"This must be the oldest ward building still in use anywhere in Britain," said Hugh Ross, a senior NHS administrator, pointing out the original home of the Bristol Royal Infirmary. The year of its foundation, 1735, is picked out in gilt on the façade.
Mr Ross is chief executive of the United Bristol Healthcare Trust, which runs the complex of hospitals centred on the Infirmary. His predecessor, Dr John Roylance, was struck off in the scandal over death rates among babies undergoing heart surgery at the hospital, which led to the longest public inquiry in the history of the NHS. "When I took over in 1995," said Mr Ross, "I had very little idea of what was to come." Now he has the task of restoring staff morale and public confidence in the BRI, as everyone in Bristol calls it.
The hospital's cramped hillside location in several ageing buildings contributed to its problems, according to the inquiry. It is not much loved. "Patients hate going there," said Dr Sandy Macara, a former head of the British Medical Association who supports the two surgeons, James Wisheart and Janardan Dhasmana, disgraced in the affair. "The buildings are lousy and there is nowhere to park. Bristolians have known for a long time about the problems of the BRI."
Mr Ross has held 10 staff meetings since Professor Ian Kennedy's inquiry report was published on Wednesday, emphasising that the 198 recommendations related to the running of the NHS as a whole rather than specifically to Bristol. "But if any NHS hospital has to achieve the aims of the report, we have to," he said, standing outside the grimy 1960s concrete block which houses most of the BRI's departments. "We have a £100m programme of refurbishment and new building. The Government is putting some serious money in, and we have to deliver."
Dr Stephen Bolsin, the anaesthetist whose years of campaigning against poor surgical performance led to a General Medical Council (GMC) hearing as well as the inquiry, saw the attractiveness of life in Bristol as one of the problems. "People were in great jobs in a fantastic place," he said. "They didn't want to have to deal with this challenge to their lifestyles and professional routines."
Steve Parker, chairman of the Bristol Heart Children's Action Group, agreed that what Professor Kennedy called the "club culture" among senior surgeons played a part. "Living in Bristol reduces the desire to move on," he said. "When you have been working with the same set of people for a long time, it is very hard to tell one of them that he is not performing. Not enough new blood was coming in."
Mr Parker, 36, was talking at a pub away from his office at the Rolls-Royce aero engine plant in Filton, where he is an information technology specialist. His employers have become uneasy about the plant being used as a backdrop for photographs and TV interviews, while calls to his home can reawaken the trauma for his wife, Diana, who lost her daughter at the BRI before they met. When their first child together needed heart surgery as well, they made sure it was done in Birmingham.
The action group represents some 300 families whose children underwent heart surgery at the hospital. For many of them, said Mr Parker, the campaign to find out what happened and who was responsible "has become the centre of their lives. It is slowly eroding their being, but those who lost their children cannot get over the feeling that they let them down. We still haven't achieved justice".
Eric Grimes also speaks of justice, but in his case he is referring to the two surgeons who were disciplined by the GMC along with Dr Roylance. The 68-year-old former journalist and public relations man, who had two heart operations performed by Mr Wisheart, speaks for the Bristol Surgeons Support Group, which believes the failings of the NHS as a whole are being blamed on a few individuals. "We and the action group both support the inquiry's recommendations, but we oppose each other head-on about the role of the surgeons," he said.
The rest of the country is likely to consider the affair closed, but in Bristol it will linger for years to come. "We do have to emphasise that things are different now, because they are," said Mr Ross. "But equally, it would be very callous and wrong if we thought that was the end of the matter. For some of the parents it will never be over."