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Last month, a major incident was declared | 0:00:02 | 0:00:05 | |
at the Royal Victory Hospital's Emergency Department in Belfast, | 0:00:05 | 0:00:08 | |
as staff became overwhelmed by an influx of sick patients. | 0:00:08 | 0:00:13 | |
From the outside, it looked like chaos. | 0:00:13 | 0:00:15 | |
It reminded me of a war picture. You know, like a disaster film. | 0:00:18 | 0:00:22 | |
There was no organisation. | 0:00:22 | 0:00:24 | |
It's a volcano and last night it erupted. | 0:00:24 | 0:00:27 | |
It's got to the point where it's embarrassing to actually stand | 0:00:27 | 0:00:30 | |
and watch doctors and nurses in tears, | 0:00:30 | 0:00:32 | |
in tears simply because they're struggling. | 0:00:32 | 0:00:35 | |
But the next day, those responsible for running the system set out | 0:00:36 | 0:00:40 | |
to reassure the public that this was a unique event. | 0:00:40 | 0:00:43 | |
This particular case was a one-off. | 0:00:43 | 0:00:47 | |
They said it showed that the system worked under pressure. | 0:00:47 | 0:00:50 | |
We got staff in and within a relatively short space of time, | 0:00:50 | 0:00:54 | |
the system reacted well. | 0:00:54 | 0:00:55 | |
Since then, health service managers have been quick to point out | 0:00:57 | 0:01:01 | |
that the emergency medicine system is not in crisis, | 0:01:01 | 0:01:04 | |
but is that really the case? | 0:01:04 | 0:01:06 | |
For the last several weeks, | 0:01:07 | 0:01:08 | |
Spotlight has been investigating the state | 0:01:08 | 0:01:10 | |
of our emergency departments here in Northern Ireland. | 0:01:10 | 0:01:12 | |
We've been speaking to doctors and nurses | 0:01:12 | 0:01:15 | |
who work in emergency medicine, | 0:01:15 | 0:01:16 | |
doctors and nurses who say that time and again, | 0:01:16 | 0:01:19 | |
they've been warning their managers | 0:01:19 | 0:01:21 | |
that the system is putting patients at risk. | 0:01:21 | 0:01:23 | |
We've also uncovered evidence that unacceptably long waiting times | 0:01:23 | 0:01:27 | |
have played a part in serious incidents | 0:01:27 | 0:01:30 | |
in which two patients died. | 0:01:30 | 0:01:32 | |
Have we evidence that shows that what we're dealing with | 0:01:32 | 0:01:36 | |
-is safe or not safe? -Yes, we do. | 0:01:36 | 0:01:38 | |
Here's a letter that talks about how waiting times | 0:01:38 | 0:01:40 | |
have contributed to two deaths. | 0:01:40 | 0:01:42 | |
One of the main considerations here | 0:01:42 | 0:01:44 | |
is that these people waited too long and they died. | 0:01:44 | 0:01:48 | |
Yeah, and we need to learn from that. | 0:01:48 | 0:01:49 | |
HEARTBEATS | 0:02:02 | 0:02:06 | |
When Carol Toland woke up | 0:02:06 | 0:02:07 | |
on the morning of Wednesday the 8th of January, | 0:02:07 | 0:02:10 | |
she knew that something was wrong. | 0:02:10 | 0:02:12 | |
I was having pains in my chest, | 0:02:12 | 0:02:15 | |
which was very unusual for me | 0:02:15 | 0:02:17 | |
and I felt breathless | 0:02:17 | 0:02:18 | |
and I said to Martin, "I don't feel the best at all." | 0:02:18 | 0:02:22 | |
But I phoned my GP surgery. | 0:02:22 | 0:02:24 | |
Carol's GP saw her immediately | 0:02:24 | 0:02:26 | |
and decided she should go to hospital for tests. | 0:02:26 | 0:02:29 | |
That would mean going to the Emergency Department | 0:02:29 | 0:02:32 | |
of the Royal Victoria Hospital | 0:02:32 | 0:02:34 | |
-and to get there, Carol needed an ambulance. -Ambulance Service. | 0:02:34 | 0:02:38 | |
This is the headquarters of the Northern Ireland Ambulance Service. | 0:02:38 | 0:02:42 | |
These dispatchers deal with up to 400 calls a day, | 0:02:42 | 0:02:46 | |
with about 50 of those being emergencies. | 0:02:46 | 0:02:48 | |
Tell me exactly what's happened. | 0:02:48 | 0:02:51 | |
Wednesday the 8th of January started off as an average day | 0:02:51 | 0:02:54 | |
for Brian McNeill, director of the Ambulance Service, | 0:02:54 | 0:02:57 | |
but these days, with increasing demand and limited resources, | 0:02:57 | 0:03:00 | |
even an average day is a busy one. | 0:03:00 | 0:03:03 | |
We've doubled our 999 calls from 2000, the year 2000, | 0:03:03 | 0:03:07 | |
-we've doubled the amount of 999 calls. -Why would that be? | 0:03:07 | 0:03:10 | |
I think it's a combination - people are confused | 0:03:11 | 0:03:15 | |
about how to access the system. | 0:03:15 | 0:03:18 | |
The public's expectations are higher, I believe, | 0:03:18 | 0:03:20 | |
and they demand an immediate response. | 0:03:20 | 0:03:23 | |
SIREN BLARES | 0:03:23 | 0:03:25 | |
In an emergency, an ambulance will still get to you | 0:03:25 | 0:03:28 | |
in an average time of ten minutes. | 0:03:28 | 0:03:30 | |
But Carol's chest pains had subsided, | 0:03:31 | 0:03:34 | |
so her case wasn't an emergency. | 0:03:34 | 0:03:36 | |
She would have to wait considerably longer for her transfer to hospital. | 0:03:36 | 0:03:40 | |
It was just two hours we had to sort of kill, | 0:03:40 | 0:03:43 | |
waiting on the ambulance coming. | 0:03:43 | 0:03:45 | |
The ambulance arrived at 2pm and transferred Carol the short distance | 0:03:45 | 0:03:49 | |
to the Emergency Department of the Royal Victoria Hospital. | 0:03:49 | 0:03:52 | |
She was brought in on an ambulance trolley. | 0:03:53 | 0:03:56 | |
To Carol and Martin, | 0:03:57 | 0:03:58 | |
it was obvious that the department was under pressure. | 0:03:58 | 0:04:02 | |
Once they'd stationed me on the trolley, | 0:04:02 | 0:04:04 | |
my back was to the action, but Martin was standing beside me | 0:04:04 | 0:04:07 | |
and he says, "God, Carol, all you can see is beds and wheelchairs." | 0:04:07 | 0:04:13 | |
There was no room even for Martin to get a chair to sit down beside me. | 0:04:13 | 0:04:18 | |
The nurses and doctors were swerving in and out of beds sideways. | 0:04:18 | 0:04:22 | |
At the nurses' station, | 0:04:22 | 0:04:24 | |
there was ten trolleys sitting there with people on them. | 0:04:24 | 0:04:28 | |
There was wheelchairs sitting beside them as well. | 0:04:28 | 0:04:32 | |
The nursing staff couldn't actually move. | 0:04:32 | 0:04:35 | |
Carol and Martin settled in for a long wait. | 0:04:37 | 0:04:40 | |
As the afternoon went on, they saw other patients waiting in distress. | 0:04:40 | 0:04:45 | |
The wee lady beside me was blind. She wanted to go to the toilet. | 0:04:45 | 0:04:48 | |
She kept shouting she'd been there from 9am. | 0:04:48 | 0:04:52 | |
She obviously knew when someone was walking past her | 0:04:52 | 0:04:55 | |
and she kept calling for someone, | 0:04:55 | 0:04:57 | |
"I want to go to the toilet." | 0:04:57 | 0:04:59 | |
Eventually a nurse took her to the toilet. | 0:04:59 | 0:05:03 | |
It's not acceptable, is it, that people should be in that situation? | 0:05:03 | 0:05:06 | |
No, it's not. | 0:05:06 | 0:05:07 | |
It's not, and I wouldn't sit here and say for one second | 0:05:07 | 0:05:10 | |
that it's acceptable. | 0:05:10 | 0:05:12 | |
By the late afternoon, three and a half hours into Carol's wait, | 0:05:12 | 0:05:15 | |
pressure on staff and resources was building. | 0:05:15 | 0:05:18 | |
The Chief Executive of the Belfast Trust was informed | 0:05:18 | 0:05:21 | |
that the Emergency Department, or ED, was unusually busy. | 0:05:21 | 0:05:25 | |
I was in our Emergency Department from about half four. | 0:05:25 | 0:05:29 | |
At that point in the evening, | 0:05:29 | 0:05:31 | |
we did have in the high 20s of trolley waits | 0:05:31 | 0:05:35 | |
and we had just over 80 people in our Emergency Department. | 0:05:35 | 0:05:38 | |
That brings with it a lot of pressure. | 0:05:38 | 0:05:41 | |
I left the site at about half six. | 0:05:41 | 0:05:45 | |
By that stage there were a few more trolley waits | 0:05:45 | 0:05:48 | |
and there were over 90 people in our ED department. | 0:05:48 | 0:05:51 | |
15 minutes later, at 6:45pm, | 0:05:52 | 0:05:55 | |
dispatchers at ambulance headquarters were asked | 0:05:55 | 0:05:57 | |
by the Royal's Emergency Department to divert non-emergency ambulances | 0:05:57 | 0:06:02 | |
to other hospitals. | 0:06:02 | 0:06:04 | |
By 7pm, the Royal issued a request that is very rare. | 0:06:04 | 0:06:08 | |
Even emergency ambulances, from some parts of Belfast, | 0:06:08 | 0:06:11 | |
were asked to stay away. | 0:06:11 | 0:06:13 | |
999 diverts are more the exception than the norm, very infrequent, | 0:06:15 | 0:06:20 | |
because of the consequences and the risks to patients. | 0:06:20 | 0:06:23 | |
So they are very, very infrequent and only in extremis. | 0:06:23 | 0:06:26 | |
FRANTIC CHATTER | 0:06:26 | 0:06:28 | |
By now there were over 100 people | 0:06:30 | 0:06:32 | |
in the Emergency Department waiting room | 0:06:32 | 0:06:34 | |
and 42 waiting on trolleys. | 0:06:34 | 0:06:37 | |
Carol was one of them. | 0:06:37 | 0:06:38 | |
She says the situation was chaotic. | 0:06:38 | 0:06:40 | |
They kept calling me by another name. They kept getting patients mixed up. | 0:06:41 | 0:06:46 | |
"Are you Mrs So and So?" "No." | 0:06:46 | 0:06:48 | |
The nurses were going up and down these lines looking for... | 0:06:48 | 0:06:51 | |
It kept reminding me of a war picture | 0:06:53 | 0:06:56 | |
where they shout out a name. | 0:06:56 | 0:06:58 | |
You know, like a disaster film where they shout out a name, | 0:06:58 | 0:07:01 | |
"Yes, that's me." | 0:07:01 | 0:07:02 | |
That's what it was like, "Are you Mrs So and So?" "No." | 0:07:02 | 0:07:05 | |
I was confident it wasn't chaotic and disorganised. | 0:07:05 | 0:07:08 | |
At 8:30pm, Colm Donaghy convened a conference call | 0:07:08 | 0:07:12 | |
with senior clinical staff. | 0:07:12 | 0:07:14 | |
By now it was clear | 0:07:14 | 0:07:15 | |
that there weren't enough doctors and nurses in the hospital | 0:07:15 | 0:07:18 | |
to deal with the patients. | 0:07:18 | 0:07:19 | |
Part of the issue was, for example, we'd exhausted the wards, | 0:07:19 | 0:07:23 | |
we'd exhausted our bank. | 0:07:23 | 0:07:25 | |
The agencies were indicating to us that they couldn't provide | 0:07:25 | 0:07:28 | |
nurses of sufficient skill to us to open additional beds, | 0:07:28 | 0:07:31 | |
so we didn't open additional beds. | 0:07:31 | 0:07:34 | |
At 9:28pm, a major incident was declared. | 0:07:34 | 0:07:38 | |
One minute later, off-duty staff were contacted by pager | 0:07:38 | 0:07:41 | |
and told to report for work immediately. | 0:07:41 | 0:07:44 | |
My initial reaction was one of surprise, | 0:07:44 | 0:07:46 | |
because we've never had a major incident declared | 0:07:46 | 0:07:50 | |
from an ED department, | 0:07:50 | 0:07:51 | |
as a consequence of congestion. | 0:07:51 | 0:07:54 | |
I was surprised by that, but major incidents come | 0:07:54 | 0:07:57 | |
in a whole variety of guises and forms. | 0:07:57 | 0:08:00 | |
I think it is for the staff at that point in time | 0:08:00 | 0:08:03 | |
and we're very clear about that, it is their call. | 0:08:03 | 0:08:06 | |
They are the people who are right beside the issue. | 0:08:06 | 0:08:09 | |
The plan worked. | 0:08:09 | 0:08:10 | |
Within an hour, 9 consultants and 24 nurses had joined the team | 0:08:10 | 0:08:15 | |
and they worked frantically to clear the congestion. | 0:08:15 | 0:08:18 | |
By midnight, most people had been moved off trolleys | 0:08:18 | 0:08:21 | |
and into the hospital. | 0:08:21 | 0:08:22 | |
Carol was one of them. | 0:08:22 | 0:08:24 | |
She says that despite her nightmare wait, | 0:08:24 | 0:08:27 | |
she has nothing but admiration for the staff. | 0:08:27 | 0:08:30 | |
They kept stopping and asking how much pain I was in. | 0:08:30 | 0:08:33 | |
Was I in any discomfort. | 0:08:34 | 0:08:35 | |
So what exactly happened that day at the Royal Victoria Hospital? | 0:08:37 | 0:08:41 | |
What was it that turned what should have been a routine mid-week shift | 0:08:41 | 0:08:44 | |
into a major incident? | 0:08:44 | 0:08:46 | |
Well, that depends on who you talk to. | 0:08:46 | 0:08:48 | |
The day after the major incident, | 0:08:49 | 0:08:51 | |
Health Minister Edwin Poots said it was | 0:08:51 | 0:08:53 | |
an unusual and unpredictable event | 0:08:53 | 0:08:56 | |
that didn't mean the system was in crisis. | 0:08:56 | 0:08:58 | |
Well, there is 100 people in ED and 42 on trolleys. | 0:08:58 | 0:09:01 | |
The response was to get more staff there to deal with the backlog. | 0:09:01 | 0:09:05 | |
The backlog was dealt with. | 0:09:05 | 0:09:06 | |
So we had an unusual spike, | 0:09:06 | 0:09:08 | |
an unreasonable spike in the numbers that were coming through. | 0:09:08 | 0:09:13 | |
Health service managers are keen to point out | 0:09:13 | 0:09:15 | |
the incident doesn't point to a wider problem. | 0:09:15 | 0:09:17 | |
I don't think there is a crisis in emergency medicine. | 0:09:19 | 0:09:22 | |
They are very busy at times and they can be congested | 0:09:22 | 0:09:25 | |
and occasionally the personal experience for individual patients | 0:09:25 | 0:09:30 | |
can be unpleasant and I'm sure it also feels very stressed | 0:09:30 | 0:09:33 | |
and pressurised for staff | 0:09:33 | 0:09:34 | |
but I don't believe "crisis" is the right word. | 0:09:34 | 0:09:37 | |
We asked the senior medical consultants | 0:09:37 | 0:09:39 | |
at the Royal's Emergency Department to take part in this programme. | 0:09:39 | 0:09:43 | |
Some raised serious concerns but none was prepared to speak publicly. | 0:09:43 | 0:09:48 | |
At the moment people are scared to speak out, both doctors and nurses. | 0:09:48 | 0:09:52 | |
They shouldn't be. | 0:09:52 | 0:09:53 | |
They shouldn't be, it's as simple as that. | 0:09:53 | 0:09:55 | |
-But they are. -But they shouldn't be. | 0:09:55 | 0:09:58 | |
Irrespective of whether they feel a sense of intimidation | 0:10:00 | 0:10:04 | |
in the employment system and whatever, | 0:10:04 | 0:10:08 | |
or not, they have an obligation to do so. | 0:10:08 | 0:10:10 | |
If you look at their actual professional obligations, | 0:10:10 | 0:10:13 | |
they don't have a choice in the matter. | 0:10:13 | 0:10:15 | |
They have an obligation to do so. | 0:10:15 | 0:10:17 | |
The consultants did, however, provide us | 0:10:17 | 0:10:19 | |
with this written statement, | 0:10:19 | 0:10:21 | |
passed on to us on the understanding | 0:10:21 | 0:10:23 | |
that it was on behalf of all the staff consultants | 0:10:23 | 0:10:26 | |
in emergency medicine. | 0:10:26 | 0:10:27 | |
In this statement, the consultants say... | 0:10:27 | 0:10:29 | |
They welcome the recent review ordered by Edwin Poots | 0:10:36 | 0:10:39 | |
and they say... | 0:10:39 | 0:10:40 | |
We were given a more detailed insight into those complaints. | 0:10:46 | 0:10:50 | |
The medical staff we spoke to didn't want to appear on camera | 0:10:50 | 0:10:53 | |
but we have been shown e-mails from a range of senior doctors | 0:10:53 | 0:10:58 | |
to senior managers at the Belfast Trust. | 0:10:58 | 0:11:00 | |
These e-mails date back several months | 0:11:00 | 0:11:03 | |
and they specifically point out | 0:11:03 | 0:11:04 | |
how understaffing and excessive trolley waits have been, at times, | 0:11:04 | 0:11:09 | |
compromising the safety of patients. | 0:11:09 | 0:11:11 | |
Colm Donaghy admits that he and his staff got the e-mails. | 0:11:12 | 0:11:15 | |
Some of the e-mails would highlight that they feel | 0:11:15 | 0:11:18 | |
when we are under extreme pressure | 0:11:18 | 0:11:20 | |
that sometimes safety can be compromised. | 0:11:20 | 0:11:22 | |
We accept that. | 0:11:22 | 0:11:24 | |
So you accept... | 0:11:24 | 0:11:26 | |
They're saying safety is compromised at periods of extreme pressure | 0:11:26 | 0:11:29 | |
and you accept that is the case. | 0:11:29 | 0:11:30 | |
It has to be managed. It's managed by them professionally. | 0:11:30 | 0:11:33 | |
It is not being managed well enough, is it? | 0:11:33 | 0:11:36 | |
We've seen some of this correspondence. | 0:11:36 | 0:11:38 | |
It goes back months | 0:11:38 | 0:11:40 | |
and we're told some of it goes back years. | 0:11:40 | 0:11:44 | |
This doesn't look good for you, does it, | 0:11:45 | 0:11:47 | |
or the Trust, if you have senior medical consultants, | 0:11:47 | 0:11:49 | |
over a period of years, | 0:11:49 | 0:11:52 | |
saying this place is unsafe at times. | 0:11:52 | 0:11:54 | |
Well, over those years, Declan, | 0:11:54 | 0:11:56 | |
what you can't ignore is the level of reform | 0:11:56 | 0:11:59 | |
and the changes that we have brought about in Belfast | 0:11:59 | 0:12:03 | |
to manage services more safely. | 0:12:03 | 0:12:06 | |
One of those e-mails was sent on the 7th of January, | 0:12:06 | 0:12:09 | |
the day before the major incident was declared. | 0:12:09 | 0:12:12 | |
It's from a consultant, addressed to his bosses. | 0:12:12 | 0:12:15 | |
He is talking about some of the things | 0:12:15 | 0:12:17 | |
he witnessed during his shift in the Emergency Department. | 0:12:17 | 0:12:20 | |
He says, | 0:12:20 | 0:12:22 | |
"The most appalling example was an elderly patient | 0:12:22 | 0:12:25 | |
"found hanging off the end of an ED trolley | 0:12:25 | 0:12:27 | |
"with fresh faeces dripping down her legs. | 0:12:27 | 0:12:30 | |
"This is one of the most disgraceful things | 0:12:30 | 0:12:32 | |
"I have had the misfortune of witnessing in my entire career." | 0:12:32 | 0:12:36 | |
That's appalling that someone has to write a letter like that | 0:12:36 | 0:12:39 | |
up the chain. | 0:12:39 | 0:12:40 | |
I think it's not acceptable that something like that would happen | 0:12:40 | 0:12:43 | |
and that would be the experience that a patient would have in her ED. | 0:12:43 | 0:12:47 | |
I'm very keen that that's not repeated | 0:12:47 | 0:12:50 | |
and that's not something that we accept | 0:12:50 | 0:12:52 | |
as a part of the ongoing care we provide for patients in our ED. | 0:12:52 | 0:12:56 | |
What would you say to that lady or her family? | 0:12:56 | 0:12:59 | |
I would apologise to them for the experience they've had. | 0:12:59 | 0:13:02 | |
The e-mail, like others we've seen, | 0:13:02 | 0:13:05 | |
goes on to raise concerns about the safety of patients. | 0:13:05 | 0:13:09 | |
How many times have medical and nursing staff | 0:13:09 | 0:13:12 | |
complained to the Trust and the board that safety | 0:13:12 | 0:13:16 | |
is an issue and patients are at too much risk? | 0:13:16 | 0:13:19 | |
I think I have never heard anybody say very directly to me, | 0:13:19 | 0:13:24 | |
"I am working in an unsafe place", | 0:13:24 | 0:13:26 | |
because, frankly, I don't believe | 0:13:26 | 0:13:28 | |
that professionals would continue to work in that way. | 0:13:28 | 0:13:31 | |
I think they would do different things | 0:13:31 | 0:13:33 | |
and they would be obligated to do different things. | 0:13:33 | 0:13:36 | |
But isn't it the case that over several months, | 0:13:36 | 0:13:38 | |
if not years, there have been e-mails, | 0:13:38 | 0:13:40 | |
and I've seen some of those e-mails, | 0:13:40 | 0:13:42 | |
where clinical staff, consultants | 0:13:42 | 0:13:44 | |
and nursing staff have been telling their bosses this is unsafe, at times? | 0:13:44 | 0:13:49 | |
I'm sure you have that sort of information. | 0:13:51 | 0:13:54 | |
I guess the difficulty about that is, | 0:13:54 | 0:13:56 | |
as you know yourself, | 0:13:56 | 0:13:57 | |
e-mails are a conversation and people can have a conversation | 0:13:57 | 0:14:01 | |
and the word "safety" can come into the conversation and that's different | 0:14:01 | 0:14:05 | |
from actually having an absolute statement about safety or otherwise. | 0:14:05 | 0:14:08 | |
These e-mails certainly read like absolute statements. | 0:14:08 | 0:14:12 | |
They come from a number of consultants and the concern | 0:14:12 | 0:14:15 | |
they all have in common is patient risk and patient safety. | 0:14:15 | 0:14:18 | |
They are addressed to managers in the Trust | 0:14:18 | 0:14:20 | |
and copied to their fellow doctors. | 0:14:20 | 0:14:23 | |
One of them, which alleges chronic understaffing, | 0:14:23 | 0:14:26 | |
is copied to Colm Donaghy, | 0:14:26 | 0:14:27 | |
the Chief Executive of the Belfast Trust. | 0:14:27 | 0:14:31 | |
When you get these e-mails from consultants | 0:14:31 | 0:14:33 | |
talking about potential safety compromises, | 0:14:33 | 0:14:36 | |
do you pass those up to John Compton at the board or to the minister? | 0:14:36 | 0:14:41 | |
No, not the actual e-mails. | 0:14:41 | 0:14:42 | |
We have the conversations about the pressures | 0:14:42 | 0:14:45 | |
that exhibit as a part of that and I've had discussions | 0:14:45 | 0:14:49 | |
with the Health and Social Care Board, including John, | 0:14:49 | 0:14:53 | |
in relation to some of the e-mails | 0:14:53 | 0:14:54 | |
but I haven't shared the actual e-mails with him. | 0:14:54 | 0:14:57 | |
He says he hasn't seen them. | 0:14:57 | 0:15:01 | |
Isn't it the case that, as the Healthcare Commissioner, | 0:15:01 | 0:15:04 | |
or indeed the minister, people like that should be made aware | 0:15:04 | 0:15:07 | |
of those concerns because they are safety concerns? | 0:15:07 | 0:15:10 | |
They are very serious. | 0:15:10 | 0:15:11 | |
They are serious concerns and we deal with them as a part of our system. | 0:15:11 | 0:15:15 | |
What we make the Health and Social Care Board aware of | 0:15:15 | 0:15:18 | |
is the fact that the concerns have been raised with us | 0:15:18 | 0:15:21 | |
and that we need to work through a process. That's where we are. | 0:15:21 | 0:15:25 | |
Spotlight has also been speaking to nurses, | 0:15:26 | 0:15:29 | |
who say that they are working under intolerable pressure | 0:15:29 | 0:15:32 | |
and that the system is to blame. | 0:15:32 | 0:15:34 | |
They've asked us to hide their identities | 0:15:34 | 0:15:36 | |
so we've reconstructed their interviews using actors. | 0:15:36 | 0:15:39 | |
The system is at complete breaking point. | 0:15:39 | 0:15:42 | |
The Health Minister needs to stop the party line of, | 0:15:42 | 0:15:45 | |
"We're all working hard and we're all coping." | 0:15:45 | 0:15:48 | |
The first thing people would appreciate | 0:15:48 | 0:15:50 | |
is acknowledgement that we're in trouble. | 0:15:50 | 0:15:53 | |
For the staff we spoke to, | 0:15:53 | 0:15:54 | |
the biggest issue by far was trolley waits - | 0:15:54 | 0:15:58 | |
patients who had been processed by the Emergency Department | 0:15:58 | 0:16:01 | |
and who are waiting for a bed in hospital. | 0:16:01 | 0:16:03 | |
They are all coming in the front door but then the back door isn't open | 0:16:03 | 0:16:06 | |
so it clogs and clogs. | 0:16:06 | 0:16:08 | |
You also don't have the cubicle space to treat your patients | 0:16:08 | 0:16:11 | |
with the respect and dignity that they deserve. | 0:16:11 | 0:16:14 | |
The nurses we spoke to said the system is having a serious effect | 0:16:14 | 0:16:18 | |
on the morale of Emergency Department staff. | 0:16:18 | 0:16:20 | |
We are the ones who have to face people and say, | 0:16:21 | 0:16:23 | |
"I'm sorry your 90-year-old mother | 0:16:23 | 0:16:25 | |
"is still on a trolley at 11 hours." | 0:16:25 | 0:16:27 | |
You can imagine saying that to somebody time and time again | 0:16:28 | 0:16:32 | |
over the space of a few years. | 0:16:32 | 0:16:34 | |
How would that make you feel? | 0:16:34 | 0:16:36 | |
In the last five years, | 0:16:36 | 0:16:37 | |
Northern Ireland has lost 18% of its hospital beds. | 0:16:37 | 0:16:42 | |
The Belfast Trust alone has lost 20% of its beds in that time. | 0:16:42 | 0:16:46 | |
Isn't it the case that there just aren't enough beds? | 0:16:46 | 0:16:49 | |
The reason why there are so many trolley waits | 0:16:49 | 0:16:51 | |
is that beds are being lost, year on year, | 0:16:51 | 0:16:54 | |
there aren't enough beds to take people out of emergency departments | 0:16:54 | 0:16:57 | |
and put them into hospital. | 0:16:57 | 0:16:58 | |
I don't think you can say that or come to that conclusion. | 0:16:58 | 0:17:01 | |
The changing pattern of medical care is tremendous | 0:17:01 | 0:17:04 | |
so the dependence on beds is not what it was once | 0:17:04 | 0:17:07 | |
in terms of the ability to treat and manage individuals. | 0:17:07 | 0:17:11 | |
The death rate has stayed very static over... | 0:17:11 | 0:17:13 | |
This is Hugh McCloy. | 0:17:13 | 0:17:15 | |
He's a campaigner for better health provision in Northern Ireland. | 0:17:15 | 0:17:18 | |
Over the years, he's built up contacts inside hospitals | 0:17:18 | 0:17:21 | |
who tell him when the system is struggling. | 0:17:21 | 0:17:24 | |
This is where we are now. | 0:17:24 | 0:17:25 | |
On the week beginning the 5th of January, | 0:17:25 | 0:17:27 | |
Hugh noticed that something worrying was happening | 0:17:27 | 0:17:30 | |
in emergency departments across Northern Ireland. | 0:17:30 | 0:17:33 | |
Antrim's Emergency Department had to open up an extra ward | 0:17:33 | 0:17:36 | |
because it became inundated with patients. | 0:17:36 | 0:17:38 | |
Soon afterwards, Altnagelvin and Craigavon hospitals | 0:17:38 | 0:17:41 | |
had to turn away ambulances. | 0:17:41 | 0:17:43 | |
So, first of all, on Sunday the 5th of January 2014, | 0:17:43 | 0:17:48 | |
you see Antrim opening up a second assessment unit and importing beds. | 0:17:48 | 0:17:53 | |
-Yes. -And then you have Altnagelvin - starts to turn away ambulances. -Yep. | 0:17:53 | 0:17:59 | |
Then you have a major incident at the Royal. | 0:17:59 | 0:18:01 | |
It's almost like it feels like a domino effect. | 0:18:01 | 0:18:03 | |
It is. Quite simply, when one hospital closes its doors, | 0:18:03 | 0:18:07 | |
the patients have to go elsewhere. | 0:18:07 | 0:18:08 | |
So, whenever Antrim began to limit its admissions, | 0:18:08 | 0:18:12 | |
people started going to the Causeway, Altnagelvin, Craigavon | 0:18:12 | 0:18:15 | |
and the Royal. | 0:18:15 | 0:18:16 | |
It's quite simple. If there was a larger incident happening, | 0:18:16 | 0:18:19 | |
only knows what would happen. | 0:18:19 | 0:18:20 | |
I think the incident you refer to in Altnagelvin | 0:18:20 | 0:18:23 | |
was a major incident because there was a five-car pile-up. | 0:18:23 | 0:18:26 | |
and they were unclear early on from the five-car pile-up | 0:18:26 | 0:18:29 | |
about how many major casualties they would receive | 0:18:29 | 0:18:32 | |
in the middle of all of that. | 0:18:32 | 0:18:34 | |
That's normal business for emergency departments. | 0:18:34 | 0:18:37 | |
I don't think that you could conclude | 0:18:37 | 0:18:40 | |
that that was a sign that, in Northern Ireland, if you like, | 0:18:40 | 0:18:43 | |
the emergency system was teetering. | 0:18:43 | 0:18:46 | |
The emergency system was working in its normal way. | 0:18:46 | 0:18:49 | |
So, what is normal? | 0:18:50 | 0:18:52 | |
Well, according to the health care professionals | 0:18:52 | 0:18:54 | |
we've been speaking to, | 0:18:54 | 0:18:55 | |
periods of extreme pressure are becoming the norm | 0:18:55 | 0:18:59 | |
and while declaring a major incident may have been a unique response, | 0:18:59 | 0:19:03 | |
the pressures which led to it are all too common. | 0:19:03 | 0:19:06 | |
It is not a one-off in terms of an ED department being as busy as that. | 0:19:07 | 0:19:12 | |
It happens frequently. | 0:19:12 | 0:19:13 | |
It was a one-off in that it was declared as a major incident. | 0:19:15 | 0:19:17 | |
That's what made it unique on that night. | 0:19:17 | 0:19:21 | |
The figures tell their own story. | 0:19:21 | 0:19:23 | |
Emergency departments in England see just under 94% of people | 0:19:23 | 0:19:27 | |
within four hours. | 0:19:27 | 0:19:28 | |
By December last year, | 0:19:28 | 0:19:29 | |
hospitals here in Northern Ireland were seeing just 72% of people. | 0:19:29 | 0:19:33 | |
In the same month, the Royal Victoria Hospital | 0:19:35 | 0:19:37 | |
managed to deal with just 62% of people within four hours. | 0:19:37 | 0:19:41 | |
Dr Brian Fisher was an Emergency Department consult | 0:19:42 | 0:19:45 | |
at the Royal Victoria Hospital. | 0:19:45 | 0:19:47 | |
He retired three years ago. | 0:19:47 | 0:19:49 | |
Even then, he says the system was constantly on the verge of crisis. | 0:19:49 | 0:19:54 | |
The nursing staff in the department | 0:19:54 | 0:19:56 | |
are not only trying to deal with the patients | 0:19:56 | 0:19:58 | |
who are coming into the department that they should be dealing with, | 0:19:58 | 0:20:01 | |
but also trying to do the job of a ward nurse | 0:20:01 | 0:20:04 | |
in looking after these people as well. | 0:20:04 | 0:20:07 | |
Were you surprised when the major incident was declared at the Royal? | 0:20:07 | 0:20:11 | |
I'm retired now three years, but even whenever I was working | 0:20:11 | 0:20:16 | |
there were times when the department | 0:20:16 | 0:20:17 | |
was very close to complete saturation, | 0:20:17 | 0:20:21 | |
and therefore it wasn't a surprise to hear that | 0:20:21 | 0:20:24 | |
it had got behind crisis point, shall we say. | 0:20:24 | 0:20:28 | |
The doctors we've been speaking to here, still working at the Royal | 0:20:28 | 0:20:31 | |
today, say that at times the pressures here | 0:20:31 | 0:20:33 | |
can reach crisis point, and that's a particular problem at weekends | 0:20:33 | 0:20:37 | |
and during out-of-hours periods. | 0:20:37 | 0:20:39 | |
The big question, of course, | 0:20:39 | 0:20:41 | |
is whether those pressures have ever compromised patient safety. | 0:20:41 | 0:20:45 | |
The medical and nursing staff we've been speaking to say that | 0:20:45 | 0:20:48 | |
most of the time the Emergency Department in the Royal is safe, | 0:20:48 | 0:20:53 | |
but at weekends and out of hours it can become unsafe | 0:20:53 | 0:20:57 | |
and has done in the past. Do you accept that? | 0:20:57 | 0:20:59 | |
No, well, what I would say is that the risks are higher out of hours. | 0:20:59 | 0:21:04 | |
Which means it has become unsafe. | 0:21:04 | 0:21:06 | |
No, it doesn't necessarily mean it's become unsafe, | 0:21:06 | 0:21:08 | |
because as I said, we avoid the department becoming unsafe. | 0:21:08 | 0:21:12 | |
So, for example, the reason I took the decision | 0:21:12 | 0:21:15 | |
to call the major incident or trigger the major incident protocol | 0:21:15 | 0:21:19 | |
was to avoid the department becoming unsafe. | 0:21:19 | 0:21:22 | |
But we've uncovered further disturbing evidence that excessive | 0:21:22 | 0:21:25 | |
waiting times have had serious consequences for patients. | 0:21:25 | 0:21:30 | |
This document was distributed to all Trusts in Northern Ireland | 0:21:30 | 0:21:33 | |
after two serious incidents at the Royal Victoria Hospital's | 0:21:33 | 0:21:36 | |
Emergency Department. | 0:21:36 | 0:21:38 | |
We were given it by someone who's concerned about patient safety | 0:21:38 | 0:21:41 | |
and who believes that incidents like this need to be exposed. | 0:21:41 | 0:21:45 | |
This document describes how two patients died | 0:21:45 | 0:21:48 | |
after receiving substandard care. | 0:21:48 | 0:21:50 | |
It's what's known in the profession as a Serious Adverse Incident. | 0:21:50 | 0:21:54 | |
The document is known as a learning letter, | 0:21:54 | 0:21:56 | |
distributed widely to medical professionals | 0:21:56 | 0:21:58 | |
and hospital managers so they can learn lessons from what went wrong. | 0:21:58 | 0:22:02 | |
Now, in these incidents, which we're told happened last year, | 0:22:04 | 0:22:07 | |
there were delays in diagnosing what was wrong | 0:22:07 | 0:22:10 | |
with two separate patients, but those initial delays | 0:22:10 | 0:22:13 | |
were compounded by the fact that the patients then had to wait longer | 0:22:13 | 0:22:16 | |
than they should have to get treated. | 0:22:16 | 0:22:19 | |
Now this report is very clear. | 0:22:19 | 0:22:20 | |
One of the contributing factors in these Serious Adverse Incidents | 0:22:20 | 0:22:24 | |
was waiting times. | 0:22:24 | 0:22:26 | |
Have we evidence that shows that what we're dealing with | 0:22:26 | 0:22:30 | |
in terms of our services is safe or not safe? | 0:22:30 | 0:22:34 | |
Yes, we do. Here's some. | 0:22:34 | 0:22:35 | |
That's a Serious Adverse Incident learning letter | 0:22:35 | 0:22:38 | |
that talks about how waiting times have contributed to two deaths. | 0:22:38 | 0:22:42 | |
But of course you have an issue of a Serious Adverse Incident. | 0:22:42 | 0:22:46 | |
You'll appreciate I know the case | 0:22:46 | 0:22:48 | |
and I can't talk of the detail of the case. | 0:22:48 | 0:22:50 | |
Serious Adverse Incidents, in my experience, are a combination | 0:22:50 | 0:22:53 | |
-of events. -But my question is... | 0:22:53 | 0:22:55 | |
Here is a learning letter regarding a Serious Adverse Incident, | 0:22:55 | 0:23:00 | |
two different ones, two different patients, two different deaths. | 0:23:00 | 0:23:03 | |
Waiting times implicated as one factor. | 0:23:03 | 0:23:06 | |
My question is how many other Serious Adverse Incidents | 0:23:06 | 0:23:09 | |
in the last six months have had waiting times as a factor? | 0:23:09 | 0:23:13 | |
Erm... I can't give you an exact number. | 0:23:13 | 0:23:15 | |
I can tell you the numbers in terms of whether there is waiting times | 0:23:15 | 0:23:20 | |
or not. But the issue for me is that we have 700,000 people go through | 0:23:20 | 0:23:25 | |
our ED departments. | 0:23:25 | 0:23:26 | |
The ability for us to go through with 700,00 people in the year | 0:23:26 | 0:23:30 | |
and not have an adverse incident, I think everyone will understand that's | 0:23:30 | 0:23:33 | |
highly improbable and unlikely. | 0:23:33 | 0:23:36 | |
And therefore, I think, is the scale of that huge? | 0:23:36 | 0:23:39 | |
No, the scale of that is not huge. It is absolutely not huge. | 0:23:39 | 0:23:43 | |
The learning letter is the only documentary evidence that we have | 0:23:43 | 0:23:46 | |
of a Serious Adverse Incident which had waiting times as a factor, | 0:23:46 | 0:23:51 | |
but we've been led to believe it's not the only time | 0:23:51 | 0:23:53 | |
that that's happened. | 0:23:53 | 0:23:55 | |
How many more Serious Adverse Incidents have there been | 0:23:55 | 0:23:57 | |
where people have waited too long? | 0:23:57 | 0:23:59 | |
Well, it's difficult, but it would be single figures. | 0:23:59 | 0:24:04 | |
I mean, we've been told it could be nine. Would that be...? | 0:24:04 | 0:24:07 | |
No, it's not as high as nine. I think at this point it's about four. | 0:24:07 | 0:24:12 | |
But I don't have those figures in front of me. | 0:24:12 | 0:24:14 | |
In how long? In the last six months? The last year? | 0:24:14 | 0:24:17 | |
No, that would be over the last couple of years, | 0:24:17 | 0:24:19 | |
and that's in the context that over that period of time | 0:24:19 | 0:24:22 | |
we would've had about 160,000 attendances in our ED. | 0:24:22 | 0:24:25 | |
But nobody should be dying because they're waiting too long. | 0:24:25 | 0:24:28 | |
Well, actually, there's a multiple of factors. It wasn't just... | 0:24:28 | 0:24:31 | |
When you read that you'll see there's a multitude of factors | 0:24:31 | 0:24:34 | |
that pertain to those particular cases. Not just the waiting... | 0:24:34 | 0:24:38 | |
The waiting time was a contributing factor, but not the only factor. | 0:24:38 | 0:24:41 | |
We interviewed Colm Donaghy yesterday. | 0:24:41 | 0:24:44 | |
This morning, his subordinate medical director, Dr Tony Stevens, | 0:24:44 | 0:24:47 | |
pointed out that the true figure for deaths involving waiting times | 0:24:47 | 0:24:51 | |
was five in the past year alone. | 0:24:51 | 0:24:53 | |
I asked you earlier, did the department ever become unsafe? | 0:24:54 | 0:25:00 | |
Now, clearly, this shows that it did. | 0:25:00 | 0:25:04 | |
For that individual, yes, the department was at a point | 0:25:04 | 0:25:09 | |
where it had an impact on the outcome for that individual patient. | 0:25:09 | 0:25:13 | |
That's right. | 0:25:13 | 0:25:14 | |
Whether or not that meant the entire department was unsafe | 0:25:14 | 0:25:18 | |
is something that I wouldn't agree with. | 0:25:18 | 0:25:20 | |
But, obviously, it's a matter for interpretation. | 0:25:20 | 0:25:23 | |
Hospital policy and good practice dictate that in incidents like this, | 0:25:23 | 0:25:27 | |
both the family of the person involved | 0:25:27 | 0:25:29 | |
and the coroner should be informed. | 0:25:29 | 0:25:32 | |
Have you informed the families who are involved here | 0:25:32 | 0:25:35 | |
that waiting times played a part in these incidents? | 0:25:35 | 0:25:38 | |
I'm not aware of the detail of both, but I know certainly | 0:25:38 | 0:25:43 | |
one of the families had been... | 0:25:43 | 0:25:44 | |
It was subject of a Root Cause Analysis for us | 0:25:44 | 0:25:46 | |
and one of the families has been very involved in relation to that. | 0:25:46 | 0:25:49 | |
The other family, I'm not sure. | 0:25:49 | 0:25:51 | |
But certainly it would be a part of our policy now that we would inform | 0:25:51 | 0:25:55 | |
families of the reasons. | 0:25:55 | 0:25:57 | |
-You would expect that a family would want to know... -Absolutely. | 0:25:57 | 0:26:00 | |
..if the system played some kind of part in their loved one's death? | 0:26:00 | 0:26:04 | |
Yes. | 0:26:04 | 0:26:06 | |
So, will you be looking into informing the other family, if... | 0:26:06 | 0:26:10 | |
If they haven't been informed? Of course, yes. | 0:26:11 | 0:26:15 | |
What about the coroner? | 0:26:15 | 0:26:16 | |
Does the coroner need to investigate something like that? | 0:26:16 | 0:26:19 | |
Well, we work very, very closely with the coroner, | 0:26:19 | 0:26:22 | |
working out the criteria and the details of when a case | 0:26:22 | 0:26:26 | |
should be referred to the coroner or when the coroner should be involved. | 0:26:26 | 0:26:29 | |
And has this one been referred? | 0:26:29 | 0:26:30 | |
Well, I'm not sure whether it has or not. I don't know. | 0:26:30 | 0:26:33 | |
It's something that I could look into, | 0:26:33 | 0:26:36 | |
but I'm not sure if it's been referred to the coroner. | 0:26:36 | 0:26:39 | |
This afternoon, the Belfast Trust confirmed that the coroner | 0:26:39 | 0:26:42 | |
has been made aware. | 0:26:42 | 0:26:43 | |
Last week, Health Minister Edwin Poots announced a review. | 0:26:47 | 0:26:50 | |
He said he asked the hospital regulator, the RQIA, | 0:26:50 | 0:26:54 | |
to look at how the acute medical department was working. | 0:26:54 | 0:26:56 | |
In fact, we've learned that before the minister made that request, | 0:26:56 | 0:27:00 | |
the medical consultants themselves had already written to the RQIA | 0:27:00 | 0:27:04 | |
asking that they intervene. | 0:27:04 | 0:27:06 | |
The regulator inspected the department and interviewed staff | 0:27:06 | 0:27:09 | |
over the first weekend of February. | 0:27:09 | 0:27:11 | |
That preliminary report by the RQIA was damning. | 0:27:11 | 0:27:15 | |
The inspector spoke to more than 100 staff across a range of roles | 0:27:16 | 0:27:20 | |
and functions. The inspection has confirmed concerns | 0:27:20 | 0:27:23 | |
about staffing levels in key areas, allegations of bullying, | 0:27:23 | 0:27:27 | |
staff under intolerable pressure and a system of care | 0:27:27 | 0:27:30 | |
that does not function fully as it was set up to do. | 0:27:30 | 0:27:34 | |
You must be concerned if you have the RQIA finding what they found | 0:27:34 | 0:27:42 | |
two weeks ago. You have Serious Adverse Incidents | 0:27:42 | 0:27:44 | |
in which patients are waiting too long, and you have | 0:27:44 | 0:27:47 | |
your own senior consultants in the Emergency Department | 0:27:47 | 0:27:50 | |
releasing a statement saying there needs to be an urgent transformation | 0:27:50 | 0:27:53 | |
in the system. | 0:27:53 | 0:27:55 | |
It all adds up to something that must be quite worrying for you? | 0:27:55 | 0:27:58 | |
Yeah, it is quite worrying, | 0:27:58 | 0:28:00 | |
but we're taking forward very strong action at this point in time. | 0:28:00 | 0:28:05 | |
Some of it which we were already in training. | 0:28:05 | 0:28:08 | |
So, for example, we'd already reviewed our nurse staffing levels | 0:28:08 | 0:28:11 | |
in our ED prior to Christmas. | 0:28:11 | 0:28:14 | |
We're now in a position to increase the numbers of nurse staffing | 0:28:14 | 0:28:18 | |
in our ED. So we're employing an additional 14 nurses. | 0:28:18 | 0:28:21 | |
We also wanted to ask Edwin Poots about the RQIA review, | 0:28:21 | 0:28:26 | |
amongst many other things, such as why three weeks ago | 0:28:26 | 0:28:29 | |
he sought to reassure the public that politicians and the media | 0:28:29 | 0:28:32 | |
were exaggerating the crisis in the emergency departments, | 0:28:32 | 0:28:35 | |
but now he has issues of serious concern about | 0:28:35 | 0:28:38 | |
how the Royal Victoria Hospital's Emergency Department is run. | 0:28:38 | 0:28:42 | |
We also wanted to ask him whether he knew of doctors' concerns | 0:28:42 | 0:28:46 | |
about patients' safety, and if not, why not? | 0:28:46 | 0:28:50 | |
But the minister declined to be interviewed for this programme. | 0:28:50 | 0:28:53 | |
He did, however, give us a statement in which he said that he recognises | 0:28:53 | 0:28:57 | |
the gravity of the situation, but that he wants to reassure the public | 0:28:57 | 0:29:00 | |
that the Belfast Trust will continue to manage the risks | 0:29:00 | 0:29:04 | |
and provide emergency services with the help of its dedicated staff. | 0:29:04 | 0:29:08 | |
The medical and nursing staff we spoke to wanted to make it clear | 0:29:09 | 0:29:12 | |
that most of the time the Emergency Department here at the Royal | 0:29:12 | 0:29:15 | |
is safe for patients. But they said that during busy times | 0:29:15 | 0:29:19 | |
and at weekends, that's not always the case. | 0:29:19 | 0:29:23 | |
Politicians and health service managers are now rushing | 0:29:23 | 0:29:25 | |
to change that, with new staff being added to the rota | 0:29:25 | 0:29:28 | |
and a major review ongoing. | 0:29:28 | 0:29:31 | |
But there's no doubt that some staff here think it should have happened | 0:29:31 | 0:29:34 | |
a long time ago. And for some patients, it's too late. | 0:29:34 | 0:29:38 | |
The people that work in this building, and others like it | 0:29:39 | 0:29:42 | |
across Northern Ireland, | 0:29:42 | 0:29:43 | |
deal with the rest of us during some of the worst moments of our lives. | 0:29:43 | 0:29:48 | |
They do so day-in, day-out, often in stressful and difficult conditions. | 0:29:48 | 0:29:53 | |
Now, many of them say, they have their own emergency, | 0:29:53 | 0:29:57 | |
and finding a remedy for them should matter to us all. | 0:29:57 | 0:30:00 |