The State of Emergency Spotlight


The State of Emergency

Declan Lawn investigates whether increasing pressure on Northern Ireland's accident and emergency departments is compromising the safety of patients.


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Transcript


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Last month, a major incident was declared

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at the Royal Victory Hospital's Emergency Department in Belfast,

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as staff became overwhelmed by an influx of sick patients.

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From the outside, it looked like chaos.

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It reminded me of a war picture. You know, like a disaster film.

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There was no organisation.

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It's a volcano and last night it erupted.

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It's got to the point where it's embarrassing to actually stand

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and watch doctors and nurses in tears,

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in tears simply because they're struggling.

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But the next day, those responsible for running the system set out

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to reassure the public that this was a unique event.

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This particular case was a one-off.

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They said it showed that the system worked under pressure.

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We got staff in and within a relatively short space of time,

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the system reacted well.

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Since then, health service managers have been quick to point out

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that the emergency medicine system is not in crisis,

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but is that really the case?

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For the last several weeks,

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Spotlight has been investigating the state

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of our emergency departments here in Northern Ireland.

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We've been speaking to doctors and nurses

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who work in emergency medicine,

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doctors and nurses who say that time and again,

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they've been warning their managers

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that the system is putting patients at risk.

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We've also uncovered evidence that unacceptably long waiting times

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have played a part in serious incidents

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in which two patients died.

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Have we evidence that shows that what we're dealing with

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-is safe or not safe?

-Yes, we do.

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Here's a letter that talks about how waiting times

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have contributed to two deaths.

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One of the main considerations here

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is that these people waited too long and they died.

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Yeah, and we need to learn from that.

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HEARTBEATS

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When Carol Toland woke up

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on the morning of Wednesday the 8th of January,

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she knew that something was wrong.

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I was having pains in my chest,

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which was very unusual for me

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and I felt breathless

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and I said to Martin, "I don't feel the best at all."

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But I phoned my GP surgery.

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Carol's GP saw her immediately

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and decided she should go to hospital for tests.

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That would mean going to the Emergency Department

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of the Royal Victoria Hospital

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-and to get there, Carol needed an ambulance.

-Ambulance Service.

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This is the headquarters of the Northern Ireland Ambulance Service.

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These dispatchers deal with up to 400 calls a day,

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with about 50 of those being emergencies.

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Tell me exactly what's happened.

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Wednesday the 8th of January started off as an average day

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for Brian McNeill, director of the Ambulance Service,

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but these days, with increasing demand and limited resources,

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even an average day is a busy one.

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We've doubled our 999 calls from 2000, the year 2000,

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-we've doubled the amount of 999 calls.

-Why would that be?

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I think it's a combination - people are confused

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about how to access the system.

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The public's expectations are higher, I believe,

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and they demand an immediate response.

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SIREN BLARES

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In an emergency, an ambulance will still get to you

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in an average time of ten minutes.

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But Carol's chest pains had subsided,

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so her case wasn't an emergency.

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She would have to wait considerably longer for her transfer to hospital.

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It was just two hours we had to sort of kill,

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waiting on the ambulance coming.

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The ambulance arrived at 2pm and transferred Carol the short distance

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to the Emergency Department of the Royal Victoria Hospital.

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She was brought in on an ambulance trolley.

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To Carol and Martin,

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it was obvious that the department was under pressure.

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Once they'd stationed me on the trolley,

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my back was to the action, but Martin was standing beside me

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and he says, "God, Carol, all you can see is beds and wheelchairs."

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There was no room even for Martin to get a chair to sit down beside me.

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The nurses and doctors were swerving in and out of beds sideways.

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At the nurses' station,

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there was ten trolleys sitting there with people on them.

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There was wheelchairs sitting beside them as well.

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The nursing staff couldn't actually move.

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Carol and Martin settled in for a long wait.

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As the afternoon went on, they saw other patients waiting in distress.

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The wee lady beside me was blind. She wanted to go to the toilet.

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She kept shouting she'd been there from 9am.

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She obviously knew when someone was walking past her

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and she kept calling for someone,

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"I want to go to the toilet."

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Eventually a nurse took her to the toilet.

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It's not acceptable, is it, that people should be in that situation?

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No, it's not.

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It's not, and I wouldn't sit here and say for one second

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that it's acceptable.

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By the late afternoon, three and a half hours into Carol's wait,

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pressure on staff and resources was building.

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The Chief Executive of the Belfast Trust was informed

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that the Emergency Department, or ED, was unusually busy.

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I was in our Emergency Department from about half four.

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At that point in the evening,

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we did have in the high 20s of trolley waits

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and we had just over 80 people in our Emergency Department.

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That brings with it a lot of pressure.

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I left the site at about half six.

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By that stage there were a few more trolley waits

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and there were over 90 people in our ED department.

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15 minutes later, at 6:45pm,

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dispatchers at ambulance headquarters were asked

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by the Royal's Emergency Department to divert non-emergency ambulances

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to other hospitals.

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By 7pm, the Royal issued a request that is very rare.

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Even emergency ambulances, from some parts of Belfast,

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were asked to stay away.

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999 diverts are more the exception than the norm, very infrequent,

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because of the consequences and the risks to patients.

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So they are very, very infrequent and only in extremis.

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FRANTIC CHATTER

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By now there were over 100 people

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in the Emergency Department waiting room

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and 42 waiting on trolleys.

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Carol was one of them.

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She says the situation was chaotic.

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They kept calling me by another name. They kept getting patients mixed up.

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"Are you Mrs So and So?" "No."

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The nurses were going up and down these lines looking for...

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It kept reminding me of a war picture

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where they shout out a name.

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You know, like a disaster film where they shout out a name,

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"Yes, that's me."

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That's what it was like, "Are you Mrs So and So?" "No."

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I was confident it wasn't chaotic and disorganised.

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At 8:30pm, Colm Donaghy convened a conference call

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with senior clinical staff.

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By now it was clear

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that there weren't enough doctors and nurses in the hospital

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to deal with the patients.

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Part of the issue was, for example, we'd exhausted the wards,

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we'd exhausted our bank.

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The agencies were indicating to us that they couldn't provide

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nurses of sufficient skill to us to open additional beds,

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so we didn't open additional beds.

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At 9:28pm, a major incident was declared.

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One minute later, off-duty staff were contacted by pager

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and told to report for work immediately.

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My initial reaction was one of surprise,

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because we've never had a major incident declared

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from an ED department,

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as a consequence of congestion.

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I was surprised by that, but major incidents come

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in a whole variety of guises and forms.

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I think it is for the staff at that point in time

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and we're very clear about that, it is their call.

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They are the people who are right beside the issue.

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The plan worked.

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Within an hour, 9 consultants and 24 nurses had joined the team

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and they worked frantically to clear the congestion.

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By midnight, most people had been moved off trolleys

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and into the hospital.

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Carol was one of them.

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She says that despite her nightmare wait,

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she has nothing but admiration for the staff.

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They kept stopping and asking how much pain I was in.

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Was I in any discomfort.

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So what exactly happened that day at the Royal Victoria Hospital?

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What was it that turned what should have been a routine mid-week shift

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into a major incident?

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Well, that depends on who you talk to.

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The day after the major incident,

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Health Minister Edwin Poots said it was

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an unusual and unpredictable event

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that didn't mean the system was in crisis.

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Well, there is 100 people in ED and 42 on trolleys.

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The response was to get more staff there to deal with the backlog.

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The backlog was dealt with.

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So we had an unusual spike,

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an unreasonable spike in the numbers that were coming through.

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Health service managers are keen to point out

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the incident doesn't point to a wider problem.

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I don't think there is a crisis in emergency medicine.

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They are very busy at times and they can be congested

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and occasionally the personal experience for individual patients

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can be unpleasant and I'm sure it also feels very stressed

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and pressurised for staff

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but I don't believe "crisis" is the right word.

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We asked the senior medical consultants

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at the Royal's Emergency Department to take part in this programme.

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Some raised serious concerns but none was prepared to speak publicly.

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At the moment people are scared to speak out, both doctors and nurses.

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They shouldn't be.

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They shouldn't be, it's as simple as that.

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-But they are.

-But they shouldn't be.

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Irrespective of whether they feel a sense of intimidation

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in the employment system and whatever,

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or not, they have an obligation to do so.

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If you look at their actual professional obligations,

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they don't have a choice in the matter.

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They have an obligation to do so.

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The consultants did, however, provide us

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with this written statement,

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passed on to us on the understanding

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that it was on behalf of all the staff consultants

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in emergency medicine.

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In this statement, the consultants say...

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They welcome the recent review ordered by Edwin Poots

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and they say...

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We were given a more detailed insight into those complaints.

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The medical staff we spoke to didn't want to appear on camera

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but we have been shown e-mails from a range of senior doctors

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to senior managers at the Belfast Trust.

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These e-mails date back several months

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and they specifically point out

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how understaffing and excessive trolley waits have been, at times,

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compromising the safety of patients.

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Colm Donaghy admits that he and his staff got the e-mails.

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Some of the e-mails would highlight that they feel

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when we are under extreme pressure

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that sometimes safety can be compromised.

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We accept that.

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So you accept...

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They're saying safety is compromised at periods of extreme pressure

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and you accept that is the case.

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It has to be managed. It's managed by them professionally.

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It is not being managed well enough, is it?

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We've seen some of this correspondence.

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It goes back months

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and we're told some of it goes back years.

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This doesn't look good for you, does it,

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or the Trust, if you have senior medical consultants,

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over a period of years,

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saying this place is unsafe at times.

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Well, over those years, Declan,

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what you can't ignore is the level of reform

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and the changes that we have brought about in Belfast

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to manage services more safely.

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One of those e-mails was sent on the 7th of January,

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the day before the major incident was declared.

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It's from a consultant, addressed to his bosses.

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He is talking about some of the things

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he witnessed during his shift in the Emergency Department.

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He says,

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"The most appalling example was an elderly patient

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"found hanging off the end of an ED trolley

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"with fresh faeces dripping down her legs.

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"This is one of the most disgraceful things

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"I have had the misfortune of witnessing in my entire career."

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That's appalling that someone has to write a letter like that

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up the chain.

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I think it's not acceptable that something like that would happen

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and that would be the experience that a patient would have in her ED.

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I'm very keen that that's not repeated

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and that's not something that we accept

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as a part of the ongoing care we provide for patients in our ED.

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What would you say to that lady or her family?

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I would apologise to them for the experience they've had.

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The e-mail, like others we've seen,

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goes on to raise concerns about the safety of patients.

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How many times have medical and nursing staff

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complained to the Trust and the board that safety

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is an issue and patients are at too much risk?

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I think I have never heard anybody say very directly to me,

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"I am working in an unsafe place",

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because, frankly, I don't believe

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that professionals would continue to work in that way.

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I think they would do different things

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and they would be obligated to do different things.

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But isn't it the case that over several months,

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if not years, there have been e-mails,

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and I've seen some of those e-mails,

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where clinical staff, consultants

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and nursing staff have been telling their bosses this is unsafe, at times?

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I'm sure you have that sort of information.

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I guess the difficulty about that is,

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as you know yourself,

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e-mails are a conversation and people can have a conversation

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and the word "safety" can come into the conversation and that's different

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from actually having an absolute statement about safety or otherwise.

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These e-mails certainly read like absolute statements.

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They come from a number of consultants and the concern

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they all have in common is patient risk and patient safety.

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They are addressed to managers in the Trust

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and copied to their fellow doctors.

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One of them, which alleges chronic understaffing,

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is copied to Colm Donaghy,

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the Chief Executive of the Belfast Trust.

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When you get these e-mails from consultants

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talking about potential safety compromises,

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do you pass those up to John Compton at the board or to the minister?

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No, not the actual e-mails.

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We have the conversations about the pressures

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that exhibit as a part of that and I've had discussions

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with the Health and Social Care Board, including John,

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in relation to some of the e-mails

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but I haven't shared the actual e-mails with him.

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He says he hasn't seen them.

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Isn't it the case that, as the Healthcare Commissioner,

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or indeed the minister, people like that should be made aware

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of those concerns because they are safety concerns?

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They are very serious.

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They are serious concerns and we deal with them as a part of our system.

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What we make the Health and Social Care Board aware of

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is the fact that the concerns have been raised with us

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and that we need to work through a process. That's where we are.

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Spotlight has also been speaking to nurses,

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who say that they are working under intolerable pressure

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and that the system is to blame.

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They've asked us to hide their identities

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so we've reconstructed their interviews using actors.

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The system is at complete breaking point.

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The Health Minister needs to stop the party line of,

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"We're all working hard and we're all coping."

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The first thing people would appreciate

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is acknowledgement that we're in trouble.

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For the staff we spoke to,

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the biggest issue by far was trolley waits -

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patients who had been processed by the Emergency Department

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and who are waiting for a bed in hospital.

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They are all coming in the front door but then the back door isn't open

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so it clogs and clogs.

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You also don't have the cubicle space to treat your patients

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with the respect and dignity that they deserve.

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The nurses we spoke to said the system is having a serious effect

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on the morale of Emergency Department staff.

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We are the ones who have to face people and say,

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"I'm sorry your 90-year-old mother

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"is still on a trolley at 11 hours."

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You can imagine saying that to somebody time and time again

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over the space of a few years.

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How would that make you feel?

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In the last five years,

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Northern Ireland has lost 18% of its hospital beds.

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The Belfast Trust alone has lost 20% of its beds in that time.

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Isn't it the case that there just aren't enough beds?

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The reason why there are so many trolley waits

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is that beds are being lost, year on year,

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there aren't enough beds to take people out of emergency departments

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and put them into hospital.

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I don't think you can say that or come to that conclusion.

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The changing pattern of medical care is tremendous

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so the dependence on beds is not what it was once

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in terms of the ability to treat and manage individuals.

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The death rate has stayed very static over...

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This is Hugh McCloy.

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He's a campaigner for better health provision in Northern Ireland.

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Over the years, he's built up contacts inside hospitals

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who tell him when the system is struggling.

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This is where we are now.

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On the week beginning the 5th of January,

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Hugh noticed that something worrying was happening

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in emergency departments across Northern Ireland.

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Antrim's Emergency Department had to open up an extra ward

0:17:330:17:36

because it became inundated with patients.

0:17:360:17:38

Soon afterwards, Altnagelvin and Craigavon hospitals

0:17:380:17:41

had to turn away ambulances.

0:17:410:17:43

So, first of all, on Sunday the 5th of January 2014,

0:17:430:17:48

you see Antrim opening up a second assessment unit and importing beds.

0:17:480:17:53

-Yes.

-And then you have Altnagelvin - starts to turn away ambulances.

-Yep.

0:17:530:17:59

Then you have a major incident at the Royal.

0:17:590:18:01

It's almost like it feels like a domino effect.

0:18:010:18:03

It is. Quite simply, when one hospital closes its doors,

0:18:030:18:07

the patients have to go elsewhere.

0:18:070:18:08

So, whenever Antrim began to limit its admissions,

0:18:080:18:12

people started going to the Causeway, Altnagelvin, Craigavon

0:18:120:18:15

and the Royal.

0:18:150:18:16

It's quite simple. If there was a larger incident happening,

0:18:160:18:19

only knows what would happen.

0:18:190:18:20

I think the incident you refer to in Altnagelvin

0:18:200:18:23

was a major incident because there was a five-car pile-up.

0:18:230:18:26

and they were unclear early on from the five-car pile-up

0:18:260:18:29

about how many major casualties they would receive

0:18:290:18:32

in the middle of all of that.

0:18:320:18:34

That's normal business for emergency departments.

0:18:340:18:37

I don't think that you could conclude

0:18:370:18:40

that that was a sign that, in Northern Ireland, if you like,

0:18:400:18:43

the emergency system was teetering.

0:18:430:18:46

The emergency system was working in its normal way.

0:18:460:18:49

So, what is normal?

0:18:500:18:52

Well, according to the health care professionals

0:18:520:18:54

we've been speaking to,

0:18:540:18:55

periods of extreme pressure are becoming the norm

0:18:550:18:59

and while declaring a major incident may have been a unique response,

0:18:590:19:03

the pressures which led to it are all too common.

0:19:030:19:06

It is not a one-off in terms of an ED department being as busy as that.

0:19:070:19:12

It happens frequently.

0:19:120:19:13

It was a one-off in that it was declared as a major incident.

0:19:150:19:17

That's what made it unique on that night.

0:19:170:19:21

The figures tell their own story.

0:19:210:19:23

Emergency departments in England see just under 94% of people

0:19:230:19:27

within four hours.

0:19:270:19:28

By December last year,

0:19:280:19:29

hospitals here in Northern Ireland were seeing just 72% of people.

0:19:290:19:33

In the same month, the Royal Victoria Hospital

0:19:350:19:37

managed to deal with just 62% of people within four hours.

0:19:370:19:41

Dr Brian Fisher was an Emergency Department consult

0:19:420:19:45

at the Royal Victoria Hospital.

0:19:450:19:47

He retired three years ago.

0:19:470:19:49

Even then, he says the system was constantly on the verge of crisis.

0:19:490:19:54

The nursing staff in the department

0:19:540:19:56

are not only trying to deal with the patients

0:19:560:19:58

who are coming into the department that they should be dealing with,

0:19:580:20:01

but also trying to do the job of a ward nurse

0:20:010:20:04

in looking after these people as well.

0:20:040:20:07

Were you surprised when the major incident was declared at the Royal?

0:20:070:20:11

I'm retired now three years, but even whenever I was working

0:20:110:20:16

there were times when the department

0:20:160:20:17

was very close to complete saturation,

0:20:170:20:21

and therefore it wasn't a surprise to hear that

0:20:210:20:24

it had got behind crisis point, shall we say.

0:20:240:20:28

The doctors we've been speaking to here, still working at the Royal

0:20:280:20:31

today, say that at times the pressures here

0:20:310:20:33

can reach crisis point, and that's a particular problem at weekends

0:20:330:20:37

and during out-of-hours periods.

0:20:370:20:39

The big question, of course,

0:20:390:20:41

is whether those pressures have ever compromised patient safety.

0:20:410:20:45

The medical and nursing staff we've been speaking to say that

0:20:450:20:48

most of the time the Emergency Department in the Royal is safe,

0:20:480:20:53

but at weekends and out of hours it can become unsafe

0:20:530:20:57

and has done in the past. Do you accept that?

0:20:570:20:59

No, well, what I would say is that the risks are higher out of hours.

0:20:590:21:04

Which means it has become unsafe.

0:21:040:21:06

No, it doesn't necessarily mean it's become unsafe,

0:21:060:21:08

because as I said, we avoid the department becoming unsafe.

0:21:080:21:12

So, for example, the reason I took the decision

0:21:120:21:15

to call the major incident or trigger the major incident protocol

0:21:150:21:19

was to avoid the department becoming unsafe.

0:21:190:21:22

But we've uncovered further disturbing evidence that excessive

0:21:220:21:25

waiting times have had serious consequences for patients.

0:21:250:21:30

This document was distributed to all Trusts in Northern Ireland

0:21:300:21:33

after two serious incidents at the Royal Victoria Hospital's

0:21:330:21:36

Emergency Department.

0:21:360:21:38

We were given it by someone who's concerned about patient safety

0:21:380:21:41

and who believes that incidents like this need to be exposed.

0:21:410:21:45

This document describes how two patients died

0:21:450:21:48

after receiving substandard care.

0:21:480:21:50

It's what's known in the profession as a Serious Adverse Incident.

0:21:500:21:54

The document is known as a learning letter,

0:21:540:21:56

distributed widely to medical professionals

0:21:560:21:58

and hospital managers so they can learn lessons from what went wrong.

0:21:580:22:02

Now, in these incidents, which we're told happened last year,

0:22:040:22:07

there were delays in diagnosing what was wrong

0:22:070:22:10

with two separate patients, but those initial delays

0:22:100:22:13

were compounded by the fact that the patients then had to wait longer

0:22:130:22:16

than they should have to get treated.

0:22:160:22:19

Now this report is very clear.

0:22:190:22:20

One of the contributing factors in these Serious Adverse Incidents

0:22:200:22:24

was waiting times.

0:22:240:22:26

Have we evidence that shows that what we're dealing with

0:22:260:22:30

in terms of our services is safe or not safe?

0:22:300:22:34

Yes, we do. Here's some.

0:22:340:22:35

That's a Serious Adverse Incident learning letter

0:22:350:22:38

that talks about how waiting times have contributed to two deaths.

0:22:380:22:42

But of course you have an issue of a Serious Adverse Incident.

0:22:420:22:46

You'll appreciate I know the case

0:22:460:22:48

and I can't talk of the detail of the case.

0:22:480:22:50

Serious Adverse Incidents, in my experience, are a combination

0:22:500:22:53

-of events.

-But my question is...

0:22:530:22:55

Here is a learning letter regarding a Serious Adverse Incident,

0:22:550:23:00

two different ones, two different patients, two different deaths.

0:23:000:23:03

Waiting times implicated as one factor.

0:23:030:23:06

My question is how many other Serious Adverse Incidents

0:23:060:23:09

in the last six months have had waiting times as a factor?

0:23:090:23:13

Erm... I can't give you an exact number.

0:23:130:23:15

I can tell you the numbers in terms of whether there is waiting times

0:23:150:23:20

or not. But the issue for me is that we have 700,000 people go through

0:23:200:23:25

our ED departments.

0:23:250:23:26

The ability for us to go through with 700,00 people in the year

0:23:260:23:30

and not have an adverse incident, I think everyone will understand that's

0:23:300:23:33

highly improbable and unlikely.

0:23:330:23:36

And therefore, I think, is the scale of that huge?

0:23:360:23:39

No, the scale of that is not huge. It is absolutely not huge.

0:23:390:23:43

The learning letter is the only documentary evidence that we have

0:23:430:23:46

of a Serious Adverse Incident which had waiting times as a factor,

0:23:460:23:51

but we've been led to believe it's not the only time

0:23:510:23:53

that that's happened.

0:23:530:23:55

How many more Serious Adverse Incidents have there been

0:23:550:23:57

where people have waited too long?

0:23:570:23:59

Well, it's difficult, but it would be single figures.

0:23:590:24:04

I mean, we've been told it could be nine. Would that be...?

0:24:040:24:07

No, it's not as high as nine. I think at this point it's about four.

0:24:070:24:12

But I don't have those figures in front of me.

0:24:120:24:14

In how long? In the last six months? The last year?

0:24:140:24:17

No, that would be over the last couple of years,

0:24:170:24:19

and that's in the context that over that period of time

0:24:190:24:22

we would've had about 160,000 attendances in our ED.

0:24:220:24:25

But nobody should be dying because they're waiting too long.

0:24:250:24:28

Well, actually, there's a multiple of factors. It wasn't just...

0:24:280:24:31

When you read that you'll see there's a multitude of factors

0:24:310:24:34

that pertain to those particular cases. Not just the waiting...

0:24:340:24:38

The waiting time was a contributing factor, but not the only factor.

0:24:380:24:41

We interviewed Colm Donaghy yesterday.

0:24:410:24:44

This morning, his subordinate medical director, Dr Tony Stevens,

0:24:440:24:47

pointed out that the true figure for deaths involving waiting times

0:24:470:24:51

was five in the past year alone.

0:24:510:24:53

I asked you earlier, did the department ever become unsafe?

0:24:540:25:00

Now, clearly, this shows that it did.

0:25:000:25:04

For that individual, yes, the department was at a point

0:25:040:25:09

where it had an impact on the outcome for that individual patient.

0:25:090:25:13

That's right.

0:25:130:25:14

Whether or not that meant the entire department was unsafe

0:25:140:25:18

is something that I wouldn't agree with.

0:25:180:25:20

But, obviously, it's a matter for interpretation.

0:25:200:25:23

Hospital policy and good practice dictate that in incidents like this,

0:25:230:25:27

both the family of the person involved

0:25:270:25:29

and the coroner should be informed.

0:25:290:25:32

Have you informed the families who are involved here

0:25:320:25:35

that waiting times played a part in these incidents?

0:25:350:25:38

I'm not aware of the detail of both, but I know certainly

0:25:380:25:43

one of the families had been...

0:25:430:25:44

It was subject of a Root Cause Analysis for us

0:25:440:25:46

and one of the families has been very involved in relation to that.

0:25:460:25:49

The other family, I'm not sure.

0:25:490:25:51

But certainly it would be a part of our policy now that we would inform

0:25:510:25:55

families of the reasons.

0:25:550:25:57

-You would expect that a family would want to know...

-Absolutely.

0:25:570:26:00

..if the system played some kind of part in their loved one's death?

0:26:000:26:04

Yes.

0:26:040:26:06

So, will you be looking into informing the other family, if...

0:26:060:26:10

If they haven't been informed? Of course, yes.

0:26:110:26:15

What about the coroner?

0:26:150:26:16

Does the coroner need to investigate something like that?

0:26:160:26:19

Well, we work very, very closely with the coroner,

0:26:190:26:22

working out the criteria and the details of when a case

0:26:220:26:26

should be referred to the coroner or when the coroner should be involved.

0:26:260:26:29

And has this one been referred?

0:26:290:26:30

Well, I'm not sure whether it has or not. I don't know.

0:26:300:26:33

It's something that I could look into,

0:26:330:26:36

but I'm not sure if it's been referred to the coroner.

0:26:360:26:39

This afternoon, the Belfast Trust confirmed that the coroner

0:26:390:26:42

has been made aware.

0:26:420:26:43

Last week, Health Minister Edwin Poots announced a review.

0:26:470:26:50

He said he asked the hospital regulator, the RQIA,

0:26:500:26:54

to look at how the acute medical department was working.

0:26:540:26:56

In fact, we've learned that before the minister made that request,

0:26:560:27:00

the medical consultants themselves had already written to the RQIA

0:27:000:27:04

asking that they intervene.

0:27:040:27:06

The regulator inspected the department and interviewed staff

0:27:060:27:09

over the first weekend of February.

0:27:090:27:11

That preliminary report by the RQIA was damning.

0:27:110:27:15

The inspector spoke to more than 100 staff across a range of roles

0:27:160:27:20

and functions. The inspection has confirmed concerns

0:27:200:27:23

about staffing levels in key areas, allegations of bullying,

0:27:230:27:27

staff under intolerable pressure and a system of care

0:27:270:27:30

that does not function fully as it was set up to do.

0:27:300:27:34

You must be concerned if you have the RQIA finding what they found

0:27:340:27:42

two weeks ago. You have Serious Adverse Incidents

0:27:420:27:44

in which patients are waiting too long, and you have

0:27:440:27:47

your own senior consultants in the Emergency Department

0:27:470:27:50

releasing a statement saying there needs to be an urgent transformation

0:27:500:27:53

in the system.

0:27:530:27:55

It all adds up to something that must be quite worrying for you?

0:27:550:27:58

Yeah, it is quite worrying,

0:27:580:28:00

but we're taking forward very strong action at this point in time.

0:28:000:28:05

Some of it which we were already in training.

0:28:050:28:08

So, for example, we'd already reviewed our nurse staffing levels

0:28:080:28:11

in our ED prior to Christmas.

0:28:110:28:14

We're now in a position to increase the numbers of nurse staffing

0:28:140:28:18

in our ED. So we're employing an additional 14 nurses.

0:28:180:28:21

We also wanted to ask Edwin Poots about the RQIA review,

0:28:210:28:26

amongst many other things, such as why three weeks ago

0:28:260:28:29

he sought to reassure the public that politicians and the media

0:28:290:28:32

were exaggerating the crisis in the emergency departments,

0:28:320:28:35

but now he has issues of serious concern about

0:28:350:28:38

how the Royal Victoria Hospital's Emergency Department is run.

0:28:380:28:42

We also wanted to ask him whether he knew of doctors' concerns

0:28:420:28:46

about patients' safety, and if not, why not?

0:28:460:28:50

But the minister declined to be interviewed for this programme.

0:28:500:28:53

He did, however, give us a statement in which he said that he recognises

0:28:530:28:57

the gravity of the situation, but that he wants to reassure the public

0:28:570:29:00

that the Belfast Trust will continue to manage the risks

0:29:000:29:04

and provide emergency services with the help of its dedicated staff.

0:29:040:29:08

The medical and nursing staff we spoke to wanted to make it clear

0:29:090:29:12

that most of the time the Emergency Department here at the Royal

0:29:120:29:15

is safe for patients. But they said that during busy times

0:29:150:29:19

and at weekends, that's not always the case.

0:29:190:29:23

Politicians and health service managers are now rushing

0:29:230:29:25

to change that, with new staff being added to the rota

0:29:250:29:28

and a major review ongoing.

0:29:280:29:31

But there's no doubt that some staff here think it should have happened

0:29:310:29:34

a long time ago. And for some patients, it's too late.

0:29:340:29:38

The people that work in this building, and others like it

0:29:390:29:42

across Northern Ireland,

0:29:420:29:43

deal with the rest of us during some of the worst moments of our lives.

0:29:430:29:48

They do so day-in, day-out, often in stressful and difficult conditions.

0:29:480:29:53

Now, many of them say, they have their own emergency,

0:29:530:29:57

and finding a remedy for them should matter to us all.

0:29:570:30:00

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