Damning report reveals toxic culture and safety risks in Royal Victoria Hospital’s Cardiac Unit

A shocking independent report into Northern Ireland’s only Cardiac Surgery Unit at the Royal Victoria Hospital in Belfast has exposed a toxic workplace culture, including allegations of bullying, verbal abuse, and even surgeons throwing instruments during operations.

The findings, described as “horrifically graphic and concerning” by DUP MLA Paul Frew, have raised serious concerns about patient safety and prompted urgent calls for reform from health officials and unions.

The report, commissioned by the Belfast Health and Social Care Trust in January 2025 following staff complaints, has not yet been made public but was obtained by UTV and discussed extensively in the Northern Ireland Assembly on Tuesday 27 May 2025.

It details a breakdown in relationships among staff, with “clear tensions” and an “apparent power battle” between senior doctors. This toxic environment has led to cancelled operations, with four heart surgeons reportedly refusing to attend theatre and four consultants working from home due to concerns for their “safety and wellbeing.”

Health Minister Mike Nesbitt, addressing Stormont’s health committee on Thursday, expressed dismay at the findings, stating he was treating the report “extremely seriously.”

He announced plans to meet health unions urgently to investigate whether similar issues exist in other health trusts and to ensure the report’s recommendations are implemented. Nesbitt also noted he is seeking legal advice on publishing the report due to concerns about identifying individuals.

Bullying and Instrument Throwing in Theatre

The leaked report paints a grim picture of the working environment in the Cardiac Surgery Unit, which conducts nearly 1,000 surgeries annually. It highlights “verbal abuse” and instances of surgeons throwing instruments during operations, with one consultant described as “particularly prone” to such behaviour, though it was not unique to them. Nursing staff, according to the report, have “borne the brunt of the bullying.”

Rita Devlin, executive director of the Royal College of Nursing (RCN), described the report as “damning,” adding that the behaviour nurses have faced is “shocking.”

The report also warns that the “cultural issues in this unit represent a significant risk to patient safety,” with “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.”

Despite these concerns, the Belfast Health and Social Care Trust has insisted the unit remains “clinically safe with excellent outcomes.” This claim, however, directly contradicts the report’s findings, which have sparked alarm among patients and healthcare advocates.

Calls for Reform and Whistleblower Protections

Paul Frew, DUP MLA for North Antrim, who has been advocating for a Private Member’s Bill on an Individual Duty of Candour in healthcare, described the report’s findings as troubling but unsurprising.

Drawing on his consultations with healthcare staff, Frew highlighted a pervasive fear of speaking out due to ineffective whistleblowing policies and a culture of intimidation.

“I speak to Nurses and healthcare staff all the time in the course of my work and in consultation on my Private Members Bill on an Individual Duty of Candour in Health care service, many are extremely nervous about speaking out against the deemed establishment,” Frew said.

“Many have suffered at the hands of bullying staff and line management and most have absolutely no confidence in the whistleblowing policies and protections and many had no faith, with some having bitter experience, that their complaint, if one were to be made, would result in a positive outcome for them.”

Frew warned that some staff believe raising concerns could lead to being “disadvantaged, shunned, moved on or even disciplined.” He stressed that this culture of fear is not confined to the Royal Victoria Hospital but is “widespread and affects staff in all Health Trusts.”

The MLA underscored the need for stronger protections for healthcare workers, noting that many feel “let down and vulnerable” in an already challenging workplace.

“We need to ensure that healthcare staff are reinforced with protections that mean they cannot be bullied into doing something wrong or pressured into silence and acquiescence when something does go wrong,” he said.

“This is critically important that we look after the people who look after us but its also vital for the people of Northern Ireland who need an effective and trustworthy healthcare service when they require it.”

Patient Safety at Risk

The report’s findings have sparked widespread concern about the standard of care at the Cardiac Surgery Unit, particularly given its critical role in Northern Ireland’s healthcare system.

Alan Robinson, a DUP member of the Stormont health committee, likened the reported behaviours to “something you’d see in a wild west bar than a surgical unit.”

The breakdown in staff relationships has already had tangible consequences, with operations cancelled due to surgeons’ refusal to attend theatre. The report’s conclusion that cultural issues pose a “significant risk to patient safety” has heightened fears among patients awaiting treatment at the unit.

The Belfast Health and Social Care Trust has acknowledged the need for change, stating it is “appalled” by the behaviours outlined and committed to addressing them. However, the Trust’s assertion that the unit remains safe has been met with scepticism in light of the report’s stark warnings.

Urgent Action Needed

As the fallout from the report continues, Health Minister Nesbitt is set to meet the chair of the Belfast Trust on Friday to discuss next steps. The minister has also pledged to work closely with health unions to address the systemic issues raised and to ensure the report’s recommendations are acted upon swiftly.

For Frew, the report is “but the tip of the iceberg,” and he fears similar issues may emerge across other healthcare settings in Northern Ireland. “Our nursing staff need to be heard and need to be treated with dignity and respect,” he said, urging immediate action to protect both staff and patients.

As Northern Ireland’s healthcare system grapples with these revelations, the focus now turns to restoring trust in the Cardiac Surgery Unit and ensuring that the toxic culture described in the report is addressed decisively. For patients and staff alike, the stakes could not be higher.