Surgeons threw instruments and bullied nurses - report

An "apparent power battle" has been unfolding between some senior doctors in the Royal Victoria Hospital's cardiac surgery unit, a leaked inspection report has said.

An independent review of the service was undertaken last year following long-running concerns about the culture. Last week, UTV reported the review had concluded that behavioural issues were creating a significant risk to patient safety.

BBC News NI has now seen a leaked copy of the report, which lays bare bullying allegations and claims of a lack of trust among staff.

The Belfast Trust said its cardiac unit was "clinically safe with excellent outcomes".

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

The report also detailed the throwing of instruments during surgery as well as "verbal abuse", which in one case had resulted in an incident report in recent months.

"This behaviour is ongoing at the time of writing this report and was widely reported by all who worked in the theatre environment," it added.

"Whilst there is one consultant who is particularly prone to throwing instruments in theatre, we were told that this behaviour is not unique.

"Staff described that the most common triggers for criticism were based around equipment and staffing. These patterns of behaviours were reported by staff as occurring on a predictable and repeated basis."

The report said nursing staff presented an "invaluable source of observation of behaviours and practice within the department, as they are independent of the apparent power battle which has been unfolding between senior consultant medical factions".

"It is the nursing staff in theatres who have borne the brunt of the bullying environment that all staff have been exposed to…

"Members of all professional groups interviewed reported that the atmosphere in theatres was tense and that some felt this pressure more than others."

It went on to say: "This precipitated some completely unacceptable behaviours, that were widely reported as being predominantly directed at the nursing staff, particularly more junior nurses.

"More junior medical staff also experience a particularly challenging time at the hands of some consultants, and it is our impression that few staff groups are completely spared."

The report also referenced powerful quotes from interviews with staff, including: "Nurses are often piggy in the middle, trying to referee disputes between surgeons and anaesthetists" and "I feel I have a target on my back".

In one section of the report, one occasion was outlined where a management decision resulted in a brief period of unannounced absence by four of the cardiac surgeons.

Staff described the unit as being in "chaos" and said "even patients who had been prepped for theatre were cancelled as nursing staff tried to get hold of the consultants".

In its conclusion, the report says the department is safe based on metrics, such as mortality data. However, it goes on to say that cultural issues in the unit represent a significant risk to patient safety.

"We do believe, however, that there are areas where patients are placed at risk of harm, or where harm has occurred, as a result of tensions, poor behaviours and a severe reluctance amongst staff to raise concerns," the reviewers said.

The Belfast Trust said: "We are reassured that the independent external review contains a universal recognition of the technical competence and clinical skills of all staff who work there.

"However, the trust fully acknowledges that the details in this independent review are appalling and the behaviour described within it is shocking and indefensible."

On Tuesday, Health Minister Mike Nesbitt described the situation as "appalling" and said behaviours must change.

The unit is a regional service for patients across Northern Ireland, with almost 1,000 operations carried out every year.