Health board asked if they are ‘fit to govern’

A member of Stormont’s health committee has questioned if the board of the Belfast Health and Social Care Trust is “fit to govern” and if it has considered “stepping down”.

During a heated exchange between senior health trust managers and members of the committee, the SDLP’s Colin McGrath asked if board members were “fit to run the trust”.

In response, the health board chair Ciaran Mulgrew described the question as “deeply serious and disappointing”.

This follows an independent external review of the cardiac surgery unit which revealed a culture of bullying and staff fearful of speaking out.

“If you think sharpening a stick at both ends and impaling someone’s head is the way to solve problems well that is entirely contrary to being open,” Mr Mulgrew said.

“We are trying to bring issues to the fore and to discuss those issues.”

This was the first time that senior members of the trust faced scrutiny from the health committee about the contents of the review.

In what at times became a war of words, it emerged that the trust has been dealing with serious complaints about the cardiac surgical unit since before 2019.

The trust board acknowledged that cultural issues and poor behaviours have persisted for some time and were still prevalent, but were related to a small number of surgeons.

The trust’s medical director, Chris Hagan, said senior management had not shied away from any issue, adding that they had “held their hands up and been transparent, but things don’t always work out”.

Mr Hagan said external reviews had been carried out on the cardiac unit including in 2020, but the pandemic had meant people and teams had to be redirected.

Health trust management repeated several times that the review found that the cardiac surgical unit is safe and patients receive the highest standard of treatment and outcomes.

The health committee heard that due to the fall-out among surgeons, seven patients had their operations postponed including one who was prepped and ready for theatre.

Mr Hagan explained that while all operations were rescheduled within weeks, one patient died during the post-operative period, but this was unrelated to the “slight delay”.

He said the death was recognised as a “post operative complication” and it was under review as a serious adverse incident.

Following a number of external reviews, management said it could take up to at least five years or more to improve the culture within the unit but they were making “good progress”.

Colin McGrath said it was “deeply concerning” to hear Mr Hagan say “there are problems, but things are generally grand”.

He said it is like “an excuse to let the staff behave the way that they are behaving”.

“You’re giving people time and space to adjust their behaviour whenever the response should be, the behaviour stops,” McGrath added.

Responding to the exchange, Mr Mulgrew said “biting someone’s head off when they’re trying to speak is behaviour which should stop as well. Let’s hold everyone to the same standards.”

Mr Hagan asked McGrath to “moderate his language a bit” and said he did not talk to him like that so to please talk to him respectfully.

Chair of the committee, Philip McGuigan, intervened and asked everyone to behave in a “courteous manner” and be respectful with no interruptions.

The DUP’s Diane Dodds raised the contents of an anonymous letter sent to health committee members on Wednesday night which referred to a “stark disconnect between the Belfast Trust leadership team and front-line health care workers”.

The letter described the “absence of routine meaningful engagement by senior leaders and clinical staff which has created a void and affected trust and moral”.

Chris Hagan said he challenged the contents of the letter as the board addresses all issues of complaints and matters are escalated weekly to the executive team.

Defending the its whistleblowing policy, the trust’s interim chair Maureen Edwards said there are strong governance frameworks and senior staff are always on the “look out for something that may be bubbling.”

Ms Edwards also said the board felt an “overwhelming sense of shame” following revelations about the behaviour of some surgeons within the cardiac surgical unit.

She said the trust accepted that cultural issues if left unresolved do “pose a risk to patients and quality over time”.