Bristol Royal Infirmary's cardiac unit was like a 'rumbling appendix' in the late 1980s and early 1990s, according to the former head of South Western regional health authority.

Catherine Hawkins, regional general manager from 1984 to 1992, told the Bristol Royal Infirmary inquiry this week that she received a number of informal complaints about the unit.

'I had reservations, ' she said. 'If you get grumbles coming and then fading, and then coming again and then fading, coming again, it is like a rumbling appendix - something is wrong, something is not quite right.'

Ms Hawkins said she became regional general manager shortly after the RHA was told to 'stop being friends' with its districts and to 'get to grips with them' at a ministerial review.

She said concerns about the infirmary's cardiac surgery performance were raised at district reviews as early as 1987, 'not always formally in a meeting, but sometimes at lunch afterwards', but nobody came forward with hard information and 'units were reluctant to give up their figures'.

Ms Hawkins said she raised the issue with infirmary head Dr John Roylance, later chief executive of United Bristol Healthcare trust, who blamed problems on a particular surgeon who subsequently retired.

But in 1990 the 'grumbles' resurfaced. Ms Hawkins told the inquiry she raised the issue with Dr Roylance again and, in 1992, visited medical director Dr James Wisheart, who said 'some of the cases that they had were difficult' and that this affected outcomes.

She said she left a 'note' of her findings for her successor when she left in October, but 'she never came to see me'.

Bristol Royal Infirmary inquiry lawyers are to write to the Department of Health demanding an explanation for why it apparently failed to provide legal support to Ms Hawkins.

At the start of her evidence on Monday, Ms Hawkins said the DoH got in touch with her on 23 September to say she would need to give evidence on 4 October, and the only help she had received was to have a statement checked by fax.

Inquiry counsel Brian Langstaff QC said the inquiry had been in touch with the DoH about Ms Hawkins giving evidence on at least three occasions.

Inquiry chair Professor Ian Kennedy regretted the 'apparent failure' of the DoH 'properly to respond or take sufficiently seriously this inquiry's legitimate needs'.