Stormont's Health Minister has moved to assure the public of the safety of Northern Ireland's hospitals following the revelation that waiting times and staff shortages contributed to the deaths of five people in one A&E department last year.
Edwin Poots said "serious questions" needed to be answered about the care given to those five patients in Belfast's Royal Victoria Hospital and said the coroner may ultimately have to probe the circumstances around the fatalities.
But he told the Stormont Assembly it would be wrong to conclude that potential failings in treatment were a direct cause of the deaths, stressing that all the people were already extremely sick and may well have died in any case.
Mr Poots insisted patients were relatively safer in Northern Ireland hospitals than elsewhere in the UK.
"The average in England in terms of mortality is higher than we have in any of our trusts across Northern Ireland," he said.
"So let's be very clear about that, the public need to know - mortality is lower in Northern Ireland than it is in England in our hospitals."
Today's disclosure by the Belfast Trust that work pressures in the Royal were a contributory factor in the five deaths came less than 24 hours after Mr Poots revealed that an inspection of the hospital's A&E found evidence of a dysfunctional system, plagued by shortages of doctors and nurses and allegations of staff bullying.
Mr Poots, addressing the Assembly following the trust's revelation, said he only learned of the five deaths, which occurred between December 2012 and November 2013, this morning.
All five were recorded as a "serious adverse incident" as major potential issues with care had been identified.
Mr Poots told Assembly question time that the incident reports "indicated the medical response could have been better had there been more doctors available, so those are serious questions we will all be seeking answers to over the course of the period of time that lies ahead".
He said he had asked his officials to examine whether more could have been done in the particular instances and whether lessons could be learned.
"I should make clear that the five people who died, died because they were seriously unwell when they attended the Royal Victoria Hospital," the minister added.
"There is a serious adverse incident report that was compiled and that will identify there was a possibility that more could have been done and there's a possibility that not all five people would have died - we don't know that, and we haven't got the evidence to either say that or actually to indicate that is not the case at this stage.
"There is always a number of deaths in emergency departments, it's a challenge for all health services in the avoidance of preventable deaths, and the speed at which appropriate medical treatment can be delivered is a factor - that includes ambulance response times, triage, diagnostic testing and the provision of clinical care. They are all essential in ensuring the best outcome for the individual."
He added: "It would be wrong to conclude at this stage that the outcome in these cases were directly related to waiting times and whilst we recognise that healthcare can never be 100% safe these were very sick patients, very complex cases, so these patients may have passed away in any case."
Sinn Fein Assembly member Cathal O h'Oisin asked the minister if he owed the families involved an apology.
Mr Poots replied: "I certainly would express my sympathies to the families and have expressed my sympathies in these circumstances."
He added: "We do need to further look into these case and identify if failings on the part of health and social care were a factor in these deaths, that needs to be identified and that needs to be avoided in other instances."
The inspection of the emergency department by the Regulation and Quality Improvement Authority (RQIA) was commissioned by the minister in the wake of a major incident being declared at the hospital last month over a huge patient backlog.
Outlining the findings at Stormont yesterday, Mr Poots had said aspects of the feedback from RQIA were "cause for concern".
At the time of the backlog incident last month, the minister insisted it was a "one off".
The SDLP's Fearghal McKinney asked him to reflect on that comment in the context of today's revelation by the trust.
Mr McKinney said: "We conclude that either the minister didn't know or did know about the longer term pressures when he was making his earlier remarks and would he therefore agree with me that the public might be right to suspect that there was at least a disguising of the situation or at worst a cover-up?"
Mr Poots said he made his response to the backlog on the basis of what staff had told him when he visited the hospital in the aftermath.
"Nothing else, nothing more and nothing less," he said.
Deaths recorded as serious adverse incidents are not uncommon within the health service, and across Northern Ireland between 2004 and 2012 there were more than 800.
Such incidents could include negligent treatment; failure to provide certain care on time or at all; exposure to a major unexpected risk or threat; and the involvement in a violent incident, such as an assault, in a health care setting.
But many incidents are not directly linked to treatment provided.
Of the 813 in that eight year period, more than half involved patients believed to have taken their own lives.
The RQIA is also examining accident emergency provision across Belfast and Northern Ireland and will report back to Mr Poots with those findings in the summer.
In a statement about the deaths, the Belfast Trust said: "Belfast Trust treats over 80,000 people each year in the Royal Victoria Hospital's Emergency Department. As part of our governance arrangements and in line with health service practice, we report every circumstance if we feel an individual may have come to harm while in our care.
"It is essential we learn from these circumstances and in a recent analysis of our Serious Adverse Incidents we have identified that delays in seeing a doctor may have been one of several contributory factors in a small number of deaths - specifically in five cases.
"We have already implemented the learning from these Serious Adverse Incidents and this has enabled us to further improve our service."