Nesbitt not surprised if ‘devastating’ culture in RVH report repeated elsewhere

By Jonathan McCambridge (PA)

Health Minister Mike Nesbitt has said he would not be surprised if “cultural issues” within the cardiac surgery unit in Belfast’s Royal Victoria Hospital (RVH) were replicated in other health settings across Northern Ireland.

Mr Nesbitt told the Health Committee that his department was “on standby” for other whistleblower claims after the contents of a report about the behaviour of some heart surgeons at the Belfast unit were made public by the media.

The minister described the findings of the report as “devastating” in his appearance before MLAs on Thursday.

It comes after the inspection reportedly raised concerns about the working culture and risks to patient safety within the cardiac surgery unit at the RVH.

The findings of the independent external review, which were first reported by UTV, are said to have included an intolerable working environment and a pattern of consistently poor behaviour within the unit.

Health Committee chairman Philip McGuigan asked the minister when committee members and the public would see the report.

Mr Nesbitt said he was taking legal advice over whether it could be placed in the Assembly library, adding he needed to be careful about not provoking legal action by identifying individuals.

He said: “It was a devastating report, a very bad culture was allowed to develop and that demonstrated itself in behaviours and in the fact that there was a terrible breakdown in relationships with one surgeon walking into the building and others walking out and saying they were working from home.”

He said he had written to the chairman of the Belfast Health and Social Care Trust and would meet him on Friday.

He added: “I would say the language that was used in that letter was robust, to say the least.”

The minister also pointed out that the report had concluded that the cardiac unit was clinically safe.

Mr McGuigan said: “Rows, abuse, bullying of junior staff by more senior staff, surgeons not coming to work, throwing of medical instruments during operations, one consultant allegedly being told that if a patient dies ‘I will tell the family it is your fault’, behaviour putting patients at risk of harm and reportedly, when staff made complaints to the Belfast trust, the result was extremely slow to be investigated.

“This is what has been reported as being in the report. It is shocking and extremely concerning.”

He said the public needed to see the recommendations of the report to be “assured of their confidence in this life-saving unit of one of our hospitals”.

Mr Nesbitt responded: “I accept if I am due to go for a procedure tomorrow, next week, next month I am now looking at it differently than I would have done before reports of this report were in the public domain.”

He added: “I cannot look you in the eye and say this unit is an outlier.

“This was a cultural issue. It would not surprise me if cultural issues existed in other units within our arms-length bodies, including those five geographically defined trusts.

“Sometimes when something like this comes into the public domain, it effectively gives permission to other people in other units to become whistleblowers.

“We are on standby for that eventuality without any knowledge that it is coming but which logic says is highly possible.”

DUP committee member Diane Dodds said she had had contact with several people this week about the report.

She said: “One thing that is becoming clear to me is that this is not isolated to one unit in the trust.

“This is exacerbated by weak management and a failure to actually deal with the issues as they arise.”

Mr Nesbitt said: “There is a question mark over the Belfast trust and whether they have been doing their jobs in this instance, but they are effectively the employers.

“If there is to be action to remedy a situation like the one that has developed in that cardiac unit, it is primarily for the trust to take that action and it is for me to make sure I hold the trust to account.”

Mrs Dodds said it was the latest in a series of “fiascos” within the Belfast trust and asked the minister if he was considering placing it in “special measures” to stop a “litany of problems”.

Mr Nesbitt said: “In terms of intervention, there are five points on the scale of interventions and the Belfast trust is at point four.

“Point five is what you are calling for. That is not a punishment, that is assistance.”

He said he was reluctant to currently take special measures because the recruitment process for a new trust chief executive is continuing.

Sinn Fein MLA Linda Dillon urged the minister to speak to health unions about the culture in other trust areas and hospitals.

She said: “Don’t wait for people to come forward. Don’t wait for people who are just trying to do their job. Some of them won’t want to report it because they just want to look after their patients.

“Don’t wait for it. Go and look for it. That is the trusts’ and the department’s responsibility.

“We need to find if there is a pervasive culture, not wait for it to come looking for us.”

SDLP MLA Colin McGrath said he was “not entirely convinced” that what he had heard from the minister at the committee showed his department was “getting to grips” with the issues uncovered by the inspection report.

He added: “It is a bit fantastical to just think a new chief executive is going to come in and sort all the woes out.”

DUP MLA Alan Robinson described the reported findings as a “bombshell moment”.

He said: “I know seasoned performers in this building, who have been here for quite some years were absolutely aghast.

“It is right up there as probably as one of the poorest news items that was ever broken.”

He said reports of what had happened were “more akin something you’d see in a wild west bar than a surgical unit”.

After the minister concluded his evidence, Mrs Dodds said the committee should invite senior figures from the Belfast Trust to give evidence about the RVH cardiac surgical unit.

Ulster Unionist MLA Alan Chambers said he supported the trust coming to the committee, but added it may be a “pointless exercise” until members had viewed the report.

The committee agreed that if the report was not made public, then a request would be made that members would be allowed to see it in a confidential setting before the trust attended.

Mike Nesbitt has encouraged any other staff facing bullying behaviour to come forward. (Brian Lawless/PA)