|
|
|
|
 Home
Page
Search
Final
Report
Interim
Report
Evidence
- Transcripts
- Witness Statements
- Submissions
- CCNR Report and associated
documents
- Statistical Reports and associated
documents
- Background Papers
- Expert Papers
Inquiry
Seminars
About
the Inquiry
Help
|
 |
Daily transcripts
Hearing summary
22nd June 1999
Today the Inquiry heard from Mrs Fiona Thomas, Clinical Nurse Manager, United Bristol
Health Care NHS Trust (UBHT) who began by describing the layout of the Cardiac Surgery
Department during the late 1980s and early 1990s. She discussed the responsibilities of
her role set out in various job descriptions during the period of the Inquiry’s
investigation and commented on the implications for nurses of the change to Trust status.
She commented on discussions surrounding the under-spending of the cardiac surgical budget
and how that under-spend was used within the Directorate of Surgery. She contrasted the
role of the Nurse Advisor, Mrs Margaret Maisey, and the role of the new Director of
Nursing. Mrs Thomas then explained the change in the way drug errors are investigated
within the Directorate since 1994. She went on to outline the nurse staffing requirements
and the difficulties experienced recruiting trained paediatric nurses and theatre nurses.
She described the structure of Directorate meetings and commented on the issues discussed
and the role of Mr Dhasmana (Associate Clinical Director) and Mr James Wisheart (Medical
Director) at the meetings. She then confirmed that occupancy of beds by children in the
ITU was a problem for the consultants with adult patients, as the children needed a longer
stay in ITU post-operatively. She then went on to describe support for nursing staff and
the involvement of the Bristol Heart Circle in providing support for families of children
undergoing open-heart surgery. She concluded by discussing the communication styles of the
consultants on the ward.
This afternoon Sister Sheena Disley, Ward Sister, Ward 5B (Intensive Care and High
Dependency Unit) UBHT, gave evidence to the Inquiry. She commented on her job description,
her lines of accountability and her perception of the role of the Nurse Advisor, Margaret
Maisey. She described how issues of concern could be raised with clinical colleagues and
managers, and then went on to describe the professional relationships between surgeons,
intensivists and nursing staff. Sister Disley then described the counselling available to
staff on the ward and the pressures of breaking bad news to families and dealing with
stressful situations. She concluded by commenting on the split-site and the implications
for nursing care.
|
FULL TRANSCRIPT
1 Day 32, 22nd June 1999
2 (9.30 am)
3 THE CHAIRMAN: Good morning everyone. Good morning,
4 Mr Maclean.
5 MR MACLEAN: Good morning, sir. Today's first witness is
6 Fiona Thomas. Perhaps she would make her way to the
7 witness's chair, please.
8 Before you get too comfortable, the first thing we
9 ask the witnesses to do is to stand to take the oath,
10 please.
11 MRS FIONA THOMAS (SWORN):
12 Examined by MR MACLEAN:
13 Q. Your full name is Fiona Vicki Thomas?
14 A. Yes.
15 Q. Can I ask you to look at the screen, please, at
16 WIT 114/1. That is the first page of the formal written
17 statement that you have made to the Inquiry?
18 A. Yes, it is.
19 Q. If we go to page 32, that is the last page?
20 A. Yes.
21 Q. And that is your signature towards the bottom?
22 A. Yes.
23 Q. You have also, I think, submitted as an annex to the
24 statement, if we go to page 33, and then over the page,
25 there is a document headed "Job profile" for the
0001
1 Clinical Nurse Manager in the Directorate of Surgery?
2 A. Yes, it is.
3 Q. Then, if we go over the page, this is the personal
4 specification for Clinical Nurse Manager in Cardiac
5 Services?
6 A. Yes.
7 Q. I think there are some other job descriptions between
8 pages 37 and 39, and then, if we go to 41 and 42, you
9 supplied two pages, 41 is the first one, and 42 the next
10 one, showing a layout of the cardiac unit at the BRI?
11 A. Yes.
12 Q. Those are the documents that you have supplied with your
13 statement?
14 A. Yes.
15 Q. Have you read your statement through recently?
16 A. Yes. Yesterday.
17 Q. Is there anything in it that you want to change or add
18 to, or subtract from?
19 A. No.
20 Q. I think you are now aware that there have been some
21 formal comments on your statement from some others?
22 A. Yes.
23 Q. I just mention who they are briefly and we may come
24 back to them in due course. At WIT 114/45, there are
25 some comments from Pat Fields. You have seen those?
0002
1 A. Yes.
2 Q. 46: some comments from Professor Angelini?
3 A. Yes.
4 Q. And I think this morning you have seen some comments
5 from Mr Dhasmana?
6 A. Yes.
7 Q. And from Mr Wisheart?
8 A. Yes. I have just read them through.
9 Q. We will come back to those. If we go back then to the
10 beginning, back to page 1 --
11 THE CHAIRMAN: Mr Maclean, I do not think we have seen
12 Mr Dhasmana's.
13 MR MACLEAN: We will not come to them until everybody
14 has seen them.
15 Back to WIT 114/1. You began your career at the
16 BRI in May 1986 as a Senior Staff Nurse?
17 A. Yes.
18 Q. You hold the Diploma in Nursing which you obtained,
19 I think, in 1990?
20 A. Yes.
21 Q. And your first promotion was after about two years,
22 was it not, when you became a G grade Sister?
23 A. Yes. I started working in the Bristol Royal Infirmary
24 in the May of 1986 and as a senior staff nurse and then
25 I undertook the G grade role when the unit expanded and
0003
1 that was in May 1988.
2 Q. That was about the time when there was an expansion of
3 the Intensive Care Unit?
4 A. Yes, it was.
5 Q. And there was some work done and new catheterisation
6 labs in the cardiological side at about the same time?
7 A. I do not know about the cardiological side. I was not
8 involved in that side at that time.
9 Q. Help us with the nomenclature of the G grade system.
10 That grading system was introduced when?
11 A. In the April of that year, just before I undertook this
12 post.
13 Q. And that led to all nurses everywhere having to be
14 enrolled into one of the new grades?
15 A. Yes. I was a staff nurse as the grading came in and
16 there was a lot of discussion about the grading issues
17 then, but I do remember I did start the Sister's job as
18 a G grade, as far as I can recall.
19 Q. You stayed in that job for about four and a half years?
20 A. Yes.
21 Q. And then became an acting Clinical Nurse Manager at
22 H grade?
23 A. Yes.
24 Q. Then eventually you took on that job full-time?
25 A. Yes. I took over for the first year while the previous
0004
1 nurse manager took maternity leave.
2 Q. You are now I think the Clinical Nurse Manager of the
3 whole Cardiac Services Directorate?
4 A. Yes.
5 Q. Embracing ward, theatre, surgery and cardiology?
6 A. Consisting of about eight areas.
7 Q. That is what you set out on page 2, if you go to page 2,
8 paragraph 6.
9 A. Yes, that is right. It is the theatres, Ward 5A, the
10 ward, 5B, which is the high dependency and the intensive
11 care, the cardiothoracic ward which joined the
12 Directorate last June, which is Ward 6. That is the
13 surgical side. Then I have the management of the
14 cardiological side which is Ward 20, coronary care unit,
15 and the nursing staff and the cardiology labs. There
16 also is another side section, of course, which is the
17 rehabilitation staff as well. I have two Sisters who
18 work the rehabilitation which covers both surgery and
19 the surgical side and the cardiological side.
20 Q. If we go to 41, please, it is not a terribly good
21 copy, but can you just help us with what time we are
22 now looking at, when this represented the layout of
23 level 6 at the BRI?
24 A. This was from when it was expanded initially in 1988.
25 Yes.
0005
1 Q. If we just run down what we have here, on the extreme
2 left-hand side we have first of all the cardiac
3 intensive care unit, have we not?
4 A. Yes.
5 Q. Next to that is the high dependency unit?
6 A. Yes.
7 Q. Then what has been titled "old nursery"?
8 A. Yes.
9 Q. That is where the children where cared for once they
10 were out of the intensive care unit?
11 A. Yes, they were. They were cared pre-surgery in there,
12 as well as post-surgery.
13 Q. And there are four spaces in there. We see the
14 numbers.
15 A. Yes.
16 Q. And there were -- is it 7 spaces in intensive care?
17 A. It is actually 7 in there with one side ward which makes
18 it 8.
19 Q. The side ward is at the very end?
20 A. The far end of the left-hand side, yes.
21 Q. Then there are various offices across the corridor?
22 A. Yes.
23 Q. I think if we run down those, from the left-hand side,
24 there is Mr Dhasmana's office, then the relatives' room;
25 is that right?
0006
1 A. At the very far left-hand side there is the stairs and
2 then the SHO's room, the Senior House Officer's room,
3 a rubbish room and Mr Dhasmana's room, the relatives'
4 room.
5 Q. The next one I cannot read.
6 A. That was a gas room. That was where blood results were
7 read, in that room.
8 Q. Then there is a staff room?
9 A. Yes.
10 Q. The secretary's office and then Mr Wisheart's office
11 which is next to the play room, a dining-room and
12 a relatives' kitchen area?
13 A. Yes. Well, the dining-room was quite a big dining-room
14 and at the very end we had -- the Heart Circle paid to
15 have that made into a kitchenette area so the children's
16 relatives could make drinks and actually make some food
17 there if they required it.
18 Q. This whole area covers both Wards 5A and 5B, we see from
19 the foot of the page?
20 A. I do not think 5A is all on this map. 5A goes up into
21 the right-hand corner.
22 Q. And that is the ward?
23 A. That is the ward, yes.
24 Q. And 5B would be the intensive care high dependency unit?
25 A. Yes.
0007
1 Q. And the writing at the top, round the corner, I think,
2 on the same floor, there were two rooms knows as Blaise
3 and Wiltshire?
4 A. Yes.
5 Q. Those were rooms where relatives could stay overnight?
6 A. Yes.
7 Q. While their friends or relatives were being treated?
8 A. It was used for the children's parents, so it was the
9 children's parents. We never used it for adult
10 relatives, we just used it for children's.
11 Q. I think the writing is a little difficult to read, but
12 there was also a property nearby, was there not, which
13 had five bedrooms in it?
14 A. That was 66 Horfield Road. I think that was jointly run
15 with the Children's Hospital and the Heart Circle and we
16 had five rooms or six rooms -- five bedrooms in there
17 where the parents were able to stay as well, which was
18 just literally up behind the back of the BRI.
19 Q. If we go over the page to 42, this shows the position
20 between 1992 and 1995.
21 A. Yes.
22 Q. If we look at the text on the right-hand side at the
23 top, Blaise and Wiltshire rooms continued as bedrooms
24 until the paediatric service transferred in October
25 1995?
0008
1 A. Yes.
2 Q. Then in October 1995 it was converted into offices?
3 A. Yes. I have put it in as "about 1992". 1992 is as far
4 as I can recall. Some of the rooms were moved,
5 changed.
6 Q. What is the important change? Is it that the nursery
7 is moved?
8 A. Yes, I think that is the important move: that the
9 nursery was moved to further up the ward, so it was in
10 the middle of the ward near the clinical rooms and near
11 the desk area and the telephones, probably. That was
12 another reason.
13 Q. So the nursery which was beside high dependency -- it
14 is not very easy to see.
15 A. No. It has moved up to where on the bottom right-hand
16 side -- that is it, that area there.
17 Q. The clinical room you referred to is just above that?
18 A. It is just opposite, yes, that is right, yes.
19 Q. And is there anything else of particular significance
20 that we should note and compare?
21 A. No, I think that was the main change while the children
22 were there. I think once the children left, then many
23 of the offices along the top were changed. I can go
24 through those if you wish me to go through those.
25 Q. In the first diagram, the first table we looked at in
0009
1 41, there was a room known as the relatives' room next
2 to Mr Dhasmana's office, as it happened?
3 A. Yes.
4 Q. Is that the room where, if there was any bad news to be
5 broken, it would tend to be broken?
6 A. Yes, it did, because it was just near the intensive
7 care unit.
8 Q. In the second map, the one we are looking at now, 42,
9 you have not actually given that room a title. Did it
10 maintain its previous use?
11 A. Yes, it is still in its present use even now today, as
12 a relatives' room.
13 Q. That is a room that is 8 square metres, the room fourth
14 from the left on the left-hand side?
15 A. Yes, that one, yes.
16 Q. Those are slightly difficult to read, but I think it
17 gives the Panel a helpful indication of what was where.
18 Is there anything else that I should be drawing out of
19 those two pages?
20 A. I suppose the only thing else was that the children's
21 nursery always had children's size bathroom facilities
22 with it. When we moved the nursery further up the ward,
23 we had to reallocate the children's bathroom and toilet
24 facilities so they were not actually en suite, but they
25 were near.
0010
1 Q. They were close by?
2 A. Yes.
3 Q. You have been a Clinical Nurse Manager since I think
4 November 1993, first of all of cardiac surgery alone and
5 then more recently the whole ambit of cardiac services?
6 A. Yes.
7 Q. If we go to 114/35, this specification for Clinical
8 Nurse Manager, cardiac services, H grade: is this the
9 one that would have applied to you once cardiac services
10 became a directorate in its own right?
11 A. Yes, it did. It continued.
12 Q. If we go to 37, this one is Clinical Nurse Manager,
13 cardiac surgery, so this one is the predecessor of the
14 one we have just looked at; is that right, because this
15 one only applies to cardiac surgery?
16 A. Can I just look in my statement? It might make it
17 a bit clearer, the order.
18 Q. If we go to 114/1 paragraph 5, the foot of the page,
19 you say, in paragraph 5:
20 "From November 1993 until December 1996, I was
21 Clinical Nurse Manager of cardiac surgery. There is
22 annexed to my statement a copy of the job description."
23 A. Yes.
24 Q. "From 1996 my responsibilities grew to include
25 cardiology".
0011
1 A. Yes, that is right.
2 Q. So I take it that the job description at 37 is the
3 one that applied up until 1996, because that is entitled
4 "Cardiac surgery", and then the one at 35 embraces
5 cardiology as well?
6 A. Yes. If you go back to the two job descriptions, I now
7 know which was the earlier one. That one I think was
8 the first one that I dealt with. Yes, I would agree,
9 yes.
10 Q. So the Inquiry is concerned primarily with events up
11 until 1995.
12 A. Yes.
13 Q. We appreciate your job has changed since then. It is
14 this one, therefore, that covers the period at the
15 latter end of the period that the Inquiry is concerned
16 with?
17 A. Yes.
18 Q. So can we just look at this one, then, a little bit?
19 You are responsible to the Inpatient Services
20 Manager, responsible for the cardiac surgery unit.
21 Actually this job description, if we look at page 39, is
22 dated at the very foot of the page there 1988.
23 A. Yes.
24 Q. So this job description --
25 A. This is why I am just slightly at a dilemma here,
0012
1 because I cannot quite remember whether there was the
2 one that I took over and the other one was the one that
3 was written at a slightly later stage. I mean, it was
4 all before 1995.
5 Q. This one is dated 1988.
6 A. Yes.
7 Q. That is obviously before Trusts?
8 A. Yes, it was before Trusts, yes.
9 Q. Before directorates?
10 A. Yes.
11 Q. To what extent did the bringing about of the directorate
12 system under the Trust alter the day-to-day life of
13 someone who was a Clinical Nurse Manager of cardiac
14 surgery?
15 A. I suppose initially probably just -- I mean I had always
16 had a budget so it did not affect the fact -- the budget
17 was still there. I suppose it affected the way the
18 contracts came into the unit and the fact that suddenly
19 we had to think of purchasers and contracts, but before
20 that -- we still cared for the patients. That probably
21 made no difference there.
22 Q. Obviously the patients were still coming in and you
23 still had the same procedures and so on, but was there
24 more or less administration when the Trust system came
25 in?
0013
1 A. I do not think it necessarily made any difference, I do
2 not think, initially. It is not as if on 1st April
3 suddenly I had a load more paperwork to do. That did
4 not happen. I think just with evolution it gradually
5 changed, for the role to be slightly different, to the
6 fact that one was having to look a lot more at where
7 contracts were coming from, and I think I also felt that
8 there was a great need for the nurses to know and
9 understand how systems had changed, from that angle, and
10 I think there may have been a lot more push on
11 finances -- I think there was.
12 Q. Because it was important to cost the service?
13 A. Yes.
14 Q. Was there more paperwork rather than less when the Trust
15 system came in, from a nurse's point of view?
16 A. I do not think there probably was. I do not think so.
17 Not initially, no.
18 Q. There was not much difference initially?
19 A. I do not think so.
20 Q. What about subsequently?
21 A. I think probably because I had to be a lot more careful
22 with the money, the budgets, I mean, in one way it was
23 slightly easier, because with purchasers you knew
24 exactly how many contracts you were going to have that
25 year, so in a way one could say it was easier to plan,
0014
1 I suppose from my angle, a nursing angle, because
2 depending on how many contracts came in we knew how many
3 beds we were going to need, so I could then work out
4 with the General Manager how many nurses we need to
5 manage that unit, so in one way it was slightly easier.
6 Q. Because it was more particular?
7 A. Yes.
8 Q. If we go in your statement, please, to WIT 114/3,
9 paragraph 14, and just look at the screen, this
10 paragraph deals with financial conflict, as you put it,
11 between cardiac surgery and other types of surgery in
12 the time before cardiac services were a separate
13 directorate?
14 A. Yes.
15 Q. Was it the impression that cardiac surgery was used
16 effectively to bail out other parts of the surgical
17 directorate?
18 A. That was my perception, yes.
19 Q. If we go to page 46, this is Professor Angelini's
20 comment on your statement. We will come to that in just
21 a moment, because he is actually dealing with the next
22 paragraph.
23 Before we go to that, can we just go to
24 Mr Wisheart's comment at WIT 114/47? It is the first
25 paragraph. Mr Wisheart says:
0015
1 "The subdirectorate of cardiac surgery became part
2 of the new Directorate of Cardiac Services in April
3 1994. It is true that while in the Directorate of
4 Surgery the underspend of cardiac surgery was sometimes
5 used to help with the overspend of other subdirectorates
6 within the Directorate of Surgery."
7 That is what you have just said?
8 A. Yes.
9 Q. "The irony is that when cardiac surgery moved to the
10 Directorate of Cardiac Services, certainly in the early
11 years, the cardiac surgery underspend was used to help
12 with the cardiology overspend."
13 Then he refers to Mrs Ferris's evidence, "So it
14 was not quite as simple as saying that cardiac surgery
15 had total control of its own resources."
16 Is that fair comment, in your opinion?
17 A. I agree with the beginning of it. I think whether the
18 directorate joined as a whole and we became
19 a directorate, I still feel that we were more in control
20 of the whole cardiac side, so at that stage I felt that
21 we were able then to use the money to benefit cardiac
22 surgery because I think with cardiology coming on line,
23 ultimately, that is the whole circle of care, the
24 patient coming in with cardiology could end up in
25 cardiac surgery. So I think what Mr Wisheart has
0016
1 written is true, but I think it seemed easier from where
2 I was to actually use money for what was to benefit the
3 patients, i.e. equipment at that time.
4 Q. So is it fair to say that to take money from cardiac
5 surgery to as it were bail out cardiology was something
6 that you did not mind so much because cardiac surgery
7 was going to get the benefit from an improved
8 cardiological surgery, albeit bailing out some of part
9 of the Directorate of Surgery would mean no benefit
10 would derive to your department? Is that what it comes
11 to?
12 A. Yes, I think that is how I probably felt about it, yes.
13 Q. It comes across I think from your statement that the
14 nurses in cardiac surgery, first of all, would see the
15 boundaries of their loyalty -- they saw themselves as
16 being part of which team? Did they owe their loyalty
17 principally to the Trust or the hospital, or their
18 unit? What was the --
19 A. To their unit, to the ward, and I still think they
20 probably do now to a degree. Their loyalty is to the
21 ward and to the team that they are working with.
22 I think that when we were part of surgery and we had
23 become a directorate, I do not think they probably
24 thought -- they knew they were part of surgery, but
25 probably their main emphasis was on the ward and getting
0017
1 things achieved in the area itself. I think people are
2 much more aware now that we are a directorate. When we
3 became a cardiac services directorate, people very much
4 then started to think a little more holistically from
5 a cardiac angle, and then it also developed a little bit
6 more when I became the nurse manager of the whole
7 directorate. I still think it was slightly split when
8 there were two nurse managers, one for cardiology and
9 one for surgery, so it was still fairly split. That is
10 why, when you talk about the cardiology side and the
11 underspend, I was not as clear of that as I am now, of
12 course.
13 Q. So can that be summarised by saying that the nurses on
14 the ward saw themselves more rationally as part of the
15 cardiac services team, once that directorate was
16 established, than they had previously done when they
17 were part of the Directorate of Surgery?
18 A. Yes, but I still think they very much are part of the
19 unit on Ward 5, wherever they are working.
20 Q. The system previously was, was it not, that nurses would
21 tend to spend a good deal of time in a single part of
22 the unit; is that right?
23 A. I am not quite sure what you mean.
24 Q. Is there more rotation now of nurses throughout the
25 cardiac services directorate than there was before?
0018
1 A. There is to a degree, yes. There is. I do try and
2 encourage nurses to move around and get experience in
3 other areas if they wish to, and a lot of nurses will
4 come and speak to a sister and say, "I would like a bit
5 of coronary care experience", and then we would look at
6 rotating them to another area, but often it would mean
7 that we have a sort of cross-fertilisation, really. We
8 need to have somebody from that area to come and swap
9 round because I do not have extra staff in all the
10 clinical areas, I just have to move them round, so I do
11 have to look at it quite carefully. So, yes, people do
12 rotate around as much as we can help.
13 If there are certain areas short on certain days,
14 then of course the Sisters will try and see if nurses
15 are free in certain areas and could rotate to that
16 ward.
17 So, yes, that is the case. But when you say
18 "rotate", I think the thing with nurses is that they
19 like to work in one area and to feel they belong to that
20 area and have the team atmospheres, that they become an
21 expert in that area. I am not keen on nurses moving
22 willy-nilly from area to area and actually having no
23 base.
24 Q. Your job now is to float a little above the different
25 sides of the directorate and take a view of the bigger
0019
1 picture?
2 A. Yes, definitely, yes.
3 Q. And is that a system that works well?
4 A. Yes. Yes, I think it does.
5 Q. So to have the single Clinical Nurse Manager who happens
6 to be you?
7 A. Yes.
8 Q. Was it an improvement?
9 A. When I was the Nurse Manager of surgery, and then there
10 was another Nurse Manager for cardiology, I found it
11 quite difficult because she would actually be asking me
12 for advice about her side and of course it was quite
13 difficult for me to get involved because I did not
14 really know the area.
15 When she left it was decided by the General
16 Manager and the Clinical Director that it would be
17 easier or it might be beneficial that I took over the
18 whole directorate. I think initially it was quite
19 daunting, the thought of having another 3 clinical
20 areas, but actually I think it was easier because I just
21 continued the same standards that I had already set or
22 which were set up in cardiac surgery over into
23 cardiology. So it was quite a serious challenge, but
24 I would say now, here two or three years later, we are
25 getting equal consistency throughout all my areas now.
0020
1 Q. Can we go to page 5, please, paragraph 21? You say:
2 "Since achieving Trust status, there have been
3 a much clearer chains of command and even more so since
4 we became a directorate in our own right after April
5 1994."
6 You worked in the BRI before Trusts. We have
7 dealt with that. You were a staff nurse and then
8 a sister?
9 A. Yes. Only in cardiac -- only in Ward 5.
10 Q. So are you able to compare like with like in the
11 pre Trust versus post Trust days?
12 A. I would find it quite difficult because I was
13 a staff ... I think as a sister, I cannot really recall
14 it being that much different, I do not think. I think
15 it is difficult to remember.
16 Q. You say there were clearer chains of command. As
17 a nurse manager, you would report in terms of managing
18 the unit to the Associate General Manager or the General
19 Manager of the directorate?
20 A. Yes.
21 Q. If we go to page 6, paragraph 23, you say:
22 "As a sister, I was involved in the clinical
23 aspects of care and had little to do with management.
24 I remember there being very little communication from
25 the Director of Nursing."
0021
1 You do not recall Julia Thomas, who was a Nurse
2 Manager, telling you that she was having any meetings
3 with the Trust's Chief Nursing Adviser.
4 The Trust's Chief Nursing Adviser was Mrs Maisey,
5 was it not?
6 A. Yes, I think it was, yes.
7 Q. What was her role, as far as you were concerned, after
8 the Trust was established when she was Director of
9 Operations and Nurse Adviser?
10 A. In the statement, in paragraph 24, I have put there that
11 I was aware of the Trust Nursing Advisory Committee
12 meetings, so I was aware that they went on. But
13 I actually did not attend those. Sue Harris, the Nurse
14 Manager of the other part of the directorate, she
15 attended those.
16 As far as I was concerned, my line of command, my
17 responsibility was to the Associate General Manager and
18 then to the General Manager, and to the associate
19 Clinical Directors or the Clinical Director. And we
20 were very much kept in that sort of remit. We did not
21 really need to go elsewhere, apart from certain bits and
22 pieces, so there was very little time I needed to
23 actually think that I needed to have a Director of
24 Nursing at that time, because it was not there when
25 I took over as Nurse Manager. It was not something that
0022
1 I thought about. There were no meetings that
2 I attended. As I said, the other Nurse Manager attended
3 those.
4 Q. There is a Nurse Manager now, a Director of Nursing now,
5 Mrs Maisey took on that title latterly, and now there is
6 a Director of Nursing?
7 A. Yes.
8 Q. In paragraph 23, do I detect an element of regret or
9 disappointment, that what you are saying is that there
10 could have been more communication from the Director of
11 Nursing?
12 A. There could have been, but I think at that time
13 Mrs Maisey's job was not actually pure Director of
14 Nursing, it was a very different role than the Director
15 of Nursing we have now.
16 Q. That is what I am trying to explore. I am not attacking
17 Mrs Maisey, I am trying to find out whether there was
18 something that she or somebody else could have been
19 doing which was not being done which you felt ought to
20 have been done.
21 A. I did feel at times that I did not know, from a nursing
22 angle, where nursing was going, sometimes, and I did not
23 know where, for instance -- I mean, I have to look at an
24 example, unlike today, for instance, at the moment, with
25 looking at nurse documentation, I am looking at nurse
0023
1 documentation now generally in the unit and having to
2 think about what we should be doing and where we should
3 be going, so I was able to talk to the present Director
4 of Nursing for advice, whereas I think previously it may
5 have been difficult to know who you talk to people for
6 advice. I mean, if I needed advice I could have gone
7 and seen the Director of Nursing, Mrs Maisey.
8 Q. You said there you have to look at an example, like,
9 today, for instance.
10 A. Yes. Clear pathways, we are looking at that, for
11 instance. And I have been to see the present Director
12 of Nursing about that. I suppose if there was a big
13 topic like that several years ago, if I would have
14 needed to, then I could have gone and seen Mrs Maisey
15 and talked to her about it.
16 Q. So there has been more strategic direction feeding down
17 through the nursing system in the Trust? Is that what
18 you are saying?
19 A. Yes, there could have been, but at that time I cannot
20 recall what there was around, compared to today.
21 Q. In your statement at paragraph 57, page 13, you say that
22 Margaret Maisey had a strict disciplinary approach to
23 drug errors. You recall some drug errors in 1992 and
24 1993 concerned with syringe pumps getting air into
25 them. You went to Pat Fields, a nursing adviser for
0024
1 surgery, and she considered the drug errors fairly
2 serious. And they were very serious, were they not?
3 A. Yes.
4 Q. It is very serious to get air into syringe pumps?
5 A. Yes.
6 Q. So there is no criticism there of Pat Fields,
7 considering the drug errors to be serious?
8 A. No, not at all, no.
9 Q. There was then formal disciplinary procedures instituted
10 and I get the impression that the nurses rather got the
11 blame initially?
12 A. I think there was a culture that nurses did tend to take
13 the blame for drug errors.
14 Q. Take the blame, or be given the blame?
15 A. Probably both. The nurses themselves took the blame
16 because they have pride in their position and their job,
17 and I think they do tend to take the blame, but I think
18 they were also probably given the blame.
19 I think may be, okay, this may not have been
20 worded quite as well as I probably could do it now, on
21 reflection, but I think what I was trying to look at, or
22 trying to get over was that Margaret Maisey had quite
23 a disciplinary approach towards some procedures.
24 Q. She was seen as being authoritarian on drug errors?
25 A. Yes. I am not saying there was a disciplinary approach
0025
1 to all drug errors, I am not saying that, I am just
2 saying there was a very formal approach to drug errors
3 and as I recall, at the same time as I took over as
4 manager there were some drug errors. This is a long
5 time ago and I am having to rethink to remember some of
6 them. I do remember this specific issue about syringe
7 pumps because it was a big issue with syringe pumps and
8 there was also the financial aspect of it as well, so
9 there were two things, really.
10 With this particular incident, what I had to do
11 was to ask Pat Fields for advice, because she was my
12 Nurse Adviser, and I would have discussed it with the
13 Associate General Manager as well. Asked Pat Fields for
14 advice, who would have said "You need to do an
15 investigation". As soon as you start doing
16 investigations it becomes a fairly formal process, and
17 I think that is what I used to consider, and the nurses
18 used to consider, that the formal process was like
19 a disciplinary process and that is how we looked upon it
20 at that stage. That is my perception and that is what
21 I would say the nurses' perception was. We would then
22 go on to investigate it formally from, you know, written
23 statements. We would then go back to Pat Fields and
24 discuss with Pat Fields the issue, and then it was up to
25 Pat Fields to decide what happened then, basically.
0026
1 Q. I think you have had a chance to see Mrs Ferris's
2 evidence to the Inquiry?
3 A. Yes.
4 Q. She says in her evidence that you spoke to her about
5 drug errors and you and Mrs Ferris between you decided
6 not to handle drug errors through the formal process in
7 the way that they had been before?
8 A. What was happening when these -- because the consequence
9 of this syringe pump and air getting into it was
10 actually nothing to do with the nurses at the end of the
11 day, it was to do with the syringe pumps malfunctioning
12 so of course we had gone through a lot of problems and
13 a lot of bad feeling, bad morale caused by all these
14 investigations going on. It was finance and it was the
15 syringe pumps -- I am sorry, I have forgotten what you
16 asked me then.
17 Q. Let us take it in stages. Mrs Ferris said that you and
18 she decided when she became General Manager not to deal
19 with drug errors in the same formal way as they had been
20 before. That is right, is it?
21 A. I remember discussing them with Mrs Ferris when one
22 occurred and I think she would probably say, "Well, what
23 in your opinion should we be doing?" You have to
24 consider then I had been a Nurse Manager for a year or
25 so and I had had quite a lot of experience with dealing
0027
1 with quite a few drug errors. So I still used to talk
2 to Pat Fields, I still remember talking to Pat Fields
3 about it, but not necessarily writing down a great
4 lengthy description to her, but I do remember discussing
5 with her still, and then Rachel and I would just take
6 a slightly different approach with myself and one of the
7 Sisters from a clinical area, whichever area it was,
8 discussing with the nurses what had actually happened.
9 Q. So it was less formal?
10 A. It was less formal, but it was still treated very
11 seriously and the nurses were interviewed by myself and
12 one of the Sisters regarding what had actually
13 happened. My main emphasis at the time then, because
14 the nurses who had been involved in the drug error
15 potentially causing harm to a patient, was that I felt
16 it was important to be seen to be actually looking and
17 maybe looking at, was there a problem, because if a drug
18 error happens, there is usually a problem somewhere.
19 Either the nurse is training or there is a systems
20 failure. It is either one or the other.
21 Q. Or the syringe pumps did not work?
22 A. Yes, or the equipment does not work.
23 Q. Do we then take it that the approach to drug errors that
24 you were referring to in the paragraph meant that
25 Mrs Maisey presented a forbidding and perhaps slightly
0028
1 hostile exterior to nurses who found themselves involved
2 in a drug error episode. Would that be fair?
3 A. I think nurses were very frightened of the fact that if
4 they were involved with a drug error, that they could be
5 disciplined, yes.
6 Q. Mrs Ferris said, at I think page 87 of her evidence in
7 the transcript, that the nursing staff were "terrified"
8 of Mrs Maisey.
9 A. I think Mrs Maisey's reputation probably terrified
10 them. I do not think many of them had ever met
11 Mrs Maisey, but I think it was the reputation that went
12 before her.
13 Q. How did that reputation filter to the nurses if they had
14 never actually met her in the flesh?
15 A. I do not know.
16 Q. Just on the grapevine?
17 A. I think it just goes on the grapevine.
18 Q. So would it follow from that, to the extent that
19 Mrs Maisey was the senior nurse in the Trust who was one
20 of the ears who would potentially be available to listen
21 to nurses with professional concerns or complaints, that
22 it would be unlikely that these nurses, frightened as
23 they were of her reputation, would go knocking on her
24 door and bring to her their concerns?
25 A. Yes. I think it would be very difficult for a nurse to
0029
1 go and talk to her.
2 Q. I do not want to go into particular drug errors in great
3 detail, but do you remember whose syringes they were,
4 who they came from?
5 A. The syringe pumps came from cardiac surgery.
6 Q. Who manufactured the faulty pumps?
7 A. No, I cannot recall at this particular moment.
8 I probably will be able to in a little while.
9 Q. If we go over the page to page 14, you say it later
10 transpired that the errors were due to syringe pumps
11 which were old and had failed. How did that come
12 about? Was that not something that could have been
13 picked up earlier?
14 A. It probably could have been picked up earlier. I mean,
15 equipment in the early time, a lot of equipment, when
16 I remember taking over, when I was a sister and an early
17 Nurse Manager, equipment was bought and donated by the
18 Heart Circle, which was very generous of them. They
19 used to buy a lot of equipment, but there was not
20 necessarily any consistency in the equipment that was
21 bought. It just tended to be what was on offer at the
22 best time, at that time. You know, reps could come in
23 and say "I have a syringe pump at this price", and that
24 is how we had it.
25 So we had quite a mixture, but, I mean, there was
0030
1 only a couple of companies that made them. I do not
2 think there was any particular programme on how old
3 certain equipment was, whereas nowadays one would say
4 most medical equipment, you should not be using it after
5 it has been used for ten years. So nowadays, I am
6 keeping an eye on how old some of our equipment is. But
7 I think in those days, I do not think we probably were
8 looking at it from that sort of angle. I mean, I think
9 just as technology has advanced and how we are using
10 more equipment today. We are having to look at that
11 continuously.
12 Q. If we go to page 45, please, and then we will leave the
13 syringe pumps. This is Pat Fields' comments. She does
14 not recall the particular incidents as being subject to
15 disciplinary process in the formal sense, which she
16 would appear to define as being involvement with the
17 union rep and personnel.
18 It is right they would not be involved?
19 A. I do recall one drug incident actually going, and it was
20 very formal and it was held in the faculty room with one
21 of the Sisters from one of the clinical areas. I do
22 recall her having her union rep. I cannot remember
23 whether that was to do with syringe pumps or not;
24 I cannot remember. But I do remember one occasion we
25 did get to that stage.
0031
1 I mean, I just perceived it as slightly different
2 than Pat Fields perceived it differently, but that is
3 just the perception I had and the nurses had in the
4 clinical area.
5 Q. Pat Fields says she does not agree -- the middle of the
6 second paragraph: "... that the nurses were disciplined
7 in any formal sense although information was gathered in
8 a proper way by way of formal statements to ascertain
9 what had happened."
10 A. Yes.
11 Q. Is it that the nurses perceived the very gathering of
12 those statements as being a formal disciplinary process,
13 even if it did not lead in the end to a letter saying
14 "You have been given a warning"?
15 A. That is right. For nurses to start writing things down,
16 nurses are not used to having to write a lot of things
17 down, apart from patient care. When they start having
18 to do this, it is formal statements, then I think that
19 is when they considered it was starting a disciplinary
20 procedure, even though Pat Fields says it is not. That
21 is fine, that is her perception of it. In the clinical
22 area, it is a different perception.
23 Q. So that is a reconciliation between what she says which
24 is accurate and what you have said is accurate but from
25 a different perspective?
0032
1 A. Absolutely, yes.
2 Q. Is it your view that there has been a bolstering now of
3 the professional accountability line for nurses in the
4 Trust? It was something that Mr Baird said in his
5 evidence, page 107. Is that your perception?
6 A. Would you just repeat that again, sorry?
7 Q. Mr Baird said there had been a bolstering of the
8 professional accountability line for nurses at the
9 Trust, a specified Director of Nursing on the Board,
10 and so on.
11 A. I would agree. I think there is a very clear line.
12 I mean, I have almost like two lines of command now.
13 I sort of have Rachel Ferris and Peter Wilde, the
14 Director and General Manager, and then I also have the
15 other line up to Lindsay Scott.
16 Q. Who is the --
17 A. Who is the Director of Nursing; and there is also an
18 Associate Director of Nursing as well, an Assistant
19 Director of Nursing, if Lindsay Scott is not around.
20 So I think it is well sorted at the moment.
21 Q. If we go to page 8 of your statement, please,
22 paragraph 34 -- let us go to 33, first of all. You are
23 referring to monthly meetings after the Trust was
24 formed, attended by surgeons, anaesthetists and
25 professions allied to medicine. The Associate Clinical
0033
1 Director in the first instance was Mr Wisheart and
2 Lesley Salmon was the Associate General Manager. We
3 heard from her yesterday.
4 A. Yes.
5 Q. You said you found the meetings difficult and you felt
6 unable to raise issues. There was conflict between the
7 surgeons and the anaesthetists.
8 What was that conflict about?
9 A. The meetings were quite difficult. They were held at
10 5.30, at the end of the day, so everybody worked all day
11 and then you went to this meeting at the end of the
12 day. It was chaired by the Associate Clinical Director,
13 John Wisheart, and there was Lesley Salmon, the
14 Associate General Manager, and at some stages there was
15 the General Manager as well, who was Janet Maher. She
16 was there on other occasions as well. I found the
17 meetings difficult. I was quite junior and it was quite
18 daunting being in a room with 20 consultants. So it was
19 quite daunting. I do remember -- I mean, I have seen
20 some of the minutes of the meetings and I did raise some
21 issues if I felt able to. There was conflict at the
22 meetings. It is quite a while ago.
23 One thing that I do recall was to do with the
24 intensivist role. There was quite a lot of discussion
25 about the intensivist role. There was also a lot of
0034
1 discussion about theatres finishing late and theatre
2 staffing levels. There was a lot of discussion about
3 theatres, a lot of times.
4 Q. Was the conflict about theatres finishing late
5 because -- obviously people wanted to get home and did
6 not want to be at work all the time. Was it about that
7 or was it about concerns being raised that the patients
8 were suffering because operations were going on too
9 long?
10 A. I think both. Both. We had trouble recruiting staff to
11 theatres, even in those days. We still have problems
12 now. A lot of it was because people did not finish at
13 5 o'clock or 6 o'clock, they ended up staying late so if
14 you had social arrangements in the evening you could not
15 go. That restricted people from coming to join the
16 department, as well as, I think maybe operations did
17 take longer than we had expected, basically.
18 Q. That happened frequently, did it?
19 A. I would not say it happened frequently. It happened.
20 Q. Regularly?
21 A. Well, it happened every week.
22 Q. Every week?
23 A. Yes.
24 Q. You have told us about the theatre finishing time, and
25 you mentioned the conflict over the intensivist's role.
0035
1 Was that a struggle, essentially, for who would be in
2 charge of the patient post-operatively? Is that what
3 that was about?
4 A. Yes, it was, because at that time there were surgeons
5 who would care for their patients predominantly in the
6 intensive care unit and then the anaesthetist would come
7 in as well and give their input as well, give their
8 clinical knowledge, and there were various different
9 anaesthetists and of course just one surgeon, and
10 I think there was a view that the management of the
11 patients in intensive care could be managed better if
12 there was one person in that day managing the care of
13 any patient. I think this is why the intensivist role
14 was suggested and other units in the country had
15 different management of patients and in the intensive
16 care unit and I think there were some consultants,
17 probably anaesthetists who had come from other areas
18 were bringing in ideas to look at maybe to have one
19 person in charge, yes.
20 Q. And the anaesthetists thought that the person in overall
21 charge should be an intensivist?
22 A. Yes. I do not know whether they were looking at taking
23 over completely; I think they were looking at working
24 with the surgeon.
25 Q. Being given a greater role than previously because they
0036
1 had been seen as subservient to the surgeons?
2 A. No, I do not think they were seen as subservient to the
3 surgeons, no. I think it was just to try and look at
4 a standardised approach of care for that patient, say
5 for that day, whereas if you had different doctors
6 coming in and changing things as the day went on, it
7 would not be as beneficial to the patient as if you had
8 one person coming in and looking after the patient for
9 that whole day.
10 Q. Did this conflict between surgeons and anaesthetists
11 ever focus on the treatment of children as opposed to
12 patients in general? Was that an area of conflict?
13 A. I think like doctors do, they can disagree with
14 a pathway of care, and I think there were times when
15 anaesthetists and surgeons disagreed with care and
16 management of children, whether it was a drug therapy or
17 what it was.
18 Q. What were the areas of debate and concern with children?
19 A. I do remember them being there, having great debates
20 over changing drugs, changing drug therapies, because
21 a tiny change of a drug therapy to a child is an
22 absolute major change and it could have a major affect
23 on the child, but often they did that together for
24 support and to get the best care for that child in
25 a way, so there were two angles really to that. One was
0037
1 to get the best care for the child and at other times
2 they may disagree with each other.
3 Q. If we look at paragraph 34, which I mentioned a moment
4 ago, do I take from that that the conflict in your view
5 was more marked than it might have been because of the
6 way in which the meetings were chaired, that it was not
7 nipped in the bud as well as it might have been?
8 A. It might have been, but I do not know because in
9 a way -- those meetings were the only times when I think
10 a group of people got together to discuss and debate
11 a situation and it was probably the only time that
12 everybody could air their view at that time. I think
13 Mr Dhasmana just probably found it quite difficult to
14 stop discussion -- you know, when was it debate, when
15 was it the right time to stop the debate.
16 Q. Mr Dhasmana, you say, was not quite sure when to stop
17 people from talking and how to stop arguments, so
18 Mr Wisheart stepped into the breach, usually, was how
19 you put it. Why was it Mr Wisheart as opposed to anyone
20 else who should have ended up chairing the meetings?
21 A. Because he had been the previous Associate Clinical
22 Director, and I think he also had those skills and
23 I think Mr Dhasmana had worked with him for a long time
24 and often looked to him for support.
25 Q. If we look at WIT 114/48, paragraph 4, these are
0038
1 Mr Wisheart's comments on your statement. He says:
2 "I cannot recall any occasion when I took over
3 a meeting chaired by Mr Dhasmana. I may have tried to
4 resolve some disagreements."
5 So Mr Wisheart is suggesting that it was his role,
6 he would take on the role, of trying to reach
7 a consensus.
8 Was that your impression?
9 A. Yes, I think it was.
10 Q. I think Mr Dhasmana has used the expression -- we will
11 see this -- that Mr Wisheart did not take over as
12 Chairman but tried to play an "elder statesman's" role
13 in order to resolve differing views after a prolonged
14 discussion." Is that fair comment?
15 A. Yes.
16 Q. That Mr Wisheart was seen, certainly by Mr Dhasmana, as
17 the "elder statesman", the wise counsel of these
18 meetings?
19 A. Yes. He had done the job before and had the
20 experience.
21 Q. Moving to something else, the nursing ratio in intensive
22 care at the end of the period when children were there,
23 let us take that period, was what, in intensive care?
24 A. In intensive care, it was one nurse per patient.
25 Q. And the way that it works is that in order to work out
0039
1 how many staff you need to staff the unit as a whole, we
2 have this concept of whole-time equivalents?
3 A. Yes, that is right.
4 Q. Because obviously it cannot be the same nurse all the
5 time?
6 A. Yes.
7 Q. What was the whole-time equivalent ratio?
8 A. One is about 5.4 full-time equivalents per intensive
9 care bed, is actually what Ward 5 -- that is what
10 I inherited when I took over, so roundabout 5 and
11 a half.
12 Q. When you took over in 1993?
13 A. 1993, yes. I do a slightly different formula now, it is
14 slightly different, but that is what --
15 MRS HOWARD: Mr Maclean, can I just interrupt for a moment
16 and ask, is that whole-time equivalent for adults, or
17 was that inclusive of the total in the intensive care
18 unit?
19 A. For the intensive care unit.
20 MR MACLEAN: I hope this reference is right. Let us go to
21 page 17, first, of your statement. You say there, at
22 the foot of the page, new professional organisations
23 have been set up, namely the British Association of
24 Critical Care Nursing and the British Cardiac Society.
25 Are you familiar with the national standards for
0040
1 nursing ratios that have been published by some of these
2 national bodies?
3 A. The Intensive Care Society, yes.
4 Q. If we go to WIT 60/11, please, this is the Paediatric
5 Intensive Care Society standards for paediatric
6 intensive care.
7 If we go to page 15, if we scan down, I hope
8 there is a heading which says "Paediatric intensive
9 care."
10 "Apart from infants who undergo treatment in
11 a neonatal intensive care unit children who become
12 critically ill at any time between birth and adolescence
13 require the facilities of a paediatric intensive care
14 unit."
15 This is in the 1990s, this document.
16 If we go to page 18 and at the foot of the page --
17 I will get you the exact date of this, but as I recall,
18 it is 1992 or 1993. I think it is 1993.
19 "It is essential that there is a senior nurse with
20 several years experience of paediatric intensive care in
21 charge of the unit ... a minimum of one trained nurse to
22 one patient is usually required throughout the entire
23 24 hour period. Flexibility of resources and staff is
24 required in order to provide optimum care of the
25 patients according to their needs. To establish the
0041
1 appropriate nurse/patient ratio, clinical classification
2 scores 'dependency categories' can be used."
3 If we go over the page to 19 and go to the foot of
4 the page, "Additional factors influencing nurse
5 establishment":
6 "When calculating nursing establishment, it is
7 also necessary to make allowances for staff handover
8 time, holidays, sickness and study leave ..."
9 The conclusion, to cut a long story short, is that
10 the bedside establishment is recommended as being 6.4
11 whole time equivalents to 1, to cover any 24 hour
12 period.
13 The next paragraph qualifies that and says it
14 might have to be higher in certain circumstances?
15 A. Yes.
16 Q. I think Dr Ratcliffe, who gave evidence on March 25th,
17 as long ago as that, said at page 152 of her evidence
18 that that ratio, 6.4 to 1, has been endorsed by the
19 Paediatric Intensive Care Society and I think holds good
20 today.
21 So that is the ratio that was never achieved?
22 A. No, but this is for paediatrics. You have to remember
23 that the unit was a mixed unit. That is why when
24 I answered the question it was 5.4 for the whole
25 intensive care unit, because of course there were
0042
1 8 beds, not necessarily 8 beds would have been
2 a patient, at this stage when we are talking, who would
3 be ventilated and may be considered an intensive care
4 patient.
5 Q. I appreciate of course it was a mixed unit and
6 I appreciate the standards are paediatric standards. Is
7 it therefore the case, is it your evidence, that for the
8 children who were in intensive care in the mixed unit,
9 they did receive that correct ratio of nurses?
10 A. They always received one nurse per patient every single
11 shift. If the patient was more dependent, which
12 sometimes they were and they needed two nurses per
13 shift, then another nurse would have worked with that
14 nurse.
15 Q. There were four, were there, paediatric intensive care
16 cases in the intensive care unit?
17 A. Well, actually, there were 8 beds. Any of those beds
18 could have been used for children, depending on their
19 need.
20 Q. If we go to page 22 of your statement, paragraph 92, at
21 the foot of the paragraph -- I am conscious of what goes
22 above it and I will come back to that:
23 "There were only two paediatric nurses permanently
24 on our staff."
25 Does that mean two paediatrically trained nurses
0043
1 per shift, or only two in total?
2 A. There were two who had RSCN in the total staff.
3 Q. So they may or may not have been on any particular
4 shift?
5 A. Yes, that is right, but there was one who was the
6 F grade who worked in both the intensive care unit and
7 the ward area, and the other RSCN worked in the
8 nursery. She was based in the nursery, but there were
9 intensive care nurses who had undertaken paediatric
10 courses but they were not necessarily an RSCN.
11 I remember recalling one nurse going to Great Ormond
12 Street for a short course of, I do not know, four weeks
13 or something over a period of time, and there was
14 another nurse who went to Southampton and did another
15 course, so there were other nurses who had done extra
16 paediatric adaptations to their training.
17 Q. And there were some people that came in from elsewhere,
18 as you referred to earlier in the paragraph?
19 A. There were, but predominantly we were looking at nurses
20 who were intensive care trained, I mean in adults.
21 Q. If the intensive care unit had been a dedicated
22 paediatric intensive care unit, only for children, how
23 many of the nurses in the 6.4 whole-time equivalent
24 ratio that was recommended would have been registered
25 sick children's nurses, would you have expected?
0044
1 A. If it was a pure paediatric unit?
2 Q. Yes.
3 A. But if it was a pure paediatric unit, it would have been
4 at a Children's Hospital.
5 Q. I know.
6 A. I probably cannot answer that because I do not know.
7 I do not think I would know, because I do not know what
8 the staffing situation would have been like for
9 a paediatric hospital paediatric intensive care unit.
10 Q. If you were put in charge for the day of a paediatric
11 intensive care unit, and somebody said to you, "What is
12 the whole-time equivalent ratio for nurse staffing?" you
13 would know that the answer was 6.4, that is the
14 recommendation; yes?
15 A. Yes.
16 Q. If somebody said to you, I appreciate you have not been
17 the Nurse Manager of a dedicated paediatric intensive
18 care unit before, but "How many of the 6.4 whole time
19 equivalents would you expect to be registered sick
20 children's nurses, in an ideal world?" what would your
21 answer be?
22 A. All of them.
23 Q. 6.4?
24 A. In an ideal world, yes.
25 Q. Now there is a dedicated paediatric intensive care unit
0045
1 in the Children's Hospital, are you able to help us with
2 what percentage of the total nursing staff there are
3 registered children's nurses?
4 A. I would assume they all were, but I would not be able to
5 tell you exactly. I would just assume it.
6 MR MACLEAN: Thank you. Sir, is it a convenient moment for
7 a short break?
8 THE CHAIRMAN: Yes. Thank you, Mr Maclean. Shall we break
9 now and return at 11 o'clock?
10 (10.47 am)
11 (A short break)
12 (11.00 am)
13 MR MACLEAN: We were dealing with the nursing ratios
14 and so on just before the break. Was there ever any
15 concerted effort made before the paediatric open heart
16 surgery went to the Children's Hospital to increase the
17 number of registered sick children's nurses working in
18 the BRI intensive care unit?
19 A. We tried several times to attract children's trained
20 nurses to the BRI by many adverts, advertising
21 nationally, but what it came down to basically was that
22 the children's nurses did not want to work in a unit
23 where there were adults. If there were times when there
24 were no children in the intensive care unit they may
25 have had to have looked after an adult and of course
0046
1 their philosophy is very different. They do not want to
2 work with adults, they want to work with children.
3 So we tried really hard to attract them. The
4 F grade that actually I would have considered our first
5 RSCN, we actually seconded her to go and do a paediatric
6 course and then she returned to Ward 5. The second one,
7 it was just an absolute added bonus, hence we did try
8 and encourage nurses to go off to other units to do
9 training, shortened courses.
10 So we tried everything I think we possibly could
11 have tried at that time.
12 Q. Was there a national surplus or deficit of registered
13 sick children's nurses?
14 A. I think there was a deficit. From what I remember from
15 talking to people at the Children's Hospital, they also
16 found it difficult to attract RSCNs with intensive care
17 experience into their intensive care unit. So with the
18 cardiac intensive care unit, what we were trying to look
19 at was trying to have lots of nurses who had done an
20 intensive care course and had intensive care
21 experience. That is the standard that we were trying to
22 achieve there. If we had an RSCN, that was just an
23 added bonus, which was excellent.
24 Q. You told us just before the break about the 8 beds in
25 intensive care and if I understood you correctly, some,
0047
1 none or all of those beds might be occupied at any one
2 time by adults or by children?
3 A. It was rare. I do not think I have ever seen it full
4 with 8 children in there. I think probably the most
5 I probably recall may be 5.
6 Q. Children would typically spend longer in intensive care
7 than would adults, post-operatively?
8 A. Yes, they did.
9 Q. So it could be the case, could it not, that there would
10 be adults ready, willing and able to have their
11 operations, but no available space in intensive care to
12 house them after the operation?
13 A. Yes. It is the same situation as there is today, yes:
14 lack of beds, basically, in the intensive care unit.
15 Patients are not well enough to move through as we would
16 have necessarily planned, yes.
17 Q. So there is always a demand for particularly adults to
18 have surgery, and one of the bottlenecks is to be found
19 in intensive care?
20 A. Yes.
21 Q. But that bottleneck would be more marked, more profound
22 in the days when there were children in the intensive
23 care because they would be there for longer?
24 A. Yes, and you could have three or four beds blocked for
25 a longer period of time because they were not moving
0048
1 through, yes.
2 Q. So that led to some tension, did it?
3 A. Yes, it did, yes.
4 Q. Do not take it from me, let us take it from your
5 statement. If we go to 114/29, paragraph 121, you see
6 in the third line you say:
7 "Some surgeons complained at times if there was
8 a shortage of beds for adult cases as children were
9 staying in ITU and blocking beds."
10 Which surgeons would voice that kind of concern?
11 A. The surgeons that needed the adult patients and the
12 other thing is that all surgeons have certain operating
13 slots; they only have a few operating slots per week,
14 I do not know, 5 sessions maybe or something a week, so
15 if some surgeons operated the day after they operated on
16 children, then they may find they did not have any
17 beds. It is not actually that much different than
18 today, where come Thursday and Friday and we have
19 operated all week you may be short of beds.
20 Q. But you would get through more patients now without
21 children than you would have done with the children,
22 because the adults spend less time?
23 A. You would expect so, but with patients, some adults are
24 very sick as well and you need a longer length of time
25 in intensive care as well.
0049
1 Q. Let us just go back to that paragraph in the third
2 line. The surgeons who would be complaining, we come
3 back to it in the last sentence, "The conflict between
4 the adults surgeons and the paediatric surgeons."
5 The paediatric surgeons I assume were Mr Dhasmana
6 and Mr Wisheart and the adults' surgeons were
7 Mr Hutter --
8 A. Mr Hutter and Mr Bryan and Professor Angelini. I mean,
9 I cannot recall whether Mr Bryan was there when the
10 children were there or not, I am not sure about the
11 dates, but, yes. And also Mr Keen at some stage,
12 because he was there. But then that is conflict that
13 happened then, and it stills happens to some degree now,
14 with beds.
15 Q. Was there ever any pressure that you could detect to
16 do fewer operations on children in order to increase the
17 number of adults who were provided with surgery?
18 A. No. I think we would then go to look at an expansion
19 programme. I think if there was an expansion in
20 contracts, then we would say "We need to look at
21 expansion within the department". So, no, there was
22 not, unless it was a planned expansion.
23 Q. The expansion that took place in the early 1990s was an
24 expansion of adult operations -- I think we saw this
25 with Mr Nix: there were 150 paediatric operations and
0050
1 after the expansion it was still planned to be 150
2 paediatric operations, but there had been an increase in
3 adult operations?
4 A. Yes.
5 Q. So would it be right to say that the focus of expansion
6 of the cardiac unit was on adult work rather than
7 paediatric work?
8 A. If Mr Nix said that the contracts were increased,
9 I would have to agree with that. I would not
10 necessarily know, to be honest, from my angle, because,
11 I mean, I was looking at just making sure that the
12 intensive care was staffed and managed.
13 Q. Do not agree with Mr Nix just because I badly report
14 what he may or may not have said. Is your evidence that
15 it is not really within your compass?
16 A. It is not in my remit, really. I do not know. In 1990
17 I was not really involved in the expansion plans.
18 Q. When you became the Nurse Manager in November 1993,
19 although you had been acting Nurse Manager from November
20 1992, the designation of the BRI as a supra-regional
21 centre for neonatal and infant cardiac surgery was
22 coming to an end. Did you have any contact with the
23 Supra Regional Services Advisory Group?
24 A. No, never.
25 Q. Or any involvement with reporting to the group through
0051
1 the Region of the numbers of paediatric operations?
2 A. No. No, I was never involved.
3 Q. Did you ever see any people from the Department of
4 Health or the Supra Regional Services Advisory Group
5 coming around the unit to carry out an inspection?
6 A. I do not recall them, no.
7 Q. Were you ever aware of any specific encouragement
8 coming from outside of the Trust to increase the number
9 of neonatal and infant open heart operations performed
10 at the BRI?
11 A. No.
12 Q. You were never aware of there being a push on to bump
13 up the numbers?
14 A. No, I do not think so, no. Not at all.
15 Q. If we go to page 14 of your statement, please, the
16 bottom of the page: support groups for nurses were set
17 up in 1988 or 1989. That is the old Health Authority
18 days before purchaser/providers, before Trusts?
19 A. Yes.
20 Q. Initially run by a social worker. If we go over the
21 page, please, "The social work department changed and we
22 were unable to receive this support."
23 Do I detect an element of regret there?
24 A. Yes. The social work department linked quite strongly
25 with the ward dealing with patients' convalescence and
0052
1 parents and financial issues and things like that, so
2 there was a social worker around quite a lot of the
3 time. It was a man; I do not remember his name or
4 anything, but he was actually quite supportive to staff
5 and he, I think, was asked, or he offered -- he may have
6 been asked, I do not know, I cannot remember -- whether
7 he would be interested in running some support groups.
8 He undertook that role and we actually went to the
9 social work department purely because it was actually
10 off the ward area, the clinical area. He did run some
11 support groups -- I cannot remember how many. I do
12 remember attending one myself, but I cannot remember how
13 many. Then it just seemed that that sort of service,
14 once we had set that up, whether it was then because it
15 was Trust status, I do not know why, actually, it
16 stopped. I do not remember really why it stopped.
17 Q. Do you remember when it stopped?
18 A. I do not, but I do remember looking in some of the
19 information that has come that I had asked Freda Gardner
20 and also Helen Stratton -- I do not remember if there
21 was a linkage there with two of them -- I know there is
22 a letter somewhere saying I had asked one or two of them
23 if they would take over running one of these support
24 sessions for the nurses.
25 Q. Let us look at UBHT 135/118 ... 23rd August 1993. This
0053
1 is to Jean Pratton of the Heart Circle:
2 "I am writing to inform you that after meeting
3 with Fiona Thomas and Lesley Salmon I have taken over
4 the co-ordination of the paediatric care on Wards 5A and
5 5B [that would include the intensive care unit]. This
6 of course will involve the co-ordination of the work of
7 the Heart Circle staff, Helen Stratton and Helen
8 Passfield and I hope you will be in agreement with
9 this."
10 Then we see what is said.
11 If we scan down, it is copied to various people
12 including you and there is a tick besides that. Is that
13 your writing?
14 A. Yes.
15 Q. "There is going to be a meeting to discuss issues
16 involved in the management of paediatric patients. We
17 will then have a regular weekly meeting to discuss the
18 ongoing management of all patients on the cardiac unit."
19 You say you are apprehensive about this?
20 A. "I am apprehensive about this", star. It has a star.
21 "I feel your advice and guidelines" -- I am not quite
22 sure. This is just notes that I must have made on this
23 memo.
24 Can you scroll back so I can see what the date is
25 of this? It might just give me some idea, then, of --
0054
1 1993. I think 1993 was to do with the set-ups in
2 paediatric interest groups. I think this is probably
3 what followed this meeting. There were paediatric
4 interest groups, which you do have copies of all those
5 minutes, and I think this was to do with this. This was
6 looking at the management -- there were two, there were
7 several. This one, we were looking at how this group of
8 staff worked together in the management and care of the
9 patients, psychological sort of care as well, and then
10 there was the other one with the paediatric interest
11 group on which we got senior nurses from the ward areas
12 and also we got intensivists involved as well. That was
13 to do with maybe more patient management. I think this
14 was to do with how we were looking at linking the Heart
15 Circle with staff involved with care.
16 Q. What Dr Gardner is concerned about here is her providing
17 services to the patients or to the relatives of the
18 patients rather than to the staff?
19 A. Yes.
20 Q. If we go to UBHT 135/97, this is December 1993, this
21 is the group, is it not?
22 A. Yes, it is. That has Steve Pryn, the intensivist, yes.
23 I think that is what it is.
24 Q. If we scan down --
25 A. I know what this was, this was looking at
0055
1 a multidisciplinary group to look at the care of the
2 children within the unit to see if we could make
3 improvements with the care of the children, basically,
4 because the Heart Circle employed more staff. The Heart
5 Circle were very good at funding several nurses because
6 they funded Helen Stratton and they funded at some stage
7 Helen Passfield as well, and also I think they may have
8 given Freda Gardner some money as well. I am not sure
9 what. They funded something to do with some of her
10 post. I cannot quite recall.
11 Q. The Inquiry has heard a bit about Helen Stratton,
12 Helen Vegoda previously. Dr Gardner has two roles: as
13 a support of the staff and support for the patients and
14 families. Let us look at the latter of those two first.
15 What was the role of Helen Stratton and the other
16 people who did that type of job?
17 A. Initially it was Helen Vegoda who was actually -- she
18 was employed as a sort of counsellor, I think we used to
19 call her, a heart counsellor, and she was employed and
20 based at the Children's Hospital, if I remember.
21 She was not a nurse. I think her background was
22 a social work background, but she was based at the
23 Children's Hospital and I think she used to work for
24 us. I remember I was a Sister, so it was in the late
25 1980s, that she used to work and care for and support
0056
1 the parents, so basically, I remember her role was to
2 support parents of children who were undergoing open
3 heart surgery, and she would meet the parents often at
4 the Children's Hospital or at the outpatient department,
5 because of course she was based there, and she would at
6 times come down and support parents through intensive
7 care.
8 She did not necessarily always come down with
9 all of them, but she used to get quite friendly with
10 some parents, not necessarily all parents.
11 Q. Can I just help you? If we go to WIT 85/32, these are
12 your comments on Sheena Disley's statement. We are
13 going to hear from her later. It is paragraph 37.
14 "Helen Vegoda was employed by the Bristol Heart
15 Circle".
16 A. Yes, that is right.
17 Q. "Her role was mainly to be based at the BCH but she ...
18 did not visit ITU on a regular basis".
19 You draw a distinction between her role on the one
20 hand and Helen Stratton on the other?
21 A. There was quite a difference.
22 Q. Helen Stratton was a nurse, Helen Vegoda was not.
23 Helen Vegoda was based at the BCH and Helen Stratton was
24 the reverse, based at the BRI, and spent some time up
25 there, as opposed to the other way round. Are those the
0057
1 key differences?
2 A. Yes, and also Helen Vegoda, because she was basically
3 employed at the Bristol Children's Hospital, she did not
4 necessarily want to come down to the BRI. Also it was
5 very difficult to get hold of her at certain times. She
6 did not drive and it was difficult to get her when
7 parents who had had support from her and also required
8 it at certain times she was not able to come. So
9 I think what we did then was we talked to the Heart
10 Circle and they said they would fund another person for
11 a short-term contract. That is, I think, how Helen
12 Stratton was employed on a contract, whether it was two
13 years or three years -- I think it may have been
14 three -- I cannot quite recall. That is what happened.
15 Helen Stratton was employed to work for Ward 5
16 specifically. She had an office in Ward 5 and she was
17 a nurse, she had intensive care background, she had
18 worked in the cardiac surgery unit in Ward 5, but
19 I cannot remember what else she had done, but she was an
20 intensive care nurse, not a paediatric nurse; she was
21 intensive care.
22 Q. So she was a cardiac liaison nurse?
23 A. Her title was cardiac liaison work, which was slightly
24 different. Her role was to support the family before
25 and after surgery in whatever remit you would say the
0058
1 support was. She probably did have a role in supporting
2 some staff at a later stage.
3 Q. Let us focus on the parents for a moment. If there
4 was bad news if things were going badly in theatre, if
5 it became clear to the nurses or to the doctors that the
6 child was not going to make it, would Helen Stratton
7 have a role in breaking that news to parents, or would
8 that be done by a clinician?
9 A. It would usually be done by a clinician, but there
10 were times where sometimes the Sisters would also speak
11 to the family as well, and there may have been times
12 when Helen Stratton may have spoken to the family, but
13 normally it was done by the clinician and Helen Stratton
14 and the Sister was there as a support. It was usually
15 done as a group. But most of the time the nurses would
16 tell the family how sick the child was because sometimes
17 the Sisters just did not necessarily know until the
18 surgeon had arrived to talk to the parents anyway.
19 Q. Can we go to UBHT 135/92? We are into 1994 now.
20 At this stage there was a vacancy and Helen
21 Stratton it would appear was not around at this point?
22 A. That is right. I think Helen Stratton had an initial
23 contract and then that was extended for another year,
24 I remember, because I think I was involved then with
25 that extension of her contract. That was through the
0059
1 Heart Circle, again, I think, and then there was going
2 to be a gap for the next year, probably, but I think the
3 children's move was probably planned for early 1995
4 because a new surgeon was coming in the early part of
5 the year, but in fact it did not actually happen until
6 October 1995. I think that is probably why the Heart
7 Circle were not keen on funding another position, and
8 also, I do not think we had any funds in Ward 5 to do
9 that, so I think we had to look at another support
10 mechanism, really, for the staff.
11 Q. So this is now turning to the staff?
12 A. Yes, this is for the staff, because Helen also used to
13 have a role of running some support groups for staff as
14 well, which actually I do not think I mentioned.
15 Q. That is clear from this memo, is it not: that there were
16 support meetings for the staff, it must be in context,
17 and Helen Stratton was to facilitate that. That was her
18 role?
19 A. Yes.
20 Q. And she was not around, so you wanted Dr Gardner to fill
21 that role, and she did?
22 A. Yes, she did.
23 Q. And that is what you referred to, if we go back to your
24 own statement, WIT 114/15, paragraphs 64 and 65.
25 A. Yes.
0060
1 Q. Just to tidy this up, UBHT 213/14, it is my incompetence
2 this is out of order, a Heart Circle meeting of
3 1st March 1993.
4 A. Yes.
5 Q. You see it is attended by Lesley Salmon, then I think
6 the Associate General Manager?
7 A. Yes, that is right.
8 Q. And you. Who was Odette Ashendon?
9 A. I am looking now, I do not know. I do not know.
10 Q. If we look down a little bit, we see the heading
11 "Helen Stratton's position: Helen has taken on more
12 responsibility for the Heart Circle and her job is
13 developing well."
14 Then there is a reference to the contract you
15 mentioned?
16 A. Yes.
17 Q. So the contract was running out in October 1993?
18 A. That is right, and then Jean was the President of the
19 Heart Circle and she suggested a 50-50 split, and then
20 Lesley and I were going to go and discuss the options.
21 Q. Can we go down a little more? Helen Passfield, and then
22 there is a reference, do you see:
23 "All three members of staff working primarily with
24 the children needed some help in setting objectives and
25 working together."
0061
1 A. Yes.
2 Q. Who were those three and what were they doing?
3 A. That was particularly Kathy Warren, the F grade
4 paediatric RSCN, and then Helen Passfield. So Kathy
5 Warren was the F grade paediatric nurse for both areas,
6 and then there was Helen Passfield who was the...
7 I think she was employed as a play leader, because she
8 had gone off. She was a nursery nurse and then had gone
9 off and done some further training to become a play
10 leader, so that we had a qualified play leader actually
11 in Ward 5 to look at play with the children.
12 Q. So this is looking not at the relatives, the parents,
13 not at the staff, but at the actual paediatric patients
14 themselves?
15 A. That is what Helen Passfield's role was, but with
16 Helen Passfield and Kathy we needed to make sure they
17 had clear objectives set so that they were all working
18 towards the same goal at the end of the day, and
19 I undertook with Freda, looking at Helen Passfield's
20 role. And I undertook Kathy Warren's role looking at
21 her objectives very clearly and setting out objectives
22 for Kathy Warren in developing the paediatric management
23 and we set up many things for her to look at practice
24 and look at improving practice in certain areas
25 following her course once she had become an RSCN.
0062
1 Q. So again the Heart Circle was involved in funding of
2 those roles?
3 A. They were not involved with Kathy Warren. She was
4 employed as an F grade on the ward, but with Helen
5 Passfield -- I cannot actually remember, to be honest,
6 with Helen Passfield. It was likely.
7 Q. Now can we go to something else? Your statement at
8 page 114/17, paragraphs 71 and 72. Paragraph 71 deals
9 with the change of nurse education in 1990. You refer
10 to your taking the Diploma in Nursing. I do not know if
11 you have seen Mr Baird's evidence, but he referred to
12 the change of arrangements for training nurses which
13 meant that they were now trained, I think, at University
14 much more than they had previously been. They used to
15 be trained on the ward. He said that he had been
16 brought up on a system which survived on student nurses
17 but that then the training arrangements changed and, as
18 he put it, "suddenly they were all very clever and they
19 have degrees".
20 What difference did that make, practically, to the
21 arrangements of nursing on the ward, the fact that this
22 change had taken place in the method of training?
23 A. It was quite drastic on some wards, because some wards
24 did require those extra staff, extra nurses, and
25 third-year student nurses particularly were used as
0063
1 a good pair of hands for patient care. Student nurses
2 up until the change were used as staff caring for
3 patients.
4 Q. So when they were not around?
5 A. When they were not around, there was a deficit of
6 nurses, of carers, then, one could say, and then the BRI
7 had introduced quite a big training programme for HCAs
8 to try and get more HCAs to try and fill up the gap that
9 was going to be present when there were no student
10 nurses.
11 Q. An HCA being ...
12 A. A health care assistant. So the Trust was being quite
13 proactive in looking at that. That was quite a good
14 angle.
15 Q. So the replacement, as it were, was to train up the HCAs
16 a bit so that the qualified nurses could be freed up to
17 do what they had to be qualified for?
18 A. Actually, auxiliaries were trained, the training for
19 auxiliaries changed to become health care assistants so
20 an auxiliary could do extra training to NVQ level 2 so
21 they were able to be more knowledgeable about certain
22 aspects of nursing care, so they were able to do some of
23 the nursing care roles.
24 Q. So this change affected the whole of the National
25 Health Service?
0064
1 A. Yes, everywhere.
2 Q. Across the country?
3 A. Absolutely everywhere. The student nurses then went
4 into University and then trained to diploma level, which
5 is still currently happening. That is Project 2000, as
6 you said. There was still another training, the degree,
7 so they have been running parallel.
8 Q. Those are the degrees Mr Baird was referring to?
9 A. Yes, I think so.
10 Q. Paragraph 72, you refer to yourself and Mrs Ferris
11 visiting Coventry in 1995. You say that you do however
12 remember two theatre nurses going to Birmingham in late
13 1993 around the same time as Mr Dhasmana?
14 A. Yes.
15 Q. You say they came back with some ideas of how areas of
16 the theatres could be changed, which were then
17 implemented. Do you remember what those were?
18 A. I think it was fairly simple things like positioning in
19 theatres and standing on one side of the operating table
20 compared to the other side, things like that, which
21 Birmingham were working with and they thought it was
22 quite good, "We think we might do it", and Birmingham
23 seemed to be working very well on that system. They
24 were quite simple things, but I think they had quite big
25 implications in the working environment initially.
0065
1 I cannot remember any other changes at that time.
2 Q. In your witness statement at paragraph 36, page 8,
3 you say:
4 "When Mr Keen and Mr Wisheart were the consultants
5 [you] remember ward rounds being very old-fashioned.
6 The Sister would follow the surgeons around the ward,
7 together with an entourage of junior doctors. As
8 a Sister", so this is pre-1992 when you became an acting
9 nursing manager, you played what you could only describe
10 as "a subservient role following the surgeons with
11 trolleys of notes and x-rays, holding up the x-rays for
12 the surgeons to view."
13 Mr Wisheart has commented on that paragraph at
14 WIT 114/48, paragraph 5. You see what he says there.
15 Was it your impression that you were the only
16 Sister who had this feeling of subservience, or was
17 there a feeling that was shared by other Sisters?
18 A. I think the ward rounds, they were on a certain day of
19 the week, on a Friday I think, and when I say
20 "subservient", I mean the Sister would take the trolley
21 and put the x-rays up. That is the subservience.
22 I think the Sisters were able to say and comment on the
23 care if they felt there was need to, so --
24 Q. Was it a case of having something to say which you felt
25 disabled from saying?
0066
1 A. No, I do not think so. I think if you felt you had
2 something to say on that patient's care, you could say
3 it. Whether it was listened to, was a different
4 matter.
5 Q. It would not be listened to if you said something? That
6 was the fear, was it?
7 A. Probably. But then I do not think it was probably any
8 different at that stage than probably in many other ward
9 rounds in any other hospital, probably, or any other
10 ward in the BRI.
11 Q. You refer to the ward rounds as being very
12 "old-fashioned" for those two particular consultants?
13 A. I suppose I am comparing "old-fashioned" from then to
14 now.
15 Q. You make another comparison, do you not, at
16 paragraph 37, 114/9. You compare the two consultants
17 you have just mentioned with Mr Dhasmana. So this is
18 not a comparison with then and now, this is a comparison
19 with then and then. You say:
20 "Mr Dhasmana's rounds were different, more
21 relaxed. He encouraged all members of the team to
22 provide input into the management of all the patients."
23 You then go on to say he had poor communication
24 skills with some nurses. Is there not a bit of
25 a tension between paragraphs 37 and 38 of your
0067
1 statement?
2 A. No, it is two different issues, really. The rounds,
3 I was comparing the other two surgeons to Mr Dhasmana's
4 rounds, the Thursday and Friday morning rounds. He did
5 have a different approach; he had a little bit more of
6 a relaxed approach to actually going around looking at
7 his patients. It was slightly different. Simple
8 things; he would pick up the x-ray himself, he did not
9 expect the Sister to pick it up. Which meant it was
10 a bit more of a relaxed way.
11 When I go on to 38, that is a different issue.
12 These issues I am talking about are really sort of 1994
13 onwards, probably, I would have said. I know I wrote
14 a letter to him at one stage, which I am sure you will
15 show.
16 Q. Yes. Let us not get ahead. The Panel are bemused
17 because they have not seen the letter.
18 A. With that -- this was really after 1994. He did have
19 a bit of a conflict with one nurse, senior, on other
20 wards and she did question him with patient care and he
21 did find sometimes conflict like that, questioning his
22 management with one patient, quite difficult at times.
23 So this was a nurse who was -- this was later on, this
24 is in 1994/95, and she was actually questioning him
25 about the care of a patient.
0068
1 Q. And that was not questioning that was welcomed?
2 A. It was not welcomed.
3 Q. So to that extent, when we were discussing a moment
4 ago with the other two consultants that you mentioned
5 that if the Sister spoke up, the fear was that what was
6 said would not be listened to, there was actually not
7 very much difference between them on the one hand and
8 Mr Dhasmana on the other?
9 A. The trouble is, because this is quite a long timespan,
10 Mr Keen had left -- I do not know when he retired. You
11 are asking me in this statement for information from
12 1988 right through to 1994, so 38 relating to the later
13 stages, 1994/95; I think the early bits I am talking
14 about with the rounds probably are earlier.
15 Q. You refer to a particular incident in paragraph 38.
16 There is only one incident there.
17 A. Yes, I did refer to a specific incident.
18 Q. You have dated it. Was that an isolated incident with
19 Mr Dhasmana, or was it repeated on other occasions?
20 A. It was repeated on other occasions, I think, not
21 necessarily probably to this degree, but he did have
22 conflict with myself if I was working clinically, or
23 with the Sisters about bed management and care in
24 intensive care, but I do not think he was necessarily
25 different from any of the other surgeons.
0069
1 Q. No, so it actually was not --
2 A. I do not think he was different. I do not think there
3 was anything different from the other surgeons.
4 Q. So apart from the more relaxed atmosphere in terms of
5 who would hold up the x-ray, on matters of substance
6 there was not much difference? Is that a fair way of
7 putting it?
8 A. Yes, probably.
9 Q. Can we go to UBHT 228/1, please? Is this the letter?
10 A. Yes.
11 Q. 26th October 1995, so this is before the incident that
12 you referred to at paragraph 38, because you date that
13 specifically to 2nd November.
14 A. What do I ...
15 Q. At paragraph 38, can we see that again, 114/9, the
16 particular incident you refer to you date very
17 specifically to 2nd November 1995.
18 A. I do, yes. I think I was referring to the letter that
19 you have just shown. I am not quite sure why I put
20 2nd November.
21 Q. Shall we see the letter again, please, then,
22 UBHT 228/1: 20th October 1995:
23 "Dear Janardan, I am very concerned that you were
24 verbally aggressive on the telephone to a health care
25 assistant ... on Ward 5A this afternoon. She came to me
0070
1 to complain of your attitude towards her".
2 I will not read it all out. We see what is said
3 in the following sentences.
4 "I have discussed this issue with the senior staff
5 nurse on Ward 5A."
6 Who would that have been?
7 A. The senior staff nurse on Ward 5A would have been
8 Rebecca Lanyon, I think, at that stage. She may have
9 been a Sister.
10 Q. "Who informed me that 9 out of 10 nurses will not do
11 a ward round with you as they are frightened at what you
12 will say to them. The theatre staff are also standing
13 up for themselves and some are refusing to scrub for you
14 in theatre.
15 "I am sure this may be a shock to you to hear that
16 the nurses have a negative attitude towards you. Your
17 attitudes towards the staff must improve to produce
18 a happy, good working atmosphere amongst the cardiac
19 team."
20 The author of that letter, which was you, would
21 seem to be reporting a different view from the one set
22 out at paragraph 37 of your statement about his rounds
23 being different, more relaxed and encouraging all the
24 members of the team to provide input?
25 A. I think it is to do with the time-scale. You have to
0071
1 look at the date here. This is October 1995. So we
2 would have had a year of paediatric media attention,
3 which I think had changed Mr Dhasmana's -- I think it
4 had changed him, drastically. I think that is the main
5 thing you have to look at. I think what I was talking
6 about was previous to this. I think in this latter
7 year, that last year, I would say like mid-1994 to here,
8 when there was all the media attention, I think things
9 changed -- seriously changed.
10 Q. So it would not be fair to take from this letter the
11 impression that 9 out of 10 nurses had always had this
12 view of Mr Dhasmana?
13 A. No, not all the time. I think during this later -- in
14 the period of time, I think life was very, very
15 difficult. Very difficult. I think that is really what
16 I want to get over to you was very different then than
17 probably the year before or two years before then, and
18 I think he was under immense stress and his stress was
19 coming out towards the nurses. He would not take it out
20 on anybody else, but he probably took it out on the
21 nurses at that time.
22 Q. I understand that. I am sure the Panel have the point
23 about reading that letter in its proper context.
24 A. I do not think I had ever written to a consultant before
25 then. It was a very difficult time.
0072
1 Q. I was going to ask you how common an occurrence this
2 was, for a Nurse Manager to write to a consultant?
3 A. That was the first time I had ever done it. The first
4 time I had ever done it. I mean now I do not worry
5 about it, I write to them all the time. But that is on
6 lots of other bits and pieces. But then, I think that
7 was probably the very first time I did it.
8 Q. You mentioned the media attention, I think you said from
9 mid-1994 onwards.
10 A. I think that was round about right at the time.
11 Q. Is that when you would date the change in Mr Dhasmana's
12 attitude, from mid-1994? I do not want to trap you into
13 naming specific dates. I know it is a long time ago.
14 A. I would have definitely said 1995. Whether I am being
15 too wide in going back to 1994, but I would have said
16 definitely 1995 when there was lots of stress going on.
17 I would probably try and say 1995, maybe. It may have
18 been the early part of the -- the later part of 1994 as
19 well.
20 Q. Might it be that media attention perhaps was more 1995,
21 but the storm was brewing in late 1994? Is that perhaps
22 how it was?
23 A. I think, yes, November -- I would have to think of the
24 people that -- I think, probably, yes, that is right.
25 I think at the end of 1994 when the storm was brewing,
0073
1 yes, I think there was lots of things going on at the
2 end of 1994.
3 Q. I should take you to Mr Dhasmana's comments on your
4 paragraph 38. It is WIT 114/43. I mentioned this
5 document earlier. I do not think we actually saw it.
6 Perhaps we could just have a look at it. He says some
7 nice things about you in paragraph 1. If we go down to
8 paragraph 2, that is a passage I have mentioned earlier
9 about "elder statesman", do you see at the end of that
10 paragraph?
11 A. Yes.
12 Q. The passage we are dealing with now is paragraph 3. He
13 makes a point I made to you, that there is an apparent
14 conflict between paragraphs 38 and 37, and then he says,
15 if we go over the page, that he used to encourage all
16 members of the team for their input into the patients'
17 management. The ward rounds became rather disjointed in
18 the early 1990s because of the junior doctors' working
19 pattern and the partial shift system and that led to
20 a lack of continuity of junior staff.
21 Do you remember that as causing a problem, ward
22 rounds?
23 A. The junior doctors' hours? I do remember, we were doing
24 them and then suddenly we were not. We were doing them
25 for quite a long time and then suddenly we seemed to
0074
1 stop doing them.
2 Q. He says at the end:
3 "I do not recall exactly but I was unhappy on
4 a few occasions when messages were not conveyed and
5 I started on double-checking on my messages. This is
6 what I might have complained about to Mrs Thomas."
7 But that is not what you are referring to in
8 paragraph 38; you are referring to the specific incident
9 of being questioned regarding patient management?
10 A. Yes.
11 Q. You clearly remember that incident of --
12 A. I clearly remember the nurse on the ward telling me
13 the whole situation.
14 Q. Which nurse was that?
15 A. That was the one I was referring to --
16 Q. Which nurse was that?
17 A. It was an E grade nurse.
18 Q. An E grade nurse? Do you remember the name?
19 A. Yes, Heather Kaphuch.
20 Q. If we go in your statement to WIT 114/11, please,
21 paragraph 48:
22 "Nurses who cared for children had to be senior,
23 at least an E grade, with one year's experience in
24 cardiac nursing, preferably in cardiac intensive care.
25 The programme involved the new staff working full-time
0075
1 with another senior nurse such as an F grade or a G
2 grade ..."
3 If we just bear that paragraph in mind, if we go
4 over the page, page 12, paragraph 52, you say there was
5 another paediatric nurse whose name you cannot recall
6 who was a D grade and a registered sick children's
7 nurse?
8 A. Yes.
9 Q. She was employed to work in the nursery?
10 A. Yes.
11 Q. The nursery had two RSCNs caring for the children.
12 Again D and E nurses worked in the nursery, with
13 support?
14 A. Yes.
15 Q. So on the one hand --
16 A. No, I can explain that. In intensive care the aim was
17 that the E grade nurses or above who looked after the
18 children following surgery, and then there was this
19 F grade RSCN, and the F grade RSCN would work always in
20 the intensive care unit on a Tuesday, late shift and
21 a Thursday late shift, which was the days that the
22 majority of children's big cases were done in those
23 days, so she was there. She may not necessarily have
24 looked after those children, but she was actually in the
25 unit for support for the nurses caring for the children
0076
1 coming out of theatre.
2 In the nursery, which was the pre- or the
3 post-operative area, she would be working there and she
4 was also based there for the other 3 days of the week
5 that she worked. She worked with a D grade RSCN who was
6 a newly qualified paediatric trained nurse. She had
7 done no adult training so all her training was in
8 paediatrics. She was employed to work in the nursery
9 because she did not have the experience of any intensive
10 care to work in ITU.
11 Otherwise, we would have had D and E grade nurses
12 working in the nursery for support as well, so she would
13 not have been in there by herself, she would have had an
14 E grade on the other shifts or the F grade, Kathy
15 Warren, on the other shifts as well.
16 Q. You see why I --
17 A. I do see, but it was different depending on which area
18 of the ward one was at, and also, the constraints we had
19 with the staff that were able to care for the children.
20 Q. Now I just want to tidy up a few final loose ends. Can
21 we go back first of all in your statement to
22 paragraph 14? That is WIT 114/3, we touched on this
23 earlier, about equipment and cardiac surgery effectively
24 cross-subsidising other areas and Mr Wisheart's comment
25 that it went from subsidising other bits of surgery to
0077
1 subsidising cardiology.
2 At the bottom of the page you referred to
3 Professor Angelini getting angry about the equipment
4 being old and needing replacing. You mentioned earlier
5 that there is now a system that you employ of making
6 sure that there is no old equipment lying around or
7 still being used. Would that comment there, the
8 evidence you gave earlier, apply to the syringe pumps
9 that we dealt with earlier?
10 A. Yes. I remember specifically more so when Rachel began,
11 but it may have just been with the Trust, I do not know,
12 it is just that we had to put in -- it might have been
13 with Lesley as well, but I cannot remember that far
14 back -- we had to put in bids for capital equipment and
15 we had to -- I am sure we have had to do that for quite
16 a while, actually, I think. We had to put bids in for
17 capital equipment. Major equipment is usually over
18 œ25,000. Anything over that value, we have to, as
19 a directorate, make a list of requirements. That goes
20 off to Trust, to HQ, and they decide where the money
21 goes. That was the process and still is the process
22 now.
23 If we were not successful at getting those bits of
24 equipment, then we would have to wait for the following
25 year before we could put the bids in again and get the
0078
1 equipment, so that could mean that the unit may have
2 been working with equipment that we did not consider was
3 adequate, or we wanted new equipment -- if a new
4 techniques was coming on, you wanted new equipment,
5 dialysis machines and things like that. It was at that
6 stage that we thought, "Well, cardiac surgery has made
7 money this year, why can we not buy another ventilator
8 or buy a dialysis machine with the money we have just
9 made, because we did X amounts of contracts?" That is
10 really what I was getting at with this bit.
11 Q. Was it your impression that, of course, units would
12 always be looking for the latest equipment and no doubt
13 there is always new equipment that could be used?
14 A. Always, absolutely.
15 Q. Relatively speaking was it your impression that cardiac
16 surgery was well-resourced compared to other areas of
17 the UBHT?
18 A. I think the thing with cardiac surgery is, it has to
19 be well-resourced. If you do not have the equipment,
20 you cannot do the work. If you do not have a good
21 ventilator or heart lung machine, there is no point in
22 doing the work, if you have no nurse to look after the
23 patient afterwards. It is more expensive work than if
24 you do general surgery, for instance, and you do not
25 need any equipment to look after a patient
0079
1 post-operatively, whereas with cardiac surgery you need
2 to have the equipment. I think a lot of the equipment
3 was getting old and there was no maintenance or renewal
4 programme. We have set up a renewal programme of when
5 equipment definitely needs to be changed.
6 I suppose I inherited it as it was. It was not
7 that there were syringe pumps and equipment there and it
8 was a matter of just trying to maintain that and upgrade
9 them as equipment failed.
10 Q. Relatively speaking, did cardiac surgery have a longer
11 or shorter shopping list than other departments in the
12 Trust? What was your impression?
13 A. It would have had a longer list, but that is because you
14 needed to have the equipment to look after the
15 patients.
16 Q. 114/31, please. Paragraph 127. You never worked at the
17 Children's Hospital, so you never had any experience of
18 open heart operations that were carried out there after
19 October 1995?
20 A. No.
21 Q. But you did work for a few months at the BRI while
22 Mr Pawade operated on children?
23 A. Yes.
24 Q. That is what you are referring to here?
25 A. Yes.
0080
1 Q. Mr Pawade joined the paediatric team in May 1995. The
2 children started returning from theatre very quickly.
3 They spent very little time being ventilated in the
4 intensive care unit and they returned to the nursery
5 very quickly.
6 Those operations were carried out in the same
7 operating theatre as had been used previously for
8 children.
9 A. Yes.
10 Q. And using the same equipment.
11 A. Yes. I expect he had a bit of equipment of his own
12 that he brought. Most surgeons usually have their own
13 instruments; nothing major, no.
14 Q. And the same nursing quotas?
15 A. Yes.
16 Q. And same perfusionist team?
17 A. Yes.
18 Q. And carrying out the same type of procedure?
19 A. Yes. There was a lot of work done prior to him coming.
20 The anaesthetist and perfusionist did go and visit
21 Australia and visit his centre in Australia, so they
22 were prepared. They spent several weeks over there with
23 Mr Pawade, so when he started at the BRI, everybody was
24 aware of his techniques.
25 Q. Are you able to comment on the relative case mix before
0081
1 or after May 1995?
2 A. No.
3 Q. It was obvious, I assume, as you say here, to the
4 nursing staff that the operations were shorter and the
5 children were spending less time being ventilated and
6 got to the nursery faster. What conclusions did you
7 draw about the condition of the children, relatively
8 speaking?
9 A. If a child spends less time in intensive care, they go
10 through the system quicker and they go home quicker,
11 basically, they just go through the system quicker
12 because they have had a shorter operating time. Some
13 children could go home after two or three days less than
14 beforehand.
15 Q. So they were more well when they came out of the theatre
16 than if they had had a longer operation?
17 A. Yes, I think so.
18 Q. Mrs Ferris referred to there being, in the hospital,
19 a "culture of fear and blame", and the culture being --
20 it was important to be "in favour", I am not sure those
21 are her exact words, with the powers that be, in order
22 to have one's concerns listened to.
23 What would your comment on that observation of
24 Mrs Ferris be?
25 A. What was the beginning of your question?
0082
1 Q. Mrs Ferris said that there was a "culture of fear and
2 blame" at the Trust in the period up to 1995, and that
3 it was important to be "in with the right crowd", to be
4 in favour with the powers that be if one's concerns were
5 to be listened to. That is my paraphrase, but
6 Mrs Ferris is nodding.
7 A. I think it was that you had to know who to go and speak
8 to, to have your views heard.
9 Q. You say at page 24, paragraph 99, the last two
10 sentences:
11 "Through now more of a team approach to clinical
12 work" and generally you feel there is now more control
13 and direction from the Chief Executive's office and the
14 Trust Board.
15 "The last 4 to 5 years", that would be the period
16 since Mr Ross became Chief Executive, is that who you
17 are referring to? It may or may not be a causal link
18 between Mr Ross becoming Chief Executive, but as
19 a matter of fact, he has been Chief Executive for coming
20 on for 4 years.
21 A. I think there has just been a general -- I suppose
22 because of everything that has gone on, I suppose we are
23 much more aware of being a team and being open and
24 trying to be open about things.
25 I also feel that probably -- I know the Chief
0083
1 Executive; he knows me quite well. I know most of the
2 executives quite well, compared to several years ago
3 when I did not, but that might have been because of the
4 problems we have been through and that is why we are
5 here today. That might be my development and how I have
6 grown and I have learned to liaise with them, I do not
7 know.
8 Q. You have been a Clinical Nurse Manager in an acting
9 capacity since November 1992?
10 A. Yes, quite a long time.
11 Q. So you had plenty of time to get to know the previous
12 Chief Executive?
13 A. Absolutely -- well, yes, but I think I probably only met
14 him once or twice. There was not necessarily any need
15 to. It was not a fact of not wanting to. There was not
16 necessarily any need to, whereas I am much more involved
17 with the directorate as a whole now, so the approach is
18 very much different. It is much more of a team
19 approach. I will attend the directorate's review
20 meetings twice a year with the General Manager and
21 Clinical Director to give the nursing perspective, so it
22 is a different approach, clearly.
23 Q. You say there is more control and direction. What type
24 of control and direction of what?
25 A. I think that Hugh Ross seems to know what is going on,
0084
1 and I think he seems to direct his sort of philosophy
2 throughout the Trust. I also think that the working
3 executives try to be part of it, and I mean, they are
4 around if required. And also, the Director of Nursing
5 has made quite a big difference with nursing. She has
6 only been there a year and a half now, but she has made
7 quite a big impact into nursing, and hence by developing
8 nursing strategy, so we have a strategy for nursing now.
9 Q. That is Lindsay Scott?
10 A. That is Lindsay Scott, yes, which I think has changed
11 how nurses look at things, really.
12 And there is also clinical governance and a lot of
13 all these other issues that are coming on board or have
14 been around -- clinical governance has been around for
15 a little while, but it is all coming to fruition,
16 really, now.
17 Q. We have touched briefly on the position in 1995,
18 Mr Pawade coming to the BRI initially. I think this
19 comes across from Sheena Disley's statement. There was
20 obviously concern among the nursing staff at the BRI in
21 1995 that they were being criticised for the standard of
22 care they were giving.
23 I just want to take you to one letter about this.
24 It is a letter at UBHT 129/5, to you from Mr Pawade. Do
25 you remember receiving this letter?
0085
1 A. Yes.
2 Q. "Dear Fiona, As you know, today was the day when
3 I operated on the last child at the BRI. Personally,
4 I have found my last five months with you most
5 enjoyable. I have no complaints whatsoever regarding
6 the promptness, expertise and level of the care that the
7 children received, both in and outside theatre. I am
8 sure that the parents will echo my feelings.
9 "Please convey my gratitude to all those people
10 involved, including those in the operating theatre,
11 Wards 5A and 5B, and ancillary staff ..."
12 That was, I assume, a welcome reassuring
13 communication?
14 A. Yes, very.
15 Q. Unless those behind me have other things they want me
16 to ask, let me turn to one more topic. Can I take you
17 to WIT 25, please, at page 1?
18 This is a statement to the Inquiry from
19 Mrs House. You will see that she has set out that she
20 was the mother of Ryan Batt born on 6th April 1989.
21 Can we go into this statement, to page 6? Just go
22 back a little, please, to page 5, to pick up
23 paragraph 12. Perhaps we need to read paragraph 11 to
24 get it in context.
25 Ryan was to have his surgery on 12th February
0086
1 1990. She goes on to say:
2 "Before surgery, we looked after Ryan in the
3 nursery on Ward 5."
4 That would be normal, would it not?
5 A. Yes.
6 Q. "While the nurses there were helpful and appeared to do
7 their job very well, we were surprised how few of them
8 there were, particularly considering that there were
9 several children on the ward who had recently come back
10 from the intensive care unit and at times there were no
11 nurses in the room at all."
12 Would it be normal for there to be some nursing
13 staff actually in the nursery at all times?
14 A. This is 1990 we are in now, is it not?
15 Q. Yes.
16 A. Yes, it would have been.
17 Q. If we read on --
18 A. But the children only went back into the nursery from
19 the intensive care when they were well. I mean, the
20 children, in 1990, used to stay in intensive care for
21 quite a while, even once they were extubated and
22 breathing by themselves, they did not go back to the
23 nursery until they were fairly well, because there was
24 nothing in-between. We had intensive care and we had
25 the nursery, there was nothing in-between. To
0087
1 a parent's perception of somebody coming back from
2 intensive care, it may have just looked fairly dramatic,
3 I suppose, they might have come back with a drip or two,
4 but they would not have actually gone into the nursery
5 very much at that stage.
6 Q. Would there be any significant difference between the
7 situation in 1990 and the situation that you described
8 in your statement between paragraphs -- it is really 47
9 and following. Perhaps we could just go to that:
10 WIT 114/11.
11 Do you remember this passage of your statement
12 from paragraph 47? This is where you explain the
13 different mix of nurses.
14 A. Yes.
15 Q. You remember, we looked at the first sentence of 48 in
16 a little detail, and then we went over the page to 52.
17 A. Yes. It would have been all about the same.
18 Q. It is much the same, is it?
19 A. 1990 was slightly early. This was more when I was Nurse
20 Manager in 1992, so 1990 was earlier.
21 Q. Let us just go back to the statement of Mrs House, if we
22 can, WIT 25/6. I do not think we need to focus on
23 paragraph 13 particularly. If we go to paragraph 14:
24 "Post-operative care", so we have moved now to
25 after the operation, the ventilator was allowed at one
0088
1 time to run out of water and the nurse, the trainee in
2 intensive care had failed to check and notice this.
3 The tube became blocked and he had to be rushed down to
4 theatre.
5 If we just go over the page, I appreciate this is
6 1990; I appreciate you were not the cardiac Nurse
7 Manager, but I assume that tubes ought not to become
8 blocked?
9 A. No.
10 Q. What about the position of the trainee in intensive
11 care?
12 A. The trainee nurses never looked after the children
13 unless they were -- they would have to be with a trained
14 nurse, so there were many times when the trained nurses
15 had a trainee with them. Maybe that was what the
16 parents were referring to; that trainee was the one who
17 was with the trained nurse. But I agree, the water
18 should not have run out in the ventilator. There was
19 a pot we used to have to top up continuously; as time
20 went on it and advances were made it used to top itself
21 up, but it had to be filled with water which made sure
22 the ventilator was humidified with oxygen and that went
23 to the child's lungs.
24 Q. So that happened from time to time, but it was not
25 difficult to spot when the water was needed?
0089
1 A. No, but it would not have been the trainee's
2 responsibility to do that. She would have been there
3 with one of the trained nurses as well.
4 Q. Can we go down to 15, then, and 16? Perhaps I could
5 just ask you to read those paragraphs to yourself,
6 please, and then I want to ask you, really, about 16,
7 about the perception of equipment, beds and staff at
8 that time. (Pause).
9 Can we just go over the page to see if there is
10 anything on page 8? No.
11 Do you remember any particular difficulties with
12 equipment or staffing of beds at that time compared to
13 any other time? I know it is a long time ago.
14 A. No. It is quite difficult to remember. I was a Sister
15 at that time and it was my job at that time to make sure
16 that patients were cared for by a nurse who was
17 experienced enough to care for them, if I did not care
18 for them myself. As a Sister, we did look after
19 patients as well, and it was my job to make sure there
20 was enough equipment. I mean, I cannot really remember
21 otherwise. If we needed extra staff we would ask the
22 Nurse Manager who would see if they could get extra
23 staff, but I cannot remember, to be honest.
24 Q. Was it easier or difficult to get staff in those days,
25 before the purchaser/provider split, than it was
0090
1 afterwards?
2 A. I think it was easier to get staff because of agencies
3 now.
4 Q. Now?
5 A. I think there were agencies then, but I cannot recall
6 getting much agency staff. We do use agency staff now,
7 but the majority of the agency staff are actually our
8 own staff.
9 MR MACLEAN: Sir, I am conscious of the time but those are
10 all the questions I want to ask this witness. I am in
11 your hands. We can either take questions from the Panel
12 now or have a short break.
13 THE CHAIRMAN: I think we should carry on and finish with
14 this witness.
15 MR MACLEAN: Perhaps I could just ask the witness whether
16 there is anything else at this stage that you want to
17 tell us, anything that you want to expand upon, or any
18 area that you would like me to cover that I have not
19 covered properly, or at all?
20 A. No, not at all.
21 MR MACLEAN: Thank you very much for your evidence. The
22 Panel may have some questions for you. The Chairman
23 will, I am sure, remind you of the usual rules about
24 submitting further to evidence us if necessary.
25 THE CHAIRMAN: Yes, Mrs Thomas. Mrs Howard?
0091
1 Examined by THE PANEL:
2 MRS HOWARD: Just one question. Very early on we
3 talked about the staffing for intensive care and the
4 whole-time equivalents that you worked and you suggested
5 you balanced that out dependent upon the patient
6 dependency in the unit.
7 Can you recall how often you had to curtail
8 surgical activity in order to maintain your minimum
9 1 to 1 standard?
10 A. I cannot remember how often, but it was very difficult
11 to do that. I mean, now we do that and it is not
12 a problem. If we do not have enough staff, we do not do
13 the operations.
14 Then it was much more difficult to say to the
15 surgeons, you know, "We do not have enough staff this
16 afternoon" to do whatever operation, and it was
17 difficult. I actually cannot recall actually doing
18 that. What I do recall doing, I think I put it in my
19 statement, was rallying round, calling extra staff, but
20 I do not remember being able to get agency staff,
21 because agency staff were not clinically able to care
22 for the children, so if we did have agency staff, they
23 would look after the adults and our own nurses would
24 look after the children, or we called in -- that is how
25 we would manage it. I do not recall cancelling
0092
1 operations; I remember just trying desperately to sort
2 the staffing matters out by phoning around.
3 Q. When you say "cancelling operations", are you talking
4 specifically about children, or would you have been able
5 to curtail adult operations in order to provide the care
6 for the children?
7 A. No, I do not think it matters; it would have been
8 whatever patient was going to surgery on that day or at
9 that time of the day.
10 MRS HOWARD: Thank you very much.
11 THE CHAIRMAN: Professor Jarman has no questions and I have
12 no questions either. Mr Miller?
13 MR MILLER: No. I do not think Mrs Thomas requires my
14 assistance.
15 THE CHAIRMAN: I am very grateful. Mrs Thomas, thank you
16 very much indeed for coming. We have benefited greatly
17 from what you have been able to tell us. As Mr Maclean
18 will have hinted, if there are other things that you
19 remember or come across or think would help us, we will
20 be very grateful to hear from you or through those who
21 represent you at any time. We will be here for a while
22 and we will benefit from hearing from all members of the
23 nursing staff as we will from all other groups. So
24 again, thank you very much.
25 Mr Maclean, thank you for reminding us of the
0093
1 time. I think it would be appropriate now to take
2 a break. Shall we say we will reconvene at 1 o'clock?
3 (12.25 pm)
4 (Adjourned until 1.00 pm)
5 (1.00 pm)
6 MR MACLEAN: Sir, I apologise for the slight delay. I think
7 Mr Langstaff may have something to say which it may be
8 sensible to deal with just before we hear from the
9 witness.
10 THE CHAIRMAN: Yes, of course. Please do not apologise.
11 I know you have occasionally to have conversations
12 before we start. Is Mr Langstaff going to come in?
13 MR MACLEAN: May I just check? (Pause).
14 Sir, Mr Langstaff will deal with the point perhaps
15 after the witness.
16 Can we press on, with apologies to her, and call
17 Sheena Disley, please?
18 Sister Disley, the first thing we ask you to do is
19 to stand to take the oath, please.
20 SISTER SHEENA DISLEY (SWORN):
21 Examined by MR MACLEAN:
22 Q. Do have a seat, please. Your full name is Sheena
23 Elizabeth Disley?
24 A. Yes.
25 Q. And you are one of the ward sisters at the Bristol Royal
0094
1 Infirmary, working in the Directorate of Cardiac
2 Services?
3 A. Yes.
4 Q. Can I ask you to have a look, please, at the screen in
5 front of you, at WIT 85/1?
6 That is the first page of your formal written
7 statement to the Inquiry.
8 A. Yes.
9 Q. If we go to, I think it is page 16, that is the last
10 page of that witness statement and that is your
11 signature?
12 A. Yes.
13 Q. And there are one or two additional documents that you
14 have submitted to us. We can have a brief look at
15 those. At page 17 there is a job description for a ward
16 manager or sister, G grade, on Ward 5B and the date of
17 this we see at the very foot of the page is December
18 1998, so this is a recent job description for that
19 post.
20 A. Yes.
21 Q. At page 21, that is what is known as the "person
22 specification" for that same post of G grade ward
23 manager or ward sister?
24 A. Yes.
25 Q. Then you have also submitted to the Inquiry pages 23
0095
1 and 24, a more elderly job description, this one going
2 back to 1980. We get that from the foot of page 24.
3 This is for a charge nurse. Finally, you have submitted
4 a diagram of the unit, that is page 25. Have you had
5 a chance to see the diagrams attached to Fiona Thomas's
6 witness statement?
7 A. Yes.
8 Q. Is there any material difference between you and she
9 as to the layout of the place?
10 A. This particular diagram was earlier than the one Fiona
11 has -- slightly.
12 Q. I think her one was 1988 to 1992, and then 1992 to 1995?
13 A. Yes.
14 Q. This one deals with the position in 1984?
15 A. Yes.
16 Q. So if the Panel were to put all three together, they
17 would have a chart of the layout throughout the period
18 the Inquiry is concerned with, which is 1984 to 1995?
19 A. Yes.
20 Q. If we go back to the beginning of your statement,
21 WIT 85/1, you have been a ward sister in cardiac
22 intensive care since 1984?
23 A. Yes.
24 Q. You are still a ward sister in cardiac intensive care?
25 A. Yes.
0096
1 Q. So you are one of the people who has been on the scene,
2 as it were, throughout the period that the Inquiry is
3 concerned with?
4 A. Yes. Since 1990 I have not been there in a full-time
5 capacity, working half time.
6 Q. I think you work, is it two days a week plus a weekend
7 a month?
8 A. Yes, that is right.
9 Q. Like Fiona Thomas, you hold the Diploma in Nursing which
10 you obtained in 1989?
11 A. Yes.
12 Q. And presently the intensive care unit consists of how
13 many beds?
14 A. Eight.
15 Q. If we go to page 17, I flashed this past your eyes
16 a moment or two ago. Is this the job description for
17 the job that you presently have?
18 A. The profile, the figures are slightly larger now. Yes,
19 it is, I am sorry, yes.
20 Q. I was not particularly focusing on the profile
21 paragraph. If we see the page as a whole, please, that
22 page and the succeeding page is setting out the
23 professional, clinical equipment, motivation,
24 managerial, health and safety roles?
25 A. Yes.
0097
1 Q. It comprises the job that you presently hold?
2 A. Yes, that is right.
3 Q. If we go to WIT 85/4, please, at paragraph 13, you
4 presently report to Fiona Thomas, whom we heard from
5 this morning?
6 A. Yes.
7 Q. She is now the Clinical Nurse Manager for the whole of
8 the cardiac services directorate?
9 A. Yes.
10 Q. Before that, it was Julia Thomas, and she was only
11 concerned with the cardiac surgery side of things?
12 A. Yes.
13 Q. Under the heading of "Lines of authority", chains of
14 command, communication, accountability and so on, you
15 say:
16 "Alternatively, I could raise nursing matters with
17 the hospital manager or Margaret Maisey as Director of
18 Nursing services."
19 Who would the hospital manager be that you are
20 referring to?
21 A. I do not think I wrote that well. I think I was
22 referring to the unit manager, Lesley Salmon, or Rachel
23 Ferris. I do not think I would have thought that
24 I would have gone to the hospital manager on a nursing
25 issue.
0098
1 Q. Previously, before the purchaser/provider split and
2 before the institution of the UBHT, there would have
3 been somebody known as a "sub-unit manager", who would
4 have been essentially the Manager of the whole BRI;
5 is that right?
6 A. Yes.
7 Q. The BRI was in the central unit and the Health Authority
8 was split into south and central units?
9 A. Yes.
10 Q. In the days before Trusts were established, when you
11 were the ward sister, as you are now, what was the line
12 of authority, the chain of command, however one likes to
13 put it, as you saw it?
14 A. I think it would have been through Julia Thomas; it
15 would have gone on to her senior, who more latterly --
16 Q. Who was the ward sister's immediate line manager in the
17 late 1980s?
18 A. They were the nursing officers covering each unit
19 within the hospital, if I recall.
20 Q. So when you say "each unit within the hospital", would
21 there be one for surgery?
22 A. One for medicine, one for surgery.
23 Q. Was that Janet Gerrish, who held that post?
24 A. I think she was at a more senior level than that. There
25 are other names that spring to mind. She was higher up
0099
1 the level than that.
2 Q. Shall we move ahead then to the Trust situation? You
3 say in paragraph 14, that you could raise, you say,
4 nursing matters with the Hospital Manager or Margaret
5 Maisey as Director of Nursing Services. From 1991 the
6 Hospital Manager was replaced by the directorate General
7 Manager.
8 We have heard this evidence already, that there
9 was a Directorate of Surgery and cardiac surgery was an
10 associate directorate within that; is that right?
11 A. Yes.
12 Q. So your immediate General Manager would have been the
13 Associate General Manager of the Associate Directorate
14 of Cardiac Surgery?
15 A. Yes.
16 Q. And that is a post that Lesley Salmon had and Rachel
17 Ferris now has?
18 A. Yes.
19 Q. Within the newly named Cardiac Services Directorate.
20 What was your perception of the role of the
21 Director of Operations or the Nurse Adviser to the Trust
22 after 1991 when the Trust was established? How did
23 Mrs Maisey impact upon your work as a ward sister?
24 A. I think we were a fairly self-contained unit. Clearly
25 we knew who she was, clearly I think she was not
0100
1 a significant presence on the unit at that time.
2 Q. She was not your manager?
3 A. No.
4 Q. But she was the Nurse Adviser to the Trust?
5 A. Yes.
6 Q. What did you understand that role of Nurse Adviser
7 actually to mean?
8 A. I would consider it a two-way post: a post that would
9 involve nurses being able to go and address problems to
10 her, and also, feedback from broader changes within the
11 nursing profession being filtered back down to the
12 unit.
13 Q. You have helpfully broken that down into those two
14 channels of communication, going in opposite
15 directions. Let us take them one at a time.
16 What type of concerns or matters might a nurse
17 raise with a Nurse Adviser to the Trust?
18 A. As far as the cardiac surgery unit was concerned,
19 I think we managed to resolve our issues at that level
20 with Julia Thomas. I have no recollection of anybody
21 going to see her in terms of an advisory capacity,
22 asking for her advice.
23 Q. On matters of professional etiquette or professional
24 ethics, if a nurse was being asked or told to do
25 something which that nurse may have felt was not
0101
1 professionally appropriate, would that be the type of
2 matter that one would take to the Nurse Adviser rather
3 than to the General Manager?
4 A. I think people would probably have tended to approach
5 the people who were most approachable for advice.
6 I think the nurse would have found herself at the Nurse
7 Adviser's eventually, but it is hard to say that it was
8 a very direct, clear and easy route.
9 Q. So that would not have been the first port of call. Is
10 that a fair way of putting it?
11 A. I think so, yes.
12 Q. The individual nurse below the Sister level would take
13 problems in the first instance to the ward sister, would
14 they?
15 A. Yes.
16 Q. That would be to you, or one of your colleagues?
17 A. Yes.
18 Q. And if a nurse brought a concern about something that
19 was happening in the unit to you as a Sister, where
20 would you typically take it if it required taking on to
21 someone else?
22 A. We are still talking about the late 1980s, or ...
23 Q. You tell me when we are talking about. Let us look at
24 the 1980s and the 1990s. Can you tell me what the
25 differences were?
0102
1 A. I do not suppose they are so very different. In the
2 late 1980s, if a nurse had brought a matter of concern
3 to me I would have tried to address it myself; I would
4 have discussed it with colleagues at a Sisters' meeting
5 and the senior nurse on the unit, and hopefully it would
6 have been channelled along the route that the nurse felt
7 it should go.
8 Today, again, the nurse will talk to me. I will
9 present that at a Sisters' meeting if I felt it was
10 relevant for everybody's attention or changing practice,
11 and Fiona then would address the problem, whether it was
12 a management issue or a nurse education issue or
13 a professional practice issue, it would move on, and
14 I suppose now it would reach Lindsay Scott.
15 Q. If it was appropriate to get to that level?
16 A. Yes.
17 Q. So it is now very clear, is it, that you would take
18 your problems to Fiona Thomas?
19 A. Yes.
20 Q. Or problems that were reported to you, I should say?
21 A. Yes.
22 Q. If we look at paragraph 16, if we scan down this
23 page a little, you say:
24 "Previously, managers were physically remote;
25 i.e. they were not in an office that was close to the
0103
1 ward ... they were in another building."
2 What time-scale are we talking about there? When
3 was "previous"?
4 A. To 1995; I would be unable to say -- yes.
5 Q. So do I take it that the situation was now different:
6 that managers are not as physically remote as they were
7 previously?
8 A. I think -- yes. Rachel Ferris's office is on the ward.
9 If there is a problem, the door is open. You could go
10 in and discuss what you wanted to say. I think in the
11 past, and I am afraid I cannot recall at what date that
12 changed, the presence of senior nurses was more on
13 a visiting basis and access to them was not as easy.
14 Q. You make two points in that paragraph, do you not? The
15 first point is about the physical separation of managers
16 being in a different building. That is the first
17 sentence.
18 A. Yes.
19 Q. The second sentence is about you not feeling that
20 Mrs Maisey was someone that you could confide in.
21 Was it the case that you did not feel you could
22 confide in Mrs Maisey because she was in a separate
23 building, or was it that you did not feel you could
24 confide in her because she was not the type of person
25 you could confide in, or both?
0104
1 A. I think because she was obviously very thinly spread
2 about a large area, we saw less of her. I think it is
3 difficult to confide in somebody that you are not
4 familiar with, you do not have a relationship with them.
5 Q. Mrs Maisey was very busy as a Director of Operations of
6 the Trust. Did you, as a ward sister, feel that she
7 was, in terms of Nurse Adviser, "spread more thinly", to
8 use your words, than you would have liked? You would
9 have liked more support from higher up the nursing
10 chain?
11 A. I think as a group of nurses, as a hospital full of
12 nurses, I sometimes felt that we lacked direction, that
13 we lacked a clear leader, and I think, although that was
14 in the back of my mind at the time, I have identified
15 over the last 18 months, since Lindsay Scott has been in
16 post, that there is a much more significant voice for
17 nurses now.
18 Q. You have noticed a difference?
19 A. Yes, dramatically.
20 Q. And in what substantive form was this dramatic
21 difference? What is it that you would notice as being
22 different?
23 A. There have been arenas for nurses to meet Lindsay Scott
24 and for nurses to identify their concerns about where
25 they work, about what is happening in the Trust. She
0105
1 has also been very active in the development of the
2 nursing strategy. She still has not found us any car
3 parking spaces, but she is very involved with
4 implementation of new trends in practice.
5 Q. Let us move on to something else. If we go over the
6 page to page 5 of your witness statement, just have
7 a look at the screen in front of you, please, at
8 paragraph 19 at the top there.
9 You just mentioned paragraph 18 about the
10 intensivists and before the intensivists arrived the
11 surgeons managed the ward rounds.
12 Then you say "Later ward rounds with the surgeons
13 and the intensivists could also be quite difficult.
14 A long-standing staff member might feel she had to
15 remain loyal to the surgeon, but equally recognised that
16 patient treatments needed to progress."
17 Was it seen as disloyal not to fall in line with
18 the surgeon on a ward round?
19 A. No, I do not think so.
20 Q. You use the words "remain loyal to the surgeon". Why
21 should the nurse be loyal to the surgeon rather than the
22 intensivist?
23 A. I think in the intensivist's early days it was rather an
24 uncomfortable time. I think the surgeons were having
25 a bit of a change in role during some of the ward rounds
0106
1 and I think what I meant was, the nurse was aware of
2 that.
3 Q. You refer to long-standing staff members feeling as if
4 they might have to remain loyal.
5 Is that the reference to nurses, "staff members"?
6 A. Yes. I could not comment on other people.
7 Q. By this time when the intensivists were beginning to be
8 on the scene more than they had been before, would you
9 consider yourself to be a long-standing staff member?
10 A. Yes, on paper, I look like one.
11 Q. Only on paper, I am sure! So would you feel that you
12 had to remain loyal to the surgeon at this time, even
13 when on occasions you recognised that, as you put it,
14 patient treatments needed to progress?
15 A. No, it is put so badly, I think perhaps for those of us
16 who had worked before the intensivists arrived, it was
17 a dilemma for all of us, which route are we addressing
18 here? I think once that role became more established,
19 it was easier to address.
20 Q. So was it just the strangeness of something new, then?
21 A. Yes. I think that is what I was referring to.
22 Q. You talk about newcomers, "input from newcomers might
23 bring to life alternative ideas". Who were the
24 newcomers bringing new ideas?
25 A. I think when medical staff came from other units,
0107
1 I think possibly particular anaesthetists, there would
2 be more information from other centres.
3 Q. Have you had a chance to see Mr Wisheart's comment on
4 this paragraph of your witness statement?
5 A. Yes.
6 Q. If we go to WIT 85/37, he is dealing here with three
7 separate paragraphs, 18, 19 and 58. He is dealing
8 generally with conflict on ward rounds.
9 "In a teaching hospital culture such as exists at
10 the Bristol Royal Infirmary there were always
11 differences of opinion on all sorts of subjects and in
12 addition, thinking changes with the passage of time."
13 Do you agree with that?
14 A. Yes.
15 Q. "These differences exist at all levels within groups and
16 between groups; they exist at policy level and at the
17 level of individual patient care."
18 Do you agree with that sentence as well?
19 A. Yes.
20 Q. "I have always regarded the open discussion of
21 alternative viewpoints to my own and the reasons for
22 them as an important means of education and learning."
23 Was that your perception of Mr Wisheart?
24 A. Yes.
25 Q. He encouraged open discussion of alternative
0108
1 viewpoints to his own?
2 A. He would encourage lengthy discussions, yes.
3 Q. Was his approach different from that of any of the other
4 surgeons?
5 A. He was very methodical in reviewing his patients; he
6 went through them system by system very thoroughly,
7 possibly more conspicuously than other people did.
8 Q. So you used the words "thorough and methodical"?
9 A. Yes.
10 Q. "More conspicuously than others": which others would be
11 less conspicuously methodical and thorough?
12 A. Probably all of them.
13 Q. You heard Fiona Thomas's evidence this morning, I think,
14 about the ward round situation with Mr Dhasmana towards
15 the end of 1995. You remember the letter that I put on
16 the screen.
17 A. Yes.
18 Q. What is your comment about Mr Dhasmana on ward rounds in
19 relation to what Fiona Thomas said this morning?
20 A. In 1995?
21 Q. Fiona Thomas explained the context in which the letter
22 came to be written -- I hope I summarise her evidence
23 fairly -- that that was the position then, but it had
24 not always been the position that 9 out of 10 nurses
25 were refusing to do ward rounds with Mr Dhasmana?
0109
1 A. No.
2 Q. What is your "take" on that?
3 A. I worked with Mr Dhasmana before he got his consultant
4 post, and as a Senior Registrar, and he was very
5 approachable and very easy to do ward rounds with, and
6 I would say that continued to be the case, unless
7 clearly he was under a lot of pressure, coming up to
8 1995.
9 Q. Coming up to 1995, or in 1995?
10 A. Coming up to 1995. I was away in 1993, but I think
11 I perceived it as I came back.
12 Q. When did you come back? Did you come back from
13 maternity leave?
14 A. Yes.
15 Q. When did you come back?
16 A. January 1994, I came back.
17 Q. And you noticed a difference then?
18 A. I think I was aware that he had changed.
19 Q. So, perhaps coming back from maternity leave, you are
20 able to date it more precisely than Fiona Thomas did,
21 but broadly speaking you agree with her explanation of
22 1995 not being typical of the whole period?
23 A. Absolutely, yes.
24 Q. Can we look at page 7, please? This is your own
25 statement, again, paragraph 32. There is a reference to
0110
1 the social work department. If we just look at
2 paragraph 32 through to paragraph 36, perhaps you could
3 just take a moment to have a look. There are three
4 paragraphs on this page. When you have read those, tell
5 me and we will turn the page. (Pause). Let me know
6 when you get to the end of paragraph 36.
7 A. Thank you.
8 Q. The away day, you say in paragraph 35 that Freda Gardner
9 and Rachel Ferris came along to talk to you. I think in
10 fact the away day was organised by Rachel Ferris, was it
11 not?
12 A. Yes, it was.
13 Q. If we go to page 31, this is the first of two pages of
14 Fiona Thomas's comments on your statement. You see she
15 comments in turn on those four or five paragraphs I have
16 asked you to read. Could you just have a look at those
17 and tell me whether you agree with Fiona Thomas there?
18 Again, let me know and we will scan down the page.
19 (Pause)
20 A. Yes.
21 Q. You agree with those, do you?
22 A. Yes.
23 Q. Do you have any qualification on any of that? Or is
24 there nothing you want to add?
25 A. No.
0111
1 Q. If we go to WIT 85/34, if we look at the middle of the
2 page, these are the comments of Dr Bolsin on your
3 statement. Have you had a chance to see those?
4 A. Yes.
5 Q. Dr Bolsin commenting on -- he heads it "32 to 41", but
6 it is the same passage of your statement we have been
7 looking at:
8 "A lot of counselling and support was required by
9 the nursing staff on the cardiac intensive care unit at
10 the Bristol Royal Infirmary. Helen Stratton ...
11 identified this need and attempted to fill the vacuum.
12 Dr Freda Gardner ... also helped to provide support to
13 the nursing staff. One of Freda's common phrases at
14 this time was, 'I don't need the patients; there are
15 enough problems with the staff'. This emotional tension
16 in the nursing staff was a constant feature of the
17 cardiac intensive care unit and I believe that the
18 underlying knowledge that the unit should have had
19 better results contributed to this emotion."
20 If we just stop there, do you agree that there was
21 emotional tension among nursing staff was a constant
22 feature of the cardiac intensive care?
23 A. I do not think it was constant. I think there were
24 times when the workload was very heavy, or there were
25 a significant number of very ill patients that people
0112
1 felt under stress about. I disagree that it was
2 constant.
3 Q. So from time to time, then, it would be your evidence
4 that there was, perhaps not surprisingly, emotional
5 tension in the cardiac intensive care unit? By
6 definition the patients who are there are very sick and
7 I assume that from time to time some of those patients
8 would die, inevitably.
9 Why was it that there would be, from time to time,
10 a heightening of the emotional tension? Was it to do
11 with the workload or the state of some of the patients,
12 or was it, as Dr Bolsin suggests, underlying knowledge
13 that the unit should have had better results? What
14 would you put it down to?
15 A. I think there is a lot of reasons why feelings might
16 have been running high. As I have said, I think the
17 workload, the dependency of the patients, was
18 significant. I think obviously when the children were
19 with us, there were anxieties about the progress that
20 they were or were not making. It is difficult to
21 identify one constant theme that contributed to those
22 tensions that the nurses had.
23 Q. Was one of those themes the theme that Dr Bolsin
24 identifies, which he refers to as "underlying
25 knowledge"; was that part of it?
0113
1 A. I think this view gradually crept in, but I have to
2 say, it is extraordinary how little information we were
3 aware of in the early stages of these anxieties arising.
4 Q. To what extent would you, as a ward sister, be aware of
5 the relative performance of your unit, whether for
6 adults or for children, compared to the performance of
7 other units?
8 A. We certainly did have discussions about our own figures
9 and the outcome of the adult and paediatric, but we did
10 not have comparative figures from other centres.
11 Q. Dr Bolsin refers to staff, and he gives as an example
12 Helen Stratton, who would visit other units and might
13 pick up some intelligence while they were there.
14 Would it be part of your job to visit other units,
15 outside of Bristol?
16 A. At that time there was less visiting between units,
17 perhaps within nursing generally, than there is now.
18 Certainly staff on my unit regularly visit other units,
19 but at that time it was not commonly undertaken.
20 Q. So did you visit other units outside of Bristol at that
21 time?
22 A. No. Obviously some of us had come from other cardiac
23 surgery units and brought that expertise with us, but
24 visiting was not --
25 Q. By the time that the matters the Inquiry is concerned
0114
1 with came to public knowledge, you had not worked
2 anywhere else for more than ten years?
3 A. No, that is true.
4 Q. Do you think Dr Bolsin is right when he says that there
5 was knowledge from staff who did visit other units that
6 the results were being seen, rightly or wrongly, in
7 Bristol as being not as good as in other units?
8 A. I am sorry, do I think he is right ...
9 Q. Dr Bolsin -- he may be right or he may be wrong about
10 this -- is asserting at the end of that paragraph that
11 there was knowledge from staff such as Helen Stratton
12 who visited other units that Bristol's results were
13 being seen, rightly or wrongly, as being not as good as
14 those other neighbouring units.
15 Are you able to comment as to whether Dr Bolsin's
16 assertion is right or wrong?
17 A. I think there was some knowledge. I think Helen
18 Stratton may have got some of her information from
19 Dr Bolsin, but there was not a lot of information widely
20 discussed.
21 Q. If we go back in your statement to WIT 85/8, we have
22 read as far as paragraph 36. I now want to look at
23 paragraph 37 and following.
24 You refer there to Helen Vegoda and Helen
25 Stratton. Again, you heard Fiona Thomas's evidence this
0115
1 morning, so there is not much point in going through it
2 all again, unless it is necessary.
3 Do you agree with the evidence that she gave this
4 morning about the roles of Helen Vegoda and Helen
5 Stratton, who worked where, and --
6 A. Yes.
7 Q. That accords with your recollection?
8 A. Yes.
9 Q. What about the giving of bad news to parents? If you
10 look at your paragraph 38, there was a burden on the
11 Sisters and staff to reassure parents when looking after
12 desperately ill children, especially when they were not
13 doing so well.
14 39: "It was difficult and devastating to tell
15 parents when a child had died or was dying, especially
16 when the nurse had become close to all of them", which
17 suggests the nurses did have to break the bad news to
18 parents?
19 A. Yes.
20 Q. Did you have to do that on occasion?
21 A. Yes.
22 Q. Would that normally be done by the consultant?
23 A. If I had spent a lot of time, not specifically me, if
24 another nurse in my situation had spent a lot of time
25 with parents, perhaps may be for the whole of the late
0116
1 shift on a busy Thursday when the child is in theatre
2 and had developed a relationship with them, sometimes it
3 appeared more appropriate that the nurse would tell
4 them, particularly if the surgeon was still in theatre.
5 Q. All other things being equal, it would be the
6 consultant's role normally to break bad news, would it?
7 A. I certainly told parents several times bad news.
8 Q. Paragraph 39: you refer to bereavement counselling. Was
9 that something that nurses asked for or were provided
10 with without having to ask for it? How was bereavement
11 counselling organised for staff?
12 A. I think that bereavement counselling was organised
13 through Julia Thomas. I cannot recall anybody
14 specifically who had gone on it, but I am told that some
15 people did.
16 Q. What time are we talking about here?
17 A. Early 1990s.
18 Q. What about previous to that? What counselling was
19 provided?
20 A. I am not aware of people who had had that training,
21 but I am told that they were around.
22 Q. What is the situation now?
23 A. I do not think it is a training commonly undertaken
24 on the unit.
25 Q. Now there are no children on the unit, does that make
0117
1 a difference, do you think?
2 A. In terms of ...
3 Q. Maybe more emotionally difficult when, as a Sister or
4 a nurse, children are dying in the unit than perhaps
5 when adults are dying; I do not know.
6 A. There is something different about it. Why it should
7 be different, I do not know, if it is somebody's
8 relative.
9 Q. It may be difficult to articulate, but your feeling is
10 that it is different?
11 A. Somehow, if an elderly person has undergone surgery that
12 the outcome was not as we had anticipated, somehow it is
13 easier to break bad news to the family of an elderly
14 person, because maybe events have logically followed on,
15 than it is for the parents of the child.
16 Q. Let us move on to page 10 of your statement, please.
17 At the bottom of the page, paragraph 51, perhaps you
18 would take a moment to read that paragraph. (Pause).
19 This is dealing with risks and what people were
20 told before the operation.
21 A. Yes.
22 Q. You say that you had no role in discussing with families
23 what the risks and benefits of the operation were.
24 Whose role was it?
25 A. The surgeon's.
0118
1 Q. Anyone else?
2 A. Possibly the cardiologists must have been involved.
3 Q. The cardiologist, would he normally be involved?
4 A. Yes, they would. They would see the children in the
5 initial stages.
6 Q. For adults, the cardiologist would be in the same
7 building as the surgeons?
8 A. Yes.
9 Q. Was there any difficulty in having these discussions
10 in the case of children when the cardiologists were
11 based elsewhere? Did the cardiologists come down to the
12 BRI to take part in this discussion?
13 A. This particular discussion, I would have imagined would
14 have taken place at the Children's Hospital before the
15 children were admitted for surgery.
16 Q. Do you remember witnessing the risk discussion, if I can
17 put it like that, between the surgeon and the
18 cardiologist and parents of a child at the BRI?
19 A. No. No.
20 Q. So when you say that you attended discussions in
21 supporting role --
22 A. I think what I am referring to is discussions that
23 probably happened maybe one or two days
24 pre-operatively. I think they were discussions to just
25 clarify issues that had been discussed several times
0119
1 before with the parents about the risks and benefits.
2 Clearly, the day before surgery is not the day to be
3 identifying those risks and benefits. That is the stage
4 to which I am referring.
5 Q. Would your role at this stage have been to provide
6 essentially reassurance to the parents, to the patients?
7 A. I think so. I think parents were probably very anxious
8 and had questions to ask afterwards. It was useful if
9 you had been there to explain.
10 Q. Let us take parents of a child. The child is going to
11 have surgery tomorrow or the next day. What kind of
12 questions would the parent ask of you, as the Sister, as
13 opposed to the cardiologist or the consultant surgeon?
14 A. I think they would be asking things about the pattern of
15 the post-operative recovery, how long the child might be
16 on a ventilator, how long they might have chest drains,
17 where they could eat, at what stage they might be
18 expected to wake up, that sort of thing.
19 Q. Would they ever ask you about the surgeon himself?
20 Would they ever say, "Is X good?"
21 A. I do not recall anybody asking me that.
22 Q. Would you provide reassurance by saying things like,
23 "Your child is in good hands with Mr X"?
24 A. I might have done. It is very difficult to remember.
25 Q. Is that the sort of reassurance that you might well have
0120
1 provided?
2 A. I think the reassurance that I am talking about refers
3 to their post-operative recovery in the intensive care,
4 explaining that route that the child would go down.
5 Q. Do you ever remember attending one of these discussions
6 and hearing a risk or a benefit quoted to a patient, or
7 a parent of a patient, that you disagreed with?
8 A. I do recall such an occasion, but it was actually after
9 the child had had surgery.
10 Q. What was the occasion?
11 A. It was an occasion where the child was -- I cannot even
12 recall the surgery he had. He had made slower than
13 expected progress, and was beginning to fit, if I can
14 recall.
15 Q. What was said that you disagreed with?
16 A. I cannot recall the details of the discussion, but
17 I felt that it seemed optimistic.
18 Q. The chances of survival being quoted? What was being
19 quoted that was optimistic?
20 A. The recovery that the child would make.
21 Q. What did you do when you heard this being quoted that
22 you thought was optimistic? How did you react?
23 A. At the time, I did not do anything -- at the time, no,
24 I did not do anything.
25 Q. When was this incident that you recall?
0121
1 A. It must have been 1995.
2 Q. Who was the clinician who was giving what you thought
3 was an optimistic prognosis?
4 A. Mr Wisheart.
5 Q. If you had a similar experience tomorrow at work with
6 a patient and a clinician, would you react differently
7 now?
8 A. Yes, I think there are occasions perhaps when we are
9 discussing the care of long-term patients, and -- yes,
10 I would.
11 Q. Who would you go and talk to? Would you go to Fiona
12 Thomas or Rachel Ferris or a clinician?
13 A. I would probably talk about it with a clinician.
14 Q. The one who had given the advice?
15 A. Yes.
16 Q. Can we go to WIT 85/35, please? This is again
17 Dr Bolsin's comments on your statement. He has given
18 a comment on this particular paragraph. He said he
19 would be surprised if a senior ward manager of
20 long-standing, which I think is a reference to you, did
21 not enquire of the surgeons whether the figures being
22 quoted to relatives were correct or not.
23 First of all, is that something that you did
24 before 1995, to enquire of the surgeons in that way?
25 A. As I have said earlier, these discussions, talking about
0122
1 figures being quoted, were undertaken pre-operatively,
2 and not commonly undertaken in the ward for the first
3 time.
4 I did not question them.
5 Q. As far as you were aware, were you alone in not
6 questioning them, or was that common practice among ward
7 sisters?
8 A. I do not know.
9 Q. Do you know of anyone who did enquire of the surgeons
10 whether the figures quoted were correct or incorrect?
11 A. No, I do not.
12 THE CHAIRMAN: Mr Maclean, just for the sake of clarity, may
13 I ask, when you described the conversation earlier, you
14 were not, as I understand it, talking about risks and
15 percentages but optimistic prognosis. Are they the same
16 or are they different?
17 A. They are different.
18 MR MACLEAN: The risk in percentage terms is the type of
19 discussion you have told us would have been held
20 pre-operatively?
21 A. Yes.
22 Q. In the case of children, perhaps at an appointment at
23 the Children's Hospital or perhaps in an outreach
24 clinic?
25 A. Yes.
0123
1 Q. For adult patients, it would not take place for the
2 first time on your ward but would again have taken place
3 pre-operatively elsewhere?
4 A. Yes.
5 Q. To take the occasion that you have referred to of the,
6 as you saw it, optimistic prognosis post-operatively,
7 what did you think was the problem or the downside of
8 giving optimistic prognosis to the patient, if there was
9 one?
10 A. Well, it was terribly disappointing when it did not
11 materialise.
12 Q. So it would have raised the hopes of the patients and
13 those who were with them?
14 A. Yes.
15 Q. If we go to paragraph 58, please, of your statement,
16 WIT 85/11:
17 "Ward rounds were a difficult arena, surgeons felt
18 that one course of action should be taken whilst
19 anaesthetists thought that another course of action was
20 more appropriate. It was difficult when there were
21 differing views. The issue was resolved, but
22 doubtfully. It left the nurses feeling very
23 uncomfortable."
24 I think we explored this with Fiona Thomas this
25 morning. I want to ask you about the comment you make
0124
1 about the issue being "resolved, but doubtfully". What
2 issues were being resolved and what do you mean by them
3 being resolved "doubtfully"?
4 Is it that it was not clear whose views were
5 prevailing? Is that what you are getting at?
6 A. I think this was a reference to the ward rounds again,
7 a reference to what we discussed earlier about the role
8 of the intensivists and the surgeons, and that the
9 difficulty there -- I think on a ward round, there are
10 likely to be differing views at the time with the
11 children.
12 Q. When you say the nurses felt uncomfortable, did they
13 feel frustrated?
14 A. Yes, I think they probably did.
15 Q. What were they frustrated about?
16 A. I think they probably felt that they were not having
17 as clear a direction as they would have liked in terms
18 of managing the children.
19 Q. Was there also a view -- tell me if there was not --
20 that the debate or tussle or conflict between the
21 anaesthetists and the surgeons was damaging to the care
22 of the patients?
23 A. I think it was certainly felt to be not helpful.
24 Q. Was there a mechanism for resolving this dispute between
25 the surgeons and the anaesthetists which, as you saw it,
0125
1 could have been used but was not, or was there nothing
2 to be done about this debate?
3 A. We discussed ward rounds regularly. We discussed the
4 way they were managed, who participated in them, but
5 I think at the time, at the end of the day, the patient
6 was, or the surgeon felt that the patient was their
7 ultimate responsibility.
8 Q. Did all the surgeons have that view?
9 A. Yes, I think so.
10 Q. And was that the traditional view that surgeons and
11 nurses had taken?
12 A. I think so.
13 Q. So the challenge, if you like, to that traditional view
14 was coming from the anaesthetists?
15 A. The anaesthetists and the development of the
16 intensivist's role and the huge development of intensive
17 care expertise.
18 Q. So this type of tussle which we are focusing on in the
19 one relatively small unit in one hospital in the
20 country, it was a type of struggle, if I can use that
21 word, that would have been going on in all intensive
22 care units throughout the country at this time?
23 A. I could not say all, but I suspect it might not have
24 been unusual.
25 Q. Pretty typical, perhaps?
0126
1 A. Yes.
2 Q. If we go to WIT 85/12, this is just over the page from
3 where we have been, the same little section of your
4 statement. In paragraph 61 you say there was
5 a particular problem with Dr Bolsin because, in essence,
6 he was difficult to get hold of when you wanted him.
7 Why do you think he would turn his bleeper off so
8 he could not be contacted? What was he doing instead?
9 A. To my knowledge, he was at home. I do not know what
10 he was doing.
11 Q. Can we go to WIT 85/37? This is Mr Wisheart's comment
12 on your statement. We see he has been asked to comment
13 on various paragraphs, but if he wants to comment on
14 some others as well, and he is welcome, there is no
15 reason why he should not. If we go over the page to 38,
16 paragraph 5, he says that he had personal knowledge of
17 such incidents which created difficulty in the working
18 relationship with Dr Bolsin.
19 So Mr Wisheart is with you on paragraph 61.
20 Can we go to WIT 85/35, then, please? Dr Bolsin's
21 comment on what you say at paragraph 61 begins at the
22 foot of the page. It does not accord with his
23 recollection or any of his records. He says he has one
24 documented complaint made by Dr Monk in 1995 concerning
25 delayed attendance at the cardiac intensive care unit.
0127
1 Was the matter that you refer to at paragraph 61
2 an isolated incident? You say "several of us found".
3 A. It is clearly not documented, but I remember them
4 happening.
5 Q. So we go over the page. Dr Bolsin explains the single
6 documented incident that he is referred to, and he says
7 "This was the only complaint of delayed attendance to
8 the cardiac intensive care unit at Bristol Royal
9 Infirmary of which I was aware in my seven years working
10 on the unit."
11 So if that is right, then it is your evidence that
12 there were other instances of which Dr Bolsin, if he is
13 right, is not aware? I am sorry, that is very
14 complicated.
15 A. No, there were other instances when he was not easy to
16 contact, and I recall there were conversations with him
17 by his anaesthetic colleagues enquiring about that. But
18 I do not know the details of them.
19 Q. You mean they had found him difficult to get hold of as
20 well?
21 A. Yes.
22 Q. The incident that Dr Bolsin mentions in his comment here
23 was in 1995.
24 A. Yes.
25 Q. What is the time-scale of the problems with him that
0128
1 you are referring to in paragraph 61?
2 A. I do not recall when Steve Bolsin started on Ward 5, but
3 I think it was something that happened intermittently.
4 Q. He refers to a seven-year period of records. You see at
5 the foot of page 35, if we just go back to that, in the
6 second line of the last paragraph, "seven-year period".
7 A. Yes.
8 Q. So is it your recollection that these problems with him
9 being difficult to locate occurred intermittently
10 throughout that period?
11 A. Yes, I think it is.
12 Q. Now can we just deal with the split site? This is
13 WIT 85/13. This is back to your own witness statement,
14 now.
15 I appreciate that what you are saying in
16 paragraph 66 is that there is a lot of apprehension
17 among the staff who were still working at the BRI who
18 were working there at the time of the events that the
19 Inquiry is concerned with, like you, about this Inquiry
20 and the evidence that might be heard at the Inquiry.
21 Were the staff made aware of the contents of the
22 letter to Fiona Thomas from Mr Pawade that we saw this
23 morning? You remember the one I am referring to?
24 A. I cannot recall the date of it. It was 1995, yes, and
25 I am fairly sure it was placed in the communication book
0129
1 on the ward for people to read.
2 Q. You say at paragraph 67 that "The children going to the
3 Children's Hospital was always on the cards, but it has
4 been reported by the media that the move was linked with
5 the publication of audit figures, which is not true."
6 The Panel has heard some evidence with Mr Nix and
7 others about the planned move of the children to the
8 BCH. What I want to ask you is what, at the time, did
9 you think was the reason for children being moved to the
10 BCH?
11 A. When I first started working there, I was given the
12 impression that the children were cared for in the BRI
13 because the facilities for open cardiac surgery were in
14 the one place and the surgeons could not be in two
15 places at once, so there was a centralising of
16 resources.
17 Perhaps as the movement towards children being
18 cared for in Children's Hospitals, in children's
19 departments, developed from outside professional bodies,
20 it was gradually felt that maybe that would be the
21 better place for them. I think that is what I was
22 referring to in that comment.
23 Q. Was the move somehow connected with the expansion of
24 adult work at the BRI?
25 A. No, not to my knowledge.
0130
1 Q. I only want to deal with a couple more points with you.
2 Still on the same point, really, paragraph 78 at
3 page 15, this is again the split site:
4 "I believe that there was not as great a problem
5 as is now made out. Does it really matter that adults
6 and children were together? We tried very hard to make
7 the facilities appropriate and to cater for both
8 children and adults."
9 Then you explain, as Fiona Thomas did this
10 morning, about the nursing staff and the play leader.
11 Can I ask you your own question: do you think that
12 it did matter that adults and children were cared for
13 together? Before you answer, I appreciate what you go
14 on to say that there was an effort made by the nursing
15 staff to provide the best care possible to the children
16 who were there; but accepting that, did it matter, do
17 you think, that adults and children were cared for
18 together?
19 A. Are you referring to it in the light of the information
20 that we now know?
21 Q. No. I know it is very difficult, but if you can, put
22 yourself back to 1993-1994. Children being operated on
23 for open heart operations at Bristol Royal Infirmary
24 were taken post-operative to the mixed intensive care
25 unit where there were two full-time paediatric nurses
0131
1 plus the other that Fiona Thomas described this
2 morning. At that time, would you have thought that it
3 mattered either to the adults or to the children that
4 there was this mixing of the two going on?
5 A. In the light of what we know now, particularly with
6 regard to the centralisation of services, for example,
7 cardiologists, it obviously did matter. It obviously
8 does matter. To any paediatric nurse, it would matter.
9 But at that time that was the only place where the open
10 heart surgery was undertaken, and significant efforts
11 were made to nurse those children and accommodate those
12 children, and support their families and be there for
13 them. It probably does not answer your question.
14 Q. It goes some way to answering the question. Let me ask
15 you another question. In 1993 or 1994, if you had had
16 a child who required an open heart operation, would it
17 have mattered to you that that child would have been
18 cared for in the BRI type setting, with the mix of adult
19 and paediatric intensive care post-operatively, rather
20 than cared for in a dedicated paediatric intensive care
21 unit?
22 A. I think if I thought that that was where the expertise
23 lay, then it would not have mattered. I recall that
24 when we used to transfer children back up to the
25 Children's Hospital after their stay with us, the
0132
1 parents were often very anxious about that, leaving the
2 facilities that they had become accustomed to and felt
3 secure with.
4 Q. As a ward sister, presumably you are well placed to
5 understand the importance of good quality nursing care,
6 post-operatively, for cardiac patients: it is an
7 important part of the treatment?
8 A. Yes.
9 Q. Would you say that if that is where the expertise had
10 lain, it would not have mattered to you whether the
11 child was cared for there or elsewhere?
12 A. Yes.
13 Q. But it would have been obvious to you, would it not,
14 that a mixed intensive care unit would not have had the
15 same ratio of paediatrically qualified nurses as
16 a dedicated paediatric centre was likely to have?
17 A. Yes.
18 Q. So would it follow that it would have been apparent
19 to you that the nursing expertise for young children was
20 relatively speaking unlikely to be in a mixed unit
21 compared to a dedicated children's unit?
22 A. Would you say that again?
23 Q. You said it would not matter if the expertise was in
24 a mixed unit, you would be quite happy to send a child
25 there?
0133
1 A. Yes.
2 Q. I said it would have been obvious to you that a mixed
3 intensive care unit would not have the same ratio of
4 paediatrically qualified nurses as a dedicated
5 paediatric centre; you agreed?
6 A. Yes.
7 Q. Then I said, would it follow on from that that it would
8 have been apparent that the nursing expertise for young
9 children would not be likely to be in the mixed unit
10 relative to the dedicated paediatric unit?
11 A. I think I would have anticipated that the staff caring
12 for my child would have been trained to look after the
13 child. I would not anticipate that a nurse with no
14 experience or training would have been looking after
15 a child in that area, that belonged to me.
16 Q. No relevant experience or training, or no experience of
17 training. Obviously there was some training. It would
18 be important to you to know that the nurses caring for
19 the child had been relevantly trained?
20 A. Had paediatric experience.
21 Q. Just to tidy this final point up, at paragraph 40 of
22 your statement, at 85/8 you say:
23 "There was a huge sense of relief when the
24 children left the unit in November 1995 because of the
25 constant criticism we were under, although there were
0134
1 nurses still wanting to look after children."
2 Was it the case that the nurses felt there was
3 added stress in caring for the children compared to the
4 adults?
5 A. Yes. Yes, there was.
6 Q. Did it follow from that that there was a reluctance on
7 the part of the nurses to care for the children compared
8 to the adults?
9 A. There were a number of nurses who enjoyed looking after
10 the children very much, and were highly skilled and
11 regularly asked to look after the children. There
12 perhaps was an occasional nurse who would have preferred
13 not to.
14 Q. Were those who were happy to look after the children in
15 the minority or the majority?
16 A. I think the majority of nurses who were trained. They
17 were E grade nurses. They had received three weeks
18 orientation working alongside somebody else, and they
19 were confident.
20 Q. I hope, finally: Fiona Thomas this morning explained
21 about the skills of the nurses on the ward in terms of
22 the number of paediatrically trained nurses. How
23 frequent would it have been that children on Ward 5
24 would have been cared for by nurses none of whom were
25 paediatrically qualified? In the intensive care part of
0135
1 the ward.
2 A. In the light of what Fiona said, there were not many
3 qualified RSCNs and there were possibly four or five
4 children in the intensive care, and at that stage those
5 nurses would have been adult trained nurses who had had
6 training on the ward or at other centres and had come
7 back. It is difficult to say what percentage.
8 Q. Would it have been fairly common?
9 A. It would be fairly common for there not to be an RSCN,
10 but it would be extremely uncommon for it not to be
11 a highly skilled nurse above E grade level who had had
12 considerable orientation and training for it. That
13 would just not happen.
14 MR MACLEAN: Sir, would you just give me a moment, please?
15 (Pause). Thank you very much, Sister Disley. I do not
16 want to ask you any more questions. Is there anything
17 else that you want to tell me about anything at all?
18 A. No.
19 Q. Are you sure?
20 A. Yes.
21 MR MACLEAN: The Panel may have some questions for you.
22 Mr Miller may have some questions for you. Can I thank
23 you very much for your evidence? Can I, as usual, leave
24 it to the Chairman to explain the ability that you have
25 to submit any further evidence to us in due course.
0136
1 THE CHAIRMAN: Mrs Disley, I have a couple of questions.
2 My colleagues do not, but unusually, I do.
3 Examined by THE PANEL:
4 THE CHAIRMAN: I want to take you back to paragraph 65 of
5 your statement, which is on page 13. To a degree, this
6 trespasses beyond where we are going in this block of
7 our evidence, and please tell me if you are not happy to
8 respond. I am looking at the sentence which says:
9 "Some people feel devastated and think that with
10 hindsight they should have done something ..."
11 It is the second part: " ... although it is hard
12 to see what they could have done with what they knew at
13 the time."
14 What does that mean, please?
15 A. I think in the light of what we now know, having sat
16 down and turned the television on and read our
17 newspapers, I think some nurses feel that we should have
18 known more and we should have done more.
19 Q. Thank you. The second question is really for you to
20 help me, if you would. May I take you to paragraph 77,
21 which is on page 14 of your statement, the next page?
22 You refer there to "critical incident forms" and
23 how you used them to deal with potentially dangerous
24 incidents. Could you tell me a little bit about how
25 that works now?
0137
1 A. In the event of an incident occurring on the ward which
2 people did not feel happy with, or that was a problem to
3 a patient or there was a problem with a piece of
4 equipment, it was really where there was just an unusual
5 situation, perhaps, those forms are filled in. The
6 forms are taken and reviewed and assessed, and themes
7 developed out of the forms as to where the issues need
8 to be resolved in terms of training time or equipment
9 time. Do you want some examples?
10 Q. Yes, please.
11 A. Perhaps the potential for a confused patient to fall
12 out of bed, something like that, that we would perhaps
13 be arguing for cot sides on all patients, something like
14 that.
15 THE CHAIRMAN: That is helpful, thank you. Mrs Disley, more
16 generally, I thank you on behalf of the Panel and myself
17 as Mr Maclean made it clear, if -- Mr Miller, I have
18 done it again, I do apologise profoundly to you. Please
19 come forward. I regret I get into a flow and then
20 I sometimes forget myself. My apologies.
21 MR MILLER: There are just a very few things I would like to
22 ask you about.
23 RE-EXAMINED BY MR MILLER:
24 Q. Going back to the beginning of your evidence when you
25 were dealing with what would be the position when
0138
1 a nurse had a complaint or concern, and the vertical
2 structure that that complaint would go up: is the
3 current position that if a nurse raised a matter with
4 you, you would try to resolve it first on your own, if
5 it was possible, then to discuss it with the Sisters at
6 the regular Sisters' meeting?
7 A. If that was appropriate.
8 Q. If it was necessary?
9 A. Yes.
10 Q. If it had to go higher, it is would go up through Fiona
11 Thomas and if necessary up to the top of the nursing
12 ladder, which is Lindsay Scott?
13 A. Yes.
14 Q. So you would not get into the management stream unless
15 Fiona Thomas was not available to deal with it from the
16 Sisters' level onwards?
17 A. No, not an immediate instance.
18 Q. You give examples -- I am sorry to interrupt; in your
19 statement you say that you had had to deal with problems
20 with Rachel Ferris because Fiona Thomas was not there to
21 deal with them at that time?
22 A. Yes.
23 Q. Otherwise, it would stay within the nursing stream?
24 A. Yes.
25 Q. When did that clear-cut structure develop? What sort of
0139
1 period are we talking about?
2 A. I think around the time of the Trust, and perhaps
3 particularly in the last 5 years.
4 Q. I think you saw early today for the first time
5 Dr Bolsin's comments on your witness statement?
6 A. Yes.
7 Q. And Mr Maclean has asked you a few questions about
8 this. I wonder if you could see WIT 85/34, which is his
9 comment on your paragraphs 32 to 41. This is talking
10 about nurse support.
11 I am not sure whether you necessarily dealt with
12 it, and I do not want to raise upsetting matters, but
13 just to see where we get to in terms of timing.
14 He suggests that the emotional tension that the
15 nursing staff was feeling was contributed to by the
16 underlying knowledge that the unit should have been
17 producing better results. Effectively he is saying that
18 the nursing staff would have known that the results
19 would have been better and Mr Maclean asked you that and
20 your response to him, transcript page 114, line 1, you
21 say:
22 "I think this view gradually crept in, but I have
23 to say it is extraordinary how little information we
24 were aware of in the early days of these anxieties
25 arising."
0140
1 All I want you to do, if you can, is to try and
2 put some timing on this. Just before you answer, in
3 your own witness statement, what you are talking about
4 is the away day in May 1995 and the low morale of the
5 nursing staff at that time and the support that they
6 required.
7 Can you help the Panel as to when this was
8 gradually creeping in, this feeling that you should have
9 been doing better?
10 A. As I said, I came back to the ward at the beginning of
11 1994 and I think, it is very hard to remember, but
12 I suspect during 1994 we probably were becoming aware of
13 these things.
14 Q. But you were not going out at that stage to see other
15 units?
16 A. No.
17 Q. Helen Stratton may have been visiting other units, but
18 did she come back with the results of performance?
19 A. I have no recollection of the particular units that she
20 did visit.
21 Q. I will leave it there, it is the timing I really wanted,
22 because it may be important just to fix the date.
23 I would like to also just ask you one more thing
24 about Dr Bolsin's comments on your statement. It is
25 WIT 85/36, dealing with what he said was the one
0141
1 documented record of a complaint having been made about
2 his non-attendance.
3 Have you got it there in front of you?
4 A. Yes.
5 Q. Do you recollect that particular incident?
6 A. Yes, I think I do.
7 Q. He makes a suggestion in his statement as to what you
8 could have done, namely, you could have got the Cardiac
9 Anaesthetic Registrar or the Intensive Care Registrar
10 instead. Why was that route not taken?
11 A. The expertise that was needed was definitely consultant
12 level.
13 Q. And the final point: it may be that your witness
14 statement is correct on the figures, I do not know, but
15 perhaps if we could just deal with it, WIT 85/13,
16 paragraph 66. You say there that only 20 out of the 100
17 staff are still in post. Is that right?
18 A. It is not quite right. Fiona and I have added up, and
19 I think the figure is more like 33 full-time equivalents
20 still on the ward out of 100 staff.
21 MR MILLER: Thank you, Sister.
22 THE CHAIRMAN: Thank you Mr Miller, that was very helpful
23 and I am grateful.
24 Thank you, Mrs Disley, very much for coming to
25 talk to us. I expressed my thanks and I repeat them.
0142
1 If there are other matters that come to your attention
2 or come to mind that you want to let us know about,
3 either yourself or through those advising you, we would
4 be most grateful to receive them, but for the moment,
5 thank you.
6 I understand, Mr Langstaff, you want to raise
7 something?
8 MR LANGSTAFF: Sir, two things really.
9 THE CHAIRMAN: If I could therefore ask Mrs Disley to bear
10 with us and forgive me if we listen to Mr Langstaff for
11 a moment.
12 MR LANGSTAFF: RE TIMETABLE & PANEL'S VISIT TO BRI
13 MR LANGSTAFF: You normally call on me to tell you what is
14 likely to happen tomorrow, and I cannot resist seizing
15 the opportunity, since I have not said anything yet
16 today in public.
17 Tomorrow I can proudly announce, as I did last
18 week, that we will have Mr Steven Boardman, formerly an
19 Associate Executive Director of the UBHT giving his
20 evidence at 9.30 in the morning. He will be followed by
21 Miss Mandie Lavin of the UKCC, who will give evidence as
22 one of our professional association type witnesses, as
23 part of the national scene.
24 The other matter, anticipating further ahead and
25 a rather different sort of evidence: you will have heard
0143
1 today both Fiona Thomas and Sister Disley tell us of the
2 way in which the wards were configured at the BRI and to
3 give you some idea as to the changes that there have
4 been over time.
5 It is of course a matter for you and the Panel,
6 but you may think that it would be appropriate for the
7 Panel now, if they felt so inclined, to pay a visit to
8 the BRI to see for yourselves.
9 I have had very useful discussions with Mr Miller,
10 who tells me that if the Panel were to go on their own,
11 and if any other representatives of any interested
12 participant were also to wish to see the premises, they
13 could go on a separate occasion, so that everybody would
14 see what is there to be seen, and everybody would know
15 what the Panel had seen, but in that way, clinical care,
16 which of course is ongoing, would not be affected.
17 Sir, that is what is available, if the Panel wish
18 to take advantage of it.
19 THE CHAIRMAN: Mr Langstaff, I am grateful. We have had it
20 in mind for a while to visit, but I thought it would be
21 proper and we all thought it would be proper for
22 evidence to develop as it has done. We would be most
23 anxious, should we visit, to cause the least possible
24 disruption to the care of patients and to the work of
25 those who are working day and night in the hospital.
0144
1 What you propose may be a way forward so that
2 large numbers of people do not descend at any given time
3 and get in the way and possibly cause disruption and
4 harm.
5 Let us take it forward on that basis. I am very
6 grateful to Mr Miller in particular for his help in that
7 regard.
8 Once we have decided how we are going to do it, we
9 will of course make it known either in this chamber or
10 through another means, but thank you for the moment. It
11 is very helpful. I am sure I speak for all of us when
12 I say we are very grateful.
13 So we meet again tomorrow morning at 9.30. Thank
14 you, Miss Disley. Thank you, everyone else. Thank you,
15 Mr Maclean. We adjourn now.
16 (2.40 pm)
17 (Adjourned until 9.30 am on Wednesday 23rd June 1999)
18
19
20
21
22
23
24
25
0145
1
2 I N D E X
3
4
5 MRS FIONA THOMAS (Sworn):
6 Examined by MR MACLEAN ....................... 1
7 Examined by THE PANEL ........................ 92
8
9 SISTER SHEENA DISLEY (Sworn):
10 Examined by MR MACLEAN ....................... 94
11 Examined by THE PANEL ........................ 137
12 Re-examined by MR MILLER ..................... 138
13
14 MR LANGSTAFF: RE TIMETABLE & PANEL'S VISIT TO BRI .. 143
15
Return to top of page
Published by the Bristol Royal Infirmary Inquiry, July 2001
© Crown Copyright 2001