Final Report > Chapter 12: Responses to Concerns and Actions Taken, and Whether Such Actions were Appropriate and Prompt > Responses within the UBH/T > Dr Roylance

Dr Roylance

33 We reached the following views as regards the actions of Dr Roylance:

• Dr Roylance did not act upon Dr Bolsin's observation in the letter of July 1990. It is doubtful, however, whether the message Dr Bolsin claimed that he intended to signify in his letter was sufficiently clear and strong to prompt Dr Roylance to take the matter further.
• Dr Roylance relied on Mr Wisheart, whether in his role as Medical Director, Clinical Director, or the senior cardiac surgeon, to advise him when the PCS service surfaced as an issue. On one view, this could be said to be appropriate. It could also be said, by contrast, that Mr Wisheart's advice was inevitably tainted by personal involvement, such that Dr Roylance should, as a manager, have obtained a second opinion. Dr Roylance did not agree to a review of the PCS service until December 1994. On any view of the evidence, this was excessively late. Furthermore, it was not appropriate in the circumstances to ask Mr Wisheart to organise the review.
• Dr Roylance's style of management was to insist on a clear demarcation between clinical and managerial issues (notwithstanding the fact that the distinction cannot be sustained). [34] It would be in keeping with this style that clinicians might be reluctant to approach him about matters of concern to them, and that he, for his part, would make it clear that he did not wish to hear or get involved in them. Concerns were raised with Dr Roylance in exchanges with Dr Bolsin, Professor Prys-Roberts, Professor Angelini and Dr Monk (although Dr Roylance does not accept this). He failed to respond to them. This managerial approach could be categorised as wilful blindness, but this is the judgment of hindsight. If, by seeming to insist that clinicians solved problems for themselves, he empowered doctors to get on with looking after patients, it was clearly reasonable. Moreover, it was entirely within the spirit of the reforms proposed by the Griffiths Report. [35] But the Inquiry regrets that Dr Roylance lacked sufficient awareness of the potential problems associated with this style of management, particularly with regard to the barriers it created to effective communication. In particular, the organisational structure created in the UBH/T, while providing for communication within a particular unit or directorate, was not at all suited to allow communication across units and directorates. This made it difficult to envision or carry out any overall strategy. Furthermore, Dr Roylance failed to appreciate that if clinicians were to be involved in management, there was a significant need for training and support for them.
• This management style, plus Dr Roylance's preparedness to rely on Mr Wisheart, meant that he refused to engage with Dr Monk and read the anaesthetists' letter in the summer of 1994 when Dr Monk showed it to him and tried to get him to read it. This could be said to be an over-rigid adherence to non-involvement in clinical matters. Any notion that his involvement would undermine the doctors' sense of empowerment could be discounted, since it was they who were asking him to get involved. This incident speaks of an inappropriate degree of rigidity. A good manager should retain the flexibility to contemplate varying his approach to management, particularly when the safety of patients is, or is said to be, at stake.
• Dr Roylance's decision not to become involved in what he saw as a matter for the clinicians to decide, namely whether to proceed with the operation on Joshua Loveday, conforms with his style of management. He was, as a manager, anxious to see that a system was in place whereby the clinicians could reach an informed view. However, while his approach is consistent with his style of management, it also illustrates the rigidity of Dr Roylance's thinking.
• When approached by Dr Doyle in late 1994, Dr Roylance did not share the relevant correspondence promptly or fully with the Trust Board or the Chairman, Mr McKinlay. He was, however, misled by Mr Wisheart's memo of 4 September 1994, [36] which unjustifiably described the problems referred to by Dr Doyle as relating to one procedure only, the rest of the work being said to be acceptable or better. That said, Dr Roylance also misled the DoH by implying in his letter to Dr Doyle that the Trust Board were aware of the problem when they were not.
• Once it was known that Joshua Loveday, sadly, had died, Dr Roylance instigated the independent review of the PCS service. Albeit belated, this was an appropriate response. It was not appropriate, however, to assign the organisation of the review to Mr Wisheart, given his central involvement in the PCS service and the need for the review to be seen to be independent.
• Dr Roylance secured the appointment of Mr Pawade and the move of PCS to the Children's Hospital (together with the start of the construction of a new Children's Hospital). By these achievements, he could be said to have resolved the long-running problems of the split site and service. That it took many years is to be regretted but cannot be a ground for criticism of Dr Roylance. What is of concern is the management and conduct of the PCS service in the years between the decision and its fulfilment.

34 We conclude that Dr Roylance's behaviour was characterised initially by inaction. He relied too heavily on Mr Wisheart and was persuaded that action was not required. In the context of the care and safety of children, Dr Roylance, as the senior manager, had two options: he could insist that he would only do something if his close colleague Mr Wisheart could be proved wrong; or he could agree to look into the matter more thoroughly. The weight of the evidence and argument is that he should have done the latter. Thus, his inaction was not appropriate. He lacked awareness of and insight into the potentially negative effect his `silo' style of management had on lines of communication between directorates within the hospital; he also was unaware of the potentially negative effects of the concentration of power and influence in the hands of a small elite group within the hospital. To this extent he can properly be criticised. We stress that we make these criticisms of Dr Roylance in his role as a manager.

35 We are aware that Dr Roylance was also a doctor. We do not, however, regard this fact alone as warranting an assumption of responsibility for the care of every child (or children generally) admitted to the UBH/T. There must be circumstances (and becoming involved in senior management to the exclusion of clinical practice must be one), in which someone who is a registered medical practitioner can put aside his duty to any particular patient (because he has none) and take up his managerial duty on behalf of all patients under his responsibility. We are aware that Dr Roylance continued to maintain a clinical session and that this complicates matters. But we hold generally to our view. To this extent, it follows that we do not agree with the decision of the Privy Council in Roylance v GMC, [37] to the extent that it decides otherwise.

Footnotes

[34] In an exchange with the Chairman, Dr Roylance said: `I was in the habit ... of telling people whether they were talking to John Roylance, whether they were talking to Dr John Roylance, or whether they were talking to the Chief Executive.'; T89 p.37 Dr Roylance

[35] See Annex A Chapter 2

[36] UBHT 0061 0276

[37] A decision reported at [1999] AC 139