Danny Donnelly has given notice of a question for urgent oral answer to the Minister of Health. I remind Members that, if they wish to ask a supplementary question, they should rise continually in their place. The Member who tabled the question will be called automatically to ask a supplementary question.

Mr Donnelly asked the Minister of Health to outline what level 5 of his Department’s performance accountability process entails in relation to the Belfast Health and Social Care Trust's cardiac services review recommendations (CSRR).

Assigning an issue to my Department's support and intervention framework creates a focused request for improvement by that trust. Level 5 is the highest intervention level and brings with it external support and escalated oversight. The Member will be aware that, at the Health Committee meeting on 29 May, when I attended with the permanent secretary, I agreed to release copies of that support and intervention framework to the Committee.

The accountability arrangements for the level 5 escalation in relation to cardiac surgery services in the Belfast Trust include enhanced arrangements with suitable external, experienced support, which, as I advised the Committee, will come from Peter McBride, accompanied by another experienced individual. I beg your pardon, Madam Principal Deputy Speaker: I advised that in a written ministerial statement rather than to the Committee.

My Department and the Public Health Agency (PHA) already had escalated oversight in place, which, given this report, has been reviewed and will now also include the Chief Nursing Officer and the Chief Medical Officer providing support. The accountability arrangements will ensure that pace and urgency are injected by the trust into appropriately managing all the issues involved.

Minister, when the behaviour became public knowledge, you said in the Chamber that six patients had had their operations cancelled. Given that cardiac patients are very ill and at risk of life-threatening events until they get surgery, are you aware of how long it took for those six patients to get their operations and whether any of them suffered any harm in the interim?

If I used the word "cancelled" that was inappropriate, because there was a postponement, not a cancellation.

I understand that the postponement was over a short number of days, and I am not aware that any harm came to any of those patients. I believe that I would have been informed had that not been the case.

Minister, the response to the Committee's request for departmental officials to attend a meeting so that we could interrogate the details of your written statement said the following:

"The Department is not yet in a position to provide any further detail ... The Minister will need time to consider the advice from his officials ... In addition, the Minister has not seen any action plans from the BHSCT ... It would be premature for officials to appear before" the Health Committee in relation to the details of what level 5 means. We welcome the Minister's intervention, which is right and proper, but, even though it was a very important step, we are very unclear about what it means in reality.

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.

Minister, it will come as no surprise that, following the leaked report on the cardiac surgery unit at the Belfast Trust, members of staff from other trusts are contacting MLAs to say that they, too, are working in toxic environments. What do you say to those staff? Will you support an individual duty of candour?

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 am grateful for the Minister's urgent response to the crisis to date. I also very much welcome the appointment of Peter McBride to a role of independent support in the Belfast Trust. Is it the Minister's belief that Mr McBride is not the sort of person to shy away from shining a light into dark corners when necessary and that he is also someone who has the skill set necessary to drive change throughout an organisation?

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.

A few days ago, I met a constituent who is going in for cardiac surgery in the next week. She is genuinely scared, given the revelations that she has read. She is getting open-heart surgery. If there is a wider cultural problem across the health service — Patricia McKeown of UNISON thinks that it is symptomatic of a wider leadership problem — what root-and-branch reforms will you put in place across the health service, not simply in the cardiac surgery unit and not simply in Belfast, if that is what is demanded?

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).

What is the Minister doing to rebuild public trust in what is a vital service and to reassure cardiac patients and their families that it is safe and effective?

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.

As my colleague Andrew McMurray just said, we need to build back patients' trust. Will Mr McBride be able to look at issues such as the number of appointments that are delayed because the consultant is not in the hospital? I have personal experience of a patient whose operation has been delayed five times. On one of the most recent occasions, they were gowned and ready to go to theatre when their operation was postponed again. Will Mr McBride look at that to ensure that patients are treated a lot more kindly and fairly throughout the process?

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."

Will the performance accountability process as it is reviewed look at the wider issue of the trust's complaints process? I had one experience with Belfast Trust when I complained about a clinician. It took the trust a year and half to close that complaint. Will the Minister commit to saying that the performance accountability process will include the trust's current complaints process?

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 appreciate the fact that the Minister has engaged with the unions on the issue. That is positive, and I hope that it continues throughout the process, either through Peter McBride or the Department.

Minister, you have yet to receive the Belfast Trust's action plan. Will you reassure me that, in the interests of accountability and transparency, when you do receive it, you will publish it for everyone to see? That is about the public confidence that other Members and you have spoken about.

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

Can we be assured that, at the end of the day, the Belfast Trust has the appropriate human resource responsibilities available to it so that it cannot and will not shy away from any appropriate disciplinary or dismissal actions that may be required as an outcome of all this?

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.

It has been raised with me that some of the people who were affected by bullying at the Royal were targeted because they are members of the LGBT+ community. Are you aware of that and, if so, do you know how many people were impacted on by it? More crucially, what are you going to do about it?

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.

Will the Minister give a sense of how long the Belfast Trust will be on level 5 special measures?

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.

That concludes questions to the Minister on the question for urgent oral answer. Members, please take your ease for a moment.