Extra measures for Belfast Trust after bullying claims

Mike Nesbitt said the report and the serious information it contained "clearly underscored the need to increase the level of escalation"

The health minister is putting extra measures in place at Belfast Health Trust to hold it accountable for recent concerns in its cardiac surgery unit.

Mike Nesbitt is enforcing the highest level of performance accountability after a leaked review laid bare bullying accusations within the regional cardiac surgery unit.

In a written statement to the Northern Ireland Assembly, Mike Nesbitt said that level five, which is commonly known as special measures, is expected to be required in "only the most serious and exceptional cases".

Last week, in a leaked inspection report, it was claimed that some surgeons had thrown instruments at staff during procedures.

A leaked review found bullying allegations within the regional cardiac surgery, which is run by the Belfast Trust

Speaking to reporters on Thursday, Nesbitt said what he had announced was not "about a punishment" for the Belfast Trust.

"It's about providing assistance so they can get cultures within the workforce where we need them to be," he said.

Intervention

The minister's statement said the leaked report and the serious information it contained "clearly underscored the need to increase the level of escalation".

The report assessed the impact of "ongoing team issues on the safety and quality of the service".

A hospital trust or facility is placed in special measures when it is rated as being "inadequate", when questions are raised over leadership or when it is unable to make sufficient improvements in a reasonable timeframe.

Nesbitt said the level five intervention will ensure "support, oversight and sustained focus".

"To be clear, it is the responsibility and duty of Belfast Trust - its senior executives and board - to deliver the action plan for improvement, and to ensure that it leads to tangible improvements in the culture and working environments for this important service in Belfast Trust," he added.

The minister explained this level of intervention will help the trust stabilise, ahead of its appointment of a new chief executive.

He is putting in place external expert support for the trust and has enhanced departmental accountability, which has now been formalised as the Departmental Accountability Team.

As part of that team, he has brought in senior leadership and clinical cultural change experts to determine "how widespread the cultural and behavioural issues evident in the cardiac surgical unit may be across the Belfast Trust" and to ensure that the overall culture of the entire health and social care system is "welcoming for all those who work there".

'Maintain public trust'

Nesbitt said every employee with concerns about bullying or other unacceptable behaviours must be properly listened to and supported and that patients and the safety of services provided to them must always be the "overriding priority".

The health minister added that there was "some comfort" that outcome data reviewed for the Royal Victoria Hospital's cardiothoracic services compared favourably with all UK benchmarked data and that the trust has been working "actively to reassure patient".

"It is important that we build and maintain public trust in this regional cardiac surgical unit.

"I am committed to ensuring that the patient's voice and lived experience is at the core of how we respond.

"Likewise, I am also committed to ensuring that all staff across the HSC system come to work in environments and settings which support and value them and enable them to give their best to the patients they serve.

"We are all patients or prospective patients, so we all have a key stake in ensuring that care is delivered in a safe, courteous and compassionate environment," he said.

Nesbitt said he would be meeting the chair of Belfast Trust again later this month for an update with further engagement planned with the trust, trade unions and professional bodies in the weeks and months ahead.

The chair of the Belfast Trust, Ciaran Mulgrew, met the health minister last week

The chair of the Belfast Trust, Ciaran Mulgrew, has insisted that the organisation is working to resolve the issues.

He met the health minister last Friday, with Nesbitt saying afterwards that his department was finalising a series of interventions to help "rebuild staff and public confidence".

It is understood that Nesbitt also met health unions and stakeholders earlier this week to brief them on his upcoming plans.

Bullying a 'systemic' issue

Unison's Patricia McKeown said during her meeting with the health minister the union was very clear about the immediate issue of "poor culture and bad conduct that needs to be sorted out".

She told BBC News NI's Good Morning Ulster programme that health service unions say the problems within cardiac units are not an "isolated incident".

Ms McKeown added it was "symptomatic of a failure of leadership, failure of accountability and governance and co-operation right across our health service.

Patricia McKeown is a representative from Northern Ireland's largest health union, Unison

Ms McKeown said the health service cannot be run on whistleblowing.

"Whistleblowing is something that happens when real management, real relationships have broken down and that's what needs to be put right," she said.

"There's a systemic problem right across the entire health service, it's been going wrong for nearly 20 years, bit by bit getting worse as time goes on and that's got to be fixed."

She added that unions have models that would "start to put the culture right".

"The workforce and unions must be at the table to come up with solutions for a problem that has festered for far too long."

What did the leaked report say?

The report said an "apparent power battle" had been unfolding between some senior doctors in the cardiac surgical department of the Royal Victoria Hospital in Belfast.

Some 70 staff spoke anonymously and the report stated there were "clear tensions" between different groups of staff.

The report also detailed the throwing of instruments during surgery as well as "verbal abuse".

The report added that while there was one consultant "particularly prone" to throwing instruments in theatre, the behaviour was not unique and nursing staff were bearing the "brunt of the bullying".