Final Report > Chapter 12: Responses to Concerns and Actions Taken, and Whether Such Actions were Appropriate and Prompt > Responses within the UBH/T > Mr Wisheart as Medical and Clinical Director

Mr Wisheart as Medical and Clinical Director

36 We reached the following views as regards the actions of Mr Wisheart:

• Mr Wisheart could be said to have been too close to the issues to act objectively as a manager and director, since he was the senior surgeon in the area and an important focus of the concerns. He would have had great difficulty separating the personal from the professional. It is no surprise that his response was denial and inaction. He lacked the insight to understand or admit the inherent conflict of interests in which he found himself. Otherwise, he would have advised Dr Roylance to seek advice from as wide a spectrum of opinion as possible, both within the hospital and beyond.
• Given that Mr Wisheart knew that the solution to the problem of the PCS service (consolidating all aspects of care at the BRHSC and appointing a new paediatric cardiac surgeon) had been agreed in principle for some time, he chose as a surgeon to believe that things would gradually get better, as regards increasing the numbers of patients treated and generally improving outcomes. He also persuaded himself that plausible justifications existed to explain the poor results obtained at Bristol. Indeed, he would not admit that the results generally, or his own in particular, were poor until, very late in the day, he accepted as much as regards his operations to correct Atrio-Ventricular Septal Defect. He adopted an approach based on optimism rather than reality, but this is a judgment of hindsight. At the time, there was enough room for doubt for him to persuade himself that things would improve, whatever others might think.
• Mr Wisheart's management style was perceived by some of those around him as autocratic. He was part of the `club culture' which fostered a sense of `them and us'. The consequence was that Mr Wisheart was not likely to be approached by colleagues, especially `junior' colleagues who might have concerns. Nor would he pay great attention to what he would regard as unsubstantiated rumour, or to what he might have felt was insubordination in the case of Mrs Ferris, when she questioned him about his figures on PCS. [38] Again, this was a regrettable barrier to the sort of open communication which should characterise the management of a unit or directorate in a large hospital.
• As a manager, he was far too busy with far too many responsibilities. Although Mr Wisheart claimed that he was able to carry out all his many responsibilities without difficulty, we take the view that this suggests a lack of insight. It may also have reflected a regrettable lack of willingness to relinquish authority and power. In particular, communication, continuity of care and leadership are crucial to the successful organisation and delivery of the post-operative intensive care of PCS patients. But, there was a failure to achieve this, due in large part to the system whereby Mr Wisheart retained overall control of the care of children in intensive care, while undertaking his surgical and other responsibilities.
• As a manager, Mr Wisheart did not show leadership in creating teamwork or co-operation. His style of leadership was ill-suited for such an essentially co-operative activity as PCS.
• As a manager, he misled the Trust Board as to the results achieved in paediatric cardiac work, in particular in the report of 8 April 1994. [39] This was wrong and warrants strong criticism.
• As a manager and colleague, he failed to tell the extraordinary meeting called to discuss the care of Joshua Loveday that Dr Roylance had in mind to commission an independent review of the PCS service, which we conclude Dr Roylance had discussed with Mr Wisheart. We recognise that Mr Wisheart's reason for not doing so was to avoid putting greater strain on Mr Dhasmana. We regard this as wrong-headed. When the question of whether to proceed or not was in the balance, we have little doubt that if the meeting had learned of the proposed review, the clinicians would have decided not to proceed with surgery but to make other arrangements. Mr Dhasmana told us as much in his evidence, [40] although this is the judgment of hindsight. Whatever his motive, Mr Wisheart's failure to tell the meeting was a serious error of judgment.

37 Mr Wisheart's actions as a manager were characterised by seeking to reassure Dr Roylance and the Trust about the PCS service on the one hand, while, on the other hand rejecting or denying concerns brought to him by others. By adopting this approach, he inhibited any proper examination of the PCS service from taking place. During the discussion of Joshua Loveday's treatment, his actions as a manager were characterised by ambivalence. He recognised the level of concern being expressed, but he, Dr Joffe and other, senior, long-serving clinicians were excessively defensive of the performance of the PCS service. It may be that this defensiveness was reflected in deciding, collectively, to support the plan to proceed with the operation rather than acknowledging that the team, and the surgeon at the centre of it (Mr Dhasmana), might not be the best team to perform the surgery. Mr Wisheart's preparedness, albeit reluctant, to let the operation go ahead showed a lack of appreciation of the effect that the surrounding stress could have on Mr Dhasmana and the rest of the team. His failure to advise Dr Roylance to seek to stop the operation was inappropriate.

38 Mr Wisheart's actions, as a manager, after the tragic death of Joshua Loveday, were characterised by a degree of denial and self-justification (which remained his approach when giving evidence to the Inquiry in December 1999). This added to the poisoned atmosphere at the BRI and was inappropriate.

Footnotes

[38] T87 p.183 Mrs Ferris

[39] UBHT 0020 0015

[40] T87 p.43 Mr Dhasmana