The Oxford Heart Centre's future is bleak unless managers and surgeons pull together to improve working conditions, NHS experts have said.

Managers are now being asked to implement 34 recommendations to stamp out a catalogue of problems within the John Radcliffe-based centre.

The authors, Papworth Hospital chief executive Stephen Bridges, thoracic surgeon Julian Dussek and Guy's and St Thomas's nursing director Wilma Macpherson, said problems at the OHC started in the late 90s when the relationship between two cardiac surgeons began to deteriorate.

Surgeons Steve Westaby and Ravi Pillai split the department, adding to cash flow problems and a lack of morale. The report said: "The cardiothoracic surgeons must put aside their personal animosities and genuinely try to work as a team, otherwise the future for this speciality in Oxford is bleak."

The External Cardiac Review concluded that the OHC had a "drinking club culture" with complacency and arrogance among the clinical team.

It added: "At a time when cardiac centres throughout the country are gearing up for the major expansion called for by the Government, the Oxford Heart Centre finds itself on its knees and riven by internal conflict."

Department surgeons were also blamed for:

**A haphazard on-call rota, which meant they would only allow other surgeons to treat their patients in an emergency 'over their dead bodies'

**Urgent and emergency cases were often left for nearly two weeks.

**Junior doctors were left in charge of patients recovering from surgery.

The report said: "Private patients always appear to be put first on the list. The current position can best be described as chaotic; the effect of cancellation on patients and their families can only be imagined."

A special surgeon assistant was also found guilty of fraudulently claiming 33,000 for on-call and emergency work.

And nurses left because of a "feeling of hopelessness" and "feeling undervalued" by the trust.

OHC is now being closely monitored and the Department of Health has brought forward a scheduled Commission for Health Improvement visit to hospitals under the jurisdiction of the Oxford Radcliffe Hospitals NHS.

Oxfordshire Community Health Council chief officer Linda Watson said: "We're pleased that the commission is going in, but when it is mainly due to a clash of personalities in the unit, it will be hard to see how anything can be done."