There was no careful political language, no diplomatic euphemisms, just strikingly honest language and a devastating conclusion.

According to a report leaked to The Herald, a destructive and toxic culture has developed among the surgeons at The Vascular Unit at Edinburgh Royal Infirmary which amounts to a recipe for serious patient safety issues. Unless very significant changes happen in the department quickly, the report concludes, vascular surgery should not continue in Edinburgh.

The investigation into the unit was ordered by NHS Lothian after it received reports that the relations between the surgeons had broken down and its conclusions could not be clearer. According to the authors, who are two of the leading vascular surgeons in England, relations have deteriorated to such an extent that the ERI surgeons are actively looking for errors in each other's work. Management was also seen to favour one surgeon over other and there are also questions about the way junior doctors are being trained. There was also evidence that some staff had been encouraged to take sides in the ongoing dispute.

None of this behaviour should be happening in a well-functioning department of a hospital, or any institution for that matter, but there are at least some positives. The report says the facilities at the unit, which has almost 50 beds and looked after 3000 patients last year, are excellent and that the results of the national service it runs to treat bulges in the main artery are excellent. This is reassuring and it should be some consolation that, unlike in some of the hospital scandals in England, the problems at the vascular unit have been uncovered before patient care can be compromised.

However, the report makes it clear that a risk to patient care does exist and that action must be taken quickly. NHS Lothian has already moved on some of the issues and has appointed a new clinical director, who is responsible for the management of the surgeons. The report also highlights the appraisal system in the department and the structure staff can use to raise concerns. We know from previous cases - not least the suspension of two surgeons at Aberdeen Royal Infirmary - how important it is that NHS staff feel they can take their worries to management and that they will be taken seriously and acted upon if necessary and NHS Lothian must act swiftly to ensure that such a system is working work in the vascular unit at ERI.

There are also lessons for staff as well as management in this report. Firstly, and this may seem axiomatic, the staff in a department have to work as a team for that department to function well and this was clearly not the case at ERI's vascular unit when the investigation was carried out. Tensions will always exist when a group of humans work together, but with the NHS Lothian report reaching such a damning conclusion, the surgeons at the vascular unit must now work out their differences. It will not be easy - as Professor Ian Ritchie, president of the Royal College of Surgeons of Edinburgh, says, teams do not just form, they have to be worked at - but if NHS Lothian can make the changes it needs to make, then so too must the surgeons.

The surgeons should also take particular note of one part of the report, which is perhaps the most important. Referring to the recent hospital scandals in England, such as Mid Staffordshire, the report says the day-to-day functioning of Edinburgh's vascular unit appeared to be based more on the surgeons, their careers and their dysfunctional relationships rather than the safe patient-centred care described in several of the reports into the scandals. It is that patient-centred approach that should be at the heart of every hospital department. The staff and managers at ERI's vascular unit must now put aside all their differences and work towards achieving it.