Final Report > Chapter 16: The Organisation of the Paediatric Cardiac Surgical Service in Bristol > The physical environment

The physical environment

2 We visited the BRI and the BRHSC (in St Michael's Hill) on 22 July 1999. [1] We make here some general comments. First, we emphasise that our visit was already 14 years after the beginning and four years after the end of the period covered by our Terms of Reference. Children undergoing open-heart surgery are all now cared for in the BRHSC. [2] There are no longer children in Ward 5 of the BRI. That said, we were told that the physical arrangements had not greatly changed.

3 We were shocked by what we saw at the BRI. There was a sense of delapidation. The corridors were dirty, with an array of discarded equipment and bric-a-brac pushed against walls and in corners. The Intensive Care Unit (ICU) was cramped and crowded. Large items of equipment were `stored' in the middle of the room, making the space even more crowded. The area previously allocated for children was small and would have allowed little space for family members. The room set aside for parents to await news was small, cramped and windowless. The main lift used to transport children to and from the operating theatre, two floors below, was cramped and old. The space in the alternative lift was so limited that on occasions staff who should have been accompanying a child had to run up the two flights of stairs to meet it. Our overall, lasting impression was that Wards 5A and 5B were cramped, overcrowded, overheated, dirty and neglected. It was a tribute to the staff that they were prepared to work there. Although we did not see other wards, it may also represent a comment on the relative importance given to these wards by the Trust. We have no doubt that this state of affairs could only have had an adverse effect on the morale of staff and parents and, to that extent, would have affected adversely the quality of care provided to children.

4 As regards the Children's Hospital, we were struck by the steep hill which divided it from the BRI, making the distance between the hospitals feel much greater than the actual 150-200 metres it is. [3] We were shown the casualty area and resuscitation room. We were impressed by the sense of space in what was a busy outpatients department. After seeing the cardiac catheter unit and echo room, we were shown Ward 3B. This Ward was used for admissions of some cardiac patients. We found it old, crowded and cramped. The ICU was rebuilt in 1994 at which time it was significantly enlarged. The main surgical ward was crowded but organised and had a play area with a play leader. The overall impression was one of crowding and some dilapidation, but also a sense of energy and direction.

Footnotes

[1] An account of our visit is set out in Annex B at 1e

[2] The brand new Bristol Royal Hospital for Children was opened in April 2001

[3] Dr Joffe's estimate. He also said `But the hill, when you were walking up it, felt as if it was almost half a mile, rather than 200 metres.' T90 p.65-6