Debate contribution: Belfast Health and Social Care Trust: Accountability and Oversight Arrangements

Debate contribution by Mr Mike Nesbitt on 9 June 2025.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

9 June 2025

Type

Debate contribution (made as a minister)

Business

Question for Urgent Oral Answer

Heading

Belfast Health and Social Care Trust: Accountability and Oversight Arrangements

Assembly identifier

Official Report component 4997623

Read the official Assembly record

Text

I can only repeat what I said to Mr Donnelly: you have a copy of what levels 1 to 5 entail. As to the practicalities of that, Peter McBride will be available to me from the beginning of next week. He will, in effect, be my ears and eyes in the trust while it implements the recommendations of the independent report commissioned by the strategic planning and performance group (SPPG) and the Public Health Agency. Let me stress that I am not the employer; the trust is the employer. It is primarily for the board of the Belfast Trust to sort out the issues, and not just in cardiac surgery. Throughout the trust, where there are behavioural and cultural issues, they must be addressed. That is why I made the level 5 intervention applicable to the entire trust and not just the cardiac surgery unit. Peter McBride will go into the trust, and he will advise me whether the issues are widespread. He will advise where else I need to be looking and demand that the trust take action about the behaviours and cultures. One of the joys of having a permanent secretary who has been embedded in healthcare delivery all his adult life is that he knows people who are good at certain things. He has identified a recently retired clinician who specialises in clinical teamwork. The permanent secretary is liaising to make this person available, so we will have a two-pronged approach. However, until those people report back to me, I cannot be definitive about the entirety of the next steps. I am trying to make the right official available to come to the Committee on Thursday.

I am aware of reports — such reports are coming to me as well as to other MLAs, including the Member — that the cultural and behavioural issues are not necessarily confined to the Belfast Trust and may apply not just to the five geographically defined trusts but to all six trusts. The challenge is to sort out which are genuine grievances and reports, given the inevitability that some people will act in a more vexatious manner, and I am determined that we will address that. However, it will take time because we have only limited resources. We are starting with the Belfast Trust, but I hope that my saying that I do not think that we will finish with the Belfast Trust provides some assurance to the Member. The Member will be aware that I have not been particularly supportive of an individual duty of candour with criminal sanctions up to this point. I accept that the revelations about what is happening in the Belfast Trust will make my position a lot more difficult.

I have every confidence in Peter McBride. As I stated in my written ministerial statement, I have known him for some 17 years, since my time as a victims' commissioner, when he was chief executive of one of Northern Ireland's leading mental health charities. He has a lifetime's experience of organisational culture, so he has the right experience and the right skills. He certainly does not hide away from confronting issues when they arise, so I am convinced that he is the right person to do that job for me. Let me emphasise once again to the Member and to the House that it is not for Peter McBride, the Department or me to do the implementation. Our job is to oversee the implementation and to satisfy ourselves that it is taking place and, ultimately, that it has taken place appropriately.

First, I understand why that constituent is extremely concerned. She is being asked to go through a very serious procedure, but there is no evidence — no evidence — of bad clinical outcomes from that cardiac surgery team. I hope that she will find some reassurance in the fact that the outcomes from such procedures are first class. The difficulty is the environment in which those first-class outcomes are being delivered. If the problem is more widespread, I will take advice from Peter McBride, and, if necessary, others: the Chief Nursing Officer, the Chief Medical Officer and whomever else I need to speak to. We will tackle the issue and do so wherever it occurs. Again, for public confidence, I say that there is no evidence to suggest that the situation is endemic. We therefore need to keep it in proportion. It is incredibly serious where it is happening, but I do not believe for one millisecond that it is happening everywhere in Health and Social Care (HSC).

As I just said, there is absolutely no evidence that the outcomes from the procedures carried out by the cardiac surgery unit in the Belfast Trust are anything other than first class. To rebuild public confidence, I am putting in place Peter McBride. I hope soon to be able to announce the name of the second person, who has expertise in good clinical teamwork. They are the right people to go into the trust and make sure that the trust board is fulfilling its duty, which is to tackle the issues and detoxify the toxic atmosphere.

The answer to that depends on whether those postponements and delays are part of the toxic culture and to do with the behaviours of the surgeons in particular. If so, I absolutely expect Peter McBride to address that issue. I should tell the House that we have not agreed the final terms of reference. One of the reasons for that is that, last week, I met the relevant unions and professional bodies and invited them to give me their thoughts on what they think the terms of reference should be, because it is important that those be genuinely co-designed and co-produced. There is a very little point in me saying, "I am satisfied with how we went about this and with the conclusions that we have come to", if the unions and others who deliver healthcare in the Belfast Trust are not. Even if it did not fall to Peter McBride to address such events because they were not directly associated with those behaviours and the culture, they should not be happening anyway. I certainly expect all trusts to work to deliver standardised regional services. The quality of that work would be measured by people's not being gowned up at the fifth time of asking and then being told, "I am sorry. It is not going to happen."

I give the Member that assurance; absolutely. We have two points here. When I had my 45-minute session with the chair the other Friday, we discussed the quality of the complaints process and how he and the trust quality-assure what their human resource team does when dealing with complaints. Reference was then made to the whistle-blowing process, which the trust has. I do not think that I am breaking the confidentiality of the discussion with the chairman when I say that I do not think that the level of staff confidence in the whistle-blowing process is as good as it needs to be. That is one of the areas that I will put in the terms of reference for Peter McBride. How do we quality-assure how complaints are handled? That includes the timeline. Also, if the way to move from complaints is to go into whistle-blowing, how do we ensure that the maximum number of staff has appropriate confidence in that whistle-blowing process?

I see absolutely no reason not to forward the action plan to, for example, the Health Committee as soon as I get it.

I can give the Member that exact assurance. Again, I have been asking what I think are pretty basic questions about the number of doctors who have been referred to the General Medical Council and the number of whistle-blowing cases and tribunals etc. If I may put it this way, perhaps the responses did not demonstrate a depth of knowledge that I might consider appropriate. That needs to change.

I am not aware of that, but if the Member is and has details, I encourage him to take the responsible route and report it.

I am not in a position to do that yet, because we have not scoped out to what extent the behavioural and cultural issues that are now known about in the cardiac surgery unit are replicated elsewhere across the trust. Peter McBride will be doing that for me, so, until he gives his assessment of that, it is impossible to put a timeline on it. For me, it is all urgent, so I say as soon as possible. What that means, I cannot tell you in days, weeks or months.

1,447 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 12:47 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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