The most senior figures in the health service are today facing questions over their handling of a row about the safety of care home residents.
There are mounting calls from across the political spectrum for the health minister to reveal whether he knew of the serious concerns held by the board of Northern Ireland's health watchdog over a decision to scale back inspections of care homes during the Covid-19 pandemic.
Robin Swann is also being asked to explain why he did not intervene in a row over the controversial measure, which prompted a mass resignation of the board of the Regulation and Quality Improvement Authority (RQIA).
At the same time, the interim chief executive of the RQIA is under pressure to explain why he told the Stormont health committee that the organisation was in agreement with the direction from the Department of Health.
Dermot Parsons appeared in front of the committee on May 14, where he was asked whether he agreed or challenged the reduction in care home inspections. In response to the question from chair Colm Gildernew, Mr Parsons said: "Our approach towards that was agreement"
However, in an email sent on April 29, Mr Parsons referred to "an appearance of a fundamental difference of approach between that promoted by the CMO, chief social worker and RQIA executive team members, and that upheld by the RQIA board".
He continued: "I would also be grateful for your urgent advice as I believe that my position as interim chief executive in RQIA may be untenable… I am content to step out of this role if it will help resolve this dilemma."
In a further email sent to Dr McBride on May 4, Mr Parsons reiterated his desire to resign over the row. He continued: "It is clear that RQIA Board does not have confidence in my performance in this role, in addition to the earlier clarity of their opposition to elements of Departmental directions. I was not appointed to this role by the RQIA Board, so I am unsure as to with whom I should discuss resignation… unfortunately I now believe my position is untenable."
It came after Professor Mary McColgan, who resigned from the post of interim chair of the RQIA board last week, raised a series of concerns about the official Covid-19 response on behalf of the board in an email sent to Dr McBride on April 28, and copying in Richard Pengelly, permanent secretary for the Department of Health.
This included the reduction in care home inspections and a redeployment of a significant number of RQIA's senior executive team "with critical loss of experience", including the interim chief executive and medical director, who have both left to take up different roles in the health service in recent months.
She continued: "We feel the process has impacted on the importance and validity of our statutory role because it has diluted our critical function as a regulator to maintain the protection of vulnerable adults in residential and nursing homes and children in care settings".
Mr Pengelly subsequently responded to Mr Parsons to provide reassurances that adult and child protection activity "remains an absolute priority".
He also offered to facilitate a meeting between Mr Parsons and Prof McColgan to "provide clear direction on any contentious matters".
Dr McBride also sent an email on May 4 in which he assured Mr Parsons that he had "responsibility for operational matters".
He continued: "I would add that you have my full support and confidence at this unprecedented time. I am indebted to you and the entire RQIA team for the lengths you have gone to in supporting the domiciliary, nursing and residential sector and the proportionate action taken to reduce unnecessary footfall into care homes while supporting standards of care."
Sinn Fein, the SDLP, DUP and Alliance Party members of the health committee are all calling for Mr Swann to provide clarity on the matter and he is facing a number of urgent oral questions from his Stormont colleagues.
Paula Bradshaw, the Alliance Party's health spokeswoman, said: "Ultimately, Mr Swann is responsible for this. I hope he can clarify in the chamber what he knew about the CMO's direction on March 20, what he knew about correspondence between lead Department officials and the chair of the RQIA Board and what he knew about correspondence between the CMO and chief executive of the RQIA on May 4."
Meanwhile, the DUP's Pam Cameron, deputy chair of the Stormont health committee, said the situation has underscored the need for a full investigation into the handling of Covid-19 in care homes.
Concerns had been raised that inspections - deemed essential to ensure care homes meet minimum safety standards - were halted at the same time care homes coped with the biggest public health emergency encountered in Northern Ireland in more than 100 years.
Dr McBride issued the controversial direction to the RQIA on March 20; however, a challenge by family members of care home residents was subsequently lodged at the High Court.
A judicial review into the direction was due to be heard today but the case was settled yesterday after the Department of Health lifted restrictions that were placed on the work of the RQIA because of the Covid-19 pandemic.
A Department of Health spokesman refused to explain why Mr Swann did not intervene to try and resolve the issues in the RQIA ahead of the mass walk-out and the RQIA did not respond to a request for comment on Mr Parson's evidence to the Stormont health committee.
However, Mr Swann said: "These board positions are by Ministerial appointment, yet it is disappointing that none of those resigning made any contact with me beforehand about any concerns.
"Both the Department and I have full confidence in the interim chief executive. I would like to thank him and his staff for the extensive work they have done supporting care homes during this pandemic."
March 20: Chief medical officer Dr Michael McBride writes to then interim chief executive of RQIA to inform her of the Department of Health direction to reduce the frequency of its statutory inspection activity and cease its non-statutory inspection activity.
April 27: RQIA board meeting attended by board members and interim chief executive Dermot Parsons discusses the implications of the departmental direction and concerns are raised.
April 28: Former interim chair of the RQIA Professor Mary McColgan writes to the Mr McBride "to reflect the concerns which we feel have arisen because of the consequences" of the Covid-19 response.
April 29: Mr Parsons emails Mr McBride seeking his "urgent advice" over the row with the RQIA board, stating that he believes his position "may be untenable".
May 4: Mr Parsons emails him again stating "it is clear now that the board oppose decisions to implement those directions taken by me" and raises the possibility that he may resign due to his "untenable" position. Dr McBride replies to confirm that Mr Parsons has "responsibility for operational matters".
May 5: Permanent secretary for Department of Health Richard Pengelly writes to Prof McColgan to offer reassurances safeguarding of vulnerable adults and children "remains an absolute priority".
May 14: Mr Parsons appears in front of the Stormont health committee where he is asked about the decision to scale back inspections of care homes. Asked whether he agreed or challenged the reduction in care home inspections, he said: "Our approach towards that was agreement."
June 18: Health Minister Robin Swann expresses disappointment at the resignation of a number of RQIA board members including Prof McColgan. Both the Department of Health and RQIA refuse to reveal who has resigned or the reason for the resignations.
June 22: The Department of Health announces it has lifted restrictions that were placed on the work of the RQIA because of the Covid-19 pandemic, less than 24 hours before a judicial review into the measure. It also emerged the entire board of the RQIA had resigned.