Final Report > Chapter 15: The Culture and Management at the UBH/T > Resources

Resources

12 Poor resourcing in terms of equipment and staffing for the PCS service was tolerated. Although resources generally were constrained and there were national as well as local shortages of cardiologists and properly trained nurses, effective measures to ameliorate the difficulties were not taken. The PCS service simply did not have the necessary priority for the UBHT to provide the service which could legitimately be expected of a supra regional centre. For example, on 31 January 1992 Mr Arthur Wilson, Deputy RGM of the SWRHA, offered advice on how to lift the pressure on the service for adults, by suggesting that open-heart surgery be moved to the Chidren's Hospital. He wrote to Dr Roylance inviting him to produce a proposal for capital funding for cardiac services taking into account a) increased capacity; b) unification of children's services; and c) steps to meet quality and cost concerns of purchasers. [14] Thus, albeit as a side-wind of the need to meet the demands of adult patients, the service for children was being offered a way forward. Dr Roylance's initial response dated 12 February [15] stated that he welcomed the approach, and the Trust responded with a full proposal developed by the Clinical Director and the General Manager for Cardiac Surgery by the 9 March deadline set by Mr Wilson. [16] But nothing came of the bid.

13 Mr Graham Nix, UBHT Finance Director, clearly believed that resources for open-heart cardiac surgery should be found by expanding the adult service. But, if everything else stayed constant, this meant placing limits or constraints on the paediatric service. [17] Eventually, as Mr Nix conceded, open-heart surgery was moved to the BRHSC, so as to meet the increased demand for adult surgery at the BRI, not out of any recognition of the legitimate needs and claims of PCS. In other words, while it had long been contemplated that open-heart surgery would move to the BRHSC, it was not until the pressure to meet the needs for adult surgery, and gain the financial benefits which would follow, that in fact action was finally taken.

14 There is a pervading sense of PCS being in the way, preventing the UBHT from increasing its income from the care of adult patients. The extremely high workload and dedication of staff were taken advantage of, rather than mobilised towards achieving any clear objectives. For example, perhaps with more managerial expertise the shortage of paediatric experience among the nurses in the ICU at the BRI might have been improved by encouraging the initiatives of Helen Stratton, Cardiac Liaison Nurse, UBH/T, 1990-1994 to bring the paediatric nursing expertise of the BRHSC to the BRI. Instead, the attempt came to a halt as a result of turf wars between the two counsellors at the BRHSC and the BRI respectively. Similarly, the provision of essential equipment from charitable sources might have been better planned to ensure compatibility and cost-effectiveness.

Footnotes

[14] UBHT 0038 0410; the letter was dated 31 January 1991 but was received in February 1992, therefore should have been dated 31 January 1992

[15] UBHT 0038 0408; letter dated 12 February 1992

[16] UBHT 0038 0369; letter dated 9 March 1992

[17] WIT 0106 0044 Mr Nix