NHS managers were powerless to stop doctors performing operations at which they had poor success rates unless doctors first made them aware of the problems, an inquiry has heard.

The public inquiry into unusually high death rates among babies receiving complex heart surgery at Bristol Royal Infirmary heard evidence from Dr John Roylance, the hospital's former chief executive.

He said it was up to doctors to expose their colleagues' shortcomings, and only then could managers act.

He told the inquiry that he felt he had been competent to deal with any complaints brought to him.

Serious professional misconduct

Dr Roylance was banned from practising medicine by the General Medical Council (GMC) for his part in the Bristol heart babies scandal, along with surgeon Mr James Wisheart.

A second surgeon, Mr Janardan Dhasmana, was banned from operating on children for three years.

The GMC banned Mr Roylance because, although he played no part in the clinical work, he should have stopped the surgeons from carrying out complex heart surgery when it became apparent they had a poor success rate.

But on Monday he told the public inquiry into the affair that "health care was run by consultants".

"That was not something I imposed," he said. "It was my recognition of reality. I recognised it was impossible for managers to interfere."

The public inquiry, led by Professor Ian Kennedy, was set up by Health Secretary Frank Dobson after the GMC case last year.

Colleges' role

Dr Roylance told the inquiry it was not the responsibility of managers to expose incompetent staff.

He said: "Managers could only seek appropriate professional advice."

Instead, the medical royal colleges should handle problems of competency among clinicians, as they are responsible for training and the maintenance of standards.

Doctors who were concerned about a colleague's competency should approach management, he said.

But this was how the system worked, not his view of how the system should work, he said.

Mr Brian Langstaff QC, the inquiry's senior counsel, questioned Dr Roylance on whether there was an "oral culture".

Dr Roylance said he favoured talking to people to resolve problems, and that he felt he dealt adequately with complaints regarding doctors' competence.

He was not questioned specifically about the quality of care offered at the hospital, simply about management structures.

However, he will be recalled in the autumn to address such issues, as will Mr Wisheart and Mr Dhasmana.

Babies died

Between 1988 and 1995, Mr Dhasmana carried out 38 arterial switch operations in which 20 of the young patients died.

Between 1990 and 1994, Mr Wisheart carried out 15 atrio-ventricular septal defect operations. Nine of the young patients died.

While the GMC hearing was limited in scope and looked only at cases involving the two doctors, the public inquiry has a wide-ranging remit.

It will examine the system that allowed Mr Wisheart and Mr Dhasmana to operate for so long and its conclusions are expected to have a huge impact on the NHS.