The Times report on Friday 31 August 2018 – “Coroner is considering fresh inquests after 150 deaths at St George’s Hospital heart unit” – makes for sad reading. It seems that an internal report has revealed “toxic” bickering between rival camps within the hospital.

I am reminded that when a mishap occurs it is usually attributable to poor systems, poor education or poor attitude. Whilst a degree of healthy competition between colleagues is a good thing if matters have degenerated to the point where it is impacting on patients’ safety there is clearly a huge problem with attitude.

Management need to look very carefully at this. Any attitude that compromises patient safety must be dealt with for the benefit of all patients who are undergoing cardiac surgery. Those patients are placing the utmost trust in the hands of the surgeons who are operating on them. However, as a lawyer in a clinical negligence team where we regularly secure large awards of damages for patients whose surgery has gone wrong in units such as St George’s, I would argue that all patients suffer because the claims can lead to large damages awards. Although those awards do not directly impact on the funds available to treat cardiac patients (for example, in St George’s) claims that result from toxic environments represent unnecessary squandering of public funds. An open and collaborative team without rivalries but with all members of the team stretching themselves to be the best they can be will result in far fewer mistakes.

Given the extreme pressures that doctors and, in particular, junior doctors operate under, it must be incumbent on those who lead to ensure that the stressful environment is acknowledged and, where possible, steps are taken to minimise its impact rather than creating an environment where there are rivalries and rumours of incompetence, cover up and cronyism.