MANAGEMENT structures at the struggling Westmead Hospital will be urgently revised after an external review found alienation and low morale among doctors and nurses could be risking patients' safety.

The report, by a senior Victorian health administrator, Patricia Faulkner, and a Sydney heart specialist, Phil Harris, criticised the removal of doctors and senior nurses from organisational decisions affecting patients. The authors pointed out less than one-third of managers responsible for particular aspects of patient care across the entire western Sydney area were themselves doctors.

According to the report: "Morale at Westmead Hospital is variable, but in pockets is extremely low … Sustained issues in relation to staff morale can lead to issues around quality and safety."

The reviewers found there were long delays in advertising vacancies and recruiting people to vacant clinical roles, while administrative positions were filled much quicker, and even very senior doctors had little control over their department's budget and could not order essential equipment.

Responding to the report, NSW Health's director-general, Debora Picone, told the Herald a general manager for Westmead - Sydney's largest hospital - would be appointed within weeks, to "rebalance" decision-making back towards clinicians.

The review was commissioned earlier this year after the hospital's doctors voted no confidence in the Sydney West Area Health Service's chief executive, Steven Boyages. Professor Boyages has disputed the validity of the doctors' motion.

Professor Picone said she agreed that Westmead's governance structure was "unnecessarily complicated" and it was "a problem" clinicians believed they could not adequately influence management decisions. She confirmed Professor Boyages would remain in his role and said a new clinical council would be appointed at the hospital along with the general manager, to ensure Westmead's interests were sufficiently represented in regional spending and management decisions.

Peter Klineberg, the chairman of Westmead's medical staff council, which represents the hospital's doctors, said a key issue raised at last night's meeting was whether the new general manager would have genuine control over budgets and staff hiring. "We discussed the delegations … Are they real or are they ghost delegations?" he said.

Professor Klineberg said doctors had been assured the new appointee would determine how money was spent, though there would be no funding increase overall.