The findings from the Bristol Royal Infirmary inquiry look set to send shockwaves through the NHS.Alison Moore talks to those close to the heart of the matter Bristol has had a vast impact on hundreds, if not thousands of people. By far the biggest effect, of course, has been on the families who lost a child or saw one suffer lasting damage.

Many others have been caught up in Bristol's web. They may have had their motives and actions questioned during the inquiry or still be asking themselves if they could have done more. They may have chosen to change jobs, move out of the area or retire.

Few are willing to talk about the impact on their lives. Some are defensive about their part in the affair. The people specifically criticised in the final report were warned several weeks before publication of the exact criticisms.

Hundreds of local staff were shaken by the affair. Pamela Charlwood, chief executive of Avon health authority, does not know what the report's impact will be on them. 'It is like a sore, It is like a wound. Every so often, you think it is just beginning to heal... then the inquiry opened.You think it is just beginning to heal again... then the report comes out.'

Hugh Ross, who became chief executive of United Bristol Healthcare Trust in 1995, has had to address the suffering of staff - though he is swift to point out that the families involved in the tragedy had the hardest time.

'There are not many staff here now who were here before 1995, but it has been very difficult for them, ' he says. 'Clearly, for some people in the Bristol Royal Infirmary and the old Bristol Children's Hospital, there have been additional pressures in the last few years.We have done all we can to support them.'

Extra counselling has been available for staff over the past couple of years. Senior managers have been available to discuss aspects of the case at staff meetings.

The long wait for the inquiry report has been an anxious time for many. Some serving members of staff were expected to be criticised for their part in the Bristol cases, but Mr Ross hopes the main focus will be on systems rather than individuals.

There is still disagreement within the trust about who or what should be criticised. Some senior medical staff disagree with the General Medical Council's findings against the three doctors in the case - although Mr Ross says their numbers are dwindling.

Rachel Ferris was appointed general manager of the cardiothoracic unit in November 1994.

'It was a very harrowing time for everyone involved, ' she recalls. 'In the early days, when information was beginning to emerge, it was very difficult - a lot of whispering in corridors, not quite being sure what was going on.

'The two surgeons involved were very well-respected figures.

A lot of people felt they could not believe it - these were hard-working people who had built up the cardiothoracic unit.

'There was a lot of disbelief and a feeling that there was a lot of politics behind it.'

Early on, many staff felt there was little evidence to support some of the accusations, but as time went on the truth of some of the allegations became obvious to all. That was hard for staff on the unit, many of whom had come to accept the high mortality rates as 'normal'.

'A lot of the nurses began to feel very guilty about it, ' says Mrs Ferris. 'Should they have known what was going on? Could they have done more?'

Staff at the unit also gave evidence to the inquiry, which many found gruelling.Mrs Ferris was one of the first to reveal details of the management ethos under Dr Roylance.But the unit has moved on. Staff have changed, the trusts' culture has transformed and its clinical performance - open for all to see on the Internet - is exemplary.

Even the two opposing patients' groups - one highly critical of the surgeons, the other supportive - are now working with the unit, almost as users' groups. 'People are coming together to develop the services and improve them, ' Mrs Ferris says. 'It feels very much more positive now.'

She hopes the publication of the final report will bring a sense of closure to many staff. After seven years in the unit she is moving on, but has promised to return to help staff through the difficult days as the report is published.

Gianni Angelini, professor of cardiac surgery, says: 'I think predominately the problem was a problem of surgical skill.'

But he, too, points out how far the unit has progressed since the dark days of children dying in the operating theatre.

'The unit has put it behind itself for years. Generally, despite the bad experience, the unit is very united. This is one of the few centres where, generally, there is a very good atmosphere, not just between doctors but everyone.

'It has completely changed in every respect. Before there were operations carried on all day and into the night. Now the operating theatre is hardly ever open for routine cases after 4pm. That is an enormous change in procedure.

And we have never lost one single switch patient. There have been more than 70 and not one has died. When people do not die, the atmosphere in a unit is going to be pretty good.'

Others further afield have been affected. Norman Halliday was the medical secretary of the supra-regional services advisory group, which approved Bristol's designation as a centre for paediatric cardiac surgery.Now retired, he has consistently argued that concerns about the Bristol unIt is performance were not raised with him and gave evidence to the inquiry. 'There is a learning curve through which all clinicians have to go... but I am concerned that they continued to operate when everyone locally was suggesting they should be stopping. Now it transpires that their own clinical colleagues had reservations, which I knew nothing about, ' he says.

'The fact that they did not stop worried me greatly. The inquiry has had a major impact on my view of the profession. I no longer have the confidence in doctors that I previously had.'

Dr Halliday says his 'conscience is clear' about his role in the affair.

'I was confident that I had done everything I could have done.

'My worry was that the evidence would not come out to support me.'

Where are they now?

Many of the principal players in the Bristol tragedy have changed jobs or retired since the story started to unravel.Stephen Bolsin, (left) the consultant anaesthetist who 'whistleblew'on the unIt is poor performance, is still working in Australia.Helen Stratton, (left) the liaison nurse at the unit who worked with Dr Bolsin to draw up a picture of outcomes, is now working in medical communications.Dr John Roylance, former BRI chief executive, retired in 1995 and was struck off by the GMC in 1998.

Surgeon James Wisheart retired in 1997 and was struck off in 1998.Last month, surgeon Janardan Dhasmana had his three-year ban on carrying out child surgery extended by another year.He will only be able to perform adult surgery under supervision.

Margaret Maisey, BRI director of operations, has retired.Dr Peter Doyle, senior medical officer at the Department of Health when problems with Bristol's mortality unit were uncovered, is medical secretary of the Unrelated Live Transport Regulatory Authority.