A public inquiry will examine governance around urology services in a Northern Ireland Health Trust, and not just the work of one urologist, a barrister has said.

The first public sitting of the Urology Services Inquiry opened in Belfast on Tuesday.

The inquiry was ordered by former health minister Robin Swann after serious concerns about the clinical practice of a hospital consultant, Aidan O’Brien.

Mr O’Brien retired from the Southern Health Trust in 2020.

The trust notified the Department of Health of concerns about his work, leading to the records of more than 1,000 patients being recalled.

The first day of public hearings heard that almost 600 patients received “suboptimal care”.

Core participants in the inquiry include the Department of Health, the Southern Health and Social Care Trust and Mr O’Brien.

Inquiry counsel Martin Wolfe KC in his opening statement outlined that there had been nine serious adverse incidents (SAI) reviews and a formal look back review of 2,112 patients under the management of Mr O’Brien between January 2019 and June 2020.

He said the SAI reviews reported additional significant shortcomings in care in all nine cases.

“The SAI reviews have reported additional significant shortcomings in the management and care of all nine patients, and instances of harm or risk of harm to those patients,” Mr Wolfe said.

“In particular the SAI documented that four of the nine patients reported on suffered serious and significant deficits in their care.”

He said in addition to the nine, a further 53 patient cases have met the threshold for an SAI, and are being examined via structured clinical record review.

Mr Wolfe added that another 583 patient cases revealed 777 instances of “suboptimal care”.

These were in areas such as diagnostics, medication, treatment, communication including record keeping and referral, but did not meet the threshold for an SAI review.

However Mr Wolfe said it is not “the Aidan O’Brien inquiry”.

He said while the performance of Mr O’Brien during his employment at the Trust are “significant aspects of the inquiry’s work”, the key focus is to scrutinise the Trust’s governance arrangements.

“The inquiry must examine aspects of Mr O’Brien’s work, especially those cases which have met the threshold for a serious adverse incident,” he said.

“We will use the available evidence to search for, describe and catalogue shortcomings in clinical practice, but it is not the function of this inquiry to make findings in individual cases or reach conclusions on causation issues for example. That is more properly the domain of civil proceedings.

“Instead, the key focus of the inquiry’s work is to scrutinise the Trust’s governance arrangements.

“The Trust’s framework for clinical and social care governance shall be examined to determine whether and to what extent it permitted clinical shortcomings to occur, whether those shortcomings were known and remedied or unchallenged, or whether they remained undetected during the course of Mr O’Brien’s employment, and whether this undermined patient care and placed patient safety in jeopardy.

“So the critical mainstay of the inquiry’s work is not to investigate Mr O’Brien per se, but it will be to examine the systems of clinical governance to expose any weaknesses or gaps in those systems.”

During his opening statement, Mr Wolfe also outlined some of the evidence from Mr O’Brien.

He said Mr O’Brien was appointed as a consultant urologist at Craigavon Hospital in 1992, and was noted as “building up urology services in the Trust singlehandedly”.

He said Mr O’Brien suggests the urology department at Craigavon Area Hospital was recognised as remarkably successful in its first decade.

However he said Mr O’Brien said there were enormous difficulties in meeting demand, and he undertook extended operation days. He described 2016 as a very difficult year.

“It is clear that Mr O’Brien considers that his commitment, dedication and hours of hard work in an effort to deliver optimal, definitive and timely management for patients was undermined by system delivery, was compromised by the lack of adequate resources and prioritisation,” Mr Wolfe said.

The inquiry heard that Mr O’Brien is being investigated by the General Medical Council (GMC).

He is still registered with the GMC, with a licence to practise medicine, however he has been the subject of an interim order since 2020 which imposes conditions on his registration.

He was described as not currently employed in any capacity.

Mr Wolfe also noted the recent publication of the report of the Neurology Inquiry, four years since the Hyponatraemia Inquiry and the ongoing Muckamore Hospital Inquiry.

“It is notable that the reports of both the Neurology Inquiry and the Hyponatraemia Inquiry point to significant governance concerns and the report for each inquiry contains recommendations for governance, improvement and reform,” he said.

“The need for these inquiries and their proliferation is undoubtedly a matter of public concern.”

In her opening remarks inquiry chairwoman Christine Smith KC said the patients and families, some of whom lost their lives, “are at the heart of the work that the inquiry is undertaking”, and she acknowledged their pain and suffering.

The inquiry has received almost 400,000 pages of evidence, including 91 witness response statements and 133 completed questionnaires from staff and 16 from patients or family members.

Ms Smith criticised how material has been supplied by core participants.

“Unfortunately, I need to state publicly that the manner in which much of that material was provided to the inquiry was far from satisfactory, and caused much unnecessary work,” she said.

“Material was not properly ordered, indexed or accessible, some material was not provided at all, and some material was shared with the inquiry that ought not to have been.

“I find it extremely surprising to receive material in such a poor state from a government department and health trust, both of whom have dedicated legal teams, and for this standard of provision of material to have been allowed to continue when the inquiry made it abundantly clear what was expected.”

The inquiry will hold sittings through to the end of 2023.