The Bristol heart scandal whistleblower has told a public inquiry that managers ignored him because they thought they might lose government cash.

Consultant anaesthetist Dr Stephen Bolsin said that senior staff wanted to maintain the hospital's designation as a specialist children's heart facility.

He told the inquiry: "The analogy that was used was of a train where occasional passengers were falling off, and the train had to keep moving in order to attract funding.

"That was one of my concerns about the subjugation of patient safety by reasons of funding and continued activity in high risk areas."

Former Bristol Royal Infirmary chief executive Dr John Roylance, later struck off by the General Medical Council, was "dismissive" of his attempts to bring the high death rates to his attention, he said.

And surgeon James Wisheart, who was also banned from practising, was angry that he had discussed the unit's performance with other doctors.

Dr Bolsin said: "Mr Wisheart made it quite clear that this was not the way to progress my career at Bristol."

Dr Bolsin appeared close to tears as he expressed his sorrow at the deaths of babies at the unit.

He described how he was shunned by the medical establishment after conducting his own audit of death rates - which showed Bristol's performance was dire compared to other units.

The train had to be kept moving to attract funding

Dr Stephen Bolsin

Mr Bolsin, 45, who is now working in Australia, was speaking on the first of four days of evidence to the inquiry.

He told the inquiry's senior counsel, Brian Langstaff QC, that he had repeatedly tried unsuccessfully to raise his concerns with hospital bosses.

He said: "My impression of this unit was that the commitment of staff was to keep doing the things they felt were important to designation, irrespective of risks to patients."

Disciplinary action

The inquiry into heart surgery at Bristol was ordered by former Health Secretary Frank Dobson following disciplinary action against two surgeons and a hospital manager by the General Medical Council.

Surgeon James Wisheart was struck off

Another surgeon Mr Janardan Dhasmana, was banned from operating on children, and has been sacked by the trust.

Dr Bolsin is acknowledged as the principal force behind the uncovering of poor results at Bristol Royal Infirmary.

He told the inquiry how working relationships with a number of doctors had broken down after he began to raise his concerns, and how he had accepted a job in Australia in 1995.

He was quizzed about talks with a British Medical Association representative about a possible claim of constructive dismissal against the Bristol Royal Infirmary.

Mr Langstaff asked him: "You were putting a gun to the head of the trust and saying: 'Pay me or I will go public?'"

But Dr Bolsin insisted that it had been a "perfectly human reason" for compensation following the disruption to his family life.