0:00:02 > 0:00:03Today, in a statement to the Assembly,
0:00:03 > 0:00:05Health Minister Edwin Poots
0:00:05 > 0:00:08was talking about solutions to problems
0:00:08 > 0:00:11in the Royal Victoria Hospital in Belfast. He promised
0:00:11 > 0:00:16more staff, better oversight and an improved system for patients.
0:00:16 > 0:00:20But he said that real change will take time.
0:00:20 > 0:00:23Tonight on Spotlight, we speak to some of the families
0:00:23 > 0:00:25for whom time has already run out -
0:00:25 > 0:00:30families whose loved ones died in remarkably similar circumstances
0:00:30 > 0:00:33- ten months apart. - His clothes were covered in blood,
0:00:33 > 0:00:35his overcoat was absolutely drenched in blood.
0:00:35 > 0:00:37He had bled a lot.
0:00:37 > 0:00:40She had some bruising to her face
0:00:40 > 0:00:42and, clearly, needed treatment.
0:00:42 > 0:00:45We hear from a doctor, who says that change
0:00:45 > 0:00:47is not happening quickly enough.
0:00:47 > 0:00:50I would say that the clinical staff of the minute
0:00:50 > 0:00:52don't have faith in the management team and that
0:00:52 > 0:00:54the only way that faith can be restored
0:00:54 > 0:00:57is if positive changes are made very quickly.
0:00:57 > 0:01:00And we reveal disturbing new evidence which suggests that,
0:01:00 > 0:01:02as recently as three weeks ago,
0:01:02 > 0:01:04patient safety was still being compromised.
0:01:06 > 0:01:10Today, the Minister said it's important that the public still has
0:01:10 > 0:01:13confidence in the emergency medicine system,
0:01:13 > 0:01:15but neither he nor the Health & Social Care Board
0:01:15 > 0:01:21nor the Belfast Trust would agree to be interviewed for this programme.
0:01:21 > 0:01:24This is a story of how systemic failings in the emergency department
0:01:24 > 0:01:26of the Royal Victoria Hospital
0:01:26 > 0:01:29affected some patients and their families.
0:01:29 > 0:01:33It's also an investigation into what's still going wrong.
0:01:54 > 0:01:57Last month, Spotlight investigated the care being provided to patients
0:01:57 > 0:02:01in the emergency department of the Royal Victoria Hospital in Belfast.
0:02:01 > 0:02:05We revealed that last year five serious adverse incident reports
0:02:05 > 0:02:08at the hospital involved deaths where waiting times
0:02:08 > 0:02:10may have been a factor.
0:02:10 > 0:02:13It came as a shock to many.
0:02:13 > 0:02:15Last night's BBC Spotlight programme
0:02:15 > 0:02:17highlighted the cases of five patients.
0:02:17 > 0:02:22In that programme, we asked the Chief Executive of the Belfast Trust
0:02:22 > 0:02:26whether the families involved in two of the incidents had been informed
0:02:26 > 0:02:29that waiting times played a part in the deaths of their relatives.
0:02:29 > 0:02:34I'm not aware of the detail of both, but I know one of the families had.
0:02:34 > 0:02:38- You would expect that a family would want to know...- Absolutely.
0:02:38 > 0:02:42..if the system played some kind of part in their loved one's death?
0:02:42 > 0:02:49- Yes.- So, will you be looking into informing the other family, if...?
0:02:49 > 0:02:52If they haven't been informed? Of course, yes.
0:02:52 > 0:02:54It soon emerged that in three out of five cases
0:02:54 > 0:02:58families had been not informed that there were failings
0:02:58 > 0:03:00in how their loved ones were treated. The Health Minister
0:03:00 > 0:03:04quickly announced that all of the families that did not know
0:03:04 > 0:03:06something had gone badly wrong would now be told.
0:03:06 > 0:03:10The treatment and care that those five people had may well have
0:03:10 > 0:03:13fallen short and, therefore, we will have
0:03:13 > 0:03:15an appropriate investigation of that matter.
0:03:15 > 0:03:18Two days after the Spotlight programme was broadcast,
0:03:18 > 0:03:21we were contacted by Grainne and Bronagh Boyle.
0:03:21 > 0:03:24A year earlier, their grandfather Charlie Patterson
0:03:24 > 0:03:26had died in the Royal.
0:03:26 > 0:03:30As far as his family were concerned, he had received the best treatment
0:03:30 > 0:03:33he could have, until Grainne received a call
0:03:33 > 0:03:36from the Royal Victoria Hospital that would devastate her
0:03:36 > 0:03:37and the rest of the family.
0:03:37 > 0:03:41It was the day before Valentine's Day - the 13th, the Thursday.
0:03:41 > 0:03:43And at ten to five, my phone rang.
0:03:43 > 0:03:47There had been a report into my grandfather's death
0:03:47 > 0:03:50and they would like for us, as a family, to come and speak to them
0:03:50 > 0:03:52about that report.
0:03:53 > 0:03:56When five deaths may have a contributory factor...
0:03:56 > 0:03:59'An hour after, I sat down to watch the news'
0:03:59 > 0:04:03and then the full enormity really kicked in and, as I was
0:04:03 > 0:04:06watching these people speak, in my mind, I was thinking,
0:04:06 > 0:04:08"That is us. That's our family."
0:04:10 > 0:04:13And that is shameful. By anyone's standards, that is shameful.
0:04:13 > 0:04:16That was the first time that we had known anything about
0:04:16 > 0:04:17what had occurred.
0:04:22 > 0:04:24Charlie Patterson was 86.
0:04:24 > 0:04:28He lived his life surrounded by a close and loving family.
0:04:28 > 0:04:33Our granda was amazing. He was everything that your granda could be.
0:04:33 > 0:04:35He was our best friend.
0:04:35 > 0:04:38We were like the Three Musketeers, always together.
0:04:38 > 0:04:41Always together. You never seen one without the other two.
0:04:41 > 0:04:45It was unusual for us not to be together
0:04:45 > 0:04:48and every single day, we would go up to granda's in the evening
0:04:48 > 0:04:52and all have our meal together and it was very important,
0:04:52 > 0:04:55at the end of each evening, that we sat together and talk about our day.
0:04:55 > 0:05:00Charlie Patterson had some health concerns associated with old age,
0:05:00 > 0:05:03but he was still very active and went out walking every day.
0:05:05 > 0:05:08SIREN BLARES
0:05:08 > 0:05:14It was after attending Mass on 27 January, 2013
0:05:14 > 0:05:17that Charlie fell and hit his head. An ambulance was called.
0:05:17 > 0:05:20He arrived at the emergency department
0:05:20 > 0:05:23of the Royal Victoria Hospital at 7.10 in the evening.
0:05:23 > 0:05:29He was bleeding from a head wound, but his family were not informed.
0:05:29 > 0:05:34Charlie would lie on a trolley for the next seven hours alone.
0:05:34 > 0:05:38That's something his family find difficult to deal with.
0:05:38 > 0:05:41Personally I'm angry, because he was never alone.
0:05:41 > 0:05:44He was an incredibly social man and to think of him
0:05:44 > 0:05:46sitting there dazed and confused
0:05:46 > 0:05:50and on his own is quite upsetting.
0:05:50 > 0:05:52The details of what happened to Charlie Patterson that night
0:05:52 > 0:05:55are contained in here.
0:05:55 > 0:05:59This is an incident report, compiled not long after he died.
0:05:59 > 0:06:03This wasn't even shown to his family until just a few weeks ago,
0:06:03 > 0:06:07three days after the Spotlight investigation was broadcast.
0:06:07 > 0:06:11But it goes into great detail about the shortcomings in the care
0:06:11 > 0:06:15he received from the moment he entered the emergency department.
0:06:15 > 0:06:18The first problem was at the triage stage.
0:06:18 > 0:06:21Charlie was seen by a nurse 20 minutes
0:06:21 > 0:06:23after arriving in the department.
0:06:23 > 0:06:26She noted that he was confused, but he was able to tell her
0:06:26 > 0:06:29that he was on the blood-thinning drug, warfarin.
0:06:29 > 0:06:32Elderly patients on warfarin are at risk of profuse bleeding
0:06:32 > 0:06:36and haemorrhaging and the report says it would have been appropriate,
0:06:36 > 0:06:40at this point, for Charlie to have been given another drug,
0:06:40 > 0:06:43to reverse the effects of the warfarin.
0:06:43 > 0:06:48But he lay on a trolley for five hours before he was given that drug.
0:06:48 > 0:06:50It almost defies belief, in a way,
0:06:50 > 0:06:53that this could happen in a busy casualty department.
0:06:53 > 0:06:58The report reveals other significant problems with delays.
0:06:58 > 0:07:02A doctor should have examined Charlie within an hour.
0:07:02 > 0:07:05He didn't see one until three and a half hours into his wait.
0:07:05 > 0:07:08He should have received a CT scan soon after arrival
0:07:08 > 0:07:12in the emergency department. That didn't happen for four hours.
0:07:12 > 0:07:15For all of that time, he lay on a trolley alone,
0:07:15 > 0:07:18growing more and more unwell.
0:07:18 > 0:07:21His family had no idea he was there.
0:07:21 > 0:07:24It's just the fact those few hours would have been valuable,
0:07:24 > 0:07:27to say goodbye, to let him know that he wasn't on his own,
0:07:27 > 0:07:29that he didn't need to be afraid -
0:07:29 > 0:07:33the things you imagine you would do for the person you love.
0:07:33 > 0:07:36To bring him his little bits of comfort, like his rosary beads,
0:07:36 > 0:07:38or having his glasses.
0:07:38 > 0:07:41The small, stupid things that weren't probably done for him.
0:07:42 > 0:07:46He would have been confused, as to what was happening around him
0:07:46 > 0:07:51and, undoubtedly, he would have been afraid and I find that just,
0:07:51 > 0:07:56for someone who was so loved, I find that very difficult to reconcile.
0:07:59 > 0:08:03All in all, this report outlines a litany of errors,
0:08:03 > 0:08:06but what runs through it is the problem of delays.
0:08:06 > 0:08:10The reason given here for the delays is that the system was
0:08:10 > 0:08:12under pressure because a large number of patients
0:08:12 > 0:08:15who were in the department that night needed to be admitted
0:08:15 > 0:08:18to hospital and there were not enough beds for them to go to.
0:08:18 > 0:08:22The emergency department was simply log-jammed.
0:08:22 > 0:08:26Eventually, at 2.00am, Grainne and Bronagh
0:08:26 > 0:08:29were informed that their grandfather was seriously ill
0:08:29 > 0:08:31- in the emergency department. - As soon as I arrived,
0:08:31 > 0:08:34I was immediately taken into a family room,
0:08:34 > 0:08:36but I was brought through the waiting area
0:08:36 > 0:08:40and it was chaos. The trolleys were just everywhere.
0:08:40 > 0:08:43It was like a Third World country, almost.
0:08:43 > 0:08:47It was like walking into a war zone.
0:08:47 > 0:08:51It had been only 12 hours since they had last seen their grandfather
0:08:51 > 0:08:53alive and well and on his way to Mass.
0:08:53 > 0:08:57Now, they were deeply shocked at what they saw.
0:08:57 > 0:09:00He was covered in blood and his clothes were covered in blood.
0:09:00 > 0:09:01He had bled a lot.
0:09:01 > 0:09:05A very nice, but very junior young doctor come in and she explained
0:09:05 > 0:09:09to us that the outcome was likely to be fatal.
0:09:09 > 0:09:16She was very upset. She seemed, sort of, visibly upset.
0:09:19 > 0:09:22As Grainne and Bronagh were shown in to see Charlie,
0:09:22 > 0:09:24other staff seemed upset, too.
0:09:26 > 0:09:30One of the nurses was crying and she had said to us,
0:09:30 > 0:09:33"I'm so sorry, I'm so sorry." We just assumed
0:09:33 > 0:09:37she was sorry because he had died and the end of any life is sad,
0:09:37 > 0:09:39but perhaps now, she was sorry
0:09:39 > 0:09:41because he had been treated so poorly.
0:09:43 > 0:09:47Gareth Martin is the union rep for the Royal College of Nursing.
0:09:47 > 0:09:49He told me that far too many patients,
0:09:49 > 0:09:52particularly the elderly, are suffering because the system
0:09:52 > 0:09:55just isn't working. You say old people
0:09:55 > 0:09:58are waiting in an environment that is not fit for purpose.
0:09:58 > 0:10:01What do you mean, that the emergency department
0:10:01 > 0:10:03at the Royal is not fit for purpose?
0:10:03 > 0:10:08Absolutely. When there's pressures of patients waiting to be admitted
0:10:08 > 0:10:12and you are hearing of large volumes of patients waiting six,
0:10:12 > 0:10:15eight, ten, 12 hours and longer,
0:10:15 > 0:10:20so the ability to provide dignified care is certainly compromised.
0:10:20 > 0:10:25This report explains why the department was overstretched that night.
0:10:25 > 0:10:29But it doesn't really answer the question of how an elderly man
0:10:29 > 0:10:34could have spent hours lying alone in a busy emergency department
0:10:34 > 0:10:36becoming more and more unwell,
0:10:36 > 0:10:39and not get the attention that he needed.
0:10:39 > 0:10:42I think there are numerous reasons he wasn't a priority.
0:10:42 > 0:10:44He sat in the corner quietly.
0:10:44 > 0:10:47He didn't cause a fuss.
0:10:47 > 0:10:50Although the Belfast Trust didn't want to be interviewed
0:10:50 > 0:10:53about Charlie Patterson's case, they did send us this statement.
0:10:53 > 0:10:56They say that what happened was a matter of deep regret to them
0:10:56 > 0:10:59and they say that Charlie's case was fully investigated
0:10:59 > 0:11:01and that they've learnt lessons.
0:11:01 > 0:11:04They also say that their policies and procedures about being open with
0:11:04 > 0:11:07families were not followed in this case and for that they are sorry.
0:11:08 > 0:11:12This statement leaves a lot of unanswered questions,
0:11:12 > 0:11:15particularly for the Boyle family, but because the Trust have decided
0:11:15 > 0:11:19not to do an interview we won't be hearing the answers.
0:11:20 > 0:11:24No-one will ever know for sure whether Charlie Patterson might have
0:11:24 > 0:11:29survived if he had got the treatment he needed in a timely fashion.
0:11:29 > 0:11:32The only thing that is clear is that he didn't get it.
0:11:32 > 0:11:34All the signals were there, all of them.
0:11:34 > 0:11:37And they were missed and they weren't missed once,
0:11:37 > 0:11:39they were missed time and time again.
0:11:39 > 0:11:43There are various opportunities where intervention
0:11:43 > 0:11:45may have had a different outcome,
0:11:45 > 0:11:49but time and time and time again, they just passed.
0:11:53 > 0:11:56What upsets Charlie's family more than anything else
0:11:56 > 0:11:59is that the hospital didn't see fit to inform them
0:11:59 > 0:12:03that so many mistakes had been made until a year after he had died.
0:12:03 > 0:12:07And only then, after the Spotlight investigation had revealed
0:12:07 > 0:12:09details of the five deaths.
0:12:11 > 0:12:13We specifically said to them, had this not broke in the media,
0:12:13 > 0:12:17would you have contacted us? And there was a non-response.
0:12:17 > 0:12:21It wasn't even an apology. They moved on to the next question.
0:12:21 > 0:12:26How did you feel about the fact that you hadn't been told,
0:12:26 > 0:12:28that you were shown this comprehensive report
0:12:28 > 0:12:31a year after he died?
0:12:31 > 0:12:33Angry. You feel resentful
0:12:33 > 0:12:37and disbelief that had the media not broke this story,
0:12:37 > 0:12:39that you would never have been any the wiser.
0:12:39 > 0:12:42We asked the Trust a direct question -
0:12:42 > 0:12:45had they discovered other families who haven't been informed
0:12:45 > 0:12:49about serious, adverse incidents involving their relatives?
0:12:49 > 0:12:51They sent us this statement
0:12:51 > 0:12:54and it says they're satisfied in the vast majority of cases
0:12:54 > 0:12:58families have been informed, but that they have identified a number
0:12:58 > 0:13:00of cases where the level of involvement
0:13:00 > 0:13:02is not what they would expect.
0:13:02 > 0:13:05Now, that sounds like a yes.
0:13:05 > 0:13:08And we would have pressed the Trust on that point in an interview,
0:13:08 > 0:13:11but because they won't meet us face-to-face on camera, we can't.
0:13:14 > 0:13:16This is Peter Walsh.
0:13:16 > 0:13:21Based in London, his charity, Action Against Medical Accidents,
0:13:21 > 0:13:24lobbies for patients' rights in the NHS.
0:13:24 > 0:13:26He's one of the leading patients' advocates in the UK,
0:13:26 > 0:13:31representing about 3,000 patients and their families every year.
0:13:31 > 0:13:35We asked him to come to Belfast to review Charlie Patterson's case
0:13:35 > 0:13:37and some of the others that have come to light.
0:13:37 > 0:13:41I'm really shocked by the circumstances,
0:13:41 > 0:13:45not just of Mr Patterson's death, but the way that the knowledge
0:13:45 > 0:13:50of a whole series of errors was kept from the family
0:13:50 > 0:13:53following his death. It's scandalous
0:13:53 > 0:13:56that this family had to wait over a year to hear
0:13:56 > 0:14:00for the very first time that something went wrong
0:14:00 > 0:14:02with Mr Patterson's treatment.
0:14:04 > 0:14:07Peter Walsh spent years campaigning for what is called
0:14:07 > 0:14:11a legal duty of candour in England, which would force hospitals to admit
0:14:11 > 0:14:14mistakes to families of people who have been harmed.
0:14:14 > 0:14:18This year, new legislation in England will make that a reality.
0:14:18 > 0:14:21But there are no plans to introduce it here.
0:14:21 > 0:14:23He's now written to the Health Minister
0:14:23 > 0:14:26asking that it be introduced in Northern Ireland
0:14:26 > 0:14:30and demanding an independent inquiry into the Royal's emergency department.
0:14:30 > 0:14:32Bronagh and her aunt Anne wanted to meet Peter
0:14:32 > 0:14:34to discuss what happened to Charlie,
0:14:34 > 0:14:37and for privacy reasons, we agreed not to film that meeting.
0:14:38 > 0:14:42What really strikes me about what I have learnt about
0:14:42 > 0:14:45what's happened in Belfast so far
0:14:45 > 0:14:49is the very clear similarities with the root causes of the problems
0:14:49 > 0:14:55that we learnt so much about at Mid-Staffordshire, the big hospital scandal in England.
0:14:55 > 0:14:58The key ingredients of that scandal, that led to it,
0:14:58 > 0:15:01were a lack of good leadership,
0:15:01 > 0:15:04a failure to listen to staff
0:15:04 > 0:15:08and also a culture of denial.
0:15:08 > 0:15:11That's a toxic cocktail.
0:15:11 > 0:15:17In our experience, a hospital that fails to be open and honest
0:15:17 > 0:15:20is likely to be a dangerous hospital.
0:15:20 > 0:15:24The Health Minister, in his statements following the revelations
0:15:24 > 0:15:27about the five deaths, took a very different view.
0:15:27 > 0:15:32Five people dying in hospital of 80,000 being treated
0:15:32 > 0:15:35is not a crisis.
0:15:35 > 0:15:38The Minister did say that he had asked all Trusts to report to him
0:15:38 > 0:15:41on serious adverse incidents going back three years,
0:15:41 > 0:15:46and tell him in how many cases families had not been informed.
0:15:46 > 0:15:50We asked the Department of Health about what that review had found so far.
0:15:50 > 0:15:53They said it's not yet complete.
0:15:53 > 0:15:56I also asked the Minister for an interview about the new information
0:15:56 > 0:16:00that is now emerging, but just as with the first Spotlight programme
0:16:00 > 0:16:03on this subject, he declined to be interviewed.
0:16:07 > 0:16:11Charlie Patterson's death raises other serious issues too
0:16:11 > 0:16:14and that's because it wasn't unique.
0:16:14 > 0:16:18Now that's significant, because this report into his death
0:16:18 > 0:16:22is about how lessons were learnt and new practices put in place
0:16:22 > 0:16:25to prevent anything like it ever happening again.
0:16:25 > 0:16:30But it did happen again. And in remarkably similar circumstances.
0:16:33 > 0:16:36This is Colette Mac Ruagain.
0:16:36 > 0:16:40Five months ago, her mother Brigid, who was 81, was admitted to
0:16:40 > 0:16:44the emergency department of the Royal Victoria Hospital.
0:16:44 > 0:16:47It was ten months after Charlie Patterson's death.
0:16:48 > 0:16:51Brigid, too, had fallen and hit her head.
0:16:51 > 0:16:55One of her daughters came to the hospital with her.
0:16:55 > 0:16:58When Collette arrived soon afterwards, it was obvious
0:16:58 > 0:17:01that the department was under pressure.
0:17:01 > 0:17:04When I arrived, it was extremely busy.
0:17:04 > 0:17:10A lot of people just sitting along the corridor. It was extremely busy.
0:17:10 > 0:17:12Brigid had sustained bruising to her face
0:17:12 > 0:17:14and seemed to have hurt her arm.
0:17:16 > 0:17:19We thought it was a minor injury.
0:17:19 > 0:17:23We weren't aware of the extent of her injuries at that time.
0:17:23 > 0:17:27In fact, Brigid was bleeding from a haemorrhage inside her head,
0:17:27 > 0:17:29but it wasn't spotted.
0:17:29 > 0:17:31The bleeding would have been made much worse,
0:17:31 > 0:17:33because, like Charlie before her,
0:17:33 > 0:17:35Brigid was on the blood-thinning drug, warfarin.
0:17:35 > 0:17:37She should have quickly been given a drug to reverse
0:17:37 > 0:17:41the effects of warfarin, but that didn't happen for six hours.
0:17:41 > 0:17:44Her family thought there was nothing seriously wrong.
0:17:44 > 0:17:47She was clearly very uncomfortable
0:17:47 > 0:17:52and she had some bruising to her face. I mean, she was clearly unwell
0:17:52 > 0:17:56and clearly needed treatment, but nobody was alerting us
0:17:56 > 0:17:58that there was anything major
0:17:58 > 0:18:01or anything that we really needed to worry about.
0:18:03 > 0:18:06Over the next few hours, Brigid began to deteriorate.
0:18:06 > 0:18:09She became confused and disorientated.
0:18:09 > 0:18:13She was seen by a doctor after four hours and a CT scan was ordered.
0:18:13 > 0:18:17But it wasn't carried out for a further hour and a half.
0:18:17 > 0:18:21And when the results finally came, it was very bad news.
0:18:21 > 0:18:26The sister in A&E had said that there was something serious
0:18:26 > 0:18:27that had shown up on the scan,
0:18:27 > 0:18:31and she said to my sister, "We're going to have to go to resus,"
0:18:31 > 0:18:35and she knew then that something terribly was wrong.
0:18:35 > 0:18:38By now, Brigid was unconscious.
0:18:38 > 0:18:40Things escalated very quickly after that.
0:18:40 > 0:18:46The neurosurgeon came down and had viewed Mum's CAT scan,
0:18:46 > 0:18:52and explained just how serious things were and the extent of her injuries,
0:18:52 > 0:18:54of her brain injuries at that time.
0:18:54 > 0:18:58It was obvious to the family that something had been missed.
0:18:58 > 0:19:00They began to ask questions
0:19:00 > 0:19:04and staff admitted that Brigid had waited too long.
0:19:04 > 0:19:07She was rushed to the neurosurgery ward, but it was too late.
0:19:07 > 0:19:09Three days later, Brigid died.
0:19:12 > 0:19:14Her family felt angry.
0:19:14 > 0:19:18Staff at the hospital had already admitted that Brigid had not
0:19:18 > 0:19:19received the care she should have,
0:19:19 > 0:19:23so now the family asked the Trust what exactly had gone wrong.
0:19:25 > 0:19:30They had done investigations, a review into mum's care in A&E
0:19:30 > 0:19:34and outlined and acknowledged the mistakes that they had made
0:19:34 > 0:19:39and told us that they had put significant measures in place
0:19:39 > 0:19:43to ensure that this wouldn't happen again.
0:19:43 > 0:19:46Of course, it wasn't the first time the hospital had said that.
0:19:46 > 0:19:50In fact, they had said it ten months previously in this report
0:19:50 > 0:19:54into the death of Charlie Patterson, another elderly patient
0:19:54 > 0:19:58also on warfarin, who had also waited too long, but incredibly,
0:19:58 > 0:20:02these aren't the only two cases with very similar characteristics.
0:20:02 > 0:20:07That's because Brigid's family were given this document after she died.
0:20:07 > 0:20:09This is a learning letter,
0:20:09 > 0:20:13which is distributed after serious adverse incidents.
0:20:13 > 0:20:16And this says that just a few days before Brigid died,
0:20:16 > 0:20:19yet another elderly patient who was also on Warfarin
0:20:19 > 0:20:22died after waiting too long for treatment.
0:20:23 > 0:20:27So, how many incidents like these two, ten months apart,
0:20:27 > 0:20:31are down to the department being overwhelmed and under-resourced?
0:20:31 > 0:20:34Spotlight has seen documents obtained
0:20:34 > 0:20:36under Freedom of Information legislation.
0:20:37 > 0:20:41They record that 720 incidents of all types occurred in the Royal's
0:20:41 > 0:20:43emergency department in 2012 and 2013,
0:20:43 > 0:20:48although the vast majority were low or medium risk.
0:20:48 > 0:20:51But significantly, 265 of them,
0:20:51 > 0:20:55over a third, were attributed to staffing and resources.
0:20:58 > 0:21:01We wanted to ask the Belfast Trust and the Health Board
0:21:01 > 0:21:04about whether this suggests that the emergency department suffers
0:21:04 > 0:21:07from chronic short staffing
0:21:07 > 0:21:09and whether that is leading to harm for patients.
0:21:09 > 0:21:13But once again, we couldn't, because they would not be interviewed
0:21:13 > 0:21:15for this programme and the statement
0:21:15 > 0:21:18they gave us doesn't address that issue.
0:21:18 > 0:21:19The big question, of course, is
0:21:19 > 0:21:23whether among all of this adverse publicity and embarrassing
0:21:23 > 0:21:29revelations about patient safety, that the situation is now improving.
0:21:29 > 0:21:32Spotlight has been given some information which suggests that
0:21:32 > 0:21:35if that is happening, it isn't happening
0:21:35 > 0:21:37quickly enough for some senior doctors.
0:21:40 > 0:21:43Today, Edwin Poots outlined a range of measures
0:21:43 > 0:21:44that have already been implemented
0:21:44 > 0:21:48to improve conditions in the emergency department of the Royal.
0:21:48 > 0:21:52We are appointing 40 additional nurses to the emergency department
0:21:52 > 0:21:55and that goes back to a report last summer,
0:21:55 > 0:21:58so many of the nurses are actually already in place,
0:21:58 > 0:22:00or being appointed as we speak.
0:22:00 > 0:22:02So, there's courses of work that is happening
0:22:02 > 0:22:04and actions are being taken to ensure
0:22:04 > 0:22:07that we can meet the needs of the public.
0:22:07 > 0:22:11In terms of what we are doing, we are responding to the problems
0:22:11 > 0:22:14that are being identified and we are dealing with the issues.
0:22:14 > 0:22:19But last week, BBC Newsline revealed that just three weeks ago,
0:22:19 > 0:22:23another elderly patient died in the emergency department
0:22:23 > 0:22:26and she too may have waited too long.
0:22:26 > 0:22:29The Belfast Health Trust is investigating the circumstances
0:22:29 > 0:22:31surrounding the death of an elderly patient.
0:22:31 > 0:22:34The Belfast Trust says that waiting times
0:22:34 > 0:22:37did not play a role in this woman's death,
0:22:37 > 0:22:41but Spotlight understands that waiting too long may have
0:22:41 > 0:22:44affected the comfort and dignity of her final hours.
0:22:44 > 0:22:47But we have uncovered disturbing new documentary evidence
0:22:47 > 0:22:50about what was happening in the emergency department
0:22:50 > 0:22:52on the weekend this death occurred.
0:22:56 > 0:23:00This is an e-mail chain dating from the weekend of 22nd February,
0:23:00 > 0:23:03when the death occurred.
0:23:03 > 0:23:06It includes e-mails from three senior consultants
0:23:06 > 0:23:07on duty that weekend.
0:23:08 > 0:23:11These e-mails describe a litany of serious concerns about
0:23:11 > 0:23:16patient safety and dignity during the weekend in question.
0:23:16 > 0:23:18All of it recorded meticulously by the consultants
0:23:18 > 0:23:20and sent up the line to their management.
0:23:20 > 0:23:25Colm Donaghy, the Chief Executive of the Trust, is copied in.
0:23:25 > 0:23:29How can it be that during a period of intense public scrutiny
0:23:29 > 0:23:32and concern about patient safety at the Royal
0:23:32 > 0:23:34that right up until three weeks ago,
0:23:34 > 0:23:38some consultants still thought that the department was unsafe?
0:23:38 > 0:23:40Now, even if there are no quick fixes,
0:23:40 > 0:23:44as the Health Minister pointed out today, these e-mails depicted
0:23:44 > 0:23:46a department that was simply overwhelmed
0:23:46 > 0:23:49and that needed immediate and comprehensive action
0:23:49 > 0:23:51to put things right immediately,
0:23:51 > 0:23:53at least on this weekend in question.
0:23:53 > 0:23:56Now, those are all questions we would have put to the Trust,
0:23:56 > 0:23:58but they have decided not to do an interview,
0:23:58 > 0:24:02so in this programme, we won't be hearing the answers.
0:24:02 > 0:24:04We have also uncovered questions
0:24:04 > 0:24:06about the number of serious incidents
0:24:06 > 0:24:11that occurred last year and whether that number could in fact rise.
0:24:12 > 0:24:14In the last Spotlight programme we asked
0:24:14 > 0:24:16the Chief Executive of the Trust, Colm Donaghy,
0:24:16 > 0:24:18how many serious adverse incidents
0:24:18 > 0:24:21there had been in which waiting times had played a part.
0:24:21 > 0:24:26Well, it's difficult, but it would be single figures.
0:24:26 > 0:24:30We have been told that it could be nine.
0:24:30 > 0:24:35No, it's not as high as nine, no. I think at this point it's about four.
0:24:35 > 0:24:38But I don't have those figures in front of me.
0:24:38 > 0:24:40In how long - in the last six months, the last year?
0:24:40 > 0:24:44No, no, that would be over the last couple of years.
0:24:44 > 0:24:46In fact, it was five deaths in one year.
0:24:47 > 0:24:51Spotlight has now been told that there may be further cases
0:24:51 > 0:24:55currently pending, which could become serious adverse incidents,
0:24:55 > 0:24:58though not all involve deaths.
0:24:58 > 0:24:59Yet that would mean there may be more
0:24:59 > 0:25:04than five serious adverse incidents with waiting times as a factor.
0:25:04 > 0:25:08That's not including the death from three weeks ago.
0:25:08 > 0:25:10Again, we put this to the Trust
0:25:10 > 0:25:13and they say they're not aware of any such incidents.
0:25:15 > 0:25:17We showed our evidence to Peter Walsh.
0:25:17 > 0:25:21Given that this information is coming out in a piecemeal fashion,
0:25:21 > 0:25:24what do you think needs to happen now?
0:25:24 > 0:25:28It underlines even more there needs to be an independent inquiry
0:25:28 > 0:25:31into how this has been allowed to happen,
0:25:31 > 0:25:33and we must have a legal duty of candour.
0:25:34 > 0:25:38Last week, it was revealed that one consultant in the Royal,
0:25:38 > 0:25:43and a patient, are now suing the Belfast Trust for negligence.
0:25:43 > 0:25:46Their lawyers said they have evidence of a toxic environment
0:25:46 > 0:25:50for staff and patients and they're calling for a full public inquiry,
0:25:50 > 0:25:54because they say the hospital has failed in its duty of care.
0:25:54 > 0:25:58Two weeks ago, I wrote to every consultant in emergency medicine
0:25:58 > 0:26:00at the Royal Victoria Hospital.
0:26:00 > 0:26:04I asked them to do on-camera interviews, either as a group,
0:26:04 > 0:26:05or as individuals.
0:26:05 > 0:26:07They declined.
0:26:07 > 0:26:11But some of those consultants did talk to us off-camera.
0:26:11 > 0:26:14They said they couldn't speak out publicly,
0:26:14 > 0:26:16because they feared for their jobs.
0:26:16 > 0:26:19That's despite the fact that in the last Spotlight programme
0:26:19 > 0:26:24on this subject, senior health managers said that they should.
0:26:24 > 0:26:26At the moment, people are scared
0:26:26 > 0:26:28to speak out, both doctors and nurses...
0:26:28 > 0:26:33- They shouldn't be. It's as simple as that.- But they are.
0:26:33 > 0:26:36But they shouldn't be. They have an obligation to do so.
0:26:36 > 0:26:39If you look at their professional obligations,
0:26:39 > 0:26:40they don't have a choice.
0:26:40 > 0:26:43So, what is the problem?
0:26:43 > 0:26:46Well, the medical and nursing staff we spoke to say that
0:26:46 > 0:26:50the reality is they would suffer for speaking out.
0:26:50 > 0:26:53They say they're operating in a climate of fear
0:26:53 > 0:26:57and that blowing the whistle could destroy their career.
0:26:57 > 0:27:00Even when it comes to patient safety.
0:27:00 > 0:27:03I spoke to a nurse this morning who said to me,
0:27:03 > 0:27:06"There are so many things I'd like to tell you about what
0:27:06 > 0:27:09"I have seen and what I'm still seeing, but I can't do that,
0:27:09 > 0:27:12"because they will get me in the long grass."
0:27:12 > 0:27:14Those were the words she used.
0:27:14 > 0:27:18That is a dangerous and unacceptable situation, isn't it?
0:27:18 > 0:27:24It absolutely is. That's very disturbing to hear a nurse say that.
0:27:24 > 0:27:29It speaks volumes of the culture. That's unacceptable
0:27:29 > 0:27:31and needs to be challenged.
0:27:32 > 0:27:34Medical and nursing staff...
0:27:34 > 0:27:38One doctor did agree to a tape-recorded interview.
0:27:38 > 0:27:41We have reconstructed that interview using an actor
0:27:41 > 0:27:42to protect his identity.
0:27:42 > 0:27:45It will be done in a subtle way, OK?
0:27:45 > 0:27:48They won't necessarily come to you
0:27:48 > 0:27:50and say, "You've spoken out, so I'm suspending you."
0:27:50 > 0:27:53The fear is they'll get us in the long grass.
0:27:53 > 0:27:57We showed this interview to Peter Walsh, who has campaigned
0:27:57 > 0:27:58on behalf of patients involved in
0:27:58 > 0:28:01some of the biggest hospital scandals in England.
0:28:01 > 0:28:05What we are now learning about the failure to listen to or even
0:28:05 > 0:28:08possibly the bullying of whistle-blowers
0:28:08 > 0:28:12and the failure to be open and honest with patients and their families
0:28:12 > 0:28:15when things have gone grievously wrong -
0:28:15 > 0:28:17we need a shock to the system.
0:28:17 > 0:28:21We need a statutory legal obligation to be open and honest,
0:28:21 > 0:28:26with serious repercussions for organisations who don't follow
0:28:26 > 0:28:29that line to make things better.
0:28:29 > 0:28:33Last month, preliminary findings of the regulator, the RQIA,
0:28:33 > 0:28:36talked about allegations of bullying and harassment
0:28:36 > 0:28:38at the Royal Victoria Hospital.
0:28:38 > 0:28:41Added to that now are the voices of doctors,
0:28:41 > 0:28:45who fear if they speak out publicly, they'll be victimised.
0:28:45 > 0:28:47Serious questions for the Belfast Trust,
0:28:47 > 0:28:50and once again, questions we would have put to them
0:28:50 > 0:28:53in the interview they've declined to give.
0:28:55 > 0:28:58On 8th January this year, a major incident was called
0:28:58 > 0:29:01in the Royal's emergency department to deal with congestion.
0:29:01 > 0:29:04It led to intense public scrutiny.
0:29:04 > 0:29:08Spotlight has been told that the term "major incident" won't be used
0:29:08 > 0:29:13again to deal with congestion, to avoid raising public concerns.
0:29:14 > 0:29:18This is simply a rebranding to protect reputation.
0:29:18 > 0:29:22This doesn't help protect patients in any way, because we have had
0:29:22 > 0:29:24circumstances as bad as the night in question,
0:29:24 > 0:29:26since the night in question,
0:29:26 > 0:29:28and there has simply been some rebranding.
0:29:28 > 0:29:31They are papering over the cracks.
0:29:31 > 0:29:34That corresponds to information in the consultants' e-mails
0:29:34 > 0:29:37regarding the weekend of 22nd February.
0:29:37 > 0:29:38In those e-mails,
0:29:38 > 0:29:40two of the consultants say
0:29:40 > 0:29:43that in their opinion, conditions were so unsafe at points
0:29:43 > 0:29:47that a major incident should have been called.
0:29:47 > 0:29:49But that didn't happen.
0:29:49 > 0:29:53Last week, Colm Donaghy, the Chief Executive of the Belfast Trust,
0:29:53 > 0:29:57resigned his position to take up a new post in England.
0:29:57 > 0:30:00Fixing what appears to be a broken system
0:30:00 > 0:30:02will now be a problem for his successor.
0:30:03 > 0:30:06The families involved say it can't come soon enough.
0:30:08 > 0:30:10These are human beings,
0:30:10 > 0:30:14human beings with families, with lives, they're loved.
0:30:14 > 0:30:18They are not just numbers or categories. They deserve better.
0:30:18 > 0:30:21They really do. We all deserve better.
0:30:21 > 0:30:24You just put so much trust in the medical establishment
0:30:24 > 0:30:25that once you enter a hospital,
0:30:25 > 0:30:27you are going to be treated properly.
0:30:27 > 0:30:30You don't expect to be left on a trolley to die.
0:30:34 > 0:30:37There are now serious questions for the Health and Social Care Board,
0:30:37 > 0:30:41the Minister and the Belfast Trust, about the real extent
0:30:41 > 0:30:44of the problems at the Royal Victoria Hospital.
0:30:44 > 0:30:48They chose not to answer them in interviews for this programme.
0:30:48 > 0:30:51The question now is whether somewhere, at some point,
0:30:51 > 0:30:53they are going to have to.