- author, Eileen Moon
- role, BBC News NI Health Correspondent
The health regulator has found overcrowding continues to affect the safety of patients and staff in the Royal Victoria Hospital’s emergency department.
A follow-up investigation was carried out by the Regulation and Quality Improvement Authority (RQIA) last winter, a year after their initial review.
It found that the ED “continues to operate beyond its capacity and outside its core purpose”.
The report details that Belfast Health Trust failed to fully comply with nine recommendations for improvements.
The Belfast trust said it was still operating under “unprecedented demand” but was committed to addressing issues within its control.
It focused on several areas including patient flow, staffing, environmental factors, ED leadership, management and governance.
A year later, RQIA inspectors said they found further evidence of continued overcrowding, but this “indicated the pressures across the system”.
Of the nine areas they asked for improvement, only three were fully met.
Issues such as workforce, physician management, communication with front-line clinical staff and environmental cleanliness are reported as “partially met”.
RQIA said ED staff described the term “cold stress” as meaningless in relation to overcrowding.
Staff said winter pressures were “always present” and that “real patient harm was under-reported in the ED environment with longer waits and delayed routes”.
Staff were concerned that a high proportion of patients with the longest stays in the ED were often over the age of 75, the report said.
“Staff feel a sense of failure when patients are harmed but feel powerless to do anything about it,” it said.
The Belfast trust has identified its staff as having “grave concerns” about overcrowding and has asked the Health and Safety Executive and the Commissioner for Older People to visit EDs to “see first-hand the impact of pressure”, the report said.
Although the trust has taken action, ED staff still feel there is “little evidence of improvement; some staff report that conditions have actually worsened”.
Despite the challenges, the inspection report highlights “areas of good practice” where there is “evidence that teams have consistently provided mutual support to each other under extreme pressure”.
The RQIA said it would take no further action as many of the problems at the heart of the overcrowding could be attributed to “wider system pressures” across Northern Ireland’s healthcare system.
Many of these issues require a “strategic regional approach and centrally-led reform,” it said.
The RQIA said there were issues that Belfast Trust could address, including improving internal communication with frontline clinical staff and continuing to strengthen the workforce assessment required across clinical and support service staff within emergency services.
‘Unprecedented demand and congestion’
In a statement, the Belfast trust said progress had been made in some areas, such as communication with frontline clinical staff and a workforce review.
But it said emergency departments “continue to face unprecedented demand and congestion”.
It added: “Belfast Trust is committed to addressing the issues within our governance and we pay tribute to the dedication of all our staff who continue to work in very challenging circumstances.”
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