The management style of former United Bristol Healthcare trust chief executive Dr John Roylance has been defended at the Bristol Royal Infirmary Inquiry.

Witnesses at the inquiry into the deaths of children who underwent complex heart surgery at the hospital have described Dr Roylance as 'dominant' and said a 'club culture' operated that made it difficult to raise concerns.

But Marie Thorne, head of the school of organisational behaviour at Bristol Business School, who had access to managers in the run-up to the firstwave trust going live, said he was 'immensely accessible'. Asked if an 'oral culture' operated at the trust, she said: 'It is breathing to chief executives to talk to people. Leaders do not often spend a lot of time writing.'

She said a 'club culture' was 'replicated almost everywhere' and that did not mean that somebody who 'rocked the boat' would be seen as 'not a UBHT person'.

'One of Dr Roylance's favourite things was actually turning the boat upside down, which is what caused immense frustration or unhappiness for people, ' she said.

Ms Thorne said Dr Roylance was 'committed to patient care at the forefront, and that was always at the centre of everything in the trust'. But there was a 'declining unit of resource' so there was 'an enormous amount of issues about how we can deliver good quality services while constantly cutting cost'.

Hugh Ross, current chief executive of UBHT, has told the inquiry that 179 hearts, lungs and other tissues were retained by the hospital during the period under investigation, and it had behaved in a 'cavalier' fashion towards parents.