness
3 statement, page 28, when you are dealing with the
4 problem about a child waiting for an operation.
5 Was that simply a routine matter, or was it
6 a one-off?
7 A. That is not the sort of thing that happened all the
8 time, but enquiries from parents or from relatives via
9 the press is not uncommon. I have often had those.
10 Q. Whose responsibility did you see it to get the
11 information for the parents?
12 A. It was my responsibility. I had been asked by the press
13 officer. It had been brought to my attention, which is
14 why I spoke to Mr Wisheart and then did all the other
15 things that are stated there.
16 MR MILLER: Thank you.
17 THE CHAIRMAN: Thank you very much. That was helpful.
18 I do apologise to you, Mrs Ferris, and to you,
19 Mr Miller, for not calling you. Having made such
20 a thing of the procedure that I have published, I forgot
21 my own procedure. Mea culpa. I repeat again, thank
22 you for coming and talking to us. We are very grateful,
23 it has been very helpful. I think it has been a long
24 day for you.
25 I would just add to what Mr Maclean said that if
0162
1 there are other things that come to mind that you would
2 like to let us know, please do so, but may I say, also,
3 that some of the comments that were put in you saw quite
4 late in the day, and if you would like to equally add to
5 the views you have expressed here, then by all means,
6 you should feel free to do that.
7 Lastly, there was a reference to exchanges between
8 Mr Wisheart and yourself concerning the question about
9 intensivists, do you remember, as to whether there were
10 letters and otherwise. If you are able to discover
11 anything by way of correspondence, of course, that also
12 we would be helpful to see.
13 So, for the moment, thank you very much indeed.
14 Mr Langstaff is going to say a couple of things,
15 as I get back on track with the procedure. Perhaps you
16 could just wait for just a second.
17 DETAILS OF TIMETABLE OUTLINED BY MR LANGSTAFF:
18 MR LANGSTAFF: Sir, it is to give an indication, as
19 I usually do at the end of each week, of what is to
20 come.
21 The treats we have in store for next week: on
22 Monday, Professor Jackson, President of the Royal
23 College of Surgeons of England. That will be at 10.30.
24 On Wednesday, at 1.00, Mr Roger Baird, Medical
25 Director of the UBHT, whose name has featured in the
0163
1 evidence this week to some extent.
2 On Thursday, Mr Durie, followed by Mr McKinley,
3 who were in turn successive Chairmen of the UBHT. They
4 will start at 9.30.
5 It is obvious that there is a gap on the Tuesday,
6 when the simple fact is that we have no witness to
7 call. It is inevitable in as long and as complex an
8 Inquiry like this, particularly at this stage of the
9 evidence, dealing with people who have limited
10 availability, that sometimes the hearing chamber is
11 likely to be available but the witness is not. Having
12 the availabilities coincide is a matter of quite
13 considerable planning, forethought and skill, and
14 unfortunately on this occasion it simply has not proved
15 possible to match the one with the other.
16 To indicate there is no shortage of witnesses at
17 all in the immediate future in this block, can
18 I anticipate what will happen in the week beginning
19 21st June?
20 On 21st June we will hear from Debbie Evans, the
21 director of contracts with the Avon Health Authority,
22 whose name again has featured on some of the memos and
23 documents we have seen; and Lesley Salmon, who was
24 Mrs Ferris's forerunner as a General Manager in that
25 particular area of the UBHT.
0164
1 Then on the 22nd, we will hear from Fiona Thomas,
2 nurse manager at UBHT, and again, whose name was
3 mentioned by Mrs Ferris in the course of her evidence,
4 and Sister Disley, who was the ward Sister in one of the
5 ward five wards.
6 On the Wednesday 23rd we will hear from
7 Mr Boardman, who was initially one of the executive
8 directors of UBHT, and from Mandie Lavin of the UKCC,
9 and on the 24th, from Miss Jenkins and Miss Burr of the
10 Royal College of Nursing.
11 Again in that week, on the Monday we will start at
12 10.30. On the other days, we anticipate beginning at
13 9.30.
14 So next week is somewhat odd in the programming.
15 If I can just run through the times again: 10.30 Monday,
16 1.00 Wednesday, and 9.30 on the Thursday.
17 THE CHAIRMAN: Yes, thank you, Mr Langstaff. One regrets
18 the gap on Tuesday, but it is, as you rightly say,
19 a very complex jigsaw puzzle and sometimes not all of
20 the pieces fit, despite the best efforts of those who
21 are working.
22 Thank you very much everyone. Thank you again,
23 Mrs Ferris. We will now adjourn and reconvene, as
24 Mr Langstaff reminded us, on Monday at 10.30.
25 (2.40 pm)
0165
1 (Adjourned until 10.30 am on Monday 14th June 1999)
2
3 I N D E X
4
5
6 MRS RACHEL CORRIE FERRIS (Sworn)
7 Examined by MR MACLEAN ....................... 1
8 Remarks on procedure by MR LANGSTAFF ......... 106
9 Examined by THE PANEL ........................ 157
10 Re-examined by MR MILLER ..................... 159
11
12 DETAILS OF TIMETABLE OUTLINED BY MR LANGSTAFF ...... 163
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18
19
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0166
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Published by the Bristol Royal Infirmary Inquiry, July 2001
© Crown Copyright 2001