He was the man running the hospital - yet he said he could not interfere with the way his surgeons were working.

"I recognised that it was impossible for managers to interfere," he told the inquiry.

There are some who blame former Bristol chief executive Dr John Roylance even more than the surgeons for Bristol's descent into crisis.

He is the one, they say, who chose to ignore warnings from whistleblower Steve Bolsin about the standard of operations being offered to young children.

He was the one who was supposed to be in charge - but he let the doctors just get on with it

One doctor's comments about John Roylance

One doctor highly critical of Roylance said: "He was the one who was supposed to be in charge - but he let the doctors just get on with it. That's unacceptable whatever else you think."

Along with James Wisheart, he was found guilty of serious professional misconduct, and struck off by the General Medical Council in 1997, but if he had not also been a doctor, the manager would have faced little sanction.

As it was, he had already stepped down from the post as the GMC investigation began, and retired with full pension rights.

The GMC ruled that he had failed in his responsibility - as a doctor rather than a manager - to intervene to ensure the safety of patients.

Dr Roylance's background was in radiology rather than surgery, but, after a stint as a general manager with the health authority, he was made chief executive in 1991.

Steve Bolsin, the anaesthetist who compiled an audit of the heart surgeons' work, says he went to the chief executive with his concerns, but felt that his job was under threat if he continued to pursue them.

'Unaware'

Roylance insists he knew nothing of any problems.

"I was never put in a position to prevent any avoidable deaths.

"Nobody ever made it known to me that the service was not merely ripe for improvement and requiring improvement but was ever thought to be unacceptable."

I was never put in a position to prevent any avoidable deaths

John Roylance

He said that, as a father-of-four, he understood "acutely" the loss of a child.

"If someone would come and tell me they are killing children in cardiac surgery and I hadn't noticed, that would be quite unthinkable."

Following the damning GMC verdict, Roylance was the only one of the three doctors who decided to take the decision to appeal.

He claimed to the Privy Council that GMC chairman, who presided over the case, had been biased against Bristol because his own grandson was suffering from a heart condition at the time of the hearing.

His lawyers also argued that he was acting as an administrator rather than a doctor, and so should not be disciplined as a doctor.

Both these arguments were rejected by the Law Lords.

At almost 70, Roylance is the oldest of the three doctors at the centre of the Bristol investigation, and had reached retirement age before the affair became public.

But the GMC case certainly rings a warning to all doctors who hold management positions in the NHS.

Tighter controls on chief executives of trust boards are being introduced by the government, but whether this will solve the problem of managers out of touch with their clinicians is unclear.