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A handful of TV crews and press photographers were scattered outside the Bristol Royal Infirmary inquiry's offices by 8.30am last Monday.

They had been largely absent from the 27 days of oral sessions held to examine evidence in blocks one and two of the inquiry's work - looking at the experience of parents and the national scene.

But on day 28, former United Bristol Healthcare trust chief executive Dr John Roylance was due to give evidence in the soothing pink and green hearing room, where state-of-the-art computers hum gently as they handle the 800,000 pages of evidence submitted so far.

There will be more press interest when Dr Roylance is asked how much he knew about mortality rates among babies undergoing complex heart operations at the BRI in the 1980s and early 1990s, and who knew what when.

But last week, inquiry counsel Brian Langstaff QC concentrated on the background - management arrangements at BRI during the period under investigation.

Three weeks earlier, the trust's present chief executive, Hugh Ross, gave evidence and examined a paper written for an executive group workshop in June 1992.

It said an 'oral culture' prevailed at the trust, in which few things were written down.

'The chief executive surrounds himself with people who can adapt to this style of working in a very personal way... People who cannot cope with that go.'

Mr Ross said there was no doubt that Dr Roylance was a 'very dominant' figure. 'It would be hard for me to think of a more dominant chief executive in any other trust I have known.'

But he said Dr Roylance had stood apart from organisational issues and 'did not appear to have proper control' over the trust's 13 clinical directorates.

Mr Ross, who became chief executive in October 1995, said 'there was no multidisciplinary audit in place that was contributed to and accepted by all', and the audit committee was 'relatively powerless'.

'I think if you were trying to design an organisation that could respond as rapidly as possible to expressions of concern and make sure they were resolved, then you probably would not have designed it to look like UBH trust did several years ago,' Mr Ross said.

Similar themes emerged from evidence given by those who were senior trust employees while Dr Roylance was chief executive.

Finance director Graham Nix said general managers reported to clinical directors, who were selected by the chief executive.

Mr Langstaff asked: 'So the analogy might be between the chief executive and the prime minister selecting his cabinet?'

'Yes,' Mr Nix replied.

'And the clinical directors would remain clinical directors as long as they retained the confidence of the 'prime minister' figure of the chief executive?'

'Yes,' Mr Nix replied.

He also said managers like himself would 'not expect' to be involved in medical matters, adding: 'Dr Roylance thought that people with a clinical background had additional skills to run the service.'

But he said: 'John was always open. People had to go and see him a lot of the time.'

Margaret Maisey, the trust's director of operations and later its nursing director, told the inquiry: 'If they wanted to see us, we would find a way of seeing them.'

But the inquiry is due to examine evidence from Rachel Ferris, general manager of cardiac services for part of the 10 years under investigation, claiming Ms Maisey 'had a personal management style of management by fear'.

Dr Roylance slipped past the photographers on his way into the inquiry, but later posed briefly for pictures. He looked thinner and more drawn than at last summer's General Medical Council hearing, which ended with him and former medical director James Wisheart being struck off and a third surgeon, Janardan Dhasmana, being disciplined.

But he made an articulate and even defiant response to the points put by Mr Langstaff.

Dr Roylance said that when he became general manager of Bristol and Weston health authority in 1985, his aims were to introduce general management in the wake of the Griffiths report and tackle a£1m overspend.

The directorate structure at the trust, and the devolution of money to operational level, were 'in accordance' with Griffiths, he said - 'not my idea' but 'policy from the Department of Health'.

Managers, he insisted repeatedly, could 'in no sense' provide healthcare, they could only facilitate it. And he said it was 'reality' that only doctors could judge the failures of doctors.

Asked if he agreed with Ms Ferris and Mr Ross that audit had been 'crude' even in 1995, Dr Roylance replied: 'I would say non-existent.'

But he said he had worked hard to introduce clinical audit, adding: 'If what (Mr Ross) did to further develop the service is offered as criticism of what we did not do, then I am not even prepared to discuss it.'

Dr Roylance accepted there was an 'oral culture' at BRI, 'if by that you mean people talked to each other'.

'I use paper if necessary - if it improves patient care. Otherwise I do not, and do not think the NHS should do it either,' he said.

'I find no difficulty in distinguishing between necessary paperwork and the unproductive consumption of paper.'

Nevertheless, Dr Roylance said he spent 'a great deal of time' communicating, and if people could not reach him direct he had a 'highly efficient personal assistant' who acted as a 'highly efficient answering service'.

On the second day of his evidence, Dr Roylance said there was 'no impediment' to surgeons, or others, raising concerns. But there were no policies to 'contain and constrain' who they should go to.

'I would find it insulting to staff of the calibre we are talking about,' he told Mr Langstaff.

He also said whistleblowers would not be persecuted. Asked what assurances they had for this, Dr Roylance said: 'My personal word, given many times.'

Mr Langstaff explored in detail one avenue for staff to raise concerns - taking them to a committee of 'three wise men', one of whom was Mr Wisheart.

'Did you see any potential problem in a system in which a complaint might be made to one of three close colleagues and acquaintances about one of those other three?' he asked.

Dr Roylance responded: 'None at all. None at all. Quite unthinkable that there should be.'

'Does it follow from what you said that you trusted them to do their duty whatever their personal feelings might be?'

'I cannot think of how personal feelings might enter into it. I cannot imagine the situation you are asking me to imagine,' replied Dr Roylance.

The inquiry is due to hear from Dr Roylance again in October or November.

Next month, it is expecting to call for evidence for 'part two' of its investigation, current developments in the health service, so it can give a 'future look' to its final report, expected next year.