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Daily transcripts
Hearing summary
5th October 1999
Hearings this week focus on evidence from Regional Health Authority and hospital staff
commenting on the Bristol Services and the adequacy of the service provided.
Today the Inquiry heard from Joyce Woodcraft, former Senior Sister, Intensive Care Unit
(ICU), Bristol Children’s Hospital. Ms Woodcraft is an RSCN (Registered Sick
Children’s Nurse) and she has completed additional English National Board courses in
Adult and Paediatric Intensive Care during the mid 1980s. She said that knowledge of both
intensive care and paediatrics was desirable for nurses working on a Paediatric ICU. She
commented on staffing levels and difficulties of recruitment within the ICU and Baby Unit
at BCH. Ms Woodcraft then told the Inquiry about the teamwork within the unit and
commented on the communications between BCH and the Bristol Royal Infirmary (BRI) and the
process by which patients were transferred between the two hospitals. She said that, in
her experience, parents, accompanied by a member of the nursing staff, were informed of
the risks of surgery by the two paediatric cardiothoracic surgeons (Mr James Wisheart and
Mr Janardan Dhasmana. She and concluded by saying that at all times the surgeons efforts
were concentrated on their patients.
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FULL TRANSCRIPT
1 5th October 1999
2 (12.40 pm).
3 THE CHAIRMAN: Good afternoon, everyone. Good afternoon,
4 Mr Langstaff.
5 STATEMENT BY MR LANGSTAFF:
6 MR LANGSTAFF: Good afternoon, sir. Sir, before
7 Miss Woodcraft is called, I should perhaps say something
8 to clarify, in case there is any misunderstanding, that
9 which I said yesterday in respect of Dr Bolsin.
10 I said, and indeed those newspapers that reported
11 the Inquiry's proceedings yesterday picked it up
12 accurately, that we intended to take his evidence by
13 video link. It is reported to me that there may have
14 been some confusion as to whether this meant that
15 Dr Bolsin would prerecord his evidence by video so that
16 it would be played in much the same way as a film or TV
17 programme would be played to us. That, of course, is
18 not what video link evidence nowadays involves.
19 What is anticipated is that, should he remain
20 unable to come and see us in person, he will sit in
21 front of a video camera in Australia. I will be here in
22 front of a video camera in this chamber and in front of
23 everyone here, he will be asked questions in the usual
24 way and he will respond. There will inevitably be,
25 because of the distance, a small time-lag between
0001
1 question and answer, much the way as one sometimes gets
2 on newsreel in the Evening News on TV, where news has
3 been given at a distance, but apart from that, it is
4 exactly the same question and answer system.
5 We have ensured that the technology will be
6 available so that he will have the documents that
7 he would have had had he been here, and save for the
8 timings of the sessions, it will be exactly as if
9 he were here in person.
10 I say that that is all comprised in the terms of
11 taking evidence by video link, but I am saying so that
12 it is absolutely clear for anyone who may have been left
13 in some doubt or uncertainty after what I said
14 yesterday. If it was my fault, I am sorry for being too
15 short and brief about it.
16 THE CHAIRMAN: Perhaps we may say one word?
17 We are beginning later than we said we would be
18 beginning, but there is an explanation; namely, not only
19 has there been an horrific train cash outside London
20 today, but there was also I understand an accident on
21 the motorway between London and Bristol which prevented
22 this witness getting here at the time she planned.
23 We are delighted to see her here nonetheless, but that
24 is the reason why we are delayed in beginning.
25 MISS GREY: Yes, indeed. Miss Woodcraft started her day
0002
1 extremely early, but notwithstanding that, was caught up
2 in a traffic jam caused by an accident, so that has been
3 the cause of our delay.
4 Miss Woodcraft, may I invite you to stand to take
5 the oath, please?
6 MISS JOYCE MARIAN WOODCRAFT (Sworn):
7 Examined by MISS GREY:
8 Q. Your full name is Joyce Marion Woodcraft?
9 A. Yes.
10 Q. If we look, please, at WIT 121/1; is that the first
11 page of a statement given by you to the Inquiry?
12 A. Yes, it is.
13 Q. If we turn, please, to page 11; that is your signature
14 on the bottom?
15 A. Yes.
16 Q. You confirm there, in that statement, that its contents
17 are true to the best of your knowledge and belief?
18 A. Yes.
19 Q. Miss Woodcraft, if we turn back, please, to page 1 of
20 your statement, we see that you are qualified as
21 a registered sick children's nurse in 1965 and as an RGN
22 in 1967. You then began to work at the Bristol
23 Children's Hospital in 1977?
24 A. That is right.
25 Q. Can you tell us where you were working before you
0003
1 started work at the BCH?
2 A. I was Sister on a general paediatric medical ward in
3 Farnborough Hospital in Kent.
4 Q. How did that experience compare to working at the BCH,
5 in terms of the specialisms that were being required in
6 your work at that time?
7 A. It was very different. At Farnborough I knew what I was
8 doing and knew what patients we would have in. I moved
9 to Bristol really for more experience in an acute field
10 and a more challenging role.
11 Q. Could you just try and speak up a little bit?
12 A. I am sorry, I am recovering from flu', so I will do my
13 best.
14 Q. You go on to say in the fourth paragraph of your
15 statement that in 1984 you obtained the ENB 100,
16 the adult intensive care course. It is right, is it,
17 that that particular course was offered at Bristol; is
18 that correct?
19 A. Yes.
20 Q. Can you recollect from what point it began to be
21 offered?
22 A. No. I was not aware how long they had been doing the
23 course at the BRI. It was offered to me at that time
24 and I took up the opportunity to do it.
25 Q. If we look at page 14 of WIT 121, these are the comments
0004
1 of Mr Wisheart on your statement. First of all, he adds
2 a note in relation to paragraph 4 that the first course
3 to train nurses in the intensive care nursing of
4 children, the ENB 415, took place some time after 1986.
5 Would that be in accordance with your recollection?
6 A. Yes.
7 Q. That is obviously the course that you helped to set up
8 and devise?
9 A. Yes.
10 Q. He then goes on to say that courses for the training of
11 nurses in paediatric cardiothoracic intensive care began
12 around 1984/85. Are you familiar with those courses?
13 A. I knew there were those courses in London but I was not
14 involved at all.
15 Q. I think it is rights to say that they were not being
16 offered as part of nurses' training at the Bristol Royal
17 Infirmary?
18 A. No, that is right.
19 Q. It is right to say, I think, that the ENB 100, the adult
20 general intensive care course, was offered at
21 the Bristol Royal Infirmary?
22 A. Yes.
23 Q. Prior to the creation of the ENB 415, would it be fair
24 to say that the ideal set of qualifications for a nurse
25 in a Children's Hospital's ICU would have been an RSCN
0005
1 with the ENB 100 qualification?
2 A. Yes.
3 Q. But thereafter, you could get even more specialised
4 training by going for the ENB 415?
5 A. Yes, and then it would be appropriate that they did the
6 415 and not the ENB 100, if they were specialising in
7 children.
8 Q. Can we look at the statements of Miss Hawkins, WIT 91/3,
9 paragraph 14? I appreciate you will not have seen this
10 yet, Miss Woodcraft, but you see that there is
11 a reflection in her statement as to a debate as to
12 whether it was more relevant for nurses who were nursing
13 children who had had cardiac surgery to have ITU
14 training or paediatric training.
15 Are you able to help us on how you would see the
16 balance of importance between those two different types
17 of training?
18 A. I spent a very short time on the cardiothoracic at the
19 BRI. That was at the time I was doing the ENB 100.
20 I certainly felt that the nurses needed some further
21 paediatric input. I could see the importance of doing
22 some intensive care training with the type of work that
23 they were doing at that time.
24 Q. But you were working on an ICU in the Children's
25 Hospital which took, amongst others, children who had
0006
1 had perhaps at times closed surgery in the BCH?
2 A. Yes.
3 Q. Or alternatively, were being transferred back from the
4 BRI, having had open-heart surgery at the BRI; is that
5 right?
6 A. Yes.
7 Q. And from that experience of nursing children with that
8 background after cardiothoracic surgery of one sort or
9 another, can you help us on the importance of firstly
10 paediatric training before undertaking that nursing?
11 A. I think that paediatric training was very important, to
12 care for the child and the whole family, really.
13 Q. What difference does it make in the approach of nurses,
14 do you think?
15 A. I find it difficult to express, but a lot of people
16 think that children are just mini adults and they are
17 not at all and they have very different needs, socially,
18 psychologically, from adults and that the paediatric
19 training is important. That is why we fought to keep
20 it, really.
21 Q. Is it social and psychological only, or are there other
22 physiological?
23 A. No, physiological as well; changes in the condition of
24 the child will vary very rapidly and generally more so
25 than in an adult. Also, your observation skills are
0007
1 much more acute in paediatrics where the child is unable
2 to tell you how it feels, particularly the babies, and
3 a lot of it is based on observation skills.
4 Q. Do you think that is something that can be picked up by
5 in-house training and experience from those who do not
6 have a paediatric background but nevertheless are
7 working with children in an intensive care ward?
8 A. I think it can be picked up, but I think it takes
9 longer. It is not part of your training. Certainly
10 from my experience, paediatric nurses have that much
11 more acutely.
12 Q. If we move on to the next page of your statement, you
13 talk in paragraph 6 about the Baby Unit and intensive
14 care at the Children's Hospital.
15 Can you just tell us a little about the breakdown
16 of children in those two wards? What sort of children
17 would be admitted to the Baby Unit with what level of
18 need, as compared to those admitted to the ICU?
19 A. The Baby Unit was for any baby under the age of a year
20 that needed hospitalisation; the Intensive Care Unit was
21 for babies and children that needed more of a one-to-one
22 care, were much more acutely ill and needed much closer
23 monitoring.
24 Q. It was not necessarily the case that children who were
25 readmitted back from the BRI would go into either of
0008
1 those two wards. Some might be admitted back to
2 a general ward within the BCH?
3 A. It would depend on the age of the child. If they were
4 over a year, as quite a few of the children were who
5 were operated on at the BRI, they would go to Ward 33,
6 the acute surgical ward. Occasionally there would be
7 a teenager who would go to the adolescent ward. They
8 were few and far between. By comparison, babies would
9 be admitted to the Baby Unit. If they required
10 long-term ventilation or more acute nursing, they would
11 be readmitted to the Intensive Care Unit at the
12 Children's Hospital.
13 Q. Was that common, or would it be more normal for a child
14 who was sufficiently well to be transferred back to the
15 Children's Hospital to be readmitted to what I might
16 call a non-ICU ward, whether the Baby Unit or Ward 33?
17 A. It varied tremendously really, but I guess the majority
18 went back to the wards and some children came back to
19 ITU, yes.
20 Q. We have heard a little about the Special Care Baby Unit,
21 but that, I think, was based at St Michael's, is that
22 right?
23 A. That is right, yes.
24 Q. I want to make sure when you are talking of the Baby
25 Unit in your statement, you are not referring to the
0009
1 SCU.
2 A. No, not to the Special Care Baby Unit.
3 Q. You speak in paragraph 7 your statement about the number
4 of Sisters dropping from 6 to 2 and the situation
5 lasting for about two years. Can you tell us what the
6 reason was for the number of Sisters dropping so sharply
7 at that point?
8 A. I think it was just coincidence in a way. Sisters
9 wanted to move on into different areas. One became
10 Casualty Sister. She felt she did not want to continue
11 in an intensive care situation. One left to be a nurse
12 counsellor; another went into the community and another
13 left to do her midwifery training. It just all happened
14 about the same time.
15 I do not think there was anything specific that
16 caused it; there was no crisis within the hospital that
17 made them all feel they wanted to get out.
18 Q. It is implicit in your statement that there were
19 difficulties in recruiting replacements for those people
20 once they had left. What sort of factors were causing
21 that difficulty?
22 A. I am not sure, really. I think partly because the
23 hospital had not decided whether or not to run the
24 intensive care side separately. It was not called the
25 intensive care side at that time, it was sort of Side A
0010
1 and Side B. I think that people that came felt that it
2 should be run as a separate unit.
3 Then we just had an unfortunate period where
4 people were appointed when they -- their husbands did
5 not get jobs within the area or for personal reasons
6 they left after a few months, so we did have sisters
7 appointed during that time, but they only lasted a short
8 time.
9 Q. So at one point during that period, the ICU was not
10 recognised as a separate ICU?
11 A. No. It was just sort of like a high dependency part of
12 the Baby Unit in a way. It took a while for Region to
13 actually acknowledge that it was an intensive care unit.
14 Q. And the consequence of that was, was it, that it was
15 less attractive for someone who wished to specialise in
16 intensive care to work on that ward?
17 A. Possibly.
18 Q. Was there any other consequence that you can see from
19 the point of view of recruitment or retention in the
20 fact that the ICU was not recognised as being
21 a designated ICU?
22 A. I am sorry, can you just ...
23 Q. You mentioned this factor as being something that was
24 potentially relevant to difficulties in recruiting
25 Sisters to work on the ward. I just wondered why it was
0011
1 that it was relevant to that difficulty?
2 A. I think, as you say, because the Baby Unit and the
3 intensive care side were separated by ancillary linen
4 rooms and kitchens and things, so they physically were
5 two separate units and were difficult to run as one
6 unit. I think people saw that as a problem. As you
7 say, once it was designated as an intensive care, it was
8 a more attractive prospect for staff, yes.
9 Q. When did the designation you are talking about take
10 place?
11 A. I am honestly not sure. I am not sure of dates. I have
12 not kept them in my mind at all, I am afraid.
13 Q. Can you help us as to whether we are talking about the
14 early 1980s, the late 1980s, or the --
15 A. I think it would be the early to mid-1980s, would be my
16 recollection.
17 Q. Can you just tell us what difference that made, if any,
18 to the running of the unit?
19 A. A sister was appointed initially for the Baby Unit, so
20 that my input then was just solely for the intensive
21 care side, which made it much easier, less babies to
22 care for in a way, less responsibility. It was just
23 easier. Then staff were appointed for the Intensive
24 Care Unit.
25 Q. So there was an increase in staffing levels at that
0012
1 point?
2 A. Yes.
3 Q. And a separation of the management of the two wards?
4 A. Yes.
5 Q. You talk about recruitment, the retention of sisters
6 throughout your statement, in particular in
7 paragraph 7. Can you just help us as to the comparative
8 experience that you had in the Children's Hospital
9 compared to your previous experience in the more general
10 set-up that you had experienced before?
11 A. When I was at Farnborough Hospital, there were two
12 sisters and they both stayed for quite a long time on
13 the ward. As far as I am aware, they did not have any
14 difficulty recruiting after I left for a general ward.
15 Q. A general ward requiring paediatric experience?
16 A. Paediatric, yes. The sisters were all RSCN
17 qualification. I think this was just a blip, really,
18 which lasted about, as I say, the two years.
19 The rest of the staff after that were very
20 stable. We always had a fairly stable core of staff
21 that stayed a long time on the unit. It was a very
22 happy place to work and people did not move a lot.
23 Q. It is just that during the inquiry, in earlier phases,
24 we were hearing some discussion about whether or not
25 there might be local difficulties in difficult parts of
0013
1 the UK in recruiting staff, and difficulties in
2 recruiting paediatric nurses might be more acute in some
3 areas rather than in others.
4 Do you think that might have been a factor in
5 Bristol to any extent?
6 A. I do not know. It may have been, yes. I must admit, it
7 is not something --
8 Q. Not something you are familiar with?
9 A. No.
10 Q. Can we turn on to paragraph 8 of your statement, which
11 is over the page, page 3, please. You talk about how,
12 if staffing numbers were low in the Baby Unit, nurses
13 would go to the intensive care for extra staff to help
14 on the unit, and vice versa?
15 A. Yes.
16 Q. Can you tell us, how often was it during the period when
17 you were working there that you generally had to make up
18 numbers by going from one unit to another?
19 A. This was really during the late 1970s, early 1980s, that
20 this happened more and because the units had been run as
21 one unit, the staff had worked on both sides and had
22 therefore experience on both sides, so we were quite
23 happy to do that. We often used to move staff between
24 the two sides.
25 Q. Generally it might be thought that if sisters or nurses
0014
1 were moving from one ward to another, that would impose
2 extra stresses on them because they were working in an
3 unfamiliar environment, and perhaps also extra stresses
4 on those they were working with.
5 Are you saying that because of the fact that
6 you had worked together as a unit before, that was not
7 really the case in this instance?
8 A. No, certainly not in the 1970s, early 1980s. There was
9 not a lot of stress caused by that, because as I say,
10 they had all worked together anyway and the staff all
11 knew each other and were happy to help out, really.
12 Q. After that, did the practice continue, or was it no
13 longer necessary?
14 A. Not as much. There was not as much movement between the
15 two units.
16 Q. Why was that?
17 A. I think the staffing levels sort of improved for
18 a while, but then there were not enough staff floating
19 on the Baby Unit to be able to use them, so we would
20 have to get bank staff in.
21 Q. So if numbers were low, it was likely to be an acute
22 problem over both units?
23 A. Yes.
24 Q. So you would have to use agency staff?
25 A. We occasionally used agency staff. We tried to form our
0015
1 own bank. There was quite a well-staffed bank within
2 the hospital, and we had training sessions on the
3 Intensive Care Unit for staff that were particularly
4 interested in intensive care work, so that the bank
5 staff were happy with the unit; they knew the
6 environment and knew what they were doing.
7 Q. Can you help us as to how that bank was made up, then?
8 You say it existed in the hospital.
9 A. Of registered sick children's nurses and enrolled
10 nurses, with paediatric experience.
11 Q. Who came from Bristol in general? They were not
12 presumably already employed by the hospital?
13 A. No, a lot of them were people that had married and had
14 young children but wanted to come back into nursing, and
15 had either trained at the Children's Hospital, got their
16 RSCN, also worked within the hospital and had experience
17 and wanted to come back because they enjoyed the work at
18 the hospital.
19 Q. So if you used a nurse from that bank, then, what was
20 the likelihood that that nurse would have worked on the
21 ward already, that you had seen their face before?
22 A. The majority of the bank staff we knew, we knew well.
23 As I say, we had a training programme set up for bank
24 staff within the Intensive Care Unit, so that they had
25 experience.
0016
1 Q. What did that consist of?
2 A. Particularly showing them the sort of monitors that
3 we were using, as we had new monitors, new ventilators,
4 and the equipment that is used on the unit and the
5 documentation that we would use.
6 Q. Who was it who would decide that the numbers were such
7 that you needed to bring in somebody from the bank, from
8 an agency, in order to make up the levels?
9 A. Whoever was in charge of that shift. We would talk to
10 the hospital co-ordinator to get more staff in.
11 Q. If you were on the shift, you would have been in that
12 position?
13 A. Yes.
14 Q. If you were not there, who would have done it in your
15 absence?
16 A. Whoever was in charge of the shift in my absence; either
17 one of the sisters or charge nurse or senior staff
18 nurses.
19 Q. And you would then speak, would you, to the hospital
20 co-ordinator?
21 A. Yes.
22 Q. Who was ...
23 A. Maggie Perrett in the latter years.
24 Q. Was there ever any difficulty in obtaining the cover
25 that you wanted?
0017
1 A. Sometimes, yes.
2 Q. What was the reason for that?
3 A. Unavailability of staff. They had other commitments.
4 Q. So there might be two reasons for difficulty. The first
5 might be financial, you cannot afford it. That was not
6 a reason in your evidence.
7 A. Occasionally, but not generally, no. If we said
8 we needed extra staff, it would be discussed within the
9 hospital, Miss Perrett may have to go to the General
10 Manager to discuss the need for extra staff, but
11 generally, we fought our corner and won.
12 Q. How far in advance would it be known that you would be
13 likely to face a situation where you would have to bring
14 somebody in?
15 A. Occasionally at the beginning of the week, if we knew
16 somebody was sick for any length of time, we would
17 inform her and she would do her best to fill that ahead
18 of time, but obviously if there was an acute sickness,
19 it may be the morning of the shift that we would have to
20 contact her.
21 Q. You said that generally there were no financial
22 difficulties in bringing in the staff that you needed to
23 cover the shifts. Can you help us as to how often
24 you did experience problems because of financial
25 reasons?
0018
1 A. I would not like to say. I have not kept any records at
2 all, I am afraid. It did happen occasionally.
3 Q. If then the difficulty was not financial, it was
4 a willingness to try and get somebody in but there might
5 still be difficulties, I think you were saying, because
6 the staff were not actually available --
7 A. Then we would go out to an agency and there was one
8 particular agency that had fairly experienced trained
9 nurses, that although they were expensive and we tried
10 to use other agencies first, they would usually be able
11 to find somebody who had experience.
12 Q. So is this right: the first port of call would be
13 the bank?
14 A. Yes.
15 Q. The second port of call would be an agency?
16 A. Yes.
17 Q. And usually, if you went through the agencies, perhaps
18 arriving at the most expensive, but the one that had
19 well-qualified staff at the end, you would generally
20 find you would get the member of staff you needed to
21 cover the shift in question?
22 A. Generally, but not always.
23 Q. If you could not, what would be the response? How could
24 you manage the unit if you were short staffed?
25 A. The person in charge of the shift may have to care for
0019
1 patients as well, and that happened quite frequently,
2 which sometimes made it difficult if you were trying to
3 actually co-ordinate the care of the whole unit and take
4 patients. That did happen fairly frequently.
5 Q. You were there from 1977 to 1993?
6 A. Yes.
7 Q. Did you notice across that period any changes in the
8 level of pressures that you were noticing in staffing
9 terms? Were they greater, smaller, at any time?
10 A. As the workload increased, the pressures on the staff
11 increased.
12 Q. And the workload increased in what way?
13 A. When the Region recognised the cardiothoracic work that
14 was being done in Bristol, and also we had more patients
15 coming from South Wales.
16 Q. So you saw an increase in the number of patients coming
17 in throughout the period you were working there; is that
18 right?
19 A. Yes.
20 Q. In terms of the use of agency staff, did the attitude or
21 policy towards the use of such staff change in any way
22 across the years?
23 A. As the agency staff got more expensive, then
24 the reluctance to use them increased.
25 Q. Was that a particular factor at any time that you can
0020
1 remember, or was it a generalised point?
2 A. I think it had blips and starts, really. There were
3 times when finances seemed to be quite good and there
4 did not seem to be much pressure, we could have the
5 staff we wanted. Then you would go through other
6 periods where there were restrictions imposed. That
7 would also include recruiting if we had had vacancies.
8 Q. Still looking at paragraph 8 of your statement, you
9 mention that occasionally during the 1970s and early
10 1980s you did not have a registered nurse for all
11 patients on ventilators and you would use senior student
12 nurses?
13 A. These were nurses that were doing their paediatric
14 training, having already got their general training, and
15 they did it under the supervision of a registered sick
16 children's nurse.
17 Q. I think it is right that after Project 2000 started, all
18 trainee nurses were meant to be supernumerary on the
19 ward?
20 A. Yes, that happened.
21 Q. Before that, were they not supernumerary?
22 A. When I first went to the hospital they were not
23 supernumerary -- in the late 1970s -- but that changed
24 fairly quickly at the beginning of the 1980s and they
25 were classed as supernumerary.
0021
1 Q. So when you talk about using senior student nurses --
2 A. This was in the late 1970s, beginning of the 1980s, yes.
3 Q. I think that if we looked at some of the documents that
4 have been given to us by the UBHT, we would see in
5 the discussion of children's nurses staffing levels some
6 points; a mention of an embargo or prohibition on nurses
7 employed by the UBHT during overtime within the Trust or
8 the hospital. Is that a policy that you were aware of?
9 A. For a time it was, yes.
10 Q. Can you help us as to the content of the policy?
11 A. I cannot remember details, but I know they did not like
12 us doing overtime and also, hospital staff were not
13 allowed to work on the bank. Permanent staff were not
14 allowed to work on the bank, or agencies. If they did
15 work for agencies, they were not employed by the
16 hospital as an agency. But that did change.
17 Q. Do you know what the concern was behind that policy?
18 A. I think tiredness of the staff, really. I think it was
19 felt that they should not be working extra hours. It
20 was as much for the patients and their own benefit,
21 really.
22 Q. If we look, please, at UBHT 57/432, this is a copy of
23 a letter which I appreciate you will not have seen
24 before. It is a letter to the Chairman of the Bristol
25 & Weston Health Authority. If you scroll through to the
0022
1 bottom of the page, please, you will see its author,
2 Mr Hucklesby, the Treasurer. This is a letter he is
3 writing in effect to complain or to perhaps raise
4 concerns about the handling of a review of nursing
5 services. If I could invite you to read it briefly.
6 (Pause).
7 I think you will see from the letter that it
8 mentions a Mr Roy Bennett has conducted a review of
9 nursing services in November 1982, and is just about to
10 do another one.
11 Can I ask you, do you have any recollection of
12 a review of nursing services by Mr Bennett at about that
13 time?
14 A. Vaguely.
15 Q. This is not a trick question in any way; it is simply
16 that we do not have or have been unable to obtain a copy
17 of that review, so I am just inviting you to shed light,
18 if you can, on its contents in any way.
19 A. No.
20 Q. Because what the letter goes on to say and I am looking
21 at the top of the second paragraph:
22 "[He is] concerned about members of the authority
23 being placed in some difficulty in knowing how to deal
24 with an appraisal which refers to unsafe levels of
25 service when we have kept going and indeed increased
0023
1 workload since this was last said two years ago."
2 If we scroll down, we can see the date on this
3 letter is September 1984.
4 So what the concern seems to be is that there was
5 a review which mentioned unsafe levels of workload, and
6 those have gone up since it was done and another review
7 presumably, it is thought, might be about to yield the
8 same sorts of results.
9 Can help us: do you recollect what sorts of things
10 were being said about the level of the workload placed
11 upon the nursing staff at about that time; that is
12 September 1984?
13 A. I cannot remember details but I think that there was
14 just general concern throughout the hospital that
15 the staffing levels were not adequate and that the work
16 that was being done was much more acute, the children
17 were much more acutely ill, and therefore there needed
18 to be more nurses, really, to care for them. I cannot
19 remember details other than that. I know that in the
20 time I was there, we had three reviews of skill mix and
21 establishment figures. I cannot remember details of
22 this particular one.
23 Q. And those were reviews that were carried out in the
24 Children's Hospital, or within the hospitals as a whole?
25 A. I would only know about the Children's Hospital; I would
0024
1 not know about the rest of the hospitals in the
2 authority.
3 Q. If there was concern about the level of nursing,
4 staffing could be made available for children within the
5 Children's Hospital. Are you aware of whether or not
6 that concern also extended to the level of paediatric
7 nursing in the Maternity Hospital?
8 A. I do not know. I have no knowledge of the Maternity
9 Hospital.
10 Q. If we go on, please, to UBHT 102/379, we see there this
11 is a letter dated 18th December 1984 from Miss Hawkins
12 to Mr Harral. It is discussing neonatal intensive care
13 services within the district generally.
14 If we could scroll down a bit, please, we can see
15 there that the Regional Health Authority is aware that
16 a major review of nursing services has been undertaken
17 and that there is a suggested shortfall in relation to
18 the Children's Hospital.
19 Does that ring a bell with you? Would you have
20 been aware of the suggestion that there was a shortfall
21 of nurses within the Children's Hospital at that time?
22 A. Yes, but I cannot remember details.
23 Q. If we go on then, perhaps to HA(A) 29/69, we are now in
24 August 1986 with a letter to Dr Baker. This is a letter
25 written in response, I think, to a complaint about
0025
1 children being turned away from the unit.
2 If we could go down a little, please, we can see
3 there that the policy set out in relation to referrals
4 for cardiology and cardiac surgery is described, the
5 admissions policy, and then, at the bottom, there is
6 a description of the nursing staff establishment.
7 It talks about the ongoing critical problem of shortage
8 of paediatric trained nurses being the major factor
9 affecting admission rates.
10 Then, on the weekend in question -- this is
11 obviously a weekend that has given rise to a specific
12 incident -- we see that four children had to be refused
13 admission; that there was a bed complement of seven. If
14 we turn over the page, please, there is a description of
15 the bed occupancy and the need to bring in bank or
16 agency staff to ensure minimum levels of coverage.
17 Again, I appreciate that this particular situation
18 would not be within your memory, but can I ask you: is
19 that a situation that you can recollect; one in which,
20 in other words, the shortfall of paediatric nurses was
21 such that children had to be refused admission because
22 there were not the beds, the staffed beds, to take care
23 of them if they had been admitted?
24 A. Yes, that did happen. Although we had seven beds,
25 we were only staffed officially for four intensive care
0026
1 beds. So, over and above four, then we often had to get
2 extra staff in. If we could not, we would have to refer
3 patients. So, occasionally, yes.
4 Q. Occasionally? How often can you recollect this sort of
5 thing happening?
6 A. Probably more than occasionally.
7 Q. "Occasionally" could mean once a year, once a month,
8 once a week or so. Can you give us any indication as to
9 how often you can remember this sort of situation
10 arising?
11 A. More than once a month, but I would not like to be more
12 specific.
13 Q. You have told us the workload had already increased
14 throughout the period you were at the BCH; more children
15 were coming for care at the hospital. Was it also
16 a consequence of the increasing workload that
17 the pressure on staff was increasing as well?
18 A. Yes.
19 Q. And does it also follow that there therefore might be
20 more situations in which you had to turn children away
21 because you could not take care of them on staffed beds
22 throughout this period?
23 A. Probably, yes.
24 Q. Finally, if we could look briefly at UBHT 211/117, this
25 is a meeting of the Division of Children's Services.
0027
1 We are now in November 1987. It is not a meeting
2 you were present at, so again, this is not a document
3 you would have seen.
4 If we go on, please, to page 118, we see that
5 Miss Hale was describing the situation of nurse staffing
6 in the Children's Hospital and she talks about the
7 decline in nurse staffing levels and there having been
8 a crisis point for some six weeks.
9 Can you just help us a little bit, first as to
10 Miss Hale's position?
11 A. She was senior nurse at that time.
12 Q. She is describing a situation in which the nurse
13 staffing levels have declined and that the hospital is
14 under established in terms of nursing posts, but there
15 has also been a short term problem caused by either
16 staff on long-term sick leave or on maternity leave.
17 Again, looking back to the period that has been
18 described there, 1987, is that a situation that you
19 would recollect from your memories of the hospital at
20 the time?
21 A. Yes, I think so.
22 Q. The reason I ask is that if one looks back at your
23 statement, you described in paragraph 7 the temporary
24 problem caused by the loss of four sisters and the fact
25 that it took a little while for two other sisters to be
0028
1 appointed to replace them, but one gets the impression
2 that the staffing problem described there had been cured
3 by the early 1980s and thereafter you do not
4 specifically mention staffing difficulties as being an
5 ongoing factor.
6 Can you help us, please, whether that is
7 an accurate summary of your memory, or whether you would
8 say that difficulties in meeting the level of need for
9 admissions were a continuing factor throughout the
10 period you worked in the Children's Hospital?
11 A. The statement in paragraph 7 really referred to
12 separating the Intensive Care from the Baby Unit and
13 that had been resolved by the appointment of the Sister
14 for the Baby Unit and the two Sisters on to the
15 Intensive Care Unit, but, yes, there were always ongoing
16 problems with staff shortages throughout the hospital,
17 either because of recruiting RSCNs or the skill mix that
18 had been agreed by management and not necessarily by the
19 people on the ground.
20 Q. Can you help us a little on that?
21 A. I can remember one of the skill mixes that was done felt
22 that we should have less senior staff nurses and more
23 auxiliaries, which at that particular time with the
24 money we had we did not agree with, so that we were able
25 to juggle, but until Neil Snee was in post, I cannot
0029
1 remember exactly when that was, all the budget was
2 sorted out by management. I had no control of staffing
3 budgets at all. Once we had control on the unit of the
4 staffing budget, then we would try and look at the skill
5 mix between the Sisters on the unit and work out the
6 best way to use the money that we had available for the
7 patients that we had in, or were likely to have in.
8 Q. So from your point of view, devolving the budget down to
9 your level was an improvement because it gave you more
10 control over the skill mix?
11 A. It gave us slightly more control, but there were still
12 times when management would either say that there had
13 been a block on recruitment, if we had a vacancy,
14 somebody left, and then we would get adverts ready and
15 then that would be blocked because management -- it was
16 difficult to ascertain whether that came from management
17 within the Children's Hospital or management higher up
18 within the UBHT. That appointment would be blocked for
19 a period of perhaps three months or sometimes longer.
20 Q. What were the sorts of factors that might lead
21 an appointment to be blocked; financial?
22 A. Yes, financial. We were told it was financial but
23 the advantage was that we could sometimes juggle and
24 we might say lose an E grade and decide to have one and
25 a half D grades or juggle slightly with the skill mix to
0030
1 try and improve the situation in the unit.
2 Q. Can you help us as to when you achieved that level of
3 control over your budget?
4 A. As I say, it was at a time when Neil Snee was there, as
5 senior nurse. I cannot remember dates. I do not know
6 the dates he was there.
7 Q. We can check that, thank you.
8 Finishing with the documents, if we look at UBHT
9 207/5, this is now a meeting in October 1989; again,
10 I think a meeting that you were not actually present
11 at. If we go down a little bit, we will see that under
12 "Matters Arising" the first matter is the NHS White
13 Paper. The report comes back from Dr Joffe, who is
14 telling the meeting that the Secretary of State, after
15 considering all the expressions of interest, had decided
16 that the one from the children's services was not likely
17 to succeed.
18 In other words, I think the understanding from
19 this minute is that the Children's Hospital had
20 expressed an interest in becoming a Trust, a first wave
21 Trust under the NHS reforms, but had been informed that
22 that was unlikely to be a successful application.
23 Can you remember anything about the background to
24 this minute and whether or not the Children's Hospital
25 had displayed such an interest?
0031
1 A. I remember that the hospital had displayed an interest
2 in becoming a Trust, but I was not involved in any of
3 the meetings at all.
4 Q. The Children's Hospital, that is?
5 A. I do not know actually, whether they wanted to be
6 separate. I cannot answer that, I am afraid.
7 Q. I was going to ask you what you thought were the motives
8 behind any wish on the part of the Children's Hospital
9 to become a Trust, but I think from your earlier answer,
10 it would be that you do not really have any
11 recollection?
12 A. No.
13 Q. You had no involvement in that?
14 A. No, I had no involvement at all.
15 Q. From your point of view, when the UBHT became a Trust in
16 1991, did you notice any differences?
17 A. No, not really. Not that I can recall.
18 Q. If we go on, please, to paragraph 10 of your statement
19 which is at page 4, please, [WIT 121/4] we see you
20 describing the team at the BCH and you mention that four
21 paediatric anaesthetists were appointed to work on
22 a weekly basis at the ITU. Can you give us their names,
23 from your recollection?
24 A. There was Jack O'Higgins, David Hughes, Steve Mather and
25 Paul Thornton.
0032
1 Q. So they were general paediatric anaesthetists without
2 a specific expertise in cardiac anaesthesia; is that
3 right?
4 A. I would not like to say what their expertise was at
5 all. I know that Jack O'Higgins was very involved at
6 the BRI. The others had a particular interest in acute
7 paediatrics.
8 Q. From the point of view of the nursing staff, we have
9 discussed already whether or not you felt that
10 paediatric experience was important to the nursing of
11 children who had cardiothoracic surgery. What about the
12 knowledge of the cardiothoracic surgical needs that you,
13 as nurses, had? Were there any times that you felt
14 that, because you were nursing on a general ICU, your
15 experience of the particular types of difficulties
16 following surgery might not be enough?
17 A. No, I do not think so. The open cardiac surgery was all
18 done at the BRI, not at the Children's Hospital, and as
19 the workload increased and we had more Sisters appointed
20 with added expertise which they brought to the hospital,
21 they talked to those who did not have the expertise. So
22 we had the expertise there.
23 Q. You mentioned that the doctors ran the ICU as a team.
24 What do you mean by that?
25 A. I am not sure at what stage, I think it was when the
0033
1 Intensive Care Unit was recognised by Region, Peter
2 Fleming was appointed as an intensivist for the unit.
3 He was a neonatologist based at the Maternity Hospital,
4 St Michael's Hospital as it is now. We had a round
5 first thing in the morning and present on that would be
6 the anaesthetist on for the week --
7 Q. Can you speak up a bit ?
8 A. The anaesthetist who was on for the week, the
9 cardiologists, the cardiothoracic surgeons, if they had
10 patients in at that particular time, and usually the
11 Paediatric Registrar who was on call for that day, plus
12 the Senior House Officer who was based on the unit at
13 all times, and the Anaesthetic Registrars who were based
14 on the unit as well.
15 So it was a very full round in the morning and
16 they had a further round at about 5 o'clock in the
17 evening, and then the paediatric team, which may include
18 the cardiothoracic senior registrar or consultant would
19 come around later, usually before the night,
20 10 o'clockish, and they would discuss very fully
21 together the needs of each particular child. Obviously,
22 if it was a cardiothoracic child, that discussion would
23 be led by the surgeons. Cardiologists would lead if
24 it was a child who had not actually been seen by the
25 surgeon at that time.
0034
1 Q. How did the surgeons manage to integrate that ward round
2 commitment with their work at the BRI?
3 A. I do not know that they did. If they were operating
4 obviously they would not perhaps be able to be at the
5 main ward round, but then they would come up later.
6 They would certainly have been on the phone.
7 Q. So if there was an operation down at the BRI, it might
8 be difficult for them to make the morning ward round;
9 is that right?
10 A. Yes.
11 Q. What sort of time did that take place, normally?
12 A. About 8 o'clock.
13 Q. And what about the afternoon ward round? Would they
14 generally be able to make --
15 A. It was about five o'clock, and either the cardiothoracic
16 senior registrar or the consultant would attend, yes.
17 There would be somebody there, depending on what their
18 operating lists were.
19 Q. Did you notice what demands the fact that the open-heart
20 surgery was taking place at the BRI placed on the
21 cardiologists?
22 A. Not unduly. I think they used to go down to the BRI, as
23 far as I am aware, after the round had been done at the
24 Children's Hospital and depending on the needs of the
25 child at the BRI, but I would not like to comment on
0035
1 that really.
2 Q. You go on to describe at paragraph 11 the breakdown of
3 the work between the BRI and the BCH and then, at
4 paragraph 12, you describe the hand-over of children who
5 had been taken down to the BRI and also the return back
6 to the BCH, if that took place.
7 Can you tell us: did you ever notice any
8 difference in the management of the children in the two
9 sites, in that you may have noticed differences in the
10 way that children had obviously been cared for at the
11 BRI when they came back from the BCH?
12 A. Occasionally we would find that perhaps a child, not
13 slightly uncared for, I think perhaps some nurses were
14 a little afraid to perhaps do the lines and things, with
15 less experience than we had, but generally the handover
16 was very full and we always knew what sort of lines and
17 drips and drains and things were present before
18 the child came up so that we had the equipment
19 available.
20 Q. You say a nurse -- I did not quite catch your words --
21 with less experience might have some difficulty with the
22 lines?
23 A. Well, sometimes you think, well, that baby perhaps could
24 have had a wash and a brush-up before it was
25 transferred, but I mean, it was not a big problem.
0036
1 Q. And how well did communication between the two sites
2 work, to manage a transfer, in your experience?
3 A. The staff at the BRI would phone us and inform us, as
4 I say, of drips and drains and particular drugs that the
5 child was on before they were transferred up.
6 Occasionally we would get -- they would forget to phone
7 us to say that the child was actually on the way, and
8 that could cause a problem if we were in the middle of
9 an acute situation. If they phoned we might have said
10 can you hang on for half an hour or an hour or
11 something. That was not a frequent occurrence.
12 Q. If we look at medical record MR 722/63, this is
13 a page from a medical record which relates to a child
14 which we have seen already in the Inquiry. I would just
15 like to ask you to look at one part of it. If we can
16 just blow up the first part, it is a record of
17 a transfer from Ward 5 up to the Children's Hospital and
18 you will see there, if you can decipher the usual
19 medical handwriting:
20 "Transferred from Ward 5. Arrived unannounced as
21 usual ..."
22 Then it goes on to give the detail of the repairs
23 that were carried out on the child in question.
24 I would like you to comment on the phrase "Arrived
25 unannounced as usual."
0037
1 Is that something that accords with your
2 experience of how handovers were managed, or not?
3 A. I think that is a bit harsh, personally.
4 Q. I think you said that it happened occasionally?
5 A. It did happen occasionally, but not -- I would not have
6 said it was a routine, that they all came up without
7 being announced, not in my experience.
8 Q. Again, "occasionally" can mean once a year, twice
9 a year, once a month?
10 A. I would not like to say.
11 Q. Something that you can remember occurring, but not with
12 great frequency?
13 A. Yes, but not as a big deal, really.
14 Q. Thank you. If we can go back to your statement then, at
15 page 5 in paragraph 13 you talk about the parents
16 obviously being concerned about children, needing
17 a great deal of counselling.
18 Are you using "counselling" in a technical sense
19 there, or would perhaps "support" be a --
20 A. Yes, support.
21 Q. What sort of things did you have in mind?
22 A. They needed somebody they could talk to, somebody that
23 was going to be with them. They needed to know what the
24 situation was going to be at the BRI because it was very
25 different from the Children's Hospital, the Intensive
0038
1 Care Unit there at that time. The babies were being
2 nursed amongst the adults, so it was a more open,
3 vast-looking perhaps to a mother of a small baby who had
4 been used to the smaller, more intimate situation we had
5 up at the Children's Hospital.
6 Q. If we go over the page, please, looking at page 6, you
7 mentioned that you do not think that the relationship
8 between the two counsellors over the years was
9 particularly warm, although you did not think that had
10 an adverse impact on the information and support given
11 to parents.
12 Can you tell us, how did you get that impression?
13 A. The two counsellors seemed to resent each other, really,
14 and at times did not perhaps communicate as well as they
15 should have done.
16 Q. Do you know what that resentment might have been founded
17 on?
18 A. Personalities, probably. Helen Vegoda, obviously, was
19 very involved with the children that we had had up at
20 the Children's Hospital. Some of them may have been in
21 for quite a long time and therefore she was quite
22 involved with the families. When they went down to the
23 BRI, that support was taken over by Helen Stratton.
24 Helen Vegoda wanted to continue the support herself
25 because she knew the families, but Helen Stratton was
0039
1 the counsellor employed by the BRI, so therefore felt
2 that it was her job to take over.
3 We talked to them about it, really to make sure
4 that they remained professional, particularly in their
5 behaviour in front of the families. It was agreed that
6 if a family particularly wanted Helen Vegoda to continue
7 as their support, then that would happen, although the
8 majority would be handed over to Helen Stratton in
9 a professional way.
10 Q. Had there been concerns that this dispute as to
11 demarcation, if I may call it that, had led to
12 situations where families had picked up a tension
13 between the two?
14 A. I have not actually been told of any, but certainly as
15 nursing staff, we were aware of it.
16 Q. How were you aware of it?
17 A. By small comments from one about another.
18 Q. Did you have many dealings with Helen Stratton yourself?
19 A. Some. She would sometimes come up and see the children
20 up at the Children's Hospital. She also helped with
21 some counselling sessions that we ran for nurses for
22 a short time, so she was quite helpful; she was not
23 somebody that I did not get on with. We all sort of --
24 Q. Helen Stratton has given evidence to the Inquiry that
25 for a time, and certainly by mid-1993 -- so, by
0040
1 the time that you left -- she was concerned about the
2 quality of the surgery that was being undertaken at
3 the BRI. Did you ever pick up from her any reflection
4 or hint as to these attitudes on her part?
5 A. No, not at all. Not at all, because I think if she had
6 mentioned it to any of the team up at the Children's
7 Hospital, we would have perhaps spoken to, I do not
8 know, the cardiologists, perhaps, Dr Joffe who was the
9 Clinical Director at the time, or to the surgeons
10 concerned. But certainly she never made any reference
11 to me about any concerns about the surgery at the BRI.
12 Q. She said, I think, that she spoke to nurses at the BCH;
13 she was on friendly terms with them.
14 Are you aware of any contact she had with other
15 nurses at the BCH?
16 A. I think she was quite friendly with Brigid O'Reilly, but
17 I am not sure whether they met socially. I do not
18 know. I cannot comment on that.
19 Q. And in any event, does it follow from what you were
20 saying earlier that Brigid O'Reilly did not come back to
21 you with any comments from Helen Stratton about surgery
22 at the BRI?
23 A. No, she did not.
24 Q. When you had any dealings with Helen Stratton, did she
25 ever discuss with you at all the surgery at the BRI or
0041
1 the care of children at that centre?
2 A. No.
3 Q. If we go on then, please, to paragraph 15 of your
4 statement which is over the page at page 7, you mention
5 there the employment of Catherine Warren at the BRI.
6 At this point I think we should go to page 13,
7 please, of the witness statement; where the UBHT has
8 offered comments on your statement and the point that
9 they make there is that Catherine Warren was a staff
10 nurse who had been employed in the cardiac surgery unit
11 from somewhere in the mid-1980s, and they say that in
12 the early 1990s, she was seconded and therefore received
13 full staff nurse payment to train as an RSCN, and she
14 returned to the cardiac surgical unit with this
15 qualification in around 1992.
16 Is that information that accords with what you can
17 remember of her?
18 A. Yes.
19 Q. They then go on to say a further RSCN was appointed to
20 the BRI cardiac surgical unit in 1994 --
21 A. I had left by then.
22 Q. So you have no knowledge of that?
23 A. No knowledge of that, no.
24 Q. In any event, what they appear to be confirming there is
25 that there was no RSCN appointed until 1992 at the BRI
0042
1 in Ward 5?
2 A. That is as I recall.
3 Q. That is as you recall, thank you. Perhaps we should
4 just note that they also go on to say that the impetus
5 for providing a more formalised children's training for
6 staff nurses was not because of any practical
7 difficulties for the staff undertaking that role at the
8 BRI, but rather in order to conform to national
9 recommendations on the care of children.
10 I think it is fair to say that you yourself do not
11 have any detailed knowledge of nursing at the BRI?
12 A. No, I do not.
13 Q. So you could not comment on the impetus for that change?
14 A. No, I could not.
15 Q. If we go back to paragraph 16 of your statement, you
16 mention at the bottom of that paragraph that there were
17 systems or exchanges in operation between the BRI and
18 the BCH to give nurses working on Ward 5 more experience
19 of working in a paediatric environment; is that right?
20 A. Yes.
21 Q. Can you remember how long that system operated for?
22 A. For a few months, but not as long as we would have
23 liked. Because of staff shortages at the BRI, they were
24 unable to release the staff.
25 Q. Because if we look at WIT 234/13, please, this is
0043
1 a statement from Barbara Sheriff, whom I think you will
2 remember.
3 A. Yes.
4 Q. If we look briefly at paragraph 63, her memory was that
5 there was an attempt to arrange an exchange of nurses
6 but it was not very practical, as all the posts were
7 within the required establishment and the skills were
8 different for both units.
9 Then she goes on to comment on the shortage of
10 paediatric trained nurses.
11 Is that a comment that you would agree with?
12 A. Yes. We were very rarely able to send anybody down to
13 the BRI. I think we did attempt it for a while, but
14 because of the staff levels, we were not able to
15 continue it.
16 Q. What do you think she means when she says that the
17 skills were different for both units? Is that something
18 you would agree with?
19 A. The work and the care of the children having open
20 cardiac surgery is different from closed cardiac
21 surgery, and we may not always have had cardiac patients
22 on the unit. It was a general Intensive Care Unit, so
23 there were general paediatric patients a lot of the
24 time.
25 Q. If we go back to your statement, paragraph 16, you
0044
1 mention that there were very few joint meetings with the
2 staff at the BRI. That leaves open the question of
3 whether you thought such joint meetings were useful?
4 A. I think they could have been useful, but I do not think
5 either of us really had the time to do -- in fact I made
6 a mistake there, because the liaison person there was
7 Julia Thomas, not Julia Crawley. I made a mistake and
8 I apologise for that.
9 Q. Do you think they were useful?
10 A. I think they could have been useful but, as I say, with
11 the staffing levels the timing factor did not work out,
12 really.
13 Q. But if they might have been useful, that implies there
14 was a gap or at least some information that could have
15 been transferred at such meetings. What do you think
16 that was, if anything?
17 A. I think it would have just improved communications
18 between the two units, with the care of the families,
19 but nothing specific, really.
20 Q. If we just run on to paragraph 17 of your statement,
21 please, in the last sentence of that -- this is now
22 page 8 of the statement -- you mention the role of
23 Mr Keen covering paediatric surgery prior to the
24 appointment of Mr Dhasmana.
25 If we look at WIT 121/12, this is the comments of
0045
1 Mr Keen himself. He mentions that in the late 1970s,
2 he, in common with most other surgeons of his
3 generation, gave up paediatric cardiac surgery and spent
4 the rest of his time working on open-heart surgery in
5 adults only.
6 Our understanding, at present, is that he was not
7 involved in paediatric cardiac surgery, therefore,
8 during the period of the Inquiry's terms of reference?
9 A. Yes. I was not sure what date he had stopped caring for
10 the children, so that was the only reason I mentioned
11 him.
12 Q. It follows, therefore, that you do not yourself remember
13 him being involved in paediatric cardiac surgery from
14 1984 onwards?
15 A. Not if he had stopped before that time, no.
16 Q. If we go on, then, please, to paragraph 20, page 9 of
17 the statement, you describe the process whereby
18 Mr Wisheart and Mr Dhasmana gave explanations to
19 families of the sorts of congenital heart defects that
20 their children had and the surgical interventions that
21 were being proposed.
22 You mention there that counsellors or nurses
23 always sat in on these meetings with the parents.
24 Was that an invariable practice?
25 A. Yes. I mean, we felt that there should be either
0046
1 a nurse or a counsellor there to answer questions the
2 parents may have afterwards, because a parent's recall
3 in an acute situation is fairly low, really, as to what
4 has been said to them. We tried to get the nurse
5 looking after the child in there if we could, but
6 obviously it depended a bit on the workload on the unit
7 at the time, or the person in charge of the shift may go
8 in plus or minus the nurse counsellor, the cardiac
9 counsellor.
10 Q. Would you have achieved a nurse or a counsellor being
11 present in all these meetings if the children with their
12 parents had come in as outpatients rather than being
13 inpatients?
14 A. No, not from the unit, we would not have. I do not know
15 what the situation was in outpatients. So far as
16 I know, while Helen Vegoda was in post as the cardiac
17 counsellor, then she would attend the outpatients and
18 therefore would be in. That is as far as I am aware,
19 but I cannot say that it is a fact.
20 Q. So what you are describing there, then, is the practice
21 in relation to inpatients at the BCH; is that right?
22 A. It is the practice on the Intensive Care Unit.
23 Q. You go on to say that many of the children who were the
24 subject of discussions were very sick and in your view
25 would not have survived transfer to other units in the
0047
1 country. What evidence do you have for that statement?
2 A. Just the state that the child was in at the time.
3 Some of the children had been born in one hospital,
4 transferred to another, then transferred up to us.
5 Some had to be resuscitated before they were transferred
6 to the Children's Hospital, and some of them were very
7 sick.
8 Q. But if open-heart surgery was to be undertaken, it would
9 have to take place in the BRI?
10 A. Yes.
11 Q. So the child would have to be stabilised sufficiently to
12 manage that short transfer?
13 A. Yes.
14 Q. Are you able to help us on the level of challenge for
15 the child, the difference between managing a transfer
16 across one short distance as opposed to across a longer
17 distance up to another unit, for instance?
18 A. It is the time factor, really. Although the child will
19 be ventilated as necessary during transfer if they are
20 already being ventilated, they are still in an enclosed
21 space of an incubator with a bumpy journey in an
22 ambulance, which is not particularly good for them,
23 really. Some of them, you just had the feeling that
24 they would not have survived a long transfer.
25 Q. You sat in on a number of discussions, obviously, with
0048
1 Mr Wisheart and Mr Dhasmana, with the parents. Can you
2 remember instances in which the possibility of transfer
3 to another unit was discussed with the parents?
4 A. Not specifically, no.
5 Q. Was there any sense that you had of particular cases or
6 particular types of procedure or defect that, within the
7 unit, would have been recognised as being ones that
8 would be suitable for at least consideration of transfer
9 to another unit?
10 A. I did not have a lot of experience with the switch
11 operation, which is obviously one that has been
12 discussed quite a lot. Some of them were at a time when
13 I was off sick or not on the unit, so I really cannot
14 comment on them.
15 Q. I was trying to explore that you might, in a unit, have
16 a sense that the unit was generally able to cope and
17 would undertake the surgery required on all the children
18 that came through its doors, or you might have a unit
19 which had a protocol or an explicit recognition that
20 some types of defect or condition might well require at
21 least consideration of transfer to another unit.
22 If those two possibilities are true possibilities,
23 are we dealing with the first or are we dealing with the
24 second?
25 A. My experience was that we were dealing with the first,
0049
1 probably.
2 Q. If we go on, then, to paragraph 24 of your statement,
3 you talk there about the GMC proceedings and, I think it
4 is fair to say, this is your personal reaction?
5 A. This was my knowledge of the GMC proceedings, yes.
6 Q. So is it right to record that, as a matter of history,
7 you are a member of the Surgeons' Support Group?
8 A. Yes, I am.
9 Q. Would you like to tell the Inquiry briefly why you made
10 the decision to join that group?
11 A. Because I have no doubts that Mr Dhasmana and
12 Mr Wisheart spent their lives looking after and doing
13 the best that they could for the children. They often
14 gave them the last chance they had of survival. If they
15 had not been offered surgery, then a lot of the figures
16 would have been different anyway, because they would not
17 have come under the surgeon's statistics. Their only
18 concern was not for their own glory but to save the
19 lives of the children that they were looking after, and
20 I feel very strongly that they are being victimised,
21 really; they are being accused of being sort of "callous
22 and uncaring", was one of the comments I heard, and this
23 was not true at all. I have seen both of them cry when
24 babies have died, particularly unexpectedly. They never
25 considered that it was just another operation or another
0050
1 sort of type of surgery; it was a patient who was
2 a patient in its own right and the family were very
3 important to them. They were never dismissive.
4 Sometimes perhaps the parents did not see that,
5 but I have seen great distress in both of those men when
6 children have died.
7 Q. I think it is also right to record that as a result of
8 your involvement with the group, you telephoned some
9 parents in order to see whether they might write letters
10 in support of the surgeons; is that correct?
11 A. Yes, that is correct.
12 Q. And would you like to say how you got the telephone
13 numbers or contact names for those parents?
14 A. They were issued by the solicitors of the two surgeons.
15 The names and addresses came from letters of support
16 that had been sent to the surgeons, and then the names
17 and phone numbers were issued by the solicitors so that
18 we could contact them.
19 Q. Miss Woodcraft, I have asked a number of questions in
20 seeking to explore some of the detail behind your
21 statement this afternoon. Is there anything else that
22 you would like to tell the Inquiry, or add to the
23 evidence that you have given to us already, obviously
24 both in written and in oral form?
25 A. I do not think so. It is just that the honesty of the
0051
1 surgeons when dealing with the families and the care
2 that they showed, I think it is very important that this
3 is known, really.
4 MISS GREY: The Panel may have some questions for you.
5 Examined by THE PANEL:
6 MRS HOWARD: Mrs Woodcraft, we have talked for some time
7 this afternoon about staff shortages, and I think you
8 also referred earlier in the transcript to your fight
9 sometimes for staffing but that you always won, and
10 I think you used words like that when you talked about
11 management?
12 A. We nearly always won, yes.
13 Q. Can you recall any time when you yourself used the words
14 "unsafe staffing", or that you had staffing which was
15 unsatisfactory to you as the professional in charge of
16 the shift?
17 A. Yes, there were times when I used those words.
18 Q. To whom did you use those words?
19 A. Initially to the Hospital Co-ordinator; also the General
20 Manager or the Nurse Manager.
21 Q. What was the response when you did use those words?
22 A. They listened. Sometimes they would find us extra
23 staff, sometimes not. We would just have to cope as
24 best we could. But most of the time they would try and
25 find us extra staff. I think they realised that if we
0052
1 were making enough noise, we were serious about the
2 concerns we had.
3 MRS HOWARD: Thank you.
4 THE CHAIRMAN: There are no more questions from the Panel,
5 Miss Woodcraft. May I remind you, as I remind everyone,
6 if there is anything else that comes to your mind that
7 you would want to bring to our attention, we would be
8 pleased to receive it. But for today, for this
9 afternoon, thank you very much for coming. I am sorry
10 you had such an awful trip, but you have helped us
11 a great deal, thank you.
12 (The witness withdrew)
13 MR LANGSTAFF: Sir, tomorrow, again for reasons that respect
14 the convenience of witnesses, we do not begin before
15 one o'clock in the afternoon. We shall then hear from
16 Dr Marian Pitman, who was the former Regional Consultant
17 in Public Health Medicine. In some documents I think
18 she is known as Marian Pearce, before, as we understand
19 this (we will confirm this tomorrow) she was married and
20 became Marian Pitman. That is what is on the cards for
21 tomorrow.
22 THE CHAIRMAN: Thank you, Mr Langstaff. I suspect that it
23 is probably the last day on which we will have a lighter
24 load than usual until we end in December, but we adjourn
25 now and reconvene tomorrow at 1 o'clock.
0053
1 MR LANGSTAFF: Sir, the load up here may be lighter. Down
2 below, where the engine room is, it will be just as
3 heavy as ever!
4 THE CHAIRMAN: Of course.
5 (2.07 pm)
6 (Adjourned until 1.00 on Wednesday, 6th October 1999)
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12 I N D E X
13
14
15 STATEMENT BY MR LANGSTAFF ........................ 1
16
17 MISS JOYCE MARIAN WOODCRAFT
18
19 Examined by MISS GREY ...................... 3
20 Examined by THE PANEL ...................... 52
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Published by the Bristol Royal Infirmary Inquiry, July 2001
© Crown Copyright 2001