'On its knees and riven by internal conflict. ' The description of the Oxford Heart Centre, the specialist centre at Oxford Radcliffe Hospital trust, was published in November, in an inquiry commissioned by South East regional office.
The report presented a vivid picture of the heart unit. This included feuding surgeons, allegations of fraud which were upheld, no robust procedures for pre and post-operative assessment and no common protocols on the cardiac recovery unit or wards.
Three months on, what has changed? According to the Royal College of Nursing, not enough. It has expressed concern that more action needs to be taken on some of the recommendations.
It also has worries about the function and some of the makeup of the trust's internal group overseeing the implementation of the 34 recommendations. Director of nursing Tricia Hart, who was criticised in the report for a lack of 'support, supervision and guidance', is one member.
The trust has now also set up an external group charged with providing a 'clear and objective oversight of the trust's progress'.
A spokesperson said it had set up this extra group in order to ensure that 'implementation needs to be seen as open and honest'. Members of this group include representatives from the RCN, the local community health council and external commissioners.
It insists it is working fast to tackle issues raised by the RCN.
The union had asked for an early Commission for Health Improvement review and, following an invitation from chief executive David Highton, CHI will begin a clinical governance review in April.
The RCN wants a cardiac strategy 'that will go beyond the publication of a mission statement'.
Management consultants KPMG have now been commissioned to help the trust develop a much wider cardiac strategy, taking into account the national service framework and revascularisation targets as well as the heart failure research programme.
A whistle-blowing practice has been brought in 'as part of good practice for the whole of the trust'.
A key failing identified in the report was an absence of job plans. The trust has now passed copies of interim job plans to regional office and these will be monitored as part of the consultant-appraisal process now being introduced for the whole trust.
The five surgeons in the unit have broadly agreed to a code of practice drafted by acting medical director Dr James Morris, aimed at meeting the report's call for 'an ethos of trust' between each consultant and a 'friendly attitude of give and take'.
'Steady progress is being made across a broad range of issues, ' insists Mr Highton. The trust is now promising to put out regular monthly updates.
It is keen to look at the RCN's views 'and take them on board as we implement the recommendations of the report', he insists.
Bernard Williams, chair of both Berkshire health authority and the external group, says implementing them would be 'a challenging task', but is 'something which must happen, and quickly'.
South East regional office said it 'welcomed the recommendations arising from the review and has been working closely with the trust and the implementation board - which includes representatives from the RCN and CHC - to ensure they are fully actioned. '
Blast from a whistle-blower
Next month, Colette O'Keefe - the service delivery manager who highlighted the problems in the unit - is bringing a whistle-blowing case against the trust, HSJ can reveal.
She has remained on sick leave since November 1999. For Ms O'Keefe, the cost of drawing attention to problems with clinical standards at the Oxford Heart Centre included 'abusive telephone calls at home'and a 'brick thrown through her children's playroom'.
Ms O'Keefe made the allegations to the Oxford Radcliffe through the Royal College of Nursing at the end of 1999, shortly after going on sick leave on advice from the trust. The RCN is now supporting her forthcoming whistle-blowing case.
The external review said Mrs O'Keefe 'was reported as setting high standards and of being a good leader who was supportive of her staff'.