The unannounced inspection was carried out by the RQIA last winter
By Aileen Moynagh
BBC News NI
The Royal Victoria Hospital’s emergency department (ED) is “significantly crowded on a sustained basis” and staff are experiencing burnout, according to a report.
The Regulation and Quality Improvement Authority (RQIA) carried out an unannounced inspection last winter.
It found the department was operating beyond its core purpose and capacity.
The Royal College of Nursing (RCN) said the report must lead to real improvement.
The inspection, carried out in response to the increasing level of concerns the RQIA received about the impact of significant pressure in the ED, focused on a number of areas.
These included patient flow, staffing, environmental factors, ED leadership, management and governance.
‘Very serious position’
RQIA inspectors said they witnessed first hand the operation of the ED, including at night and at weekends, and spoke with patients and staff.
Among their concerns that they believe had an impact on providing safe and effective patient care were: Staffing, crowding, infection prevention control/environmental issues, patient care, medicines management and governance.
The RQIA said it is concerned it will be difficult for the quality standards to be achieved and sustained if the service continues to operate outside of its capacity and core purpose, due to wider system pressures.
Briege Donaghy, RQIA’s chief executive, said “this is a very serious position to find ourselves in”.
“This is now saying very briskly, very openly, that the minimum that we should expect in quality is not possible to be delivered in the environment that the Royal ED staff are trying to work in.
“So, this adds further, reinforces the need for change,” she said.
Briege Donaghy from the RQIA said little change is expected without service reform
The inspection report sets out a Quality Improvement Plan (QIP) that the Belfast Trust has agreed to implement.
This will help alleviate some of the immediate safety issues identified, but Ms Donaghy said these will not resolve the underlying problems.
“Without service reform, the ED will continue to be pressed to operate beyond its capacity and outside its core purpose with resulting increased risks to patient safety and to its staff,” she continued.
Ms Donaghy said that there is a “danger of being complacent and saying hasn’t it all been heard before”, but that the Belfast Trust has accepted the findings and are implementing recommendations made by the RQIA.
“The recommendations we have made in this, I would say, are very modest.
“They are not service changing but if the Trust take these ‘modest’ actions, they will keep people a little safer, but they will not change the service so that it is able to actually deliver its function.”
Sources have told BBC News NI that this report does not go far enough and does not reflect what has been happening in the Royal Victoria Hospital over the past six to nine months.
Ms Donaghy said: “Let’s not take this one [report] in isolation and say this doesn’t go far enough. It collectively adds to the weight of evidence that the service needs to change,” she said.
The RQIA said it recognises that many of the pressures observed during the inspection are occurring at emergency departments across Northern Ireland.
‘Accountability and responsibility’
Rita Devlin, Northern Ireland director of the Royal College of Nursing, said the report had been a long time coming.
She said action was needed so the findings do not become another “piece of paper on a shelf”.
“It was less punchy than I thought it would have been,” Ms Devlin said.
Rita Devlin from the RCN said the report was “less punchy” than she thought it would be
“Our nurses have told me that they raised and escalated their concerns and spoke out to the RQIA and in some ways they don’t feel that their concerns are fully recognised within the report.
“I don’t think [the nurses] could say it any firmer or louder to help people to understand just how bad things have got, not just in the Royal, but in every one of our EDs within Northern Ireland,” she explained.
Ms Devlin said the RCN wanted to know “who is going to take accountability and responsibility for implementing the quality improvements within the report?”
The trade union, she continued, wanted reassurance from the Department of Health, the Strategic Planning and Performance Group, and the Belfast Trust that something will be done “to help those nurses and above all the patients who are actually suffering in those conditions”.
“I would like to hope that the report will make a difference,” she continued.
The Belfast Trust said it had taken steps to address some of the concerns raised by the RQIA ahead of the report’s publication and further measures will be undertaken to address additional issues.
It said steps already included “the establishment of new triage pathways, significantly improved ambulance turnaround times at our ED, and the reconfiguration of the RVH Emergency Care Village to create a dedicated Medical Assessment Unit, including a frailty assessment area”.
The Trust said it continued “to work closely with the Department of Health on issues within the hospital and to create additional community capacity”.
